The numerous modes of treating sarcoma or any other variety of cancer,
and the constant experimentation on the part of the profession with new
methods, only go to show how inadequate is our ability to meet this
intractable disease.
These neoplasms are not so rare, as there are ninety-nine authentically
recorded cases, situated within the restricted domain of the
naso-pharynx and pharynx.
For these reasons, and because I have been able to find only one case of
sarcoma treated with Coley’s fluid reported in our homeopathic
literature, do I take the liberty of occupying your time with the
_résumé_ of my investigations into the subject and my meager practical
experience.
Although surgery is, at present, the best method to meet this condition,
personally I believe that more investigation into or trials of the
remedial treatment should be made, because cancer is a constitutional
disease, and it so very frequently recurs after removal with the knife.
Apropos to this, C. Mansell Moullin says in the Boston _Medical
Journal_: “There is at least as much hope after an internal remedy that
causes disappearance by atrophy or fatty degeneration as from the most
extensive removal by operation. On _a priori_ grounds there may be even
more.”
Among the numerous drugs or substances which have been experimented with
are the interstitial injection of alcohol 40 per cent., by Haase; the
injection of Pure Yeast Ferment, by De Bracher; subcutaneous use of 50
per cent. solution of the fluid extract of chelidonium majus re-enforced
by same drug per orem; the cataphoric diffusion of mercury from gold
electrodes used by Massey; and lastly the mixed toxins of the
streptococcus erysipelas and bacillus prodigiosus.
From my research the last is the only one that has attained any success
or wide reputation and not been relegated to the usual oblivion of other
medical fads. The reason for this I consider to be because Dr. Coley has
not only been persevering, but scientific, unbiased, and very cautious
in its advocacy. At first he hoped and believed that in some form it
would be beneficial in all forms of cancer; but he now only recommends
it in sarcoma, and claims marked results only in the spindle-celled
variety of this.
As in many other cases, the discovery of the influence of erysipelas on
sarcomatous growths was by investigation founded upon accidental
occurrences, to wit: Busch reported a case of multiple sarcoma of the
face cured by an attack of facial erysipelas; Durante, a sarcoma of the
neck; Biedert, an enormous round-celled sarcoma, including the mouth,
nose, and pharynx; Bruns, a melanotic sarcoma of the breast; Gerster and
Bull, each a recurrent sarcoma of the neck; all cured or disappeared
with no return, after an erysipelatous attack. This happy result does
not always follow erysipelas, as cases of sarcoma relieved by
erysipelas, and later recurring or progressing after the attack is over,
are reported by Busch, Nelaton, Deleus, Richochon, Winslow, Powes, and
Dowd.
On account of these accidental cures a few observers produced erysipelas
artificially by infusion with the living culture, with success in many
cases.
Then almost simultaneously Lassar of Berlin, Spronck of Utrecht, and
Coley of New York, believing that the curative action of erysipelas lay
in the toxin of the living culture, experimented and found that they
could produce equally good results with toxin, thereby avoiding both the
danger and discomfort of the patient passing through an attack of
erysipelas.
It has been shown by different observers that the combination of certain
bacilli with disease toxins makes such toxins more potent, and Rogers of
Paris demonstrated that the combination of the bacillus prodigiosus with
the streptococcus of erysipelas greatly augmented the virulence of the
streptococcus on rabbits. Thereupon Dr. Coley used the combination on
the human subject in sarcoma with far better results than before.
Regarding this, Dr. Coley says he cannot say exactly what part the
bacillus prodigiosus plays in the cure of sarcoma, but remarks that the
only cases cured were treated by the combination.
This preparation, the combined toxins, had been given the name of
Coley’s fluid, and that used during the last seven years has been made
by Dr. B. H. Buxton of Loomis Laboratory.
Until about five years ago the toxins were made from cultures from a
fatal case of erysipelas, but since that, sufficient strength has been
obtained by passing the cultures through about fifty rabbits. The method
of the preparation is virtually this: the mixed unfiltered toxins of the
streptococcus of erysipelas and the bacillus prodigiosus are made from
cultures grown together in the same bouillon and sterilized by heating
to 58 degrees C. and then diluted in a sterilized menstruum.
