Cancer Its Cause and Treatment

LECTURE IV RELATION OF DIET TO CANCER

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

107For the proper understanding of the relation of food and drink to cancer, and the satisfactory application of the principles involved, it is necessary to bear well in mind the chemistry of the body and the relation to nutrition of the various elements which contribute to form healthy and diseased tissues.

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

As the actual composition of the body is changing day by day, through the activities of the system, so that it is commonly believed that after some years all the tissues are entirely renewed, the daily wear and tear, as also the material expended in heat and activity, must be supplied by the diet. For the ordinary requirements of the system, in health, the appetite serves as a guide, which should suffice in man as in wild animals, to preserve the balance of nutrition. But man has also the power to gratify the taste, which must be recognized in our study as distinct from the satisfying of the appetite; and the refinements of civilization have added so greatly to the temptation of wrong and over-eating and drinking, as they have to many other temptations, 109that it is questionable if reason, and what is often spoken of as the natural instinct for food, can be trusted in mankind.

It is to be remembered that the advance of civilization, and the facilities of transportation and cold storage, have brought from far and near an innumerable number and variety of articles for food and drink, including condiments, which bear no relation to the few simple articles formerly consumed; even the fruits which we eat are rarely ripened fully by nature, but are picked more or less green, and undergo an artificial ripening without the action of the sun, which is really akin to decay. In the combination and preparation of articles of food also, so-called civilization and refinement have made the greatest departure from the simple life of the aborigines, who are free from cancer, and with increasing ease and wealth throughout the civilized world more and more individuals are sharing 110in unnecessary and often harmful indulgences, more and more freely: and this is especially true of animal food, the consumption of which has increased so greatly. Many other elements likewise enter into the matter of the digestibility and consequent nutritive power of food and drink; such are nervous conditions, rapid eating, imperfect mastication and insalivation, heat and cold, character of the air breathed, micro-organisms, etc., and all the various causes which may derange the action of the digestive organs and so prevent the perfect metabolism between nutrient material and the cells of the body, as I tried to show you in some former lectures.

As is well known, the nutrition of man is supplied by the organic substances, protein, carbohydrates, and fat; these are found in various combinations in animal and vegetarian foods, and as a rule contain also much of the inorganic or mineral substances necessary for the system; all of 111these with water, and its salts, and oxygen, supplied by the lungs, unite, through anabolism and catabolism, to build and maintain the human body in health.

It is also well known that in order to preserve health and proper weight there must exist in the economy a certain balance or equilibrium between the amount of the ingesta and excreta, representing the various elements which enter into nutrition; thus we speak of a nitrogen equilibrium, a carbo-hydrate equilibrium, a phosphorus equilibrium, and iron equilibrium, etc., some of which are disturbed continually in ill health and in various diseases, including cancer, as has been shown in our last lecture.

Until quite recently the principles of diet (even if not often carried out in practice) have been established on lines laid down by Carl Voit, of Munich; this eminent physiologist, after studying the dietary habits of various classes of workers, claimed that 112the adult man of 150 pounds, doing moderate muscular work, requires daily 118 grams of protein or albuminous food, 56 grams of fat, and 500 grams of carbo-hydrate, with a total fuel value of 3000 large calories, in order to maintain the body in equilibrium. But the remarkable and scientific experiments of Chittenden have demonstrated beyond question that perfect bodily and nitrogenous equilibrium can be maintained with one-third of the amount of protein called for by the Voit standard, and with a total value in the diet of only about 1600 calories, or about one-half of that indicated as necessary by Voit. These experiments were based on a group of five men of varying ages, professors and instructors at Yale, thirteen volunteers from the Hospital Corps of the United States Army, and eight students in Yale, all thoroughly trained athletes, twenty-six in all.

It would be quite beyond the scope of 113this lecture to enter at all into the intricate questions connected with the metabolism of nitrogenous and other foods, but Chittenden has well put the reasons “why prominence is given to the establishment of nitrogenous equilibrium and why the proteid intake assumes a greater importance than the daily amount of fat and carbo-hydrate consumed. Fats and carbohydrates when oxidized in the body are ultimately burned to simple gaseous products, viz., carbonic acid and water. Hence these waste products are easily and quickly eliminated and cannot exercise much deleterious influence, even when formed in excess.... With protein foods, on the other hand, the story is quite different. These substances when oxidized yield a row of crystalline, nitrogenous products which ultimately pass out of the body through the kidneys. Prior to their excretion, however, these products—frequently spoken of as toxins—float through the body and may 114exercise more or less of a deleterious influence upon the system, or, being temporarily deposited, may exert some specific or local influence that calls for speedy removal. Hence the importance of restricting the production of these bodies to the minimal amount, owing to their possible physiological effect and the part they are liable to play in the causation of many diseased conditions.”

When we consider the small share which nitrogen plays in the composition of the human frame, as shown in the table presented, only three per cent., it is easy to see how an excess of nitrogenous food must necessarily either pass off unassimilated or undergo imperfect metabolism, and so derange the general metabolism; and this is found to be the case in many conditions of disease, and, as has been shown, in cancer. Chalmers Watson and others have shown in a most remarkable manner, by animal experiments, that an 115excessive meat diet alters very materially the microscopic structure of very many organs and portions of the body.

Beneke, who is often quoted, was one of the first to seriously consider the actual diet beneficial in cancer, his observations dating back to 1875 upon material in the service of Esmarck and Oldehop, who treated patients according to his plan. While the diet he gives is not wholly vegetarian, he limits the nitrogenous intake very greatly, and reported some very favorable results, with the complete disappearance of some malignant new formations.

Referring now to the data presented in the second lecture, in regard to the frequency and geographical distribution of cancer, we can understand better, on scientific grounds some of the reasons why cancer is so steadily increasing in civilized communities, and why in some sections of the earth it is less common, while certain 116aborigines have seemed to be almost immune.

