beneficial results of treatment, although in such a hopeless case, with
such a mass of ulcerating cancerous tissue as she presented, secreting
its poisonous hormone, any other end could hardly be expected. There is
no question, however, but that life was greatly prolonged and much
comfort secured, as to sleep, diminution of pain and offensive
discharge, etc. The case was watched with interest by members of the
attending staff, and careful laboratory studies of the blood and
volumetrical analyses of the urine were made weekly; the latter was
generally scanty, running even as low as nine ounces a day, though of a
fair specific gravity, and it was very difficult to raise the total
solid urinary output to anywhere near a normal standard. The saliva,
tested and recorded before and after each meal, was commonly acid, often
strongly so, though at periods it would be neutral and occasionally
became alkaline for a while under active treatment.
I have taken up so much of your time with cancer of the breast that
little is left for consideration of the disease in other localities, and
I will be as brief as possible:
CANCER OF THE UTERUS.—Two cases, in private practise, among the eight of
cancer in this location which are on my list, are so interesting and
remarkable that I must give them somewhat in full. I may say that the
other cases had little or no satisfactory treatment. One of these two
would gladly present herself for your inspection, that you might verify
her present condition of excellent health, but she lives in Bangor,
Maine, and now only comes on periodically; this is in order to be sure
that she continues in the straight and narrow road necessary to keep her
free from her previous distressing condition. The case is as follows:
_Case VII._—Mrs. F. L. A., aged 48, weighing 105 pounds, was first seen
on March 21st, 1916. She had had four children aged 22, 20, 17, and 12
years, and had had a miscarriage 9 years ago. There had never been any
trouble with confinements, and never laceration of the cervix. The
menopause had occurred suddenly two years previously, but she had had
some vaginal discharge since October, and had felt weak for some months.
She had, however, never suspected any serious trouble until there was a
slight hemorrhage, consisting of only a few drops of bright blood, on
February 24th. That afternoon she was examined by a surgeon at home, Dr.
McCann, of Bangor, Maine, who sent her to me. He discovered that she had
already an inoperable cancer of great extent, which diagnosis was
confirmed by others, who refused to operate. The report which came to me
from the department of Pathology and Bacteriology of Bowdoin College
was, “About one third of the cervix destroyed, vaginal wall involved.
Right broad ligament infiltrated.” Curettings were made then, which from
“numerous slides show squamous cell carcinoma. From histological
appearance I judge that the cancerous process is developing rapidly,”
signed F. N. Whittier. The slides which were brought to me were
submitted to Dr. H. H. Janeway, who confirmed them to be “rapidly
growing, malignant epithelioma.” Those who saw the patient on February
24th gave the opinion that she would hardly live six months.
She had been following an absolutely vegetarian (green card) diet for a
week or two, and had been taking some compound cascarin tablets, which I
had sent her (℞ Podophyllin, Aloin, Cascarin, āā gr. ¼), as she had
always been very constipated, and since this treatment had felt much
better in every way. I gave her douches morning and night, of carbolic
acid and biborate of soda, ℨss and ℨii ad Oi hot water.
I then sent her to Dr. H. H. Janeway, who confirmed the physical
condition and gave her one single treatment with emanations of 300
milligrams of radium, for 16 hours, on March 25th, dilating the os, but
not curetting. She was then given ℞ Potass. acetatis ℥i, Tinct. Nuc.
Vom. ℨiv, Extr. Cascara fld. ℨii, Ext. Rumicis rad. fl. ad ℥iv,
Teaspoonful in water half an hour before eating, which she has taken
more or less continuously ever since, alternated with other remedies as
indications arose. Later she took pyrophosphate of iron, five grains
after meals, in conjunction with the mixture. For some time she had
suffered from severe neuritis in the neck and arm, which yielded
completely to aspirin, five grains every two hours, taken also again on
several occasions when it recurred.
