Part 6

In the classical work of Walshe we find numerous references to the constitutional nature of cancer, original or quoted from recognized authorities, as well as expressions in regard to the futility of expecting that surgical interference would cure the real disease in any great proportion of cases. He says, “It would in theory appear that the removal of a tumor cannot in itself cure the disease, as the local formation is but a symptom of a general vice of the economy.”... “This tissue being, as the normal textures, the seat of nutrition, is like them susceptible of its disordered actions,” and he alludes more or less to the effect of diet on the disease.

The late Willard Parker, one of New York’s great surgeons, in a study of 397 cases of cancer of the female breast, observed from 1830 to 1880, wrote very strongly in regard to the constitutional relations of cancer. In considering the etiology he places constitutional causes first, and says, “luxurious living, and particularly excess in animal food, increases the waste products of the body, and if coupled with insufficient exercise, the waste products are retained in the system and have a tendency to produce abnormal growths.”... “Cancer is to a great degree one of the final results of a long continued course of error in diet, and a strict dietetic regimen is, therefore, a chief factor in the treatment, preventative and curative.” Concluding his study he says, “There is such a _consensus_ of opinion as to the advisability of early removal of the growth, that a discussion of the subject would be useless. So then, in the first place, let us remove the tumor, and thoroughly. But after we have done so, after we have taken it out by the very roots, is this sufficient? No. We must then adopt the means stated above to prevent a second development. We must change the diathesis; we must seek to modify the patient’s constitution so that it will be no longer prone to reproduce the disease: and then only may the surgeon be satisfied that he has done his duty.” He further says, “In regard to the effect of abstemiousness on cancer I can speak with great positiveness, that vegetable, or at least a very bland diet, does check the progress of the disease, and, in some cases now under treatment, has been attended by an alleviation of symptoms; and in a few instances even by a recession of the growth.” He also quotes from Sir Astley Cooper some strong language which, as he says, “shows a broader and more enlightened view of the subject than is contained in the writings of some more recent observers, who have supposed that they were working far in advance of the great English surgeon”; the rather long quotation then given proves that that great surgeon also believed absolutely in the constitutional nature of cancer.

Sir James Paget is often mentioned by writers, sometimes even with derision, as a believer in the Constitutional Nature of Cancer, and his words are very strong; says he, “I believe it to be constitutional, in the sense of having its origin and chief support in the blood, by which the constitution of the whole body is maintained,” and speaks at some length in his lecture, in support of this view; I will give you one other small quotation. “The existence of the morbid material in the blood, whether in the rudimental or in the effective state, constitutes the general predisposition to cancer,” etc. It is remarkable that the views of this prince of surgeons and pathologists should not have carried more weight in regard to cancer, when his other views are so well accepted.

Time does not permit us even to refer to the great mass of more or less similar views and corroborative evidence scattered in books and current literature during the last fifty years, but a few more references may be given. In 1884, and again lately, Merriam has called attention to cancer occurring as a reversion of tissue cells to earlier or embryonic forms under the influence of a disordered, or as he calls it, a poisoned blood stream, from over nutrition from a meat diet; and Haig has long maintained that uric acid is a prominent factor in the etiology of cancer.

While few will agree with Haig in all his conclusions, there is no doubt but that a faulty nitrogenous metabolism plays a not inconsiderable part in the causation of many diseased conditions, as has been also shown in a previous lecture to be true in regard to cancer: and while it may not be actually uric acid or urea which does the harm, as these are relatively harmless end products of metabolism, it is true that the purin and xanthin bases, of many forms, and imperfectly oxidized nitrogenous elements, are active agents in the production of disease. Venus and Isenberg have both written very strongly in regard to the unquestioned value of a vegetarian diet in cancer, the former citing many supporters of the view, from ancient times to the present. If time permitted any amount more of corroborative evidence could be given in regard to the connection of cancer with metabolic disorders.

There have been many scattered articles concerning the chemico-pathology of cancer, all looking in much the same direction as that which we are pursuing, which cannot even be alluded to, but brief mention must be made of a most illuminating and suggestive study by Bristol. Reviewing the many theories of the etiology of neoplasms he shows pretty clearly that cell reproduction comes from outside the cell, or from the surrounding cell medium by a process of diffusion, or by a definite chemical attraction, and is closely associated with the nutrition and growth of the cell, especially the nucleus; also that a fixed ratio between the salts in the blood, lymph, and tissues is necessary for normal activity and reproduction of cells; further that a disturbance in this ratio and an upset in the chemical equilibrium will lead to abnormal metabolism, growth, and reproduction, and result in an atypical growth in the local area involved.

