extension alone it will be found that the patient while asleep will gradually slip down in the bed until the foot is against the foot-board or pulley. The muscles will then draw the femur upward so that the trochanter major is above Nelaton's line. If this does not occur even sand bags will not prevent rotation, and apposition fails in this

way.

The idea of the Hamilton splint is to prevent rotation. It makes a very pretty picture as shown in surgeries, but when applied, because of the lack of contour of the leg, it is impossibe to adjust it snugly from foot to axilla, and the very parts which prevent its snug adjustment, viz., the ankle, trochanter major, crest of the ilium and ribs, will not bear pressure as they are so slightly padded by muscular tissue. Upon visiting a patient after its adjustment, you will frequently find the Hamilton splint on top of the leg instead of at the side or crossing the abdomen. and chest or slipped around the upper portion of it under the body.

All of these complications are obviated in the long extension hip splint, the Thomas hip splint or the double plasterof-Paris spica with the lateral screw pressure. If this fails a pegging of the ununited fracture is certainly justifiable. In fractures of the spine so much space is taken up in our surgeries describing and explaining laminectomies and the now and then recovery which takes place after laminectomy that very little space is left to recommend immobilization, which is important whether a laminectomy is done or not. It should be the principal part of the treatment, both before and after a laminectomy, if a laminectomy must be done. The water bed is only mentioned here to condemn it, for when a patient is placed on a water bed, with every movement of the hands, shoulders or head the entire body is set in motion, causing pain, and adding still further to the injury; yet in every hospital the water bed is brought out for the fractured spines to prevent the bed sore, which is, of course, neuropathic, and if there is anything in keeping the spine quiet to improve the condition causing paralysis, certainly the water bed is the very thing which ought not to be used.

In watching a patient on a water bed, or on an air bed, it is hard to understand how they prevent any more pressure than a hard bed, as it seems impossible to so accurately fill them with air or water as to make equal pressure on all parts of the body, and the weight will be on the projecting bony points which can be better protected if the patient is lying on an unyielding surface, each projection being protected by rings or rubber cushions. We know from experience that sores do occur when patients are on water beds.

About the best union that can be obtained in a fractured patella without wiring it or using kangaroo tendon is a fibrous union. Since there are so many cases reported of perfect bony union where the fragments were placed in good position by operative measures, why should we attempt any other than operative treatment, the leg being thoroughly extended and held firmly in position with a plaster-of-Paris cast, which cast should envelop and extend well up the thigh to prevent rotation as well as flexion of the knee.

In fractures of the elbow joint the extension method, that is dressing the arm fully extended and supinated,

which was advocated many years ago and a little later very enthusiastically advised by Allis of Philadelphia, is now pretty well recognized as the best position for all fractures in or about the elbow joint, using the plaster-of-Paris cast, extending it from the base of the fingers to the axilla. This is a dressing of easy application, most comfortable for the patient, and the circulation is less interfered with. Fractures of the elbow joint are most frequent in children, and usually it is a fracture of the external or internal condyle or both. The muscles arising from these condyles have a tendency to draw the fractured portion toward the median line and in front of the elbow, but with the straight splint they are easily held in position. In this position the callus cannot fill the olecranon fossa. Some thirty cases treated by this method were reported at the last meeting of the State Medical Society, showing very good results.

It may be of interest to know that a malpractice suit was brought against a practitioner in which a fracture of the internal condyle of the humerus was treated by this extension method. extension method. A verdict for the defendant was rendered.

In fractures of the wrist no better splint can be applied than a plaster cast, extending from the elbow to the base of the fingers, leaving the fingers and thumb exposed. In this way the fingers can be kept from becoming stiffened by the adhesion of the tendons passing in the locality of the fracture.

In fractures about the ankle joint a plaster cast is by far the best means of securing immobilization.

