years previously she had noticed a lump in the left breast which was
removed on January 6th, 1911, but it soon regrew, and a complete
operation was performed at the New York Skin and Cancer Hospital, May
30th, 1911. Two years later there was some return, and she was again
operated on at the Hospital, May 30th, 1914. About two months before her
first visit, September 17th, 1914, a swelling of the sternum was
noticed, and soon another above it, both of which increased pretty
rapidly to the time of her visit. When seen there was a hard mass in the
scar over the sternum, about an inch and a half long, raised a quarter
of an inch or so, reddened and immovable: an inch or so above it was
another, smaller one, not reddened: they were not particularly painful
on moderate handling, but painful when at hard housework. When last
seen, December 7th, both lumps had subsided fully one-half, there was no
pain at any time, and her general condition had improved immensely, she
feeling better than she did four or five years ago, that is, before the
beginning of the cancerous development: she has been working all the
time, unusually hard, as janitor of four buildings and also going out
scrubbing and washing. She weighed 157¼ pounds when first seen, then ran
down to 154, but is again gaining, being 155½ at her last visit. The
outcome of this case it is, of course, impossible to conjecture, for one
can seldom be sure that patients will be absolutely faithful to
treatment, for a long enough time, but certainly the change in the woman
and in the lesions in this two months and a half has been remarkable,
compared with the increasing development of the disease in the two
months previous.
I must mention one more case, which, although fatal, exhibited some of
the good results of careful medical treatment even when a primary case
had advanced far beyond the possible aid of surgery.
Mrs. M. B. J., aged 68, a private patient, was first seen on February
17th, 1914. Two years previously she noticed a lump in the upper part of
the right breast, after great and repeated mental distress from the
death of a number of very near relatives, and a sister’s mental
derangement; the great nervous strain had been attended with various
bilious attacks and nervous indigestion. The mass increased steadily in
size and was kept concealed even from her family, until the day before
she called, when her family physician who was consulted saw that it was
far beyond the possible hope from any operation, in which view a surgeon
concurred.
When seen the whole breast was involved, was double the size of the
other, hard, immovable, and with an adherent crust over an ulcerating
surface on its lower half, several inches in diameter, from beneath
which was a moderate discharge: the axillary glands were enormously
enlarged, as also the supra-clavicular, and she was strongly cachectic.
She was placed on an absolute vegetarian diet, with no coffee or tea,
and appropriate medical treatment, and the breast kept painted with
fifty per cent. ichthyol and water, care being taken not to disturb the
adherent crust. In a very short time the discharge ceased, and the
protective crust adhered until her death from exhaustion, with pulmonary
œdema, on September 9th, 1914. On August 15th it was recorded that the
breast had done very well, that it was soft and movable, and not larger
than the other breast, with no discharge, and no pain since a short time
after beginning treatment: the axillary glands had diminished
three-quarters in size, and the supra-clavicular glands were also very
much smaller.
And now, gentlemen, my task is done. I have tried to let you see cancer
through my spectacles, as I have seen it for very many years past, and
to share with me my optimism in regard to the prophylaxis and cure of
cancer, if only there can be sufficient enlightenment in the profession
and public: and I must tell you that in collating and preparing the
material to support my long held views I have expended very much more
time and labor in study, for some months past, than I could have
believed possible. But as the subject developed, and as I discovered
more and more support for my thesis, there was a fascination about the
work which I could not resist; and if I have tried you with the many
details of proof presented I beg that you will pardon me: for I wanted
to present the subject so strongly that my hearers, at least, would
accept the propositions I have developed, and believe what I have said
in regard to my own experience with the terrible disease under
consideration, and act upon both, and thus aid some sufferers with
cancer.
From my recent article on “The Relation of Diet to Cancer” many medical
journals have quoted me as ascribing the disease wholly to the use of
meat, but you who have heard these lectures now know that animal
proteids are only one of the contributing causes.
