º | A 575535 º - CANGER AND ITS CURE BY ABSORPTION, PAINLESS EXTRACTION, AND RESOLUTION, AND THE USE OF SPECIFIC MEDICINES, TOGETHER WITH ILLUSTRATIVE CASES, AND AN APPENDIX ON LUPUS, BY -- R. S. GUTTERIDGE, M.D., F.A.S., Physician to the bispºns ARY FOR CANCER AND constºption, GEORGE STREET, MANchkEstER squake; Honor ARY PHYSICAN TO THE CHURCH OF ENGLAND scripºrukº READERs' FRIENDLY Association; LATE LECTURER ON PRACTICE of MEpicine to ZENANA MEDICAI. Col. HºH ; LATE - pºsician to THE Homº For DISEASES OF WGMEN AND METROPOLITAN PROVIDENT 1915 PHNSARY, £ombon : KEENE AND Ashwell, 74, NEw BoxD STREET. New York: A. L. CHATTERTON AND Co. tº item Selected tion By MDP 2008 For Reten * LONDON PRINTED BY SOUTH wood, SMITH, & Co., THE GUILDHALL PRESS, KING STRFFT rºtºr a recºr-- - - PR E FA C E . PREFACE TO THE FIRST EDITION. I have refrained until now from reprinting this Treatise on Cancer in order that I might still further test the efficacy of the treatment therein laid down. Extended trial does but corroborate the views advocated, and renders still more certain the complete cure of this dread disease by medicine. January, 1884. PREFACE TO THE SECOND EDITION. s The greater part of this Edition has been entirely re-written and brought up to the present time, so as to embody the most recent views on Cancer, as to its origin, and the most approved and successful treatment of this dire malady. * R. S. GUTTERIDGE, 58. BRook STREET, GROSVENOR SQUARE. December, 1889. C O N T E N T S. -º | I.—OPERATION FoR CANCER II.-NATURE of CANCER ". . III.-PREVALENCE of CANCER IV.-DIAGNoSIs of CANCER - W.-MEDICINAL TREATMENT—SPECIALLY of CANCER of THE BREAST --- --- --- --- VI.-TREATMENT of CANCER BY ABsor PTION, DISINTEGRA- Tion, AND SECTIONAL REMovAL VII.-TREATMENT of AdvancED, OPEN, or ULCERATED CANCER ... --- --- --- --- VIII.-TREATMENT of CANCER of THE LIP, FACE, Bow EL, StomACH AND Wom B... ---- --- l IX. —CASEs ILLUSTRATIVE of THE TREATMENT APPENDIx—LUPUs PAGE 12 16 48 CANCER AND ITS CURE. CHAPTER I. OPERATION FOR CANCER. THE question, the all-important and absorbing question for those who are themselves afflicted with Cancer or who know or are interested in those who similarly suffer, is “What is best to be done?” This answer is given truthfully and on sufficient data in these pages. Ordinarily, the reader knows that the direction by almost all physicians and surgeons of all creeds and persuasions, orthodox and heterodox alike, is “You must have it removed by the knife; there is nothing else.” Now, notwithstanding this concensus of opinion, I do not hesitate to say that these very scientific persons are giving you the worst advice. They are wrong—altogether wrong. Operation by the knife is always unnecessary, is un- scientific, sometimes dangerous, always delusive, and generally fatal in its results. 6 Concer and its Cure. The Cancer is sure to return, sometimes before the scar left after its removal is thoroughly healed, or at best in a few months. How very often it is that we have news but twice after an operation. The patient did so well, the wound healed beautifully; and then in a little while, if you inquire, you are met with the exclamation, “Oh, don't ask me ; the patient is dead, there was soon a return and nothing could be done.” - As we have before remarked, all this is generally known and is matter of common observation when Cancer is talked of. It may be as well, however, to append some medical and surgical opinions on this point. Dr. Tanner remarks: “The views of surgeons are much divided. Still there are few who will deny that, as a rule, extirpation by the knife is quite insufficient to effect a cure. The operation may relieve the local dis- tress and will probably prolong life for a few months, whilst the use of chloroform renders the proceeding painless. It must not be forgotten that the operation itself will possibly prove fatal, whilst, in some cases, it certainly appears to increase the malignity of the disease.” Thus, as Dr. Walshe points out, excision of a cancerous tumour seems to awaken a dormant force. Cancers spring up in all directions and enlarge with a power of vegetation almost incredible. Again, of the cases of cancer of the tongue, the most frightful are those where the disease has returned after operation. Mr. Weedon Corke says the disease re-appears with Concer and its Cure. 7 intense malignity, not only in the tongue itself, but in all the neighbouring glands. This is the rule in patients operated upon; it is the exception in cases healed con- stitutionally. Sir Spencer Wells says that the knife is not to be used in the early stages of Cancer. Dr. Affleck, of Edinburgh, remarks: “It must be admitted that the results of removal by the knife are generally disappoint- ing, from the intense tendency of the disease to recur” Scarcely, then, is it to be wondered at that, backed up by these opinions, I say under no circumstances allow yourself or those belonging to you to be operated on by the knife, especially when I know an eminent operating surgeon who refuses any amount of fee to induce him to use his knife in Cancer. If I could embody here all the sad tales I have heard, if I could concentrate all the vain laments it has been my fate to listen to, I think I could make you pause and before long decide on the side of common sense and humanity, and say “No.” Lastly, I claim to be heard on my own account. For more than twenty years, having given special attention to this disease in all its phases, I can truthfully say that I know of no single case in which, where contrary to my urgent entreaty, an operation has been undergone by the knife, where the patients themselves and all belonging to them have not deeply but unavoidably regretted that my advice to decline had not been taken. Having often had as many as thirty patients under my care for Cancer at Cancer and its Cure. the same time, I have had repeated opportunities for estimating the value of various kinds of treatment. I have written on the subject in the Lancet and else- where, and my observations have been translated into French and published by Dr. Claude, of Paris. If there is not to be operation by the knife, it may reasonably be asked, “What do you advise, what course do you say we should pursue?” First and fore- most and throughout internal medicines and treatment, without which you will not be safe to do well. Secondly, absorption by medicines aided by plaisters externally. Thirdly, resolution or withdrawal, so that the Cancer is cast forth from the system. Lastly, when nothing more is practicable or advisable, the Sectional Treatment, by which exuberant growth is checked and the whole Cancer cautiously undermined and destroyed. Disintegration is often successfully accomplished in from three to six weeks. It was a method freely used by the late Sir James Simpson, of Edinburgh, and is as comparatively painless as it is efficacious. CHAPTER II. THE NATURE OF CANCER. To enter upon a consideration of the Nature of Cancer, is to answer the question, as far as we can, What is Cancer 2 Cancer and its Cure. 9 To subject cancerous matter to the microscope will not help us; to divide and sub-divide it into its com- ponent parts will not bring us nearer the solution of the difficulty. In appearance and in ultimate composition Cancer is, in no respect, different from purely healthy structure. . And yet there is a certain disease recognised as Cancer, manifesting itself in well-known positions and organs of the body, by no means in all, with which physicians and surgeons and not a few of the laity are so well acquainted, so as to be able, at first sight, to