Journal : Photographic review of medicine & surgery ; vol. 1., no. 5.
Philadelphia : J. B. Lippincott & Co., 1870-71.
Description : pp. 60-63,  pl. ; ill.: 1 photo. ; 24 cm.
Photograph : mounted albumen.
Subject : Lips — Epithelioma.
I FOUND the old man, whose case is represented by the accompanying photographs, waiting in my outer office quite late in the evening of Saturday, October 28th last, whither he said he had been sent by a friend to solicit relief for the suffering which he had been enduring, for more than year, from an ulcer of the lower lip. This ulcer had all the characteristics of an epithelial cancer, and involved, with its accompanying induration, the whole of the lip, save just so much as I could cover with the pulp of my index-finger at the right corner. The ulcerated surface itself was two inches long by one inch and a quarter at its widest part, which was in the left half of the lip. The man confessed himself as an inveterate user of the pipe. His expression was one of great suffering, and he stated that the pain he endured was so constant and severe that he could not rest at night, and he desired, if I could not do anything else, that I might at least give him some relief for the pain. My experience of the past two years as to the effects of clayey earth in the relief of the pain of various forms of ulcerative action, prompted me to apply immediately some prepared clay which I had convenient in my office. This application met my anticipations, for the patient expressed himself as as very materially relieved as soon as it was made to the ulcerated surface. This effect, conjoined with the lateness of the hour and the fact of its being my first interview with the patient, caused me to abstain from any expression of opinion as to the nature of the case, and the probable necessity, as it then seemed to me, for the use of the knife to make a cure ; for although I had before then succeeded in healing up some small epithelial ulcers with the earth, I had not anticipated the possibility of so curing such an extensive one as this.
My mode of applying the earth in this case, I should state, was in the form of a thick paste, made by mixing some finely sifted clayey earth with water; and to retain it in place I laid over the paste a piece of blue tissue-paper. I directed the patient -that, if the dressing stayed on, he need not come back to see me until the next Monday evening. On that evening he returned, with the dressing still on, arid assured me that the relief of the pain had continued. I therefore renewed the dressing, and at the end of the week, and after three renewals of the earth, I was delighted to find a most positive diminution in the induration of the surrounding tissue, and an improved appearance in the ulcer itself. To prove more definitely the nature of the ulcer, I then made a microscopic examination of a portion which had been the least subjected to the action of the earth, and was fully satisfied of its cancroid character. Some of the portion which had been most directly under the action of the earth I also examined, and found it revealed a state of things which I had frequently seen before in similar cases under the same dressing, namely, the destruction of all other than some fat cells, which were themselves robbed in a marked manner of a greater portion of their oily contents. These conditions gave me great encouragement to continue the use of the earth-dressings, and at the end of two months I had the satisfaction of not only finding all the induration surrounding the ulcer removed, but the ulcer itself reduced one-half in size.
To confirm my convictions of the nature of the trouble, I about this time (the end of December) sent the patient to my friend Dr. James Tyson, with the request that he should take such portions of the growth as he might see fit, such portions of the growth as he might see fit, and, after his examination of them, communicate to me his opinion of the nature of the ulcer. The doctor's opinion fully confirmed my own.
The idea also first suggested itself to me then to preserve photographic representations of the ulcer at regular intervals of time. The first of these pictures (Fig. 1) here reproduced is that taken on the 3d day of January, the sixty-seventh day from the first application of the earth. In it can be readily seen the cicatrix then forming on the seat of that portion of the ulcer in the right side of the lip.
In the picture (Fig. 2) taken two weeks later, namely, on January 17th, the traces of this cicatrization are not only almost entirely effaced, but the portion of the ulcer, which was on the 3d of January well defined as an entity, can be seen io have become divided into two smaller ulcerated points, by the development of a perfect band of healthy epithelium across it.
In Fig. 3, from negative taken four weeks later than this, namely, on the 2 1st of February, and on the one hundred and seventeenth day of the treatment, there is but a trifling trace of the original ulcer to be seen. The ulcer was then but the size of the head of an ordinary glass-headed pin. The hardening of the base, which then existed for this ulcerated point, can readily be recognized in the picture.
The last picture here reproduced was taken on the 26th of April, about two weeks after all the ulcer had disappeared, and the perfectness of the cure can be readily recognized. The seat of the original ulcer was then covered by a perfectly healthy epithelial structure, and no one could suspect it of having been occupied by a cancer. Its condition is the same at the date of the writing of the statement, namely, the 1 8th of May.
During the whole of the treatment the patient never lost a day from his work, — that of out-door labor, — and was entirely free of pain from the tenth day after the first application of the earth.
No internal treatment was ever added to this local one. During the treatment the patient was frequently exhibited to the class attending my clinics at the Pennsylvania Hospital and also examined by many of my professional friends, among whom I would specially mention Professor Gross, on account of the very great interest which he manifested in the progress of the case.
Besides the evidences observed in this case of the earth exerting a chemical action similar to what has been observed in other cases so treated, there were also those of such action being intensified or prolonged by the covering of blue paper. Indeed, the patient himself noticed the difference when other colored papers were used, specially those belonging to the red end of the spectrum, — which always increased the discharge, the pain, and the necessity for renewing the application, and delayed the healing.
An article of blue paper used by some of the druggists of this city in dispensing one part of the Seidlitz powders, and which has a reputation with them of preserving it effectually from damp air, proved here (as also in other cases) so valuable an adjuvant to the earth that I became quite curious to know a reason for it, and sought information on the subject of my friend Mark Willcox, Esq., of the long-established firm of J. M. Willcox & Co., paper men, and he ascertained the facts from the manufacturers themselves of the special article, that the coloring matter was the same as used in the tissue-paper which I had been employing, namely, indigo; but that the latter species of paper did not contain any clay, whereas the former (this Seidlitz powder paper) was more than usually charged with that substance for a paper of its character. This circumstance I have deemed worthy of mention, as it adds an unexpected and valuable proof of the earth having been the agent in the cure.