The phrase “Conquest of Cancer”, though perhaps emotive rather than
scientific, nevertheless implies the existence of a very real and
important problem. And this problem, it may be confidently affirmed, is
one that will never be solved, in action, by the efforts of the medical
profession _alone_. Whatever be the future, and as yet reserved,
revelations of Science, and whatever the further developments of Art,
cancer will not cease to exact its toll unless medical science and
art obtain the intelligent co-operation of an instructed public. It
is for this reason that it has been thought useful to place before
the public this little book, written by a practical surgeon who has
given special attention to the problems of the laboratory. The book
itself, which not only states in simple language the essential points
that should be comprehended by the public, but puts forward a plan for
concerted action, is based upon one of a series of University Extension
lectures given during the winter of 1922–23, at the Shantung Christian
University, Tsinan, China, where Mr Wright is actively engaged in the
Surgical Department of the School of Medicine.
* * * * *
The task of prefacing this essay by some words of introduction
has devolved upon the present writer, not because he either has,
or desires to present, any claim to speak with special authority
concerning Cancer, but by reason of a close personal and professional
friendship that has led him to appreciate very warmly the knowledge,
the sincerity, and the disinterestedness that characterize Mr Wright’s
thought and work. And he is confident that we may accept what has been
said about Cancer at Shantung as an honest and candid attempt to
instruct and to construct, in detachment from the pribbles and prabbles
that have sometimes confused discussion nearer home.
Now, although the public has the undoubted right to demand information
on this subject, and although, as has been suggested, without admission
of the public to the arena of discussion little can be done to diminish
the present mortality from Cancer, yet is there real difficulty in
communicating knowledge, without engendering unnecessary fear and
alarm and sending the hypochondriac to those quacks and charlatans who
diagnose non-existent disease in order that they may reap reward by
announcing its cure.
Some weaker minds there will always be: so, whenever attention is
directed towards some public danger, there are those who adopt the
possible contingency as a peg on which to hang some ragged vestment of
distracted emotion or thought. Thirty years ago, the insane feared
the telephone: during the Boer War, many thought that the “scouts were
after them”; now-a-days lunatics babble of persecution by wireless, by
Bolsheviks, or even by psycho-analysts. So, in Victorian times, the
_malades imaginaires_ who then thronged consulting rooms spoke with
bated breath of Bright’s disease: to-day, the hysterical secretly hope
to hear the blessed word “Colitis”, and the hypochondriac as secretly
dread the verdict of “Cancer”!
The task of the medical profession is to enlighten the laymen, that
their help may be enlisted, and yet to avoid alike exaggeration and
smooth sayings, false hopes and false fears. Macaulay, in a familiar
passage, once said that there is nothing more ridiculous than the
British public in one of its periodical fits of morality. At present,
the British Public is less concerned than formerly with questions of
morality, but is very much concerned with questions of health. Perhaps
it is not so much health that is sought and desired as absence of pain
and avoidance of death――which is not quite the same thing. But, though
there is nothing intrinsically ridiculous in seeking the “advancement
of morality” or the “conquest of disease”, the one, no less than the
other, may be pursued in a ridiculous and dangerous manner.
The adoption of ill-conceived measures, designed to improve morals or
to abolish disease, may, and often does entail consequences that are
even less desirable than the evils it is hoped to combat. While the
prohibition of the consumption or sale of alcoholic drinks may diminish
certain ills, it has yet to be shewn that the casting out of devils in
the name of Beelzebub may not be followed by possession with others yet
more violent. A few years ago we were adjured to boil all milk, lest
we became poisoned by certain microbes: we are now told that, if all
milk be boiled, we are as if deprived of vitamines, and must suffer
accordingly. Instances might be multiplied; but it should be obvious
that moral and physical health must be considered, not as physical
objects, but as relations, or states of equilibrium. Like all states
of adjustment or equilibrium, they are the result of accommodation:
of poise and counterpoise. They are not always and everywhere to be
secured by the throwing of a certain weight into one or other scalepan,
or by the cutting-off so many inches from the table-leg that seems
the longest. So much, at least, should be recognised by a seriously
disturbed public told by the daily press that so many more people
than formerly now die of cancer; that science has not yet discovered
the “cause of cancer”; but that all may be well if only we live on
Nebuchadnezzar food washed down by paraffin.
Mr Wright’s essay, combining as it does a well-balanced and sufficient
statement of what is known, with the outline of a constructive
proposition that merits careful consideration, and at least indicates
to the public the kind of way in which relative safety may be obtained
under present conditions, seems one that is eminently suitable for
what may be called general reading. The problem is fairly and lucidly
presented: the resources of surgery are quietly and reasonably
demonstrated: and the advantages are shown of exhibiting that kind of
prudence which leads the business man to seek auditing of his accounts
and the sportsman to enquire how his score stands. But some words may
perhaps be added from the standpoint of one who is a physician, and no
surgeon.
