Part 8

Reference was made to certain cases of recurrent cancer in the Hospital which had been under active medical treatment during the past year, with careful laboratory studies, but it is naturally too early to report anything very definite in regard to them, especially as most of them were desperate cases, which had advanced far beyond any possible operative relief. Moreover several of them remained but a short time under treatment, as it is very difficult to convince this class of patients that any possible benefit can accrue from anything but an operation, and this being impossible they often give up and leave, preferring to die at home; moreover the dietary restraint seems also very irksome and useless to them and their friends. In one particular patient, however, there was such a remarkable improvement that it is worth reporting to you.

Mrs. C. M. was first seen February 12th, 1914. Nineteen years previously she had an abscess of the right breast, which healed and left a tumor the size of a pigeon’s egg in the inner, upper quadrant of the breast; this remained quiescent until it began to enlarge, eleven months before it was removed at the New York Skin and Cancer Hospital, November 14th, 1912. The tumor was then about the size of a hen’s egg, with an area of skin the size of a quarter, attached to it: a second tumor was felt just below the nipple, which was not retracted, and the axillary glands were involved: there were no signs of metastases in the abdomen. A complete operation was then performed, with dissection of the glands in the axillary and supra-clavicular regions, and she was discharged January 16th, 1913.

On February 9th, 1914, she returned to the Hospital and was placed under medical treatment, with vegetarian diet. There was then an ulceration along the line of incision, from the second to the fourth rib, with many nodules around it, averaging a third of an inch in diameter, raised and reddened. The liver extended two inches below the edge of the ribs, with a hard and nodular margin; the right arm was enormously swollen and helpless. When she left the Hospital, June 20th, 1914, the ulcer had entirely closed, many of the cutaneous nodules had entirely disappeared, the arm had returned to normal size, like the other, by measurement, and the liver had retracted to a trifle below the margin of the ribs, with hardly any nodules to be felt. The treatment had included twenty-five X-ray exposures, from 8 to 10 minutes each, about twice a week, over three areas each time.

While in the Hospital careful laboratory investigations were made, according to a definite schedule. The _blood_, studied weekly, maintained a hæmoglobin of 80+ for over two months, then fell a little, and again rose. The erythrocytes were 3,262,000 on entering, and rose within two months to 4,282,000, then fell a little and rose again to almost 4,000,000: the leucocytes were 9,000 on entering, and fell to 5,200 just before leaving, the poly-nuclear 69 per cent. on admission, fell to 60 per cent., and again rose a little, and the proportion of the other forms remained about normal. The _urine_, volumetrically analyzed every three days, was kept a little below the normal acidity, and the specific gravity a little low, with a free daily amount of excretion, largely by Bethesda water: in spite of the vegetarian diet the urea excretion was not much below normal, and sometimes above, the chlorides were diminished, owing to the rather small amount of food taken, the phosphates varied a little above and below normal, there was never any indican, and the sulphates averaged a trifle below normal. The _saliva_, tested before and after each meal, was acid at first, but became neutral and alkaline off and on. The _weight_, taken weekly, fell a little from the first, but maintained a good level, and rose a little before she left the Hospital.

This was a very difficult patient to manage, as she was a very ignorant Polish woman, who often rebelled at the diet, and wearied of the routine and restrictions imposed; she left the Hospital June 20th, 1914, against my wish, but with as great a change in her physical condition and disease as could be imagined, after about four months and a half treatment, carried out under disadvantageous circumstances.

One other case, seen recently, where the disease was recurrent after three operations, deserves mention, although it will be some time before any decisive result can be reported.

Mrs. W. C., aged 45, was first seen September 17th, 1914. Nearly four years previously she had noticed a lump in the left breast which was removed on January 6th, 1911, but it soon regrew, and a complete operation was performed at the New York Skin and Cancer Hospital, May 30th, 1911. Two years later there was some return, and she was again operated on at the Hospital, May 30th, 1914. About two months before her first visit, September 17th, 1914, a swelling of the sternum was noticed, and soon another above it, both of which increased pretty rapidly to the time of her visit. When seen there was a hard mass in the scar over the sternum, about an inch and a half long, raised a quarter of an inch or so, reddened and immovable: an inch or so above it was another, smaller one, not reddened: they were not particularly painful on moderate handling, but painful when at hard housework. When last seen, December 7th, both lumps had subsided fully one-half, there was no pain at any time, and her general condition had improved immensely, she feeling better than she did four or five years ago, that is, before the beginning of the cancerous development: she has been working all the time, unusually hard, as janitor of four buildings and also going out scrubbing and washing. She weighed 157¼ pounds when first seen, then ran down to 154, but is again gaining, being 155½ at her last visit. The outcome of this case it is, of course, impossible to conjecture, for one can seldom be sure that patients will be absolutely faithful to treatment, for a long enough time, but certainly the change in the woman and in the lesions in this two months and a half has been remarkable, compared with the increasing development of the disease in the two months previous.