distinguish it with certainty. There is an arrest of function, an alteration of development and repair in the part or organ, determined apparently by accident, or it may be by direct injury; the liability or the proclivity to which arrest or altera- tion may be inherited or may be acquired from floating germ, or living bacillus or microbe. In a treatise on Cancer, published in 1886, it is stated that “The discovery of a parasite in other diseases, as tubercle, malignant carbuncles or anthrax, of equal malignancy to Cancer, has led to the application of this theory to the origin of Cancer. It is not claimed that tumour is the parasite, but that it contains a parasite just as do leprosy and tubercle. º “The development of Cancer, its rapid growth and dissemination; the similarity of the secondary deposits to the original growth, and the all but impossibility of 10 Cancer and its Cure. the removal of the disease, as Dr. Sheare's thinks, bears - a close resemblance to the processes at work in other - | diseases in which a parasite is found, and has been | - supposed to be the existing cause of disease. So far, no such parasite has been discovered, but its existence is not impossible, for only within the last few years has the parasite of tubercle been discovered.” The above is the opinion of an American physician. Judging from the geographical distribution of Cancer in this country, and from other data as far back as 1882, - - I demonstrated the bacillary origin of Cancer, and my claim to this has been allowed by other writers on the - subject. - This theory, it will be noted, is capable of defence, although we cannot demonstrate it by the microscope any more than we can demonstrate by the same means the existence, or elucidate the nature, of the scarlatina, small-pox, measles, or cholera poisons. Just as the scarlatina, or other germ, is utterly innocuous to many who are exposed to it, and when it invades the system manifests its virulence in diverse forms, some benign and others most malignant, not only in the same neighbourhood but amongst members of the same family who are stricken down at one time, so is it with Cancer. Many defy its slightest approach, and from those who suffer we can select cases widely different in origin, course, aspect, constitutional perme- ation, development, and time, and manner of result. Cancer and its Cure. 11 In saying this we advance no more than can be written about all constitutional diseases. They are modified by temperament, individual idiosyncrasy, type of muscular and glandular development, habits of life, occupation, and general sanitary conditions. It will be evident, from all this, that we contend for only one Cancer-poison, let its manifestations be as diverse as they may, and educe therefrom the practic- ability of treating Cancer on a sound and scientific principle, with every hope of success. Hence the futility and the evil effects of concealment when Cancer exists. It must have happened to all who have had the charge of Cancer patients that, owing to a profound conviction of the incurability of the disease, persons who have an idea that they are the subjects of it, keep the knowledge most strictly to themselves, deceive those around them as to the nature of their malady, go often to the length of denying that anything whatever ails them, and studiously refrain from seeking medical advice until an open cancerous sore displays itself, the lymphatic glands become involved, and the entire constitution con- taminated. If we can hold out legitimate hope that Cancer is susceptible to rational treatment, the fact will remove the delicacy and fixed disinclination of sufferers to seek for aid. When once the public become convinced of this, we shall have the best possible chance of curing Cancer. We shall get to see it and treat it in its earliest stages. Such chance is now rare. 12 Cancer and its Cure. CHAPTER III. - THE PREVALENCE OF CANCER. SINCE the year 1851 Cancer has been on the increase in England. The Registrar-General, in the thirty-seventh Annual Report, published in 1876, calls special attention to the fatality of this affection. He says, in his forty-first Report, bearing date 1880, “It was fatal to 5,218 in 1851, and to 12,664 in 1878; the average annual mortality during the five years 1850-4 was 302 in one million living; in the five years 1870-4 it was 443, while in the year 1878 the rate was 512; thus the mortality from Cancer has increased year by year since 1851. It is a malignant disease, slow in its progress, but surely fatal.” The above figures show that in the year 1878 the deaths from Cancer were almost equal to those accounted for by measles and typhoid fever; a fact of startling import. We may, then, well inquire how it occurs, and why it is more fatal at the present time than it was during the last generation; and, further, ask if there be any, and what means by which such fatality may be lessened, or altogether averted. In these queries lie the object of this pamphlet. Cancer and its Cure. 13 It is difficult, as we have already stated, to define Cancer, and to classify it with scientific precision. We trust it may prove a more hopeful task to account for its prevalence, throw light on its origin, and give some indications for a rational and successful plan of treat- ment. In the year 1875 attention was specially directed to the geographical distribution of this disease by the lectures of Mr. Haviland, and the maps by which they were illustrated. - Turning to his map, which sets forth the distribution | of Cancer, we see that each bank of the Tweed about Ber- wick, of the Tyne at Newcastle, of the Swale, the Ouse, and the Humber in Yorkshire, the Trent about Notting- ham, and the whole of our beautiful Lake district, are - fertile beds of Cancer. Wales is nearly free, except about the Conway, and the Dovey; so are the manufacturing districts; whilst Chester, Shrewsbury, Derby, Newark and Lincoln are bad, as also are parts of Birmingham, Nuneaton, Lutter- | worth and Huntingdonshire, Norwich, Stamford, and Peterborough. Cornwall is comparatively free, except in the neighbourhoods of Falmouth and Bodmin. A belt of liability runs across Devonshire, from Barnstaple to Exeter and Exmouth. Plymouth and vicinity, with Totnes, are above the average, as also are Taunton, Axminster and Bridport, Wells, Warminster, Blandford, and Poole in Dorsetshire. 14 Cancer and its Cure. Bath stands high for mortality in this disease, so do Tetbury, Marlborough, Devizes, Shaftesbury, and Lymington. The Isle of Wight is all but free from Cancer, and so likewise the New Forest. Brighton and its district are bad; so are Hastings, Romney Marsh, Folkestone, Dover, Deal, Ramsgate, and Margate. Coming near the metropolis, we find that in Chertsey, Guildford, Dorking, Epsom, Reigate, East Grinstead, it is pretty equally prevalent. The huge London district (excepting Uxbridge and Hendon), extending to Oxford and Aylesbury, with St. Albans on the one side to Ware, Epping, Ongar, and Shoeburyness on the other, is one appalling Cancer field. In London itself, strangely enough, the parish of St. Luke's, the swarming neighbourhood of Bishopsgate Street, crowded Bethnal Green, far-away Old Ford, Bow, Poplar, the Isle of Dogs, savoury Rotherhithe, and fragrant Bermondsey, are almost entirely exempt. One respectable part of the metropolis, that about the Marylebone Road, Regent's Park, and Primrose Hill, stands out as exceptionally bad. - The returns for London go partly to show, what is demonstrable in another way, that density of popula- tion, hard living, and laborious toil, have very little