746 
Treatment. This, to be effectual, ought to 
commence with the commencement of the 
disease. _ When matter has formed to any 
extent, the malady is highly dangerous. Blis- 
ters to the loins, volatile embrocations ; 
very small doses of calomel, with opium or 
hyoscyamus. When a tumour has formed in 
the thigh, which continues to increase, it is to 
be opened. During the subsequent dis- 
charge, the patient’s strength is to be care- 
fully supported, by nourishing diet, wine, 
opium, bark, and pure air. 
Of cancer. Cancers, previously to their 
appearing in the form of ulcer, are termed 
occult. An occult cancer is a schirrous 
swelling of a gland, attended with lancinating 
pains, which state of parts often exists for 
some time before ulceration or open cancer 
is produced ; this last, however, sometimes 
appears without any previous schirrosity. 
The symptoms of cancer will be best describ- 
ed by tracing the usual progress of a cancer- 
ous breast. A small knotty tumour is gene- 
rally lirst perceived on some part of the 
mamma ; this continues nearly in the same 
state, perhaps, for some months : it at length 
increases, and a pain is felt to proceed from it 
towards the axilla; the integuments gradually 
become discoloured, and at length ulceration 
is formed. 
Cateses and peculiarities. There has been 
much dispute whether cancer be a disease of 
parts merely, or of the system: all, however, 
that ought to be understood respecting the 
general nature of cancer, is, that a suscepti- 
bility, as we have above endeavoured to ex- 
plain, exists in some habits, and especially at 
certain periods of life, to this malady, which 
in such habits may be induced by the same 
causes, which occasion common inflamma- 
tion. The usual time for the formation of 
catieerous mamma is when the menses disap- 
pear. • Previous to this period, swellings of 
the breast assume more of the scrophulous 
character. 
Treatment. Cicuta has- been much ex- 
tolled as a remedy for sebirrus ; faith in its 
■virtues are, however, gradually declining. It 
may be combined with small doses of calo- 
mel. Mercurial ointment to the part, vola- 
tile embrocations, not too stimulating. Lac 
assafostida has been employed as a lotion in 
occult cancer with seeming benefit. If the 
disease advance, no cure can be expected but 
from operation, which should be had recourse 
to early, previously to the extension of the 
disease into the contiguous glands. 
Operation. If the skin be sound, a longi- 
tudinal or transverse incision, according to 
the shape of the tumour, is to be made with 
the scalpel along its whole length, at a small 
distance from the nipple ; this incision is to 
pass through the skin and cellular substance, 
and while the patient’s arm is extended, the 
mamma is to be carefully dissected from the 
integuments and pectoral muscle; all the 
glandular substance should be detached, al- 
though only a part be the seat of the disease. 
3n closing the integuments after the comple- 
tion of the operation, the twisted suture may 
be employed, assisted by straps of adhesive 
plaster; a pledget of simple ointment is to be 
laid over the part, covered by soft linen or 
tow, and the dressings are to be retained by 
appropriate bandage. 
When the operation is performed, after the 
"SURGERY 
existence of the disease for some time in an 
open state, it will often be necessary to cut 
away a considerable portion of integument : 
the incision nrav, in this case, be made of an 
oval form ; and if the axillary glands be 
found schirrous, the scalpel should be carried 
on full into the arm-pit, and the indurated bo- 
dies carefully dissected out. When* the ope- 
ration is over, the divided edges are to be 
brought up as nearly together as possible, and 
dressings and bandages applied, as in other 
similar wounds. 
Venereal affection. 
The venereal disease is an example of that 
species of inflammation which we have called 
specific. It appears in two forms. To the 
one is more generally applied the denomina- 
tion of syphilis ; the other is called gonor- 
rhoea virulenta. These affections are ima- 
gined by some to originate from the same 
specific poison ; by others, the cause produc- 
tive of true, syphilis, and that occasioning 
gonorrhoea, are supposed to be of a different 
kind. This last is perhaps the best founded 
opinion, viz. that the matter which, applied to 
the genital organs, produces a discharge from 
the urethra, called gonorrhoea, is not capable, 
under any circumstances, of producing true 
venereal chancre. 
Symptoms of gonorrhoea. A peculiar itch- 
ing and smarting sensation about the extre- 
mity of the urethra, attended with some feed- 
ing of stricture or tightness ; this is succeeded 
by the appearance of mucus about the extre- 
mity of the penis, which soon increases in 
quantity : it is generally of a brown appear- 
ance, is attended with more or less smarting 
upon discharging the urine, and with nocturnal 
erections. Sometimes the lymphatic glands 
of one or both groins become inflamed, en- 
larged, and thus form bubo. The time ’at 
which the symptoms of gonorrhoea make their 
appearance is variable: sometimes the dis- 
order will follow impure coition in the space 
of a few hours ; at others it will be several 
days. 
