sumption is so very common that the people feel at home with it. It is considered a terrible affliction, but one so often observed that familiarity with it has bred more than pity.

The intelligent people need but this specific education. They need but to know that this fell destroyer is capable of control, that to control it it is but necessary to destroy the virus contained wholly in the discharges from the diseased organ, and the assurance that, in its control, the loved victim need suffer no curtailment of his inherent rights, no diminution of their tender care, and that in a careful observation of sanitary regulations, he is not only protecting them, but is, by so much, making his own cure the more possible. And they need to realize the necessity of an early and accurate diagnosis, and the danger of neglecting the first beginning signs of enfeeblement.

With the ignorant poor, and the wilfully careless and the vicious, the case is not so simple. Because of the greater difficulty in educating these classes, it is a question if it would not be wise at the start to empower health boards to isolate, in specially adapted hospitals, such as will not or cannot conform to the regulations for home care. That certainly will come in time, for, as soon as a public sentiment in favor of the restriction of infectious diseases is firmly established, just so soon will the people force those put in charge of the public health to compel an observance of sanitary laws on the part of the wilful and the ignorant.

If we are profoundly convinced of the possibility of restricting the ravages of this scourge of mankind, shall we escape deserved censure for not making a vigorous effort, because there are difficulties in the way?

No timid, half-hearted, apologetic and advisory action will ever win the coöperation of the profession and the respect of the people. But if the plain facts are vigorously stated, that tuberculosis is a curable disease, a contagious disease, and a preventable disease, and that with the coöperation of the people of the State, every one of whom is vitally interested, the number of cases can be diminished 50 per cent. in ten years-as is firmly believed I predict that we should have such strong support from the more intelligent of our citizens that the ignorant and the vicious would be speedily compelled to conform to the prescribed sanitary regulations.

To summarize, the following conclusions may be drawn:

1. Tuberculosis is an infectious and curable disease, capable of restriction.

2. That the State should compel the registration of every case of tubercular disease.

3. That circulars of information as to the nature, communicability, and sanitary care of all tubercular disease should be sent to those afflicted with the disease, and to those attending them.

4. That instruction as to the nature of contagious and infectious diseases, and the practical methods for their control should be given to all senior pupils in public grammar schools.

5. That all owners and trustees of places of public entertainment, including churches and schools, and all public carriers should be required to prevent contamination of their halls and conveyances, and to disinfect them when contaminated.

6. That the hopelessly ignorant, wilfully careless and vicious afflicted with tuberculosis should be isolated in special hospitals provided by the State.

THE TREATMENT OF MALIGNANT TUMORS IN SO-CALLED CANCER CURE

INSTITUTIONS.1

BY NATHAN JACOBSON, M.D.,

OF SYRACUSE, N. Y.;

PROFESSOR OF CLINICAL SURGERY, COLLEGE OF MEDICINE, SYRA-
CUSE UNIVERSITY; SURGEON TO ST. JOSEPH'S
HOSPITAL, SYRACUSE, N. Y.

It is rather my purpose in this paper to invite a discussion upon the subject of what is claimed for and accomplished in the so-called "cancer cure" institutions, than to enter widely upon its consideration. It is known to all, that people afflicted with what is, or what they are told is malignant disease, seek relief from their afflictions at the hands of these "cancer specialists," both because of their fear of the knife, and the glowing promises made for their certain cure by escharotics. The claims of these cancer hospitals are set forth in very seductive language and the most positive assurance is given that their method, and only their method, can effect a permanent cure.

While not aiming a blow at any single institution as my intent is rather to discuss methods and results-my attention has been particularly directed to the work done in one of them, and I assume that this work is the type of all.

In the pamphlets issued by this and similar institutions, it is stated in vigorous language, that the knife fails to cure more than ninety-five per cent. of the cases operated; that the only argument in favor of operation upon cancer of the breast, for example, is that it can be done in from one to three hours, and the wound healed in from 1 Read before the New York State Medical Society, January 28, 1896.

two to four weeks.

But in the same breath we are assured that such a procedure is certain to witness a return of the disease in worse form, and that the arm on the diseased side is sure to be impaired and in many instances rendered entirely useless.

