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                                 CANCER
                                  ITS
                          CAUSE AND TREATMENT


                               VOLUME II




                           BY THE SAME AUTHOR


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




                                 CANCER
                                  ITS
                          CAUSE AND TREATMENT


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

    Senior Physician to the New York Skin and Cancer Hospital, etc.


                               VOLUME II

[Illustration]

                                NEW YORK
                             PAUL B. HOEBER
                                  1917




                            Copyright, 1917
                           BY PAUL B. HOEBER

                        _Published, April, 1917_


                          Printed in U. S. A.

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




                                   To
                             THE GOVERNORS
                                 of the
                   NEW YORK SKIN AND CANCER HOSPITAL
        whose kind appreciation of and assistance to the author
             in his clinical work in their institution have
                   done much to encourage him and to
                 promote the interest of the profession
                           in the branches of
                              DERMATOLOGY
                                  and
                                 CANCER
                           this second volume
                              is inscribed




                                PREFACE


Two years ago the present writer ventured to put forth a small book in
which cancer was considered from quite a different standpoint from that
commonly held by the profession and laity. The kindly reviews of the
medical press indicated that, while this was antagonistic to accepted
views, there was warrant for such an investigation, in view of the
steadily increasing mortality from cancer all over the world, under the
present mode of purely surgical treatment.

In these two years there has been very active study of cancer together
with a campaign of education in regard to the desirability and necessity
of operating very early in the disease, and consequently an increased
surgical activity. In spite of all this, or possibly on account of it,
the mortality from cancer during 1915 has been appreciably higher than
the average yearly death rate during the preceding five years. It would
seem, therefore, that there was increasing necessity for the study of
the conditions which cause the disease, as found in the human system,
rather than an increased study of pathological specimens and
experimentation on animals.

During these two years the writer has sought to understand the disease
better by constant clinical observation in private and public practise
and by wider acquaintance with literature, and has been only
strengthened and confirmed in the views which were set forth in the
former small book, and which he has held and practised for over thirty
years.

With some care he has prepared a second series of lectures which were
given to practising physicians attending the regular Wednesday afternoon
clinics at the New York Skin and Cancer Hospital in November and
December, 1916, and which are now submitted to the profession at large.

The reasons for presenting the medical aspects of cancer were given in
the former volume, also the hesitancy I felt lest, from an imperfect
carrying out of the necessary lines of internal treatment, harm might be
done or time lost in which there might possibly be some gain from
surgical treatment.

But the more I have studied cancer in the living and dying subject, and
the more I have tried to compass literature and analyze statistics, the
more have I felt compelled to push forward a campaign of education in
regard to the basic causes of the disease, ever with the thought of
prophylaxis, by inculcating right living.

It has been painful to me to present the mortality statistics in such an
unfavorable light as is seen in the following pages: but truth is truth
and truth must prevail.

No one can study carefully the remarkable book of Hoffman on “The
Mortality Statistics from Cancer Throughout the World,” and Williams’
“Natural History of Cancer,” and Wolff’s “Die Lehre von der
Krebskrankheit,” and the special volume concerning “Mortality from
Cancer and Other Malignant Tumors in the Registration Area of the United
States,” recently issued by the Bureau of the Census, without feeling
that something more should be attempted to arrest the progress of this
direful disease.

This seems all the more necessary and proper in view of the gratifying
decrease of mortality which has been obtained in tuberculosis, of 27.8
per cent from 1900 to 1915, by diligent and intelligent medical
supervision.

The problem of cancer is indeed a great one, but surely it is not to be
solved by greater activity along the lines under which its mortality has
steadily risen 28.7 per cent during the same period just mentioned, in
which tuberculosis has fallen so greatly. If this death rate of both
diseases should continue the same for fifteen years more, cancer would
outstrip tuberculosis in its actual fatality. Reason would seem to
indicate the necessity of a radical change in our point of view and a
complete change in our line of treatment.

