Part 5

It is also well known that in order to preserve health and proper weight there must exist in the economy a certain balance or equilibrium between the amount of the ingesta and excreta, representing the various elements which enter into nutrition; thus we speak of a nitrogen equilibrium, a carbo-hydrate equilibrium, a phosphorus equilibrium, and iron equilibrium, etc., some of which are disturbed continually in ill health and in various diseases, including cancer, as has been shown in our last lecture.

Until quite recently the principles of diet (even if not often carried out in practice) have been established on lines laid down by Carl Voit, of Munich; this eminent physiologist, after studying the dietary habits of various classes of workers, claimed that the adult man of 150 pounds, doing moderate muscular work, requires daily 118 grams of protein or albuminous food, 56 grams of fat, and 500 grams of carbo-hydrate, with a total fuel value of 3000 large calories, in order to maintain the body in equilibrium. But the remarkable and scientific experiments of Chittenden have demonstrated beyond question that perfect bodily and nitrogenous equilibrium can be maintained with one-third of the amount of protein called for by the Voit standard, and with a total value in the diet of only about 1600 calories, or about one-half of that indicated as necessary by Voit. These experiments were based on a group of five men of varying ages, professors and instructors at Yale, thirteen volunteers from the Hospital Corps of the United States Army, and eight students in Yale, all thoroughly trained athletes, twenty-six in all.

It would be quite beyond the scope of this lecture to enter at all into the intricate questions connected with the metabolism of nitrogenous and other foods, but Chittenden has well put the reasons “why prominence is given to the establishment of nitrogenous equilibrium and why the proteid intake assumes a greater importance than the daily amount of fat and carbo-hydrate consumed. Fats and carbohydrates when oxidized in the body are ultimately burned to simple gaseous products, viz., carbonic acid and water. Hence these waste products are easily and quickly eliminated and cannot exercise much deleterious influence, even when formed in excess.... With protein foods, on the other hand, the story is quite different. These substances when oxidized yield a row of crystalline, nitrogenous products which ultimately pass out of the body through the kidneys. Prior to their excretion, however, these products—frequently spoken of as toxins—float through the body and may exercise more or less of a deleterious influence upon the system, or, being temporarily deposited, may exert some specific or local influence that calls for speedy removal. Hence the importance of restricting the production of these bodies to the minimal amount, owing to their possible physiological effect and the part they are liable to play in the causation of many diseased conditions.”

When we consider the small share which nitrogen plays in the composition of the human frame, as shown in the table presented, only three per cent., it is easy to see how an excess of nitrogenous food must necessarily either pass off unassimilated or undergo imperfect metabolism, and so derange the general metabolism; and this is found to be the case in many conditions of disease, and, as has been shown, in cancer. Chalmers Watson and others have shown in a most remarkable manner, by animal experiments, that an excessive meat diet alters very materially the microscopic structure of very many organs and portions of the body.

Beneke, who is often quoted, was one of the first to seriously consider the actual diet beneficial in cancer, his observations dating back to 1875 upon material in the service of Esmarck and Oldehop, who treated patients according to his plan. While the diet he gives is not wholly vegetarian, he limits the nitrogenous intake very greatly, and reported some very favorable results, with the complete disappearance of some malignant new formations.

Referring now to the data presented in the second lecture, in regard to the frequency and geographical distribution of cancer, we can understand better, on scientific grounds some of the reasons why cancer is so steadily increasing in civilized communities, and why in some sections of the earth it is less common, while certain aborigines have seemed to be almost immune.

We found that in England the per capita consumption of meat was 130 pounds per year, and that it had doubled during the past fifty years, while during the same period cancer had increased _four fold_; but in Ireland, where the meat consumption was estimated in 1895 at only 40 pounds per capita, or less than one-third that in England, the cancer death rate is very much lower, not much over one-half. We found that in Italy, where the per capita consumption of meat was the smallest of any European country the cancer death rate was almost the lowest. Also that in certain other countries, where vegetarianism was the rule, cancer was very infrequent, while among certain aborigines the disease was practically unknown; but we found also that in both the latter classes of individuals cancer has slowly increased, in proportion as the inhabitants of different sections had come under the influence of modern civilization, and adopted the dietary and other habits of foreigners.

In the United States cancer has certainly increased very greatly during the last fifty years, and statistics were presented showing that in seven of the largest cities, during the past five years, the number of cancer deaths had augmented between seven and eight per cent. It is known that the consumption of meat here has increased steadily, until in a communication from the Bureau of Agriculture in Washington we learn that it had recently reached the enormous amount of 172 pounds per capita yearly, much more than in England.