It is further stated that the entire profession recognizes the inability of the knife to remove the disease, and hence recommends operation, only as a last resort. Moreover, the most serious objection to removal of the breast by operative measures, we are told, is that the surgeon is unable to determine, be he ever so skillful, whether or not he has removed the last vestige of the disease, while the escharotic method entirely circumscribes the mass, protects the healthy parts from further invasion, and when the slough has separated there remains a granulating wound so absolutely bloodless that one is enabled to determine what portion, if any, of the disease still remains. We are further informed that if any cancer cells exist, they positively stare you in the face, and that they can be at once removed by this same method. appears furthermore, that the particular remedies applied are of secondary importance, and that the value of the treatment lies in this ability to determine whether or not the disease has been removed, and only their particular method renders this possible.

It

The claim is further set up that no other known method is as painless, and produces so little inconvenience; that the pain is never severe enough to prevent sleep, nor to confine the individual to her

room.

It is asserted by one of these institutions, that up to the present time, there never has been a failure to effect a permanent cure in any case in which their physicians were able to give a favorable opinion. To use their own statement, "We can truthfully say, that we never fail to cure any case of cancer, where we have had and accepted the first opportunity for treatment," and this is from the institution of which we will hear more in detail. In a circular at hand, we learn that more than three-quarters of all physicians and surgeons in good standing in the United States, indorse their method. The serious charge is made that the surgeon is aware of his inability to cure this disease, and that for mere pecuniary gain and absolutely for no other reason, he performs an operation, knowing full well that it cannot prolong life, but in reality shortens it, as the disease is certain to progress more rapidly after than before operation.

cancer and treat as such, is perhaps summarized best in one of their published statements, which I quote verbatim: "Nearly all those lumps and kernels that appear on or in the breast, and all those sores, lumps, or unnatural appearances in the form of crusts, warty excrescences, which occur in either sex, but far more commonly in the male, on the lip, nose, eyelids, face or any part of the surface, are cancers, and should have immediate attention. The only symptoms for months, and in many cases for years, are occasionally a stinging, shooting, burning, itching or creeping sensation, and in many cases not even any of these. If you have a branny, scaly, crusty or warty appearance, with an occasional exfoliation of the same upon the face, lip, nose, or any other portion of the skin, attended with any of the above symptoms, or giving an occasional sensation as though a fly had alighted upon the part, or a hair were tickling it, the evidence should be conclusive that your trouble is cancer, and no delay should be made in having it cured. Life is far too valuable to be tampered with or sacrificed."

We are assured that the time required for the cure of these cases by escharotics is quite brief. The enticing statement is made in a pamphlet issued by an institution, whose work I shall presently analyze, that by recent improvements in their method, they are enabled to shorten the stay of their patients, so that for cancer of the breast, even though extensive, three to five weeks suffices, and in the less severe cases the period is proportionately shorter. In another institution, as low a period as two weeks is given. Each case, however, can be and is told approximately, how long a time will be required to effect a cure, after the preliminary examination has been made.

Unfortunately, many of these institutions are in the hands, not of ignorant, uneducated pretenders, but men who have been liberally educated in the arts and are graduates of recognized medical schools.

My attention was particularly called to this. subject by the treatment a lady who had previously been under my care received in what is claimed to be the largest and most successful of the sanitariums for the cure of cancer in the United States. Certain it is, this institution in the printed circulars it issues, makes the most extravagant representations as to the simplicity, painlessness, brevity, and efficiency of the treat

ment.

To place in bold relief, however, the actual condition of things as opposed to the false and untenable positions taken by the so-called "can

cer specialists," allow me to present to you not only the history of this patient, but also what was unearthed during her stay in this cancer hospital.

Mrs. A. consulted me November, 1891, when I found present in the outer upper quadrant of her left breast a movable, hard, nodular tumor, which presented the usual appearances of scirrhus. I urged amputation of the breast. She was fearful of the knife and would not consent. For a year I had her under observation, during which time the growth made very slow progress, remaining freely movable, excepting as it grew toward the surface, where it became quite adherent to the skin. However, it could be entirely circumscribed, and at no point was it attached to the chest wall. There were no glandular enlargements recognizable in the axilla. The continued presence of the tumor and the diagnosis given naturally alarmed her, and without seeking further medical advice, she placed herself in a widely known "cancer institution."

