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LONDON: SATURDAY, NOVEMBER 14, 1903.

A New Serum for the Treatment ofCancer.

BECAUSE of the importance of carefully considering every JOHNS

method which may appear to afford the least possibility of cancer

success in the treatment of malignant disease and because active

of the somewhat loud advertisement which has been given by the

the daily press to the latest "cancer cure," we have thought sterili

well to publish in THE LANCET a full report of the Address on Dr. OTTO SCHMIDT’S Specific Treatment of Cancer with

which was delivered by Dr. H. JossE JOHNSON before the rende

Abernethian Society of St. Bartholomew’s Hospital, together jecticwith an abstract of the discussion which followed thereon. is sta

In his address Dr. JOHNSON deals with two aspects of a ris

the matter under consideration ; first he refers to Dr. primSCHMIDT’S view as to the causation of carcinoma and

sarcoma, and next he describes a method of treatment which desc

was suggested to Dr. SCHMIDT by the alleged discovery of a in

parasite which, it is claimed, can be found in every case of quitcarcinoma and sarcoma and which has been isolated in in c

pure culture from cases of both forms of malignant disease. that

And we may ay at once that before Dr. SCHMIDT’S theory ver]as to the exact causation of malignant disease can be met

accepted by the medical profession it will be necessary ceri

for very much more evidence to be produced. It is wh’

stated that Dr. SCHMIDT has isolated the parasite in In

pure culture and that he has produced tumours in two white cla

mice by the injection of such cultures. But as to the me

exact nature of the parasite, or as to the kind of tumour otl

which was produced by the injection, nothing which is foi

in any way relevant is said. It is stated that Dr. SCHMIDT ot]

has isolated a parasite which, in one or other phase fa’

of its existence, corresponds with the various " cancer in

parasites " which have been described by writers on the ta

subject from the date of RUSSELL’S " Address on a Charac- di

teristic Organism of Cancer" in 1890 down to the publica- tion of SCHTLLER’S Monograph in 1901. Dr. SCHMIDT’S tl

description of a parasite may be, in a sense, comprehen- ii

sive, but it is wanting in many details of proof which will be required by the pathologist before the validity of s

any claim to be the discoverer of the cause of cancer Ican be seriously considered. On one important point in connexion with this aspect of the matter Dr. JOHNSON

is, we think, under a misapprehension ; he stated in

his reply to the discussion which followed on his address:"Dr. ANDREWES said he must sound a note of caution

when we remember the number of cancer parasites whichhave been found. It is perfectly true that they have beenfound, but they are all one. No one has ever cultivated

them before ; that is the point. This man has cultivatedthem for the first time." The actual fact of the matter, of Bcourse, is that a considerable number of writers claim to

have isolated and cultivated the several "cancer parasites

which they have described, and as examples we mightmention SANFELICE, RONCALI, MONSERRAT, PLIMMER,LÉOPOLD, AIEVOLI, KAHANE, WLAEFF, GAYLORD, SCHÜLLER,and V0N LEYDEN.

However, it may be conceded that exact proof as to

causation is immaterial if only Dr. SCHMIDT can show thathe has in truth discovered the long-sought-for cure for oneof the most distressing of all diseases. His treatment must

at the present moment be judged by its empirical resultsr irrespectively of any scientific foundation which it may have

in the alleged discovery of the specific parasite. Dr.

y JOHNSON gives us to understand that the new treatment forcancer comprises two methods, first, the production of an

e active immunity against the disease by the inoculation of

y the patient with a "vaccine" which is obtained byit sterilising a culture of the parasite ; and, second, the pro-ss duction of a passive immunity by inoculating the patienter with the serum of a horse or a sheep which has beenae rendered actively immune by the first method. The in-

er jection of the "vaccine" into a patient with cancer

is stated to be followed by a specific reaction which includesof a rise of the body temperature and a local reaction in the)r. primary new growth and in any metastatic formations in thend glands or elsewhere; and in addition there are curative effectsich described. The treatment by serum injection is spoken ofa in perhaps rather less favourable terms. It will be seen that,

of quite apart from any curative use, a most important valuein in diagnosis is claimed for the "vaccine," for we are told

that although patients with the " cancerous cachexia" "

iory very often will not react to the vaccine " we have now a

be method by means of which innocent growths can be with

sary certainty diagnosed from malignant ones and by means ofis which the existence of metastatic deposits can be detected.in In hesitating to accept without more definite evidence the

claims which are put forward on behalf of this new treat-the ment of cancer one thing justifies all precaution apart from

nour other and grave sources of uncertainty. It is impossible toh is forget that quite similar claims have been urged on behalf ofNIIDT other "cancer cures" and have, on being tested, proved

fallacious. Thus, WLAEFF obtained a "cancer serum" byancer inoculating asses with yeast parasites which had been ob-i the tained from cases of carcinoma and which were stated to pro-

duce malignant growth when inoculated into experimentalblica- animals. WLAEFF’s serum, it was stated, was used for

HDT’s the treatment of 40 patients with malignant disease, andrehen- in nearly every case a local reaction both at the site of

which injection and in the tumour itself was observed. But, inof spite of this, WLAEFP has not been able to convince other

cancer pathologists of the value of his discovery. Dr. LOVELL

)int in DRAGE, who took part in the discussion at the Abernethian

Society, was also struck by the similarity of the reactions sted in which follow the injection of the cinnamic acid com-

idress: pounds, which he has been using for the treatment of

caution cancer, with the reactions which Dr. SCHMIDT has obtained.

