of the _urine_ in connection with cancer, as that might be expected to
reveal the metabolic changes connected with this disease. While many
departures from the normal have been reported, and while under complete
volumetric analysis the urine of a subject of cancer is rarely if ever
that of health, it cannot be said that any definite and specific changes
have been established which may not be found in those without cancer;
although there have been several who have so claimed even diagnostic
signs from the urine. But minute, volumetric analysis is often of great
service in guiding the nutrition and medication of these patients, and
gross errors are continually met with, which have the greatest bearing
on the case in hand, as indicating very great metabolic disturbance: and
constantly the urinary excretion will be found to be extremely
deficient, both as to its quantity and its total solid elimination. In
one very interesting case of cancer of the breast, in a stout, flabby
lady, near 55, in private practice, the total daily quantity of the
urine, measured for weeks, is always very far below the normal amount;
and in spite of active medication it seems almost impossible to raise
the total daily solids excreted in the urine, to more than one-half of
that called for by the weight of the patient. We may now briefly
consider some salient points reported in connection with the urine in
cancer.
As remarked in regard to other elements in the study of the disease, it
would be very desirable to have a knowledge of the urine in
pre-cancerous stages of health, or ill health, and also in very early
cancer, likewise after surgical operations, that we might better
understand the metabolic changes which lead up to malignant disease; but
unfortunately these are exceedingly few and unsatisfactory, and almost
all the studies have been made in advanced cancer, and often when the
disease has affected vital organs, or when by its own poison it has
disturbed the workings of the economy.
Many observers agree that there is a disturbance of proteid metabolism
in cancer, and dependent upon this many deviations from normal are found
in the urine, some of which in turn are related to the inanition which
occurs. The _urea_ is almost invariably diminished, often very greatly,
as I have verified time and again in many cases.
A number of studies have been made upon the nitrogen partition in cancer
by Einhorn, Kahn, and Rosenblum, also by De Bloeme, Swart, and Terwen,
and others, showing an increase in colloid nitrogen, to more than double
the normal amount, increased elimination of xanthin, oxyproteic acid,
and urinary ammonia, together with many other changes which show that
disintegration of the protein elements is very imperfect and often
excessive. An interesting statement is made by Blumenthal that the
oxyproteic acids are increased even in very early cancer, and
independently of the size of the tumor and degree of cachexia, seemingly
showing them to have some specificity for cancer, because they have not
been found in other forms of malignancy. He also states that urobilin is
increased in a large proportion of cases of cancer, especially when
cachexia is setting in, and is a grave symptom.
Reid, who has confirmed many of these matters reported by others, says:
“I have found an increase of amino-acid nitrogen in practically every
case of cancer I have examined”; ... “Hence we can only infer that in
cancer, the liver, while not involved in the disease, is still unable,
for some reason, to perform its functions in synthetizing urea. The
organ is functionally injured, no lesions having been found to explain
its insufficiency”; or possibly ... “cancerous subjects form proteids
which the liver is unable to deal with, so that they are excreted
unchanged, or nearly so.” Degrez has made confirmatory studies along
these lines, and found the nitrogen disintegration very imperfect, with
increase of the ammonia fraction of nitrogen, and increased elimination
of xanthin bases. He states that “the toxicity of the urine is increased
apparently as the result of the presence of substances which have not
been fully oxidized.”
Notable changes have also been recorded concerning the _sulphur_
elements in the urine, with a great increase in neutral (unoxidized)
sulphur and a considerable excess of sulpho-cyanic acid, together with
an increase in sulphates and indican showing the results of intestinal
fermentation of protein elements, which also I have constantly observed.
The _chlorides_, on the other hand, are, as a rule, diminished in
cancer, especially in its late stages, when there is inanition or kidney
insufficiency; and probably any change in them has only a relation to
the nutrition of the patients, for the chlorides come from the food and
are commonly an index of the amount of nutriment absorbed. Robin finds
some relation between the excretion of chlorine and nitrogen, according
to the stage or degree in which the system is affected by cancer.
