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the two nodular masses from whence dated the progression of fatal epithelial disease. I saw cancer of the tongue, also, once proceed from similar irritation.
When the small nodule, then, has remained for some little time, ulceration commences at the centre of the mass. The edges of the ulcer are nodulated, and the diseases spreading rapidly, give rise to constant ichorous discharge, constant and unmitigated pain, and now and then to hæmorrhage. Deep fissures which bleed readily form across the ulcerated surface, firm structures lying beneath or near the ulceration are involved, and from the pain, the discharge, and the inability on the part of the sufferer to receive nourishment, the ultimatum is reached.
Cases again may happen in which the tumour first formed does not immediately ulcerate, but taking its base over some portion of mucous membrane, beneath which lies a carious portion of bone or tooth, increases largely in size, and becomes a pendulous fleshy tumour, which may remain for months very painful and troublesome, but without ulceration. If the disease is really malignant, time is the only element, nevertheless, to ensure ulceration. The ulceration at last commencing on the surface of the tumefied mass, goes on spreading, the parts beneath become involved, and the symptoms take the same course as in the cases previously discussed. - Turn we now to the principles of treatment in cases of malignant disease affecting the organs of mastication. To the practitioner of dentistry, as occurring in his every-day life, these are few and simple; to the practitioner of surgery they are momentous, and of all others most difficult. Let us glance at both positions.
The practitioner of dentistry meeting with doubtful cases of malignant disease has two points to bear in mind :
First. To use such means as science shall supply to him of ascertaining the nature of the disease. . Secondly. To use such means as come within the scope of his art, to relieve symptoms, or to test by operation the cause of symptoms.
Thus, in disease involving the antrum, if there be no indication of polypoid growth in the nasal canal, and if the evidence is doubtful whether the enlargement or pain are due to cancer growth or to accumulation of fluid, it is as much his duty as that of the surgeon to endeavour, if he sees the opportunity, to settle this point by extraction of a molar, and perforation of the maxillary. · In cases of doubtful disease of the maxillary bone, it is equally his care to remove the sources of irritation arising from teeth.
In cases of epithelial cancer, doubtful in character, the same rule obtains. In all these instances there is one rule of practice common to the duties of both professions, to remove exciting causes, and the member of either profession does that best whose hand is most skilled in the work.
But these simple rules obeyed, the malignant malady proved by the inefficacy of the simpler measures or by the specific symptoms, the rest belongs to the physician or to the surgeon, according as cancer shall be considered a medical or a surgical disease; and now the grand question of treatment turns on one of two points, the general or the local.
The general aims at removing the systemic cause.
The local treatment, however applied, goes to the local eradication of the diseased part.
In the way of local treatment how many plans might not one enumerate. From the seething iron of the old barbarians, to the sulphate of zinc caustic of Dr Fell, you shall find in medical literature every variety of caustic and every shade of resolvent.
In modern days the local war wages between the knife and the caustic. Before the time of Alexander Monro the knife had unlimited sway. Then Monro declaring that out of sixty cases operated on which he observed, only four recovered, and that those operated on died sooner than those who were let alone, blunted the edge of the knife for a long season.' In the hands of Sir Everard Home, the prince of physicians, and Sir Astley Cooper, the prince of surgeons, the knife came again into full repute. Lately there has been another change. Some years ago Professor Paget expressed an opinion which endorsed the almost forgotten statement of Monro. Since that time this eminent man has changed, I believe, his views. So opinion fluctuates.
Now, apart from the abstract question of removal and nonremoval, this surely is the common-sense view, as between removal by the knife and removal by caustics; that what the caustic can do by removal the knife can do better, cleaner, infinitely quicker, and in the end, banishing even chloroform, with much less pain.
This admitted, the question next turns on the propriety of removal at all. In the confliction of statement it is difficult to answer this question. But this fact seems evident, that if the knife is to be used at all, it is to be used effectively when once taken up, and it is to be taken up as early as diagnosis is complete.
Except I were to trouble you with the details of operations for special cancerous diseases, I could say no more; and this is all I have to say as regards the knife.
But I must not omit to name one novelty in local treatment. My excellent friend Dr James Arnott has of late years suggested the removal of cancerous growths by means of benumbing cold. He would entirely destroy the life of the new growth by the frequent application of freezing mixture ; recently he has suggested the additional use of caustics with cold; by which suggestion he hopes that more effectual removal may be obtained without the establishment of any additional pain. Dr Arnott's plan has not yet been tried with such observation
from the history of many cases as would warrant the expression of an opinion as to its ultimate value.
But whatever mode of local treatment be employed, this truth must be told of it, that it is palliative at best, and no more. The disease will return. It need not return in the same part, but it will return somewhere. As well attempt to destroy mankind by destroying all the infants as to attempt to destroy cancer by removing its products.
