Part 2

A great deal of thought, study, and speculation have been given in regard to the behavior of the cells themselves, and strong arguments are adduced for a local cell pathology, that is, regarding the cells as “autonomous beings, possessed of morphological and physiological independence.” But on the other hand we must recognize some restraining influence which continually causes the great mass of cells to reproduce those of homologous structure, in an orderly manner, and only very rarely some of them to break loose and form tumors, which may then become malignant and even destroy life. How this restraining influence is modified or withdrawn is, of course, a part of the problem of cancer. Those who maintain their autogenous character lay great stress upon the polarity of cells, and the relation of the centrosome to the nucleus, indicating a change in the polar axis in cells about to be cancer-genetic, as does Ewing in his recent classical study of pre-cancerous lesions. But whatever changes are observed microscopically we must recognize that the cells themselves must be influenced ultimately by that mysterious force which we call life, which ends with its extinction from the body as a whole, and which is ultimately related to nerve action. We must also recognize that the cells everywhere depend for their life and activity upon the plasma in which they are bathed and from whence they draw their sustenance; and this plasma is renewed day by day from the food and drink taken.

Students of cancer are more and more recognizing and acknowledging that “all these phenomena, apparently so different, are merely protean manifestations of one common process which underlies and is the cause of them all, to wit, cell growth and proliferation. The particular outcome of the process in any given case is due to the influence of the conditions of nutrition—understanding by this term the whole of the material changes wrought in the organism through its relation with the surrounding world. This being so it is easy to understand how, under favorable conditions, certain cells may take on independent action, growing and multiplying without regard to the requirements of adjacent tissues and of the organism as a whole.”

There seems to be some reason to support the view advocated by Williams, that tumor formation and growth are but forms of agamogenesis, or non-sexual reproduction of cells, distinctly related to the decline in growth of the body in general. Hence while the forces of growth, development, and reproduction are in greatest activity the tendency to this disease is relatively small: but when growth declines and nutrition is relatively low the cells undergo gemmation, owing to perverted nutriment, and thus hyperplasia and not inflammation is the starting point of every neoplasm.

Experimental work has time and again demonstrated that cell growth, either good or bad, is modified in no uncertain way by the character of the nutrition furnished. Cancer has repeatedly been observed to disappear spontaneously, as such cases are on record by careful and competent medical men: in certain of these instances it has occurred in connection with a radical change in the mode of life and diet, but in the majority of instances there is no record of the special cause of its disappearance. The lesson to be learned from this is that there are conditions of the system which are antagonistic to the abnormal proliferation of cell tissue, even when it has begun to take place, as we must believe that there are other conditions of the system which favor such diseased action of aberrant cells.

An interesting confirmation of this is attributed to Ehrlich, but I cannot find the original reference. He “has shown that mice living upon a rice diet cannot be inoculated with cancer, while mice living on a meat diet can be readily inoculated, cancerous tumors developing quickly and continuing to grow until the animal dies. Ehrlich also found that when mice with cancerous tumors, the result of inoculation, were placed upon a rice diet, the tumors ceased to grow, and in many cases degenerated and disappeared.” Valuable corroboration of this has been given by Sweet, Corson, White, and Saxon. They made a series of experiments in regard to the “influence of certain diets upon the growth of experimental tumors,” all with the same results. Of fifty white mice, 25 fed on glutenin and gliadin, and 25 on normal diet, 23 of the 25 on normal diet acquired tumors, against only 4 in the 25 on the glutenin and gliadin. This was repeated on 50 males, with the result of 18 in 25 against 3 in 25: and in a third series, of 50 females, the figures were 15 in 25 against 7 in 25. Thus, they found that 75 per cent. of 75 mice developed experimentally inoculated tumors when under normal diet, while only 19 per cent. of other 75 mice developed such tumors when under a diet of glutenin and gliadin, that is, vegetable proteins; moreover, the tumors in the latter were in 30 days hardly larger than those in the former in 10 days. Rous has recently shown that large growths of certain transplanted rat and mouse tumors are checked in their development by underfeeding the host on a special diet.

The chemistry of cancer has been studied in most varied directions, and the literature relating thereto is very voluminous and can be hardly more than alluded to here. It is unfortunate, however, that most of the researches have been made in connection with patients who have advanced cancer, and very commonly with the disease affecting internal organs, which of itself interferes very greatly with their function, and so causes many of the perturbations of metabolism observed. What is needed are researches in regard to the metabolism of patients before the development of the disease, or in its earlier stages, before it has exerted its injurious effects on the system, in order to learn of the causes which lead up to and induce the wrong action of the cellular elements, whose invasion and malignant action subsequently become so serious.