to do in favouring the growth and appearance of Cancer. Liverpool, like the metropolis, is situated on the banks of a large tidal river; it has a teeming and not Cancer and its Cure. 15 over sober population; its deaths in 1878, from all causes, outnumbered by a thousand the total of its births, and yet Liverpool, with its over 552,000 inhabitants and its heavy general mortality, has an enviably small per- centage of deaths from Cancer, because it is surrounded by a district not liable to Cancer, one, in fact, with the lowest mortality from this cause. On the other hand, London is a Cancer bed in itself, and at nearly every conceivable point the country round it for many miles is equally bad. From the preceding facts Haviland deduces the fol- lowing conclusion, in which we are constrained to agree, unless we are prepared to controvert his statements, and question the accuracy of the Registrar-General's returns. All places and districts with a high mortality from Cancer present common characteristics. They have rivers or streams taking their rise in soft crumbling rocks of loose formation; the volume of their waters is periodically liable to overflow after violent rains or sudden thaws, such increase, badly restrained by low and defective sedgy banks, or added to by artificial dams, submerges to a considerable extent the surrounding dis- trict on one or both sides. From the very nature of the country, subsidence of these floods is much more gradual than the rapidity of - their rise and development. Hence we have complete saturation of the soil to a considerable depth, constant exhalation of decaying 16 Cancer and its Cure. matter, both vegetable and organic. The land never having time to purge itself from its poisonous malaria, has a store in hand with which to welcome the next deadly overflow. Consequently, these Cancer beds, once estabished, go on in an ever-increasing ratio in the manufacture, pro- pagation, and dissemination of germs which we conceive to be the true cause of Cancer. If we have not here given the real answer to the Registrar-General's query as to the continuously increased mortality from Cancer, we claim to have propounded the nearest solution which has hitherto been set forth. Cancer is by no means distinctly hereditary, and the consumptives of one generation may usher in the can- cerous of the next. Treatises have been written on the connection of the two diseases. Lupus, which is regarded by many to be as distinctly a tuberculosis as consump- ºtion itself, may be the connecting link. CHAPTER IV. - THE DIAGNOSIS OF CANCER. THE diagnosis of Cancer, or how to distinguish it, is a matter of the highest importance, both as fixing our treatment for each individual case and enabling us to Cancer and its Cure. 17 propound anything for future guidance beyond the rankest empiricism. Above all things, it is necessary to be persuaded as to the nature of the affection with which we have to contend. Sir Astley Cooper was once (at least) present at an operation when another surgeon commenced to remove a tumour of the breast which turned out to be merely an ordinary mammary abscess; and he himself, on another occasion, opened a supposed abscess in the groin which proved to be fungus haematodes. In the latter instance, in less than ten days, his patient was dead. If a doctor feels certain, he should act on his belief - º at once; if doubtful, let the patient reap the benefit. CANCER OF THE BREAST. In reference to the diagnosis of cancer of the breast, in practice very little reliance can be placed on the usually recognised signs; very few of them being reliable. As by far the greater number of cases of cancer which submit themselves to our treatment are arranged under this category, it becomes all the more important to have clear ideas as to what we may rely upon and what we ought to reject. A patient presents herself to us complaining of a painful tumour in the breast; we should be able to decide whether we have to deal with a simple glandular B 18 Cancer and its Cure. enlargement, with an ordinary painful tumour, or with Cancer in a more or less advanced stage. To take first the glandular enlargement. If it be nothing more, the present aspect and history of the individual will suffice to enable us to come to a determination. The patient will be considerably beyond twenty years of age; will manifest traces of constitu- tional delicacy, perhaps evidences of old cicatrices under the jaws or elsewhere; may have been subject to gather- ings, and be of an incontestably scrofulous constitution. But the case is altogether different if we find a tumour almost always painful, with a twinge that well nigh sickens and a throb that seldom ceases ;-in a subject worn with anxiety and wearied with grief. Or if, in women too young to be suspected of Cancer, we meet with adenomatous enlargement of the breast of con- siderable size, the veins distended, the skin discoloured, and the nipple altogether displaced, whilst the textures all round are healthy and the glands in the armpit not the least affected, it is inconvenient and often painful, but it is not Cancer. In some instances it will transpire that although for weeks, perhaps months, various uncomfortable sensations and even violent pains have been experienced, the most searching investigation will fail to discover anything abnormal in the condition of the breast, such cases requiring to be treated as purely neuralgic or as sym- pathetic of some uterine disturbance. Cancer and its Cure. 19 If, ultimately, a doubt should remain in the mind of the doctor as to the precise nature of a supposed growth in the breast of a patient, let him first satisfy himself as to the existence of a tumour other than that of the \\ ordinary mammary gland. º Let the examination be carefully and thoroughly conducted with the patient in a standing position, and then let her recline on a couch. Should any enlargement be discovered, its position, attachments, and the sensation afforded to the touch of the examiner, revealing or not an interior, stomy hard- ness, however small in extent, accompanied at irregular intervals by darting pains, as of a hot needle quickly passed through; the age, general appearance, and uterine condition, must be taken into account. Should the patient have attained the age of thirty- five years, whether married or single, it will be well not to pronounce a decided opinion, to treat the case accord- ing to its prominent symptoms, and wait for a further development or retrogression of the tumour. In the event of a suspicious tumour existing in the breast, usually a short space of time will suffice to render its character incontestable. If malignant, it will almost invariably develop itself, its rapid increase being perceptible on repeated examina- tions. Before long the skin above it will alter its colour, becoming of a dusky hue, and, as it grows, a dimpling 20 Cancer and its Cure. - shows itself — unmistakably diagnostic evidences of Cancer. The nipple may (or may not) be affected throughout the whole course of Cancer, being invariably retracted in the case of atrophic schirrus only. In unmarried women, and in women who have never suckled their children, the nipple is frequently un- developed, the breast remaining thoroughly healthy. Then, if there be ulceration, is it cancerous or one of some other kind? The situation in which it appears (e.g., the lip, vulva, or the scrotum), the czclusion of specific infection and the gradual elimination of this particular one from other sorts which it might possibly - be, will lead us a good way in our solution of the doubt - as to its