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, dis

position.*

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

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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 mercurial course; but that the parts had been so injured in powers, that they ulcerate, and are gradually thrown out of the system. Here then we 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 has 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

me that this breast had been uneasy from the age of fourteen. She was the mother of many children, some still very young, and had nursed them; but suckling with this breast had always given a good deal of pain. Now, for six months, she had suffered very severe pain, in one spot, about the centre of the breast, but below the nipple. On this point she could place her hand, and was sensible of a degree of thickening and enlargement. The pain was so severe as to deprive her much of rest. She could not raise her arm to her head, nor put it behind her to adjust her dress, with convenience, nor without aggravating the pain. Lying on the affected side at night also much aggravated the pain, and, indeed, was not tolerable.

Upon examination, I found the disease so deeply seated, and the subject so large, that I could determine nothing but a general thickening about the seat of the complaint. But the whole breast had not the soft, pliant, and healthy feel of the sound one. It was more flaccid, and, at the same time, stringy. A slight degree of handling, also, gave much uneasiness.

Though this lady looked in health, it was, however, by no means the case. The respiration was not strong, and she was not equal to taking her former exercise. The legs were disposed to swell. She was troubled with spasmodic pains of the stomach; often repeatedly in the course of the day; and every third or fourth month she had more serious attacks, seated in the organs of digestion; but which, having never seen her under them, I cannot more particularly describe. The bowels were habitually bound. She had also been considerably troubled, for a twelvemonth, with humors (as they are termed) affecting various parts of the body. The most troublesome was a thin and acrid defluxion from behind both ears. She described, on one occasion, the state of the sensorium very expressively, though the sensation was such as is never experienced, and cannot, therefore, be clearly conveyed to a healthy person. She felt, she said, sometimes, as if she was out of herself.

This lady began the regimen in the above month of January, 1810. During this year, herself and her friends were sensible that her general health improved. The bowels became open without medicine, and the spirits rather improved. But there was no change in the local disease. She thought rather that it got worse, instead of better. All the other affections continued unabated. However, the improvement of her strength encouraged her to persevere.

But during the second year, 1811, the pain very sensibly diminished; it no longer appeared to be spreading, and the disease to be becoming deeper; but, on the contrary, the diseased part seemed to be looser, and the pain to be confined more entirely to the part affected. The sores behind the ears dried up. But the eyes became sore; the diseased action appearing to be transferred to these parts. The general state of health was far from good; but now, her encouragement to proceed was from the manifest soothing of the disease of the breast.

The year 1812 was passed nearly in the same manner: the pain in the breast was not gone, but it was much diminished. The diseased breast was quiet, and the health improved. At this time she became pregnant; and toward the end of the year was safely delivered. She attempted to suckle her infant. The attempt, however, caused so much pain in the diseased breast, that, in the same circumstances, I would not again advise it to be made. At this time, a redness came on the surface of the breast, over the diseased part. The infant did not live many weeks. Some time after its death, the breast again became easy; more so, indeed, as she said, than it had been for years.

About this time, I again examined it. I readily now found a tumor, and of considerable magnitude, I think of the size of a walnut.

In October, 1813, she had a kind of irregular gout. The wrists and hands swelled, with some pain, but without redness. At this time she was considerably indisposed; but not for any length of time.

In November, of the same year, a few pimples appeared on the skin of the diseased breast. But they did not continue permanent. There was still pain, but of no severity. The general health continued good.

And, at this time, after a lapse of fourteen months, she still complains of pain in the part. I examined it about Christmas, 1814, and felt a small thickening, now in the part of the gland above the nipple, and nearer the sternum. But the whole mamma was soft, without tumefaction, inflammation, or any injury of the skin. The pain is enough to give her uneasiness; but not enough to derange the health, materially to encroach on the sleep, nor to impede any of the functions of life. The general health is so good that no one would take her to be an invalid. It is quite as good, if not, indeed, better, than it was in 1810. She is, in the countenance, a little more contracted,

tnan at that time, but not materially so; and is thinner, but without any emaciation.

As to what has taken place in the gland itself, it is obviously difficult to speak positively. I do not believe, however, that the thickening which I felt at the close of last year, 1814, is the same as the tumor I felt about two years before, nor still that that tumor was the same as the thickening which was the seat of the pain in 1810. The situation of the uneasiness was considerably different at each examination. There have been times during which the breast has been almost entirely easy, after which the pain again increased. It appears probable, therefore, that the different parts of the gland, in which there was a diseased disposition, have taken on diseased action successively, and that each successive induration has resolved. On this point, however, I would not speak decisively.

It is necessary, now, to review the principal circumstances of

this case.

1st. This disease was carcinoma. Its history, both as a local and as a constitutional disease, proves this. The previous uneasiness of the part, the tumor, the severity of the pains, the extreme tenderness to handling, and the obstinacy of the disease, now continued for a series of years, all conspire in forcing this conclusion. We must suppose that active disease took place in this breast, in the course of the year 1809, when the pain became so severe as to disturb the rest, and impede the motion of the arm. The constitutional affections, the derangement of the organs of digestion, the tendency to anasarcous swelling, the state of the sensorium, are equally convincing as to the nature of the disease.

2d. I am equally satisfied that at this time, after a course of five years' attention to this regimen, the disease continues to be truly carcinomatous. The pain, the tumor, and the highly irritable state of the part to handling prove this to be the case. It cannot therefore be said that the disease is cured.

3d. But by the regimen life itself has been probably preserved. Five years is more than, upon an average, such a case could be expected to last. But under this regimen that period has elapsed, and the health is as good, or better, than when it was entered upon.

4th. The gland has been preserved. It continues uninjured, of its natural form and appearance, with no other complaint than a trifling induration, not readily discoverable by examination.

5th. It is a consequence of this, but which from the impor