the actual diet beneficial in cancer, his observations dating back to
1875 upon material in the service of Esmarck and Oldehop, who treated
patients according to his plan. While the diet he gives is not wholly
vegetarian, he limits the nitrogenous intake very greatly, and reported
some very favorable results, with the complete disappearance of some
malignant new formations.
Referring now to the data presented in the second lecture, in regard to
the frequency and geographical distribution of cancer, we can understand
better, on scientific grounds some of the reasons why cancer is so
steadily increasing in civilized communities, and why in some sections
of the earth it is less common, while certain aborigines have seemed to
be almost immune.
We found that in England the per capita consumption of meat was 130
pounds per year, and that it had doubled during the past fifty years,
while during the same period cancer had increased _four fold_; but in
Ireland, where the meat consumption was estimated in 1895 at only 40
pounds per capita, or less than one-third that in England, the cancer
death rate is very much lower, not much over one-half. We found that in
Italy, where the per capita consumption of meat was the smallest of any
European country the cancer death rate was almost the lowest. Also that
in certain other countries, where vegetarianism was the rule, cancer was
very infrequent, while among certain aborigines the disease was
practically unknown; but we found also that in both the latter classes
of individuals cancer has slowly increased, in proportion as the
inhabitants of different sections had come under the influence of modern
civilization, and adopted the dietary and other habits of foreigners.
In the United States cancer has certainly increased very greatly during
the last fifty years, and statistics were presented showing that in
seven of the largest cities, during the past five years, the number of
cancer deaths had augmented between seven and eight per cent. It is
known that the consumption of meat here has increased steadily, until in
a communication from the Bureau of Agriculture in Washington we learn
that it had recently reached the enormous amount of 172 pounds per
capita yearly, much more than in England.
Cancer has been repeatedly spoken of as a disease of civilization, and
there are many other elements besides meat to be considered in
connection with its etiology.
Coffee and tea are so widely and almost universally used in civilized
countries, and their apparently pleasant effect is so great that few
realize the harm that may result therefrom; although from time to time
their injurious effects, especially along the line of digestive and
nervous troubles, are dwelt on by medical writers. Of late years,
however, more attention has been paid to their influence on metabolism
and also to the relation of their consumption to the increase of cancer.
From a report to the House of Commons in England, Holland is shown to be
the largest per capita consumer of coffee of any country in Europe, and
the cancer death rate there in 1905 was among the highest, while Hungary
was the smallest consumer of coffee, and the cancer mortality in 1903
was only 39 per 100,000, or a little over one-third that in Holland. It
may be interesting to know that Thompson states that “the people of the
United States consume one-third of the total coffee produced, or more
than Germany, Austria, Hungary, France and the United Kingdom combined.
On the other hand England and her colonies consume one-half of the
world’s output of tea, and the United States but one-fifth of it.”
The scientific basis of a possible relationship of the consumption of
coffee and tea to the prevalence of cancer may be better understood when
we remember that caffeine and theine belong to the xanthin group, and
contain exactly the same equivalent of nitrogen as uric acid. A single
cup of coffee of fair strength, it is stated by Hutchinson, contains
from one to three grains of caffeine, and a cup of fairly strong tea
1.21 grains, or more than the average medicinal dose of this drug; and
all know how great may be the consumption of coffee and tea by some
individuals, and that many of the working class, especially, consume
enormous amounts of tea, which is kept brewing all day. Roberts has very
clearly demonstrated, by clever experiments, that tea interferes very
greatly with both the salivary and gastric digestion.
Alcohol, or some of its combinations, has also been shown by several
observers to be undoubtedly an element contributory to the causation of
cancer; this relates not only to countries or cities where the
consumption is the greatest or least, but also to various occupations,
in which statistics show the more or less abundant use of distilled or
fermented drinks, and deaths from the same, and in regard to total
abstainers; and a careful study of the subject makes it pretty clear
that the incidence of cancer corresponds in a measure with drinking
habits; that is, that cancer mortality is highest among those classes of
persons among whom primary or secondary mortality from alcoholism is
greatest. There are so many elements to be taken into consideration in
connection with the derangement of metabolism which leads to cancer,
that it is difficult to fix the precise influence which each may exert;
but in watching cancer cases for any length of time it is easy to see
the harmful effect when alcoholic beverages are indulged in, and the
improvement when all such are absolutely excluded.
An interesting confirmation of the beneficial results of a low diet and
simple life, as regards cancer, is found in certain reports of
Commissioners of Prisons and Asylums in England, where the matter has
been studied, as given by Russell. “Asylums contain an excessive number
of persons who have inherited or acquired constitutional weaknesses, and
in many cases tendencies toward consumption or cancer; also many
alcoholics who are prone to these maladies. Yet the habits and rules of
these institutions reduce the cancer rate much below the rate of the
classes from which they are drawn, and below the rate of both occupied
and unoccupied persons.” The same is observed in regard to many
religious orders, where the members lead a very simple and frugal life,
and where cancer is reported to be almost unknown.
