Two years have elapsed since I said to you in the last lecture of the former course, “The test of everything lies in the results obtained. Theories, discussions and arguments are all unavailing unless results show their truth.” I can now repeat the same phrases after two years’ further observation and experience. And I can also speak much more strongly than I did at that time, not only after testing the matters then presented further, in private and hospital practise, but also after an amount of study of literature which I should hardly have thought possible some years ago.

First I want to recall to you the report of the interesting and remarkable case which was made at our last lecture by Dr. C., one of your number, who promised that if possible the patient would be presented at a later lecture. This was in the person of a lady, now about fifty, seen nearly ten years ago, who presented a great mass of disease in the lower abdomen. On consultation it was decided to attempt an operation, which was performed by Dr. ——, a well known surgeon. On opening the abdomen there was found an amount of malignant tissue, involving many organs to such a degree that it was decided that no removal was possible, and the wound was closed, after securing a section for microscopic study. This was examined by Dr. H., a well known pathologist, and found to be sarcoma.

About that time, nine or ten years ago, I had briefly spoken in one of my lectures about the value of an absolutely vegetarian diet and medical treatment in cancer, and Dr. C., thinking, as he told us, that it might possibly be of advantage to her, in prolonging life or perhaps making it more comfortable, placed her upon it. He has followed the case up to the present time, and stated to us that there was now no evidence of the disease, the abdomen being normal under every examination possible. Surely one such case should be sufficient to direct serious attention to a plan of treatment capable of securing such a result in a patient who is now living in comfort, nine years and more after the surgical removal of the tumor was found to be impossible, and who would otherwise have been dead long ago.

In my former lectures I detailed eight cases of undoubted breast cancer, verified by surgeons, some of them well known, in which the results obtained by the methods I have been presenting were most gratifying, and I need but refer you to the account of them given in my book in which the lectures were published.

You will perhaps remember that the first two cases had been followed up for sixteen years and had remained well, without operation; the next two cases, curiously enough, had each been observed for over nine years, and as they are still under my medical care for various complaints I can add two years more, making over eleven years that they have remained well, without operation.

In those lectures I stated that I had recorded on my books in private practise a total of 744 patients with Epithelioma, Carcinoma, and Sarcoma. I now find recorded in private and hospital practise a total of 196 cases of carcinoma, 36 of sarcoma, and 685 of epithelioma, a total of 917 cases of malignant disease. There are also records of some dozens of cases of adenoma, cysts and chronic mastitis, etc., of the breast, besides fibroma, lipoma, angioma, papilloma, etc., generally benign in character, in various locations, all of which are, of course, excluded from our study.

Epithelioma.—Although epithelioma of the skin is included with cancer in the Mortality Tables of the United States and elsewhere, I do not purpose to admit it in connection with the results of treatment of cancer, for several reasons. First, Because cutaneous epithelioma occasions but a very small proportion of the deaths from cancer, something over three per cent. Second, Because its cause and treatment are almost entirely local, and so it does not relate greatly to our general inquiry as to the internal or constitutional cause and treatment of real cancer. Third, Because dietary and medicinal treatment seem to have relatively little, if any, effect on cutaneous epithelioma, except in the later stages, where the disease has caused great ravages, and lastly, Because if the proper treatment of cutaneous epithelioma is begun early and carried out faithfully it need never, or exceedingly seldom, acquire a severity such as is often depicted by overzealous surgeons who advocate only the knife.

In regard to epithelioma on the skin and also on the tongue, lip, and oral cavity, however, I want to give you one word of caution, and that is in regard to the use of nitrate of silver. I have seen so many epitheliomatous lesions in these regions which have been goaded on to a severe degree of ulceration by the injudicious and meddlesome “touching up” of the same with nitrate of silver, that I would make it an axiom to never use this superficial caustic at any time in connection with anything which may possibly be epithelioma. I would almost consider it criminal to do so. On another occasion I may take up the subject of epithelioma very fully, but already I have shown you many interesting cases, demonstrating how it can be cured by intelligent and faithful treatment without surgical operation. Some of you may recall the enormous ulcerating epithelioma on the left ear of a man of about fifty, who showed himself repeatedly after the disease had been entirely cured by the thorium paste, which you have often seen me use. You may remember that the upper portion of the pinna was gone, but presented a thin, delicate cicatricial surface, freely movable; the last time he was here was fully two years after it had been entirely well.

It is not worth while to attempt to analyze here the 685 cases of 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:

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.

