EXTRACTED FROM THE AMERICAN JOURNAL OF THE MEDICAL SCIENCES 
FOR JULY, 1876. 
AN 
Unusual Case of Cancer. 
BY 
JAMES S. GREENE, M. D„ HARV., 
OF BOSTON (DORCHESTER), .MASS. [Extracted from the American Journal of the Medical Sciences for July, 1876.] 
AN UNUSUAL CASE OF CANCER OF BREAST, 
WITH 
Tissue Infiltration and Cachexia; Child-birth and Post-partum Hemor- 
rhage; Retrogression of Disease and apparent Restoration to Health 
for more than two years; Excision of Mamma owing to Renewal 
of Disease; Subsequent Appearance of Cancerous Nodules in the 
Skin; Death after two more years of slow decline, accompanied 
by some symptoms pointing to Intracranial Disease; Autopsy; 
Remarks. 
By JAMES S. GREENE, M.D. Harv., 
OF BOSTON (DORCHESTER), MASS. 
The patient whose case is here recorded first came under my observa- 
tion in the summer of 1870. She was then forty-five years of age, mar- 
ried, and the mother of five healthy children. All her brothers and sis- 
ters, four in number, were living and well; as likewise her mother. Her 
father died of acute pulmonary trouble at the age of seventy-six. All 
the ancestors, as far back as to include the great-grandparents, lived to 
advanced age, and showed no taint of cancer, or other hereditary disease ; 
and the only instances of cancer known in collateral branches are a 
mother’s cousin, upwards of seventy, and a maternal cousin still further 
removed, dying at eighty, both of reputed scirrhus. 
This lady was above the middle stature of her sex, of good figure and 
erect carriage, having a fair complexion and light-brown hair. Born in 
Massachusetts, her life had been passed in her native State, excepting 
some later years in California, where she had intermittent fever. Her 
health otherwise had been excellent. She was prevented from nursing 
her eldest child by the occurrence of inflammatory trouble of the left 
breast; with her other children lactation was normal. 
About the end of April, 1870, she became pregnant with her sixth 
child. In June she revealed the fact, concealed for some unknown length 
of time, that she had a disease of the left breast. 
Having arrived at Boston from California, July 5th, she consulted Dr. 
Henry J. Bigelow, who now distinctly remembers and describes her dis- 
ease as “ a thorough-going cancer of the breast, in active progress and 
highly vascular.” 
He advised non-interference, except with means for relief of pain, until 
after recovery from the expected confinement, and his advice was followed. 
February 4, 1871, after a labour of two hours’ duration, she gave birth 
to a healthy female child weighing ten and a half pounds. Flooding ad 
deliquium followed, though the uterus was prevented from relaxation by a 2 
firm grasp over the fundus, maintained from the moment of the expulsion 
of the child until the danger was past. The pulse was almost, and part 
of the time quite, imperceptible for two hours and more; but, by prompt 
and diligent efforts, restoration was finally secured. 
There was no attempt at lacteal secretion in the diseased breast. 
Strength returned very slowly, and it was not until the latter part of 
May that she a second time visited Dr. Bigelow, and renewed the question 
of surgical interference. He found the tissues near the breast so impli- 
cated in the disease that he again, and finally, advised against an ope- 
ration. 
Her condition at the end of May was as follows : Dull eyes, a haggard 
countenance, paleness and sallowness of complexion, and weakness were 
marked symptoms, chargeable in part to the progress of organic disease, 
in part to antemia resulting from the post-partum hemorrhage; while the 
vascularity of the local disease had probably lessened since child-birth. 
The left breast was hard and firmly adherent to the pectoral muscle, and 
was crossed by a horizontal furrow, into which the nipple was deeply 
drawn. This sulcus was filled with a scab, moistened by a slight, exco- 
riating discharge, and the surrounding skin was bright-red for the space 
of a few lines. The left clavicle had a central point of extreme tenderness 
to touch, and above and below it the tissues were tense, indurated, and 
painful. There was also some thickening of the tissues near the right 
clavicle. Some glands in the left axilla were enlarged and tender; left 
hand was puffy and somewhat livid. Movement of the arm greatly re- 
stricted and painful; not more than three or four inches space between 
elbow and side could be tolerated in adduction, and rotation was almost 
wholly prevented. 
Just at this time cundurango bark was first advertised to possess spe- 
cific virtues against cancer. 
