CANCER.
There is no treatment for this disease save earliest possible removal of the tumour by surgical methods. It must not be denied that very occasionally a success can be attributed to X-ray or radium treatment, nevertheless these two popular agents seem to be finding their true place as adjuvants to surgical treatment either immediately before, at the con clusion of an operation, or for many weeks or months after healing of the surgical wound, with the view of destroying any stray cancer cells which have escaped the knife. Much contention still exists as to the. relative merits of radium and X rays, which can only be settled by future observation, but the increasing penetrating power of hard X rays by improved methods of application seems to be turning the scale against radium.
In inoperable cases there cannot be a doubt that relief to pain, ameliora tion of all the symptoms, and even retardation of the progress of the growth, arc frequently observed, and most authorities report cases where the use of these agents have after a few weeks brought inoperable ex amples of the disease within the zone of the operable. (It may be here remarked that splendid results have been obtained by X rays in inoperable sarcomatous tumours of the round-celled type.) Superficial cutaneous cancers, especially rodent ulcers, have been successfully cured by a few massive doses of the X rays and radium ; unfortunately the best results obtainable in epitheliomata are in those cases which also can be most successfully treated by the knife.
High-frequency currents have been employed by the method known as Fulguration. Its best results have been obtained in those cases where the surgeon has been unable to remove the entire growth by the knife or curette, in which case excellent effects have followed by drawing from the exposed raw surface numerous sparks by the use of a powerful high frequency apparatus. This treatment destroys the superficial cancer cells and acts as a painless escharotic, but any specific selective action over the diseased cells is denied, though the method has given curative results in such cases as cancer of the tongue and bladder and superficial inoperable carcinoma of the breast. Coley's Fluid has proved useless in cancerous
tumours, but its curative action in many cases of a purely sarcomatous nature must be regarded as proven. Trypsin, Pepsin and Papain have been tried as injections into the tumour or its immediate neighbourhood with the view of causing digestion or disintegration of the cancer cells, but the method has proved a failure, and the same may be safely said of injections of antiseptics and every attempt at serum therapy.
A survey of all recent experience conclusively proves that early opera tion, affords the best means of treating cancer. Not only the growth itself, but the widest possible extent of surrounding tissue with all the neigh bouring lymphatic glands and vessels must be removed, and the greatest care taken that no cancer cells are implanted in the wound. This latter result may be effected by avoidance of cutting into the diseased mass during operation, and by flushing the wound with unirritating antiseptics, or better still by exposure of the raw surface to the X rays before suturing and the systematic exposure for short periods of the site of thoperation to their influence after healing has been accomplished.
The method of removing epitheliomatous growths by Caustics (Lime, Arsenic, and Zinc Chloride) has but one plea in its favour—viz., the fact that many patients consent to this form of operation without hesitation or delay who would otherwise postpone operations of a cutting nature till too late. If the X rays be skilfully employed after the separation of the slough it is possible that better results may he obtained than by the use of the knife in some cases.