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Title: Cancer—Its Cause and Treatment, Volume 1 (of 2)
Author: Bulkley, Lucius Duncan
Language: English
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                                 CANCER
                                  ITS
                          CAUSE AND TREATMENT


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

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

[Illustration]

                                NEW YORK
                             PAUL B. HOEBER
                                  1915



                            Copyright, 1915
                           BY PAUL B. HOEBER

                      _Published, February, 1915_


                          Printed in U. S. A.



                                   To

                             THE GOVERNORS

                                 of the

                   NEW YORK SKIN AND CANCER HOSPITAL

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

                              DERMATOLOGY

                     this little book is inscribed



                                PREFACE


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

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

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

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

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

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

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

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

 January, 1915.
   531 Madison Avenue.



                                CONTENTS


                                                           PAGE

                               LECTURE I

         NATURE OF CANCER                                    15


                               LECTURE II

         FREQUENCY AND GEOGRAPHICAL DISTRIBUTION OF CANCER   43


                              LECTURE III

         METABOLISM OF CANCER                                70


                               LECTURE IV

         RELATION OF DIET TO CANCER                         106


                               LECTURE V

         MEDICAL TREATMENT OF CANCER                        135


                               LECTURE VI

         CLINICAL CONSIDERATIONS AND CONCLUSIONS            170

         BIBLIOGRAPHY                                       211

         INDEX                                              221



                                 CANCER
                                  ITS
                          CAUSE AND TREATMENT



                               LECTURE I
                            NATURE OF CANCER


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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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.

Williams has also made some most interesting studies in regard to the
increase of cancer in connection with changed conditions of life, and
from his analysis of statistics, he very clearly shows that the spread
of the disease has closely followed urbanization, and the rapid increase
in material prosperity of recent years: in England where 80 per cent. of
the population are now town dwellers, this tendency to collect in cities
and towns has gone farther than in any other community. He recognizes
that any far-reaching, environmental change of some duration is probably
potent in disturbing the stability of the constituents of living bodies,
and the sudden change from poverty to riches and plenty is conducive to
the development of cancer: allusion has already been made to the inverse
relation of deaths from cancer and tuberculosis, the latter diminishing
with improved material conditions, while the former increases as wealth
and indolence increase.

He shows this by statistics from various localities, and by data from
towns in different countries he makes it pretty clear that “Cancer
mortality is lowest where the conditions of life are hardest, the
surroundings the most squalid, the density of population greatest, where
the tubercle mortality is highest, the general and infantile mortality
greatest, and where sanitation is least perfect—in short, among the poor
of the industrial class in our great towns: whereas among the wealthy
and well-to-do, where the standard of health is at its best and life is
easiest, and where all the conditions of life are just the reverse of
the foregoing, there the cancer mortality is highest.”

While this is a pretty strong statement and many exceptions could
undoubtedly be found, careful investigation will show it to be true in
the main; for it must be remembered that even among the poorer classes
gluttony, especially in regard to proteids, is not at all uncommon, and
indolence, with impeded metabolism, is not at all unusual. Dr. Latham
found that the mortality from cancer in England, from 1881‒1890, was
more than twice as great among well-to-do men having no specific
occupation, as among occupied males in general, the respective mortality
ratios being 96 for the former and only 44 for the latter. Sir William
Banks confirms the steady increase in cancer very strongly, which he
attributes to richer and more abundant food, of which males eat more
than females, and consequently cancer is increasing proportionately more
among men, as all statistics show.

Switzerland is reported to have the highest death rate from cancer of
any country, it having augmented from 114 per 100,000 living in 1889, to
132 in 1898. There again the cancer mortality varies greatly in the
different sections or cantons: thus, in wealthy Lucerne it is 204 per
100,000 living, and only 36 in poverty stricken Valais. In the city of
Geneva it is 177 per 100,000 living.

Denmark, next to Switzerland, is reputed to have the highest cancer
death rate of any country in Europe, viz.: 130 per 100,000 living in
1900. But here the statistics are only from the towns, which comprise
but a quarter of the whole population: the per capita wealth is said to
be higher there than any other country in Europe except France.

France shows a high cancer mortality, with a constantly increasing death
rate; and, next to England, France is the richest country in Europe, and
wealth is much more widely diffused: the French workers own nearly 8
times, per capita, more than those in England. In Paris the cancer death
rate has increased as follows, for each 100,000 living, in 1865, 84; in
1870, 91; in 1880, 94; in 1890, 108; in 1900, 120.

Italy, a comparatively poor country, shows a low cancer mortality, but
even here it is increasing from 20 per 100,000 living in 1880, to 52 in
1899, and 58 in 1905. The consumption of meat is there the smallest in
any European nation, namely 23 pounds per capita in 1895. In the chief
towns the rate of death from cancer is high: thus for each 100,000
living, in Florence 137, Ravenna 120, Venice 103, Milan 101, and Rome
77.

Time does not permit a wider survey of the field of distribution of
cancer, as presented so remarkably from official statistics by Williams,
and Wolff; but in connection with the high percentages of deaths above
quoted among the richer classes it may be interesting to mention some of
the lowest records. Thus, in the poor country of Kerry, Ireland, it was
27 per 100,000 living, in the province of Dalmaltia 19, in the Shetland
Islands 16, in Servia 8 (from 1895 to 1904), and in Ceylon in 1903 the
mortality from cancer was about 6 for each 100,000 living.

The United States, unfortunately, has not kept the vital statistics of
the country in years past with anything like the fullness and accuracy
which has obtained in England, nor even at the present time is it
possible to learn definitely the frequency and increase of cancer in
every locality. But all the statistics which have been gathered show
unequivocally that the disease has steadily increased in a manner which
is alarming. Analyzing the recorded deaths from cancer in thirty-one
cities, and the percentage of increase in four years, one writer
estimates that, if the same increase is continued, by the end of the
century there will be a death rate, approximately, of 1000 in every
100,000 inhabitants, or one in every hundred.

In a recent Bulletin of the Board of Health of New York City the
following statements are made in regard to the mortality from cancer in
1913: “The statistics of our seven largest cities recently tabulated,
show that the cancer death rate was the highest on record. For New York
City the rate was 82 per 100,000 of the population, against an average
of 79, for the last five years: for Boston 118 against an average of
110: for Pittsburgh 79, against an average of 70: for Baltimore 105,
against an average of 94: for Chicago 86, against an average of 81: for
Philadelphia 95, against an average of 88: for St. Louis 95, against an
average of 85.” This average increase of almost 8 per cent. of deaths
from cancer in the combined population of these seven cities, during the
last five years is certainly an alarming fact, and cannot be explained
on the ground of greater accuracy of diagnosis: for it is not to be
presumed that there has been such great improvement along diagnostic
lines during the single year 1913.

It is difficult to state the exact prevalence of cancer in the entire
United States, as the “registration areas” include only about two-thirds
of the total population: much can be learned, however, from the annual
volumes published since 1900. According to these Mortality Statistics of
the United States, the deaths from cancer and other malignant tumors per
100,000 population were as follows: in 1900, 63, in 1904, 70.2, in 1909,
73.8; and in 1912 there were 46,531 deaths from cancer, or 77 per
100,000 population, an increase in the death rate from this disease of
almost 25 per cent. since 1900; while, as before stated the tuberculosis
mortality had fallen a little over 25 per cent. in the same period.

As in other countries, which might also be expected from the statements
already made, the disease varies in frequency in different localities
and communities. Thus, cancer is stated to be much more prevalent in the
northern than in the southern states, and as already stated, the negroes
are much less subject to the disease than whites, especially when they
are living their own natural home life; but when they come to the
cities, as waiters, etc., in hotels, their cancer death rate increases.
But even in New York City in 1912 the deaths from cancer in negroes was
1 in 32.2 total deaths, against 1 in 17.7 in whites; the mass of negroes
here, of course, live plainly and work hard. The North American Indians
also are believed to be almost exempt from cancer in their primitive
savage condition, but as they have come under the influence of
civilization they are more affected. It has also been noted by several
observers that immigrants and their descendants present a very much
higher mortality from malignant diseases than prevails in their native
countries; from these and other considerations Williams suggests that
abrupt change of environment may also be a factor in the causation of
this disease.

We have thus seen while cancer is very widely distributed over the globe
it is present in varying degrees of severity in different localities,
and careful analysis shows that the disease affects different classes of
persons with unlike severity. All these statistical studies and
observations serve to confirm the statement made earlier that cancer is
a disease of so-called civilization, and that it has increased in
proportion as human beings have come under the influence of wealth, and
consequent luxury and overindulgence, with bodily inactivity; all these
elements lead to a disturbed metabolism, which as we shall see later,
is, at least, a contributing cause to the deviation from normal of some
of the cellular elements of the body. It also appears that some of these
metabolic shortcomings have to do with a disturbed nitrogenous balance,
which is due to the constantly increased consumption of meat. In 1909
the meat consumption in the United States had reached the high figure of
172 pounds per capita, as I learned recently from Washington, a far
greater amount than in England, 130 pounds, as already stated; and with
this steady increase in the use of nitrogenous food cancer has also
increased by leaps and bounds in both countries.



                              LECTURE III
                          METABOLISM OF CANCER


In the first lecture we saw that cancer was an alteration of the normal
cells of the body, whereby they take on a malignant action and continue
to do so, destroying contiguous tissues and leading to a lowered
vitality, with an apparent poisoning of the system, which finally causes
death. As the cells of various organs furnish different secretions,
which in health contribute to proper metabolism, resulting in growth or
maintenance of the tissues, so these disordered cells are believed to
secrete a toxic substance, or malignant hormone, which has a prejudicial
action on the body, and hæmolytic action on the blood, as has been
brought out pretty clearly by Troisier and others.

