of malignancy. In order of frequency is found, first, cancer of the vaginal portions of the cervix; second, cancer of the uterine body, and third, cancer of the cervix proper. In order of malignancy, lesions in the cervix proper come first, vaginal portion second, and uterine body third. The reason for the greater malignancy of the disease occurring in the cervix proper is chiefly due to the fact that the uterine body easily dilates, while the cervix holds the tissues in close contact with the lesion by reason of its small canal and unyielding walls. The most insidious cases are those occurring in this locality. Bleeding on touch is considered an early sign, yet it is impossible to feel a nodule within the cervix when the os is closed. Inspection of the vaginal portion of the cervix may or may not show a nodular area, and often it is apparently normal. However, every nodule seen on a cervix should be examined.

Text-books on gynecology give a long list of lesions to be differentiated from cancer by a physical examination, history, etc., but no such examination is trustworthy without a microscopic examination by a competent pathologist of sections of the cervix or curettings from the uterus. Frankl of Schauta's clinic stated that in 1007 cases that applied for treatment, only 34 could be classed as early cases. He classed as early cases only those in which a microscopic examination was necessary for a diagnosis. Of this number, 32 were well after a period of five years, the absolute accomplishment being 94 per cent. Compare this percentage with the absolute accomplishment of only 16 per cent. of those who applied for treatment.

A systematic diffusion of knowledge among young women of the early symptoms of uterine cancer, and its cure by early surgical intervention, should be instituted by boards. of health, doctors, and nurses. I hope I shall see before long the newspapers of this country forced by public opinion. to desist from defrauding sick men and women by printing false advertisements. Freedom of the press should not

carry with it the right to rob the ignorant of their health and life.

In conclusion, I insist that it should be a matter of routine to have a pathologist examine the tissues in every operation upon the cervix and curettings from the uterus. No one in the profession performs a greater service than the pathologist in detecting the early cases and saving life, and his remuneration should be in keeping with this service.-Va. Med. Semi-Monthly.

THE DANGER OF DELAY IN CANCER:-Thousands of lives now needlessly sacrificed to cancer could be saved if the patient would go to the surgeon as promptly as does the average person attacked by, appendicitis. Nor is there any reason why the cancer patient should not seek this, the only safe treatment, with the same high degree of confidence in the outcome that is now common among those suffering from the other more fashionable disease. Unfortunately, the evidence is only too clear that a different attitude toward cancer prevails and occasions many preventable deaths. The almost superstitious dread of the disease and unwillingness to admit its existence or to seek medical advice in time are well known and difficult obstacles to progress in its control. Proof of this fatal neglect is found in the experience of a prominent surgeon who recently studied his case records in order to obtain definite information as to the delay in the average case. Of 65 recent patients, 35 were men and thirty Further study of these 65 cases showed that after the first discovery of suspicious sympathy the men had waited an average of 12.2 months before consulting the doctor, and the women had waited, on the average 11.9 months, practically a year's delay in all cases. Many other surgeons could produce very similar records. Winter, of Konigsberg, Prussia, the pioneer in the education of the public in regard to cancer, examined the records of 1,062 operable cases and showed that 87 per cent. of these patients could and should have applied for treatment much earlier,

were women.

when they would have had a far higher chance of recovery than was actually the case.

To the delay when the symptoms are manifest must be added the previous indefinite period after the beginning of the disease and before the patient realizes the trouble. This period can be shortened by education. Fortunately, the symptoms of cancer are present quite early and can usually be recognized if the patient understands their importance. In too many instances, however, the disease is not suspected until the symptoms are pronounced or until there is a tumor of considerable size. If we assume that this period averages six months, and then add the year's delay for which the patient is responsible, we find that the average patient does not seek advice until at least a year and a half after the onset of cancer. This precious time, thrown away, means, if not a fatal outcome, at least a serious instead of a minor operation.

In the present state of our knowledge of malignant disease it cannot be too frequently emphasized that the hope of curing cancer is to be found in its earlier recognition and in prompt and competent surgical treatment. The unfortunate patient who, because of ignorance or unwarranted fear or the blandishments of quacks, hesitates to seek proper advice should realize that in this delay he or she is recklessly throwing away a splendid chance of cure.-American Society for the Control of Cancer.

THE CONTROL OF CANCER DEMANDS OUR ATTENTION:Such a menace has this disease become to civilized nations and so much to be dreaded is it for the suffering entailed as well as its ultimate outcome, when not taken in hand in its beginning stages, that cancer is attracting more widespread attention in the medical profession and medical organizations every year. A toll of 75,000 lives is taken in the United States each year from this one disease, and many of these deaths are preventable if, as stated by the American Society for the Control of Cancer, "the patient

would go to the surgeon as promptly as does the average person attacked by appendicitis."

It being now conceded that cancer is at first a local growth and not a systemic disease as was formerly supposed, medical organizations are more and more trying to impress upon the laity as well as upon the profession the necessity to look out for the early warning symptoms and treat them without delay. As pain is rarely present in a beginning external cancer, a lump, scab, or an unhealed wound or sore should not be allowed to continue without at least being investigated. An abnormal discharge from any part of the body, especially if bloody, persistent indigestion, or loss of weight with change of color should be viewed with suspicions until proved not to be a beginning cancer, as it may prove the adage of "an ounce of prevention is worth a pound of cure."

Cancer is a disease chiefly of middle and late adult life and is more common among women than men. The organs attacked in order of their frequency, according to statistics of 1913, are the stomach and liver, the uterus and other organs of generation, and the breast, cancer of other organs and parts causing only one-third of the deaths from cancer for that year.

The only solution of the question as to how to control cancer is in the removal of every vestige of the disease and, for this purpose, an early diagnosis is all important. The services of the most eminent surgeon can avail little if the disease fails to receive early recognition and treatment.— Va. Med. Semi-Monthly.

"SOME IMPORTANT MEMORANDA FOR THE BUSY PRACTITIONER" is the title of a little brochure published by the Fellows Company, containing a mass of useful information which is put in a terse concise way, particularly useful for the busy practitioner, also a diet table for tubercular patients. If you have not already received a copy it would pay you to write to the Fellows Company for one.

TUBERCULIN TREATMENT IN PULMONARY
TUBERCULOSIS.

BY WM. LITTERER, A. M., PH. C., M. D., Professor of Bacteriology, Vanderbilt Medical College, Nashville, Tenn.

Soon after the announcement by Robt. Koch in 1882, of the discovery of the tubercle bacillus there quickly followed many attempts to destroy the bacillus in the tissues of the infecting organism by the administration of various substances found to kill it in vitro. All such attempts were, of course, futile, especially since many of the substances that were recommended which if used in sufficient strength would have killed the host as quickly as the parasite. The literature during that period abounded in wonderful cures and marvelous results obtained by some, from the use of the so-called "false specifics," only to be followed by others, by deep disappointment and ultimate abandonment of the remedies. Today a sign of the times is the paucity of publications referring to fresh or new remedies aside from the specific treatment of tuberculosis by the various tuber