1646 THE RISK OF INFECTION AT FUNERALS.-LIVERPOOL.

of Dr. Newman himself. Can Dr. Newman have forgottenthe discussion on Cancer in 1886 at the GlasgowClinical and Pathological Society. in which he relatedthree cases to "illustrate to you the fact that such homo-logous growths as adenomata and papillomata may bysome perversion of their nutrition develop into epitheliomataor adenoid cancer" ? This statement is repeated in some-what different terms in the essay printed six years later, and,granting with Dr. Newman that simple tumours can undergosuch a transformation, and bearing in mind how generallyaccepted is the belief in irritation and traumatism as etio-logical factors of cancer, it is fair to ask why operative pro-cedure should not be allowed as at least one source of this"perversion of their nutrition," and especially since it is

simply impossible to decide whether "growths which arehomologous in their origin at a later period of life becomeheterologous and develop signs of malignancy" except bymicroscopic examination of removed portions-that is to say,by "surgical interference," an element present in each ofthese three illustrative cases as well as in the other one ofDr. Newman previously noticed. The bearing of these cases onthe question at issue is so important that I must ask per-mission to quote them at length. "I have seen somewhatsimilar instances (to a case quoted by Dr. Cameron), and withyour permission, Mr. President, I shall narrate three of them.The first I shall describe was a case of papilloma in the larynx.Six years ago the late Dr. Foulis removed a papilloma,and within six months it returned and was again removed.It appeared once more and was removed by myself. Allthese specimens were clearly (not were ’believed to be)papillomata : the epithelium showed no tendency to extendbeyond its normal limit-that is to say, beneath the basementmembrane. About six months after the last operation wasperformed, on laryngoscopic examination I found a charac-teristic epithelioma involving the larynx and epiglottis, fromwhich the patient ultimately died. The second case wasexhibited to the society at a meeting at the beginning of thesession-an old man was in the Royal Infirmary with a largetumour about the size of a walnut, situated at the base ofthe epiglottis. I showed the patient here, and at the timeI believed the tumour to be an adenoma, and Dr. Coatsagreed with me in that opinion. Subsequently I removedmore than half of it by means of forceps, and as I removedthe pieces I submitted them to microscopical examination. Thefirst portion of the growth presented the characteristics of asimple adenoma, whereas the deeper portions, or those whichwere removed last, showed the structure of adenoid carci-noma, with unusually abundant stroma. The third specimenis one which I have in the museum of the Royal Infirmary.The first growth, a papilloma, was removed by Dr. MorellMackenzie five years previous to the appearance of an epithe-lioma. which was diagnosed by my predecessor, the lateDr. Foulis, who performed laryngectomy."

In reviewing these cases for our present purpose it is to beborne in mind that in two of the cases it was not a questionof fragmentary removal, but of complete evulsion, with anunqualified statement as to the primary innocence of all

previous specimens. Moreover, the length of interval-fiveyears and five years and a half-between the first removalsand the development of malignancy was sufficiently great toexclude the supposition that they were in the first instancecases of "cancer aggravated by endo-laryngeal manipula-tions," or "illustrations of the danger of intra-laryngealinterference in cancer of the larynx."

Again, Sirs, I ask you and your readers whether I am not

fairly justified in claiming that I have traversed the threepoints on which Dr. Newman in his letter to you desires tcinsist ; for not only had I "a right to claim him as anadherent to the opinions expressed by me," but also as anauthor whose published,facts are consistent with the theoryI have tried to demonstrate; and even if, as Dr. Newmarnow wishes to insist, I have "failed to prove that a benigrgrowth is likely to undergo malignant degeneration as a con.sequence of intra-laryngeal interference" I ask, in confidenceof the answer, To what extent is my view supported o]

discounted by Dr. Newman’s published utterances ?But I must ask to go one step further.Dr. Newman, in the preface to his work on "Malignan

Disease of the Throat and Nose, " says : " The cases, eight number, have been selected from a series of over fift;patients, and these are employed in the text to illustrat,

5 Glasgow Medical Journal, vol. xxv., pp. 439 and 440.6 Op. cit., p. 106.

only special features in the disease." Why were these threenot included, since none of the eight selected illustrate thisspecial feature in the pathology of cancer of the larynxinsisted upon but a few years previously by Dr. Newman asan article of faith ?

