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CANCER
ITS
CAUSE AND TREATMENT
BY
L. DUNCAN BULKLEY, A.M., M.D.
Senior Physician
The New York Skin and Cancer Hospital, etc.
[Illustration]
NEW YORK
PAUL B. HOEBER
1915
Copyright, 1915
BY PAUL B. HOEBER
_Published, February, 1915_
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 branch of
DERMATOLOGY
this little book is inscribed
PREFACE
Cancer has hitherto been regarded almost wholly from its histological
and surgical aspects. The investigators and practitioners along these
lines have been innumerable, the work done prodigious, and the
literature relating thereto enormous. But relatively little attention
has been paid to the medical aspects of this most threatening malady,
although voices have been raised from time to time, with more or less
force, all joining in the same plea that the basic cause of the disease
lies in some derangement in the vital forces of the organism, as
influenced largely by diet and mode of life.
It has, therefore, seemed to the writer that it was time to stop and
look at cancer from a broader aspect, and by synthesis and deduction to
seek to understand some of the underlying causes of malignant disease;
also to see if some general principles could not be ascertained upon
which could be based an explanation of the views he had long held, and
of the practice which he had long followed in regard to the prevention
and cure of this dire malady. And as his studies progressed he was more
and more satisfied that the true solution of the cancer problem lay
along the lines indicated, although there was still very much to be
learned regarding the details and application of the principles
involved.
The lectures were prepared for and delivered to practicing physicians at
the New York Skin and Cancer Hospital, in connection with the regular
Wednesday lectures on Diseases of the Skin, as I felt that I should give
them the benefit of what I felt to be of value in my own practice,
private and public.
Although holding the views here expressed for many years I have
hesitated writing strongly on the subject before, lest I should be
misunderstood or misjudged: for favorable results based solely on a
clinical diagnosis of cancer are always doubted. I have also feared lest
by advocating a dietetic and medical consideration and treatment of
cancer, which possibly might not be carried out exactly, I might really
do harm; since some might be led to neglect operative measures in proper
cases, at the proper time; and so in certain instances great injury and
injustice might be done to the patient, and the time pass in which a
surgical operation might possibly be of service.
But with my views and experience, strengthened greatly by what studies I
have been able to make in the midst of a busy professional life, I now
feel that I should do wrong in not presenting the results and
conclusions of my study and observation. And I wish also to enter my
strong protest against the course which is usually followed in regard to
cancer, both before and after operation. With a rather extended
experience during the last forty years, I have rarely if ever found a
patient with cancer who has received adequate and continuous medical
care before operation, with a view of discovering and rectifying the
cause of the morbid growth. Too often when a cancer is suspected or
discovered it is taken as a foregone conclusion that the malady is
hopeless, except as the _results of the disease_, that is the new
growth, may be removed by the knife, X-ray, radium, caustics, etc. And
after a surgical operation, as far as my observation goes, the patients
are invariably left entirely to their own resources, with the hope,
alas, too often futile, that the tumor will not regrow, but with no
attempt to so guide the life that there shall not be the same tendency
to a recurrent malignant new-formation. Against this latter course I
also raise my earnest protest.
In presenting matter from literature bearing on the subject under
discussion I am well aware that I have hardly more than touched the
surface of the deep ocean of recorded observations on cancer, but it was
the best that I could do in my busy life. I only hope that others will
take up in earnest the subjects here presented, and that this pioneer
work may lead to the building of a strong and permanent structure
regarding the true basic cause of cancer. Truth never fears proof.
In studying the subject I have been greatly assisted by the masterful
work of Roger Williams, so often referred to and quoted from; and I feel
that a candid and careful perusal of that book will be a revelation to
many. I know that some have endeavored to throw discredit upon some of
the deductions which he makes from various statistics, but in the main
they all teach a valuable lesson and are worth serious consideration, as
they are taken from reliable sources.
Realizing fully that the problem of the cause and proper treatment of
cancer is a most profound one, which master minds have long wrestled
with and which cannot be fully settled without much further study, these
lectures are presented to the profession at large in the hope that they
may be the means of helping some one threatened with or suffering from
malignant disease; and also that they may possibly stimulate others to
investigate even more diligently along the lines of the medical aspects
of cancer.
January, 1915.