We saw that as yet the definite cause had not been determined, why at
some period certain cells take on the action which we call cancer, nor
why they persist in their destructive course. Long continued and
abundant laboratory and clinical research have about decided certain
questions negatively in regard to its etiology, so that in a measure the
field is cleared for the study of some of the possible basic causes of
the disease in question. Thus, all are pretty well agreed that cancer is
_not_ contagious or infectious, that it is _not_ caused by a
micro-organism or parasite, that it is _not_ wholly due to local injury,
that it does _not_ appertain to any particular occupation, that it is
_not_ hereditary to any great degree, that it does _not_ especially
belong to or affect any particular sex, race or class of persons, _nor_
is it confined to any location or section of the earth, and that it is
_not_ wholly a disease of older age.

We saw further that there appeared to be good evidence that certain
misplaced “embryonal rests” were the original starting points of
diseased cell action, but as these are now known to exist in every one
from birth, this offers no real explanation of the occurrence of the
disease at different times in life. It is, of course, quite possible
that local injury of one kind or another may be the exciting cause which
determines that a cell or group of cells shall revert to its original
reproductive activity, as Williams contends that the process is one of
agamogenesis, dependent upon excessive and faulty nutrition. The
question as to the relation of uricacidæmia, or lithæmia, to cancer has
never been fully studied, and it is worth considering whether, as in
gout and rheumatism, to which cancer is often associated and perhaps
closely allied, the exciting cause may not be the lodgment somewhere of
uratic deposit, which is further excited and fed by effete or
imperfectly oxidized nitrogenous elements; for later we shall see that
perverted metabolism, largely of proteid elements, is closely associated
with cancer.

We noted also that some attributed cancer to independent cell action,
relating to the polarity of cells, etc.; but it is inconceivable that a
cell or cells can idiopathically start out on a rampant course and
pursue it with increasing severity, even until death results, without,
at least, some definite pre-disposing cause, even though diligent and
earnest work has not as yet determined just what that cause may be. The
error has been, we believe, in searching too exclusively by the
microscope and by certain laboratory methods, and not sufficiently along
clinical and bio-chemical lines. For it must be recognized that all the
cells of the body are continually bathed in the vitalizing fluid of the
blood, whence they derive their nutriment, and into which, with the
lymphatics, they return the products of their vital action, by anabolism
and catabolism.

By exclusion, therefore, we are reduced to seek the etiology of cancer
along other lines, and about all that is left is metabolism, as
influenced by advancing, so-called civilization, which relates very
largely to diet and mode of life. This we will take up later, but will
first examine some of the scientific findings in regard to the blood in
cancer, and data relating to the various secretions and excretions of
the body bearing upon metabolism in this disease.

That the blood shows great changes in advanced cancer is recognized by
all, as is clinically manifested by the intense cachexia and anæmia
commonly present and always strongly marked toward the end, of which the
cytology has been very fully studied and presented by Türk. When then
examined there is found to be a marked reduction of red cells, low
hæmoglobin index, and distinct leucocytosis, with greatly diminished
alkalescence.

The reported changes in the blood have also varied with the location of
the malignant disease, according as it may interfere mechanically or
otherwise with the function of certain organs, which fact naturally
obscures the question of the true relationship of the blood to cancer.
Thus, it is stated that in cancer of the liver and pancreas there is
always leucocytosis and glycogen, and that “cancer appears to interfere
greatly with the function of the liver as a destroyer of intestinal
toxins, they pass into the general circulation, probably cause the
glycogen reaction, and at least part of the leucocytosis, and very often
give rise to fever.” There are also other microscopical alterations in
the blood in late cancer. Thus, degenerative change in the leucocytes
are common, with derangement in the normal proportion of their different
forms, as also changes in the erythrocytes, with nucleated red cells and
megalocytes in severest cases.

Price Jones in a study of the blood in 30 cases of cancer (9 of the
breast) found the red blood cells diminished on an average of 6 per
cent., the white blood cells increased 38 per cent., lymphocytes
increased by 10 per cent., large mononuclear cells increased 164 per
cent. and polynuclears 42 per cent. Burnham states that in the severe
grades of anæmia with malignant disease, poikilocytosis is marked, and
nucleated cells of both normoblastic and megaloblastic type may be
present. The red corpuscles may be reduced to 2,500,000, and
exceptionally to 1,000,000. Cohnreich in a very technical study of blood
from cancer subjects, observed very great increase in the resisting
power of the red blood cells to osmotic tension, that is, in regard to
their hæmoglobin, which he believed to be of diagnostic value in
doubtful cases.

Unfortunately, there have been relatively few studies of the plasma of
the blood in this or other diseases; and yet the condition of this fluid
must be of the utmost importance, as from it are derived the nutrient
principles not only of the solid constituents of the blood, but also
those of the entire system, about 8 per cent. of it being serum albumen
and serum globulin. It also holds in solution the phosphates,
carbonates, sulphates, and chlorides, the latter often varying greatly,
and being chiefly responsible for the isotonic relation of cells and
serum. In cancerous cachexia a diminution of carbonic acid, a constantly
diminished alkalinity, and an increase of acid principles of the blood
have been fully demonstrated, pointing in all probability to the
existence of an acid intoxication. The formation of the corpuscular
elements of the blood must be greatly interfered with when metastases
occur in the blood making organs, the lymphatic tissue, bone, marrow,
and spleen, which probably occur more frequently than is generally
recognized. It seems that the toxic secretion from a cancerous mass has
a distinct action upon the blood, for after complete removal there is
often observed an increase of hæmoglobin, as I have witnessed, and a
high leucocytosis has disappeared after the removal of schirrus of the
breast, only to return again with the recurrence of the tumor.
Abderhalden states that in from two to three weeks after the operative
removal of cancer, certain defensive ferments can no longer be found in
the serum.

Many laboratory studies have been made upon the chemistry of cancer
tissue, seeking to determine the nature of the toxin produced, and its
experimental effect on animals, but thus far no great results have been
obtained. It has been observed, however, by Gruner that when cancer
juice is injected intra-venously a marked lymphocytosis arises, which is
followed by the appearance of large mast cell myelocytes in the blood.
This cancer juice is supposed to be autotoxic in cancer patients, and to
comprise toxic albuminoids, which being in quantities too great to be
quickly neutralized poison the system, especially the blood and the
hæmatopoietic organs.

In regard to the real bio-chemistry of cancer, we are still greatly in
the dark. Vast numbers of studies and researches have been made to
determine the real character and nature of the bio-chemical changes
which occur in cancerous tissue, and the mere recounting of the reported
findings and theories elaborated from them would occupy far more time
than can be profitably given in these lectures. Some have claimed very
positive findings which account in a measure, at least, for the
pathological conditions, while others, as Beebe, state that “the
chemical study of tumors is in its infancy. We have scarcely proceeded
far enough to know where the medical problems are, nor have methods now
available been perfected to such an extent as to enable a decisive
experiment to be made.” “No phase of metabolism,” says he, “has been
described in cancer which does not have a counterpart in non-cancerous
conditions. This applies to such questions as the nutritive relations
between the cancer cells and the normal body tissue, to the nitrogenous
balance, retention, elimination of sodium chloride, excretion of
acetone, the relation of ammonia excretion, and a possible acidosis.” He
adds, however, “Diet doubtless forms an important part in the growth of
cancer, possibly even in the origin of the disease.” It is encouraging,
therefore, to find that this able and careful laboratory investigator
recognizes, in a measure, the basic cause of diet, toward which all
evidence points so strongly, although the definite connection may not
yet have been established by laboratory methods.

In all our study in regard to the relation of diet to cancer it must be
remembered that there are divers elements and agencies which combine to
produce the many and various disordered conditions of the body, to which
we give the names of different diseases, and that cancer is no exception
to this general rule. For instance, in old-fashioned gout the patient
may have consumed an excess of Port and Madeira wine for years before
the system finally rebelled and acute gout resulted; and among the
causes for the systemic reaction we know that frequently it is great
mental strain or shock which has so disturbed metabolism that the wine
was no longer tolerated. Much the same is true in regard to cancer and
nitrogenous diet. And we will see later that mental disturbance and
nerve strain or shock often seem to be causative elements; also that
constipation, or intestinal stasis, is so common in cancer subjects that
it must be looked upon as one of the contributing causes among others,
to be mentioned later.

Although it is quite possible that many of the reported bio-chemical
changes found in primary cancerous tissue and metastases may not be of
etiological importance, it may be interesting to briefly refer to some
of them as indicating the vital alteration in tissues connected with
what we recognize as malignancy; even as in acute and chronic gout the
affected tissues exhibit abnormal conditions in regard to uratic
deposit.

Many writers, some of them dating back many years, agree that albuminous
constituents predominate in cancer tissue, and, as in actively growing
structures in general, sugar forming substances abound. Wolter states
that cancer of the breast contains 20 per cent. more nucleo-proteids
than the normal breast. Casein is also present in breast cancers, and
the abundance of fatty matters, contained in the cells of such
neoplasms, is well known. In regard to the proteids, Wolff, after many
studies, concludes that their character is identical with that of normal
tissues, and it is only the quantitative distribution of these that
differentiates the tumor from the physiological tissue. Wells agrees
with others that there is no very distinctive character in the
bio-chemistry of malignant tumors, but by reason of their excessive
chemical component, as compared with benign tumors, they naturally show
a high content of nuclear proteins; they, therefore, contain a high
proportion of phosphorus and iron.

