the blood conditions in the disease, we see what a formidable task is
before one who would attempt to lessen its morbidity and mortality. We
see also how blind all have been who have so long looked to surgery to
stay its progress. In my former lectures I collected and quoted
statements from many surgeons of prominence in times past, and even some
in quite recent times, all expressive of a belief in a constitutional
origin of cancer, and many of them looking to a dietary cause. I also
gave biochemical laboratory and experimental evidence showing the
medical aspects of cancer. I then remarked that it seemed strange that
the medical profession and the public had been so slow in accepting and
acting on the accumulated evidence which I have tried to put before you
in these and the former lectures.
The reason for this seems to be that the medical profession, being
occupied largely with acute disease and apparently definite and speedy
results, became readily discouraged with the unsatisfactory course
commonly observed in cancer; as in the case of tuberculosis, until the
revival of an interest in the latter in recent years, with the well
known beneficial consequences. They, therefore, turned the cancer cases
over to the surgeons, in the hope that they could do better.
By the brilliant advances in modern surgery along many lines, the laity
also have become obsessed with the idea that it has limitless power in
many directions, and have yielded to the knife in spite of the rising
mortality of late years. The glamour of modern surgery and its often
spectacular results have quite blinded the eyes of many to real facts.
It is not a little interesting to note that the period to which we have
referred, 1910 to 1915, in which the mortality of tuberculosis has
fallen so steadily while that of cancer has so steadily risen, even in
greater proportion, is that in which active laboratory work has also
dazzled the public and professional mind. The enormous activity with the
microscope in regard to the minute structure of the diseased tissues,
and the elaborate and extensive work done in animal experimentation,
have turned the thoughts of many from the homely and practical studies
of the human frame in its various departures from health; thus too
little attention has been given to the deranged activities of its
various organs, and the perverted metabolism which, has resulted from
the stress and strain, with the temptations and errors accompanying the
present intensity of human civilization.
Matters being as they are it is hardly to be expected that the surgeons
would incline to any other treatment than by the knife, especially since
good pathologists have asserted that cancer is only a local affair and
have urged its early removal. Nor would one expect that the surgeon
would think along medical lines and investigate metabolic conditions,
when the immediate results of operation seemed often to be so
satisfactory. Neither would one expect the surgeon to seek from
statistics the unfavorable aspects of this line of treatment, but rather
those from which he could draw encouragement in trying to overcome so
dire a disease.
But slowly light is beginning to shine, and you have seen and heard
enough to realize that the simple removal of the _product_ of the
cancerous process, and surrounding tissues, can never check greatly the
morbidity and mortality of cancer. You know now what the real cancer
problem is. It surely is not the sole continuance of a line of treatment
under which the death rate has steadily risen from 63 to 81.1 persons in
each 100,000 living, or 28.7 per cent since 1900, with a mortality of
about 90 per cent of those once affected with the disease.
The cancer problem is by no means yet solved, but I think that you will
all agree with me that we are on the right track, and I cannot do better
than to close with a remark I made to you two years ago: “Scientific
research must still go on in the laboratory; but clinical research and
study, with laboratory work, on the human subject, which have not been
hitherto sufficiently cultivated, should be pushed, so that by a mass of
carefully recorded observations the truth or falsity of what has been
here quoted and said may be refuted or confirmed.”
LECTURE V
DIETETIC AND MEDICAL TREATMENT OF CANCER PROPHYLAXIS
Although all statistics show a steady and alarming increase in the death
rate from cancer when regarded and treated as a surgical disease, it is
probable that this course will be persisted in until sufficient evidence
is accumulated to satisfy the medical profession and the laity that
relief can be obtained by other means. For, as the drowning person
catches at a straw, so the cancer patient hopes against hope that an
operation will be permanently successful in this particular case, though
the odds are so immeasurably against it. You have already seen some
patients who have illustrated the possibility of controlling cancer by
dietary and medical measures, and in the next lecture I shall hope to
show and report other cases and present statistics which will further
illustrate this possibility. We will now consider briefly what this
dietary and medical treatment of cancer consists in, and how it is to be
carried out, and also the bearing of all this on the prophylaxis of
cancer. In order to make this clear I must more or less repeat some
things that I have said in former lectures.
