Study of the relation of traumatism to malignant growths based on 328 cases of carcinoma and 171 of sarcoma observed in the surgical clinic in Munich during the last five years. Of the 328 cases of carcinoma, 117 were in men and 211 in women; and of 171 cases of sarcoma, 81 were in men and 00 in women. After de ducting tumors of the mamma and geni tal organs there were 108 tumors in men and 102 in women. In the carcinomata there was a history of a single trauma 92 times. In the sarcomata a single trauma was noted 35 times, and 32 times there was a history of chronic irri tation (including warts). Some cases of single trauma seem to stand in doubt ful relation to the formation of the tu mor, but, as a rule, the new formation has been occasioned by injury. Vir chow's theory of the high percentage 25 per cent. for single trauma, and 18 per cent. for continuous irritation—is adopted. Ziegler (Minch. med. Woeb., Nos. 27, 28, '95).
The fundamental phenomenon underly ing the development of cancerous or other neoplasms is the assumption of a habit of growth, of rapid cell division, by certain cells independent of external stimulus. In man chronic irritation of moderate intensity causes a proliferation of cells of highly organized tissues with the as sumption of an embryonic type, and this at times doubtless passes on into cancer. The only distinction between the inflammatory and cancerous growths is that in the former the abnormal growth ends when the cause of irritation is re moved, while in the latter the cells have gained the habit of unrestrained growth from frequent and rapid multiplication in a somewhat embryonic state. Among the factors which may possibly be con cerned in the production of the habit of growth are increased nutrition, modi fied nerve-control, chronic irritation, and parasitic action. Parasites may be, at most, one cause, by producing chronic irritation. After the climacteric, when the absorption of certain components of various tissues occurs, portions receive increased nourishment; and espe cially where by injury, possibly years previously, a certain amount of in stability has already been introduced, we have a condition particularly favor able to irregular and sub-adult cell growth. J. G. Adami (Montreal Med. Jour., Feb., '96).
The connection between cancer and in jury is not an immediate one, but con sists rather of an unbroken series of morbid phenomena, each of which is de pendent on its predecessor. Berger (Viertelj. f. gericht. Med. v. offentl. Sanitiits., xiv, '97).
One hundred and seventy cases of sar coma personally examined with a view to determine the frequency of trauma as an exciting cause. Out of these, 46, or 27 per cent., followed injury; IS of these
were osteosarcorna and 26 affected the soft parts. The sarcomas were round celled in 29 cases, spindle-celled in 5, melanotic in 5, cylindroma in 1, chondro sarcoma in 2, mixed in 3, and doubtful in 2 cases.
The intervals of time between the in jury and the development of the sarcoma were: Within a week in S cases; from 1 to 4 weeks in 10 cases; from 4 to S weeks in 6 cases; from 2 to 6 months in 7 cases; from 6 to 12 months in 4 cases; i.e., 24 out of the 46 eases developed within 2 months after the injury.
The nature of the injuries included blows, falls, contusions, fractures, sprains, lacerations, burns, shot wound, and abrasions.
Assuming that sarcoma is due to an infectious micro-organism (which is not unlikely), the explanation of sarcoma following injury is easy. W. B. Coley (Annals of Surg., May, TS).
Fibromata are usually of traumatic origin, and, if careful investigation be made, the majority will be found to contain minute foreign bodies, such as slivers, splinters, etc., which have served as the exciting cause. This is especially true of those fibrous tumors found about the hands and feet.
The lipomata find their explanation in some disturbance of nutrition due to faulty innervation. They are usually of traumatic origin. The injury has usually been so slight and so long past as to be forgotten. Lipomata are fre quently multiple. and then usually sym metrically placed, and such distribution can be explained only through the agency of the nervous system. Roswell Park (Amer. Jour. Med. Sci., May, 'OS).
4. The fourth group consists in the overgrowth of some constituent of the body while the contiguous tissue is un dergoing senile atrophy. For example, some epitheliomata which occur in old age are due to the fact that the epithelial cells have not lost their power of pro liferation, while the connective tissue is undergoing atrophy and seems to be no longer able to protect the tissues under neath from the ingrowth of the epithe lial cells.
5. Ribbert believes that a separation of cells or a group of cells from the or ganic (nervous) control of the tissues in which they are normally found is the determining factor in the production of a tumor. This loss of control may take place either by disturbances in intra uterine development, or, later on, by the influence of external agents. And yet this very thing frequently occurs and no tumor develops, but rather atrophy of the tissue. A portion of thyroid gland introduced into the breast of a patient suffering from myxoma gives rise to a certain amount of curative action, but the piece of gland inoculated quickly atrophies and entirely disappears.