RESEARCH WITHOUT VIVISECTION
No phase of modern science so closely touches the welfare of humanity
as the studies which concern the prevention of disease. Up to a very
recent period, well within the lifetime of many now living,
practically the entire energy of the medical profession was given up
to the treatment of human ailments, with an almost complete disregard
of problems of prevention or studies of origin. To-day, in great
measure, all this has been changed, and the importance of preventing
disease has come well to the front. It is permissible to doubt
whether the "cure" of any of the principal infectious diseases is
likely to be so thoroughly accomplished as to eliminate it as a cause
of mortality, and we may regard with greater promise attempts to
discover the mysterious causes of our diseases, and the best methods
by which their spread may be prevented. It is certainly a great gain
that during the last hundred years mankind has learned that
deliverance must come through human activity, and has ceased to regard
typhoid or consumption as a dispensation of Providence.
For the conquest of some of the principal maladies affecting the human
race at the present time I have long questioned whether the laboratory
for experimentation upon animals offers the opportunity for the surest
results. The average man has his attention fixed upon mysterious
researches which are being carried on in this or that "Institute";
rumours of impending discoveries and almost certain cures are
published far and wide; and gradually one gets the impression that
notwithstanding abundant disappointments, it is only by yet more
vivisection that the mystery will be solved. Is this a valid
conclusion? In many cases, might not scientific research have a better
chance to discover the secret of origin were it directed into other
channels? I propose to suggest one method of scientific research with
which vivisection is in no way concerned--an investigation into the
cause of one of the most terrible and most threatening of human
maladies--cancer, or malignant disease.
The subject is a vast one. Within the limits of a few pages it cannot
be treated with any approach to the completeness which its importance
demands. The utmost that can now be attempted is the suggestion of
certain lines of research independent of animal experimentation,
which, if carried out with completeness, might lead to results of
incalculable benefit to humankind.
Outside the medical profession there are few who have the faintest
realization of the facts pertaining to malignant disease. One reason
for such ignorance is the lack of any organized system, in the United
States, for recording the annual mortality. Except among barbarous or
semi-civilized people, no such condition exists. When, during the
autumn of 1912, Dr. Bashford, the Director of the Imperial Cancer
Research Fund of England, was invited to lecture in New York, he
confessed that he had tried in vain to obtain American statistics
concerning cancer which might be compared to those of other nations;
they simply did not exist. There are a few states and a few cities
for which mortality records exist, but in some of the principle states
of America there is no official record showing even the total number
of deaths from murder, from accident, or disease. Once in ten years
the Federal Government resents us the mortality report of the census
year, but even here the information is not available until a
considerable period after it is collated. There is, however, one
nation whose official registers for many years have recorded the
mortality from each cause of disease, for either sex, and for each
ten-year period of life. These records have no equal elsewhere, and
are only approached by the mortality records of the Empire of Japan.
The figures concerning cancer upon which we may chiefly depend are
those which pertain to the English people. There can be no doubts but
that the mortality from cancer in America exhibits the same phenomena,
though the rate may be higher.
The first thing to impress the student is the immensity of the tribute
of mortality exacted by this disease, from those in the maturity of
life, and in large measure at the period of greatest usefulness.
During thirty years, from 1881 to 1910 inclusive, there perished in
England and Wales from cancer no less than 703,239 lives. Figures
like these, for the average intelligence, are practically
incomprehensible; for this thirty-year tribute to malignant disease in
a signle country represents more human being than all estimated to
have perished on the battlefields of Europe for two hundred years.
And if we were able to add the mortality from this one disease on the
Continent of Europe, it might represent a total of several millions.
Another significant circumstance is the uniformity of the tribute
exacted by cancer, year after year. We can see that best by taking
the actual number of deaths from this cause, in a single country, and
observing with what slow, implacable, and ever-increasing steps the
great destroyer advances.
