similar views and corroborative evidence scattered in books and current
literature during the last fifty years, but a few more references may be
given. In 1884, and again lately, Merriam has called attention to cancer
occurring as a reversion of tissue cells to earlier or embryonic forms
under the influence of a disordered, or as he calls it, a poisoned blood
stream, from over nutrition from a meat diet; and Haig has long
maintained that uric acid is a prominent factor in the etiology of
cancer.
While few will agree with Haig in all his conclusions, there is no doubt
but that a faulty nitrogenous metabolism plays a not inconsiderable part
in the causation of many diseased conditions, as has been also shown in
a previous lecture to be true in regard to cancer: and while it may not
be actually uric acid or urea which does the harm, as these are
relatively harmless end products of metabolism, it is true that the
purin and xanthin bases, of many forms, and imperfectly oxidized
nitrogenous elements, are active agents in the production of disease.
Venus and Isenberg have both written very strongly in regard to the
unquestioned value of a vegetarian diet in cancer, the former citing
many supporters of the view, from ancient times to the present. If time
permitted any amount more of corroborative evidence could be given in
regard to the connection of cancer with metabolic disorders.
There have been many scattered articles concerning the chemico-pathology
of cancer, all looking in much the same direction as that which we are
pursuing, which cannot even be alluded to, but brief mention must be
made of a most illuminating and suggestive study by Bristol. Reviewing
the many theories of the etiology of neoplasms he shows pretty clearly
that cell reproduction comes from outside the cell, or from the
surrounding cell medium by a process of diffusion, or by a definite
chemical attraction, and is closely associated with the nutrition and
growth of the cell, especially the nucleus; also that a fixed ratio
between the salts in the blood, lymph, and tissues is necessary for
normal activity and reproduction of cells; further that a disturbance in
this ratio and an upset in the chemical equilibrium will lead to
abnormal metabolism, growth, and reproduction, and result in an atypical
growth in the local area involved.
As before remarked, it seems strange that the medical profession and the
public have been so slow in accepting the views here presented. But both
have become so obsessed with the idea that nothing can be done for
cancer except operative procedure of some kind, and so dazzled with the
glamour of modern surgery, so fascinated with the apparent definiteness
of laboratory proceedings, and so attracted by the glory of purely
scientific research, that it is very difficult for any other doctrines
to make headway: moreover, any dietary or medical treatment,
prophylactic or curative, is very tedious and also difficult, in the way
of attention to minute details, etc., and patients weary of restrictions
and are restless at seeing little or slow progress made. Haig found the
same difficulty with Hospital patients, but does not hesitate to state
that in private practice “some undoubted cases of cancer have gotten
well” under his dietary restrictions.
But when it is remembered that it is calculated that, under present
existing conditions and treatment, fully 90 per cent. of those attacked
with cancer ultimately die from it, and that there were last year nearly
50,000 recorded deaths from this cause in the “Registration area” of the
United States, covering but two-thirds of its population, and that the
disease is rapidly and surely increasing, it behooves the Medical
Profession to put forth the best efforts possible to stay the progress
of the disease. In New York City, according to the Weekly Bulletins of
the Board of Health, there were from May to November, 1914, in 26 weeks,
2173 deaths from Cancer, Malignant Tumor, or an average of 83.5 per
week, almost twelve deaths daily from malignant disease.
Operative surgery has unquestionably been of great service in certain
cases and along certain lines of cancer, and the claim for the earliest
possible removal of morbid growths is certainly a just and proper one;
moreover, with our present knowledge it is perhaps wise to attempt to
remove the offending mass while there is some hope or prospect of
benefit, and personally I am occasionally advising this in proper cases.
X-ray and radium have also their sphere of usefulness in a certain class
or group of cases, but the excessive exploitation of the latter, not
long ago, did harm in raising false hopes in multitudes of sufferers,
and as these were shattered so also was confidence shaken in regard to
all help for cancer from other than surgical removal.
But every one who has been brought much into contact with cancer knows
full well what a mass of recurrent cases exist, possibly many of them
due to bad operation, in regard to which surgery has to acknowledge that
it can offer nothing more, that they are inoperable and therefore they
are regarded as incurable. Every one also knows how many cases there are
which have advanced so far before coming to a competent surgeon, that
they are also inoperable. Every one likewise knows that there are
numerous cases of cancer in internal regions, and in certain localities,
and presenting peculiar features, which are also recognized as
inoperable, at least with any proper justification. Thus it may safely
be said that of the total number of cases of cancer existing at any one
time, which would be included under the above classes, fully 50 per
cent. are such that operative surgery can offer no hope of material
benefit: also, it must be acknowledged that but a relatively small
proportion of all cancer cases are likely to secure the very best
surgical service, such as claims the highest percentage of success.