Interesting observations have also been made on other characteristics of
cancerous tissues, such as the great abundance of enzymes of great
variety which are actively autolytic, also in regard to certain
relations of cholesterin, in regard to which Ewing has recently said,
“There appears to be something in the chemical or mechanical nature of
the irritation of cholesterin which is peculiarly effective in producing
atypical proliferation of epithelium”; this has been found to be no less
than 65 per cent. greater in quantity in fatty deposits, as in the
mesentery, in subjects of cancer than in healthy persons, etc., etc. It
would weary you to no purpose to attempt to refer further to the
bewildering mass of research studies in connection with the
bio-chemistry of cancer which are found in special literature: much of
it is fragmentary and some of it contradictory, but all has its value as
contributory to our knowledge of the actual conditions developed in
connection with cancer growth; but up to the present time it cannot be
claimed that any very practical results have been thus attained which
will aid us in treating the disease.

As all cell life and proliferation of tissue depends on the activity of
the cell nuclei, much attention has been paid to the changes found in
them and the behavior of the centrosomes and chromosomes, all of which
is too technical for us to consider here: suffice to say, however, that
several observers have demonstrated heterotypic mitosis in malignant
tumors, and that histologic examination confirms what other judgment has
indicated, namely, that the cancer cell differs from a normal tissue
cell mainly in its aberrant action under some stimulus, probably derived
from the animal fluids by which it is surrounded. Thus we come back to
our original proposition, for these fluids are, of course, but a
reflection of the nutrition of the body or diet, as modified by the
action of the various organs, including the internal secretions; all
this is influenced again by the action of the nervous system.

It is difficult to produce definite proof in regard to the influence of
nervous and mental strain and shock in the production of cancer, but
careful observers have long claimed that there is such an influence, and
from what I have seen I am firmly convinced that in some way these
conditions often do so disturb the metabolism, or otherwise operate, in
such a manner that cancer results. The influence of the mind upon the
body is unquestionable, as has been so fully illustrated by Tuke, and
from what I have observed I cannot doubt but that the mental depression
common in those with the beginning of a process which they fear might
result in active cancer, has much to do with accelerating its growth;
whereas, on the other hand, the hopefulness which can arise with the
attempt to change the diseased process by diet and proper medication,
has much to do with the favorable results which may follow in suitable
cases. In the same way the constant fear of recurrence after operative
removal can have its share in inducing and perpetuating the metabolic
error which excites the tissues to renewed cancerous action. I know that
some of you will think that this is fanciful theorizing, but many a
scientific fact, in many branches of science, has been worked out from a
theory which at first has seemed fanciful.

We will now consider some of the data which have been recorded in regard
to the relation of the secretions and excretions of the body to cancer,
including the internal secretions.

Much labor has been expended, by very many observers, upon the analysis
of the _urine_ in connection with cancer, as that might be expected to
reveal the metabolic changes connected with this disease. While many
departures from the normal have been reported, and while under complete
volumetric analysis the urine of a subject of cancer is rarely if ever
that of health, it cannot be said that any definite and specific changes
have been established which may not be found in those without cancer;
although there have been several who have so claimed even diagnostic
signs from the urine. But minute, volumetric analysis is often of great
service in guiding the nutrition and medication of these patients, and
gross errors are continually met with, which have the greatest bearing
on the case in hand, as indicating very great metabolic disturbance: and
constantly the urinary excretion will be found to be extremely
deficient, both as to its quantity and its total solid elimination. In
one very interesting case of cancer of the breast, in a stout, flabby
lady, near 55, in private practice, the total daily quantity of the
urine, measured for weeks, is always very far below the normal amount;
and in spite of active medication it seems almost impossible to raise
the total daily solids excreted in the urine, to more than one-half of
that called for by the weight of the patient. We may now briefly
consider some salient points reported in connection with the urine in
cancer.

As remarked in regard to other elements in the study of the disease, it
would be very desirable to have a knowledge of the urine in
pre-cancerous stages of health, or ill health, and also in very early
cancer, likewise after surgical operations, that we might better
understand the metabolic changes which lead up to malignant disease; but
unfortunately these are exceedingly few and unsatisfactory, and almost
all the studies have been made in advanced cancer, and often when the
disease has affected vital organs, or when by its own poison it has
disturbed the workings of the economy.

Many observers agree that there is a disturbance of proteid metabolism
in cancer, and dependent upon this many deviations from normal are found
in the urine, some of which in turn are related to the inanition which
occurs. The _urea_ is almost invariably diminished, often very greatly,
as I have verified time and again in many cases.

A number of studies have been made upon the nitrogen partition in cancer
by Einhorn, Kahn, and Rosenblum, also by De Bloeme, Swart, and Terwen,
and others, showing an increase in colloid nitrogen, to more than double
the normal amount, increased elimination of xanthin, oxyproteic acid,
and urinary ammonia, together with many other changes which show that
disintegration of the protein elements is very imperfect and often
excessive. An interesting statement is made by Blumenthal that the
oxyproteic acids are increased even in very early cancer, and
independently of the size of the tumor and degree of cachexia, seemingly
showing them to have some specificity for cancer, because they have not
been found in other forms of malignancy. He also states that urobilin is
increased in a large proportion of cases of cancer, especially when
cachexia is setting in, and is a grave symptom.

Reid, who has confirmed many of these matters reported by others, says:
“I have found an increase of amino-acid nitrogen in practically every
case of cancer I have examined”; ... “Hence we can only infer that in
cancer, the liver, while not involved in the disease, is still unable,
for some reason, to perform its functions in synthetizing urea. The
organ is functionally injured, no lesions having been found to explain
its insufficiency”; or possibly ... “cancerous subjects form proteids
which the liver is unable to deal with, so that they are excreted
unchanged, or nearly so.” Degrez has made confirmatory studies along
these lines, and found the nitrogen disintegration very imperfect, with
increase of the ammonia fraction of nitrogen, and increased elimination
of xanthin bases. He states that “the toxicity of the urine is increased
apparently as the result of the presence of substances which have not
been fully oxidized.”

Notable changes have also been recorded concerning the _sulphur_
elements in the urine, with a great increase in neutral (unoxidized)
sulphur and a considerable excess of sulpho-cyanic acid, together with
an increase in sulphates and indican showing the results of intestinal
fermentation of protein elements, which also I have constantly observed.

The _chlorides_, on the other hand, are, as a rule, diminished in
cancer, especially in its late stages, when there is inanition or kidney
insufficiency; and probably any change in them has only a relation to
the nutrition of the patients, for the chlorides come from the food and
are commonly an index of the amount of nutriment absorbed. Robin finds
some relation between the excretion of chlorine and nitrogen, according
to the stage or degree in which the system is affected by cancer.

The _phosphates_ are known to be increased in the urine of cancer
subjects, although irregularly and in an inverse ratio to the chlorides;
as inanition increases there is greater autolysis of cellular structure,
and the nuclei yield an excess of phosphates, which are excreted in the
urine. A more or less general demineralization of the system through the
urine has been observed by several, and has been recognized as a
significant matter, and is of special importance when we consider what
an important part minerals take in the nourishment of cell life.

While the changes which have been observed in the urine in connection
with cancer are not wholly pathognomonic, but occur in connection with
other diseased states of the system, so that none of them can be
accepted as diagnostic of malignant disease, they all have a certain
significance as indicating the metabolic changes which accompany and, as
we believe, have much to do with the etiology of cancer; and, as stated
before, a careful, systematic, and frequently repeated volumetrical
analysis of the urine certainly assists greatly in the proper management
of these cases, that is when the departures from normal are carefully
studied and correctly interpreted.

The _saliva_, and its action, constitutes a very important part in the
process of digestion, and consequently of metabolism and the genesis of
cancer; far too little attention, however, has been paid to it
practically, in ordinary life or disease, although there have been many
laboratory studies and writings on the physiological action of this
secretion; but I have not been able to find in literature any
investigations relating to its condition in cancer. And yet the
experience and writings of Mr. Fletcher and others have demonstrated
wonderful results from perfect mastication and thorough insalivation,
and a careful consideration of digestion must convince every one of the
importance of this secretion in connection with nutrition, both in
health and disease.

Our time does not permit of more than a brief allusion to the subject,
but in cancer patients I have so constantly found the salivary secretion
acid, and often strongly so, instead of the normal alkaline or neutral,
that I cannot but believe that this condition has some bearing upon the
subject which we are studying; the saliva also is apt to be acid in
diabetes, which is closely allied to cancer. It is to be remembered that
the saliva, which amounts in health to between one and two quarts daily,
varying somewhat with the food, is not wholly for the purpose of
lubricating the mouth and facilitating deglutition, but its enzymes,
ptyalin and maltase, effect radical and important changes in the starchy
matters consumed. It is also to be remembered that the latter cannot be
acted upon by the stomach secretions, but must be passed on to the
influence of the pancreatic fluid in the small intestine, in case the
action of the saliva has not been effective; hence there follows delayed
and imperfect digestion, faulty metabolism, deranged nutrition, and
possibly tumor growth. The importance, therefore, of very slow eating,
thorough mastication, and perfect insalivation cannot be too strongly
insisted on, both as an element of importance in the prevention of
cancer, and also as a curative measure in patients in whom the diseased
process has already manifested itself.