531 Madison Avenue.
CONTENTS
PAGE
LECTURE I
NATURE OF CANCER 15
LECTURE II
FREQUENCY AND GEOGRAPHICAL DISTRIBUTION OF CANCER 43
LECTURE III
METABOLISM OF CANCER 70
LECTURE IV
RELATION OF DIET TO CANCER 106
LECTURE V
MEDICAL TREATMENT OF CANCER 135
LECTURE VI
CLINICAL CONSIDERATIONS AND CONCLUSIONS 170
BIBLIOGRAPHY 211
INDEX 221
CANCER
ITS
CAUSE AND TREATMENT
LECTURE I
NATURE OF CANCER
It may be safely said that no disease which has afflicted mankind has
received as much attention as Cancer, or concerning which there has been
as much diligent search to find out its nature and cause. Tuberculosis,
which seemed at one time to threaten even the existence of the race, has
sunk into relative significance, as we have learned its true nature and
conquered some of the causes of its ravages, and reduced its mortality
very largely. Syphilis, under various names, forms, and aspects, was
formerly much more of a menace than now, and in earlier years caused
veritable epidemics, but is now well understood and controlled. Leprosy
is less of a terror than in earlier times, since it has been definitely
shown not to be contagious. Smallpox no longer rages, and yellow fever,
and the plague, and hook worm disease have been hunted down by
scientific study and the application of proper sanitary and medical
measures. And so on in regard to many of the ills which afflict mankind.
But cancer has held its own and has even increased in frequency, with
rapid strides and bounds in some localities, until now it looms large as
a national[1] or even universal scourge; it has been estimated to cause
the death of half a million persons yearly among the civilized people of
the earth, and untold misery and suffering to many times this number.
And all this is still going on in spite of the earnest, faithful, and
intelligent labors of innumerable research workers, the sacrifice of
countless animal lives, and the expenditure of vast sums of money; and
the end, as far as relates to its prevention and cure, seems almost as
far away as ever, for many surgeons, in past and present times, have
acknowledged their inability to cope with the disease.
Much, however, has already been established by scientific research, and
still more earnest thought, observation, and endeavor should be given to
seeking most diligently for the cause of the disease, in the laboratory
as well as in practice; for there must be some cause of cancer, and also
some reason for its steady increase.
But it is never to be forgotten that, as Pope says, “the proper study of
mankind is man,” and clinical observation, with laboratory research, on
cancer as it appears in the human being, must be the ultimate base upon
which all true advance in the knowledge of the nature, treatment, and
prevention of the malady can ever rest. To effect this we must study the
human being in all relations of life, must know the constitution and
class of subjects in which the disease is most apt to manifest itself,
understand the chemico-physiologic actions going on in the system,
before and during the existence of the disease, and by a process of
synthesis and deduction understand what is wrong and endeavor to correct
it.
All this is indeed a great undertaking, and can only be accomplished by
great effort on the part of many careful and skilled observers. But I
want, in these lectures, to give you an outline of my own thought and
study for many years, and, if possible, to let you see as I do the lines
along which investigation should be directed. It is hoped, therefore,
that this and the following lectures will throw some light on the
connection of cancer with diet and mode of life, and some suggestions as
to its prevention and cure.
_Parasitism_ has been excluded: for while at different times many
observers have reported various organisms which were thought to be the
cause of malignant growths, none of these have been definitely confirmed
by others, in spite of earnest endeavor; and all experimental and
clinical evidence is against a parasitic etiology of cancer. It is
therefore seen how improper it is to speak any longer of “_the germ of
cancer_,” for, as is now widely acknowledged, there is no such germ, it
is an _ignis fatuus_ which has been chased in vain.
The _contagiousness_ of cancer has also been excluded, certainly in the
sense in which this term is applied to other affections. For while in
some animals inoculation experiments have resulted in the transmission
of certain tumors, little has been determined except that such tumor
material when transplanted can, in some unknown manner, multiply its
cells indefinitely and form a focus of malignant disease, with
disastrous effects on adjoining tissue. The same occurs in metastasis in
cancer patients. But this does not at all explain the true basic nature
of cancer, nor its development in those who have had no connection with
other patients so afflicted. On the other hand the instances of
suggested or supposed human transmission of cancer from one individual
to another are so remarkably few, and so exceedingly doubtful, that a
recent author, Janeway, states that “no well-authenticated cases of the
transfer of a malignant tumor from one human being to another exist.” It
has been found impossible to inoculate human cancer into rats, mice, and
apes, nor can animal tumors be inoculated into animals of a different
species.
_Heredity_ has been advanced as a cause, but statistics fail to verify
this in any degree whatever. While certain instances have been brought
forward in which heredity seemed evident, the study of large numbers of
those afflicted with cancer, in connection with others free from the
disease, has shown almost the same proportion of antecedents with cancer
in both classes of persons; although some recent evidence seems to show
that there is some tendency in different families for different organs.
Experimental studies have, it is true, seemed to demonstrate that tumors
occur apparently along hereditary lines in some animals in regard to
certain organs; but in these instances it is to be remembered that the
animals were kept in captivity, and all fed alike, conditions which have
been found to cause the development of malignant disease in wild animals
when confined in Zoölogical Gardens.
