CANCER 
AND ITS TREATMENT. 
BY 
DANIEL LEWIS, M.D. 
REPRINTED FROM THE “ AMERICAN PRACTITIONER," (DECEMBER, 1874). 
JLeto JJflrh: 
A. C. Maclauclilan, Printer and Stereotyper. 
1875. CANCER 
AND ITS TREATMENT. 
BY 
DANIEL LEWIS, M.D. 
REPRINTED FROM THE “AMERICAN PRACTITIONER;' (DECEMBER, 1874). 
ftefo gork: 
A. C. Maclanclilan, Printer and Stereotyper. 
1875. CANCER AND ITS TREATMENT. 
READ BEFORE THE MEDICAL SOCIETY OF THE COUNTY OF NEW YORK. 
The dogma of a distinctive “ cancer-cell ” having now been 
abandoned by its discoverers, the histologists, the leading -pa- 
thologists of the day may be said to have adopted the opinions 
of Virchow, who many years back declared the cells of true 
cancer to be of the epithelial type. A more recent view of the 
subject, however, inculcates that a. special stroma is the ana- 
tomical characteristic of cancer; and Mr. Arnott, who is an able 
advocate of the doctrine, gives expression to it in the following 
definition of carcinoma :* “ A tumor in which a more or less 
dense fibroid growth forms a sponge-like or cavernous frame- 
work, whose alveoli are filled with loose cells of an epithelial 
type grouped together disorderly, bathed in a clear fluid, and 
having no visible intercellular substance.” 
In view of such conflicting testimony it has been justly said 
that the microscopist has thus far failed to furnish any positive 
knowledge on this subject, yet it seems but fair to allow that 
enough has been accomplished to warrant the belief that the 
solution of this most important question may yet come from 
the labors of the histologist. It may be added in this connec 
tion that one of the direct results of microscopical study has 
been to place epithelioma in the list of cancers, where it prop 
* Cancer : its arieties, their Histology and Diagnosis. Henry Arnott, London. 4 
CANCER AND ITS TREATMENT. 
erly belongs, and there seems reason to believe that rodent 
ulcers will also be placed in the same category. 
The question of cancer being of local or constitutional origin 
is, as I need hardly remark, of the first importance as regards 
its treatment. Until very recently pathologists were well-nigh 
agreed that cancer was a general or systemic affection, which 
originated in a morbid condition of the blood ; and this opinion 
seems to be in no wise shaken by the fact that the most careful 
chemical analysis of the blood of cancerous patients has uni- 
formly failed to detect anything abnormal in that fluid. The 
constitutional as against the local origin of cancer may be said 
to rest mainly on the four following propositions : 
1. Cancer is hereditary. 
2. It usually recurs after removal both in the same and in 
distant organs. 
3. Cancer is often found in tubercular families. 
4. It is attended by a peculiar cachexia. 
There can be no doubt as to the hereditary character of many 
cases of cancer. Medical literature abounds in instances of this 
character. The records of the Middlesex Hospital show it to 
be so in one out of every nine cases; the London Cancer Hospi- 
tal in one out of eight cases. affirms that cancer is in- 
herited in one in every four cases, while Velpeau’s experience 
furnished p*roof of hereditary predisposition in one in three 
cases. Walsh is equally decided in the opinion, but gives no 
statistics. Warren, as quoted by Lawrence,f gives perhaps the 
most remarkable history on record of hereditary transmission 
of cancer. lie says, “ The grandfather died of cancer of the 
lip; the son had a cancer of the breast; two of his sisters had 
cancer of the breast; a daughter of one of the ladies had cancer 
* Surgical Pathology. 
f Lawrence on Otuicer. CANCER AND ITS TREATMENT. 
5 
of the breast, which was removed at an early period (she died 
some years after of cancer of the uterus); a daughter of the 
gentleman has a cancer of the breast.” 
In a recent discussion on the origin of cancer, in the London 
Pathological Society, Mr. Paget declared that it was “ not 
possible to conceive of the origin of cancer, or, I would add, 
of any disease of the like kind, except by inheritance.” The 
localists, as they are called, admit the hereditary nature of 
cancer, but claim that this does not prove the existence of a 
dyscrasia of the blood, because many innocent tumors are also 
hereditary. 
