The Bradshaw Lecture on the Pathology of Cancer
Authors: W. S. Savory
Journal: BMJ (1884)

WHAiT'S ill : ; naiae ?"Xot very mnuch, perh7sps, in the senase ill which 8hakcspeare puts the ititv-stio, ilito) the mouth of .luliet.No .reatdtanger,probably, or source of error, when tho matter under .on- ,je1seation is as simple and dlear as the odour of a rose; but it is sfurely otlerwise when idleas intvolving far larger andl nore complex issnes 'ouie to be expreass,jed by a .sinigleterm.It is often saidl, and indeed with truith, that for one's self it is 11o .,utter,vlhat yout call a thing, so long as you understand the subject or ;cture of it; buit this always signifies very mile], to otilers who nay 1ot.so cleLrly compillrehlendi it.It would be ejsy emnough to illustrate the tyranny of phrases in the study of pathlology and in thie practice of surgery; for here the power of words for inisclhief is sometimes seen in a two-fol(l aspect; not only in the perpetuation of error, htut in the maintenance of confu.sinlltoo.Certiain ternms andi titles have liot only given the stamp of currencN to false dictrines; but by thl,' clhlnges they are prone to undergo, and have unmdergpone, ill tfieir mtieaniieg, they sigluify dlifferent things at dlifleremit times, anid at the same tillle difrerent things to dliflerent persons.I say it would not he very difficult to finad abun(lant illustration,; of these renmarks, but I will take now only the one that is to be found ill the terTns loe-al an(d conistittutional.In a general sense, perhaps, these ae sufficiently intelligible, -s when we speak of constitutional dis- btrbance fronm local disease.When neither the patient nor the sur- geen can detect any evidence of inischief, except in a limitedl portiojn of the boly, such affection may very well be ternie'ut locaL When the patient is conscious, or the surgeon cant discover, that the functions in general ares disturbed, the condition i.s very fairly e!xpressed by the term constitutional.But when these same terms, local andl constitt- tional, are omployed morledfinitely, and in relation, not to phenomena merely, but to the nature and origin of disease, difficulties soon appear whicI lead to error and confusion.The oldest, the largest, the nlainest, and inost popular divisioni of tumours, is into innocent and miligniant growtlcs ; and, altlhougli it las always been easy to show that these two great classes often approach very closely, and even pass into each other, still, in the main, thlt several broad and well-defined lines of demarcationhavebeeci sli- iently obvrious.Not only surgeons, btut the public, have come to understan4d the great point of distinction.The crucial questiola is continually asked, If the tumnour be removed, will it come again ?But then, of course, to those who think on these things, thie further quetion inevitably arises, Wlhy are tumours in their nature and history thus different, Whence the cause of such a conitrst ?What does it mean?And these leeper questions liave been replied to, over and over agaii, by the phasaes-local alnd constitutional.The innocent tumour is a purely local one.Thereb is no extension, save by the growth Of the sen.sibl, mass.Its substance anid whole influence lie withlin a imall.sPa''e of the body, which can be clearly defined.To this place it is strictly limited; and, if it be removed from this, it is gone for ever.Rut, of the nlignant tumours, nonie of these conditions can be :Lftirmcd.Whatever may be true, at any given time, of the sensible iaas, the exiateuace of the disease is not so limited ; and tlhus, in coat- tret to innocelmt ones, malignant tumours have been salled conlstitutional.But then, wlhen the inquliry is carTied further, anid somoe ICplallatiomi of con-stitutional, in this sense, is demamided-whcn it is askedl in what way the wordI constitutional advances our knowledgte beyonzd the terni mialignant -it must be conlfessed that the answer is net al0together a satisfactory one.Mlany of us Can remember the celebr-ated discuxssion on Cancer at the Pathologia Society ; and the fact that seems to stan(d olut in it most