The so-called _internal secretions_ have also been the subject of much
research and speculation of late years, in regard to their influence on
metabolism and the life processes of the economy, and many studies have
been made concerning their connection with cancer, which cannot be long
dwelt upon now; but there seems to be little doubt but that the
secretions of the ductless glands in common have much to do with
regulating the metabolism of the cells. We know, for instance, that
disease of the pituitary body produces bone disorder, resulting in
gigantism, that thyroid derangement results in myxœdema, and that
disease of the supra-renal capsules gives rise to Addison’s disease, or
bronzed skin; and it is not at all impossible that the derangement of
secretion of one or more of these and other organs may be an element in
the disordered action of certain epithelial cells, resulting in cancer.
Harrower calls attention to the fact that cancer is essentially a
disease of that period of life when certain of the ductless glands lose
their normal function, this loss entailing related changes in the whole
chain of interrelated functions of the ductless glands.

The _supra-renal_ glands by their secretion have, as we know, great
vaso-constrictor influence, and their complete removal is followed by
death; it is more than possible that some failure in this secretion
allows the exuberant blood to supply cancerous growths. Sajous says:
“Certain growths, particularly the more malignant forms of sarcoma and
carcinoma, seem closely connected with adrenal insufficiency and its
normal consequences,” and there have been some clinical and research
data confirming such a conclusion. Sajous further says, “The adrenals,
as supporters of the thyroid apparatus in the defensive process, and in
sustaining oxidation, metabolism, and nutrition, seem to offer a new
clew to the pathogenesis and treatment of cancer that is worthy of
further inquiry.”

The _pancreas_ has been thought to have some influence in a perverted
metabolism leading to cancer, Kahle stating that there is a retention of
silica in that organ in cancer patients, to even double the normal
amount. A treatment of cancer introduced by Beard, also strongly
presented by Saleeby, by trypsin and amylopsin, the enzymes of the
pancreatic fluid, excited some attention a while ago; but unfortunately
no satisfactory results have thus far been obtained from this line of
medication, as was fully demonstrated by Bainbridge at the New York Skin
and Cancer Hospital, in one hundred cases.

The _pituitary gland_ by its secretion has undoubtedly some coordinating
power, with the adrenals and thyroid, over the processes of metabolism,
and a number of observers have regarded it as of importance in
connection with the genesis of cancer. Little has recently reported some
cases of cancer in which _pituitary extract_ with that of the pancreas
has produced remarkable results.

The _thyroid_ is now recognized as playing an important part in
assisting metabolism, and, like the adrenals and pituitary, its complete
removal, with the parathyroids, in animals is followed by death. While
the study of the hormones is still in its infancy, there seems to be no
question but that the endocrinous glands act conjointly, the one
influencing the other, and that together they exert a very great
influence in the life processes of the body and on the behavior of its
component cells. The thyroid has been shown to be one of the main
factors in the management of calcium within the body, which is believed
to be an element in cancer, and enhances the catabolism of toxic wastes,
which are etiologic elements in this disease. Many have reported
favorably on the effect of thyroid feeding in cancer, and after an
experience with it in many cases I am convinced that it has been one of
the means which contributed to the good results obtained. On the other
hand it has been claimed by Stuart-Low that the surgical removal of the
thyroid, or part of it, or ligation of the thyroid blood vessels has
arrested cancer, in several cases.

_Thymus gland_ feeding has also been reported on favorably by a number
of observers (Rohdenburg, Bullock, and Johnson, also Gwyer), they
reporting relief of pain and improved general conditions, notably gain
in weight and increased hæmoglobin in all but one of sixteen cases,
though some of them died. On the other hand Ross reports most
unfavorably on the administration of thymus, which he gave to some
inoperable and hopeless cancer cases, in which he said that in two or
three weeks the tumors had quadrupled in size and the condition of the
patients was very much worse; the same occurred also when some cancer
patients were given calcium salts freely. Ross makes some interesting
suggestions in regard to the thymus, and its relation to calcium and
magnesium; these latter are freely utilized in the growth of bone up to
the age of twenty-five years, by which time the thymus gland has quite
disappeared; but after this time these salts tend to have pathological
relations in various tissues, and also cancer becomes frequent.

The internal secretions of the _testicles_ and _ovaries_ are also
thought to have some share in metabolic processes, and observations have
been made in regard to their influence in cancer. Thus Cahen reported
that Beatson’s operation of castration for cancer, done first in 1896,
had been repeated by many, so that Lott had reported 99 cases including
his own. Of these in 23.2 per cent. the operation caused a distinct
improvement in the cancer. In 15 cases the improvement persisted for a
year, in 4 cases for 4½ years and in one case for over 5 years. Cahen
operated on seven women with remarkable results; in two cases life was
prolonged 4 and 6 years respectively. Others, however, have shown by
statistics, that damage to the ovaries by disease, or their removal by
operation, greatly increases the proclivity to cancer. Several writers
have connected cancer with the waning of the sexual powers, and the
suggestion is made by Sherrington and Copeman that in the period which
antedates the cancer age, the reproductive glands, by means of internal
secretions, are able to inhibit the growth of cancer.

In looking back over what has been observed in regard to the secretions,
including those of ductless glands, we see that very strong evidence has
accumulated to show that they have a very intimate connection with the
development of cancer, as was to be expected, since they are very
important factors in connection with metabolism.

We have also seen that while there has not been demonstrated any very
definite and specific change in the bio-chemistry of tumors, and no
specific enzymes or poison secreted by cancer cells which can
communicate the disease, there is evidence that the disordered cells
secrete a something which deranges the blood and ultimately tends to end
life; for the blood in advancing cancer undergoes very radical,
degenerative changes, some of which improve decidedly when a cancerous
mass is removed surgically, but return with the regrowth of the tumor.

We have also seen that the urine manifests alterations which show a
disturbed metabolism, and that the saliva has an abnormal acidity
leading to disturbed amylaceous digestion.

We have further seen that there is evidence that the internal secretions
of many organs, probably, through their influence on metabolism, are
factors of importance in connection with the genesis and cure of cancer.
Little well says, “Cancer is a disease of disordered nutrition, as a
result of which cells revert to a primitive stage, which permits
reproduction. The disordered nutrition is due to relative hypofunction
of the ductless glands.” In later lectures we shall consider the basic
causes of this deranged nutrition, which, as has been already intimated,
has much to do with diet and the various elements of life which tend to
induce functional and other derangements of the system, many of which
are included in and influenced by what we term the advance of
civilization.



                               LECTURE IV
                       RELATION OF DIET TO CANCER


In our earlier lectures we saw that cancer was undoubtedly a diseased
action of originally normal tissue cells, due largely to perverted
metabolism, the special features of which were brought out last week. In
the second lecture we studied the frequency and geographical
distribution of cancer, which was found to be very different for various
peoples in diverse sections of the earth, and which we saw was
proportioned in a great measure according to their diet and mode of
life. In this lecture we will examine into the details of these matters
more particularly, and endeavor to discover their practical bearing upon
the prevention and cure of cancer.

For the proper understanding of the relation of food and drink to
cancer, and the satisfactory application of the principles involved, it
is necessary to bear well in mind the chemistry of the body and the
relation to nutrition of the various elements which contribute to form
healthy and diseased tissues.

The human body is composed of some fifteen different elements, the
relative proportions of which may be understood by the following table
from Sherman, which represents probably as approximately correct an
average as any that can be given.

                       COMPOSITION OF THE HUMAN
                                 BODY

                                            _Per
                                           cent._
                      Oxygen, about        65
                      Carbon, about        18
                      Hydrogen, about      10
                      Nitrogen, about       3
                      Calcium, about        2
                      Phosphorus, about     1
                      Potassium, about      0.35
                      Sulphur, about        0.25
                      Sodium, about         0.15
                      Chlorine, about       0.15
                      Magnesium, about      0.05
                      Iron, about           0.004
                      Iodine   } very
                      Fluorine } minute
                      Silicon  } traces

As the actual composition of the body is changing day by day, through
the activities of the system, so that it is commonly believed that after
some years all the tissues are entirely renewed, the daily wear and
tear, as also the material expended in heat and activity, must be
supplied by the diet. For the ordinary requirements of the system, in
health, the appetite serves as a guide, which should suffice in man as
in wild animals, to preserve the balance of nutrition. But man has also
the power to _gratify the taste_, which must be recognized in our study
as distinct from the satisfying of the appetite; and the refinements of
civilization have added so greatly to the temptation of wrong and
over-eating and drinking, as they have to many other temptations, that
it is questionable if reason, and what is often spoken of as the natural
instinct for food, can be trusted in mankind.

It is to be remembered that the advance of civilization, and the
facilities of transportation and cold storage, have brought from far and
near an innumerable number and variety of articles for food and drink,
including condiments, which bear no relation to the few simple articles
formerly consumed; even the fruits which we eat are rarely ripened fully
by nature, but are picked more or less green, and undergo an artificial
ripening without the action of the sun, which is really akin to decay.
In the combination and preparation of articles of food also, so-called
civilization and refinement have made the greatest departure from the
simple life of the aborigines, who are free from cancer, and with
increasing ease and wealth throughout the civilized world more and more
individuals are sharing in unnecessary and often harmful indulgences,
more and more freely: and this is especially true of animal food, the
consumption of which has increased so greatly. Many other elements
likewise enter into the matter of the digestibility and consequent
nutritive power of food and drink; such are nervous conditions, rapid
eating, imperfect mastication and insalivation, heat and cold, character
of the air breathed, micro-organisms, etc., and all the various causes
which may derange the action of the digestive organs and so prevent the
perfect metabolism between nutrient material and the cells of the body,
as I tried to show you in some former lectures.

