to a fistula: no second incision to repair damage done during operation.

Nor was drainage required in but a small per cent of the cases-eight cases out of seventy-three (about 11 per cent) of the class, of all others, which calls most frequently for drainage. Consider what that means: no chance for subsequent infection, no fistulæ, no hernia, no ligatures to come away after long suppuration, no tedious and troublesome and expensive dressings of wounds and drainage tubes or tracks, primary healing of all wounds, and no bad-smelling patients, as occur after the vaginal operation.

In conclusion, the following is the status of the abdominal section for pelvic inflammatory lesions, as is demonstrated by my own quoted work and by that of many other surgeons:

1. The operation is the safest in this particular class of cases of almost any other to which abdominal section is applied. 2. Shock rarely enters into the case as a serious sequel: never more so than in the vaginal operation.

3. Drainage is the exception: it is the rule in vaginal work. 4. Hernia occurs in not more than one per cent of cases operated upon.

5. Women are not prone to complain of the abdominal scar. 6. The patient could arise from her bed and return to her home at as early a date as after the vaginal operation, were it considered advisable for her to do so.

7. A completed operation is always possible by the abdominal route: in a large per cent of the bad cases it is impossible by the vaginal route.

8. The technique of the abdominal operation is much more easy than that by the vagina.

9. There is less danger of damage to the hollow viscera by the abdominal route: if such injury does occur there is less danger of infection from such injury and the damage is more readily repaired. As a matter of fact such injuries are impossible of repair by the vaginal route.

10. The mortality of the abdominal operation is all that could be desired, and no other major operation shows a better record.

All cases in the tables are arbitrarily divided into salpingitis and pyosalpinx, simply to indicate the presence or absence of pus.

Remarks.

Died third day of septic peritonitis Pulse bad
before operation; never became better.

Puerperal phlebitis
and lymphangitis.|
Double salpingitis..

(tubercular).

rhaphy.

Double pyosalpinx. Hysterectomy

R.

CLINICAL DATA RELATING TO CANCER OF THE UTERUS.

BY

ANDREW F. CURRIER, M.D.,

New York.

THERE is no form of disease which has been more patiently and thoroughly studied by pathologist and clinician than cancer, and none which up to the present time has more completely baffled human effort to eradicate it. This seems the more strange since Virchow, Cohnheim, Waldeyer, and others long since declared that in its initial condition it was a local disease. Such a statement may, however, be misleading, for it is prone to attack weak, poorly resisting tissues, and may have more than one focus of development. These foci may have coalesced and reached the dangerous or incurable limit before the alarm has been sounded and the offending material removed. Does not this teach us that if we are to expect success in the treatment of any form of cancer, whether in horny tissues like the skin or the softer tissues of the mamma, rectum, stomach, or uterus, we must educate our patients to direct our attention to it in its incipiency and make wide and deep removal at that period?

We need not occupy ourselves at this time with a lengthy consideration as to the nature of cancer. While it often presents connective-tissue elements which may be misleading in the investigation of a given specimen, it is essentially a disease of the epithelium, whether that epithelium be of the flat squamous variety upon the surface of the skin or mucous membrane, or the cylindrical epithelium lining a follicle, a gland, or a duct. In epithelial tissue it begins, and in such tissue we must study its structure and follow it in its invasion and destruction of other tissues which it attacks.

While it has no un varying formation, it commonly presents an alveolar framework of connective tissue, a net-like structure, the holes or cavities of which are more or less filled with epithelial cells or fragments of cells. As these cells are reproduced or proliferated new tissues are invaded and infiltrated; these in turn are destroyed and break down, and hemorrhage and offensive discharge are apparent.

As the blood and lymph vessels are entered by the accumu. lating cells the latter are carried from the original seat of the disease to other parts of the body, and thus we have the secondary deposits which make the complete removal of the disease at its primary location only an ineffectual attempt.

It thus appears that there are no fixed bounds or limits to this disease, unlike the benign growths which have capsules and definite boundaries; on the contrary, it advances and destroys and advances again, infecting the tissues which it meets in its progress and others to which it is carried by the blood and lymph streams, until the patient succumbs from exhaustion. and malnutrition. In the concise words of Waldeyer, it may be defined as an atypical epithelial new growth.

Such is the pathological picture of cancer, and an apology may be necessary for recalling so much as is elementary in the foregoing remarks.

In cancer of the uterus we have, as is well known, one of the most frequent localizations of the disease. It has been stated that in cancer of the uterus and of the mammæ more than half of all cases and all localizations of the disease are to be found. Common experience will sustain the statement that cancer in women includes the large majority of all cases of malignant disorder. It therefore demands unusual attention, and uterine disturbance which is in the slightest degree suspicious from the presence of erosion of epithelium or from bloody discharge should at once furnish a signal for careful investigation.

With reference to what may be termed the initial lesion of cancer of the uterus, there are several well-recognized varieties with uniform characteristics in so far as their mode of origin is concerned.

1. The most common variety is that which begins in the cylindrical epithelium lining the follicles with which the mucous membrane of the vaginal portion of the cervix is studded. It is a hard, warty growth, progresses slowly and painlessly, the different foci coalescing after a time, breaking down with more or less hemorrhage, and then extending to the vaginal mucous membrane, the pelvic cellular tissue, and the mucous membrane of the cervical canal. This variety is commonly known as the cauliflower growth, cancroid, papilloma, etc. As it progresses slowly, it is the most amenable of any of the varieties to radical treatment if removed early and thoroughly.

2. The second variety attacks primarily the flat epithelium upon the vaginal portion of the cervix and the contiguous