We found that in England the per capita consumption of meat was 130 pounds per year, and that it had doubled during the past fifty years, while during the same period cancer had increased four fold; but in Ireland, where the meat consumption was estimated in 1895 at only 40 pounds per capita, or less than one-third that in England, the cancer death rate is very much lower, not much over one-half. We found that in Italy, where the per capita consumption of meat was the smallest of any European country the cancer death rate was almost the lowest. Also that in certain other countries, where vegetarianism was the rule, cancer was very infrequent, while among certain aborigines the disease was practically unknown; but we found also that in both the latter classes of individuals cancer has slowly increased, in proportion as the inhabitants of different 117sections had come under the influence of modern civilization, and adopted the dietary and other habits of foreigners.

In the United States cancer has certainly increased very greatly during the last fifty years, and statistics were presented showing that in seven of the largest cities, during the past five years, the number of cancer deaths had augmented between seven and eight per cent. It is known that the consumption of meat here has increased steadily, until in a communication from the Bureau of Agriculture in Washington we learn that it had recently reached the enormous amount of 172 pounds per capita yearly, much more than in England.

Cancer has been repeatedly spoken of as a disease of civilization, and there are many other elements besides meat to be considered in connection with its etiology.

Coffee and tea are so widely and almost universally used in civilized countries, and their apparently pleasant effect is so great 118that few realize the harm that may result therefrom; although from time to time their injurious effects, especially along the line of digestive and nervous troubles, are dwelt on by medical writers. Of late years, however, more attention has been paid to their influence on metabolism and also to the relation of their consumption to the increase of cancer. From a report to the House of Commons in England, Holland is shown to be the largest per capita consumer of coffee of any country in Europe, and the cancer death rate there in 1905 was among the highest, while Hungary was the smallest consumer of coffee, and the cancer mortality in 1903 was only 39 per 100,000, or a little over one-third that in Holland. It may be interesting to know that Thompson states that “the people of the United States consume one-third of the total coffee produced, or more than Germany, Austria, Hungary, France and the United Kingdom combined. On the 119other hand England and her colonies consume one-half of the world’s output of tea, and the United States but one-fifth of it.”

The scientific basis of a possible relationship of the consumption of coffee and tea to the prevalence of cancer may be better understood when we remember that caffeine and theine belong to the xanthin group, and contain exactly the same equivalent of nitrogen as uric acid. A single cup of coffee of fair strength, it is stated by Hutchinson, contains from one to three grains of caffeine, and a cup of fairly strong tea 1.21 grains, or more than the average medicinal dose of this drug; and all know how great may be the consumption of coffee and tea by some individuals, and that many of the working class, especially, consume enormous amounts of tea, which is kept brewing all day. Roberts has very clearly demonstrated, by clever experiments, that tea interferes very 120greatly with both the salivary and gastric digestion.

Alcohol, or some of its combinations, has also been shown by several observers to be undoubtedly an element contributory to the causation of cancer; this relates not only to countries or cities where the consumption is the greatest or least, but also to various occupations, in which statistics show the more or less abundant use of distilled or fermented drinks, and deaths from the same, and in regard to total abstainers; and a careful study of the subject makes it pretty clear that the incidence of cancer corresponds in a measure with drinking habits; that is, that cancer mortality is highest among those classes of persons among whom primary or secondary mortality from alcoholism is greatest. There are so many elements to be taken into consideration in connection with the derangement of metabolism which leads to cancer, that it is difficult to fix the precise 121influence which each may exert; but in watching cancer cases for any length of time it is easy to see the harmful effect when alcoholic beverages are indulged in, and the improvement when all such are absolutely excluded.

An interesting confirmation of the beneficial results of a low diet and simple life, as regards cancer, is found in certain reports of Commissioners of Prisons and Asylums in England, where the matter has been studied, as given by Russell. “Asylums contain an excessive number of persons who have inherited or acquired constitutional weaknesses, and in many cases tendencies toward consumption or cancer; also many alcoholics who are prone to these maladies. Yet the habits and rules of these institutions reduce the cancer rate much below the rate of the classes from which they are drawn, and below the rate of both occupied and unoccupied persons.” The same is observed in regard to many 122religious orders, where the members lead a very simple and frugal life, and where cancer is reported to be almost unknown.

Kessler has called attention to the disturbance of sulphur partition in cancer in connection with diet, and the desirability of excluding those foods exhibiting an excess of sulphur, giving lists of the same and indicating a satisfactory diet.

Packard has made a strong argument in regard to the value and importance of the mineral elements contained in plant life, in connection with the disturbances in these same elements which has been observed in connection with cancer, as we have already seen. He recalls that modern chemistry teaches that the inorganic principles of the vegetable kingdom are absolutely necessary to the highest degree and type of animal tissue and health, and resistance to disease. Plant life is the connection between the minerals and salts of the earth and animal life, but in the 123manufacture or refinement, and cooking, of products of the vegetable kingdom, many of them are largely demineralized; this especially illustrated in the case of fine white wheat flour, rice, potatoes (in peeling and cooking), etc. So that while animals get plenty of mineral matter from plants and the earth, man gets but little, and while the herbivorous animals are rarely affected with cancer, civilized man is succumbing to it more and more. It is stated that among savage tribes, who are practically free from cancer, the water in which vegetables are cooked is also consumed as food, thus securing all the salts. The same idea has been popularly presented to the public in a startling manner by McCann in a book which, with a great deal of verbiage contains a large amount of valuable information concerning nutrition, and its disturbance by erroneous, or worse, preparation and administration of food.

124Possibly there are other dietary elements which may play some part in the causation of cancer, but the demonstrated facts in regard to them are so few and uncertain that they need not detain us here, although it is certainly desirable to investigate any that seem to have reasonable support.

