Cancer has long been a problem over which master minds have wrestled, and to read much that is written it would seem that we were yet as far from its solution as ever. Countless able men, at the expense of millions of dollars, have labored faithfully in the laboratory, and it may safely be said that more effort and time have been expended in investigations on cancer, and more has been written concerning it, than ever in connection with any other disease affecting humanity. And yet its mortality is steadily increasing pitifully, in spite also of active, skilful, and faithful surgical treatment.
Is it not possible, therefore, that there is something wrong in our conception of cancer and its treatment? If any other disease presented such a steady and alarming increase in its death rate would we not stop and consider if our treatment were the best possible? If with the introduction of antitoxin the mortality from diphtheria had steadily risen until it was about 90 per cent of all cases, would we persist in employing it? And yet the profession and the laity go blindly on, with the idea that surgery offers the only hope of reaching cancer, when the Mortality Statistics of the United States show that under this line of treatment the death rate has risen steadily from 63 per 100,000 of the population in 1900 to 81.1 per 100,000 in 1915, or 28.7 per cent.
Surely the lesson taught by the steadily and greatly decreased death rate of tuberculosis should teach us something of the value of most careful dietary, hygienic, and medical control of other diseases. For the great white plague, which a while ago threatened even the destruction of the race, shows now a mortality which has steadily fallen 27.8 per cent since 1900, and that even with the continued presence of the tubercle bacilli. I realize that the comparison is not quite correct in all respects, for it is well established that cancer is not due to a microörganism; but it does show us that nutritive errors are at the bottom of the ravages of tuberculosis, and efficient biochemical studies in cancer have satisfied many that the same, although different in character, are true of this disease.
In other words, erroneous nutrition, which is productive of disease of the kidneys, heart, and blood vessels, with their steadily rising mortality of ten to twenty per cent since 1900, as shown on the chart before you,[3] is operating to steadily increase also the morbidity and mortality of cancer, in spite of active and intelligent surgical treatment. And yet the profession and laity seem to be blind to this fact.
It is also not a little remarkable that during the year 1915, when there was a special effort made to educate both the laity and the medical profession in regard to the advisability or necessity of early operations in cancer, the actual death rate rose by 1.7 persons per 100,000 living, whereas the average yearly rise for the preceding five years had been only 1.2 persons per 100,000!
What, then, is the real problem of cancer? Surely it is not to increase the surgical activity, which has resulted only in a steadily ascending scale of mortality, which in reality is greater than that observed in any other malady! For the increase in the death rate from cancer throughout the United States from 1900 to the present time has been coincident with the greatest activity both in laboratory research, and in the advanced surgery of the disease. I repeat, is it not time for us to stop and consider whether our laboratory work with the microscope on morbid tissues, and our experimentation on rats and mice are truly serving to solve the real problem of cancer? Or whether we had not better turn our attention to human beings, and by careful clinical study of our patients, discover where the fundamental error lies, which first induces the formation of an aberrant cell mass, which we call cancer, and then continually feeds it by the same deranged blood stream, so that it becomes utterly uncontrollable and invades and destroys other tissues; while at the same time the anemia, pernicious and progressive in character, gradually saps the life of the patient to a lethal end? For repeated and most careful laboratory studies have demonstrated great and significant changes in the blood in cancer. I hope to satisfy you that the mass which is excised is only the product of a far deeper systemic change, which has probably already produced other, more or less similar masses or deposits elsewhere—in the bones and internal organs or lymphatics. So that surgical removal of the one often stimulates the development of others.
It is seen, then, that it is here denied that the local lesion which we call cancer is the first and only cause of disease. It is also denied that the surgical removal of the offending lump and adjoining glands and tissues, however early it is performed, is a sure and only cure for cancer.
In the recent cancer propaganda, urging the very early and complete removal of everything which could possibly be called pre-cancerous, it is interesting to observe that most of the pictures shown and arguments presented relate to cutaneous epithelioma, which the United States Mortality Statistics show to be the cause of only 2.7 per cent of all deaths included under cancer! Moreover, those of us who see epithelioma daily know that, if properly treated early by other means than the knife, it is commonly a relatively innocent affection. It is acknowledged, however, that by meddling and wrong treatment, as with nitrate of silver, it can be goaded on so as to become a serious affair. In our present consideration of cancer as a disease it is to be understood, therefore, that cutaneous epithelioma is excluded, and that reference is made to the serious malignant disease known as cancer, affecting various other organs of the body. However, many cases of what might be called epithelioma of the lip and oral cavity are of such malignity that they are properly ranked as carcinoma.