DEATHS FROM CANCER IN ENGLAND AND WALES
-----------------------------------------------
| Year. | Males | Females |
|--------------------------|--------|---------|
| 1905 .. .. .. | 12,470 | 17,761 |
| 1906 .. .. .. | 13,257 | 18,411 |
| 1907 .. .. .. | 13,199 | 18,546 |
| 1908 .. .. .. | 13,901 | 18,816 |
| 1909 .. .. .. | 14,263 | 19,790 |
| 1910 .. .. .. | 14,843 | 19,764 |
| 1911 .. .. .. | 15,589 | 20,313 |
| 1912 .. .. .. | 16,188 | 21,135 |
| | | |
-----------------------------------------------
The terrible thing about these figures is their uniformity from year
to year. With as great a degree of certainty as the farmer foretells
the produce of his fields and the results of his seed-sowing, so the
statistician can calculate the tribute that cancer will exact from the
human race in future years. How many persons in England and Wales
will die from some from of cancer during the year 1917? Unless some
great catastrophe shall vastly lessen the total population, the number
of victims destined to perish from malignant disease during that one
year will hardly be less than 38,500, and in all probability will be
more. And we have no reason to doubt that in the United States the
mortality from cancer would be found equally uniform were it possible
to know the facts.
Nor does uniformity pertain to numbers of either sex only. Each
period of life has to furnish its special toll. If we look at the
mortality among men or women for a period of years, we shall see this
phenomenon very clearly. In the following table we see the deaths of
men from cancer, in England, at each ten-year age-period.
DEATHS FROM CANCER AT DIFFERENT AGE-PERIODS (ENGLAND):
AGE-PERIODS OF MALES
--------------------------------------------------------------
|YEAR|Under|25-35.|35-45.|45-55.|55-65.|65-75.| Above |Total.|
| | 25. | | | | | | 75. | |
|----|-----|------|------|------|------|------|-------|------|
|1906| 250 | 322 | 927 | 2,454| 4,087| 3,651| 1,566 |13,257|
|1907| 305 | 277 | 921 | 2,392| 4,041| 3,675| 1,588 |13,199|
|1908| 274 | 317 | 925 | 2,594| 4,147| 3,957| 1,687 |13,901|
|1909| 262 | 296 | 921 | 2,581| 4,319| 4,174| 1,710 |14,263|
|1910| 283 | 337 |1,001 | 2,778| 4,377| 4,315| 1,752 |14,843|
|1911| 309 | 317 | 978 | 2,901| 4,627| 4,602| 1,855 |15,589|
--------------------------------------------------------------
Precisely the same phenomenon is to be found in the cancer-mortality
of women. Each ten-year period of life exacts its own proportion,
with an increasing death-rate out of proportion to the increase of
population.
Another fact, attainable only by the study of English statistics, is
the singular regularity with which malignant disease selects different
parts of the body year after year. If proclivity to this mysterious
ailment were a matter of chance, or dependent upon the irregular
action of certain forces, we should certainly fail to find such
uniformity, or such approach to uniformity, as exists. One year, for
instance, there would be, let us say, a preponderance of attacks upon
the skin; another year the digestive organs would be the principal
sufferers; a third year the joints and muscles would be chiefly
involved. The actual experience proves that we are subject here to
forces of incalculable stress, which nevertheless press steadily and
uniformly upon humanity, where the habits and environment are the
same. In the year 1901, for example, of the total number of fatal
cases among men, the seat of the disease was the stomach in a little
over 21 per cent. of the total number of cases. In 1910 the
proportion was also 21 per cent. During the ten years 1901-1910, of
the total mortality, the stomach was the organ involved in but a
fraction over 21 PER CENT. OF THE TOTAL CASES.
Is cancer increasing? This is a question of vast importance to the
human race. That in proportion to total population more die from the
disease to-day than twenty or thrity years ago, is a fact about which
there can be no doubt. Dr. Stevenson, in the Report of the Registrar-
General for the year 1910, tells us that in "all countries from which
returns have been received the mortality has shown a general tendency
to increase in recent years." Speaking on the "Menace of Cancer," the
statistician of the Prudential Insurance Company of America affirmed
that "the cancer death-rate in the United States is increasing at the
rate of 2.5 per cent. per annum, and a corresponding increase is
taking place practically throughout the civilized world." The cancer-
rate among men in the United States has increased, according to the
same authority, 29 per cent. during the last decade. The steady
increase of cancer year after year is strikingly shown by a curve
diagram, based upon the English mortality for several years.