Treatment. In the first and inflammatory 
stages, demulcents largely drank, such as de- 
coction of linseed, solution of gum arabic, 
tragacanth, &c. Mild purgatives, such as 
manna and senna. Opiates at night. Bathe 
the penis in warm milk and water. Saturnine 
lotions. If from the too precipitate or early 
use of astringent injections, or from other 
causes, the inflammation extends itself to the 
testicle, causing pain and swelling of this 
part (hernia humoralis), the scrotum is to be 
supported by bandage. Leeches are to be 
applied should the inflammation be violent, 
and the testicles are to be preserved constant- 
ly moistened with a solution of sugar of lead, 
or some other saturnine preparation. Forthe 
swelled glands, friction with mercurial or com- 
mon ointment and camphor. Volatile em- 
brocation. If the inflammation- cannot be 
repelled, the suppurative process to be soli- 
cited by bread and milk poultices. If every 
symptom of the disorder go off, with the ex- 
ception of a white mucous discharge from 
the urethra, which continues notwithstanding 
the use of astringent injections, give tincture 
of cantharides in gradually augmented doses, 
which will be for the most part found more 
efficacious than the balsams generally em- 
ployed for this purpose. Should still the 
discharge continue, and, from the unusual ap- 
pearance in the stream of urine, a stricture fn 
some part or parts be suspected, introduce 
bougies. 
Symptoms . of syphilis. True syphilis is ; 
perhaps invariably introduced into the system | 
.through the medium of chancre, unless in; 
cases where it is transhiitled from parents to - 
children. Chancre is a small ulcerated sore, | 
; occasioned always by contact or coition. 
This, when it appears on the penis, is fre- 
quently followed by an inflammation and en- 
largement of one or both groins ; these, if 
neglected, pass on to suppuration ; ulcers on 
the tonsils succeed, with eruptions of the skin, 
especially about the roots of the hair ; at 
length come on pains in the bones, which are 
olten highly excruciating, and although some- 
times taken for, are to be distinguished from, 
rheumatic swellings, by their being rather in 
the centre of the bones, and deep seated, than 
in the joints, and superficial ; by their not be- 
ing accompanied with fever equivalent to the 
violence of the pain ; by the absence of that 
general swelling of the soft parts which at- 
tends rheumatism, and sometimes by a cir- 
cumscribed swelling extremely painful grow- 
ing up from the bone. When any doubt ex- 
ists respecting the nature of those ulcers in 
the tonsils, throat, &c. which are suspected 
to be venereal, they may generally be de- I 
t ided such by their peculiar coppery appear- ; 
ance : they are likewise, in general, more cir- 
cumscribed than other ulcers, and their 
edges have a peculiar callosity. 
Treatment. Mercurials given in such a 
form, and in such quantity, that what is called 
an alterative kind of action shall be for some 
length of time maintained in the system,, 
without occasioning salivation, is an effect from 
mercury, which appears always to defeat its 
own .object. Chancres on the penis may, if 
the application be made to them a very short! 
time after their production, be totally destroy- 
ed by caustic, and the absorption of the vi- 
rus and consequent disease thus prevented... 
When the swellings in the groin are first per- 
ceived, they are to be kept from enlarging 
by the vigorous application of mercurial oint- 
ment, which, ii not inconvenient, is perhaps 
the best and surest mode of introducing this 
medicine into the general habit. For other 
preparations of mercury, see Materia Me- 
eica- and Pharmac y.’ With respect to the 
time of continuing mercury, it may perhaps; 
be laid down as a-general rule, not to disconti- 
nue the medicine until two or three weeks 
alter the apparent discontinuance of the dis- 
order. Secondary affections, from the vene- 
real action not having in the first instance- 
been entirely subdued, are extremely fre- 
quent, and are always formidable. Opiates,, 
sarsaparilla, and, recently, nitrous acid, have 
each been judged specifics for venereal af- 
fection ; but it is now pretty generally sup- 
posed that they merely act as auxiliaries to-- 
mercurials. 
There aive some other affections that were 
not noticed in the article Medicine, which! 
depend upon a specific poison, and which, 
though constituted by a species of cutaneous 
inflammation, are not, like the exanthemata 1 
of authors, preceded or accompanied by fe- 
brile irritation. The cutaneous eruptions 
which require to be noticed here, are the ai>' s 
nulus repens, the tinea, and psora. 
Annulus repens, ring-ivorm. This is a , 
S 
