121 



PRODUCTS, ADVENTITIOUS. 



integration and alteration, is matter of physical 

 demonstration changes which divest them 

 apparently of their pathological properties. 

 On analogy, which seems in nowise strained, 

 we may then admit that disintegration of the 

 elementary cells of the morbid Growth is the 

 cause of the occasionally unproductive cha- 

 racter of cancerous absorption.* When, on 

 the other hand, secondary Growths form in 

 localities free from direct lymphatic commu- 

 nication with the seat of the primary forma- 

 tion, there can be no doubt (although the 

 productive elements have not yet been found 

 in transitu with the circulating blood) that 

 the venous system acts as the agent of trans- 

 lation of such elements from the one to the other 

 site. In the instance of cancer the following 

 arguments may be adduced in favour of this 

 notion, a. " Cancerous matter exists in a 

 multitude of cases in the veins of the diseased 

 part ; now this is obviously a most favourable 

 circumstance for its circulation with the re- 

 turning blood. 6. The rapidity of the suc- 

 cessive development of the disease in different 

 organs, sometimes observed, seems only pro- 

 ducible by the agency of a fluid which, like 

 the blood, pervades them all. 7. The liver 

 and lung, the two organs in which foreign 

 bodies introduced into the circulation are 

 almost invariably observed to stagnate, are by 

 far the most frequent seats of the secondary 

 development of carcinoma. 5. The parenchy- 

 matous viscera and the bones, the precise 

 structures most frequently affected with se- 

 condary abscess, are those peculiarly liable to 

 secondary cancer, e. In respect of both mor- 

 bid products, the liver and lungs stand at the 

 head of the list for frequency of implication. 

 f. Secondary abscesses affect a special pre- 

 ference for the peripheric strata of the viscera ; 

 so likewise do secondary cancers. In the 

 instance of the lung, I believe this readily 

 explicable, by the fact that the majority of the 

 ultimate ramifications of the pulmonary artery 

 reach the periphery of the organ before be- 

 coming continuous with the capillaries, where- 

 in stagnation must occur. t\. Double organs 

 are very rarely the simultaneous seats of pri- 

 mary abscess ; in cases of secondary abscess 

 both invariably suffer : the same propositions 

 hold good of cancer. &. Secondary cancer 

 in the liver and lung occupies the same ele- 

 mentary seat (the lobules) as the pus of 



* Absorption of cancerous matter artificially in- 

 duced, would a priori appear likely to prove of the 

 unproductive kind, as disintegration of the primary 

 particles of the growth must, in all probability, form 

 a stage of the absorptive process. The question is 

 rendered one of practical interest by the prospect 

 held out of removing these tumours by the ingenious 

 system of pressure invented by Dr. Arnott. It is 

 clear, in truth, that if that system only lead to the 

 translation, from one part of the frame to another, 

 of elements endowed with the facility of unlimited 

 germination, the benefit obtainable from it is more 

 apparent than real. Whereas if, while that system 

 causes their entry into the circulating fluids, it 

 deprives their elements of all productive power, 

 and leaves them in a condition fit for excretion as 

 effete particles, a perfect cure of the disease is ef- 

 fected by the removal 'of the tumour. 



secondary abscesses."* Some apparent ob- 

 jections to the doctrine here upheld are ex- 

 amined and (as we believe) refuted in the 

 same place. 



Or, thirdly, in certain cases where numerous 

 parts are found to be the seats of tumours of 

 the same species, it is more than probable that 

 the development of these tumours has been 

 simultaneous, and each mass been evolved 

 independently of its fellows. There can be 

 no doubt, for instance, that internal cancer is 

 frequently described as secondary to external 

 cancer (especially when the latter has been 

 removed with the knife, and the former has 

 not manifested its existence by symptoms 

 until after the operation), where no proof of 

 the two Growths not having originated at the 

 same time can possibly be adduced. The 

 same is true of Fibrous Growths. 



The {nonliability of Growths has not been 

 maintained except in the instance of cancer, 

 and, even in respect of this product, upon 

 very imperfect evidence. Experimental re- 

 sults may be cited against (Dupuytren), and 

 in favour of (Langenbeck), the transmissibility 

 of the disease by inoculation ; while, on the 

 other hand, we learn from M. Gluge that his 

 attempts generally failed utterly, and in rare 

 cases appeared to succeed. Theoretical con- 

 siderations, repudiating, as they do, the idea 

 of the constant inoculability of cancer-ele- 

 ments in organisms of all varieties of morbid 

 aptitude, nevertheless do not wholly oppose 

 the notion, that where constitutional predispo- 

 sition to cancer exists in an animal, the ger- 

 minal element of that product, introduced 

 into its blood, may prove prolific. Unless 

 this constitutional state exist, " even the ac- 

 tual elements of cancer only manifest them- 

 selves as simply irritative agents, the perfection 

 of the seed is not enough to secure the de- 

 velopment of the plant; the soil, in which it 

 is sown, must be capable of feeding it." Per- 

 haps these views furnish a clue to the con- 

 tradictorv statements of experimentalists. 



8. Clinical observers of disease have long 

 been aware that certain Growths are of evil, 

 others of innocent, tendency ; that they are 

 " malignant" and "benignant." Morbid ana- 

 tomists have sought to connect definite and 

 invariable structural characters with the pos- 

 session of one or the other tendency ; and 

 their search has been vain. Micrologists are 

 divided on this question ; some affirm that 

 "malignancy" depends on the presence of a 

 special cell ; others deny the distinctiveness 

 of microscopical elements. 



We, for our own parts, believe that the 

 qualities of a growth cannot be determined 

 by the characters of its cell. We have known 

 Growths, which had destroyed life with the 

 cachexia of cancerous disease, and clearly 

 exhibited the local progress and naked-eye 

 characteristics of encephaloid; Growths which, 

 nevertheless, were composed of non-nucle- 

 ated cells {indistinguishable from those of 

 common exudation-matter. Nor do we be- 



* Nat. and Treatment of Cancer, p. 106. 



