B. Medical Treatment

The medical treatment has the following points in view: To strengthen the organism by a proper mode of nourishment, thereby prolonging life as much as possible, and to alleviate the morbid phenomena. The first point can be achieved by a proper diet. The more food the patient can be made to take and to assimilate the better.

This should be the most important principle in guiding us. Ample variety in the bill of fare and the individual inclination of the patient will have to be considered. Trousseau said that the patient should be allowed to eat what he himself thinks he can best tolerate. The following may be given as general rules: The diet should consist of milk, kumyss, matzoon; farinaceous foods; soups containing leguminous foods in a finely divided state (ground); eggs, either raw or soft-boiled, or well beaten up in soup or milk; small quantities of meat, either raw and well scraped, or broiled; the white meat of a chicken; squab, calf's brain, sweetbreads, oysters, fish, white French bread; crackers, with the addition of a small quantity of sweet butter; tea and coffee, wine, ale. In the later stages of the disease many articles of the just-described diet will not appear suitable, and the maintenance of nutrition becomes gradually more difficult. Here the artificial foods, the various peptone preparations (Wyeth's beef juice, Kemmerich's or Rudisch's peptone, Mosquera's beef jelly, somatose, Armour's beef peptone), are in place.

Medicinal Treatment

As yet no specific remedy against cancer has been found. The treatment must therefore, be a palliative one, and chiefly directed toward combating the more pronounced morbid manifestations and alleviating pain. In cardiac strictures Boas1 recommends the use of potassium iodide. This author reports a case of oesophageal cancer in which he employed sodium iodide (2 to 3 gm. pro die) for over six months. During this whole period the patient remained free from symptoms, and even gained nine pounds in weight. I have also administered this drug in several cases of cardiac stenosis, and frequently obtained transient good results. Arsenic has also been given in this affection (solutio arseni-calis Fowleri, three drops three times daily), sometimes with good results. One of the principal remedies which is employed in gastric cancer is condurango. This drug was recommended in 1874 by Friedreich,1 as a specific against cancer. While, however, further researches did not substantiate this favorable report, but rather proved that condurango has in no way a specific action on cancer, many writers agree that it is an excellent stomachic and as such helps greatly to alleviate some of the gastric symptoms accompanying malignant affections of the stomach.

Ewald, Rosenheim, Boas, strongly advocate the use of this drug. I also administer it in the greater number of cases. Ewald usually employs it in combination with hydrochloric acid. Condurango may be given in the form of a decoction. 25 to 200 gm. water, one tablespoonful every four hours; or in the form of fluid extract, of which twenty drops or even more can be given three to four times daily. Another drug from which I have sometimes seen beneficial effects in this malady is methylene blue. I2 was the first to recommend its internal use in cases of cancer. I have employed it in eight cases of cancerous affection of either the oesophagus or the stomach. In three of these cases I was able to note a great improvement of most of the morbid phenomena. In one case, in which a considerable tumor occupied the gastric region, this appeared to have become sormwhat smaller after the drug had been used for about three weeks. This patient took methylene blue for a period covering eight to nine months uninterrupt-edly, being all the time quite free from pain and not lotting in weight, the tumor meanwhile not getting any larger. After this period, however, the tumor began to grow again and the patient rapidly succumbed. Methylene blue is best given in gelatin capsules, 0.2 gm. once or twice daily.

While I do not believe that this drug is able to cure a cancerous disease permanently, 1 am of the opinion that it seems to exert a beneficial action in some cases of cancer.

1 Boas: l. c.

1Friedreich: Berl. klin. Wochcnschr., 1874.

2 Max Einhorn: "Ueber die Anwendung des Mcthylenblau." Deutsche med. Wochcnschr., 1891, No. 18.

In all cases in which either decomposition of food or ulceration is taking place, one of the best remedies to alleviate these conditions, and also subdue the discomforts produced by them, is chloral hydrate. Ewald was the first to advise its use, and I also advocate it highly. It may bo given in the form of a three per cent solution, one tahlespoonful every two or three hours. The remainder of the remedies em-plexed is simply symptomatic; thus, in case of pain, epann, morphine, or codeine must be administered. The combination of an opiate with belladonna is very must be relieved, either by mild aperients (rhubarb, compound licorice powder, cascara sagrada), or by enemata, or glycerin suppositories. Occasionally the following pills may be prescribed:

℞ Extr. aloes,

Extr. rhei comp.,.......aa. 2.0

M t. pfl. No. xx. D. 8. One to two pills in the evening. 21