It is quite impossible in these lectures to enter at all fully upon the various bio-chemical studies which have been carried on in regard to cancer, but brief mention will be shortly made of some of the salient points. Not only has the structure of carcinomatous tissue been examined chemically, but the blood and urine have been submitted to most painstaking investigation, and metabolism in general has been studied in almost all possible directions, in the search for the cause of cancer; and yet, as Beebe says, “no phase of metabolism has been described in cancer which does not have a counterpart in non-cancerous conditions.” But, as previously mentioned, all these observations and studies have been largely made upon advanced cancer cases, when the system has already felt the unsettling and depressing effect of what is probably an injurious secretion from the deranged and actively proliferating cells of the cancerous mass. In a later lecture we will consider some of these matters in so far as they have relation to the dietetic and medical treatment of cancer.

The essence of our study thus far has been, that in every instance what is called malignant disease is but an aberrant action of originally normal body cells. That, as normal cells find their nutriment in the circulating plasma, so some pathological change in this latter causes them to take on abnormal action, and they no longer develop homologous cells, capable of forming normal tissue, but heterologous elements which have a natural tendency to disintegrate or break down, and exert a destructive influence on adjoining cells of any kind; and in this process they secrete a hormone which is prejudicial to the system and tends to destroy life. In later lectures we shall endeavor to understand this more perfectly, and consider some of the elements in life which tend towards the production and arrest of cancer.

LECTURE II FREQUENCY AND GEOGRAPHICAL DISTRIBUTION OF CANCER

Cancer in man exists all over the globe, but in different degrees of frequency, according to varying conditions of life, as we shall presently see. Malignant growths occur also in animals and fishes, though also with greatly varying frequency under different conditions; but there are few real tumors in reptiles or amphibians. Tumors are also occasionally found in vegetable organisms, presenting increased growth and proliferation of cells, arising from adventitious, or abnormally evolving buds, as also from parasitic and other external irritants. While these vegetable tumors are very interesting and in a measure instructive, in regard to the peculiarities of cell growth which they exhibit, they bear, of course, no relation to cancer in the animal kingdom, although some have endeavored to argue otherwise. There is, however, a certain suggestion of analogy to be found in the observation made by one writer, that “the origin of buds, as well as their subsequent development, is chiefly determined by the conditions of nutrition. Wherever there is an excess of nutritive material, capable of being utilized for growth by the cells of the part, there buds may arise”; we shall see later that the same thought applies to cancer in man and animals, when we come to the consideration of the relation of overindulgence along certain lines of eating and drinking to cancer.

Cancer has well been styled a disease of modern civilization, like tuberculosis, although of quite a different nature. Interesting studies have been made in regard to the increased death rate from the former in England, coincident with a diminished mortality of the latter, in accordance with nutritional changes which have taken place in certain populations: and in the first lecture I mentioned that in the United States the mortality from tuberculosis had fallen 25 per cent. between 1900 and 1912 while, as we shall see later, the mortality from cancer has certainly risen.

Williams, who quotes very largely from the accurate statistics which have long been carefully recorded in England, says that “while tubercle has declined with great rapidity, cancer has increased at a still faster rate, and these inversely related changes are still in active progress. In illustration of these remarks it may be mentioned that during the last half of the nineteenth century, the cancer mortality for England tripled: while, during the same period the tubercle death rate declined to the extent of nearly one-half. Unless some great change in the national habits takes place, of which there is at the present no well marked indication, cancer will ere long claim more victims than phthisis, as is already the case in many localities—e. g., Hampstead, Clifton, Bath, etc.” He further says, “I regard this decline in the presence of tuberculous diseases as the direct outcome of the better food and improved hygienic conditions, for which we are indebted to our increased national prosperity: and I shall endeavor to show that conditions of this kind, by their action in another direction, are also mainly responsible for the augmented cancer mortality.” We shall see later that cancer has asserted itself where modern civilization has augmented the opportunities of overindulgence along many lines of eating and drinking: for while advancing scientific knowledge has undoubtedly diminished mortality in general, and has added to the average length of life, the various factors included in our modern mode of living have also with certainty increased morbidity along such lines as neurotic and vascular disorders, tumors, etc.

