Leading articles.

The Medical Treatment of Cancer.

Cancer of the Breast - Cancer of the Lip - Cancer of the Stomach - Cancer of the Rectum - Cancer of the Uterus

S. F. March, M. D., Kansas City, Missouri

I shall not try to give you the etiology and pathology of cancerous growths in this necessarily brief exposition of the treatment of this class of diseases; neither shall I try to classify or name the different kinds of cancer, but my object will be to give a rational treatment, other than the use of the knife, for patients afflicted with this class of diseases and the numerous complications that are always found accompanying them. The sooner the physician recognizes these complications or specific conditions, and treats them specifically, the sooner he will get the cancerous disease under control.

In order to treat chronic conditions of this character, and be successful, you must consider three important features: (a) the cause, (b) the adoption of a treatment adapted to your individual patient, and (c) take sufficient time to restore the parts and the general health to a physiologic state.

These three features specifically indicate a long and judicious course of treatment, both local and constitutional, in order to strengthen and restore normal functions.

There should be a due appreciation of the starting point of cancer and the lesions that not infrequently develop it and of the harmless tumors that are liable to take on a cancerous growth.

Watch the obstinate fissure that will not close; the excoriation that will not heal; the senile wart that becomes irritated; the naevus that bleeds repeatedly; the scar that becomes hypertrophic; these are suspicious conditions, especially when they are accompanied by the characteristic itching, crawling, gnawing and lightning-like pains, when experienced by the patient who has passed the meridian of life.

It is best to be able to recognize this kind of growth in its earliest stages, and when patients present themselves with the above named symptoms, although the local manifestation may be very small, they should be looked upon with suspicion and the proper treatment resorted to immediately.

This knowledge is very important from a practical point of view and cannot be overestimated. The prognosis of the disease depends largely upon the stage at which it is diagnosed. A well developed case is readily recognized, but often difficult or impossible to cure. Exactly the reverse is true of a case at or near its development.

Dr. Senn, the eminent surgeon, tells us that "carcinoma involves by local extension all tissues and organs irrespective of their anatomical structure."

"Generalization of carcinoma takes place in consequence of the entrance into the general circulation of carcinoma-cells or fragments of tumor tissue, which, when arrested anywhere in the arterial system, constitute carcinomatous emboli from which the metastatic tumors grow."

This being true, who can determine just when a cancer has ceased to be local and has become distinctly general? Thus the importance of both local and constitutional treatment.

It has been argued that the majority of cancers are primarily and essentially local because they are encapsulated, and that the individual is thereby protected against systemic invasion.

Is such an argument tenable in view of these well established facts: (1) that some varieties of cancer are never encapsulated at any period of their development; (2) that almost without exception cancerous tumors are richly endowed with nutrient vessels through which circulation is abundant; (3) that in certain instances metastasis develops so promptly that it is quite impossible to determine with any degree of accuracy which is the primary growth.

Can the most erudite clinician be positive concerning (a) the variety of cancer to which it belongs, (b) whether or not it is distinctly encapsulated, (c) whether systemic invasion has or has not already taken place.

It is impossible to effect enduring relief by surgical means alone of cancerous growth, even in operations on epithelioma of cutaneous and mucous surfaces, where incision may be safely accomplished, and when it comes to cancer involving glandular, internal and deeper structures, the enduring relief is greatly lessened by operative procedure.

This class of diseases, under the treatment of a physician who uses his knowledge of the pathological wrongs of the human body to good advantage and treats conditions instead of names, will often readily yield to the specific use of the appropriate drug, or drugs, in relieving the specific condition, or conditions, found in his patient. Cancer is no longer the dread disease it used to be. Scientific research and investigation of this once feared disease makes its treatment more simple and easier to comprehend when the physician simply uses the knowledge he already possesses with good common judgment.

Cancer patients, like all patients afflicted with other diseases, present an array of pathologic conditions, that, if interpreted aright, and the proper remedies applied and given, can be greatly relieved and benefited, lives prolonged and a majority of them cured. Some of my readers may think that last statement rather strong. I can pick out a score or more of our physicians that have cured cancer without using the knife by simply using the means within their knowledge, of specific remedies to relieve specific conditions.

Having had some experience in treating cancer specifically, I will describe a few cases to illustrate the method of treating this disease, or diseases, without the use of the knife.

Cancer of the Breast

The breast is made up of a peculiar tissue different from the tissues of other parts of the body. This tissue is easily impressed by outside influences-such as a blow-the patient may have fallen against something and bruised the breast-or an ill-fitting corset may produce irritation, cicatricial tissue following the formation of an abscess at confinement, which caused a temporary soreness and redness, which by the use of simple home remedies, disappeared.

