Produced by Richard Tonsing, Turgut Dincer and the Online
Distributed Proofreading Team at http://www.pgdp.net (This
file was produced from images generously made available
by The Internet Archive)
CANCER
ITS
CAUSE AND TREATMENT
VOLUME II
BY THE SAME AUTHOR
CANCER, ITS CAUSE AND TREATMENT. Vol. I. $1.50 net.
DIET AND HYGIENE IN DISEASES OF THE SKIN. $2.00 net.
COMPENDIUM OF DISEASES OF THE SKIN, based on an analysis of thirty
thousand consecutive cases, with a Therapeutic Formulary. $2.00.
THE RELATIONS OF DISEASES OF THE SKIN TO INTERNAL DISORDERS. $1.50.
PRINCIPLES AND APPLICATION OF LOCAL TREATMENT IN DISEASES OF THE SKIN.
$1.00.
THE INFLUENCE OF THE MENSTRUAL FUNCTION ON CERTAIN DISEASES OF THE
SKIN. $1.00.
ECZEMA, with an analysis of eight thousand cases of the disease.
$1.25.
ACNE, ITS ETIOLOGY, PATHOLOGY, AND TREATMENT. $2.00.
SYPHILIS IN THE INNOCENT (Syphilis insontium), clinically and
historically considered, with a plan for the legal control of the
disease. $3.00.
ACNE AND ALOPECIA. The Physician’s leisure library. Fifty cents.
THE SKIN IN HEALTH AND DISEASE. Fifty cents.
THE USE AND ABUSE OF ARSENIC IN THE TREATMENT OF DISEASES OF THE SKIN.
Fifty cents.
ARCHIVES OF DERMATOLOGY. A quarterly Journal of Skin and Venereal
Diseases. Vols. I-VIII. $3.00 each.
PAUL B. HOEBER, 67‒69 East 59th St., N. Y.
CANCER
ITS
CAUSE AND TREATMENT
BY
L. DUNCAN BULKLEY, A.M., M.D.
Senior Physician to the New York Skin and Cancer Hospital, etc.
VOLUME II
[Illustration]
NEW YORK
PAUL B. HOEBER
1917
Copyright, 1917
BY PAUL B. HOEBER
_Published, April, 1917_
Printed in U. S. A.
------------------------------------------------------------------------
To
THE GOVERNORS
of the
NEW YORK SKIN AND CANCER HOSPITAL
whose kind appreciation of and assistance to the author
in his clinical work in their institution have
done much to encourage him and to
promote the interest of the profession
in the branches of
DERMATOLOGY
and
CANCER
this second volume
is inscribed
PREFACE
Two years ago the present writer ventured to put forth a small book in
which cancer was considered from quite a different standpoint from that
commonly held by the profession and laity. The kindly reviews of the
medical press indicated that, while this was antagonistic to accepted
views, there was warrant for such an investigation, in view of the
steadily increasing mortality from cancer all over the world, under the
present mode of purely surgical treatment.
In these two years there has been very active study of cancer together
with a campaign of education in regard to the desirability and necessity
of operating very early in the disease, and consequently an increased
surgical activity. In spite of all this, or possibly on account of it,
the mortality from cancer during 1915 has been appreciably higher than
the average yearly death rate during the preceding five years. It would
seem, therefore, that there was increasing necessity for the study of
the conditions which cause the disease, as found in the human system,
rather than an increased study of pathological specimens and
experimentation on animals.
During these two years the writer has sought to understand the disease
better by constant clinical observation in private and public practise
and by wider acquaintance with literature, and has been only
strengthened and confirmed in the views which were set forth in the
former small book, and which he has held and practised for over thirty
years.
With some care he has prepared a second series of lectures which were
given to practising physicians attending the regular Wednesday afternoon
clinics at the New York Skin and Cancer Hospital in November and
December, 1916, and which are now submitted to the profession at large.
The reasons for presenting the medical aspects of cancer were given in
the former volume, also the hesitancy I felt lest, from an imperfect
carrying out of the necessary lines of internal treatment, harm might be
done or time lost in which there might possibly be some gain from
surgical treatment.
But the more I have studied cancer in the living and dying subject, and
the more I have tried to compass literature and analyze statistics, the
more have I felt compelled to push forward a campaign of education in
regard to the basic causes of the disease, ever with the thought of
prophylaxis, by inculcating right living.
It has been painful to me to present the mortality statistics in such an
unfavorable light as is seen in the following pages: but truth is truth
and truth must prevail.
No one can study carefully the remarkable book of Hoffman on “The
Mortality Statistics from Cancer Throughout the World,” and Williams’
“Natural History of Cancer,” and Wolff’s “Die Lehre von der
Krebskrankheit,” and the special volume concerning “Mortality from
Cancer and Other Malignant Tumors in the Registration Area of the United
States,” recently issued by the Bureau of the Census, without feeling
that something more should be attempted to arrest the progress of this
direful disease.