A significant illustration of the steady increase in the mortality
from cancer is shown by its fatality among women in England between
the ages of forty-five and sixty-five. In the year 1875, of all
deaths of women at this period of life, one in ten (in round numbers)
was due to some form of malignant disease. In 1890 the tribute
exacted by the disease had become one in eight. Ten years later--in
1900--of all women dying in England during this period of middle life,
the toll of cancer was one in seven; and in 1910 the corresponding
proportion was one in five! At this rate of increase it will not be
many years before a full third of all the deaths of women at this time
of life will be due to malignant disease. There can be little doubt
that the same phenomenon would be found to pertain to American
experience, were it possible to disentangle the facts from the
obscurity in which they are now permitted to lie. It is a curious
fact that in England until the year 1900--and, so far as we know, for
thousands of years--the death-rate from consumption among women was
considerably higher than that of malignant disease; that in 1903, for
the first time, the cancer-mortality of women exceeded that of
phthisis; and that in 1910 it had so far surpassed it that they are
not likely ever again to be equal, unless we shall discover the cause
of the more fatal plague.
The theory has been put forth by certain writers that the increased
death-rate from cancer is due, not to any increased frequency of the
dissease, but rather to improved methods of detection. It is quite
certain that fifty years ago, for instance, surgeons were less able
and less willing to pronounce judgment regarding obscure cases of
internal tumours. But if the better diagnosis of to-day accounts for
some part of this increase since 1860, it does not seem probable that
it can explain the rising death-rate of the last ten or fifteen
years. The medical practitioner of 1900 was certainly as well
qualified to pronounce upon the character of the disease as the
surgeon or physician of to-day. Nevertheless, the cancer death-rate
of England in 1910 had increased 16 per cent. above that of ten years
before, and during the fifteen years 1895-1900 it had increased fully
28 per cent. Certainly in these last few years there has been no such
increased ability to detect the disease as would account for all
this. Yet another fact suggests doubt of this optimistic hypothesis.
If the increased cancer death-rate were due merely to the increased
ability of the physician or surgeon to recognize the ailment, we
should certainly find that the increase of cancer would be seen only
in those parts of the system, such as internal organs, where some
degree of doubt might perhaps be entertained; while, on the other
hand, there would be little or no increase discernible in the
mortality of cancers affecting parts of the body where its nature
could not be mistaken by any intelligent physician or surgeon. Now,
for a number of years, perhaps with this hypothesis in view, the
Registrar-General in England has tabulated all deaths from cancer of
either sex, not only by different age-periods, but also by the part of
the body affected by the fatal disease. A study of the facts thus
made known is extremely suggestive. It is true that a marked increase
in the death-rate has occurred in cancer affecting internal organs, as
we should naturally suppose; but it is also true that malignant
disease affecting parts of the body where little or no doubt of the
character of the ailment could be entertained by the physician,
exhibit in some instances as marked an increase in the death-rate as
in some other cases, where doubt of malignancy might be justifiable.
For example, cancer of the tongue among men showed a death-rate of 32
per million population in 1897; it went up to 47 per million in 1910--
an increase of nearly 50 per cent. Cancer of the female breast showed
a death-rate of about 142 per million population in 1897; it had
arisen to a rate of 190 per million only thirteen years later; and
here, assuredly, the nature of the disease in fatal cases cannot be
mistaken.[1] Cancer of the stomach in its final stages does not
present insuperable difficulties in way of diagnosis, but the
death-rate increased for men about 40 per cent. in fifteen years; and
although some of this increase may be due to more careful
discrimination between cases of malignant disease affecting the liver,
yet this explanation cannot account for the increase when both organs
are considered together. The subject is worthy of careful and
extended investigation, but even a cursory examination of the facts
now available indicate a real increase in the death-rate from cancer
in England, and probably in every other civilized country in the
world.
[1] "During fourteen years ... the mortality from mammary cancer has
increased by about 29 per cent., NOTWITHSTANDING LIVES SAVED BY
IMPROVED METHODS OF OPERATION."--Registrar-General's Report for 1910,
p. 69.
