MEDICINE. SOME LIGHT ON CANCER.-Than cancer, the nosological category has no disease that has been more thoroughly studied, clinically, pathologically, and therapeutically, nor any which has yielded under such study more discouraging results. To this date the etiology of cancer and its nature are unsolved mysteries; it is still doubtful if hereditary predisposition has ought to do with determining its development in any case, while the theory of its contagious character has, till now, received no support from physiological experimentation. These considerations, together with the undoubted fact that the disease is rapidly on the increase in Europe and America, the frightful operations which are often undertaken for the temporary relief of its victims, and the prognosis of despair which at last must be made in the majority of cases, clearly entitle it to the chief place among the furies whose office it is to scourge mankind. It is, therefore, with uncommon interest that we learn that Hanau, of Zurich (La Samaine Medical), has succeeded in transferring the carcinoma of a rat afflicted with papillar cancroid to two animals of the same species. The inoculation of an animal with cancer has hitherto been considered an impossibility. Success in this case will give stimulus to renewed study, and gives hope that the etiology of the disease may yet be mastered. A vital point in the treatment of cancer, though not new, was given due emphasis by Prof. Heidenhain at the Eighth Congress of the German Society of Surgery, held in Berlin, April 24th to 27th. In some remarks on the causes of the local recurrence of cancer after extirpation of the breast, he said that “in all cases where there was afterwards recurrence he had been able to convince himself, by microscopic examination, that particles of cancer had been left in the wound during the operation. Sections of apparently sound tissue in the vicinity of the morbid tumor revealed epithelial trails infiltrating the parts. These epithelial trails follow the lymphatic vessels and sometimes extend to the aponeurosis of the pectoral muscle." Heidenhain had studied eighteen cases in which the breast had been extirpated for primary cancer. In six of these he found the tissues surrounding the tumor free from epithelial infiltration, and in these the disease had not returned. Since the lymphatic vessels which constitute the channels of infiltration run perpendicularly down into the pectoral fascia, this structure, with sometimes a part of the muscle itself, should always be removed with cancer of the breast. Kuster has long followed this practice. Cancers of the breast when adherent to the pectoral aponeurosis are always a bad prognosis. Of Von Volkman's sixty-five cases in which this adhesion was noted, but two of the patients failed to suffer recurrence of the disease. While the crumbs of comfort found by the pathologist in these observations may be never more than crumbs, the practical surgeon will find excuse for enthusiasm in the rosy prognosis of cancer under treatment which the discussion at the Congress brings to view. Von Bergmann presented a case of carcinoma of the pharynx operated upon in 1884; three months afterward disease returned, when complete extirpation of the glands was affected; since then the patient has remained free from cancer. A case of cancer of the face, extirpated four years ago, no return; two cases of cancer of the lips, operated upon two years ago, no return. Thiersch, of Leipzig, some time ago operated on cancer of the stomach; there has been no return. Korte, of Berlin, two years ago extirpated a cancer of the larynx; the patient has had no recurrence. Von Bergmann said that four years ago he removed half the larynx for cancer. The patient had remained well to the present time. Schmidt, of Frankfurt, three years ago removed the entire larynx for cancer; no recurrence. Schmidt, of Settin, had also removed, two and a half years ago, the entire larynx for cancer; the patient recovered and kept well; he breathed through a canula. Von Esmarch stated that twenty years ago he operated on a case of cancer of the tongue; the patient remained free of his cancer; recently he died of apoplexy. Schebe, of Hamburg, had operated on three cases of lingual cancer; after several years there had been no recurrence. Von Bergmann presented a case of cancer of the tongue operated on two years ago, and another operated on four years ago; both had remained well and exempt from recurrence. Kuster and Krause had had similar cases. Of cancer of the rectum, three cases were communicated by Krause; extirpation was performed six, eight and nine years ago; all are now free from the disease. Bergmann presented a patient on whom the "high amputation" of the rectum for cancer had been performed four years ago; no recurrence. Schinzinger, of Friburg-in-Bresgau, reported that he had operated on eighty-six cases of cancer of the breast; in twenty-six only there had been a return in course of a couple of years. -Am. Pract. and News. TO CLEAN SPONGES.