Limestones are always associated in England and Wales with the lowest mor tality from cancer, and flooded clays with the highest. Alfred Haviland (Practi tioner, Apr., '99).
Cancer is rarely associated with tuber culosis in the same individual; this is, perhaps, partly due to the different ages at which these diseases occur. culosis is found everywhere; carcinoma is not found in certain areas, as in the polar regions. Cancer is undoubtedly on the increase in Great Britain, and in certain sections of America: e.g., Buf falo, N. Y. Cancer is found at an earlier age than formerly, though this is pos sibly due, in some cases, to earlier diag nosis.
Attention called to the increasing mor tality from carcinoma in recent years. The increasing prevalence of carcinoma in England and Wales since IS40 and the relative increase among males and females is as follows: In 1S40 carcinoma caused 27S6 deaths, the proportion being I in 5646 of the total population and I in 129 of the total mortality, or 177 per million living. In 1S96 the deaths due to the same disease numbered 521. or I in 1306 of the total population and 1 in 22 of the total mortality, or 764 per million living. No other disease can show anything like such an immense increase. It is believed that this in crease may be in part due to the excess ive consumption of meat of late years. Statistics show that more than double the amount of meat is consumed at pres ent than there was fifty years ago. In sufficient exercise and deficient fresh vegetable food may also have an influ ence. The heavy mortality at advanced ages may be due to the survival in in creased numbers of weakly lives arti ficially prolonged by improved conditions of existence. The increased frequency in males may be due to the increasing urban population, the men living under conditions resembling more closely those for women than heretofore. W. Roger Williams (Lancet, Aug. 20, 'OS).
Statistical data available do not justify the conclusion that an increase in cancer mortality has occurred within recent years. They rather tend to the conclu sion that the increase in cancer is only apparent, and is due to improved diag nosis and more careful certification of the causes of death, especially to the latter. However, absolute proof is out of the question with such imperfect data. This conclusion only applies to the last forty years.
Cancer causes about 6 per cent. of the total deaths registered among males at ages over forty-five, and over 7 per cent. of the total deaths registered among females at ages over forty-five. Were the real facts known, it would be found that the number of deaths due to cancer is even greater than these figures indi cate. Arthur Newsholme (Practitioner, Apr., '09).
Specimens. — When it is decided to have a tumor studied by a pathologist, the entire mass removed should be sent to him in as fresh a condition as pos sible, with as much of the history as will assist him in making a diagnosis. Too
many surgeons show a disposition to con ceal facts bearing upon the case, as if the pathologist were not to be trusted with them. The pathologist is an expert, and as such should be treated with the same consideration as any consultant. If the tumor cannot be forwarded in a fresh state, it should be placed in weak alcohol (from 40 to 50 per cent.) or weak formalin (from 1 to 2 per cent.) in a filled jar at least five times the size of the spec imen.
On the occurrence of any turbidity of the fluid or reddening of the tissues, especially where they rest upon the bot tom of the jar, the fluid should be im mediately changed. When a portion of the tissue is saved for microscopical study alone, it is of the greatest impor tance that it should be taken from the margin of the tumor, and, when possible, should include a portion of the surround ing normal tissues. Such a piece need not exceed the size of the tip of the index finger, but its relations to the body and to the tumor should be very carefully noted.
One or two such pieces may be placed in a wide-mouthed four-ounce bottle, well stoppered, containing 95-per-cent. alcohol, 3-per-cent. formalin, saturated solution of bichloride of mercury, or :Miler's solution. A very satisfactory solution is that composed of equal parts of a 3-per-cent.-formalin and 3-per-cent. bichromate-of-potassium solution. The mixture should be made fresh when needed, and changed every day, when the pieces should be thoroughly washed in running water three or four hours and then placed in alcohol, 1 part, and water, 2 parts. If any discoloration occurs, the specimens arc to be again washed and placed in the alcohol. This is to be re peated until the alcohol remains clear. If the specimen has become dried, it should be placed in water and when it resumes its normal size, alcohol should be gradually added until sufficient strength has been reached to preser\'e the tissue. Frozen sections from a tu mor or uterine scrapings may be made with ether, carbon dioxide, or ethyl chloride (see article by the writer in the Internat. Med. Mag., Dec., '96), stained, and mounted, under the most favorable conditions, in ten minutes from the time of removal of the tumor or a portion of the tumor from the body. The advan tages of this are evident. The pathologist can be present at an operation, and the microscopical findings will often be suffi cient to decide, while the patient is still under the ether, whether a limb will have to be amputated, a hysterectomy performed, or the axillary glands thor oughly removed. Care must, of course, be taken that the decision be not a hasty one; but very often the surgeon must decide this very thing at the time of the operation, and considerable assistance may be afforded him by the opinion of a competent microscopist as to the imme diate procedures to be taken.