It takes from 6 to 12 months to produce more or less favorable results in any fully developed case of Cancer. It takes from 3 to 5 months to clear up a cancerous condition in its initial stage. In far advanced cases, all we can offer is palliative treatment, with the object of giving the patient some relief and comfort from his terrific pains and sufferings. It is essential for the physician to assume an optimistic state of mind and to acquire the full confidence of the patient, in order to have a thorough and intelligent co-operation between patient and physician. At Last-The "S" Bacillus.-Just before going to press, we see that according to the daily papers, the "real" cause of cancer has, at last been discovered. This time it is a German scientist, Dr. Josef Schumacher, who anounced before the Berlin Microbiological Society that he had made the important discovery. It is a negetable (sic) organism, with a well defined membrance, S shaped, with terminal nodules and visible when magnified only sixty diameters. But it only causes cancer in those who are predisposed! The contrary little cuss! Another characteristic of this "S" bacillus, is that it will not show itself unless it is dyed a beautiful red; the surrounding tissues remaining blue. It constitutes no less than ten per cent. of the cancerous mass. How these swarming bacilli ever escaped the eye of other investigators is a mystery. Oh, yes, we forgot the most important item in the dispatches: The great discovery was made in three tiny rooms with a noisy dance hall above and a saloon below. "There the scientist would treat some patients to keep starvation from the door, and spent the rest of his waking hours toiling over his test tubes!" This information leaves no doubt regarding what is expected of the generous American public. Our New Collaborator.-It is with great pleasure that we can announce to our subscribers, a new collaborator to "Cancer." Our new colleague, Dr. A. H. Roffo, is one of the best known research workers in the field of cancer, and our readers will remember him best from the abstracts that have appeared in our Review of Literature, regarding the effects of Selenium on neoplastic tissue. Doctor Roffo is the Director of the Institute of Experimental Medicine for the Study and Treatment of Cancer, Buenos Aires, Argentina. He has made numerous and important contributions to the study and treatment of cancer; some of which will be translated and will appear in "Cancer," from time to time. A PRACTICAL QUARTERLY JOURNAL Under the Ausipices of the American Association for the Prevention and Cure of Cancer EDITOR L. DUNCAN BULKLEY, A.M., M.D. ASSOCIATE EDITOR PAUL LUTTINGER, M.D. COLLABORATORS RUSSELL C. KELSEY, M.D. EDWARD PREble, M.D. THOMAS L. STEDMAN, M.D. J. AEBLY, M.D., Switzerland A. H. ROFFO, M.D., Argentina All original matter must be addressed to the Editor and contributed exclusively to this Journal. Address subscriptions and matter relating to advertising, reprints, etc., to 121 East 60th St., New York City Copyright, 1926, by L. D. Bulkley Price, prepaid, $5.00 per volume, United States, Canada and Mexico; TRAUMATISM AND CANCER Ewing, in the February issue of the American Journal of Surgery, has made a most interesting and instructive study of the relation of trauma to malignant tumors, which should have wider attention. He considers the subject under five headings, which are very important to consider in connection with legal cases, when there is any question of compensation. They are as follows: 1. The authenticity and sufficient severity of the trauma. 2. Previous integrity of the wounded part. 3. The identity of the injured area with that giving origin to the tumor. 4. The tumor must be of a type that could conceivably result from trauma. 5. There must be a proper time interval between the receipt of the injury and the appearance of the tumor. It is not the purpose of this writing to enter at all into the medicolegal aspect of the subject, but cancer is so constantly and wrongly called a local disease, with traumatism or chronic irritation as the sole cause, that it is well to treat the matter from a broad aspect, and consider facts which show as to the truth or error of this postulate. The paper by Dr. Ewing is so excellent and logical that it may be best to make some quotations from it. But the main point is, how far and how trauma and chronic irritation actually do produce that which we call malignant disease, cancer or sarcoma, without there being some constitutional condition rendering originally healthy body cells liable to take on a change of form, and enter upon a malignant course, with all its well-known sad results. It is hard to conceive this possible, for there must be a cause for everything, but the mass of the medical profession, especially the surgeons, are slow in receiving and acting on the evidence, repeatedly presented, of the systemic or constitutional nature and basic cause of cancer. For it must be granted that injury in many cases does seem to be the exciting cause of lesions of the disease in certain localities, even as trauma causes the late lesions of syphilis or tuberculosis, and the acute symptoms of gout. Some three years ago the present writer offered (International Clinics, Vol. III, Series 33) from the writings of dozens of the ablest surgeons and physicians of the last 100 years, abundant proof of the soundness of the view of the constitutional nature and cause of cancer, to which the editor added the following note: "These radical views of the author will