Chapter III: Part 3

It is well known that not long ago three years was considered as the time at which, if there had been no recurrence, the cancer could be considered as cured, and very many statistics have been based on this period. But with further experience and closer observation, and with more diligent following up cases, it was found that recurrences did take place more or less frequently at subsequent periods, and now the time limit has been arbitrarily extended to five years. This is because the very large proportion of recurrences are in the first year, varying for different locations and conditions from as high as 50 to 80 per cent in different statistics.

But as the patients who have lived out the five-year limit are followed up more carefully, it is found that recurrences do happen all along the following years, so that they are recorded as occurring 6, 8, 9, 20, and 25 years after operation; I have met with many after 3 or 5 years, and even as late as 15 years after operation. The vast majority of cases, however, are not thus accurately followed out, much less reported, and thus far we have few data on which to make accurate statements as to the actual permanent cure of cancer by the knife.

Recurrent cancer, as one constantly observes it, is most deplorable, and many who have had much to do with these cases realize that the distress is often far greater than in other cases in which the disease has run a natural course, without operation and under good medical guidance. The pain attending growths in scar tissue is generally intense and commonly requires anodynes continually and increasingly; these in turn, by disturbing digestion and locking up the secretions, seem to augment the disease. Even with these patients, however, very much may be done to relieve their suffering by proper dietary and medicinal means, with suitable local medication, as I have constantly seen, so that opiates need be but little used.

METASTASES form a very considerable and important element in inoperable and recurrent cancer, and we will briefly consider these. They occur mainly through three channels: 1. The lymphatic system; 2. The venous system; and 3. The arterial system. The permeation theory of Handley relates to direct extension laterally through lymphatic spaces, and belongs to the first mentioned means of extension. It is also believed that metastases may be formed in the peritoneal cavity, and likewise in the pleural cavity, by direct contact of cancer cells or pieces of malignant tissue which have gained access to those cavities and have been carried down by gravity and movement of viscera. They then become engrafted on healthy tissue and form metastases there.

While holding firmly to the belief that the original cancerous growth and other foci of disease are developed from a vicious state of the blood current, there seems to be no reason for doubting that the disease may also be extended in the manner above indicated. Although cancer material cannot be inoculated from one person to another, or from a human being to animals, nor from one species of animal to another, experience and observation show that the malignant process can be transferred from one organ or structure of the same individual to another part or structure, whether there has been a surgical operation or not.

The lymphatic system is apparently the first means for the spread of the malignant process, and all are familiar with the lymph nodes seen in the neighborhood of cancerous masses. It is supposed that these are caused by the lodgment of detached cells which have taken on the abnormal reproductive action which characterizes cancer. As with other foreign bodies, pus cocci, etc., the minute lymphatic glands seek to arrest their passage into the circulation, and it is probable that some of them are destroyed there, for the single enlarged gland will often remain for a long time as the only manifestation of metastasis. In many cases, where the original cancer has disappeared under dietary and medicinal treatment, the enlarged glands also disappear, as I have seen many times.

When the disease is unchecked, however, the glands fail in their endeavor to protect the system and continue to enlarge one after another along the line of the lymphatics, and the lymph stream then carries certain cancer elements through the thoracic duct into the venous circulation; thence they reach distant parts of the body, through the arterial system, and, being lodged in capillaries, a more or less general carcinosis results. Cancer elements can also proliferate along lymphatic tracts, and, furthermore, they may enter the venous and arterial systems directly by the invasion of a malignant growth.

All these and other points regarding the metastasis of cancer form a very interesting study, but time does not permit of further elaboration. All know that while primary carcinoma of the liver is very rare, its secondary or metastatic involvement is very common. The bones, lungs, spleen, kidney, and viscera generally are all often found to be the seat of metastases, and in general carcinosis, which has lasted some time, metastases will be found abundantly both in the lymphatics of many parts of the body and in many organs and tissues. Metastases in the lungs are not uncommon in breast cancer, as also metastasis in the bones of the thorax. In the last lecture reference was made to the frequency of metastases in the skeletal structures of the body, which probably have much to do with the pernicious anemia which carries off the patient.

An interesting study relates to the extension of the carcinomatous process in the skin; this occurs at first near, and then around, and even at a distance from the site of an operation, especially after removal of the breast. These nodules are at first small, and felt deep in or below the skin, and are not colored. They steadily increase in size, and when about that of a small pea, they become red and elevated a line or so. Later they may appear more numerous and even involve a large area, forming the so-called _cancer en cuirasse_, and may ulcerate. Sometimes single lesions of some size may appear here and there, even some distance from the site of the original tumor, and may not be colored. While these may represent lymphatic infarctions, it is often impossible to trace any direct connection with lymph ducts, and they more probably arise from capillary deposits of cancerous elements. I have frequently had these scattered cutaneous lesions excised, in cases under medical treatment, with a view of removing mechanically some of the foci from which the disease could be spread. The wounds have invariably healed promptly and perfectly, and no carcinomatous process has resulted.

The BLOOD IN CANCER has been studied mainly in reference to its solid constituents, and very little in regard to its plasma; whereas it is from the plasma that the blood corpuscles are formed, and this is the principal agent in the development and nutrition of tissues, normal and malignant. For it is to be remembered that the chyle is discharged directly into the venous blood current, and the venous radicles absorb much of the nutritive material directly from the abdominal organs. The plasma, therefore, carries with it constantly a varying quantity of partially assimilated material to be oxidized in the lungs, and slowly purified by the agency of the kidneys; the serum albumen and serum globulin are also active agents in the formation of tissue, malignant or other. There is great need of laboratory studies along these lines, and also on the alkalescence of the blood, which we found to have a marked diminution in cancer.

We know also comparatively little in regard to the origin and destruction of the cellular elements of the blood, and can only depend on the microscopic examination of their forms and appearances in health and in many conditions of disease. These have been abundantly studied morphologically, but mainly in the more severe forms and later stages of cancer, as detailed somewhat in my former lectures. Enough was there quoted to show the continued degeneracy of the blood after a cancerous growth had acquired some progress; there has also been observed some improvement for a while after the removal of a tumor, evidencing the deleterious effect of the hormone secreted by a cancerous mass.

The laboratory study of the blood from 22 of the cancer patients in the New York Skin and Cancer Hospital under my care, has been instructive as well as valuable along certain lines. In most of them it was made weekly, and often over long periods of time, and the results tabulated for easy comparison, in order to study closely the condition of the patient and the effect of remedies. No very startling revelations were made by these blood studies, they confirmed in the main the observations of others, though some interesting facts were learned from an analysis of the data. They referred to ten cases of cancer of the breast, four of the stomach, two of the uterus, one of the rectum, one of general abdominal carcinosis, and the rest in scattered locations.

The lowest hemoglobin index was 35, with 2,800,000 red blood cells, in a woman aged 59 with cancer of the stomach. The next lowest hemoglobin index was 45, with which the patient, aged 53, died, with inoperable cancer of the right breast; the blood count showed 3,700,000 erythrocytes, and 10,400 white blood cells, 76 per cent of which were polynuclear. During the course of observation, covering several months, the red blood cells were once 2,100,000, but under careful treatment rose to 4,110,000 not long before death. The next lowest red cell count observed was 2,200,000, with 12,000 white blood cells, and 65 hemoglobin index, in a man aged 52, with a terrible inoperative cancer of the cheek and neck, of which he died.

The highest red cell count made was 5,400,000, in a case of cancer of the uterus, in a patient aged 52, the count being 4,064,000 on entering the hospital. The highest hemoglobin index was 90 in a number of severe cases, and 100 in one case of sarcoma, to be detailed in the next lecture. In one recurrent case of cancer of the left breast, which was very distressing at first, the patient died peaceably and without pain, with a hemoglobin index of 90, and 4,900,000 red cells, and 7,400 white cells, of which 75 per cent were polynuclears, 17 per cent small lymphocytes, and 7 per cent mononuclears. Her hemoglobin had been 70 per cent on entering the hospital with 3,360,000 red cells. The highest leukocyte count observed was 18,600 in a case of inoperable cancer of the right breast, not long before death, in an unmarried female of 53; but in the course of treatment it had fallen to 6,200, about normal, from 10,520 before beginning treatment.

I will not weary you with more of these figures, which are interesting and instructive as one studies them week by week in connection with the physical condition of the patient. However much can be done for these distressing and inoperable cases of cancer, one has to acknowledge that when general carcinosis has set in we are still helpless in arresting the lethal progress of the disease, although very much can be done in prolonging life and alleviating suffering; and this does not mean with morphia or codeia which in the end does harm, and was very seldom administered to the patients referred to.

Forbes Ross, after ten years of constant microscopic clinical and surgical research, has made some interesting observations, covering many pages, on the blood of cancer patients, which have a close bearing on our subject, and to which I can only briefly allude, and I do not know if I can make it clear in the time I can give to the subject. By long study of sections of carcinomatous tissue he claims that the mononuclear leukocyte behaves in a very different manner from the polynuclear. Briefly he charges the mononuclear white corpuscles with actually producing the disease, by conjugating with certain epithelial cells, thereby giving them the reproductive capacity which enables them to push forward on their destructive career. The polynuclears seem to come up to the defense of the body, but are overcome by the poison secreted by the rapidly growing tumor cells.

The red blood cells he also finds, with other observers, nucleated more frequently in cancer than in any other form of secondary anemia, and subject to a change of composition, and deficient in lecithin and nuclein. He shows the importance of potash, which we shall later find clinically of such great value in cancer, and I cannot do better than quote some of his words: “How vitally important potassium salts are to the red corpuscles is shown by the following: One thousand parts of red corpuscles are found to contain six hundred and eighty-eight parts of water, three hundred and eight parts of organic solids, and eight parts of mineral. Of these eight parts three and one half are of potassium chlorid, two and one half are potassium phosphate, and decimal one potassium sulphate; the remaining 1.9 parts are divided between the iron, sodium, calcium, and magnesium, comprising the rest of the corpuscles. More than three quarters of the total mineral ash of the red corpuscles is, therefore, composed of potassium. This fact is an important one, and the reader is earnestly requested to bear it in mind.” Later we will again see some of the valuable clinical suggestions which arise from his researches.

From our study of inoperable and recurrent cancer, and of metastasis and the blood conditions in the disease, we see what a formidable task is before one who would attempt to lessen its morbidity and mortality. We see also how blind all have been who have so long looked to surgery to stay its progress. In my former lectures I collected and quoted statements from many surgeons of prominence in times past, and even some in quite recent times, all expressive of a belief in a constitutional origin of cancer, and many of them looking to a dietary cause. I also gave biochemical laboratory and experimental evidence showing the medical aspects of cancer. I then remarked that it seemed strange that the medical profession and the public had been so slow in accepting and acting on the accumulated evidence which I have tried to put before you in these and the former lectures.

The reason for this seems to be that the medical profession, being occupied largely with acute disease and apparently definite and speedy results, became readily discouraged with the unsatisfactory course commonly observed in cancer; as in the case of tuberculosis, until the revival of an interest in the latter in recent years, with the well known beneficial consequences. They, therefore, turned the cancer cases over to the surgeons, in the hope that they could do better.

By the brilliant advances in modern surgery along many lines, the laity also have become obsessed with the idea that it has limitless power in many directions, and have yielded to the knife in spite of the rising mortality of late years. The glamour of modern surgery and its often spectacular results have quite blinded the eyes of many to real facts.

It is not a little interesting to note that the period to which we have referred, 1910 to 1915, in which the mortality of tuberculosis has fallen so steadily while that of cancer has so steadily risen, even in greater proportion, is that in which active laboratory work has also dazzled the public and professional mind. The enormous activity with the microscope in regard to the minute structure of the diseased tissues, and the elaborate and extensive work done in animal experimentation, have turned the thoughts of many from the homely and practical studies of the human frame in its various departures from health; thus too little attention has been given to the deranged activities of its various organs, and the perverted metabolism which, has resulted from the stress and strain, with the temptations and errors accompanying the present intensity of human civilization.

Matters being as they are it is hardly to be expected that the surgeons would incline to any other treatment than by the knife, especially since good pathologists have asserted that cancer is only a local affair and have urged its early removal. Nor would one expect that the surgeon would think along medical lines and investigate metabolic conditions, when the immediate results of operation seemed often to be so satisfactory. Neither would one expect the surgeon to seek from statistics the unfavorable aspects of this line of treatment, but rather those from which he could draw encouragement in trying to overcome so dire a disease.

But slowly light is beginning to shine, and you have seen and heard enough to realize that the simple removal of the _product_ of the cancerous process, and surrounding tissues, can never check greatly the morbidity and mortality of cancer. You know now what the real cancer problem is. It surely is not the sole continuance of a line of treatment under which the death rate has steadily risen from 63 to 81.1 persons in each 100,000 living, or 28.7 per cent since 1900, with a mortality of about 90 per cent of those once affected with the disease.

The cancer problem is by no means yet solved, but I think that you will all agree with me that we are on the right track, and I cannot do better than to close with a remark I made to you two years ago: “Scientific research 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.”

LECTURE V
DIETETIC AND MEDICAL TREATMENT OF CANCER PROPHYLAXIS

Although all statistics show a steady and alarming increase in the death rate from cancer when regarded and treated as a surgical disease, it is probable that this course will be persisted in until sufficient evidence is accumulated to satisfy the medical profession and the laity that relief can be obtained by other means. For, as the drowning person catches at a straw, so the cancer patient hopes against hope that an operation will be permanently successful in this particular case, though the odds are so immeasurably against it. You have already seen some patients who have illustrated the possibility of controlling cancer by dietary and medical measures, and in the next lecture I shall hope to show and report other cases and present statistics which will further illustrate this possibility. We will now consider briefly what this dietary and medical treatment of cancer consists in, and how it is to be carried out, and also the bearing of all this on the prophylaxis of cancer. In order to make this clear I must more or less repeat some things that I have said in former lectures.

We have seen that, as shown by the kidney excretion and the condition of the blood, the metabolism is deranged, both in the early and late stages of cancer. We have seen that the nitrogenous and sulphur partition is materially different from that of health, and reason indicates that in some way protein, or rather its metabolism, is at fault. We have seen that there is a deficiency in the urinary secretion, not only as to the actual quantity, but also that the total urinary solids are commonly far below the normal, often not half the amount required for the body weight of the individual. We have seen that the intestinal excretion is commonly imperfect and that constipation is the rule in these cases, even long before the administration of anodynes. The secretion from the skin is also generally defective, and the tissues dry and harsh, and the saliva is generally acid.

All these, and perhaps other, elements point to a faulty performance of the bodily functions, and to erroneous or deficient elaboration and elimination of the waste products of the body; these latter are known to be toxic to animals, and we know that in the human system they lead to an auto-intoxication and derangement of the blood stream, which in turn causes faulty cell and tissue action. Such a condition is recognized in gout, as causing the local inflammatory manifestations, and in rheumatism, which is so common in cancer subjects. All recognize that obesity is due to some nutritive change, naturally acting through the blood, and it is well known that cancer is peculiarly rebellious in those subject to obesity. Diabetes likewise relates to a peculiar blood condition, and there have been many observations concerning the relation of diabetes to cancer. All these diseases and many more have their foundation in faulty nutrition, depending largely on dietary errors.

We see, then, that to understand and rightly treat the systemic condition belonging to cancer, which is indeed its basic factor, one needs to take a very broad view of the complex processes in the human system which pertain to metabolism and nutrition. This is indeed quite a different proposition from the very simple surgical view which regards the tumor as a local matter, of absolutely unknown origin, which only needs the knife to end its career. Deranged, disturbed, perverted nutrition is then the bottom fact of all erroneous growth, whether it be obesity or a benign or malignant tumor.

Now it must be acknowledged that we are yet in the dark regarding the exact or precise blood changes which precede and accompany cancer; but in our last and also in previous lectures we saw that the blood did exhibit changes which were evidently connected with the production and continuance of the disease. Until all these matters which have been referred to have been accurately determined by laboratory work and investigation we are forced, as in time past, and as is still the case also in regard to many diseases at the present time, to rest our judgment and treatment on clinical experience, joined with deductive observation, based on such knowledge as we have. And this we have endeavored to do in these and former lectures.

Coming down, then, to the actual and practical facts relating to the dietary and medical treatment of cancer, we readily see that the real cancer problem relates to placing the patient in such a normal or ideal state of life that the function of nutrition is performed in an exactly proper manner, as nature intended, and from which man has erred through the manifold temptations incident to our artificial existence, in the presence of our so-called advanced civilization; for we have seen that all over the world cancer has steadily increased with the intensity of human progress.

Since first writing on the subject under discussion medical reviewers have spoken as though I regarded the eating of meat as the sole cause of cancer, and enforced absence therefrom as the single element in its cure and prevention. From what I have just said you can see that this is by no means true. But that I regard animal protein as a fertile cause of the derangement of metabolism which leads up to and fosters the growth of cancer, is most certainly true; this I have developed largely in my lectures two years ago. While there are many elements which contribute to the deranged blood stream of cancer, the question of diet is so preeminently important that we must treat of it very fully. For, as in gout the continuance of an indulgence in Port and Madeira wine in excess would invalidate any attempt to cure the trouble permanently, so in cancer an excess of animal, or even a large amount of vegetable protein, militates against any effort to remove the disease medically; this is probably true also of coffee and alcohol.

The first point, therefore, is to remove from the intake of food everything which furnishes an excess, or even such a modicum, of nitrogenous matter as is found by laboratory means to be badly metabolized. The second step is to eliminate effete nitrogenous elements from the system, including the cancerous mass, and the third step is to restore the system to a proper tone by remedies and measures which improve the blood and nutrition. It may happen, therefore, that in treating a cancer patient over the long time necessary to effect a cure, the greatest number and variety of remedies may be employed from time to time, as intelligent observation and experience may indicate, to restore and hold the metabolism and nutrition in a perfectly normal state: the erroneous action of certain individual body cells which in the aggregate we call cancer, will then cease to exist, as is seen in cured cases.

As, however, the diet is the basic element on which all health, good and bad, rests it is all important that the physician and patient come to a perfect understanding as to how this is to be carried out. And remember, gentlemen, that there is no absolute or fixed time during which this diet is to be continued; or rather, there is no fixed time when it may be discontinued, and my patients are made to understand that it is at their own risk that it is stopped. For safety from recurrence a proper diet should be persisted in indefinitely or even permanently.

I recognize that it is often very difficult to persuade patients to adopt and faithfully follow out this course of procedure for a long enough time to secure perfect results, so obsessed is the medical profession and the laity with the idea that surgery offers the only hope of cancer. Numbers of patients, many of whom I have followed for some years, now entirely freed from undoubted cancer, which had been previously diagnosed as such by prominent surgeons, have told me that they had suffered much more distress from the persistent solicitations of their physician, surgeon, or friends, urging an operation, than they had from the treatment or from the disease itself, as it slowly vanished under the measures employed.

But as the true facts in regard to the ultimate results of operations are becoming known, and as it is more generally realized and accepted that the disease is amenable to rightly directed dietary and medical treatment, patients are coming more and more to the Medical Clinic for Cancer in this hospital, and adhering more and more faithfully to treatment. Thus far, however, these have been mostly recurrent cases, in which further operations were impossible, or primarily inoperative cases. To illustrate the satisfactory treatment of early cases I shall have to depend largely on those observed in private practice during the last thirty years, of whom I shall try to show you some; for as yet primary and operable cases are referred directly to the surgeons of the hospital for operation.

At first the idea of an absolutely vegetarian diet is distasteful and seemingly impossible to many patients, but when it is patiently explained, as to the reason for its employment and the real benefit to be derived from it, it is readily acquiesced in and commonly carried out very faithfully; indeed many a patient has asserted that they are more than pleased, and have no desire for animal food.

Among the poorer classes especially it has been hard to make matters clear, and to facilitate the work of our Medical Clinic for Cancer I prepared a dietary card, or folder, with a daily menu, which has now been in very satisfactory use by hundreds of patients in private and public practice. To make the whole matter of this line of treatment perfectly clear, certain statements in regard to cancer have been presented on the first page, and on the last page some directions as to diet and mode of life of a practical character, as you will see on the samples now passed around, known as the “green card diet slip.” I may say that the hospital has already used up one thousand of these sheets given to patients and to physicians making inquiries, and there have just been printed this revised edition of five thousand copies, which will be gladly furnished to those who can make good use of them for cancer patients.

New York Skin and Cancer Hospital, Second Ave. and 19th St.
DIRECTIONS FOR CANCER PATIENTS

1. Cancer is a serious disease which should receive constant medical care from the time it is first suspected.

2. “Cancer Specialists,” who advertise, should be avoided.

3. Cancer is not contagious, and there is no danger of communicating the disease to others.

4. Cancer is not a disgraceful disease, and there is no reason for being ashamed of it or hiding it.

5. As soon as cancer is suspected, whether there be a lump, or sore, or other symptoms, it should be at once cared for by a competent medical man, as the earlier it is rightly treated the more prospect there is of its being cured.

6. Anything suspected to be cancer should not be handled or squeezed, but should be kept from all irritation, as all this increases and spreads the trouble and renders the cure more difficult.

7. If it is decided that a surgical operation is desirable and wise, this should be done very completely at the earliest possible moment; delay is dangerous.

8. The proper medical treatment of cancer should never be neglected, both at the very beginning, and also long after an operation has been performed, to prevent recurrence.

9. It is not necessary to operate on every cancer; x-ray and radium are often of value, and the disease can also disappear and remain absent under careful and efficient dietetic and medical treatment alone.

10. This treatment consists in an absolutely vegetarian diet, with continuous proper medication, for a long time.

11. To get favorable results this treatment should be kept up faithfully and strictly until discontinued by the physician.

To assist in carrying out a strictly vegetarian diet, a diet list for cancer is here given, which should be closely adhered to. Coffee, chocolate and cocoa, as also alcoholic drinks, even beer, are harmful and must be avoided. The rules given at the end of this card are also to be strictly observed.

DIET FOR CANCER

FIRST DAY

Breakfast

Baked apple
4 ounces Rice
3 〃 Corn bread
1¼ 〃 Butter
½ 〃 Sugar
Hot water

Dinner

5 ounces Tapioca soup
3 〃 Baked potatoes
3 〃 Stewed celery
3 〃 Peas
1 〃 Graham bread
1¼ 〃 Butter
1 Fresh apple

Supper

4 ounces Boiled oats
2 〃 White bread
1¼ 〃 Butter
4 〃 Stewed prunes
¼ 〃 Sugar
Very weak tea

SECOND DAY

Breakfast

Orange
4 ounces Hominy
2 〃 Graham toast
1¼ 〃 Butter
½ 〃 Sugar
Postum

Dinner

5 ounces Pea soup
3 〃 Macaroni
3 〃 String beans
3 〃 Carrots
2 〃 Bread
1¼ 〃 Butter
Dates

Supper

4 ounces Cream of Wheat
2 〃 White bread toast
1¼ 〃 Baked apple
2 〃 Crackers
1¼ 〃 Butter
¼ 〃 Sugar
Very weak tea

THIRD DAY

Breakfast

Banana
4 ounces Pettijohn
2 〃 White bread
1¼ 〃 Butter
½ 〃 Sugar
Hot water

Dinner

5 ounces Corn soup
3 〃 Baked potatoes
3 〃 Squash
3 〃 Boiled onions
2 〃 Bread
1¼ 〃 Butter
Raisins

Supper

4 ounces Farina
4 〃 Stewed figs
2 〃 Graham crackers
1½ 〃 Butter
¼ 〃 Sugar
Very weak tea

FOURTH DAY

Breakfast

Raw apple
4 ounces Cornmeal mush
2 〃 Graham bread
1¼ 〃 Butter
¼ 〃 Sugar
Postum

Dinner

5 ounces Vegetable soup
4 〃 Baked beans
3 〃 Cauliflower
3 〃 Asparagus
2 〃 Bread
1¼ 〃 Butter
Figs

Supper

4 ounces Rice
4 〃 Stewed prunes
2 〃 Graham crackers
1¼ 〃 Butter
¼ 〃 Sugar
Very weak tea

FIFTH DAY

Breakfast

Orange
4 ounces Cracked wheat
3 〃 Corn muffins
1¼ 〃 Butter
½ 〃 Sugar
Hot water

Dinner

5 ounces Sago soup
4 〃 Spaghetti
3 〃 Lima beans
3 〃 Boiled onions
2 〃 Bread
1¼ 〃 Butter
Dates

Supper

4 ounces Cream of wheat
Sliced orange
2 ounces Oatmeal crackers
1¼ 〃 Butter
¼ 〃 Sugar
Very weak tea

SIXTH DAY

Breakfast

4 ounces Samp
2 〃 Graham toast
1¼ 〃 Butter
½ 〃 Sugar
Postum

Dinner

5 ounces Celery soup
4 〃 Baked potatoes
3 〃 Carrots
3 〃 Spinach
2 〃 Bread
1¼ 〃 Butter
Orange

Supper

4 ounces Wheatena
4 〃 Stewed figs
2 〃 Saltine biscuit
1¼ 〃 Butter
¼ 〃 Sugar
Very weak tea

Repeat this bill of fare on
successive days.

Some interchange of the different articles may be made according to the season and to suit the appetite or convenience of patients; but in the main this bill of fare should be followed, with occasional substitution of similar articles, if necessary.

Bread at least 24 hours old may be taken as desired.

A little old cheese may be grated on the macaroni and spaghetti, but not cooked with it.

One boiled or poached egg may be taken for breakfast every other day, and very fat bacon on the alternate days, unless otherwise directed by the physician.

It is desirable to eat the skin of potatoes, baked or boiled.

Each and every meal should be eaten very slowly, for at least half an hour, with long chewing.

One tumbler of water, not iced, is to be taken with each meal, but not when food is in the mouth; also a tumbler full of hot water, one hour before breakfast and supper.

No milk is to be taken unless specially ordered.

The vegetable soups are to be made from a stock composed of the water in which all vegetables, including potatoes, have been boiled, added to, day by day, kept hot, and allowed to evaporate; a portion is each day thickened as desired with barley, rice, farina, sago, vermicelli, etc.

The cereals are to be boiled with water, three or four hours, and may be cooked in the afternoon and re-heated in the morning, adding more water. Rice, farina, and cream of wheat require only an hour. Chopped dates, figs, raisins, or currants may be added to cereals when desired.

All the cereals are to be served very hot, on hot plates, and eaten with butter and salt to taste (not milk and sugar). They are to be eaten very slowly, with a fork, and very well chewed.

The crackers with supper may be varied to suit the taste; they should be eaten dry, with butter, and chewed very thoroughly.

Nothing should be taken between meals, unless especially directed, and the life should be as simple and healthful as possible, with early and long bed hours.

* * * * *

This diet list has been carefully gone over by the dietitian of the hospital, and as presented represents an average of 2,100 calories per day, with 140 of vegetable protein. This is calculated for a person of about 150 pounds, either in bed or not taking active exercise. The quantity of each article may, of course, be increased if necessary, or diminished for lighter weights, but in the main this has sufficed, so that fat persons have come nearer normal weight, while thin persons have gained in flesh. You will remember the girl of 20 years whom I showed you last week, with the right upper jaw gone after an operation for sarcoma, who weighed 89½ pounds on entering the hospital, and weighed 130½ pounds when she sat before you, three to four months later, with the opening in the cheek perfectly cicatrized on the edges, and all trace of the disease gone, on this diet.

You will notice certain directions on the last page of the folded sheet which are of importance to remember: kindly look them over carefully. I wish to call your particular attention to that in regard to perfectly chewing, masticating, or Fletcherizing the food, even cereals, for at least half an hour. Note also that the latter are to be eaten with butter and salt, and not with milk and sugar, and with a fork, and not with a spoon, in order to encourage slow eating. You will remember that in my previous lectures I called your attention to the fact that the salivary secretion was found to be at fault even in early cases of cancer, and this perfect mastication is intended to stimulate these glands and facilitate the change of starchy foods into glucose; for our rapid eating in modern days may be one of the contributing basic causes of the perverted nutrition manifested in cancer.

I would also call attention to the preparation of the vegetable soup, which is to be employed in place of the stock ordinarily used, which naturally contains the most poisonous extract of meat, or with milk, which is not desirable. This vegetable stock contains all the salts and other valuable extracts of the vegetables, which are commonly thrown away, to the great detriment to proper nutrition; there is a great loss of nutritive elements also occurring in connection with very many of the so-called refinements of food which are the result of modern civilization. Thus, the United States Agricultural Experiment Bureau tells us that thirty per cent of the nutritive value of potatoes is ordinarily wasted in the common method of peeling and cooking them. This loss of vitamines is also true in regard to wheat and other articles. You will notice that a portion of this vegetable stock for soup, made from all the water in which all the vegetables are cooked for the whole family, daily, is each day to be thickened and flavored as desired, to which also chopped vegetables may be added and also various cereals, vermicelli, tapioca, sago, etc. I may remark that many patients in private practise have told me that their families pronounced this to be the best soup they have ever tasted. Pardon all these homely remarks, but as attention to details is of the utmost importance in dermatology, so it is particularly true in regard to the management of cancer.

It will be noticed in the menu that I encourage the use of butter, giving a quarter of a pound a day, in three portions. This contains 800 calories, or one third of the total amount required; a certain amount of sugar is also prescribed, as affording an additional carbohydrate which is completely oxidized under favorable conditions.

It is realized, of course, that this bill of fare may be improved on. But it has been compiled with considerable care and thought, and an experience with it for over two years, in dozens, or rather hundreds, of cases shows that it is workable and accomplishes results which are often surprising and most gratifying, not only in my own practise but also in the hands of other physicians. I have sometimes remarked to you, perhaps thoughtlessly, that if a person had lived for three or four years according to this card, and continued to do so, I could guarantee that he would never have cancer.

So much for prophylaxis. For, as stated before, I feel confident, after many years’ observation and experience, that if the principles and practise which I have tried to present to you in my former lectures and these were closely followed by the community at large, there would before long be a very gratifying diminution in the cases of cancer, and in the mortality therefrom.

You may remember that in a former lecture I mentioned that in an extensive trip I was not able to see or hear of any cancer in the rice eating countries of the East, in Japan, China, India, Siam, and Egypt; although I understand that there is some malignant disease among the natives who adopt foreign habits, or who eat more or less meat, pork, etc. With this experience in view I have sometimes placed certain cancer patients, for a longer or shorter time, on what you are familiar with as my “rice diet,” and with manifestly beneficial results. I would not, of course, push it or continue it too long, but as a means of making an impression on a full blooded person, with beginning cancer, and as a means of facilitating the exclusion and elimination of nitrogenous elements from the system, it has sometimes served a valuable purpose. I also continually rather urge the consumption of rice by cancer patients, as largely as possible, even daily, in place of other cereals.

In regard to the medicinal treatment of cancer it is difficult to be clear and definite, and yet concise within the limits allowed for a lecture. For, as you may imagine from what has been said in these and the previous course of lectures two years ago, there is no one remedy or even any single course of treatment which is to be invariably followed or is always successful in every case of cancer.

In a disease of such uncertainty as to its definite causation, and of such obstinacy and duration from its first inception, the remedies which may be required in different cases are as varied as are the peculiarities of the individual. The treatment requires the utmost diligence and solicitous care and attention to details on the part of both the physician and patient, and over a period of time which it may be difficult to secure. This is rather a different proposition from that of a relatively brief surgical operation, after which the patient is dismissed with the hope that the disease will not recur!

Patience and perseverance, with medical acumen, are the first requisites-but before this there must be a belief and confidence in the truth of the statements, the correctness of the theory, and the value of the method to be employed; with this there must also be an optimism on the part of the physician which begets a confidence in the patient, which will do much toward reaching the desired result. Unless much time, thought, study, and effort can be given to each case of cancer, I should deprecate any attempt to treat it medically, and rather risk at once the chances of surgery, poor as they are. It was for fear of harm following an incomplete understanding of, and an imperfect or careless carrying out of the line of practise which I had pursued satisfactorily for thirty years and more that I hesitated and delayed so long before urging it generally. But the steady rise in mortality under the ordinarily accepted treatment has impelled me to strive to make clear what I conceive to be the correct view of its nature and cause, and the approximately correct treatment of cancer.

From what has preceded in these and former lectures it will be seen at once that rational and right internal treatment must proceed and continue along the lines previously indicated relating to the biochemistry of cancer. Some tissue cells have taken on wrong and rampant action, of a reproductive character, owing to an erroneous metabolism, which has induced a deranged or disordered blood current, and some measures are to be devised and carried out to restore the bodily functions to a normal state.

The first line of medical treatment, therefore, after preventing the introduction of animal protein, coffee, and alcohol by dietary measures, is to seek to restore to normal the various bodily secretions and excretions. The urine, by repeated, complete, volumetrical analysis, serves as a constant guide along many lines, which I considered pretty fully in the former lectures and need not repeat now. In one private case of cancer of the breast the total amount of urine passed each day was measured and recorded daily, almost without an exception, for a whole year, and specimens of the same were carefully analyzed and studied almost every week. The total quantity of solids, which was at first only one half what the body weight called for, was brought up to about normal as the condition of the patient improved.

It is impossible in a single lecture to tell you of all the indications and teachings which may be learned from the urine, much of which must be acquired by close observation and experience. The urea is almost always diminished, and this indicates an imperfect anabolism of the body cells, as the urea represents the final metabolism of their nitrogen. Uratic deposits are not uncommon, but other evidences of faulty nitrogenous metabolism also occur, free uric acid, ammonia, aromatic oxyacids, etc., whose individual significance in relation to cancer it is hard to trace, but clinically these derangements seem to have to do with the virulence of the disease. Indican in excess, and often greatly increased sulphates, are common, evidencing disturbed intestinal action. All these and other abnormalities, having to do with a deranged blood current, are to be rectified by proper treatment, the minor details of which cannot be elaborated in a single lecture.

I have told you that imperfect intestinal excretion and constipation are almost invariably found in the subjects of cancer, even in very early stages and long before they have been induced by opiates given for pain. I may here remark casually that even in severe inoperable cases up to a fatal ending, I seldom have to give morphin when the patients are under a full and complete line of dietary and other proper treatment; these latter seem to so change the character of the blood stream, or act in some way so that there is not the pain previously suffered. Possibly it is in part through lowering the blood pressure.

The subject of intestinal stasis or constipation is, with urinary derangement, such a very large one that it cannot be fully compassed in a single lecture. So I shall take the liberty of speaking dogmatically and shall tell you more or less definitely what observation and experience has taught me to do along these lines of faulty urinary and intestinal action in cancer. And really you will find it similar in many respects to the lines of theory and practise which I try to develop for you in connection with certain diseases of the skin. For, after all, in many conditions of disease we are to treat the patient in regard to a disordered system, and not always so much the particular disease by name. You will also remember that I have told you how it was by observing certain breast tumors which had been diagnosed as cancer by competent surgeons, urging immediate removal, disappear without operation under such treatment as I was giving for other complaints, that led me to my present point of view and practise.