The case was a very interesting one and exhibited certainly some of the beneficial results of treatment, although in such a hopeless case, with such a mass of ulcerating cancerous tissue as she presented, secreting its poisonous hormone, any other end could hardly be expected. There is no question, however, but that life was greatly prolonged and much comfort secured, as to sleep, diminution of pain and offensive discharge, etc. The case was watched with interest by members of the attending staff, and careful laboratory studies of the blood and volumetrical analyses of the urine were made weekly; the latter was generally scanty, running even as low as nine ounces a day, though of a fair specific gravity, and it was very difficult to raise the total solid urinary output to anywhere near a normal standard. The saliva, tested and recorded before and after each meal, was commonly acid, often strongly so, though at periods it would be neutral and occasionally became alkaline for a while under active treatment.

I have taken up so much of your time with cancer of the breast that little is left for consideration of the disease in other localities, and I will be as brief as possible:

Cancer of the Uterus.—Two cases, in private practise, among the eight of cancer in this location which are on my list, are so interesting and remarkable that I must give them somewhat in full. I may say that the other cases had little or no satisfactory treatment. One of these two would gladly present herself for your inspection, that you might verify her present condition of excellent health, but she lives in Bangor, Maine, and now only comes on periodically; this is in order to be sure that she continues in the straight and narrow road necessary to keep her free from her previous distressing condition. The case is as follows:

Case VII.—Mrs. F. L. A., aged 48, weighing 105 pounds, was first seen on March 21st, 1916. She had had four children aged 22, 20, 17, and 12 years, and had had a miscarriage 9 years ago. There had never been any trouble with confinements, and never laceration of the cervix. The menopause had occurred suddenly two years previously, but she had had some vaginal discharge since October, and had felt weak for some months. She had, however, never suspected any serious trouble until there was a slight hemorrhage, consisting of only a few drops of bright blood, on February 24th. That afternoon she was examined by a surgeon at home, Dr. McCann, of Bangor, Maine, who sent her to me. He discovered that she had already an inoperable cancer of great extent, which diagnosis was confirmed by others, who refused to operate. The report which came to me from the department of Pathology and Bacteriology of Bowdoin College was, “About one third of the cervix destroyed, vaginal wall involved. Right broad ligament infiltrated.” Curettings were made then, which from “numerous slides show squamous cell carcinoma. From histological appearance I judge that the cancerous process is developing rapidly,” signed F. N. Whittier. The slides which were brought to me were submitted to Dr. H. H. Janeway, who confirmed them to be “rapidly growing, malignant epithelioma.” Those who saw the patient on February 24th gave the opinion that she would hardly live six months.

She had been following an absolutely vegetarian (green card) diet for a week or two, and had been taking some compound cascarin tablets, which I had sent her (℞ Podophyllin, Aloin, Cascarin, āā gr. ¼), as she had always been very constipated, and since this treatment had felt much better in every way. I gave her douches morning and night, of carbolic acid and biborate of soda, ℨss and ℨii ad Oi hot water.

I then sent her to Dr. H. H. Janeway, who confirmed the physical condition and gave her one single treatment with emanations of 300 milligrams of radium, for 16 hours, on March 25th, dilating the os, but not curetting. She was then given ℞ Potass. acetatis ℥i, Tinct. Nuc. Vom. ℨiv, Extr. Cascara fld. ℨii, Ext. Rumicis rad. fl. ad ℥iv, Teaspoonful in water half an hour before eating, which she has taken more or less continuously ever since, alternated with other remedies as indications arose. Later she took pyrophosphate of iron, five grains after meals, in conjunction with the mixture. For some time she had suffered from severe neuritis in the neck and arm, which yielded completely to aspirin, five grains every two hours, taken also again on several occasions when it recurred.

I will not burden you with the many details recorded on her case paper, but can only say that to-day she is as well a woman in every way as one could wish. Her color is good, and a recent examination of her blood showed hemoglobin 80 per cent, red blood cells 4,500,000, leukocytes 5,800, of which polynuclears 64 per cent, lymphocytes 27 per cent, transitionals 8 per cent, and eosinophiles 1 per cent. She has made the trip back and forth from Bangor, Maine, half a dozen or more times, without fatigue, recently walked several miles, eats and sleeps well, is no longer constipated, and has a good urinary excretion, with rather an excess of solid contents; on December 6th she weighed 110½ pounds; her normal weight before her sickness had always been 93 pounds.