In the text of these and former lectures I have endeavored to show why
and how cancer should be regarded from its medical aspects, and to
illustrate by a few cases some of the results which could be obtained
from this line of procedure. There is absolutely no claim or suggestion
that the cancer problem has been solved, but only an aim to put the
_real cancer problem_ in such a light that others might follow and
develop the subject in a manner fitting to the very great importance of
the end so strongly desired by all, namely, the checking of the steadily
rising morbidity and mortality of cancer.

Laboratory studies are of practical value as they supplement and
enlighten clinical observation. The microscope and test tube have
accomplished much for medicine and with animal experimentation have
undoubtedly rendered inestimable service in its scientific advancement.
But divorced from the practical study of patients they may fail in the
ultimate end desired. In these and the former lectures I have endeavored
to indicate certain lines of scientific investigation along which much
more laboratory effort is desirable, in order to determine more
definitely the metabolic and blood conditions which lead up to cancer.
These I have attempted to follow to a limited degree in many cases, and
found them of great service in their management.

In some of the reviews of the former volume some adverse criticism was
given on account of the absence of microscopic findings confirming the
diagnosis of the cases reported. I explained at the time that any
attempt to excise portions of tissue for such study would at once
endanger the patient and imperil the success of treatment, by giving
occasion to metastases, from the opening of blood vessels and
lymphatics. This matter is treated of more fully in the present
lectures. It is to be remembered that the vast majority of operations
for cancer are undertaken upon a purely clinical diagnosis, and it may
be undeniably stated that not one half of them are confirmed
subsequently by competent microscopic evidence, except, of course, in
properly equipped hospitals. In some of the cases now presented
pathological proof has been presented, while in every one the clinical
signs were so unmistakable that no one could possibly doubt the
correctness of the diagnosis.

A number of reviewers of the former volume regretted that fuller and
more definite statements had not been made in regard to the exact diet
and mode of treatment employed in the cases reported. I had explained
that it was very difficult to develop all this in the brief compass of a
few lectures; indeed I may now say that it would take many times the
space and time which could be given to it to develop fully all the
possibilities and requirements of a dietary and medicinal treatment in
every case. The object rather was to inculcate the basic idea of the
true causation of cancer, leaving it to the practitioners present to
carry out the measures calculated to reach the desired end. In order to
make matters very clear I may occasionally have repeated some things
said in the former lectures, and some repetition may be found in these
successive lectures; but this will be pardoned when it is considered how
necessary repetition often is in order to establish correctly a new
thought. The cases were given as illustrations of what could be
accomplished along the lines indicated.

In the present lectures I have endeavored to carry the thought still
further and to develop the fundamental principles on which treatment and
prophylaxis are to be based. I have also been much more explicit in
regard to diet, and have given the exact dietary which has been used
with advantage in very many cases in private and hospital practise. In
regard to medical treatment I have also been more definite, although it
would be quite impossible to indicate all the different remedies which
those and other patients have taken over varying periods of time, to
meet different requirements of the system and individual peculiarities.
I think and believe, however, that sufficient data are given to enable
the competent and careful physician, who is able and willing to give
sufficient time and adequate attention to these cases, to accomplish the
same results, provided he has thoroughly mastered and applied the matter
contained in these two small books.

I fully realize the responsibility I have undertaken in gathering and
revealing the evidence of the unsatisfactory results of the manner of
regarding and treating cancer in years past, and certainly would not
have done this were I not so strongly assured that there was something
better to offer. How far I am right in my thesis I now leave to the
kindly judgment of my professional brethren. My only hope is that I may,
in some measure, have assisted in stemming the tide of the fearful
ravages made by cancer, and that others may investigate still more
deeply along the lines of its medical aspects, with increasingly
satisfactory results.

                                                      L. DUNCAN BULKLEY.

 JANUARY, 1917.
   531 MADISON AVE.




