LOCAL TREATMENT OF MALIGNANT NEOPLASMS 229 



SECTION III 



THE LOCAL AND SURGICAL TREATMENT OF 

 MALIGNANT NEOPLASMS 



We have seen that the development of a local neoplasm implies 

 defective conditions of general blood supply. 



Such deficiencies may be accentuated by local perversion of 

 circulation, as, for example, where the capillaries and veins are 

 rendered patulous by the persistent application of heat, as in the 

 use of a clay pipe, or of the abdominal heaters carried by certain 

 natives of the Orient. 



In a slightly different way, the presence of an excess of adipose 

 tissue, may interfere with the circulation, and tend to produce a 

 local anaemia even while the general blood supply is fairly 

 adequate. 



In a case in which the general conditions of protein metabolism 

 were just at the border line, so to speak, of the cancerous condi- 

 tion, that is to say, of out-and-out abnormality, a compara- 

 tively slight interference with circulation at some local point may 

 give opportunity for the development of a neoplasm that other- 

 wise would be held in check. 



Such a condition is found, for example, in nearly all scar tis- 

 sue. Every pathologist knows that scar tissue is poorly supplied 

 with blood vessels, and that it tends rather readily to break down 

 under irritation. In other words, it has not a normal degree of 

 resistance. Doubtless this lack of resistance is closely associated 

 with the defective blood supply. If, now, in addition, there is 

 some source of irritation that tends to stimulate the growth of 

 the cells (as all irritation does tend to do), conditions are favor- 

 able for the development of a neoplasm, which will be non- 

 malignant or malignant according to the general condition of the 

 blood, or according to the precise character of the new tissue 

 itself. 



If the balance of leucocytes is right, and there is an adequate 

 supply of red corpuscles to deal with the later products of protein 

 decompounding, the new tissue will be cared for by the system, 

 and the condition of malignancy cannot develop. 



If, on the other hand, the red cells are inadequate either in 

 number or in activity, the development of the new cells will 

 almost of necessity result in a condition of malignancy. 



Even when at the outset the red cells are adequate the growth 

 of the new tissue may be so rapid as to supply a larger amount 

 of protein than can be dealt with (particularly if the red cells 



