Dissertations on Inflammation, Vol. 2

by John Burns

When cancer has continued some time, it was believed that the matter was absorbed, taken into the blood, and that all the humours were speedily assimilated; and it was by this absorption and assimilation that they explained the fatal and rapid progress of relapses, after an apparent cure had been obtained. That matter is absorbed, is an undeniable fact; but the only effect which is produced by this, is on the lymphatic glands[125], which intervene betwixt the sore and the heart; for, beyond these, the matter does not pass qua virus, but is changed in its nature and properties, as is the case with every other part or production of the animal, which is absorbed and formed into part of the blood. Neither cancerous matter, nor variolous matter, nor syphilitic matter, ever are formed in the blood, or ever can enter into it, unless by means of an wounded vessel. This point I shall consider more fully, when I come to treat of the venereal inflammation. Here I shall only observe, that were the reverse true, then the contagious matter must pass through every gland, and every portion of the human form, in as much as the blood circulates in every point; and, therefore, every spot should become diseased, and every part, in the same circumstances, should become diseased at the same moment[126]. Disease is not spread in the living system mechanically, by the absorption of matter, which is conveyed over the whole body, but by the sympathetic connection of parts, which has been already explained, and which will afterwards be farther illustrated. It is in consequence of this, that a distant part shall become diseased, and yet all the rest remain healthy; and even where every part becomes affected, and a general disease is suddenly produced from a local sore, as, for instance, in small-pox, there is no diffusion of matter, nor is it ever conveyed beyond the lymphatic glands.

In this particular complaint, the consequence of sympathetic action, or the propagation of action, is sometimes the induction of the same disease in other parts; but most commonly the effect is the establishment of the hectic, or diseased formative action; for an explanation of which I refer to the dissertation on simple inflammation.

By examination, we find, that, in many instances, cancer is evidently produced by the same causes which are capable of producing simple inflammation; and, in every instance, I apprehend, that although the causes may be obscure, yet they are exactly of the same nature. It is, however, a general opinion, that this disease arises frequently from some unknown and mysterious cause which we cannot detect, and which, therefore, has been resolved into some constitutional taint, or cancerous ferment. But, so far as we know, the constitution is perfectly healthy in the commencement of this disease; nor is there the smallest of that it resembles scrophula, in depending upon any peculiarity of constitution, before the causes operate.

Blows, bruises, and other exciting causes of inflammation, are apt to produce cancer; but, in many instances, we can detect no evident local cause acting directly on the part. In the breast, for instance, we frequently perceive cancer commence without the interference of any topical agent. In these cases, however, we may uniformly detect an irregularity or disappearance of the menstrual secretion. It was formerly observed, that the uterus and mammæ exhibited very powerfully the sympathy of equilibrium; and it is upon this doctrine, which it is unnecessary farther to illustrate, that we are to explain the affection of the breast, which so frequently takes place in consequence of the cessation of the menses; for when the active state of the uterus is lost, the action of the mammæ is preternaturally increased, and a species of slow inflammation is induced. It is upon this principle only that we can explain why cancers are so frequent at the cessation of the menses[127]. It is ridiculous to suppose that this discharge acts as a drain to the constitution, and carries off impurities, which would otherwise collect elsewhere, and produce local diseases. The breast is almost the only organ which becomes thus affected without any agent acting directly upon the part alone; for, in most other instances, we may detect the operation of such causes at least as tend to induce simple affections of the same part; but, in both instances, the modus operandi of the cause is alike, only circumstances are somewhat varied.

