the number of cures does not exceed 5 per cent. Such a conclusion may probably be correct, if it be made to include all the patients who suffer with this disease, those that come under observation so far advanced that nothing can be done: except to relieve their suffering, as well as those to whom hope of permanent relief may be held out.

The percentage of permanent cures, however, must be influenced largely by the quality of the medical men in the community from which these statistics are taken. Kehr, when asked why it was that he met wit hso many cases of gall stone disease, replied, that "it was because his friends, the internents, were such expert diagnosticians;" so a surgeon, reporting a large percentage of cures from operations for cancer of the uterus, may with justice say that his success was due to the expertness of his friends, the general practitioners, in making such an early diagnosis, that he was enabled to operate at a time when a cure was possible.

The disease is much more prone to affect women who have borne children, than those who have not been married; or, being married, have remained sterile. Emmet contends that this is due to the injuries to the cervix that result from child-bearing, and he practices and advises the repair of all such injuries before the climateric. Lapthorn Smith, of Montreal, in a recent article, lays stress upon the same preventive treatment. Bassi (quoted in the Jour. Am. Ass., Jan. 17, 1903) reports observations upon 1,000 repaired lacerations of the cervix with subsequent freedom from cancer, and 1,000 cases of injuries to the uterus that were permitted to go unrepaired, in which 21 cases of cancer were subsequently observed. With such a record before him, he necessarily advocates very strongly repair of all injuries to the uterus.

The limit of this paper will not permit me to discuss at length the theories advanced as to the cause of cancer, were I inclined to try your patience with a dissertation upon this still unsettled question. It will suffice to draw your attention to certain facts in its etiology, with which you are familiar from your own observation.

That hereditary tendencies or a vulnerability to cancer may be inherited, can no more be denied than that other predispositions are transmitted. If the tumor matrix (pre natal or post natal) theory be accepted, and it be granted that a

diminution of physiological resistance of the tissues, whatever that may be, is sufficient to admit of rapid proliferation of the tumor matrix cells, then we may safely assume that this impaired resistance may be inherited.

Age Cancer appears usually at a time of life when the waste is greater than the repair; hence, lowered vitality and a lessened resistance in some way stimulates "rests" into active cell proliferation.

Traumatism-No amount of injury of itself has ever been proven to be the actual cause of cancer. The irritation of a pipe, a blow upon the breast, or a laceration of the cervix, of themselves, are insufficient to account for the disease; but in an already weakened physiological resistance in the tissues, because of age any one of these may be the spark required to excite into active flame the dormant fires of an old tumor matrix. In the cervix uteri, lacerated by child-bearing or other forces, there is another factor to which I may with profit invite your attention. During the healing process of lacerations, post natal rests may be formed by the involving or including of epithelial cells. These, by the power known as physiological resistance, remain dormant, until the organ takes on senile changes with a diminution of physiological resistance, when they may suddenly become actively proliferating and produce cancer. The early removal of the injured parts of the cervix, as advised by Emmet, for the preven tion of cancer, and the satisfactory application of this plan by Bassi, who demonstrated its efficiency in a series of 1,000 with and without operation, is the logical sequence of a belief in this theory of a tumor matrix, held in abeyance by physiological resistance, until this resistance is overcome by age or injury.

This tumor matrix theory bears out the truth of the accepted teaching that cancer is at first a local growth and that its early removal is not followed by a return. It should, however, be borne in mind that a tumor matrix in the uterus does not preclude the possibility of rest or inclusion masses (one or many), existing in other parts of the body, and that impaired physiological resistance may permit them to spring into activity subsequently to the early and complete removal of an actively developing tumor matrix in the uterus or

mamma. This is in no sense of the term a return of the original growth, though it might be an argument in favor of the heredity of malignancy.

The whole theory of cancer formation as well as the facts observed in connection with its growth and cure, prove that its complete removal is possible when it is early attempted. It follows then that an early recognition of the disease is essential, if we are to hope for permanent relief from its dreadful influence.

An early diagnosis is by no means easy; nor is it always possible; yet much more can be done towards its recognition in its first stages, than has been accomplished in the past.

The United States census shows that the average physician signs one death certificate for cancer every three years; and as there are about 150,000 doctors in this country, the deaths from cancer yearly is 43,000. This is a large clinical field, hence the lack of opportunity to study this disease in all its phases cannot be advanced in extenuation of the appalling apathy, to speak mildly, shown by so many of us, towards the marked early symptoms of the disease.