As before remarked, it seems strange that the medical profession and the public have been so slow in accepting the views here presented. But both have become so obsessed with the idea that nothing can be done for cancer except operative procedure of some kind, and so dazzled with the glamour of modern surgery, so fascinated with the apparent definiteness of laboratory proceedings, and so attracted by the glory of purely scientific research, that it is very difficult for any other doctrines to make headway: moreover, any dietary or medical treatment, prophylactic or curative, is very tedious and also difficult, in the way of attention to minute details, etc., and patients weary of restrictions and are restless at seeing little or slow progress made. Haig found the same difficulty with Hospital patients, but does not hesitate to state that in private practice “some undoubted cases of cancer have gotten well” under his dietary restrictions.

But when it is remembered that it is calculated that, under present existing conditions and treatment, fully 90 per cent. of those attacked with cancer ultimately die from it, and that there were last year nearly 50,000 recorded deaths from this cause in the “Registration area” of the United States, covering but two-thirds of its population, and that the disease is rapidly and surely increasing, it behooves the Medical Profession to put forth the best efforts possible to stay the progress of the disease. In New York City, according to the Weekly Bulletins of the Board of Health, there were from May to November, 1914, in 26 weeks, 2173 deaths from Cancer, Malignant Tumor, or an average of 83.5 per week, almost twelve deaths daily from malignant disease.

Operative surgery has unquestionably been of great service in certain cases and along certain lines of cancer, and the claim for the earliest possible removal of morbid growths is certainly a just and proper one; moreover, with our present knowledge it is perhaps wise to attempt to remove the offending mass while there is some hope or prospect of benefit, and personally I am occasionally advising this in proper cases. X-ray and radium have also their sphere of usefulness in a certain class or group of cases, but the excessive exploitation of the latter, not long ago, did harm in raising false hopes in multitudes of sufferers, and as these were shattered so also was confidence shaken in regard to all help for cancer from other than surgical removal.

But every one who has been brought much into contact with cancer knows full well what a mass of recurrent cases exist, possibly many of them due to bad operation, in regard to which surgery has to acknowledge that it can offer nothing more, that they are inoperable and therefore they are regarded as incurable. Every one also knows how many cases there are which have advanced so far before coming to a competent surgeon, that they are also inoperable. Every one likewise knows that there are numerous cases of cancer in internal regions, and in certain localities, and presenting peculiar features, which are also recognized as inoperable, at least with any proper justification. Thus it may safely be said that of the total number of cases of cancer existing at any one time, which would be included under the above classes, fully 50 per cent. are such that operative surgery can offer no hope of material benefit: also, it must be acknowledged that but a relatively small proportion of all cancer cases are likely to secure the very best surgical service, such as claims the highest percentage of success.

For this large number of hopeless victims of this dire disease, at least, proper dietary and medical treatment should be most carefully studied and patiently applied, with the hope and expectation that the same, if correctly employed, would more or less hinder or check its progress or prevent a recurrence after operation. But experience shows that such measures, if taken promptly and thoroughly, can also prevent the development of early threatening lesions into those of malignant character, suggesting surgical removal, and these should never be neglected when there is the slightest suspicion of cancer. For it must be acknowledged that the surgery of cancer is only an attempt at the physical removal of a something, which medical science and art should not have allowed to develop out of normal tissue. And in the matter of the general prophylaxis of cancer it is certainly worth while to consider and act strongly upon the facts which have been presented, especially in those individuals who have any hereditary suspicions, or who exhibit the habit of body or life which could lead to the development of cancer.

The medical care of cancer, as of all diseases, naturally includes both prophylaxis and the treatment of a morbid condition which has already developed; the former of these is always considered to be of the highest importance.

_Prophylaxis of Cancer._ From what has preceded in this and other lectures it can readily be understood that the prevention of cancer lies largely along dietary and hygienic lines, including such medical attention as shall secure healthy action of the secreting and excreting organs. If the figures and facts heretofore given are correct, if cancer has surely been observed to increase under certain conditions of life, if it is found to be absent or relatively rare under certain other conditions of living, if cancer has been known to disappear spontaneously in certain individuals, especially when they have changed their mode of living, it must then follow that when the exactly correct habit and state of life are continually assumed the disease will not occur.