Looking at cancer, therefore, as a general disease of which the local lesion, which is ordinarily excised surgically, is simply the result or product of a previous, perhaps long-standing, blood or nutritive disorder, we can readily understand why the simple excision of the tumor and surrounding tissues cannot be expected to eradicate the malady permanently. We can also see why the disease recurs so readily in the scar tissue after operation; for all recognize and admit that cancerous degeneration is apt to develop on any scar tissue. It is also well known that occasionally a tumor which after removal has been proved microscopically to be only a simple adenoma, has eventually been followed by true carcinoma in the cicatrix or elsewhere, under the stimulation of surgical procedure.
Metastatic development, after or without operation, can also be readily understood on the ground of the disease being a constitutional disorder. For, as far as I have observed, there is seldom or never any continuous attempt made after an operation to alter the dyscrasic condition producing the tumor, but the patient is dismissed with the vain hope that there will be no more trouble. It is quite natural, therefore, that the transference of cancerous cells by the lymphatics or blood vessels, will form foci which are readily made to grow further by the vitiated blood stream.
Regarding, then, cancer as a systemic disease, of which the tumor is but a local expression, often or perhaps always the result of local injury or irritation, possibly of one or more “embryonic rests,” let us briefly review the evidence in support of this view, and the measures found successful in combating the basic cause of the disease.
First let me remind you of the negative and positive results of laboratory and other study, which are pretty well conceded by those who know most about the disease; and in presenting these I cannot do better than to quote what I have collected in a former article.[4] There are eight of these in each group.
1. Clinically and experimentally cancer is shown to be not contagious or infectious; although under just the right conditions certain malignant new growths can be inoculated in some animals of the same species, but not in other species, and human cancer cannot be transplanted on animals.
2. Although microörganisms of many kinds often have been found and claimed as the cause of cancer, there has been no concurrence of opinion in regard to them, and it is now pretty conclusively agreed that cancer is not caused by a microörganism or parasite.
3. Cancer is not wholly a result of traumatism; although local injury may have much to do with its development in some particular locality, even as in connection with the late lesions of syphilis.
4. Cancer is not hereditary in any appreciable degree; although some tendency in that direction has been demonstrated in certain strains of mice.
5. Occupation has not any very great influence on the occurrence of cancer; although it is more frequent in some pursuits than in others.
6. Cancer is not altogether a disease of older years; although its occurrence is decidedly influenced by advancing age.
7. It does not especially belong to or affect any particular sex, race, or class of persons.
8. Cancer is not confined to any location or section of the earth, but has been observed in all countries and climates.
But while laboratory and other investigations have not demonstrated any single cause of cancer and have yielded only negative results, they have, by elimination, cleared the way for a study of its cause along other lines, which are bright with promise. They have also established certain facts which confirm the views which from time to time have been briefly expressed by many who were best acquainted with cancer; namely, that, because of its constant recurrence, and from the failure of surgery to check its rising mortality, it must be of a constitutional nature, intimately associated with dietary or nutritional elements, as I have elsewhere shown.[5]
The positive results of laboratory investigation are more encouraging:
1. We know now that the local mass, which we call cancer, represents but a deviation from the normal life and action of the ordinary cells of the body. These once normal cells, for some as yet unexplained reason, take on an abnormal or morbid action, with a continued tendency to malignancy which invades and destroys contiguous tissue, and is associated with a progressive anemia which destroys life.
2. Microscopic study has shown that there is a certain change in the polarity of cells about to be cancer-genetic, with an altered relation of the centrosome to the nucleus. These changes have been well attributed to an alteration in the enzyme contained in the cell, which further depends on the nutrition of the cell as influenced by a faulty metabolism of food elements.
3. The exclusion of all other possible causes leads us naturally to look to a disordered metabolism as a cause of the disturbed action of the hitherto normal cells; and we find much to confirm this view both in laboratory studies on the biochemistry of cancer, and also in clinical and statistical observations.
4. The blood in advancing cancer has repeatedly been shown to exhibit many manifest changes, which indicate vital alteration in the action of the organs which form blood, and so control the nutrition of the body and its cells.