The _phosphates_ are known to be increased in the urine of cancer
subjects, although irregularly and in an inverse ratio to the chlorides;
as inanition increases there is greater autolysis of cellular structure,
and the nuclei yield an excess of phosphates, which are excreted in the
urine. A more or less general demineralization of the system through the
urine has been observed by several, and has been recognized as a
significant matter, and is of special importance when we consider what
an important part minerals take in the nourishment of cell life.
While the changes which have been observed in the urine in connection
with cancer are not wholly pathognomonic, but occur in connection with
other diseased states of the system, so that none of them can be
accepted as diagnostic of malignant disease, they all have a certain
significance as indicating the metabolic changes which accompany and, as
we believe, have much to do with the etiology of cancer; and, as stated
before, a careful, systematic, and frequently repeated volumetrical
analysis of the urine certainly assists greatly in the proper management
of these cases, that is when the departures from normal are carefully
studied and correctly interpreted.
The _saliva_, and its action, constitutes a very important part in the
process of digestion, and consequently of metabolism and the genesis of
cancer; far too little attention, however, has been paid to it
practically, in ordinary life or disease, although there have been many
laboratory studies and writings on the physiological action of this
secretion; but I have not been able to find in literature any
investigations relating to its condition in cancer. And yet the
experience and writings of Mr. Fletcher and others have demonstrated
wonderful results from perfect mastication and thorough insalivation,
and a careful consideration of digestion must convince every one of the
importance of this secretion in connection with nutrition, both in
health and disease.
Our time does not permit of more than a brief allusion to the subject,
but in cancer patients I have so constantly found the salivary secretion
acid, and often strongly so, instead of the normal alkaline or neutral,
that I cannot but believe that this condition has some bearing upon the
subject which we are studying; the saliva also is apt to be acid in
diabetes, which is closely allied to cancer. It is to be remembered that
the saliva, which amounts in health to between one and two quarts daily,
varying somewhat with the food, is not wholly for the purpose of
lubricating the mouth and facilitating deglutition, but its enzymes,
ptyalin and maltase, effect radical and important changes in the starchy
matters consumed. It is also to be remembered that the latter cannot be
acted upon by the stomach secretions, but must be passed on to the
influence of the pancreatic fluid in the small intestine, in case the
action of the saliva has not been effective; hence there follows delayed
and imperfect digestion, faulty metabolism, deranged nutrition, and
possibly tumor growth. The importance, therefore, of very slow eating,
thorough mastication, and perfect insalivation cannot be too strongly
insisted on, both as an element of importance in the prevention of
cancer, and also as a curative measure in patients in whom the diseased
process has already manifested itself.
The so-called _internal secretions_ have also been the subject of much
research and speculation of late years, in regard to their influence on
metabolism and the life processes of the economy, and many studies have
been made concerning their connection with cancer, which cannot be long
dwelt upon now; but there seems to be little doubt but that the
secretions of the ductless glands in common have much to do with
regulating the metabolism of the cells. We know, for instance, that
disease of the pituitary body produces bone disorder, resulting in
gigantism, that thyroid derangement results in myxœdema, and that
disease of the supra-renal capsules gives rise to Addison’s disease, or
bronzed skin; and it is not at all impossible that the derangement of
secretion of one or more of these and other organs may be an element in
the disordered action of certain epithelial cells, resulting in cancer.
Harrower calls attention to the fact that cancer is essentially a
disease of that period of life when certain of the ductless glands lose
their normal function, this loss entailing related changes in the whole
chain of interrelated functions of the ductless glands.
The _supra-renal_ glands by their secretion have, as we know, great
vaso-constrictor influence, and their complete removal is followed by
death; it is more than possible that some failure in this secretion
allows the exuberant blood to supply cancerous growths. Sajous says:
“Certain growths, particularly the more malignant forms of sarcoma and
carcinoma, seem closely connected with adrenal insufficiency and its
normal consequences,” and there have been some clinical and research
data confirming such a conclusion. Sajous further says, “The adrenals,
as supporters of the thyroid apparatus in the defensive process, and in
sustaining oxidation, metabolism, and nutrition, seem to offer a new
clew to the pathogenesis and treatment of cancer that is worthy of
further inquiry.”
