Secondly, Cancer, and all these variations, are originally, in the strictest sense of the word, local diseases, depending neither upon any constitutional affection, nor the presence of any general cause. They do, however, in progress of time, affect not only parts in their vicinity, but also the system in general, producing, by means of sympathetic actions, specific hectic affections, as has been formerly explained, when treating of simple hectic. They likewise spread over more surface in the part at first affected, and produce the same morbid actions without variation, by means of the sympathia consociationis serpens. They also induce a similar disease in the nearest lymphatic glands, by absorption.
Of the Prevention and Treatment of Cancer.
From what has been said, it will appear, that cancer is to be prevented by using the most vigorous means for the removal of simple schirri, upon their first appearance. Of these, local bleeding is the most powerful, and ought to be freely employed. Next to this, an issue in the neighbourhood of the part ought to be most depended on; and these two remedies must be employed early, and continued carefully. Whenever a simple schirrus arises, we ought to be on our guard, in whatever situation it may be placed; but, if it occupy a secretory gland, we require to be doubly vigilant. This, at first, is not painful, at least the patient only complains of slight uneasiness shooting for a moment through it. This circumstance too frequently prevents the patient from attending to it; for where there is no inconvenience sustained, there is little inducement to apply for assistance; and, not unfrequently, an ill-judged modesty contributes to this delay. But, although the patient may be little concerned at this period, yet the surgeon must not observe the same indolence. Aware of the dangerous consequences of allowing the tumor to follow its natural course, he will apply leeches once and again, and insert an issue as near the part as possible. The remedies called discutient have been much recommended at this stage; such as sal ammoniac dissolved in vinegar; and this is sometimes useful, but perhaps not more so than the vegetable acid by itself: When it does not interfere with bleeding, it may be usefully employed. By means of these remedies, we may frequently remove recent tumors, which depend merely upon the enlargement of an organ, without any other considerable change of structure. But it is more difficult to remove tumors which are not produced by the mere enlargement of a part, but depend upon a change of structure, or the formation of new parts; as, for instance, warts, polypi, &c. The small indolent tumors, however, which take place in the cellular substance, may sometimes be removed by the early use of these remedies.
When these means have either been neglected, or fail when employed, and the schirrus begins to inflame, there is little hope of performing a cure by either local or general applications; and extirpation affords the only chance of recovery which can be depended on. But, as it is not always at the very first certain that the schirrus has assumed the cancerous inflammation, and is not curable, the operation ought not to be advised in the first instance, or upon the very first appearance of the pain, or symptoms of commencing inflammation; on the contrary, we ought to have recourse to local bleeding, the use of issues, mild diet, and perhaps the use of cicuta; but if these remedies do not evidently arrest the progress of the disease, diminish the pain very considerably, and make the tumor perceptibly softer and less, in the course of a few weeks, we ought, without hesitation, to advise the removal of the part, which I shall presently consider.
The local bleeding is to be performed with leeches, which are preferable to the scarificator, being attended with less irritation. Three leeches may be applied to the part every second day, as has been proposed by some writers on this disease. This practice must be continued for a considerable time; and, during the intervals of bleeding, cloths dipped in cold water ought to be applied. If, in the course of a month, the tumor becomes freer from pain, and softer, we may apply the leeches only every third day, and continue this for another month, and afterwards either persist for some time longer in the same way, or repeat the application at longer intervals, according to circumstances. But if, on the contrary, the tumor become rather larger, and more painful, as sometimes happens, when the disease is farther advanced before we begin, and if the constitution suffer by the repeated evacuations, we must desist.
Issues may be formed, either by introducing a small seton superficially on each side of the tumor, or by blistering the part, and afterwards keeping it open with savine ointment. The latter of these methods is not admissible, when the disease has proceeded so far as to make the skin adhere to the gland, and become puckered; indeed, at this period, issues formed in any way ought never to be advised, unless the operation will not be consented to; because the chance of their producing a cure is very little, and we lose time by trusting to them.
Mild and spare diet has a very considerable influence over this disease, in almost every period, and contributes greatly to retard its progress. It ought therefore rigidly to be conjoined with the bleeding and issues, in the commencement of the disease, and will tend to abate the action in the part, and promote its resolution. The diet ought to consist of stewed apples, or prunes, panada, and weak broths, with bread. It has even been proposed to prohibit almost entirely the use of solid food, and to allow the patient nothing but water for the course of several weeks. This was much recommended by M. Pouteau, who was led to make trial of it by the success attending the empirical practice of an ecclesiastic. It was afterwards enforced by Callison; and more lately abstinence has been favourably mentioned by Mr. Pearson, who relates some cases of cancer, or appearance of cancer, in the uterus, in which it produced very astonishing effects, abating the pain, diminishing the swelling, and re-establishing the general health.
By means of these remedies, we may sometimes succeed in removing by degrees a schirrus, after it has evidently begun to inflame, and threatens to become cancerous. But if, notwithstanding these remedies, the disease evidently continues to increase, or if, in the course of a few weeks, they do not produce an evident effect, we cannot with propriety delay the operation, which is the most certain method of cure, and one which succeeds in a majority of instances, if early and properly performed; nor ought any other method of treatment to be proposed in opposition to it, unless in the very commencement of the inflammatory state; and it is in this period only that I propose the above treatment, unless the patient absolutely decline the operation; for when the skin becomes puckered, and the inflammation has continued clearly for a considerable time, without any measures being taken to remove it, the success of any local or general remedy is exceedingly precarious, and delay is not only useless, but frequently dangerous. It has, however, been doubted by some very ingenious surgeons, whether it was proper to advise the operation at any period, they believing, from the number of relapses, that it was almost useless; whilst others have been against the early performance of it, on the principle, that some parts already diseased might not have, at this period, become evidently affected; and, therefore, might inadvertently be allowed to remain.