The action of the kidneys is also always a very important element to watch and control in cancer patients; this does not have reference to albumen and casts, or glycosuria, but to a functional derangement of the secretion: for the former are relatively infrequent compared to the latter. This is so large a subject that time does not permit of its elaboration; I made the matter pretty clear to you in my lectures not long ago on the relations of diseases of the skin to internal disorders. I must tell you, however, that, as a result of numberless studies of the urine of many cancer patients, I have almost constantly found a deficient or defective urinary secretion: in many cases I have had the total daily amount accurately measured, and reported in writing each week over long periods, and while the total quantity may at times be near normal, the total solids sometimes fall to, and remain at, even less than one-half the amount which should be passed for the patient’s body weight.
I want here to urge upon you the importance and value of repeated volumetric examination of all possible ingredients of the urine, as indicating in the best manner obtainable the state of the arterial blood, from which the urine is derived: especially is this true of the exact volumetric acidity, representing the diminished alkalescence of the blood common in cancer.
The actual medicinal and dietary treatment of the various possible departures from normal can hardly be elaborated here, but they are along very much the same lines which you have often watched in connection with certain diseases of the skin; for you must remember that carcinoma is an epithelial disease, and that the laws of nutrition are much the same for this as for various other morbid conditions of the economy. I may say, however, that very many of my cancer patients have received the greatest benefit from acetate of potassa, often in the formula familiar to you (℞ Potass. Acetatis ℥i Tinct. Nucis Vomic ʒiv Extr. Cascar. fld. ʒij-ʒiv Extr. Rumicis radicis fld. ad ℥iv M. Sig. One teaspoonful half an hour before eating, well diluted). For many years I have administered potassa largely to these patients, and it is gratifying to find not only support but an incentive to its greater use, in the studies and experience of Ross, who pushes it to a very great extent, giving as high as 240 grains of potassium phosphate in a day. Ross also advises the free use of crude or brown sugar, as it contains a large proportion of potassium salts, which are for the most part removed from the white or refined article. I must also remind you of the great value of Bethesda water, in washing out the kidneys, given a tumblerful with each meal, and one tumblerful, hot, one hour before breakfast and also an hour before the evening meal.
The blood should also be watched, and in my hospital cases I have a count made every week; for the hæmoglobin content, and the number of the erythrocytes, and the percentage of the varieties of leucocytes afford very valuable information as to the physical state of the patient, and the progress or recession of the cancer, and in a measure these data are of value in directing therapy. I have also the weight of the patient taken and recorded each week, as a guide to nutrition and dietary matters. Also the saliva is tested and recorded before and after each meal, and furnishes an indication in regard to the administration of alkalies.
Iron is found to be greatly wanting in the blood and tissues late in cancer, and should always be an element in the treatment of this disease. Skene Keith, noticing that after a cancerous mass was removed the blood recovered in regard to hæmoglobin and erythrocytes, administered iron with arsenic, with the greatest benefit, the growth shriveling up and the patient gaining in weight; he recommends the citrate of iron and ammonia, the preparation which I have given to patients for many years past. He also advises hypodermic injections of iron, arsenic, and soda, and reports cases thus treated, some of them with good results. There is a loss of phosphates in these patients, and phosphate of iron or other phosphates are valuable.
When considering the metabolism of cancer mention was made of derangement in the action of the ductless glands in this disease, and of the use and value of certain preparations of the internal secretions in its treatment. While a hormone therapy of cancer is still in its infancy, in spite of many books and innumerable journal articles on the internal secretions, it is quite possible that the future may demonstrate its efficacy in helping to control the disease: for, that the latter are efficient agents in carrying on the vital processes in the body, there can be no question, although as Biedl remarks, “Our knowledge of the chemistry of hormone formation is very slight.”
But considerable clinical evidence has been accumulated that one at least of the internal secretions, namely, that of the thyroid, has a definite beneficial effect upon cancer; this I have administered to many cancer patients, and have reason to believe that it contributed to the favorable results obtained. Sajous, believing that insufficiency of the adrenal secretion is an element in altered nutrition, advocates thyroid extract on the ground that it stimulates the activity of the adrenals: Vincent quotes Erlich as believing that “there may be substances circulating in the organism which may stimulate the body cells to resist the athreptic influence of cancer cells.” Shirlaw advises a tablet made of thyroid 6 grains, supra-renal ¾ grain, and pituitary 1
16 grain. While the treatment by these hormones from internal secretions is really in rather an experimental stage, it would seem more than probable that the correct use of these pluriglandular extracts, in combination with other proper dietary and medicinal treatment, would be of service in the prophylaxis and treatment of cancer. I have been a little cautious in the use of thyroid, beginning with two or three grains with meals, three times daily; for, as a promoter of catabolism it can disintegrate tissue faster than the emunctories can remove the effete products, and may thus poison the system.
Serum- and Vaccine-therapy are yet in a stage of development, and as I have had little or no personal experience with them I will not attempt to discuss their value, which time alone will demonstrate. While there have been many claims of success from treatment along these lines, unfortunately they have not been confirmed by later observations by others: I may say frankly that they have never appealed to me as rational, in consideration of the views and experience I have long had along other lines of thought and practice. If, however, future investigations shall confirm some of the remarkable reports which have been made, the latest of which is by Nowell, there may be opened a non-surgical line of treatment of cancer which would mean much to many otherwise hopeless cases.
The local medical treatment of cancer is also an important matter which should receive careful attention. For many years in early cancer of the breast, under proper, general, dietetic, hygienic, and medicinal treatment, I have seen the lump vanish under the continued application of the iodide of lead, in Hebra’s diachylon ointment of the German Pharmacopœia (ʒss-ʒi ad ℥i), and in very many instances I have had the assurance of patients that its application relieved the pain and was of the greatest benefit also in axillary and other metastases. In other cases the continuous painting with ichthyol (50 p.c. in water) has seemed to be of great service, in combination with other proper treatment: all of this in earlier cases, before ulceration has occurred.
After ulceration has set in, either in primary or recurrent cases, proper local medication is very important. The ordinary micro-organisms, finding a suitable nidus, very readily germinate and add greatly to the suppuration, and consequent exhaustion and pain, and by their toxins, aid also in the general contamination of the blood and tissues. Hydrogen peroxide, laid on with pledgets of absorbent cotton is often of great service in changing the conditions of the part, and when followed by Russian oil, also applied with cotton, makes a most satisfactory dressing. Adrenalin 1–1000 is also often of service, both in checking active hemorrhage, and in relieving pain, and shrinking up the granulations. Ichthyol, 10 to 25 per cent. in water, and permanganate of potash in water, 1 to 2 per cent., are also often of service, likewise acetate of aluminium, 3 to 5 per cent.: methylin blue and fuchsin in watery solution, 1 to 2 per cent. were formerly much used, and often served a good purpose. It is understood, however, that none of these measures have any great curative effect on cancer, but as contributory elements they should never be neglected. Ichthyol ointment (℞ Ichthyol ʒss-ʒi Zinc Oxid ʒss Unguent. Aquæ Rosæ ℥i) often proves most satisfactory, spread on thin layers of absorbent cotton, and changed several times daily, after soaking the part with one of the liquids above mentioned.