Some of these which have been suggested probably have to do with local irritant action on the digestive organs, as we have previously seen that local irritation undoubtedly plays an important part in the determination of the actual time of occurrence and site of the cancerous disease. Thus, some have ascribed cancer to hot food or drink, or to stimulating drink, condiments, etc. It is quite possible that these contribute to the development of cancer in the pylorus, irritating the secreting cells in their passage. Mayo says: “In civilized man one-third of all cancers are seated in the stomach. This is not known 125to be the case in uncivilized man or in animals. There should, therefore, be something—some one cause—which causes this preponderance. The acid secretion may favor its development, for when we come to the colon, also with an acid secretion, we again meet with cancer, and we seldom see it in the alkaline, small intestine. Gastric ulcer, which may be pre-cancerous, is connected with hyperacidity.” In Scandinavia cancer of the stomach is remarkably frequent, according to Soëgaard, thus, of 1235 cases in Norway, 73.9 per cent. were in that location. In our last lecture we found that cancer in general was connected with a lowered alkalescence of the blood, and all our studies show hyperacidity to be related to cancer genesis; and nitrogenous acidity, or uric acid (purin, xanthin, etc.), undoubtedly plays a great part in inducing malignant action in tissues, as Haig has so long contended, even in regard to cancer.

126The increasing frequency of cancer of the mouth, œsophagus, and stomach in men certainly looks toward an irritating character of substances which traverse these regions, including alcoholic drinks, and the irritant effect of tobacco should not be overlooked in regard to mouth lesions. But of the millions who use tobacco only very few are affected with cancer, and only those who are predisposed thereto by some metabolic disturbance, whose true character and other manifestations are not yet fully determined. We have already referred to the practice of so-called betel chewing in the Far East as a frequent cause of cancer within the mouth, also to the wearing of the Kangri charcoal baskets in India, for warmth, causing a burn on the front of the body which may develop into epithelioma; it is claimed, however, by some that of the many cases of “Kangri burn,” but few result in epithelioma.

There are yet other considerations concerning 127the 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 128of 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 129coffee 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 130by 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, 131as 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.

132In 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 133does 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 134saturated 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 136made 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.” 137He 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 138from 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? 139No. 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 140long 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 141to 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 142purin 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 143process 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, 144that 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 145efforts 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 146as 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, 147fully 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 148cancer 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 149as 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, 150when 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 151perfect 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, 152and 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 153even 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 154amount 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 155which 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 156diet 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 157perfect 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 158a 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.

159I 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 (℞ 160Potass. Acetatis ℥i Tinct. Nucis Vomic ʒiv Extr. Cascar. fld. ʒij-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 161every 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 162gaining 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 163body, 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 164these 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 165frankly 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 166of 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, 167and 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 168week 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 169question 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 171this 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 172have 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 173to 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, 174in 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, 175which 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 176would 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 177a 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 178the 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 179which 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 180of 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 181she 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. 182The 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 183for 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 184been under constant observation and treatment off and on for various troubles from November 13, 1905, until yesterday. Fifteen years previous to her first visit she had fallen and struck the left breast which was bruised, but the effects wore off in some months, and there was no sensation in the breast for some years. Then 7 or 8 years later she began to have pain in the breast, aggravated before and during menstruation, which had continued until her visit, and for the last months she had been kept from her work in school, the pain being severe in the breast, and more recently in the axilla: in July there had been bleeding from the nipple. She had seen a number of medical men, with the diagnosis of cancer, and one surgeon of prominence in one of the large hospitals had strongly pressed for an immediate operation.

When first seen there was a tumor between two and three inches in diameter, in the upper, inner segment of the left breast, 185hard, sharply defined, and more or less nodular on the surface: there were some enlarged glands in the left axilla. She had long been constipated and was passing about 60 per cent. of the amount of urinary solids proper for her weight. Under very active treatment it was recorded four weeks later that there had been hardly any sensations in the breast during the previous week, that the tumor had diminished materially in size, with only moderate hardness, and that she was now out doors every day, and feeling much better. One month later it was recorded that the breast was very well and on examination was almost the same as the other, there being some general caking in both: she had had no pain for some time. One month or so later she was again at her duties as a public school teacher, which she has continued at since, with rare exceptions, when some temporary ailment prevented: the lump in the breast did not wholly disappear for a 186month or two later, but on April 7th it was recorded that the left breast was the same as the other, and no glands could be felt in the axilla.

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

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

Miss H. M., aged 61, came to me June 18721st, 1913, with the following history: About two years previously a lump appeared in the outer, lower segment of the left breast, which was removed in August, 1911; this healed soon, leaving a good axillary scar, and there was no thought of trouble until two months before her visit, when a small red spot appeared near the edge of the sternum. This enlarged and hardened and others appeared around the scar, until, when seen there were a dozen red nodules up to half an inch in diameter, near the center of the former site of the breast, with others, not red, above; with the tense skin and rapidly developing, multiple nodules here and there, further surgical operative procedure was out of the question.

Since that date she has been under strict vegetarian diet and medication, including thyroid from time to time, with repeated application of X-rays, and under all these measures together many of the nodules have disappeared; although some 188new ones have formed, several of which have been removed under local anæsthesia, the wounds healing kindly. As she resides some distance from the city she has not been seen since October 7th, 1914, she wishing to take the X-rays nearer home, but she was earnestly charged to continue also the dietetic and other treatment. In this instance the patient has lived comfortably and without pain for almost sixteen months after coming under treatment, and, although she has lost some flesh, the active cancerous process, which would otherwise have carried her off long ago, has been in a measure checked. What will be the further history of the case one cannot tell, for it is quite possible that being away from my care she may neglect dietetic and medicinal treatment, trusting only to the X-rays, which, of course, cannot influence the real nature and course of the disease.