Kessler has called attention to the disturbance of sulphur partition in
cancer in connection with diet, and the desirability of excluding those
foods exhibiting an excess of sulphur, giving lists of the same and
indicating a satisfactory diet.
Packard has made a strong argument in regard to the value and importance
of the mineral elements contained in plant life, in connection with the
disturbances in these same elements which has been observed in
connection with cancer, as we have already seen. He recalls that modern
chemistry teaches that the inorganic principles of the vegetable kingdom
are absolutely necessary to the highest degree and type of animal tissue
and health, and resistance to disease. Plant life is the connection
between the minerals and salts of the earth and animal life, but in the
manufacture or refinement, and cooking, of products of the vegetable
kingdom, many of them are largely demineralized; this especially
illustrated in the case of fine white wheat flour, rice, potatoes (in
peeling and cooking), etc. So that while animals get plenty of mineral
matter from plants and the earth, man gets but little, and while the
herbivorous animals are rarely affected with cancer, civilized man is
succumbing to it more and more. It is stated that among savage tribes,
who are practically free from cancer, the water in which vegetables are
cooked is also consumed as food, thus securing all the salts. The same
idea has been popularly presented to the public in a startling manner by
McCann in a book which, with a great deal of verbiage contains a large
amount of valuable information concerning nutrition, and its disturbance
by erroneous, or worse, preparation and administration of food.
Possibly there are other dietary elements which may play some part in
the causation of cancer, but the demonstrated facts in regard to them
are so few and uncertain that they need not detain us here, although it
is certainly desirable to investigate any that seem to have reasonable
support.
Some of these which have been suggested probably have to do with local
irritant action on the digestive organs, as we have previously seen that
local irritation undoubtedly plays an important part in the
determination of the actual time of occurrence and site of the cancerous
disease. Thus, some have ascribed cancer to hot food or drink, or to
stimulating drink, condiments, etc. It is quite possible that these
contribute to the development of cancer in the pylorus, irritating the
secreting cells in their passage. Mayo says: “In civilized man one-third
of all cancers are seated in the stomach. This is not known to be the
case in uncivilized man or in animals. There should, therefore, be
something—some one cause—which causes this preponderance. The acid
secretion may favor its development, for when we come to the colon, also
with an acid secretion, we again meet with cancer, and we seldom see it
in the alkaline, small intestine. Gastric ulcer, which may be
pre-cancerous, is connected with hyperacidity.” In Scandinavia cancer of
the stomach is remarkably frequent, according to Soëgaard, thus, of 1235
cases in Norway, 73.9 per cent. were in that location. In our last
lecture we found that cancer in general was connected with a lowered
alkalescence of the blood, and all our studies show hyperacidity to be
related to cancer genesis; and nitrogenous acidity, or uric acid (purin,
xanthin, etc.), undoubtedly plays a great part in inducing malignant
action in tissues, as Haig has so long contended, even in regard to
cancer.
The increasing frequency of cancer of the mouth, œsophagus, and stomach
in men certainly looks toward an irritating character of substances
which traverse these regions, including alcoholic drinks, and the
irritant effect of tobacco should not be overlooked in regard to mouth
lesions. But of the millions who use tobacco only very few are affected
with cancer, and only those who are predisposed thereto by some
metabolic disturbance, whose true character and other manifestations are
not yet fully determined. We have already referred to the practice of
so-called betel chewing in the Far East as a frequent cause of cancer
within the mouth, also to the wearing of the Kangri charcoal baskets in
India, for warmth, causing a burn on the front of the body which may
develop into epithelioma; it is claimed, however, by some that of the
many cases of “Kangri burn,” but few result in epithelioma.
There are yet other considerations concerning the relation of diet to
cancer which are worthy of attention. We have mentioned some principal
agents, which seem unquestionably to have an influence in the production
and continuance of cancer, namely, proteids, coffee and tea, and
alcoholics. But millions of human beings partake of these with apparent
impunity, while in the relatively few they appear to have cancer-genetic
powers. This need not surprise or puzzle us any more than do the many
other problems in medicine which we are seeking to solve: for we know
how often it happens that the system reaches a point where certain
things, once well borne, are no longer tolerated. We know, for instance,
that Port and Madeira wine certainly can cause gout, but with many
individuals they may be indulged in freely for some time before this
result follows: likewise that tobacco may even be abused for a long
time, without apparent ill effects, when suddenly there is a revulsion
of the system and the slightest use of tobacco will be intolerable: also
that many edible substances which have long been well borne, will at a
certain time act unfavorably and excite eruptions, urticaria, acne,
eczema, etc.