                                CONTENTS


                                                                    PAGE
                                LECTURE I

 CANCER AS A MEDICAL OR SURGICAL DISEASE                              19


                               LECTURE II

 INFLUENCE OF SEX, AGE, OCCUPATION, RACE, CLIMATE, AND FOOD ON
   CANCER                                                             47


                               LECTURE III

 THE MORTALITY FROM CANCER; ANALYSIS OF SURGICAL STATISTICS.          74


                               LECTURE IV

 INOPERABLE AND RECURRENT CANCER; METASTASIS; THE BLOOD IN CANCER    111


                                LECTURE V

 DIETETIC AND MEDICAL TREATMENT OF CANCER PROPHYLAXIS                144


                               LECTURE VI

 RESULTS: PERSONAL CASES                                             188


                                 SUMMARY

 THE REAL CANCER PROBLEM                                             239


 INDEX                                                               273




                                 CANCER
                                  ITS
                          CAUSE AND TREATMENT




                               LECTURE I
                CANCER AS A MEDICAL OR SURGICAL DISEASE


In my lectures given here two years ago I considered, as far as I could
in the time allowed, the nature of cancer,[1] and the evidence in favor
of its being a medical rather than a purely surgical disease; and in
order that the trend of what shall follow may be clearly understood,
brief reference may be made to some of the principal points studied and
developed in the preceding lectures. To this end I may restate the
conclusions presented at their close, as developed in the lectures,
perhaps with some alterations or additions which two years’ further
study, observation, and treatment of cancer may suggest.

1. Cancer is but a deviation from the normal life and action of certain
of the ordinary cells of the body, which, for some reason, difficult to
understand, take on an abnormal or morbid action: with this there is a
continued tendency in them to a malignancy which invades contiguous
tissue, associated with a pernicious anemia which in the end tends to
destroy life.

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

3. Cancer is _not_ wholly due to traumatic causes; although these may
play a not inconsiderable part in its occurrence in certain localities
and cases.

4. It is pretty conclusively decided that cancer is _not_ caused by a
microörganism or parasite; although various forms of these have been
found in connection with the disease, and each has been claimed as the
cause of cancer.

5. It is known clinically and experimentally that cancer is _not_
contagious.

6. _Nor_ is it hereditary in any appreciable degree; although certain
rare instances have been reported in which such seems to be the case,
and though some tendency in that direction has been demonstrated in
certain strains of mice.

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 years; although its
incidence is greatly increased with advancing age.

9. Cancer does _not_ especially belong to or affect any particular sex,
race, or class of persons. It is, however, more frequent in females than
in males, although of late years the proportion in the latter is
steadily rising.

10. Cancer is _not_ confined to any climate, location, or section of the
earth, but has been observed in all countries and climates, though with
different frequency.

11. _No_ single cause of cancer has yet been demonstrated; nor is it
likely that this will ever be the case, as experimental and other
investigations have covered almost every possible line of research, with
only _negative_ results.

12. The exclusion of almost every other possible cause of cancer, as
well as its pathological history and biochemical studies, all lead,
therefore, to deranged metabolism as the only remaining possible
etiological element. This latter acts by inducing changes in nutrition,
and these in turn depend on diet and the proper or improper action of
the secretory and excretory organs; these latter may, still further, be
affected by nervous influences.

13. While the biochemistry of cancer does not as yet throw very great
light on its true nature and cause, enough has been determined 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
alterations in the action of the organs which form blood and control the
nutrition of the body and its cells.

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

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

17. The mortality from cancer is undoubtedly on the increase in every
portion of the globe, in spite of the assiduous activity of the
laboratories and the immense advances in surgical procedure.

18. This increase in mortality is seen to vary inversely, and in about
the same proportion, with the steadily diminishing mortality of
tuberculosis, under recent careful medical guidance.

