Part 1

Produced by Richard Tonsing, Turgut Dincer and the Online Distributed Proofreading Team at http://www.pgdp.net (This file was produced from images generously made available by The Internet Archive)

CANCER ITS CAUSE AND TREATMENT

BY L. DUNCAN BULKLEY, A.M., M.D.

Senior Physician The New York Skin and Cancer Hospital, etc.

NEW YORK PAUL B. HOEBER 1915

Copyright, 1915 BY PAUL B. HOEBER

_Published, February, 1915_

Printed in U. S. A.

To

THE GOVERNORS

of the

NEW YORK SKIN AND CANCER HOSPITAL

whose kind appreciation of and assistance to the author in his clinical work in their institution have done much to encourage him and to promote the interest of the profession in the branch of

DERMATOLOGY

this little book is inscribed

PREFACE

Cancer has hitherto been regarded almost wholly from its histological and surgical aspects. The investigators and practitioners along these lines have been innumerable, the work done prodigious, and the literature relating thereto enormous. But relatively little attention has been paid to the medical aspects of this most threatening malady, although voices have been raised from time to time, with more or less force, all joining in the same plea that the basic cause of the disease lies in some derangement in the vital forces of the organism, as influenced largely by diet and mode of life.

It has, therefore, seemed to the writer that it was time to stop and look at cancer from a broader aspect, and by synthesis and deduction to seek to understand some of the underlying causes of malignant disease; also to see if some general principles could not be ascertained upon which could be based an explanation of the views he had long held, and of the practice which he had long followed in regard to the prevention and cure of this dire malady. And as his studies progressed he was more and more satisfied that the true solution of the cancer problem lay along the lines indicated, although there was still very much to be learned regarding the details and application of the principles involved.

The lectures were prepared for and delivered to practicing physicians at the New York Skin and Cancer Hospital, in connection with the regular Wednesday lectures on Diseases of the Skin, as I felt that I should give them the benefit of what I felt to be of value in my own practice, private and public.

Although holding the views here expressed for many years I have hesitated writing strongly on the subject before, lest I should be misunderstood or misjudged: for favorable results based solely on a clinical diagnosis of cancer are always doubted. I have also feared lest by advocating a dietetic and medical consideration and treatment of cancer, which possibly might not be carried out exactly, I might really do harm; since some might be led to neglect operative measures in proper cases, at the proper time; and so in certain instances great injury and injustice might be done to the patient, and the time pass in which a surgical operation might possibly be of service.

But with my views and experience, strengthened greatly by what studies I have been able to make in the midst of a busy professional life, I now feel that I should do wrong in not presenting the results and conclusions of my study and observation. And I wish also to enter my strong protest against the course which is usually followed in regard to cancer, both before and after operation. With a rather extended experience during the last forty years, I have rarely if ever found a patient with cancer who has received adequate and continuous medical care before operation, with a view of discovering and rectifying the cause of the morbid growth. Too often when a cancer is suspected or discovered it is taken as a foregone conclusion that the malady is hopeless, except as the _results of the disease_, that is the new growth, may be removed by the knife, X-ray, radium, caustics, etc. And after a surgical operation, as far as my observation goes, the patients are invariably left entirely to their own resources, with the hope, alas, too often futile, that the tumor will not regrow, but with no attempt to so guide the life that there shall not be the same tendency to a recurrent malignant new-formation. Against this latter course I also raise my earnest protest.

In presenting matter from literature bearing on the subject under discussion I am well aware that I have hardly more than touched the surface of the deep ocean of recorded observations on cancer, but it was the best that I could do in my busy life. I only hope that others will take up in earnest the subjects here presented, and that this pioneer work may lead to the building of a strong and permanent structure regarding the true basic cause of cancer. Truth never fears proof.

In studying the subject I have been greatly assisted by the masterful work of Roger Williams, so often referred to and quoted from; and I feel that a candid and careful perusal of that book will be a revelation to many. I know that some have endeavored to throw discredit upon some of the deductions which he makes from various statistics, but in the main they all teach a valuable lesson and are worth serious consideration, as they are taken from reliable sources.

Realizing fully that the problem of the cause and proper treatment of cancer is a most profound one, which master minds have long wrestled with and which cannot be fully settled without much further study, these lectures are presented to the profession at large in the hope that they may be the means of helping some one threatened with or suffering from malignant disease; and also that they may possibly stimulate others to investigate even more diligently along the lines of the medical aspects of cancer.

