64: THE TONER LECTURES. 



from the primary disease? On the other hand if a tumor be 

 extirpated which does not possess the anatomj'^ of cancer ; in 

 ■which no proper cancer cylinders have been formed ; as for ex- 

 ample in the first case of mammary tumor to which I alluded 

 this evening, can we be sure that the growth would not have 

 ultimately acquired the cancerous anatomy if it had been let 

 alone ? Can we be sure that it will not, in spite of its timely 

 extirpation, recur and prove fatal ? 



A proper discussion of these important questions, based 

 upon a consideration of all the evidence, would require much 

 time and thought and be a work of no small labor and diffi- 

 culty. Of course it cannot be undertaken in the present 

 lecture. Nevertheless it may not be amiss to state that the 

 general tenor of surgical experience would seem to give a 

 negative answer to both these important questions. With re- 

 gard to the first, the negative answer is the justification of the 

 operation of extirpation, still so generally resorted to, and 

 the motive for urging operative interference as early as pos- 

 sible. It implies a more or less confident belief in the local 

 significance of the primary lesion, and it is not inconsistent 

 with the circumstance that practically the majority of tumors, 

 which on extirpation prove to have the anatomy of cancer, do 

 in fact recur, for the incomplete extirpation of marginal por- 

 tions of the primary growth, or the existence already at the 

 time of the operation of small secondary growths in distant 

 organs, Avill sufficiently account for this result, without any 

 more violent supposition. 



On the other hand the negative answer to the second question 

 might have been anticipated on purely anatomical grounds, 

 since it would seem that in every cancer there miTst be a 

 period when the small-celled infiltration of the connective 

 tissue, and perhaps some increase in the number of the epithe- 

 lial elements of any glandular part involved, is all that has 

 taken place, and whenever this process commences simultane- 



