One other case, seen recently, where the disease was recurrent after three operations, deserves mention, although it will be some time before any decisive result can be reported.
Mrs. W. C., aged 45, was first seen September 17th, 1914. Nearly four years previously she had noticed a lump in the left breast which was removed on January 6th, 1911, but it soon regrew, and a complete operation was performed at the New York Skin and Cancer Hospital, May 30th, 1911. Two years later there was some return, and she was again operated on at the Hospital, May 30th, 1914. About two months before her first visit, September 17th, 1914, a swelling of the sternum was noticed, and soon another above it, both of which increased pretty rapidly to the time of her visit. When seen there was a hard mass in the scar over the sternum, about an inch and a half long, raised a quarter of an inch or so, reddened and immovable: an inch or so above it was another, smaller one, not reddened: they were not particularly painful on moderate handling, but painful when at hard housework. When last seen, December 7th, both lumps had subsided fully one-half, there was no pain at any time, and her general condition had improved immensely, she feeling better than she did four or five years ago, that is, before the beginning of the cancerous development: she has been working all the time, unusually hard, as janitor of four buildings and also going out scrubbing and washing. She weighed 157¼ pounds when first seen, then ran down to 154, but is again gaining, being 155½ at her last visit. The outcome of this case it is, of course, impossible to conjecture, for one can seldom be sure that patients will be absolutely faithful to treatment, for a long enough time, but certainly the change in the woman and in the lesions in this two months and a half has been remarkable, compared with the increasing development of the disease in the two months previous.
I must mention one more case, which, although fatal, exhibited some of the good results of careful medical treatment even when a primary case had advanced far beyond the possible aid of surgery.
Mrs. M. B. J., aged 68, a private patient, was first seen on February 17th, 1914. Two years previously she noticed a lump in the upper part of the right breast, after great and repeated mental distress from the death of a number of very near relatives, and a sister’s mental derangement; the great nervous strain had been attended with various bilious attacks and nervous indigestion. The mass increased steadily in size and was kept concealed even from her family, until the day before she called, when her family physician who was consulted saw that it was far beyond the possible hope from any operation, in which view a surgeon concurred.
When seen the whole breast was involved, was double the size of the other, hard, immovable, and with an adherent crust over an ulcerating surface on its lower half, several inches in diameter, from beneath which was a moderate discharge: the axillary glands were enormously enlarged, as also the supra-clavicular, and she was strongly cachectic. She was placed on an absolute vegetarian diet, with no coffee or tea, and appropriate medical treatment, and the breast kept painted with fifty per cent. ichthyol and water, care being taken not to disturb the adherent crust. In a very short time the discharge ceased, and the protective crust adhered until her death from exhaustion, with pulmonary œdema, on September 9th, 1914. On August 15th it was recorded that the breast had done very well, that it was soft and movable, and not larger than the other breast, with no discharge, and no pain since a short time after beginning treatment: the axillary glands had diminished three-quarters in size, and the supra-clavicular glands were also very much smaller.
And now, gentlemen, my task is done. I have tried to let you see cancer through my spectacles, as I have seen it for very many years past, and to share with me my optimism in regard to the prophylaxis and cure of cancer, if only there can be sufficient enlightenment in the profession and public: and I must tell you that in collating and preparing the material to support my long held views I have expended very much more time and labor in study, for some months past, than I could have believed possible. But as the subject developed, and as I discovered more and more support for my thesis, there was a fascination about the work which I could not resist; and if I have tried you with the many details of proof presented I beg that you will pardon me: for I wanted to present the subject so strongly that my hearers, at least, would accept the propositions I have developed, and believe what I have said in regard to my own experience with the terrible disease under consideration, and act upon both, and thus aid some sufferers with cancer.
From my recent article on “The Relation of Diet to Cancer” many medical journals have quoted me as ascribing the disease wholly to the use of meat, but you who have heard these lectures now know that animal proteids are only one of the contributing causes.
I have tried to make it plain that metabolic errors, inducing a vitiated blood stream, are the basic cause of the aberrant action in the cellular elements of the body which may ultimately lead to malignant disease; and I have tried to show that there are many elements connected with modern so-called civilization which conspire to effect this end. I have quoted many who were well acquainted with cancer, who believed that luxurious living, which includes much animal food, coffee and tea, and alcohol, with indolence or want of sufficient muscular activity to burn up the waste products, and the persistent neglect of hygienic laws, should be placed first among the causes of cancer: but I have also mentioned that the refining and preparation and cooking of food prevented a proper supply of the mineral and other elements of nutrition, and also that nervous influences could so disturb the action of the organs of the body that they could not perform their functions perfectly in the elaboration of nutritive material, etc.
But I cannot go over again all the matter already given in these lectures, and only mention these to remind you that there is no one single cause of cancer, and consequently that its prophylaxis and cure can never be found in any one single remedy; hence I can never believe in the sole use of thyroid, much less in the idea that sero-therapy can overcome a disease dependent upon the continued operation of so many causes; and still less can I believe that the mere cutting out of an already diseased portion of the body is the proper and only means of overcoming such a malady as cancer.
I have acknowledged that local irritation of many kinds may be the proximate cause for the development of a malignant tumor in any particular locality, as Ewing has so clearly shown in his excellent resumé on pre-cancerous lesions; but I have also contended that we should withal look into and overcome the cause; why, when once started by local injury the cells should pursue such a progressive, aggressive, and invasive course; and this is found, I believe, in the disturbed character of the fluids which provide them with nourishment for their abnormal growth.