CANCER A PRACTICAL QUARTERLY JOURNAL Under the Auspices of the American Association for the Prevention and Cure of Cancer EDITOR L. DUNCAN BULKLEY, A.M., M.D. ASSOCIATE EDITOR J. LYMAN BULKLEY, M.D. COLLABORATORS RUSSELL C. KELSEY, M.D. EDWARD PREBLE, M.D. SEELYE W. LITTLE, 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 THE CANCER PUBLISHING COMPANY 121 East 60th Street, New York City Copyright, 1923, by L. D. Bulkley Price, prepaid, $5.00 per volume, United States, Canada and Mexico; PROFESSOR OPITZ ON THE NATURE AND TREATMENT OF CANCER Professor Eric Opitz, the well known gynecologist of Freiburg, states in an article, which is the subject of an editorial, that in his opinion cancer can be visualized equally as a local and general disease. This saying is something of a paradox, but the following argument may be used to uphold it in part. Veterinary pathologists inform us that certain diseases believed originally to be generally transmitted by inoculation are in reality contracted mostly by swallowing the virus. The best example of the sort is farcy, which has so strong a predilection for the nasal chambers and other facial localities as to suggest direct inoculation, although the virus is merely deposited there from the blood of the patient. Leprosy is a malady of the same general type and its early local appearance in the nasal septum has sometimes been called by the French the "leprous chancre," although it is highly improbable that the disease is inoculated. Tetanus is sometimes, even if rarely, absorbed from the intestines and some of the trivial wounds which are accused of having been the port of entry show no evidences of the bacillus. Syphilis is, of course, always inoculated, but all syphilographers know that once the spirochete is in the blood a chancre-like lesion can be caused by external irritation. This evidence and reasoning may be transferred to cancer. From analogy of tar cancer and experimentally inoculated animal cancer, we can hardly dispute its possible local origin but it is reasonable to suppose that if the virus have arrived in the blood after enteric absorption, persistent irritation may cause it to be arrested at the precancerous site and there go through its cycle. This reasoning naturally applies only to one conception of a constitutional disease, while the word "virus" is used in a generic sense as the unknown exciting factor. Professor Opitz, who is co-author with Menge of a classical textbook, has made cancer the principal avocation of his life. An operator and extensive user of radiation, he has never lost sight of the possibility of a successful medical treatment. In his student days he heard Esmarck often and recalls how that optimist never failed to give his patients arsenic after operation, and in inoperable cases. No matter how despairing the outlook, the patient received the benefit of any doubt and in not a few cases the disease process was arrested. In a serial article in the Muenchener medizinische Wochenschrift for September 17 and 24, he sums up the results of his thirty years of active experience in this field. His numerous associates in the past have, when possible, devoted themselves to cancer study at his request, but always without conditions-they were allowed a free hand. Opitz's reasoning is as follows: Cancer sometimes undergoes spontaneous cure. There is now a considerable literature on this subject in which we find the names of Czerny, Ewing, Sauerbruch, Ceelen, Orth and others. Schmidt and Lubarsch have shown that in the fight with the human organism most of the cancer cells go down in defeat, and that only a few survivors cause the metastases. Lymph node cancer is much less malignant than the average, and these metastases sometimes undergo involution. In partial excision the remaining cells often disappear or are held in check. All of this evidence shows that there are forces in the body which antagonize the development of cancer. Thirty years ago the author said and repeats today that much of the local pathology of cancer is made up of defensive activities. Therefore there should be ways in which we can assist Nature in this battle against cancer. Even as matters are today with thousands of cancer victims, most people are still immune. Study of racial and constitutional groups shows immunity and susceptibility. The Indian of both Americas, the Abyssinian and Congo negro do not have cancer until they adopt the customs of civilization, neither does the white man develop immunity if he settles among these primitives. Numerous physical types of whites have an immunity, as the hyperthyroids and vagotonics. Opitz and associates have for years worked with mouse cancer and with cancer mice from the old Ehrlich strains, from Blumenthal's laboratory and elsewhere. Healing efforts have been carried out on the same general plan with animal and human cancer. There is something