being cancerous or not. Supposing, then, we come to the conclusion that we have to deal with schirrus or Stone Cancer in its early stage, what course should we pursue with the greatest advantage to our patient and the greatest credit to our- selves? The whole circumstances of the case must be well considered and such medicines and other treatment pursued as best adapted to give ease and effect a cure. At all events, in every instance, we may speak in words of hope. The conviction of the incurability of Cancer is so deeply rooted, so insisted on, on all sides, so acted on in ordinary medical practice and medical writings, that any one who declares that, on the contrary, it is curable, º Concer and its Cure. 21 is thought to be a credulous simpleton or a wilful deceiver. I venture to assert that Cancer is curable, and by no secret methods, but by recognised medicines, without the \ aid of the knife, and usually without the stupefying, \ deadening influence of opium in any form or under any disguise. \ I am determined to proclaim this far and wide, so that at all events I may prevent a few at least from yielding blindly to the surgeon's dictum, “You must have it removed.” Alas ! how many thousands have con- sented, to their sorrow. -- - - It has been my lot to see so many instances of unavailing regret and most painful suffering, needlessly \produced, that I feel very strongly and write strongly about it. - I would say most earnestly, even if you are unwilling to try anything else, never by any persuasion, however urgent, nor by any authority, however eminent, be per- suaded to be operated upon. If you do your chance of life, humanly speaking, is gone. What we have to offer as alternative, treatment based on sound principles, as the result of the experience of | many years, will be set forth in the next chapter, and cases will be cited in support of our assertions. 22 Cancer and its Cure. CHAPTER V. THE MEDICINAL TREATMENT OF CANCER. CANCER, wherever it be and whatever its form, being considered by us but as the local or outward manifesta- tion of blood disorder, calls of necessity from the very first for medicinal treatment persistently adhered to. We subjoin a description of the medicines we employ, with precise indications or directions for their use. º The employment of these, however, we supplement by Absorption, Resolution, Withdrawal or Sectional Treatment, as most likely to be beneficial to our patients, and, in the event of very extensive ulceration and implication of the system, we combat the cachexia as far as possible, maintain the strength, subdue the pain, and in every way mitigate the pressure of an otherwise almost insupportable condition. First, then, where we have a swelling unquestionably felt, of the essentially hard nature of scirrhus, liable to pain at uncertain times, as of hot needles thrust through the part (especially if the skin above is altered in how- ever slight a degree), and the complexion generally suspicious, the look worn and jaded, the appetite failing, discard all other medicines and use Hydrastis, internally and externally, freely and persistently. We are aware that the virtues of this drug in Cancer has been warmly Cancer and its Cure. 23 disputed. For the last sixteen years we have employed one preparation of it with almost unvarying success. That preparation is the neutral Hydrastin of Tilden, of New York, intimately incorporated with an equal quantity of the Hydrastis of the same firm. This com- bination is as different in appearance, taste, and odour, as it by far surpasses all others in its local and con- stitutional effects. Hydrastin is now a recognised drug, both in allopathic and homoeopathic practice, and as such is easily procurable, so that when from any cir- cumstances we have been unable to purchase Tilden's | powder we have resorted to the preparations of other makers. Consequent on this enforced change we have invariably found that our patients have lost ground rapidly, both in health and in the local trouble. In saying this we speak after repeated trials, improvement taking place at once on the resumption of Tilden's medicine. We had an opportunity of trying the effect of this medicine internally and as a lotion for five months, under the inspection of a distinguished operator and acute observer, in a patient of his, on whom he desired, but feared to operate, mainly on account of her general º health, though he was apprehensive that the growth of the Cancer would compel him to use the knife as the only chance open to him. After taking the Hydrastis and having it locally applied, the swelling became stationary, then perceptibly decreased, her general health correspondingly improving. 24 Cancer and its Cure. Whenever Hydrastin is given internally we invariably apply a lotion of the tincture of powdered root. Inasmuch as Hydrastis does not apply to every case, we subjoin the indications for the use of other medicines. In instances where Hydrastin either does not suit, or appears to have lost its power, or cannot be tolerated, and the tumour becomes harder, nodulated, and thoroughly defined, the pain throbbing and lancinating, the patient sallow and greatly debilitated, the Galium Aperinum (a very old remedy in Cancer), together with Phytolacca and Condurango are the best medicines to which we can resort. Next we proceed to the effects of Belladonna and Conium, which have been employed in Cancer almost from time immemorial. Under the use of these remedies we have found true scirrhus disappear, without a return after the lapse of several years, so that it is not unreasonable to suppose that they have effected cures, and, therefore, will do so again. Belladonna is more suitable for plethoric, sanguine individuals liable to congestions of various kinds, who have periodically been subject to profuse menstruation. Conium is better adapted to torpid constitutions, inclined to melancholy, of rigid, spare make, and irritable temper, in whom menstruation has been scanty, some- times suppressed, and generally accompanied by pain. Belladonna to more recent affections, Conium to those Cancer and its Cure. 25 of longer standing, particularly sensitive at each menstrual epoch, especially if the Cancer be traceable to a blow or injury. Other distinctive symptoms as may range themselves under either of these remedies may serve to guide our decision. - Conium is mentioned by Pliny as curing tumours, \ º abscesses, and ulcers of a bad character, so also Avicenna, and many others, refer to its use in indurated scirrhus or carcinomatous tumours. Then Stoerck makes mention of it in reference to glandular indurations of the mammae, and in the most malignant Cancers, discharging an acrid, corrosive ichor, with implication of the axilliary glands \ in the armpit, and, further, in scirrhus induration and ulceration of the sublingual and cervical glands, and, lastly, in carcinomatous excrescences of other parts and in lupus. Hoffmann, Hufeland, Hallé, and others, unite in justifying the use of Conium in the same affections. Further special indications for Conium are lancinating pains of a burning and stinging nature, especially felt in the evening or night. Another medicine, Cicuta Virosa, is in its action similar to Conium, but more powerful. Cicuta Virosa is suitable for irritable, nervous, and excessively fanciful patients; the tumour not very sensi- tive to pressure, but a burning pain in or about the nipple, with tearing sensations in the whole of the left arm as far as the fingers, the arm feeling very heavy when the patient attempts to raise it, stitches in the 26 Cancer and its