—A number of years ago Fehleisen, calling attention to the fact that cancers had seemed to improve or possibly even disappear after an attack of erysipelas, suggested deliberate infection of the surface of such a growth from a case of erysipelas. In this procedure he met with some success, but there were numerous objections to it, one being the impossibility of controlling the spread of the infection thus produced. Coley, of New York, then undertook a much more systematic study of the relation between the two diseases, and devised a method of injecting the toxins produced by the streptococci of erysipelas and of reinforcing them, if necessary, by those of the bacillus prodigiosus. The intent of this treatment is to produce reasonable reaction in the hope of mitigating the rapidity of the growth, checking its progress, or even causing its disappearance. It has been on trial now for several years, and while in a few cases of sarcoma, especially in the hands of its originator, the treatment has apparently been of service, it has proved disappointing in the majority of instances.
Liquid Air.
—The application of liquid air to superficial malignant growths has proved successful in a number of instances, but inasmuch as this is practicable in only one or two of the largest cities of the country, it is not a measure which need be discussed here at length. The liquid seems to act as an almost painless escharotic, and its use produces sloughing, or a drying up under a scab, which after a day or two will loosen and be easily detached.
Radium.
—This remarkable element has aroused within the past few years an amount of scientific interest and experimentation with which there is little else to compare. The enormous expense of a preparation of any great activity, and the rather bewildering contradictory statements which have been made by those who use the weaker preparations, have caused it to occupy a doubtful position in any list of reliable therapeutic agencies. It is undeniable that certain rodent ulcers, tuberculous lesions of the skin, and a few carcinomatous lesions have been much improved or apparently cured by its use. It is ordinarily used in glass or aluminum tubes or capsules, which are applied upon the surface of the growth to be treated. It has also been used sprinkled upon a plaster whose surface has been prepared with Canada balsam, and thus directly applied. Again, it has been enclosed in a capsule to which a strong silk thread has been fastened so that the former may be swallowed, retained in the stomach for a few hours, and then withdrawn. These last means of using it are of questionable value. Of still less value are the suggestions to dissolve it in water or to administer water in which a receptacle containing radium has been allowed to stand. There is much of interest and perhaps something of value in radiotherapy, but nothing as yet of positive value in the hands of the profession generally.
Ultraviolet Light
, or, as it is often named after its promoter, Finsen light, has proved of value in many cases of lupus, and in some cases of superficial epithelioma. Its effects, however, can scarcely be made to penetrate into the deeper tissues, and in its use it is even necessary to make pressure upon the part treated with quartz compressors, because ordinary glass shuts out a great proportion of these rays from whatever source may produce them, and because it is necessary to create a temporary anemia of the lesions, as the fluids of the body have the same effect as does glass. For these reasons the method, which is of but limited value, can be made serviceable in but a small proportion of cases.
X-ray Therapy.
—The Röntgen or cathode rays have played a large part during the last few years in the therapy of cancer. Such varying statements have been made concerning their value as to keep them still on trial and nothing very positive can be said regarding their efficacy. It may be said, however, that the nearer the malignant growth is to the surface of the body the more promptly can their effects be produced. The superficial growths, especially of the epitheliomatous variety, often yield readily to their use; the deeper the lesion the more vague the effect, both in character and permanence. It has been the writer’s experience that they furnish the best method of relieving pain, in a large number of these growths, short of the anodyne effects produced by powerful drugs, which are in every other respect undesirable. He holds that no one can predicate with certainty what may be their effect in any given instance, but that they are worthy a trial in every inoperable, painful, or otherwise hopeless case. Occasionally improvement follows their use, while in the next, apparently a similar case, one may be doomed to great disappointment. There are as yet no indications by which the cases which are most amenable can be easily recognized. Even in cases of extensive and disseminated abdominal cancer marvellous improvement may follow, but never a cure. It is indeed questionable whether deep cancer can ever be really cured by these means. As against their undoubted and unchallenged value in some instances, certain disadvantages are met in the difficulty of selecting a proper vacuum tube, the frequency and duration of exposure, the distance, etc. Dermatitis, sometimes mild, sometimes severe, has too often followed the injudicious use especially of a “high” tube, and more painful, irritable, or intractable ulcers are seldom seen than some following so-called “x-ray burns” of the skin. Moreover this is not the worst of these cases, for efforts intended for the best have been in repeated instances turned into a travesty by the development on surfaces thus burned of epithelioma, necessitating later mutilating operation. A well-known American surgeon suffered amputation of one hand and nearly all of the other as a penalty for inattention to the destructive effects of too prolonged exposure of his hands. It has, therefore, impressed itself upon the writer that the x-rays should not be indiscriminately employed. Nevertheless in skilled hands and used with great discretion they can be made a powerful instrument for good in many cases, especially for the relief of pain. They should never be regarded as a substitute for operation if operation be feasible, but they may often be employed to advantage after operating, in serious cases, where there is reason to fear recurrence.
The efficiency of the x-rays is apparently enhanced by the simultaneous administration of thyroid extract; although the explanation for this improvement is not known, it is, however, of enough importance to be borne in mind. The extract should be given in 5-grain doses three or four times a day. All the remarks above made may pertain as well to the employment of cathode rays in non-malignant affections, i. e., tuberculous lesions, neuralgia, etc.