The distinction betwixt cancer and the venereal ulcer is so very striking, that it is scarcely possible for these diseases to be mistaken for each other, if the discriminating marks of each be attended to. The cancerous sore is always dark coloured; the surface fiery, yet of a fungous nature; the discharge foul, and of an intolerable smell; and the bottom and surrounding parts are hard and painful. If there be not an open running sore, the part is covered with a dry elevated scab, of a dark colour; the skin around this is livid, and the neighbouring parts indurated. The base of the venereal sore is much softer, the discharge is of a different nature, and its aspect so peculiarly unlike the cancerous sore, that it is impossible to confound them[112]. [112] It is to be regretted, that some who belong to our profession, reason upon the nature of ulcers, not from appearances and characteristic marks, but from the patients manner of life, or the idea which they have formed of the country whence they come. I remember two instances of people who came from the Hebrides, the one with a cancer of the lip, the other with a cancerous ulcer on the neck, both fungous, and possessing the burning pain, and every character of cancer; but as the sibbens unluckily prevailed in that country, it was thought that the patients might have received this infection, and accordingly were, by a full consultation of surgeons, condemned to undergo a course of mercury. The lip was, in three days, greatly worse; the mercury was omitted, and the patient cured by an operation. The sore on the neck was instantly exasperated, and the patient, to use the words of Hildanus, “had her soul speedily sent to heaven.” There is another disease, which is very apt to be confounded with cancer, and which, at one period, resembles it very much. It begins with a small tumor, like a phlegmon, of a dull colour, and without much pain. This soon assumes a soft elastic feel, and bursts at the top; a bloody matter oozes out, the lips of the orifice become tumid, and the integuments ulcerate. The whole has a convex surface, the ulcerated part being most prominent; and the sloping margins are red and painful: The ulcer itself is foul, of a dark fungous appearance, and covered with thick offensive matter, with sloughs in different parts; the margins are hard, and lie, in a serrated manner, over part of the sore: The pain is smarting. This sometimes spreads to a considerable extent, and cuts off the patient. At other times, by the use of mild dressings, good diet, and opium internally, the fungous surface sloughs off by degrees, and shows a smooth red bottom, somewhat striated, and of a glossy appearance, which contracts, and scabs over, like the pseudo-cancer. The fungus, in this ulcer, never rises high; it is generally slightly convex, being most prominent at the centre, and has never the retorted trumpet-like appearance of some cancers.