We have seen that, as shown by the kidney excretion and the condition of
the blood, the metabolism is deranged, both in the early and late stages
of cancer. We have seen that the nitrogenous and sulphur partition is
materially different from that of health, and reason indicates that in
some way protein, or rather its metabolism, is at fault. We have seen
that there is a deficiency in the urinary secretion, not only as to the
actual quantity, but also that the total urinary solids are commonly far
below the normal, often not half the amount required for the body weight
of the individual. We have seen that the intestinal excretion is
commonly imperfect and that constipation is the rule in these cases,
even long before the administration of anodynes. The secretion from the
skin is also generally defective, and the tissues dry and harsh, and the
saliva is generally acid.
All these, and perhaps other, elements point to a faulty performance of
the bodily functions, and to erroneous or deficient elaboration and
elimination of the waste products of the body; these latter are known to
be toxic to animals, and we know that in the human system they lead to
an auto-intoxication and derangement of the blood stream, which in turn
causes faulty cell and tissue action. Such a condition is recognized in
gout, as causing the local inflammatory manifestations, and in
rheumatism, which is so common in cancer subjects. All recognize that
obesity is due to some nutritive change, naturally acting through the
blood, and it is well known that cancer is peculiarly rebellious in
those subject to obesity. Diabetes likewise relates to a peculiar blood
condition, and there have been many observations concerning the relation
of diabetes to cancer. All these diseases and many more have their
foundation in faulty nutrition, depending largely on dietary errors.
We see, then, that to understand and rightly treat the systemic
condition belonging to cancer, which is indeed its basic factor, one
needs to take a very broad view of the complex processes in the human
system which pertain to metabolism and nutrition. This is indeed quite a
different proposition from the very simple surgical view which regards
the tumor as a local matter, of absolutely unknown origin, which only
needs the knife to end its career. Deranged, disturbed, perverted
nutrition is then the bottom fact of all erroneous growth, whether it be
obesity or a benign or malignant tumor.
Now it must be acknowledged that we are yet in the dark regarding the
exact or precise blood changes which precede and accompany cancer; but
in our last and also in previous lectures we saw that the blood did
exhibit changes which were evidently connected with the production and
continuance of the disease. Until all these matters which have been
referred to have been accurately determined by laboratory work and
investigation we are forced, as in time past, and as is still the case
also in regard to many diseases at the present time, to rest our
judgment and treatment on clinical experience, joined with deductive
observation, based on such knowledge as we have. And this we have
endeavored to do in these and former lectures.
Coming down, then, to the actual and practical facts relating to the
dietary and medical treatment of cancer, we readily see that the real
cancer problem relates to placing the patient in such a normal or ideal
state of life that the function of nutrition is performed in an exactly
proper manner, as nature intended, and from which man has erred through
the manifold temptations incident to our artificial existence, in the
presence of our so-called advanced civilization; for we have seen that
all over the world cancer has steadily increased with the intensity of
human progress.
Since first writing on the subject under discussion medical reviewers
have spoken as though I regarded the eating of meat as the sole cause of
cancer, and enforced absence therefrom as the single element in its cure
and prevention. From what I have just said you can see that this is by
no means true. But that I regard animal protein as a fertile cause of
the derangement of metabolism which leads up to and fosters the growth
of cancer, is most certainly true; this I have developed largely in my
lectures two years ago. While there are many elements which contribute
to the deranged blood stream of cancer, the question of diet is so
preeminently important that we must treat of it very fully. For, as in
gout the continuance of an indulgence in Port and Madeira wine in excess
would invalidate any attempt to cure the trouble permanently, so in
cancer an excess of animal, or even a large amount of vegetable protein,
militates against any effort to remove the disease medically; this is
probably true also of coffee and alcohol.
The first point, therefore, is to remove from the intake of food
everything which furnishes an excess, or even such a modicum, of
nitrogenous matter as is found by laboratory means to be badly
metabolized. The second step is to eliminate effete nitrogenous elements
from the system, including the cancerous mass, and the third step is to
restore the system to a proper tone by remedies and measures which
improve the blood and nutrition. It may happen, therefore, that in
treating a cancer patient over the long time necessary to effect a cure,
the greatest number and variety of remedies may be employed from time to
time, as intelligent observation and experience may indicate, to restore
and hold the metabolism and nutrition in a perfectly normal state: the
erroneous action of certain individual body cells which in the aggregate
we call cancer, will then cease to exist, as is seen in cured cases.
