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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 tne 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 in-: fant. 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, IS 14, 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. tance of the fact deserves to be particularly noticed, that io this case the ulcerative process has been wholly and completely superseded.
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
Such have been the facts of this case; facts which I must be permitted to say fully corroborate all the conclusions which I formerly drew regarding this disease. I must refer, therefore, those to whom these conclusions are unknown to my " Reports." They are, in fact, very nearly the same appearances which took place during the long attendance, from May, 1805, to October, 1808, in conjunction with Mr. Abernethy, on the case which he put into my hands, due allowance being made for the different stages at which the cases were taken up. In that there was no fresh ulceration for three years and five months; and we may assert, therefore, confidently, that there too the ulcerative process was superseded.* This, I say, was seen by Mr. Abernethy so long ago as the years 1805 and 1806.
The event of this case takes away the last apology for the most severe, not to say shocking operation, of which the unhappy subjects of this disease have been, from time immemomorial, the objects. I therefore cannot but be surprised that that gentleman, having seen the ulcerative process superseded in that case, should say, "It is after an operation that, in my opinion, we are most particularly incited to regulate the constitution, lest the disease should be revived or renewed by its disturbance." But this writer has informed us, "That he has known a patient die soon after an operation for the removal of a cancerous tumor of no great magnitude, merely in consequence of the shock imparted to the constitution by the operation." Common sense, therefore, seems to dictate that the constitution should, if possible, be improved previous to any operation, and U) enable the patient to sustain it.
11 is quite evident, that if the diseased part be removed, we can never feel perfectly convinced that the nature of the disease has not been mistaken. As it is properly observed by Mr. Abernetay, it is more from the history and progress of the complaint that its nature becomes evident, than from any thing that is obvious to the senses. Had this lady submitted to an operation several years ago, which I have no doubt would have boon proposed by the surgeons, it is impossible that there could have bee* that sort of proof of the nature and progress of the dtsease which it has now afforded us.
* A fc•w *mall ulceration* firmed upon one part, at the expiration of *V\v• monlha, but they aoou healed, aud continued well to the end.— 5W tfce " Keivvw o» Cancer," p. 109.
!• would ask on this subject one very plain question. If a medicine were proposed as a cure for a cancerous tumor, would any one think, as a previous step to a trial of its powers, of first cutting off the diseased part? would not the proposal of such a step be deemed even ridiculous? why then should not the power of regimen, which Mr. Abernethy has acknowledged to be more likely to affect such a disease than medicine, be treated with equal fairness?
I have only to add that the beneficial effects of this regimen in scirrhous tumors of the mammae have been distinctly acknowledged by a surgeon of a public institution. In one of the medical journals, of the year 1809, was a communication on this subject, of which the following is an extract:
"In scirrhous tumors, where the patient's stamina is good, and particularly where the uterine secretion is regular, the vegetable diet and distilled water have proved very beneficial. The good effects of Dr. Lambe's treatment depend entirely on the natural stamina of the patient."
I entirely coincide with this writer on this point. He has signed himself "A Dispensary Surgeon." I am sorry to say that the author of this communication, which carries with it strong internal marks of correct observation, should have thought it proper to assume the mask of an anonymous signature, by which the weight which would have been attached to his evidence is considerably diminished.
January 20, 1815.—I relate the circumstances of the following case rather to show the changes which are introduced into the habit, by the regimen, than as an example of relief from severe disease.
A lady, now near forty years old, was induced to adopt this regimen between four and five years ago. She had no disease upon her, but was not in a firm state of health. The respiration was weak; she was not able to take a full inspiration. The habit was relaxed and languid; the pulse feeble and sluggish; she was always chilly, and the skin was cold and damp. The feet were always cold.
I mention these circumstances, because they are what are