* * * * *
Cancer is a class name given to certain kinds of growths, otherwise
spoken of as tumours (or swellings) and ulcers, which are, as we say,
characterised by malignancy. A growth, tumour, or ulcer which is _not_
malignant is _not_ called a cancer. By malignancy we mean a tendency
to spread, by local and direct extension (as spreads a fire), or
by convection, as when sparks fly from a locomotive to a haystack.
Malignant tumours or ulcers tend to recur when removed, and, in the
long run, to destroy life.
These general features are associated with certain microscopical
characters found in the tumours or ulcers, so that the nature of any
growth――whether malignant or otherwise――can be sometimes determined
by the surgeon or physician, and sometimes by the pathologist or
microscopist alone, but, as a rule, is most certainly settled by the
physician or surgeon acting in conjunction with the microscopist.
Yet, and this is important, not every cancer does actually destroy
life. Surgeons of the greatest experience, such as the late Sir Alfred
Pearce-Gould, have affirmed that undoubted cancers do occasionally
undergo spontaneous cure, or at least arrest of growth, _even in the
absence of any treatment_. Again, if excision is practised early, and
sufficiently extensively, recurrence does not happen, in a certain
proportion of cases. Finally, pain is no necessary or inevitable
concomitant of cancer. In many cases pain is absent, or almost so;
death may be due to mechanical consequences entailed by the growth
rather than to destruction of any vital or sensitive part.
Now, medical men are in the habit of splitting up the group or class of
malignant growths (or “cancers”) into two subsidiary groups or classes.
One of these is named Sarcoma; the other Carcinoma. Sarcoma is the name
given to a group of malignant growths taking origin in the structures
and tissues developed from the “middle layer” of the embryo: the
growths themselves――sarcomata――partake the nature of the tissues formed
from this middle layer. The other group, of carcinomata, consists of
growths taking origin in, and partaking the nature of one or other of
the two remaining embryonic layers and the structures developed from
them.
These two layers form respectively:
(1) The skin and related structures, and
(2) The lining of the tube passing through the body;
its backwaters, out-growths and appendages.
It is these two layers which, as Mr Wright so aptly remarks, are in
direct contact with the outer world. Now, while the carcinomata (which
constitute the class of cancers chiefly discussed in this book) in
general affect people who have passed the midpoint of life――those for
whom, as Rabelais says, it is _midi passé_――the sarcomata, which are
less common than the carcinomata, are rather more frequently, yet not
exclusively, found in young people; in those indeed, who have not
reached life’s apogee. It is important that these facts should be borne
in mind, for generalisations founded upon the study of carcinomata
alone cannot be necessarily true in respect of all Cancer, unless the
use of the term cancer _be restricted_ to the class technically known
as carcinoma. To say that Cancer can be prevented if constipation
is avoided is clearly misleading, when we remember that quite young
children, nay, infants, may be the subject of sarcoma; unless of course
we define cancer, as some would do, as the kind of growth that, _ex
hypothesi_, is prevented when constipation is avoided. It is confusion
of this sort, bred by slovenly expression out of loose thinking, that
is in great part responsible for the present bewilderment of the public.
Another fertile source of confusion is the obscurity that attends both
the popular and the professional use of the words “cause”, “causation”,
and the like. The public demands that “the” cause of cancer be
discovered, and is prepared to pay generously that this discovery
be made. Unfortunately neither the public, nor men of science, care
overmuch to discuss what they mean by cause and causation. This is no
place in which to trench upon a province unsuccessfully explored by
Locke, by Hume, and by Kant. Yet it is of vital importance that all
doctors, scientists, and laymen should recognise two different _uses_
of these words.
When we speak about “the” cause of a “disease”, in a generalised or
conceptual sense, as when we say that Koch’s bacillus is “the cause
of tuberculosis”, we are really defining our concept of the disease
in terms of _one_ correlative. We are saying that tuberculosis is a
disease in which Koch’s bacillus is invariably present. A _circulus
in definiendo_ is only just escaped because we happen to know that,
if Koch’s bacillus is injected into certain animals, the “disease”
as we say, develops. Koch’s bacillus is the one constant correlative
found in all cases of the kind that we agree to call tuberculous,
by reason of certain clinical and pathological signs that we find.
Possibly even this statement is not to be taken as absolutely true;
though it represents what we find it convenient to say. But, when we
thus declare Koch’s bacillus to be “the” cause of tuberculosis, we
have by no means exhausted the study of all the correlations that may
be called causal in respect of _particular_ cases. Of ten cases of
tuberculosis, each one exhibiting Koch’s bacillus, we may say that _for
each particular case_ “the” cause of the illness is different.
Thus:
A. is tuberculous because he was gassed in France;
B. is tuberculous because he was infected by his sick
wife;