295 



18. The substitutions of seats in gout are too numerous antl 

 well-Known to require a single illustration. 



These cases here so rapidly sketched have fallen under my own 

 observation. I could swell the list to five times, or may be ten 

 times this number: these however must suffice where .my business is 

 rather to indicate generally, than to enter into particular details 

 and inquiries. 



15. It has been remarked that there is nothing new in the 

 observation of this class of diseases, Hipocrates was as well aware 

 if them as any of those who have succeeded him. But tSiere would 

 be something new in the inference that all diseases which succeed 

 rach other in the different seats hold, like the substituted ones indi- 

 cated above, a curative relation: this inference would indeed be new, 

 and it would be no great difficulty to prove it false. We will keep 

 tliis refutation a little in view, in our exhibition of a few examples 

 of our second class of " extension of disease." 



1. A schirrous tumour of the breast, of a small size, proceeds 

 on to the ulcerated stage of cancer; the axillary glands which are 

 in the course of the absorbents, proceeding from the seat of the 

 primary disease, become swelled, indurated, and finally, perhaps, 

 the skin covering them ulcerates or sloughs, and the secondary 

 disease resembles in its phenomena the primary one. The primary 

 disease in the mean time runs its course, sloughing and ulcerating 

 mid bleeding, &c. until the patient dies. The only result of the 

 econdary disease in this case is, that the patient has a cancerous 

 disease in two seats instead of one. During these processes the 

 constitution also participates in the local disease; to mention only 

 one consequence, a febrile diathesis is produced. It would be diffi- 

 cult to shew how cancer of the axillary glands is likely to cure cancer 

 of the breast, or what tendency fever has to arrest the progress of 

 an irritable ulcer of such a kind, when we know that all its symp- 

 toms are aggravated by any causes which produce fever or quicken 

 the circulation. This is one instance of extended disease. 



2. A chancre on the prepuce, left to spontaneous processes, con- 

 tinues to ulcerate ; from this primary arises the secondary disease of 

 an abscess in the groin : we should not in this case expect the 

 primary to be much benefited by the secondary disease; we knovr 

 that the chancre spreads and the bubo will spread ; that from these 

 teats the disease will be extended to the skin, to the throat, and to 

 the bones. From all this extension of disease the primary one, the 

 chancre, does not derive the least benefit; all the consequences of 

 it tend to death, and before this event happens the primary disease, 

 which, according to some reasoners, should have been cured by 

 the consecutive processes, has unluckily destroyed without a 

 vestige the whole organ in which it was situated, together perhaps 

 with some collateral ones belonging to the same system. If, again, 

 the tendency of the consecutive phenomena should be inquired after, 

 we have only to observe, in regard to the primary disease, that 

 the local destruction of parts goes oa the more rapidly, iu propor- 



