So time went on, and still my patient insisted on conversing with me about his mother, of whom he is very fond. He even stopped me at railway stations to tell me of the poor ladys sufferings. Finally, en desespoir de cause, he brought her to me for my opinion. I am now particularly pleased that he did so, as the course of the case taught me for the first time the vastly important lesson, that even after an operation we need not give up hope, –nay, more, that where an operation has been performed, constitutional treatment should be began at once, to get at the root of the matter and prevent any further local expression of the disease, by attacking its cause or causes.
I say or causes, for cancer is not a disease that can produce its like after the manner of, say syphilis or scarlatina, but is essentially a hyperplasia of a degraded type at the end of a chain that has many (causal) links. But to my case:.
October 23rd, 1883. Mrs. — 47 years of age, had her left breast removed for cancer two years ago last May by an eminent surgeon. In February, 1883, she had had erysipelas of the face, and as she lay in bed therewith paresis of right foot, which passed off. She had variola at the age of three; is subject to winter bronchitis with much dyspnoea. On examining the chest, one sees a long but very neat scar where the left breast used to be.
The outer and inner ends of the scar are a little tender, and the tissue at the outer end is rather swollen of late. The patient cannot bear the part to be touched. The right breast is the seat of a hard painful tumour of the size of a hens egg. The pain, however, is worst in the stomach (the ventriculus), which pain is described as “cruel”, like cramp, and worse at night.
Rx Tc. Cundurango Ix, 3iv. Five drops in water three times a day.
November 16th. Only had two attacks of stomach-pain since she was here. Anorexia no better; much flatulence; “flying spasms”.
December 12th. Much better in herself; stomach-pain gone; had had it a year; pain in the toe no better; the mammary tumour is less hard.
February 6th, 1884. Menses at first stopped, and patient gave up the medicine, as she attributed their cessation to the medicine; after leaving if off for a fortnight she got menorrhagia; gets nocturnal dyspnoea; wakes up with a cough; stomach continues better; feet are sore; the appetite is now good.
March 28th. Has been laid up with a cold and bronchitis, but the nocturnal dyspnoea is much better; digestion fair; feet less sore; the pain in the stomach has not returned; the tumour is very much softer.
Rx. Tc. Silicea 30, 3iv. Five drops in water night and morning.
April 28th. The tumour of right breast is decidedly less painful; there is now a hard painful portion of tissue over the site of the left breast, which pains most at midnight; patient feels ill.
Rx Psoricum 30.
May 5th. Feet very tender; both breast and the painful tissue very much better.
Rx Tc. Hydrastis canadensis I, 3iv. Five drops in water three times a day.
June 11th. Menorrhagia every fourteen days; feet very tender; tumour softer.
June 26th. Has prolapsus recti, with constipation; dirty brown leucorrhoea; breast is painless; tumour smaller; no pain in the stomach; feet better, less painful.
Rx Tc. Thuja 30.
July 23rd. Worse; very much pain in the stomach; last night it was most severe; tumour hard and painful.
Rx. Tc Cundurango Ix, 3iv. Ten drops in water twice a day.
August 20th. The tumour is rather smaller, but more painful; severe pain in the stomach. Patient has gone back to the lemons, which I formerly recommended, and which seemed to suit. There are now two painful nodes on the edges of the scar of left breast. Has had menorrhagia twice.
Rx Psor. 30, and Cundurango O.
September 5th. About the same; feet very tender.
Rx Tc. Cundurango O and Silicea 6 trit.
October 15th. Feet no better; stomach well; no pain in the scar; tumour in the breast is smaller and softer.
November 10th. Tumour of the breast much softer; the vaginal discharge has now ceased. Pains are always at night.
26th. Much better altogether.
January 7th, 1885. Gone back very much; breast very painful; the submaxillary glands are swollen and painful; the pain is “Cruel” and causes “vomiting by the hour”; vomits blood; pain keeps her awake at night; she has a taste of phosphorus in the mouth. She tells me now, for the first time, that she is an enormous pepper eater, which I forbid.
21st. Been to the seaside to pull up; the nocturnal pain is much better; the feet are tender and swell.
Rx Repeat et Cund. O.
March 4th. Much better; right breast much more elastic; the nipple is still very much retracted.
Rx Psor. C. et Cund.
30th. The pains wake her up; she shrinks from pressure on the chest.