19. The increase of cancer mortality is found to follow closely along
the lines of modern civilization.

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

21. The augmentation in the consumption of meat, coffee, and alcoholic
beverages in civilized communities is seen to be coincident with the
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 has been, or will probably ever be,
discovered, since it is conceded that there is no single cause for the
disease. The history of cancer abounds in the heralding of various
vaunted remedies, quack and other, including sera, whose employment has
only ended in the disappointment of medical men and in the deluded hopes
of innumerable sufferers.

24. Modern surgery has materially improved the statistics relating to
the immediate results of operative procedures; but the total
achievements along this line are insignificant when compared with the
steadily rising death rate, and ultimate mortality of about 90 per cent
of those once afflicted with cancer.

25. Surgery has had, and may yet have, its function to perform in
removing some of the _products_ of the constitutional state causing
cancer, more or less efficiently, curing some patients and prolonging
the life of others; but from past experience it can never hope to lessen
the morbidity of cancer. The reason for this is that it attacks a
symptom only, and not the underlying cause.

26. The X-ray and radium, as also caustics, are in the same position as
surgery, and can do little more than cause to disappear, more or less
temporarily, some of the 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, depends largely on the duration and the
extent of development of the malignant growth before treatment: the
earlier such local treatment is undertaken, other things being equal,
the greater the possibilities of success.

28. The same is true in regard to the treatment of cancer by dietary and
medical means. The earlier the morbid constitutional process, or state,
leading to tumor formation is attacked by proper dietetic, hygienic, and
medicinal measures, the greater the promise and expectation of success,
present and permanent.

29. The cure and prevention of cancer, therefore, and the checking of
its increasing occurrence and mortality, depend largely upon the early
adoption of such measures as will limit the agencies which induce the
formation of the new growth: these are certain derangements of the body
juices which tend to bad nutrition and disturbance of the action 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 its rapidly increasing
development and mortality throughout the world.

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

It is quite impossible and unnecessary to elaborate again the facts upon
which these conclusions are based, which were given very fully in my
previous lectures and book; but we may briefly consider some of the
features just presented, and some of the evidence why cancer should be
considered from a medical rather than a surgical standpoint. For it must
be conceded that both the general medical profession and the laity still
regard the disease as belonging to surgery, and look only to the knife
for any hope in its treatment. In spite of all that has been done the
present outlook for the checking of its rising mortality by this means,
and for the prevention of cancer, is bad indeed, as will be shown in a
later lecture.

But, gentlemen, many great surgeons, in past and present time, as quoted
in my former lectures, have acknowledged verbally and in writing their
inability to cope with cancer as a disease, and have recognized time and
again that they operated only because they knew of nothing better to do.
Often it is acknowledged that the operation is only palliative, in the
hope, alas, how often futile, that some good might result from it, in
the chance that the dread disease would not return. We shall see later,
when we come to study the mortality of cancer in various locations, and
an analysis of surgical statistics, how slight the foundation is for
such hopes.

Both in the past and present times many surgeons of eminence, well
acquainted with the disease, whom I quoted in my former lectures, have
also more or less casually expressed the conviction that there was some
deep-seated constitutional cause of cancer which baffled recognition,
but which must have to do with the diet or mode of living of those
afflicted. The most recent of these is Dr. William J. Mayo, who has
spoken in no uncertain terms along this line, in a recent address as
President of the American Surgical Association. And yet how relatively
little intelligent effort has been put forth to discover and amend these
conditions, and to remove the bodily derangement which eventuates in the
formation of the foci of disease which later become malignant and form
what is called cancer, or to modify the blood changes which ultimately
destroy life!

In a long experience I have seldom, if ever, come across a patient with
cancer who had had any intelligent and prolonged attempt to check its
development by dietary, hygienic, and medicinal means; invariably the
knife, X-ray, and radium have been the only measures under
consideration. Also, after an operation the patient is dismissed, or
watched for a recurrence and again operated on, with no prolonged effort
to so modify the constitution that the same causes shall not reproduce
the malady in the same or other localities. And yet I have narrated to
you cases of undoubted cancer, verified by competent surgeons, who urged
instant removal, which had entirely disappeared without operation under
the line of treatment detailed, and who remained in perfect health for
many years, sixteen in two instances. I also reported cases illustrating
the beneficial result of dietary and medicinal measures in cases
recurrent after operation. This matter will be more fully considered in
a later lecture, with further illustrations.