All statistics from various localities show that cancer has certainly increased in frequency very greatly of late years, and though some have attempted to claim that this increase is only apparent, and is due to greater accuracy of diagnosis, and the prolonging of more lives to an age when cancer is more common, there is no doubt in the minds of those who have studied the figures that the increase is certainly very real; and unless there be found some way to check its production, the death rate at the end of the century will be appalling.

It is quite impossible here even to give a comprehensive idea of the immense amount of work which has been given to the study of the statistics of cancer in various parts of the world, as collected in the remarkable works of Roger Williams and Jacob Wolff, but brief mention must be made of some of the items observed and recorded in order to properly understand our subject. Williams in particular has analyzed the recorded facts in an interesting and convincing manner, and shown again and again in connection with the figures from different countries, sections, and cities, that the occurrence of cancer bears a striking relation to the condition of the people in reference to their material prosperity; namely, that the well-to-do, who can overindulge in many ways are vastly more subject to cancer than those in the poorer walks of life; also that aborigines in the wilder parts of the world are either almost exempt from cancer, or suffer from it to a very much less degree than civilized foreigners who come to their lands. This is also shown in a very striking manner by Wolff, and I present here a table which he gives in regard to the progress of cancer in a single country, Australia, among the native born and foreigners.

OF 100,000 LIVING THERE DIE OF CANCER IN AUSTRALIA

_Year_ _Number of _Native Born_ _English_ _Other Inhabitants_ Nationalities_ 1851 403,889 28 14 1861 1,153,973 5.6 30.5 19 1871 1,168,377 9.7 56.7 25 1881 2,252,167 16.8 72.9 32.6 1891 3,183,237 19.8 119.8 45.9 1901 3,771,715 22.6 203.1 57.3

He remarks, “We see from this comparison in what a great degree the death rate from cancer has increased in foreigners as compared to the native born, in whom the disease has remained about stationary, when the increase in population is considered.” Another writer remarks that when native Australians mingle with foreigners as servants or employés, and adopt their diet and customs, cancer occurs more frequently in them. Much the same has been reported in regard to other peoples and nationalities, and later we will consider the influences of urban life on the production of cancer.

In New Zealand, according to Hislop and Fenwick, where the general death rate is the lowest in the world, cancer is on the increase, as civilization advances. In the great majority of cases the alimentary canal is the seat of invasion, even in women: all the patients studied were hearty eaters, taking also very much strong tea many times daily.

The Polynesians and Melanesians seem to be peculiarly exempt from cancer. Sir William McGregor, although he had operated several times on whites in the Fiji Islands, never remembers operating on a Polynesian or Melanesian, who are practically vegetarians. He never saw a case in British Guinea in 9½ years, and then saw an encephaloid cancer of the tibia in a Papuan, who for 7 or 8 years had lived practically a European life, eating canned Australian meat daily.

In regard to Africa, Williams quotes Dr. Madden of Cairo, who says, “The consensus of opinion among medical men in Egypt is, that cancer is never found, either in male or female, among the black races of that country. These include the Berberines and the Sudanese, who are all Mussulmans, and live almost entirely upon vegetable diet.” Of 19,529 deaths among natives of Cairo during 1891, only 19 were due to cancer (females 10, males 9) or 1 in 1028. In England during the same year the proportion of cancer deaths to total deaths was 1 in 29. In the Islands of Lagos, on the West Coast of Africa, Dr. Johnson, in 14 years’ practice there saw 5 cases of cancer in natives all of whom lived as Europeans. In southern Africa, “among the Boers and Europeans, who are large flesh eaters, malignant tumors are common: but among the natives, who are mainly vegetarians, these tumors are so rare as to be almost unknown.”

Renner reports interestingly in regard to cancer among the descendants of liberated Africans or Creoles, in Sierra Leone, Africa. During 30 years, from 1870 to 1900, there were but 20 cases recorded as malignant disease among 22,453 admitted to the Colonial Hospital: in the next ten years there were 26 among a total of 10,163, a slow but steady gain in cancer incidence, with the advancing influence of the white man. He says that while the aborigines eat no meat, the “Creoles” eat much meat; the teeth of the latter are beginning to decay, like those of the whites, which is attributed to the sweets introduced by the latter. Every case of cancer recorded has been in a Creole, living like a European, and not a single case among the aborigines.

Much the same freedom from cancer has been noted in regard to negroes when first brought to the United States in slavery, when their food and mode of life was simple: but since emancipation and in proportion as they have mingled with whites and eaten their food, with their own natural tendency to gluttony and laziness, cancer has increased among them, although their death rate from malignant disease is still much less than that of whites.

