theory, but recent scientific and bacteriological investigations from many and varied sources indicate, at the present time, the ultimate triumph of the latter. Many independent histological experiments show certain distinct polymorphous bodies peculiar to all cancerous diseases, including sarcomas; though the exact nature is not yet fully determined, they are believed to be cancer bacteria. The very recent inoculation experiments, particularly of Sanfelice and Roncari of Italy, and Gaylord of Buffalo, tend strongly to establish a specific parasite as the cause of cancer.

Upon examination, it is found that nearly 50 per cent. of cancers in men are in and about the mouth; while in women three-fourths of the cases are in the breast and uterus (those of the breast being, it is thought, slightly in excess). The state ment is made that these organs are affected most because most exposed to infection; but it is equally true that these very organs and parts are also most exposed to traumatism; and it may be asked why does not infection attack the mouths of women as well as of men? Even if it shall be established that the disease is caused by a parasite, it does not dispose of the fact of traumatism as a common antecedent condition of its manifestation. It must, therefore, it seems to me, stand in the relation of an established predisposing cause at least.

Cancer of the cervix is peculiar to women who have borne children and generally occurs in the latter part of the child-bearing period or immediately following. "It is rare in women who have never conceived" nor been subjected to lesions of instrumentation. If the disease begins in the cylindrical or epithelial cells of the cervix, it invades the body by direct extension. If the latter should not be affected, it is evidence that the disease commenced in the squamous or surface epithelium, and the latter is true of most cases. The initial lesion can only be determined with certainty in the early stage.

Park quotes, with seeming approval, Williams' statement that cancerous families are more prolific than non-cancerous, but it seems a more rational and justifiable conclusion that women who have had two, four and eight children are more certain to have suffered from injury and conditions favoring infection than those who have had one, two and four children. I cannot see that it shows any relation between fecundity and cancer as intimated.

Williams and Dührssen agree that cancer is more common in the well-to-do or better classes than in the hard worked, while the reverse is true as to consumption. This would indicate that the former class is more susceptible to injury and less able to resist cancer infection, as of most diseases.

A diagnosis at the earliest possible moment is of the greatest importance, for upon it rests our chief hope of curing the disease by the one reliable remedy-complete extirpation. Whatever place heredity may seem to occupy in some cases, the disease in the beginning is purely local. Simple non-specific ulceration of the cervix, it is known, is not common.

Suspicious leucorrhea-a watery, irritating discharge and hemorrhage are not the first expressions of the disease, though generally the first outward manifestation. Histological examination of the blood may, as predicted, come to our aid in the matter of early diagnosis. True, there is less phosphorus in the blood of cancer subjects, but this is true of other anaemias. While there is more chlorine in the blood of such subjects, and may be sugar in the sarcomatous, and peptones in the blood of the carcinomatous, yet these facts and probabilities are of little value at the present time in a prompt determination of the diagnosis; for the disease being local in the early period, it is not probable that blood examinations at this time, before there are local evidences, will be sufficiently decisive to fix a conclusion.

Matthew Duncan, one of the most acute diagnosticians and best clinical teachers of this generation, twelve years ago said, concerning the diagnosis of cervical cancer: "We have no way of making sure of the beginning, even if we were constantly examining. The earliest and best grounds attainable are indications of disease already considerably advanced." A statement, it must be conceded, that still appeals forcibly to most physicians at the present hour. Yet more watchful care and frequent examinations just before, during and soon after the menopause will reveal evidence of disease earlier than at present, which will mean earlier operations and more recoveries.

As previously intimated, certain local symptoms, especially at the climacteric, are significant intimations of serious disease. If these are attended with ulceration, a nodular or hardened condition of the cervix or body, they are indicative of cancer. If in doubt at any time as to the pathology, the microscope will aid in the determination. Long delay is always dangerous, and when incident to a doubtful diagnosis at the critical period of life, is particularly unfortunate, when vaginal hysterectomy, with no extra uterine complication, is not only attended with little. danger, but usually with favorable result as to recurrence.

It is a matter of common observation and experience that cervical cancer is a very common sequel to lesions of the cervix. Most cases, if seen early, show evidence of traumatism. It is manifested in laceration and contusion. It cannot be doubted that there is often injury within the cervix that is not always

attended with laceration of the external os, or revealed by it when it does exist; as some of the most serious perineal tears do not involve the skin and are not revealed by ordinary inspection. Hard, rigid, cicatricial tissue often exists in the cervix and at the internal os with an external os that appears normal. Such local condition establishes a predisposition to cancer. there is as a result innutrition, interstitial infiltration, hardness, cicatricial (which is weak and non-resisting) tisssue, interruption of the normal circulation, innervation and nutrition, we have, it must be conceded, the most favorable condition and environment for degenerate cell development and for parasitic infection. If a parasite or specific cancer germ is proven to be the exciting cause of the disease. it will still remain true that traumatism frequently gives the parasite its favorable environment and opportunity for action, for the disease is local in the beginning and is amenable to local treatment.

