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FREEZING, CARBONIC ACID, ETC.

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aggravated by the treatment, as I conceive the degree of cold applied is not sufficient to destroy the parts, but only to increase the inflammatory action.

Carbonic acid, as an application to cancerous ulceration, was first recommended by Peyrilhè. The benefit is acknowledged to be only temporary, if of any service. I have lately seen a case of ulcerated cancer of the tongue where this was applied; but, instead of checking, it rather aggravated the disease. Tar, creasote, and similar preparations have been tried; but I doubt if with any good results.

Gastric juice, from its alterative and solvent properties, has been tried in ulcerative cancer. There is no doubt but this agent effects a distinct improvement in ulcerative cancer; but there is no proof of its ever having effected a cure.

Caustics have been employed for many years in the treatment of this disease.

The actual cautery, according to Bayle, was probably the first agent used for this purpose. It is still extensively used among French surgeons; but rarely in this country. "Le Comte d'Arceuil proposed the plan of cauterizing malignant ulceration by concentrating the solar rays by means of a lens, which was attended with success in one case.' "'*

* Mémoires de la Soc. Roy. de Médecine, 1776. · ·

Of all preparations employed as a caustic, perhaps arsenious acid holds the most important place. As Mr. Walshe, in his work upon Cancer of the Breast, enters fully upon this subject, I copy from it the history of its use:-"Fuschius, who first used it, combined it with soot and serpentery; Guy, in his secret remedy, with sulphur, ranunculus sylvestris, and soot. Rousselot's celebrated powder consists of two drachms of arsenious acid, carefully mixed with two ounces each of the bisulphuret of mercury, and of the resin of Pterocarpus Draco; those of Frère Come, and Dubois, of the same ingredients in different proportions. When about to be used, these powders are mixed with a sufficient quantity of saliva to form a paste, which is laid on the surface (previously properly cleansed) in a layer of two lines thick. Dupuytren was in the habit of using a powder composed of ninety-nine parts of calomel to one of arsenious acid, increasing the latter to five or six parts in the hundred; or a liquid of somewhat greater strength, composed of the same ingredients, suspended in distilled water. Generally speaking, in twentyfour hours after the application of the paste, this adheres closely to the subjacent surface, and a slough separates within a period varying from twelve days to six weeks. The new surface exhibits a sound

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aspect, and is capable of granulating in a healthy manner. At least, such is the result in favourable cases, and a number of these are on record. But in some instances a second and third application are required; and the danger increases to such a degree, that it is now matter of received doctrine, that these preparations should only be used in cases of superficial cancer,-in ulcerations, similar somewhat. in character to those of lupus and of noli me tangere. The powder of Rousselot possesses the advantage of being less easily absorbed a point of vast importance, as fatal effects (cases of Fernel and Roux, for example) have more than once ensued from the entry of the poison into the circulation. M. Grandpré has introduced, and successfully employed, the practice of fumigations of superficial cancerous ulcers with cinnabar and arsenious acid; a particular apparatus is of course necessary to prevent inhalations of the vapour. That arsenical preparations have, with some frequency, effected a cure of cancerous ulcers in the manner described, is a fact concerning which no doubt can be held. But the hazardous nature of the treatment makes it desirable that a caustic, possessed of similar destructive powers, and free from its poisonous properties, should, if possible, be found. Within the last few years the chloride of zinc has

been introduced with these claims by MM. Hänck and Canquoin. I have seen some superficial ulcers of an intractable character cured with this substance in the Paris hospitals; and the experience obtained in this country is favourable to its employment. According to Mr. A. Ure, it produces a rapid and salutary change on the characters of corroding ulcers. In two cases of cancerous ulceration of the face, where the disease, though of long standing, was superficial, it acted most favourably in the hands of Mr. Lawrence, and the cures have been permanent. Mr. M'Clintock reports three successful cases of the same kind. The preparation employed by Mr. Ure is a combination of one part of chloride of zinc and two of sulphate of lime; M. Canquoin mixes the salt with various proportions of flour. The thickness of the layer of paste must be proportioned to the depth of the eschar required to be produced. Its immediate effect is that of a powerful stimulant, causing great vascular excitement, with swelling, bright redness, and severe pain, the last continuing twenty-four or forty-eight hours or even longer.” *

Of the use of chloride of zinc I intend speaking more fully when I discuss the subject of enucleation of cancerous tumours by means of caustics.

* Walshe On Cancer, p. 218.

Nitrate of silver is still frequently used. I have seen many cases in which it has been employed in epithelial cancer of the tongue, and I am sorry to say in every such case it has not only aggravated the symptoms, but also hastened the fatal termination of the disease.

M. Recamier mentions remarkable results which he obtained from the use of this agent; but so far as I know, it has been but little used alone by others.

Caustic potash, corrosive sublimate, the chloride of antimony, and other caustics, have been tried in the treatment of this disease, but the results could not have been very successful, otherwise they would have been more in repute at the present day.

"It is well known that there are many plants in the vegetable kingdom which have the power of removing tumours and similar diseased masses. Among these, I think the wood-sorrel is the best and safest. It is commonly used among the Sioux, Crow, Blackfeet, and other North American Indians, from whom I first learned its properties and method of preparation. It causes but little pain, and, when applied to a tumour, it removes it in a few weeks (dependent on the size), leaving a healthy wound, which these primitive surgeons dress with other herbs, and very soon effect a cure which any member of the College

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