The _pancreas_ has been thought to have some influence in a perverted
metabolism leading to cancer, Kahle stating that there is a retention of
silica in that organ in cancer patients, to even double the normal
amount. A treatment of cancer introduced by Beard, also strongly
presented by Saleeby, by trypsin and amylopsin, the enzymes of the
pancreatic fluid, excited some attention a while ago; but unfortunately
no satisfactory results have thus far been obtained from this line of
medication, as was fully demonstrated by Bainbridge at the New York Skin
and Cancer Hospital, in one hundred cases.
The _pituitary gland_ by its secretion has undoubtedly some coordinating
power, with the adrenals and thyroid, over the processes of metabolism,
and a number of observers have regarded it as of importance in
connection with the genesis of cancer. Little has recently reported some
cases of cancer in which _pituitary extract_ with that of the pancreas
has produced remarkable results.
The _thyroid_ is now recognized as playing an important part in
assisting metabolism, and, like the adrenals and pituitary, its complete
removal, with the parathyroids, in animals is followed by death. While
the study of the hormones is still in its infancy, there seems to be no
question but that the endocrinous glands act conjointly, the one
influencing the other, and that together they exert a very great
influence in the life processes of the body and on the behavior of its
component cells. The thyroid has been shown to be one of the main
factors in the management of calcium within the body, which is believed
to be an element in cancer, and enhances the catabolism of toxic wastes,
which are etiologic elements in this disease. Many have reported
favorably on the effect of thyroid feeding in cancer, and after an
experience with it in many cases I am convinced that it has been one of
the means which contributed to the good results obtained. On the other
hand it has been claimed by Stuart-Low that the surgical removal of the
thyroid, or part of it, or ligation of the thyroid blood vessels has
arrested cancer, in several cases.
_Thymus gland_ feeding has also been reported on favorably by a number
of observers (Rohdenburg, Bullock, and Johnson, also Gwyer), they
reporting relief of pain and improved general conditions, notably gain
in weight and increased hæmoglobin in all but one of sixteen cases,
though some of them died. On the other hand Ross reports most
unfavorably on the administration of thymus, which he gave to some
inoperable and hopeless cancer cases, in which he said that in two or
three weeks the tumors had quadrupled in size and the condition of the
patients was very much worse; the same occurred also when some cancer
patients were given calcium salts freely. Ross makes some interesting
suggestions in regard to the thymus, and its relation to calcium and
magnesium; these latter are freely utilized in the growth of bone up to
the age of twenty-five years, by which time the thymus gland has quite
disappeared; but after this time these salts tend to have pathological
relations in various tissues, and also cancer becomes frequent.
The internal secretions of the _testicles_ and _ovaries_ are also
thought to have some share in metabolic processes, and observations have
been made in regard to their influence in cancer. Thus Cahen reported
that Beatson’s operation of castration for cancer, done first in 1896,
had been repeated by many, so that Lott had reported 99 cases including
his own. Of these in 23.2 per cent. the operation caused a distinct
improvement in the cancer. In 15 cases the improvement persisted for a
year, in 4 cases for 4½ years and in one case for over 5 years. Cahen
operated on seven women with remarkable results; in two cases life was
prolonged 4 and 6 years respectively. Others, however, have shown by
statistics, that damage to the ovaries by disease, or their removal by
operation, greatly increases the proclivity to cancer. Several writers
have connected cancer with the waning of the sexual powers, and the
suggestion is made by Sherrington and Copeman that in the period which
antedates the cancer age, the reproductive glands, by means of internal
secretions, are able to inhibit the growth of cancer.