In India all writers agree that cancer is rare among the inhabitants of warmer country districts, where they live largely on rice or millet, with a little milk and butter, and vegetables: they eat meat rarely, the immense majority of the people live a rural life, depending upon agriculture for their sustenance.

Investigations of late years, however, might seem to indicate that cancer is more prevalent in India than previously supposed, but its incidence still bears no real relation to that in many other countries, and an analysis of some recent reports explains in an interesting and curious manner the reasons for the diversity of opinion as to the actual frequency of the disease.

Thus, Benratt collected a total of 1700 cases only from 5 years’ statistics of 15 Mission Hospitals and 34 Government Hospitals, representing, of course, many million inhabitants, whereas in New York City, according to the weekly Bulletin of the Board of Health, there were 2193 deaths from cancer in the last six months, a striking illustration of the rarity of cancer in India. Moreover of these 1700 cases, over 1200 were about the mouth, a very large share of these arising from the very common habit of chewing betel, which contains also much calcium, which latter is one of the salts incriminated in the causation of cancer. Sandwith attempts to show that cancer is prevalent in India, but refers to only 2000 cases reported in the hospitals there, in three years, also among many millions of people, and he refers likewise to the betel chewing cancer, and the “kangri burn” on the abdomen of men, from the charcoal furnace worn for warmth: these peculiar local disorders vitiate any deductions which could be drawn from such statistics.

In China, according to a recent writer, “cancer is comparatively uncommon in those parts where the bulk of the people live on an almost exclusively vegetarian diet, being too poor to purchase any of the various flesh foods, which are there used for culinary purposes.” But in places where cancer is said to be more prevalent, the reporter adds, “All Chinamen there eat fish and pork at morning and evening meals: fowls and ducks are always on the table of all but the most humble of the coolie class.”

In regard to the occurrence of cancer in the Far East, however, some of the modern investigators, such as Bashford, have endeavored to overturn the generally accepted view as to its infrequency, but I do not feel that the evidence presented can at all weigh against the unprejudiced opinion of most capable medical men who have long lived and practiced in those regions, some of whom as medical missionaries have had most intimate contact and acquaintance with the natives. Only very recently a medical missionary, who has long been connected with the medical college and hospital in Beirut, Syria, told me that cancer was practically unknown among the thousands of patients who flock there from all over the Near East, he adding that they were all largely vegetarians.

During a rather extensive trip through the Far East I was unable to see or even hear of any cancer, although I met a large number of medical men, and made diligent inquiry regarding the same. As I wished to verify my views in regard to the rarity of the occurrence of cancer among those who lived on rice or other vegetarian diet, I visited very many civil, military, and mission hospitals, with a total of many thousands of patients, and ministering to many millions of population; in Japan, Korea, China, the Philippines, India, Siam, and Egypt, I met the same response, that cancer was rarely seen among those vegetarian natives.

Brazil is credited with having the lowest cancer record of any portion of the western hemisphere, especially among the natives in the Equatorial regions, while in the Argentine Republic, where meat is known to be largely consumed, cancer is fairly common. From many parts of the world there come reports of the relative infrequency or even absence of cancer among simple living natives, one writer in regard to the West Indies stating “Even those cases which I have witnessed in this class of people have been among the better orders of them, whose habits of living assimilated to those of Europeans.”

England and Wales present the most satisfactory field for the study of the progress of cancer, as the national vital statistics have been well kept since 1840; even at that time under the able direction of William Farr they had already acquired a well-deserved reputation for reliability, as Williams remarks, from whom I shall freely quote.

In that year, 1840, there died of malignant disease in England and Wales 1 in 5,646 of the total population, 1 in 129 of the total mortality, or 117 per million living. In 1905, the deaths, due to this cause were 1 in 1,131 of the total population, 1 in 17 of the total mortality, or 885 per million living: thus, while the population had only a little more than doubled, the cancer death rate per million living had increased five fold. Dr. Williams answers by figures and tables the several objections which have been raised in regard to the actual increased mortality from cancer, as it has been repeatedly claimed that the increase is only apparent and not real; thus it has been asserted that it is due—1. To mere increase of population: 2. To the average age of the population having advanced: and 3. To improved diagnosis and more careful death certification. Time does not admit a full presentation of his statistical refutation of these claims, to which he devotes some pages very convincingly, but it can be safely accepted that for some as yet unknown reason, cancer has made strides in England which are truly alarming.