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any gland of no great extent or sensibility, it is, after a long period of time, liable to suppurate without inducing fever, like the indolent tumors of the conglobate or lymphatic glands above mentioned; whence collections of matter are often found after death, both in men and other animals; as in the livers of swine, which have been fed with the grounds of fermented mixtures in the distilHeries. Another termination of scirrhus is in cancer, as described below. See Class I. 2. 3. 22.
16. Carcinoma, Cancer. When a scirrhous tumor regains its sensibility by nature, or by any accidental hurt, new vessels shoot amongst the yet insensible parts of it, and a new secretion takes place of a very injurious material. This cancerous matter is absorbed, and induces swelling of the neighbouring lymphatic glands; which also become scirrhous, and afterwards cancerous.
This cancerous matter does not seem to acquire its malignant or contagious quality, till the cancer becomes an open ulcer; and the matter secreted in it is thus exposed to the air. Then it evidently becomes contagious, because it not only produces heótic fever, like common matter in ulcers open to the air; but it also, as it becomes absorbed, swells the lymphatic glands in its vicinity; as those of th: axilla, when the open cancer is on the breaft. See Class II. I. 3.
Hence exsection before the cancer is open is
generally generally a cure; but after the matter has been exposed to the air, it is seldom of service; as the neighbouring lymphatic glands are already infected. I have observed fome of these patients after the operation to have had diseased livers, which might either have previously existed, or have been produced by the fear or anxiety attending the operation. Erosion with arsenic, after the cancer is become an open ulcer, has generally no better effect than exsection, but has been successful before ulceration. The best manner of using arsenic, is by mixing one grain with a drachm of lapis calaminaris, and strewing on the cancer some of the powder every day, till the whole is destroyed. Cancers on the face are said to arise from the pe. riosteum, and that, unless this be destroyed by the knife, or by caustics, the cancer certainly recurs. After the cancer becomes an open ulcer of some extent, a purulent fever supervenes, as from other open ulcers, and gradually destroys the patient. See Class II. I. 6, 13. Two very interesting cases have been lately published by Dr. Ewart, of Bath, in which carbonic acid gas, or fixed air, was kept constantly in contact with the open cancerous ulcers of the breast; which then healed like other common ulcers. This is rather to be ascribed to the exclusion of oxygen, than to any specific virtue in the carbonic acid, As in common ulcers the matter does not induce l hečtic for many months, and to drink nothing stronger than common weak small beer, consisting of three strike of malt to the hogshead, or wine diluted with thrice its quantity of water. If caustics cannot be applied so as to destroy the whole, even before ulceration, I suspect that they aggravate the evil, and sooner destroy the pa. tient; as, I was well informed, occurred to a quack who was for a time much resorted to, in this part of the country. Another method of using charcoal-powder is by mixing it with boiled oil, to the consistence of common paint; and to soak a piece of flannel with this, and cover the ulcer; and daily to shove or thrust this off by applying the edge of another piece of flannel, soaked with the oil and charcoal, to the edge of that upon the ulcer, so as to change them without the possibility of letting any air come into conta&t with the cancerous fore. gout or rheumatism; the former of which is liable to disable the fingers by chalk-stones, and thence to have somewhat a similar appearance. But the arthrocele, or swelling of the joints, affects people who have not been intemperate in the use of fermented or spirituous liquors; or who have not previously had a regular gout in their feet; and in both these circumstances differs from the gout. Nor does it accord with the inflammatory rheumatism, as it is not attended with fever, and because the tumors of the joints never entirely subside. The pain or sensibility, which the bones acquire when they are inflamed, may be owing to the new vessels, which shoot in them in their soft state, as well as to the distention of the old Ones.