Any disease is much easier treated in its incipiency than after it has become deep seated. A lump that makes its appearance in a woman's breast after she has passed the age of thirty-five should not be "laughed at," but should be looked upon seriously and should receive careful attention. If the physician is able to recognize the lesion and can give the proper treatment much suffering and perhaps a life may be saved. The best thing for a physician to do is to treat the lesion he finds specifically, if he knows how, and if he don't know how, it is his duty to send the case to some one that does know.

Case 1.—Cancer of the breast. Mrs. S., aged 46 years. Came under my observation and treatment September 2, 1905. She was suffering with cancer of entire left breast, consisting of a deep open wound, or cavity, in the center.

This open sore was surrounded with hard and infiltrated tissues. The skin overlying these tissues was very dark, almost purple, and presented a rough nodular appearance. The ulcer or sore presented as a sloughing wound, which exuded a watery discharge mixed with blood. This required several dressings during the twenty-four hours, and was of a very disagreeable odor.

The pain was sharp and lancinating, and was accompanied with a dull, heavy ache which extended under the arm and down the arm to the elbow. The glands under the arm were involved. She had suffered four years, the first start being a small lump or tumor in the breast. These are some of the most prominent symptoms of cancer of the breast.

During the four years mentioned, she had tried various treatments, but gradually grew worse, and when she came to me for treatment was very despondent and had cried herself to sleep every night. She had become so disheartened, as she thought she was suffering from an incurable disease.

This case was diagnosed as "Scirrhus cancer," and treatment begun on the date above named. As the breast is composed of gland tissue consisting of lobes, and these again composed of lobules opening into the branches of lactiferous ducts, phytolacca becomes one of the indicated remedies, as this remedy, Ellingwood tells us, has a direct influence on glandular structures. This can be used both locally and internally in the proper doses, and of course gives the best results when the specific phytolacca is used. Give the dose which is suited to the individual case. A local application can be made from equal parts of phytolacca, distilled witch hazel, and glycerin. This is rubbed in well on the hard part around the open sore. Capsicum can be added to this if a more stimulating effect is needed. Chelidonium is another remedy that can be used in this class of cases, and especially where there is an irregular action of. the glandular system and a sluggish and deficient circulation of the tissues, glands and organs of the abdominal cavity. Leptandra, podophyllin, pulsatilla, thuja, iris, chionanthus and sodium phosphate all find their place of utility in some cases.

Where the case is of long standing as this one and the tissues have become degenerated into the foul smelling, ulcer, it is best to use some escharotic to get rid of the diseased mass of tissue that keeps poisoning the system. A paste of chloride of zinc, with or without the addition of powdered bloodroot, with a base of petrolatum or vaselin proportioned to suit your individual case, will turn the foul ulcer into a simple sore which can readily be healed by some soothing and healing application after this foul smelling tissue has been killed and sloughed out. The general health must be looked after also and every organ of the body be made to perform its proper function.

In using this kind of treatment the suffering and pain are alleviated, the swelling and soreness and inflammation subdued, the hardened, elevated and infiltrated tissues softened and brought back to a normal condition, and the dark purple and diseased tissue sloughed out, the sore brought down to a level with the healthy surrounding tissue, and by the help of specific echinacea to eradicate any remaining disease germs in the system, the sore was readily healed.

On December 26, 1905, she returned to her home entirely well, sore healed, the swelling, of the glands under the arm removed, her general health built up, as she had gained eighteen pounds in weight.

In a recent letter from her she informs me that neither the breast nor glands have given her any trouble since, and that she has as good health and also the use of her arm as ever she had, does her own housework for herself and family, consisting of her husband and two children. Her health is better in every way than it has been for years.

Cancer of the Lip

Cancer of the lower lip is more frequent than that of the upper lip, one of the principal causes being smoking a pipe or cigars; the stem of the pipe or the stub of a cigar proving to be an irritant to the mucous membranes and tissues of the lip, causing indurations and forming a hard and painful lump at the seat of a crack in the lip, or ulcer, or fever sore. Several of our most prominent men have fallen victims to this dread disease from being inveterate smokers. But all cases of cancer of the lower lip are Dot brought on by smoking a pipe or cigar, as any injury to the lower lip will sometimes produce the condition. A bruise of mucous membrane from biting the lip, or lip becoming irritated from some protruding rough edged tooth. Any induration, fissure or lump in the lip should be treated promptly and not "let alone" to develop into a malignant disease. Timely treatment of the right kind will save your patient much suffering, and the eclectic physician, if rightly trained, should be equal to the task of treating it. Study the "conditions" to be overcome, then select the "indicated remedies," and success will follow.