In other words, when the blood stream nourishing the tissues is ideally correct, the individual cells of the body perform their functions normally, and as each cell is worn out it is removed by a healthy catabolism and renewed by a normal anabolism, and homologous cells then replace those which have ceased to be able to perform their function. On the other hand, when there is perverted metabolism we have various forms of deranged action, to which we give the names of various diseases, one of which is cancer: here in place of homologous cells maintaining the tissues in a normal condition, we have a malignant metamorphosis into heterologous cells, which take on a disorderly or rampant action, and refuse to assimilate themselves to others, so as to form healthy tissue; we have then a mass of low vitality, tending to easily break down or ulcerate, and to extend their malignant action to adjoining tissues, under the continued influence of a contaminated blood current. When once ulceration has occurred, the ordinary parasitic micro-organisms, which are practically omnipresent, find an acceptable nidus, and aid in the destructive work, and also in the systemic poisoning of the tissues.

The aim, then to be sought in the prophylaxis of cancer is to secure the most perfect blood stream possible, which is accomplished by simple living, perfect mastication, and the avoidance of excesses, especially along the lines of protein, tea and coffee, alcohol, etc., with the maintenance of healthy habits of life, especially in regard to bowel action. As already intimated, we do not know just why in some persons and at a certain time a disturbance of metabolism results in perverted cell growth, but there is, of course, a reason, and the physician’s duty is so to regulate the patient’s whole life that the metabolism is kept in the state of perfect health. All this seems very simple and trite, but really it is a task which is most important and often most difficult to accomplish, and requires very careful study and infinite patience. Dr. Kellogg, of Battle Creek, says that of the many thousands who have passed under his care he has not known cancer to develop in any one who had been faithful to the principles which he inculcates, and I may say the same of the many who have been under my care in private practice, often with notes extending over many years.

Time does not permit of going into detail here in regard to the special features of diet and hygiene, which I discussed with you fully two years ago, in my lectures, which were subsequently published: suffice it to say, as previously remarked, that the refinements of civilization add greatly to the temptation of over-eating, and wrong eating and drinking, as they do to numerous other temptations, and in many instances it requires the utmost amount of grit as well as patience, both in the patient and doctor, to secure the perfect result necessary.

It is understood, I trust, that I believe that for the proper treatment of cancer, and to prevent its occurrence and recurrence, it is absolutely necessary to maintain a perfect vegetarian diet, which includes even the exclusion of eggs and milk, with food; but the yolk of eggs may sometimes be taken with advantage, and also milk alone and separate, at a body temperature, one hour before eating, according to the plan which I have often demonstrated to you. As remarked in my last lecture, the vegetable kingdom contains proteid sufficient for the system, and the diet should be so arranged as to give the requisite quantity of calories, in proper proportion, of vegetable protein, carbohydrates, and fats: the latter is accomplished largely with butter, of which a quarter of a pound may be taken daily. Many writers on diet hold that the protein in casein acts differently from that contained in meat, and this is allowed in many vegetarian dietaries: it also contains phosphorus, which is an integral part of living cells, especially their nuclei. When nutrition seems to demand it, this can, perhaps, be added to the diet, mixed with cereals or in soups, and a small amount of certain kinds of cheese is also sometimes allowable. It is impossible to elaborate the details of diet fully in a lecture such as this, and I must refer you to the many excellent works on food and nutrition (Hutchinson, Sherman, Thompson, Buttner, Braithwaite), for further information.

The _medical treatment of cancer_ patients is a matter which should receive most careful and constant attention; indeed, the patient in whom cancer is threatening or has developed should be under the watchful and unremitting guidance of a physician who grasps the importance of the matter and is prepared to guard the health, and to meet and correct functional disorders as they arise; for a careful study of patients with cancer for many years has constantly shown me gross errors in their life and in the action of various organs, and consequently disorders of metabolism which are of weight in connection with the disease.

The first point of importance to which I wish to call your attention is in regard to the action of the bowels. Some of you may remember that even that great surgeon, Sir Arbuthnot Lane, has recently emphasized the fact that one of the terminal results of intestinal stasis may be cancer. This may seem strange, but it would surprise you if you knew how very commonly there was imperfect intestinal excretion, or intestinal stasis, as it is now called, in these subjects; indeed, I might almost say that it is the rule, and that this assuredly plays a most important part in the auto-intoxication which leads up to cancer; in fact, I almost feel like saying that the toxins produced by the millions of micro-organisms generated through intestinal stasis and fecal putrefaction are the real, incidental cause of cancer. Under a perfect vegetarian diet there is less likelihood of trouble in this direction, but even then there is necessity of watching continually, that there may be at least, one, full, free movement of normal character, daily, after breakfast. In many cancer patients I have secured this by having the entire potato eaten, skin and all, whether boiled or baked; by this means also one gets the full value of the inner layer of skin, which contains the mineral salts so necessary to the economy, which are entirely lost when the potatoes are peeled before boiling; so that potatoes should always be cooked in their skins, even if the outer layer is stripped off afterwards.