Recurrence of cancer after its removal is, as is well known, 
extremely common. The cause of this is assumed by the gen- 
eralist to be the pre-existing dyscrasia of the blood. The local- 
ist claims, on the other hand, that it is the result of successive 
infection. It is a clinical fact that cancers recur, sooner or 
later, according as the cells are loosely or firmly held together, 
thus encephaloid recurs sooner than scirrhous, while epithelioma, 
if removed early, often never returns. This seems to favor the 
idea of the disease becoming constitutional by direct infection 
from the primary cancer. 
De Morgan gives two cases illustrative of this point. The 
first was one in which, on the removal of a solitary encephaloid 
tumor on the sole of the foot, a host of similar tumors were 
rapidly developed in different parts of the limb and in the lym- 
phatic glands.* The second case was in a man who had the 
globe removed for a tumor of the eye, when traces of tumor 
elements were found in the cut surface of the optic nerve. The 
patient dying a year after with paralysis, the autopsy revealed 
a growth about the stump of the optic nerve, and another and 
* De Morgan on Cancer. 6 
CANCER AND ITS TREATMENT. 
larger one in the canda equina. It here seemed evident that 
cell elements from the primary tumor had drifted in the arach- 
noid fluid until, becoming entangled in the network of nerves, 
they developed into the secondary tumor. 
In reference to the relation existing between cancer and 
tubercle, it may in general terms be remarked that many cases 
of cancer occurring in consumptive families are simply coinci- 
dences, and not the result of any direct connection between 
the two diseases. Walsh does not believe that cancer and tuber- 
culosis are in any way related, while Paget gives cases to prove 
them actually antagonistic. 
The cancer cachexia has been regarded as positive evidence 
of the constitutional origin of the disease. There are often 
symptoms in the latter stages of cancer which taken together 
have been called secondary cachexia. These symptoms are direct 
results of the systemic infection, and vary in severity accord- 
ing to the degree of pain, amount of hemorrhage, discharge, 
etc., and derangement of the general system. 
A specific primary cachexia has now come to be regarded by 
many surgeons as, to say the least, exceedingly, problematical. 
Mr. Arnott * declares it to be a symptom of no value from any 
point of view. It is a fact well established by observation that 
cancer is more often found in persons of robust health than 
otherwise, and very often in long-lived families. 
Virchow was among the first to maintain the local origin of 
cancer. Many of the German pathologists now advocate it, 
among whom are Waldeyer, Thiersch, and Billroth. In the 
recent discussion in London the “localists” and “generalists” 
were about evenly divided as to numbers, which shows the 
great progress of these views during the past few years. De 
* Amott on Cancer. 7 
CANCER AND ITS TREATMENT. 
Morgan, Hutchinson, Simon, Arnott, Erichsen, Moxon, and 
Gull have declared their belief in the local origin of the dis- 
ease. Here then is the practical point in the whole question. 
If we accept as correct the theory of blood-origin, we must give 
preference to the constitutional treatment, which every one knows 
has thus far proved utterly powerless. The local ist, on the other 
hand, bases the hope of cure upon complete and early removal. 
If it be urged that the diagnosis of cancer is uncertain in its 
earlier stages, the fact remains that the welfare of the patient 
would not suffer so much in the removal of an innocent tumor 
early as by the late excision of a cancer. 
A word as to the curability of cancer before entering upon 
the subject of its treatment. Well-authenticated cases are on 
record of the spontaneous cure of cancer. Walsh refers to one 
case reported by Nicod and several cases observed by Bayle. 
Many surgeons of large experience report cases well twenty 
years after operation. Dr. Willard Parker has recently re- 
ported three cases continuing well after twenty, twenty-two, 
and twenty-seven years. 
The treatment may be embraced under two heads, the con- 
stitutional and local. I need not remark that nearly every 
leading preparation of the materia medica, and hundreds which 
have no place there, has been recommended at one time and 
another for the cure of cancer in some of its forms, until it 
would seem vain to hope that any mere drug will ever rise to 
the dignity of a remedy in the disease. Arsenic is believed by 
some to possess a certain power over the affection, and hence 
has been recommended after extirpation of cancer to prevent 
its recurrence. Marsden * says “ carbonate of soda and other 
alkalies have undoubtedly a tendency to arrest the growth of 
' Marsden on Cancer, page 90. 8 
CANCER AND ITS TREATMENT. 
cancer.” Dr. Willard Parker assigns mental anxiety as the 
cause of the disease in forty-five of liis cases, and in view of the 
fact urges the employment of what he terms “ moral treat- 
ment.” We know mental anxiety is the cause of many other 
diseases, and its relation to cancer slionld therefore be carefully 
studied. 