Rx. Ranunculus sceleratus 3x. Four drops in water night and morning.
May 4th. Has now much pain under left arm, where there is some swelling and redness.
Rx Bellis p. I.
Rx Lapis alb. 5 trit.
June 17th. Tumour decidedly smaller and better both sides.
July 22nd. Parts very tender, and there is much acidity.
Rx. Tc. Acid hippuric 6, 3iv. Five drops in water night and morning.
August 28th. Did her seemingly much good for three weeks, when she had a dreadful attack of pain.
Rx Repeat (12)
October 21st. Did her much good.
Rx. Tc. Creatine 12, 3ij. Three drops in water night and morning.
November 20th. Much better; in fact, nearly well, but has whites now badly.
February 5th, 1886. Has not been since November 20th, 1885. She says the powders then given gave her cramp in the stomach, waking per up between 12 and 2 a.m., and causing nauseous risings; pains in the feet, which are sore and tender. Left them off, and the same phenomena recurred on resuming them. Has had no medicine for a month, and these symptoms persist. When she has a stool, the faecal mass slips backwards and forwards in the rectum.
Rx. Trit. 6, Silicea gr. vj., ter die.
March 17th. The breast is nearly normal, but the womb and feet are painful.
May 5th. Womb and feet better; gums very spongy, much waterbrash and vomiting of water.
Rx. Tc. Natrum muriaticum 12, 3iv. Five drops in water three times a day.
June 28th. Says the drops have very much upset her; gums are very blue.
Rx. Aconite and Silicea.
November 2nd. Breast well, gums still red and swelled and sore. Much abdominal pain from 2 to 4 a.m.
Rx. Trit. 4, Urea gr. vj., ter die.
Patient has paid me irregular visits off and on since, for gouty pains in various parts, but there is no return of the cancer.
I have given so many tedious details of this obstinate and difficult case to illustrate several points as clearly as I am able. In the first place, this case caused me to modify my previously oft-expressed opinion, that when once an operation had taken place, treatment by medicine is useless. I now known that this is not necessarily the case, but that a cure may be obtained even after an operation, and after a recurrence has begun. In the next place I again learn, and continue to insist upon, the importance of dogged perseverance in the medicinal treatment. And finally, it confirms my general practice of striking out on new therapeutic lines when the old ones do not suffice. The influence of the late Dr. Amekes teachings will be readily recognized by the learned in pharmacologic and therapeutic offshoots.
Looking now back on the whole of this case, considering all its points, the remedies that helped and those that did not, I get a comparatively clear view of its nature, which helps me in other cases. Were I asked to name its biopathology, I should say it was a hybrid union of psora, vaccinosis, chronic poisoning by pepper and tissue-gout, to which complexity there came the element trauma.
On July 5th, 1883, a lady of 73 came under my observation for a small hard tumour in her left breast. This breast had been injured thirty years ago, and gave her much trouble for a long time. For some months she had noticed its swelling and hardening. If pains a good deal; worse at night; and on moving the arm. In the preceding November there had been an eruption on the patients left leg, “large inflamed patches showed themselves”. The principal remedies used were Bellis perennis I, Psor, 30, Var, 30, Hydrastis I, and then finally Bellis I again; and on January 29th, 1885, patient was discharged cured; and she remained well, and is, I believe, alive and well at the time of going to press.
I do not give the details of this case as it is badly kept in my diary, but the foregoing contains most of the essential points, and the fine pharmacologist will readily see that the prescriptions were all more or less ex hypothesia. I might add that patient is deeply pitted with small-pox marks.
HARD PAINFUL TUMOUR OF BREAST.
On August 13th, 1878, Mrs.–, a country clergymans wife, between 40 and 50 years of age, came under my care for a tumour of the left breast in its out and upper aspect. It was about the size of a very small hens egg, hard and very painful. It had existed for some time, and she and her husband had become very anxious about it, the more so as her mother had died of vulvar cancer (an enormous epithelioma). Perhaps I ought to say that the mother died with the cancer, as she was 82 years of age. at her death. The mother had been my patient, but she was, she averred, unable to persevere with my medicines (Thuja O, 3, and 30) as they caused her so much pain.
Patient is married, has several fine children, and has been long subject to a very severe form of leucorrhoea.
It would occupy too much space were I to give all my notes of this interesting case in detail, for she was under my treatment for this tumour about three years.