-Dr. Ap Morgan Vance, of Louisville, gives the following directions (Pract, and News): The sponges, being full of sand and other mineral matters when purchased, should be first soaked in clear water, dried, and beaten thoroughly; this repeated several times, the water brings many of the small particles to the surface. All the sand having been beaten out that is possible to be removed, they should be immersed in the first bath and allowed to remain for twentyfour hours. The bath should be of the following proportions. They should then be wrung dry and immersed in each bath (wrung dry after each), as follows: Having been run through several waters and dried, they should then be immersed in a carbolized solution (1 to 20) until ready to be used. The dark spots which are seen in many of the sponges, especially the "Potter's sponge," are natural and cannot be removed. It may be found necessary to run the sponges through the baths more than once; but this, however, should not be done too often, as the action of the strong acids is deleterious to the integrity of the sponge. SUBLUXATION OF THE HEAD OF THE RADIUS. - Prof. Robert T. Morris, of the New York Post Graduate School, as the result of a number of experiments on cadavers of infants and young children, draws the following conclusions (N. Y. Medical Journal) : I. Subluxation of the head of the radius consists in a separation of the head of the radius from the capitellum by the interposition between them of the loop of the orbicular ligament, accompanied in some cases by a small portion of the anterior ligament of the elbow, and some fibers of the brachialis anticus and supinator brevis muscles. The articular surface of the head of the ulna and of the trochlea remain slightly separated at the same time because of the wedge of orbicular ligament between the head of the radius and the capitellum. Passive movements of the joint give rise to clicking sounds caused by the rocking together of the separated ulnar and humeral articular surfaces. There is no appreciable deformity on inspection or palpation, but the range of flexion of the forearm upon the arm is slightly limited. 2. The accident occurs at an instant when the biceps muscle is relaxed and as a result of direct traction force upon the radius while the forearm is in a position of partial or complete supination. It also occurs under the same anatomical conditions when force is applied directly to the outer side of the elbow, forcing the head of the radius inward and a little downward from the humerus. The former mechanism is brought into play when a child led by the hand stumbles and falls, its hand remaining grasped in the hand of the nurse. The latter machanism is brought into play when in a violent fall the outer side of the elbow strikes the curb-stone. 3. The mechanism of spontaneous reduction has not been determined, but it may, perhaps, occur as a result of swelling of the pinched ligaments and muscular fibers and consequent pull of the pinched tissues up and down. 4. Reduction may be accomplished by the surgeon as a result of various movements which tend to work the head of the radius back under the loop of orbicular ligament, and the most frequently successful movement seems to be pronation and pressure upward along the long axis of the radius, the arm being at the time completely extended. A quick snap gives evidence of reduction. 5. In treating cases in which reduction can not be accomplished by the surgeon, the arm should be fixed in a position of nearly complete extension, as this gives the loop of orbicular ligament the best opportunity for escape according to the testimony of my small number of specimens. I suspect that there are about the country a great many cases in which reduction has never taken place, the surgeon's efforts having been unsuccessful and spontaneous reduction having been impossible. 6. The muscular disability of the arm during the early days of the injury is apparent rather than real, as I have demonstrated upon a patient a young lady-since Dr. Van Arsdale's paper was read. cause of the pain consequent upon any movement at the elbow joint, the patient could with difficulty be persuaded to move the arm at all, but movement once begun, she could carry the forearm through almost its complete range of motion. DR. W. W. VAN ARSDALE, of the New York Polyclinic, after a study of one hundred clinical cases, draws the following conclusions (Annals of Surgery) : I. The injury frequently occurring in children and called subluxation of the head, or displacement by elongation, of the radius is a well defined, typical injury with well-marked, constant symptoms, and due to the same anatomical lesion in each case. 2. The frequency is over one per cent. of surgical injuries in children. 3. It occurs in children under nine years of age. 4. The most frequent exciting cause is sudden traction by the hand or fore-arm; more rarely a fall. 5. The principal symptoms of the injury are: absence of appreciable deformity; loss of function of the arm; localized pain over the head of the radius on pressure; pronation of the hand; slight flexion of the elbow. Crepitation or snapping upon forced supination with restoration of function. 6. Treatment with a splint is advisable in order to prevent recurrence. 7. The anatomical lesion causing the injury is not yet satisfactorily established. THE DUTY OF THE PHYSICIAN TO HIMSELF.-The physician is generally his own worst enemy. His calling interferes with regular hab-. its. In the language of the rhymist: "I've warned them, in a learned way, Of careful diet and talked of tone, And when I have preached on regular meals Aside from interfering with all the physiological laws of his being by way of regularity in eating and rest, the busy practitioner is beset by contingencies, unforseen yet certain to occur, but uncertain as to time, such as accidents, obstetrical, &c. He feels that his presence at home is a necessity, not alone for the bread and butter there is in it, although this is a weighty matter to a majority of us, but he feels under a moral obligation to his patrons. He has been notified of an expected confinement and is requested to make his presence at home numerous. A convalescent patient or |