January, 1915. 531 Madison Avenue.

CONTENTS

PAGE

LECTURE I

NATURE OF CANCER 15

LECTURE II

FREQUENCY AND GEOGRAPHICAL DISTRIBUTION OF CANCER 43

LECTURE III

METABOLISM OF CANCER 70

LECTURE IV

RELATION OF DIET TO CANCER 106

LECTURE V

MEDICAL TREATMENT OF CANCER 135

LECTURE VI

CLINICAL CONSIDERATIONS AND CONCLUSIONS 170

BIBLIOGRAPHY 211

INDEX 221

CANCER ITS CAUSE AND TREATMENT

LECTURE I NATURE OF CANCER

It may be safely said that no disease which has afflicted mankind has received as much attention as Cancer, or concerning which there has been as much diligent search to find out its nature and cause. Tuberculosis, which seemed at one time to threaten even the existence of the race, has sunk into relative significance, as we have learned its true nature and conquered some of the causes of its ravages, and reduced its mortality very largely. Syphilis, under various names, forms, and aspects, was formerly much more of a menace than now, and in earlier years caused veritable epidemics, but is now well understood and controlled. Leprosy is less of a terror than in earlier times, since it has been definitely shown not to be contagious. Smallpox no longer rages, and yellow fever, and the plague, and hook worm disease have been hunted down by scientific study and the application of proper sanitary and medical measures. And so on in regard to many of the ills which afflict mankind.

But cancer has held its own and has even increased in frequency, with rapid strides and bounds in some localities, until now it looms large as a national[1] or even universal scourge; it has been estimated to cause the death of half a million persons yearly among the civilized people of the earth, and untold misery and suffering to many times this number. And all this is still going on in spite of the earnest, faithful, and intelligent labors of innumerable research workers, the sacrifice of countless animal lives, and the expenditure of vast sums of money; and the end, as far as relates to its prevention and cure, seems almost as far away as ever, for many surgeons, in past and present times, have acknowledged their inability to cope with the disease.

Much, however, has already been established by scientific research, and still more earnest thought, observation, and endeavor should be given to seeking most diligently for the cause of the disease, in the laboratory as well as in practice; for there must be some cause of cancer, and also some reason for its steady increase.

But it is never to be forgotten that, as Pope says, “the proper study of mankind is man,” and clinical observation, with laboratory research, on cancer as it appears in the human being, must be the ultimate base upon which all true advance in the knowledge of the nature, treatment, and prevention of the malady can ever rest. To effect this we must study the human being in all relations of life, must know the constitution and class of subjects in which the disease is most apt to manifest itself, understand the chemico-physiologic actions going on in the system, before and during the existence of the disease, and by a process of synthesis and deduction understand what is wrong and endeavor to correct it.

All this is indeed a great undertaking, and can only be accomplished by great effort on the part of many careful and skilled observers. But I want, in these lectures, to give you an outline of my own thought and study for many years, and, if possible, to let you see as I do the lines along which investigation should be directed. It is hoped, therefore, that this and the following lectures will throw some light on the connection of cancer with diet and mode of life, and some suggestions as to its prevention and cure.

_Parasitism_ has been excluded: for while at different times many observers have reported various organisms which were thought to be the cause of malignant growths, none of these have been definitely confirmed by others, in spite of earnest endeavor; and all experimental and clinical evidence is against a parasitic etiology of cancer. It is therefore seen how improper it is to speak any longer of “_the germ of cancer_,” for, as is now widely acknowledged, there is no such germ, it is an _ignis fatuus_ which has been chased in vain.

The _contagiousness_ of cancer has also been excluded, certainly in the sense in which this term is applied to other affections. For while in some animals inoculation experiments have resulted in the transmission of certain tumors, little has been determined except that such tumor material when transplanted can, in some unknown manner, multiply its cells indefinitely and form a focus of malignant disease, with disastrous effects on adjoining tissue. The same occurs in metastasis in cancer patients. But this does not at all explain the true basic nature of cancer, nor its development in those who have had no connection with other patients so afflicted. On the other hand the instances of suggested or supposed human transmission of cancer from one individual to another are so remarkably few, and so exceedingly doubtful, that a recent author, Janeway, states that “no well-authenticated cases of the transfer of a malignant tumor from one human being to another exist.” It has been found impossible to inoculate human cancer into rats, mice, and apes, nor can animal tumors be inoculated into animals of a different species.