As is well known, the nutrition of man is supplied by the organic
substances, protein, carbohydrates, and fat; these are found in various
combinations in animal and vegetarian foods, and as a rule contain also
much of the inorganic or mineral substances necessary for the system;
all of these with water, and its salts, and oxygen, supplied by the
lungs, unite, through anabolism and catabolism, to build and maintain
the human body in health.

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.

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.

When considering the metabolism of cancer mention was made of
derangement in the action of the ductless glands in this disease, and of
the use and value of certain preparations of the internal secretions in
its treatment. While a hormone therapy of cancer is still in its
infancy, in spite of many books and innumerable journal articles on the
internal secretions, it is quite possible that the future may
demonstrate its efficacy in helping to control the disease: for, that
the latter are efficient agents in carrying on the vital processes in
the body, there can be no question, although as Biedl remarks, “Our
knowledge of the chemistry of hormone formation is very slight.”

But considerable clinical evidence has been accumulated that one at
least of the internal secretions, namely, that of the _thyroid_, has a
definite beneficial effect upon cancer; this I have administered to many
cancer patients, and have reason to believe that it contributed to the
favorable results obtained. Sajous, believing that insufficiency of the
adrenal secretion is an element in altered nutrition, advocates thyroid
extract on the ground that it stimulates the activity of the adrenals:
Vincent quotes Erlich as believing that “there may be substances
circulating in the organism which may stimulate the body cells to resist
the athreptic influence of cancer cells.” Shirlaw advises a tablet made
of thyroid 6 grains, supra-renal ¾ grain, and pituitary 1/16 grain.
While the treatment by these hormones from internal secretions is really
in rather an experimental stage, it would seem more than probable that
the correct use of these pluriglandular extracts, in combination with
other proper dietary and medicinal treatment, would be of service in the
prophylaxis and treatment of cancer. I have been a little cautious in
the use of thyroid, beginning with two or three grains with meals, three
times daily; for, as a promoter of catabolism it can disintegrate tissue
faster than the emunctories can remove the effete products, and may thus
poison the system.

Serum- and Vaccine-therapy are yet in a stage of development, and as I
have had little or no personal experience with them I will not attempt
to discuss their value, which time alone will demonstrate. While there
have been many claims of success from treatment along these lines,
unfortunately they have not been confirmed by later observations by
others: I may say frankly that they have never appealed to me as
rational, in consideration of the views and experience I have long had
along other lines of thought and practice. If, however, future
investigations shall confirm some of the remarkable reports which have
been made, the latest of which is by Nowell, there may be opened a
non-surgical line of treatment of cancer which would mean much to many
otherwise hopeless cases.

The _local medical treatment_ of cancer is also an important matter
which should receive careful attention. For many years in early cancer
of the breast, under proper, general, dietetic, hygienic, and medicinal
treatment, I have seen the lump vanish under the continued application
of the iodide of lead, in Hebra’s diachylon ointment of the German
Pharmacopœia (ʒss-ʒi ad ℥i), and in very many instances I have had the
assurance of patients that its application relieved the pain and was of
the greatest benefit also in axillary and other metastases. In other
cases the continuous painting with ichthyol (50 p.c. in water) has
seemed to be of great service, in combination with other proper
treatment: all of this in earlier cases, before ulceration has occurred.

After ulceration has set in, either in primary or recurrent cases,
proper local medication is very important. The ordinary micro-organisms,
finding a suitable nidus, very readily germinate and add greatly to the
suppuration, and consequent exhaustion and pain, and by their toxins,
aid also in the general contamination of the blood and tissues. Hydrogen
peroxide, laid on with pledgets of absorbent cotton is often of great
service in changing the conditions of the part, and when followed by
Russian oil, also applied with cotton, makes a most satisfactory
dressing. Adrenalin 1‒1000 is also often of service, both in checking
active hemorrhage, and in relieving pain, and shrinking up the
granulations. Ichthyol, 10 to 25 per cent. in water, and permanganate of
potash in water, 1 to 2 per cent., are also often of service, likewise
acetate of aluminium, 3 to 5 per cent.: methylin blue and fuchsin in
watery solution, 1 to 2 per cent. were formerly much used, and often
served a good purpose. It is understood, however, that none of these
measures have any great curative effect on cancer, but as contributory
elements they should never be neglected. Ichthyol ointment (℞ Ichthyol
ʒss-ʒi Zinc Oxid ʒss Unguent. Aquæ Rosæ ℥i) often proves most
satisfactory, spread on thin layers of absorbent cotton, and changed
several times daily, after soaking the part with one of the liquids
above mentioned.

Time does not permit us to go into the matter of the X-ray, which
undoubtedly has often been of great service in certain cases of cancer:
it should be carefully but systematically employed, once or twice a week
in connection with other medical treatment; radium can also be of real
service in these cases. In some inoperable cases a mild surgery,
especially with the actual cautery, in the way of removing exuberant
masses, which would have to slough off, can add much to the good
progress of the case, and the occasional excision of cutaneous nodules
removes just so much cancerous tissue, which by its secretion would
poison the system.

In our study thus far we have seen that there is much to be done for
cancer besides the surgical removal of the offending mass, the existence
of which is an opprobrium to medical science, which has not thus far
guarded mankind against it: and until time has passed, and by right
living and proper medical attention cancer has ceased to be produced, or
become greatly diminished, surgery will probably be a great factor in
its treatment, as its mortality statistics are constantly improving. But
there can be no question but that with the adoption of proper dietary
and medical treatment, even from the first suspicion of a malignant
growth, and before, as also after operation, the final results of
operative procedure will be even far better than have been yet attained.



                               LECTURE VI
                CLINICAL CONSIDERATIONS AND CONCLUSIONS


The test of everything lies in the results obtained. Theories,
discussions, and arguments are all unavailing unless results show their
truth. In medicine, however, it is sometimes difficult to demonstrate
results until after the lapse of time, as was well illustrated by the
preposterous claims first put forth for “606,” which is gradually
attaining about its correct status. The same is true in regard to the
surgery of carcinoma, where operations which formerly were attended with
very bad results have gradually been improved, so that, while the late
Dr. Agnew of Philadelphia once said, toward the close of his life, that
he did not know if he had ever been justified in any operation he had
performed on this disease, the best surgeons are now claiming notable
successes, with relatively good percentages of recovery: but here again,
time comes in, and while the three-year limit of freedom from recurrence
is valuable, it is still said that fully 90 per cent. of those who have
once been affected with true cancer, die of the disease, and its general
mortality is still increasing in spite of all surgery. Dr. John B.
Murphy of Chicago, has also repeatedly expressed himself most
pessimistically in regard to the ultimate results of the surgical
treatment of carcinoma, especially in those patients who are fat, and
with lax tissue, that is, exhibiting evidences of imperfect metabolism.

Dietetic and medical treatment of cancer, in the fullest sense, have
never yet been given a fair and fully intelligent trial on a scale large
enough to produce general conviction in regard to their value. Many
cases have occurred here and there which have recovered spontaneously,
that is, without surgical interference, and often really to the surprise
of the medical attendant: this of itself shows that under certain
circumstances something may occur in the system which causes the
malignant process to cease, and the cells to return to a normal
function. This certainly should be a stimulus to discover what the
reason is for this beneficial change, and we believe that it is to be
found in what has preceded in these lectures.

When the New York Skin and Cancer Hospital was founded, over thirty
years ago, Cancer was included with Diseases of the Skin, in the hope
and expectation that in studying the internal causes of the latter light
would be thrown on the etiology of carcinoma, which, as we know, is a
disease of epithelial elements; and the earlier Report of the Hospital
shows but one department, including Cancer with Skin Diseases, with
operating surgeons and a gynæcologist to assist, whenever their services
were requested by the physicians in charge. Before long, however, for
reasons which cannot now be given, and against the judgment of the
present speaker, the plan was changed, and a separate cancer department
was erected under the exclusive charge of surgeons. A Prize Fund was
also early established, which has been slowly increasing, for the
discovery of a cure for cancer by other than surgical removal.

For thirty or forty years I have held very much the same views regarding
cancer which have been presented in these lectures, and have acted on
them more or less strongly, and in later years very stringently, and
have rarely seen cause for regret. For one reason or another I have also
had many hundreds of patients, with various affections, on a vegetarian
diet over varying periods: in a number of cases I have records extending
over many years, in which I have observed the patients from time to time
(one psoriasis patient having continued it for over twenty years) and
with only the best results, so I trust that you will accept and test the
validity of my statements.

In looking over my case histories in private practice I find that I have
more or less complete records of 96 cases of carcinoma, mostly of the
breast (two of them having Paget’s disease), 29 of sarcoma in various
situations, and 619 of epithelioma of different degrees of severity, of
which four others had Paget’s disease; a total of 744 patients with
these forms of neoplasm. Some of these patients were seen in
consultation, others only once or for a brief period, but many of them
were under care and observation for a greater or less length of time.
During the past year I have also treated on the plan here indicated a
number of cases of recurrent carcinoma in the New York Skin and Cancer
Hospital, which have been submitted to very careful laboratory study,
some of whom have exhibited decidedly favorable results: some of these
will be referred to later, but they are too recent to afford positive
data, and I prefer to confine my consideration mainly to private
patients, in regard to whom more reliable evidence can be obtained.