But the regulation of the bowel action should not be left to the judgment and action of patients, with a spasmodic use of remedies, and with alternate constipation and purgation; the physician himself should carefully guide and direct the proper treatment frequently enough to secure perfect results. Of course each one may have their own ideas and methods, but I have long used with the best results the remedies which you have often heard me order in this clinic. Thus, at the beginning of treatment, and often on the same days of many succeeding weeks, I give ℞ Ext. Colocynth. Co., Mass Hydrarg ‾aa‾ gr. x Pulv. Ipecac gr. ‾ij‾ M. Div. in Capsules No. IV. Sig. Take two at night and two on the second night after. For continuous use, or in the nights between these, I have long used a compound Cascarin tablet (℞ Podophylin, Aloin, Cascarin ‾aa‾ gr. ¼) one or more each night, or have depended on the Cascara in a mixture of which I shall shortly speak. I do not like the action of salts or laxative mineral waters in these cases, and, of course, enemata are entirely useless to secure real, effective liver and intestinal action, and should be used only in an emergency.

The action of the _kidneys_ is also always a very important element to watch and control in cancer patients; this does not have reference to albumen and casts, or glycosuria, but to a functional derangement of the secretion: for the former are relatively infrequent compared to the latter. This is so large a subject that time does not permit of its elaboration; I made the matter pretty clear to you in my lectures not long ago on the relations of diseases of the skin to internal disorders. I must tell you, however, that, as a result of numberless studies of the urine of many cancer patients, I have almost constantly found a deficient or defective urinary secretion: in many cases I have had the total daily amount accurately measured, and reported in writing each week over long periods, and while the total quantity may at times be near normal, the total solids sometimes fall to, and remain at, even less than one-half the amount which should be passed for the patient’s body weight.

I want here to urge upon you the importance and value of repeated volumetric examination of all possible ingredients of the urine, as indicating in the best manner obtainable the state of the arterial blood, from which the urine is derived: especially is this true of the exact volumetric acidity, representing the diminished alkalescence of the blood common in cancer.

The actual medicinal and dietary treatment of the various possible departures from normal can hardly be elaborated here, but they are along very much the same lines which you have often watched in connection with certain diseases of the skin; for you must remember that carcinoma is an epithelial disease, and that the laws of nutrition are much the same for this as for various other morbid conditions of the economy. I may say, however, that very many of my cancer patients have received the greatest benefit from acetate of potassa, often in the formula familiar to you (℞ Potass. Acetatis ℥i Tinct. Nucis Vomic ʒiv Extr. Cascar. fld. ʒ‾ij‾-ʒiv Extr. Rumicis radicis fld. ad ℥iv M. Sig. One teaspoonful half an hour before eating, well diluted). For many years I have administered potassa largely to these patients, and it is gratifying to find not only support but an incentive to its greater use, in the studies and experience of Ross, who pushes it to a very great extent, giving as high as 240 grains of potassium phosphate in a day. Ross also advises the free use of crude or brown sugar, as it contains a large proportion of potassium salts, which are for the most part removed from the white or refined article. I must also remind you of the great value of Bethesda water, in washing out the kidneys, given a tumblerful with each meal, and one tumblerful, hot, one hour before breakfast and also an hour before the evening meal.

The _blood_ should also be watched, and in my hospital cases I have a count made every week; for the hæmoglobin content, and the number of the erythrocytes, and the percentage of the varieties of leucocytes afford very valuable information as to the physical state of the patient, and the progress or recession of the cancer, and in a measure these data are of value in directing therapy. I have also the _weight_ of the patient taken and recorded each week, as a guide to nutrition and dietary matters. Also the _saliva_ is tested and recorded before and after each meal, and furnishes an indication in regard to the administration of alkalies.

Iron is found to be greatly wanting in the blood and tissues late in cancer, and should always be an element in the treatment of this disease. Skene Keith, noticing that after a cancerous mass was removed the blood recovered in regard to hæmoglobin and erythrocytes, administered iron with arsenic, with the greatest benefit, the growth shriveling up and the patient gaining in weight; he recommends the citrate of iron and ammonia, the preparation which I have given to patients for many years past. He also advises hypodermic injections of iron, arsenic, and soda, and reports cases thus treated, some of them with good results. There is a loss of phosphates in these patients, and phosphate of iron or other phosphates are valuable.