The foot should always be placed at a right angle and slightly adducted to prevent pronation of the foot, a very common and troublesome affection following fractures of the ankle, which pronation is due to the action of the peroneus muscles. In fact the displacement in Pott's fracture can only be reduced and held so, in this position. -St. Paul Med. Jour.

HYPODERMOCLYSIS.

This valuable therapeutic measure was first brought into prominence by Cantani in 1892, during the cholera. epidemic. R. C. Kemp gives the results of several experiments which have been made upon the dog to demonstrate the rapidity and nature of the action of hypodermoclysis. By the use of potassium ferrocyanide combined. with the saline solution it was found that in 31⁄2 minutes the secretion of the Prussian blue was noted and became very marked in four minutes. From this time the increased flow of urine was a very prominent feature, but there was no perceptible increase in the blood pressure. Profuse diuresis occurred even after the renal nerves were severed, thus showing that the action of the normal saline solution was upon the renal cells. In numerous experiments upon artificially congested kidneys it was found that the congestion was much diminished by the injection of saline solutions. In regard to the technic of the operation it is suggested that the fluid be allowed to flow slowly, so that the tissues may not be overdistended and the absorption may readily occur. The needle should be inserted slowly and obliquely, avoiding nerves and blood vessels. It is not advisable to inject into muscles as

painful lumps or even abscesses may result. The best region to use for this injection is perhaps the iliolumbar, the space between the crest of the ilium and the twelfth rib. It is practically the point of least motion in the body and does not interfere with the dorsal position or cause pain through movements of the limbs or from abdominal or thoracic respiration. The ideal solution to use is a 0.6 per cent salt solution in boiled and filtered water. One dram of the solution to one pound of bodyweight is the maximum quantity that will be taken care of by the kidneys every fifteen minutes, and hence in a patient weighing one hundred pounds 121⁄2 ounces will be taken care of in the given time. The rapidity of absorption depends considerably, however, upon the condition of the circulation and with a rapid and feeble heart with poor action of the capillaries, it is a much slower method than enteroclysis. The danger of overdistention. here becomes an important one. If, however, in such a case we combine with the hypodermyclosis, enteroclysis with normal solution at 120° F., the heart is immediately started up and absorption occurs more rapidly. For practical purposes the fluid may be injected once, twice or three times during twenty-four hours, depending upon the reaction and the rapidity of absorption. In an adult six ounces to a pint is indicated in uremia and allied conditions; from a pint to a quart, if there is shock or hemorrhage. In pulmonary hemorrhage or in hemorrhage from intestinal ulcers, as in typhoid hypodermoclysis, is an excellent method. An infusion or enteroclysis might stimulate the heart too vigorously and cause a recurrence of the hemorrhage. Preferably a fountain syringe should be used, but a Davidson's syringe or funnel may be employed. Usually an elevation of two to three feet is sufficient, unless a very small needle is used. An aspirating needle of moderate size is best, but an ordinary hypodermic needle can be used in emergency. Gentle peripheral massage assists absorption. As there is considerable loss of heat in passing through the tube the fluid. should be at a temperature from 115° to 120° F. Indications for its use may be deduced from the effects produced by the procedure: (1) It increases the quantity of fluid in the vessels by replacing that which has been lost be hemorrhage or diarrhea. It adds fluid to the circulation and, therefore, stimulates a rapid and feeble heart as in shock; (2) it dilutes the poison and aids in the elimination of toxic products through its diuretic action, as in sepsis or in urema; (3) it causes profuse diuresis and relieves acute renal congestion, as in uremia and oliguria: (4) it is asserted by many to have a hemostatic effect, and, hence, is of benefit in various kinds of hemorrhage for several reasons. From this it would appear that in a large number of toxemic cases due to bacterial or other causes hypodermoclysis may serve a valuable end and it undoubtedly merits a much wider field of usefulness than is accorded it at the present time. -Med. News.

Notices and Reviews.

"The Practical Medicine Series of Year Books IV. MarchGynecology." Edited by E. C. Dudley, M. D., and Wm. Healey, M. D. Chicago: The Year Book Publishers, 40 Dearborn Street.

