TUMORS. 545 



duced by the friction of decayed and broken teeth; also from 

 gummy tumors (Langenbeck). Persons addicted to alcoholic 

 drinking are more prone to carcinoma of the oesophagus and 

 stomach than those of teniperate habits. Men in advanced age 

 with a phimotic prepuce are subject to cancer of the penis ; and 

 those suffering from piles may acquire cancer of the rectum. 

 Cancer of the breast and the uterus, in many instances, can be 

 traced back to mechanical injuries. Ulcers of the skin, more 

 especially the so-called varicose ulcers, nay, simple callosities on 

 the feet, may take on a cancerous character. The primary cause 

 for the growth, of cancer we do not know. Middle and advanced 

 age are most favorable for the growth of cancer so much so, 

 that it is rarely observed under the thirtieth year j it very sel- 

 dom occurs in children. The older a person, the more liable is 

 he to cancer. This disease is observed only in civilized races ; 

 travelers report it is never found amongst savages. A com- 

 paratively good constitution is requisite for its growth j indi- 

 viduals of the so-called phthisical constitution, or those broken 

 down by chronic diseases, including syphilis, are not prone to 

 cancer, though a gummy tumor may exceptionally give rise to a 

 cancerous growth. Cancer and tuberculosis do not exclude each 

 other, as was thought to be the case by older pathologists. In 

 many instances we can trace the cancer as the primary disease, 

 which, by breaking down the constitution, causes tuberculosis of 

 different organs. I have observed eight cases of this kind. 



Besides the local spreading of cancer, it almost invariably 

 invades the lymphatics within its range, which are also trans- 

 formed into cancer-tissue, and from which evidently starts the 

 general infection. Secondary cancer formations have been 

 observed not only in the lungs, the liver, or any organ, but 

 sometimes almost all the internal viscera are found crowded 

 with small nodules, identical in every respect to miliary tuber- 

 cles', the so-called " miliary carcinosis." 



THE DEVELOPMENT OF CARCINOMA IN LYMPH-GANGLIA. 

 BY A. W. JOHNSTONE, DANVILLE, KY.* 



During the winter of 1880-1, whilst working in Dr. Heitzmann's 

 laboratory in New-York, I examined four lymph-ganglia, three of which 

 showed the initial stages of the formation of cancer. 



The first came from a man, forty-eight years old, who had noticed a few 

 small nodules on his prepuce. One of these was cut out and sent to the 

 laboratory for diagnosis. Upon its being pronounced cancer the penis was 

 * Printed in abstract from the author's manuscript. 



35 