I must mention one more case, which, although fatal, exhibited some of the good results of careful medical treatment even when a primary case had advanced far beyond the possible aid of surgery.

Mrs. M. B. J., aged 68, a private patient, was first seen on February 17th, 1914. Two years previously she noticed a lump in the upper part of the right breast, after great and repeated mental distress from the death of a number of very near relatives, and a sister’s mental derangement; the great nervous strain had been attended with various bilious attacks and nervous indigestion. The mass increased steadily in size and was kept concealed even from her family, until the day before she called, when her family physician who was consulted saw that it was far beyond the possible hope from any operation, in which view a surgeon concurred.

When seen the whole breast was involved, was double the size of the other, hard, immovable, and with an adherent crust over an ulcerating surface on its lower half, several inches in diameter, from beneath which was a moderate discharge: the axillary glands were enormously enlarged, as also the supra-clavicular, and she was strongly cachectic. She was placed on an absolute vegetarian diet, with no coffee or tea, and appropriate medical treatment, and the breast kept painted with fifty per cent. ichthyol and water, care being taken not to disturb the adherent crust. In a very short time the discharge ceased, and the protective crust adhered until her death from exhaustion, with pulmonary œdema, on September 9th, 1914. On August 15th it was recorded that the breast had done very well, that it was soft and movable, and not larger than the other breast, with no discharge, and no pain since a short time after beginning treatment: the axillary glands had diminished three-quarters in size, and the supra-clavicular glands were also very much smaller.

And now, gentlemen, my task is done. I have tried to let you see cancer through my spectacles, as I have seen it for very many years past, and to share with me my optimism in regard to the prophylaxis and cure of cancer, if only there can be sufficient enlightenment in the profession and public: and I must tell you that in collating and preparing the material to support my long held views I have expended very much more time and labor in study, for some months past, than I could have believed possible. But as the subject developed, and as I discovered more and more support for my thesis, there was a fascination about the work which I could not resist; and if I have tried you with the many details of proof presented I beg that you will pardon me: for I wanted to present the subject so strongly that my hearers, at least, would accept the propositions I have developed, and believe what I have said in regard to my own experience with the terrible disease under consideration, and act upon both, and thus aid some sufferers with cancer.

From my recent article on “The Relation of Diet to Cancer” many medical journals have quoted me as ascribing the disease wholly to the use of meat, but you who have heard these lectures now know that animal proteids are only one of the contributing causes.

I have tried to make it plain that metabolic errors, inducing a vitiated blood stream, are the basic cause of the aberrant action in the cellular elements of the body which may ultimately lead to malignant disease; and I have tried to show that there are many elements connected with modern so-called civilization which conspire to effect this end. I have quoted many who were well acquainted with cancer, who believed that luxurious living, which includes much animal food, coffee and tea, and alcohol, with indolence or want of sufficient muscular activity to burn up the waste products, and the persistent neglect of hygienic laws, should be placed first among the causes of cancer: but I have also mentioned that the refining and preparation and cooking of food prevented a proper supply of the mineral and other elements of nutrition, and also that nervous influences could so disturb the action of the organs of the body that they could not perform their functions perfectly in the elaboration of nutritive material, etc.

But I cannot go over again all the matter already given in these lectures, and only mention these to remind you that there is no one single cause of cancer, and consequently that its prophylaxis and cure can never be found in any one single remedy; hence I can never believe in the sole use of thyroid, much less in the idea that sero-therapy can overcome a disease dependent upon the continued operation of so many causes; and still less can I believe that the mere cutting out of an already diseased portion of the body is the proper and only means of overcoming such a malady as cancer.