Psoriasis also furnishes an illustration which may be of service in
understanding the relation of diet to cancer; for psoriasis is
characterized by a disordered epithelial growth, which both shows on the
surface and manifests itself by epithelial prolongations into the
corium, which are quite comparable to the ingrowing cellular masses of
early cancer: moreover cancer is not very rare in psoriasis patients. In
this eruption it has been very clearly demonstrated, clinically and
experimentally, that error in nitrogenous metabolism is commonly at the
bottom of the eruption, which has been seen to promptly disappear
entirely simply under an absolute vegetarian diet, correctly regulated,
excluding also coffee and alcohol, without the use of any medical
treatment whatever, internal or external; but, of course, this result
cannot always be obtained, and sometimes the eruption will relapse
during what is thought to be a strict vegetarian diet. There must,
therefore, be some systemic disturbance which causes nutritive material,
at some particular time, thus to derange cell action in the eruptions
mentioned, and the same is true in regard to the production of cancer.
Some years ago Braithwaite called attention to the occurrence of cancer
among certain peoples who were vegetarians, and attributed it to the
great amount of salt which they consumed. While the suggestion of salt
being a cause of cancer has been ridiculed, it is quite possible that a
great excess of sodium chloride may disturb the salt equilibrium in the
blood, by replacing the potassium which is so necessary for proper
cellular nutrition, and also by hindering the excretion of uric acid, as
Haig has pointed out.
When we inquire into the cause of the systemic disturbance which tends
to such faulty metabolism that the nutrition of cellular structures is
deranged, even to the degree of taking on malignant action, we find many
possible elements, more or less connected with what is known as modern
civilization, to which we have time to but briefly allude. Williams has
shown pretty clearly that wealth, with its tendency to luxury and
idleness, greatly increased the proclivity to cancer: not only is this
observed in different countries, but in certain cities the difference is
very striking between the cancer mortality in sections which are
occupied by the rich and well-to-do, and those in which the poorer
classes are herded. Also in England it was found in one decennium that
cancer mortality was more than twice as great among the well-to-do men,
having no specific occupation, as among occupied males in general, the
ratio being 96 to 44.
Change in the mode of life, and sudden changes of environment have also
been found to have a great effect in the production of cancer, as has
already been mentioned in another lecture.
Finally, for our time does not permit a fuller discussion, nervous
conditions unquestionably can and very often do exert a profound
influence on the secretion of the various organs of the body, and can so
disturb digestion, metabolism, and nutrition that the most varied
results may follow, to which the names of different diseases are given;
so that nerve strain, more or less incident to modern life, must be
accredited with a certain share of influence in the production of
cancer. The part which imperfect and deficient intestinal and urinary
excretion play in inducing or perpetuating the disease will be treated
of in later lectures.
In our next lecture we will consider certain matters relating to the
medical treatment of cancer, but from long experience and study I am
firmly convinced that such measures are of relatively little service
unless coupled with a rigid care of the diet and hygiene. As Bell
remarks, “Cancer is essentially a disease supervening upon a persistent
neglect of hygienic laws.” It is a disease of sub-oxidation, and all the
hygienic elements of importance in tuberculosis are equally necessary in
cancer; fresh air and sunlight with, as far as possible, an ideal
regulation of life in all its aspects, are indispensable.
Inasmuch as there is no specific medical antidote for cancer, and we
cannot be certain of securing at once the metabolism of health, it is
wise to remove and to keep away from the system those articles which
have been shown to have more or less influence in its production,
namely, animal proteids, coffee, tea, and alcoholics. Time does not
admit a discussion of vegetarianism, nor is it necessary, for there is
abundant evidence in literature and on every side that perfect health
can be maintained thereby, and I went over the subject pretty thoroughly
two years ago. The vegetable kingdom contains protein enough to build up
and maintain the tissues of the body, as is shown in animals, and an
extra number of calories can be easily obtained from butter, of which a
quarter of a pound contains some 800 calories, or fully one-third of the
total daily quantity required by most individuals. The details of a
purely vegetarian diet, which experience has shown to be of the greatest
value in cancer, can be worked out for individual cases as required. I
am also firmly convinced that in this absolutely vegetarian diet, with
other proper hygienic and medicinal measures, to be detailed next week,
we shall find a great power for the prevention of cancer; although many
persons are already so saturated with poisoned blood and tissues from
prolonged errors of life, that perhaps no very striking general effect
on the community can be obtained therefrom in this generation.
