CANCER OF THE LUNG. 257 



is the fever ; for it is of the fever alone that the majority of those at- 

 tacked perish. Large doses of quinine should be given, particularly at 

 the outset of the disease and as long as the rigors continue to occur, 

 and at a later period use digitalis, nitre, and the acids. Little success, 

 however, is to be anticipated. For the dyspnoea, cold is to be applied. 

 Combat the cough with narcotics ; and, should appearances lead us to 

 suspect the existence of meningeal tuberculosis, apply ice to the 

 head. 



OHAPTEK XV. 



CANCER OF THE LUNG. 



ETIOLOGY. The pathogeny and etiology of this malady are as ob- 

 scure as those of the malignant neoplasms in general. 



Cancer of the lung is a somewhat rare disease, and primary cancer 

 of this organ is of especially unusual occurrence ; that is to say, the 

 substance of the lung is scarcely ever the point at which the first 

 traces of it develop themselves. Cancer of other organs, particularly 

 of the breast, almost always precedes cancer of the lungs. 



ANATOMICAL APPEARANCES. In the lung, cancer assumes almost 

 exclusively the medullary form, far more rarely that of the scirrhus or 

 of alveolar degeneration. It sometimes assumes the form of rounded 

 isolated masses, varying from the size of a hemp-seed to that of a fist, 

 constituting cancerous nodules of a marrowy appearance and soft con- 

 sistence, which, when they touch the pleura, are apt to show a flattened 

 or umbilicated depression. Sometimes the disease appears as the so- 

 called infiltrated cancer. Unlike the previous variety, the latter form 

 does not present a distinct limit between the cancer and the surround- 

 ing parenchyma, but makes a gradual transition ; nor does the disease 

 present the rounded contour of cancerous nodules. 



The old hypothesis, that, in the latter case, we had to do with a 

 conversion of an infiltration into cancer, has been abandoned ; and it is 

 now believed that, in the origin of infiltrated cancer, after the trans- 

 formation into cancer-cells of a few of the connective tissue-cells of the 

 matrix of the lung, and of a few of the epithelial cells of the vesicles, 

 this conversion is propagated into the neighboring connective tissue, 

 and into the connective tissue-cells of the adjacent alveoli. On the 

 other hand, with regard to the appearance of isolated cancerous nodule? 

 in the lung, we must suppose that here, too, the cancer-cells originate 

 from the elements of the tissue, and then proliferate without furthei 

 implication of the contiguous tissues in the disease. The enlargement 

 of the tumor therefore, is due to proliferation of the original cancer-cell 

 18 



