OF HEPATIC CANCER. 185 



occurred within three weeks ; in that case there was 

 fever, tenderness, and jaundice, with perceptible enlarge- 

 ment of the tumours from day to day till death took 

 place. As a rule the medullary form of cancer is cha- 

 racterized by a rapid course : the scirrhotic form by a slow 

 course : the termination in any case is always fatal, as 

 no one has yet succeeded in proving beyond doubt, a 

 single instance of a radical cure. Our prognosis, there- 

 fore, in all cases must be a gloomy one : in the soft cancer 

 it runs a rapid course to a fatal termination ; in those 

 hard cancers which grow slowly much may be done, by 

 appropriate means, to prolong life for some years, and 

 make that life bearable. 



SYMPTOMATOLOGY. The clinical history of cancer 

 of the liver varies considerably ; there are in many cases 

 certain prominent " landmarks " which seldom fail us 

 in diagnosing the disease ; and there are on the other 

 hand, many cases so very obscure as to baffle the skill 

 of the most acute observer. Cases of this kind are not 

 unfrequently met with where all signs of hepatic disease 

 are wanting, where symptoms of an undefined character 

 constitute its leading characteristics namely, indiges- 

 tion, flatulence, constipation, together with a disordered 

 condition of the nervous system a group of symptoms 

 often looked upon as simply " hypochondriasis ;" and it 

 is not till grave symptoms arise, terminating in death, 

 that we are able to discover the cause which led to a 

 fatal issue. In other cases we have consecutive dis- 

 eases, such as chronic peritonitis, ascites, and pleurisy, 

 all of which may mask the fundamental disease. 

 Again, in other cases, there are derangements proceeding 

 from the primary diseases, to which the liver affection is 



