On the Cancerous Inflammation.
The cancerous inflammation generally comes in slowly, in some glandular part, which becomes rather harder, and somewhat larger[106], than it ought to be; but the pain, for the most part, at first is trifling. By degrees, both the hardness and swelling increase, and a pain, like the pricking of needles, is felt in the part. This pain, after some time, becomes more violent, darting through the whole of the gland, and leaving a sensation, as if the part had been rudely wrung or twisted. The tumor still remains moveable under the skin, which is of the natural colour; but when the disease has continued a little longer, a greater degree of inflammation takes place, and adhesions are formed betwixt the skin and the gland, or the gland and the parts below, at the same time that the pain becomes more continued. The skin now becomes puckered, or drawn inward, and of a dirty or leaden hue, which in time acquires more of the red, but is never of a bright colour. The veins are varicose, and the tumor is, with difficulty, moveable. When the skin becomes red, we may be able to discern a superficial fluctuation, which proceeds from part of the gland forming an abscess[107]. This at last bursts, and discharges a thin yellowish matter, which frequently oozes out in very considerable quantity; the orifice enlarges, and the sore penetrates, for a little way downward, pretty rapidly, and the edges become hard, and overlap a small part of the disk of the sore; but, soon after this, a fungus rises up; and although, in some places, the ulcer may become deeper, yet its chief progress is laterally.
The cancerous ulcer increases more or less rapidly, and is soon attended with a burning pain; the surface is unequal, excavations appearing in some parts, whilst in others a fungus rises up. The colour is brown, but glistening or fiery. The granulations very soft and indistinct. A thin ichor, of an abominable fœtor, is discharged in great plenty, mixed with blood; whilst, in many parts, small pellicles, like lymphatic exsudations, cover the sore. The surrounding skin is of a dark purple colour, and the adjacent parts very hard. The margins, which at first were overlapping the sore, in the course of a few days are uniformly elevated, and frequently retorted and unequal, as if they had been bitten by an animal; and over these the fungus frequently shoots or protrudes, so that the sore assumes the appearance of a cauliflower. This ulcer bleeds a little upon the slightest touch, so that at every dressing the cloths are generally bloody; but, at times, this bleeding is more alarming, proceeding from the bursting of the diseased veins. These hemorrhages are, in some instances, very frequent, and reduce the patient to the greatest weakness. Sometimes they suddenly relieve the unhappy persons from all their woe.
Some time after the abscess forms, and frequently before ulceration takes place, the neighbouring lymphatic glands swell, and become affected with a similar action, and follow the same course with the original sore; only in them the progress is generally more rapid.
After ulceration takes place, sometimes before it, if the abscess be considerable, hectic fever takes place; the countenance becomes sallow and unhealthy; the pulse quickens, and becomes small and sharp; the strength fails; night sweats come on, and colliquative diarrhœa hastens death.
The parts in which cancer most frequently appears, are the under lip, the breasts of women, and the testicles of men: But there is no one part of the body in which it may not occur, although most frequently it is, in its original attacks, confined to secreting glands.
In the breasts, parotid glands, and some other conglomerate glands, the disease begins as has been described; but on the skin, and in some other parts, the progress is somewhat different. The skin, particularly that of the face, is apt to have a small chronic pustule formed on it, by the inflammation of one of the sebaceous glands, which, by degrees, becomes harder, firmer, and more elevated. Soon afterwards, it becomes rough, and of a warty appearance: It then ulcerates on the surface. This is covered with a scale or scab, which repeatedly falls off, and forms again upon the part, until it assume the appearance and character of the cancerous sore. But, more frequently, the disease is not allowed to follow this progress, the wart either being rubbed off accidentally, or removed by ignorant persons. The part then forms a superficial ulcer, which is slightly hollowed. It is of a glistening flabby appearance, and the margins are hard, tumid, and a little turned back: But after the disease has continued some time, the flabby appearance of the sore is converted into fungus. We may, therefore, from this, and other cases, conclude, that cancerous ulcers, which are formed without previous abscess, form fungus more slowly than those which are formed with them.
When the lips become cancerous, there is generally first perceived an indurated lump, of greater or less bulk. The skin over it becomes tender, frets, and is covered with a scurf or scab, which gradually becomes elevated. Part falls occasionally off, but it is soon replaced. This by degrees extends itself over the prolabium, and, after some time, falls off entirely, leaving the part with all the common characters of the cancerous ulcer. The pain is burning.
When the testicle becomes cancerous, it sometimes follows the common course of cancer in other glands, beginning with hardness and shooting pain in some part of the testicles or epidydimis, which gradually forms an abscess, and ulcerates. But, at other times, soon after the testicle becomes diseased, an effusion takes place within the tunica vaginalis. In this case, the disease of the testicle becomes complicated with hydrocele. It is distinguished by our feeling the hardness of the epidydimis behind, or the hardness and inequality of the testicle, when the water is drawn off. It likewise, after some continuance, becomes more painful than a common case of hydrocele. If the testicle be not extirpated in due time, the cord becomes hard and swelled, and comes to ulcerate.
Cancer in the penis generally begins by a kind of warty tumor, and follows the course of cancer in the face. Sometimes the penis becomes just like a cauliflower, a large fungus extending from its ulcerated extremity.