may be more successfully used in Cancer than iodine, opium, prussic acid, &c. may be all advantageously employed, both as internal remedies and as local applications, according to the changing indications of the case. When Cancer is suffered to run its course undisturbed by the knife of the surgeon, or the physic of the doctor, the usual termination of it is this A small ulcer shows itself the upon skin of the most prominent part of the tumour, gradually increasing in dimension. And so exceedingly weak do the atomic attractions of the matter of the breast become during the change produced by the disease, that scarcely has the atmospheric air been allowed to come in contact with the tumour, than it commences to mortify and die-falling away in most cases,. (as it did indeed in the case of the lady to which I have already alluded,) after a certain time in a dead and corrupted mass. The ulcer which it leaves behind, is in all such cases, extremely fœtid, and shows a great disposition to spread; the reason of which is this, first, because the whole constitution of such persons is more or less weak; and secondly, because the particles of dead, or half-dead matter, which coat the bowl of the ulcer, not only have no power of reparation in themselves, but are the cause of a further failure of reparative power in the already weak parts. with which they come in contact. Exactly the same thing takes place when any part of an old tree becomes decayed, and very much after the manner of such vegetable decay, as you may see it in a gnarled oak, we have in this disease mushroom-like and other excrescences springing from the sides and bottom of the ulcerous and decaying part, and that too with a rapidity truly astonishing. A case of this kind I lately attended with Mr. Farquhar of Albemarle Street. Unless every portion of these fungoid bodies be completely removed, you must not hope to arrest the progress of the disease. The whole surface of the ulcer should be cauterised and completely destroyed with a burning-iron, nitrate of silver, ammonia, or potass. All four may, in some cases, be resorted to with advantage. Nor must you here spare any part that shows even a symptom of weakness; but cauterise, and cauterise again and again, until you get red, small, healthy granulations to appear. The dressings which you will now find most successful, are ointments or other preparations of the red oxide of mercury, iodine, arsenic, creosote, lead, &c.; and each and all of these will only prove beneficial in particular cases, and for particular periods. The law that holds good in the case of internal remedies, will be now more conspicuous in the case of external applications,-namely, that all medicinal powers have a certain relation to persons and periods only, and must in no case be à priori expected to do more than produce a temporary action. If that action be of a novel kind, they will produce beneficial results; if, on the contrary, the increased motion from their action be in the old direction, and which cannot be foreseen till tried, the result of such trial will be a greater or less aggravation of the state for whose improvement you ordered them to be applied. Dr. Abel Stuart, while practising in the West Indies, where the disease is more frequent than in England, had many opportunities of making himself acquainted with every one of the various states and stages of Cancer-and since I settled in London, where he also now practises, he has shown me cases of this kind, which he has treated with the greatest success. You must not then suppose, like most of the laity, and not a few of the members of the profession, that Cancer of the Breast is necessarily a mortal disease. So long as you can prevent the ulcer from spreading, and at the same time keep up the general health to a certain mark, how can there be danger? The Breast, I repeat, is not a strictly vital organ; it is not necessary to the individual life,—it is a part superadded for the benefit of another generation. How many women at one time remarkable for a large full bosom, have in the course of years, lost every appearance of breast by the slow but imperceptible process of interstitial absorption ;-what inconvenience do these suffer in consequence? But for the tendency to spread, and the accompanying pain, Cancer would seldom terminate fatally at all; it is the pain principally that makes the danger, not any loss of the organ itself. Pain alone will wear out the strongest relieve this in every way you can, but avoid : leeches and depletion, which, I need not say, are the readiest means, not only to exhaust the patient's strength, but to produce that extreme sensibility of nerve, that intolerance of external impression, which converts the merest touch into the stab of a dagger. Strong people seldom complain of pain: it is bloated or emaciated persons who mostly do so. Keep up the health, then, by every means in your power, and your patient may live as many years with a Cancer of the Breast, as if she had never suffered from such a disease. Sir B. Brodie mentions the case of a lady who lived twenty years with Cancer, and died at last of an affection of the lungs, with which he says it had no necessary connexion. What shall I tell you in regard to amputation of the Breast? Will amputation harmonise the secretions? Will it improve the constitution in any way whatever? Those patients who, in the practice of others, have been induced to undergo operations, have seldom had much cause to thank their surgeons,-the disease having, for the most part, reappeared at a future period in the cicatrix of the wounded part. Gentlemen, you have only to look at the pallid, bloated, or emaciated countenances of too many of the sufferers, to be satisfied that something more must be done for them than a mere surgical operation,—a measure at the best doubtful in most cases, and fatal in not a few. Shiverings, heats, and sweats, or diarrhoea, or dropsy,— these are the constitutional signs that tell you you have something more to do than merely dissect away a diseased structure, - which structure, so far from being the cause, was in reality but one feature of a great totality of infirmity. That the knife may sometimes be advantageously employed I do not deny, but instead of being the rule it should be the exception; the majority of honourable and enlightened surgeons will admit how little it has served them in most cases beyond the mere purpose of temporary palliation. When you hear a man now-a-days speaking of the advantage of early