Recurrent cancer, then, is but the result of a continuance of the operation of the same causes which produced the first local lesion, and need surprise no one, if those causes are left entirely unchecked and the system unchanged. Undoubtedly in many instances the recurrence, or increased production of the disease, is made more certain by the operation itself; it is also recognized that handling or manipulation then or at any time may also contribute to this, as may be understood from the following: 1. Cancer cells, which have a reproductive capacity, may be forced into the adjoining tissue, or find entrance into blood vessels or lymphatics severed during operation, and there continue their activity and produce new lesions. 2. By implantation, cancer cells, already started on their reproductive career, may be transferred to freshly cut surfaces, and there may develop new lesions, favored by the continued derangement of the blood current. 3. Cancer cells may have existed outside of the immediate area which was removed surgically, and so may continue to develop new lesions, being further stimulated thereto by the manipulations attending the operation. 4. We know, finally, that the occasional removal of lesions which are afterwards shown microscopically to be benign, such as adenoma, cysts, chronic mastitis, etc., will sometimes be followed by the development of true cancer, which will then pursue a malignant course. On the occurrence, therefore, of any lump or lesion which might possibly be or become cancer, the greatest caution should be exercised to avoid all manipulation, lest a spread of the disease should render it more rebellious to treatment. For in the medical management of cancer it is naturally more difficult to cure a patient when there are large numbers of diseased cells, in one or various locations, which are already giving forth their poisonous hormone, vitiating the blood stream. The New York Board of Health has recently inaugurated a service for the examination of specimens excised from suspected cancer, in order to establish the diagnosis microscopically before surgical operation. There could hardly be devised a more effective plan to increase the mortality from cancer and to render many more cases really inoperable than this one would surely be; for by thus cutting into cancerous tissue and opening lymphatic channels and blood vessels, with the opportunity for absorption of cancerous elements during the necessary delay, metastases would certainly be induced which would render a surgical removal or a dietary and medicinal treatment immeasurably less effective. It is to be hoped that this scheme will be immediately abandoned.