F. because he drank and was dirty.
The difference between a medical cause in the generalised sense, (where
cause means a defining correlative for a concept), and a medical
cause in the particular sense (when we seek to find out or state the
antecedent without which this man would not be as he is here and now)
is one of enormous importance, and one that should be constantly borne
in mind when discussion is commenced. It is true that it involves the
oldest of logical and metaphysical problems in respect of scientific
thought――the question of universals and particulars; but that does not
make it any the more easily shirked. Its relevance to the question of
cancer is this: that the proof of the production of cancer in men or in
animals _under one set of circumstances_ does not warrant us in saying
that that set of circumstances _as known to us_ involves _all_ the
factors without which cancer cannot occur. And, even if research work
demonstrated that, in every case now called cancer, some parasite or
growth-form, some irritating factor that can be isolated, does actually
obtain, _unless it could be shewn that this parasite or factor is never
found except where there is cancer as we now define it_, we should
have to proceed to investigate why and how cancer does not always
occur when this factor is present. Just so are we at present seeking
to explain why and how, of so many persons exposed to infection by
Koch’s bacillus, only certain ones do become diseased. If we find that
only those persons who possess a character that we may call “X” become
infected, we shall then have to say that, not Koch’s bacillus, but the
character “X” is “the” cause of tuberculosis. It is thus that science
progresses: not by making the absolute and positive discoveries that
the public is taught to expect, but by arranging and rearranging our
experiential knowledge, as such grows, in terms of so-called laws and
generalisations, that are found _progressively convenient_. But such
laws and generalisations are not necessarily the one more “true” than
the other, _except in relation to the knowledge that they summarize_.
If such considerations as these were more frequently borne in mind,
there would be less unconscious deception, less disappointment, and
greater economy in work and thought.
Explanations of the causation of cancer have been sought in many
directions; and three chief theories have been set out. The most
important, and the most interesting from the point of view of the
practising physician, is that which considers cancer as provoked by
long continued irritation under certain circumstances. This doctrine
seems more “true” in respect of the Carcinomata――the cancers of the
adult and the old, and of tissues in contact with the extra-personal
world――than it is in respect of the Sarcomata――the cancers of the
young, and of those inner parts not exposed to irritation by contact
with the world. Yet sarcomata in real life do often seem to follow
_injury_, and the tissues in which they form _may_ be obnoxious to
injurious influences of which we know nothing.
Another view is that cancer may be due to a parasite of some kind or
another. Certainly, so far as some lower animals are concerned, this is
true, for certain rat and mice cancers are now known definitely to be
associated with parasites. But then we may say, and properly, that in
such cases the parasites are merely acting as do other irritants, and
are not “specific” causes of cancer.
The third doctrine, or set of doctrines, regards cancers as arising
when parts of the body (or rather, elements in the tissues of certain
parts) no longer act in due subordination to the needs of the
whole organism, but comport themselves “anti-socially”: developing
irregularly; propagating themselves illegitimately; and so becoming
parasitic to the commonwealth of the body. Those who hold this
will admit that, in many cases, this revolutionary tendency is one
provoked by irritation and the like: that sometimes it is a mere
manifestation of irregular decay; and that, when it occurs in young
subjects, it is because some islets of tissue have become misplaced,
tucked away, ill-formed, and hampered in development, and so liable
to provoke trouble later under stress of greater or less urgency.
Such a view has much plausibility; there are flaws in a steel girder;
there are tucked-in edges in even the best bound book, and there are
developmental errors in most of us.
Moreover, there is Dr Creighton’s doctrine of physiological resistance.
A part not put to its proper use is more apt than another to become
cancerous. Certainly, unmarried women are more liable than are married
to suffer cancer of the breast or ovary. Yet married women are more
apt than unmarried to suffer cancer of the womb. Are we to say that
in these latter there has been physiological misuse, or irritation
produced by unhealthy child-bearing? So far is the problem removed from
simplicity!
On the other hand, it is certainly as true as ever, that the gods
still cancel a sense misused, and, if we leave out of account for the
moment the cases in which cancer seems due to developmental error――and
who can say whether even then a child does not suffer vicariously
for some physiological transgression by its parents?――the doctrine
that cancer is due to irritation, whether produced by a clay pipe,
hot drinks, constipation, or crude paraffin, does not really tell us
much more than _that_. The difficulty is this: _How_ to walk in the
way of physiological righteousness, and _how_ to preach it, without
falling into a dogmatism as stupid as unbelief? Mr Wright tells us
how, in medieval times, the Church declared cancer of the tongue to be
sometimes a judgment on sinners for their blasphemy. Well, I for one,
am not prepared to limit the “misuse” that entails physical disease
and suffering to misuse in the material, or physiological sense.
Organs, through the nerves of the “sympathetic”, are directly connected
with the play of emotions and of feeling-states. I am not sure that
investigation would not shew a correlation――sometimes――between certain
persistent and voluntary mental states (_morbid_ mental states, that
is) and the development of cancer in certain organs. The “argument”
that cancer is infrequent in lunatic asylums, where the majority are
mindless rather than wrongly thoughtful, evades the question.
The quest for a single causal factor, whose “discovery” will lead us to
“abolish cancer”, is then, it would seem, just one more hunt for the
philosopher’s stone. Yet, to use the formula of “right living” does not
seem to be merely a verbal solution of the difficulty.
If we agree that to live rightly is the best insurance we can make
against cancer, we are probably stating, as compendiously as possible,
_all_ we do and shall ever know, in respect of the causation of cancer.