I will not burden you with the many details recorded on her case paper,
but can only say that to-day she is as well a woman in every way as one
could wish. Her color is good, and a recent examination of her blood
showed hemoglobin 80 per cent, red blood cells 4,500,000, leukocytes
5,800, of which polynuclears 64 per cent, lymphocytes 27 per cent,
transitionals 8 per cent, and eosinophiles 1 per cent. She has made the
trip back and forth from Bangor, Maine, half a dozen or more times,
without fatigue, recently walked several miles, eats and sleeps well, is
no longer constipated, and has a good urinary excretion, with rather an
excess of solid contents; on December 6th she weighed 110½ pounds; her
normal weight before her sickness had always been 93 pounds.
On June 2nd she was examined by Dr. Janeway, who reported: “I find no
ulceration whatever on the cervix or vagina, the uterus is movable and
of normal size. There are no evidences of any disease remaining which
can be detected by examination.” On July 7th he wrote: “I have examined
Mrs. F. L. A. again and find that there has been no return of the
evidences of her disease.” On October 20th he wrote: “Mrs. F. L. A.
appears to be absolutely free from disease.” Her surgeon, Dr. McC.,
confirmed all this by examination. It is now over 9 months since she was
given 6 months to live, with an inoperable uterine cancer, and to-day is
in better health than she has been for years.
This patient had one single application of radium, as mentioned, on
March 25th, which probably aided in modifying the local disease, but it
would be beyond human credulity to believe that this was a very large
factor in restoring her to her present condition of health. The cure is,
of course, a very recent one, but there is no reason why the same
measures would not be effective should there be any return, as they are
directed against the real cause of the disease. Nor is there any
likelihood that there will be any possible relapse, as she is a most
intelligent patient who adheres strictly to the treatment and diet, and
will undoubtedly do so until directed otherwise.
Strangely enough another very similar case was also sent to me from
Bangor, Maine, which I will mention very briefly:
_Case VIII._—Mrs. H. F. J., aged 52, weighing 102 pounds, was first seen
August 3, 1916. She had been under an absolutely vegetarian diet (green
card) since July 17th, and was feeling better than before. She had had
three children, 27, 25, and 16 years of age, the menses had been regular
up to April 15, then nothing up to July 1st, when there was a clotted
flow, checked by treatment, which had returned in two weeks, with pain,
after an auto ride. On July 14th she was examined by two physicians who
found cancer of the cervix, which was confirmed by Dr. Janeway on July
31st, who reported “cancer of the cervix and vaginal canal, with some
cauliflower excrescence; the uterus was not much enlarged or fixed.” She
received one application of radium on August 1st, 300 mil. Curies to the
canal, and 120 to the cervix, for 12 hours.
She was given the same mixture as Mrs. F. L. A. and the “green card
diet,” and the injection of carbolic acid and biborate of soda. Briefly,
to report further, on September 30th it was recorded that she had
improved every day; she had gained steadily, and again on September 30th
that she had improved every day. She had a good appetite and was getting
back her strength, and seemed “quite like herself again.”
On October 20th Dr. Janeway reported that Mrs. H. F. J. was “free from
disease, although the healing is not quite complete.” This is, of
course, a very recent case, but the progress has been so satisfactory
that in view of the former case and the results so often obtained when
all proper measures are carefully carried out, there is reasonable
expectation that this will also result in a cure.
I will not dwell longer on carcinoma, though if I had time I could
relate many other interesting and instructive cases, showing
satisfactory results of treatment. My experience has naturally been
principally with the disease as it affects the breast, and many of the
patients affected elsewhere I have seen in consultation, or only a few
times, though some have been faithful to prolonged treatment.
But if the thesis which I have tried to establish in these and my former
lectures is correct, then sooner or later we will be able to apply the
same principles, more fully developed and more perfectly adjusted, to
cancer in other locations. And as the public and profession are better
educated along these lines patients will apply earlier, and the
pre-cancerous constitutional relations will be recognized and treated
before the cancerous mass has gained such headway. There can be little
doubt but that the same principles of treatment and prophylaxis apply
equally to the cancerous process wherever the primary lesion has first
developed.
SARCOMA.—Of the 36 cases of sarcoma, of various types and in different
situations, which enter into our list of malignant neoplasms, very few
can be mentioned as illustrations of the value of dietary and medicinal
treatment; many of them were seen only in consultation, or once or
twice, and it is very difficult for those afflicted with such affections
to be persuaded of the value of prolonged internal treatment when
surgery apparently offers such brilliant immediate results.