5. Laboratory and clinical evidence demonstrate that the secretions and excretions of the body, both in early and late stages of cancer, exhibit departures from normal which deserve consideration. Although not one of these has as yet been established as pathognomonic of cancer, they all indicate metabolic disturbances which influence the nutrition of the cellular elements, and so these secretory and excretory disturbances are of importance in connection with its causation.
6. As all healthy cells of the body, by their catabolism and anabolism contribute a hormone or something to the general circulation, so experimental evidence shows that the cells of a cancer mass itself, when fully developed, secrete a hormone or something which is poisonous to animals, and which probably hastens the lethal progress of the disease.
7. Repeated laboratory experiences have demonstrated, in a most remarkable manner, the absolute controlling effect of diet on the development of inoculated cancer in mice and rats, so that the process was inhibited almost entirely with certain vegetable feedings.
8. We thus see that as the laboratory has eliminated the local nature of cancer, it has also, in a measure, established the fact that there are medical aspects of the disease which further studies will show to be of the utmost importance. These all tend to demonstrate its constitutional origin, that is, its relation to deranged metabolism, which is now recognized as the basis of so many diseases of more or less serious character.
But clinical and statistical studies come in with overwhelming force to confirm the correctness of this position.
1. We have already seen that with utter medical neglect the death rate of cancer has steadily and greatly increased in the United States, of late years, in spite of the prodigious advances of surgery during the same time. This is also true in all the countries from which we have any accurate statistics. We know also that tuberculosis, as a result of careful medical attention, has decreased in mortality by almost as great a percentage as cancer has increased. The same is reported by reliable observers all over the civilized world.
2. Any number of observers, in many lands, have recorded the almost entire absence of cancer among aborigines, living simple lives, largely vegetarian; they have also shown the definite increase in the disease, and in its mortality, in proportion to their adoption of the customs and diet of so-called modern civilization.
3. This increase of cancer mortality seems to depend largely upon the altered conditions of life attending advanced civilization, particularly along the lines of self-indulgence in eating and drinking and in indolence.
4. Statistics from many countries show that increase 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.
5. Clinical observation has time and again shown the effect of specific nerve strain and shock in the development of cancer; and there seems to be little question but that the enormous nerve strain of modern life is an element of importance in this direction, both through metabolic disturbance and by direct action on living cells.
6. At present no clear demonstration is possible of the direct method by which errors of metabolism effect the changes in cells to which we give the name malignant, any more than we know how other alterations on the body are produced; such as arterial degeneration, bone changes, obesity, etc., which are recognized as due to metabolic derangement.
7. The results which have been observed in connection with the starvation of cancer, by ligature of vessels, illustrate the relation of the blood supply to growing cancer.
8. Finally, the repeated observation and report of the spontaneous disappearance of cancer, by careful and competent medical men, shows that conditions of the system may arise which are antagonistic to malignant growth, even when it has begun to take place; just as there are other conditions of the system which favor the aberrant action of previously normal cells, resulting in cancer.
The medical aspects of cancer thus loom large, and appear in quite a different light from that in which they have been commonly viewed. We now begin to see some of the reasons why cancer is not primarily a surgical disease, and some of the lines along which observation and investigation should proceed; namely, biochemistry, secretory and excretory derangements, metabolic disturbances, diet, etc., etc. The subject is too new a one to afford a great amount of corroborative proof at present, other than the long personal experience of the writer and others, who have seen tumors disappear under means other than surgical, X-ray, and radium. More clinical and laboratory investigations of human beings are needed, and not simply microscopic studies and experiments on animals, valuable as these have been in the advancement of medical science in connection with other diseases.
We will now consider briefly some of the practical points in regard to the successful treatment of cancer by means other than the knife. I will not take time to review or even to mention the various methods and means which have been proposed and advocated for the cure of cancer, only to end in disappointment for the reason that they did not reach the basic cause of the complaint. The very multiplicity of the suggestions proves their futility.
The line of thought and practise to which I would devote your special attention is not entirely new, but has been hinted at by many careful observers during the past hundred years or more, though it has never before been fully developed or strongly urged. But the experiences of over forty years, together with much study, has so convinced me of the correctness of the principles and practise which I advocate that I cannot too strongly urge you to consider them fully and without bias, and to put them to a satisfactory test, although I quite realize that they are contrary to the generally accepted views of the profession and laity.
