no extension of the lesion in the next four or five months, while the case was under observation. I also tried various lauded new or old "cures," such as formalin, absolute, to 30 per cent., alcoholic injections and the local application of calcium carbid. None of these did any positive good, some did harm. The antiseptic treatment did all that was done to benefit the condition.

Cancer, as usually understood, is an open, "eating," destructive sore. The condition present is one of carcinoma plus infection with pus organisms. Destruction of and keeping out pus germs accomplishes much in prolonging the life of the patient and rendering his existence less miserable and offensive.

It may be of interest to give, briefly, the details of the different methods of treatment employed. In cases where excision is practiced, the direction of the wound should be parallel to the normal lines or folds of the skin. The distance which the incisions shall be beneath and beyond the visible borders of the growth must be left to the judgment of the operator, guided by pathological principles. A wide margin of apparently healthy tissue must be removed and a deep dissection made beneath the lesion in all cases. In the dissection care should be had not to cut into the diseased growth lest implantation of cancer cells into healthy tissues follow. If adjacent glands are involved they must be removed en masse with the primary growth.

The thermo-cautery is used at a cherry red heat, all visible disease being destroyed, in doing which a capsule of apparently healthy tissue becomes secondarily necrosed. This is a troublesome, and to a watchful patient, barbarous looking treatment. Healing is slow, but if the wound is properly managed the scar is soft and not like that of an ordinary burn.

Marsden's arsenic paste I have rarely used, because it is a most tediously acting and continuously painful treatment. The advantages claimed for it have not been fully demonstrated to my mind, and I have seen no statistics showing it superior to caustic potash, or even the thermocautery.

The paste is made of equal, or slightly varying, proportions of arsenious acid and pulverized gum acacia mixed with water. Many of those who use it cut or curette away any redundant cancerous tissue and then apply the paste on cloth, extending a little over the visible margins of the lesion. Cocain locally used affords but little relief from the pain. The paste is left on for from twelve to twentyfour hours, as required. The eschar and wound are treated on general principles.

The stick of caustic potash is my preference among the caustics, and for several years I have rarely used any other. If the cancerous mass is quite thick a little time will be saved and pain spared by the instrumental removal of part of the growth. A two to four per cent. solution of cocain may be injected to moderate the pain. The surrounding tissue is protected by the application of acetic acid, and the same drug may be used to neutralize the action of the potash when it has gone far enough. The lesion is thoroughly destroyed by boring in the stick of caustic potash, or in very simple lesions, the application of a few drops of the deliquescing chemical. We change to a gelatinous substance all apparent disease, and secondarily necrose a capsule of tissue which should contain all the outlying cells. The eschar separates in from one to two weeks, and healing then proceeds as in any other wound. However deep this may be, it fills rapidly under proper management, and the resulting scar is remarkably superficial and pliant.

Since I have used this chemical in the corner of the eye without damage to the ball, and on the gum without injury to adjacent parts, I feel that there is no visible place where it may not safely be used if properly handled.

CANCER OF THE BREAST.

BY SAMUEL LLOYD, M.D., NEW YORK.

This is a most appropriate time to discuss the subject of cancer in general. Every one in this audience can recall the time when the etiology of tuberculosis was as vague as that of cancer, and most of us have hoped that the time would come in the not distant future when some one would do for cancer what Koch's discovery of the tubercle bacillus has done for tuberculosis.

I am free to confess that I have for many years declined to accept the embryonic cell theory as a satisfactory explanation of the cause of this disease, and it has been, to my mind, a strong argument in favor of some infectious element that cancer should be on the increase. This increase, too, has been proven to be greater in thickly settled civilized communities than among uncivilized tribes. A friend of mine who for several years has been a medical missionary in Africa, told me but a few days ago that he could recall only one breast cancer in his experience. This is decidedly in contrast to the statistics presented to the last meeting of the New York State Medical Society by Dr. Roswell Park, who said, "In England and Wales, where most careful statistics are kept, the cancer death-rate has risen from one in 5,646 of population in 1840, to one in 1,306 of population in 1896; that is, in fifty years the proportion has increased nearly five times." In New York State "in 1887 there were 2,363 deaths from cancer and 11,609 from consumption. In 1898 there were 4,456 deaths from cancer and only 12,552 from consumption."

Locality seems to have a decided influence in the production of the disease, and some years ago I collected considerable data bearing on this point in an editorial in the Annals of Surgery, and there has been recently an article on this same subject embodying the results of later investigations. in several numbers of the Centralblatt fuer Chirurgie.

Perhaps more startling than this of clinical experience, however, is the almost simultaneous announcement from the New York State Laboratory, from Dr. Armand Ruffer's laboratory, and from Dr. Bra, of Paris, that they have discovered certain bodies in cancer cells which seem to be distinctive of the disease.

Parks says "that results obtained already within the past six months have been almost startling or even dramatic, and give promise of great advance in our knowledge in the future. In every case of cancer yet examined where we have had access to the fresh specimens, it has been possible, by improvements in technic, to find bodies, which cannot be other than parasites, present in vast numbers. These are undoubtedly the same bodies which some observers in time past have called cell degenerations, others fat globules, but which are now quite generally recognized as parasites, though opinion is still divided as to whether they are sporozoa or fungi." He adds that "both cultures and inoculations have been so often successful as to leave no doubt in the minds of those who are doing this work that cancer is unmistakably a parasite-i. e., an infectious disease.

Mr. Plimmer, after his investigation in Ruffer's laboratory, concluded that the organism was a yeast and his intravenous and intraperitoneal injections in animals, while as yet inconclusive, resulted in "an abundance of new foci,"