In looking back over what has been observed in regard to the secretions,
including those of ductless glands, we see that very strong evidence has
accumulated to show that they have a very intimate connection with the
development of cancer, as was to be expected, since they are very
important factors in connection with metabolism.
We have also seen that while there has not been demonstrated any very
definite and specific change in the bio-chemistry of tumors, and no
specific enzymes or poison secreted by cancer cells which can
communicate the disease, there is evidence that the disordered cells
secrete a something which deranges the blood and ultimately tends to end
life; for the blood in advancing cancer undergoes very radical,
degenerative changes, some of which improve decidedly when a cancerous
mass is removed surgically, but return with the regrowth of the tumor.
We have also seen that the urine manifests alterations which show a
disturbed metabolism, and that the saliva has an abnormal acidity
leading to disturbed amylaceous digestion.
We have further seen that there is evidence that the internal secretions
of many organs, probably, through their influence on metabolism, are
factors of importance in connection with the genesis and cure of cancer.
Little well says, “Cancer is a disease of disordered nutrition, as a
result of which cells revert to a primitive stage, which permits
reproduction. The disordered nutrition is due to relative hypofunction
of the ductless glands.” In later lectures we shall consider the basic
causes of this deranged nutrition, which, as has been already intimated,
has much to do with diet and the various elements of life which tend to
induce functional and other derangements of the system, many of which
are included in and influenced by what we term the advance of
civilization.
LECTURE IV
RELATION OF DIET TO CANCER
In our earlier lectures we saw that cancer was undoubtedly a diseased
action of originally normal tissue cells, due largely to perverted
metabolism, the special features of which were brought out last week. In
the second lecture we studied the frequency and geographical
distribution of cancer, which was found to be very different for various
peoples in diverse sections of the earth, and which we saw was
proportioned in a great measure according to their diet and mode of
life. In this lecture we will examine into the details of these matters
more particularly, and endeavor to discover their practical bearing upon
the prevention and cure of cancer.
For the proper understanding of the relation of food and drink to
cancer, and the satisfactory application of the principles involved, it
is necessary to bear well in mind the chemistry of the body and the
relation to nutrition of the various elements which contribute to form
healthy and diseased tissues.
The human body is composed of some fifteen different elements, the
relative proportions of which may be understood by the following table
from Sherman, which represents probably as approximately correct an
average as any that can be given.
COMPOSITION OF THE HUMAN
BODY
_Per
cent._
Oxygen, about 65
Carbon, about 18
Hydrogen, about 10
Nitrogen, about 3
Calcium, about 2
Phosphorus, about 1
Potassium, about 0.35
Sulphur, about 0.25
Sodium, about 0.15
Chlorine, about 0.15
Magnesium, about 0.05
Iron, about 0.004
Iodine } very
Fluorine } minute
Silicon } traces
As the actual composition of the body is changing day by day, through
the activities of the system, so that it is commonly believed that after
some years all the tissues are entirely renewed, the daily wear and
tear, as also the material expended in heat and activity, must be
supplied by the diet. For the ordinary requirements of the system, in
health, the appetite serves as a guide, which should suffice in man as
in wild animals, to preserve the balance of nutrition. But man has also
the power to _gratify the taste_, which must be recognized in our study
as distinct from the satisfying of the appetite; and the refinements of
civilization have added so greatly to the temptation of wrong and
over-eating and drinking, as they have to many other temptations, that
it is questionable if reason, and what is often spoken of as the natural
instinct for food, can be trusted in mankind.
It is to be remembered that the advance of civilization, and the
facilities of transportation and cold storage, have brought from far and
near an innumerable number and variety of articles for food and drink,
including condiments, which bear no relation to the few simple articles
formerly consumed; even the fruits which we eat are rarely ripened fully
by nature, but are picked more or less green, and undergo an artificial
ripening without the action of the sun, which is really akin to decay.
