SECT. XLV.—ON CANCER.
Cancer is an uneven swelling, rough, unseemly, darkish, painful, and sometimes without ulceration (which Hippocrates called also concealed cancer), and if operated upon, it becomes worse, and sometimes with ulceration, for it derives its origin from black bile, and spreads by erosion; forming in most parts of the body, but more especially in the female uterus and breasts. It has the veins stretched on all sides as the animal the crab (cancer) has its feet, whence it derives its name. Wherefore, the treatment of it by medicine has been sufficiently delivered by us in the [Fourth Book]; and cancer of the womb has been treated of in the [Third]. But since putrid parts and such as are simply altered from their natural state require amputation, cancers in the womb, indeed, it is neither possible nor expedient to operate upon; but of those of the external parts, and especially of the breasts, we have now to explain the surgical treatment. Some, then, have consumed the whole redundant matter by cauteries; but others first make an excision of the whole breast, and then burn the place. But Galen approves only of the excision, writing thus of the operation: “If ever you attempt to cure cancer by an operation, begin your evacuations by purging the melancholic humour, and having cut away the whole affected part, so that not a root of it be left, permit the blood to be discharged, and do not speedily restrain it, but squeeze the surrounding veins so as to force out the thick part of the blood, and then cure the wound like other ulcers.” Such are the words of Galen. And other malignant and putrid ulcers, such as phagedæna, gangrene, and the like, must be treated in the same manner.
Commentary. Hippocrates forbids the surgeon from interfering with occult cancers, that is to say, with such as have not ulcerated, remarking that if healed the patient soon dies, whereas, if let alone, he may live a long time. (Aph. vi, 38.) Upon this his commentator, Theophilus, remarks that even if the disease is eradicated by cutting or burning, many untoward symptoms follow, and the strength of the patient does not stand out. (Ed. Dietz. ii, 506.)
Celsus describes, we fear but too truly, the general result of every known method of treating cancer. He says, some use corrosive applications, some burning irons, and others cut it out with the scalpel; but medicines are of no avail, burning only exasperates the disease, and excision only removes the part affected, for the disease immediately returns, (v, 28.)
Galen’s sentiments are partly explained by our author. He states, that the disease is curable only at its commencement. When it has attained any considerable magnitude, he says, it admits of no remedy without a surgical operation; and when the tumour is cut out all around there is danger of hemorrhage, which, if restrained by ligatures, may give rise to the disease in the neighbouring parts, whereas, if cauteries be used to burn the roots of the vessels no inconsiderable danger may result from their application so near to the vital parts. (Therap. ad Glauc. ii; Meth. Med. xiv; Isagoge.)
Aëtius gives from Leonidas the following description of the operation on cancerous mammæ. Laying the patient in a supine position, he says, I make an incision into the mammæ above the cancer, and immediately apply a cautery until an eschar be produced to stop the bleeding. I then make another incision deep into the substance of the mamma, and again burn the parts, and so proceed—first cutting and then burning alternately, in order to restrain the bleeding. In this way there is no danger of hemorrhage. After the amputation is completed I again burn the parts until they are quite dry. The first burnings are for the sake of the bleedings, and the last with the intention of eradicating the disease. (xvi, 45.) This operation, described in nearly the same words, occurs in Soranus. (61.) He says, when the disease is scrofulous the burning may be omitted. (Ibid.)
Avicenna mentions that after the excision of a cancerous part the actual cautery may be required. And yet, he adds, there may be danger from the burning provided the part affected be near any vital organ. (iv, 3, 2.)
Rhases says, that they who make an incision into a cancerous part merely produce ulceration thereof, unless it be so seated that the disease can be completely removed and the parts afterwards burned. (Ad Mansor. vii, 9.) In another work he expresses himself rather favorably of excision and burning. (Contin. xiii.)
Haly Abbas approves of the operation when the cancer is seated in the mammæ or extremities. He recommends us to allow the part to bleed until all the melancholic humour is evacuated, and says nothing of the cautery or ligature. (Pract. ix, 12.)
Albucasis says that he never saw a case of cancer cured unless the tumour was small and recently formed. He directs us, when the operation is attempted, to cut out the tumour by the roots, and if the hemorrhage from any vein be profuse to stop it by the cautery. (Chirurg. ii, 53.)
Serapion expresses himself rather diffidently of excision. (v, 24.)
Soranus gives a full account of scirrhous breast distinct from the cancerous. He states that when the whole breast is scirrhous and adheres to the chest, the excision of the sound parts from the diseased ought not to be attempted; but when only the extremity of the breast, or only the half of it is hardened, he approves of amputation without burning, there being no danger of bleeding in this case as in cancer. (66.)