But there is one patient with sarcoma of the upper jaw, whom you saw a
while ago in an ulcerative condition, with a great hole in the cheek and
a cavern within, whose improvement is so phenomenal that I now present
her to you again to-day, as she is about to leave the hospital, after a
little over four months’ stay.
_Case IX._—Miss R. L., aged 19, entered the New York Skin and Cancer
Hospital, in my service, July 24th, 1916, weighing 89½ pounds. She had
formerly weighed 120. About three years ago a small lump developed
beneath a pigmented mole which had long existed, an inch or so below the
right eye. This grew rapidly until it was about an inch in diameter, and
was movable and painless. About January 1st a tooth in the right upper
jaw became loose and three teeth were extracted; a radiograph was taken,
and she was advised hospital treatment. She then entered another
hospital and the gum was incised and radium applied for 18 hours on
March 1, 1916. After this operation the face became swollen and very
painful, and an extensive operation was performed in May, the right
upper maxilla being removed, together with the tumor. Four weeks before
entering the New York Skin and Cancer Hospital a pin hole opening was
noticed in the scar on the cheek, which increased in size up to the time
of admission. She remained in that hospital until she came to us. The
microscopic examination of the portions removed showed the disease to be
sarcoma.
On entering the hospital there was an opening in the right cheek
something over an inch in diameter with ulcerated edges, and a cavity
extending down to the tongue, the superior maxilla having been removed
surgically. From the upper margin of the opening there was a mass of
dead bone hanging, nearly three quarters of an inch long by half an inch
wide. The interior of the cavity presented a mass of ulceration, giving
forth a foul odor. She was thin, pale, and anemic with 85 per cent
hemoglobin and 3,620,000 red blood corpuscles.
She was placed on an absolutely vegetarian diet (green card) and began
with the same mixture as the cases of carcinoma mentioned. The cavity
and opening were kept packed with absorbent cotton, saturated with the
following solution: ℞ Acidi Carbolici ℨss, Listerine ℥i, Liquor sodæ
chlorinatæ ℥i, Glycerin ℥ss, Aquæ hydrogenii dioxidi ad ℥iv, M., changed
several times daily. Under this treatment there was almost from the
first a remarkable change in her condition. The discharge ceased shortly
and also the foul odor. Within a few weeks the cavity and edges of the
opening showed a healthy condition and evidences of cicatrization could
be seen. The tongue of dead bone, which was soaked several times daily
with muriatic acid, separated entirely within three months, leaving a
healthy granular surface. By the end of four months the entire edge of
the opening on the face had cicatrized perfectly, and the interior
appeared in a healthy condition, with no ulceration whatever, as you saw
when she was presented the second time, a few weeks ago.
From the first her general condition improved and she began to gain
weight, even several pounds a week, being weighed every week in the same
hospital wrapper, by several nurses, who took great interest in the
case. I could hardly believe that she weighed 128 pounds on a Monday, as
reported, and on the following Wednesday I weighed her myself and found
that she weighed 130, which was quite a little over that called for by
her height and age, and ten pounds more than she had ever weighed
before. She had been taking for some time pyrophosphate of iron, five
grains after eating, in addition to the mixture mentioned, which had
hardly been changed since she entered.
The blood, which was carefully studied weekly, steadily improved until,
on September 18th, the hemoglobin stood 95 per cent, with 4,600,000 red
blood corpuscles and 8,000 white, and on November 10th the hemoglobin
reached 100, and the red corpuscles 4,700,000. The urine, which
presented albumen and granular casts on admission, had lost these, and
on November 10th she passed 1,000 cc., with a specific gravity of 1.025,
and normal in every respect, except a faint trace of indican.