_Heredity_ has been advanced as a cause, but statistics fail to verify this in any degree whatever. While certain instances have been brought forward in which heredity seemed evident, the study of large numbers of those afflicted with cancer, in connection with others free from the disease, has shown almost the same proportion of antecedents with cancer in both classes of persons; although some recent evidence seems to show that there is some tendency in different families for different organs. Experimental studies have, it is true, seemed to demonstrate that tumors occur apparently along hereditary lines in some animals in regard to certain organs; but in these instances it is to be remembered that the animals were kept in captivity, and all fed alike, conditions which have been found to cause the development of malignant disease in wild animals when confined in Zoölogical Gardens.

In former years _malaria_ was believed to have an influence in the production of cancer, and some investigators have thought to trace the prevalence of the disease to _telluric influences_, showing a preponderance of cases along certain water courses, or in certain streets or houses; but no definite proof of such connection has ever been established, and this theory is dismissed by the best authorities. _Syphilis_, in its latent effects, has also been claimed as an element in the causation of cancer, and undoubtedly the disease may develop, in suitable persons, upon old syphilitic lesions, especially about the mouth, anus, and genital region: but no one well informed in regard to cancer would regard syphilis as the real cause of the disease. All these and other etiological propositions are no longer considered to be tenable, and the very multiplicity of suggested causes shows that we are yet very far from the true etiology of cancer.

_Age_ undoubtedly has a powerful influence in the development of cancer, the vast majority of cases occurring after the age of forty or fifty. But, again, this does not at all explain the true nature of the disease, for only a certain proportion of elderly people are so afflicted, and malignant tumors have been observed in those of all ages, and even in young children. The degeneration of tissue belonging to advancing years undoubtedly renders it more susceptible to malignant disease, but this does not explain why one person is affected and not another, nor why the tissues in one locality or another take on this morbid action.

More recent scientific study has attempted to show that cancer originates from what are called “_embryonic rests_,” or pre-natal, wrongly placed, tissue elements, which at some time or other take on morbid action and develop into what we know as the various forms of cancer. Williams says, “From a biological standpoint tumor formation must be regarded as a phenomenon of the same order as reproduction in general: that is to say, as a special form of overgrowth of the individual.” But here again it is necessary to determine what causes them at certain times and in certain places to thus proliferate and form new tissue, which then becomes malignant and may proceed to destroy all contiguous tissues, and even to cause death.

_Traumatism_ has been claimed by many as the cause which determines the activity of the misplaced cells, and starts them on their disastrous or rampant course: the various percentages of the cases in which it was believed that traumatism started up the malignant process has varied greatly with different observers, even up to 50 per cent, or more. But it is far from proven that this is always the case, nor does local injury in any way explain the persistency with which malignant disease, when once started, pursues its destructive and even fatal career; nor can traumatism account for the great tendency to recurrence constantly observed, either in the former site or at some distant focus, through the agency of the lymphatic or vascular system. For of multitudinous traumatisms, even in cancer subjects, how few ever develop into malignant disease!

It would seem, therefore, that for the development of the local manifestation of cancer (the tumor or new growth) three elements are requisite, namely: 1. A predisposition or suitable blood condition. 2. A local stimulation or irritation of the part affected, _upon_, 3. The site of an “embryonic rest.”

On the basis of the embryonic theory surgeons have of late most earnestly advocated the very early and complete removal of malignant lesions, including those of suspected malignancy, and even also the removal of many innocent lesions which are observed occasionally to lead to cancerous formation; and unless a better plan can be determined this cannot be urged too strongly in proper cases.

But while early operation has improved surgical statistics, it has not contributed to our real knowledge of the basic cause of cancer, nor has it taught us why those lesions or “embryonic rests” will remain quiescent for years, or prove harmless in some individuals, while in others they become most formidable agents of destruction. For it is now recognized that these wrongly placed tissue elements are very common anatomical or histological accidents, indeed it is claimed that they occur and exist in every individual: and the removal of isolated “embryonic rests” which have developed into cancer, does not by any means prevent the transformation of other similarly misplaced cells into malignant disease, as the frequent recurrence of cancer after operation demonstrates.

The same is true of the many and various forms of treatment other than surgical excision, such as deep acting caustics, and even the X-ray and radium, which like surgery, only remove the focus of possible systemic infection, and do not affect the basic cause of the complaint: this latter is being shown more and more, by scientific investigation and observation, to be associated with metabolic or chemico-physiological changes in the system, and evidence is accumulating that it is dependent upon them.