Case 2.—Mr. H., a farmer, aged 56 years, applied to me for treatment of cancer of the lower lip on February 17, 1903. The sore was a ragged, ugly looking one extending from the left corner of the mouth two-thirds the way across the lip, involving the mucous membrane on the inside and skin on the outside, involving the muscle between, one-half way down the chin. The growth had turned over, or rather folded over, like a rose petal, making it impossible for him to close his mouth. This first appeared in the form of a small tumor four years prior to the date above mentioned. He paid but little attention to it, treating with some simple home remedies, but it steadily grew worse. One year after its appearance he consulted a physician, who treated it for several weeks with no good results, it gradually getting worse by involving the surrounding tissues, and some one advised him to take the X-ray treatment. He did so, and during a period of nine months of submission to this mode of "scientific" (?) treatment he took "one hundred and ninety exposures," but instead of stopping the spreading of the disease the "exposures" increased the diseased surface. The X-ray acted on the surrounding healthy tissues, and caused a degeneration of this tissue also, and therefore did nothing toward checking or healing the previous sore but caused conditions that enlarged it.

The X-ray machine in the hands of an incompetent manipulator does more harm than good. This is only one of numerous cases that have come under my care and observation where the X-ray had first been used and with bad results, the flesh all around the sore being terribly burned, complicating matters very much indeed, and requiring long and tedious course of treatment to cure the X-ray burn. Some months after the X-ray experience the patient came under my care.

One of the cardinal principles in treating diseases of a cancerous or malignant nature is to keep the sore thoroughly clean and aseptic. This can be done by the use of any of the good antiseptics. Permanganate of potash is preferred in most cases, as it seems to possess cleansing powers and disinfectant qualities not found in some of the others. Pix creosote is efficient in some cases. He was also put upon an alterative in which echinacea, baptisia, berberis aquifolium, dulcamara, ailanthus glandulosa and phytolacca were prominent ingredients when indicated. An escharotic suited to the case was used to get rid of the diseased tissue. Owing to the "scientific" (?) treatment with the X-ray he lost about half of his lip, as all the tissue that had come under the one hundred and ninety "exposures" sloughed out. In six weeks' time, under the above treatment, he returned to his home well, the growth removed and the lip healed. He had lost about half of the lip and it was difficult for him to hold the saliva in his mouth for a while, but that part of the lip has developed so that he now has no difficulty in doing so.

A short time since he visited me and while the deficiency in the lip can be noticed, yet it does not interfere with his speech whatever. He has had no sign of a return of the trouble.

Cancer of the Stomach

Cancer of the stomach is extremely difficult to treat because of the involvement of so important an organ of the body. Any derangement of this viscus shuts off an important factor in our well being-as "we must eat to live,"

Case 3.—Mrs. K., a native of Iowa, aged 46 years, applied for treatment in September, 1905. Had been suffering eighteen months with stomach trouble. She had been treated for indigestion, gallstones, ulceration of the stomach, enlarged liver, and not until a well-formed lump developed in the stomach, together with other characteristic symptoms, was her trouble looked upon as cancer. Had been confined to her bed, more or less, for five or six months prior to this time, and was reduced in flesh until she weighed less than a hundred pounds. Complained of a dull, aching pain in the region of the stomach, increased on pressure. The pain was not increased on introduction of food into the stomach. The lump could be easily detected and was located in the pyloric end of the stomach, and appeared to be larger than a good-sized hen's egg. She was very anemic. The abdominal wall was so thin that when she was lying on her back the lump could be easily seen. The characteristic coffee-ground vomit, with the dark, tarry stool, with constipation and diarrhea alternated. The characteristic cachectic color appeared with the skin drawn over the check bones. She was hollow-eyed, and, as her husband described it, "looked very much the color of a pumpkin."

The treatment in this case was principally constitutional, although a local application of distilled witch hazel was made to remove the soreness and pain, as the stomach was very tender and sore and she was so weak that she could not walk across the floor. The treatment varied as symptoms and conditions varied. Phytolacca was given for its general influence on the irritated mucous membranes and glands of the stomach. Pulsatilla was prescribed for its soothing effect on the nervous system. Iodide of potash was used for its peculiar influence in the relief of cachectic conditions and its action on the glandular system. Subnitrate of bismuth was used for the pyrosis existing and the gastric flatulence. Hydrastis was used for its influence on the mucous membrane of the stomach and as the most natural stimulant to the normal function of digestion.

