DISCUSSION ON DR. SLACK'S PAPER. Dr. Bernard Wolff, Atlanta: Mr. President-I heard only a part of the doctor's paper, and my experience is commensurate with the small portion of the paper which I heard. My experience in the use of pyoktanin has been limited to one case. The case was that of an old lady about sixty years of age, who had an epithelioma near the angle of the eyelid the size of a nickel, which overreached upon the tarsal cartilage. The patient declined a surgical operation for removal of the diseased area, and as a compromise measure, I suggested the use of yellow pyoktanin, which causes less disfigurement than the blue. The result was excellent. I used a ten per cent. solution, painted on the growth, and in about six weeks the growth disappeared entirely. I treated this case about three years ago, and as yet there has been no return of the disease. There was some cicatricial contraction which limited the elevation of the upper lid, so that there was produced what might be called a traumatic ptosis. I referred the case to an oculist, and I think the patient is still under treatment. That has been my only experience with the use of pyoktanin, and it is favorable. In the future, if I have any cases of epithelioma, particularly in the neighborhood of the eyelid, where Marsden's paste, and other pastes, cannot be used without injuring the eyeball, I shall again use pyoktanin. I prefer, however, from simply a cosmetic standpoint, the yellow pyoktanin to the blue. I have been favorably impressed with the report of the doctor's cases. Dr. J. B. Morgan, Augusta: I have listened to Dr. Slack's paper, and the discussion which has ensued, with a great deal of interest. I have had some little experience in the use of pyoktanin, during the past year, having used it in five cases. I have employed it in every way that it 7 mt has been recommended for cancer of the uterus. I have tried the dry powder, used it as an injection, and employed it in the stick form; and for packing the uterus, after it has been curetted and cauterized, I frequently use pyoktanin gauze. I am fully satisfied, however, from carefully studying the effects of this remedy, that it has absolutely no curative effect, not the slightest. I think it is very probable that it does somewhat retard the progress of the disease, and in a slight degree lessen the pain. I have adopted it now, as a routine practice, for cases of inoperable cancer, using at the samne time opium internally. This probably gives us the best palliative treatment for inoperable cancer that we now have at our comamnd. I shall continue to use and study it until I find something better. Dr. Slack (closing the discussion): I do not claim to have cured any single case that I have had. The only claim I made was that is was a good palliative treatment, and that by the use of pyoktanin the neoplasm was very much diminished in size. In the case I reported, the growth has not as yet disappeared, but the man is living and doing well. While the pyoktanin may not cure, it does diminish the growth, but when the injections are stopped, the cancer grows again. If the injections are used twice a week, the tumor again subsides. How long it is going to keep the cancer under control, I am not prepared to state. So long as it does as much as it has for my patients, I shall continue the use of pyoktanin and recommend it to the profession. Dr. C. C. Stockard, Atlanta: I have treated two cases of malignant growth with the use of methyl blue. This was about six years ago, and I am sorry Dr. Slack's cases have not been sufficiently long treated in order to determine what the results will be. As Dr. Lloyd has said, I think he will find that they are not cured, as they seem now to promise. In reading up the subject at the time the two cases came under my observation, it was stated that in nearly every case there was marked improvement for a time. following the use of pyoktanin, but that this improvement did not continue, and finally the patient got worse and died. I think, however, there is more likelihood of getting permanent results in cases of sarcomata than in other forms of malignant growth. One of my cases was cancer of the uterus, and I did nothing more than to remove the odor and to relieve pain. Pyoktanin does relieve pain and remove odor. The other case was one of multiple sarcoma of the skin, and after having tried to remove it with the knife, I found new nodules springing up before the wound healed, and I began with the injections of methyl blue. These injections would destroy the nodules, and there would be no return of the disease at the site of the injection, but other nodules would spring up around those that had been injected. It was in 1891 that I treated this case, and the man still lives, but the disease has now almost spread over his entire body. The last time I saw him was about two years ago. He received probably five hundred injections. One injection would destroy the nodule completely, but others would spring up around. Dr. R. R. Kime, Atlanta: I wish to speak of one point with reference to the palliative treatment in cancer of the uterus or cervix. I have had but little experience so far as pyoktanin is concerned, but it seems to me we have a more certain palliative treatment for these conditions, one which causes the patient less pain and less trouble to yourself, and that is amputation of the cervix where this can be done, and the actual cautery properly applied; this will give more permanent relief and do the patient more good than to occasionally, once or twice a week, puncture the cervical tissue or the tissue around the cervix, thus favoring the spread of the disease by puncturing tissues so intimately connected by vascular and lymphatic supplies as the pelvic organs. THE TREATMENT OF CUTANEOUS CANCERS. BY J. B. MORGAN, M.D., AUGUSTA, GA. In discussing the treatment of skin cancers, it is well to understand at the commencement, that I do not intend or undertake to define the different varieties of cancer, or to discuss the different theories as to their etiology. This part of the subject is highly interesting and important, and has occupied some of the best thoughts of our brightest minds. In the last four years, fully one hundred able and scientific papers have appeared in various languages, treating exclusively of the etiology of cancer. We have neither time nor inclination to even refer to the various theories which have been propounded in attempted solution of this problem. But there are three of the recent theories of the etiology of cancer which it might be well to mention, since they are at present claiming more than passing attention throughout the scientific world, each having its plausible side and each its warm advocates. "Asymmetric Cell Division in Cancer, and its Biologic Significance," is the title of a thesis by Hanseman, wherein the theory of indirect cell division is advanced. The second theory, which has a great many advocates, who differ slightly, however, as to details, supposes that an intracellular, or intranuclear parasite-according to some a coccidium, to others a psorosperm, and still others a gregarina-infests the tissues, and through its presence induces a lawless growth of epithelial and connective tissue elements. The parasite theory is the third one; this supposes that the cancer parasites are animals, and that there are no epithelial elements at all in these neoplasms; the polymorphous bodies found in the growth being, in reality, not epithelial cells, but the parasites themselves; and that these parasites produce a toxic substance known as cancroid, which is responsible for the so-called cachexia. Such widely different ideas would seem to indicate that the final solution of the subject has not yet been reached. So far as the subject of this paper is concerned, the treatment here suggested is equally applicable, whichever one of these theories is accepted. For whether any of these theories are true or not, we do know as a fact, that in cancer we have a most intractable, malignant disease to combat, and which under the very best treatment of surgeon or physician, has an exceedingly unfavorable prognosis. Neither sex, Whatever ingenious and modern theory of its etiology may be believed or advocated, cancer still remains one of the most dreadful and fatal diseases known to science. No one has any assurance of exemption from it. physical strength, social position, culture, nor refinement, seem to furnish any immunity against it. While this is unfortunately true, and while in surgery or medicine we have no specific for cancer, on the whole the outlook is decidedly encouraging. We know more about the nature of cancer, macroscopically and microscopically, than we did even five years ago. Some of the greatest minds in our profession confidently predict that in the near future the specific bacillus will be found, and with it the complete antidote. We treat cancer now more successfully every year. Some things we have learned concerning it are of the highest importance, and entirely influence our present treatment. For instance, it is now almost universally held, by all |