swelling as of no consequence, readily believing that a tumour without pain cannot be cancer. This is not so, especially in the encephaloid form of the disease, for occasionally we see cases in which large medullary tumours pass through all their stages without pain; indeed, in some forms of scirrhus we find no pain for several months after its commencement.

"There is not a week in which I do not meet with patients, who, in answer to the surprise that I express at their having suffered from the disease for so long a time without speaking of it, allege as their principal excuse, But I have no pain, I have never experienced any suffering from it!'"*

Although this disease is sometimes unaccompanied with pain, yet, unfortunately, it is not always so; for the excruciating agony that the patients suffer is more than words can express. In describing such cases, Paget says, "In such a case the patient could wish herself dead,' for the sake of freedom from the fierce anguish of her pain—pain as if a hot dart were thrust swiftly through her breast, or right through her chest-pain startling with a sudden pang, and then seeming to vibrate till it fades out slowly : or sometimes more abiding pain, likened to the burning and scalding of hot water or of molten lead.

* Henry's Velpeau's Disease of the Breast, p. 426.

With such resemblances as these, do patients strive to describe the agonies, which are, indeed, beyond description, and of which the peculiar intensity is perhaps best evidenced by the fact, that the sufferers almost always thus liken them to some imaginary pain, and not to anything that they have felt before. The memories of those who have suffered even the pains of child-birth supply no parallel of that which is now endured; the imagination can alone suggest the things with which it can be compared."*

Fortunately for human nature, such cases are comparatively rare; indeed, cancer without pain, and cancer accompanied by such excruciating agony, must be considered as exceptional cases. Generally, scirrhus in the early stages has but little sensibility, examination by pressure and handling causing but little uneasiness at the time, although shortly afterwards a sense of numbness and uneasiness generally comes on. As the disease advances, the pains become more frequent, of a lancinating character, described by some like the stinging of wasps, by others like the probing of knives or lancets. These feelings are not constant, but come on when least expected, with a sudden dart, like an electric shock. Again, the pain is not one usually ascribed to this disease, being that

* Paget's Surgical Pathology, vol. ii. p. 340.

of a dull, heavy, aching character. These pains are intermittent, generally most severe at night, and I have no doubt that they are more frequent and more severe in damp than in dry weather. The sufferer can generally foretell a change of weather by the increased pain; indeed, I have some patients under my care at present who from their feelings can foretell a change some hours before it actually takes place.

As to the cause of this pain, some consider it to be owing to inflammatory action; others, again, suppose it to be purely neuralgic. This last cause is the one generally assigned by modern pathologists.

Hæmorrhage from the nipple is frequent in some stages of scirrhus of the breast; and it is often the first warning of the existence of cancer in the womb. It is most frequently met with after ulceration has taken place, and then sometimes it becomes most alarming.

Another frequent and sad symptom which I have met with during the past winter is rheumatic pains; the patient complaining of rheumatism in the shoulder, or in the hips, or elsewhere. In some few cases they in time disappear, or return periodically; but in others they gradually increase until almost every joint in the body is affected, and the patient becomes perfectly helpless. In these latter cases, recovery is very rare;

indeed, although it assumes the form of rheumatism, yet it is a specific action of the disease.

Drawing-in of the nipple is also almost always present in stony cancer of the breast.

Pattison, in his pamphlet On Cancer, mentions an important symptom which I have not seen noticed by any other writer. He says "The sufferer soon feels a numbness in the arm and hand; and there is one peculiar symptom which I have never seen mentioned in any treatise on the subject, viz., a feeling of pain in the back of the arm, immediately above the elbow joint, and also a similar pain across the back of the hand. I have met these two symptoms in almost every advanced case, and often even in those cases where the axillary glands had not yet become affected. There is also frequent numbness at the tips of the fingers; sometimes there is a pricking sensation; these last symptoms, however, are not always present."*

Having viewed some of the symptoms, it is now a proper time to look into the causes that can produce such a terrible disease. Unfortunately we know of none; here we must confess our ignorance.

"Neither temperament, mode of life, civilization, previous disease, nor moral effects have been proved * Pattison On Cancer, 1856, p. 14.

to have any special predisposing influence. The dark and the bilious are not more subject to cancer than

the light and florid.

than the poor; but

The rich are rather more liable

this is because they are not so often cut off before by other diseases. The healthy and the well-fed, the happy and the prosperous, are as liable as their less fortunate brethren."*

If we examine into what may be termed the specific causes, we find that we have no proof of the disease being infectious, although Zacutus Lusitanias and Tulpius have quoted cases to prove that it is so; but the former's statement of a solitary case wants confirmation, and the latter's story is very improbable and exaggerated.

Contagion.-Pathologists of the present day do not believe that it is contagious, although Gooch relates the case of a man, in drinking some fluid in which some cancerous matter (that had exuded from an ulcerated breast) had been mixed, in whom the disease appeared. I do not believe either in the contagion or infection of cancer, for I have daily, for years past, bent over from forty to fifty patients, breathing the exhalation from their disease, and receiving the discharge upon my hands, yet I have never experienced the slightest inconvenience.

* Druitt's Surgeon's Vade-Mecum, sixth edition, p. 111.

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