She entered it September 19, 1893, and was assured that her case was a promising one and that a cure was certain. Fourteen months of treatment—I might more truthfully say of torture -were spent here. Her husband states that the first application was made at 10 o'clock in the morning, and that until 4.30 in the afternoon she was almost wild. The application was repeated on three consecutive days, and afterward every three to four weeks, during the period of her stay. Widespread sloughing resulted.

She became steadily more emaciated and enfeebled until, on the 10th of October, 1894, she was obliged to take to her bed, and then was told she had pneumonia. On the night of November 5. 1894, she was carried out of the "sanitarium," placed upon a train, and transported home. On leaving the institution, her medical attendants declared that there was no trace of

the malignant disease left, that she was entirely clear of every vestige of cancer.

I saw her on November 11, 1894. Her pulse was so feeble that I could scarcely feel it; the respirations were 24 and the temperature 99.

At the previous site of the left breast, instead of a mamma, there was extensive scar tissue. Midway between the mammary and axillary lines, on a level with the third rib, there was an unhealed

into the left pleural cavity. Pleural adhesions existed on all sides. Each pleural cavity contained serum. The left lung was filled with small secondary deposits, but at no place was there direct extension inward, from the surface, nor was there any involvment of the ribs. The right lung was very much contracted, solidified here and there, and saturated with secondary growths, varying from one-half to three-quarters of an inch in size. The heart wall was thin and flabby. There was no evidence of secondary involvement of any other organ.

While at the institution, her husband had been her constant attendant. He became well acquainted with the various inmates, and as a matter of personal interest, formulated a table which records the names of all the inmates of the institution, at the date of admission of his wife, i.e., September 19, 1893. His table notes the residence, the respective age, sex, date of admission and dismissal of the various patients, the site at which the disease was located and the ultimate termination of the various cases.

Let me present to you these statistics. Whether they are better or worse than we could obtain from the same institution at other times, or whether this tabulated statement tells the full truth for all

time, I cannot say. Certain it is that these "cancer specialists" do not publish their statistics and that it is rarely we can ever obtain exact information concerning them.

To avoid any legal entanglement, as I am not desirous of courting a lawsuit, I do not mention the name of the institution. I can assure you, however, that my statistics are absolutely trustworthy and that they are presented as furnished

me.

66

It appears that there were twenty-six patients in the hospital" September 19, 1893. These are classified in four groups. The first contains ten cases of cancer of the breast and includes my patient. All of these had been subjected to the treatment and each one of the others was dead when my patient passed away, December 14, 1894. One of these after a period of treatment of five and a half months died in the institution. Another lived ten days after her dismissal; still another died in four weeks, my patient in six weeks, and yet another in two months. None lived longer than nine months. One of these was under treatment in this institution for a period of one and a half months, one four and a half, one five and a half, and the remainder from nine to fourteen months, with an average of eight months for the

ten.

In the next group are placed six cases who were under treatment for periods of five months, seven and a half months, eleven, twelve and fourteen months, respectively, with an average of ten months, and who after this prolonged period of torture were finally pronounced hopeless and sent home to die. How many of these are dead I cannot state, inasmuch as their cases have not been followed up. In this class the breast was involved twice, the uterus once, and likewise once, each, the eyelid, lip and face.

In the third series were eight cases indicated as not having recovered. Of these, four were of the breast and four were epithelioma of the face, one being described as being the size of a "hazelnut, the second of a "bean," the third as "trifling," and the fourth involving the face and nose, and is

To summarize then: Of the twenty-six patients, ten were dead at the time the cases were tabulated, six were pronounced hopeless, three more had the cancer recur and seven believed themselves to be cured. Among the latter, four certainly were very trifling affairs. Whether all of these were positively cancerous, there is grave question, and whether all so indicated and not heard from have remained free from recurrence I cannot state. But were we to concede that they all were cancers and that none had recurred, the results still make a frightfully bad showing.

When we compare these results with the fair promises held out by these institutions of the certainty of cure, where the patients are accepted. for treatment and assured that their cases are favorable for escharotic treatment, it becomes at