The local treatment of cancer embraces four methods: 1. 
Compression ; 2. Electrolysis ; 3. Excision ; 4. Caustics. 
Recamier published in 1829 thirty cases of cancer treated by 
compression alone with the view of producing atrophy. Of 
these ten were cured, and the remainder, with two exceptions, 
more or less benefited. For a time it was considered a great 
conquest in therapeutics, but after a more thorough trial in the 
Middlesex Hospital and elsewhere it was deemed inefficient, 
and is now very rarely if ever employed. 
The first reported case with which I am acquainted where 
electricity seemed to possess any remedial power in cancer was 
reported by Dr. Easton, and was in the person of a lady who, 
having been struck by lightning, found that a scirrhous tumor 
with which she was affected, and which had resisted various 
modes of treatment, gradually disappeared. It is unnecessary 
to add that since that time many experiments have been made 
with electricity with results so well known that I shall not 
repeat them here. Suffice it to say that in my opinion electric- 
ity as a remedy in cancer is not to be compared to such agents 
as the arsenical mucilage, or indeed to any of the caustics in 
common use. 
Excision has long been a favorite remedy with the profession, 
and in many cases, as is well known, is the most efficient of all 
modes of treatment. I may add that the tendency among sur- 
geons at the present time is to nse the knife at an earlier period 
of the disease and excise more of the surrounding tissues than CANCER AND ITS TREATMENT. 
9 
formerly, and that the results are thought to be more satisfac- 
tory. 
The treatment of cancer by caustics is of almost equal value 
with that by excision, and is so recognized by many re- 
cent authorities. The agents which are in most common use 
are the strong sulphuric acid, nitric acid, caustic potash, 
terchloride of antimony, bromine, chloride of 'zinc, and arseni- 
ous acid. The principal objection to most of these is the ex- 
cessive pain attending their application. The least painful of 
the above-named is the arsenious acid, used according to the 
method practiced by Dr. Marsden, of the London Cancer Hos- 
pital, who after an experience of nearly twenty years, and cov- 
ering upward of six thousand cases of cancer, pronounces it su- 
perior to every other caustic. lie recommends it in every form 
of cancer, except the cystic or colloid varieties—provided the 
disease does not exceed four square inches in size—when re- 
moval by the knife appears to be the only remedy. Arsenic 
may be used in this way for cancers in every situation, except 
the interior of the mouth or nose, localities where the nature of 
the remedy makes it dangerous. The formula used at the 
cancer hospital is the following : 
R. Arsenious acid, .... 3 ij; 
Mucilage of gum acacia, . 3 j. 
Mix into a paste too thick to run. This is to be spread over 
the entire surface of the cancer, provided this does not exceed 
one square inch in size; a bit of dry lint is then placed over 
the sore in order to absorb any excess of paste. In the course 
of an hour the lint becomes dry and hard, and adheres firmly to 
the parts. In the course of twenty-four hours some inflamma- 
tory action is visible in the tissues immediately adjacent to the 
cancer. There is often also some pain, but this is not usually 10 
CANCER AND ITS TREATMENT. 
severe, and lasts but for a day or two. -After the lapse of two 
or three days, according to circumstances, bread and water 
poultices, changed every few hours, are to be constantly applied 
over the sore. A distinct line of demarkation is usually to be 
seen by this time, and the slough gradually separates and comes 
away, leaving a healthy cup-like depression, varying in depth 
and size according to the mass removed. Granulation pro- 
ceeds rapidly, and the case is then treated as a simple ulcer. 
The slough separates at periods varying from six to thirty days, 
according to its size. The disease usually comes away entire 
with the slough; but where this is not the case the paste is to 
be applied to the remaining portion, as in the first instance, 
every second or third day, till the desired effect is produced. 
The arsenic really appears to have a positive power of election 
so that if applied to sound tissue along with the cancerous, the 
diseased part alone is destroyed. Marsden’s large experience 
seems to prove this conclusively. The arsenical paste is ecpially 
applicable to cancer, whether on the lip, face, head, arm, hand, 
abdomen, breast, penis, testicle, labium, scrotum, or foot; but 
must, as I have stated, be carefully watched, and never applied 
where the disease involves more than four square inches of tis- 
sue. Many medullary and scirrhous cancers can be removed in 
this way, but it is especially applicable to the epithelial variety. 
Marsden believes that nine out of ten cases of this form may be 
perfectly cured if taken in time. 
