CANCEROUS TUMORS. 33 



regular cells with large nuclei, that the older descriptions of 

 scirrhus and medullary cancer, so familiar to 3-ou all, were 

 drawn, and I wish you to remember that these descriptions 

 were true to nature so far as they went. Simply you must 

 understand that growths are none the less cancerous which 

 are extirpated before this later stage has set in. My last 

 illustrations represent sections of the interior portion of a 

 medullary cancer, and some cells scraped from the surface 

 of a well advanced scirrhus, which may serve as samples of 

 the large cell foi'ms referred to, which are in fact what the 

 older writers described as cancer cells. (Five photographs, 

 Nos. 70 to 74, shown.) 



If now. I recur, as I promised to do, to the question of diag- 

 nosis, I think you will understand, without any detailed repeti- 

 tion of the descriptions I have given, that in the present state 

 of our knowledge, we ought, on anatomical grounds, to call any 

 growth a cancer, at the margins of which we find the nucleated 

 or cell cylinders I have described, associated with the infil- 

 tration of small cells in the intervening connective tissue. It 

 is not necessary to wait till the cells of the cylinders have ac- 

 quired any great size in order to arrive at an opinion. It is 

 necessary, however, to cut sections of considerable dimensions, 

 and to prepare them suitably for satisfactory microscopical 

 study ; and this requires of course a reasonable amount of 

 practice, while the profitable study of the sections, Avhen pre- 

 pared, presupposes a practical acquaintance with modern nor- 

 mal and pathological histology. 



And at this point the important question of prognosis thrusts 

 itself again upon our attention. Can we be sure that a growth 

 which has the anatomy of cancer will have the history that is 

 usually indicated by the word malignant ; that it will ulcerate if 

 left to itself ; that it will recur if extirpated ; that in either case 

 similar growths will develop in some of the internal organs ; 

 and that the patient will surely die from this cause, if not 

 33 