My notes begin with August 13th, 1878, and my prognosis was a serious one unless medicines could be made to prevent the disease advancing.
I began with Urkalkgneiss 4th trituration ten grains at bed- time, and soon got into trouble on its account, for my patient showed the prescription to a learned lay lady. who is the recognized stock-taker general of all the unfortunate leeches of the neighbourhood in which they dwell, and she said. “Oh, Mrs.–, I know what the doctor thinks you have the matter with you, its cancer !”.
“How do you know ?”.
“Oh, the chemist told me it was the new German cancer medicine”.
Naturally this caused my patient much and needless anxiety, but then the chemist and the learned lady must have their confidential little whisperings about the doctors doings-it is no inconsiderable part of their rather monotonous lives. But this and many other similar experiences have compelled me often to withhold the names of the remedies.
Well, Mrs.– took Grauvogls Lapis alb. (4, 5, and 6 trit.) for a number of months without any noticeable effect; the lump went on growing, and the pain getting worse.
July 26th. 1879. Acid acet.1.
August 28th. No better; very weak. Conium maculatum 3x.
This remedy was continued for about two months, and it took away the pain, but it did not lesson the size of the tumour. Then followed Carbo. an 30, which was suggested by the profound adynamia.
November 28th. No pain; and she is now stronger, but the tumour is no smaller.
On January 6th, 1880, I received a letter telling me that the powders were finished, and that in addition to some pain in the tumour, patient had a good deal of pain in the stomach. I sent Condurango 1, and ordered her to take six drops in water three times a day.
February 24th. “A good deal of pain and uneasiness in the whole breast and shoulder and down the arm:.
April 10th. No change in the tumour; “for two or three weeks I did not feel it at all, and now I have a good deal of uneasiness, though no acute pain”.
Hydrastis1, Five drops in water night and morning.
May 19th, 1880. On this day the lady was brought by her husband to London, and they called to inform me that having continued my treatment ever since August, 1878 their friends wished for another opinion. The lady herself did not wish for any further opinion, but the husband was rather needlessly loud in demanding the opinion of at least one other, and that of Sir James Paget.
To this I declined to assent, because, said I, “What is the use of an opinion, or for the matter of that, what is the use of a barrowful of opinions ? The tumour is there; you can feel it and see it; that it is hard you can also feel; that it pains your wife knows but too well, and what possible prognosis can the men of the knife give but the everlasting old story, Oh, you must be operated upon as soon as possible.” Truth to tell, I am sick and weary of the lying statements that the knife is even any, and least of all the only cure for tumours. Not only does the knife not cure, but anyone having a tumour or lump cannot, as a rule, take a shorter road to the grave than via the knife-that is, unless it be very large, and unless the tendency to its recurrence be outrooted simultaneously with the operation, or soon thereafter.
Oftener than not, cutting out a small tumour is like pruning a vine.
But to return to my patient and her choleric husband, I absolutely declined any second opinion.
Simply because a very considerable number of people with tumours literally die of doctors opinions, and then what is the use or value of a never so eminent a pathologist on a therapeutic point ? Just none.
Of course, I know it is said to be very unprofessional to decline an eminent colleagues co-operation in a given case. But I did it for my patients good, not for my own; and, moreover, they do the same to me when people want my opinion.
Under date of May 19th, 1880, I find in my Case-book, “She has suffered for many years from white sticky leucorrhoea, very much like the white of an egg; the tumour is softer, and about one- half its original size; the whites are considerably better since the last medicine (Hydrastis 1x, gtt. v., night and morning). The tumour is more painful eight days before menstrual period.
July 20th. Whites worse; more pain in the tumour; pain in the epigastrium, making her feel quite sick, especially when standing.
R Thuja 3, 3iv., gtt. v., bis die.
September 16th (1880). It brought out an eruption. Thuja 6.
November 16th. “Have been almost entirely free from pain until last week, when the breast pained me; I am much better in regard to the whites. So far as I can judge, the last medicine has been the right one”.
Thuja 12, 3iv., gtt. v., bis die.
January 28th, 1881. “I have taken the last medicine for two months. When I first began to take it, I had more pain in the affected part than I had had for a long time previously, but lately, I have been quite well, except a spell of toothache, which yielded to Belladonna and Gelsemium. The tumour is very much smaller”.
R Hydrastis can. 1, 3iv., gtt. v., night and morning.
