SECT. XXVI.—ON CANCERS.
Cancer occurs in every part of the body; for it takes place in the eyes and uterus (as we have stated when treating of those parts), and in most other parts of the body; but it is more particularly frequent in the breasts of women, because owing to their laxity, they readily admit the thick humours which occasion it. For cancers are formed by black bile overheated; and if particularly acrid, it is attended with ulceration. On this account, they are darker than phlegmons, without being attended with the same degree of heat. The veins are filled and stretched around like the feet of the animal called cancer (crab), and hence the disease has got its appellation. But some say that it is so called because it adheres to any part which it seizes upon in an obstinate manner like the crab. Owing to the thickness of the humour which occasions it, cancer is an incurable disease, for it can neither be repelled nor discussed; not yielding to purging of the whole body, resisting the milder applications, and being exasperated by the stronger ones. It may be possible, however, to prevent incipient cancers from increasing, by evacuating the melancholic humour before it becomes fixed in the part. We may evacuate, first, if nothing prohibit, by venesection, and afterwards by purging at the commencement, with the simpler purgatives, such as giving dodder of thyme to the amount of oz. ivss; in whey or honied water, and afterwards hiera, containing the black hellebore.
The juice of strychnos may be applied to the ulcerated parts without exciting pain, a linen rag being folded and wetted in it, and laid on; but externally to this, we must apply soft wool, which also has been soaked in the juice, and care must be taken that they do not become dry, by frequently pouring on some of the juice. In all carcinomatous ulcers of a chronic nature, one may use the preparation from pompholyx; and those remedies which were mentioned in the [Third Book] for cancers in the womb may be applied with advantage.
For carcinomatous and malignant ulcers, for rugose ulcers on the fundament, and for inflammations on the pudenda, testicles, and breasts. In a leaden mortar, and with a leaden pestle, having triturated the Lemnian earth with oxycrate and honied water or milk, so that it become black, or having triturated rose-oil, or the oil of unripe olives, or the juice of house-leek, or that of wall-pennywort, or of lettuce, or of fleawort, or of unripe grapes in like manner, anoint with them. The patient’s diet should consist principally of the juice of ptisan and the whey of milk, and from among pot herbs, of mallows, orache, blite, and gourd, of the fishes which live among rocks, and of all kinds of fowls, except those that live in marshes.
From Archigenes, for carcinomatous and malignant ulcers. Levigate equal parts of burnt river crabs and calamine, and sprinkle or apply the ashes of crabs with cerate; or apply the seed of hedge mustard triturated with honey.
Commentary. See Hippocrates (Epidem. v); Galen (de Tumoribus; Meth. Med. xiv; Therap. ad Glauc. ii); Celsus (v, 28); Scribonius Largus; Aëtius (xvi, 43); Oribasius (Morb. Curat. iii, 28); Actuarius (Meth. Med. iv, 16); Avicenna (iv, 3, 2, 15); Serapion (v, 24); Alsaharavius (Pract. xxix, 1, 16); Avenzoar (ii, 7, 27); Haly Abbas (Pract. iii, 32); Rhases (ad Mansor. vii, 9; Contin. xxvii.)
Hippocrates relates a fatal case of cancer in the breast, attended with a sanious discharge, but he does not explain the nature of the treatment.
Our author’s description of cancer is abridged from Galen (de Tumor. l. c.) The treatment is derived from the 14th Book of the ‘Meth. Med.’ He recommends melanogogues to remove the material cause of the disease. In external applications he places little confidence, but prefers those prepared from metallic substances which have been burnt and washed. The only chance of a radical cure consists, he says, in making a complete excision of the part; but in doing this he forbids us to secure the arteries with ligatures, as they will occasion a recurrence of the disease. The part, he says, is loaded with a thick, black, or recrementitious blood. When the cancer is ulcerated, he disapproves of cutting and burning.