The patient went to Washington, where she remained about six weeks, 
taking the bark under the direction of Dr. Bliss. The supply, scanty 
from the beginning, and doled out in the most frugal manner, then became 
exhausted ; and, July 10th, with a certain improvement in condition, she 
returned to Massachusetts, there to await a new invoice of the alleged 
cancer specific. This was received, and its use resumed about the end of 
the same month. She then used, in addition to a decoction of 5'j of the 
bark daily, a tincture made by percolation of the residue with alcohol. 
August 8, ten days after she resumed the use of the drug, an oppor- 
tunity was granted me to examine the breast. Its redness had disap- 
peared, so had some of its former hardness ; it was movable on the under- 
lying muscles. Manipulation did not elicit pain nor tenderness. The 
horizontal sulcus which included the nipple appeared to be less tightly 
drawn. That portion of the scab which had filled the inner half of it, 
having become loosened, had been removed by the nurse and had not 
been reformed. There appeared to be a letting out of a margin of skin 
which had been drawn into the furrow. There was a spot on the left 
clavicle still a little tender to pressure; and the infiltration of the adjacent 
tissues, though less marked than before, was noticeable. There were no 
longer any tender or enlarged glands in the axilla. The puffy, livid ap- 
pearance of the left hand, remarked only a few days previously, was 
wholly gone, and the arm had regained considerable freedom of motion. 
August 16, a further “letting out” of the skin from the sulcus in the 
breast had become very perceptible, and the range of movement of the 3 
arm was daily increasing. There had been a slight menstrual flow two 
or three times, at irregular intervals, and I think the final cessation of the 
catamenia took place about the last of August. 
The history of the next two years of her life may be condensed into a 
few sentences. She rapidly reached, and maintained during most of that 
period, a condition of thoroughly good health ; having early lost all out- 
ward signs or symptoms of disease. Complexion, eye, and movement all 
betokened health and strength, and in 1872 she weighed more than ever 
before. Coincidently all local infiltration of tissue disappeared. The 
arm regained its entire mobility and freedom from lameness, if not its full 
strength. 
The process of absorption of morbid deposits did not reach its full com- 
pletion in the breast itself, for the nipple continued to be in some degree 
retracted. The shallow groove around it became free from any unwhole- 
some secretion, and the gland, though harder than normal, was without 
tenderness. 
During this period she was taking liberally of cundurango, under the 
direction of Dr. Bliss. Sometimes its use was suspended for awhile, but, 
allowing for these intervals, she probably took it in full doses at least two- 
thirds of the time. 
In the later months of the. period now under notice, while her general 
condition remained good, and she ate and slept well, there was neverthe- 
less a perceptible lowering from the standard of thorough good health. 
During some of these weeks she would be rather nervous, and would feel 
fretted because she had not her usual executive ability. All this time her 
residence was in Massachusetts, though visits of a few weeks were made 
both in California and at Washington. 
In September, 1873, the family removed to Washington, and I did not 
see the patient until the following April. I learn that she began, as early 
as October, to be apprehensive of a renewal of the disease in the breast; 
but she only took her medicine the more diligently, and said nothing. It 
was not until February, 1874, that her husband became aware of the recur- 
rence of local symptoms ; and Dr. Bliss, being consulted, advised, and soon 
afterwards performed, the operation of excision of the mamma. 
The wound healed well, but the patient was still weak from the effects 
of the operation, when required to undergo the fatigue, anxiety, and respon- 
sibility attending the illness and death of her mother; This involved a 
journey to the north early in March, a return journey with the sick 
woman the beginning of April, devoted attendance for rather more than 
two weeks longer, and a second journey to Massachusetts with the remains 
for interment. To this period, immediately succeeding the surgical opera- 
tion, are referred the slighter beginnings of a new class of symptoms, 
traceable to the nerves and to the nerve centres, pointing to a stealthy, 
hidden influence, harassing, weakening, and finally destroying the powers 
of life near their source. 
The increasing feebleness, which I could not fail to notice on the occa- 
sion of the above-mentioned visits, was attributed by her friends to fatigue 
and anxiety. It has since been said that she never seemed to recover from 
the shock of the surgical operation. Periods of languor, pallor, indispo- 
sition to move occurred, and increased in frequency. Iligors came at 
irregular intervals, suggesting the revival of former malarial influences. 
Pain, both of fixed and darting character, in back and limbs, became trou- 
blesome. This was called rheumatism, or sometimes neuralgia. Her 4 
husband, ever devoted and full of resource, maintained that she was over- 
come by the heat of Washington latitude ; and, July 1st, brought her 
north to Massachusetts, where she remained for six or seven weeks, always 
bravely resisting the progress of enfeeblement. 