Cancer has been repeatedly spoken of as a disease of civilization, and there are many other elements besides meat to be considered in connection with its etiology.

Coffee and tea are so widely and almost universally used in civilized countries, and their apparently pleasant effect is so great that few realize the harm that may result therefrom; although from time to time their injurious effects, especially along the line of digestive and nervous troubles, are dwelt on by medical writers. Of late years, however, more attention has been paid to their influence on metabolism and also to the relation of their consumption to the increase of cancer. From a report to the House of Commons in England, Holland is shown to be the largest per capita consumer of coffee of any country in Europe, and the cancer death rate there in 1905 was among the highest, while Hungary was the smallest consumer of coffee, and the cancer mortality in 1903 was only 39 per 100,000, or a little over one-third that in Holland. It may be interesting to know that Thompson states that “the people of the United States consume one-third of the total coffee produced, or more than Germany, Austria, Hungary, France and the United Kingdom combined. On the other hand England and her colonies consume one-half of the world’s output of tea, and the United States but one-fifth of it.”

The scientific basis of a possible relationship of the consumption of coffee and tea to the prevalence of cancer may be better understood when we remember that caffeine and theine belong to the xanthin group, and contain exactly the same equivalent of nitrogen as uric acid. A single cup of coffee of fair strength, it is stated by Hutchinson, contains from one to three grains of caffeine, and a cup of fairly strong tea 1.21 grains, or more than the average medicinal dose of this drug; and all know how great may be the consumption of coffee and tea by some individuals, and that many of the working class, especially, consume enormous amounts of tea, which is kept brewing all day. Roberts has very clearly demonstrated, by clever experiments, that tea interferes very greatly with both the salivary and gastric digestion.

Alcohol, or some of its combinations, has also been shown by several observers to be undoubtedly an element contributory to the causation of cancer; this relates not only to countries or cities where the consumption is the greatest or least, but also to various occupations, in which statistics show the more or less abundant use of distilled or fermented drinks, and deaths from the same, and in regard to total abstainers; and a careful study of the subject makes it pretty clear that the incidence of cancer corresponds in a measure with drinking habits; that is, that cancer mortality is highest among those classes of persons among whom primary or secondary mortality from alcoholism is greatest. There are so many elements to be taken into consideration in connection with the derangement of metabolism which leads to cancer, that it is difficult to fix the precise influence which each may exert; but in watching cancer cases for any length of time it is easy to see the harmful effect when alcoholic beverages are indulged in, and the improvement when all such are absolutely excluded.

An interesting confirmation of the beneficial results of a low diet and simple life, as regards cancer, is found in certain reports of Commissioners of Prisons and Asylums in England, where the matter has been studied, as given by Russell. “Asylums contain an excessive number of persons who have inherited or acquired constitutional weaknesses, and in many cases tendencies toward consumption or cancer; also many alcoholics who are prone to these maladies. Yet the habits and rules of these institutions reduce the cancer rate much below the rate of the classes from which they are drawn, and below the rate of both occupied and unoccupied persons.” The same is observed in regard to many religious orders, where the members lead a very simple and frugal life, and where cancer is reported to be almost unknown.

Kessler has called attention to the disturbance of sulphur partition in cancer in connection with diet, and the desirability of excluding those foods exhibiting an excess of sulphur, giving lists of the same and indicating a satisfactory diet.

Packard has made a strong argument in regard to the value and importance of the mineral elements contained in plant life, in connection with the disturbances in these same elements which has been observed in connection with cancer, as we have already seen. He recalls that modern chemistry teaches that the inorganic principles of the vegetable kingdom are absolutely necessary to the highest degree and type of animal tissue and health, and resistance to disease. Plant life is the connection between the minerals and salts of the earth and animal life, but in the manufacture or refinement, and cooking, of products of the vegetable kingdom, many of them are largely demineralized; this especially illustrated in the case of fine white wheat flour, rice, potatoes (in peeling and cooking), etc. So that while animals get plenty of mineral matter from plants and the earth, man gets but little, and while the herbivorous animals are rarely affected with cancer, civilized man is succumbing to it more and more. It is stated that among savage tribes, who are practically free from cancer, the water in which vegetables are cooked is also consumed as food, thus securing all the salts. The same idea has been popularly presented to the public in a startling manner by McCann in a book which, with a great deal of verbiage contains a large amount of valuable information concerning nutrition, and its disturbance by erroneous, or worse, preparation and administration of food.

Possibly there are other dietary elements which may play some part in the causation of cancer, but the demonstrated facts in regard to them are so few and uncertain that they need not detain us here, although it is certainly desirable to investigate any that seem to have reasonable support.