We may now consider some general matters bearing on the question of a
medical rather than an exclusively surgical aspect of cancer.

The founders of the Index Medicus placed cancer among the diseases of
metabolism, along with gout, obesity, chronic rheumatism, diabetes, and
a few conditions of minor importance. This grouping of cancer in no wise
interferes with the idea that a chronic local irritant may be the
_exciting_ cause of the _local_ development of the tumor, which becomes
malignant, in any particular situation; any more than what is observed
in the case of late syphilis, where a gummy tumor or a bone lesion may
appear at a point of injury, or where gout will develop in a joint which
has been bruised.

But it does show that broad medical thought has long recognized that
cancer is not a purely local disease, but that it arises from some
disturbance of nutrition, tending to localize in some particular spot,
even as a neuralgia will occur in some special nerve and be reached, not
by local measures, but by those of a general nature. Repeated casual
observations have often been made by clinicians, and even by surgeons of
prominence, of the apparent relations between cancer and gout or
rheumatism, and also diabetes, and all recognize the rebelliousness of
cancer when it occurs in connection with obesity. The late Dr. John B.
Murphy was very strong in regard to this latter point. The constant
occurrence of cancer in rheumatic individuals is a very striking
feature, which I observe almost daily.

It is worthy of remark that cancer begins to appear at a wholesale rate
at the age when metabolism begins to slow up, and some time after the
body growth has become fully established. At this period people are apt
to lose the balance between physical effort and the intake of food,
eating as much as ever, perhaps more, while becoming more sedentary. At
the same time the emunctories become less active. The various affections
of metabolism now tend to appear and are associated with imperfect
oxidation, or diminished tolerance toward certain ingesta. It is
interesting to note that in a study of many thousand cases of eczema I
found the disease to be actually more frequent, in proportion to those
living, between the ages of 50 and 55 than at any other period of life
after the infantile period, or the first five years of life; just about
the same time when cancer is most common. And the constitutional
conditions at the bottom of eczema are very much the same as those in
cancer.

Patients with a cancer just beginning will often, or even generally,
seem to be in excellent health. It is indeed remarkable to observe how
commonly patients with beginning breast cancer will seem to be in a
splendid condition of health. They are ruddy and blooming in appearance,
and when the lump is first discovered it is hard indeed to believe that
if the erroneous life processes which caused the cancerous lesion to
develop are not checked, the patient will before long succumb to the
direful disease. Williams remarks that “such types are indications of
hypernutrition.”

But a most careful study of these patients in every particular will so
constantly reveal such errors of life and derangements of metabolism
that these must be looked upon as contributing causes, at least, to the
development of the local condition which later becomes malignant; in the
same way as the patient will appear to be in blooming health just before
an attack of acute gout. For when these conditions are rectified by
proper dietary and medicinal measures the local cancerous condition not
only ceases to develop but actually disappears without surgical removal,
as I have repeatedly shown you. These errors and derangements are not
commonly evident on a superficial examination, and often are recognized
only after very painstaking search, and re-search.

We have not yet arrived at such a clear knowledge of metabolism as to
understand just where the fault lies in these cases of seeming perfect
health, with the beginning of a neoplasm which may eventuate so
disastrously. But we do know that what passes for good health is often
fictitious, and is quite compatible with even grave disorders of various
kinds. It is more than possible that the apparent well-being of the
patient with beginning cancer, which is often observed to be associated
with uricacidemia, points also to the correctness of our thesis in
regard to its internal causation. As remarked in one of my former
lectures, quoting Ribert, “no one has ever seen the beginning of mammary
cancer” and no one will ever see the beginnings of cancer of internal
organs.