be replied to by competent surgeons and clinicians in the next issue of the International Clinics." But up to the present time, now over three years, we do not know of any such reply. Much the same occurred when, five years ago, the present writer read a paper, with a wall chart, before the American Association for Cancer Research (N. Y. Med. Jour., July 20, 1921), presenting "Proofs of the Constitutional Nature of Cancer." It was received with respectful silence, and not one word of scientific discussion or criticism was uttered, nor has it ever been controverted. At that time the only answer made was by two or three surgeons, who claimed that they had cured cancer by operation, and that they did not believe that it was of a constitutional nature, but that it was a local disease. It is strange, indeed, that so many intelligent and supposedly scientific men, composing a Cancer Research Society, should not be willing to study a matter which has so much to do with the life and well-being of mankind, and should be content to accept blindly the conclusions which are wholly unsupported by evidence. But the present belief or obsession that cancer is purely a local disease, curable by the removal of the local products or manifestations of a constitutional condition, still very generally obtains, in spite of the enormous evidence which has accumulated, during the past 100 years, and which is daily increasing, proving that exactly the reverse is true. As one of the best editors of a medical journal expressed it, during the world war: "It is difficult to overthrow intrenched prejudice with gentle words." Angels weep and devils laugh at man's obtuseness. Laboratory workers, who have acknowledged that they have not found the cause or cure of cancer, after spending millions of hours of work and thousands of animal lives, and enormous sums of money, and who yet support the local nature of cancer, seem to be the chief culprits in supporting the medical profession in their strange and unreasonable position in regard to cancer. Turning now to our subject of Traumatism and Cancer, let us examine the subject as closely and intelligently as possible. He Ewing cites a considerable number of medico-legal cases which had come to his attention, and criticized freely the findings, and his whole article shows that he takes little stock in the causation of cancer by traumatism; and although he recognizes the possibility, he has rarely if ever met with such an authentic case: and we may say the same. says: "The foregoing review of the data required to establish the traumatic origin of a malignant tumor emphasizes the complexity of the problem. It is obvious that such data are very seldom presented, and many of them are difficult to obtain. Some of them are essentially matters of interpretation, rather than of definite determination. Nevertheless, without them we cannot assert that a tumor is of traumatic origin. The traumatic theory runs against too many general objections to permit its uncritical acceptance. The most formidable obstacle is the fact that there is not a single form of supposed traumatic cancer that does not arise frequently in exactly the same form, entirely free from any suspicion of trauma. Loewy, in an observation of 26,389 injured persons, found 37 malignant tumors, attributable to trauma, as either a primary or an activating factor. Assuming that all the cases were genuine, this degree of frequency of alleged traumatic cancer, 1 to 700 injured persons, is not much greater than the incidence of cancer in uninjured persons. The annual death rate from cancer in some cities runs about one per thousand of the persons living. Moreover, the effective exciting factors of most of the common forms of cancer are sufficiently well known to exclude trauma. Hence, it is a safe conclusion that trauma very rarely produces cancer de novo. More often it brings to light a previously existing cancer, or excites a miniature cancer or possibly a pre-cancerous lesion, to more rapid growth." . . . "Elaborate efforts to produce cancer by various forms of single trauma have been carried out on an elaborate scale by Ribbert, Lubarsh, Langermann, and others. Not a single definite success has followed these efforts." Looking at the subject still more closely, let us see what the chances are of malignant neoplasms being of local origin, or caused solely by local causes, such as trauma. Taking first the hands; we all know how extremely rare it is for carcinoma or sarcoma to be found on the fingers and hands, and yet we all know that these parts have more traumatism, both acute and chronic, or repeated, than any other portion of the body. We do occasionally see epithelioma on the back of one hand, which is least exposed to injury. In former times, before the danger was recognized and guarded against, the x-ray and radium produced a dermatitis which resulted in cancer on the hands or fingers, for which amputation was performed, and which ultimately resulted fatally in a few cases, probably in those who were in a susceptible constitutional condition, otherwise they would be more frequent and seen at the present time. The daily winding of a stiff spring, stem-winding watch produces a repeated, deep-seated bruise of the periosteum, but who ever saw sarcoma in that region? The same may be said of cancer of the feet. How often are they exposed to active trauma, or to chronic irritation, by corns, and bunions, but the feet seem to be peculiarly immune to cancer, although they may have much callus, which is epidermic. |