You will now, however, be specially interested when you see the change
which has been wrought in her face by Dr. Semken, one of our attending
surgeons, who performed a plastic operation on her, beginning Nov. 14,
with the preparation of a flap on the right arm. This flap was lined
with a Thiersch skin graft from the leg, so as to secure a proper mucous
lining in the mouth, and left _in situ_ until Nov. 24, when it was
attached to the face, after the scar tissue had been cut away. The arm
was held in place by a plaster of Paris dressing until yesterday, when
the attachment to the arm was finally severed, after several partial
separations. The skin graft took from the first, without any drawback,
and now you see the opening entirely and perfectly covered. You will
notice that the ectropion, which was so marked when you first saw her
with the ulcerating surface, has about disappeared, and Dr. Semken
believes that there will be still further improvement in this respect.
I must not keep you longer, though I should have liked to narrate other
cases of carcinoma in other locations which are of interest. I trust,
however, that you have heard and seen enough to be quite satisfied as to
the correctness of the principles I have tried to lay down, and also as
to the success following their proper and careful application. How far
they will serve for cancer in general, as it affects various organs and
parts of the body, remains to be seen, when many others have reported
their results. Whether also this line of thought will apply to sarcoma
in general remains to be seen, for sarcoma is really of much the same
nature of malignant cell growth, only affecting the connective tissue
elements instead of the epithelium.
In closing I must again remind you that it is no trifling matter to
undertake the treatment of cancer by dietary and medicinal means, even
though from what you have seen and heard you may think otherwise. Each
case requires the utmost careful study and adaptation of remedies as may
be indicated to bring the patient into a condition of perfect health.
Diet alone will not accomplish this, but without the proper diet, as
already indicated, all other efforts are unavailing to check the dire
disease. With the proper carrying out of every detail the success is
certainly much greater than with surgery, and with advancing knowledge
and practise along these lines we shall undoubtedly see a satisfactory
diminution in the deaths from cancer, whose death rate has so steadily
risen under the measures heretofore employed.
SUMMARY
THE REAL CANCER PROBLEM[2]
Cancer has long been a problem over which master minds have wrestled,
and to read much that is written it would seem that we were yet as far
from its solution as ever. Countless able men, at the expense of
millions of dollars, have labored faithfully in the laboratory, and it
may safely be said that more effort and time have been expended in
investigations on cancer, and more has been written concerning it, than
ever in connection with any other disease affecting humanity. And yet
its mortality is steadily increasing pitifully, in spite also of active,
skilful, and faithful surgical treatment.
Is it not possible, therefore, that there is something wrong in our
conception of cancer and its treatment? If any other disease presented
such a steady and alarming increase in its death rate would we not stop
and consider if our treatment were the best possible? If with the
introduction of antitoxin the mortality from diphtheria had steadily
risen until it was about 90 per cent of all cases, would we persist in
employing it? And yet the profession and the laity go blindly on, with
the idea that surgery offers the only hope of reaching cancer, when the
Mortality Statistics of the United States show that under this line of
treatment the death rate has _risen steadily_ from 63 per 100,000 of the
population in 1900 to 81.1 per 100,000 in 1915, or 28.7 per cent.
Surely the lesson taught by the steadily and greatly _decreased death
rate_ of tuberculosis should teach us something of the value of most
careful dietary, hygienic, and medical control of other diseases. For
the great white plague, which a while ago threatened even the
destruction of the race, shows now a mortality which has steadily
_fallen_ 27.8 per cent since 1900, and that even with the continued
presence of the tubercle bacilli. I realize that the comparison is not
quite correct in all respects, for it is well established that cancer is
not due to a microörganism; but it does show us that nutritive errors
are at the bottom of the ravages of tuberculosis, and efficient
biochemical studies in cancer have satisfied many that the same,
although different in character, are true of this disease.
In other words, erroneous nutrition, which is productive of disease of
the kidneys, heart, and blood vessels, with their steadily rising
mortality of ten to twenty per cent since 1900, as shown on the chart
before you,[3] is operating to steadily increase also the morbidity and
mortality of cancer, in spite of active and intelligent surgical
treatment. And yet the profession and laity seem to be blind to this
fact.
It is also not a little remarkable that during the year 1915, when there
was a special effort made to educate both the laity and the medical
profession in regard to the advisability or necessity of early
operations in cancer, the actual death rate rose by 1.7 persons per
100,000 living, whereas the average yearly rise for the preceding five
years had been only 1.2 persons per 100,000!