In a recent conversation with Dr. Buxton he said that at present he made
a double sterilization and then added some drugs such as thymol to
preserve the preparation.
Dr. Coley, in his exhaustive article in the _Jour. Am. Med. Assoc._,
August 20 and 27, 1898, affixed a table of fifty-seven cases of
cancerous tumors treated with either his fluid or other preparation of
erysipelatous poison with cure, or at least disappearance of the then
present manifestation of the disease and lengthening of the usual period
of a recurrence of the condition.
The following is a list of cases of sarcoma of the nose and throat
treated by cultures of erysipelas, or Coley’s fluid, the physicians in
charge, and the time the patient is living after treatment at the time
of the report in Dr. Coley’s paper, in 1898:
(a) A spindle-celled sarcoma of the neck and tonsils, inoculated
culture—patient living six years after.
(b) A spindle-celled sarcoma of the parotid; it had been extirpated
twice previous to treatment—patient living one year after.
(c) A sarcoma (mixed celled) of the parotid—patient living three years
after. The foregoing under Dr. Coley’s care.
(d) A spindle-celled sarcoma of the palate and pharynx extending to the
vocal cords—Dr. W. B. Johnson—living four and three-quarter years.
(e) A round-celled sarcoma of antrum, pharynx, and neck—Dr. L. L.
McArthur—child aged five years, weight gained from 37 to 69
pounds—later, fatal recurrence.
(f) A round-celled sarcoma of parotid, size of the fist—Czerny of
Heidelberg—living over a year.
(g) A spindle-celled sarcoma of the parotid—Horace Packard—living two
and three-quarter years.
(h) A round-celled sarcoma of the neck—H. Montague—slight return in six
months.
(i) A recurrent sarcoma of the neck and tonsil—J. O. Roe—six months
after treatment died of erysipelas.
The mode of administration is cumulative. The injection is of course to
be made under the most thorough antiseptic principles attainable. It is
by far preferable to make the injection into the growth itself,
although, if this is impossible, it may be introduced into the nearest
accessible point, but in the latter case the dosage needs to be doubled.
As a rule one-half drop is the initial dose, and this is increased
one-half drop each succeeding day until toleration is reached. This is
evidenced by the natural reactionary fever rising to 102° or 103° F. In
such case the following dose should be the same as the preceding, and if
it should again go so high reduce the next dose one-half drop. The dose
is increased in this manner until the maximum is attained. When applied
to the neoplasm itself 8 drops is the full dose, or if elsewhere, double
that amount, 16 drops.
This last amount is to be continued daily until the tumor has
disappeared.
The toxin may commence to reduce the tumor in a week, but its
administration should not be abandoned in less than three weeks’ trial.
The time necessary to effect a cure is very variable; occasionally the
neoplasm will almost disappear in two weeks, while on the other hand it
may take several months.
The reactionary symptoms are a chill, followed by fever, generally
lasting about three hours, although occasionally it may continue twelve
hours; acute transitory swelling of tissues in the immediate vicinity of
injection; usually myalgic pains commencing at point of injection and
radiating frequently over the whole body; in the more severe reactions
there is nausea or even vomiting—in my own case it produced a weakening
menorrhagia.
CASE.—Mrs. E. C., æt. thirty-four years. A tall, thin woman of
neurotic temperament.
_Family History._—Father had chronic bronchitis, but died of kidney
disease. Mother was an invalid for seven years with rheumatism of
hip and knee until death, which was caused by apoplexy; a sister
died of gastric disease. The patient married eleven years; has two
children living; boy at nine months died of entero-colitis; boy
three and one-half years died of fall from window; two miscarriages.
At ten years æt. the patient had diphtheria; at twenty-six,
pleurisy; at thirty-one years, rheumatism of left shoulder and
post-cervical region. It is impossible to obtain any indication of
hereditary predisposition.