Cure. shoulder, so severe that the slightest movement causes a cry of agony, and the fingers keep rigid through fear of additional suffering. Besides all this there is a complete want of strength in the arm. Where the enlargement is permanent, painless, and apparently stationary, Calcium Iodide is the medicine which should be administered, but when there is debility and manifest increase the Iodide of Arsenic is to be substituted. Kreosote, a prominent medicine when the entire breast is hard, bluish-red, and covered with pro- tuberances. Phytolacca applies rather to doubtful cases of en- largement or induration of the breast. Condurango unquestionably aids in antidoting the cachexia, and thus may be useful sometimes as an inter- mediate medicine when patients get tired of Hydrastis. This drug possesses the beneficent power of relieving the neuralgic piercing pain of Cancer. . Comocladia serves in some cases to retard the pro- gress of ulceration and to aid cicatrization. Misisiquoi Water is a serviceable table beverage for Cancer patients. Owygen, which is very easily procurable and adminis- tered, also helps in the matter of cachexia and weariness. The medicines which we have so far enumerated apply to cancer of the breast before ulceration takes place. The cases which come under our notice are more º * Cancer and its Cure. 27 usually in a later stage, that is, they are ulcerated, often to a very considerable extent. Many who might be disposed to admit that much may be done in the resolu- tion of unbroken cancer would be inclined to question A the advisability of attempting more than the mitigation of pain, the enforcement of cleanliness, and the lessening of foetor in open Cancer. We are fortunately able to accomplish very much more than this. We can retard, the progress of the disease almost indefinitely, assuage the pain and discom- fort, maintain the strength or bring it back when sup- | posed to be gone, perceptibly alter the aspect of the complexion, and, therefore, the condition of the blood, \ and render life not only endurable but comfortable. We \ are thankful to say that especially in cancer of the womb and rectum or lower bowel this has frequently been our experience, so that in advanced cases where it has hap- pened that our treatment has been suspended, the change for the worse has been rapid and appalling. - CHAPTER WI. | TREATMENT OF CANCER BY ABSORPTION, DISINTEGRATION, AND SECTIONAL REMOWAL. IT does not detract in the very least from the supreme potency and necessity of the medicinal treatment of the 28 Cancer and its Cure. effects of which we have written at length and in such high terms, to say that medicine can be most usefully aided in many instances by one of the processes enumerated above. Cancer is a bad tenant and the sooner it is ejected the better. It is a mischevious, dangerous tenant, all the worse the longer it remains. It is corrupting in its influence; if it stay long enough it will infect the whole body; therefore, out with it, if it can be done safely, without too much violence, without inflicting too much injury. So that while we ply the medicines with unremitting diligence and assiduity, at the same time we try to hasten the cure by endeavouring to bring about absorption. ABSORPTION. This we have often effected, in our own Cancer patients, by medicines alone, supplemented by lotions. At other times we have deemed it advisable, especially in cases of cancer of the duodenum, to apply * Conium plaister, which we have found very efficacious. Again, in other instances, as in scirrhus or hard cancer of the breast, we have employed alternate plaisters of a metallic base. Further, it may happen that the process of absorp- tion, attempted by any means, would be too slow if the Cancer be increasing rapidly or occasioning any great discomfort and inconvenience; we then decide to adopt some one or other of our processes of Resolution or Complete Withdrawal. Cancer and its Cure. - 29 RESOLUTION. How this shall be brought about is a question of almost as great importance to the patient, as that for or against operation or removal by the knife, under the hands of the surgeon; which, even though performed under chloroform, is sure to produce shock, and then most generally does not succeed in extirpating the whole of the cancerous mass, is almost always attended by anything but a harmless revulsion of the system, and almost always bespeaks a return of the Cancer, very often in a remarkably short space of time. - There is, therefore, very little doubt that removal by other methods will be advisedly preferred by the great majority of sufferers. Which and what method shall be employed ? Can you ensure that removal by pastes of any kind will not be followed by a return ? Not absolutely, but practically we can, by choosing the most searching and at the same time a practically painless method. On account of the extreme pain necessarily attending it, we reject the Michel or Sulphuric Acid plan, the secret of which was purchased by Dr. Bell for 25,000 francs, we are adverse to its use; and then again by it, the whole of the Cancer is very rarely detached. The Pattison enucleation method is tedious, dis- agreeable, and not always successful. We prefer and practise a much speedier and more effectual application than either, which, generally with 30 Cancer and its Cure. once using, will accomplish the complete withdrawal and casting out of the Cancer in from three to six weeks, leaving only an ordinary sore to be dressed and healed by ordinary methods. In the case of a larger Cancer, it is sometimes found advantageous to treat it in a precisely similar way, but in sections, thus in a short time attacking and getting rid of the whole. Or, lastly, by a very cleanly method, attacking a fairly sized and even deep-seated Cancer by repeated dressings until the whole is disintegrated and got rid of The number of dressings is regulated by the extent to which the Cancer has spread, and the depth which it has infected. It is absolutely necessary that patients so operated upon should continue medicinal treatment and be seen from time to time, for a few months at least. No other applications, such as salves, lotions, oint- ments or poultices, save those which are expressly ordered or prescribed by the doctor, are for one moment to be thought of or tolerated. It very often happens that patients are strongly urged by their friends to try this or that, without acquainting their medical attendant. If they do, if this warning be disregarded, the consequences cannot fail to be disastrous. Again, frequent feeling or touching of the affected part must be strictly forbidden, as well as all pressure of stays or other articles of dress. Cancer and its Cure. 31 It is advised that a layer of cotton wool be invariably interposed, especially over a Cancer or tumour of the breast, in order to prevent the least suspicion of pressure, and as a safeguard against damp and variations of temperature. A cheerful, hopeful temper must be assiduously cultivated. CHAPTER VII. . TREATMENT OF ADVANCED OPEN OR ULCERATED CANCER. THIS Chapter must be considered as supplemental to the last, for it is not always possible, nor is it always advisable, to attempt the removal of very large open Cancers. The patient may object, and prefer local retarding, soothing and disinfectant procedure. Then, necessarily, we have to deal with the circumstances in which we find ourselves, and a very great deal is possible | to be done to prolong life, to render it more enjoyable, - to ease pain, and very considerably to abate the foetor. Both Hydrastis and Hamamelis possess the