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.
_Case I._—Miss T. M. M., aged 37, consulted me on March 23rd of this
year, for a mass in the left breast which a surgeon of great eminence
had diagnosed as cancer, and urged most strenuously an immediate
operation, and from its rapid development had said that she would die
within six months if not operated on. She had had a neurasthenic
breakdown the preceding autumn, and for some months had now been under a
very great nervous strain, with a father aged 71, who was slowly dying
of Bright’s disease. Two years ago she had suffered severely from
uricacidemia, for which she had dieted six months.
The mass in the left breast was noticed only a month or two previous to
her visit and had increased rapidly; when seen there was a hard,
lobulated mass about two inches in diameter, in the outer, upper
quadrant of the left breast, attached to the puckered skin over an area
of more than an inch; there were also a number of enlarged, hard
axillary glands. There was considerable pain at times, which had been
increased considerably by the rather rough handling of the surgeon.
She was placed on an absolutely vegetarian diet, following what I call
the green card menu, which I gave you in my last lecture, and a mixture
of acetate of potassium, nux vomica, fluid extract of cascara and fluid
extract of rumex root, which I also mentioned to you at that time.
For eight months she has been under my constant observation every week
or two, and the improvement in her general condition and in the breast
tumor is very marked; you heard her say that she felt a thousand per
cent better. Her color is excellent, she has held her weight, 153
pounds, which is a trifle above that called for by her height and age,
and all this in spite of daily office work and very great trouble and
anxiety in nursing her sick father for thirteen weeks, who died in
October.
The breast, as you see, has still a lump in it, but it is soft and
hardly half the original size, the area where the skin was attached has
decreased, so that there is now only this slight dimpling or puckering,
and the enlarged lymphatic glands in the axilla have disappeared.
It is impossible in a brief lecture to enter upon all the details of
treatment followed out during these eight months, for they have been
varied according to the principles laid down in these and the previous
lectures. The former habitual constipation has been overcome and the
urine, which exhibited a great shortage of solid constituents, with
occasional indican, etc., has attained more nearly a normal character,
and in various ways she has regained better metabolism. To accomplish
all this there have been many remedies used from time to time to meet
various indications, as are shown by my voluminous notes every week or
two. I may add that the affected breast and axilla have been kept
painted with ichthyol, 50 per cent solution in water, which for some
years I have found to aid in the absorption of malignant lesions. The
patient is not well, by any means, and it will be some months before the
mass in the breast has entirely disappeared; but instead of being dead
within the six months, as prophesied, she is as healthy, happy, and
hearty a woman as one could wish, after eight months, under very adverse
circumstances, without pain, not having lost a day from work, and with
the tumor steadily diminishing.
I am often asked if the cure is permanent after this line of treatment?
In answer I can only refer to the cases reported in my former lectures,
where two were observed well after sixteen years and two after eleven
years. I may add also that if there is recurrence, and if the principles
which I have long advocated are correct, the recurrence would be due to
the same causes which produced the original trouble, possibly a neglect
of full treatment, and one would expect that a perfect following out of
proper treatment would again check the trouble, which is more than can
be said of surgery. Personally I have never seen recurrences, though, of
course, this may have happened and the patient being discouraged may
have yielded to the solicitation of friends and to the knife.
_Case II._—Mrs. J. J. T., aged 38, was first seen August 11, 1914. She
had been confined with her first child 4 months previously, but had not
nursed the baby at all, and had no trouble with the breasts. Four weeks
before her visit she had noticed a tumor in the upper left segment of
the left breast, which had increased steadily, with considerable pain.
When seen there was a mass the size of an egg, hard, and well defined,
somewhat tender on manipulation, with some glandular enlargement in the
axilla. She was placed on an absolutely vegetarian diet, with no coffee,
and the same mixture as the preceding case, the bowels being
constipated, and the breast was kept painted with the 50 per cent
ichthyol, which was afterwards changed to iodid of lead in Hebra’s
Diachylon Ointment. Later she took thyroid extract, also iron, etc., and
maintained her weight and strength perfectly. The mass in the breast
disappeared rather slowly, and it was not until just a year later that I
find it recorded that the breast was perfectly normal, with no trace of
the tumor, nor axillary adenopathy. She was again confined of a healthy
child in June, 1916, and the surgeon who had made the original diagnosis
of cancer reported the breast perfectly normal. Seen recently she still
remains absolutely free from trouble.
_Case III._—Mrs. I. T. G., aged 43, first noticed a lump in the left
breast two weeks before her first visit, May 17, 1905; this had been
diagnosed as cancer by at least four medical men, one of them a
prominent surgeon in Hartford, who urged immediate operation. When seen
there was a hard, sharply defined mass an inch and a half in diameter in
the left breast, above the nipple; it gave pain and was painful on
pressure. Beginning with the same treatment as the other cases mentioned
the change in the tumor was most remarkable, and eight weeks later it
was recorded that there was no trace of the tumor, that both breasts
were alike. She was a large, flabby woman, weighing 207½ pounds, the
kind who do so badly after operation. She maintained her treatment
faithfully, with an absolute vegetarian diet, and when seen two years
later weighed still 199 pounds, with no return of the breast trouble.