Calendula has its use in cases of this kind, as it helps to relieve the pain and quickly relieves the soreness, and to a great extent prevents a contraction of the tissues and the formation of a cicatrix, and quickly heals ulcerated surfaces, as well as allaying nausea and sickness at stomach.

Baptisia has its place in the treatment of this class of cases, as it exercises a great influence upon the glandular system of the whole alimentary canal, reinforces the character of the blood, prevents the destruction of the red corpuscles, carries off the waste material and has a marked sedative power.

Iris versicolor was used in this case for its effect upon the mucous membranes of the digestive tract with an altered secretion; nausea or vomiting of an acid liquid, with burning and distress in the esophagus and stomach.

Thuja was used for the abortive effect this remedy exercises over cancerous tissue, and in retarding its growth, as it exercises a specific influence over abnormal growths and tissue degenerations and especially those of an epithelial character.

Sulphide of sodium found its place in the treatment of this case, especially in the beginning of the treatment, when the tissues of the tongue possessed that peculiar symptom of pallor, and was also covered with a dirty fur, or with a whitish or yellowish thick, moist coat. It also aided in correcting the fermentation.

Arsenicum was given for its stimulating effect upon the stomach and to promote the flow of the digestive fluids. It materially improved the tone of the stomach, and is especially indicated where there is an engorged or an edematous condition of the cellular tissues, with a deficiency of normal elasticity. When this condition is due to an inactive liver and spleen it is especially useful.

About five weeks after the writer was first called to see this patient she was suddenly taken with a violent sneezing paroxysm and continued to sneeze for several hours. Each time she complained of excruciating pain which was followed by quite a profuse hemorrhage from the stomach, after which she fainted and remained in a semi-conscious condition for some hours.

After regaining consciousness, she expressed herself as being entirely relieved—no more pain or soreness in the stomach, the lump seemed to have shifted its position, and in a day or two could not be located in the stomach at all. Some four or five days later there. was passed from the bowel a tumorous mass that was about four inches in length and one and a half inches in diameter. Upon examination it was found to be composed of dark substances resembling clotted blood, and upon a more careful examination it was found to consist of tissue formation, and a microscopical examination proved it to be formed of cancer cells. In ten days the patient had developed a ravenous appetite and was not troubled any more with vomiting or sickness of the stomach. From this on she was allowed more solid food, which was retained and digested, and she began to improve, increasing in strength and gaining in weight, and by November 1 was able to leave her bed.

The writer saw and examined her within the past month and found her to be in perfect health. She weighs one hundred and ninety pounds and has not had a sick day since November, 1905.

Her general health is in excellent condition and she can do a great deal of work without fatigue or complaint, and considers herself a well woman.

Cancer of the Rectum

This disease is equally as difficult to treat as cancer of the stomach, as the location is as difficult to reach with remedies as that of the stomach, and for the further reason that lesions of the rectum are kept irritated by the accumulation and passage of the feces when the bowels move. However, by the internal and local use of the indicated remedies the majority of cases can be cured, if they are secured in time.

Case 4.—Mr. M., a farmer, aged 54 years, a native of Nebraska, came under my care March 17, 1904, and gave a history of having suffered from piles for four years. Eighteen months prior to coming to me he had undergone an operation for what he termed internal hemorrhoids. There was considerable trouble in getting one side to heal. He remained for treatment in the hospital, where the operation had been performed, about four months, and finally went away before it was entirely healed.

At the time I saw him there was a well formed tumor located on the left side of the rectum, two and a half inches to three inches inside of the internal sphincter, that appeared to be larger than a quail's egg. Microscopical examination of a portion of this tumor revealed the fact that it was a cancer of the epithelial type. His general health was greatly reduced, and he was very weak and anemic. He was also suffering from intense pain in the back and hips, with almost a constant desire to evacuate the bowels. He said he frequently went to stool as many as thirty and forty times in twenty-four hours, but was, usually, only able to pass a small amount of mucus mixed occasionally with blood, and when a freer passage was needed he was compelled to use an enema, which always gave him great pain. He could only get a thorough evacuation by lying flat on the back and kneading his abdomen with his hands.

Internal treatment was commenced by giving him the comp. syr. of hypophosphites three times a day, to which his system responded nicely. The lower bowel was thoroughly cleansed every day, using an antiseptic solution of permanganate of potash, after which an-injection of a preparation of thuja was thrown into the bowel through a long glass tube syringe and carried above the tumor mass, and patient compelled to lie on his left side for two or three hours before getting on his feet again.

