and mind should be put completely to rest, and the stomach should be kept out of function. Sometimes careful and rapid lavage with ice water or weak adrenalin is of service. Morphine with atropine or hyoscine should be given in amount sufficient to quiet the patient. Bismuth and light magnesium carbonate in gelatin water given frequently will control overacidity. Warm saline solu

ing a good light, lying evenly on the back, with the chest and abdomen well exposed. Failure in discovering a tumor, even by good physicians, is not rarely due to want of observance of these abvious precautions. At this early stage there are rarely signs of a tumor, as one has not yet formed, but there may be signs of spasm of the walls of the stomach, as described

given by rectum at frequent intervals. No food is to be given for several days or a week. Even nutrient enemata are to be withheld at first; after two or three days small injections of milk and glucose should be used. In case of alarming weakness, food should be given in form of thin gruel or arrowroot or farina, or milk and lime water. In convalescence no one rule for feeding should be adhered to as invariable. Some patients do best on rather full feeding with ani

mal foods; others can stand only bland liquid foods. Hyperacidity is to be controlled by milk alkalies. External heat or cold may give relief. Olive oil may promote gastric calm. Long continuance of treatment and of observation after

cessation of symptoms must be emphasized. Surgery is called for in ulcer cases for the following indications: Perforation, otherwise uncontrollable bleeding, pyloric stenosis or motor insufficiency due to adhesions, and continued severe pain. Cyclopædia of Practical Medicine, March, 1908.

Physical Signs in Can- McPhedran

(Bufcer of the Stomach. falo Medical Journal, April, 1908) gives the following practical points in the physical examination of patients suspected of gastric can

cer:

In making an examination due care should be taken to have the patient fac

which Boas has drawn attention anew under the designation of "gastric rigidity." When present it is at first so below the left costal margin, as a faint slight as only to be felt by the hand placed contraction of the fundus, and lasting only a moment. Later, as the contractions become more marked and rigid, they cannot only be felt, but the abdominal wall, if thin, can be seen to rise as a slight mound, which after a brief period disappears. When so marked as this it gives the patient a sensation of spasm and may cause an audible gurgling sound. as it disappears. For obvious reasons rigidity does not occur when the stomach is empty, and is most marked if it be moderately full. It recurs at variable intion, especially by the cold hand. Gastervals and may usually be excited by frictric rigidity is a sign of much diagnostic value, as it indicates forcible contraction of the fundus excited by obstruction at the pylorus. It may begin fairly early, after the obstruction has developed, probably while the disease is still localized in most cases, and in time to permit of successful resection of the pylorus, infection of the lymphatic glands not having yet occurred.

The stomach should be inflated in order to determine its size, position and relation to other organs, and to a tumor if such exists. The colon should also be inflated, especially if there is a tumor of

uncertain attachments. Inflation may enable us to determine the seat of the tumor, those in the pylorus before adhesion forms being movable, while in the lesser

curvature they are relatively fixed. The supraclavicular glands are found enlarged in some cases, but rarely in the early stage.

The Cancer Problem.

Dr. Roswell Park delivered an address before the Hartford Academy of Medicine upon this subject, an epitome of which appears in the American Journal of Surgery, May, 1908. After reviewing every phase of the subject the writer closes with the following concerning the curability and treatment of cancer:

"The most important question, after all, is, What can be done with cancer? This rests largely on the matter of the early recognition of this disease. Cancer so far has proven itself to be essentially a surgical disease; no one has been able to do much with it in any other way. It will be a long time before it is really taken out of the hands of the surgeon.

"I believe thoroughly in the statement that cancer begins as a result of local conditions. I have never for a moment asserted that all forms of cancer are due to a single parasite, but believe that there are several, perhaps numerous, organisms which may produce this condition under favorable conditions.

"If the surgeon is going to operate, he must do so early. If treated early and radically handled the patient may be saved, as is proven by many thousands of instances. Everything is determined by early recognition. It is one of the charges made against us that we do not recognize cancer early. That is true. Even the most expert cannot do that.

"Here is a statement regarding cancer

which you will not yet find in general literature, references in my own new book and my other writings furnishing the only places I know of where you can find it, and that is to this effect, strange as it may seem: Cancer with all its local characteristics and its fatal termination is a disease without a symptomatology of its own. It is a disease without a distinctive or definite symptomatology. Take any organ you like-the stomach for instance, In the early stages of cancer of the stomach the patient has vague, disturbing symptoms, which cannot be identified at that time. There is nothing about it from beginning to termination which might not be ascribed to some other condition. There is vomiting, but that is incidentally due to pyloric obstruction; there may be hæmorrhages, but they may be due to some other conditions of the stomach. There is, therefore, nothing distinctive in the way of symptoms about cancer of the stomach. When a tumor is found in the stomach region, that is the first sign, not symptom. Everyone acknowledges it is impossible to make the diagnosis early, since many cases, while suspicious, cannot be determined until there are wellmarked signs in addition to the symptoms of which the patient complains, and then it is usually pretty late. Now, this is a presentation of the subject that is not generally appreciated, and there is perhaps an excuse both for mistakes and failures to make early diagnoses. There

fore, with that view of it, what shall be said about the disease? We shall always have to be uncertain until some more accurate means of recognizing it is discovered. Still, it affords a legitimate excuse for this advice, and I do not hesitate to give it in general, that in every case where there is a legitimate cause for suspicion of cancer, it is justifiable to make an exploration, that is, if the part be at all accessible, because we may substitute other means of diagnosis when we have our eyes and fingers upon a lesion, which was before the seat of but vague complaints upon the part of the patient.