Celsus describes carcinoma as an immovable and unequal tumour, attended with swelling of the veins, which are pale or livid. His account of the treatment is so important that it deserves to be given in his own words: “Quidam usi sunt medicamentis adurentibus; quidam ferro adusserunt; quidam scalpello exciderunt: neque ulla unquam medicina profuit; sed adusta, protinus concitata sunt, et increverunt donec occiderent; excisa, etiam post inductam cicatricem, tamen reverterunt, et causam mortis attulerunt: cum interim plerique nullam vim adhibendo, qua tollere id malum tentent, sed imponendo tantum lenia medicamenta quæ quasi blandiantur, quo minus ad ultimam senectutem perveniant, non prohibeantur.” In another place, however, he recommends compositions containing arsenic, copperas, cantharides, galls, &c. (v, 22.) He makes a distinction between the cacoethes, or malignant tumour, and the true carcinoma, but says that the difference between them is to be recognized only “tempore et experimento.” He marks the gradations of malignant disease with singular precision: first, there is cacoethes; then carcinoma without ulceration; and last, there is the fungated ulcer. (The reading in the edition of Milligan is a great improvement.) In doubtful cases he directs us, first to apply caustics or heating medicines, and, if the disease is alleviated, to proceed to the scalpel or burning, according to circumstances; but if it is exacerbated, we are to conclude that it is of a carcinomatous nature, and must abstain from all acrid and vehement applications.
Scribonius Largus recommends for all malignant ulcers, even such as are cancerous, an application consisting of arsenic, p. vj; of squama æris, p. iij; of elaterium, p. j; of burnt paper, p. iij.
Aëtius gives from Archigenes and Leonidas an interesting account of the disease, which he divides into ulcerated cancer, and cancer without ulceration. He describes the disease in the female breast as consisting of a large tumour which is unequal and resisting, extending its roots far, and being attended with varicose veins: its colour is either cineritious, verging to redness or livid; it appears soft, but is in reality very hard; is accompanied with a pungent pain, and gives rise to malignant phlegmons in the armpits. The pains shoot to the clavicle and scapula. An ulcerated cancer, he says, goes on corroding and spreading deeper, nor can it be stopped; it discharges a sanies of an abominable smell, and is aggravated by medicines and handling. The disease he considers as generally incurable. His surgical treatment will be stated in the [Sixth Book]. He recommends purging with hiera and the theric, Mithridatic antidote, &c. Apparently, in order to mitigate the violence of the pains, he directs us to make an application containing equal portions of plantain, poppy heads, the seed of the wort, and other things of the like kind. For ulcerated cancer he recommends emollient epithemes, such as the one containing litharge, axunge, white wax, oil, and the yelks of eggs.
Oribasius and Actuarius supply nothing of importance that is not to be found in our author. Nonnus, according to Sprengel, is the only ancient author who attributes cancerous ulcerations to acrimony of the bile. But Nonnus merely copies the words of our author.
The Arabians agree with the Greeks in representing the disease as being produced by black bile. They were, no doubt, led to form this opinion from remarking that the blood in the part is thick and black, which they considered owing to its not being properly purged of its recrementitious sediment. The moderns deride this theory, but they have substituted nothing satisfactory in its stead. Van Swieten thinks more favorably of the ancient doctrines. (Comment. § 485.) Avicenna speaks highly of a milk diet. Serapion likewise approves of milk deprived of its butter, and of a vegetable diet. He speaks of no other treatment as being likely to prove remediable, with the exception of excision and the cautery. Haly Abbas rather approves of excision when the disease is seated in a part which admits of this operation. However, like Galen, he disapproves of tying the arteries. The characteristic symptoms of the disease, he says, are a stony hardness and distension. The account given by Alsaharavius is nothing different. Rhases has little confidence in excision. After ulceration has taken place he approves of using a cooling application, containing ceruse, tutty, rose-oil, the juice of nightshade, and some other such things of a cold nature. He mentions a case of cancer of the breast, in which the whole mamma was extirpated, but the disease returned on the other side. One of his authorities, Antyllus, describes the cancerous sore as having a tendency to spread inwards, its edges being thick, large, and everted, and the discharge thin and acrid. When the disease cannot be got completely extirpated, he forbids us to meddle with it.
Theodoricus and all the earlier modern writers on medicine, call the cancer by the name of apostema melancholicum, and recommend the same treatment for it as the Greeks and Arabians.