It is then our duty to ascertain how to live rightly in every sense
of the word, and we may so come to realise that almost every one of
what we call the blessings of civilisation has been purchased at the
expense, in some respect, of right living. For this, heavy interest
has to be paid, and even the efforts of science to put matters right
seem too often not more than the borrowing of fresh capital to pay
off old debts. It is right to call attention to the fact that certain
“uncivilised” races, who live healthily and naturally in respect of
food, drink, and sexual activity, do not suffer from cancer. But it is
wrong to suggest that therefore we should adopt either their dietetic
or their sexual customs. What is one man’s meat is another man’s
poison. Adjustment to our surroundings, right living _here and now_ is
what we need. Though Papuans and Sikhs may be very properly adjusted in
_their_ contexts, it is not their adjustments that may best suit our
cases.
This problem――that of right living――is the problem of prevention of
cancer put upon the broadest basis. But, until or unless we work this
out, we have to consider how best to avail ourselves of the knowledge
already in our possession. Herein is one merit of Mr Wright’s plan. He
tells people what, in his judgment, they can best do, _here and now_.
It is a plan to be discussed; but, let it be clearly understood, it is
one submitted by the author for individual consideration and action.
Supposing it to be found, on analysis and trial, of real value, a cry
might at once be raised for its putting into execution by central or
local provision of the necessary facilities: at first for voluntary
acceptance, then for compulsory adoption. Nothing could be a greater
error. In matters of health what is advantageous for the individual is
often not so, or even grossly disadvantageous, for the State.
Let every member of the State have the opportunity to avail himself or
herself of what Science and Art can do for him: let none who has the
will suffer because he has not the means. But the too easy provision
of means for the avoidance of consequences of neglect does, very
seriously, put a premium on neglect and penalise those who themselves
make effort in the right direction. Again: hard on individuals
though it would seem, there is a very real racial advantage in the
elimination――natural and inevitable, unless we interfere――of those
who _will not_ take advantage of opportunities offered them. We are
not automata: we exercise _choice_; when the opportunity of choosing
rightly is offered us, if then we choose wrongly, we have no right to
demand escape from the consequences, _at the expense of others_.
At any rate, if the facts relating to Cancer are plainly stated,
every man has but himself to blame if he shrink from obtaining such
diagnosis and treatment, as is now available, at the earliest moment.
It were better still that he avoid from the beginning all what we know
to be predisposing causes of cancer: all the errors of omission and
commission in respect of the physiological and spiritual――or physical
and psychical――functions and relations of his Self.
It is the principle, the pursuit of the unattainable ideal, that really
counts. The simple injunction to eat greens and take paraffin is the
physiological counterpart of seeking to make people moral by act of
Parliament, religious by church-going, and intelligent by attendance at
evening lectures. But even if we make all possible effort, we cannot
_all_ hope to escape, and the necessity for seeking early diagnosis
when things go not well is as imperative as is true the maxim that “A
stitch in time saves nine”.
There is perhaps one more question that may be touched upon: that of
the so-called _increase_ of cancer. It is commonly stated that cancer
is increasing: it is as commonly asked if this is really so. As a
matter of fact, the question (which we are usually told can be only
answered by statisticians) is one that statisticians can only answer
when we have agreed what they are to understand by it. And that is not
so easy as may be at first thought.
It is certainly true that, in the British Isles, the number of
deaths certified each year as due to cancer of one form or another
is gradually and steadily increasing, both absolutely and relatively
to the population. But then we have in the first place, to consider
whether cancer is not diagnosed more frequently in ratio to the cases
seen than was formerly the case, and, in the second, to remember that
cancer is, on the whole, a disease suffered during the second half of
life. Now, our population is an older one than it was: the birth-rate
is falling: so many youths who would now be vigorous men of thirty-five
to forty lost their lives in the war; and lives are, on the whole,
longer than they were, owing to a diminishing liability to suffer from
certain ailments other than Cancer.
Supposing that children ceased to be born, at the same time that the
Ministry of Health succeeded in “abolishing” all diseases except
cancer, and the Home Office and Police reduced the probability of death
from accident, from homicide, and from suicide, to vanishing point.
Would we not then all die from either “old age” or from “cancer”? If
so; should we be justified in declaring that cancer had “enormously
increased” since the successful institution of control of our own
deaths and other peoples’ births?
We are, indeed, again confronted with the old problem of the one and
the many, under one of its numberless aspects. From the point of view
of the statistical bureaucrat, cancer is increasing. That is to say, an
increasing number of deaths, and an increasing proportion of deaths,
are every year presented to him, both absolutely and in relation to
the population. And so many more perforated cards are in consequence
manipulated by his counting machine.
Can it be said that, for any one reader of these pages, the chances of
death from cancer are year by year increasing, as are the chances of
being run over in the London streets? Who can say?
But this is true. We must all die. We are, for the most part, anxious
to postpone the day of death, and many of us dread, more than aught
else, a death from cancer.
Effort in the path of right living――if steadily pursued――and the
intelligent utilization of what Science and Art and Experience have
to teach, will undoubtedly make for healthier and longer lived
communities, and will lessen, _for each individual_, the probability
of dying otherwise than in the fashion thought of by the doctor when
he ascribes death to “old age”. The problem we are considering becomes
indeed swallowed up by a still greater one; but, those who profit by
what Mr Wright has had to say about Cancer, will profit in respect of
this greater problem as well. Therein, so it seems, lies its greatest
value.