The relation of epithelioma of the lips, tongue and vicinity to chronic injury or to injury and infection is a fair analogy. If the local pathological conditions, no matter whether benign or malignant, are due to or promoted by distinct local lesions, they are only amenable to surgical measures, and these should not be needlessly delayed.

If the diseases that are only curable by surgical means can be prevented, it is as much our duty as it is to prevent or to arrest the prevalence of ordinary diseases. Therefore, prophy laxis of uterine cancer is worthy of our deepest consideration. Give to Nature just consideration in the dilating stage of natural labor, with the exercise of all gentleness and care to prevent injury from instrumentation in operative procedures.

Dührssen, on suspicious evidences, removes the entire uterine mucosa in the belief of certain pathologists that cancer can only develop in epithelial tissue; as his object is to permanently destroy the mucous membrane, vaginal hysterectomy would seem to be preferable, being safer and more certain in results. Others advise high amputation of the cervix in some cases of disease and trachelorraphy in others, if attended with infiltration, eversion of lips, catarrh, etc., to prevent the development of

cancer.

Examinations are advised more frequently than women who are feeling well will submit to. It is difficult to impress its importance on many physicians as well. The only safe course is to repair every appreciable lesion of the cervix at 40 years or over, and every case at any age if well known local conditions of disease exist or if pregnancy is not again probable.

In a paper on prophylaxis, read before the Gynecological Section of the American Medical Association at Columbus in June, I advanced the proposition that it was dangerous to delay repair of cervical lesions because of the absence of evidence of actual disease, and that trachelorraphy, which is not a dangerous operation, was the only certain way to overcome just apprehension and to anticipate a constant danger that was not met by a temporizing or tentative policy. Such an operation, by restoring the integrity of an organ, its vascular, nerve and nutritive supply, places it in the best possible condition to resist disease of every kind, whether benign or malignant, infectious or non-infectious.

The operative mortality in cancer of the uterus is about 40 per cent. It will be rapidly reduced by the early repair of those lesions which invite infection and cause cancer, and by earlier diagnosis, and as a consequence the prompt application of the more perfect radical operative methods of the present time.

Since writing this paper I observe that Penrose, the wellknown author, in the June Annals of Surgery, makes the statement that in the last three or four years he has "observed fewer cases of cancer of the cervix," which he attributes "to the more widespread use of the operation of trachelorraphy." This is gratifying testimony and justifies the expression of a hope that its use in all cases as a preventive measure will meet with still more general acceptance.

ANIMAL DOCTORS AND ANIMAL PATIENTS.
By JAMES WEIR, Jr., M.D.,
Owensboro, Kentucky.

When we come to examine the structural anatomy of the higher animals, including man, we see at once that they are related; when we carry our investigations still further and enter the domains of microscopical anatomy and physiology this relationship is strengthened; when we make an exhaustive examination of the mental manifestations that are to be observed in the life-histories of these creatures when in health, this kinship is still more apparent; but when we study the psychical and physical traits of the higher animals when they are suffering with disease, taking ourselves as standards of comparison, we find them to be so strikingly like the mental and physical traits evinced by our

selves under similar conditons that their relationship ceases to be apparent and becomes real, definite, and very close indeed!

And what has been said of the higher animals can be applied with equal truth to many of the lower animals (crustaceans, insects, reptiles, etc.,) which evince malease when attacked by disease, not only through physical agencies, but through phychical manifestations as well. In point of fact, many of the lower animals, when sick, show very plainly by their actions that such is the case. Not only are they able to show disease, but they likewise indicate that they know perfectly well how to combat disease.

The honey bee, when attacked by diarrhoea (a disease to which under certain conditions it is very prone) will immediately begin to suck the astringent pieces of the dogwood, poplar, wild cherry or hickory, and will soon effect a cure of this distressing and often fatal malady. Indeed, such is the intelligence of these little creatures that, in winter, when they become sick with this disease, they will readily drink a decoction of wild cherry bark if it be placed in the hive. When we remember that the bee's taste is even more discriminating that our own, and that it is by no means fond of bitter substances, this instance of their intelligence becomes all the more remarkable.

These insects seem to be aware of the fact that filth is a source of disease; hence, when ill in winter, they select a spot, as far from the combs as possible, at which all of the sick members of the hive deposit their dejecta. As soon as warm weather arrives the accumulated filth is removed and the spot carefully cleansed. In summer all excrementitious matter is deposited without the hive.

Again, crayfish are frequently the hosts of innumerable little parasitic leeches (histriobdellae) which, strange to say, only become parasites and thus harmful to their hosts, when their number has increased to such an extent that they can no lo ger live natural lives. As long as they are few in number they are of distinct benefit to their host, the crayfish, for they cat the unimpregnated eggs and dead embryos, thus keeping the other eggs and embryos in a healthy state. But as soon as their number becomes so great that the decomposing eggs and embryos are no longer a sufficient food supply, the mutualists become parasites they begin to devour the healthy eggs and embryos. The crayfish, which carries her eggs beneath her tail, can tell at once when this state of affairs exists, and will straightway set in motion very effective measures for freeing herself from her harmful visitors.