Some of these which have been suggested probably have to do with local irritant action on the digestive organs, as we have previously seen that local irritation undoubtedly plays an important part in the determination of the actual time of occurrence and site of the cancerous disease. Thus, some have ascribed cancer to hot food or drink, or to stimulating drink, condiments, etc. It is quite possible that these contribute to the development of cancer in the pylorus, irritating the secreting cells in their passage. Mayo says: “In civilized man one-third of all cancers are seated in the stomach. This is not known to be the case in uncivilized man or in animals. There should, therefore, be something—some one cause—which causes this preponderance. The acid secretion may favor its development, for when we come to the colon, also with an acid secretion, we again meet with cancer, and we seldom see it in the alkaline, small intestine. Gastric ulcer, which may be pre-cancerous, is connected with hyperacidity.” In Scandinavia cancer of the stomach is remarkably frequent, according to Soëgaard, thus, of 1235 cases in Norway, 73.9 per cent. were in that location. In our last lecture we found that cancer in general was connected with a lowered alkalescence of the blood, and all our studies show hyperacidity to be related to cancer genesis; and nitrogenous acidity, or uric acid (purin, xanthin, etc.), undoubtedly plays a great part in inducing malignant action in tissues, as Haig has so long contended, even in regard to cancer.

The increasing frequency of cancer of the mouth, œsophagus, and stomach in men certainly looks toward an irritating character of substances which traverse these regions, including alcoholic drinks, and the irritant effect of tobacco should not be overlooked in regard to mouth lesions. But of the millions who use tobacco only very few are affected with cancer, and only those who are predisposed thereto by some metabolic disturbance, whose true character and other manifestations are not yet fully determined. We have already referred to the practice of so-called betel chewing in the Far East as a frequent cause of cancer within the mouth, also to the wearing of the Kangri charcoal baskets in India, for warmth, causing a burn on the front of the body which may develop into epithelioma; it is claimed, however, by some that of the many cases of “Kangri burn,” but few result in epithelioma.

There are yet other considerations concerning the relation of diet to cancer which are worthy of attention. We have mentioned some principal agents, which seem unquestionably to have an influence in the production and continuance of cancer, namely, proteids, coffee and tea, and alcoholics. But millions of human beings partake of these with apparent impunity, while in the relatively few they appear to have cancer-genetic powers. This need not surprise or puzzle us any more than do the many other problems in medicine which we are seeking to solve: for we know how often it happens that the system reaches a point where certain things, once well borne, are no longer tolerated. We know, for instance, that Port and Madeira wine certainly can cause gout, but with many individuals they may be indulged in freely for some time before this result follows: likewise that tobacco may even be abused for a long time, without apparent ill effects, when suddenly there is a revulsion of the system and the slightest use of tobacco will be intolerable: also that many edible substances which have long been well borne, will at a certain time act unfavorably and excite eruptions, urticaria, acne, eczema, etc.

Psoriasis also furnishes an illustration which may be of service in understanding the relation of diet to cancer; for psoriasis is characterized by a disordered epithelial growth, which both shows on the surface and manifests itself by epithelial prolongations into the corium, which are quite comparable to the ingrowing cellular masses of early cancer: moreover cancer is not very rare in psoriasis patients. In this eruption it has been very clearly demonstrated, clinically and experimentally, that error in nitrogenous metabolism is commonly at the bottom of the eruption, which has been seen to promptly disappear entirely simply under an absolute vegetarian diet, correctly regulated, excluding also coffee and alcohol, without the use of any medical treatment whatever, internal or external; but, of course, this result cannot always be obtained, and sometimes the eruption will relapse during what is thought to be a strict vegetarian diet. There must, therefore, be some systemic disturbance which causes nutritive material, at some particular time, thus to derange cell action in the eruptions mentioned, and the same is true in regard to the production of cancer.

Some years ago Braithwaite called attention to the occurrence of cancer among certain peoples who were vegetarians, and attributed it to the great amount of salt which they consumed. While the suggestion of salt being a cause of cancer has been ridiculed, it is quite possible that a great excess of sodium chloride may disturb the salt equilibrium in the blood, by replacing the potassium which is so necessary for proper cellular nutrition, and also by hindering the excretion of uric acid, as Haig has pointed out.