power of retarding threatened ulceration. When it has taken place and the edges are jagged, uneven and angry, Comocladia proves of undoubted efficacy. Baptisia removes the foetor, and relieves the cachexia, acting 32 Cancer and its Cure. extremely well after Iodide of Arsenic, which, as an internal remedy, checks a tendency to ulceration, even where the skin is puckered and discoloured and the axillary glands implicated. - In far advanced cases, where the ulcerated surface is of large extent, the cancerous mass very considerable, the discharge continuous and very fetid, rendering the room almost unbearable, it may be advisable to have carbolic tow about the room and carbolic lotion with Hydrastis or Hamamelis. The sore must be carefully dressed twice a day, morning and night, and the dressings as removed burned. It must be well sprayed with four ounces of the Hydrastis and Carbolic acid lotion, then very gently and carefully dried, and the Hydrastin ointment applied, spread thickly on lint, over this a large pad of cotton wool covered by gutta-percha tissue. Carbolic acid must be frequently sprayed about in the sick room, a fire when practicable kept in the room, and the window open night and day. Resorce in, in powder and with vaseline or lanoline, Iodol and Iodoform will prove of great service, both in open Cancer of the breast, cauliflower excresence, and in Cancers of the womb and rectum. We have often been able to do much by their aid. Cancer and its Cure. 33 | CHAPTER VIII. TREATMENT OF CANCER OF BOWEL, WOMB, LIP, FACE, AND STOMACH. enumerated above is, for the most part, Epithelioma, or Soft Epithelial Cancer. It is very frequently met with, and in the case of Cancer of the lower bowel or of the womb, for obvious reasons, is most distressing, and appeals loudly for aid. |- The advanced surgery of to-day considers that it makes this field particularly its own, and that here it has achieved wondrous triumphs. Dismemberment of the womb, or even its complete removal may be accomplished to the self-gratification of surgery, that it has prolonged life in a grossly-mutilated patient, or by the removal of part of the lower bowel or the performance of colotomy condemns the subject of it to a loathsome living death. We can do far more by medicine, and by the careful local administration of soothing and absorbent dressing we can ensure a much | longer extension of life, in a fair condition of health and \body, and in comparative comfort. And yet, marvellous as maiming, mutilating surgery deems itself, many prefer it or submit to it, perhaps, as to the stronger domineering will, and so permit it further C 34 Cancer and its Cure. opportunities of demonstrating how much of structure - it can destroy without destroying life, or of pointing out, until we are sick of it, in how great discomfort, weariness and pain, it is possible to linger out a much- enduring, greatly to be pitied extension of life. It is a mercy when the grave hides such bungling. If I had not met with so many cases in point, of unavailing sor- row and regret, I would not write as I do, for I have only one object in view—that is, the rescue of the suffer- ing. But it may be said it is all very well to wish and promise so much. To which we reply, “We have done all that we state we can, and we can do it again.” We have heard of most affectionate inquiries by these same surgeons, or others like them, as to the precise data and circumstances of the death of certain former patients of theirs whom they had left to die at an early date, when they have been rather unexpectedly told that their former doomed patient had not died, but that very morning had been walking about in the room, or the day before had been for a drive in the park. It may also surely be urged, without any vanity or boasting on my part, that what I have generally accom- plished has been at tremendous disadvantage, after others had tried and failed. It has been my lot before now to undertake, single-handed, cases where six or more of the usual routine physicians and surgeons had attended and left the patient to die, whom, notwithstanding, I am thankful to say, I have piloted back to life. Cancer and its Cure. 35 º º º Another example of soft or epithelial Cancer is Cauliflower eacrescence, an advanced instance of which is given further on. One of the largest we ever saw or treated was situated in the armpit. Fungus Haemwatodes is a still further phase of this variety. It grows quickly and bleeds freely, whilst often it is terribly painful. The sacrifice of a limb to get rid of such a troublesome manifestation is not usually associated with anything but speedy fatality. Hamaemelin controls the hoemorrhage, however severe; the abatement by local measures, and the keeping up of the strength by food and the constitution by medicine, are the points at which we aim. CANCER OF THE LIP is also an epithelionia or epithelial Cancer. It makes its appearance almost exclusively on the upper lip, coming as a firm, fixed lump or swelling, or as a brownish wart, at first not of large size; the lip projects with a slightly raised border until the edges become thick, nodulated and fixed on a hard granulated base, exuding a thin offensive fluid; the glands below the jaw are not infrequently affected early in the progress of the disease. There is some darting, burning, neuralgic pain. In its early stage it is easily disintegrated or drawn out in from three to six weeks, by one application, and usually without fear of return; whilst always, and in the most extreme cases, the pain can be assuaged, the 36 Cancer and its Cure. strength maintained, and the constitution kept from being undermined. - In epithelionia three medicines appear to afford us most of the help which we require. They are Ranun- culus, Arsenic, and Hydrastis. Ranunculus causes tumefaction, infiltration, and great inflammation. If applied to any fleshy part of the body it causes severe, deep, and obstinate ulceration; a fact which has long been turned to account by mendicants and malingerers in the plying of their nefarious impositions. Gangrene of the arm has been known to follow the application of Ranunculus, the tendons and bones being laid bare. Arsenic, in paste and internally, has been reported as curative in a little girl six years old, who had lost the left half of the upper lip and the soft parts of the face as far as the molar bone, and laterally a good portion around the left corner of the mouth ; also in a woman of seventy-one years for a cancerous ulcer in the face with Arsenic internally, and an ointment of lard and Arsenic externally; the carcinomatous character of the ulcer disappeared, and the ulcer healed down to the base; the cure was completed by Silicea. CANCER OF THE STOMACH. Again, Cancer of the stomach not at all infrequently presents itself in patients. - In this affection we find Cicuta of the greatest service when we have a clean tongue, hiccup, regurgitation of Cancer and its Cure. 37 food, and vomiting, severe pinchings and croakings of , flatulence in the bowels, cutting pains in the limbs, abundant and fetid flatulence. The tumour is to be felt on pressure, but it is not very sensitive. Ranunculus is to be given for burning and con- vulsive pain from the oesophagus into the stomach, inability to distinguish tastes, frequent ineffectual efforts to vomit, with moaning; the tongue is inflamed and excoriated. Phosphorous: Heartburn, chronic vomiting, marasmus and hectic ; the vomited matter is stringy, flaky, pulpy, or thick, greenish, or even black. * Argentum nitricum is called for in great malaise in the region of the