In former years _malaria_ was believed to have an influence in the
production of cancer, and some investigators have thought to trace the
prevalence of the disease to _telluric influences_, showing a
preponderance of cases along certain water courses, or in certain
streets or houses; but no definite proof of such connection has ever
been established, and this theory is dismissed by the best authorities.
_Syphilis_, in its latent effects, has also been claimed as an element
in the causation of cancer, and undoubtedly the disease may develop, in
suitable persons, upon old syphilitic lesions, especially about the
mouth, anus, and genital region: but no one well informed in regard to
cancer would regard syphilis as the real cause of the disease. All these
and other etiological propositions are no longer considered to be
tenable, and the very multiplicity of suggested causes shows that we are
yet very far from the true etiology of cancer.
_Age_ undoubtedly has a powerful influence in the development of cancer,
the vast majority of cases occurring after the age of forty or fifty.
But, again, this does not at all explain the true nature of the disease,
for only a certain proportion of elderly people are so afflicted, and
malignant tumors have been observed in those of all ages, and even in
young children. The degeneration of tissue belonging to advancing years
undoubtedly renders it more susceptible to malignant disease, but this
does not explain why one person is affected and not another, nor why the
tissues in one locality or another take on this morbid action.
More recent scientific study has attempted to show that cancer
originates from what are called “_embryonic rests_,” or pre-natal,
wrongly placed, tissue elements, which at some time or other take on
morbid action and develop into what we know as the various forms of
cancer. Williams says, “From a biological standpoint tumor formation
must be regarded as a phenomenon of the same order as reproduction in
general: that is to say, as a special form of overgrowth of the
individual.” But here again it is necessary to determine what causes
them at certain times and in certain places to thus proliferate and form
new tissue, which then becomes malignant and may proceed to destroy all
contiguous tissues, and even to cause death.
_Traumatism_ has been claimed by many as the cause which determines the
activity of the misplaced cells, and starts them on their disastrous or
rampant course: the various percentages of the cases in which it was
believed that traumatism started up the malignant process has varied
greatly with different observers, even up to 50 per cent, or more. But
it is far from proven that this is always the case, nor does local
injury in any way explain the persistency with which malignant disease,
when once started, pursues its destructive and even fatal career; nor
can traumatism account for the great tendency to recurrence constantly
observed, either in the former site or at some distant focus, through
the agency of the lymphatic or vascular system. For of multitudinous
traumatisms, even in cancer subjects, how few ever develop into
malignant disease!
It would seem, therefore, that for the development of the local
manifestation of cancer (the tumor or new growth) three elements are
requisite, namely: 1. A predisposition or suitable blood condition. 2. A
local stimulation or irritation of the part affected, _upon_, 3. The
site of an “embryonic rest.”
On the basis of the embryonic theory surgeons have of late most
earnestly advocated the very early and complete removal of malignant
lesions, including those of suspected malignancy, and even also the
removal of many innocent lesions which are observed occasionally to lead
to cancerous formation; and unless a better plan can be determined this
cannot be urged too strongly in proper cases.
But while early operation has improved surgical statistics, it has not
contributed to our real knowledge of the basic cause of cancer, nor has
it taught us why those lesions or “embryonic rests” will remain
quiescent for years, or prove harmless in some individuals, while in
others they become most formidable agents of destruction. For it is now
recognized that these wrongly placed tissue elements are very common
anatomical or histological accidents, indeed it is claimed that they
occur and exist in every individual: and the removal of isolated
“embryonic rests” which have developed into cancer, does not by any
means prevent the transformation of other similarly misplaced cells into
malignant disease, as the frequent recurrence of cancer after operation
demonstrates.
The same is true of the many and various forms of treatment other than
surgical excision, such as deep acting caustics, and even the X-ray and
radium, which like surgery, only remove the focus of possible systemic
infection, and do not affect the basic cause of the complaint: this
latter is being shown more and more, by scientific investigation and
observation, to be associated with metabolic or chemico-physiological
changes in the system, and evidence is accumulating that it is dependent
upon them.
All this leads thoughtful persons to inquire if there is not some
deeper, fundamental cause lying back of the trouble, which should be
reached and rectified by medical skill and acumen, something to do with
the life or diet of a person which renders the tissues liable to take on
malignant disease. So that a recent surgical writer on cancer states
that “all study, whether clinical, pathological, or experimental, points
to the fact that there is some underlying, hidden cause which leads to
that aberration in the action of tissue cells which we call cancer,” ...
a cause “residing in only the cells themselves or in some abnormal
chemical constitution of the plasma bathing the cells, or in both of
these possibilities acting together.”