I have tried to make it plain that metabolic errors, inducing a vitiated
blood stream, are the basic cause of the aberrant action in the cellular
elements of the body which may ultimately lead to malignant disease; and
I have tried to show that there are many elements connected with modern
so-called civilization which conspire to effect this end. I have quoted
many who were well acquainted with cancer, who believed that luxurious
living, which includes much animal food, coffee and tea, and alcohol,
with indolence or want of sufficient muscular activity to burn up the
waste products, and the persistent neglect of hygienic laws, should be
placed first among the causes of cancer: but I have also mentioned that
the refining and preparation and cooking of food prevented a proper
supply of the mineral and other elements of nutrition, and also that
nervous influences could so disturb the action of the organs of the body
that they could not perform their functions perfectly in the elaboration
of nutritive material, etc.
But I cannot go over again all the matter already given in these
lectures, and only mention these to remind you that there is no one
single cause of cancer, and consequently that its prophylaxis and cure
can never be found in any one single remedy; hence I can never believe
in the sole use of thyroid, much less in the idea that sero-therapy can
overcome a disease dependent upon the continued operation of so many
causes; and still less can I believe that the mere cutting out of an
already diseased portion of the body is the proper and only means of
overcoming such a malady as cancer.
I have acknowledged that local irritation of many kinds may be the
proximate cause for the development of a malignant tumor in any
particular locality, as Ewing has so clearly shown in his excellent
resumé on pre-cancerous lesions; but I have also contended that we
should withal look into and overcome the cause; why, when once started
by local injury the cells should pursue such a progressive, aggressive,
and invasive course; and this is found, I believe, in the disturbed
character of the fluids which provide them with nourishment for their
abnormal growth.
From this study of cancer in regard to its nature, frequency,
geographical distribution, metabolism, dietetic relations, medical
treatment, and clinical considerations, what conclusions can be drawn?
Have we solved the problem of cancer? Far be it from us to make any such
claim. Scientific research and study must still go on in the laboratory,
but clinical research and study, with laboratory work, on the human
subject, which have not been hitherto sufficiently cultivated, should be
pushed, so that by a mass of carefully recorded observations the truth
or falsity of what has been here quoted and said may be refuted or
confirmed.
From the enormous work which has been done on cancer with the microscope
and the test tube, it would seem sometimes that research workers have
become somewhat myopic, and not farsighted enough to recognize the true
value of statistical studies and clinical observations. In these
lectures we have attempted to make a brief synthetic study of some of
the work which has been done in connection with cancer, and from this we
believe that certain conclusions can be drawn; if these are correct and
followed, it is hoped that much more can be accomplished in regard to
the prophylaxis and cure of this more than threatening, fatal malady. In
order that you may hold clearly the points which have been made I want
to give you a synopsis or conclusions of them, as they have been brought
out in this and preceding lectures.
1. Cancer is but a deviation from the normal life and action of certain
of the ordinary cells of the body, which, for some as yet unexplained
reason, take on an abnormal or morbid action; with this there is a
continued tendency to a malignancy which invades contiguous tissue, and
in the end tends to destroy life.
2. There is some reason to believe that this action first takes place in
what are known as “embryonic rests,” or pre-natal, wrongly placed tissue
elements, which, however, are now shown to exist in every one, in many
localities: but the reason why they take on this malignant action, and
form cancer, has not been satisfactorily explained.
3. Cancer is _not_ wholly due to traumatic causes, although those play a
not inconsiderable part in its occurrence in certain localities and
cases.
4. It is pretty conclusively decided that cancer is _not_ caused by a
micro-organism, or parasite.
5. It is also known clinically and experimentally that it is _not_
contagious.
6. _Nor_ is it hereditary in any appreciable degree.
7. Occupation has _not_ any very great influence on the occurrence of
cancer, although it is more frequent in some pursuits than in others.
8. Cancer is _not_ altogether a disease of older age, although its
incidence is greatly increased with advancing years.
9. It does _not_ especially belong to or affect any particular sex,
race, or class of persons.
10. It is _not_ confined to any location or section of the earth, but
has been observed in all countries and climates.
11. No single cause of cancer has yet been demonstrated, nor is it
likely that this will ever be the case, as the experimental and other
investigations have covered almost every possible line of research, with
only _negative_ results.