I have acknowledged that local irritation of many kinds may be the proximate cause for the development of a malignant tumor in any particular locality, as Ewing has so clearly shown in his excellent resumé on pre-cancerous lesions; but I have also contended that we should withal look into and overcome the cause; why, when once started by local injury the cells should pursue such a progressive, aggressive, and invasive course; and this is found, I believe, in the disturbed character of the fluids which provide them with nourishment for their abnormal growth.

From this study of cancer in regard to its nature, frequency, geographical distribution, metabolism, dietetic relations, medical treatment, and clinical considerations, what conclusions can be drawn? Have we solved the problem of cancer? Far be it from us to make any such claim. Scientific research and study must still go on in the laboratory, but clinical research and study, with laboratory work, on the human subject, which have not been hitherto sufficiently cultivated, should be pushed, so that by a mass of carefully recorded observations the truth or falsity of what has been here quoted and said may be refuted or confirmed.

From the enormous work which has been done on cancer with the microscope and the test tube, it would seem sometimes that research workers have become somewhat myopic, and not farsighted enough to recognize the true value of statistical studies and clinical observations. In these lectures we have attempted to make a brief synthetic study of some of the work which has been done in connection with cancer, and from this we believe that certain conclusions can be drawn; if these are correct and followed, it is hoped that much more can be accomplished in regard to the prophylaxis and cure of this more than threatening, fatal malady. In order that you may hold clearly the points which have been made I want to give you a synopsis or conclusions of them, as they have been brought out in this and preceding lectures.

1. Cancer is but a deviation from the normal life and action of certain of the ordinary cells of the body, which, for some as yet unexplained reason, take on an abnormal or morbid action; with this there is a continued tendency to a malignancy which invades contiguous tissue, and in the end tends to destroy life.

2. There is some reason to believe that this action first takes place in what are known as “embryonic rests,” or pre-natal, wrongly placed tissue elements, which, however, are now shown to exist in every one, in many localities: but the reason why they take on this malignant action, and form cancer, has not been satisfactorily explained.

3. Cancer is _not_ wholly due to traumatic causes, although those play a not inconsiderable part in its occurrence in certain localities and cases.

4. It is pretty conclusively decided that cancer is _not_ caused by a micro-organism, or parasite.

5. It is also known clinically and experimentally that it is _not_ contagious.

6. _Nor_ is it hereditary in any appreciable degree.

7. Occupation has _not_ any very great influence on the occurrence of cancer, although it is more frequent in some pursuits than in others.

8. Cancer is _not_ altogether a disease of older age, although its incidence is greatly increased with advancing years.

9. It does _not_ especially belong to or affect any particular sex, race, or class of persons.

10. It is _not_ confined to any location or section of the earth, but has been observed in all countries and climates.

11. No single cause of cancer has yet been demonstrated, nor is it likely that this will ever be the case, as the experimental and other investigations have covered almost every possible line of research, with only _negative_ results.

12. The exclusion of almost every other possible cause of cancer, as well as its pathological history, leads to deranged metabolism as the only remaining possible etiological element; this acts by inducing changes in nutrition, which latter depends on diet and the proper action of the secretory and excretory organs, which, still further, may be affected by nervous influences.

13. While the bio-chemistry of cancer throws little light on its true nature, enough is known to show that the morbid changes in the cells are largely associated with deranged metabolism.

14. The blood, in advancing cancer, manifests changes which indicate vital alteration in the action of the organs which form blood and control the nutrition of the body and its cells.

15. Clinical and experimental evidence demonstrate that the secretions and excretions of the body exhibit departures from normal, which, while not pathognomonic of cancer, indicate metabolic disturbances involving the nutrition of the cellular elements, which disturbances are of importance.

16. The evidence seems certain that the cancer mass itself, when fully developed, secretes a poison which tends to augment its own growth and hastens the lethal progress of the disease.

17. Cancer mortality is undoubtedly on the increase in every portion on the globe.

18. This increase seems to vary inversely with the decline of tuberculosis, in many localities.

19. The incidence of cancer seems to follow closely along the lines of modern civilization.

20. This extension of cancer seems to depend largely upon the altered conditions of life, particularly along the lines of self-indulgence in eating and drinking, and indolence.

21. The augmentation in the consumption of meat, coffee and alcoholic beverages appears to be coincident with a very great, and proportionately greater, augmentation of the mortality from cancer.

22. The nerve strain of modern life seems to be an element of importance, both through disturbance of metabolism, and by direct action on morbidly deranged cells.