But all these phenomena are of secondary importance compared with the
great problem of medical science--the yet undiscovered cause of
malignant disease. During recent years the study of cancer has been
conducted with scientific enthusiasm in many laboratories. Vast sums
of money have been given, in the hope that these studies may one day
lead to the discovery of a cure. One whom I knew in his youth became
the heir of great wealth; lived to see one whom he loved perish from
the disease; was struck down himself, and dying, left a fortune for
the purpose of promoting research concerning cancer. And yet to-day
the problem, as attacked in the various laboratories of Europe and
America, is apparently as far from solution as it was forty years
ago. Sir Henry Butlin, ex-President of the Royal College of Surgeons,
England, is said to have operated on as many cases of cancer as any
surgeon of his day. Yet, speaking in October, 1911, he said:
"I have been associated with the Imperial Cancer Research and in touch
with its staff from the foundation of the Research, and have been a
member of the publication committee of all its scientific reports. IT
HAS DONE NOTHING ON THE LINES IN WHICH OBSERVATION HAS BEEN SO
USEFUL. It has not unfolded the life-history of a single variety of
cancer, so that we can base our operations on the information. It has
not even discovered whether spontaneous cancer of a particular part of
the body in the rat or mouse runs a similar course to spontaneous
cancer of the same part of the body in the human subject. These
problems are not suited for experimental investigation; they are
determined by observation."[1]
[1] Lancet, London, October 7, 1911.
No "serum," no drug, no curative agency of any kind, has thus far been
discovered upon which the slightest dependence may be placed. The
only measure of relieve which medical science can now suggest is early
and complete extirpation. Of what proportion of cases even this
insures immunity we cannot tell.
Without decrying what has been done in the laboratory, may it not be
that we have gone in that direction as far as there is any hope for
success, and that all effort should now be directed TO THE DISCOVERY
OF THE CAUSE OF MALIGNANT DISEASE IN HUMAN BEINGS? That great secret
still eludes us, but until we can penetrate that mystery, it is
difficult to perceive how we may hope to prevent the increasing
prevalence of the great destroyer . Yet there is one method of
investigation which (speaking from a study of cancer statistics for
more than twenty-five years) seems to me to offer, more than all
others, a reasonable hope of ultimate success. It is independent of
all sacrifice of animal life. It involves, however, an expenditure
far greater than is possible for any private investigator, and
probably only by the co-operation of the Government can it be
undertaken with any chance of success. Yet, if Society can once be
aroused to a recognition of the need for the completest possible
investigation concerning malignant disease, and particularly the
reasons for its differing prevalence among people of different
nationalities, habits, and general environment, that inquiry will take
place, even though it cost the price of a battleship.
The subject is so vast and involved that it cannot be discussed with
any approach to completeness in a single essay. Suppose, however,
that we glance at the theory which regards cancer as due to a microbe
which in some mysterious ways gains admission into the human body,
lying for a time dormant, but liable under appropriate stimulation to
be awakened into malignant activity. We know at the outset that if
any such germ of disease exists, it has thus far escaped visual
recognition. No human eye can be said with certainty to have seen it,
even when aided by the most powerful microscope; but this may be due
to the fact that, like the germ of certain other diseases, it is so
minute that it lies beyond the range of human vision. There are,
however, certain facts pertaining to the disease which have
significance. We have already seen that in a given country there is a
kind of uniformity in the number of those dying from the disease from
year to year; but another phenomenon relates to the unequal pressure
in difference countries of the causes of the disease.
1. THE DEATH-RATE FROM CANCER APPEARS GREATLY TO VARY ACCORDING TO
RACE AND ENVIRONMENT.
CANCER DEATH-RATE IN DIFFERENT COUNTRIES PER 100,000 POPULATION
---------------------------------------------------------------
| Five-Year Periods. | Switzerland. | England. | Italy. |
|--------------------------|--------------|----------|--------|
| 1886-1890 .. .. | 114 | 63 | 43 |
| 1891-1895 .. .. | 122 | 71 | 44 |
| 1896-1900 .. .. | 127 | 80 | 51 |
| 1901-1905 .. .. | 128 | 87 | 55 |
---------------------------------------------------------------
Here is the record of a period of twenty years. These differences of
proclivity to cancer are exceedingly curious. Can the reader perceive
why they exist?
The rate in England is quite 50 per cent. higher than that of Italy.
If we explain this by the hypothesis of greater skill in detecting the
disease, what are we to say of the cancer-rate in Switzerland, which
is 50 per cent. higher than that of England?
But here is another curious fact. The United States census of 1900
permits a contrast of the mortality of cancer according to the
birthplaces of mothers of those attacked. Here, for instance, is the
death-rate from cancer and tumour of persons of different nationality,
calculated in three sections of the country--the rural districts of
the registration area, the cities of the same section, and the cities
outside the registration area.
