glands from scirrhus, the explanation is all the more applicable to the Rodent disease, in which those conditions fail in the most eminent degree.

The property possessed by most Cancers of infecting the subordinate lymphatic glands being usually absent from Rodent disease, it is a mere extension of this distinction between them to find the one capable of further dispersion, and the other not so. Rodent is a Cancer concentrated in its first site, and spreading only by contiguity of growth. Whilst some Cancers do no more than this, others detach fragments endued with separate vitality, and able to multiply where they next adhere. Between these extremes there is every variety and degree of endogenous growth within the body. It depends upon the accident of dispersion, whether the secondary Cancer shall appear in one or other distant part of the body. First, and most frequently, glands lodge the travelling cell, but all parts are liable to the intrusion of it. Nothing can seem more complex than those problems relating to the dissemination of Cancer which are not yet solved, and among them is the question whether the cancerous matter, as it accumulates in the system, tends to any special organ for its elimination. But, whatever the progress of Cancer when once established in the body, its origin is simple, and need not be complicated by its subsequent progress. I have elsewhere endeavoured to

distinguish these questions from one another, and have concluded that Cancer originates where it first appears, and becomes a constitutional disease only after it has been primarily a local one.* It is a confirmation of this opinion, that there is a disease presenting every local character of Cancer, but failing in that quality of ubiquitous reproduction, which depends upon the mobility or the superior vitality of the material of which it is composed.

There is an especial and considerable similarity in some points between the Rodent disease of the face and the very slow 'phagedænic' Cancer of the breast. Both are very concentrated, and of very slow growth, and both show a marked preference for extension by the skin. In both, also, the process of destruction almost keeps pace with the new formation, and their meagreness prevents their dissemination. Only in the modes of their destruction are they unlike. Instead of ulcerating, which the Rodent growth readily does, the mammary cutaneous Cancer tends to wither after a certain duration of life. It thus presents the appearance of a solid slowly growing margin, with a central or following shrunken tough scar, or with here and there a very superficial ulcer. The truly cancerous nature of the mammary disease would appear as doubtful as that in the face, if, after

The Antecedents of Cancer, 1865.

a duration of perhaps twenty years, it did not somewhat rapidly grow, and destroy the patient by a widely spread local, or by constitutional Cancer. The Rodent disease, likewise, towards the end of life, though it does not spread to distant parts, yet does advance locally with a more rapid solid growth, and presents a more distinctively cancerous ulceration.

Under the name of Cancroid, M. Lebert has grouped with the Rodent disease of the face various other growths and ulcerations. Relying upon the character of ulceration, he associates with it the perforating ulcer of the intestinal tract and the Rodent ulcer of the uterus; and in consequence of dissimilarity in their microscopic elements, he ranks with the Rodent disease, and not with scirrhus or medullary, all epidermal or epithelial productions, however their clinical progress be analogous to that of Cancer. Hence his group includes alike the rapidly diffused and fatal Cancers of the genitals, epithelial tumours of the arachnoid, epithelioma of the uterus, and—though he has never traced its origin to an epithelial growth, and though, by his own statement, it frequently heals-a gastric ulcer. The alliances of these diseases with one another are far less striking than the connections of some of them with ordinary Cancer; and in nothing more distinctly than in this, that fragments of them, though formed

in the generative organs, or in the skin, retain their vitality, and grow largely when transplanted to the liver or the lungs. The gastric ulcer is not one of these. Whatever be its nature, it fails in those characters which connect the ulcer in the face with Cancer. The perforating ulcer of the stomach has a marginal thickening, but none of the solidity of the Rodent disease, neither is an epithelial microscopic element detected in it, the presence of which is a strong reason for placing Rodent disease among the Cancers. The gastric ulcer appears to be arrested in its progress by its thickened edge, which is therefore a curative part of it; but the solid exterior of the Rodent ulcer is the means of its extension. On this difference it depends that the gastric ulcer deepens more than it spreads abroad, there being little or no solid substance at its base; while the Rodent ulcer extends in every direction; nowhere without its preceding solid base, and furthest where that is most easily formed. Hence also the gastric ulcer is a deep and often circular pit; whilst the characteristic of the Rodent is its width. Considering these fundamental distinctions between the ulcer of the stomach and intestinal tract, and the Rodent facial disease, I should exclude that ulcer from amongst the Cancers and the Cancroids; but at the same time I should join M. Lebert in connecting the Rodent with the other diseases which make up his group

of Cancroid, and should add to them that form of fatal and infecting cell-growth which sometimes comes on in chronic ulcers. In these various forms of epithelial growth and decay, most British Surgeons recognise the nature of the disease which is designated Cancer. M. Lebert's grouping and my own observation of the characters of Rodent disease of the face agree in showing its title to be held as Cancer.

A

The tongue has been found partly occupied with a tumour which existed in a state of ulceration for many years, and after death presented a dense thin margin, in which there were no microscopic cancerous elements. Such a tumour appeared to Dr. Bristowe and Mr. Jonathan Hutchinson, who examined it, to be of the nature of the Rodent disease of the face. I am led by another case, however, to think it probable that this disease was essentially cancerous. gentleman, aged about 64, was committed to my care by Dr. Crompton, of Manchester, with a mass of rather rapidly growing Cancer, as large as a small chestnut, in the left side of the tongue, the anterior pillar of the fauces, and the adjoining portion of the lower jaw and gum. In the digastric triangle were two hard and enlarged glands. The history of the case was, that Mr. Paget had removed a tumour from that situation, which was entirely devoid of microscopic cancerous elements, and that the patient