"This is particularly true of abdominal troubles, also conditions within the cranium and chest. When we have learned to recognize this disease early, if that happy day ever arrive, we shall be in a better position to cure it. Until then it will still be a malady for the surgeon's

knife.

"We have had some reason to think, from study in Buffalo, that there may come a time when serum therapy may be used to master cancer, as antitoxin is used for diphtheria, because of very interesting experiences in the lower animals in the production of retrocession of malignant tumors, but it will be a long time before we get many human individuals with spontaneous retrocession, and it will be a longer time before we shall be permitted to experiment upon them.

"I have had a feeling, which I have not hesitated to voice in public, that there are a good many individuals, persons who are of no use to society, who ought to be subjected to this legitimate experiment, for instance, condemned murderers. To use some of these men for cancer experimentation would be a far greater service to humanity than to electrocute them. But, of course, there is a certain false

sentiment in regard to all this, and the yellow journalists would raise a howl. How much better it would be if many of the criminals who are sent to Sing Sing, and many of the other places where criminals are executed, were committed to experimentation rather than to execution. It will be a happy day when this condition of affairs arrives, if it ever does.

"Regarding the curability of cancer, I would like to put it in this way. I feel that if a case were recognized early, and if it were located in an accessible portion of the body, and if it were completely extirpated at that time, there would be a great probability of cure and with a much lower mortality. These 'ifs' are tremendous in size, and yet I do believe in the curability of cancer. As Behla says, ‘If cancer is to be regarded as a constitutional disease, there is but very little use in operating, since in that case there would be almost as much reason for amputating the foot of a gouty patient.

pretend to be fundamentally new guides for the treatment, but are principles which are practically self-evident as soon as coxa vara is interpreted in the only correct manner, namely, as a purely traumatic affection-a subcapital separation of the epiphysis. Trivial as the above rules may sound, they are very frequently violated at the present day. It is certain that part of, perhaps the majority of, coxa-vara cases are not treated soon enough. The secret of successful coxa-vara treatment is based upon the long duration of promptly instituted therapeutic measures. The following two cases may serve as typical examples for future therapeutic procedures:

Male, 18 years, laborer. Anamnesis: The patient, who was formerly always well, and whose parents are likewise healthy, one and a half years ago developed severe pain in the right leg, but kept up his hard work in an iron foundry until compelled to seek admittance to the hospital in February, 1906. There he was treated for three weeks with extension bandages. The disturbances returned after his discharge, but the patient delayed until April, 1907, before again seeking clinical

treatment.

Findings:

Strong youth, without signs of old rickets. Actual shortening of right leg 4 cm; since distance of anterosuperior spine from external malleolus on right side amounts to 93 cm., on left side to 97 cm. Functional shortening on right side, 41⁄2 cm. Distinct elevation of right trochanter major. External rotation of right leg, but no unreasonable adduction. Among the movements of the right hip flexion well preserved, abduction distinctly limited and painful, rotation not particularly limited. The Xray picture showed distinct displacement of the head epiphysis downwards, with inversion of the lower margin of the

femoral neck, giving rise to the typical mushroom shape.

Treatment: Horizontal extension for three months, followed by application of plaster dressings to pelvis. About two months later discharged after application of another plaster bandage of the pelvis, reaching only to above the knee, patient to walk with this bandage. Recommendation of the utmost care, no work for a time of three months; patient was requested to return for examination at the end of that time, or sooner, if necessary.

Findings at time of discharge: Actual shortening of right leg 4 cm., functional shortening 1⁄2 cm., lowering of right half of pelvis by 31⁄2 cm., with abduction of right leg of about 20 degrees. Slight external rotation of right leg, the muscles of which were somewhat atrophic. Functionally, the right hip presented a marked limitation of abduction and internal rotation. Findings three months later same as at time of discharge.

CASE 2.

Male, 18 years of age. Onset of trouble about 31⁄2 months before admission, as the result of lifting heavy sacks of wheat. Findings: Actual shortening of right leg 1 cm., functional shortening also I cm. External rotation of right leg and slight elevation of trochanter; no adduction. All movements of right hip impaired, but abduction least of all. The X-ray picture showed a slightly suggested mushroom configuration of the upper femoral end.

Treatment: Precisely the same as in Case 1. Discharged five and a half months later; again under injunction of care for a quarter of a year. Findings at time of discharge: Actual shortening of right leg 1 cm., functional shortening o. On the right side still a tract of external rotation. Functionally, some slight per