The method of death in cancerous patients is as free from distinctive characteristics as the course of the disease. It is usually associated with two prominent features, malnutrition and some terminal infection. At the last there is usually some toxemia, which renders the closing hours free from actual pain, while if the toxemia be profound patients may linger unconscious for several days.
GENERAL REMARKS ON THE TREATMENT OF CANCER.
Accepting the views expressed when discussing the nature of the cancerous process, the following may be assumed to be true: Cancer begins as a local disease. There is therefore a period in its history when if it be recognized in time, if it be or can be made accessible, and if it be thoroughly removed, it can be frequently cured. The “ifs” in the foregoing statement afford such insuperable obstacles in so many cases that the difficulties in the way of treatment are very great. It has been said that, “The resources of surgery are rarely successful when practised upon the dying.” It happens too often that these cases are not submitted to the surgeon until long after the favorable period above indicated is past. This is explained by the difficulties of diagnosis, by the inaccessibility of many primary cancers, and by the unwillingness of patients to submit to the knife. Nevertheless the best time to treat a cancer is when its existence is first suspected, and the best way is the most radical, i. e., by thorough extirpation.
While such extirpation should include a wide area of apparently healthy tissue and of the entire organ which seems to be involved, for instance, in the case of the liver, this last may be impossible; and yet by removal of a considerable area of healthy liver around a cancerous gall-bladder the writer has seen complete and apparent final recovery follow. The principal direction is to be thorough.
That cancer so often returns after operative attack is largely due to the fact that the general practitioner, under whose observation most of these cases first come, is slow to recognize the malady, and timid to advise radical methods.
It has been recognized that in cancer the internal administration of arsenic has been beneficial. In order to obtain the best results from its use, it must be pushed to the physiological limit and in preparations of the most active and reliable kind.[16]
[16] The preparations of arsenic which have proved most satisfactory are the imported cacodylate of sodium, which comes in capsules ready sterilized for use, and the following solution, which is original and needs to be made up in accordance with the formula herewith furnished:
(1) Dissolve 7 grains mercuric biniodide with 10 grains potassium iodide in a little water. (2) Dissolve 48 grains arsenic bromide in a little water with the aid of gentle heat. (3) Dissolve 24 grains gold chloride in a small amount of water. (4) Mix the mercuric and the arsenic solutions and then add the gold solution, which will cause a whitish precipitate, becoming brownish in color. (5) Heat this mixture and decant the clear portions, setting it aside. (6) Add 2 drachms nitromuriatic acid to the above precipitate and heat gently until a clear red solution results. (7) Add to this the decanted portion of 5, which will cause a reddish precipitate. Heat the whole mixture up to the boiling point and until all residue is dissolved. (8) Add sufficient distilled water to make 15 fluidounces. The product should be bright, clear, and wine colored.
Of this solution 10 drops are supposed to represent ¹⁄₁₀₀ grain mercuric chloride, ¹⁄₃₀ grain gold chloride, ¹⁄₁₅ grain arsenic bromide. The commencing dose is 10 minims, which may be increased to 25 or more, taken in abundance of water.