Whenever the viscera become the seat of secondary cancer, or, as Mr. Fergusson objects to that term, whenever cancer attacks these organs at a period subsequent to the appearance of the disease in any external part, it will be of course much more readily recognised, because the surgeon knows how frequent are these further manifestations of the constitutional character of the disease, and he is consequently on the watch to meet them, if they may be met, by appropriate treatment. The whole glandular system is prone to exhibit a tendency to take on the cancerous action, but perhaps the largest gland in the body, the liver, besides its liability to the primary affection, is more frequently affected as a sequence to operations for the removal of scirrhus of the mamma, than any other part of the body. The probable reason of this election is, that in this country the important functions of the liver get deranged very generally towards the end of middle life, and thus it is rendered an apt receptacle for the deposition of diseased molecules. I have seen extension of cancer inwards from the mamma through the intercostal muscles to the pleura and pericardium, and the lung itself does occasionally become diseased in this manner; but more commonly cancer of the lung has an independent origin, and may or may not be associated with a similar affection of the breast. Hydrothorax is a very usual result in these cases, and when there is much dyspnoea from this cause, tapping affords considerable relief for a time. This pleuritic effusion should always be suspected and looked for whenever the patient is unable to lie down with ease; and although some will refuse to undergo even this slight operation, it should always

be offered as a sure means of relieving a most distressing symptom.

With regard to the medicinal treatment of all these internal cancers, I would urge the great value of codliver oil, in conjunction with hydrochloric acid, or some preparation of iron. I have been astonished at the beneficial results obtained, even in very advanced cases, by a persistence in the use of this remedy. I have now under my care a man who was rapidly falling into the cachectic condition, consequent on a very evident cancer of the liver. Since taking the oil, which he has done for four months, the sickness and pain are considerably diminished; he can take food with appetite, and the tumour is lessened. In an interesting case of cancer of the bladder, a very marked improvement is quite traceable to cod-liver oil and hydrochloric acid with bark. The patient was a pale, thin, married woman, aged thirty. An aunt had died of cancer of the breast. The pubic region was occupied by a hard tumour, painful on pressure, and there was some induration of the inguinal glands. The vaginal examination showed that the bladder was one hard mass, the induration extending nearly to the meatus urinarius. She required to pass water every half-hour. Menstruation was regular, but excessive, and very painful; and she had much leucorrhoea. Coition was also very painful. No children. She had been ill for fifteen months, and was becoming so weak that she could walk only a few yards with the greatest difficulty. She first came under my care May 19, 1864; I then ordered cold bathing with the view of checking the leucorrhoea and the excessive catamenial flow, directing her to stop the latter by this

means after it had continued three days. She was to take bark and hydrochloric acid. In time the leucorrhoea was got rid of, and the menorrhagia lessened. She was now able to walk a little. I then sent her to the seaside for a month, and she returned greatly improved, able to walk some miles. The tumour diminished; coitus not painful now. To take cod-liver oil and the same bark and acid, and apply a supporting plaster over the pubic region. September 29: much general improvement, able to retain the urine some hours. She continued this treatment through the winter, and was able to do her household duties with moderate comfort, except at the menstrual periods.

She is now, May 1865, comparatively well, although the indurated condition of the whole bladder is still apparent. The urine did not afford any microscopic evidence of the nucleated irregular cells usually found in the secretions from organs affected with cancer; but I think this may be accounted for, as it is evidently a case of scirrhus, not of epithelioma, and at present is not throwing off any detritus from the mucous surface of the bladder. The hereditary tendency to cancer, the extreme induration and the glandular enlargements seem to me incompatible with any other diagnosis.

The same treatment will be found most serviceable in cancer of the uterus and ovaries. The discharges which accompany cancer of the uterus rob the blood of its red particles; so that iron, and especially the red oxide, is generally the most useful medicine to accompany the cod-liver oil.

Whilst we are thus improving the general condition from within, it is necessary to check the local destructive

outflow of vital fluids; and for this purpose many astringent applications are used. I have not failed to employ everything that has any sort of reputation, including the actual cautery; and the result of my investigations is, that the chloride of zinc and the sulphate of copper deserve the most approval. My usual prescription is forty grains of the zinc, or sixty grains of the copper, to the pint of water; and this answers the purpose in most cases. It would seem that it is not an astringent or styptic we want in these cases, but a stimulating lotion, which heals the ulcerated part as it does when the same application is made to a foul ulcer on the leg.

In cancer of the lungs, cod-liver oil would in all probability be given; but I see no reason why it should not be tried also in cancer of the stomach. The nausea which accompanies this affection is owing to mechanical causes, not to that reflex action which is induced by an offence to the sense of taste; for in fact there is often a craving for food in these cases, and it is swallowed with avidity, although it be ejected in a very short time. When the elements of nutrition cannot be retained in the system, it is of course almost a hopeless task to attempt the healing of an ulcer in this position; but seeing how much good is done in the almost equally severe cases of cancer of the liver and of the uterus, I should not despair of obtaining some respite even in this instance.

A generous diet, easy of assimilation and often varied, is a necessary accompaniment to all treatment in internal as well as external cancer. Those patients who are enabled to take bottled stout derive much

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benefit from it. The sleep which is thus obtained is much more tranquil and restorative than that effected by any kind of soporific medicine. For more tender stomachs the sparkling wines of France, and perhaps those recently introduced from Austria, afford the best means of gently stimulating the digestive function, which is always defective in action whenever the individual from any cause does not undergo a certain amount of daily muscular exercise.

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