The fundamental principle of my thesis lies in the fact that with the so-called advance of modern civilization, certain diseases, for the last fifteen years at least, have showed a steadily increasing mortality. The deaths in the United States from apoplexy, nephritis, and heart disease have steadily increased over ten, fifteen, and twenty per cent respectively, and those from cancer 28.7 per cent. We all realize that the results in the three former diseased conditions are from errors in the mode of life, including eating and drinking, and indolence, and careful study shows that cancer has the same origin. On the other hand, as already stated, the deaths from tuberculosis have steadily declined 27.8 per cent under rational medical treatment, directed mainly along the lines of correct nutrition: the death rate of tuberculosis and cancer have thus approached each other 56.5 per cent, and at this rate in fifteen years more the mortality from cancer will exceed that from tuberculosis!
Careful and prolonged studies of cancer patients, both in the earlier and later stages of the disease, as I have recorded elsewhere,[6] show that there are always departures from normal metabolism, as is shown by the condition of the blood, and in the excretion from the bowels, kidneys, and skin, and in the salivary and hepatic secretions, and possibly in those of the ductless glands. Time does not permit here of elaborating this subject, which has been done elsewhere, but it is evident that some combination of internal systemic disorders must be recognized as the basic cause of the complaint, although at the present time it is difficult to point to a single causative element, if, indeed, it will ever be discovered.
But a broad view of metabolism and nutrition recognizes that all cell changes, whether good or bad, depend on the character and composition of the blood furnished to the tissues, although little definite may be known concerning it. Thus, no one has demonstrated the single causative change in the blood in arteriosclerosis, gout, rickets, scorbutus, etc., but no one questions that it exists, and we direct our therapeutic measures accordingly, largely from experience.
The same is true in cancer. Most careful and prolonged study of the patient in every respect has shown a certain uniformity in regard to particular deviations from health, the correction of which has been followed by a complete disappearance of tumors classed as malignant, so that the connection must seem obvious to an unprejudiced mind. And yet it cannot be claimed that the exact, single cause of the cancerous growth has been demonstrated, and from the nature and character of the systemic disorders found, it is evident that there can never be any single remedy which can be rightly claimed as a cure for cancer.
But that cancer can be cured by medical means and without the knife is absolutely certain, as the experience of many testify, and as the writer has observed in so many cases during the past 30 and more years. Many of the instances in the hands of others have occurred unexpectedly, and without definite or careful study and record of the measures employed. But in some way the condition of the blood and system has become altered so that there has occurred a retrogressive process which resulted in the absorption of the tumor. I may say that this was the case in regard to the earlier patients in my own practise, when I observed that tumors of the breast, which had been diagnosed as cancer by surgeons, disappeared under dietetic and other measures given for some skin affection; later observation and study have crystallized my views and confirmed my methods of procedure, which I hope to make plain, as briefly as possible, lack of time to explain everything must make me a little dogmatic.
An absolutely vegetarian diet is the first requisite in the treatment and prophylaxis of cancer, for, as mentioned, this has been found experimentally to inhibit, often to a remarkable degree, the production of artificially produced cancer in rats and mice, and experience throughout the world has shown cancer to be extremely rare in vegetarians. This diet, which should be maintained indefinitely, must be rigorous and absolutely vegetarian, excluding animal protein, even eggs and milk; butter is the only article allowed which does not grow, and of this one quarter of a pound is to be taken daily, by a person weighing 150 pounds. Cereals are to be freely employed, eaten slowly, with a fork, and with butter, and not with milk and sugar, though the latter may be used moderately, where it seems necessary and where it perfectly agrees with the patient.
Perfect mastication, with thorough insalivation, is very essential, and I insist on at least half an hour being taken for even the lightest meal. Coffee, chocolate, and cocoa are excluded from the diet, only weak tea being allowed, with some postum or other artificial substitute for coffee.
Alcohol in each and every form is absolutely excluded, as it always has a very harmful effect on cancer. Sufficient water, not iced, should be taken to answer to the needs of the system, and I commonly give half a pint with each meal, and half a pint, hot, one hour before both breakfast and the evening meal.
Cancer being a disease of advancing civilization, with all its temptations and errors in living, it is essential that the cancer subject lead a very simple and healthy life, with regular hours of eating and sleeping, with a reasonable amount of exercise, and the avoidance of everything which could disturb normal metabolism.
There is, of course, no single medicine which can cure cancer, but proper medication plays a very important part in overcoming the disease and should never be neglected or interrupted in any case; indeed, one suffering from or threatened with cancer should be under the most careful medical guidance indefinitely, and this is especially true after the surgical removal of the tumor, or local manifestation of the morbid process, as Abernethy so strongly asserted, nearly a hundred years ago.
