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Jane L., aged 59. Scirrhus of right breast. Mother and sister died of phthisis.

Annie C., aged 53. Cuirass-scirrhus of both breasts. Father and other members of family died of phthisis.

Eliza B., aged 44. Scirrhus of right breast. No cancer in family; but father's sister died of phthisis, and her own sister has adenoid tumours.

Sarah G., aged 51. Atrophic scirrhus. Several members of the family phthisical.

Elizabeth P., aged 46. with surrounding tubercles.

cancer.

Scirrhus of right breast,

Phthisis in family, but no

Mary C., aged 54. Scirrhus of left breast. Father and sister died of phthisis.

Jane I., aged 50. Cuirass-scirrhus of both breasts. Phthisis in family, but no cancer.

Mrs. R., aged 42. Scirrhus of left breast. Phthisis in family, but no cancer.

Caroline P., aged 48. Scirrhus of both breasts. Father and two sisters died of phthisis.

Elizabeth V., aged 60. Scirrhus of right breast. Several brothers and sisters died of phthisis.

Harriet H., aged 39. Scirrhus of right breast. Phthisis in family, but no cancer.

Eliza S., aged 65. Scirrhus of left breast. Phthisis but no cancer in family.

Sarah S., aged 49. Atrophic scirrhus of left breast. Brother died of phthisis.

Louisa H., aged 43. Atrophic scirrhus of left breast. Phthisis on both sides of family.

Cuirass-scirrhus of right

Mary Ann H., aged 42. breast. Father died of phthisis.

Mary Ann A., aged 47. Scirrhus of left breast. Three sisters phthisical.

Emma B., aged 60. Scirrhous tumour in right breast. Both cancer and phthisis in family.

Miss B., aged 53. Scirrhus of right breast. Both father and mother cancerous; and father's sister, as well as many of her children, died of phthisis.

Mrs. G., aged 66. Scirrhus of right breast. All her brothers and sisters died of phthisis.

Lady G. phthisis.

Scirrhus of breast. Daughter died of

Susan R., aged 30. Cysto-scirrhus of right breast. All her family have died of phthisis.

Mrs. C., aged 49. Ulcerated scirrhus of both breasts. Two great-aunts died of cancer, and a sister is now dying of phthisis.

Mr. L., aged 62. Scirrhus of liver. Two daughters died of phthisis. Mrs. L. and family perfectly free from either disease.

Mr. W. R., aged 44. Cancer of rectum. Mother and sisters died of phthisis; and two of his own children died of phthisis.

There is a case recently recorded in the 'Lancet' by Mr. George Rawson, of the Middlesex Hospital, in which he operated for scirrhus of the breast. He comments upon the absence of an hereditary predisposition to cancer, and only mentions incidentally that a sister died of phthisis.

I trust that the publication of these facts will excite the attention of my professional brethren, and induce a more extended enquiry to be made, so that the question

of the transmutation of these diseases may be well sifted; for assuredly, whether considered from a therapeutical point of view, or as an item of vital statistics interesting to the political economist, it claims the earnest interest and scrutiny of all those who have the requisite opportunities for investigating a matter the right comprehension of which will necessarily throw much light into one of the most obscure points of pathological science.

Treatment.

The sum of all our enquiries into the etiology and symptomatology of this as of all other disease is the practical question of treatment. Ever since medicine assumed the form of a distinct science under the remarkable teaching of Hippocrates, cancer has been known and studied. The chemists and the rationalists, but especially the empirics, have laboured in the praiseworthy hope of obtaining a mastery over this disease. Each age has produced its specific; but, alas! the earth hath bubbles, as the waters have, and these are of them.'

Nothing of this kind has maintained more than a most ephemeral existence, and it may be said that, except for ague and itch, medicine knows of no specific, acting always as such in all the varying physical and moral circumstances which distinguish the divinely-made machine-man-from those formed of human hands.

But whilst the experiments of chemists, the theories of rationalists, and the guesses of the empirics, have failed in arriving at the desired goal per saltum, pathology, aided by the great improvements in the microscope, has been steadily unravelling the web which had

heretofore bound up all tumours in one confused mass, and thus has rendered most essential service, by separating the true from the spurious-that which was really cancerous, from simple glandular engorgements, which have been confounded for ages with the more serious affection.

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The acquirement of this knowledge enables us to pursue our studies with more exactitude, and gives us the advantage also of holding the rod of diagnosis ' over those foolish and wicked pretenders to medical skill, who especially batten upon the sufferers from a disease which is supposed to be abandoned as incurable by the regular practitioner.

And whilst histological pathology has enabled us in the great majority of instances to distinguish cancer from its counterfeits, it has also shown in what measure cancer differs from the normal structures, and thus has given us a really scientific clue to the mischief which has been done, and, as a consequence, to the means of rectifying this serious error of growth. With this knowledge as our guide in a wide field of observation, watching the actions of nature herself when untended by any interference from art-noting the effects of therapeutic agents supposed to influence the course of this malady, and weighing well the results of operative interference-we may now, with a full acknowledgment of the difficulties of our task, humbly, yet with a chastened confidence, approach the all-important question of the proper treatment of cancer when affecting the breast.

The first question presented to the mind of the surgeon, as soon as he has diagnosed cancer of the

mamma, is that of operation. If it comes from the patient herself-if there be a strong desire, as is sometimes the case, to have the tumour removed our task is relieved of much difficulty and responsibility. Supposing the entire removal of the diseased structure possible with a good prospect of union by first intention, all our doubts as to the issue may be thrown aside, and we may join the patient in hoping that there will be no further return of the malady. If the question of operation be urged by the friends of the patient, and she herself be passive in the matter, the surgeon is placed in a highly responsible judicial position, and whatever the consequences may be, he should advise in strict accordance with the dictates of science and experience.

If the surgeon himself be of opinion that an operation is the best mode of procedure, he should state it decidedly, and give his reasons for that decision; but by no means should he abandon the treatment of such a case because the fears or the prejudices of the patient will not permit her to follow the advice he has felt it his duty to give. He may, in case of refusal, console himself with the reflection that he has done his duty to his patient, and that, after all, nature may find a way out of the difficulty, if she be carefully watched and aided in the never-ending contest between the forces of growth and decay.

It has been the fashion of late to attempt to arrive at a decision as to the propriety of removing a cancerous breast upon arithmetical principles. Statistics have been collected and published; but, unfortunately, the results obtained at different hospitals and by independent collectors do not tally, and indeed go far to

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