: which Dr. DRAGE’S observations have appeared in our columns.e been At the conclusion of his Address Dr. JOHNSON very

ltivated properly indicated that he had been speaking of a "methodltivated of treatment" and not of a "cure." Before the word

).tter, of "cure can be used much that is at present uncertain will

}laim to have to be established clearly, and we understand that

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- Dr. SCHMIDT is pledged to give full details of the discoverywhich he claims to have made at a meeting of the Comitié

fiir Krebsforschung before the end of the year. It is also

understood that at the present time there is no supply ofeither " vaccine " or serum available for use in this country,and that consequently patients who may wish to undergothe treatment must proceed to Cologne and place them-selves under Dr. SCHMIDTS care. This course under

present conditions, and until considerably more detailed

information has been given, is not one which we feel

justified in advising our readers to recommend. Further,we cannot but regret the premature publicity which hasbeen given to the treatment as a "cure" in the pagesof the daily press. Almost monthly the discovery of

new "cancer cures" is made known to the public whenthe announcement has too frequently no better founda-

tion than the elaborate ingenuity of a newspaper man

in search of a sensational heading for the next day’sissue. The inevitable result of these announcements is that

patients with inoperable cancer turn with eager hope to thatwhich they are assured will relieve their pain and suffering,only to meet with disappointment and to suffer, if possible,

.-a. deepening of their despair. Surely the most elementaryideas of humanity would suggest that the sale of a

few extra copies of a journal is but a poor set-off to

the aggregate of sorrow and disappointment caused to l

those who have already sufficient evil to endure. 1

Every observation bearing on the cause or on the treat-

ment of malignant disease is keenly watched for by the medical profession, not only in this country but throughout c

the civilised world, and every rational theory prcpounded on Ithe subject is carefully weighed and examined; no good 1,

service therefore can possibly be rendered by the sensational c

publication in popular journals of the details of "cures" v

which have, so far as can be judged, no claim whatever to be o

regarded as such. That Dr. SCHMIDT’S treatment may prove c

to be the long expected cure for cancer is hoped for by none fl

more sincerely than by ourselves. But until fuller informa- m

tion is afforded we are not able to express any favourable fa

opinicn on the subject. bl

m

Private Nursing Homes.IN a recent issue 1 a correspondent urged the need of

organisation of the medical and surgical nursing homes inthis country and to point the moral he drew an unfavourable

picture of the difference between the arrangements in

English health resorts and in those of a small Swiss bathing town. One of the chief sources of complaint lay in the pre-postercus charges of English nursing homes which would Iseem to show that in England only the wealthy must besick. That there is a large degree of truth in this com-

plaint is evident to all practitioners who have endeavouredto arrange for the needs of middle-class or comparativelypoor patients who are scarcely fit subjects for treatment in

general hospitals and yet cannot cope with the expense- of a nursing home without unduly crippling their

.resources. The fees in nursing homes are necessarily a

1 THE LANCET, Oct. 31st, p. 1258.

ery matter of private arrangement. Those who cannot pay them

iti6 j need not enter, since broadly the cost is fairly set forth whenthe preliminary inquiries are made. There may be extras

’ of for operation fee, for medicines, for dressings, for washing,ry, and for stimulants if required and these may amount to more

rgo than was anticipated, but the terms generally are dependentm- upon the nature of the nursing required and upon the roomier occupied. These in turn vary to some extent with the

led locality of the nursing home and in one sense it is to be

eel deplored that nursing homes must almost inevitably be in

er, the immediate neighbourhood of the medical quarter, whererents and rates are extremely high and where it is not always

Y-es possible to insure quiet.of With few exceptions the nursing homes in London are

en commercial undertakings which must pay their way, and

a- owing to the uncertainty of work the fees chargedmust be calculated so as to give a fair return for the

’’s original outlay, for the current expenses, and for the

at risk of many of the rooms remaining unoccupied duringat a large part of the year. It is often assumed that a

g, large staff of trained nurses must continually be kepte, upon the premises, either actively engaged or ready for

yany sudden rush of work, and this furnishes further

aexcuse for keeping up the high cost to the patients. To

those with intimate knowledge of the working of nursingo homes this plea scarcely seems justifiable. In most homes

. the matron is herself a trained nurse who is able to

undertake a certain share of nursing duties, and whethere she assists at an operation or not she is generally present,t directing, supervising, and receiving instructions, com-

i plaints, or other remarks with the urbanity acquired byI long habit and holding herself responsible for any short-t comings. The number of nurses at’ached to the home’ varies with the number of patients and with the size

of the home. Some are permanently engaged, others

come and go as the rooms fill and empty, and this

, fluctuation, of which the medical men visiting the housemay scarcely be conscious since they always see the

familiar faces, is often necessitated by the value of spacebeing so great that many of the narses must sleep out and

may therefore come from one of the neighbouring institu-tions for nurses. In this way the expenses of the nursinghome are legitimately decreased, since there is no advantagein attempting to keep on the permanent staff greaternumbers than are actually required for the average serviceof the home and there is a distinct objection to a largeunemployed staff, since it must sometimes be difficult to

maintain the discipline and quiet required equally whetherpatients are many or few.

Apart from these expenses it is often urged that the

dietary ordered involves a large outlay, but expensivedelicacies are surely very rarely demanded. and, as

our correspondent points out, the directions are not

always implicitly followed. Freshly minced meat may notmake its appearance with sufficient frequency and recookedmutton may sometimes be served instead of fresh mutton.

Although these difficulties are obviously of frequent occur-rence in every household, in a nursing home where urgentcases demand excessive care some means should surelybe found to overcome them. The question is whether

greater organisation would produce more satisfactory results.