_Occupation_ has been questioned, but with most unsatisfactory results,
for in some statistics which have been gathered cancer has been observed
in those following all possible pursuits: and while laborers stood first
on the list, clergymen stood fourth, while carters, threshers, and
guides, who would be exposed to local injury, were at the bottom of a
long list. It has been found, however, to be more frequent in trades or
occupations in which the individual is most subject to the habitual
abuse of alcoholics, as in bartenders, printers, etc.
We see, then, that thus far no satisfactory cause has been established
for the occurrence of cancer, much less for the steady and great
increase of the disease of late years. And as far as can be learned, no
measures are recognized, or at least generally adopted, to prevent its
occurrence or recurrence; although, as already stated, modern surgery
has seemed to improve the statistics in regard to its mortality in
certain forms or locations, and the X-ray and radium have certainly also
been able to remove, perhaps temporarily, some of the products of the
disease.
We come then to the question, what is the real nature of cancer? Alas,
all scientific, experimental, and clinical investigations have failed to
solve the problem, except that all “evidence points to the conclusion
that cancer is to be considered as a pathological disturbance of the
normal cell life,” from some unknown cause. A curious suggestion has
been made by Schmidt, who found that of 241 cases of cancer of the
chylopoietic system, 180 had never had any infectious disease of
childhood, and 99 went through life without any infection of any kind;
the figures point to the existence of a cancer diathesis—one which is
resistent to germs.
It would carry us too far from the practical side of our subject, even
if we were at all able, to present or analyze the vast number of
contributions which have been made to the pathological histology of
cancer, and the changes which take place in the transformation of normal
cells into those of malignant character: the amount of microscopic work
which has been done along this line can hardly be imagined, and the
literature relating to it is enormous.
Ewing, accepting the definition that the cancer process is “atypical and
destructive proliferation of epithelium,” quotes Ribert as saying that
“no one has ever seen the beginnings of mammary cancer”: but he does not
bring us much nearer to the solution of the cancer problem than we were
before. Bainbridge rejects all possibility of a blood condition, and
finds the only solution of it in the early removal of everything which
is thought to lead to cancer, even the simplest benign new formations,
but Ewing states that “in some cases carcinoma has developed after
excision of wholly benign fibro-adenoma”: and the immense number of
cases of recurrent cancer after operations shows that we must look
further than surgery if we wish to stay the progress of this formidable
disease.
It would be useless to attempt to present the many theories which have
been advanced relating to cellular metaplasia, or even to detail all the
more or less accepted views in regard to the manner in which normal
cells change and degenerate into those of malignant character: but some
of the principal facts may be of service in understanding somewhat of
the mode of development of malignant tissue from that which has been
normal.
The statement of Virchow, “Omnis cellula e cellula,” that is, “where a
cell arises there a cell must have previously existed, just as an animal
can spring only from an animal and a plant from a plant,” forms the
basis of all study on the genesis of cancer and all tumor formation;
karyokinesis, or indirect nuclear or cell division, is at the bottom of
all growth, both normal and malignant, and the two classes of growth
differ only in their methods and activity. In healthy tissues cell
proliferation and destruction proceed in an orderly manner, forming
homologous structures, as when the hair and nails are constantly
produced from newly formed cells at the root, and the result of this new
growth is removed mechanically when the hair and nails are cut from time
to time, or the hairs fall out. In the case of the skin the epidermal
layers are pushed forward and finally exfoliated as useless epithelial
débris.
With the cells composing other, or internal structures, however, the
process is different. For here each normal cell reproduces others of
homologous structure, and the different parts of the system are thus
kept in active service through anabolism, by means of which new cells
are formed with renewed vitality, and the older, or effete cells are
removed by catabolism; the elements of which they are composed are thus
split up into their component parts, and carried off by the blood or
lymph stream, and are then either discharged as effete substances or
reutilized in the system, along physiological lines. Wakefield has
pretty clearly shown that the developing cancer cell is the product of
sub-catabolism, or a sub-oxygenation, induced by hyperacidity or oxidase
deficiency in the surrounding medium of the blood plasma.
A great deal of thought, study, and speculation have been given in
regard to the behavior of the cells themselves, and strong arguments are
adduced for a local cell pathology, that is, regarding the cells as
“autonomous beings, possessed of morphological and physiological
independence.” But on the other hand we must recognize some restraining
influence which continually causes the great mass of cells to reproduce
those of homologous structure, in an orderly manner, and only very
rarely some of them to break loose and form tumors, which may then
become malignant and even destroy life. How this restraining influence
is modified or withdrawn is, of course, a part of the problem of cancer.