As, however, the diet is the basic element on which all health, good and
bad, rests it is all important that the physician and patient come to a
perfect understanding as to how this is to be carried out. And remember,
gentlemen, that there is no absolute or fixed time during which this
diet is to be continued; or rather, there is no fixed time when it may
be discontinued, and my patients are made to understand that it is at
their own risk that it is stopped. For safety from recurrence a proper
diet should be persisted in indefinitely or even permanently.
I recognize that it is often very difficult to persuade patients to
adopt and faithfully follow out this course of procedure for a long
enough time to secure perfect results, so obsessed is the medical
profession and the laity with the idea that surgery offers the only hope
of cancer. Numbers of patients, many of whom I have followed for some
years, now entirely freed from undoubted cancer, which had been
previously diagnosed as such by prominent surgeons, have told me that
they had suffered much more distress from the persistent solicitations
of their physician, surgeon, or friends, urging an operation, than they
had from the treatment or from the disease itself, as it slowly vanished
under the measures employed.
But as the true facts in regard to the ultimate results of operations
are becoming known, and as it is more generally realized and accepted
that the disease is amenable to rightly directed dietary and medical
treatment, patients are coming more and more to the Medical Clinic for
Cancer in this hospital, and adhering more and more faithfully to
treatment. Thus far, however, these have been mostly recurrent cases, in
which further operations were impossible, or primarily inoperative
cases. To illustrate the satisfactory treatment of early cases I shall
have to depend largely on those observed in private practice during the
last thirty years, of whom I shall try to show you some; for as yet
primary and operable cases are referred directly to the surgeons of the
hospital for operation.
At first the idea of an absolutely vegetarian diet is distasteful and
seemingly impossible to many patients, but when it is patiently
explained, as to the reason for its employment and the real benefit to
be derived from it, it is readily acquiesced in and commonly carried out
very faithfully; indeed many a patient has asserted that they are more
than pleased, and have no desire for animal food.
Among the poorer classes especially it has been hard to make matters
clear, and to facilitate the work of our Medical Clinic for Cancer I
prepared a dietary card, or folder, with a daily menu, which has now
been in very satisfactory use by hundreds of patients in private and
public practice. To make the whole matter of this line of treatment
perfectly clear, certain statements in regard to cancer have been
presented on the first page, and on the last page some directions as to
diet and mode of life of a practical character, as you will see on the
samples now passed around, known as the “green card diet slip.” I may
say that the hospital has already used up one thousand of these sheets
given to patients and to physicians making inquiries, and there have
just been printed this revised edition of five thousand copies, which
will be gladly furnished to those who can make good use of them for
cancer patients.
New York Skin and Cancer Hospital, Second Ave. and 19th St.
DIRECTIONS FOR CANCER PATIENTS
1. Cancer is a serious disease which should receive constant medical
care from the time it is first suspected.
2. “Cancer Specialists,” who advertise, should be avoided.
3. Cancer is not contagious, and there is no danger of communicating the
disease to others.
4. Cancer is not a disgraceful disease, and there is no reason for being
ashamed of it or hiding it.
5. As soon as cancer is suspected, whether there be a lump, or sore, or
other symptoms, it should be at once cared for by a competent medical
man, as the earlier it is rightly treated the more prospect there is of
its being cured.
6. Anything suspected to be cancer should not be handled or squeezed,
but should be kept from all irritation, as all this increases and
spreads the trouble and renders the cure more difficult.
7. If it is decided that a surgical operation is desirable and wise,
this should be done very completely at the earliest possible moment;
delay is dangerous.
8. The proper medical treatment of cancer should never be neglected,
both at the very beginning, and also long after an operation has been
performed, to prevent recurrence.
9. It is not necessary to operate on every cancer; x-ray and radium are
often of value, and the disease can also disappear and remain absent
under careful and efficient dietetic and medical treatment alone.
10. This treatment consists in an absolutely vegetarian diet, with
continuous proper medication, for a long time.
11. To get favorable results this treatment should be kept up faithfully
and strictly until discontinued by the physician.
To assist in carrying out a strictly vegetarian diet, a diet list for
cancer is here given, which should be closely adhered to. Coffee,
chocolate and cocoa, as also alcoholic drinks, even beer, are harmful
and must be avoided. The rules given at the end of this card are also to
be strictly observed.