stomach, relieved by pressure, it is so extreme as to induce the patient to press in his fist violently, utter feeling of emptiness, desire for tasty food, insatiable hunger, depression of spirits; the oppression and burning drawing distress either continuous or paroxysmal; the vomiting is excessive, of an acid character and pulpy, or mucous or stringy, amongst which portions of food are distinguishable. Extreme cases are characterised by black vomiting. The pain is usually of an excruciating nature ; the cries of the patient are plaintive, Arsenic is to be resorted to when we find a heat and burning in the stomach with excessive pain, oppressive boring or tearing sense of weight as of a stone, frequent hiccup with eructations, faintness, tremor, and great 38 Cancer and its Cure. nausea, or vomiting after every meal and after drinking, accompanied with violent exertion; the matter vomited is either thick, glairy mucus, or bluish, dingy yellow, followed by great exhaustion, or it may be brownish or blackish, sometimes mixed with blood, and followed by an aggravation of the pains in the stomach. Hydrastis applies to and relieves constant faint, gone feeling at the stomach, with dull aching, quite through to the back, or a cutting pain in the stomach, which is most distressing, accompanied by nausea, constant erutations of sour fluid, gurgling in the bowels with pain about the navel, with constipation, complete loss of appetite, countenance pale and wan. Baptisia we give for a sense of rawness in the throat, constant distress in the stomach, or severe pains every few minutes, vomiting without nausea, or slight nausea with vomiting, pain and cramp, great aggravation on attempting to walk or even from turning over in bed, gone feeling in the stomach, with a sensation as though there were a hard substance in it, want of appetite and constant desire for water. Ignatia helps us when we find alternate paroxysms of emptiness in the stomach, with canine hunger and a feeling of repletion, nausea, sensation as of long fasting, peculiar weakness in the epigastrium and pressure, spasmodic pains and sensitiveness of the stomach to contract. Repeated cases have recovered under Hydrastis and Baptisin, Ignatia and Arsenic, Cicuta and Arsenic. Cancer and its Cure. 39 In a late case of scirrhus of the duodenum a sixth part of a drop of Opium 0 invariably relieved the pain in the Cancer itself when Hydrastis failed; and Bella- donna was equally efficacious in pains of a reflex nature. In Cancer and malignant ulceration of the stomach the greatest care has to be exercised in the matter of diet, some cases requiring to be put on revalenta and milk exclusively, and those articles in small quantities. All demand a milk diet, with bread, cocoa, tapioca, and sago, plain biscuits without sugar soaked in milk, oatmeal with cold milk, farinaceous puddings without sugar, and white fish. Tea, coffee, uncooked food of all kinds, bread (unless soaked and free from alum), vege- tables, pastry, beer, and stimulants must be strictly forbidden. Nutritive enemata and suppositories may be necessary. With these medicines and these restrictions we have little hesitation in asserting that Cancer of the stomach, as well as other kinds of Cancer, is fairly amenable to remedial treatment. CHAPTER IX. CASES OF ILLUSTRATIVE TREATMENT.-CANCER OF THE BREAST, ABSORPTION. TWELVE years ago, the housekeeper of a colonel, a patient of mine, consulted me as to what she feared was Cancer of the breast. She had been to a Cancer hospita 40 Concer and its Cure. and been told that without doubt it was Cancer, and that “there was nothing for it but an operation, and that the sooner this was submitted to the better.” I found that her general health was but very indifferent, that the breast had been troubling her for a long time, but, as is usually the case, “she had kept it to herself.” She has the unmistakable straw-coloured cancerous complexion, and is of a lymphatic temperament. The breast exhibits a decidedly cancerous tumour, as hard as a stone, not of great size, and perfectly movable, but it is beginning to ulcerate, and there will, unless something be done speedily, be an open sore. She was in a dilemma as to what she should do. Should she be operated on, or trust herself to my care for purely medicinal treatment? She would trust to medicine if I would promise to cure her. I gave her a few days to decide, then she asked me to undertake the case, which I did, and she has never had reason to repent. Her general health at once improved, the pain decreased, the threatening ulceration healed, and in a short time the Cancer entirely disappeared. She is quite well at the present time. Soon after I had another case, near to where the last patient lived, in a woman about her age, where the Cancer was much larger and much nodulated; that, too, mended in the same way, and the patient remains quite well. Lady F has a suspicious swelling in her right breast. She has not long noticed it, but it causes her - º Cancer and its Cure. 41 - º great anxiety. It is small but very hard. Under Conium and Iodide of Arsenic it soon disappeared. Mrs. D , 47 years of age, married, has had eight children. After her last child her left breast troubled her a good deal, and has inconvenienced her considerably of late; she has constant stabbing, aching, darting pain with soreness after. The tumour is of such size that she cannot put her left arm in front of her at all; it is also nodulated but perfectly movable. She has consulted a near relative, who is a doctor. He says there is nothing but operation, and advises that this be done at once by an eminent surgeon. To this her husband objects, unless medicine fails, and so, consequently, he brings her to me that it may be tried. The result was most satisfactory in every way. In two months the breast was just a quarter of the size it had been at first. There is still a little pain, but it is not constant. In six months the report is : the breast still alters a good deal and causes some uneasiness, and a small ulceration about the size of a shilling shows itself towards the breast bone. This soon heals, and the breast continues to decrease and mend in every way, so that she is able to report in the spring of the next year: the breast is now the natural size, but is susceptible to cold and draught. The arm on the affected side kept tender for some time. This patient varied a good deal from time to time, and now and then almost gave up in despair. She was ultimately well rewarded by thorough recovery. 