Those who maintain their autogenous character lay great stress upon the
polarity of cells, and the relation of the centrosome to the nucleus,
indicating a change in the polar axis in cells about to be
cancer-genetic, as does Ewing in his recent classical study of
pre-cancerous lesions. But whatever changes are observed microscopically
we must recognize that the cells themselves must be influenced
ultimately by that mysterious force which we call life, which ends with
its extinction from the body as a whole, and which is ultimately related
to nerve action. We must also recognize that the cells everywhere depend
for their life and activity upon the plasma in which they are bathed and
from whence they draw their sustenance; and this plasma is renewed day
by day from the food and drink taken.
Students of cancer are more and more recognizing and acknowledging that
“all these phenomena, apparently so different, are merely protean
manifestations of one common process which underlies and is the cause of
them all, to wit, cell growth and proliferation. The particular outcome
of the process in any given case is due to the influence of the
conditions of nutrition—understanding by this term the whole of the
material changes wrought in the organism through its relation with the
surrounding world. This being so it is easy to understand how, under
favorable conditions, certain cells may take on independent action,
growing and multiplying without regard to the requirements of adjacent
tissues and of the organism as a whole.”
There seems to be some reason to support the view advocated by Williams,
that tumor formation and growth are but forms of agamogenesis, or
non-sexual reproduction of cells, distinctly related to the decline in
growth of the body in general. Hence while the forces of growth,
development, and reproduction are in greatest activity the tendency to
this disease is relatively small: but when growth declines and nutrition
is relatively low the cells undergo gemmation, owing to perverted
nutriment, and thus hyperplasia and not inflammation is the starting
point of every neoplasm.
Experimental work has time and again demonstrated that cell growth,
either good or bad, is modified in no uncertain way by the character of
the nutrition furnished. Cancer has repeatedly been observed to
disappear spontaneously, as such cases are on record by careful and
competent medical men: in certain of these instances it has occurred in
connection with a radical change in the mode of life and diet, but in
the majority of instances there is no record of the special cause of its
disappearance. The lesson to be learned from this is that there are
conditions of the system which are antagonistic to the abnormal
proliferation of cell tissue, even when it has begun to take place, as
we must believe that there are other conditions of the system which
favor such diseased action of aberrant cells.
An interesting confirmation of this is attributed to Ehrlich, but I
cannot find the original reference. He “has shown that mice living upon
a rice diet cannot be inoculated with cancer, while mice living on a
meat diet can be readily inoculated, cancerous tumors developing quickly
and continuing to grow until the animal dies. Ehrlich also found that
when mice with cancerous tumors, the result of inoculation, were placed
upon a rice diet, the tumors ceased to grow, and in many cases
degenerated and disappeared.” Valuable corroboration of this has been
given by Sweet, Corson, White, and Saxon. They made a series of
experiments in regard to the “influence of certain diets upon the growth
of experimental tumors,” all with the same results. Of fifty white mice,
25 fed on glutenin and gliadin, and 25 on normal diet, 23 of the 25 on
normal diet acquired tumors, against only 4 in the 25 on the glutenin
and gliadin. This was repeated on 50 males, with the result of 18 in 25
against 3 in 25: and in a third series, of 50 females, the figures were
15 in 25 against 7 in 25. Thus, they found that 75 per cent. of 75 mice
developed experimentally inoculated tumors when under normal diet, while
only 19 per cent. of other 75 mice developed such tumors when under a
diet of glutenin and gliadin, that is, vegetable proteins; moreover, the
tumors in the latter were in 30 days hardly larger than those in the
former in 10 days. Rous has recently shown that large growths of certain
transplanted rat and mouse tumors are checked in their development by
underfeeding the host on a special diet.
The chemistry of cancer has been studied in most varied directions, and
the literature relating thereto is very voluminous and can be hardly
more than alluded to here. It is unfortunate, however, that most of the
researches have been made in connection with patients who have advanced
cancer, and very commonly with the disease affecting internal organs,
which of itself interferes very greatly with their function, and so
causes many of the perturbations of metabolism observed. What is needed
are researches in regard to the metabolism of patients before the
development of the disease, or in its earlier stages, before it has
exerted its injurious effects on the system, in order to learn of the
causes which lead up to and induce the wrong action of the cellular
elements, whose invasion and malignant action subsequently become so
serious.
It is quite impossible in these lectures to enter at all fully upon the
various bio-chemical studies which have been carried on in regard to
cancer, but brief mention will be shortly made of some of the salient
points. Not only has the structure of carcinomatous tissue been examined
chemically, but the blood and urine have been submitted to most
painstaking investigation, and metabolism in general has been studied in
almost all possible directions, in the search for the cause of cancer;
and yet, as Beebe says, “no phase of metabolism has been described in
cancer which does not have a counterpart in non-cancerous conditions.”
But, as previously mentioned, all these observations and studies have
been largely made upon advanced cancer cases, when the system has
already felt the unsettling and depressing effect of what is probably an
injurious secretion from the deranged and actively proliferating cells
of the cancerous mass. In a later lecture we will consider some of these
matters in so far as they have relation to the dietetic and medical
treatment of cancer.
