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frequent than is generally supposed, and often escapes recognition till an advanced stage of its existence, the symptoms being attributed to one or other of the affections concurring with cancer. I have seen many cases where the patient was presumed to be suffering from fistula, hæmorrhoids, dysentery, stricture, constipation, &c., and a useless plan of treatment pursued whilst the vital powers had gradually declined under the insidious advances of a fatal disease. There is a greater tendency to cancer in females than in males, and in them is frequently developed about the time of the cessation of the menstrual function. The meridian of life, in both sexes, is the period' most obnoxious to cancerous affections; but no age is exempt : encephaloid disease is more likely to attack the young than carcinoma. Bushe* saw a case of the former in a boy of twelve years, and Mr. Busk's patient, previously referred to, was sixteen years of age.
Whatever may be the character of the disease, whether carcinomatous, encephaloid, or colloid, it makes considerable progress, in the majority of cases, before giving rise to any severe or prominent symptoms. Constipation is one of the early effects, and often attributed to functional derangement only, but arises from the morbid growth projecting into and narrowing the capacity of the bowel, and also annihilating the function and power of contraction. Fistula in ano is often met with as a complication. Hæmorrhoidal excrescences, internal and external, are frequent concomitants, resulting from obstruction to the circulation by the cancerous mass : in some cases a muco-sanguineous discharge, more or less profuse, may be all that engages the patient's attention ; but sooner or later a dull aching and fixed pain in the sacral region, violent tenesmus, weight and bearing down, especially after defecation, severe shooting and lancinating pains extending to the loins, hips, and down the thighs, are experienced. The stools are passed with difficulty and pain, are scanty and frequent, and attended with bleeding or a puriform sanies, which is often excessively foetid : in fungoid disease considerable hæmorrhage occurs from time to time. In most instances the stools are compressed and figured, or passed in small pellets, as in simple stricture, or diarrhæa may be present. From contiguity or implication severe vesical irritation is induced, and the patient is tormented by a constant desire to micturate : in the female the uterus and vagina are frequently affected. Last year I saw, in consultation, a young lady, a patient of Dr. Barnes, who had cancer of the anterior and left walls of the rectum, which were extensively ulcerated : the cancer
* Op. cit., p. 292.
also affected the posterior wall of the vagina, the mucous membrane of which was not ulcerated, yet she complained of more pain in this part than in the rectum. I saw a similar case in consultation with Dr. Ridsdale. The whole of the digestive organs become deranged, causing flatulent distension of the stomach and intestines, and acute pains in the abdomen: as the disease advances, hiccough, eructations, nausea, and vomiting are present; the appetite fails, emaciation and loss of strength ensue, the countenance assumes the peculiar leaden hue indicative of malignant disease, anasarca and hectic supervene, and under continuous suffering the vital powers succumb. Sometimes obstruction takes place, and the patient dies with the symptoms of internal strangulation ; or ulceration having extended up the bowel, rupture takes place during an expulsive effort, and fatal peritonitis occurs. This happened to Dr. — , an eminent physician residing in Lincolnshire, who sent for me in July, 1859, the day before he died. His bowels had not been moved for eight days previously to my seeing him : I passed a small O'Beirne's tube and injected some thin warm gruel, which had the effect of bringing away large quantities of fæcal matter ; this was repeated several times. I left him on the following morning to return to town: subsequently he had several free evacuations : late in the afternoon, while
at the closet, he suddenly exclaimed, “something has given way :" great abdominal pain ensued, which continued, in spite of all that was done, till he died.
In the commencement, unless the disease is within reach of the finger, and occurs as hardened tubercles or irregular fungoid growths, the diagnosis of the disease is not easy, and requires a close and accurate consideration of all the symptoms, and a familiarity with the various phases and phenomena of malignant disease, to arrive at a just conception ; but in the advanced stage the excessively severe shooting pain, the foetid puriform discharge, the rapid progress of the affection, and the peculiar unhealthy aspect of the countenance, lead to a correct conclusion. Yet the latter appearance is not invariably present, as was illustrated in a man aged fifty, who applied at the Blenheim Dispensary, in 1852, affected with fungoid disease, the masses of which nearly filled the pelvis; his countenance remained clear, and his general health was not much disturbed for a considerable time; he lost blood at stool, and a copious hæmorrhage fol. lowed any examination, even when conducted with the greatest care and gentleness.
In the treatment of this disease all our efforts will be unavailing in effecting a cure ; but by well-directed means we shall be able to mitigate the sufferings, and even to prolong existence. Narcotics are the remedies
chiefly to be relied on to afford ease from pain; they must be administered by the mouth and by the rectum. It will be desirable, in most instances, to confine the patient to a couch, as walking, or even the upright position, will aggravate all the symptoms, in consequence of the vessels of the rectum becoming congested by the gravitation of blood. Great attention must be paid to diet, which should be nutritious, light, and easy of digestion ; all stimulating and heating articles of food being strictly forbidden. The bowels must be kept open by small doses of castor or olive oil, and, after each dejection, emollient and anodyne enemata must be used. Suppositories of hyoscyamus and conium, separately or conjoined, with or without the addition of camphor; also opium and its various preparations will be required to allay the distressing pain. The warm hip-bath, by its soothing effects, will be a useful adjunct in the treatment, and as it produces no fatigue to the patient, may be used at all periods of the disease. Irritation is to be allayed by injections of warm oil, lime-water and oil, and decoction of marsh-mallows with opium. If there is acrid and foetid discharge, emollient and mucilaginous enemata, containing chloride of zinc, well diluted, Peruvian balsam, creosote, &c., must be used. According to the patient's condition, we may prescribe the various preparations of