the inguinal canal, the spermatic cord (and in woman the round ligament) must be carried well outwards toward the anterior superior iliac spine. In weak abdominal walls it would be well to make a new canal for the cord under the skin. The cord would no doubt functionate between the skin and aponeurosis of the external oblique muscle. The fibers of the external oblique in either tendonous or muscular portion can be simply separated without cutting and the cord carried well toward the iliac spine.

Then, the latest principles which indicate that hernial operations may be permanently successful are:

1. Restoration of the anterior wall of the inguinal canal. 2. The formation of a new canal for the cord.

3. The buried suture, which will remain in position for two to three months.

It is curious to observe how each surgeon with some peculiar method of operating reports cases with such wonderful success but the element of time is too short for general acceptance. It is difficult to cure any disease while it exists under the cause that produces it. It is almost impossible to cure malaria in a region infested by malarious influences. Rheumatism is almost impossible to cure while its subject exists in the very causes that produced it. It is the same with hernia.

Hernia generally exists under congenital or acquired defects. It occurs from some weak point in the wall, and the weak point in the abdominal wall is not always capable of being mended or restored to normal. It is noted often when a person acquires a hernia on one side that the other side may and often does develop a hernia.

The truss generally cures a hernia in five or six years, if it is faithfully worn. But, until lately, hernial operations were not on an average permanent five years. Still at present the mortality of hernial operations is very small. However, up to 1890, it would average five per cent mortality. With such low mortality as at present is reported, operations seem more justified. Yet, if one divides hernias into ordinary small ones and very large ones, he will do well to attack with caution the very large hernias, as they are quite fatal.

I have dissected the abdominal walls in regard to hernia a good many times, and I have done the operation under what I thought was fair circumstances, but in some ten months I could

note a slight bulging at the old wound. The hernia was beginning to return. With the new methods of Marcy, Bassini and Halstead, of restoring the posterior wall of the inguinal canal and forming a new channel for the cord, I think hernia will stand in a new light as a surgical operation.

Sections.

MEDICINE.

Under the Charge of SAM'L O. L. POTTER, M.D., M.R.C.P.L.

Etiology of Cancer.-Mr. S. G. Shattock, F. R. C. S., Curator of the Museum of St. Thomas' Hospital, in his Morton Lecture before the Royal College of Surgeons of England, gives the results of recent experimental work by himself and others, in the investigation of this subject. If cancer was a micro-parasitic disease, it should be capable of experimental transmission. Mr. Ballance and the lecturer had carried out a series of experiments, in which they had inserted portions of freshly removed carcinoma of the breast into the abdominal cavity, the subcutsneous tissue, the muscles and the anterior chamber of the eye of various animals. The result was in all cases negative; the portions so inserted underwent coagulation, necrosis, and were either absorbed or became encapsuled. At the present time there was no authentic case on record, in which human carcinoma had been transferred to any of the lower animals. Success, however, had followed in certain cases, when the transplantations had been made from one animal to another of the same species. And in this the results followed the laws of grafting rather than those of ordinary infection, for they showed that a portion of a growing carcinoma, if so transferred, would grow in a second individual as it would have done in the first; but they did not really show that carcinoma was infective. Although there were such strong clinical reasons for regarding cancer to be an infective disease, it was only lately that methods had been devised of cultivating a contagium vivum. Mr. Ballance and he had made a long series of experiments in this direction, and with a negative result. Up to the present time no specific microphyte-bacterium, micrococcus or other had been cultivated from carcinomatous tumors. Speaking generally, the patho

genic action of bacteria arose from the specific albumoses and alkaloids which they elaborated; but neither albumoses nor alkaloids could be extracted from carcinoma by the most exhaustive and careful analyses.

The only positive results were obtained in experimenting on the line of Koch's second postulate, namely, the cultivation of a micro-organism alleged to be in the tissues. In sterilized sand and specially distilled water in Petri capsules, pieces of the growing edge of mammary carcinomata were placed, and in no fewer than six such capsules, of which five were infected from different tumors, they had obtained actively moving amœbæ. In check experiments, made with broth or blood plasma, no similar results were had. One of the tumors used was a sarcoma, and it was not a little curious that the same microzoon occurred in carcinoma and sarcoma; it was evident, also, from the great numbers found, that a process of multiplication was concerned. That the bodies in question were not surviving leucocytes was proved by their living in water, the action of which was lethal in the case of the mammalian corpuscle, and what completely disproved this possibility was that there were other phases met with in the sand of the capsules,-encapsulation and sporulation.—British Medical Journal.

