always likely to cause abortion. No matter how likely the appearances are that a woman is likely to have obstruction during confinement, it rarely occurs ; and unless there are positive indications we should not interfere in any way with the pregnancy and not consider the induction of abortion. Dr. A. H. Tuttle, Cambridge, Mass., referred to two eases of pregnancy complicated with uterine myomata. In the first case the patient was very much upset with symptoms of Read in the Section on Surgery and Anatomy of the American Medical Association, at the Fifty-seventh Annual Session, June, 1906.

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Though signal advances have been made recently in many surgical problems, the treatment of cancer of the head and neck has, it would seem, neither received the attention nor kept the pace of progress in other fields.These unhappy cases are too often regarded as specters at the clinic. The operative treatment is hampered by tradition and conventionality, and the tragic ending of so large a proportion of these cases has held back lay and even professional confidence.In this paper it is intended to present an outline sketch of the conclusions regarding the surgical treatment of cancer of the head and neck in the curable stage. The etiology, the diagnosis and the pathology will not be considered. It is generally admitted that cancer is primarily a local disease. Each case, then, is presumably at some period curable by complete excision.The immediate extension from the primary focus is principally by lymphatic permeation and metastasis in the regional lymphatic glands. Secondary foci in distant organs and tissues are probably due to cancer emboli. A careful study of 4,500 cases, exclusive of the thyroid gland, traced to their original report in literature, made for me by Dr. Hitchings, showed that in less than 1 per cent, have secondary" cancer foci been found in distant organs and tissues. That is to say, in cancer of the head and neck, death almost aways occurs by local and regional develop¬ ment of the disease. The collar of lymphatics of the neck forms an extraordinary barrier through which cancer rarely penetrates (Figs. 1 and 2). Every portion of this barrier is surgically accessible. Paired organs or distinctly one-sided foci usually metastasize regularly, while un¬ paired organs, as the tongue, or the mesial tissue, such as the nose and the middle of the lip, metastasize irregularly (Fig. 3).After the lymphatic stream has been blocked, as by carcinomatous invasion, it may flow in any direction and every sort of irregularity in the further métastases may follow, but always somewhere within the accessible lym¬ phatic collar. After all, how much more favorable such distribution is than that of certain other organs, as, for instance, the breast with its thoracic and abdominal métastases, the stomach and intestines with their inac¬ cessible retroperitoneal métastases? What, then, is the best method of surgical attack? An incomplete operation disseminates and stimulates the growth, shortens life and diminishes comfort. Local excision of the primary focus only is as unsurgical as excision of a breast, leaving the regional glands. Excision of individual lymphatic glands, as one would excise a tuberculous gland, not only does not afford permanent cure, but is usually followed by greater dissemination and more rapid growth. Judged by analogy and experience, the logical technic is that of a "block" dissection of the regional lymphatic system as well as the primary focus on exactly the same lines as the Halstead operation for cancer of the breast. Such a dissection is indicated whether the glands are or are not palpable. ...

No abstract