The essence of our study thus far has been, that in every instance what
is called malignant disease is but an aberrant action of originally
normal body cells. That, as normal cells find their nutriment in the
circulating plasma, so some pathological change in this latter causes
them to take on abnormal action, and they no longer develop homologous
cells, capable of forming normal tissue, but heterologous elements which
have a natural tendency to disintegrate or break down, and exert a
destructive influence on adjoining cells of any kind; and in this
process they secrete a hormone which is prejudicial to the system and
tends to destroy life. In later lectures we shall endeavor to understand
this more perfectly, and consider some of the elements in life which
tend towards the production and arrest of cancer.
LECTURE II
FREQUENCY AND GEOGRAPHICAL DISTRIBUTION OF CANCER
Cancer in man exists all over the globe, but in different degrees of
frequency, according to varying conditions of life, as we shall
presently see. Malignant growths occur also in animals and fishes,
though also with greatly varying frequency under different conditions;
but there are few real tumors in reptiles or amphibians. Tumors are also
occasionally found in vegetable organisms, presenting increased growth
and proliferation of cells, arising from adventitious, or abnormally
evolving buds, as also from parasitic and other external irritants.
While these vegetable tumors are very interesting and in a measure
instructive, in regard to the peculiarities of cell growth which they
exhibit, they bear, of course, no relation to cancer in the animal
kingdom, although some have endeavored to argue otherwise. There is,
however, a certain suggestion of analogy to be found in the observation
made by one writer, that “the origin of buds, as well as their
subsequent development, is chiefly determined by the conditions of
nutrition. Wherever there is an excess of nutritive material, capable of
being utilized for growth by the cells of the part, there buds may
arise”; we shall see later that the same thought applies to cancer in
man and animals, when we come to the consideration of the relation of
overindulgence along certain lines of eating and drinking to cancer.
Cancer has well been styled a disease of modern civilization, like
tuberculosis, although of quite a different nature. Interesting studies
have been made in regard to the increased death rate from the former in
England, coincident with a diminished mortality of the latter, in
accordance with nutritional changes which have taken place in certain
populations: and in the first lecture I mentioned that in the United
States the mortality from tuberculosis had fallen 25 per cent. between
1900 and 1912 while, as we shall see later, the mortality from cancer
has certainly risen.
Williams, who quotes very largely from the accurate statistics which
have long been carefully recorded in England, says that “while tubercle
has declined with great rapidity, cancer has increased at a still faster
rate, and these inversely related changes are still in active progress.
In illustration of these remarks it may be mentioned that during the
last half of the nineteenth century, the cancer mortality for England
tripled: while, during the same period the tubercle death rate declined
to the extent of nearly one-half. Unless some great change in the
national habits takes place, of which there is at the present no well
marked indication, cancer will ere long claim more victims than
phthisis, as is already the case in many localities—e. g., Hampstead,
Clifton, Bath, etc.” He further says, “I regard this decline in the
presence of tuberculous diseases as the direct outcome of the better
food and improved hygienic conditions, for which we are indebted to our
increased national prosperity: and I shall endeavor to show that
conditions of this kind, by their action in another direction, are also
mainly responsible for the augmented cancer mortality.” We shall see
later that cancer has asserted itself where modern civilization has
augmented the opportunities of overindulgence along many lines of eating
and drinking: for while advancing scientific knowledge has undoubtedly
diminished mortality in general, and has added to the average length of
life, the various factors included in our modern mode of living have
also with certainty increased morbidity along such lines as neurotic and
vascular disorders, tumors, etc.
All statistics from various localities show that cancer has certainly
increased in frequency very greatly of late years, and though some have
attempted to claim that this increase is only apparent, and is due to
greater accuracy of diagnosis, and the prolonging of more lives to an
age when cancer is more common, there is no doubt in the minds of those
who have studied the figures that the increase is certainly very real;
and unless there be found some way to check its production, the death
rate at the end of the century will be appalling.
It is quite impossible here even to give a comprehensive idea of the
immense amount of work which has been given to the study of the
statistics of cancer in various parts of the world, as collected in the
remarkable works of Roger Williams and Jacob Wolff, but brief mention
must be made of some of the items observed and recorded in order to
properly understand our subject. Williams in particular has analyzed the
recorded facts in an interesting and convincing manner, and shown again
and again in connection with the figures from different countries,
sections, and cities, that the occurrence of cancer bears a striking
relation to the condition of the people in reference to their material
prosperity; namely, that the well-to-do, who can overindulge in many
ways are vastly more subject to cancer than those in the poorer walks of
life; also that aborigines in the wilder parts of the world are either
almost exempt from cancer, or suffer from it to a very much less degree
than civilized foreigners who come to their lands. This is also shown in
a very striking manner by Wolff, and I present here a table which he
gives in regard to the progress of cancer in a single country,
Australia, among the native born and foreigners.
