Part 25

Justamond on Cancers, p. 141. This gentleman relates a case, in which, by destroying the skin with lunar caustic, and then applying arsenic, he removed the gland. The arsenic, in this instance, was fused with antimony, in proportion of two parts of the first to one of the last. This was powdered and mixed with equal parts of powdered opium, and made into a liniment with yolk of egg.

This method, however, is liable to several material objections: It is uncertain in its issue; for, if the gland be not completely removed, the disease makes a rapid progress afterwards. It frequently happens, that some smaller glands around the large one are affected; and these are greatly irritated by the action of the caustic in their vicinity: It is more painful than the operation with the knife; and the subsequent process of healing, even granting the method to succeed in removing the diseased part, is much more tedious than when the incision is employed, and union by the first intention procured.

On all these accounts, but most especially on account of its uncertainty, the method of cure by caustic can never be sanctioned by any modern surgeon, much less can it ever be held up in opposition to extirpation by the knife.

This practice, which has had many advocates for its employment in schirrus, has been equally recommended in cases of cancerous ulcers; but here it is still less admissible; for the extent of diseased parts is generally greater; the neighbouring parts are affected to a greater distance; indurated and diseased lymphatics frequently extend from the breast to glands in the axilla. It is, therefore, next to impossible to turn out the morbid parts, as “nuclei,” by destroying the substance around them; and it is equally improbable that we shall, unless the sore be very small, and the caustic very strong, be able to make it slough off in successive layers. Farther we can propose no advantage to ourselves, from employing caustic in preference to the scalpel; because in every instance in which we can destroy the parts by means of this, we can equally safely, infinitely more speedily, and with much less pain, remove the parts with the knife. There is only one case in which caustic is useful, and that is merely as an appendage to the operation of excision. When we dissect off ulcers from parts where, owing to the want of cellular substance, the skin is not lax enough to be brought over the parts, or when so much of this has been removed, that, although lax, it cannot be made to cover it, we may find it of service to rub the bottom of the wound with lunar caustic, as we thus stop the oozing of blood, and destroy any little portions of the diseased part which we may have left.

For the purpose of destroying cancerous ulcers, many caustics and escharotics have been proposed, such as the arsenic, corrosive sublimate, lunar caustic, &c. Of these no one seems to possess a preference over the rest, if we consider only their local action; but some of them, especially arsenic, are apt to produce bad effects, and that very unexpectedly, on the constitution.

After making these remarks upon the method of cure, I shall conclude with some observations on different remedies, which have been proposed as palliatives, where the operation is not admirable, or will not be consented to, and which have even been supposed capable of changing the mode of acting altogether, and producing of themselves a cure. These remedies I shall divide into general and topical.

Of the general remedies, those which have been most frequently, and with the greatest confidence, employed, are narcotics, such as the cicuta, opium, nightshade, &c.

The cicuta is a medicine which was, at one time, in very high repute, and owed its reputation to the experimenting talent of Storck, who has written several libelli on this plant. According to him, cicuta possesses very evident powers over cancer, and has cured a great many cases; but, in less prejudised hands, it has been much less successful; and even in many of the instances adduced by Baron Storck of its utility, it is by no means proved, that the disease was really cancer. The present opinion of the public seems to be very unfavourable with regard to this medicine; and from the numerous instances in which it has failed, this opinion seems to be very just. Alongst with the proper local applications which have been formerly noticed, it sometimes is of service in removing simple schirri; but I have never found it of any service when the schirrus had affirmed the cancerous inflammation, much less when it has proceeded the length of ulceration. In the last case, I have never found it even produce the temporary melioration which many talk of.

If I am not mistaken, the present Dr. Monro mentions, in his lectures, one instance, in which a small schirrus appeared to be removed by it; but whether this was simple or cancerous, I do not know.