August 18th she was taken by her husband overland to California, 
where, almost as soon as she arrived, she succumbed to nervous prostra- 
tion. This illness proved serious and prolonged. It was called malarial 
fever, from the frequent occurrence of chills ; there being a settled policy 
never to admit the possibility of a return of cancerous cachexia. Indeed, 
cundurango was held to be the restorer and preserver of her life, and was 
still used largely. These nervous chills were frequent and prolonged ; a 
sip of water would often induce one. Another persistent and perplexing 
symptom was a quick, feeble, very irregular, and intermittent pulse. Quinia, 
to the extent of twenty grains daily, was used, with good effect on the 
pulse. 
I do not learn that much fever was present, but do not suppose that any 
thermometric observations were made. There was no headache, and the 
patient’s own mental operations were as clear and rapid as ever; but she 
began to require that any one who addressed or read to her should speak 
slowly. At other times she could tolerate no talking near her. In the 
middle of December, four months after leaving the Atlantic coast, she had 
rallied sufficiently to venture upon a return. The journey, made with 
every modern appliance for a sick person’s ease, and with attentive nurs- 
ing, did not cause exhaustion nor apparent strain of such of her powers as 
remained ; but on her arrival at Washington, every attempt at resuming 
the least part in social or home affairs resulted in most discouraging pros- 
tration, attended by pallor and disinclination to move. Talking in her 
presence would then be distressful. She no longer had chills. 
Through that winter, and until the succeeding summer of 1815, she 
remained at Washington, and this unequal, but still courageous contest 
continued against the lurking, concealed disease. One letter would inform 
us of her sitting up to receive visitors, or even driving out to Arlington 
Heights; the next would describe her in a state of prostration seemingly 
but little less than collapse. 
She came to Massachusetts, her last journey, the first of July, 1875. 
The trip seemed to exhaust the last particle of physical energy. In one 
or two drives that she attempted after her arrival, the pallor, the dull, 
glassy eye, the expressionless countenance, gave her almost the aspect of a 
corpse sitting and moving ; nevertheless nearly six months of existence still 
remained. 
My attention was called to the presence, on the integument of the head 
and back, in the flexure of the thigh, and in the line of the cicatrix on the 
breast, of several painless nodules, probably twenty or more in number. 
In shape and size they were like fully-developed vaccine vesicles, umbili- 
cated, without areolae, and, in colour, like the surrounding skin. They had 
begun to appear several months previously, and did not increase in number 
nor change in appearance during the remainder of life; but some of them, 
pressed upon as she lay, finally became very painful. At one or two 
points along the scar on the breast there was a slight scarlet blush, and 
this also henceforward remained stationary. Not only the cicatrix, but the 
whole surrounding skin over the space formerly covered by the mamma, was 
firmly fixed to the chest walls ; and this region was the seat of a good deal of 
pain. Soon, however, pain of a much severer and more persistent character 5 
attacked the right side, beneath the lower ribs; and when this ceased, after 
about a month, there remained lasting numbness of the same parts. About 
the same period there occurred hypenesthesia of the skin and mucous mem- 
brane of the cheek and lips on the left side, and of the surface of the chin ; 
and this becoming persistent, though unattended by any marked appear- 
ance of motor paralysis, nevertheless prevented mastication, and limited 
the patient during the remainder of life to liquid diet. There was also 
incipient palsy of the left upper eyelid ; and by the middle of August this 
had slowly developed into complete ptosis, with divergent strabismus of 
the same side, and she spoke of seeing objects double. During this time her 
rapidly failing strength compelled the relinquishment of all effort. She 
ceased to ride, to sit up, to recline in a hammock. The slightest muscular 
effort was usually attended by pain somewhere, and followed by exhaustion. 
Remaining almost motionless in bed, sounds, even the slightest, became 
intolerable. All noises, even to the rustle of a dress, were abolished in 
the house. Nevertheless, in her quieter moments, she read with her one 
useful eye, and wrote cheerful letters to her husband, then unavoidably in 
California, concealing from him all unfavourable tendencies and symptoms. 