OF 100,000 LIVING THERE DIE OF CANCER IN AUSTRALIA
_Year_ _Number of _Native Born_ _English_ _Other
Inhabitants_ Nationalities_
1851 403,889 28 14
1861 1,153,973 5.6 30.5 19
1871 1,168,377 9.7 56.7 25
1881 2,252,167 16.8 72.9 32.6
1891 3,183,237 19.8 119.8 45.9
1901 3,771,715 22.6 203.1 57.3
He remarks, “We see from this comparison in what a great degree the
death rate from cancer has increased in foreigners as compared to the
native born, in whom the disease has remained about stationary, when the
increase in population is considered.” Another writer remarks that when
native Australians mingle with foreigners as servants or employés, and
adopt their diet and customs, cancer occurs more frequently in them.
Much the same has been reported in regard to other peoples and
nationalities, and later we will consider the influences of urban life
on the production of cancer.
In New Zealand, according to Hislop and Fenwick, where the general death
rate is the lowest in the world, cancer is on the increase, as
civilization advances. In the great majority of cases the alimentary
canal is the seat of invasion, even in women: all the patients studied
were hearty eaters, taking also very much strong tea many times daily.
The Polynesians and Melanesians seem to be peculiarly exempt from
cancer. Sir William McGregor, although he had operated several times on
whites in the Fiji Islands, never remembers operating on a Polynesian or
Melanesian, who are practically vegetarians. He never saw a case in
British Guinea in 9½ years, and then saw an encephaloid cancer of the
tibia in a Papuan, who for 7 or 8 years had lived practically a European
life, eating canned Australian meat daily.
In regard to Africa, Williams quotes Dr. Madden of Cairo, who says, “The
consensus of opinion among medical men in Egypt is, that cancer is never
found, either in male or female, among the black races of that country.
These include the Berberines and the Sudanese, who are all Mussulmans,
and live almost entirely upon vegetable diet.” Of 19,529 deaths among
natives of Cairo during 1891, only 19 were due to cancer (females 10,
males 9) or 1 in 1028. In England during the same year the proportion of
cancer deaths to total deaths was 1 in 29. In the Islands of Lagos, on
the West Coast of Africa, Dr. Johnson, in 14 years’ practice there saw 5
cases of cancer in natives all of whom lived as Europeans. In southern
Africa, “among the Boers and Europeans, who are large flesh eaters,
malignant tumors are common: but among the natives, who are mainly
vegetarians, these tumors are so rare as to be almost unknown.”
Renner reports interestingly in regard to cancer among the descendants
of liberated Africans or Creoles, in Sierra Leone, Africa. During 30
years, from 1870 to 1900, there were but 20 cases recorded as malignant
disease among 22,453 admitted to the Colonial Hospital: in the next ten
years there were 26 among a total of 10,163, a slow but steady gain in
cancer incidence, with the advancing influence of the white man. He says
that while the aborigines eat no meat, the “Creoles” eat much meat; the
teeth of the latter are beginning to decay, like those of the whites,
which is attributed to the sweets introduced by the latter. Every case
of cancer recorded has been in a Creole, living like a European, and not
a single case among the aborigines.
Much the same freedom from cancer has been noted in regard to negroes
when first brought to the United States in slavery, when their food and
mode of life was simple: but since emancipation and in proportion as
they have mingled with whites and eaten their food, with their own
natural tendency to gluttony and laziness, cancer has increased among
them, although their death rate from malignant disease is still much
less than that of whites.
In India all writers agree that cancer is rare among the inhabitants of
warmer country districts, where they live largely on rice or millet,
with a little milk and butter, and vegetables: they eat meat rarely, the
immense majority of the people live a rural life, depending upon
agriculture for their sustenance.
Investigations of late years, however, might seem to indicate that
cancer is more prevalent in India than previously supposed, but its
incidence still bears no real relation to that in many other countries,
and an analysis of some recent reports explains in an interesting and
curious manner the reasons for the diversity of opinion as to the actual
frequency of the disease.
Thus, Benratt collected a total of 1700 cases only from 5 years’
statistics of 15 Mission Hospitals and 34 Government Hospitals,
representing, of course, many million inhabitants, whereas in New York
City, according to the weekly Bulletin of the Board of Health, there
were 2193 deaths from cancer in the last six months, a striking
illustration of the rarity of cancer in India. Moreover of these 1700
cases, over 1200 were about the mouth, a very large share of these
arising from the very common habit of chewing betel, which contains also
much calcium, which latter is one of the salts incriminated in the
causation of cancer. Sandwith attempts to show that cancer is prevalent
in India, but refers to only 2000 cases reported in the hospitals there,
in three years, also among many millions of people, and he refers
likewise to the betel chewing cancer, and the “kangri burn” on the
abdomen of men, from the charcoal furnace worn for warmth: these
peculiar local disorders vitiate any deductions which could be drawn
from such statistics.