For this large number of hopeless victims of this dire disease, at
least, proper dietary and medical treatment should be most carefully
studied and patiently applied, with the hope and expectation that the
same, if correctly employed, would more or less hinder or check its
progress or prevent a recurrence after operation. But experience shows
that such measures, if taken promptly and thoroughly, can also prevent
the development of early threatening lesions into those of malignant
character, suggesting surgical removal, and these should never be
neglected when there is the slightest suspicion of cancer. For it must
be acknowledged that the surgery of cancer is only an attempt at the
physical removal of a something, which medical science and art should
not have allowed to develop out of normal tissue. And in the matter of
the general prophylaxis of cancer it is certainly worth while to
consider and act strongly upon the facts which have been presented,
especially in those individuals who have any hereditary suspicions, or
who exhibit the habit of body or life which could lead to the
development of cancer.
The medical care of cancer, as of all diseases, naturally includes both
prophylaxis and the treatment of a morbid condition which has already
developed; the former of these is always considered to be of the highest
importance.
_Prophylaxis of Cancer._ From what has preceded in this and other
lectures it can readily be understood that the prevention of cancer lies
largely along dietary and hygienic lines, including such medical
attention as shall secure healthy action of the secreting and excreting
organs. If the figures and facts heretofore given are correct, if cancer
has surely been observed to increase under certain conditions of life,
if it is found to be absent or relatively rare under certain other
conditions of living, if cancer has been known to disappear
spontaneously in certain individuals, especially when they have changed
their mode of living, it must then follow that when the exactly correct
habit and state of life are continually assumed the disease will not
occur.
In other words, when the blood stream nourishing the tissues is ideally
correct, the individual cells of the body perform their functions
normally, and as each cell is worn out it is removed by a healthy
catabolism and renewed by a normal anabolism, and homologous cells then
replace those which have ceased to be able to perform their function. On
the other hand, when there is perverted metabolism we have various forms
of deranged action, to which we give the names of various diseases, one
of which is cancer: here in place of homologous cells maintaining the
tissues in a normal condition, we have a malignant metamorphosis into
heterologous cells, which take on a disorderly or rampant action, and
refuse to assimilate themselves to others, so as to form healthy tissue;
we have then a mass of low vitality, tending to easily break down or
ulcerate, and to extend their malignant action to adjoining tissues,
under the continued influence of a contaminated blood current. When once
ulceration has occurred, the ordinary parasitic micro-organisms, which
are practically omnipresent, find an acceptable nidus, and aid in the
destructive work, and also in the systemic poisoning of the tissues.
The aim, then to be sought in the prophylaxis of cancer is to secure the
most perfect blood stream possible, which is accomplished by simple
living, perfect mastication, and the avoidance of excesses, especially
along the lines of protein, tea and coffee, alcohol, etc., with the
maintenance of healthy habits of life, especially in regard to bowel
action. As already intimated, we do not know just why in some persons
and at a certain time a disturbance of metabolism results in perverted
cell growth, but there is, of course, a reason, and the physician’s duty
is so to regulate the patient’s whole life that the metabolism is kept
in the state of perfect health. All this seems very simple and trite,
but really it is a task which is most important and often most difficult
to accomplish, and requires very careful study and infinite patience.
Dr. Kellogg, of Battle Creek, says that of the many thousands who have
passed under his care he has not known cancer to develop in any one who
had been faithful to the principles which he inculcates, and I may say
the same of the many who have been under my care in private practice,
often with notes extending over many years.
Time does not permit of going into detail here in regard to the special
features of diet and hygiene, which I discussed with you fully two years
ago, in my lectures, which were subsequently published: suffice it to
say, as previously remarked, that the refinements of civilization add
greatly to the temptation of over-eating, and wrong eating and drinking,
as they do to numerous other temptations, and in many instances it
requires the utmost amount of grit as well as patience, both in the
patient and doctor, to secure the perfect result necessary.
It is understood, I trust, that I believe that for the proper treatment
of cancer, and to prevent its occurrence and recurrence, it is
absolutely necessary to maintain a perfect vegetarian diet, which
includes even the exclusion of eggs and milk, with food; but the yolk of
eggs may sometimes be taken with advantage, and also milk alone and
separate, at a body temperature, one hour before eating, according to
the plan which I have often demonstrated to you. As remarked in my last
lecture, the vegetable kingdom contains proteid sufficient for the
system, and the diet should be so arranged as to give the requisite
quantity of calories, in proper proportion, of vegetable protein,
carbohydrates, and fats: the latter is accomplished largely with butter,
of which a quarter of a pound may be taken daily. Many writers on diet
hold that the protein in casein acts differently from that contained in
meat, and this is allowed in many vegetarian dietaries: it also contains
phosphorus, which is an integral part of living cells, especially their
nuclei. When nutrition seems to demand it, this can, perhaps, be added
to the diet, mixed with cereals or in soups, and a small amount of
certain kinds of cheese is also sometimes allowable. It is impossible to
elaborate the details of diet fully in a lecture such as this, and I
must refer you to the many excellent works on food and nutrition
(Hutchinson, Sherman, Thompson, Buttner, Braithwaite), for further
information.