Other internal remedies were given as the conditions indicated. Aconite, baptisia, phytolacca, nux vomica, echinacea, gelsemium, iodide of potash, ergot and last, but not least in effectiveness, collinsonia for its specific influence in the control of the circulation in the rectum.

He was under my personal care and attention for almost four months, at which time the tumor had been reduced to about the size of a cherry.

His general health had improved, he increased in weight, he had better control of bowels, could sleep fairly well. It being necessary for him to return home for a short time, I prepared treatment to take with him and gave him instructions as to its use, and gave him a three weeks' vacation with instructions to return at the end of that time. In three weeks he wrote me that he was doing nicely and had continued to improve right along, and had been able to use the medicines very satisfactorily. He was advised to continue and send for more medicine. I did not see him for about four months and upon examination found the tumor had entirely disappeared. He stopped all treatment, as his general health had entirely recovered, but he was instructed not to perform any hard manual labor, especially anything that would require him to be on his feet any length of time.

I have had the opportunity of seeing him once a year since, and upon examination, less than a month ago, I did not find any trace of the tumor whatever. He tells me that during the past year he has performed a man's work on a ranch and he has felt no inconvenience from doing so.

Cancer of the Uterus

Case 5.—Mrs. H., aged 50 years, came under my observation in February, 1903. She was the mother of six children. At the birth of the last child, ten years previous to the above named date, extensive laceration took place, which had not been repaired, and had given her more or less trouble ever since. An older sister had died from cancer of the uterus.

Mrs. H. had been treated by several physicians for her affliction before she came under my care, and each had diagnosed her trouble as cancer, and of course advised operative measures. She refused to submit to a surgical operation, and said if she could not be cured by some other method, she would have to die as her sister did.

When she first came under my treatment the womb was very much enlarged, especially the os and neck, and about one-half of the body. There was a large ulcer on the os and a portion of the *tissue had been removed by sloughing.

She was suffering with extreme pain in the hips and back, with a bearing down sensation and occasional hemorrhages, with a profuse discharge and disagreeable odor. She was very anemic from loss of so much blood and her health was very poor. The bowels were very irregular in action, alternating between constipation and diarrhea. Her appetite was good, yet her food did not assimilate properly, and seemingly did but little good, as she gradually lost in weight and only weighed 94 pounds when she began my treatment. Both local and internal treatment was used. For local applications I used wool tampons saturated with thuja, a weak solution of chloride of zinc, alternated preparations of bismuth subnitrate, hydrastis, both in powdered form, and other specifics as indicated. Antiseptic washes to keep the parts clean were always used, and the bowels kept regular and in a healthy condition by the use of the proper remedies. For a period of several weeks she was given iron, quinine and strychnia to tone up the general health and make better blood.

Calcarea fluor. 3x was also given for its beneficial influence generally.

Arsenicum from 3x to the 12X was given for its special tonic effect.

Phytolacca, echinacea, baptisia, pulsatilla, ergot, gelsemium, aconite, viburnum and other remedies were used as conditions would indicate them. She continued under my care and treatment six months, at the end of which time I dismissed her as cured. I have examined her from time to time in the past few years and find the parts remain entirely healed and the womb remaining the normal size for a woman of her age.

Now in conclusion I would speak a word for the specialist in this line, and claim that he has a place among the physicians of the land, even though he restricts his practice to certain diseases, provided, of course, he prepares himself for the work he undertakes and does a legitimate, honest business.

Those afflicted with the disease he treats may be few in number in the vicinity where the specialist is located, therefore he must needs use some method of letting the afflicted know of his ability to treat them. This may be done in many ways, the most prevalent method being by recommendation of his brother physicians after their due investigation, or the proper use of the medical journals.

I will admit that the lay press is sometimes used by charlatans for improper purposes and not for the good of their fellow beings. This is not the kind of use the specialist, who wishes to do good in the treatment of disease, should resort to. But the specialist that has spent his time in study, research and development of methods to cure certain classes of disease and has fully demonstrated by practical examples of living patients that lie has cured those that had been classed by other physicians as incurable, should not be classed as being "unethical", or snubbed, or the cold shoulder turned toward him by his brother physicians, if he lets the sufferer know what can be done to ease suffering and prolong life. The physician that usually "howls" the most against the specialist is the one that has told his patient to "let it alone," "it will get well itself," and such foolishness.

Let the specialist have fair play at your hands. He is only treating those cases that you don't or won't treat, and if he can do them good you should wish him "God speed. "

Ellingwood's Therapeutist, Vol. 2, 1908, was edited by Finley Ellingwood M.D.