A STUDY of the clinical histories and pathological changes occurring in 700 patients suffering from malignant tumours who were admitted as in-patients into St. Giles's Hospital during a period of just over five years, form the data for this article. All but thirty of these patients were found to have malignant tumours originating in epithelial structures ; and as a result of these investigations, aided by a study of over 160 post-mortem examinations, certain facts bearing on the problem of carcinoma were ascertained. Three factors in particular were found to play an important part in the diagnosis, pathology, and treatment of malignant tumours :- 1. The first factor consisted of the mechanical changes associated with the proliferation of the tumour cells ; and the resulting strictures of hollow organs or pressure effects on neighbouring structures led to complex changes in the body, but were frequently amenable t o simple surgical procedures.
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The second factor consisted of the infective changes which occurred directly or indirectly as a result of the activity of the tumour cells. This factor was considered t o be of the utmost importance in malignant disease, and was responsible for a large proportion of the deaths which occurred in this series of cases.
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The third factor was the property of dissemination which is a characteristic of malignant cells, and which may result in wiaespread metastases and give rise to puzzling clinical pictures as well as lead to disappointment in the results of treatment.
The 700 patients have been classed into eight sections : (1) 71 who had the primary tumour situated above the level of the larynx; (2) 22 with carcinoma of the larynx ; (3) 8 having primary growths of the lung, and 8 with primary growths originating in mediastinal structures or in the pleurn. ; (4) 317 suffering from carcinoma of the alimentary canal; (5) 82 who had carcinoma of the breast ; (6) 56 with tumours originating in the male genitourinary tract ; (7) 99 having tuniours of the female genito-urinary tract ; (8) 23 with abdominal carcinoma of uncertain primary origin, and 14 cases of miscellaneous tumours.
An examination of the cases included in these different sections showed the importance of the three factors mentioned above relative t o the anatomical site of the primary growth. Detailed reference to these cases would be too lengthy for this contribution, but before presenting the conclusions which * These * Notes ' are part of an abstract from a thesis submitted for the degree of Master of Surgery of the University of London in 1928.