12. The exclusion of almost every other possible cause of cancer, as
well as its pathological history, leads to deranged metabolism as the
only remaining possible etiological element; this acts by inducing
changes in nutrition, which latter depends on diet and the proper action
of the secretory and excretory organs, which, still further, may be
affected by nervous influences.
13. While the bio-chemistry of cancer throws little light on its true
nature, enough is known to show that the morbid changes in the cells are
largely associated with deranged metabolism.
14. The blood, in advancing cancer, manifests changes which indicate
vital alteration in the action of the organs which form blood and
control the nutrition of the body and its cells.
15. Clinical and experimental evidence demonstrate that the secretions
and excretions of the body exhibit departures from normal, which, while
not pathognomonic of cancer, indicate metabolic disturbances involving
the nutrition of the cellular elements, which disturbances are of
importance.
16. The evidence seems certain that the cancer mass itself, when fully
developed, secretes a poison which tends to augment its own growth and
hastens the lethal progress of the disease.
17. Cancer mortality is undoubtedly on the increase in every portion on
the globe.
18. This increase seems to vary inversely with the decline of
tuberculosis, in many localities.
19. The incidence of cancer seems to follow closely along the lines of
modern civilization.
20. This extension of cancer seems to depend largely upon the altered
conditions of life, particularly along the lines of self-indulgence in
eating and drinking, and indolence.
21. The augmentation in the consumption of meat, coffee and alcoholic
beverages appears to be coincident with a very great, and
proportionately greater, augmentation of the mortality from cancer.
22. The nerve strain of modern life seems to be an element of
importance, both through disturbance of metabolism, and by direct action
on morbidly deranged cells.
23. No single remedy for cancer will probably ever be discovered, since
it is conceded that there is no single cause for the disease.
24. Surgery has improved materially the statistics relating to the
mortality of operative cases; but the total achievements along this line
are insignificant compared with the general ultimate mortality of over
90 per cent. of those once afflicted with cancer.
25. Surgery has had, and may long have its function to perform in
removing the products of the disease, more or less efficiently, curing
some and prolonging the life of others, but it can never hope to lessen
greatly the morbidity of cancer.
26. The X-ray and radium, as also caustics, are in the same position as
surgery, and can do relatively little more than cause to disappear
lesions which have developed from causes which they cannot reach.
27. With all these means the measure of success, aside from the
technical skill of the operator, largely depends on the time or period
of development of the malignant tumor before treatment; the earlier the
removal is undertaken, other things being equal, the greater the
possibilities of success.
28. The same is true in regard to the treatment of the disease by means
other than those mentioned: the earlier the morbid process leading to
tumor formation is attacked by dietetic, hygienic, and medicinal
measures, the greater the promise and expectation of success, present
and permanent.
29. The prevention of cancer, therefore, or the checking of its
increasing occurrence, depends largely upon the early enough adoption of
such measures as will limit the agencies which induce a derangement of
the body juices which tend to bad nutrition and derangement of the body
cells.
30. The simple life, with the avoidance of the dietetic and other causes
which have been found to induce cancer in nations and individuals,
promises the best hope for the arrest of the rapidly increasing
development of cancer throughout the world.
31. It is more than possible, however, that the long continued operation
of many baneful causes has produced such a degeneration of tissue in the
human race, that it will take a generation or more of proper living to
make the beneficial impression on the general incidence of cancer which
is so longed for.
