Book 5
28
A carcinoma does not give rise to the same danger unless it is irritated by imprudent treatment. This disease occurs mostly in the upper parts of the body, in the region of the face, nose, ears, lips, and in the breasts of women, but it may also arise in an ulceration, or in the spleen. Around the spot is felt a sort of pricking; there is a fixed, irregular swelling, sometimes there is also numbness. Around it are dilated tortuous veins, pallid or livid in hue; sometimes in certain cases they are even hidden from view; and in some the part is painful to the touch, in others there is no feeling. And at times the part becomes harder or softer than natural, yet without ulcerating; and sometimes ulceration supervenes on all the above signs. The ulceration at times has no special characteristic; at times it resembles what the Greeks call condylomata, both in a sort of roughness and in size; its colour is either red or like that of lentils. It is not safe to give it a blow; for either paralysis or spasm of the sinews follows at once. Often from a blow on it a man loses speech and faints; in some also, if the place is pressed, the parts around become tense and swollen. Then it is the worst kind. And generally the first stage is what the Greeks call cacoethes; then from that follows a carcinoma without ulceration; then ulceration, and from that a kind of wart. It is only the cacoethes which can be removed; the other stages are irritated by treatment; and the more so the more vigorous it is. Some have used caustic medicaments, some the cautery, some excision with a scalpel; but no medicament has ever given relief; the parts cauterized are excited immediately to an increase until they cause death. After excision, even when a scar has formed, none the less the disease has returned, and caused death; while at the same time the majority of the patients, though no violent measures are applied in the attempt to remove the tumour, but only mild applications in order to soothe it, attain to a ripe old age in spite of it. No one, however, except by time and experiment, can have the skill to distinguish a cacoethes which admits of being treated from a carcinoma which does not. Therefore, as soon as the lesion is first noted, caustic medicaments should be applied. If the disease is relieved, if tis indications are lessened, the treatment can be advanced to the use of the knife and of the cautery. If it is irritated at once, we may recognize that it is already a carcinoma, and that all acrid and severe remedies are to be avoided. But if the place is hardened without ulceration, it is enough to put on a fig of the fattest sort or the plaster called rhypodes. If there is an ulceration level with the skin, the rose cerate is to be applied, to which must be added powder from a crusted earthenware pot, into which a blacksmith has been accustomed to dip red-hot iron. If there is a considerable growth upon it, copper scales, which are the mildest of the caustics, are to be tried, until they check the tendency to growth; but only so if it is in no wise made worse: when the growth is less prominent we ought to rest content with the rose cerate.