DEATH-RATES IN THE UNITED STATES FROM CANCER AND TUMOUR PER 100,000
WHITE POPULATION, ACCORDING TO THE BIRTHPLACE OF THE MOTHERS OF
PATIENTS
---------------------------------------------------------------
| | | |
| | Registration Area. | Other |
| COUNTRIES. |----------------------| Cities. |
| | Rural | Cities. | |
| | Districts. | | |
|--------------------------|------------|---------|-----------|
| Italy .. .. .. | 20 | 24 | 39 |
| Russia and Poland .. | 26 | 30 | 26 |
| England and Wales .. | 79 | 77 | 80 |
| Ireland .. .. | 90 | 82 | 86 |
---------------------------------------------------------------
How are these facts to be explained? What is there about the habits,
the environment, the dietetic peculiarities of the Italians in
America, which tends to confer upon them a greater immunity from
cancer than is possessed by those whose maternal ancestry goes to
England or Ireland? Assuredly this immunity is not due to chance. It
is governed by some law, even though that law be unrecognized to-day.
If the low cancer mortality of Italy made itself manifest only in that
country, we might suspect it indicated a lack of skilled diagnosis;
but here we find it just as prominent in three different section of
the United States. Not only that, but the difference is seen in
comparison of parts affected by cancer. For persons whose mothers
were born in Ireland the death-rate in cancer of the stomach per
million population was 184; the corresponding rate for Italians was
56.
Does the poverty of the people have anything to do with proclivity to
cancer? In one way this is a probability. If we could compare the
general prosperity of men and women whose parents were born in the
United States with the entire population of which the parents were
born in other countries, it seems to me that we should find the second
class, taken as a whole, to be financially less prosperous than the
first. Now, in 1900, the census reveals that in the United States the
class to suffer chiefly from malignant diseasewas that which included
THE FOREIGN-BORN POPULATION, alike in cities, in rural districts,
within or without the registration area. This is certainly a fact of
tremendous import. In America the population is a blend of every
European nationality. Why, taken as a whole, should the native
American suffer from one mysterious disease less than some of those
who have come more recently to the United States?
In another work I have ventured to suggest that if we are to discover
the cause of cancer, we must study the habits and customs of those
still living who have become the victims of some form of this
mysterious disease. A theory held by some is that cancer is due to
the consumption of meat. If one means that the flesh of perfectly
healthy animals is liable to cause cancer, the hypothesis is one for
which it seems to me that the evidence is far from being sufficient to
justify belief. But if, on the other hand, it is suggested that
malignant disease may be due to germs derived from animals which were
suffering from som form of cancer when they were killed for the food
of human beings, then much that is otherwise obscure becomes plain.
We should expect in such cases to find cancer more prevalent among the
poor than among the rich, and especially prevalent among those who,
from carelessness, or ignorance, or seeming necessity, consume the
cheaper kinds of meat. And since, both in their native land and in
America, the Italian population consumes less meat than peoples of
other nationalities, we should expect them to be less liable to be
infected by the germs of malignant disease.
A few years ago a medical writer who has given much attention to this
disease published some of his investigations into the cancer
death-rate of Chicago. Taking the figures for a single year, he
discovered that the "cancer death-rate among the Irish and German
residents of Chicago is the highest in the world, being nearly 300 per
cent. higher than in their native countries."[1] Of each 10,000
population of each nationality living at the age of forty years and
over, he found that the deaths from cancer among the Germans was 76,
among the Irish 70, among the Scandinavians 52, and among the natives
of Italy 24. It was found that, while the staple diet of Italians in
Chicago was macaroni and spaghetti, the people of other nationalities
among whom the cancer-rate was exceedingly high, "consume large
quantities of canned and preserved meats and sausages, OFTEN EATEN
UNCOOKED." He discovered that a large part of the fresh meat prepared
at the establishment of a certain slaughtering establishment in
Chicago was derived from animals which had been condemned on the ante-
mortem inspection, but the flesh of which was perimitted TO BE SOLD AS
PURE FOOD AFTER THE DISEASED PARTS HAD BEEN REMOVED. Sold thus at a
cheaper price, such meat was chiefly consumed by the poorer classes of
the foreign population. And while Dr. Adams does not adopt the
hypothesis of the cancer-germ, he does not think there can be "the
slightest question but that the increase in cancer among the foreign-
born over the prevalence of that disease in their native countries is
due to the increased consumption of animal foods, PARTICULARLY THOSE
DERIVED FROM DISEASED ANIMALS."