In closing this lecture I must again urge upon you the necessity of
great patience and perseverance, with very much careful study of the
patient in all particulars, over a great length of time, if really
favorable results are to be obtained in cancer; and this is true whether
the disease be incipient, or fully developed, or even post-operative.
The causes of cancer are deep seated, and, as with many chronic
affections, there is no tendency to continue an improvement once begun,
but under a return to the same conditions as before the disease will
certainly assert itself. We have learned the lesson of assiduous
perseverance in tuberculosis; let us learn it in regard to cancer.
LECTURE V
MEDICAL TREATMENT OF CANCER
It is remarkable that so little serious attention has been paid to the
medical treatment of cancer, in standard works, in view of the
occasional strong statements and reports which have appeared from time
to time in current literature and in occasional books, dating back for
many years. Much of this, of course, relates to imperfect observation
and erroneous diagnosis, and also to crude medical knowledge, but there
have been also plenty of good men, who knew the disease and have
reported favorable results, and even the complete disappearance of
cancer, under dietetic regimen and proper medication alone, without
operative interference of any kind.
Not to go back too far, reference can be made to Lambe, who one hundred
years ago wrote clearly in regard to the causation of cancer from
luxurious living, and adduced strong proof to show the effect of diet in
curing certain cases of undoubted cancer of the breast and uterus, the
diagnosis of which was confirmed by prominent surgeons of the day,
several of whom endorsed the vegetarian diet. Abernethy wrote pointedly,
soon after, regarding the constitutional origin of tumors and says,
“There can be no subject which I think more likely to interest the mind
of the surgeon, than that of an endeavor to amend and alter the state of
a cancerous constitution. The best timed and best conducted operation
brings with it nothing but disgrace, if the diseased propensities of the
constitution are active and powerful. It is after an operation that, in
my opinion, we are most particularly incited to regulate the
constitution, lest the disease should be revived or renewed by its
disturbance.” He then gives an endorsement of Lambe’s dietetic treatment
of cancer, and presents several reasons why it should be fairly tried.
In the classical work of Walshe we find numerous references to the
constitutional nature of cancer, original or quoted from recognized
authorities, as well as expressions in regard to the futility of
expecting that surgical interference would cure the real disease in any
great proportion of cases. He says, “It would in theory appear that the
removal of a tumor cannot in itself cure the disease, as the local
formation is but a symptom of a general vice of the economy.”... “This
tissue being, as the normal textures, the seat of nutrition, is like
them susceptible of its disordered actions,” and he alludes more or less
to the effect of diet on the disease.
The late Willard Parker, one of New York’s great surgeons, in a study of
397 cases of cancer of the female breast, observed from 1830 to 1880,
wrote very strongly in regard to the constitutional relations of cancer.
In considering the etiology he places constitutional causes first, and
says, “luxurious living, and particularly excess in animal food,
increases the waste products of the body, and if coupled with
insufficient exercise, the waste products are retained in the system and
have a tendency to produce abnormal growths.”... “Cancer is to a great
degree one of the final results of a long continued course of error in
diet, and a strict dietetic regimen is, therefore, a chief factor in the
treatment, preventative and curative.” Concluding his study he says,
“There is such a _consensus_ of opinion as to the advisability of early
removal of the growth, that a discussion of the subject would be
useless. So then, in the first place, let us remove the tumor, and
thoroughly. But after we have done so, after we have taken it out by the
very roots, is this sufficient? No. We must then adopt the means stated
above to prevent a second development. We must change the diathesis; we
must seek to modify the patient’s constitution so that it will be no
longer prone to reproduce the disease: and then only may the surgeon be
satisfied that he has done his duty.” He further says, “In regard to the
effect of abstemiousness on cancer I can speak with great positiveness,
that vegetable, or at least a very bland diet, does check the progress
of the disease, and, in some cases now under treatment, has been
attended by an alleviation of symptoms; and in a few instances even by a
recession of the growth.” He also quotes from Sir Astley Cooper some
strong language which, as he says, “shows a broader and more enlightened
view of the subject than is contained in the writings of some more
recent observers, who have supposed that they were working far in
advance of the great English surgeon”; the rather long quotation then
given proves that that great surgeon also believed absolutely in the
constitutional nature of cancer.
Sir James Paget is often mentioned by writers, sometimes even with
derision, as a believer in the Constitutional Nature of Cancer, and his
words are very strong; says he, “I believe it to be constitutional, in
the sense of having its origin and chief support in the blood, by which
the constitution of the whole body is maintained,” and speaks at some
length in his lecture, in support of this view; I will give you one
other small quotation. “The existence of the morbid material in the
blood, whether in the rudimental or in the effective state, constitutes
the general predisposition to cancer,” etc. It is remarkable that the
views of this prince of surgeons and pathologists should not have
carried more weight in regard to cancer, when his other views are so
well accepted.