« PreviousContinue »
like the common practice of surgeons in general to recommend even such a diet, as Mr. Abernethy has said is “sanctioned by general experience.” I could, if necessary, bring the direct proof of the contrary, but I am restrained from motives which are very obvious.
Nor indeed is this wonderful, when we consider how trifling is the relief which such a diet can be thought to afford. It is very doubtful whether it would give any relief to the pain which forms so distressing a feature of the disease. It is quite certain that the strictest vegetable regimen, unaided by ther attention, will not prevent the formation of a carcinomatous tumor, nor its regular progressive increase, nor its final ulceration. It is not surprising, then, that patients should be unwilling to submit to restraints which appear to them to produce little or no advantage. That the disease goes through its stages in the usual manner, while the patient is confined to vegetables, may be safely inferred from the silence of writers who, had the contrary been the case, could not have failed to inform us of it.
Indeed, I have myself had ocular proof of the fact. In the spring of 1810, I saw Mrs. M— , the wife of a tradesman living near Westminster Bridge, laboring under a large ulcerated cancer, with the breath much oppressed, as is usual in the last stages of the disease. This woman had lived almost entirely upon vegetable diet her whole life. She had an aversion to animal food. She would take a little fish sometimes, but very rarely. Her own account was to the following purport. “When I lived in the country, I was very healthy; but as soon as I began to drink the Thames water my health began to fail, and I have not been in good health since.” I am obliged to Dr. Richard Reece, for introducing me to this patient, and he saw her with me. I think it right to add, in favor of her vegetable regimen, that I never saw more placidness, cheerfulness, and resignation under the appearance of so much suffering.
Mr. Abernethy's luminous description of this disease leaves nothing to be desired with regard to its general history. I could have wished that he had spoken with more decision on the most important feature of the disease—the manner in which it spreads. The facts which I showed him throw much light on this point, but they require to be verified and multiplied. Mr. Abernethy cites the doctrine of Mr. Hunter, with apparent approbation : "That a disposition to cancer exists in the surrounding parts, prior to the actual occurrence of the diseased
action. This remark, which is verified by daily experience, led to the following rule in practice—That a surgeon ought not to be contented with removing merely the indurated or actually diseased part, but that he should also take away some portion of the surrounding substances, in which a diseased disposition may probably have been excited.”
If the disease be propagated by contamination, a part, which is tainted, communicating disease to the parts in contact with it, this practice must be injudicious. But if the spreading of the disease be from internal causes, foreign to the part itself, it is equally clear that this removal of the parts, to whatever extent it be carried, cannot prevent the recurrence of the disease. Let us attend then to the evidence of a most impartial and upright observer, who has left us among others the following history.
“A lady, hetween fifty and sixty, the wife of a surgeon, of a melancholic temperament, lusty, using little exercise, and living luxuriously, felt pain, and perceived a small degree of hardness in one breast. The whole breast was taken off, within a fortnight after it was first noticed. Upon examination after removal, there was neither extravasation nor glandular induration, but a thickening and a hardness of what seemed to be more like condensed diseased cellular membrane than any thing else to which I could compare it. The axillary glands were not affected, nor was the tumor of great size, and it was perfectly movable.
“If, in this case, the indurated part only had been removed, without taking away the whole of the mamma, I should not have wondered at a relapse ; but when the operator went clearly beyond the apparent extent of the disease in every direction when he dissected the whole from the pectoral muscle, so as to leave the fibres of that muscle bare, and that too at an early period of the disease-I say, when all these circumstances were considered, it was matter of astonishment to me that the unfortunate sufferer did not obtain a cure. But the fact was otherwise." · This is not a solitary example. In the same work in which the writer appears to have recorded the experience of his life, are nine or ten other cases, in which the disease repullulated after operations. This circumstance is inexplicable on the hypothesis of the unsound parts contaminating the sound. But they occasion no difficulty, if we suppose (as I have done) the progress of the disease to be from internal causes. Is it not indeed revolting to common sense to suppose that cutting off the breast can counteract the effect of luxurious living ? This would be truly a matter of astonishment.
This fact is of itself enough to make us doubt whether this disease be propagated by contamination, which is the most common doctrine of surgeons. The belief in this doctrine it is which makes them so anxious to remove every particle of a diseased breast, in which any degree of hardness is perceptible. And the almost uniform failure of the operation was, for a time, often attributed to a defect in this respect. I suppose, however, that, at present, very few are disposed to maintain this opinion,
On the mode in which the disease is propagated there may be three distinct hypotheses proposed. ist. It may be supposed that there is a poison generated in the part, which, being absorbed, infects the constitution. This may be true in part, but cannot be so entirely; for in that case excision would be a radical cure. 2d. The diseased part may be thought to injure the neighboring parts by simple contact, the diseased part being a sort of focus or centre of diseased action. This is certainly the prevailing opinion of surgeons; but it is as little tenable as the first hypothesis. 3d. All the phenomena may be thought to be the effect of internal causes, remote from the part itself, and common to this with other chronic diseases. If this be true, these causes, being common causes, there can be no specific poison of cancer. And such I conceive to be the truth, and to afford a just explanation of the symptoms of the disease. I must leave the proofs of it to the judgment of others.