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INDEX
Abderhalden, defensive ferments in cancer, 78
Abernethy on vegetarian diet, 136
Aborigines, freedom from cancer of, 48, 116
Abstemiousness, effect on cancer, 139
Acid, amino nitrogen, increased in cancer, 91
Acid intoxication in cancer, 77
Acidosis in cancer, 80
Acids, oxyproteic, in the urine, increased in cancer, 90
Addison’s disease, 97
Adrenals, relation to cancer, 98
Africa, absence of cancer in, 50, 52
Agamogenesis, relation to cancer, 72
Age affecting cancer, 22
Ages of patients with cancer, 176
Agnew on surgery in cancer, 170
Alcohol, relation to cancer, 120
Alkalinity of blood, diminished in cancer, 77
Amino-acid nitrogen, increased in cancer, 91
Ammonia fraction of nitrogen, increased in cancer, 91
Amylopsin in cancer, 99
Anabolism and cancer, 33
Anæmia in cancer, 74
Animal food a cause of cancer, 50, 51, 52, 55, 63, 69, 110, 113, 116,
117, 132, 138, 141
Animals, cancer in, 43
Argentine Republic, cancer in, 57
Australia, cancer in, 48
Auto-intoxication and cancer, 155
Autonomous action of cells, 33
Bainbridge, local nature of cancer, 30
Baltimore, cancer in, 65
Banks, Sir William, on diet in cancer, 61
Bashford, 55
Beard, trypsin in cancer, 99
Beatson’s operation, 102
Beebe, diet and cancer, 80
Beirut, rarity of cancer in, 56
Bell, cancer from neglect of hygienic laws, 132
Beneke, diet in cancer, 115
Benratt, rarity of cancer in India, 53
Betel chewing cancer, 54
Biedl, hormone formation, 163
Bio-chemistry of cancer, 39, 79, 83
Blood changes in cancer, 74, 191
frequent study of, in cancer, 160
Blumenthal, oxyproteic acids increased in cancer, 90
Boston, cancer in, 65
Bowel action and cancer, 155, 157
Braithwaite, plainer fare and less of it, 154
salt and cancer, 129
Brazil, rarity of cancer in, 57
Breast, carcinoma of, 176
non-cancerous tumors of, 178
Bristol, disturbance of chemical equilibrium causing cancer, 143
British Guiana, rarity of cancer in, 50
Burnham, blood changes in cancer, 76
Butter, valuable in cancer, 153
Buttner, a fleshless diet, 154
Cachexia in cancer, 74, 77
Caffeine, nitrogen in, 119
percentage of, in coffee, 119
Cahen on Beatson’s operation, 102
Calcium salts, effect on cancer, 101
Cancer in the occupied and unoccupied, 130
personal statistics of, 176
problem, 201
Carcinoma, personal statistics of, 174
Casein sometimes allowable in cancer, 153
Cases, personal, of cancer, 180‒197
Catabolism and cancer, 33
Causes of cancer, 27
Centrosomes in cancer, 34, 85
Cheese sometimes allowable in cancer, 154
Chemistry of cancer, 39, 79, 83
of cancer tissue, 78, 82
of the body, 107
Chicago, cancer in, 65
China, rarity of cancer in, 55
Chittenden’s experiments on nutrition, 112
Chlorides in the urine, diminished in cancer, 92
Cholesterin, relation to cancer, 83
Chromosomes in cancer, 85
Civilization, cancer a disease of, 44, 46, 50, 68, 109, 117
Clinical considerations, 170
study of cancer, 17, 18
Coffee, consumption in United States, 118
nitrogen in, 119
relation to cancer, 117
Cohnreich, blood in cancer, 76
Cold storage, relation of, to cancer, 109
Composition of human body, 107
Conclusions, 170, 203
Constipation and cancer, 157
Contagiousness excluded, 19
Cooper, Sir Astley on constitutional nature of cancer, 139
Creoles in Africa, freedom from cancer of, 52
Cytology of cancer, 74
Danger from thyroid in cancer, 164
Deaths from cancer in New York City, 145
in United States, 144
De Bloeme, Swart, and Terwen, imperfect nitrogen partition in cancer,
90
Defective urinary excretion and cancer, 158
Deficiency of urinary solids in cancer, 88
Definition of cancer, 30
Degrez, imperfect nitrogen disintegration in cancer, 91
Denmark, cancer in, 82
Demineralization and cancer, 113
Diabetes, relation of to cancer, 95
Diet, effect of simple, in cancer, 121
relation of, to cancer,
46, 51, 53, 55, 57, 61, 63, 67, 80, 106, 115, 116, 133, 198
Dietetic treatment of cancer, 171
Disordered metabolism the cause of cancer, 74
Ductless glands in cancer, 97