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average time that elapses before a patient has completely recovered from a cutting operation, it is probable that the difference between the two modes of treatment, in point of expedition, is by no means great.

IX. That the undersigned have not as yet had time to ascertain the average duration of the benefit conferred by the treatment, nor have they any means of knowing whether, in the event of a return of the disease, there be any difference observable from what is known to take place after excision.



March 18th, 1857.


I hope I shall be pardoned for returning my sincere acknowledgments to the Board of Governors and the medical gentlemen connected with the Middlesex Hospital for their uniform kindness and courtesy to me during my connexion with them. I also desire to express my obligations to Drs. Hamilton Roe, W. V. Pettigrew, and Julius; also to Surgeons Jonson, Jordan, Meates, D. Smith, Whitmore, Brunskill, and Pettigrew, who were among my first, and, I believe, are still my friends.

With an apology for delaying the publication,

which has been unavoidable on my part, I leave my method of treating one of the worst diseases that flesh is heir to to the medical profession, only asking for it a fair and candid trial.


70, Warwick Square, S. W.

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CANCER is considered by most modern pathologists to be a disease of constitutional origin; but there are still many who believe it to be, in the first instance, a local disease. Mr. Parker, of Birmingham, says: "I am of opinion that cancer, like syphilis, manifests itself in two ways; first as a local mischief, the constitution becoming secondarily contaminated."*

In my opinion, cancer, in many cases, is a constitutional disease, existing in the system for some time before it appears externally, which is merely one of its stages. In other cases, again, I believe the disease to be purely local, never having existed previously to its external appearance, and in which no predisposition exists in the constitution for its production.

Although cancer is always the same disease, yet it

* Treatment of Cancerous Diseases by Caustics. By L. Parker; p. 11.


occurs in various forms; and almost every author who has written upon the subject has made his own divisions; thus we find that Velpeau describes cancer under the forms of scirrhous, encephaloid, melanotic, chondroid, colloid, and fibro-plastic, epithelial, keloid, and anomalous cancers. Walshe, on the other hand, gives but three species of the disease; viz., scirrhous, encephaloid, and colloid cancer; but as the object of our present work is not so much to give a detailed pathological and anatomical account of this disease (which has been so ably done by many distinguished living writers), as to describe a new means of treatment which has proved so successful in my hands, I shall, therefore, briefly notice the three forms most frequently met with in this country, viz., encephaloid or medullary cancer, scirrhous or stony cancer, and epithelial cancer.

Encephaloid.-Encephaloid cancer is so called from its soft medullary or brain-like appearance. "This form of disease includes the spongoid inflammation of Burns (1800), the fungus hæmatodes of Hey (1803), and the pulpy medullary sarcoma of Abernethy (1804)."

This form of the disease is said to be seldom met with in the breast in this country. "So rare, indeed,

* Henry's Velpeau on Diseases of the Breast, p. 359.

is well-marked medullary cancer in the breast in this country, that Mr. Lawrence, in his immense experience, has met with but two examples of it; and in our museums it is very rarely seen. This rarity is the more remarkable by its contrast with the occurrence of the disease abroad. In France, according to M. Lebert, "about one-fifth of the cancers of the breast are soft and encephaloid. In America, Dr. J. B. S. Jackson has assured me that the proportion is not less than one-fifth; and I gather from the records of German writers that it is with them about the same.'

"The general history of medullary cancers presents the best-marked type of malignant growths. Among all tumours they appear, in a general view, to be the most independent of seat and of locality; the most rapid in growth; the most reckless in the invasion of diseased tissues; the most abundant in multiplication; they have the most evident constitutional diathesis; they are the most speedily fatal." †

I cannot agree with Mr. Paget and Mr. Lawrence as to its extreme rarity in this country; for (although not nearly so frequent as scirrhus), within the last year I have met with no less than nine cases of true medullary cancer in the breast, of which no fewer * Paget's Surgical Pathology, vol. ii. p. 380. + Ibid., p. 388.

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