Wiener (Am. Jour. of Obstetrics, vol. 40, page 722), in speaking of the early diagnosis of uterine cancer, says: "Every error in diagnosis costs a human life; every delay endangers one." If this be true, and I believe there are but few men who will have the temerity to challenge his statement, our duty as physicians is so illumined that it should shine out clear and bright under the most befogged conditions. A human life sacrified! For all the wealth of India what conscientious physician would stand under the burden. A human life endangered! What lover of humanity would permit it? And yet, sufferers from uterine cancer are permitted to go unexamined until the odor from the breaking down tissues takes voice and cries to the highest heavens, a warning against the deadly enemy that is sapping the vitality of God's chiefest handiwork.

The

How shall we recognize trouble in its incipiency? problem is a difficult one. The symptoms uppermost in the minds of the generality of practitioners at the present time, and indeed relied upon for diagnostic purposes by not a few excellent men, with large practices and wide clinical experiences are growth, hemorrhage and odorous discharges. These

men are no dreamers about the results to be obtained by exaggerations, causal or mental. They are hard, practical, common sense fellows, who use their five good special senses when then can. Touch, sight and smell are to be relied upon and they make the diagnosis by their use, and the diagnosis is almost invariably correct. But of what value is this diagnosis to the patient? In most cases it is of little or none; when the disease has reached the point where it may be detected by the nose or fingers it has advanced to a stage in which the most thorough and complete surgical proceedure will probably fail to remove all of the cancerous affected tissue. This kind of diagnosis furnishes to the surgeon the class of cases described by Baldy, as being always sooner or later followed by recurrence and death.

I have said that an early diagnosis is fraught with difficulties; but it is not impossible.

That an early recognition of this fatal malady may be made, it is necessary that the patient be seen when the first symptoms manifest themselves; unfortunately, the general public is not yet educated to the recognition of the nature and character of these early symptoms, or to the importance of seeking relief in the first stages of malignant disease. Here is the first duty of the physician, in our efforts to lessen the prevalence of cancer of the uterus. Medical students aud medical practitioners should have it in.pressed upon them that women should be made to understand:

1. That cancer is prone to occur between the ages of 35 and 55.

2. That it is a local growth at first, and curable in its early stages.

3. Irregular or unusual uterine bleeding at any time in life, but more especially between the ages of 35 and 55, is a symp tom requiring investigation.

4. That a return of the flow, after the establishment of the menopause, is one of the gravest symptoms.

5. That leucorrhoea is a symptom of a diseased condition requiring investigation.

6. That change of life means cessation of menstruation, and that increased flow at a time when menstruation is expected to stop, is a danger signal.

7. That pain is a symptom that appears late and should 1 ot be expected or looked for as a sign of cancer in the early stages.

When the general public understands the importance of these teachings, women will not be found going about in fancied security, while they are tottering on the brink of the grave as the result of advanced uterine cancer. No longer will we hear the often repeated phrase, "Oh, there is nothing the matter with me, except change of life," from women whose cmaciated frames and cachectic counterances speak loudly of the silent ravages of deadly diseases. The medical profession will have done its first duty, and cancerous patients will seek professional advice, at a time when the disease is in its early stages, and the physician will have the opportunity of performning his second duty.

An early diagnosis of uterine cancer is the second duty of the physician to those affected by this disease. The first symptoms of uterine cancer are as a rule sufficiently marked to excite suspicion and occasion investigation. The picture presented by the disease, when carefully scrutinized, is quite as clear as that created by many other affections of the human body.

Haemorrhage is perhaps the most common symptom of the trouble. It may be almost pathognomic or it may be but a faint suspicion that will attract the attention of none but the most careful observer. The appearance of a bloody vaginal flow from a woman past the climateric and whose menstrua. tion has not appeared for a year or more, is in the majority of cases indicative of malignant disease.

During the menstrual life of a woman, and more especially in its late years, irregularity of the flow, increase in quantity, staining, or shows following intercourse, exertion or excitement, are suspicious signs that should lead to investigation. The history of the patient's menstrual life will frequently aid in determining the cause of the flow which may be due to many other conditions besides cancer.

Leucorrhoea is a symptom of cancer which in my opinion is not given due weight. The free uterine or cervical secretion, brought about by a too free blood supply to the uterine glands, is a symptom of many diseased conditions; but it is not