Before mentioning my own experience in the use of the 
remedy I will give the history of two cases kindly furnished me 
by Prof. Fordyce Barker, and which he reported at the blew 
York Library and Journal Association in 1873. 
Case I.—A lady with a most malignant type of 'cancer, re- 
fusing to have it removed by the knife, was treated by Mars- 
den’s method. In eighteen days after the first application of CANCER AND ITS TREATMENT. 
11 
the paste the slough separated and cicatrization was soon com- 
pleted. Nearly four years after removal there has been no 
recurrence of the disease. 
Case II.—Had at one time a tumor of the right breast, 
which Professor Parker considered noil-malignant, and which 
disappeared under treatment. Three years after the patient 
returned with a true cancer of the left breast, which had 
existed about a year. Marsden’s treatment was at once used. 
It gave but little pain. In eighteen days the slough came 
away, and in ten more days cicatrization was complete. This 
was in April, 1873. The patient remained well for a year, 
when the disease returned in the same breast. Peing in Lon- 
don at the time she consulted Dr. Marsden, who decided in favor 
of immediate removal by the knife. The result was a wound 
eight inches in diameter, which healed by granulation in about 
two months. The further history of the case is not known. 
I)r. William W. Crandall, of Andover, N. Y., has kindly 
furnished me notes of the three following cases occurring in 
his practice : 
Case 1.—Mr. , aged sixty-nine years (no history of can- 
cer), had an epithelioma, three-quarters of an inch in diameter, 
situated behind and a little below the left ear, of two years’ 
standing. The paste was applied, followed in ten days by the 
fall of the slough, and healing of the ulcer in three weeks. 
The patient lived two years without any recurrence of the dis- 
ease, when he died of some cardiac affection. 
Case II.—Mrs. , aged fifty years, had an epithelioma 
about the size of a dime on the right cheek. A second appli- 
cation of the mucilage was necessary to effect the required de- 
struction. The slough came away in nine days, and the sore 
was completely healed in about two weeks. Five years after 
she remains well. 12 
CANCER AND ITS TREATMENT. 
Case III. was under my own care, for the most part, after 
Dr. Crandall first applied the paste. The patient, aged sixty- 
two years, was first seen in the spring of 1872. Four years 
before he had a small epithelioma of the neck removed by 
nitric acid. Nine months after a tumor on the vertex, supposed 
to be a wen, commenced ulcerating in consequence of a slight 
/ 
blow, and assumed the character of medullary carcinoma. 
Wl len I first saw him, the broad overhanging portion was two 
inches in diameter, and rested upon a firm base half that size. 
The fetor was almost intolerable. The site of the old epithe- 
lioma had also ulcerated anew. There was no glandular 
affection. The paste was first applied to one-third of the tumor, 
left on two days, and another part attacked, and after the same 
length of time the remaining portion ; poultices were then 
applied. The line of demarkation was perfect, but it was. 
nearly six weeks before the diseased mass was completely 
removed. The bone was found to be denuded of periosteum 
for a space more than an inch in diameter. The healing pro- 
cess was very tedious. Three bony exfoliations were at 
different times removed, and over a year elapsed before cica- 
trization was complete. 
Six months after the tumor of the scalp was cauterized I re- 
moved by the same treatment the recurrent epithelioma of the 
neck, which meanwhile had become one inch in diameter. 
The slough speedily separated, and in six weeks the sore was 
healed. There has been no return of the disease up to this 
date. I have treated the following cases in the same way, and 
with uniformly satisfactory results : 
Case I.—Mr. L., aged fifty-five years, had a small warty 
growth on the side of the nose, which two years before began 
to show signs of malignancy. At that time a physician advised 
him to let it alone, which he did until the cervical and axillary CANCER AND ITS TREATMENT. 
13 
glands became successively infected. Removal was effected by 
the paste in ten days, and healing complete in six weeks, 
without leaving any visible cicatrix. lie died two years after 
of what was supposed to be cancer of the lung. 
Cask II.—Mrs. , aged sixty years, had an epithelioma on 
the forehead just above the left eye, which had annoyed her for 
nearly three years, and had finally attained a diameter of three- 
quarters of an inch. The paste was applied to the entire sur- 
face. The slough came away in ten days, and in four weeks 
cicatrization was complete. The patient has continued well 
now for two years. 
Case III. was an epithelioma of the face in a man aged 
fifty-eight years. It was ten lines in diameter, was removed 
in eight days, and the sore healed by granulation in six weeks. 