I will not weary you with any full analysis of these cases, nor will I
consider any of them except those of carcinoma: for while I believe that
sarcoma is of the same nature and origin, save that it relates to
connective tissue cells, but few of the cases were submitted long enough
to a vigorous treatment calculated to yield efficient results. I may say
in regard to the cases of epithelioma, mainly of the skin, that some of
the more severe ones showed very markedly the benefit of dietetic and
medicinal measures of the character now being considered, and that it is
my custom to treat such in the same manner; for reason would seem to
show that the same causes would produce abnormal proliferation of
epithelial elements on the cutaneous surface as well as in other parts
of the body.

In regard to the cases of carcinoma there were 6 in males and 90 in
females; of these the right breast was affected 42 times, the left
breast 45 times, and both breasts 3 times. In 28 cases the patients were
operated on surgically before adequate treatment had been employed; many
of these were earlier cases, or those seen in consultation. In seven
instances it seemed wise to have an operation, after a more or less
faithful trial of medical treatment. There were no cases of cancer of
internal organs, except metastases, as these would not naturally come to
me. The average age of the breast cases was 51.8 years.

In the large majority of cases, except those who had been surgically
operated on, the diagnosis was clinical only, as it is an accepted fact
that it is very unwise to make a biopsy, even before surgical removal,
and manifestly improper where this is not undertaken; but in most of the
cases there was the independent diagnosis of one or more other medical
men, and many of the patients came to me on account of threatened
operations by prominent surgeons, and even after these had been arranged
for; in 27 cases there had been previous surgical removal with
recurrence, and in several cases more than one operation, with again
recurrence.

The exact duration of cancer before coming under observation is always
an uncertain item, for undoubtedly a tumor starts in an individual cell
or group of cells, and has probably been forming some time before being
noticed by the patient or attracting attention in any way. The average
stated duration of the disease was 1.6 years before coming under
observation.

Surgeons are fully agreed that the earlier a tumor is recognized and
removed the better the prospect of ultimate success, and this is
eminently true in regard to remedial measures other than surgical: for
as we have seen, after a cancerous process is well under way its cells
secrete a something which hastens the general depravement of the system,
and quickens the growth of the neoplasm, and naturally greatly increases
the difficulty of overcoming the dyscrasia.

Thus in the effort to get at and remove all possible or prospective
cancerous lesions, many innocent or non-malignant adenomata, etc., are
operated on, which are afterwards found to be such microscopically. In
the same way it is quite possible that some of the small breast tumors
which have disappeared under the dietetic and medical measures here
described were still non-malignant, and should not be grouped with
carcinoma.

It is fair to say, therefore, that among my notes are also 22 cases of
breast tumors which have been excluded from the carcinoma list, and
entered with other titles, such as abscess, cyst, chronic mastitis,
adenoma, etc. But I claim that even if some of these also disappear
under the measures we are considering, as they frequently have done, it
is a better and more desirable result than if they had been removed by
the knife: for in the former case the cause which induced the unnatural
growth has been overcome, whereas by surgery only the obnoxious mass has
been dislodged, and perhaps with it adjoining tissue and glands, but
nothing has been accomplished toward checking the cause producing the
offending lesion. But the very fact of the frequent recurrences after
operation, in the neighboring skin or elsewhere, demonstrates the fact
that surgery is but an attempt to rectify past errors, which might or
might not have been prevented by careful medical foresight and action;
we must, however, be thankful for the measure of success which has
followed the noble efforts of our distinguished surgeons, only it is to
be hoped that hereafter other measures will also be more commonly
adopted, looking towards a prevention of the recurrence of carcinoma
after operation.

Not to detain you too long with these clinical considerations, I would
like to give the details of a few of the cases which have been most
striking.

Mrs. B. E. C., aged 44, was first seen on account of trouble in the
right breast, on September 19, 1892. She then had a flat tumor in the
outer lower segment, an inch and a half in diameter, rather sharply
defined, and tender on pressure at the sides, which she had noticed
about two months. Not satisfied with the diagnosis of cancer, and
hesitating at the thought of medical treatment, she consulted a well
known, prominent surgeon, who pronounced the tumor as undoubtedly
cancer, and urged its instant removal; this I did not know until she
informed me of it some time later, after the tumor had entirely
disappeared under treatment. I saw her at frequent intervals for six
months, and the breast became entirely normal. Four years later she was
again seen in regard to the menopause, which she was undergoing, and the
breast was found still to be normal: she was maintaining her diet.
Nearly three years later I learned from her husband that she was in
perfect health, with absolutely no breast trouble, and for eight years
later, while he himself was under occasional treatment, I learned
repeatedly that she remained still perfectly well, over sixteen years
after beginning treatment, with no recurrence of the breast tumor.

Miss B. M. L., aged 45, was first seen on January 4, 1894, with a tumor
in the left breast, which had been diagnosed as cancer by three medical
men, and one of them, a surgeon of prominence, had arranged for
immediate surgical removal the next day. The mass was situated in the
upper and outer quadrant, well defined, not painful on moderate
handling, but subsequently she experienced pain in it. Two months later
the lump was recorded as less distinct and flatter, and within eleven
months it had entirely disappeared. A month or two later she had some
pain in the breast, in connection with the menstrual disturbance
accompanying the menopause, but no trace of the tumor. On Nov. 8th,
1905, she called, bringing a relative for treatment, and the breast was
found perfectly normal, and again five years later she called, with
another trouble, the breast still remaining perfectly well, also sixteen
years after first coming under treatment.

Miss J. M. A., aged 45, was first seen October 12th, 1905, with a tumor
of the left breast, above, toward the median line, near the nipple, not
painful on handling, though there was some pain afterwards, and it had
been awaking her with pain at night for some months, with also a numb,
shooting pain in the daytime. She had seen a number of medical men
always with the diagnosis of cancer, but she had declined operation. Two
months later, Dec. 15th, 1905, it was recorded that there was very
little to be felt in the breast, and there was no pain at any time, and
on January 5th, 1906, both breasts were the same on palpation, with no
sign of the former tumor. For one reason or another she has been seen
from time to time, almost up to the present date, and remains perfectly
free from her former trouble, a period of over nine years. She has been
a most faithful patient, adhering strictly to diet and more or less
medication, except when on certain occasions I have let up on the same;
and all the time from the first she has been under great strain of work,
mental and physical, as a city missionary.

Another very similar case was in the person of Miss G. M., aged 44, who
has been under constant observation and treatment off and on for various
troubles from November 13, 1905, until yesterday. Fifteen years previous
to her first visit she had fallen and struck the left breast which was
bruised, but the effects wore off in some months, and there was no
sensation in the breast for some years. Then 7 or 8 years later she
began to have pain in the breast, aggravated before and during
menstruation, which had continued until her visit, and for the last
months she had been kept from her work in school, the pain being severe
in the breast, and more recently in the axilla: in July there had been
bleeding from the nipple. She had seen a number of medical men, with the
diagnosis of cancer, and one surgeon of prominence in one of the large
hospitals had strongly pressed for an immediate operation.

When first seen there was a tumor between two and three inches in
diameter, in the upper, inner segment of the left breast, hard, sharply
defined, and more or less nodular on the surface: there were some
enlarged glands in the left axilla. She had long been constipated and
was passing about 60 per cent. of the amount of urinary solids proper
for her weight. Under very active treatment it was recorded four weeks
later that there had been hardly any sensations in the breast during the
previous week, that the tumor had diminished materially in size, with
only moderate hardness, and that she was now out doors every day, and
feeling much better. One month later it was recorded that the breast was
very well and on examination was almost the same as the other, there
being some general caking in both: she had had no pain for some time.
One month or so later she was again at her duties as a public school
teacher, which she has continued at since, with rare exceptions, when
some temporary ailment prevented: the lump in the breast did not wholly
disappear for a month or two later, but on April 7th it was recorded
that the left breast was the same as the other, and no glands could be
felt in the axilla.

From that time to the present she has had a variety of troubles,
rheumatic and other, and it has been difficult to keep up a proper
action of the bowels and kidneys; but in spite of strenuous and often
exhausting work as a New York City public school teacher, she has had no
return of the breast trouble, now for over nine years. A sister, aged
60, has just died with cancer of the stomach in a distant country town.

I could multiply these histories but do not want to tire you, though I
do want to mention one more patient, to show what can be done in the
case of recurrent carcinoma, after operation, of which I have had a
number of cases with varying results, according to the duration and
severity of the disease.

Miss H. M., aged 61, came to me June 21st, 1913, with the following
history: About two years previously a lump appeared in the outer, lower
segment of the left breast, which was removed in August, 1911; this
healed soon, leaving a good axillary scar, and there was no thought of
trouble until two months before her visit, when a small red spot
appeared near the edge of the sternum. This enlarged and hardened and
others appeared around the scar, until, when seen there were a dozen red
nodules up to half an inch in diameter, near the center of the former
site of the breast, with others, not red, above; with the tense skin and
rapidly developing, multiple nodules here and there, further surgical
operative procedure was out of the question.

