34o THE POPULAR SCIENCE MONTHLY. 



extension ; but complete extirpation with the knife, including the 

 adjacent connective tissue and lymphatics, leaves behind no dis- 

 ease to be extended. Recurrence of the disease in this case would 

 take place after cicatrization of the wound, and would be by new 

 cell proliferation and not by extension. External cancerous 

 tumors have been excised, and in the course of a few weeks the 

 patients have died of internal cancer ; but in such cases, if the in- 

 ternal had not antedated the external disease, the metastatic pro- 

 cess had surely begun before the operation, and would scarcely 

 have occurred had the tumor been excised five or six months 

 before. 



Since it appears from analysis of the observations of surgeons 

 of long and vast experience that a large proportion of benign 

 tumors in time become malignant, and that most malignant 

 tumors have a stage of benignity, there should be no hesitation in 

 advising the extirpation of these tumors as soon as discovered, 

 and this advice may be regarded as the very essence of conserva- 

 tism and of prophylaxis. From a purely aesthetic point of view 

 it is of no little consequence to minimize scars resulting from the 

 excision of tumors of the face, neck, arms, or hands, particularly 

 those occurring in the gentler sex, and this can be best accom- 

 plished by the timely removal of such morbid growths as are 

 likely to increase to the extent of greatly disfiguring the patients. 

 It should, however, be noted that almost any scar is better than 

 an ugly tumor. 



The naBvi that appear upon the faces of infants, though be- 

 nign, often grow so rapidly as to constitute serious disfigurement, 

 and to require operations which leave extensive scars. If before 

 these little vascular tumors cover a space of more than two or 

 three millimetres they are promptly destroyed with the thermo- 

 cautery, the ensuing scar is likely to be almost imperceptible. 

 The operation is completed in a few seconds, and the pain is very 

 slight. 



The greatest mischief arises from temporization in the case of 

 small epithelial growths upon the lip. Any tumor of the lip of 

 doubtful character should unhesitatingly be removed. As a gen- 

 eral rule, the subsequent dissection and microscopical examination 

 of the tumor shows the operation to have been justifiable. Early 

 excision is the surest means of obtaining a long period of im- 

 munity from recurrence. The period of immunity from recur- 

 rence after operations is very variable even in the same species of 

 tumors. Thus, in cancer the average is stated by some observers 

 to be three years and a half, and by others seven years ; the ex- 

 tremes are three months and forty years. The writer has re- 

 ported cases in which the periods of immunity varied from seven 

 to forty years. As soon as a tumor recurs, when it is still small, 



