JAMA. 1919;73(15):1112-1114. doi:10.1001/jama.1919.02610410014004.
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Case 1.  —In November, 1917, Mrs. H., aged 43, was referred to me. Her general health was good. She came complaining of a severe irritation of the bladder. There was undue frequency of urination (nocturnal and diurnal), a burning sensation, and difficulty in voiding. This had been more or less continuous for about six years. Eighteen months prior to her visit to me she had passed in the urine a small piece of tissue which had been submitted to a pathologist, who had reported the tissue to be carcinoma.The woman was well nourished, had lost no weight, and in general had the appearance of good health. The blood count was about normal save for a leukocytosis of mild degree. Vaginal examination revealed nothing of interest except that the vesicovaginal septum was not indurated at all, and no mass could be felt in the region of the


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