Since that date she has been under strict vegetarian diet and
medication, including thyroid from time to time, with repeated
application of X-rays, and under all these measures together many of the
nodules have disappeared; although some new ones have formed, several of
which have been removed under local anæsthesia, the wounds healing
kindly. As she resides some distance from the city she has not been seen
since October 7th, 1914, she wishing to take the X-rays nearer home, but
she was earnestly charged to continue also the dietetic and other
treatment. In this instance the patient has lived comfortably and
without pain for almost sixteen months after coming under treatment,
and, although she has lost some flesh, the active cancerous process,
which would otherwise have carried her off long ago, has been in a
measure checked. What will be the further history of the case one cannot
tell, for it is quite possible that being away from my care she may
neglect dietetic and medicinal treatment, trusting only to the X-rays,
which, of course, cannot influence the real nature and course of the
disease.

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.



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                                 INDEX


 Abderhalden, defensive ferments in cancer, 78

 Abernethy on vegetarian diet, 136

 Aborigines, freedom from cancer of, 48, 116

 Abstemiousness, effect on cancer, 139

 Acid, amino nitrogen, increased in cancer, 91

 Acid intoxication in cancer, 77

 Acidosis in cancer, 80

 Acids, oxyproteic, in the urine, increased in cancer, 90

 Addison’s disease, 97

 Adrenals, relation to cancer, 98

 Africa, absence of cancer in, 50, 52

 Agamogenesis, relation to cancer, 72

 Age affecting cancer, 22

 Ages of patients with cancer, 176

 Agnew on surgery in cancer, 170

 Alcohol, relation to cancer, 120

 Alkalinity of blood, diminished in cancer, 77

 Amino-acid nitrogen, increased in cancer, 91

 Ammonia fraction of nitrogen, increased in cancer, 91

 Amylopsin in cancer, 99

 Anabolism and cancer, 33

 Anæmia in cancer, 74

 Animal food a cause of cancer, 50, 51, 52, 55, 63, 69, 110, 113, 116,
    117, 132, 138, 141

 Animals, cancer in, 43

 Argentine Republic, cancer in, 57

 Australia, cancer in, 48

 Auto-intoxication and cancer, 155

 Autonomous action of cells, 33


 Bainbridge, local nature of cancer, 30

 Baltimore, cancer in, 65

 Banks, Sir William, on diet in cancer, 61

 Bashford, 55

 Beard, trypsin in cancer, 99

 Beatson’s operation, 102

 Beebe, diet and cancer, 80

 Beirut, rarity of cancer in, 56

 Bell, cancer from neglect of hygienic laws, 132

 Beneke, diet in cancer, 115

 Benratt, rarity of cancer in India, 53

 Betel chewing cancer, 54

 Biedl, hormone formation, 163

 Bio-chemistry of cancer, 39, 79, 83

 Blood changes in cancer, 74, 191
   frequent study of, in cancer, 160

 Blumenthal, oxyproteic acids increased in cancer, 90

 Boston, cancer in, 65

 Bowel action and cancer, 155, 157

 Braithwaite, plainer fare and less of it, 154
   salt and cancer, 129

 Brazil, rarity of cancer in, 57

 Breast, carcinoma of, 176
   non-cancerous tumors of, 178

 Bristol, disturbance of chemical equilibrium causing cancer, 143

 British Guiana, rarity of cancer in, 50

 Burnham, blood changes in cancer, 76

 Butter, valuable in cancer, 153

 Buttner, a fleshless diet, 154


 Cachexia in cancer, 74, 77

 Caffeine, nitrogen in, 119
   percentage of, in coffee, 119

 Cahen on Beatson’s operation, 102

 Calcium salts, effect on cancer, 101

 Cancer in the occupied and unoccupied, 130
   personal statistics of, 176
   problem, 201

 Carcinoma, personal statistics of, 174

 Casein sometimes allowable in cancer, 153

 Cases, personal, of cancer, 180‒197

 Catabolism and cancer, 33

 Causes of cancer, 27

 Centrosomes in cancer, 34, 85

 Cheese sometimes allowable in cancer, 154

 Chemistry of cancer, 39, 79, 83
   of cancer tissue, 78, 82
   of the body, 107

 Chicago, cancer in, 65

 China, rarity of cancer in, 55

 Chittenden’s experiments on nutrition, 112

 Chlorides in the urine, diminished in cancer, 92

 Cholesterin, relation to cancer, 83

 Chromosomes in cancer, 85

 Civilization, cancer a disease of, 44, 46, 50, 68, 109, 117

 Clinical considerations, 170
   study of cancer, 17, 18

 Coffee, consumption in United States, 118
   nitrogen in, 119
   relation to cancer, 117

 Cohnreich, blood in cancer, 76

 Cold storage, relation of, to cancer, 109

 Composition of human body, 107

 Conclusions, 170, 203

 Constipation and cancer, 157

 Contagiousness excluded, 19

 Cooper, Sir Astley on constitutional nature of cancer, 139

 Creoles in Africa, freedom from cancer of, 52

 Cytology of cancer, 74


 Danger from thyroid in cancer, 164

 Deaths from cancer in New York City, 145
   in United States, 144

 De Bloeme, Swart, and Terwen, imperfect nitrogen partition in cancer,
    90

 Defective urinary excretion and cancer, 158

 Deficiency of urinary solids in cancer, 88

 Definition of cancer, 30

 Degrez, imperfect nitrogen disintegration in cancer, 91

 Denmark, cancer in, 82

 Demineralization and cancer, 113

 Diabetes, relation of to cancer, 95

 Diet, effect of simple, in cancer, 121
   relation of, to cancer,
 46, 51, 53, 55, 57, 61, 63, 67, 80, 106, 115, 116, 133, 198

 Dietetic treatment of cancer, 171

 Disordered metabolism the cause of cancer, 74

 Ductless glands in cancer, 97

 Duration of cancer before treatment, 177


 Early treatment of cancer, medically, 147, 178, 208
   surgically, 177

 Eating, wrong- and over-, and cancer, 152

 Egypt, rarity of cancer in, 51, 57

 Ehrlich, effect of diet on cancer, 37

 Einhorn, Kahn, and Rosenblum, imperfect nitrogen partition in cancer,
    90

 Embryonic rests in cancer, 23, 25, 72

 Endocrinous glands, relation of, to cancer, 100

 England, cancer in, 51, 57, 61
   increase of cancer, with meat consumption, 116

 Environmental change and cancer, 59

 Enzymes, autolytic, in cancer tissue, 83

 Equilibrium of tissue elements, 111

 Esmarck and Oldehop, vegetarian diet in cancer, 115

 Etiology of cancer, 74

 Ewing, change in polar axis of cells in cancer, 34
   relation of cholesterin to cancer, 83


 Far East, rarity of cancer in, 55, 56

 Fiji Islands, rarity of cancer in, 50

 Fletcher, imperfect insalivation and cancer, 94

 France, cancer in, 62

 Frequency of cancer, 43

 Functional kidney derangement and cancer, 158


 Geographical distribution of cancer, 43

 “Germ of cancer,” 19

 Gigantism, 97

 Gout, relation to cancer, 72, 81

 Gratifying the taste, a cause of cancer, 108

 Gruner, toxicity of cancer juice, 78

 Gwyer, thymus feeding in cancer, 101


 Haig, cures of cancer by dietary restrictions, 141
   uric acid and cancer, 125, 141

 Harrower, relation of ductless glands to cancer, 97

 Heredity, influence of, 20

 Heterologous elements in cancer, 41

 Highest cancer mortality, 62

 Hislop and Fenwick, diet and cancer, 50

 Holland, high cancer mortality in, 118

 Hormones, relation of, to cancer, 100

 Hormone therapy in cancer, 162

 Hungary, low cancer mortality in, 118

 Hutchinson, amount of caffeine in tea and coffee, 119

 Hygienic laws, neglect of, a cause of cancer, 132

 Hyperacidity and cancer, 33


 Ichthyol locally in cancer, 166, 167

 Ideally correct blood stream and cancer, 149

 Increase of cancer, 47
   in the United States, 66

 Incurable cancer, 146

 Independent cell action, 73

 Indians, North American, rarity of cancer in, 67

 India, rarity of cancer in, 53

 Infectious diseases and cancer, 29

 Inoperable cancer, 146

 Insalivation, thorough, importance of in cancer, 95

 Internal secretions in cancer, 96‒103

 Intestinal fermentation in cancer, 92, 155
   stasis and cancer, 155
   toxins and cancer, 155

 Intolerance of certain articles a cause of disease, 127

 Intoxication, intestinal, and cancer, 155

 Iron, value of, in cancer, 161

 Irritation, local, and cancer, 124

 Isenberg on vegetarian diet in cancer, 142

 Italy, low cancer with low meat consumption, 63


 Jones, blood in cancer, 76


 Kahle, silica retention in cancer, 98

 “Kangri burn” cancer, 54, 126

 Keith, Skene, iron in cancer, 161

 Kellogg, absence of cancer with normal metabolism, 151

 Kerry, Ireland, low cancer mortality, 64

 Kessler, sulphur partition in cancer, 122

 Kidneys, faulty excretion and cancer, 157

 Korea, rarity of cancer in, 57


 Laboratory study of cancer, 175, 191

 Lambe on vegetarian diet, 136

 Lane, Sir Arbuthnot, intestinal stasis and cancer, 155

 Latham on cancer of the unoccupied, 61

 Leucocytosis in cancer, 75

 Lithæmia, relation to cancer, 72

 Liver, condition of in cancer, 91

 Local irritation and cancer, 21, 124
   medical treatment, 165

 Lott, Beatson’s operation for cancer, 102

 Lowest cancer mortality, 60, 64

 Lucerne, cancer in, 62

 Luxurious living a cause of cancer, 68, 138, 199


 McCann, erroneous preparation of foods, 123

 McGregor, absence of cancer in Fiji Islands, 50

 Madden, absence of cancer in Africa, 50

 Malaria and cancer, 21

 Mastication, thorough, importance of in cancer, 95

 Mayo, acidity and cancer, 124

 Meat consumption,
   in England, 116
   in the United States, 69

 Meat, relation to cancer, 51, 53, 55, 57, 63, 116

 Medical treatment of cancer, 135, 154

 Melanesians, exempt from cancer, 50

 Mental depression, influencing cancer, 86
   strain, relation to cancer, 81, 85

 Merriam, meat diet a cause of cancer, 141

 Metabolism, disordered, the cause of cancer, 74
   of cancer, 70
   perverted, and cancer, 150