operating, you may fairly accuse him of ignorance, with which, I regret to say, interest, in this instance, may occasionally go hand in hand. The fee for amputating a breast enters into the calculation of some operators. - I have twice in my life seen Cancer of the male Breast-the subject of one was a European, the other a native of India. Let me now say a few words on TUMORS generally; premising that the term "Tumor" is merely the Latin word for any Swelling, though we usually employ it in the more limited sense of a morbid growth. It is a very common error on the part of medical men, to state in their reports of cases, that a "healthy" person presented himself with a particular tumor in this or that situation. Now, such practitioners by this very expression show how much they have busied themselves with artificial distinctionsdistinctions which have no foundation in nature or reason-to the neglect of the circle of actions which constitute the state of the body termed Health. Never did a tumor spring up in a perfectly healthy subject. In the course of my professional career, I have witnessed Tumors of every description, but I never met one that could not be traced, either to previous constitutional disturbance, or to the effect of local injury on a previously unhealthy subject. Chills and heats have been confessed to by almost every patient, and the great majority have remembered that in the earlier stages their Tumor was alternately more or less voluminous. Every individual, we have already shown, has a predisposition to disease of a particular tissue. Whatever shall derange the general health may develope the weak point of the previously healthy, and this may be a tendency to Tumor in one or more tissues. The difference in the organic appearance of the different textures of the body, will account for any apparent differences betwixt the Tumors themselves; and where Tumors appear to differ in the same tissue, the difference will be found to be only in the amount of the matter entering into such tissue, or in a new arrangement of some of the elementary principles composing it. It is a law of the animal economy, that when a given secretion becomes morbidly deficient, some other makes up for it by a preternatural abundance. If you do not perspire properly, you will find the secretion from the kidneys or some other organ increase in quantity. I was consulted some time ago by a female patient, whose bosom became enormous from excess of adipose or fatty deposit. Now, in the case of this female, the urine was always scanty, and she never perspired. Every tissue of the body is built up by secretion. The matter of muscle, bone, and skin, is fluid before it assumes the consistence of a tissue, and the atoms of one texture are constantly passing into some other. "The great processes of nature," says Professor Brande, "such as the vegetation of trees and plants, and the phenomena of organic life generally, are connected with a series of chemical changes." But, Gentlemen, this chemistry is of a higher kind than the chemistry of the laboratory ;-it is Vital Chemistry, under the influence, as I shall afterwards show you, of Vital Electricity. Secretion of every kind is the effect of this vital chemistry; and Tumors, instead of being produced, as Mr. Hunter supposed, by the "organisation of extravasated blood," are the result of errors of secretion. They are principally made up of excess of some portion of the tissue in which they appear, or the result of new combinations of some of the ultimate principles which enter into its composition. If you search the records of Medicine upon the subject of Tumors, you will find that the agents by which these have been cured or diminished, come at last to the substances of greatest acknowledged efficacy in the treatment of ague. One practitioner (Carmichael) lauds Iron; another (Alibert) speaks favourably of the Bark; the natives of India prefer Arsenic; while most practitioners have found Iodine and Mercury more or less serviceable in their treatment. Gentlemen, do you require to be told that these substances have all succeeded and failed in ague! Marvel not, then, if each has one day been lauded, another decried, for every disease which has obtained a name, Tumors of every description among the number. We now come to PREGNANCY. But this, you will very likely say, is not a disease. In that case, I must beg to refer you to K ladies who have had children, and I will wager you my life, that they will give you a catalogue of the complaints that affected them during that state, equal in size to Cullen's Nosology. In the case of every new phenomenon in the animal economy, whether male or female, there must be a previous corporeal revolution. We find this to be the case at the periods of Teething and Puberty-and so we find it in the case of Pregnancy. Can the seedling become an herb in the frost of winter, or the sapling grow to maturity without a series of changes in the temperature and motion of the surrounding earth?-No more can the foetal germ become the infant without a succession of FEBRILE revolutions in the parent frame! Once in action it re-acts in its turn. a person who has had a blow on the head, or who has been much bled? It appears to me probable that the infant's growth must take place principally during the period of maternal sleep; for it is chiefly in the morning, just as she awakes, that the mother experiences those vomitings and other symptoms from which I infer the Brain has been too long neglecting her own economy. But even as a natural consequence of the more favourable alternations of cerebral movement which take place during pregnancy, the mother for the most part experiences Chills, Heats, and Sweats,-she has symptoms, or shades of symptom at least, of the same disorders that may arise from any other agency affecting the Brain in a novel or unusual manner-she becomes at certain times pale and flushed alternately, and, as in the case of other Fevers, frequently complains of headache. When blood-letting the usual refuge of the ignorant-is in such cases tried, the blood drawn exhibits the same identical crust which, under the name of "buffy-coat," "inflamed crust," &c., so many practitioners have delighted to enlarge upon as the great peculiarity of "true inflammatory fever!" The influence of the mother's Brain over the growth of the child while in the womb, is sufficiently proved by the effects of frights and other passions, induced by the sight of objects of horror, and so forth, while in the pregnant