The _medical treatment of cancer_ patients is a matter which should
receive most careful and constant attention; indeed, the patient in whom
cancer is threatening or has developed should be under the watchful and
unremitting guidance of a physician who grasps the importance of the
matter and is prepared to guard the health, and to meet and correct
functional disorders as they arise; for a careful study of patients with
cancer for many years has constantly shown me gross errors in their life
and in the action of various organs, and consequently disorders of
metabolism which are of weight in connection with the disease.
The first point of importance to which I wish to call your attention is
in regard to the action of the bowels. Some of you may remember that
even that great surgeon, Sir Arbuthnot Lane, has recently emphasized the
fact that one of the terminal results of intestinal stasis may be
cancer. This may seem strange, but it would surprise you if you knew how
very commonly there was imperfect intestinal excretion, or intestinal
stasis, as it is now called, in these subjects; indeed, I might almost
say that it is the rule, and that this assuredly plays a most important
part in the auto-intoxication which leads up to cancer; in fact, I
almost feel like saying that the toxins produced by the millions of
micro-organisms generated through intestinal stasis and fecal
putrefaction are the real, incidental cause of cancer. Under a perfect
vegetarian diet there is less likelihood of trouble in this direction,
but even then there is necessity of watching continually, that there may
be at least, one, full, free movement of normal character, daily, after
breakfast. In many cancer patients I have secured this by having the
entire potato eaten, skin and all, whether boiled or baked; by this
means also one gets the full value of the inner layer of skin, which
contains the mineral salts so necessary to the economy, which are
entirely lost when the potatoes are peeled before boiling; so that
potatoes should always be cooked in their skins, even if the outer layer
is stripped off afterwards.
But the regulation of the bowel action should not be left to the
judgment and action of patients, with a spasmodic use of remedies, and
with alternate constipation and purgation; the physician himself should
carefully guide and direct the proper treatment frequently enough to
secure perfect results. Of course each one may have their own ideas and
methods, but I have long used with the best results the remedies which
you have often heard me order in this clinic. Thus, at the beginning of
treatment, and often on the same days of many succeeding weeks, I give ℞
Ext. Colocynth. Co., Mass Hydrarg ‾aa‾ gr. x Pulv. Ipecac gr. ‾ij‾ M.
Div. in Capsules No. IV. Sig. Take two at night and two on the second
night after. For continuous use, or in the nights between these, I have
long used a compound Cascarin tablet (℞ Podophylin, Aloin, Cascarin ‾aa‾
gr. ¼) one or more each night, or have depended on the Cascara in a
mixture of which I shall shortly speak. I do not like the action of
salts or laxative mineral waters in these cases, and, of course, enemata
are entirely useless to secure real, effective liver and intestinal
action, and should be used only in an emergency.
The action of the _kidneys_ is also always a very important element to
watch and control in cancer patients; this does not have reference to
albumen and casts, or glycosuria, but to a functional derangement of the
secretion: for the former are relatively infrequent compared to the
latter. This is so large a subject that time does not permit of its
elaboration; I made the matter pretty clear to you in my lectures not
long ago on the relations of diseases of the skin to internal disorders.
I must tell you, however, that, as a result of numberless studies of the
urine of many cancer patients, I have almost constantly found a
deficient or defective urinary secretion: in many cases I have had the
total daily amount accurately measured, and reported in writing each
week over long periods, and while the total quantity may at times be
near normal, the total solids sometimes fall to, and remain at, even
less than one-half the amount which should be passed for the patient’s
body weight.
I want here to urge upon you the importance and value of repeated
volumetric examination of all possible ingredients of the urine, as
indicating in the best manner obtainable the state of the arterial
blood, from which the urine is derived: especially is this true of the
exact volumetric acidity, representing the diminished alkalescence of
the blood common in cancer.