DIET FOR CANCER
FIRST DAY
Breakfast
Baked apple
4 ounces Rice
3 〃 Corn bread
1¼ 〃 Butter
½ 〃 Sugar
Hot water
Dinner
5 ounces Tapioca soup
3 〃 Baked potatoes
3 〃 Stewed celery
3 〃 Peas
1 〃 Graham bread
1¼ 〃 Butter
1 Fresh apple
Supper
4 ounces Boiled oats
2 〃 White bread
1¼ 〃 Butter
4 〃 Stewed prunes
¼ 〃 Sugar
Very weak tea
SECOND DAY
Breakfast
Orange
4 ounces Hominy
2 〃 Graham toast
1¼ 〃 Butter
½ 〃 Sugar
Postum
Dinner
5 ounces Pea soup
3 〃 Macaroni
3 〃 String beans
3 〃 Carrots
2 〃 Bread
1¼ 〃 Butter
Dates
Supper
4 ounces Cream of Wheat
2 〃 White bread toast
1¼ 〃 Baked apple
2 〃 Crackers
1¼ 〃 Butter
¼ 〃 Sugar
Very weak tea
THIRD DAY
Breakfast
Banana
4 ounces Pettijohn
2 〃 White bread
1¼ 〃 Butter
½ 〃 Sugar
Hot water
Dinner
5 ounces Corn soup
3 〃 Baked potatoes
3 〃 Squash
3 〃 Boiled onions
2 〃 Bread
1¼ 〃 Butter
Raisins
Supper
4 ounces Farina
4 〃 Stewed figs
2 〃 Graham crackers
1½ 〃 Butter
¼ 〃 Sugar
Very weak tea
FOURTH DAY
Breakfast
Raw apple
4 ounces Cornmeal mush
2 〃 Graham bread
1¼ 〃 Butter
¼ 〃 Sugar
Postum
Dinner
5 ounces Vegetable soup
4 〃 Baked beans
3 〃 Cauliflower
3 〃 Asparagus
2 〃 Bread
1¼ 〃 Butter
Figs
Supper
4 ounces Rice
4 〃 Stewed prunes
2 〃 Graham crackers
1¼ 〃 Butter
¼ 〃 Sugar
Very weak tea
FIFTH DAY
Breakfast
Orange
4 ounces Cracked wheat
3 〃 Corn muffins
1¼ 〃 Butter
½ 〃 Sugar
Hot water
Dinner
5 ounces Sago soup
4 〃 Spaghetti
3 〃 Lima beans
3 〃 Boiled onions
2 〃 Bread
1¼ 〃 Butter
Dates
Supper
4 ounces Cream of wheat
Sliced orange
2 ounces Oatmeal crackers
1¼ 〃 Butter
¼ 〃 Sugar
Very weak tea
SIXTH DAY
Breakfast
4 ounces Samp
2 〃 Graham toast
1¼ 〃 Butter
½ 〃 Sugar
Postum
Dinner
5 ounces Celery soup
4 〃 Baked potatoes
3 〃 Carrots
3 〃 Spinach
2 〃 Bread
1¼ 〃 Butter
Orange
Supper
4 ounces Wheatena
4 〃 Stewed figs
2 〃 Saltine biscuit
1¼ 〃 Butter
¼ 〃 Sugar
Very weak tea
Repeat this bill of fare on
successive days.
Some interchange of the different articles may be made according to the
season and to suit the appetite or convenience of patients; but in the
main this bill of fare should be followed, with occasional substitution
of similar articles, if necessary.
Bread at least 24 hours old may be taken as desired.
A little old cheese may be grated on the macaroni and spaghetti, but not
cooked with it.
One boiled or poached egg may be taken for breakfast every other day,
and very fat bacon on the alternate days, unless otherwise directed by
the physician.
It is desirable to eat the skin of potatoes, baked or boiled.
Each and every meal should be eaten very slowly, for at least half an
hour, with long chewing.
One tumbler of water, not iced, is to be taken with each meal, but not
when food is in the mouth; also a tumbler full of hot water, one hour
before breakfast and supper.
No milk is to be taken unless specially ordered.
The vegetable soups are to be made from a stock composed of the water in
which all vegetables, including potatoes, have been boiled, added to,
day by day, kept hot, and allowed to evaporate; a portion is each day
thickened as desired with barley, rice, farina, sago, vermicelli, etc.