This seems all the more necessary and proper in view of the gratifying
decrease of mortality which has been obtained in tuberculosis, of 27.8
per cent from 1900 to 1915, by diligent and intelligent medical
supervision.
The problem of cancer is indeed a great one, but surely it is not to be
solved by greater activity along the lines under which its mortality has
steadily risen 28.7 per cent during the same period just mentioned, in
which tuberculosis has fallen so greatly. If this death rate of both
diseases should continue the same for fifteen years more, cancer would
outstrip tuberculosis in its actual fatality. Reason would seem to
indicate the necessity of a radical change in our point of view and a
complete change in our line of treatment.
In the text of these and former lectures I have endeavored to show why
and how cancer should be regarded from its medical aspects, and to
illustrate by a few cases some of the results which could be obtained
from this line of procedure. There is absolutely no claim or suggestion
that the cancer problem has been solved, but only an aim to put the
_real cancer problem_ in such a light that others might follow and
develop the subject in a manner fitting to the very great importance of
the end so strongly desired by all, namely, the checking of the steadily
rising morbidity and mortality of cancer.
Laboratory studies are of practical value as they supplement and
enlighten clinical observation. The microscope and test tube have
accomplished much for medicine and with animal experimentation have
undoubtedly rendered inestimable service in its scientific advancement.
But divorced from the practical study of patients they may fail in the
ultimate end desired. In these and the former lectures I have endeavored
to indicate certain lines of scientific investigation along which much
more laboratory effort is desirable, in order to determine more
definitely the metabolic and blood conditions which lead up to cancer.
These I have attempted to follow to a limited degree in many cases, and
found them of great service in their management.
In some of the reviews of the former volume some adverse criticism was
given on account of the absence of microscopic findings confirming the
diagnosis of the cases reported. I explained at the time that any
attempt to excise portions of tissue for such study would at once
endanger the patient and imperil the success of treatment, by giving
occasion to metastases, from the opening of blood vessels and
lymphatics. This matter is treated of more fully in the present
lectures. It is to be remembered that the vast majority of operations
for cancer are undertaken upon a purely clinical diagnosis, and it may
be undeniably stated that not one half of them are confirmed
subsequently by competent microscopic evidence, except, of course, in
properly equipped hospitals. In some of the cases now presented
pathological proof has been presented, while in every one the clinical
signs were so unmistakable that no one could possibly doubt the
correctness of the diagnosis.
A number of reviewers of the former volume regretted that fuller and
more definite statements had not been made in regard to the exact diet
and mode of treatment employed in the cases reported. I had explained
that it was very difficult to develop all this in the brief compass of a
few lectures; indeed I may now say that it would take many times the
space and time which could be given to it to develop fully all the
possibilities and requirements of a dietary and medicinal treatment in
every case. The object rather was to inculcate the basic idea of the
true causation of cancer, leaving it to the practitioners present to
carry out the measures calculated to reach the desired end. In order to
make matters very clear I may occasionally have repeated some things
said in the former lectures, and some repetition may be found in these
successive lectures; but this will be pardoned when it is considered how
necessary repetition often is in order to establish correctly a new
thought. The cases were given as illustrations of what could be
accomplished along the lines indicated.
In the present lectures I have endeavored to carry the thought still
further and to develop the fundamental principles on which treatment and
prophylaxis are to be based. I have also been much more explicit in
regard to diet, and have given the exact dietary which has been used
with advantage in very many cases in private and hospital practise. In
regard to medical treatment I have also been more definite, although it
would be quite impossible to indicate all the different remedies which
those and other patients have taken over varying periods of time, to
meet different requirements of the system and individual peculiarities.
I think and believe, however, that sufficient data are given to enable
the competent and careful physician, who is able and willing to give
sufficient time and adequate attention to these cases, to accomplish the
same results, provided he has thoroughly mastered and applied the matter
contained in these two small books.
I fully realize the responsibility I have undertaken in gathering and
revealing the evidence of the unsatisfactory results of the manner of
regarding and treating cancer in years past, and certainly would not
have done this were I not so strongly assured that there was something
better to offer. How far I am right in my thesis I now leave to the
kindly judgment of my professional brethren. My only hope is that I may,
in some measure, have assisted in stemming the tide of the fearful
ravages made by cancer, and that others may investigate still more
deeply along the lines of its medical aspects, with increasingly
satisfactory results.
L. DUNCAN BULKLEY.
JANUARY, 1917.
531 MADISON AVE.
CONTENTS
PAGE
LECTURE I
CANCER AS A MEDICAL OR SURGICAL DISEASE 19
LECTURE II
INFLUENCE OF SEX, AGE, OCCUPATION, RACE, CLIMATE, AND FOOD ON
CANCER 47
LECTURE III
THE MORTALITY FROM CANCER; ANALYSIS OF SURGICAL STATISTICS. 74
LECTURE IV
INOPERABLE AND RECURRENT CANCER; METASTASIS; THE BLOOD IN CANCER 111
LECTURE V
DIETETIC AND MEDICAL TREATMENT OF CANCER PROPHYLAXIS 144
LECTURE VI
RESULTS: PERSONAL CASES 188
SUMMARY
THE REAL CANCER PROBLEM 239
INDEX 273
CANCER
ITS
CAUSE AND TREATMENT
LECTURE I
CANCER AS A MEDICAL OR SURGICAL DISEASE
In my lectures given here two years ago I considered, as far as I could
in the time allowed, the nature of cancer,[1] and the evidence in favor
of its being a medical rather than a purely surgical disease; and in
order that the trend of what shall follow may be clearly understood,
brief reference may be made to some of the principal points studied and
developed in the preceding lectures. To this end I may restate the
conclusions presented at their close, as developed in the lectures,
perhaps with some alterations or additions which two years’ further
study, observation, and treatment of cancer may suggest.
1. Cancer is but a deviation from the normal life and action of certain
of the ordinary cells of the body, which, for some reason, difficult to
understand, take on an abnormal or morbid action: with this there is a
continued tendency in them to a malignancy which invades contiguous
tissue, associated with a pernicious anemia which in the end tends to
destroy life.
2. There is some reason to believe that this diseased action first takes
place in what are known as “embryonic rests” or pre-natal, wrongly
placed tissue elements. These latter, however, are now shown to exist in
every individual in many localities, but the reason why at some
particular time they take on this malignant action, and form cancer, has
not yet been satisfactorily explained.
3. Cancer is _not_ wholly due to traumatic causes; although these may
play a not inconsiderable part in its occurrence in certain localities
and cases.
4. It is pretty conclusively decided that cancer is _not_ caused by a
microörganism or parasite; although various forms of these have been
found in connection with the disease, and each has been claimed as the
cause of cancer.
5. It is known clinically and experimentally that cancer is _not_
contagious.
6. _Nor_ is it hereditary in any appreciable degree; although certain
rare instances have been reported in which such seems to be the case,
and though some tendency in that direction has been demonstrated in
certain strains of mice.
7. Occupation has _not_ any very great influence on the occurrence of
cancer; although it is more frequent in some pursuits than in others.
8. Cancer is _not_ altogether a disease of older years; although its
incidence is greatly increased with advancing age.
9. Cancer does _not_ especially belong to or affect any particular sex,
race, or class of persons. It is, however, more frequent in females than
in males, although of late years the proportion in the latter is
steadily rising.
10. Cancer is _not_ confined to any climate, location, or section of the
earth, but has been observed in all countries and climates, though with
different frequency.
11. _No_ single cause of cancer has yet been demonstrated; nor is it
likely that this will ever be the case, as experimental and other
investigations have covered almost every possible line of research, with
only _negative_ results.
12. The exclusion of almost every other possible cause of cancer, as
well as its pathological history and biochemical studies, all lead,
therefore, to deranged metabolism as the only remaining possible
etiological element. This latter acts by inducing changes in nutrition,
and these in turn depend on diet and the proper or improper action of
the secretory and excretory organs; these latter may, still further, be
affected by nervous influences.
13. While the biochemistry of cancer does not as yet throw very great
light on its true nature and cause, enough has been determined to show
that the morbid changes in the cells are largely associated with
deranged metabolism.
14. The blood in advancing cancer manifests changes which indicate vital
alterations in the action of the organs which form blood and control the
nutrition of the body and its cells.
15. Clinical and experimental evidence demonstrate that the secretions
and excretions of the body exhibit departures from normal; these, while
not wholly pathognomonic of cancer, still indicate metabolic
disturbances which involve the nutrition of the cellular elements, and
these disturbances are of importance.
16. The evidence seems certain that the cancer mass, when fully
developed, secretes a hormone or poison which tends to augment its own
growth, and hastens the lethal progress of the disease.
17. The mortality from cancer is undoubtedly on the increase in every
portion of the globe, in spite of the assiduous activity of the
laboratories and the immense advances in surgical procedure.
18. This increase in mortality is seen to vary inversely, and in about
the same proportion, with the steadily diminishing mortality of
tuberculosis, under recent careful medical guidance.
19. The increase of cancer mortality is found to follow closely along
the lines of modern civilization.
20. The extension of cancer appears to depend largely upon the altered
conditions of modern life, particularly along the lines of
self-indulgence in eating and drinking, and indolence.
21. The augmentation in the consumption of meat, coffee, and alcoholic
beverages in civilized communities is seen to be coincident with the
great and proportionately greater augmentation of the mortality from
cancer.
22. The nerve strain of modern life seems to be an element of
importance, both through disturbance of metabolism and by direct action
on morbidly deranged cells.
23. No single remedy for cancer has been, or will probably ever be,
discovered, since it is conceded that there is no single cause for the
disease. The history of cancer abounds in the heralding of various
vaunted remedies, quack and other, including sera, whose employment has
only ended in the disappointment of medical men and in the deluded hopes
of innumerable sufferers.
24. Modern surgery has materially improved the statistics relating to
the immediate results of operative procedures; but the total
achievements along this line are insignificant when compared with the
steadily rising death rate, and ultimate mortality of about 90 per cent
of those once afflicted with cancer.
25. Surgery has had, and may yet have, its function to perform in
removing some of the _products_ of the constitutional state causing
cancer, more or less efficiently, curing some patients and prolonging
the life of others; but from past experience it can never hope to lessen
the morbidity of cancer. The reason for this is that it attacks a
symptom only, and not the underlying cause.
26. The X-ray and radium, as also caustics, are in the same position as
surgery, and can do little more than cause to disappear, more or less
temporarily, some of the lesions which have developed from causes which
they cannot reach.
27. With all these means the measure of success, aside from the
technical skill of the operator, depends largely on the duration and the
extent of development of the malignant growth before treatment: the
earlier such local treatment is undertaken, other things being equal,
the greater the possibilities of success.
28. The same is true in regard to the treatment of cancer by dietary and
medical means. The earlier the morbid constitutional process, or state,
leading to tumor formation is attacked by proper dietetic, hygienic, and
medicinal measures, the greater the promise and expectation of success,
present and permanent.
29. The cure and prevention of cancer, therefore, and the checking of
its increasing occurrence and mortality, depend largely upon the early
adoption of such measures as will limit the agencies which induce the
formation of the new growth: these are certain derangements of the body
juices which tend to bad nutrition and disturbance of the action of the
body cells.
30. The simple life, with the avoidance of the dietetic and other causes
which have been found to induce cancer in nations and individuals,
promises the best hope for the arrest of its rapidly increasing
development and mortality throughout the world.
31. It is more than possible, however, that the long continued operation
of many baneful causes has produced such a degeneration of tissue in the
human race that it will take a generation or more of proper living to
make the beneficial impression on the general occurrence and mortality
of cancer which is so longed for.
It is quite impossible and unnecessary to elaborate again the facts upon
which these conclusions are based, which were given very fully in my
previous lectures and book; but we may briefly consider some of the
features just presented, and some of the evidence why cancer should be
considered from a medical rather than a surgical standpoint. For it must
be conceded that both the general medical profession and the laity still
regard the disease as belonging to surgery, and look only to the knife
for any hope in its treatment. In spite of all that has been done the
present outlook for the checking of its rising mortality by this means,
and for the prevention of cancer, is bad indeed, as will be shown in a
later lecture.
But, gentlemen, many great surgeons, in past and present time, as quoted
in my former lectures, have acknowledged verbally and in writing their
inability to cope with cancer as a disease, and have recognized time and
again that they operated only because they knew of nothing better to do.
Often it is acknowledged that the operation is only palliative, in the
hope, alas, how often futile, that some good might result from it, in
the chance that the dread disease would not return. We shall see later,
when we come to study the mortality of cancer in various locations, and
an analysis of surgical statistics, how slight the foundation is for
such hopes.
Both in the past and present times many surgeons of eminence, well
acquainted with the disease, whom I quoted in my former lectures, have
also more or less casually expressed the conviction that there was some
deep-seated constitutional cause of cancer which baffled recognition,
but which must have to do with the diet or mode of living of those
afflicted. The most recent of these is Dr. William J. Mayo, who has
spoken in no uncertain terms along this line, in a recent address as
President of the American Surgical Association. And yet how relatively
little intelligent effort has been put forth to discover and amend these
conditions, and to remove the bodily derangement which eventuates in the
formation of the foci of disease which later become malignant and form
what is called cancer, or to modify the blood changes which ultimately
destroy life!
In a long experience I have seldom, if ever, come across a patient with
cancer who had had any intelligent and prolonged attempt to check its
development by dietary, hygienic, and medicinal means; invariably the
knife, X-ray, and radium have been the only measures under
consideration. Also, after an operation the patient is dismissed, or
watched for a recurrence and again operated on, with no prolonged effort
to so modify the constitution that the same causes shall not reproduce
the malady in the same or other localities. And yet I have narrated to
you cases of undoubted cancer, verified by competent surgeons, who urged
instant removal, which had entirely disappeared without operation under
the line of treatment detailed, and who remained in perfect health for
many years, sixteen in two instances. I also reported cases illustrating
the beneficial result of dietary and medicinal measures in cases
recurrent after operation. This matter will be more fully considered in
a later lecture, with further illustrations.
We may now consider some general matters bearing on the question of a
medical rather than an exclusively surgical aspect of cancer.
The founders of the Index Medicus placed cancer among the diseases of
metabolism, along with gout, obesity, chronic rheumatism, diabetes, and
a few conditions of minor importance. This grouping of cancer in no wise
interferes with the idea that a chronic local irritant may be the
_exciting_ cause of the _local_ development of the tumor, which becomes
malignant, in any particular situation; any more than what is observed
in the case of late syphilis, where a gummy tumor or a bone lesion may
appear at a point of injury, or where gout will develop in a joint which
has been bruised.
But it does show that broad medical thought has long recognized that
cancer is not a purely local disease, but that it arises from some
disturbance of nutrition, tending to localize in some particular spot,
even as a neuralgia will occur in some special nerve and be reached, not
by local measures, but by those of a general nature. Repeated casual
observations have often been made by clinicians, and even by surgeons of
prominence, of the apparent relations between cancer and gout or
rheumatism, and also diabetes, and all recognize the rebelliousness of
cancer when it occurs in connection with obesity. The late Dr. John B.
Murphy was very strong in regard to this latter point. The constant
occurrence of cancer in rheumatic individuals is a very striking
feature, which I observe almost daily.
It is worthy of remark that cancer begins to appear at a wholesale rate
at the age when metabolism begins to slow up, and some time after the
body growth has become fully established. At this period people are apt
to lose the balance between physical effort and the intake of food,
eating as much as ever, perhaps more, while becoming more sedentary. At
the same time the emunctories become less active. The various affections
of metabolism now tend to appear and are associated with imperfect
oxidation, or diminished tolerance toward certain ingesta. It is
interesting to note that in a study of many thousand cases of eczema I
found the disease to be actually more frequent, in proportion to those
living, between the ages of 50 and 55 than at any other period of life
after the infantile period, or the first five years of life; just about
the same time when cancer is most common. And the constitutional
conditions at the bottom of eczema are very much the same as those in
cancer.
Patients with a cancer just beginning will often, or even generally,
seem to be in excellent health. It is indeed remarkable to observe how
commonly patients with beginning breast cancer will seem to be in a
splendid condition of health. They are ruddy and blooming in appearance,
and when the lump is first discovered it is hard indeed to believe that
if the erroneous life processes which caused the cancerous lesion to
develop are not checked, the patient will before long succumb to the
direful disease. Williams remarks that “such types are indications of
hypernutrition.”
But a most careful study of these patients in every particular will so
constantly reveal such errors of life and derangements of metabolism
that these must be looked upon as contributing causes, at least, to the
development of the local condition which later becomes malignant; in the
same way as the patient will appear to be in blooming health just before
an attack of acute gout. For when these conditions are rectified by
proper dietary and medicinal measures the local cancerous condition not
only ceases to develop but actually disappears without surgical removal,
as I have repeatedly shown you. These errors and derangements are not
commonly evident on a superficial examination, and often are recognized
only after very painstaking search, and re-search.
We have not yet arrived at such a clear knowledge of metabolism as to
understand just where the fault lies in these cases of seeming perfect
health, with the beginning of a neoplasm which may eventuate so
disastrously. But we do know that what passes for good health is often
fictitious, and is quite compatible with even grave disorders of various
kinds. It is more than possible that the apparent well-being of the
patient with beginning cancer, which is often observed to be associated
with uricacidemia, points also to the correctness of our thesis in
regard to its internal causation. As remarked in one of my former
lectures, quoting Ribert, “no one has ever seen the beginning of mammary
cancer” and no one will ever see the beginnings of cancer of internal
organs.
But, whatever may be thought of Haig’s theories or statements regarding
uric acid, there is no question but that many maladies of many kinds
have their origin in the concatenation of processes which has long been
recognized clinically as lithemia. Personally I believe that sooner or
later it will be generally recognized that the starting point of cancer
occurs in some cell or cells, previously normal, probably as the result
of local irritation, in which there is a deposit of some of the elements
of faulty nitrogenous partition, induced by undue ingestion of animal
protein: and that the malignant, reproductive process in the cells is
kept up by a continuance of the same supply of imperfectly disintegrated
nitrogenous matter.
The condition of the urine furnishes a most invaluable indicator and
guide as to the systemic derangements and their correction. This has not
reference to the presence of sugar, albumin, or casts, but rather to
other features, reflecting the manner in which metabolism is performed.
This subject was gone into pretty thoroughly in my former lectures, but
must be briefly considered here, because of the great importance of the
subject.
It is well known that, while the products of the digestion and
disassimilation of carbohydrates and fats pass off by the lungs,
generally without harm, those of protein and salts are eliminated by the
kidneys, and may be the cause of various systemic derangements. The
urine, therefore, when most carefully analyzed volumetrically, exhibits
in the clearest possible manner how the metabolism is carried on and
where the error lies.
From a study of hundreds of complete volumetric analyses of urine in
dozens of cancer patients, both in the very early and late stages of the
disease, I have found that this excretion almost invariably exhibits
departures from normal which are significant.
First to be mentioned is the relation of the total solids excreted daily
to the body weight of the individual; for it is evident that a person
weighing 200 pounds should pass off more than a smaller person. The
following table represents fairly well the total solids that should pass
daily in order to maintain a healthy equilibrium:
_Body Weight_ _Total Urinary Solids_
90 pounds 500 grains
95 〃 535 〃
100 〃 570 〃
105 〃 605 〃
110 〃 640 〃
115 〃 675 〃
120 〃 710 〃
125 〃 745 〃
130 〃 780 〃
135 〃 815 〃
140 〃 850 〃
145 〃 885 〃
150 〃 920 〃
155 〃 955 〃
160 〃 990 〃
165 〃 1025 〃
170 〃 1060 〃
175 〃 1095 〃
180 〃 1130 〃
185 〃 1165 〃
190 〃 1200 〃
195 〃 1235 〃
200 〃 1270 〃
205 〃 1305 〃
These figures do not represent much active exercise, and with increased
bodily exertion the solids passed should be more. Men excrete about
one-tenth more than women; there are also less urinary solids passed
with advancing age, and about five per cent may be deducted for each ten
years after forty.
The estimation of the total solids is easy with Haines’ modification of
Hasser’s method. _Multiply the last two figures of the specific gravity
of the urine by the number of ounces voided in 24 hours, and add ten per
cent to the product._ Thus, if the amount passed in 24 hours was 36
ounces with a specific gravity of 1.021, it would be 36 × 21 = 756 + 10
per cent = 832 grains of solids in the whole amount of urine excreted
that day. By comparing this with the table it can be readily ascertained
if the amount is above or below the normal standard for the body weight
of the patient. For many years I have employed this method of
determining the urinary output in hundreds of patients with various
diseases of the skin and cancer, and have found it of inestimable value.
It is understood, of course, that by dietary and medicinal measures the
urinary solids are to be brought up to and maintained at normal.
The actual acidity of the urine, as measured by the oxalic acid and
phenolphthalein test, is also of the greatest importance. This is not
difficult of application and is daily used in my laboratory; the litmus
paper test is of relatively little value in comparison with an actual
chemical measurement. Thus, with an average standard of 300 we not
infrequently find an acidity of 500 or 600, or even 1000 or more, or it
may sink to 200 or 100, or even be strongly alkaline. In cancer I have
striven, by diet and remedies, to keep it a little below normal, as it
has been shown that the blood in this disease exhibits a constantly
increasing tendency to diminished alkalescence, or, wrongly called,
increased acidity.
But further and very careful volumetrical urinary analysis is very
important to determine and maintain the metabolism in its proper
condition. Time does not permit such an elaboration of this subject as
might be desired, and I can only call your attention briefly to some of
the points brought out in my former lectures.
Many observers have found the nitrogenous disintegration very imperfect
in cancer cases, and oxyproteic acids are increased and even that in
very early cancer. An increase of amino-acid nitrogen was found by Reid
in practically every case studied. Others have found an increase in
colloid nitrogen, to more than double the normal amount, and also
increased elimination of xanthin and urinary ammonia; so that all
observers testify to a disturbed nitrogen partition in cancer. The
elimination of urea is certainly greatly diminished, even in early
stages and when on a full diet, as I have almost invariably observed.
The sulphur partition is also found to be imperfect, in new and old
cancer cases, and even a great increase in the urinary discharge of
sulphates is constantly noticed in my analyses. Associated with these
errors in the nitrogenous and sulphur element is the very common and
persistent increase of indican, showing stasis in the small intestine,
with bacterial putrefaction.
Imperfect intestinal elimination is constantly observed in cancer cases,
both habitually and in the very early, formative period, and also later,
even before any recourse to morphin, which, of course, heightens the
trouble. In recording the statements of these patients I have been so
struck with the almost invariable history of constipation before the
first appearance or suspicion of the cancer that I cannot help feeling
very strongly the possibility that the toxins produced by the millions
of microörganisms, generated through intestinal stasis and fecal
putrefaction, play a great part in the production of that blood
dyscrasia which culminates in the formation of the malignant new growth.
I mentioned to you last year that in hundreds of tests of the saliva in
cancer patients the reaction was found to be acid almost invariably,
until corrected by dietary and other treatment. I have this test made
and recorded daily, half an hour before meals and half an hour after
meals, on my cancer patients in the New York Skin and Cancer Hospital. I
have also the urine volumetrically analyzed each week, and the results
all tabulated in columns on the history sheet, so that the changes may
be compared weekly, in regard to each constituent, as treatment
progresses. The same is done with the weekly studies on the blood, which
I hope to present in full before long.
I think, gentlemen, that from what I have said you can see that the
medical aspects of cancer loom up pretty large, and yet we are only
beginning to study the disease along these lines. We see, thus, that
cancer is not primarily a surgical affection, and that the mere ablation
of an offending portion of the body which has become diseased can never
preclude a new portion from becoming affected, or prevent a recurrence
in the same location; indeed, this often seems to be stimulated and
increased by the trauma and by the deranged lymphatic and vascular
circulation caused by the operation and the dissemination of actively
growing cancer cells through these channels. This will appear more fully
later when we come to study the increasing mortality of cancer during
these later years of active surgery, and when we come to analyze the
actual reports of operative procedures.
I hope, gentlemen, that by these lectures I may succeed in satisfying
your minds that if anything is to be done towards staying the steadily
rising frequency and increasing mortality of cancer, it must be by
carefully wrought out medical means, and not by the knife.
LECTURE II
INFLUENCE OF SEX, AGE, OCCUPATION, RACE, CLIMATE, AND FOOD ON CANCER
While cancer is no respecter of persons, and affects all, rich and poor,
old and young, male and female, there are some interesting features
regarding the disease as it occurs under various conditions which are
worthy of consideration.
We have seen in the former lecture that cancer is not a definite
something, from without, that attacks the human frame, but that it is
only a faulty development and action of certain body cells, which were
once normal, with a steady decline in bodily health which tends to a
fatal issue in a very large proportion of those once affected with the
disease.
We have seen that the cancer patient, both in the very earliest stages
and during the whole period of the disease, gives evidence of departures
from the ideal normal life, and presents functional disorders of various
organs, with derangements of metabolism; these point to errors of
nutrition, which latter are of significance in connection with the
development and continuance of the malignant disease. The conclusion
offered was that cancer is a medical affection, due to systemic causes,
and that the simple surgical excision of a certain diseased portion
cannot be expected to check or remove such a malady, or to prevent
recurrence. And this has been abundantly demonstrated by the history of
the disease, with its steadily increasing mortality under increasingly
active surgical treatment during the last fifteen years, as was shown in
my former lectures and will be further illustrated later.
Recognizing, then, that cancer is a great and widespread disorder of
nutrition, let us consider some of the facts regarding its extension and
some of the influences concerned in its production.
SEX.—Cancer is much more frequent in females than in males. In the
United States Mortality Reports for 1914 there were 31,138 females to
21,282 males; thus, in a total of 52,420 deaths from cancer 59.4 per
cent were in females, with a preponderance of 9,856. This excess is
largely due to cancer of the breast, from which there were 5,423 deaths,
and cancer of the female genital organs, causing 8,152 deaths, of which
7,470 were from cancer of the uterus.
The death rate in males, however, seems to be increasing of late years;
in the United States in 1912 males formed 39.7 per cent; in 1913, 40.1
per cent; and in 1914, 40.6 per cent. In England, according to Williams,
the proportion of males to females is increasing much more rapidly. This
greater mortality of males is due to the greater number of deaths from
cancer of the stomach and liver, buccal cavity, and skin. In 1914 there
were 19,889 deaths from cancer of the stomach and liver, or 37.9 per
cent of the whole number; of these 10,122 were in males to 9,767 in
females, or an excess of 355 males, whereas in 1912 the females were 87
in excess. In the United States the cancer death rate for males has
increased since 1901 31.8 per cent and for females 25.3 per cent.
AGE.—Carcinoma is exceedingly rare under 20 years of age, most malignant
tumors at that period being sarcomata. After 25 the number of deaths
from cancer about doubles each five years up to 40, and then increases
steadily, until the actually greatest number of deaths, 6,909 (3,071
males, 3,838 females), occurred between 60 and 64 years of age, after
which they decreased steadily; there were 267 deaths at 90 and over, 8
of them being 100 years and over. At no period did the deaths of males
exceed that of females, and from 35 to 39 years of age the latter were
almost three times that of males.
OCCUPATION.—Many attempts have been made to trace the influence of
occupation upon the incidence of cancer, but thus far very little of
practical interest has been demonstrated; the difficulties concerning
this investigation are immense, owing to absence of essential and
accurate data. There have been many lists presented, but few of which
agree as to details, and all need to be corrected as to the proportion
of those living at different ages. There is also the question as to the
effect of local or general agencies; thus, as to the result of local
injuries on the skin, and also in regard to other agencies, whatever
they may be, which produce internal cancer; for tables of occupation do
not generally refer to sex, age, or location of the disease.
First, to dismiss the question as to the direct result of local injuries
in inducing cancer of the skin, which, at the most, caused only 3.7 per
cent of all cancer deaths in 1914, we may cite a few instances in which
this appears to be pretty well established.
The occurrence of epithelioma as a direct result of repeated and
protracted exposure to X-ray is familiar to all, and is particularly
interesting because it occurs commonly among younger persons, and at a
time of life when epithelioma is rare; and especially also because the
X-ray is constantly effective in curing epithelioma. The rarity of
epithelioma resulting from X-ray, considering the enormous amount of
exposure which must have occurred in making and using X-ray tubes,
implies, however, that there must be some other cause also at work. It
has been urged, therefore, that the skin tissue being altered and
weakened from repeated and protracted exposure to X-rays, more readily
falls prey to some of the chemical or other irritating agencies which
have been observed to be followed by epithelioma.
