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of Surgeons might be proud of. This, without doubt, is the best and safest mode of removing tumours that are non-malignant, and I now use it in such cases, in preference to all other known means." *

Having proved that no external application has any effect in curing this disease, we shall now examine and see whether the actual removal of the tumour by the knife or other means produces better results.

Cancerous tumours may be removed by the knife, but in doing this the morbid growth alone is removed, and, as we shall find, the tendency for the reproduction of the disease either in the cicatrix or elsewhere is excited, and soon after most operations the sufferer is in a worse position than before. At the present time few surgeons recommend ablation by the knife, although for years it seems to have been a disputed point whether operations were justifiable or

Hippocrates taught "that occult cancers should not be interfered with, because experience had shown that persons submitted to treatment had perished more rapidly than those who had not been thus meddled with."+

Celsus points out that the disease returns even after cicatrization has taken place. The first Monro,

* Pattison On Cancer, p. 42. 1856.

† Aphor. vi. 38.

"finding that of nearly sixty persons who had submitted to the excision of cancer, four only remained free from relapse at the end of two years, and that, in those in whom the disease returned, it made more rapid progress than it commonly did in others, became a staunch opponent of surgical interference.*

Scarpa, during a long and extensive practice, only knew of three cases of amputation of cancerous breasts proving permanently successful; and he laid it down as a law, that the removal of encephaloid by the knife hastens death.

Mr. Mayo says " After amputation of a scirrhous breast, under the most favourable circumstances, that is to say, when the operation is performed at the earliest period at which the structural character of the disease has declared itself in the gland, no other part being yet invaded by it, and the diseased structure being entirely removed, I believe that in ninety-nine cases out of a hundred the disease returns either in the cicatrix or in the axillary or subclavian glands."+

Mr. Druitt says "The first and most obvious remedy is extirpation by the knife, against which must be alleged the facts, that the removal of one affected part cannot remove the diathesis, and that

* Ed. Med. Essays, vol. v.

+ Mayo's Outlines of Pathology, p. 573.

the disease is almost sure to return in the original situation, or in some other." Again, Mr. Druitt says-"That the removal of the outward cancer, like the pruning of a tree, sometimes seems to rouse the activity of the diathesis, and give increased energy to the morbid growth, if produced afterwards. That the entire removal of all affected particles of tissue is often unattainable. That some patients are killed by the operation itself, and that some have died from being operated on, for what afterwards proved to be no cancer at all."*

Dr. M'Farlane, now Professor of the Practice of Medicine in the University of Glasgow, states (Medical Gazette, 24th June, 1838), that of thirty-two cases of well-marked cancer of the breast, which were operated upon by himself, and eighty-six cases that were operated upon by his friends, not one was permanently cured. Several of the operations were fatal. He is of opinion that "the operation never arrests, but almost uniformly accelerates, the progress of the disease."

Mr. Fergusson says-" My own experience coincides entirely with that of every unprejudiced observer, that when malignant growths are removed with the knife, their return is but too likely."

* Druitt's Surgeon's Vade Mecum, sixth edition, pp. 115, 116.

Professor Miller says "It is only a small number of the many cases which present themselves to the surgeon which warrant operation."

M. Velpeau thinks" that half the tumours found in the breast ought not to be interfered with."

In a Report "On the Utility of Surgical Operations in Cancer," presented to the French Academy of Sciences by Dr. Leroy d'Etiolles, in 1844, it was shown, from documents furnished by 174 practitioners, that the average time from operation until death is one year and five months; and he adds, that in operating early it does not appear to be the fact that the tumour is prevented from degenerating.

The late Mr. Liston wrote-" Recourse may be had to the knife in some cases, but the circumstances must be very favourable indeed to induce a surgeon to recommend, or warrant him in undertaking, any operation for the removal of malignant disease."

The late Professor Colles, of Dublin, wrote-" For my own part, it is an operation I would not press on a patient, or her friends at all; it is one by which very little service is rendered at any time; after submitting to it the patient will get a relapse, and generally sinks within two years."

Mr. Paget says "I am not aware of a single case of recovery; and as to the influence of an operation

in prolonging life, I believe that the removal of the local disease makes no material difference in the average duration of life."

Speaking of the periods of the recurrence of the disease after operation, he states that in seventyfour cases, comprising twenty-one collected by M. Lebert, and fifty-three by himself, they were as follows:

Between 1 and 3 months in 23 cases.

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"Neither of us," says Mr. Paget, "has met with a case in which recurrence was deferred beyond eight years."

Notwithstanding such strong testimony against operations, yet we find some who believe that such an important step as ablation is justified by the results, and uphold it accordingly. Mr. Travers is of opinion that permanent recovery generally ensues when cancer of the breast is removed before the

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