The case was a very interesting one and exhibited certainly some of the beneficial results of treatment, although in such a hopeless case, with such a mass of ulcerating cancerous tissue as she presented, secreting its poisonous hormone, any other end could hardly be expected. There is no question, however, but that life was greatly prolonged and much comfort secured, as to sleep, diminution of pain and offensive discharge, etc. The case was watched with interest by members of the attending staff, and careful laboratory studies of the blood and volumetrical analyses of the urine were made weekly; the latter was generally scanty, running even as low as nine ounces a day, though of a fair specific gravity, and it was very difficult to raise the total solid urinary output to anywhere near a normal standard. The saliva, tested and recorded before and after each meal, was commonly acid, often strongly so, though at periods it would be neutral and occasionally became alkaline for a while under active treatment.
I have taken up so much of your time with cancer of the breast that little is left for consideration of the disease in other localities, and I will be as brief as possible:
Cancer of the Uterus.—Two cases, in private practise, among the eight of cancer in this location which are on my list, are so interesting and remarkable that I must give them somewhat in full. I may say that the other cases had little or no satisfactory treatment. One of these two would gladly present herself for your inspection, that you might verify her present condition of excellent health, but she lives in Bangor, Maine, and now only comes on periodically; this is in order to be sure that she continues in the straight and narrow road necessary to keep her free from her previous distressing condition. The case is as follows:
Case VII.—Mrs. F. L. A., aged 48, weighing 105 pounds, was first seen on March 21st, 1916. She had had four children aged 22, 20, 17, and 12 years, and had had a miscarriage 9 years ago. There had never been any trouble with confinements, and never laceration of the cervix. The menopause had occurred suddenly two years previously, but she had had some vaginal discharge since October, and had felt weak for some months. She had, however, never suspected any serious trouble until there was a slight hemorrhage, consisting of only a few drops of bright blood, on February 24th. That afternoon she was examined by a surgeon at home, Dr. McCann, of Bangor, Maine, who sent her to me. He discovered that she had already an inoperable cancer of great extent, which diagnosis was confirmed by others, who refused to operate. The report which came to me from the department of Pathology and Bacteriology of Bowdoin College was, “About one third of the cervix destroyed, vaginal wall involved. Right broad ligament infiltrated.” Curettings were made then, which from “numerous slides show squamous cell carcinoma. From histological appearance I judge that the cancerous process is developing rapidly,” signed F. N. Whittier. The slides which were brought to me were submitted to Dr. H. H. Janeway, who confirmed them to be “rapidly growing, malignant epithelioma.” Those who saw the patient on February 24th gave the opinion that she would hardly live six months.
She had been following an absolutely vegetarian (green card) diet for a week or two, and had been taking some compound cascarin tablets, which I had sent her (℞ Podophyllin, Aloin, Cascarin, āā gr. ¼), as she had always been very constipated, and since this treatment had felt much better in every way. I gave her douches morning and night, of carbolic acid and biborate of soda, ℨss and ℨii ad Oi hot water.
I then sent her to Dr. H. H. Janeway, who confirmed the physical condition and gave her one single treatment with emanations of 300 milligrams of radium, for 16 hours, on March 25th, dilating the os, but not curetting. She was then given ℞ Potass. acetatis ℥i, Tinct. Nuc. Vom. ℨiv, Extr. Cascara fld. ℨii, Ext. Rumicis rad. fl. ad ℥iv, Teaspoonful in water half an hour before eating, which she has taken more or less continuously ever since, alternated with other remedies as indications arose. Later she took pyrophosphate of iron, five grains after meals, in conjunction with the mixture. For some time she had suffered from severe neuritis in the neck and arm, which yielded completely to aspirin, five grains every two hours, taken also again on several occasions when it recurred.
I will not burden you with the many details recorded on her case paper, but can only say that to-day she is as well a woman in every way as one could wish. Her color is good, and a recent examination of her blood showed hemoglobin 80 per cent, red blood cells 4,500,000, leukocytes 5,800, of which polynuclears 64 per cent, lymphocytes 27 per cent, transitionals 8 per cent, and eosinophiles 1 per cent. She has made the trip back and forth from Bangor, Maine, half a dozen or more times, without fatigue, recently walked several miles, eats and sleeps well, is no longer constipated, and has a good urinary excretion, with rather an excess of solid contents; on December 6th she weighed 110½ pounds; her normal weight before her sickness had always been 93 pounds.
On June 2nd she was examined by Dr. Janeway, who reported: “I find no ulceration whatever on the cervix or vagina, the uterus is movable and of normal size. There are no evidences of any disease remaining which can be detected by examination.” On July 7th he wrote: “I have examined Mrs. F. L. A. again and find that there has been no return of the evidences of her disease.” On October 20th he wrote: “Mrs. F. L. A. appears to be absolutely free from disease.” Her surgeon, Dr. McC., confirmed all this by examination. It is now over 9 months since she was given 6 months to live, with an inoperable uterine cancer, and to-day is in better health than she has been for years.
This patient had one single application of radium, as mentioned, on March 25th, which probably aided in modifying the local disease, but it would be beyond human credulity to believe that this was a very large factor in restoring her to her present condition of health. The cure is, of course, a very recent one, but there is no reason why the same measures would not be effective should there be any return, as they are directed against the real cause of the disease. Nor is there any likelihood that there will be any possible relapse, as she is a most intelligent patient who adheres strictly to the treatment and diet, and will undoubtedly do so until directed otherwise.
Strangely enough another very similar case was also sent to me from Bangor, Maine, which I will mention very briefly: