Chapter III: Part 3

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.