five per cent of all cases of cancer can be cured if gotten in time.

First to remember in the early diagnosis is that cancer of the uterus is most common between the ages of thirty-five and fifty, although it is seen in much younger women. I have seen it in a woman as young as twentythree, who died at twenty-five of the disease. Christian Science helped her on her way from twenty-three to within about four months of her death. I am satisfied had she consented to an operation when first seen she would be living today. Although the type of mucous membrane covering of the cervix, its canal, and the fundus are different, it makes no difference. The squamous cell mucous covering of the vaginal portion of the cervix, the racemose or branching glands of the cervical canal, of the tubular glands of the mucous membrane of the cavity of the fundus, are all attacked alike by the cancer cell and cancer does develop from all of them.

In the uterus there is an outgrowth from the surface of the mucosa as well as a penetration of the deeper structures. Inordinately rich in blood vessels, the slightest disturbance of the growth causes it to bleed. In fact, I am satisfied that many of these cases bleed more or less constantly because of high blood pressure. Progression of the growth leads to necrosis, and the tissues become soft and friable, which, in time, leads to breaking down, and an offensive, fetid discharge occurs. This peculiar discharge comes early in cancer, but is sometimes absent if the growth is not very vascular.

The presence of a slightly blood or watery discharge should cause one to earnestly seek its origin. In these cases the cervix will often be found lacerated, rough, and bleeding. It is often nodular, and over its surface are fine finger-like outgrowths, which bleed when touched with the finger or

applicator. Every one which presents such a macroscopical picture must be carefully studied, and, if possible, a small section of the diseased cervix removed, dropped into a ten per cent solution of formalin, and submitted to some competent pathologist for careful study and diagnosis.

If a fetid and watery discharge exists and the cervix presents no signs of abnormality, the disease is probably in the cervical canal or in the cavity of the uterus. If upon bimanual palpitation irregular nodules are found, it is probable that myomata are present. In the great majority of cases if the myoma is of the submucous variety there is profuse menstrual discharge, but, unless there is sloughing of a fibrous nodule, there is no bloody discharge between the monthly periods. If there is a sloughing submucous nodule, the discharge may be fetid and bloody. In this case, many times it can be seen in the cervical canal. When this is true, it can be easily removed, and submitted to the pathologist for study.

As a rule a diagnosis can be made without the aid of the microscope. A fibrous nodule is generally tough and not friable, and if the finger can be introduced into the cervical canal or cavity of the uterus, they will be found to be clearly defined masses, around which one can sweep the finger. A cancerous mass, on the other hand, is soft, easily broken down, and bleeds violently. Pelvic inflammation sionally gives rise to a bloody discharge. A history carefully taken will reveal old pelvic lesions, recent vaginal infection, or an incomplete abortion. The presence in these cases of elevated temperature often clears up the diagnosis.

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Intro-uterine pregnancy may cause a discharge similar in character, but not identical to the cancer discharge. It is intermenstrual, rarely offensive, and a history will generally reveal a missed period. Bimanual examination will generally reveal the soft, yielding, boggy mass on one side of the uterus.

In all cases where the physical examination is unsatisfactory as far as ro vealing the exact nature of the lesion is concerned, the uterus should be curetted. In order to do this little procedure so as to secure a sufficient amount of curetted material, the mucosa should be removed from the anterior, posterior, and lateral walls of the cavity as well as from the cervical canal. It is very probable, if much tissue is secured, that malignancy is present. All the tissue removed by the curette, including the blood, should immediately be dropped into a ten per cent solution of formalin without washing.

Occasionally the pathologist has difficulty in determining as to whether the specimen is malignant or not, but as a rule the differentiation is promptly and correctly made between normal tissue.

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profession and the people the great danger that lies in procrastination. If procrastination is the thief of time, how surely is it the greatest criminal of all in its theft of life of every individual who is afflicted with cancer.

There is no censure too great for the doctor, whether he be young or old, who, for the sake of practice, holds on to a case until it has passed the border line of safety and enters the realm of uncertainty. There can be no excuse. Ignorance in these days of enlightenment is not good ground in the profession for delay in early diagnosis. "Safety first" is a maxim in these cases that applies both to the welfare of the patient and redounds to the everlasting credit of the doctor.

Along with early diagnosis goes early operation, and with early operation is lifted the veil of uncertainty and death, which goes with watchful waiting, tampons, iodin applications, and douches.

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With the present knowledge we possess one is absolutely unjustified in allowing a case under our care in which there is the least ground for suspicion of cancer to go on and develop the disease until it is recognized macroscopically. From no other part of the body can we so easily obtain material for diagnostic study, and there is no excuse for failure to make an early diagnosis of cancer. Where suspicion exists in our mind, the patient and family should be frankly told of the situation and the necessity of rapidly arriving at the conclusion, which means saving the life of the afflicted individual.

Early curettage in suspected cases can do no harm and clears up an uncertainty, which, if allowed to go on, may result disastrously. It is our duty as teachers and specialists along these lines to keep constantly before the

surgically I will say nothing, because it is a large subject and one requiring a whole evening for its discussion.

GOLDEN JUBILEE - VICTORY CEL

EBRATION MEETING.

The Fiftieth Annual Meeting of the American Medical Editors' Association will be held at the Marlborough-Blenheim Hotel, Atlantic City, on Monday and Tuesday, June 9th and 10th, and will take the form of a semi-centennial celebration and a Victory Meeting, emphasizing the part which this Association and its members have taken in the world's war.

The enthusiasm manifested upon the part of the President, Ex-Presidents and Officers of this Association is an assurance of its successful outcome.

A most attractive program is now being prepared and every physician, even remotely interested in medical journalism, will find it to his advantage to attend.