The actual medicinal and dietary treatment of the various possible
departures from normal can hardly be elaborated here, but they are along
very much the same lines which you have often watched in connection with
certain diseases of the skin; for you must remember that carcinoma is an
epithelial disease, and that the laws of nutrition are much the same for
this as for various other morbid conditions of the economy. I may say,
however, that very many of my cancer patients have received the greatest
benefit from acetate of potassa, often in the formula familiar to you (℞
Potass. Acetatis ℥i Tinct. Nucis Vomic ʒiv Extr. Cascar. fld. ʒ‾ij‾-ʒiv
Extr. Rumicis radicis fld. ad ℥iv M. Sig. One teaspoonful half an hour
before eating, well diluted). For many years I have administered potassa
largely to these patients, and it is gratifying to find not only support
but an incentive to its greater use, in the studies and experience of
Ross, who pushes it to a very great extent, giving as high as 240 grains
of potassium phosphate in a day. Ross also advises the free use of crude
or brown sugar, as it contains a large proportion of potassium salts,
which are for the most part removed from the white or refined article. I
must also remind you of the great value of Bethesda water, in washing
out the kidneys, given a tumblerful with each meal, and one tumblerful,
hot, one hour before breakfast and also an hour before the evening meal.
The _blood_ should also be watched, and in my hospital cases I have a
count made every week; for the hæmoglobin content, and the number of the
erythrocytes, and the percentage of the varieties of leucocytes afford
very valuable information as to the physical state of the patient, and
the progress or recession of the cancer, and in a measure these data are
of value in directing therapy. I have also the _weight_ of the patient
taken and recorded each week, as a guide to nutrition and dietary
matters. Also the _saliva_ is tested and recorded before and after each
meal, and furnishes an indication in regard to the administration of
alkalies.
Iron is found to be greatly wanting in the blood and tissues late in
cancer, and should always be an element in the treatment of this
disease. Skene Keith, noticing that after a cancerous mass was removed
the blood recovered in regard to hæmoglobin and erythrocytes,
administered iron with arsenic, with the greatest benefit, the growth
shriveling up and the patient gaining in weight; he recommends the
citrate of iron and ammonia, the preparation which I have given to
patients for many years past. He also advises hypodermic injections of
iron, arsenic, and soda, and reports cases thus treated, some of them
with good results. There is a loss of phosphates in these patients, and
phosphate of iron or other phosphates are valuable.
When considering the metabolism of cancer mention was made of
derangement in the action of the ductless glands in this disease, and of
the use and value of certain preparations of the internal secretions in
its treatment. While a hormone therapy of cancer is still in its
infancy, in spite of many books and innumerable journal articles on the
internal secretions, it is quite possible that the future may
demonstrate its efficacy in helping to control the disease: for, that
the latter are efficient agents in carrying on the vital processes in
the body, there can be no question, although as Biedl remarks, “Our
knowledge of the chemistry of hormone formation is very slight.”
But considerable clinical evidence has been accumulated that one at
least of the internal secretions, namely, that of the _thyroid_, has a
definite beneficial effect upon cancer; this I have administered to many
cancer patients, and have reason to believe that it contributed to the
favorable results obtained. Sajous, believing that insufficiency of the
adrenal secretion is an element in altered nutrition, advocates thyroid
extract on the ground that it stimulates the activity of the adrenals:
Vincent quotes Erlich as believing that “there may be substances
circulating in the organism which may stimulate the body cells to resist
the athreptic influence of cancer cells.” Shirlaw advises a tablet made
of thyroid 6 grains, supra-renal ¾ grain, and pituitary 1/16 grain.
While the treatment by these hormones from internal secretions is really
in rather an experimental stage, it would seem more than probable that
the correct use of these pluriglandular extracts, in combination with
other proper dietary and medicinal treatment, would be of service in the
prophylaxis and treatment of cancer. I have been a little cautious in
the use of thyroid, beginning with two or three grains with meals, three
times daily; for, as a promoter of catabolism it can disintegrate tissue
faster than the emunctories can remove the effete products, and may thus
poison the system.
Serum- and Vaccine-therapy are yet in a stage of development, and as I
have had little or no personal experience with them I will not attempt
to discuss their value, which time alone will demonstrate. While there
have been many claims of success from treatment along these lines,
unfortunately they have not been confirmed by later observations by
others: I may say frankly that they have never appealed to me as
rational, in consideration of the views and experience I have long had
along other lines of thought and practice. If, however, future
investigations shall confirm some of the remarkable reports which have
been made, the latest of which is by Nowell, there may be opened a
non-surgical line of treatment of cancer which would mean much to many
otherwise hopeless cases.
The _local medical treatment_ of cancer is also an important matter
which should receive careful attention. For many years in early cancer
of the breast, under proper, general, dietetic, hygienic, and medicinal
treatment, I have seen the lump vanish under the continued application
of the iodide of lead, in Hebra’s diachylon ointment of the German
Pharmacopœia (ʒss-ʒi ad ℥i), and in very many instances I have had the
assurance of patients that its application relieved the pain and was of
the greatest benefit also in axillary and other metastases. In other
cases the continuous painting with ichthyol (50 p.c. in water) has
seemed to be of great service, in combination with other proper
treatment: all of this in earlier cases, before ulceration has occurred.