state. Hare-lip, distortions, moles, marks, &c., have been traced by the mother to such passions in far too many instances to render us in the least sceptical upon that point. Now, in this particular instance, some of the parts or divisions of the mother's Brain must act in association or simultaneously, while others act independently or in alternation; for otherwise you could not understand how the Brain of the mother should influence the growth of the child in utero, and at the same time continue to play its part in the parental economy. Some of its various portions must act in these respects alternately, for they cannot do both at one and the same moment of time. But, here again, as in other instances, a want of harmony may arise the Brain may continue to exercise its influence over the child too long; in other cases it may forget the child for the mother. How such want of harmony affects the child, we can only guess from analogy. How a too long cerebral neglect of the mother's economy may influence her, we daily see in the numerous disorders to which she is then liable-more particularly in the periodic vomitings, and also in the swoon or faint which occasionally comes on during the pregnant state. Are not these the very symptoms that happen in the case of || she became pregnant her Squint diminished, Pregnancy has been defined by some very great doctors, to be a "natural process." Now, that certainly is a very great discovery; but they might have made the same discovery in the case of Disease and Death. Is not every thing in Nature a natural process, from the fall of an apple to the composition of the Iliad? Every thing that the eye can see or the ear can hear is natural; miracles only are miraculous; for they are events that are CONTRARY to the natural order of things. Pregnancy, then, is a natural process ;-but is it on that account the less surely a FEBRILE state? Is it for that reason the less certainly an Intermittent Fever? What disorders have not originated in Pregnancy? What, in cases where they previously existed, has it not, like every other Fever, cured? If it has produced Epilepsy, Apoplexy, Toothache, Consumption, Palsy, Mania, each and every one of these diseases have I known it to ameliorate, suspend, or cure! I remember the case of a lady who, before her marriage, squinted to perfection. But when and long before the period of her confinement it was cured ;;-never did I see such an improvement in the face of any person. Still, if Pregnancy has cured squint, I have known cases where it produced it. How completely, then, does this harmonise with the Unity which pervades Disease generally! PARTURITION, I have already said, is a series of pains and remissions, but it is NOT an Intermittent Fever; nor, indeed, has it any resemblance to that affection! So, at least, I have been assured by very clever doctors: and they have told me the same of Pregnancy! Is this question, then, completely settled in the negative? Certainly -It is settled to the satisfaction of all who pin their faith upon mere human Authority. But human Authority seldom settled anything with me; for wherever I have had an interest in knowing the truth, I have generally appealed from the decree of that unsatisfactory court to the less fallible decision of the Court of Fact. And what does Fact say in this instance? Fact says that child-labour, in almost every case, commences with chills and heats, and that these are again and again repeated with longer or shorter periods of immunity during its progress. But how do I know all this? you will ask,-I who hold modern midwifery in horror! I will tell you truly-I first guessed it; for I could not suppose that Parturition, unlike every other great revolution of the body, could be either a pain-less or an unperilous state; or that it could be free from the chills, heats, and remissions, which I had always observed in cases of that character. Still, not being a person easily satisfied with guess-work, I took the trouble, in this particular instance, to interrogate Nature. And as sure as the sun ever shone on this earth, Nature completely verified the fact of my anticipation, that Parturition, in every instance, is an intermittent fever. In some of my medical books, too, I found shiverings among the numerous other symptoms mentioned as incidental to women at this period. "Sometimes," says Dr. Ramsbotham, himself a man-midwife, "they are sufficiently intense to shake the bed on cold which the patient lies, and cause the teeth to chatter as if she were in the cold stage of an ague-fit; and although she complains of feeling cold, the surface may be warm, and perhaps warmer than natural." Now, this sensation, as you well know, is often complained of by ague patients, even in the hot stage. In spite of every assertion to the contrary, then,-in spite of every declaration on the part of medical or other persons, Pregnancy and Parturition are agues—agues in every sense of the word; for not only do their revolutions take place in the same manner as those of ague, but, like ague, both may be influenced by medicines as well as by mental impressions. Indeed, in most cases of parturition, the labour-fit-mark the word !—will stop in a moment from the new cerebral movement induced by Fright or Surprise. In some the fit never returns, and the most terrible consequences ensue. When the foetus is fairly developed in the case of Pregnancy, and the labour completed in that of Parturition, health is the general result; but in the course of both, as in the course of other fevers, every kind of disease may show itself, and, when developed, may even proceed to mortality. An occasional termination of Pregnancy is ABORTION OR MISCARRIAGE; and this, in every case, is preceded by the same constitutional symptoms as Pregnancy and Parturition, namely, the symptoms or shades of symptom of ague. Moreover, when a woman gets into a habit of miscarrying, such miscarriage, like an ague, recurs periodically, and takes place almost to a day at the same month as the first. A lady who had been married several years, but who had never borne a living child, although she had had frequent abortions, consulted me upon the subject. Her miscarriages having always taken place at the same period of pregnancy-about the end of the third month-I desired her when she should again become pregnant to let me hear from her within a fortnight of the time she might expect to miscarry. She did so, telling me at the same time she knew she should soon be taken ill, as she had already had shiverings. |