She was seen last for quite another trouble five years and a half after
her first visit, and the breast was found perfectly normal.
There is no necessity of illustrating this part of our subject further,
but I wish to make a remark about this last case, especially in
reference to the desirability of early treatment. We hear much from the
advocates of the knife that it should be used early, and yet we all meet
cases where lumps are removed from the breast almost as soon as they are
discovered and yet there is recurrence. Early dietary and medical
treatment, in this instance two weeks after discovery of the lump, was
observed to be followed by perfect freedom for five and a half years,
and beyond question permanently, if she continues to live along proper
lines.
Having now seen how very much can be accomplished in primary cases, that
is, in those who have not been submitted to an operation, let us
consider what can be done for those truly pitiful cases where surgery
has been tried and failed, and where one or many successive recurrences
after repeated operations has left the patient even worse than before;
and, as some surgeons tell us, worse than the patient would have been if
the disease had been left to nature, without operation and with only
ordinary medical guidance.
In regard to the cases with recurrent cancer after operation of which
there were 72, it can be readily understood that one cannot speak with
enthusiasm. But in my former lectures I reported three such cases in
which the benefits were certainly very remarkable. I also reported from
private practise another totally inoperable cancer of the breast, of two
years’ previous duration, with great cachexia, in which the enormous,
hard, ulcerating breast was reduced to about half the extent, with a
diminution in the large axillary and supraclavicular glands to fully one
half their size. The patient suffered no pain from soon after beginning
treatment until she peacefully died six months later, of exhaustion and
pulmonary edema.
In many cases, both in private and hospital practise, the beneficial
effect of a dietary and medical treatment have been very striking, even
after recurrences following repeated surgical operations; but it would
be unreasonable to expect any startling effects in cases which had
become so saturated with the poisonous hormone generated by repeated new
developments of cancerous tissue that there were numerous metastases,
not only in internal organs and lymphatic glands, but also with
cutaneous nodules produced in various parts of the skin through
capillary infection.
And yet in most of these cases there has been a betterment of condition
in nutrition, color, weight, etc., which sometimes seems to encourage
one that the real disease would be conquered. But although life has
frequently been prolonged far beyond what might be expected, and
discomfort and distress have often been greatly lessened, we have not
yet reached the position of checking and curing far advanced cancer at
all comparable with what can be accomplished in its early stages. I
dislike to weary you with the narration of cases, but a few instances
may help you to understand what is meant.
_Case IV._—Mrs. D. S., aged 53, first seen July 6, 1916, is a rather
recent case of recurrent cancer of the left breast, in private practise,
but it is instructive. Over five years ago a small pimple, as she called
it, appeared on the left side, which was left alone for five years. Then
on January 21, 1914, the left breast was removed by a surgeon of
prominence, and all seemed well for six months, when there was some
return and a second operation was performed in January, 1915; there was
again a third removal in April, and a fourth in August, 1915, all by the
same excellent surgeon, and the wound has never healed since. There had
never been any attempt at dietary or medical treatment or any effort to
check the causes producing the malignant growth.
Since January, 1916, there have been many cutaneous nodules developing
around the open sore, which when first seen presented a characteristic
ulceration eight inches long, by two or three inches irregularly wide.
The axillary glands were enlarged and the left arm, which had been
greatly swollen since the first operation, was hard, tense, and painful,
and, of course, helpless. The forearm measured 13 inches and the upper
arm 14 inches, the right arm being 8½ and 9½ inches, respectively. Her
weight, which had been 168 three years ago, was reduced to 133; she was
always very constipated and her urine deficient and irritating, calling
her also at night; she had long suffered from rheumatism, and also
severe headaches up to the menopause, seven years ago.
Under a rigid “green card diet” and the mixture already referred to,
with a larger amount of cascara, she began to improve at once in her
feelings, the arm became softer, and somewhat flabby, and the nodules,
which had been painted with 50 per cent ichthyol, were less prominent.
Later thyroid extract being added after meals, brought her weight down a
little, but during the last months it had been maintained steadily at
about 120 pounds. The urine which at the first was sometimes only 26
ounces in the 24 hours, with great deficiency in solids, has been
brought up some days to 45 ounces, with the proportion of solids to the
body weight about right. The saliva, which was very acid, is much less
so, though still acid and scanty, and the mouth dry.
Not to dwell too long on the case I may say that I find a recent note to
the effect that she said that she feels very well and friends think that
“there cannot be much the matter with me.” But she still has a
considerable ulcerating surface, though with islands of healing; she
still has many metastatic nodules in the skin in various places, and the
arm, which is still swollen, though no longer tense, is smaller, and,
really, the flesh shakes when the arm is quickly moved.
