"Emaciation is another symptom of this complaint, yet it is not a uniform consequence even of malignant disorganization of the stomach. Napoleon Bonaparte was very fat when he died. His omentum is described as having been "remarkably fat;" and "the fat was upwards of an inch thick upon his breast, and one inch and a half upon his abdomen."

Treatment

This can only be palliative. If the patient is in pain he may take Bromide of Potash or Hydrate of Chloral in ten grain doses three times a day, or if these fail to give relief he can try Opium. The Permanganate of Potash might possibly be of service in this complaint. I am not aware that it has ever been tried, but it is well worth a trial. It may be taken in doses of half a grain three times a day, dissolved in water. Or one ounce of Condy's disinfectant fluid may be mixed with seven ounces of water, and a tablespoonful taken three times a day. If the patient seems to derive benefit from the mixture, the dose may be increased by degrees.

With regard to diet, the patient should be very careful; nothing of a hard or indigestible character should be taken, and only a little at a time. Generally speaking the stomach can digest animal food more readily than vegetable. Still a certain proportion of vegetables is desirable, but they should be well boiled. Boiled meat is generally more easily digested than fried or baked, and the more easily the food is digested, the less work there is for the sick stomach to do.

Cancer Of The Lung

Cancer of the Lung as a primary affection is very rare; when it takes place it is usually the result of Cancer in the breast in women or of the testicle in men.

In these cases all that can be done is to alleviate the patient's pains by means of sedatives and narcotics, and to pay attention to the general state of the health.

Cancer Of The Testicle

Malignant disease of the testicle is almost invariably Medullary Sarcoma, very rarely Scirrhus. At first the gland swells, and becomes very hard and heavy; it is scarcely, if at all, painful or tender, and merely causes slight aching in the loins by its weight. After a time it enlarges rapidly and becomes soft,-the cord swells,-there are occasional darting pains, a fungus protrudes, the glands in the loin become affected, the health fails, and death soon follows in the ordinary course. This disease is to be distinguished from Dropsy by its opacity and weight, and from chronic inflammation or the hydatid disease by the darting pains, swelling of the cord, and cancerous loss of health. It may further be distinguished from chronic inflammation by the fact that neither mercury nor any other remedy produces any permanent benefit.

Treatment

Castration should be performed before the cord is affected.

Chimney-sweeper's Cancer is a foul, ragged ulcer of the scrotum, with the skin hardened and tuberculated around. It rarely, if ever, occurs till after the age of thirty. It commences as a small wart, and is caused by the irritation of soot.

Treatment

The whole of the ulcer, and of the diseased skin around it must be extirpated-but it is rarely, if ever, necessary to remove either of the testicles.

Cancer of the Penis may begin either on the glans or on the prepuce, and invariably occurs to elderly persons who have had Phymosis. It forms a foul, ragged, excavated ulcer, gradually destroying the whole organ, and contaminating the glands in the groin.

Treatment

The part must be amputated before the glands are affected.

Cancer of the Lip commences as a small scirrhous tumour or wart, or as a small fissure caused by the irritation of smoking, which gradually degenerates into a foul ulcer, with hardened base and ragged surface.

Treatment

The disease must be extirpated by excision; taking care to remove the whole of it. The extirpation cannot be expected to be effectual unless performed before the glands are implicated, but it is justifiable at any stage, in order to avoid for a time the horrible pain and foetor of the ulcerative process. It has been very clearly shown by Mr. Earle, that any ulcers, if subjected to perpetual irritation, and especially ulcers near the outlets of the body, may assume a malignant appearance,which ceases on the removal of the source of irritation. When, therefore, there are foul ulcers on the lips, cheeks,or tongue, the teeth should be well examined in order to remove any roughness,or collections of tartar,and proper attention paid to the state of the bowels, and the general health.

Cancerous Ulcers On The Skin

When the skin is affected with malignant disease it is generally found either near one of the natural orifices of the body, in a part largely supplied with follicles, as the lip and glans penis; or else in the neighbourhood of some scirrhous gland from which the disease is propagated. But it occasionally commences independently, in any other situation, as a small, hard, indolent lump, which gradually degenerates into scirrhus ulceration.

