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The Turn Of The Century
Electrotherapy Museum FACIAL CANCER, CARBUNCLE, CHELOID, ACNE, ALOPECIA AREATA, SYCHOSIS, FIBROID TUMOR, PSORIASIS, LUPUS, PRIMARY AND RECURRENT CARCINOMA OF THE BREAST ARTIFICIAL FLUORESCENCE OF LIVING TISSUE. By WILLIAM JAMES MORTON, M.D., PROFESSOR OF ELECTROTHERAPEUTICS AND OF DISEASES OF THE MIND AND NERVOUS SYSTEM IN THE NEW YORK POST-GRADUATE MEDICAL SCHOOL AND HOSPITAL.
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| WHATEVER early expectations may have
been, later experience has shown that the treatment of cancer by the
x-ray is, in many instances, a long and difficult one. True, cases of
the rodent ulcer type get well most rapidly; again instances of sarcoma and
of recent recurrent nodules or of infiltrations in the scars of operations,
disappear in a few weeks, and also certain primary carcinomatous tumors of
the breast disappear in a reasonable time. But the process of ascertaining
the true limitations of the x-ray in cancer, in general, is a slow one. And
to add to the difficulties of the problem there are those whose opinions are
entitled to great confidence who claim that the high-frequency,
high-potential electricity associated with a certain class of x-ray
administrations, exercises, if not the whole, at least the preponderating
influence toward the cure, when this is effected,
To arrive at an impartial view of what may be expected of the x-ray treatment, it would be essential to report all cases, both favorable and unfavorable, and this, so far as my own experience extends, I intend to do at an early date, but at the present moment I present a few cases in which the x-ray has relieved, or caused the evidences of disease to disappear and thus apparently cured. But although a doubt as to whether the x-ray itself or whether the high-potential, high-frequency current accomplishes the result may be said to be arising, still the fact itself is well established that cancerous disease, v: hen not caused to disappear altogether, exhibits, at least for a longer or shorter time, a retrogression under x-ray treatment. There are, however, exceptions even to this statement, for I have watched an advanced and inoperable carcinoma of the neck, and in another instance equally advanced and inoperable carcinomatous glands of the axilla steadily growing in size in spite of and in the face of most faithful treatment. And, again, in a case of extensive ulceration of recurrent and inoperable carcinoma I have observed recurrent cancer areas steadily disappear, while at the same time the case went on to a fatal termination, due to the existence of cachexia and of secondary septic infection. Or, again, I have caused local cancer to disappear and yet known death to ensue from distant and unexpected metastases. If then we would still claim that the x-ray is as nearly a cure for cancer as any other method of procedure yet found, we must also, at the same time, admit that from a comprehensive point of view it is certain that it is meeting with cases of certain stages and types which it cannot under present management and conditions overcome. While all admit that the more superficial the growth, the greater are the chances of cure, be the case one of epithelioma, of primary or recurrent carcinoma or of sarcoma, my own experience furthermore leads me to believe that the newer the new growth is, the more certainly will the x-ray act favorably upon it. But as a modification to this view I would suggest that the more preponderant the "scirrhus" or fibrous character the slower is the action of the x-ray. When an open ulcer with much secondary septic infection exists, the case is almost sure to progress unfavorably. There is also reason to believe that the connective tissue stroma in some cases of scirrhus is caused to grow, while at the same time the cancer cells degenerate and decrease. Much time, therefore, will yet be required before we may differentiate what cases of cancer may be successfully combated by the x-ray, and until we can decide what the limitations as to treatment are. In the meantime, looking the field over-taking conservatively into account both successes and failures in my own as in the reported result of others-I think there is ground for the belief that in the x-ray we possess a relief or cure for cancer, especially in its early stages, which in its ultimate results compares favorably with operative treatment. It would seem to me that a case of primary carcinoma of the breast may as hopefully, and with as little ultimate danger to the patient, be submitted to the x-ray as to any other procedure. I believe that properly selected cases of primary mammary carcinoma or other cancer may be submitted to the x-ray before resorting to an operation with a certainty that no valuable time will be lost. For if the x-ray does not succeed in effecting a cure, the patient is at least in a better condition for operation than before, for the reason that the outlying areas of infection are cleared up and the actual remaining disease is more accurately localized to a given and known position.It is now pretty generally accepted that the x-ray should be employed after an operation in order to prevent a recurrence. It may reasonably be asked if the x-ray is effective to prevent a recurrence or to cause a recurrence to disappear, why is it not equally effective in the first instance and before an operation. I trust that some of the cases I here report may help substantiate this view. I am fully aware of what it means to advise a patient with a primary carcinoma of the breast or elsewhere to delay operation. Could the operation positively preclude a recurrence or, again, could the x-ray present a certainty of cure, there could, of course, be no hesitation as to the advice to give. With wider experience before us, as to the capabilities of the x-ray the time of doubt should soon be over, and at the present moment there exists no other course than frankly to lay before the patient or the patient's family " the present state of the art" of x-rav_ therapy and of surgery, and if the x-ray course is chosen, to follow it only so long as the patient makes decided progress toward recovery. If no progress is made, an operation, if one were ever possible, may still be done and the x-ray continued later on. At this point some one will remark, "but "valuable time will be lost." This I do not believe. For in breast cases I have observed that infected, indurated, swollen, and sensitive lymphatic vessels and lymph glands have become, to all intents and purposes, normal, even though, in several instances, I have thought it wise to have a rebellious (to the x-ray) scirrhous lump removed finally by the knife. I may say here in general that one class of cases which all have found to be the most resistant to x-ray treatment and altogether incurable by its aid is precisely that class of cases which have advanced to a stage where no surgical operation is possible. On the other hand the x-ray has already cured some of these inoperable cases. One fact at least stands forth most clearh-, and that is that cancerous disease in its incipiency, when not too deeply located, is decisively arrested in its growth and caused to disappear. CASE I.-Carcinoma of the left orbital region; inoperable. George Van A., aged sixty -three years, Jamesburg, N. Y. June 24, 1902. (See Figs. i and 2.) The disease began about fifteen years ago as an apparent mole on the cheek, below the lower canthus of the left eye. During ten years this molelike growth laid fairly dormant, and then broke down into an ulcer with the formation of scabs. The ulcer increased in size until two years ago it was about one-half an inch in diameter and quite deep. It was now treated by a cancer paste, and apparently healed in about a month. But soon hard nodules formed around the edges and quickly broke down into an excavation larger than ever before, and discharged much pus. The bone of the orbit now became involved. In November, 1902, the paste was again applied, but the disease still continued to spread angrily in every direction. He then took the Alexander treatment of about thirty-seven injections, but with no benefit; on the contrary, the disease has spread rapidly until it presents the appearance shown in the accompanying illustration. (Fig. i.) Present appearance: Both the upper and lower eyelids are more than half destroyed, ...
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