The patient was thirty-five years of age, and had a cancerous ulcer on the internal surface of the cervix uteri, which had appeared after a continual evacuation of an offensive secretion during several years, and sanguinolent discharges two months previous to the interview. This patient had been one of questionable morality, and Mauriceau found that she had suffered from gonorrhoea of a virulent character, which he believed had materially contributed to the formation of the malignant change. She died five months afterwards.1

Case DXXXV. is dated August 10, 1688, four months after delivery. The patient had a carcinomatous growth occupying the whole lower section of the uterus, and extending to the neck of the bladder, causing a constant involuntary discharge of urine. The author prognosticated a speedy and fatal termination, but the sequel is not mentioned. The offensive and abundant discharge had existed during the whole of pregnancy, and was believed to have been caused by a virulent gonorrhoea.2

The fifth case (DLVII.) occurred August 5, 1689. The pains of labour were just commencing, and the patient had voided, for two or three days, a considerable quantity of coloured serosity of a very offensive odour, which circumstance induced the sagefemme in attendance to seek the assistance of the writer. Having made an examination, he found the lower part of the uterus occupied by a cancerous growth; and as this kind of offensive leucorrhoea had been experienced during the whole of pregnancy, he judged the malignant change to be owing to a venereal affection with which she had been previously troubled. The husband had been affected with an erup

tion about the lips, of venereal character, for some time past. The patient died in a short time after.1

The last case recorded is that marked DCXCI., and occurred August 10, 1693. The patient had been troubled with an offensive leucorrhoea two years, which had, during the preceding six months, been occasionally mixed with blood, escaping, from time to time, in form of large coagula. He found the lower portion of the uterus occupied by cancerous ulceration, which had supervened upon an attack of virulent gonorrhoea, of more than twelve years' duration. He remarks that these kinds of ulceration, which are always incurable, however trifling in appearance they may seem to be,-arise, for the most part, from the same cause; and, being misunderstood by those who are thus afflicted, are liable to be mistaken for cases of simple leucorrhoea; "elles qualifient les vilaines excrétions purulentes de ces ulcères malins, du nom de simples fleurs blanches. . . . Mais il est facile de juger," continues this author, "par l'extrème puanteur de ces excrétions, qu'elles viennent d'un ulcère carcinomateux de la matrice, dont l'orifice interne est pour lors tout skirreux et tout inégal; ce qui se connait aisément par le simple toucher du doigt.

Case XXIX., of cauliflower cancer, recorded in the preceding chapter, was clearly the result of a venereal affection, the incipient manifestation having been a warty state of the cervix uteri.

Mauriceau believes that the only mode of treatment by which amelioration of the symptoms can be effected in these cases is reiterated venesection. "Le plus souverain remède dont la femme de cet âge (during the middle period of life) puisse user pour s'en préserver, et pour se 'Op. cit., t. ii. p. 462. 2 Op. cit., t. ii. p.

563.

garantir aussi de beaucoup d'autres incommodités auxquelles elle est ordinairement sujette en ce même temps, est la saignée souvent réiterée, afin de suppléer au defaut de l'évacuation menstruelle, et d'empêcher que le sang et les humeures ne se portent en trop grande abondance à la matrice." The late Mr. White, Surgeon to the Westminster Hospital, told me that Mr. Abernethy had a case of genuine cancer of the breast, which, by repeated ab straction of blood in small quantities by means of leeching, was kept in subjection twenty-two years, and the lady at length died from the effects of another disease. Acting upon this principle, I have succeeded in keeping down a cancerous tumour of the breast during a period of nine years, and the affection has at length disappeared from the part altogether. That the tumour was cancerous there can be no doubt. The patient's mother died of uterine disease of long duration, which in all probability was malignant, as it was attended with profuse, offensive, sanguinolent discharges, lancinating pain, emaciation, and the carcinomatous complexion. Such inference is further strengthened by the fact, that her maternal aunt died of cancer of the breast. The patient's ailment commenced at the age of thirty-two. It supervened after some months, upon a very slight blow, accidentally received on the part where the disease afterwards manifested itself. The tumour was at first isolated and moveable, but afterwards became fixed to the surrounding textures. It was very hard, nodulated, tender to the touch, attended with severe shooting pains, retraction of the nipple, and escape of blood from the mammillary pores.

301

CHAPTER IV.

EXTERNAL CHARACTERS OF CONSTITUTIONAL SYPHILIS.

THERE are sufficient reasons for believing that the blood of persons labouring under diseases of this class is in a depraved state from the onset of the attack to its termination; and it is probable that this abnormal condition is due to the addition of some noxious agent, the precise nature of which, microscopical and chemical processes have so far failed to determine. The potency of this morbid principle is sufficiently evident in the effects which it produces,-the perversion, for instance, of the processes of nutrition, the impairment of organic function, disturbance of the fundamental arrangement of the solid tissues, derangement of the health generally, and the consequent abridgment, in many instances, of the natural term of life. But, although too imperfectly understood to be indicated by any term expressive of its precise nature, it may nevertheless be adequately represented by the general denomination of Venereal Dyscrasis.

That this abnormal state of the circulating fluid depends upon the addition of some principle not naturally belonging to it, may be inferred from the train of pathological phenomena which its presence determines upon different parts of the body; and such inference is further countenanced by the constant and uniform gradations manifested in the occurrence of certain inflam

matory, exudative, ulcerative, and exanthematous processes, of a character not seen in any other class of diseases, which supervene at certain intervals, after its introduction into the system. These processes succeed each other with a degree of regularity sufficiently marked to be susceptible of arrangement, by aid of which knowledge their orderly appearance may, with tolerable certainty, be looked for, at least during the primary stages of the complaint. When the primary phasis has gone by, that is to say, when the secretion of the sores no longer possesses the property of producing a primary sore by inoculation,-the subsequent development of the symptoms is less certain as to time, although equally certain as to the appearance of the phenomena, if uninterfered with by treatment, and to a certain extent if improperly treated. Great dissimilarity exists, however, in different individuals, of adult age especially, relative to the length of time required for the development of the secondary phenomena after the disappearance of the primary symptoms in those who have experienced the disease in its acute form, as well also as in infants who have inherited the secondary taint, under varying circumstances. This irregularity depends in some measure upon the following conditions, and perhaps upon others of more recondite nature:-1st, the temperament, habit of body, predisposition, state of the general health, and power of resistance which the system may happen to possess at the time; 2nd, the benign or virulent nature of the poison imbibed, for there seems to exist a notable variation in this respect; 3rd, the stage of the disease existing in the person from whom the taint has been derived at the time of its transplantation, and the remoteness of the primary infection; 4th, the medium through