These became so threatening, however, that, in the middle of August, I 
sent a telegraphic message advising his immediate return. She, ignorant 
of this, sent the same day a brave letter, while the effort of writing cost 
her some days of great pain in the back, shoulders, and neck, keeping her 
for the time almost motionless. The pulse at this period was once more 
irregular, intermittent, and weak. A little later, under the use of quinia, 
it regained considerable steadiness. The distressing hypersensitiveness of 
hearing gradually ceased during September; and, about two months before 
death, it was accidentally discovered that there was deafness of the right 
ear. 
Among the symptoms always noticeably absent were irritable stomach 
and headache. During the last weeks there were times when her head 
“felt dreadfully”—she could not describe it, but it must be bathed or 
stroked or combed very carefully, avoiding the nodules, and she must not 
be troubled with words. She partook liberally of a variety of liquid 
nourishment until the last hours of life, but during the last few days the 
sense of taste was manifestly lost. She usually had considerable sleep at 
night, and some by day. Decubitus was wholly on the back ; she could 
move her limbs, but had no power over the trunk. Passive motion of the 
upper part of the body was very distressing, and for days together the 
slightest attempt at changing its position inflicted torture. Constipation, 
and the occasional resulting necessity of relieving the rectum of its accu- 
mulated contents, became a source of serious suffering and exhaustion. 
The tendency to remission and exacerbation was traceable throughout, 
so that while the tide of disease constantly encroached upon the powers of 
life, it did so by successive wave-like advances and recessions. Thus, as 
in Washington months before, brief intervals of activity came between 
periods of prostration, so, now, days of comparative comfort intervened 
to relieve the distressful soreness of body. At times her tongue, commonly 
deep red and covered with a thick white coat, gradually became, and for a 
short time remained, clean and normal in colour. Towards the close, 
short times of such exhaustion came that life often seemed nearly pushed 
from its foothold in the body ; then rallied and made a feeble stand. 
I do not attribute this trait to malarial influence, for I do not know 
that it was more noticeable than in many cases of prolonged disease 6 
where the circumstances exclude suspicion of such agency. Indeed, this 
tendency to periodicity, seen everywhere throughout nature, was, perhaps, 
especially conspicuous here owing to the level steadiness and undeviating 
onward progress of the current of disease, permitting a view of each undu- 
lation in its course. 
In the last days of life the power of articulate speech had become so far 
withdrawn, partly through weakness, partly from actual palsy, that she 
uttered only a few words very indistinctly. 
Death came the 16th of December, 1875, from no other apparent 
proximate cause than asthenia. The power of voluntary motion gone, 
slowly the vagus nerve seemed to yield its function. The conscious mind 
probably maintained its seat almost to the end. 
It will be seen from the foregoing record that the duration of her dis- 
ease, allowing for the probable time when she was withholding the know- 
ledge of it, was not much less than six years. 
More than four and a half years of life remained after the opinion was 
given by the highest surgical authority that the disease had already too 
far contaminated her system to warrant an attempt at relief by the knife. 
Following this expression of opinion, began rapid retrogression of the 
disease and recovery of health, fairly maintained for nearly two years and 
a half. Then came local relapse, culminating in excision of the mamma 
and complete removal of all external evidence of disease ; and finally, 
thereafter, something less than two years of slow decay preceding the 
fatal issue. Her age at death was fifty years and nine months. 
The day following death I availed myself of permission gained to make 
a preliminary examination of the contents of the thorax and abdomen. 
On the whole left front of the thorax the skin was tightly adherent to 
the ribs and intercostal muscles. The left lung was free from disease, but 
contained no air, being compressed by a collection of from two to three 
pints of clear serum. From the base of the lung extended a narrow, very 
strong fibrous band to the costal pleura. The right pleural cavity con- 
tained a half pint of serum. The spleen was somewhat enlarged. All 
the other parts appeared healthy. 
Five days later, leave was granted to examine the brain ; and an 
autopsy was carefully performed by Dr. R. H. Fitz, Pathologist of the 
Massachusetts General Hospital, who has kindly furnished me with his 
minutes, as follows :— 
“Autopsy.—Six days after death. Body exceedingly well preserved, much 
emaciated. A cicatrix, resulting from the removal of the left breast, in the 
vicinity of which, as well as elsewhere in the skin of the thorax, abdomen, and 
head, were several dense, flattened, rounded, somewhat elevated cancerous 
nodules, often umbilicated. 