42 Concer and its Cure. Belladonna, Conium, Galium, Condurango, Arsenic, Iodide of Arsenic, Silicea, Hamamelis, and Hydrastis, externally as a lotion, and internally, were the medicines employed. We will take another typical case in detail that was under treatment for rather more than seven years. The Cancer was prevented from ulcerating for three years and a half, and after ulceration the patient lived in tolerable comfort for nearly four years, and once during that period the wound had entirely healed. She had to undergo a great deal of trouble and anxiety, which always had a depressing influence upon her health and a deleterious effect on the Cancer. She was irregular in her attendances, and, on one occasion, in the early part of the treatment, almost precipitated an ulceration of the tumour by putting herself under the ministrations of a “wise woman" in Cambridgeshire. For a long time this patient was kept entirely under Hydrastin, internally and locally, and Iodide of Arsenic. Her general health was maintained, and the Cancer visibly lessened, the ordinary pain being reduced to a minimum, when, after being much harrassed, she com- plained that the pain was much worse, that it went down her arm and affected her hand and thumb, so that she could not use them to press anything, and sewing was utterly impossible. She was ordered Condurango twice a day, and Hydrastin night and morning. She had not taken the Condurango more than three days before the Concer and its Cure. 43 pain began to abate, the Cancer also becoming smaller and decidedly softer, a dull, heavy, aching pain remaining in the fingers, which she likened to rheumatism. She continued these medicines from November until Jannary. The Cancer is still smaller, but the Condurango has lost its influence over the pain. On January 13th the Cancer pointed far in under the breast, presenting a flat head, which was injected and dark coloured; the Hydrastin and Iodide of Arsenic were resumed, and Hamamelin ointment applied ; the breast was also very tender. This retrogression is accounted for by further anxiety which she had under- gone. The Hamamelin ointment was to be applied only to the threatened ulceration. On November 17th, although the breast itself seemed larger, the Cancer was decidedly not increased. She was to continue her medecines and use the following to the breast generally:-Glycerine áss, water āj, Hydrastin 3ij, powdered white starch sufficient to form a paste. On June 10th the record was as follows:–Ulcera- tion extensive and increasing, the edges jagged, and the foetor considerable. She was ordered Comocladia three times a day, Baptisin night and morning, and Baptisia injection to the wound. On August 6th the wound was nearly healed, the pain very much decreased, but considerable soreness and some inflammation existed. To continue the Comocladia and Baptisin. 44 Concer and its Cure. On September 21st she was not nearly so well, suffering severely from dyspepsia, and altogether out of sorts. The wound had increased, bled somewhat, and appeared inclined to spread. Was ordered Sanguinaria twice a day, and ſodide of Arsenic night and morning. On October 8th it was found that she was not greatly better for the Sanguinaria, and that the foetor had returned. She was ordered Hydrastin twice a day, Baptisin night and morning, Hamamelis lotion to the breast generally, and Baptisia lotion syringed on the wound. On the 27th of the same month (October), very much better, the breast smaller, and the sore nearly healed. To continue as on October 8th. She went on improving until March 5th, 1875, when she was not so well again, the breast larger and Very painful, the ulceration angry, irritable, and increasing. She was ordered to use Hydrastin ointment, to be applied with a camel's-hair brush to the ulceration after it had been syringed with Hydrastin and Carbolic acid, in the pro- portion of ten drops of tincture and five of acid to one ounce of water. She was to take Hydrastin night and morning, and Tincture Condurango three times a day. On April 6th she was very much better in every respect, and had very much less pain since taking the Condurango. The medicines prescribed on the 5th of March were continued to the end of September (same year), as she had made favourable progress. On the latter date, with a view of lessening the Cancer generally, Cancer and its Cure. 45 | - Hydrastin was given her in the day, and Iodide of | Arsenic night and morning Soon after this she went to live in a distant part of the country, where, unfortunately, after a short time, she || || omitted to take the medicines. She was not seen until - January, 1877, when the breast was found to have º greatly increased in size, was nodulated throughout, and presented a dark appearance. She was put upon Galium three times a day, and Hydrastin night and morning. Very shortly after this she caught a severe cold and had a sharp attack of bronchitis, to which she speedily suc- cumbed. From the history of the patient, given above, it may -- not be unreasonable to conclude that Hydrastin is our most reliable medicine in scirrhus, seldom (if ever) , failing to subdue the pain, while generally benefiting \\ the patient, and that it is at times usefully supplemented by Condurango, especially when there is more suffering than usual. CASE OF CANCER OF THE WINDPIPE. Sir Joseph N is suffering from cancer of the windpipe, a precisely similar case to that of the late Emperor Frederick of Germany. He has been under local care and that of an eminent specialist for a long time, but is getting rapidly worse. He is very emaciated, can only swallow liquids, and of these very little at a time. He is constantly hawking up foetid small detached 46 Cancer and its Cure. mucus, is a nuisance to himself and everyone else; he cannot mix with his fellow men, he simply hides himself at their approach ; nor can he on account of the hawking and the extreme foetor, drive in the carriage with his wife. His life is a burden and a misery. He is put under the Hydrastin treatment and has a small quantity blown into his throat night and morning with this result, that he is able in three weeks to swallow meat and resume ordinary diet; he drives without any inconvenience in a close carriage, with company, and freely goes to his club and mixes with mankind. EPITHELIOMA, CAULIFLOWER EXCRESCENCE. Mr. C , schoolmaster, age 48, consulted me in January, 1887. Had always been a strong, healthy man until afflicted with Cancer which was of the epithelial type and had attained large dimensions. It was what is termed a cauliflower growth. It presented the size and appearance of one most exactly. It had been increasing for seven years and was excessively painful. It was treated at first with nitric and carbolic acid, but as fast as the pieces were removed the faster they grew. This went on for two years, then another surgeon was consulted who said that it must be removed at once or it would spread and break out in the glands. He more- over assured the patient that life would not be prolonged for more than two years. For the next two years, until the date given above, nothing was done, then, as the Cancer and its Cure. 47 patient states, he put himself under my care, and that he has no cause to regret it. He soon felt the benefit of the medicines. In fact, almost as soon as he began taking them he got ease, felt better, and enjoyed his rest at night, which he had not done for years. His general health and appetite must be considered as having been fairly good whilst under the treatment. He obtained ease, comfort and rest, and has been able to be in school nearly every day for the discharge of his duties. - THE END. 48 Appendia-Lupus. APPENDIA. - LUPUS AND ITS TREATMENT. - LUPUs is chiefly confined to the face and is much more common in women than in men. It shows itself in three chief varieties. First, that which is allied to crythema, consisting of dark red patches on the nose, forehead, and cheeks, with a thickening and wrinkling of the skin. Scraping with the knife has been recom- mended for this as for the other kinds. I find very readily yield to Veratrum viride and Arsenic internally and a solution of Arsenic externally. Secondly, another variety more obstinate, affecting the alloe of the nose, the sides of the nose, and the cheeks covered by crust. This yields to medicines of a tonic nature, and Hydercotyle externally and internally. Thirdly, Lupus exedeus, or the devouring wolf, as it is termed, with thick brownish crusts and great loss of substance, without any constitutional disturbance or pain. The crusts need to be removed, Acetic acid taken with Arsenate of gold, Gurgun oil, or Balsam applied locally. -