Reference was made to certain cases of 189recurrent cancer in the Hospital which had been under active medical treatment during the past year, with careful laboratory studies, but it is naturally too early to report anything very definite in regard to them, especially as most of them were desperate cases, which had advanced far beyond any possible operative relief. Moreover several of them remained but a short time under treatment, as it is very difficult to convince this class of patients that any possible benefit can accrue from anything but an operation, and this being impossible they often give up and leave, preferring to die at home; moreover the dietary restraint seems also very irksome and useless to them and their friends. In one particular patient, however, there was such a remarkable improvement that it is worth reporting to you.

Mrs. C. M. was first seen February 12th, 1914. Nineteen years previously she had an abscess of the right breast, which 190healed and left a tumor the size of a pigeon’s egg in the inner, upper quadrant of the breast; this remained quiescent until it began to enlarge, eleven months before it was removed at the New York Skin and Cancer Hospital, November 14th, 1912. The tumor was then about the size of a hen’s egg, with an area of skin the size of a quarter, attached to it: a second tumor was felt just below the nipple, which was not retracted, and the axillary glands were involved: there were no signs of metastases in the abdomen. A complete operation was then performed, with dissection of the glands in the axillary and supra-clavicular regions, and she was discharged January 16th, 1913.

On February 9th, 1914, she returned to the Hospital and was placed under medical treatment, with vegetarian diet. There was then an ulceration along the line of incision, from the second to the fourth rib, with many nodules around it, averaging a 191third of an inch in diameter, raised and reddened. The liver extended two inches below the edge of the ribs, with a hard and nodular margin; the right arm was enormously swollen and helpless. When she left the Hospital, June 20th, 1914, the ulcer had entirely closed, many of the cutaneous nodules had entirely disappeared, the arm had returned to normal size, like the other, by measurement, and the liver had retracted to a trifle below the margin of the ribs, with hardly any nodules to be felt. The treatment had included twenty-five X-ray exposures, from 8 to 10 minutes each, about twice a week, over three areas each time.

While in the Hospital careful laboratory investigations were made, according to a definite schedule. The blood, studied weekly, maintained a hæmoglobin of 80+ for over two months, then fell a little, and again rose. The erythrocytes were 3,262,000 on entering, and rose within two 192months to 4,282,000, then fell a little and rose again to almost 4,000,000: the leucocytes were 9,000 on entering, and fell to 5,200 just before leaving, the poly-nuclear 69 per cent. on admission, fell to 60 per cent., and again rose a little, and the proportion of the other forms remained about normal. The urine, volumetrically analyzed every three days, was kept a little below the normal acidity, and the specific gravity a little low, with a free daily amount of excretion, largely by Bethesda water: in spite of the vegetarian diet the urea excretion was not much below normal, and sometimes above, the chlorides were diminished, owing to the rather small amount of food taken, the phosphates varied a little above and below normal, there was never any indican, and the sulphates averaged a trifle below normal. The saliva, tested before and after each meal, was acid at first, but became neutral and alkaline off and on. The weight, taken weekly, 193fell a little from the first, but maintained a good level, and rose a little before she left the Hospital.

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

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

Mrs. W. C., aged 45, was first seen September 17th, 1914. Nearly four years previously she had noticed a lump in the left breast which was removed on January 6th, 1911, but it soon regrew, and a complete 194operation was performed at the New York Skin and Cancer Hospital, May 30th, 1911. Two years later there was some return, and she was again operated on at the Hospital, May 30th, 1914. About two months before her first visit, September 17th, 1914, a swelling of the sternum was noticed, and soon another above it, both of which increased pretty rapidly to the time of her visit. When seen there was a hard mass in the scar over the sternum, about an inch and a half long, raised a quarter of an inch or so, reddened and immovable: an inch or so above it was another, smaller one, not reddened: they were not particularly painful on moderate handling, but painful when at hard housework. When last seen, December 7th, both lumps had subsided fully one-half, there was no pain at any time, and her general condition had improved immensely, she feeling better than she did four or five years ago, that is, before the beginning of the cancerous development: 195she has been working all the time, unusually hard, as janitor of four buildings and also going out scrubbing and washing. She weighed 157¼ pounds when first seen, then ran down to 154, but is again gaining, being 155½ at her last visit. The outcome of this case it is, of course, impossible to conjecture, for one can seldom be sure that patients will be absolutely faithful to treatment, for a long enough time, but certainly the change in the woman and in the lesions in this two months and a half has been remarkable, compared with the increasing development of the disease in the two months previous.

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

Mrs. M. B. J., aged 68, a private patient, was first seen on February 17th, 1914. Two years previously she noticed a lump 196in the upper part of the right breast, after great and repeated mental distress from the death of a number of very near relatives, and a sister’s mental derangement; the great nervous strain had been attended with various bilious attacks and nervous indigestion. The mass increased steadily in size and was kept concealed even from her family, until the day before she called, when her family physician who was consulted saw that it was far beyond the possible hope from any operation, in which view a surgeon concurred.

When seen the whole breast was involved, was double the size of the other, hard, immovable, and with an adherent crust over an ulcerating surface on its lower half, several inches in diameter, from beneath which was a moderate discharge: the axillary glands were enormously enlarged, as also the supra-clavicular, and she was strongly cachectic. She was placed on an absolute vegetarian 197diet, with no coffee or tea, and appropriate medical treatment, and the breast kept painted with fifty per cent. ichthyol and water, care being taken not to disturb the adherent crust. In a very short time the discharge ceased, and the protective crust adhered until her death from exhaustion, with pulmonary œdema, on September 9th, 1914. On August 15th it was recorded that the breast had done very well, that it was soft and movable, and not larger than the other breast, with no discharge, and no pain since a short time after beginning treatment: the axillary glands had diminished three-quarters in size, and the supra-clavicular glands were also very much smaller.