On June 2nd she was examined by Dr. Janeway, who reported: “I find no ulceration whatever on the cervix or vagina, the uterus is movable and of normal size. There are no evidences of any disease remaining which can be detected by examination.” On July 7th he wrote: “I have examined Mrs. F. L. A. again and find that there has been no return of the evidences of her disease.” On October 20th he wrote: “Mrs. F. L. A. appears to be absolutely free from disease.” Her surgeon, Dr. McC., confirmed all this by examination. It is now over 9 months since she was given 6 months to live, with an inoperable uterine cancer, and to-day is in better health than she has been for years.

This patient had one single application of radium, as mentioned, on March 25th, which probably aided in modifying the local disease, but it would be beyond human credulity to believe that this was a very large factor in restoring her to her present condition of health. The cure is, of course, a very recent one, but there is no reason why the same measures would not be effective should there be any return, as they are directed against the real cause of the disease. Nor is there any likelihood that there will be any possible relapse, as she is a most intelligent patient who adheres strictly to the treatment and diet, and will undoubtedly do so until directed otherwise.

Strangely enough another very similar case was also sent to me from Bangor, Maine, which I will mention very briefly:

Case VIII.—Mrs. H. F. J., aged 52, weighing 102 pounds, was first seen August 3, 1916. She had been under an absolutely vegetarian diet (green card) since July 17th, and was feeling better than before. She had had three children, 27, 25, and 16 years of age, the menses had been regular up to April 15, then nothing up to July 1st, when there was a clotted flow, checked by treatment, which had returned in two weeks, with pain, after an auto ride. On July 14th she was examined by two physicians who found cancer of the cervix, which was confirmed by Dr. Janeway on July 31st, who reported “cancer of the cervix and vaginal canal, with some cauliflower excrescence; the uterus was not much enlarged or fixed.” She received one application of radium on August 1st, 300 mil. Curies to the canal, and 120 to the cervix, for 12 hours.

She was given the same mixture as Mrs. F. L. A. and the “green card diet,” and the injection of carbolic acid and biborate of soda. Briefly, to report further, on September 30th it was recorded that she had improved every day; she had gained steadily, and again on September 30th that she had improved every day. She had a good appetite and was getting back her strength, and seemed “quite like herself again.”

On October 20th Dr. Janeway reported that Mrs. H. F. J. was “free from disease, although the healing is not quite complete.” This is, of course, a very recent case, but the progress has been so satisfactory that in view of the former case and the results so often obtained when all proper measures are carefully carried out, there is reasonable expectation that this will also result in a cure.

I will not dwell longer on carcinoma, though if I had time I could relate many other interesting and instructive cases, showing satisfactory results of treatment. My experience has naturally been principally with the disease as it affects the breast, and many of the patients affected elsewhere I have seen in consultation, or only a few times, though some have been faithful to prolonged treatment.

But if the thesis which I have tried to establish in these and my former lectures is correct, then sooner or later we will be able to apply the same principles, more fully developed and more perfectly adjusted, to cancer in other locations. And as the public and profession are better educated along these lines patients will apply earlier, and the pre-cancerous constitutional relations will be recognized and treated before the cancerous mass has gained such headway. There can be little doubt but that the same principles of treatment and prophylaxis apply equally to the cancerous process wherever the primary lesion has first developed.

Sarcoma.—Of the 36 cases of sarcoma, of various types and in different situations, which enter into our list of malignant neoplasms, very few can be mentioned as illustrations of the value of dietary and medicinal treatment; many of them were seen only in consultation, or once or twice, and it is very difficult for those afflicted with such affections to be persuaded of the value of prolonged internal treatment when surgery apparently offers such brilliant immediate results.

But there is one patient with sarcoma of the upper jaw, whom you saw a while ago in an ulcerative condition, with a great hole in the cheek and a cavern within, whose improvement is so phenomenal that I now present her to you again to-day, as she is about to leave the hospital, after a little over four months’ stay.

Case IX.—Miss R. L., aged 19, entered the New York Skin and Cancer Hospital, in my service, July 24th, 1916, weighing 89½ pounds. She had formerly weighed 120. About three years ago a small lump developed beneath a pigmented mole which had long existed, an inch or so below the right eye. This grew rapidly until it was about an inch in diameter, and was movable and painless. About January 1st a tooth in the right upper jaw became loose and three teeth were extracted; a radiograph was taken, and she was advised hospital treatment. She then entered another hospital and the gum was incised and radium applied for 18 hours on March 1, 1916. After this operation the face became swollen and very painful, and an extensive operation was performed in May, the right upper maxilla being removed, together with the tumor. Four weeks before entering the New York Skin and Cancer Hospital a pin hole opening was noticed in the scar on the cheek, which increased in size up to the time of admission. She remained in that hospital until she came to us. The microscopic examination of the portions removed showed the disease to be sarcoma.