In regard, then, to the actual medical treatment employed I may say that in the Skin and Cancer Hospital, and also in private practise, these patients are almost always first given a certain mixture with which you are familiar, ℞ Potassæ acetatis ℥, Tinct. Nuc. Vom. ℥ss, Extract. Cascar. fl. ℨi-ℨv, Extract. Rumicis radicis fl. ad ℥iv, the amount of cascara being varied according to the action of the bowels, which should move freely twice daily. This commonly acts also somewhat on the urine. This mixture is always taken three times daily, half an hour before eating, in one third of a tumbler of water.

It is interesting to note that Forbes Ross, a London cancer surgeon, whose untimely death has deprived us of a valuable scientific worker along our present lines, was an ardent advocate of potassium in the treatment of cancer, whose value he established on biochemical as well as clinical grounds. He, however, pushed the administration of the salts of potassium far in excess of that which I have found necessary. He has related instances of advanced cancer in which the results were remarkable, and one of them, a case of cancer of the uterus in a widow aged 59, was quite a counterpart of one which I shall narrate to you next week. I wish I could give you _in extenso_ some of the remarkable arguments from microscopic and chemico-physiological study which he gives, to explain how potassium has such a controlling effect on cancer cells; but it is quite out of the question in a lecture such as this to enter fully into every enticing field of inquiry, and I must refer you to his valuable work. I am quite aware that when published this book was the subject of some criticism and even ridicule, but reviewers could not have properly grasped the whole book, which was simply so far ahead of the times that it was not understood. Cancer was then, even more than now, in the grip of the surgeon, who resented any thought of treatment other than by the knife.

Dr. Ross had operated much in cancer, but, realizing the inefficiency of surgery to cure the disease, he wrote very severely in regard to cancer surgery in the opening chapter of his book. After “ten years of constant microscopic, clinical and surgical research,” he advanced the hypothesis that “cancer is due to a want of balance in particular mineral salts of the body, and that the disturbance of this balance leads to the disorderly and malignant growth of epithelial cells (epiblastic and hypoblastic) which is professionally known as Cancer or Carcinoma,” and that the main disturbance is in regard to the potash balance in the body. By very careful deductive and inductive reasoning, and by actual experimentation and practise he shows how this answers and explains more of the puzzles and intricacies of the cancer problem than any other hypothesis. In the previous chapter I referred somewhat to his interesting studies on cell polarity, the red blood cells, and the probable rôle of mononuclear leukocytes in inducing cancer-genetic changes in the tissues.

Pardon this rather long reference to Dr. Ross, who was much misunderstood by his fellow practitioners because of his blunt expressions and his presentation of a new thesis regarding cancer, which was not grasped, and, as far as I know, has been neglected by the profession; his book was published in 1912, and has only rather recently come under my notice. He died the following year, but at the end of the book, three months after it was written, he added a note stating that “all the cases described therein have continued to improve under treatment, until some of them have practically ceased to be cases of recognizable cancer.”

It is, therefore, not a little satisfactory to find from a cancer surgeon such microscopic, biochemical, and clinical explanation and support for the treatment which I have followed for thirty years and more, and which I am now presenting for your consideration. Dr. Ross makes three references which in a measure support the potassium theory of cancer.

1. “The old physiological adage ‘Potassium is the salt of the tissues, and sodium the salt of the fluids of the body’ still holds good as an absolute physiological truth.”

2. “Animal physiology teaches us that the whole range of the animal creation, from an ameba to man, follows the same law, ‘Potassium is the salt of the tissue cell.’”

3. “Examination of the botanical world brings us face to face with the same identical statement ‘Potassium is the salt of the chemical physiology of the vegetable cell.’”

The first treatment, therefore, which is given to these patients is potassium acetate, as previously mentioned, in combination with nux vomica, and some cascara, and rumex fluid extract; this latter is one of the old alternative remedies which I have used for years with most favorable results in certain skin diseases. In some of the cases related two years ago and in some of those I shall report in the next lecture, this mixture, with little variation, has been employed almost from the first to the last, with occasional alternation with other remedies. Dr. Ross has used principally the citrate of potassium and phosphate of potassium combined, which he gave in doses up to 90 grains per day, and even more. I have quite recently used the same, though in smaller doses, but it is too soon to report any results, and do not know if they will serve better than the acetate, which I have so long employed. Dr. Ross makes the interesting statement that, having used enormous quantities of potash salts in his practise for fifteen years, for various complaints, not one single case of cancer had ever to his knowledge occurred amongst the clientele of his own practise, though he had constantly been engaged in operating on cancer sent to him by other medical men. I made much the same remark in one of my former lectures (p. 152), though I did not ascribe it wholly to the acetate of potassa which I have long used so freely, but to the additional normal salts which I got from a strictly vegetarian diet.