THE EARLY EXTIRPATION OF TUMORS. 



339 



late upon the natural history of tumors, it is proper to inquire if 

 this precept can be regarded as truly conservative. The well- 

 known fact that any solid benign growth is liable to become 

 malignant should be sufficient to induce surgeons to condemn the 

 arbitrary expectancy which is so generally counseled and which 

 so surely leads to disaster. Even if a particular tumor increases 

 without showing signs of malignity, there can be no advantage 

 in waiting until it shall have attained a great size, as the larger 

 the tumor the more formidable the operation for its removal. 

 The advice that a morbid growth should not be removed because 

 it is stationary and causes no inconvenience does not seem to be 

 founded on sound principles. Because it does not produce present 

 inconvenience gives no surety that it will not sooner or later cause 

 the greatest distress, if only from its increase in size or its inter- 

 ference with a vital function ; but the liability to malignant trans- 

 formation is what is most to be dreaded. Therefore, as a general 

 rule, it may be considered unwise to allow any accessible tumor 

 to so increase in size as to be damaging to the individual, or, if it 

 be stationary, to wait until it is metamorphosed before proposing 

 an operation for its cure. The true spirit of conservatism is mani- 

 fested by advising the removal of a morbid growth when it is be- 

 nign, when it is stationary, when it is small, when the operation 

 for its eradication is trifling in comparison with what it must be 

 when the tumor has attained a great size, or when the neighbor- 

 ing lymph-glands are implicated. The modern improvements in 

 inducing anaesthesia, simplifying surgical processes, and insuring 

 asepticism of wounds render operations safe as compared to those 

 of former times, so that no serious harm need now be apprehended 

 from the extirpation of most tumors. Morbid excrescences of all 

 kinds, being worse than useless to the human economy, should be 

 treated like foreign invaders, and removed before they become 

 too mischievous. 



4. There can be no reasonable doubt of the advantage of excis- 

 ing a small tumor believed to be malignant, even if this be owing 

 only to the ease with which the operation can be executed, or to 

 the slight degree of violence inflicted upon the parts as contrasted 

 with the magnitude of the procedure needed for the ablation of a 

 growth which has attained great dimensions or which has infected 

 the adjacent lymph-glands. 



For a long time there has been a prevailing belief that extir- 

 pation of a quiescent malignant tumor only serves to stimulate 

 the extension of the disease. But this belief does not appear to 

 have been founded upon trustworthy clinical observations or 

 pathological data. It is undoubtedly true that any incomplete 

 cutting operation upon a malignant tumor, or its partial cauteri- 

 zation with silver nitrate or arsenic, only serves to stimulate its 