When we inquire into the cause of the systemic disturbance which tends to such faulty metabolism that the nutrition of cellular structures is deranged, even to the degree of taking on malignant action, we find many possible elements, more or less connected with what is known as modern civilization, to which we have time to but briefly allude. Williams has shown pretty clearly that wealth, with its tendency to luxury and idleness, greatly increased the proclivity to cancer: not only is this observed in different countries, but in certain cities the difference is very striking between the cancer mortality in sections which are occupied by the rich and well-to-do, and those in which the poorer classes are herded. Also in England it was found in one decennium that cancer mortality was more than twice as great among the well-to-do men, having no specific occupation, as among occupied males in general, the ratio being 96 to 44.

Change in the mode of life, and sudden changes of environment have also been found to have a great effect in the production of cancer, as has already been mentioned in another lecture.

Finally, for our time does not permit a fuller discussion, nervous conditions unquestionably can and very often do exert a profound influence on the secretion of the various organs of the body, and can so disturb digestion, metabolism, and nutrition that the most varied results may follow, to which the names of different diseases are given; so that nerve strain, more or less incident to modern life, must be accredited with a certain share of influence in the production of cancer. The part which imperfect and deficient intestinal and urinary excretion play in inducing or perpetuating the disease will be treated of in later lectures.

In our next lecture we will consider certain matters relating to the medical treatment of cancer, but from long experience and study I am firmly convinced that such measures are of relatively little service unless coupled with a rigid care of the diet and hygiene. As Bell remarks, “Cancer is essentially a disease supervening upon a persistent neglect of hygienic laws.” It is a disease of sub-oxidation, and all the hygienic elements of importance in tuberculosis are equally necessary in cancer; fresh air and sunlight with, as far as possible, an ideal regulation of life in all its aspects, are indispensable.

Inasmuch as there is no specific medical antidote for cancer, and we cannot be certain of securing at once the metabolism of health, it is wise to remove and to keep away from the system those articles which have been shown to have more or less influence in its production, namely, animal proteids, coffee, tea, and alcoholics. Time does not admit a discussion of vegetarianism, nor is it necessary, for there is abundant evidence in literature and on every side that perfect health can be maintained thereby, and I went over the subject pretty thoroughly two years ago. The vegetable kingdom contains protein enough to build up and maintain the tissues of the body, as is shown in animals, and an extra number of calories can be easily obtained from butter, of which a quarter of a pound contains some 800 calories, or fully one-third of the total daily quantity required by most individuals. The details of a purely vegetarian diet, which experience has shown to be of the greatest value in cancer, can be worked out for individual cases as required. I am also firmly convinced that in this absolutely vegetarian diet, with other proper hygienic and medicinal measures, to be detailed next week, we shall find a great power for the prevention of cancer; although many persons are already so saturated with poisoned blood and tissues from prolonged errors of life, that perhaps no very striking general effect on the community can be obtained therefrom in this generation.

In closing this lecture I must again urge upon you the necessity of great patience and perseverance, with very much careful study of the patient in all particulars, over a great length of time, if really favorable results are to be obtained in cancer; and this is true whether the disease be incipient, or fully developed, or even post-operative. The causes of cancer are deep seated, and, as with many chronic affections, there is no tendency to continue an improvement once begun, but under a return to the same conditions as before the disease will certainly assert itself. We have learned the lesson of assiduous perseverance in tuberculosis; let us learn it in regard to cancer.

LECTURE V MEDICAL TREATMENT OF CANCER

It is remarkable that so little serious attention has been paid to the medical treatment of cancer, in standard works, in view of the occasional strong statements and reports which have appeared from time to time in current literature and in occasional books, dating back for many years. Much of this, of course, relates to imperfect observation and erroneous diagnosis, and also to crude medical knowledge, but there have been also plenty of good men, who knew the disease and have reported favorable results, and even the complete disappearance of cancer, under dietetic regimen and proper medication alone, without operative interference of any kind.

Not to go back too far, reference can be made to Lambe, who one hundred years ago wrote clearly in regard to the causation of cancer from luxurious living, and adduced strong proof to show the effect of diet in curing certain cases of undoubted cancer of the breast and uterus, the diagnosis of which was confirmed by prominent surgeons of the day, several of whom endorsed the vegetarian diet. Abernethy wrote pointedly, soon after, regarding the constitutional origin of tumors and says, “There can be no subject which I think more likely to interest the mind of the surgeon, than that of an endeavor to amend and alter the state of a cancerous constitution. The best timed and best conducted operation brings with it nothing but disgrace, if the diseased propensities of the constitution are active and powerful. It is after an operation that, in my opinion, we are most particularly incited to regulate the constitution, lest the disease should be revived or renewed by its disturbance.” He then gives an endorsement of Lambe’s dietetic treatment of cancer, and presents several reasons why it should be fairly tried.