If we are to expect any cure for cancer, we must seek for it in general measures. We must find its cause or its antidote. What number of antidotes have been raised I could not tell in a single lecture. The whole Pharmacopoeia' fifty times edited has been tested ; and yet no remedy save in that narcotic series, of which opium is the great representative, which palliate without cure. Shall we then hopelessly give up the search ? Certainly not. I for one believe, though no worshipper of nostrums and symbolicals, that as cancer is a chemical disorder, so there is for it a chemical remedy. That as quinine, by its chemical influence, cures ague, and arsenic lepra, so shall a like remedy be found some day for malignant disease.
Meanwhile, living in hope, this outline of a provisional treatment for cancer must be given. That the cancer-stricken will find his best remedy, not in hospital ward, nor in crowded city, but on the hills, where flowers grow, the sun shines, and the air gives even that lease of life which physic as yet fails to supply.
MONTHLY MEETING, TUESDAY, JUNE 7th.
PETER MATTHEWS, ESQ., IN THE CHAIR. REPORT OF COMMITTEE ON ELECTRICITY AS AN ANÆSTHETIC
IN DENTAL OPERATIONS.
The last ordinary Meeting of the Session was held on Tuesday, June 7th, when, in addition to a large attendance of Members, there were present, Drs Richardson, Camps, Kidd, Burrows, Lawrence, Mackenzie, Wyld ; Messrs Harry Lobb, Marshall, Betts, Forsyth, Hertslet, &c.
Mr MATTHEWS, on taking the chair, said, that as this was the last ordinary meeting of the Members of the College for this Session, it had been thought a fitting opportunity for the Report of the Committee on Dental Anæsthesia to be presented. It would be remembered that at the public meeting in October, 1858, when there was a very large assembly of the profession generally—who had been invited to attend and express their opinion upon Electricity as an Anæsthetic applied to Dental Surgery, a Committee had been formed, he was happy to say, a very large Committee, consisting of many eminent men, physicians and surgeons, and a great many dental surgeons. That Com. mittee had been very arduous in their exertions and inquiries, and they were prepared to present their Report that evening.
Dr RICHARDSON then read the Report of the Committee, which elicited considerable applause.
REPORT OF COMMITTEE. It is the business of the committee appointed by the College of Dentists on the 12th of October, 1858, to bring forward in the report now presented the results of the inquiries instituted by the members of the committee, relative to the value of electricity as an anæsthetic in operations on the teeth.
The points of inquiry specially recommended to the notice of the committee seemed to resolve themselves primarily into the following:
1. In a strict physiological sense can electricity be ap
plied in such a way as to remove from any part of
the body its normal sensibility ? 2. Can electricity be so applied with promise of success
in the operative department of dentistry ? 3. Granting that an affirmative is given to the two
preceding questions, what apparatus is to be commended as at once the cheapest, the most compact, and the most manageable for the Dental Practitioner?
Historical Note.—Electricity as an assumed anæsthetic was for the first time brought forward prominently in practice by our American brethren, in the course of the year 1858. In
commencing its report, the committee must indicate, however, that the question of anæsthetic agency derivable from electricity had been brought forward as a curious scientific problem on many occasions. Thus the application of an electrical current to parts suffering from neuralgiac pain as a means of reducing that pain has been practised for many years, and, according to the observations of various authors, with a considerable measure of success. These observations have been made on the continent and in this country. The subject has likewise been accidentally studied by experiment. As far back as the year 1853, one of ourselves, in performing an experiment on a dog with a Leyden battery, prostrated the animal by a powerful shock, and proceeded, whilst the animal was insensible, to cut down to the external jugular. The vein was disclosed, blood was drawn from it, and sutures were placed in the wound while yet the animal was insensible. After the operation was completed the dog became conscious anti recovered. The observation thus made was without intention, and, in so far as the result bore on anæsthesia, was accidental. But the circumstance led the author of the experiment to carry on for some months inquiries as to the reduction of sensation in parts locally by the aid of the electric current and the adininistration of repeated discharges from the Leyden battery. The end of these experiences was, that the electric current had no anæsthetic virtues when locally applied, and that the electrical discharge could only be considered as effective when so employed as to destroy the consciousness of the animal.
In the way of history the few facts above supplied include all that we can discover towards the attempt of producing anæsthesia by electricity. Until such time as the members of the Dental Profession in America, headed by Dr Francis, recommended and practised the system of employing an intermittent induced current in extraction.
The committee at their earliest sittings met to discuss only the order in which they should proceed in their researches, and to familiarise themselves with the use of the instruments about to be employed. At the fourth meeting resolutions were unanimously carried to the effect :
That each gentleman who should bring cases for operation should describe the nature of the case and the operation required. That tivo members of committee should then inspect the case and report their opinions. That in operating with the electrical current as an adjunct, the method of applying the current should be variously modified, the intermittent and