With the removal by knife, many surgeons also consider the question of removing tumors of the breast by caustic pastes. The chloride of zinc, arsenic and Landolf's paste are the most popular comparatively, and are still used in various places in different forms (in France as caustic arrows, Maissoneuve). When these pastes are applied to non-ulcerated healthy skin over the tumor they cause very great pain. The application of caus tic pastes to ulcerated tumors of the breast is sometimes followed by good results, if they act deeply enough; if such be not the case, they should be re-applied. The uncertainty of the procedure has mostly deterred me from using it, and I have therefore had very little experience with it. As regards the treatment of carcinoma, which cannot be extirpated, the ichorous discharge from the ulcer and the pains, as well as the marasmus, are the best indicators. Antiseptic dressings, such as a solution of chlo ride of lime, permanganate of potassium, creosote water, charcoal, coal tar, and carbolic acid may be tried, and caustics may be applied locally for the destruction of the cancerous mass.
Among the popular remedies against cancer, which have descended from the Middle Ages, pastes of carrots, of figs with milk, yeast, gastric juice of owls (formerly not infrequently used in Italy), played a great part. None of them have caustic or destructive properties, nor do they promote absorption. On one occasion I allowed an incurable patient, with a discharging, fearfully smelling cancerous ulcer of the breast, on which I had vainly used all disinfectants, to use dried figs cooked in milk. Contrary to my expectation, the odor, which had filled the whole house, and was mixed with that of chlorine and carbolic acid in the most disgust ing way, ceased; and, in place of it, there was a faint odor of lactic acid, given off from a process of lactic fermentation, which had been estab lished. With two such dressings daily, the bad smell was entirely mas tered; the deodorizing and antiseptic action was excellent. Artificial gastric juice, repeatedly applied to the ulcer, did not act as well; it proba bly digested the necrotic tissue, though the deodorizing effect was not as good.
After Thiersch had practised the parenchymatous injection of solution of nitrate of silver, experiments were made at my clinic with parenchy matous injection of tincture of iodine. Fowler's solution, solutions of chloride of gold, albuminate of mercury, chromic acid, carbolic acid, etc.. in carcinoma of the breast. The results were so absolutely negative, that in not a single case, would a report of the methods have been worth the trouble. Nor can I report anything favorably of electro-puncture (re peatedly tried in my clinic for hours at a time). The continuous use of an ice-bag will not only check the growth of the carcinoma, but will sometimes reduce its size. In doubtful cases I have confined myself to a partial. operation, in case the discharging ulcer was sufficiently localized and could be excised. At all events, a simple granulating wound is com bined with fewer discomforts than an ichorous ulcer. In the periods of incurability, I pay no attention to the wishes of the patients or their friends for all sorts of cures with wonderful means. I have never seen any effects from them. But I do not mean to say that it is impos sible to find remedies which may cause the disappearance and cure of tumors generally, and of carcinomas especially; and it is entirely right to seek for and use such remedies methodically. Still, until such remedies are found, we must remain true to the repeatedly expressed axioms as to operative treatment; we now know, more certainly than formerly, that radical cure, even of cancer of th6 breast, can be attained by early opera tion; it is our duty, above all things, to follow this way energetically; un fortunately there is no lack of carcinomatous patients, who seek for in. ternal cures, of whom it may be confidently asserted that they are no longer curable by operation. For easing the fearful pains towards the end of life, we use anodynes. There is scarcely any sense in giving rob orants to such patients, or in tormenting them with food. We let them sleep, sleep, sleep 1 For these unhappy people, subcutaneous injections of morphia are the only and best means of relief.