When the inflammatory action is slowly induced, whether by a bruise, or any other cause, acting directly on the part, or by sympathetic union with another part, we find, that the tumor which is consequent to this, seldom manifests a disposition to remove quickly, or assume the healing process. The part neither performs any distinct and acute inflammatory action, nor does it resume its natural condition and appearance, but remains in a new state, different from either, which I will call the state of simple schirrus[128]. If this state, which may follow the application of the common exciting causes of inflammation in any part, take place in cellular substance, or similar parts, which are possessed of no glandular structure, then a chronic tumor is produced, which is either slowly diminished by absorption, or at last unable to carry on its actions in perfection, being, in some respect, insulated, and deprived of the support of the surrounding parts[129]; a diseased action, or morbid performance of its actions, takes place; a slow inflammatory condition is produced[130], and at last ulceration succeeds. This, in general, forms pseudo-cancer, provided that the constitution be simple, that is to say, healthy: But if it take place in a scrophulous habit, the tumor is apt to become scrophulous, having its morbid actions modified by the morbid condition of the system. If this event take place in a lymphatic gland, instead of the cellular substance, then the tumor is still more apt to become affected with scrophulous inflammation, in consequence of even a very trifling scrophulous modification of the habit. If this state be produced in a secretory gland, the affection is somewhat different from that in simple parts, or those which do not secrete; because the inflammatory action becomes somewhat modified by the natural secreting action of the part; and, in this point of view, the gland may be considered as possessing a specific constitution, although the general constitution be simple; for, naturally possessing a peculiar mode of action, it follows, that new actions induced in such a part, ought to be performed in a different manner from the same actions in parts which naturally do not possess this peculiarity, and that the actions ought to be specifically different. When these parts are attacked with acute simple inflammation, it differs from inflammation in the cellular substance in certain circumstances, and particularly in being much more tedious; but when the nature of the part is still farther altered by the accession of a slow inflammatory action, which operates in the manner above described, then it assumes a specific inflammation, which ends in ulceration. The exact, or specific nature, of this, is various; and the state, which we call cancerous, is probably only one of the varieties of this morbid inflammatory action; and whether the part shall assume this variety, or some other variation, as, for instance, pseudo-cancer, depends probably upon local circumstances, which we cannot as yet detect or explain. If, however, the constitution possess any specific mode of action, the tumor generally assumes nearly the same mode; and, therefore, in scrophulous people, these tumors more frequently become affected with scrophulous inflammation, than with cancer: At the same time, if the previous change on the gland, induced by the slow inflammatory condition, have been great, the scrophulous condition, which it possesses in common with the rest of the system, becomes modified in it, in the same way as the simple condition, in healthy habits, is modified by the new or schirrous state of the gland; and, therefore, the scrophulous inflammation is sometimes different, and the ulceration more fungous than in other parts.

The causes, then, of simple inflammation, when they operate slowly, or leave the part in a state neither inflamed nor healthy, give rise to a chronic enlargement, and change of nature, which I have called simple schirrus[131]. This performs, like every other part, certain actions, which are intended for its own support, and which must make a part of the general action of the system, or be in unison with the rest of the body. But as its actions are different in nature from those which any part of the body naturally ought to perform, and as originally this organ, (which, from the changes induced on it, is to be considered as new and extraneous), formed no part of the human frame, there is not that connection betwixt it and the rest of the system, which is necessary for its support. It, therefore, does not derive the same aid and support from the neighbouring parts which natural organs do, (for no part, or individual organ, can exist and support itself singly, and independent of the rest), and, accordingly, must soon come to suffer. It is unable to perform its necessary actions in perfection; they become morbid, and of an inflammatory nature. The tumor is now an inflamed schirrus; and this inflammation either assumes a modification, from the specific nature of the constitution, or from the peculiar nature of the tumor itself, which, as has been explained, is different from the healthy state of the tumid part. We have, therefore, the scrophulous, the cancerous, the pseudo-cancerous inflamed schirrus; and the symptoms of these different kinds of schirri, and the appearance of the ulceration, will, cæteris paribus, be modified by the nature of the part affected. The same disease, therefore, exhibits slight variations in different organs, as has been described in the history of cancer, and might, therefore, were we inclined to multiply distinctions, be considered as so many different diseases.

This disease is most apt to take place in elderly people, (in so much that some consider it as peculiar to old age); because in them, parts sustain injury of their actions worst, or are less able to recover from them. Hence, two consequences follow: First, Simple schirrus is more easily produced, resolution of inflammation being more difficult, especially in parts which are, at all times, rather tedious in their recovery, when inflamed: Second, The simple schirrus is more apt to inflame, or have, what may be called, its necessary actions impeded and deranged. It must, however, be remembered, that there is no age whatever exempted from this disease: I have seen it distinctly marked, and attended with a fatal event, in children of five years old[132].

It is a controverted point, how far it is possible to produce cancer by inoculation; some maintaining, that the application of cancerous matter to a sound part will induce the disease; others, that it is altogether harmless. Analogical evidence is certainly in favour of the first opinion; because the majority of specific ulcers may be inoculated, and have been so by accident. But, at the same time, it must be admitted, that there are few well established cases of this particular point. We find, however, that, like the venereal matter, the cancerous, when absorbed, induces a disease in the lymphatic glands, of a cancerous nature. We would, therefore, be led to conclude, that if the matter be capable of inducing cancer by absorption, in a distant part, it ought likewise to be capable of producing the same disease in another person by inoculation. The same be said of the spongoid inflammation, &c.

From these observations, it will, I presume, appear, first, That when a part is incapable of performing the actions necessary for its preservation in a state of health, it generally slowly assumes the inflammatory state, which goes on to ulceration; but the part being unable to support its natural action, can much less perform the actions necessary for restoration from this morbid condition, which, therefore, continues permanently and progressively increasing; that the nature of this unhealthy action is not always the same, but admits of variations dependent upon certain conditions in the previous state of the part affected, with regard to which we are greatly in the dark. Cancer, pseudo-cancer, spongoid inflammation, &c. are some of these variations.