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The blood-vessels near to and in the cancer are generally large and fatty; and it is no doubt in consequence of this condition that the hæmorrhage is so constant and difficult of control in this disorder. In a case of epithelial cancer of the uterus, I met with the appearance shown in plate 9, fig. 5. At a short distance from the tumour, a cancerous growth was observed connected with the lining membrane of a small vein. There were similar projections in some of the neighbouring veins.

It is not uncommon to find flakes, to which small cells are attached, in the blood of persons affected with cancer. These are generally referred to new growths forcing their way into the veins; but it is not improbable that in many instances they are detached from tumours arising, as in the foregoing case, independently from the lining membrane of the bloodvessels.

But fatty degeneration is not confined to the structures in the vicinity of the cancer. I have often found the muscular tissue of the heart in a state of degeneration. The fibres are very soft, their markings faint, or in some cases entirely lost, and the structure is loaded either with fat globules or granular matter. (See plate 9, fig. 1.)

The blood is very different from that of a person affected with scirrhus of the breast. It coagulates slowly and imperfectly when mixed with alcohol, and seems loaded with fat.

From these remarks there can be no doubt that as in scirrhus we have both locally and generally a tendency to the increased formation of fibres and nuclei, so, the cancers affecting the uterus and some other

organs are associated with fatty degeneration of the whole structures of the body. It is very important to bear in mind that the changes in the distant organs, such as the stomach and heart, are similar in character to those which take place in the neighbourhood of the cancerous tumour, for any severe local action, such as inflammation, produces anatomical changes in the tissues in its immediate vicinity.

But may not the morbid changes in the distant organs be merely the results of the cancer? I think not. For, as we have before seen, although animal poisons produce inflammation of the gastric mucous membrane, it is usually in the form of tubular gastritis, and we have no proof that they can give rise to the fibroid degeneration and rapid wasting of the glandular structures of the stomach so often seen in cancer of the breast. In one female who had died from the effects of amputation of a recently-formed scirrhus of the mamma, and in whom there were no enlarged axillary glands, or other secondary developments of cancer, I found extensive fibroid degeneration of the gastric mucous membrane; and in another, who died some time after the operation, without presenting any return of the local disease, the morbid changes in the stomach were very marked. In neither of these cases could the internal alterations have arisen from the effects of the local malady; for in neither was there any evidence that the system had suffered from the cancerous growth.

It

Nor can we maintain the hypothesis that the state of the digestive organs is the cause of the cancer. does indeed appear to me impossible to explain why the gastric mucous membrane should be so constantly

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affected in scirrhus of the breast and stomach, and not in cancer of the uterus or rectum, without supposing that there is some connection between those organs in the former instance. But, on the other hand, the facts, that the fibroid degeneration is often not confined to the stomach, that a similar change seems locally to precede the formation of scirrhus, and that great loss of digestive power often occurs without the production of malignant disease--all these seem to me to negative the supposition.

We must fall back, then, upon the only other remaining explanation, viz.-that cancer is a disease requiring for its development a rapid and contemporaneous degeneration of many of the tissues of the body-that, in fact, as tubercle results from an abnormal state of growth, so does cancer arise from a too sudden and rapid decay of the vital powers.

The prominent facts regarding the causation of cancer are in accordance with this theory. The tendency to its development increases with the age of the patient, and this we know is also the case as regards degenerations. It is most liable to attack the breast and uterus at the time of life at which the functional activity of these organs is about to cease. We have already seen that, after middle age, the pyloric region of the stomach loses its powers of secretion, and becomes liable to fibroid and other degenerations, and we find that this organ, and especially this part of it, stands in the third rank as regards its liability to malignant disease.

Degeneration of a tissue appears to arise from a loss of the formative power of the part in which it occurs, and it is upon the results of this that microscopists