The common way of exhibiting the hemlock, is to begin with small doses, and increase these gradually, until they produce vertigo: For this purpose, we may begin with two grains of the extract, or four of the powder, recently prepared, twice or thrice a-day, and gradually increase the quantity. In this way, we find that some patients have come to take an ounce of the extract daily; but if a much less quantity than this produce no good effect, we may consider it as useless to continue a remedy, which, in this dose, must injure the constitution every day that it is continued. On the continent, the hemlock has been used in the form of a bath; but it is so disagreeable, that few can be brought to use it.

As different parcels of this medicine may not be of the same strength, it is prudent, when we begin a new supply, that we diminish the dose at first, if it have formerly been very considerable. By not attending to this, fatal effects have followed.

The belladona has been much recommended by Lambergen, who tried it in many cases of cancer; but these trials, when repeated with attention, have not been greatly in favour of the remedy. During its use, he kept the bowels open with clysters, administered every second day. The dose, at first, ought to be a grain of the dried leaves, made into a pill. This, in the beginning, is to be given morning and evening, and afterwards more frequently.

The hyocyamus has also been frequently used in cancer, and was very much in repute with the ancients. I have tried it occasionally, but with very little effect. The dose with which we begin, is two grains of the extract.

The aconitum is a more powerful and dangerous narcotic, in so much that a quarter of a grain of the extract is generally the dose with which we begin.

The solanum dulcamara, Paris quadrifolia, phytolacca, &c. have been likewise recommended and employed, but are now so little used, that it is unnecessary to take any notice of them here.

I have tried the hepatized ammonia, but without any benefit.

The laurus cerasus is a very powerful narcotic, and has been used, in this particular complaint, by Richter, but with very little success. The most common preparation of this medicine, is the distilled water; but the dose of this is very uncertain. Some have, therefore, proposed to give, for a dose, four or five grains of the fresh leaves infused in a little water.

The digitalis has a considerable power of abating vascular action, and may, therefore, be of use, in the same point of view with abstinence, bleeding, &c. in abating the action of schirri; but concerning its real utility in this disease, I cannot say any thing with certainty.

Opium is seldom employed with an intention of curing this disease, although it is probable, that it possesses just as much power over cancer, as those other narcotics which have been more frequently used. It is, however, liberally employed with a view to abating the pain of cancerous ulcers.

Tonic remedies have frequently been used in this disease; but although they may sometimes improve the general health, yet they never produce any effect upon the local disease. On this account, they are now very seldom employed.

Arsenic is a medicine, which has, by some, been considered as a specific against cancer; but even those who maintain this, add, that although they believe and think so, yet they have not been able to administer it in such quantities as to produce any good effect.

Justamond on Cancers.

Mercury has also been recommended; but there is no fact more certainly ascertained than this, that mercury uniformly exasperates this disease, especially when it has proceeded the length of ulceration. In this case, the sores enlarge rapidly, become much more painful, and bleed frequently. It is worthy of observation, that those who are affected with cancer, have in general the mercurial action induced very easily and very speedily; and the changes which take place on the ulcer are equally rapid. This circumstance, of mercury increasing the disease, in so marked a manner as it usually does, ought not only to make surgeons careful of exhibiting this remedy, upon slight suspicions of the sore being venereal, but may likewise be attended to as a step toward the discovery of a better mode of treatment for cancer than we yet possess; because if, at any time, we discover the means of directly displacing and counteracting the mercurial action, we may perhaps find the same to be useful in abating the cancerous; these two actions appearing to possess some general coincidence, from their mutual effect in increasing each other.

Alongst with this, it was customary to prescribe decoctions of guaiac, sarsaparilla, &c.

It likewise continues very long after giving up the use of the mercury.

Some cases of this kind I have already mentioned.

Copper, in the form of cuprum vitriolatum, has been used in cancer; and one case is recorded, in which it is said to have produced a cure; but in every other case it has failed; and, from the violent effects which it is apt to produce, considerable danger attends its exhibition.

Muriated barytes has been proposed as a cure for this disease; but now none employ it with this expectation.