And now, gentlemen, my task is done. I have tried to let you see cancer through my spectacles, as I have seen it for very many years past, and to share with me my optimism in regard to the prophylaxis and cure of cancer, if only there can be sufficient enlightenment in the profession and 198public: and I must tell you that in collating and preparing the material to support my long held views I have expended very much more time and labor in study, for some months past, than I could have believed possible. But as the subject developed, and as I discovered more and more support for my thesis, there was a fascination about the work which I could not resist; and if I have tried you with the many details of proof presented I beg that you will pardon me: for I wanted to present the subject so strongly that my hearers, at least, would accept the propositions I have developed, and believe what I have said in regard to my own experience with the terrible disease under consideration, and act upon both, and thus aid some sufferers with cancer.

From my recent article on “The Relation of Diet to Cancer” many medical journals have quoted me as ascribing the disease wholly to the use of meat, but you 199who have heard these lectures now know that animal proteids are only one of the contributing causes.

I have tried to make it plain that metabolic errors, inducing a vitiated blood stream, are the basic cause of the aberrant action in the cellular elements of the body which may ultimately lead to malignant disease; and I have tried to show that there are many elements connected with modern so-called civilization which conspire to effect this end. I have quoted many who were well acquainted with cancer, who believed that luxurious living, which includes much animal food, coffee and tea, and alcohol, with indolence or want of sufficient muscular activity to burn up the waste products, and the persistent neglect of hygienic laws, should be placed first among the causes of cancer: but I have also mentioned that the refining and preparation and cooking of food prevented a proper supply of the mineral and other elements 200of nutrition, and also that nervous influences could so disturb the action of the organs of the body that they could not perform their functions perfectly in the elaboration of nutritive material, etc.

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

I have acknowledged that local irritation of many kinds may be the proximate cause for the development of a malignant tumor 201in any particular locality, as Ewing has so clearly shown in his excellent resumé on pre-cancerous lesions; but I have also contended that we should withal look into and overcome the cause; why, when once started by local injury the cells should pursue such a progressive, aggressive, and invasive course; and this is found, I believe, in the disturbed character of the fluids which provide them with nourishment for their abnormal growth.

From this study of cancer in regard to its nature, frequency, geographical distribution, metabolism, dietetic relations, medical treatment, and clinical considerations, what conclusions can be drawn? Have we solved the problem of cancer? Far be it from us to make any such claim. Scientific research and study must still go on in the laboratory, but clinical research and study, with laboratory work, on the human subject, which have not been hitherto sufficiently cultivated, should be 202pushed, so that by a mass of carefully recorded observations the truth or falsity of what has been here quoted and said may be refuted or confirmed.

From the enormous work which has been done on cancer with the microscope and the test tube, it would seem sometimes that research workers have become somewhat myopic, and not farsighted enough to recognize the true value of statistical studies and clinical observations. In these lectures we have attempted to make a brief synthetic study of some of the work which has been done in connection with cancer, and from this we believe that certain conclusions can be drawn; if these are correct and followed, it is hoped that much more can be accomplished in regard to the prophylaxis and cure of this more than threatening, fatal malady. In order that you may hold clearly the points which have been made I want to give you a synopsis or conclusions of them, as they have been 203brought out in this and preceding lectures.

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

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

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

4. It is pretty conclusively decided that 204cancer is not caused by a micro-organism, or parasite.

5. It is also known clinically and experimentally that it is not contagious.

6. Nor is it hereditary in any appreciable degree.

7. Occupation has not any very great influence on the occurrence of cancer, although it is more frequent in some pursuits than in others.

8. Cancer is not altogether a disease of older age, although its incidence is greatly increased with advancing years.

9. It does not especially belong to or affect any particular sex, race, or class of persons.

10. It is not confined to any location or section of the earth, but has been observed in all countries and climates.

11. No single cause of cancer has yet been demonstrated, nor is it likely that this will ever be the case, as the experimental and other investigations have covered 205almost every possible line of research, with only negative results.

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

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

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

15. Clinical and experimental evidence 206demonstrate that the secretions and excretions of the body exhibit departures from normal, which, while not pathognomonic of cancer, indicate metabolic disturbances involving the nutrition of the cellular elements, which disturbances are of importance.

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

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

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

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

20. This extension of cancer seems to depend largely upon the altered conditions of life, particularly along the lines of self-indulgence 207in eating and drinking, and indolence.

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

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

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

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

20825. Surgery has had, and may long have its function to perform in removing the products of the disease, more or less efficiently, curing some and prolonging the life of others, but it can never hope to lessen greatly the morbidity of cancer.

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

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

28. The same is true in regard to the treatment of the disease by means other than those mentioned: the earlier the morbid process leading to tumor formation is 209attacked by dietetic, hygienic, and medicinal measures, the greater the promise and expectation of success, present and permanent.

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

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

31. It is more than possible, however, that the long continued operation of many baneful causes has produced such a degeneration of tissue in the human race, that it will take a generation or more of proper 210living to make the beneficial impression on the general incidence of cancer which is so longed for.