But, whatever may be thought of Haig’s theories or statements regarding
uric acid, there is no question but that many maladies of many kinds
have their origin in the concatenation of processes which has long been
recognized clinically as lithemia. Personally I believe that sooner or
later it will be generally recognized that the starting point of cancer
occurs in some cell or cells, previously normal, probably as the result
of local irritation, in which there is a deposit of some of the elements
of faulty nitrogenous partition, induced by undue ingestion of animal
protein: and that the malignant, reproductive process in the cells is
kept up by a continuance of the same supply of imperfectly disintegrated
nitrogenous matter.

The condition of the urine furnishes a most invaluable indicator and
guide as to the systemic derangements and their correction. This has not
reference to the presence of sugar, albumin, or casts, but rather to
other features, reflecting the manner in which metabolism is performed.
This subject was gone into pretty thoroughly in my former lectures, but
must be briefly considered here, because of the great importance of the
subject.

It is well known that, while the products of the digestion and
disassimilation of carbohydrates and fats pass off by the lungs,
generally without harm, those of protein and salts are eliminated by the
kidneys, and may be the cause of various systemic derangements. The
urine, therefore, when most carefully analyzed volumetrically, exhibits
in the clearest possible manner how the metabolism is carried on and
where the error lies.

From a study of hundreds of complete volumetric analyses of urine in
dozens of cancer patients, both in the very early and late stages of the
disease, I have found that this excretion almost invariably exhibits
departures from normal which are significant.

First to be mentioned is the relation of the total solids excreted daily
to the body weight of the individual; for it is evident that a person
weighing 200 pounds should pass off more than a smaller person. The
following table represents fairly well the total solids that should pass
daily in order to maintain a healthy equilibrium:

              _Body Weight_        _Total Urinary Solids_
                      90 pounds                    500 grains
                      95   〃                       535   〃
                     100   〃                       570   〃
                     105   〃                       605   〃
                     110   〃                       640   〃
                     115   〃                       675   〃
                     120   〃                       710   〃
                     125   〃                       745   〃
                     130   〃                       780   〃
                     135   〃                       815   〃
                     140   〃                       850   〃
                     145   〃                       885   〃
                     150   〃                       920   〃
                     155   〃                       955   〃
                     160   〃                       990   〃
                     165   〃                      1025   〃
                     170   〃                      1060   〃
                     175   〃                      1095   〃
                     180   〃                      1130   〃
                     185   〃                      1165   〃
                     190   〃                      1200   〃
                     195   〃                      1235   〃
                     200   〃                      1270   〃
                     205   〃                      1305   〃

These figures do not represent much active exercise, and with increased
bodily exertion the solids passed should be more. Men excrete about
one-tenth more than women; there are also less urinary solids passed
with advancing age, and about five per cent may be deducted for each ten
years after forty.

The estimation of the total solids is easy with Haines’ modification of
Hasser’s method. _Multiply the last two figures of the specific gravity
of the urine by the number of ounces voided in 24 hours, and add ten per
cent to the product._ Thus, if the amount passed in 24 hours was 36
ounces with a specific gravity of 1.021, it would be 36 × 21 = 756 + 10
per cent = 832 grains of solids in the whole amount of urine excreted
that day. By comparing this with the table it can be readily ascertained
if the amount is above or below the normal standard for the body weight
of the patient. For many years I have employed this method of
determining the urinary output in hundreds of patients with various
diseases of the skin and cancer, and have found it of inestimable value.
It is understood, of course, that by dietary and medicinal measures the
urinary solids are to be brought up to and maintained at normal.

