Epithelioma.—Although epithelioma of the skin is included with cancer in the Mortality Tables of the United States and elsewhere, I do not purpose to admit it in connection with the results of treatment of cancer, for several reasons. First, Because cutaneous epithelioma occasions but a very small proportion of the deaths from cancer, something over three per cent. Second, Because its cause and treatment are almost entirely local, and so it does not relate greatly to our general inquiry as to the internal or constitutional cause and treatment of real cancer. Third, Because dietary and medicinal treatment seem to have relatively little, if any, effect on cutaneous epithelioma, except in the later stages, where the disease has caused great ravages, and lastly, Because if the proper treatment of cutaneous epithelioma is begun early and carried out faithfully it need never, or exceedingly seldom, acquire a severity such as is often depicted by overzealous surgeons who advocate only the knife.
In regard to epithelioma on the skin and also on the tongue, lip, and oral cavity, however, I want to give you one word of caution, and that is in regard to the use of nitrate of silver. I have seen so many epitheliomatous lesions in these regions which have been goaded on to a severe degree of ulceration by the injudicious and meddlesome “touching up” of the same with nitrate of silver, that I would make it an axiom to never use this superficial caustic at any time in connection with anything which may possibly be epithelioma. I would almost consider it criminal to do so. On another occasion I may take up the subject of epithelioma very fully, but already I have shown you many interesting cases, demonstrating how it can be cured by intelligent and faithful treatment without surgical operation. Some of you may recall the enormous ulcerating epithelioma on the left ear of a man of about fifty, who showed himself repeatedly after the disease had been entirely cured by the thorium paste, which you have often seen me use. You may remember that the upper portion of the pinna was gone, but presented a thin, delicate cicatricial surface, freely movable; the last time he was here was fully two years after it had been entirely well.
It is not worth while to attempt to analyze here the 685 cases of epithelioma mentioned, many of which were small and very superficial, and easily cured. There were, however, many cases which were originally classed as epithelioma which sooner or later, either with or without a previous surgical operation, took on such a malignant action, with a destruction of tissue, as would at once class them with carcinoma. In reality, as you know, carcinoma is but an aggravated or malignant new growth of epithelial cells, from the skin or glandular organs, infiltrating the surrounding tissue; while sarcoma is a somewhat similar malignant proliferation of connective tissue cells.
The ordinary distinction between epithelioma proper and carcinoma is, therefore, vague and not scientific, and for the present will probably have to rest on the basis of a superficial, or deep cellular, disturbance. But, for the reasons already given, I protest against including all instances of epithelioma under cancer, as in the propaganda for early operations, and I do not include the mass of them in my studies as to the results of treatment. Inasmuch as the border line between the superficial and deep epithelial misbehavior is often so indistinct, it is difficult to designate as carcinoma all that might possibly belong there, but certain of them should be mentioned. In looking over the records of my patients in private and public practise I find at least 80 with the diagnosis of epithelioma whose disease was so malignant in its course that they should certainly be included in the carcinomatous class; these, therefore, appear in the following table, which gives also the sex and location of the cases, both of carcinoma and sarcoma:
| Private and Hospital Cases | |||
|---|---|---|---|
| Carcinoma | Male | Female | Total |
| Breast | 1 | 147 | 148 |
| Uterus | 8 | 8 | |
| Stomach | 7 | 5 | 12 |
| Liver | 2 | 2 | 4 |
| Lip | 19 | 3 | 22 |
| Mouth and tongue | 17 | 3 | 20 |
| Pharynx and esophagus | 2 | 1 | 3 |
| Jaw and neck | 10 | 10 | |
| Nose | 5 | 3 | 8 |
| Orbital region | 3 | 1 | 4 |
| Penis | 5 | 5 | |
| Other localities | 12 | 17 | 29 |
| 83 | 190 | 273 | |
| Sarcoma | |||
| Head, face and neck | 12 | 6 | 18 |
| Trunk | 5 | 6 | 11 |
| Extremities | 3 | 4 | 7 |
| 20 | 16 | 36 | |
| Totals | 103 | 206 | 309 |
Carcinoma of the Breast.—Of the 147 cases of carcinoma of the breast in females the right breast was affected 64 times, the left breast 77 times, and both breasts 6 times. Of these cases 74 had never been admitted to surgical operation; 59 had been operated on once, 12 twice, 1 three times, and 1 four times, with recurrence, or rather with continued development of the disease. In 28 cases a surgical operation was advised and performed by various surgeons, either before internal treatment or after a trial for a greater or lesser period; in eight of these it seemed wise to have an operation after a more or less faithful trial of medical treatment. I may here remark that it is very difficult to hold all patients firmly to the dietary and medical requirements necessary to remove the disease, and many dropped off after a short trial, while quite a number, 77, were seen only a few times or in consultation, and were thus lost sight of. There were 101 married or widowed females with cancer of the breast and 41 single, and 5 unknown. The average age was almost 50.
The total number who were under dietary and medical treatment for a sufficient time to form any judgment from, amount to 41, while a considerable number are still under treatment and improving. It may be noted that the first case of carcinoma I find recorded was on September 29, 1879, the second on October 31 of that same year. Many of the early cases were noted accidentally, in patients coming for various diseases of the skin.
Time does not permit my dwelling on many interesting points concerning some of the cases represented in the foregoing table, but I want to relate and present some cases illustrating the beneficial effect of carefully directed treatment in this class of affections.
Before doing so, however, I want you to inspect a private patient, Mrs. R. F. C., aged 50, who has only to-day for the first time come on from a distant city for treatment, and has kindly consented to come before you, veiled. The case presents many features well worthy of consideration, and I hope on some future occasion to be able to report favorably concerning her; although, as you see, it is quite an inoperable case, or at least one in which the disease would certainly recur if treated with the knife. The entire left breast is greatly enlarged, like half a melon, hard, firmly attached, and with the axillary glands greatly involved. It is interesting to know that she was first conscious of a lump in the breast on September 1st, only thirteen weeks ago, and all this has developed since. She presents the usual picture commonly seen in these cases, namely, constipation, urine scanty and deficient in solids, and the saliva acid. She still appears to be in robust health, as is so common early in the disease.
The first case showing the effect of dietetic and other non-surgical treatment to which I would call your attention is the private patient who so kindly exhibited herself, veiled, at our lecture week before last. I showed it then purposely as a case undergoing treatment, now for eight months, in which there was still evidence enough of the disease, with the history presented, for those who examined it to confirm the diagnosis of unquestionable cancer.