LOCAL TREATMENT OF MALIGNANT NEOPLASMS 231 



Where the protein in question is new tissue of cancerous char- 

 acter, the process of decompounding and elimination is of course 

 entirely comparable. The leucocytes (in particular, probably, 

 the large mononuclears) begin the process of hydrolysis, and the 

 red corpuscles continue it beyond the polypeptid stage and carry 

 away the toxic by-products. 



So we might expect a certain amount of relief, and even in 

 favorable cases an actual curative process, to be engendered by 

 local inflammation, however induced, in the region of a malignant 

 neoplasm at an early stage. Such an expectation is occasionally 

 justified. I have recently had called to my attention at first hand 

 a case in which, seemingly, an accidental streptococcus infec- 

 tion resulted in the disappearance of an epithelioma of the lip 

 quite without treatment; and this observation is by no means 

 unprecedented. Doubtless there are scores of irritative or caustic 

 compounds that have in exceptional instances produced the "cure" 

 of a local epithelioma, or of a carcinomatous ulcer of the breast, 

 through inducing such a local inflammation. 



Such cases, however, would obviously be exceptional, and in 

 general it is to be hoped that a local inflammation will prove 

 curative in any case of a well-developed malignant neoplasm only 

 in occasional instances. As an adjunct to general treatment, how- 

 ever, the application of a local irritant may be of value. But at 

 best this treatment must be considered as an adjunct only. 



It is my belief that much the same statement may be made 

 with regard to the efficacy of the treatment of the local neoplasm 

 with the knife. I am aware that this view is heretical, but it 

 follows as a natural conclusion from the line of reasoning above 

 outlined. 



To be sure, it is current surgical doctrine that if cancer can be 

 removed early enough, and removed in its entirety, the patient 

 is cured. 



But in point of fact, if the present thesis as to the nature of 

 cancer is tenable, the surgeon who has removed a malignant 

 neoplasm, even in its earlier stages, and even though the removal 

 had been as complete as is ever feasible, far from curing the 

 malady, has not really treated the malady at all. He has removed 

 a local manifestation of the essential systemic abnormality that 

 is the true "malignant condition," but at best the treatment is a 

 tentative dealing with symptoms, and has no reference to the 

 essential disease itself. 



It is true that the removal of the local neoplasm takes away a 

 certain amount of tissue that, through partial dissolution, is 

 poisoning the system ; and thus may be a valuable aid in the treat- 

 ment of the amaladjustment in the process of nutrition, which 

 constitutes the essential character of cancer. But to treat the 



