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 interference with a vital function; but the liability to malignant transformation 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 manifested by advising the removal of a morbid growth when it is benign, 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 neighboring lymph-glands are implicated. The modern improvements in inducing anæsthesia, 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 excising 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 extirpation 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 cauterization with silver nitrate or arsenic, only serves to stimulate its
