Haly Abbas recommends such an operation as that described by Celsus and our author. He directs us to do it, not with iron, but with the root of the long birthwort smeared with oil. (Pract. ix, 74.) The use of the root of the birthwort (aristolochia) as a cautery is also mentioned by Aëtius. (xii, 3.) Cornarius, by the way, seems not to have been aware of this circumstance, which has led him into a mistake in translating the sentence where it is mentioned.
The practice of burning the chest in chronic diseases of the lungs is strongly advocated by Caillot. (Elemens de Physiologie, i.) It was tried by Dr. Mudge in his own person with great success. (See Dr. M. Good’s ‘Study of Medicine,’ ii, 786.)
Our author, it will be remarked, disapproves of paracentesis thoracis. This operation is recommended and described in one of the Hippocratic treatises. (De Morbis, i, and ii.) It is also mentioned in the ‘Isagoge’ of Galen. Rhases likewise mentions it in brief terms. (Cont. iv, 3, and x.) Rhases directs us to open the chest by a small orifice, that the matter may be slowly evacuated. He mentions that Galen recommends burning the chest, and also the operation of paracentesis in such cases.
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.)