“The pericranium was infiltrated with the new formation as dense, gray 
slightly translucent patches. Calvaria thick and heavy from condensation of 
the diploetic. portion. Dura mater unusually adherent; its periosteal surface 
presented diffused, slightly elevated patches of new formation. The inner 
surface of the dura, especially on the right side, in the frontal and parietal 
regions, studded with dense, gray nodules and patches, in parts confluent, the 
largest three-fourths of an inch in diameter and one-fourth of an inch in thick- 
ness, to many of which the pia mater was intimately adherent. Between and 
sometimes upon these growths the dura presented a delicate, thin, vascularized 
false membrane, containing numerous small points of hemorrhage. The vessels 
of the pia mater, injected; over the pons Varolii, anteriorly, slightly thickened 
and opaque. The brain in general apparently normal; the ventricles not 
dilated. “The third pair of cranial nerves on the left, just before passing under the 
clinoid process, became suddenly of nearly twice the ordinary thickness, gray, 
dense, homogeneous, thus extending along the wall of the cavernous sinus. 
“A nodule of new formation, as large as a pea, was found in intimate relation 
with the fifth nerve as it entered the right Gasserian ganglion. The motor root 
of this nerve was outspread upon the nodule. The thoracic organs presented 
no evidence of disease; the pleural surfaces apparently healthy. Spleen mode- 
rately enlarged, dark, and firm. Nothing abnormal found in the abdominal 
cavity. 
“ The structure of the nodules in the dura mater and skin was composed of 
a dense, fibrous stroma inclosing alveolar spaces, round, oval, and elongated, 
in which were groups of large, irregularly polygonal cells, but little degenerated 
and with large nuclei. There was no evident intercellular substance. Their 
arrangement at times was that of anastomosing bands. 
“Diagnosis.—Cancerous meningitis and neuritis, with hemorrhagic pachy- 
meningitis. 
“ With regard to symptoms, the examination explains only in part. The 
affection of the muscles of the left eye is apparent. The alterations united with 
the right fifth should be rather neuralgic, motor of the masticatory muscles, 
with possibly some affection of taste through the lingual nerve. 
“The hemorrhagic inflammation of the dura—the pachymeningitis interna 
of Yirchow—might explain a good many mental peculiarities, to say nothing of 
subjective and objective phenomena. The left-sided facial paralysis below the 
eye was not explained anatomically.” 
Among the many points of interest in the foregoing history, the signal 
retrogression of the far-advanced disease is especially prominent and note- 
worthy. 
Yelpeau emphatically denies the possibility of such an occurrence. 
“ Une fois ne, on ne voit point le cancer retrograder absolument; si la tumeur 
diminue parfois sur un point, c’est qu’il s’en forme ailleurs ou que l’6conomie 
s’infecte. II n’y a pas plus lieu d’esp6rer la disparition spontanee d’un cancer 
quand il est petit, du volume d’une t§te d’6pingle par exemple, qu’ it partit du 
moment oh il 6gale le volume du poing ou de la tete.” (Traits des Maladies 
du Sein, Paris, 1858, p. 513.) 
He admits, in scirrhus, one seeming exception, namely, the atrophic 
variety, so called; but avers, in opposition to Yirchow, that even this form 
is as steadily progressive in its way as any other. 
This atrophic scirrhus, however, has no analogue nor illustration in the 
case I have detailed, which, as we have seen, is an instance of retrogression 
not merely of the tumour, but of all visible signs and symptoms of disease, 
both in the tissues surrounding the tumour and in the general economy; 
and, as such, remains among recorded cases a very rare, and, perhaps, en- 
tirely unique one. 
Is it possible satisfactorily to account for the phenomenon of retrogres- 
sion as here displayed? 
Dr. Bigelow emphasizes the consideration that the juiciest period of the 
disease was coincident with pregnancy, when the mamma was in its high- 
est state of functional activity; and his comment, I suppose, would be 
that the most favourable time for a pause in the progress of malignant 
disease is when local physiological activity has just ended. It is even fur- 
ther not unlikely that a physiological retrogression of the functionally 8 
enlarged breast might be associated with the retrogression of a neoplasm 
in such breast. 
Secondly, it is possible that not only the physiological crisis, but the 
appalling puerperal accident attending it, proved ultimately an advantage. 
If the patient had constitutional power enough to rally with any vigour 
from such a shock and loss of vital fluid, the repair would naturally be 
less obstructed, and the healthful efforts would gain better ascendancy after 
the veins had been drained of the mass of blood which must, at that stage 
and condition of the disease, have been loaded with morbid material. 