[1] See article by Dr. G. Cooke Adams in Chicago Clinic of August,
1907, pp. 248-251.
A statement like this is calculated to induce serious reflections.
The average reader finds it difficult to believe that, according to
the present interpretation of the law, the flesh of animals found to
be suffering from cancer at the time of their slaughter would be
permitted to pass into the world's food-supply. We are int the
presence of a great mystery. We do not know how the gret plague
originates. But no reflecting man or woman can be insensible to the
significance of possibilities when he learns that cancer affects
animals which are killed for food; that in the majority of cases the
disease affects some part of the digestive tract; that it chiefly
prevails among the very poorest classes of the population, excepting
only those like Italians, who use but little meat; and that, according
to the official regulations of the United States Government in force
to-day, THE FLESH DERIVED FROM CANCEROUS ANIMALS NEED NOT ALWAYS BE
DESTROYED AS UNFIT FOR HUMAN CONSUMPTION. The cancerous tumour, the
affected parts, must indeed be cut away, and carefully condemned. The
disposition of the remainder of the meat is left to the decision of
the inspector!
The regulation so far as it applies to meat of this kind, is as
follows:
"ANY ORGAN OR PART of a carcass, which is badly bruised, or which is
affected by tumours, MALIGNANT or benign, ... shall be condemned; but
when the lesions are so extensive as to affect the whole carcass, the
whole carcass shall be condemned."[1]
[1] Regulations governing Meat Inspection, U.S.A. Regulation No. 13,
section 23. See also Appendix VIII., p. 362.
The meaning of this regulation would seem to be perfectly clear.
There is no demand by the Government that the entire carcass of an
animal affected by malignant disease shall be utterly destroyed for
food purposes, unless the disease has involved the entire body,--a
condition as rarely found among domesetic animals, as among human
beings. Otherwise than this, what is there in the official
regulations of the bureau governing meat inspection to prevent such
use of the flesh of diseased animals as the inspector may authorize?
It seems to me that if science is ever to discover the cause of
malignant disease, there should be a careful study of all the
conditions under which the disease now manifests itself. The
mortality from cancer in the state of New York, in 1912, amounted to
8,234; in England, the number of those who perished from the disease
in 1911 was nearly 36,000. By what figure must we multiply this
mortality in order to ascertain the number of persons living who have
been affected, or who now are suffering from cancer? Nobody knows.
What has been the success of surgery in securing immunity from a
recurrence of the disease? So far as the entire country is concerned,
we are entirely ignorant. Is it true that among the class of people
in such cities as Chicago, where cancerous animals are used for food,
cancer is especially prevalent year after year? If true, it should be
fully known. Such facts must be ascertained, if ever we are to
penetrate the secret of the dissease. Even the number of victims of
each sex is not given in the mortality reports of the state of New
York at the present day.
Let us suppose that the time comes, when with a realization of peril
pertaining to ignorance, public sentiment shall urge the attainment of
knowledge concerning cancer as it now affects the general population.
In what way is information of this character to be secured? Assuredly
not by any of the ordinary census methods, implying publicity. The
only practicable enumeration would be one conducted privately, by
members of the medical profession. Nor can it be done
parsimoniously. In the state of New York, there may be, to-day,
50,000 cases of malignant disease. To have every case, completely
reported, might cost the state half a million dollars. Perhaps even
the patient should be compensated. Certainly some method could be
adopted whereby the reports should be absolutely confidential, the
patient being known only by a number. But all this is of minor
consequence. When the necessity of the inquiry is everywhere
recognized, the details pertaining to accomplishment will be easily
arranged.
Assuming the willingness of patients and friends to assist in making a
State-wide inquiry concerning the prevalence of malignant disease, let
us see in what directions the investigation will be conducted.
FIRST. After securing the name, age, and place of birth of each
individual sufferer, and the particulars which would suggest
themselves to every physician or surgeon, inquiry should be made
concerning the parents; the names, nationality, religious faith, place
and date and cause of death. Especially should inquiry be made
whether there have been other cases of cancer in the family, and their
termination or present state.
SECOND. What is the location of the suspected ailment? When were the
first symptoms manifested? To what cause, if any, were they ascribed?
Has any surgical operation been performed, and if so, what are the
details of time and place? Has recurrence followed operation? For what
period was there freedom from symptoms?