to be said under operative treatment, for the light operation and against the radical; in the former the natural defenses are not lowered and may actually improve, as in cases where after partial excision Nature finishes the cure. The radical operation by lowering the natural defense paves the way for further mischief. We know that arsenic alone internally can cure skin cancer and Lassar has many such cases to his credit. Hence there is nothing improbable in the supposition that some of the other elements can antagonize the cancer cell and especially selenium, copper, gold, cerium, and lead, silicon and iron appear to possess this power. The first step in the constitutional treatment of the disease lies in the employment of solutions of minerals. Calcium, silica, phosphorus, iron and arsenic appear to act favorably, at least in mouse cancer; while sodium chloride is withheld and potassa is given with care, for an excess sometimes acts unfavorably on mice. Formate of sodium can imitate the taste of salt in a salt free diet, and the author uses it for those who feel loss of salt as a hardship. Of organic principles substances containing cholesterol are excluded, while those containing lecithin are favored. Vegetable oils are substituted for animal fats. In regard to nourishment it must be remembered that Opitz's diet is designed chiefly for patients who are cachectic and under weight. We have to vary the diet in these cases and alternate with a roborant and a spare diet. He finds it necessary to keep up the weight of the patient and his strength, but institutes pauses in which the processes of elimination are favored. Opitz terms his medical treatment the "injection treatment" and evidently nothing is given by the mouth. His anticancer remedies fall under two heads but all the drugs used are believed to act directly on the cancer cells, or, presumably, the defensive cells. The basic idea is to combine a hydrocarbon of the olefine class with a special contact substance, the latter including metals, dyes or sulphur-containing bodies. In the second group we find adrenalin, cholin, cerium, and trypan blue. These drugs of both types can surely modify the cancer cells, and evidence is often seen in the form of a focal reaction or a distinct clinical improvement, an arrest or regression. Opitz does not particularize the drugs to use, for evidently this is largely a matter of chance and idiosyncrasy; and contents himself with giving the general principles. His injection treatment is usually employed as a synergist of some form of radiation. He appends a series of cases of inoperable cancers in which he secured positive results, chiefly arrest of growth or disappearance, in about half the number. Professor Opitz is a worthy member of the group of surgical optimists, which comprises such men as Murphy, Esmarck, Billroth, Doven, Delbet, Bier, Sauerbruch, Czerny, Blair Bell, Lapthorn Smith and many others equally eminent. ECHO FROM MOHONK THE PRESENT STATE OF SCIENTIFIC KNOWLEDGE OF CANCER* At the close of the conference on cancer held last week at Lake Mohonk, N. Y., more than a hundred specialists from various countries joined in the following statement: Although the present state of knowledge of cancer is not sufficient to permit of the formulation of such procedures for the suppression of this malady as have been successfully employed for the control of infectious diseases, there is enough wellestablished fact and sound working opinion concerning the prevention, diagnosis and treatment of cancer to save many lives, if this information is carried properly into effect. Although the causation of cancer is not completely understood, it may be accepted that for all practical purposes cancer is not to be looked upon as contagious or infectious. Cancer itself is not hereditary, although a certain predisposition or susceptibility to cancer is apparently transmissible through inheritance. This does not signify that because one's parent or parents or other members of the family have suffered from cancer, cancer will necessarily appear in other persons of the same or succeeding generations. The control of cancer, so far as this subject can be understood at the present time, depends upon the employment of measures of personal hygiene and certain preventive and curative measures, the success of which depends upon the intelligent cooperation of patient and physician. Persons who have cancer must apply to competent physicians at a sufficiently early stage in the disease in order to have a fair chance of cure. This applies to all forms of cancer. In some forms early treatment affords the only possibility of cure. Cancer in some parts of the body can be discovered in a very early stage, and if these cases are treated properly the prospect for a permanent cure is good. The cure of cancer depends upon discovering the growth *From Science, October 1, 1926. |