A series of double malignant tumours

THE occurrence of multiple tumours, whether of the same kind or of different kinds, in one individual is unusual, but not very rare.In the majority of cases there is no obvious connection between the different turnours, and the appearance, simultaneously or successively, of two or more tumours in the same tissue (e.g.multiple rodent ulcers), or in different tissues (e.9.mammary carcinoma and a gastric carcinoma), appears to be merely a coincidence.It might be held that some common cause was at work, and in most cases there is at any rate a common condition, namely, advancing age, but the comparative rarity (so far as yet observed) of the condition in contrast with the singleness of malignant growths, which is the rule, deprives this suggestion of much weight or interest.There are, however, cases apparently much rarer, in which the circumstances of the growths suggest some more intimate relationship.The interest of these rarer growths has been greatly increased by the observations of Ehrlich and Apolant, during the propagation of mouse carcinoma, of a sarcomatous condition developing in the connective tissue stroma of the turnours, which gradually destroyed, and in the course of two or three transplantations completely displaced, the original carcinoma.The circumstances of these cases strongly suggest that the carcinoma in some manner provoked the formation of the sarcoma ; was, in fact, the cause of another malignant growth.In 1905 Fischer-Defoy and Lubarsch were abIe to select, out of many records of multiplicity of growths in the human subject, thirteen ca8es in which similar causal relationship between two malignant tumours was at least suggested, and it is the purpose of this paper to record seven more cases of similar nature, and to consider in each case whether or no such an hterpretation is justified.The following seven cases occurred a t the Western Infirmary, Glasgow, between 1 9 0 4 and 1906, and represent the gleanings of