Next, these physiological conditions were reinforced by psychological 
ones of no little power. This patient had a vigorous constitution and a 
strong will. She had also a susceptible mind and an impressible nervous 
organization. One possessing such a temperament would droop rapidly 
when faced by the horrible spectre of cancer, and assured that hope must 
be left behind; and under such circumstances the disease would advance 
with redoubled swiftness; but aided by the same temperament, the forces 
of life would grandly reassert their influence, if hope were substituted for 
despair by the assurance of rescue by means of an unlooked-for, and, until 
then, unknown antidote. 
Cundurango bark was just then introduced through the channel of the 
State Department at Washington, and extraordinary specific powers 
against malignant disease were claimed for it. The husband of my 
patient, standing near this official source of the meagre information then 
received concerning the alleged remedy, willingly convinced himself that 
here was the destined agent of her cure. I think it is literally true, and 
not a mere figure of speech, that her failing powers were first re-energized 
from the ample resources of his overflowing, sanguine vitality, lavished 
on her with the deliberate purpose to admit no doubt nor questioning. 
The returning health current, when thus set in motion, was strengthened 
and steadied by the power of her own will, the natural vigour of her con- 
stitution, and every aid that change of air and mental diversion could 
furnish; while it was kept free from contamination by the depuration of 
her blood through depletion, and by the cessation of functional activity in 
the tissue which was the local fountain-head of the disease. 
All these conditions and agencies, namely, the physiological crisis, the 
hemorrhage, the quality of the patient, the incidents and accidents of her 
station, are, without doubt, when combined, sufficiently powerful to ac- 
count for a prolonged check in the downward career. But can they, ex- 
ceptionally potent as they are, be accepted as adequate explanation of 
retrogression of the advanced local disease? Or must this, for the present, 
remain one of the unexplained, as well as exceptional, facts in the natural 
history of cancer ? 
I cannot answer. But the tissue infiltration, the enlarged and tender 9 
axillary glands, and the subsequent resolution of these morbid deposits 
were, and as a matter of record still remain, stubborn facts. 
What of cundurango ? it will be asked. 
There is, I suppose, a qualified sense in which the idea of specific 
remedies is still admissible in scientific discussion. In no sense has cun- 
durango, during the ample time which has elapsed since its introduction, 
established a title to be regarded as a cancer specific, whether by published 
results of its use or by chemical analysis of its components. In default 
of supporting evidence, I do not think the facts of this history, fairly in- 
terpreted, justify such claim. 
I neither affirm nor deny its possession of medicinal properties suited 
to the general needs of persons debilitated like this patient; but the dis- 
cussion of such alleged virtues is foreign to the purpose of this paper ; 
and I am, therefore, unable to say more than that its public announce- 
ment came at a fortunate time for the patient by setting in motion potent 
agencies in her behalf. 
In closing it will be well to recall the principal features which make the 
case memorable :— 
1. The exceptionally clear family record. 
2. The employment of a supposed specific which, as such, could neither 
earlier nor later than that very time have commanded the unswerving 
confidence of the patient and her friends ; not earlier, because until then 
unknown—nor later, because since generally discredited after ample trial. 
3. The retrogression of disease coincident with the employment of the 
alleged remedy. 
4. The subtle manner in which the disease made its second advance 
and final triumph, wearing the garb of other affections—anaemia, neu- 
ralgia, neurasthenia, rheumatism, intermittent fever, I had almost said 
hysteria. 
5. The wonderful hold upon life displayed both as a physical and 
mental trait, and the pre-eminent fortitude and bravery of the patient, 
surpassing any that I ever witnessed. 
6. The almost total absence of the usual symptoms of meningeal 
trouble, while the dura was so extensively metamorphosed by cancerous 
disease. 
7. The entire non-implication of the mental faculties throughout. 
8. The thoracic and abdominal pains, the intolerance of movement, the 
left facial palsy, and the hypersensitiveness of hearing, followed by deaf- 
ness—all probably of centric origin, but not directly explained by the 
autopsy. 
9. The explanation of the ptosis on the left side, by the discovery of 
the cancerous enlargement in the course of the third nerve, and per 
contra, the absence of symptoms, either motor or sensitive, during life, 10 
dependent on the similar but greater tumour found in the fifth nerve on 
the right side. 
10. The unsuspected and unexplained hydrothorax. 
11. Finally, the peripheral character of the disease from beginning to 
end, neither the brain nor any thoracic, abdominal, or pelvic organs or 
tissues being implicated in any recognizable degree. 
Dorchester, May 1, 1876.