By attending to these circumstances, we may generally form a pretty just diagnosis. At the same time, it must be admitted, that, occasionally, cases do occur, in which it is impossible to deliver a decided opinion: Nor is it doubtful, that many ulcers are considered as cancerous, which are of a different nature, and some of which admit of a cure. In forming our judgment, we must be directed by the nature of the first symptoms, and the history of the schirrous stage; by the appearance and aspect of the fungus, and the other circumstances which have been already described. Concerning the peculiar state of the parts in cancer, or the proximate cause, many opinions have prevailed; but these, however they might differ in certain points, have almost unanimously agreed in admitting obstruction as the chief cause of this disease. Until lately, the melancholic humour was supposed to be the fluid which was obstructed, and accumulated, in consequence of which it fermented, and produced a burning ulcer; and whatever promoted the generation of this humour, was currently admitted as a remote cause of cancer. Women, says Ambrose Paré, are more subject to schirrus than men; “because their liver is warmer, and their spleen being weaker, is less able to purge the blood of choler.” Grief and chagrin, by promoting the formation of this fiery fluid, were accordingly considered by the celebrated Heister, as very apt to induce the “cancerous diathesis;” and he slyly adds, by way of corollary, that “old maids, and women who do not breed, are very subject to cancer in the breast[115].” [115] Heister’s Institut. Vol. I. p. 229.