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    'Secret' predates Mohs method

    Perry Nichols and the escharotic cancer cure


    Frederic Mohs is credited with developing in situ chemosurgical technique that set the stage for today's fresh-tissue Mohs surgery. However, the now-famous doctor may owe a debt of gratitude to a lesser-known figure, who in the late 1800s developed a "secret" escharotic substance that eventually was used to treat more than 70,000 cancer patients.

    In the beginning, Perry Nichols might not have appeared much different than numerous other "irregular practitioners," many offering home-brewed remedies that had little, if any, basis in science. But based on early treatment successes with his mysterious milky liquid, which in retrospect bore similarities to the dark zinc chloride paste that made Mohs famous, Nichols went on to found a series of clinics that culminated in a 200-bed facility in Savannah, Mo.

    Derided by American Medical Association investigators as a "quack" and an "old rascal," Nichols was a benefactor to the community and possibly, even an influence on the more famous proponent of escharotics, according to Gary A. Dyer, M.D., associate clinical professor of dermatology with the University of Missouri at Columbia.

    "I secretly wonder, deep down, if Mohs didn't have a look at one of Nichol's yearbooks, and it may have given him an idea," said Dr. Dyer, a dermatologist and dermatopathologist who practices in St. Joseph, Mo., just 13 miles from the city of Savannah, where the Nichols Sanatorium had its greatest success.

    Dr. Dyer has spent the past two years piecing together a history of Nichols, interviewing nurses who worked in his institution, and scouring medical archives and local historical records. He has monitored eBay and Internet booksellers for surviving copies of yearbooks Nichols wrote touting his methods, patient testimonies, and cure rates. The yearbooks, titled "Cancer and Its Proper Treatment - The Value of Escharotics," were published starting in 1909 or earlier.

    Nichols' method of chemosurgery The contents of Nichols ' escharotic mixture had been a carefully guarded secret , described as a " double compound " ( two main ingredients ) that was " about four times stronger than chloride of zinc or the arsenic of Marsden ' s Paste."

    Nichols' chemosurgery method, according to Dr. Dyer, was to make an adhesive plaster dam around the rim of the lesion, lay down cloth strips on the lesion, and apply the liquid escharotic to the cloth. After making pinpricks with a sterile needle, he applied salve for occlusion. This preparation was left in place for a period of time, depending on the lesion (a few hours for skin, perhaps three to four days for breast cancer). The tumor would separate, and a curet was used to clean out the bed. If clinical evaluation revealed residual tumor, the patient would be retreated; otherwise, a poultice was applied and the treated area was allowed to heal. Some patients were offered plastic repair (at no additional charge, at least in the earlier years of practice).

    There were no careful studies of the Nichols technique. If Nichols' yearbooks are to be a guide, the escharotic technique had a 75-percent cure rate for all patients accepted (the sanatorium refused to treat patients believed to have no chance for cure). However, this rate was measured using methodology that seems quite lax by today's rigorous standards, and was based largely on reports from nurses or cards sent in by former patients. What's more, the "cure rates" lump together all cancers treated, regardless of diagnosis as skin, mucosal or breast cancer.

    Nichols' early treatment successes - and his keen business acumen - led him to open the Nichols Sanatorium, a successful and well-known practice that drew patients from every state and several foreign countries. The practice, founded in Iowa, moved to South Dakota and finally to Missouri in 1911, where it survived until 1956, more than 30 years after Nichols' death.


    Andrew Bowser
    Andrew Bowser is a medical writer based in Brooklyn, New York.

    Derm Pulse
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