23. No single remedy for cancer will probably ever be discovered, since it is conceded that there is no single cause for the disease.

24. Surgery has improved materially the statistics relating to the mortality of operative cases; but the total achievements along this line are insignificant compared with the general ultimate mortality of over 90 per cent. of those once afflicted with cancer.

25. Surgery has had, and may long have its function to perform in removing the products of the disease, more or less efficiently, curing some and prolonging the life of others, but it can never hope to lessen greatly the morbidity of cancer.

26. The X-ray and radium, as also caustics, are in the same position as surgery, and can do relatively little more than cause to disappear lesions which have developed from causes which they cannot reach.

27. With all these means the measure of success, aside from the technical skill of the operator, largely depends on the time or period of development of the malignant tumor before treatment; the earlier the removal is undertaken, other things being equal, the greater the possibilities of success.

28. The same is true in regard to the treatment of the disease by means other than those mentioned: the earlier the morbid process leading to tumor formation is attacked by dietetic, hygienic, and medicinal measures, the greater the promise and expectation of success, present and permanent.

29. The prevention of cancer, therefore, or the checking of its increasing occurrence, depends largely upon the early enough adoption of such measures as will limit the agencies which induce a derangement of the body juices which tend to bad nutrition and derangement of the body cells.

30. The simple life, with the avoidance of the dietetic and other causes which have been found to induce cancer in nations and individuals, promises the best hope for the arrest of the rapidly increasing development of cancer throughout the world.

31. It is more than possible, however, that the long continued operation of many baneful causes has produced such a degeneration of tissue in the human race, that it will take a generation or more of proper living to make the beneficial impression on the general incidence of cancer which is so longed for.

BIBLIOGRAPHY[2]