What, then, is the real problem of cancer? Surely it is not to increase
the surgical activity, which has resulted only in a steadily ascending
scale of mortality, which in reality is greater than that observed in
any other malady! For the increase in the death rate from cancer
throughout the United States from 1900 to the present time has been
coincident with the greatest activity both in laboratory research, and
in the advanced surgery of the disease. I repeat, is it not time for us
to stop and consider whether our laboratory work with the microscope on
morbid tissues, and our experimentation on rats and mice are truly
serving to solve the real problem of cancer? Or whether we had not
better turn our attention to human beings, and by careful clinical study
of our patients, discover where the fundamental error lies, which first
induces the formation of an aberrant cell mass, which we call cancer,
and then continually feeds it by the same deranged blood stream, so that
it becomes utterly uncontrollable and invades and destroys other
tissues; while at the same time the anemia, pernicious and progressive
in character, gradually saps the life of the patient to a lethal end?
For repeated and most careful laboratory studies have demonstrated great
and significant changes in the blood in cancer. I hope to satisfy you
that the mass which is excised is only the _product_ of a far deeper
systemic change, which has probably already produced other, more or less
similar masses or deposits elsewhere—in the bones and internal organs or
lymphatics. So that surgical removal of the one often stimulates the
development of others.
It is seen, then, that it is here denied that the local lesion which we
call cancer is the first and only cause of disease. It is also denied
that the surgical removal of the offending lump and adjoining glands and
tissues, however early it is performed, is a sure and only cure for
cancer.
In the recent cancer propaganda, urging the very early and complete
removal of everything which could possibly be called pre-cancerous, it
is interesting to observe that most of the pictures shown and arguments
presented relate to cutaneous epithelioma, which the United States
Mortality Statistics show to be the cause of only 2.7 per cent of all
deaths included under cancer! Moreover, those of us who see epithelioma
daily know that, if properly treated early by other means than the
knife, it is commonly a relatively innocent affection. It is
acknowledged, however, that by meddling and wrong treatment, as with
nitrate of silver, it can be goaded on so as to become a serious affair.
In our present consideration of cancer as a disease it is to be
understood, therefore, that cutaneous epithelioma is excluded, and that
reference is made to the serious malignant disease known as cancer,
affecting various other organs of the body. However, many cases of what
might be called epithelioma of the lip and oral cavity are of such
malignity that they are properly ranked as carcinoma.
Looking at cancer, therefore, as a general disease of which the local
lesion, which is ordinarily excised surgically, is simply the result or
product of a previous, perhaps long-standing, blood or nutritive
disorder, we can readily understand why the simple excision of the tumor
and surrounding tissues cannot be expected to eradicate the malady
permanently. We can also see why the disease recurs so readily in the
scar tissue after operation; for all recognize and admit that cancerous
degeneration is apt to develop on any scar tissue. It is also well known
that occasionally a tumor which after removal has been proved
microscopically to be only a simple adenoma, has eventually been
followed by true carcinoma in the cicatrix or elsewhere, under the
stimulation of surgical procedure.
Metastatic development, after or without operation, can also be readily
understood on the ground of the disease being a constitutional disorder.
For, as far as I have observed, there is seldom or never any continuous
attempt made after an operation to alter the dyscrasic condition
producing the tumor, but the patient is dismissed with the vain hope
that there will be no more trouble. It is quite natural, therefore, that
the transference of cancerous cells by the lymphatics or blood vessels,
will form foci which are readily made to grow further by the vitiated
blood stream.
Regarding, then, cancer as a systemic disease, of which the tumor is but
a local expression, often or perhaps always the result of local injury
or irritation, possibly of one or more “embryonic rests,” let us briefly
review the evidence in support of this view, and the measures found
successful in combating the basic cause of the disease.
First let me remind you of the _negative_ and _positive_ results of
laboratory and other study, which are pretty well conceded by those who
know most about the disease; and in presenting these I cannot do better
than to quote what I have collected in a former article.[4] There are
eight of these in each group.