Medical treatment lies mainly along the lines of elimination, which is always found to be faulty, both by the bowels and kidneys. My records of large numbers of private patients show that there is imperfect intestinal secretion, both in the very early stages and late in cancer, even before morphin is taken. Therefore I have long come to look upon intestinal auto-intoxication as a prime factor of causation, and lately Sir Arbuthnot Lane has spoken of cancer as a terminal result of intestinal stasis. This constipation, however, is not to be met with occasional purgatives, but by measures which will secure a good normal evacuation once or oftener daily. My principal reliance for this is cascara, in combination with other remedies, although I also very often give once a week, on alternate days, two good laxatives of blue mass, colocynth, and ipecac. Mineral waters, Russian oil, etc., are not desirable, and enemata are resorted to only in emergencies.
The kidney secretion in early and late cancer is always faulty. This does not refer to albumen and casts, or sugar, which are searched for but seldom found. But very careful and repeated volumetric analyses of its many normal ingredients reveal errors in its composition which are of significance and which serve as a guide in therapy. There is always a faulty nitrogenous partition, and in that of sulphur; indican is commonly in excess, often very greatly so, and the chlorids and phosphates and sulphates deranged. The urinary secretion will constantly be found to be extremely deficient, both as to the actual quantity passed in the 24 hours, and in its total solid contents, which are often hardly one half of that called for by the body weight of the patient; this I have verified by hundreds of analyses. As these errors are corrected by proper treatment there will be a coincident improvement in the vitality of the patient and in the tumor.
The remedy which I have largely relied on in these cases for many years is acetate of potassa, and it is interesting to note that Ross[7] of London claims that a cause of cancer is found in a disturbance in the mineral contents of the blood, and that there is a lack of potassa, and he gives as high as 90 grains of phosphate and carbonate of potassa in the day, with excellent results. I commonly give the acetate in combination with other remedies, thus ℞ Potass. acetatis ℥i, Tinct. Nuc. Vom. ℨiv, Ext. Cascara fld. ℨi-ℨiv, Extr. Rumicis radicis fld. ad ℥iv, M. Teaspoonful in water ½ hour before eating.
But in the long treatment necessary for these cases before the malignant growth has quite disappeared, and possibly for a good while afterward, there may be many remedies used with advantage to secure and maintain that healthy metabolism requisite to overcome the cancerous habit. Iron and arsenic, phosphates and strychnin, and even cod liver oil and many reconstructive remedies and measures may bear their share in overcoming this dire disease. Thyroid extract sometimes assists materially in removing the malgrowth, but must be given with caution, and in connection with other proper remedies; for sometimes it will promote catabolism and disintegrate the diseased tissue faster than the emunctories can remove the effete products, and these may poison the system.
It has been difficult in a single address to present such a vast subject, which is more or less new to many, in a clear and concise form, and I fear that I have trespassed too greatly on your patience, and have yet only imperfectly made matters clear. But I shall be satisfied if I have excited your interest sufficiently to cause you to investigate the medical aspects of cancer, in which lies the real problem of its prevention and cure. Surgery has been tried faithfully by many brilliant and honest men, some of whom now and then acknowledge the failure of the knife to arrest the steadily increasing mortality from the disease, which is now about 90 per cent of all those once attacked.
But I fully realize that there is danger in my strenuous advocacy of other lines of treatment, lest these should not be fully and perfectly carried out, with such intelligence, patience, and persistence, on the part of the physician and patient as is requisite to accomplish the end desired. For I must say that it is extremely tedious and tiresome to care minutely for these patients, who should be seen at least weekly, and even for months or years, with careful and accurate records, innumerable urinary and blood analyses, etc., etc.
On the other hand, however, we have the alternatives of leaving the patient to suffer and die, or to submit to a surgical operation with the expectation of recurrence in a considerable proportion of cases, attended often with greater suffering and final death.
My experience with the disease for forty years or more in private practise, and for the last few years in my medical clinic for cancer, in the New York Skin and Cancer Hospital, and in the wards of the hospital, have so fully convinced me of the correctness of the views I have stated here and elsewhere that I cannot too strongly beg you to give them due consideration, and not simply to class them with the various passing claims and suggestions regarding cancer, which have so often proved illusory. For along the lines which I have presented lies the real cancer problem, as I can demonstrate by many cases more or less similar to those detailed in my little book.