This series of monthly résumés continues to please the eye and to merit our unqualified indorsement. The present volume is, we believe, an improvement upon the former one; it certainly most admirably fulfills the objects of such a work. The contents are presented under six general headings.

1. General Principles, including Etiology, Examination, Disinfection for Operation, Instruments, etc.

2. Infections and Allied Disorders. The condensed presentation of Dr. Small's article on Gonorrheal Infections and their treatment is alone of sufficient value to make the book quite indispensable to the general practitioner.

3. Tumors, including those of the different organs and their differential diagnosis.

4. Traumatism. Of special merit are the abstracts on vulvar hypertrophy, cystocele and genital fistulæ.

5. Displacements-Uterine prolapse is given considerable space, and the article on displacement of the tubes and ovaries is very interesting.

6. Disorders of Menstruation and Sterility.-The literature has evidently been considered very thoroughly, and the selections have been made with rare discernment. while the abstracting is of the highest order. Sufficient illustrations have been inserted to elucidate the description of operative procedures. The editors are to be congratulated upon the intrinsic value of this volume.

PAMPHLETS RECEIVED.

A. I. B.

"Reflex Neuroses," by William Cheatham, M. D., of Louisville, Ky.

Transactions Rhode Island Medical Society, Vol. VI., Part IV., 1902.

"The Therapeutical Value of Roentgen Ray in the Treatment of Pseudoleucemia-Iodized Catgut," by N. Senn, M. D., Ph. D., L. L. D., of Chicago.

"The Value of the Roentgen Rays in the Treatment of Carcinoma-The Roentgen Rays in Differentiating Between Osteomyelitis, etc., and Other Osseus LesionsCorrected Mal Union in Fractures of the Radius and Ulna of Both Forearms-Exploratives Princip und Technik beim secundären Brustschnitt," by Carl Beck. M. D., of New York.

SPITTING IN PUBLIC IN LONDON.-The following bylaws or regulations have been made by the Board of Trade under the powers conferred upon the board by the London County Tramways' Act, 1896: "(1) No person shall spit in, or upon, any carriage used on any tramway worked by the London County Council. (2) Any person offending against or committing a breach of the foregoing by-law or regulation shall be liable to a penalty not exceeding £2 ($10). (3) These by-laws or regulations. came into operation on April 28, 1903."

Railway Miscellany.

ANOTHER TRANS-CANADIAN RAILWAY IN SIGHT.

The people of Canada are now offered the opportunity of securing, on extraordinarily easy terms, the benefits of another transcontinental railway which will open the undeveloped regions of their vast domain from the Atlantic to the Pacific, if parliament ratifies the contract entered into by the government and representatives of the Grand Trunk Railway. Heretofore railway building in Canada has been incited by liberal subsidies, national, provincial and municipal, in money and lands. The Canadian Pacific was given $25,000,000 and 25,000,000 acres of land, and the country has already received large returns on that investment. Under the plan proposed for the Grand Trunk Pacific enterprise, the government will pay for the construction of about one-half of the line by an issue of bonds, without any immediate cash expenditure, and will lease this section to the operating company for a percentage upon the cost corresponding to the interest on the bonds. The remainder of the line will be built and owned by the operating company, the government simply lending its credit by guaranteeing 75 per cent of a limited bond issue.

The entire line will be operated by the Grand Trunk Pacific Company, but the government will explicity reserve the right to give any other railways running powers not only over the section which the people will own, but also over the costly stretch from Winnipeg through the promising country to the Pacific. In lieu of paying a direct subsidy the government waives the payment of rental by the company on the section east of Winnipeg during the first seven years of construction and development, and also will pay the interest ou the bonds of the western section, owned by the company, for the initial 7-year period. The contribution of the country to the company which undertakes the tremendous responsibility and risk of bringing into existence and carrying on a railway line more than 3,000 miles long, therefore, amounts to the payment of interest on a portion of the cost for a limited period of years. During this period the new line cannot be expected to earn any profit on the investment, although from the outset it will prove vastly profitable to the new regions which it opens, and to the country as a whole. One feature of this ingenious and remarkable agreement is challenging strong criticism in Canada and elsewhere on the ground of its apparent connection with local interests and partisan qualities. This is the provision for constructing a 400-mile extension from Quebec eastward to Moncton to take the business which the new road would otherwise pour upon the government's railway, the Intercolonial, at Montreal and Quebec.