.INine months after there has been no recurrence. In this case 
the power of election already mentioned was well shown. 
The lint was accidentally moved from the point of application 
before it hardened, so that when he came back in two days it 
covered nearly as much healthy skin as cancerous tissue, but 
the diseased portion only had been destroyed. 
Case l\r.—Miss , aged fifty years, whose father died 
of cancer, had an epithelial ulcer of two years’ standing near 
the inner cantlms of the left eye. In February, 1874, the 
mucilage was applied and allowed to remain on for thirty-six 
hours. The swelling of the eyelids and face was considerable 
but soon subsided under poultices, and the cure was complete 
in five weeks. The patient remains well, November, 1874. 
Case V.—Mr. , aged sixty-four, had a fiat epithelioma, 
situated over the superior angle of the left scapula, an inch 
and a half in diameter and nearly circular, which had existed 
for two years, and was the seat of severe stinging and darting 
pains. The skin was first cauterized with potassa fusa to 14 
CANCER AND ITS TREATMENT. 
produce a good absorbing surface, and then the mucilage 
applied in March, 1874. After the slough came away, some 
hardness remaining in a portion of the sore, this was treated 
in the same way. The cure was complete in two months, and 
continues so November, 1874. 
Case VI.—Mrs. R., aged forty-nine years, had a medullary 
pancer of the arm seated over the middle of the triceps muscle. 
It first appeared as a wart, six years before, and had gradually 
increased in size until it measured three inches in diameter 
and rested upon a base about half that size. Increasing pain 
compelled her to seek relief. The fetor was excessive find 
hemorrhages frequent. There was a hard tumor in the axilla, 
which was very painful. The case was similar to one of 
Marsden’s, in which he removed the tumor with a loop of 
wire, and then applied the mucilage to the base; but in order 
to test the power of the arsenic I applied it to one-fourth 
of the surface, repeating the operation every other day, until 
the whole was cauterized. The mass was then cut away to 
the base without pain, and the paste once more applied, which 
brought away the remaining portion six days after. The cure 
was completed in twenty-six days. In the meantime the 
tumor in the axilla proved to be an abscess, was opened, and 
soon healed. The patient remains well at present—November, 
1S74—while her general health has greatly improved. 
Case VII.—Miss , aged forty-five years, applied for 
treatment at Demilt Dispensary, March C, 1874, with a malig- 
nant tumor on the forehead just above the outer angle of the 
left eye. It was oblong, nearly two inches in length and 
one in width, with considerable elevation. It was soft, very 
vascular, and often bled freely. Four years before the growth 
was treated for a time with terchloride of antimony, but the CANCER AND ITS TREATMENT. 
15 
severity of the pain attending the application caused her to 
abandon it. The tumor was rapidly reproduced. In October, 
1872, it was almost entirely removed with nitric acid. When 
first seen by myself the tumor was larger than ever before. 
The mucilage was applied and allowed to remain thirty-six 
hours, when, the line of demarkation having nearly encircled 
the growth, poultices were applied. Two days after the paste 
was re-applied to the deepest portion. In two weeks the 
slough separated, and granulation proceeded rapidly until the 
wound was almost healed, when diseased tissue again showed 
itself. It was necessary to make another application of the 
paste, with the result of securing perfect cicatrization in sixty 
days. Six months after the patient continues well. 
To summarize my experience in the use of the arsenical 
mucilage in cancer, I believe— 
1. That it is to he preferred to any other caustic, as giving 
less pain during its application. 
2. In cases to which it is adapted it is superior to excision, 
(a) because of the greater readiness of patients to submit to it, 
(b) the less amount of shock, and (c) the avoidance of anaes- 
thetics. 
3. It acts in a remarkable degree on the cancer, while the 
surrounding diealthy tissues are comparatively unaffected by 
it. * 
4. When properly used it is free from danger, and the fear 
therefore of poisoning is groundless. 
5. It is most efficient in the earlier stages of cancer, the 
same being true of all other modes of treating this affec- 
tion. 
6. It being of such easy application, cancer patients may be 
treated promptly at home and by their usual medical attend- 
ant. 16 
CANCER AND ITS TREATMENT. 
7. Finally, a general acceptance of this plan of treatment 
would so far promote the early removal of cancer that many 
lives, which would otherwise be lost in consequence of the 
dread of a surgical operation, would thereby be saved. 
New York.