Cancer: Its Cause and Treatment, Volume 1 (of 2)

by Lucius Duncan Bulkley

When first seen there was a tumor between two and three inches in diameter, in the upper, inner segment of the left breast, hard, sharply defined, and more or less nodular on the surface: there were some enlarged glands in the left axilla. She had long been constipated and was passing about 60 per cent. of the amount of urinary solids proper for her weight. Under very active treatment it was recorded four weeks later that there had been hardly any sensations in the breast during the previous week, that the tumor had diminished materially in size, with only moderate hardness, and that she was now out doors every day, and feeling much better. One month later it was recorded that the breast was very well and on examination was almost the same as the other, there being some general caking in both: she had had no pain for some time. One month or so later she was again at her duties as a public school teacher, which she has continued at since, with rare exceptions, when some temporary ailment prevented: the lump in the breast did not wholly disappear for a month or two later, but on April 7th it was recorded that the left breast was the same as the other, and no glands could be felt in the axilla.

From that time to the present she has had a variety of troubles, rheumatic and other, and it has been difficult to keep up a proper action of the bowels and kidneys; but in spite of strenuous and often exhausting work as a New York City public school teacher, she has had no return of the breast trouble, now for over nine years. A sister, aged 60, has just died with cancer of the stomach in a distant country town.

I could multiply these histories but do not want to tire you, though I do want to mention one more patient, to show what can be done in the case of recurrent carcinoma, after operation, of which I have had a number of cases with varying results, according to the duration and severity of the disease.

Miss H. M., aged 61, came to me June 21st, 1913, with the following history: About two years previously a lump appeared in the outer, lower segment of the left breast, which was removed in August, 1911; this healed soon, leaving a good axillary scar, and there was no thought of trouble until two months before her visit, when a small red spot appeared near the edge of the sternum. This enlarged and hardened and others appeared around the scar, until, when seen there were a dozen red nodules up to half an inch in diameter, near the center of the former site of the breast, with others, not red, above; with the tense skin and rapidly developing, multiple nodules here and there, further surgical operative procedure was out of the question.

Since that date she has been under strict vegetarian diet and medication, including thyroid from time to time, with repeated application of X-rays, and under all these measures together many of the nodules have disappeared; although some new ones have formed, several of which have been removed under local anæsthesia, the wounds healing kindly. As she resides some distance from the city she has not been seen since October 7th, 1914, she wishing to take the X-rays nearer home, but she was earnestly charged to continue also the dietetic and other treatment. In this instance the patient has lived comfortably and without pain for almost sixteen months after coming under treatment, and, although she has lost some flesh, the active cancerous process, which would otherwise have carried her off long ago, has been in a measure checked. What will be the further history of the case one cannot tell, for it is quite possible that being away from my care she may neglect dietetic and medicinal treatment, trusting only to the X-rays, which, of course, cannot influence the real nature and course of the disease.

Reference was made to certain cases of recurrent cancer in the Hospital which had been under active medical treatment during the past year, with careful laboratory studies, but it is naturally too early to report anything very definite in regard to them, especially as most of them were desperate cases, which had advanced far beyond any possible operative relief. Moreover several of them remained but a short time under treatment, as it is very difficult to convince this class of patients that any possible benefit can accrue from anything but an operation, and this being impossible they often give up and leave, preferring to die at home; moreover the dietary restraint seems also very irksome and useless to them and their friends. In one particular patient, however, there was such a remarkable improvement that it is worth reporting to you.

Mrs. C. M. was first seen February 12th, 1914. Nineteen years previously she had an abscess of the right breast, which healed and left a tumor the size of a pigeon’s egg in the inner, upper quadrant of the breast; this remained quiescent until it began to enlarge, eleven months before it was removed at the New York Skin and Cancer Hospital, November 14th, 1912. The tumor was then about the size of a hen’s egg, with an area of skin the size of a quarter, attached to it: a second tumor was felt just below the nipple, which was not retracted, and the axillary glands were involved: there were no signs of metastases in the abdomen. A complete operation was then performed, with dissection of the glands in the axillary and supra-clavicular regions, and she was discharged January 16th, 1913.

On February 9th, 1914, she returned to the Hospital and was placed under medical treatment, with vegetarian diet. There was then an ulceration along the line of incision, from the second to the fourth rib, with many nodules around it, averaging a third of an inch in diameter, raised and reddened. The liver extended two inches below the edge of the ribs, with a hard and nodular margin; the right arm was enormously swollen and helpless. When she left the Hospital, June 20th, 1914, the ulcer had entirely closed, many of the cutaneous nodules had entirely disappeared, the arm had returned to normal size, like the other, by measurement, and the liver had retracted to a trifle below the margin of the ribs, with hardly any nodules to be felt. The treatment had included twenty-five X-ray exposures, from 8 to 10 minutes each, about twice a week, over three areas each time.

While in the Hospital careful laboratory investigations were made, according to a definite schedule. The blood, studied weekly, maintained a hæmoglobin of 80+ for over two months, then fell a little, and again rose. The erythrocytes were 3,262,000 on entering, and rose within two months to 4,282,000, then fell a little and rose again to almost 4,000,000: the leucocytes were 9,000 on entering, and fell to 5,200 just before leaving, the poly-nuclear 69 per cent. on admission, fell to 60 per cent., and again rose a little, and the proportion of the other forms remained about normal. The urine, volumetrically analyzed every three days, was kept a little below the normal acidity, and the specific gravity a little low, with a free daily amount of excretion, largely by Bethesda water: in spite of the vegetarian diet the urea excretion was not much below normal, and sometimes above, the chlorides were diminished, owing to the rather small amount of food taken, the phosphates varied a little above and below normal, there was never any indican, and the sulphates averaged a trifle below normal. The saliva, tested before and after each meal, was acid at first, but became neutral and alkaline off and on. The weight, taken weekly, fell a little from the first, but maintained a good level, and rose a little before she left the Hospital.

This was a very difficult patient to manage, as she was a very ignorant Polish woman, who often rebelled at the diet, and wearied of the routine and restrictions imposed; she left the Hospital June 20th, 1914, against my wish, but with as great a change in her physical condition and disease as could be imagined, after about four months and a half treatment, carried out under disadvantageous circumstances.