232 THE PROTEAL TREATMENT OF CANCER 



local condition, and imagine that in so doing one has cured the 

 malady, is hardly less futile than would be the supposition that 

 one has cured a case of syphilis because one has excised a syphili- 

 tic wart or healed a chancre or a tertiary ulcer by local cauteriza- 

 tion. 



The futility of even the most drastic surgical interference is 

 unequivocally illustrated by the history of a case examined and 

 diagnosed by me in which both breasts and the axillary glands had 

 been removed because of the presence of small nodules which were 

 pronounced of doubtful malignancy by a competent microscopist ; 

 yet in which the blood six months later recorded 17 per cent, of 

 large mononuclear leucocytes, half of them myelocytes, leucoblasts, 

 and lymphoidocytes ; together with red cells showing poikilocytosis 

 and polychromasia, and not infrequent normoblasts, evidencing a 

 condition of myelogenous excitation that in connection with the 

 history of the case left one not at all in doubt as to the existence 

 of the cancerous condition. Here surgery had been given the best 

 possible chance, and had obviously failed. The patient died, un- 

 treated, six months later. 



It does not follow that the surgeon's knife should be held in 

 abeyance. On the contrary, there is the most logical reason for 

 using the knife, and removing as much as possible of the local 

 neoplasm that evidences the systemic disturbance. But such a 

 procedure should be but a small part of the process of treatment 

 of the cancerous condition. In every case where a malignant 

 neoplasm is removed by the surgeon's knife, there should be the 

 most careful examination of the blood, with full count of the 

 corpuscles both red and white, and differential count of the lat- 

 ter. There should be the closest scrutiny of the patient's habits 

 of living, with notable reference to the diet, the condition of the 

 bowels and kidneys, and the general processes of assimilation and 

 bodily metabolism. Only by attention to these, and the readjust- 

 ment of the perturbed process of assimilation, can there by any 

 reasonable grounds for hope that the excised neoplasm will not 

 recur. 



It is partly because surgeons usually fail to give such attention, 

 that the neoplasm does return after surgical removal in so pre- 

 ponderant a proportion of cases. That it ever fails to recur must 

 be ascribed to the good luck of the patient, or to his chance obser- 

 vation by an internist of discrimination and judgment, rather 

 than to any merit of the average performer of the operation. 



I shall have something more to say presently about the pre- 

 operative and post-operative treatment of malignant neoplasms, 

 suggesting, among other things, that any surgeon who fails to 

 avail himself of therapeutic measures now available for general 

 treatment of the case in connection with his operations must be 