_Subjective Symptoms._—Complains of post-nasal dropping of mucus,
constant short hacking cough, malodorous breath, pain in region of
spleen; aggravated when lying down and throbbing in character when
walking rapidly. After discovering the swelling in the throat and
speaking of it she admitted there had been a sensation of a lump in
the throat for about a year, but so slight she considered it of
little consequence.
_Objective Symptoms._—Nares: Rhinitis sicca, covered with dry
crusts, but turbinated bodies hypertrophied.
Naso-pharynx and pharynx: Mucosa slightly hyperæmic, follicles
inflamed and enlarged. On the left side of these cavities is a
sessile swelling, the general surface of which is much inflamed, and
half of the surface is covered with varicose veins about one-eighth
of an inch in diameter; it extends more than half the width of the
pharynx and vertically from the vault above to the lateral sinuses
below; is neither painful nor hyperæsthetic; it has a boggy feel,
but not as soft as an abscess. The tumor springs from the posterior
wall of the pharynx, not connected with the tonsil, as the left
posterior pillar lies in front of the neoplasm and can be lifted
free from it. Neither of the tonsils is inflamed nor hypertrophied;
a few cervical lymphatics on the left side are slightly indurated,
but slightly sensitive—if at all.
The swelling had probably existed longer than an abscess would be in
forming, and there was neither pain nor fluctuation. Still an
exploratory incision was made, but with the expected negative
results.
Although the tumor was situated over the principal chain in
lymphatics of the pharynx, it was not nodular, but smooth. Therefore
the neoplasm was probably not of lymphatic origin, but an
implication of the muscular tissue behind the pharynx.
A specimen was submitted by Dr. Klotz, the pathologist of the
hospital, and the provisional diagnosis of angio-sarcoma
made—sarcoma because it seemed to spring from the muscular tissue
and apparent predominance of blood-vessels, and of the angiomatous
variety because of the enlarged blood vessels on the surface.
The removal of the specimen for microscopical examination caused
quite a severe hemorrhage, lasting about two hours, notwithstanding
the employment of the usual hemostatics.
The microscopist pronounced it a small round-celled sarcoma.
I showed the case to the Academy of Pathological Science, where two
general surgeons who examined the case advised against extirpation
of the tumor, because of its close proximity to the important blood
vessels and nerves of the neck, an opinion I entirely coincided
with, because of seeing two similar cases before. This agreement
decided me in determining to try the mixed toxins as the treatment
promising the best results for the patient.
April 4. Commenced injections with one-quarter of a drop. I
diminished the initial dose one-half because Dr. Coley personally
advised it, as he thought the possible reactionary local swelling
might seriously interfere with respiration.
April 14. The dose was increased one-quarter drop each day to
date—when she took only two drops, because it was deemed advisable
to omit treatment two days during menstruation on account of great
weakness of patient.
April 20. Increased dose half drop per diem—on 16th and 19th
treatment omitted on account of debility—dose 4 drops, which dose
was continued till April 23, when on account of the temperature
twice having risen to 103° F. and menorrhagia having supervened only
ten days after previous regular menstruation, I thought it prudent
to reduce dosage to 3½ drops, which was continued until April 26.
Examination of pharynx to-day for first time showed a decided
diminution in the congested appearance and size of the tumor.
Formerly the tumor pushed the posterior pillar forward, so that, if
the pillar could not have been lifted away from swelling by the ring
probe, it would have seemed to be part of it; while to-day a small
space could be distinguished between the tumor and the pillar.
Dosage 4 drops.
In _résumé_, I would call attention to the apparent susceptibility of
the patient to the toxin. Because, although she never received over half
the maximum dose, the following reactionary symptoms developed: Of the
seventeen days on which full records were kept, on thirteen she had
chills after every dose; there were muscular pains throughout the left
side, occasionally extending to the right—one-third of the time the
patient was nauseated, and three times vomited—the average temperature
was 100.8° F.; twice it did not rise at all after injections of ½ or 2½
drops. ’Tis well to bear in mind that chills very seldom occur after the
third injection.
Finally, I wish to thank Dr. Clausen, resident physician, who carried
out most of the treatment while the patient was at the Ophthalmic
Hospital; also Dr. Bernard Clausen, who continued it after she returned
home.