In China, according to a recent writer, “cancer is comparatively
uncommon in those parts where the bulk of the people live on an almost
exclusively vegetarian diet, being too poor to purchase any of the
various flesh foods, which are there used for culinary purposes.” But in
places where cancer is said to be more prevalent, the reporter adds,
“All Chinamen there eat fish and pork at morning and evening meals:
fowls and ducks are always on the table of all but the most humble of
the coolie class.”
In regard to the occurrence of cancer in the Far East, however, some of
the modern investigators, such as Bashford, have endeavored to overturn
the generally accepted view as to its infrequency, but I do not feel
that the evidence presented can at all weigh against the unprejudiced
opinion of most capable medical men who have long lived and practiced in
those regions, some of whom as medical missionaries have had most
intimate contact and acquaintance with the natives. Only very recently a
medical missionary, who has long been connected with the medical college
and hospital in Beirut, Syria, told me that cancer was practically
unknown among the thousands of patients who flock there from all over
the Near East, he adding that they were all largely vegetarians.
During a rather extensive trip through the Far East I was unable to see
or even hear of any cancer, although I met a large number of medical
men, and made diligent inquiry regarding the same. As I wished to verify
my views in regard to the rarity of the occurrence of cancer among those
who lived on rice or other vegetarian diet, I visited very many civil,
military, and mission hospitals, with a total of many thousands of
patients, and ministering to many millions of population; in Japan,
Korea, China, the Philippines, India, Siam, and Egypt, I met the same
response, that cancer was rarely seen among those vegetarian natives.
Brazil is credited with having the lowest cancer record of any portion
of the western hemisphere, especially among the natives in the
Equatorial regions, while in the Argentine Republic, where meat is known
to be largely consumed, cancer is fairly common. From many parts of the
world there come reports of the relative infrequency or even absence of
cancer among simple living natives, one writer in regard to the West
Indies stating “Even those cases which I have witnessed in this class of
people have been among the better orders of them, whose habits of living
assimilated to those of Europeans.”
England and Wales present the most satisfactory field for the study of
the progress of cancer, as the national vital statistics have been well
kept since 1840; even at that time under the able direction of William
Farr they had already acquired a well-deserved reputation for
reliability, as Williams remarks, from whom I shall freely quote.
In that year, 1840, there died of malignant disease in England and Wales
1 in 5,646 of the total population, 1 in 129 of the total mortality, or
117 per million living. In 1905, the deaths, due to this cause were 1 in
1,131 of the total population, 1 in 17 of the total mortality, or 885
per million living: thus, while the population had only a little more
than doubled, the cancer death rate per million living had increased
five fold. Dr. Williams answers by figures and tables the several
objections which have been raised in regard to the actual increased
mortality from cancer, as it has been repeatedly claimed that the
increase is only apparent and not real; thus it has been asserted that
it is due—1. To mere increase of population: 2. To the average age of
the population having advanced: and 3. To improved diagnosis and more
careful death certification. Time does not admit a full presentation of
his statistical refutation of these claims, to which he devotes some
pages very convincingly, but it can be safely accepted that for some as
yet unknown reason, cancer has made strides in England which are truly
alarming.
Williams has also made some most interesting studies in regard to the
increase of cancer in connection with changed conditions of life, and
from his analysis of statistics, he very clearly shows that the spread
of the disease has closely followed urbanization, and the rapid increase
in material prosperity of recent years: in England where 80 per cent. of
the population are now town dwellers, this tendency to collect in cities
and towns has gone farther than in any other community. He recognizes
that any far-reaching, environmental change of some duration is probably
potent in disturbing the stability of the constituents of living bodies,
and the sudden change from poverty to riches and plenty is conducive to
the development of cancer: allusion has already been made to the inverse
relation of deaths from cancer and tuberculosis, the latter diminishing
with improved material conditions, while the former increases as wealth
and indolence increase.
He shows this by statistics from various localities, and by data from
towns in different countries he makes it pretty clear that “Cancer
mortality is lowest where the conditions of life are hardest, the
surroundings the most squalid, the density of population greatest, where
the tubercle mortality is highest, the general and infantile mortality
greatest, and where sanitation is least perfect—in short, among the poor
of the industrial class in our great towns: whereas among the wealthy
and well-to-do, where the standard of health is at its best and life is
easiest, and where all the conditions of life are just the reverse of
the foregoing, there the cancer mortality is highest.”