It is difficult to understand the importance attached by the Canadian prime minister to the idea of building this apparently unnecessary extension on account of the assumed dan ger that the United States may some time suspend the bonding privilege under which Canadian merchandise is now allowed to enter and leave American ports without paying duty. Under the reciprocity agreement a vast amount of traffic is now carried over numerous roads between points in the United States and points in Canada under bond without paying duty, as, for instance, between Detroit and Buffalo over the Grand Trunk, Michigan Central, Wabash, Canadian Pacific, Pere Marquette and other roads. Abolition of the bonding privilege would be a mutual injury which neither country is likely to desire. Should it ever be contemplated Canada has already two routes from Montreal and Quebec to Saint Johns and Halifax, "every inch on Canadian soil," beside its great waterway to the ocean, and it could build as many more outlets as might be needed. The prime minister's appeal to nationa! pride and fear does not seem to satisfy the matter-of-fact people who fail to see why $15,000,000 or $20,000,000 should be expended by the government in paralleling its own line without reaching any ports not already served by its railway. If the opposition party, in the vigorous discussion in

parliament which is certain to be invoked, shall succeed in pruning off from the Laurier agreement this aftergrowth, it will leave a consistent plan which, in connection with the government's existing line from Halifax, Quebec and Montreal, will give a new transcontinental line that will be of the greatest importance and benefit to Canada.

EXIT EVANSVILLE & TERRE HAUTE.

Because of the continued depression in the stock market, the New York firm of brokers for about a year and a half in control of the Evansville & Terre Haute failed two weeks ago, and, because of this failure, the Chicago & Eastern Illinois has been able to buy the Evansville & Terre Haute on favorable terms. While official announcements are lacking. the semi-official statement is that the shares acquired amount to $500,000 par value, and that this amount, with the stock already owned, gives the Chicago & Eastern Illinois interest a majority of the $3.987,383 of common stock. The average cost to the Chicago & Eastern Illinois of all of its holdings is said to have been 52 to 55, the price paid for the 10,000 $50 shares just acquired being 57%. The company has outstanding $1.282,417 of 5 per cent preferred stock, which has no voting power.

For a good many years the Evansville & Terre Haute has been the connecting line between the Chicago & Eastern Illinois at the north and the Louisville & Nashville at the south in forming the Evansville route from Chicago to all points reached by the Louisville & Nashville system. The usual fate of small companies of late has been to be absorbed by the neighboring big ones, and the disappearance of the Evansville & Terre Haute as an independent property has long been expected. The absorption of the Chicago & Eastern Illinois by the St. Louis & San Francisco and of the 'Frisco by the Rock Island, of course, adds the Evansville route to the great Rock Island system.

As an investment the buyers probably have done well by themselves, although dividends on Evansville & Terre Haute common have been irregular and uncertain. In 1894-98 no dividends were paid; in 1899 the rate was 2 per cent: in 1900, 3 per cent, and in 1901, 1% per cent, while since the spring of 1901 nothing has been paid on this issue. The preferred shares were issued in 1895-98, and 5 per cent has been paid on them regularly since 1899. The past year has been a particularly good one, and, according to good Wall street authority, the company earned in 1902-03 8 per cent on the common after paying 5 per cent on the preferred.