On entering the hospital there was an opening in the right cheek something over an inch in diameter with ulcerated edges, and a cavity extending down to the tongue, the superior maxilla having been removed surgically. From the upper margin of the opening there was a mass of dead bone hanging, nearly three quarters of an inch long by half an inch wide. The interior of the cavity presented a mass of ulceration, giving forth a foul odor. She was thin, pale, and anemic with 85 per cent hemoglobin and 3,620,000 red blood corpuscles.

She was placed on an absolutely vegetarian diet (green card) and began with the same mixture as the cases of carcinoma mentioned. The cavity and opening were kept packed with absorbent cotton, saturated with the following solution: ℞ Acidi Carbolici ℨss, Listerine ℥i, Liquor sodæ chlorinatæ ℥i, Glycerin ℥ss, Aquæ hydrogenii dioxidi ad ℥iv, M., changed several times daily. Under this treatment there was almost from the first a remarkable change in her condition. The discharge ceased shortly and also the foul odor. Within a few weeks the cavity and edges of the opening showed a healthy condition and evidences of cicatrization could be seen. The tongue of dead bone, which was soaked several times daily with muriatic acid, separated entirely within three months, leaving a healthy granular surface. By the end of four months the entire edge of the opening on the face had cicatrized perfectly, and the interior appeared in a healthy condition, with no ulceration whatever, as you saw when she was presented the second time, a few weeks ago.

From the first her general condition improved and she began to gain weight, even several pounds a week, being weighed every week in the same hospital wrapper, by several nurses, who took great interest in the case. I could hardly believe that she weighed 128 pounds on a Monday, as reported, and on the following Wednesday I weighed her myself and found that she weighed 130, which was quite a little over that called for by her height and age, and ten pounds more than she had ever weighed before. She had been taking for some time pyrophosphate of iron, five grains after eating, in addition to the mixture mentioned, which had hardly been changed since she entered.

The blood, which was carefully studied weekly, steadily improved until, on September 18th, the hemoglobin stood 95 per cent, with 4,600,000 red blood corpuscles and 8,000 white, and on November 10th the hemoglobin reached 100, and the red corpuscles 4,700,000. The urine, which presented albumen and granular casts on admission, had lost these, and on November 10th she passed 1,000 cc., with a specific gravity of 1.025, and normal in every respect, except a faint trace of indican.

You will now, however, be specially interested when you see the change which has been wrought in her face by Dr. Semken, one of our attending surgeons, who performed a plastic operation on her, beginning Nov. 14, with the preparation of a flap on the right arm. This flap was lined with a Thiersch skin graft from the leg, so as to secure a proper mucous lining in the mouth, and left in situ until Nov. 24, when it was attached to the face, after the scar tissue had been cut away. The arm was held in place by a plaster of Paris dressing until yesterday, when the attachment to the arm was finally severed, after several partial separations. The skin graft took from the first, without any drawback, and now you see the opening entirely and perfectly covered. You will notice that the ectropion, which was so marked when you first saw her with the ulcerating surface, has about disappeared, and Dr. Semken believes that there will be still further improvement in this respect.

I must not keep you longer, though I should have liked to narrate other cases of carcinoma in other locations which are of interest. I trust, however, that you have heard and seen enough to be quite satisfied as to the correctness of the principles I have tried to lay down, and also as to the success following their proper and careful application. How far they will serve for cancer in general, as it affects various organs and parts of the body, remains to be seen, when many others have reported their results. Whether also this line of thought will apply to sarcoma in general remains to be seen, for sarcoma is really of much the same nature of malignant cell growth, only affecting the connective tissue elements instead of the epithelium.

In closing I must again remind you that it is no trifling matter to undertake the treatment of cancer by dietary and medicinal means, even though from what you have seen and heard you may think otherwise. Each case requires the utmost careful study and adaptation of remedies as may be indicated to bring the patient into a condition of perfect health. Diet alone will not accomplish this, but without the proper diet, as already indicated, all other efforts are unavailing to check the dire disease. With the proper carrying out of every detail the success is certainly much greater than with surgery, and with advancing knowledge and practise along these lines we shall undoubtedly see a satisfactory diminution in the deaths from cancer, whose death rate has so steadily risen under the measures heretofore employed.