 Mineral disturbances in the system in cancer, 122

 Mitosis, cell, relation to cancer, 85

 Mortality from cancer 90 per cent., 144

 Murphy on surgery in cancer, 171

 Myxœdema, 97


 Nature of cancer, 15, 29

 Negroes, rarity of cancer in, 52, 67

 Nervous strain, relation to cancer, 85

 New York City, deaths from cancer in, 65, 145
   negro death rate from cancer, 67

 New York Skin and Cancer Hospital, 8, 172

 New Zealand, cancer in, 50

 Nitrogen disintegration, imperfect in cancer, 91
   increase in colloid, in cancer, 90
   partition in cancer, 90
   small amount needed in the economy, 114

 Nitrogenous diet and cancer, 51, 53, 55, 57, 63, 81, 116

 Non-cancerous tumors of breast, 178

 Normal body cells and cancer, 31, 41, 70

 Nowell, serum therapy, 165

 Nuclei of cells, in cancer, 84

 Nucleo-proteids in cancer, 82

 Nutrition and cancer, 35, 36


 Occupation and cancer, 28

 Ovaries, internal secretion of, relation to cancer, 102

 Over-eating and cancer, 152

 Over-indulgence, effect of, 68

 Oxyproteic acid, relation to cancer, 90


 Packard, disturbance of mineral elements in blood, in cancer, 122

 Paget, Sir James, on constitutional nature of cancer, 140

 Paget’s disease, 174

 Pancreas, relation of, to cancer, 98

 Parasitism excluded, 19

 Paris, cancer in, 63

 Parker, Willard, on constitutional cause of cancer, 137

 Patience required for medical treatment of cancer, 134, 152

 Perseverance required for medical treatment of cancer, 134

 Personal cases of cancer, 180‒197

 Perverted metabolism and cancer, 74, 150

 Philadelphia, cancer in, 65

 Philippines, rarity of cancer in, 57

 Phosphates in the urine, diminished in cancer, 94

 Pittsburgh, cancer in, 65

 Pituitary secretion in cancer, 97, 99

 Plants, cancer in, 43

 Plasma of blood in cancer, 77

 Pluriglandular extracts in cancer, 164

 Polarity of cells in cancer, 34, 73

 Polynesians, exempt from cancer, 50

 Potassium acetate in cancer, 159
   phosphate in cancer, 160

 Precancerous conditions, 89

 Prevention of cancer, 148

 Prize fund for cure of cancer, 173

 Problem of cancer, 201

 Prophylaxis of cancer, 148

 Prosperity and cancer, 48, 68, 109

 Protein foods, harm from, 113
   metabolism, disturbed in cancer, 89
   requirement of the body, 112
   sufficient in vegetarian diet, 133

 Psoriasis, lessons from, in cancer, 128

 Putrefaction, intestinal, and cancer, 155


 Radium, value in cancer, 29, 145, 168

 Recurrent cancer, 146, 187‒195

 Red corpuscles in cancer, 76, 77

 Refinement of food, relation of, to cancer, 109

 Reid, increase of amino-acid nitrogen in cancer, 91

 Relation of diet to cancer, 198

 Renner, rarity of cancer among creoles, 51

 Requisites for development of cancer, 25

 Rheumatism, relation to cancer, 72

 Ribert, beginnings of cancer, 30

 Roberts, disturbance of salivary digestion from tea, 119

 Robin, relation between chlorine and nitrogen in cancer, 92

 Rohdenburg, Bullock, and Johnson, thymus gland in cancer, 101

 Rome, cancer in, 63

 Ross, thymus and calcium, harm from in cancer, 101
   relation of potash salts to cancer, 160

 Rous, cancer in rats checked by diet, 39

 Russian oil as a dressing in cancer, 166


 Saleeby, trypsin and amylopsin in cancer, 99

 St. Louis, cancer in, 65

 Sajous, adrenals in relation to cancer, 98

 Salivary secretion, acid in cancer, 94, 95, 161

 Salt, effect of, on cancer, 129

 Sarcoma of same origin as carcinoma, 175

 Scandinavia, cancer in, 125

 Schmidt, infectious diseases and cancer, 29

 Serum therapy, 164

 Sherman, composition of the human body, 107, 154

 Sherrington and Copeman, reproductive glands inhibiting growth of
    cancer, 103

 Shirlaw, pluriglandular extracts in cancer, 163

 Silica, retention of, in pancreas, in cancer, 98

 Simple diet, effect of, in cancer, 121

 Soëgaard, stomach cancer frequent in Norway, 125

 Solids in the urine, deficient in cancer, 87, 88

 Spontaneous disappearance of cancer, 36

 Stasis, intestinal, and cancer, 155

 Stuart-Low, relation of thyroid to cancer, 100

 Sub-oxidation and cancer, 132

 Sulphates, increased in cancer, 92

 Sulpho-cyanic acid, increased in cancer, 92

 Sulphur elements, altered in cancer, 92

 Supra-renal glands, relation of, to cancer, 97

 Surgery, operative, in cancer, 145, 147, 168, 179

 Surgical aspects of cancer, 7, 9, 10, 25

 Sweet, Corson, White, and Saxon, effect of diet on experimental tumors,
    38

 Switzerland, cancer in, 62

 Syphilis and cancer, 22


 Taste gratified, a cause of cancer, 108

 Tea, relation to cancer, 117

 Telluric influences in cancer, 22

 Testicles, internal secretion of, relation to cancer, 102

 Thompson on consumption of coffee and tea, 118, 154

 Thymus gland in cancer, 101

 Thyroid, danger from in cancer, 164
   relation to cancer, 97
   value of in cancer, 99, 163

 Tobacco, influence of, in cancer, 126

 Toxicity of urine, increased in cancer, 91

 Toxic secretion from cancerous mass, 70, 78, 104, 206

 Toxins, intestinal, and cancer, 92, 155

 Transmission of cancer, 20

 Traumatism and cancer, 24

 Trypsin in cancer, 99

 Tuberculosis and cancer, 16, 44, 45

 Tuke, influence of the mind on morbid processes, 86

 Türk, cytology of cancer, 74


 United States, cancer in, 16, 64, 68
   consumption of coffee in, 118
   consumption of meat in, 117

 Urea excretion, deficient in cancer subjects, 89

 Uricacidæmia, relation to cancer, 72

 Urinary disturbance, functional, and cancer, 158

 Urinary solids, deficient in cancer, 87, 88

 Urobilin, increased in cancer, 90


 Vaccine-therapy in cancer, 164

 Valais, cancer in, 62

 Vegetable protein, 133

 Vegetable tumors, 43

 Vegetarian diet affords sufficient protein, 133, 153

 Vegetarian diet and cancer, 50‒53, 55‒57, 63, 115, 123, 128, 136, 142,
    180‒197

 Venus on vegetarian diet in cancer, 142

 Vincent, quoting Ehrlich on resistance to athreptic influence, 163

 Virchow, on tumor formation, 31

 Voit’s dietary standard, 111

 Volumetric analysis of urine in cancer, 87, 94, 159


 Wakefield on hyperacidity of the blood plasma in cancer, 33

 Wales, cancer in, 57

 Walshe on the cause of cancer, 137

 Watson, effect of meat diet on tissue cells, 114

 Wealth, relation to cancer, 48, 68, 109

 Weight in cancer, 161, 192, 195

 Wells, nuclear proteins in cancer cells, 83

 Well-to-do men and cancer, 130

 West Indies, cancer in, 57

 Williams, cancer problems,
 36, 45, 47, 50, 58, 72

 Wolf, cancer in Australia, 47, 48

 Wolter, nucleo-proteids in cancer tissue, 82

 Wrong eating and cancer, 152


 Xanthin bases, increased in cancer, 90, 91

 X-ray, value in cancer, 29, 145, 167

-----

Footnote 1:

  According to the United States Mortality tables for 1912 there were
  44,531 deaths from cancer that year, or 77 per 100,000 living, while
  the rate in 1911 was 74.3, an increase of 2.7. Tuberculosis has shown
  a steady decline, the death for 1912 being the lowest on record, 149.5
  per 100,000, it having fallen from 200 per 100,000 in 1900, or over
  25%.

Footnote 2:

  No attempt has been made to collect an extensive bibliography, which
  might cover many pages, and a list is only given of those books and
  journal articles which I have been able to personally consult and to
  refer to in the text.



                          BY THE SAME AUTHOR.


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                  *       *       *       *       *

               PAUL B. HOEBER, 67‒69 East 59th St., N. Y.

------------------------------------------------------------------------



                          TRANSCRIBER’S NOTES


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