The financial status of the Evansville & Terre Haute is somewhat complicated by the existence of the subsidiary Evansville & Indianapolis Company, all of the stock of which is owned by the Evansville & Terre Haute, while the parent company owns the equipment used by both roads. In 1902 the Evansville & Terre Haute reported a surplus of about $328,000, while the Evansville & Indianapolis showed a deficit of $64,000. But the subsidiary company is vitally essential to the parent company as a preventative of possible competition, and the maintenance of distinct capital accounts and of distinct organizations, so far as earning power and dividends. are concerned, is purely a legal fiction.

Combining the operations of the two companies, the income accounts show the full dividends to have been earned on the preferred stock in 1890-1893 and in 1899-1901, but not in 1894-98. However, the years prior to 1898 afford no fair index to the present condition of the property, and the road unquestionably is now earning substantial surpluses over and above the full requirements of the preferred shares. This is true not only on the face of the earnings but in view of the details of the maintenance accounts.

In physical condition the Evansville & Terre Haute may not be quite up to the standard of its stronger neighbors, but in New York it is stated that "but little additional expenditure will be required to put the road into condition to fill its place as a part of the Chicago & Eastern Illinois," and this assertion has ample support in the facts. The transportation department has done remarkably well with the property

of late. The earnings of the two Evansville companies jointly rose from about $4,150 per mile in 1897 to $5,775 in 1902, and will show still better for 1903. Since 1900 every county crossed by the Evansville & Terre Haute has increased in population. The company's lines traverse live communities, in a prosperous State, with established traffic in coal and lumber as well as in agricultural products and general merchandise. The permanence of the through business, no doubt, is assured by the change of ownership.

FROM OCEAN TO OCEAN AT LAST.

From present indications the Rock Island interests will be the first in the United States to control railway lines spanning the continent. Norfolk promises to be the Atlantic terminus, San Francisco the Pacific. The result outlined is rendered possible by the "deal" in the East, through which the Seaboard Air Line has passed into Rock Island hands, as described last week, and by one in prospect in the West between the Santa Fe and the Rock Island for the joint use of the Santa Fe tracks from Albuquerque to the Golden Gate, together with the completion of the links still missing in New Mexico to bring both the Rock Island and the Santa Fe into Albuquerque from the east on the route of the Atlantic & Pacific scheme of a generation ago. That the Santa Fe and the Rock Island are to enter into an agreement for exchange of trackage rights through which the latter will be able to run its trains to San Francisco, while the former will gain the use of part of the Rock Island mileage in southwestern Kansas, Oklahoma, the Texas Panhandle and New Mexico, has not been announced officially, but has good unofficial support. The prospective through line from ocean to ocean includes, of course, for intermediate mileage the Kansas City Memphis & Birmingham and the Choctaw Oklahoma & Gulf divisions of the Rock Island system, extending from Birmingham, Ala., to Amarillo, Tex.

The common expectation has been that the ambition of Jay Gould for a transcontinental line would be realized by his son in advance of competitors, and the Gould interests now have a system in sight connecting Baltimore with Ogden and El Paso. From these points to "the coast" a gap remains to be filled in the Gould project. With the co-operation of the Santa Fe, for reciprocal advantages, the Rock Island people seem to be ahead in this matter.

By way of explanation of the change of control in the Seaboard Air Line, the official statement was made last week that "the transaction does not involve the purchase of the Seaboard Air Line by the Rock Island or 'Frisco interests, although the 'Frisco lines extend into Birmingham and they are a part of the southern situation. It does, however, further emphasize the fact that all of the great railway systems are carrying out the policy of more closely cementing the railway transportation interests of the country, which will greatly retard, and it is hoped entirely prevent, demoraliza-⚫ tion of the rate situation, or unnecessary construction and duplication of property." To this it was added that the management of the Seaboard Air Line will remain as at present. That company's board of voting trustees includes eight members. Two of them represent New York banking interests, two are Mr. B. F. Yoakum and Mr. H. Clay Pierce, who may be taken to represent themselves directly and the Rock Island Company indirectly, and one of the remaining trustees, it is understood, is pledged to act with the four new members. In other words, those who have now bought into the company have full control, although the Seaboard Air Line is not formally owned by any railroad.