The cereals are to be boiled with water, three or four hours, and may be
cooked in the afternoon and re-heated in the morning, adding more water.
Rice, farina, and cream of wheat require only an hour. Chopped dates,
figs, raisins, or currants may be added to cereals when desired.
All the cereals are to be served very hot, on hot plates, and eaten with
butter and salt to taste (not milk and sugar). They are to be eaten very
slowly, with a fork, and very well chewed.
The crackers with supper may be varied to suit the taste; they should be
eaten dry, with butter, and chewed very thoroughly.
Nothing should be taken between meals, unless especially directed, and
the life should be as simple and healthful as possible, with early and
long bed hours.
* * * * *
This diet list has been carefully gone over by the dietitian of the
hospital, and as presented represents an average of 2,100 calories per
day, with 140 of vegetable protein. This is calculated for a person of
about 150 pounds, either in bed or not taking active exercise. The
quantity of each article may, of course, be increased if necessary, or
diminished for lighter weights, but in the main this has sufficed, so
that fat persons have come nearer normal weight, while thin persons have
gained in flesh. You will remember the girl of 20 years whom I showed
you last week, with the right upper jaw gone after an operation for
sarcoma, who weighed 89½ pounds on entering the hospital, and weighed
130½ pounds when she sat before you, three to four months later, with
the opening in the cheek perfectly cicatrized on the edges, and all
trace of the disease gone, on this diet.
You will notice certain directions on the last page of the folded sheet
which are of importance to remember: kindly look them over carefully. I
wish to call your particular attention to that in regard to perfectly
chewing, masticating, or Fletcherizing the food, even cereals, for at
least half an hour. Note also that the latter are to be eaten with
butter and salt, and not with milk and sugar, and with a fork, and not
with a spoon, in order to encourage slow eating. You will remember that
in my previous lectures I called your attention to the fact that the
salivary secretion was found to be at fault even in early cases of
cancer, and this perfect mastication is intended to stimulate these
glands and facilitate the change of starchy foods into glucose; for our
rapid eating in modern days may be one of the contributing basic causes
of the perverted nutrition manifested in cancer.
I would also call attention to the preparation of the vegetable soup,
which is to be employed in place of the stock ordinarily used, which
naturally contains the most poisonous extract of meat, or with milk,
which is not desirable. This vegetable stock contains all the salts and
other valuable extracts of the vegetables, which are commonly thrown
away, to the great detriment to proper nutrition; there is a great loss
of nutritive elements also occurring in connection with very many of the
so-called refinements of food which are the result of modern
civilization. Thus, the United States Agricultural Experiment Bureau
tells us that thirty per cent of the nutritive value of potatoes is
ordinarily wasted in the common method of peeling and cooking them. This
loss of vitamines is also true in regard to wheat and other articles.
You will notice that a portion of this vegetable stock for soup, made
from all the water in which all the vegetables are cooked for the whole
family, daily, is each day to be thickened and flavored as desired, to
which also chopped vegetables may be added and also various cereals,
vermicelli, tapioca, sago, etc. I may remark that many patients in
private practise have told me that their families pronounced this to be
the best soup they have ever tasted. Pardon all these homely remarks,
but as attention to details is of the utmost importance in dermatology,
so it is particularly true in regard to the management of cancer.
It will be noticed in the menu that I encourage the use of butter,
giving a quarter of a pound a day, in three portions. This contains 800
calories, or one third of the total amount required; a certain amount of
sugar is also prescribed, as affording an additional carbohydrate which
is completely oxidized under favorable conditions.
It is realized, of course, that this bill of fare may be improved on.
But it has been compiled with considerable care and thought, and an
experience with it for over two years, in dozens, or rather hundreds, of
cases shows that it is workable and accomplishes results which are often
surprising and most gratifying, not only in my own practise but also in
the hands of other physicians. I have sometimes remarked to you, perhaps
thoughtlessly, that if a person had lived for three or four years
according to this card, and continued to do so, I could guarantee that
he would never have cancer.
So much for prophylaxis. For, as stated before, I feel confident, after
many years’ observation and experience, that if the principles and
practise which I have tried to present to you in my former lectures and
these were closely followed by the community at large, there would
before long be a very gratifying diminution in the cases of cancer, and
in the mortality therefrom.