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ing it as of great importance with regard to the result of operation.

When the adventitious structure is of considerable size, and has been of long standing, we shall find the surrounding structures perfectly healthy, or a little condensed, provided no inflammation has been excited. On the other hand, where inflammation has been known to exist, either repeatedly or obstinately, the neighbouring textures are frequently, though not invariably, affected with the disease in what has been termed the infiltrated form.

It is also probably to be ascribed to the occurrence of neighbouring inflammation, that a material having, in some respects, the character of a malignant growth has occasionally been found in the vessels leading to or proceeding from a malignant tumour.

Instances of this kind have been adduced in favour of the theory that malignant disease commences by the production of an abnormal principle in the blood, an idea which appears to me equally untenable in theory and in fact.

We see wounds heal with perfect facility and in the healthiest manner in persons labouring under malignant disease, provided the part in which they are situated be exempt from the disease; a fact which seems to be irreconcileable with the supposition that cancerous matter is circulating in the blood in quantities sufficient to occasion the obstruction of vessels of considerable size. When we find in connection with parts suffering from inflammation of different

kinds, the arteries, veins and absorbents, somewhat similarly affected, in which examples we cannot doubt the influence of local disease, there does not appear to be any necessity to reject a similar influence in cases of malignant disease, in order to resort to another more improbable and more difficult of proof.

It may not be amiss for me now briefly to state the conclusions which I wish to be drawn from the observations contained in this paper.

1st. That continued observation has confirmed the constant presence of the type of compound serous cysts in a class of adventitious structures, which comprehends the whole family of cancerous diseases. I may add, that I have found it, not only in man, but also in the inferior animals, as, for example, the horse, the ox, the cat, and different species of birds.

Several practised observers have fully confirmed my conclusions, and I may here be allowed to record that the late Professor Delpech, and the present Professor Rokitanski, have personally informed me that they had independently been led to take similar

views.

2ndly. That the microscopic examination of these tissues, though extremely interesting, does not furnish perfectly conclusive tests of any particular form of adventitious structure to which a specimen may belong, but that it demonstrates the application of the nucleated cell theory, whilst it is fatal to that of cancerous matter being formed in the blood, and

eliminated at the spots at which the tumours become manifest. It therefore furnishes an important argument in favour of operation, though other practical considerations require to be attended to, before operation is decided on.

3rdly. That to have a complete view of the mode of production of these structures, we must combine the cell theory of Schwann and Müller, the coagulation principle which I had previously suggested, and the process of organization investigated by Kiernan-three stages of development which appear to occur in the order in which they have been enumerated, and that none of the phenomena, taken singly, is an adequate test of malignancy, which, as stated in my first paper, must be regarded as the sum of several characters.

4thly. That chemical analysis, though extremely important and interesting, affords an imperfect and inadequate criterion; as the principles concerned may vary, or be changed, in the progress of development.

5thly. That in operating for the removal of a tumour of this class, it is extremely important to leave behind none of those minute cysts which often form granules in the surrounding cellular membrane, though it may appear to be in other respects perfectly healthy this appears to be a mode of extension of the disease, independent of inflammation.

6thly. That experience teaches us that the infiltrated form of these diseases occurs in the structures in the neighbourhood of the purely adventitious

growth, when these structures have been the seat of inflammation, and that the chances of success from operation are consequently infinitely diminished when such surrounding inflammation has taken place. The presence of the peculiar matter of the disease, in the interior of vessels, appears to be one of the modes in which infiltration, the result of inflammation, exhibits itself, and is therefore not a valid argument in favour of the pre-existence of such matter in the circulating blood.

AN

ACCOUNT OF A CASE

IN WHICH

A FOREIGN BODY

WAS

LODGED IN THE RIGHT BRONCHUS.

BY SIR BENJAMIN C. BRODIE, BART., F.R.S.,
SERJEANT-SURGEON TO THE QUEEN, ETC., ETC.

READ JUNE 27TH, 1843.

I AM induced to communicate the following history to the Royal Medical and Chirurgical Society, believing that it embraces some points of considerable practical importance, which may be deemed not unworthy of their attention.

On the 3rd of April 1843, Mr. B. being engaged immediately after dinner in amusing some children, placed a half-sovereign in his mouth. By some accident it slipped behind the tongue, and a violent fit of coughing, in which he had the appearance of being nearly choked, was the consequence. This was immediately followed by vomiting, the contents

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