This is certainly a desperate case, after four operations, but the
difference between her present condition and what she would have been
without treatment can hardly be imagined. For in these five months she
probably would have been in her grave, whereas, during all this time she
has been traveling back and forth from her home, some distance away in
New Jersey, to my office, a happy woman. What the end will be I cannot
foretell.
I want you now to see and examine a Bohemian woman who has been treated
in my medical clinic for cancer at the hospital since July 26, 1916,
something over four months.
_Case V._—Mrs. P. A., aged 46, noticed a lump in the left breast two
weeks before it was removed, in this Hospital, two years previous to her
first visit to me at the medical clinic for cancer in the hospital.
Three months later the right breast was also removed on account of a
lump found there. All seemed to go well until about a year ago, when
cutaneous nodules appeared on the chest, first around the site of the
former operations; these increased till seen, when, as she now tells
you, there were fully fifty of them, forming a veritable _cancer en
cuirasse_, absolutely inoperable, of course. She was habitually
constipated, depending on medicine.
Being placed on the “green card” diet and the same mixture, though with
considerable cascara in it, and all the affected area painted night and
morning with Thiol in olive oil, fifty per cent, she seemed to improve
at once, and it was recorded that, after removing a crust which had
formed with the thiol and talcum powder over it, all the nodules were
less red and much less elevated. A small raw surface had formed, which
was touched with thorium paste, diluted to 25 per cent. This surface was
found entirely healed two weeks later, but other larger raw surfaces
have formed from time to time, which, however, have all healed
completely and perfectly, as you can see, with the occasional use of the
diluted thorium paste.
As you see her now the entire surface over both sides of the chest is
perfectly healed, and passing my hand over all the surface there is
hardly a trace of the nodules which once were so abundant. All who know
anything about the ravages of cancer will realize the difference between
her present condition and what would have happened under ordinary
circumstances. She has had no pain since soon after beginning treatment.
I could multiply these histories indefinitely, with, of course, varying
degrees of benefit, but I will trouble you with only one more case, that
of one of the many patients in the wards of the hospital. In this case
there were at first very satisfactory results, but after a long and
brave fight on the part of the patient she at length succumbed to the
dire disease.
_Case VI._—Miss J. M., aged 53, was admitted to the New York Skin and
Cancer Hospital, July 16, 1914. One year before there was an enlargement
of the right breast, with a general hardness. Later it became discolored
and a blue ring appeared around the whole breast, and some purulent
discharge from the nipple. Three months before entering the hospital the
breast softened in one place and ruptured, discharging pus and blood.
There had been some pain from the beginning, and latterly it was more
constant and severe. On admission the tumor involved the whole breast,
which was hard and immovable, with an ulcerating surface over almost the
whole extent, with an offensive discharge, and axillary glandular
enlargement. There were also small cutaneous nodules near the sternum.
She was transferred as inoperable from the surgical to my service on
August 26, 1914; she weighed then 106½ pounds, and presented a great
fungous mass on the right side about six inches in either diameter, with
a profuse and very offensive discharge; she was very weak, with a septic
temperature running up to 101 and over, and complained greatly of pain
in the tumor. She had been having X-ray once a week, which was continued
for a while twice a week, for twenty-four exposures, but without
apparent effect. She was very constipated and passed a small amount of
urine.
She was placed at once on a vegetarian diet (green card) and the same
mixture as the other patients, for a while, and a little later was given
dialyzed iron during the meals; the wound was dressed with a one per
cent solution of permanganate of potassium, later with Russian oil, with
some use of peroxid of hydrogen to check the suppuration.
For a while she seemed to do remarkably well, the color and strength
improving, with less pain and very comfortable nights, without an
hypnotic. In a week her weight had increased to 110¾ pounds, but then it
fell off a while, but on October 28th it had risen to 111¼ pounds. As
there was still a great mass of fungating tissue, helping to keep up the
toxic condition, quite a portion of it was excised on September 29th,
just after which the hemoglobin rose from 75 to 80 per cent, which was
maintained for six weeks, the red blood corpuscles increased to
3,490,000 and the leukocytes diminished to 8,500 from 10,000 when she
first came under my care.
The general condition had improved so greatly that she was out of bed
all day, but the body weight dropped quite a little, to 104½ pounds,
only to rise again four weeks later to 111¼ pounds. By October 10th the
wound was secreting very little, she slept well with no opiate, and
complained little of pain, day or night, and by October 28th it seemed
as though the disease was being overcome, as there was some evidence of
cicatrization in certain portions of the wound. All this continued for a
month or more, when she had a number of severe hemorrhages from the
wound and the hemoglobin fell to 60 per cent and the red corpuscles to
2,100,000. From this, however, she rallied under an intravenous saline
injection and Murphy drip, and the hemoglobin rose to 75 per cent, and
on May 21st the red corpuscles were actually 4,110,000.
I must not weary you with too many of these details, nor can I indicate
to you the varied treatment which was employed from time to time. I can
only add that she had her ups and downs, but finally succumbed on July
3rd, 1915, about a year after entering the hospital.