Arsenic is still used internally by a few men, Sherwell, in particular, advocating it, and even Pusey seeming to think that it may have a slight inhibitive action. It is used either in the form of Fowler's solution or as Donovan's solution, the maximum dose usually being employed. There is no doubt of the value of this form of treatment in sarcoid and in the border line cases between sarcoid and sarcoma, but there is very little evidence that it is of any value in true cancer of the skin, other than acting as a general tonic.
The internal use of methylene blue has been advocated by no less an authority than Jacobi* in internal cancer, that author believing that, while it will not cure the disease, it will at least hold it in check for some time. So far as the. author knows, the internal administration of this drug has never been shown to have the slightest effect upon cutaneous cancer.
*Dade: Trans. 6th Inter. Dermat. Con., 1907, ii, 672.
Whitehouse: Jour. Amer. Med. Assn., 1907, xlix, 371. 80 Pusey: Jour. Amer. Med. Assn., 1907, xlix, 1354. Jour. Cutan. Dis., 1909, xxvii, 32. Jour. Cutan. Dis., 1910, xxviii, 352. Low: Carbonic-acid Snow, New York, 1911. "Jacobi: Jour. Amer. Med. Assn., 1906, xlvii, 1545.
Within a short time preparations of colloidal copper have been injected into cancer patients. Loeb, Mc-Clurg, and Sweek* state that they "are now able to cause the gradual retrogression of human cancer, which until now has withstood various modes of treatment; and, furthermore, that the treatment does not seem to be limited to one kind of cancer, but applicable in the effective treatment of various kinds of cancer." Weil* has published a paper on the use of this method from the Cancer Research Service of the Cornell University Medical School, in which he details his experiments with and his clinical use of this method, and decides that this form of treatment is probably without value. Weil finds that the injections are not well borne, that they are followed by chills and rigors, and that nausea and vomiting are very common. In addition to these symptoms, there is usually a progressive anemia. Locally, there may result either phlebitis or periphlebitis.
The various attempts to produce either an active or a passive immunization against cancer is an extremely interesting one, but so far the results have been so contradictory that it would probably be a waste of time to attempt a description of even a few of them. The literature is voluminous, but speedily becomes obsolete.
A. E. Thayer,* of Mobile, has recently written a very interesting paper on epitheliolysis against cancer. He has worked on the assumption, now well grounded, that the injection of cells from one animal into the body of another would make the serum of the recipient animal lytic for such cells, and this was a specific reaction. In addition, the carcinoma cells are less resistant than normal epithelial cells; hence, if the lytic power of the serum could be raised, the cancer cells would be the first destroyed. In one case of inoperable cancer of the uterus, washed autolyosates of cancer were injected with apparently beneficial results. More confirmation is necessary before we can be sure of our ground.
At the Freedmen's Hospital we have tried to produce active immunization against epithelial cancer in a few cases. This was done by making an extract of a cancer of a similar histological origin, splitting it into toxic and non-toxic parts as suggested by Vaughan, and using injections of the non-toxic part once a week. The results were negative, although one patient did state that the injections were distinctly stimulating.
*Loeb, McClurg, and Sweek: Interstate Med. Jour., 1912, xix, 1015. aWeil: Jour. Amer. Med. Assn., 1913, lxi, 1034. 24 Thayer: South. Med. Jour., 1913. vi. K3*.
Many attempts have been made to induce passive immunization by the injection of an immune serum. As Berkeley and Beebe* point out, this theoretically is an ideal treatment for cancer, for it is soluble in the blood, transmissible by the blood and lymph to all portions of the body, and should possess a selective affinity for the cancer cells. So far the very best results obtained with any of the methods proposed are simply mildly encouraging-no more.
In certain cases, either because of the advanced age of the patient, because of the extent of skin involvement or of the presence of a severe secondary infection, because of some other organic disease, or because of the presence of cancerous metastases, general supportative treatment becomes necessary. In certain of these cases it is questionable whether it would not be better to do a palliative operation, if only for the moral effect. But in these instances the patient, and not the disease, must be studied, and each victim furnishes a radically different problem, and one that must be solved according to the conscience and experience of the physician in charge, he usually being better able to determine in such a case than the consulting surgeon; this because of his supposedly better knowledge of the patient.
Supportative treatment, in general, consists of fresh air, good food, and the proper amount of rest or amusement, as the case may be. It is always essential to have an air of good cheer around such a patient, and a good nurse can sometimes accomplish wonders.
So far as medicines go, about all that one can do is to employ simple tonics, or analgesics if necessary. Concerning analgesics, the author can see no good reason for withholding morphine from a patient who has an inoperable cancer; to him it seems needless cruelty. Of course, pain can often be relieved by dividing a nerve that is being pressed upon, or by some simple operation, but this is not always possible. As a general rule, it is probably advisable to start in with a combination of codeine, phenacetine, and aspirin, and not use morphine until absolutely necessary, for fear of it losing some of its effect when it has to be administered over a long space of time. It must likewise be remembered that either the x-ray or radium may greatly relieve pain, even though they do not cure the tumor. Dressing the new growth with charcoal, or with some mild antiseptic agent, may be a great comfort. An ointment composed of one dram of orthoform to an ounce of any fatty base will frequently relieve pain from exposed nerve endings.
*Berkeley and Beebe: Med. Record, 1912, lxxxi, 513.