Dissertations on Inflammation, Vol. 2

by John Burns

The uterus, in elderly women, is very frequently affected with cancer[108]. It begins with a feeling of weight and uneasiness in the lower part of the belly, and the natural discharge of the parts is increased, so that the disease passes for fluor albus. By examination, however, we may generally discover a hardness, and sometimes an inequality, about the os uteri, and may discover the uterus to be unequally enlarged. After some time, ulceration takes place, and matter, mixed with a bloody fluid, is discharged. Occasionally, considerable hemorrhages take place, which are not unfrequently confounded with menorrhagia; but it may be distinguished by the continued discharge of a bloody sanies during the intervals of the hemorrhage; by the continual pain, and especially by our feeling the projection of the os uteri into the vagina, in some places hard, and in others soft, but rough, which shows ulceration. After some time, the glands about the vagina swell; and that canal, in many places, becomes considerably straitened. Hectic terminates the sufferings of the patient. On opening the body, we find the uterus generally though not always, considerably enlarged, with abscess and ulcers in different parts of its substance. These ulcers, as well as those of the ovarium, and, so far as I know, every gland in the internal cavities of the body, have a less tendency to fungate, than cancerous ulcer on the surface of the body.

When inflammation attacks any organ, or part of the body, and leaves a chronic tumor, this may assume, as will afterwards be mentioned, a new inflammation, and may become affected with cancer; though it more frequently happens, that it assumes the pseudo-cancerous action. The symptoms and progress of cancer are much the same here as in the breast.

When the eye becomes cancerous, it, unless the disease begins in one of the glands, such as the lachrymal, or those of Meibomius, is first of all affected with simple inflammation, which destroys the whole texture of the eye, and makes it of a different structure, rather resembling a confused mass than a well organised body. The lucid cornea becomes opake, and protrudes; the eye enlarges, is affected with a violent deep-seated pain, and at last bursts, generally on the apex: From this a fungous substance protrudes, which manifests all the symptoms of the cancerous ulcer, and in a short time arrives at a great size.

When the nose becomes cancerous, the disease either begins in the outside, with a small tumor or wart, as in other parts of the face, or within, by a firm and somewhat painful polypous projection, which frets on the surface, and soon assumes the cancerous ulceration.

The diagnosis of this disease is of the utmost importance; because if we mistake cancer for some other disease, we not only neglect the proper practice, but frequently are led to prescribe remedies which do infinite harm. If, on the contrary, we mistake another disease for cancer, we neglect the necessary means of cure, and may even be led to extirpate a part which might be easily cured by gentler treatment.

Cancer may be confounded with scrophula, syphilis, and some other affections, which have received no particular name.

There is an affection[109] which begins like cancer, by a hard schirrus, either of a gland, or still more frequently of one of the chronic tumors, which has been already mentioned as succeeding slow inflammation. This remains, for a considerable time, hard, and free from pain, and there is no puckering of the skin over it. By degrees, some part of the surface becomes of a purple or livid colour, and ulcerates. This ulcer remains long superficial; the edges are hard and rounded; the discharge is thin; the surface is glossy, and no distinct granulations can be seen; the pain is slightly smarting, but not burning, and instead of being fungous, the sore is slightly hollowed out below the level of the surrounding skin. By the continuance of this affection, the gland is apt to shrink and diminish in size; and generally where this takes place, the sore contracts and heals with a very puckered unequal cicatrix, having, in some places, a thick dark coloured scab covering it[110]. The neighbouring glands become affected; but they are soft, and rather resemble the spongoid inflammation than schirrous hardness: But I have never had an opportunity of observing them proceed the length of ulceration. If the continuance of the sore be long, the constitution is affected, and the patient becomes hectic[111]. This kind of ulcer may be distinguished from cancer, if we attend to the absence of the fungous, and peculiar appearance of the cancerous sore, and the want of the burning pain: But, before ulceration takes place, the two diseases may be confounded; because there are no certain characteristics of schirro-cancer.

This disease may attack the uterus, and is very apt to be confounded with cancer; nor is it easy to distinguish them, as the parts are unseen. There is never much enlargement. The ulcer is pretty smooth, and the margins circular, hard, and glabrous. The pain is not very considerable. The discharge is thin, copious, and of a yellowish colour, but seldom bloody, unless when the disease has continued very long.

The spongoid inflammation has been considered as cancerous by those who have seen it; but the distinction betwixt the two is sufficiently obvious: The one begins with a spongy elastic tumor, the other with a firm hard lump.