In the combination and preparation of articles of food also, so-called
civilization and refinement have made the greatest departure from the
simple life of the aborigines, who are free from cancer, and with
increasing ease and wealth throughout the civilized world more and more
individuals are sharing in unnecessary and often harmful indulgences,
more and more freely: and this is especially true of animal food, the
consumption of which has increased so greatly. Many other elements
likewise enter into the matter of the digestibility and consequent
nutritive power of food and drink; such are nervous conditions, rapid
eating, imperfect mastication and insalivation, heat and cold, character
of the air breathed, micro-organisms, etc., and all the various causes
which may derange the action of the digestive organs and so prevent the
perfect metabolism between nutrient material and the cells of the body,
as I tried to show you in some former lectures.
As is well known, the nutrition of man is supplied by the organic
substances, protein, carbohydrates, and fat; these are found in various
combinations in animal and vegetarian foods, and as a rule contain also
much of the inorganic or mineral substances necessary for the system;
all of these with water, and its salts, and oxygen, supplied by the
lungs, unite, through anabolism and catabolism, to build and maintain
the human body in health.
It is also well known that in order to preserve health and proper weight
there must exist in the economy a certain balance or equilibrium between
the amount of the ingesta and excreta, representing the various elements
which enter into nutrition; thus we speak of a nitrogen equilibrium, a
carbo-hydrate equilibrium, a phosphorus equilibrium, and iron
equilibrium, etc., some of which are disturbed continually in ill health
and in various diseases, including cancer, as has been shown in our last
lecture.
Until quite recently the principles of diet (even if not often carried
out in practice) have been established on lines laid down by Carl Voit,
of Munich; this eminent physiologist, after studying the dietary habits
of various classes of workers, claimed that the adult man of 150 pounds,
doing moderate muscular work, requires daily 118 grams of protein or
albuminous food, 56 grams of fat, and 500 grams of carbo-hydrate, with a
total fuel value of 3000 large calories, in order to maintain the body
in equilibrium. But the remarkable and scientific experiments of
Chittenden have demonstrated beyond question that perfect bodily and
nitrogenous equilibrium can be maintained with one-third of the amount
of protein called for by the Voit standard, and with a total value in
the diet of only about 1600 calories, or about one-half of that
indicated as necessary by Voit. These experiments were based on a group
of five men of varying ages, professors and instructors at Yale,
thirteen volunteers from the Hospital Corps of the United States Army,
and eight students in Yale, all thoroughly trained athletes, twenty-six
in all.
It would be quite beyond the scope of this lecture to enter at all into
the intricate questions connected with the metabolism of nitrogenous and
other foods, but Chittenden has well put the reasons “why prominence is
given to the establishment of nitrogenous equilibrium and why the
proteid intake assumes a greater importance than the daily amount of fat
and carbo-hydrate consumed. Fats and carbohydrates when oxidized in the
body are ultimately burned to simple gaseous products, viz., carbonic
acid and water. Hence these waste products are easily and quickly
eliminated and cannot exercise much deleterious influence, even when
formed in excess.... With protein foods, on the other hand, the story is
quite different. These substances when oxidized yield a row of
crystalline, nitrogenous products which ultimately pass out of the body
through the kidneys. Prior to their excretion, however, these
products—frequently spoken of as toxins—float through the body and may
exercise more or less of a deleterious influence upon the system, or,
being temporarily deposited, may exert some specific or local influence
that calls for speedy removal. Hence the importance of restricting the
production of these bodies to the minimal amount, owing to their
possible physiological effect and the part they are liable to play in
the causation of many diseased conditions.”
When we consider the small share which nitrogen plays in the composition
of the human frame, as shown in the table presented, only three per
cent., it is easy to see how an excess of nitrogenous food must
necessarily either pass off unassimilated or undergo imperfect
metabolism, and so derange the general metabolism; and this is found to
be the case in many conditions of disease, and, as has been shown, in
cancer. Chalmers Watson and others have shown in a most remarkable
manner, by animal experiments, that an excessive meat diet alters very
materially the microscopic structure of very many organs and portions of
the body.