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INDEX

• Abderhalden, defensive ferments in cancer, 78
• Abernethy on vegetarian diet, 136
• Aborigines, freedom from cancer of, 48, 116
• Abstemiousness, effect on cancer, 139
• Acid, amino nitrogen, increased in cancer, 91
• Acid intoxication in cancer, 77
• Acidosis in cancer, 80
• Acids, oxyproteic, in the urine, increased in cancer, 90
• Addison’s disease, 97
• Adrenals, relation to cancer, 98
• Africa, absence of cancer in, 50, 52
• Agamogenesis, relation to cancer, 72
• Age affecting cancer, 22
• Ages of patients with cancer, 176
• Agnew on surgery in cancer, 170
• Alcohol, relation to cancer, 120
• Alkalinity of blood, diminished in cancer, 77
• Amino-acid nitrogen, increased in cancer, 91
• 222Ammonia fraction of nitrogen, increased in cancer, 91
• Amylopsin in cancer, 99
• Anabolism and cancer, 33
• Anæmia in cancer, 74
• Animal food a cause of cancer, 50, 51, 52, 55, 63, 69, 110, 113, 116, 117, 132, 138, 141
• Animals, cancer in, 43
• Argentine Republic, cancer in, 57
• Australia, cancer in, 48
• Auto-intoxication and cancer, 155
• Autonomous action of cells, 33
• Bainbridge, local nature of cancer, 30
• Baltimore, cancer in, 65
• Banks, Sir William, on diet in cancer, 61
• Bashford, 55
• Beard, trypsin in cancer, 99
• Beatson’s operation, 102
• Beebe, diet and cancer, 80
• Beirut, rarity of cancer in, 56
• Bell, cancer from neglect of hygienic laws, 132
• Beneke, diet in cancer, 115
• 223Benratt, rarity of cancer in India, 53
• Betel chewing cancer, 54
• Biedl, hormone formation, 163
• Bio-chemistry of cancer, 39, 79, 83
• Blood changes in cancer, 74, 191
  • frequent study of, in cancer, 160
• Blumenthal, oxyproteic acids increased in cancer, 90
• Boston, cancer in, 65
• Bowel action and cancer, 155, 157
• Braithwaite, plainer fare and less of it, 154
  • salt and cancer, 129
• Brazil, rarity of cancer in, 57
• Breast, carcinoma of, 176
  • non-cancerous tumors of, 178
• Bristol, disturbance of chemical equilibrium causing cancer, 143
• British Guiana, rarity of cancer in, 50
• Burnham, blood changes in cancer, 76
• Butter, valuable in cancer, 153
• Buttner, a fleshless diet, 154
• Cachexia in cancer, 74, 77
• Caffeine, nitrogen in, 119
  • percentage of, in coffee, 119
• Cahen on Beatson’s operation, 102
• 224Calcium salts, effect on cancer, 101
• Cancer in the occupied and unoccupied, 130
  • personal statistics of, 176
  • problem, 201
• Carcinoma, personal statistics of, 174
• Casein sometimes allowable in cancer, 153
• Cases, personal, of cancer, 180‒197
• Catabolism and cancer, 33
• Causes of cancer, 27
• Centrosomes in cancer, 34, 85
• Cheese sometimes allowable in cancer, 154
• Chemistry of cancer, 39, 79, 83
  • of cancer tissue, 78, 82
  • of the body, 107
• Chicago, cancer in, 65
• China, rarity of cancer in, 55
• Chittenden’s experiments on nutrition, 112
• Chlorides in the urine, diminished in cancer, 92
• Cholesterin, relation to cancer, 83
• Chromosomes in cancer, 85
• Civilization, cancer a disease of, 44, 46, 50, 68, 109, 117
• Clinical considerations, 170
  • study of cancer, 17, 18
• Coffee, consumption in United States, 118
  • nitrogen in, 119
  • relation to cancer, 117
• 225Cohnreich, blood in cancer, 76
• Cold storage, relation of, to cancer, 109
• Composition of human body, 107
• Conclusions, 170, 203
• Constipation and cancer, 157
• Contagiousness excluded, 19
• Cooper, Sir Astley on constitutional nature of cancer, 139
• Creoles in Africa, freedom from cancer of, 52
• Cytology of cancer, 74
• Danger from thyroid in cancer, 164
• Deaths from cancer in New York City, 145
  • in United States, 144
• De Bloeme, Swart, and Terwen, imperfect nitrogen partition in cancer, 90
• Defective urinary excretion and cancer, 158
• Deficiency of urinary solids in cancer, 88
• Definition of cancer, 30
• Degrez, imperfect nitrogen disintegration in cancer, 91
• Denmark, cancer in, 82
• Demineralization and cancer, 113
• Diabetes, relation of to cancer, 95
• Diet, effect of simple, in cancer, 121
  • relation of, to cancer,
• 22646, 51, 53, 55, 57, 61, 63, 67, 80, 106, 115, 116, 133, 198
• Dietetic treatment of cancer, 171
• Disordered metabolism the cause of cancer, 74
• Ductless glands in cancer, 97
• Duration of cancer before treatment, 177
• Early treatment of cancer, medically, 147, 178, 208
  • surgically, 177
• Eating, wrong- and over-, and cancer, 152
• Egypt, rarity of cancer in, 51, 57
• Ehrlich, effect of diet on cancer, 37
• Einhorn, Kahn, and Rosenblum, imperfect nitrogen partition in cancer, 90
• Embryonic rests in cancer, 23, 25, 72
• Endocrinous glands, relation of, to cancer, 100
• England, cancer in, 51, 57, 61
  • increase of cancer, with meat consumption, 116
• Environmental change and cancer, 59
• Enzymes, autolytic, in cancer tissue, 83
• Equilibrium of tissue elements, 111
• Esmarck and Oldehop, vegetarian diet in cancer, 115
• 227Etiology of cancer, 74
• Ewing, change in polar axis of cells in cancer, 34
  • relation of cholesterin to cancer, 83