We are constantly deluded by language. We say a person dies of a cancer; which is just as true as when we say that the sun rises in the east and sets in the west. The truth must be that a person dies of the causes of cancer; and the cancer is not the cause, but the mode of dying.
Mr. Howard has, in so many words, maintained the same doctrine as myself, that there is no specific poison of cancer. He says, “If the cause of some cancers be a virus, I suspect it is not, strictly speaking, sui generis, as the small-pox, but an affection of the elephantiasis kind.”
But I not only coincide with the doctrine of Mr. Hunter, that there is a morbid change in the parts in which there is no mani. fest change of structure, but contend that this change is the very essence of the disease; and that upon this, as upon a foundation, the whole superstructure of morbid action is built. I have already cited in favor of this doctrine, the phenomenon in
Case II. of my “Reports,” in which, under the regimen, one mamma apparently sound perished by absorption, while the other was in a state of ulceration. I therefore not only say, with Mr. Hunter, that there is a morbid change in the parts surrounding the tumor, but in distant parts also, not contiguous to any tumor. This may be called, if it be thought right, disposition.*
The phenomena of carcinoma of the eye illustrates this fully. • When the fungus hæmatodes," - which is I presume another name for carcinoma-“takes place in children, they are generally found to have entirely lost the affected eye, before it is remarked by the parents.” This is the evidence of Mr. Wardrop. To the same purpose Mr. Ware says, “ that in the beginning of carcinoma of the eye in adults, the sight is lost, and the disease at first seems simply a gutta serena, without pain or discoloration.” Thus it is clear that the first stage of the disease is a loss of power of the simple fibre, or radical structure of the part affected; and (as I have said) upon this the change of organization is built.
Removing the parts, then, in which this diseased disposition is supposed to exist, does not secure the patient from a return of the disease, nor does it form any solid justification of this operation. “If after the removal of cancer,” says Mr. Abernethy, “when the operation has been properly performed, the cicatrix remains healthy for five or six years, or even for a
* By disposition to disease as contra-distinguished to action, must be meant the state of the fibres previous to any change that is obvious to the senses. Mr. Hunter, I believe, was the first who used this language, and insisted on these different conditions of diseased parts. He argued, particularly with regard to syphilis, that we were able, by the application of the specific, to cure the action, but not the disposition. This doctrine seems the offspring of the spirit of generalization, carried too far. It seems impossible to lay down any general rule on this subject; but many facts show that the one laid down by Mr. Hunter cannot be correct in its full extent. A single course of mercury often radically cures syphilis, It is probable, in all such examples, that some parts were only disposed to disease, while others had taken on diseased action. But further, where there has been an obvious infection, and the parts have got well by the power of the specific, sores have broken out even on parts that were not infected, which, by their habit and history under treatment, have proved not to be syphilitic. See Hunter on the Venereal Disease, p. 247, second edition. The only rational account that can be given of this is, that these parts have been contaminated, that is to say, in Mr. Hunter's language, disposed to disease; that the syphilitic taint' had been cured by the mercorial course; but that the parts had been so injured in powers, that they ulcerate, and are gradually thrown out of the system. Here then wo appear to have evidence that the disposition can be cured as well as the action. In other cases, no doubt, Mr. Hunter's doctrine is correct. ..), shorter period, and becomes indurated and carcinomatous, etc." Mr. Abernethy, of course, would not have mentioned such results, as the consequences of the operation, unless he had seen facts to warrant the assertion. But it is certain, that the “cicatrix remaining healthy for five or six years," must be a very rare occurrence. Half a year, a year, or two years is the more common interval. Even two years is a long period. But granting that a patient has continued well six years, it proves nothing in behalf of this operation. I have seen myself, within these last four years, a woman with a cancerous mamma, in whom the disorder had continued eight years. The whole breast was a hard lump, the skin was reddened and adherent, but it never ulcerated, and the woman died with little suffering, complaining principally of breathlessness upon going up stairs. Here then was a slow proceeding case, of which the result showed that no advantage would have been gained by operating.
In another case the disease went through all its stages, from a small knot, no larger than a pea, to the death of the patient, in fifteen or sixteen months.
The only ground of justification of this operation is, that it saves the patient the misery of an ulcerated cancer. This, undoubtedly, is an ample justification of the practice, as it has hitherto been established in surgery. If it bas afforded so fortunate a result only every second, third, or fourth time, it may have been right to give the patient the chance. But I have every reason to believe that the peculiar regimen, which I proposed for this disease, will, if adopted in time, prevent this horrible, ulcerating, self-destroying process. Of course, with experience so limited as that which I possess, I should not be justified in making general assertions. Cancer, like all other diseases, is subject to infinite variety of forms. In certain states, either of constitution or of age, it must be, at all times, hopeless. Other subjects may be relatively favorable. According to my best judgment, the subject of the following relation presented a specimen of the disease, which was perfect in kind, and which might be said to hold a middle rank as to malignity, and which, had the disease been allowed to follow its common course, would have terminated, as they invariably do, probably before the present period.
January 16, 1815.-A lady, now in her forty-fifth year, requested me to examine her right breast, in the month of January, 1810. She was, in appearance, healthy, with a fine color, and fleshy, without being grossly corpulent. She told