Time does not permit even a mention of the various elements, which are
many, that have been credited as excitants of cutaneous epithelioma; but
brief allusion may be made to one which formerly attracted much
attention, mainly in England; this refers to chimney-sweeps cancer, the
mortality from which was at one time at least 5 times greater than that
from cancer in males generally, at the same age. This is now, however,
of relatively infrequent occurrence, owing to the adoption of other
methods of cleaning chimneys. The epithelioma, which more commonly
developed on the scrotum, was believed to be due to the long continued
irritation caused by the constant presence of soot on the part; other
products of combustion and tar derivations have also been accredited
with the same result.
The question of the influence of occupation along other lines is really
more interesting, because more obscure; but a careful study of available
data tends to show the correctness of the thesis on which my former
lectures and these are based. This, as you know, is that our so-called
advancing civilization, with all its errors of life, in many directions,
is at the bottom of the steady increase in the mortality from cancer.
One of the most interesting contributions to this was the investigation
made by Dr. Latham, Registrar-General, in a study of cancer returns in
England; this showed that the mortality from the disease was more than
twice as great among well-to-do men having no specific occupation as
among occupied males in general, the respective mortality ratio being 96
for the former and only 44 for the latter. The same observation has been
made elsewhere.
Moreover, it is reported from several reliable sources that the death
rate from cancer in many cities is proportionately greater among the
rich and those in easy circumstances than among the poor, wage-earning
element of society. This would seem to show that occupation in general
acts favorably against the development of cancer. This fact is quite
understandable when we consider that those engaged in active work are
less liable to suffer from the effects of gluttony and indolence, with
their concurrent metabolic disturbances, than the well-to-do with ease
and luxurious habits. It is remarkable, however, that in asylums, homes
for the aged, prisons, convents, monasteries, etc., where the inmates
are relatively unoccupied, many writers confirm the fact that cancer is
very seldom seen; but this again is explained by the simple and frugal
diet enforced, with very little meat, which agrees with our thesis.
Statistics from life insurance companies show that cancer is decidedly
more common among persons of over-weight than among under-weights.
In regard to the occupations of those dying from cancer it is
interesting to note that standing among the highest per 100,000
population, in English statistics, come brewers, inn-keepers, and
butchers, whose metabolism can be greatly disturbed by alcohol and meat;
also indoor servants are more apt to be affected, while those of more or
less sedentary occupation, such as school teachers, clergymen,
physicians, and tailors, likewise stand very high on several lists. On
the other hand, those engaged in active physical exercise, such as
miners, farm laborers, carpenters, blacksmith, mail-carriers, and
others, are among those least frequently attacked.
RACE.—Cancer has been observed in every race, though the proportion of
cases is observed to vary greatly among different peoples; but it is
interesting to note that it is universally agreed by those that have
studied the subject that the difference in frequency relates very
largely to the degree of civilization involved. The blond Nordic race,
however, seems to be more susceptible to the disease than the darker
races, originally of Asiatic origin; and it is the former who have
pushed forward modern civilization, with all its errors of life.
Thus cancer is everywhere reported to be rare, and sometimes almost
absent, in primitive, uncivilized peoples, but it has been repeatedly
observed, in many localities, that as these same people mix with
Europeans and adopt their diet and mode of life, cancer is sure to
increase, until its frequency often about equals that in their highly
civilized neighbors. I went over this matter pretty fully in my former
lectures and cannot dwell on it now, or give examples. I can only
emphasize the fact that this furnishes a strong support to the
contention that cancer depends upon disorders of metabolism, which are
certainly increasing under the various elements which compose what is
called advanced civilization.
CLIMATE AND LOCALITY.—There is no evidence to prove that climate has any
influence in the production of cancer, nor is it affected by locality;
the disease occurs in hot, warm, temperate, and cold climates, and in
every possible location on the earth. But it is undoubtedly most
prevalent in temperate regions, for the reason that it is in these that
modern civilization, with all its faults and foibles, is most highly
developed.
The subject of the topical distribution of cancer, or its occurrence in
certain regions, has been the subject of much controversy in England and
France especially, and to read certain statements one would be inclined
to believe that certain telluric conditions were of influence in its
production, as along certain water courses, etc. But a more careful
analysis of all these statements shows that such elements can act only
as contributing causes, as, for instance, through a rheumatic influence,
which is known to be found in so many cancer patients.
The same may be said in regard to so-called “cancer houses” concerning
which there are still occasional references. A careful investigation of
these houses has commonly found them to be old, moldy, damp, badly
ventilated, and otherwise unsanitary; also that such old houses are
commonly tenanted by old people in succession, so that there are more at
a cancer age to be affected. With our present knowledge of the causes
which lead up to cancer we cannot but conclude, therefore, that the
occurrence of the disease in groups, with some apparent connection, has
been only the result of all living under the same conditions of ill
health, including wrong diet, etc.; for we know that cancer is not
contagious or infectious, and there is no other reasonable explanation
which can be sustained.
FOOD AND MODE OF LIFE.—In my former lectures I presented very fully the
evidence that cancer was certainly a disease of civilization, its
frequency and mortality advancing steadily in proportion as various
tribes or peoples, previously exempt, have come more or less under its
influence and adopted its manners and customs.