Whatis the social position of the patient? Does he belong to that
class which is enabled always to select the best food, the most
sanitary dwellings, and all the conveniences of well-ordered and
comfortable existence; or, on the other hand, to the extremely poor
class, which disregards cleanliness, indulges to excess in the use of
stimulants, and consumes the poorest and cheapest kinds of meat? I
deem it of great importance that the completest possible information
be secured concerning the usual diet of every sufferer from this
disease. Is he a vegetarian? Are viands invariably well-cooked, or
eaten sometimes rare or raw? Is there a liking for the canned products
of the packing-house, or for sausage that comes from the same
source?[1] What is the water-supply? Within the knowledge of the
patient or friends, has there been any other case of malignant disease
in the same house? Is residence near any fresh-water lake or stream?
[1] The relation between diseased meat and human ailments is treated
at length in my work on "American Meat," New York, 1909.
These are suggestions only. They constitute merely an outline of the
information that is necessary, concerning the living sufferers, in
whom the disease has made its appearance. Doubtless the average
reader will discern no reason for all these inquiiries. Yet each one
has some pertinency to the possible discovery of the great secret.
Does inquiry concerning family history seem useless? It should have a
decided bearing on any theory of heredity. Does the occurrence of
near-by cases have no significance? We are not yet in a position to
state this as a fact. Does inquiry concerning religion seem
especially impertinent? What if some future investigation should prove
that cancer everywhere, is more prevalent among the Christians than
the Jews? Does the social condition of the sufferer seem to have no
relation to cause? What if we discover, that everywhere,--and not
among the foreign population of Chicago only,--cancer finds an undue
proportion of its victims among the poorest and most poverty-stricken
element of every nationality? Does suggestion of inquiry concerning
diet induce a smile? It should not, as long as meat derived from
cancerous animals is permitted by Government authority, to pass
inspection, and to be distributed throughout the world. And no
inquiry concerning cancer can be deemed complete which has not fully
investigated the extent to which this atrocious practice has been
carried on for the past quarter of a century.
But this State-wide inquiry is only a part of the work. Every year,
for a period of at least ten years, the record must be revised, the
result of surgical operations recorded, the deaths enumerated, the new
cases added. The expense of each annual revision would be far less
than that of the original inquiry; but the inquiry will be costly, and
should be costly, if it is to be accurate and complete. Here, indeed,
would be the opportunity for the co-operation of organizations devoted
to "cancer research," and particularly of that new foundation, the
income of which for a single year is far more than the original
investigation would cost.
And when the inquiry is completed; when all attainable information
concerning the occurrence of malignant disease shall have been secured
not for a single year, but for a period of successive years, not for
one community, but for an entire state, and for each of its
constitutuent parts, what then? Then I believe a knowledge of the
cause of cancer will soon be attained. When we know the cause, then
there will be hope for prevention, which is far better than cure. All
the various experiments upon mice, for example, whatever they may
teach concerning the disease in the lower animals, have not
enlightened us concerning the cause of the malady in mankind. The
greatest and most promising fields for scientific research, now almost
untrodden, awaits the explorers of the future. In a world where now
there is comparative unconcern, there may soon be fearful
apprehensions of the increasing prevalence of an almost irremediable
disease. Within the coming century, the investigation I have here
outlined, will sometime be made; and, as a result, the cause of cancer
may be as well known to medical science, as the causes of typhoid
fever or malaria,--mysteries that seemed insoluble less than a century
ago. And I venture with assurance to predict, that some time within
the next fifty years, the Governments of England and of the United
States, alarmed, it may be, by a continually increasing mortality from
cancer, will condemn under severest penalties, the sale for human food
of meat deriveed from animals affected by malignant disease,--no
matter how great may be the pecuniary loss to every slaughtering
establishment and packing-house in either land. The public awakening
to danger that must precede legislation cannot yet be discerned; and
before the national apprehension is aroused and apathy ceases,
probably more than a million lives will be sacrificed to cancer, in
England and America alone.
------------------------------
Note.--"The deaths ascribed to cancer or malignant disease in England
and Wales during 1912, numbered 37,323. The mortality of males was
913 per million living, as compared with 891 in 1911, and that of
females, 1,117, as compared with 1,098. IN THE CASE OF EACH SEX,
THESE RATES ARE THE HIGHEST ON RECORD."--From 75th Report of
Registrar-General, 1914, p. lxxxiii.