1. ABDERHALDEN—Defensive Ferments. New York, 1914.

2. ABERNETHY—Surgical Observations on Tumors. Lond., 1816, 221.

3. BAINBRIDGE—_Medical Record_, 1909, LXXVI, 85.

4. BAINBRIDGE—The Cancer Problem. New York, 1914.

5. BANKS—_Lancet_, 1900, I, 684.

6. BEARD—The Enzyme Treatment of Cancer. Lond., 1911.

7. BEEBE—_New York Medical Journal_, 1910, LXXXII, 1058.

8. BELL—Cancer: Its Causation and Its Curability Without Operation. London, 1903.

9. BENEKE—_Berl. Klin. Wochenschr._, March 15, 1880.

10. BENRATT—_Indian Med. Gaz._, 1908, XLIII, 452.

11. BIEDL—The Internal Secretory Organs. New York, 1913.

12. BLUMENTHAL—Handb. d. Spezial Pathol. d. Harns., 1913, 263.

13. BRAITHWAITE—_Lancet_, 1902, I, 400.

14. BRAITHWAITE—Plainer Food and Less of It. London, 1908.

15. BRISTOL—_Medical Record_, 1913, LXXXIII, 787.

16. BULKLEY—Relations of Diseases of the Skin to Internal Disorders. New York, 1906.

17. BULKLEY—Some Problems in Metabolism, _Jour. Cutan. Dis._, 1911, XXIX, 217.

18. BULKLEY—Diet and Hygiene in Diseases of the Skin. New York, 1913.

19. Bureau of Agriculture, 28th Annual Rep. Washington, 1911.

20. BURNHAM—Hæmocytes and Hæmic Infections, 1913; 92; 138.

21. BUTTNER—A Fleshless Diet. New York, 1910.

22. CAHEN—_Deut. Zeitschr. f. Chir._, 1909, CXIX, 415.

23. CHITTENDEN—Physiological Economy in Nutrition, 1904.

24. COHNREICH—Folia Hæmatologica, 1913, XVI, 307.

25. COOPER, SIR ASTLEY—Lectures on Surgery, Boston, 1825.

26. DE BLOEME, SWART, and TERWEN—_Munch. Med. Wochenschr._, 1914, LXI, 1718.

27. DEGREZ—_Gaz. Med. de Paris_, 1913, LXXXIV, 400.

28. EINHORN, KAHN and ROSENBLUM—_Arch. f. Verdauungskr._, 1911, XVII, 557.

29. EWING—Cancer Problems, Report of the C. P. Huntington Fund for Cancer Research, Vol. II, 1908.

30. EWING—_Medical Record_, 1914, LXXXVI, 951.

31. GRUNER—Biology of the Blood Cells, 1913, 153; 260.

32. GWYER—_Ann. of Surgery_, 1907, XXXXVI, 86; 643, 1908, XXXXVII, 506; 631.

33. HAIG—Uric Acid as a Factor in the Causation of Diseases. Phila., 1908, 420.

34. HAIG—_Brit. Med. Jour._, 1912, II, 81.

35. HARROWER—Practical Hormone Therapy, 1914, 29.

36. HISLOP AND FENWICK—_Brit. Med. Jour._, 1909, II, 1222.

37. HUTCHINSON—Food and Dietetics. New York, 1911, 324.

38. ISENBERG—_Monotschr. f. prakt. Wasserheilk_, 1910, XVII.

39. JANEWAY—_Sajous’ Anal. Cyclopedia of Pract. Med._, 1912, II, 753.

40. JOHNSON—_Brit. Med. Jour._, 1900, II, 982.

41. JONES—_Arch. Middlesex Hosp._, London, 1911, XXIII, 72.

42. KAHLE—_Munch. Med. Wochenschr._, 1914, LXI, 752.

43. KEITH—Cancer: Relief of Pain and Possible Cure. New York, 1908.

44. KEITH—_British. Med. Jour._, 1909, II, 140.

45. KESSLER—_New York Medical Journal_, 1912, XVIC, 1122.

46. LAMBE—Additional Reports on the Effects of a Peculiar Regimen of Cancer. London, 1815.

47. LITTLE—_Boston Med. and Surg. Jour._, 1914, CLXXI, 587.

48. MAYO, W. J.—_Annals of Surgery_, 1914, LIX, 805.

49. MCCANN—Starving America. New York, 1912.

50. MCGREGOR—_Brit. Med. Jour._, 1900, II, 982.

51. MERRIAM—_St. Louis Courier of Med._, 1884, XII, 385; _New York Medical Journal_, 1912, XVIC, 378.

52. Mortality Statistics, Bureau of the U. S. Census, 1911, 1912.

53. MURPHY’S Clinics, Aug. 1912, Dec. 1912, Aug. 1913, Oct. 1913, Dec. 1913, Feb. 1914, June 1914.

54. NOWELL—_New England Med. Gaz._, 1914, XLIX, 461.

55. PACKARD—_Boston Med. and Surg. Jour._, 1912, CLXVI, 452.

56. PAGET—Lectures on Surgical Pathology. Philadelphia, 1854, 632.

57. PARKER—Cancer. New York, 1885.

58. REID—Cancer Research Laboratory, Manchester _Medical Chronicle_, Nov. 1912, and April 1914.

59. RENNER—_Brit. Med. Jour._, 1910, II, 587, also 1911, I, 110.

60. ROBERTS—Lectures on Dietetics and Dyspepsia. London, 1886, II Edition.

61. ROBIN—_Bull. Gen. de Therapeutique_, 1913, CLXVI, 433.

62. ROHDENBURG, BULLOCK, and JOHNSON—_Arch. of Int. Med._, 1911, VII, 491.

63. ROSS—Cancer, Its Genesis and Treatment. London, 1912, 88.

64. ROUS—_Jour. of Exper. Med._, Lancaster, Pa., 1914, XX, 433.

65. RUSSELL—Preventable Cancer. London, 1912, 96.

66. SAJOUS—_Monthly Cyclop. and Med. Bull._, 1912, V, 219.

67. SAJOUS—Internal Secretions, Vol. I, 785.

68. SALEEBY—The Conquest of Cancer. New York, 1911.

69. SANDWITH—_Clinical Journal_, 1910, XXXV, 409.

70. SCHMIDT—_Medizin Klinik_, 1910, VI, 1690.

71. SHERMAN—Chemistry of Food and Nutrition. New York, 1911, 260.

72. SHERRINGTON and COPEMAN—_Brit. Med. Jour._, 1910, II, 787.

73. SHIRLAW—Liverpool _Medico Chir. Jour._ 1913, XXXIII, 398.

74. SOEGARD—_Zeitschr. für Krebsforsch_, 1913, XIII, 89.

75. STUART-LOW—_Lancet_, 1909, II, 1138.

76. SWEET, CORSON, WHITE, and SAXON—Proceed. Soc. for Exper. Biol. and Med. New York, Vol. X, 175.