• Far East, rarity of cancer in, 55, 56
• Fiji Islands, rarity of cancer in, 50
• Fletcher, imperfect insalivation and cancer, 94
• France, cancer in, 62
• Frequency of cancer, 43
• Functional kidney derangement and cancer, 158
• Geographical distribution of cancer, 43
• “Germ of cancer,” 19
• Gigantism, 97
• Gout, relation to cancer, 72, 81
• Gratifying the taste, a cause of cancer, 108
• Gruner, toxicity of cancer juice, 78
• Gwyer, thymus feeding in cancer, 101
• Haig, cures of cancer by dietary restrictions, 141
  • uric acid and cancer, 125, 141
• Harrower, relation of ductless glands to cancer, 97
• Heredity, influence of, 20
• Heterologous elements in cancer, 41
• 228Highest cancer mortality, 62
• Hislop and Fenwick, diet and cancer, 50
• Holland, high cancer mortality in, 118
• Hormones, relation of, to cancer, 100
• Hormone therapy in cancer, 162
• Hungary, low cancer mortality in, 118
• Hutchinson, amount of caffeine in tea and coffee, 119
• Hygienic laws, neglect of, a cause of cancer, 132
• Hyperacidity and cancer, 33
• Ichthyol locally in cancer, 166, 167
• Ideally correct blood stream and cancer, 149
• Increase of cancer, 47
  • in the United States, 66
• Incurable cancer, 146
• Independent cell action, 73
• Indians, North American, rarity of cancer in, 67
• India, rarity of cancer in, 53
• Infectious diseases and cancer, 29
• Inoperable cancer, 146
• Insalivation, thorough, importance of in cancer, 95
• Internal secretions in cancer, 96‒103
• Intestinal fermentation in cancer, 92, 155
  • 229stasis and cancer, 155
  • toxins and cancer, 155
• Intolerance of certain articles a cause of disease, 127
• Intoxication, intestinal, and cancer, 155
• Iron, value of, in cancer, 161
• Irritation, local, and cancer, 124
• Isenberg on vegetarian diet in cancer, 142
• Italy, low cancer with low meat consumption, 63
• Jones, blood in cancer, 76
• Kahle, silica retention in cancer, 98
• “Kangri burn” cancer, 54, 126
• Keith, Skene, iron in cancer, 161
• Kellogg, absence of cancer with normal metabolism, 151
• Kerry, Ireland, low cancer mortality, 64
• Kessler, sulphur partition in cancer, 122
• Kidneys, faulty excretion and cancer, 157
• Korea, rarity of cancer in, 57
• Laboratory study of cancer, 175, 191
• Lambe on vegetarian diet, 136
• Lane, Sir Arbuthnot, intestinal stasis and cancer, 155
• 230Latham on cancer of the unoccupied, 61
• Leucocytosis in cancer, 75
• Lithæmia, relation to cancer, 72
• Liver, condition of in cancer, 91
• Local irritation and cancer, 21, 124
  • medical treatment, 165
• Lott, Beatson’s operation for cancer, 102
• Lowest cancer mortality, 60, 64
• Lucerne, cancer in, 62
• Luxurious living a cause of cancer, 68, 138, 199
• McCann, erroneous preparation of foods, 123
• McGregor, absence of cancer in Fiji Islands, 50
• Madden, absence of cancer in Africa, 50
• Malaria and cancer, 21
• Mastication, thorough, importance of in cancer, 95
• Mayo, acidity and cancer, 124
• Meat consumption,
  • in England, 116
  • in the United States, 69
• Meat, relation to cancer, 51, 53, 55, 57, 63, 116
• Medical treatment of cancer, 135, 154
• Melanesians, exempt from cancer, 50
• Mental depression, influencing cancer, 86
  • strain, relation to cancer, 81, 85
• 231Merriam, meat diet a cause of cancer, 141
• Metabolism, disordered, the cause of cancer, 74
  • of cancer, 70
  • perverted, and cancer, 150
• Mineral disturbances in the system in cancer, 122
• Mitosis, cell, relation to cancer, 85
• Mortality from cancer 90 per cent., 144
• Murphy on surgery in cancer, 171
• Myxœdema, 97
• Nature of cancer, 15, 29
• Negroes, rarity of cancer in, 52, 67
• Nervous strain, relation to cancer, 85
• New York City, deaths from cancer in, 65, 145
  • negro death rate from cancer, 67
• New York Skin and Cancer Hospital, 8, 172
• New Zealand, cancer in, 50
• Nitrogen disintegration, imperfect in cancer, 91
  • increase in colloid, in cancer, 90
  • partition in cancer, 90
  • small amount needed in the economy, 114
• Nitrogenous diet and cancer, 51, 53, 55, 57, 63, 81, 116
• 232Non-cancerous tumors of breast, 178
• Normal body cells and cancer, 31, 41, 70
• Nowell, serum therapy, 165
• Nuclei of cells, in cancer, 84
• Nucleo-proteids in cancer, 82
• Nutrition and cancer, 35, 36
• Occupation and cancer, 28
• Ovaries, internal secretion of, relation to cancer, 102
• Over-eating and cancer, 152
• Over-indulgence, effect of, 68
• Oxyproteic acid, relation to cancer, 90
• Packard, disturbance of mineral elements in blood, in cancer, 122
• Paget, Sir James, on constitutional nature of cancer, 140
• Paget’s disease, 174
• Pancreas, relation of, to cancer, 98
• Parasitism excluded, 19
• Paris, cancer in, 63
• Parker, Willard, on constitutional cause of cancer, 137
• Patience required for medical treatment of cancer, 134, 152
• Perseverance required for medical treatment of cancer, 134
• 233Personal cases of cancer, 180‒197
• Perverted metabolism and cancer, 74, 150
• Philadelphia, cancer in, 65
• Philippines, rarity of cancer in, 57
• Phosphates in the urine, diminished in cancer, 94