March 25th. “I am going on improving, indeed I am very seldom reminded of my ailment; the tumour is now so small that my husband cannot find it”.
R Hydrastis can. 6, gtt. v. 3iv., night and morning.
May 27th. “After I began to take the last medicine I felt a good deal more uneasiness in the affected part than I had done for some time before, now I am much as I was while taking the previous medicine. I think my husband told you of the decrease in size”.
R Psor.30, four in twenty-four.
July 29th. “My husband thinks the lump nearly gone, I think it is gone. While I was taking the last medicine, and for a week after, I had a good deal of pain in the region of the womb, and at the time I had this pain I was also a good deal annoyed with the whites; now I am quite free”.
July 29th, 1881, is the last note of the case in my book, but I saw the patient on another matter on November 3rd, 1886-more than five years thereafter-and learned that there had been no return of the tumour or of other ill-health, and she had enjoyed very good general health.
TUMOUR OF LEFT BREAST.
Mrs.–, 26 years of age, came under my care in February 19th, 1883, complaining of a swelling in her left breast about the size of a small orange. It was hard, and had been first noticed in August, 1882. Last spring she had squeezed out some fluid from the left breast. Slight leucorrhoea. She was the mother of one child which was then three years old. Patient had been twice vaccinated, and was subject to labial herpes.
I informed the lady that the tumour was, in my opinion, due to her use of modern preventive measures, that it was, in fact, due to reflex irritations from the hypogastric region. My wide experience teaches me that a large number of mammary tumours in comparatively young married ladies are due to hanky panky manoeuvres of various kinds, the organism being, additionally, dyscratic. Without any dyscrasia, the hypogastric irritation would in all probability not so easily suffice, unless, indeed, it were very great and applied over a long period. I explained that Nature in the long run is very rarely insulted with impunity. Nemesis may tarry, but she inevitably follows the t rail of wrong doing. Oh, how true it is that the way o the transgressor is hard !.
March 3rd. The tumour is rather smaller. She says “I find it decreased by about one-half”.
19th. The tumour is a trifle larger than it w as last time. The old itching has entirely disappeared.
R. Kali chlor. 6 trituration, in six grain doses night and morning.
April 2nd. Emansio mensium : she is probably enceinte. Herself she feels rather weak, but the tumour has much diminished.
R Tc. Thuja occidentalis, 30.
Patient needed no further treatment, the tumour quite disappeared, and in due time a baby came.
UTERINE FIBROID; SMALL TUMOUR ON LEFT BREAST. DISEASE OF LEFT NIPPLE.
An unmarried lady, 43 years of age, came under my observation on September 24th, 1881, for a severe sprain of the left ankle. It was several months before she got well, it being complicated by gout, dyspepsia, and dysmenorrhoea. The accident was a severe fall down stairs, and, in falling, she struck with great violence against the low part of the body, causing for many months much vesical trouble with metritis. The case was further complicated with attacks of breast-pang, and with fainting fits.
Evidently the fall had given her a rude shaking, and disturbed many important organs, the liver and spleen giving at times much trouble. This lady remained under my care, and very slowly got the better of most of the just described ailments, when, on March 14th, 1882, she took me so far into her confidence as to tell me she had, for the past four years, a little red lump on her left breast that discharged something. It was about the size of a hazelnut, and situated at the lowest outermost part of the left breast. With it there was much pain all down the left side.
At her next visit on April 19th, 1882, patient took me further into her confidence, and stated that she had been for some time getting very large in the uterine region,-in fact, the size had been noticed by strange ladies, who thought she was married, and was expectant. On this account alone the position was most painful. The case went on, the abdomen continued to increase in size, when, on November 23rd, 1882, I came to the conclusion, from an examination obtained with much difficulty, that it was a uterine fibroid.
The mammae became greatly hyper-trophied. I could never quite make up my mind where the fibroid really sat, and sometimes, from the hard nodes of the cervix uteri, I opined it might be a kind of fibrous hypertrophy of the whole organ. Very many remedies were used-Lappa major O, Thuja 30, Merc. met. 30, Lapis alb. 3, Aurum met. 100, Helonin, Kali chlor. 6, Aur. mur. 3x, Silicea 4, Bovista 3x, psor. 30,-but all with but little apparent effect. Moreover, the left nipple became the seat of most distressingly painful moist cracks, and which are particularly significant.