In view of these facts, it is apparent that the Seaboard Air Line is not to be considered as a member of the Rock Island system as regards finances, although from the traffic point of view it may be so reckoned. Just what the new relations will produce of advantage to either side in the way of increased traffic and revenue is not apparent. The St. Louis & San Francisco has now at Birmingham friendly connections with the Southern and the Central of Georgia.

This business for Seaboard Air Line and other competitive eastern points can hardly be diverted altogether to the Seaboard's line from Birmingham to Atlanta, which will go into operation within a few months. Looking at the map one would say that one outcome of the new relations must be the construction by the Seaboard of a line to connect Birmingham and Montgomery, but "a man acquainted with the geography" and topography of the Birmingham district will realize the obstacles to be encountered. No doubt the interchange of traffic at Birmingham between the 'Frisco and the Seaboard will be considerable and profitable, but the conditions seem hardly to be such as to warrant expectations that a great through route between the East and the West is bound to follow. Of course the Seaboard Air Line gains a friendly ally at an important point, and the new combination may be considered as a fair offset for that between the Atlantic Coast Line and the Louisville & Nashville.

As an independent proposition the Seaboard Air Line has grown steadily in strength and importance from the day in which Mr. Williams set about welding into a unit a number of distinct properties of minor importance. The income account lately published for the fiscal year 1903 shows for the system gross earnings of $12,706,000, as against $11,579,000 in 1902, and a surplus after all charges of $832,000, as compared with $820,000 the previous year. Excellent operating results have been produced under Mr. Barr's administration, as the annual report will show later.

Passing from the combination, even though it be a loose one, between the Seaboard Air Line and the St. Louis & San Francisco to that understood to be in prospect between the Rock Island and the Santa Fe, it may be said that the latter arrangement is on its face as natural and as explicable as the former. Occupying to a great extent the same territory, the Santa Fe and the Rock Island usually have got on peaceably, and the use of the Santa Fe Pacific by the Rock Island for its Pacific coast outlet is, geographically speaking, much more reasonable than the employment of the Southern Pacific line from El Paso. In Wall street circles the Rock Island capitalists have been credited from time to time with purchases of Santa Fe stock for control. Such control will be extremely difficult to establish. Perhaps equally satisfactory results to all parties will be effected by a trackage arrangement, if and whenever one shall be entered upon.

W. D. Cantillon, general superintendent of the Chicago & Northwestern, has issued a circular calling upon the employes of the company to lend their assistance to the city authorities, and, at the same time, render the company's sur roundings more attractive and healthful by making a strenu ous effort to improve the condition of the thoroughfares on and around its property, warehouses, freight and passenger terminals, and by providing proper receptacles for the reception of rubbish, sweepings, waste paper, etc., and then seeing that such refuse is cleaned up and deposited in said receptacles instead of being scattered over the company's own and surrounding property.

The Buffalo Rochester & Pittsburg has established a pension system which is similar to that in use on the Pennsylvania, excepting that the monthly allowance is based upon 2 per cent per year of the average pay of the retired employe, instead of 1 per cent. Employes will be retired at the age of sixty-five provided that they have to their credit 20 years of continuous service, and no inexperienced person over thirty-five will be employed.

American railways do not have a monopoly of accidents. terrible as has been their record in that respect. A cablegram of August 3 reports that on a railway in Austrian Silesia a number of cars loaded with stone broke their couplings and ran down a steep grade for 20 miles until they collided with a passenger train, killing 30 persons and severely injuring 52 others.

VOL. X.

TRAUMA AS A CAUSE OF MALIGNANT DIS

EASE.*

BY D. S. FAIRCHILD, M. D., OF DES MOINES, IA.