The Parasites of Cancer.-Kurloff has found what appears to be the organism (Rhopalocephalus canceromatosus) described by Korotneff, in a primary cancer of the dorsum of the hand in a male, aged 80 years. The supposed parasite lay in a vacuole within the epithelial cell. The tissue was prepared as follows: small pieces were fixed in Flemming's solution and cut in paraffin. Sections were stained in various ways, those treated by safranin being the most successful. The most notable feature of this parasite is its great size; it is readily seen under a magnification of 300 to 400. It presents well-marked pseudopodia, by which movement, with passage from cell to cell, appears to take place. Kurloff is satisfied of the parasitic nature of this body. Establishing itself within the epithelial cell of the carcinoma, it leads to hypertrophy of this cell, which results in the formation of epithelial "nests."-Centralbl. f. Bakt., B. xv, 10 and 11.

Living Parasites in Carcinoma.-In patients suffering from carcinoma, Kahane finds in blood from the fresh growth and also from the finger tip, minute, irregular, amoeboid, highly refractile bodies, which he regards as parasites. These show very

active rotatory and progressive movements. The small bodies lie free in the blood stream, and also within the red corpuscles. The movements are kept up for an appreciable time after penetration of the corpuscle. Kahane thinks that further investiga tion may show morphological and biological points of resemblance between these bodies and the plasmodia of malaria. Examination in the fresh state disclosed similar bodies within the cells of the cancer. The growths examined were epitheliomata situated upon the face, prepuce and cervix.—Centralbl. f. Bakl., B. xv, 12.

Lesions of the Stomach Simulating Cancer.-In Paris lately, M. Ferrier drew the attention of his colleagues of the Surgical Society to a form of gastric disorder simulating cancer, and which was much ignored in a surgical point of view in France. A woman entered the hospital with gastric troubles, presenting all the symptoms of cancer and coinciding with the existence of an epigastric tumor. M. Ferrier performed laparotomy for exploring purposes, and found the stomach adherent to the walls of the abdomen, and to the left lobe of the liver. After breaking down those adhesions, the operator closed the wound, and the patient gradually lost all bad symptoms, and left the hospital quite recovered. In concluding, M. Ferrier said that in many cases, purely inflammatory lesions could simulate cancer, and an exploring operation would put the case in its true light and do no harm to the patient.--Med. Press and Circular.

Cancer a Local Disease.-The evidence for this doctrine has been strongly presented by Dr. Jennings, in his work on "Cancer and Its Complications," the second edition of which has been recently published in London. If cancer be a local disease it is imperative that not only those tissues which are seen to be subjected to cancerous infiltration, but some of the surrounding tissues and the neighboring lymphatic glands should be taken away by means of the knife at as early a date as possible. The amount of personal observation given in support of this method of treatment is not very great, but the careful analysis of the work and opinions of others, and the comparison of the methods of termination of the disease under different methods of treatment amply warrant Dr. Jennings in drawing very wide and general conclusions.-Brit. Med. Jour.

The Early Diagnosis of Uterine Cancer.-Dr. Ernest Herman, in an address before the S. E. Branch of the British Medical Association, lays stress upon the importance of an early diagnosis of cancer of the cervix uteri, for the reason that secondary growths occur later and less often with cancer of the uterus than with that of any other part of the body, and, if it is removed, there is a better prospect of freedom from recurrence than in any other form of the disease. This disease occurs chiefly toward the end of the child-bearing period, but it has been seen in childhood and in extreme old age, and therefore the patient's age should not influence the diagnosis. A tendency to cancer is sometimes hereditary, but this should not have the slightest weight, as only a very small proportion of patients inherit the disease.

The first symptoms of cancer are usually hemorrhage and leucorrhoea; pain and wasting come later. The early diagnosis is so important, says Dr. Herman, that any unusual hemorrhage or discharge in a woman who has had children is a reason for vaginal examination, for it may be the first symptom of cancer, and the nature of this disease can not be determined without local examination. In considering the local signs, the features which distinguish cancer in any part of the body must be taken into consideration.

When cancer begins as an outgrowth from the surface it may look like a growth of warts, or papillæ, or granulations on the vaginal portion, and the surface feels uneven or even rough. It can be detected by an angry, livid red spot the surface of which is at first quite smooth. This angry color depends upon the vascularity caused by the new growth and upon its tendency to break down, which leads to minute hemorrhages into the growth before the breaking down is extensive enough to make a breach of the surface. The livid surface of a cancer spot bleeds on being rubbed, so that a smooth, dark red spot, bleeding on contact, is very suspicious. This is the earliest stage of cancer, and if there is a nodule that can be felt, the suspicion is still stronger. If the cancer has so advanced as to form a growth like a mushroom or a cauliflower, the diagnosis can scarcely be doubtful.

With regard to microscopical diagnosis, Dr. Herman thinks that the value of the microscope has been overestimated, and that to rely upon its use may lead to many mistakes.

It may