D. of the same, aged 54, 1827.
3. Generation. Mrs. B. had 5 daughters and 2 sons.
1. Son died young.
2. Son died of cancer of the stomach, aged 64.
3. Daughter died of cancer of the breast, aged 35.
4. Daughter, of the same.
5. Daughter, of the same. aged between 35 and 40 years.
6. Daughter, died of cancer of the liver..
7. Daughter, remained free of cancer.
In another form, I might say more localized, Cohnheim' has conceived the beginning of the tumor as an exquisitely and even exclusively congenital one. He first of all excludes a large part of the disease-processes and products, which Virchow had introduced into oncology, and places again the origin, as the older pathological anatomists and gynecologists had limited it. Further, from different critical discussions, he comes to the conclusion, to which I entirely assent, that the most important difference between a tumor formation and the inflammatory neoplasms can lie only in the territory of etiology, as all clinicians will agree without hesitation. Finally he says: "The main point is and always will be, that it is a fault, an irregularity of the embryonal foundation, which must be sought as the true cause of the later tumor." Without regarding this view as more than a plausible hypothesis, Cohnheim subsequently deduces the theory that there are probably always parts of a tissue or organ which have not come to normal physiological function on account of some disturbance of development, and from which tumors are formed during life. In so ingenious a manner is this train of thought of Cohnheim carried out and supported, partly by known, partly by new observations, that one is cer tainly, at first thought, somewhat impressed by the boldness of seeing a hypothesis, hitherto employed in explaining a few rare forms of tumor, suddenly set up as the etiological factor of tumors in general. But on more mature consideration, one can scarcely deny the fact that this hypothesis has a great deal in it, notwithstanding that its fundamental principle can scarcely be established even by direct research. It would be too much of a digression were I to more closely examine everything favorable or un favorable to Cohnheim's view. Yet I shall make a few observations on it as regards the mamma. According to Colinheim, tumors would only originate in those mammm in which an "irregularity of the embryonal foundation" exists somewhere. In my opinion we should not take this literally for the mamma; an organ which is developed in three stages, (fetal formation, further development at the time of puberty, and complete growth with the first pregnancy), is exposed to irregularities of develop ment in each of these three stages. These irregularities may probably only be shown in that, in a gland which, except as to difference in size.
continually spreads like a tree, a developed branch or a developed lacteal cluster(of vesicles) is cut off from its connection with its trunk, its excre tory duct, by constriction. Probably this can never be proved anatomi cally, and as we can only examine microscopically the snutllest parts of these glands by sections, the proof of the non-connection with the gland ular tree can never be exact.
We may expect now any kind of abnormality from such a disconnected portion of gland, which either never or at most incompletely attains a physiological function, whenever any irritation acts on the gland-cells condemned to isolation; but it is hard to understand why without such an irritation the affected portion of the gland, in these abnormal circum stances, cannot remain quiet throughout the whole life. It seems to me that even on this hypothesis the assumption is not supported that cer tain physiological internal or traumatic external irritations operate upon such abnormal foundations as the exciting cause for the development of the tumor, so that what has been said before will be in no way upset by Cohnheim's hypothesis.• We are in a far more difficult situation when we wish to clear up with the aid of Cohnheim's hypothesis, the origin of those mammary fibromas, sarcomas and chondromas (in bitches), in which the epithelial elements of the gland take so small a part that there can he no doubt as to their sole origin in the connective-tissue-like interstitial and supporting tissue. We would then have to assume that in the different stages of development, through which the mamma passes, occasionally a small focus of embryo nal connective-tissue elements remains here and there for years in the stage of indifferent cellular tissue, and then on the occasion of an irrita tion, which even here we cannot do without, suddenly develops to this or that pathologically formed connective tissue. I freely admit that I can not really agree to this, especially in cases in which such a connective tissue tumor includes probably a fourth or a third of the glandular ele ments of the whole mamma. Also for those giant tumors, the cysto Earcomas, which affect the whole mamma of women who have formerly nursed their children in a natural way, as well as for those cases of bilateral diffuse sarcoma of the whole mamma which originate during pregnancy, though so rarely, Cohnheim's hypothesis offers great difficul ties. I am always ready to acknowledge that Cohnheim's statement has impressed me so very much, that the impression contributes materially in checking my intention of criticizing it sharply.