This is not the occasion, nor am I in the mood, to discussat Dr. Newman’s bidding other points raised by him on thegeneral question. But this much may at present be said.Since I first drew attention to the subject nineteen yearsago many cases have been reported which, having beendiagnosed by competent and even eminent authorities asbenign, have after endo-laryngeal operation developed evi-dences of malignancy. As an alternative to acceptance ofmy view that such a result illustrates malignant degenerationdue to instrumental irritation-in other words, to an "undulyincreased formative excitability" (Newman)-it has becomefashionable for my opponentss to plead guilty of an erroneousdiagnosis in the first instance ; nor is it for me to quarre)with the choice of horn on which they find themselves

impaled. I am content to have had an opportunity of

directing attention to the grounds on which I have claimedDr. Newman as an adherent. He appears to have sincerecanted. I am. Sirs. vours faithfullv.

Ma.nsfield-street, W. , June 18oh, 1894. LENNOX BROWNE.

THE RISK OF INFECTION AT FUNERALS.To the Editors of THE LANCET.

SIRS,-I have been consulted by a clergyman as to thefeeling which has been aroused through his arranging to havethe funeral conducted entirely at the graveside in the case ofa death from scarlet fever. It was represented as a want offeeling to the relatives in not having the coffin placed inthe church during the first part of the service. His reason,of course, was the fear of spreading infection. This iseminently a question on which the medical profession shouldadvise, and a definite expression of opinion from you, I amsure, would be of great comfort and value to the clericalprofession throughout the country. Personally, I considerthat when the corpse is well and closely fastened up the riskis nil, but a great danger must undoubtedly arise from the con-gregation in the building through the friends probably wearingthe clothes in which they have waited upon the deceased; aschildren, at any rate in country places, flock to a funeral asto a show. In connexion with this risk I had the followingexperience : A boy died of diphtheria in one of two lonelycountry cottages. The brother borrowed a suit of clothes toattend the funeral. Soon afterwards the lender, who alsolived in an isolated place, fell ill with a very severe attack.I was unable to trace any other possible source of infection,and I am convinCld that the disease was carried by theclothes I am. Sirs. vours trulv.

June 21st, 1834. -

M. D.

LIVERPOOL.

(FROM OUR OWN CORRESPONDENT.)

Intemp6’l’anOe in Boys.THE city coroner (Mr. Sampson) has had two cases of

juvenile intemperance brought to his notice lately-one inhis capacity as city coroner, the other in that of magistrate.In the former, alcohol was found in the stomach of thedeceased, a boy aged fourteen ; the cause of death was attri-buted by the medical attendant and analyst to alcoholicpoisoning, and this view was adopted by the jury. In theother case a boy, also fourteen years of age, was found bythe police in a state of complete insensibility, but re-

covered at the hospital after the use of the stomach pump.He had had wine given him on board a Spanish ship by oneof the crew, who was severely censured by the magistrate.

Crimes of Violence and the Use of the Knife.On a recent Monday, which for obvious reasons is always a

very heavy day at the police court., the stipendiary magistrate(Mr. Stewart) had no fewer than eighteen cases of wounding

7 On the Treatment of New Formations of Benign Character in theLarynx. Brit. Med. Jour., May 8th, 1875.

8 Dr. Newman admits to a mistaken diagnosis in four out of elevenpublished examples. Is it "to inquire too curiously" to ask whatwould be the proportion if we had a record of his whole "fifty casesand over " of malignant disease of the larynx ?