• Pittsburgh, cancer in, 65
• Pituitary secretion in cancer, 97, 99
• Plants, cancer in, 43
• Plasma of blood in cancer, 77
• Pluriglandular extracts in cancer, 164
• Polarity of cells in cancer, 34, 73
• Polynesians, exempt from cancer, 50
• Potassium acetate in cancer, 159
  • phosphate in cancer, 160
• Precancerous conditions, 89
• Prevention of cancer, 148
• Prize fund for cure of cancer, 173
• Problem of cancer, 201
• Prophylaxis of cancer, 148
• Prosperity and cancer, 48, 68, 109
• Protein foods, harm from, 113
  • metabolism, disturbed in cancer, 89
  • requirement of the body, 112
  • sufficient in vegetarian diet, 133
• 234Psoriasis, lessons from, in cancer, 128
• Putrefaction, intestinal, and cancer, 155
• Radium, value in cancer, 29, 145, 168
• Recurrent cancer, 146, 187‒195
• Red corpuscles in cancer, 76, 77
• Refinement of food, relation of, to cancer, 109
• Reid, increase of amino-acid nitrogen in cancer, 91
• Relation of diet to cancer, 198
• Renner, rarity of cancer among creoles, 51
• Requisites for development of cancer, 25
• Rheumatism, relation to cancer, 72
• Ribert, beginnings of cancer, 30
• Roberts, disturbance of salivary digestion from tea, 119
• Robin, relation between chlorine and nitrogen in cancer, 92
• Rohdenburg, Bullock, and Johnson, thymus gland in cancer, 101
• Rome, cancer in, 63
• Ross, thymus and calcium, harm from in cancer, 101
  • relation of potash salts to cancer, 160
• Rous, cancer in rats checked by diet, 39
• 235Russian oil as a dressing in cancer, 166
• Saleeby, trypsin and amylopsin in cancer, 99
• St. Louis, cancer in, 65
• Sajous, adrenals in relation to cancer, 98
• Salivary secretion, acid in cancer, 94, 95, 161
• Salt, effect of, on cancer, 129
• Sarcoma of same origin as carcinoma, 175
• Scandinavia, cancer in, 125
• Schmidt, infectious diseases and cancer, 29
• Serum therapy, 164
• Sherman, composition of the human body, 107, 154
• Sherrington and Copeman, reproductive glands inhibiting growth of cancer, 103
• Shirlaw, pluriglandular extracts in cancer, 163
• Silica, retention of, in pancreas, in cancer, 98
• Simple diet, effect of, in cancer, 121
• Soëgaard, stomach cancer frequent in Norway, 125
• Solids in the urine, deficient in cancer, 87, 88
• Spontaneous disappearance of cancer, 36
• Stasis, intestinal, and cancer, 155
• 236Stuart-Low, relation of thyroid to cancer, 100
• Sub-oxidation and cancer, 132
• Sulphates, increased in cancer, 92
• Sulpho-cyanic acid, increased in cancer, 92
• Sulphur elements, altered in cancer, 92
• Supra-renal glands, relation of, to cancer, 97
• Surgery, operative, in cancer, 145, 147, 168, 179
• Surgical aspects of cancer, 7, 9, 10, 25
• Sweet, Corson, White, and Saxon, effect of diet on experimental tumors, 38
• Switzerland, cancer in, 62
• Syphilis and cancer, 22
• Taste gratified, a cause of cancer, 108
• Tea, relation to cancer, 117
• Telluric influences in cancer, 22
• Testicles, internal secretion of, relation to cancer, 102
• Thompson on consumption of coffee and tea, 118, 154
• Thymus gland in cancer, 101
• Thyroid, danger from in cancer, 164
  • relation to cancer, 97
  • value of in cancer, 99, 163
• 237Tobacco, influence of, in cancer, 126
• Toxicity of urine, increased in cancer, 91
• Toxic secretion from cancerous mass, 70, 78, 104, 206
• Toxins, intestinal, and cancer, 92, 155
• Transmission of cancer, 20
• Traumatism and cancer, 24
• Trypsin in cancer, 99
• Tuberculosis and cancer, 16, 44, 45
• Tuke, influence of the mind on morbid processes, 86
• Türk, cytology of cancer, 74
• United States, cancer in, 16, 64, 68
  • consumption of coffee in, 118
  • consumption of meat in, 117
• Urea excretion, deficient in cancer subjects, 89
• Uricacidæmia, relation to cancer, 72
• Urinary disturbance, functional, and cancer, 158
• Urinary solids, deficient in cancer, 87, 88
• Urobilin, increased in cancer, 90
• Vaccine-therapy in cancer, 164
• 238Valais, cancer in, 62
• Vegetable protein, 133
• Vegetable tumors, 43
• Vegetarian diet affords sufficient protein, 133, 153
• Vegetarian diet and cancer, 50‒53, 55‒57, 63, 115, 123, 128, 136, 142, 180‒197
• Venus on vegetarian diet in cancer, 142
• Vincent, quoting Ehrlich on resistance to athreptic influence, 163
• Virchow, on tumor formation, 31
• Voit’s dietary standard, 111
• Volumetric analysis of urine in cancer, 87, 94, 159
• Wakefield on hyperacidity of the blood plasma in cancer, 33
• Wales, cancer in, 57
• Walshe on the cause of cancer, 137
• Watson, effect of meat diet on tissue cells, 114
• Wealth, relation to cancer, 48, 68, 109
• Weight in cancer, 161, 192, 195
• Wells, nuclear proteins in cancer cells, 83
• Well-to-do men and cancer, 130
• West Indies, cancer in, 57
• Williams, cancer problems,
• 23936, 45, 47, 50, 58, 72
• Wolf, cancer in Australia, 47, 48
• Wolter, nucleo-proteids in cancer tissue, 82
• Wrong eating and cancer, 152
• Xanthin bases, increased in cancer, 90, 91
• X-ray, value in cancer, 29, 145, 167

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