But there is a class of morbid growths which may be called semi-malignant; which, although incurable if left to themselves, destroying the tissues in which they are situated,spreading progressively and destroying the parts in their vicinity, and finally fatal to life from their constant irritation, still are not really malignant, because they do not attack the lymphatics, do not appear in several remote organs simultaneously, and do not return if effectually removed. To this class belong the following:-

The Cancerous Ulcer occurs on the face or neck of old people, especially below the under eyelid. It begins with a flat, brown, irregular crust, like a wart, which falling off, displays an ulcer with slightly elevated edges, but no hardened base. Its progress is slow; it is unaccompanied by haemorrhage, and it occasionally cicatrizes for a time. The tumours called moles; oblong patches of imperfectly organized skin, with black matter deposited in its interstices, together with warts, and other anomalous imperfections of the skin, sometimes degenerate into malignant ulcers, after existing-in a quiet state from birth for many years. Any such tumour of the skin therefore, which appears inclined to increase or to become irritable should be removed by the knife or by caustic. Sir Benjamin Brodie preferred the caustic for these purposes, because he believed it less liable to be followed by Erysipelas.

Lupus is a destructive ulceration of the skin, commencing with tubercular inflammation. There are two forms: First, the genuine lupus, herpes exedens, or noli me tangere; and secondly, the herpes or lupus non exedens.

In the first form of the disease, a portion of the skin of the face, (mostly on or near the nose), inflames, swells, and becomes of a bright red tint; The swelling frequently occurs in the form of one or more tubercles. The inflamed surface sooner or later becomes excoriated, and secretes an ichorous matter which dries into a scab. After a time, a painful, foul, excavated ulcer forms; variable in its progress, sometimes stationary or partially cicatrizing, but, in the end, destroying the flesh of the nose and cheek, and causing decay of the bones; till the patient, a horrid spectacle, dies worn out with pain; his eye dropping from its socket into the chasm made by the destruction of the cheek. This disease mostly occurs to adults, especially if of weakly, scrofulous habits, vitiated by intemperance and gross feeding.

The second is a milder form of the disease, and attacks scrofulous children. It begins with shining tubercles, which ulcerate; but the ulceration has a tendency to spread widely, rather than deeply; causing prodigious deformity by the successive ulceration and puckered cicatrization of the face.

Treatment

The general health must be brought into a satisfactory condition by means of purgatives, warm bathing, and a proper attention to the diet, sufficient rules for which have been given in various other parts of this work. "With regard to the local treatment, as much mischief might easily be done by injudicious meddling, the patient should have the advice of a properly qualified surgeon.

Cancer has generally been looked upon by the medical profession as a constitutional and an incurable disease. It has been held that a person who had had Cancer, even if that Cancer had been removed at an early stage, must necessarily, at some future time, have a return of it, and must die of it, unless, in the meantime, he was fortunate enough to die of some other disease. The opinions of some members of the profession, however, are changing on this point. Mr. H. Arnott, Assistant Surgeon to St. Thomas's Hospital, in a late article on Cancer, has the following remarks:

"To speak of the knife as some distinguished surgeons have done, as the only trustworthy resource for the cancerous patient, and this, too, in the face of the unsatisfactory results hitherto achieved by this means, and to rank with quacks those who earnestly seek for better remedies, is calculated to advance neither our knowledge of disease, nor our faith in therapeutics."

"Lastly, there is no reason in the world why we should refuse to admit that a Cancer has been cured or permanently removed. It has become quite common to hear surgeons say of a tumour which has not returned after extirpation some years previously, ' I suppose it was not really Cancer, as it has not come back, but it had certainly all the ordinary characters of Cancer.' In like manner it is frequently said of reputed cures of Cancer by pressure, or caustic, or by other means, that the tumours could not have been cancerous simply because they disappeared under the treatment. It is surely time that we give up these notions of the specific and inevitably mortal character of malignant tumours, for such doctrines are not only to be deprecated on account of the insufficiency of pathological facts to be urged in their support, but for the far more serious reason that they stand in the way of any advance in rational therapeutics."