All this leads thoughtful persons to inquire if there is not some deeper, fundamental cause lying back of the trouble, which should be reached and rectified by medical skill and acumen, something to do with the life or diet of a person which renders the tissues liable to take on malignant disease. So that a recent surgical writer on cancer states that “all study, whether clinical, pathological, or experimental, points to the fact that there is some underlying, hidden cause which leads to that aberration in the action of tissue cells which we call cancer,” ... a cause “residing in only the cells themselves or in some abnormal chemical constitution of the plasma bathing the cells, or in both of these possibilities acting together.”

_Occupation_ has been questioned, but with most unsatisfactory results, for in some statistics which have been gathered cancer has been observed in those following all possible pursuits: and while laborers stood first on the list, clergymen stood fourth, while carters, threshers, and guides, who would be exposed to local injury, were at the bottom of a long list. It has been found, however, to be more frequent in trades or occupations in which the individual is most subject to the habitual abuse of alcoholics, as in bartenders, printers, etc.

We see, then, that thus far no satisfactory cause has been established for the occurrence of cancer, much less for the steady and great increase of the disease of late years. And as far as can be learned, no measures are recognized, or at least generally adopted, to prevent its occurrence or recurrence; although, as already stated, modern surgery has seemed to improve the statistics in regard to its mortality in certain forms or locations, and the X-ray and radium have certainly also been able to remove, perhaps temporarily, some of the products of the disease.

We come then to the question, what is the real nature of cancer? Alas, all scientific, experimental, and clinical investigations have failed to solve the problem, except that all “evidence points to the conclusion that cancer is to be considered as a pathological disturbance of the normal cell life,” from some unknown cause. A curious suggestion has been made by Schmidt, who found that of 241 cases of cancer of the chylopoietic system, 180 had never had any infectious disease of childhood, and 99 went through life without any infection of any kind; the figures point to the existence of a cancer diathesis—one which is resistent to germs.

It would carry us too far from the practical side of our subject, even if we were at all able, to present or analyze the vast number of contributions which have been made to the pathological histology of cancer, and the changes which take place in the transformation of normal cells into those of malignant character: the amount of microscopic work which has been done along this line can hardly be imagined, and the literature relating to it is enormous.

Ewing, accepting the definition that the cancer process is “atypical and destructive proliferation of epithelium,” quotes Ribert as saying that “no one has ever seen the beginnings of mammary cancer”: but he does not bring us much nearer to the solution of the cancer problem than we were before. Bainbridge rejects all possibility of a blood condition, and finds the only solution of it in the early removal of everything which is thought to lead to cancer, even the simplest benign new formations, but Ewing states that “in some cases carcinoma has developed after excision of wholly benign fibro-adenoma”: and the immense number of cases of recurrent cancer after operations shows that we must look further than surgery if we wish to stay the progress of this formidable disease.

It would be useless to attempt to present the many theories which have been advanced relating to cellular metaplasia, or even to detail all the more or less accepted views in regard to the manner in which normal cells change and degenerate into those of malignant character: but some of the principal facts may be of service in understanding somewhat of the mode of development of malignant tissue from that which has been normal.

The statement of Virchow, “Omnis cellula e cellula,” that is, “where a cell arises there a cell must have previously existed, just as an animal can spring only from an animal and a plant from a plant,” forms the basis of all study on the genesis of cancer and all tumor formation; karyokinesis, or indirect nuclear or cell division, is at the bottom of all growth, both normal and malignant, and the two classes of growth differ only in their methods and activity. In healthy tissues cell proliferation and destruction proceed in an orderly manner, forming homologous structures, as when the hair and nails are constantly produced from newly formed cells at the root, and the result of this new growth is removed mechanically when the hair and nails are cut from time to time, or the hairs fall out. In the case of the skin the epidermal layers are pushed forward and finally exfoliated as useless epithelial débris.

With the cells composing other, or internal structures, however, the process is different. For here each normal cell reproduces others of homologous structure, and the different parts of the system are thus kept in active service through anabolism, by means of which new cells are formed with renewed vitality, and the older, or effete cells are removed by catabolism; the elements of which they are composed are thus split up into their component parts, and carried off by the blood or lymph stream, and are then either discharged as effete substances or reutilized in the system, along physiological lines. Wakefield has pretty clearly shown that the developing cancer cell is the product of sub-catabolism, or a sub-oxygenation, induced by hyperacidity or oxidase deficiency in the surrounding medium of the blood plasma.