It is no doubt true that malignant growths sometimes have their origin in local traumas. To what extent the localized disturbance due to injury may induce pathologic changes of the nature above referred to can only be determined by clinical experience. Logical deductions based on isolated facts are not sufficient data to furnish a working hypothesis upon which to predicate an opinion in determining a reasonable expectation in a given case. From observations based on 5,000 cases of all kinds of traumatic injuries carefully recorded, I have come to ignore the future probabilities of malignant changes in all cases which come under observation in estimating the chances of complete recovery. In this statement we do not deny the possibility of a sarcoma or carcinoma following a local injury, but such a result is very rare. It has been our contention in the past that the occurrence of a neoplastic formation in a part which has once been the seat of an injury is not sufficient evidence that the injury had a predisposing influence, unless it was reasonably evident that the part had not fully recovered from the effects of the trauma.

If an injury occurs which does not cause a destruction of tissue, a limited inflammatory reaction follows attended by an exudate more or less extensive, with an escape of a little blood into the tissues. This means, of course, that some damage has been done to the tissues involved, including blood vessels and nerves. In the reparative process new cells are formed, the blood is absorbed, the leucocytes disappear, and the parts are rapidly or slowly restored to a normal condition. If a fracture of a bone is produced or a loss of tissue occurs, the same process of repair follows, but is more extensive and is attended by the formation of a callus or scar. The formation of a callus differs from the formation of a scar in that the callus is composed of osteoblastic cells which are soon transformed into bone, and if undisturbed becomes of the same character of the original bone, even if the lime is somewhat changed and the point of fracture becomes permanently evident. In the loss of soft tissue the new formed tissue becomes of the nature of a fibrous connective tissue, having a different function and a different resistance, perhaps, from the original tissues, and may at a later period be affected by degenerative influences. But there is little or no evidence to show that the degenerative

*Read before the ninth annual meeting of the American Academy of Railway Surgeons, held at Kansas City, October 23, 1902.

No. 4

process which may occur in old scar tissue is malignant in character. The most that can be said is that, admitting the possible parasitic origin of cancer, the scar tissue would offer less resistance to its influence.

According to the views of Brosch the true influence of trauma in producing tumors is the formation of new cells in excess of the physiologic requirements. That the distinction between the reparative processes after injury and the productive processes in the formation of tumors is that in the productive processes the cells are endowed with extraordinary powers of proliferation. On this hypothesis Brosch contends that superficial injuries, as bruises and burns, are followed by carcinomas and more severe injuries by sarcoma. If then it is admitted that malignant disease is produced by a single injury or trauma, it must on this theory be contended that the new cells formed for the purpose of repair are in excess and assume the type of malignancy. In the formation of malignant growth from this cause it may be presumed that there will be a definite relation between the trauma and the malignant growth following. Granting that the development of cells following trauma results in a malignant process, it is logical to assume and is probably in accord with the facts, that the process commences before these cells have reached a state of nutritive stability in the repair of the damage. We shall therefore expect to find that before all the local symptoms of the injury have disappeared a new formation will manifest itself at the focus of the trauma. W. B. Coley of New York has collected 270 cases of cancer preceded by trauma, in 80 cases in 11.5 p. c. the disease appeared within a week of the accident. His views. of the relation of injury to the production of cancer are somewhat different from those offered by Brosch. Coley believes that cancer is of parasitic origin and that traumatism excites the organisms into activity. Farquhar Curtis is of the opinion that it is a mistake to trust too implicitly to the patients' history of injury.

Dr.

Dr. J. Collins Warren of Boston is of the opinion that locality has much influence in producing cancer and cites facts in support of the infectious nature of the disease, calling attention to the so-called "cancer houses," in which

one inmate after another suffered from this disease. In the opinion of Dr. Warren irritation plays some part in the production of cancer.

C. A. McWilliams states that in 100 cases of cancer of the breast trauma was present in 44.6 p. c. The character of the trauma is not stated in the abstract of the paper; whether it was a single trauma or repeated irritation is not certain.

Wurz in 714 cases of tumor found 2.6 p. c., probably of