The actual acidity of the urine, as measured by the oxalic acid and
phenolphthalein test, is also of the greatest importance. This is not
difficult of application and is daily used in my laboratory; the litmus
paper test is of relatively little value in comparison with an actual
chemical measurement. Thus, with an average standard of 300 we not
infrequently find an acidity of 500 or 600, or even 1000 or more, or it
may sink to 200 or 100, or even be strongly alkaline. In cancer I have
striven, by diet and remedies, to keep it a little below normal, as it
has been shown that the blood in this disease exhibits a constantly
increasing tendency to diminished alkalescence, or, wrongly called,
increased acidity.

But further and very careful volumetrical urinary analysis is very
important to determine and maintain the metabolism in its proper
condition. Time does not permit such an elaboration of this subject as
might be desired, and I can only call your attention briefly to some of
the points brought out in my former lectures.

Many observers have found the nitrogenous disintegration very imperfect
in cancer cases, and oxyproteic acids are increased and even that in
very early cancer. An increase of amino-acid nitrogen was found by Reid
in practically every case studied. Others have found an increase in
colloid nitrogen, to more than double the normal amount, and also
increased elimination of xanthin and urinary ammonia; so that all
observers testify to a disturbed nitrogen partition in cancer. The
elimination of urea is certainly greatly diminished, even in early
stages and when on a full diet, as I have almost invariably observed.

The sulphur partition is also found to be imperfect, in new and old
cancer cases, and even a great increase in the urinary discharge of
sulphates is constantly noticed in my analyses. Associated with these
errors in the nitrogenous and sulphur element is the very common and
persistent increase of indican, showing stasis in the small intestine,
with bacterial putrefaction.

Imperfect intestinal elimination is constantly observed in cancer cases,
both habitually and in the very early, formative period, and also later,
even before any recourse to morphin, which, of course, heightens the
trouble. In recording the statements of these patients I have been so
struck with the almost invariable history of constipation before the
first appearance or suspicion of the cancer that I cannot help feeling
very strongly the possibility that the toxins produced by the millions
of microörganisms, generated through intestinal stasis and fecal
putrefaction, play a great part in the production of that blood
dyscrasia which culminates in the formation of the malignant new growth.

I mentioned to you last year that in hundreds of tests of the saliva in
cancer patients the reaction was found to be acid almost invariably,
until corrected by dietary and other treatment. I have this test made
and recorded daily, half an hour before meals and half an hour after
meals, on my cancer patients in the New York Skin and Cancer Hospital. I
have also the urine volumetrically analyzed each week, and the results
all tabulated in columns on the history sheet, so that the changes may
be compared weekly, in regard to each constituent, as treatment
progresses. The same is done with the weekly studies on the blood, which
I hope to present in full before long.

I think, gentlemen, that from what I have said you can see that the
medical aspects of cancer loom up pretty large, and yet we are only
beginning to study the disease along these lines. We see, thus, that
cancer is not primarily a surgical affection, and that the mere ablation
of an offending portion of the body which has become diseased can never
preclude a new portion from becoming affected, or prevent a recurrence
in the same location; indeed, this often seems to be stimulated and
increased by the trauma and by the deranged lymphatic and vascular
circulation caused by the operation and the dissemination of actively
growing cancer cells through these channels. This will appear more fully
later when we come to study the increasing mortality of cancer during
these later years of active surgery, and when we come to analyze the
actual reports of operative procedures.

I hope, gentlemen, that by these lectures I may succeed in satisfying
your minds that if anything is to be done towards staying the steadily
rising frequency and increasing mortality of cancer, it must be by
carefully wrought out medical means, and not by the knife.




                               LECTURE II
  INFLUENCE OF SEX, AGE, OCCUPATION, RACE, CLIMATE, AND FOOD ON CANCER


While cancer is no respecter of persons, and affects all, rich and poor,
old and young, male and female, there are some interesting features
regarding the disease as it occurs under various conditions which are
worthy of consideration.

We have seen in the former lecture that cancer is not a definite
something, from without, that attacks the human frame, but that it is
only a faulty development and action of certain body cells, which were
once normal, with a steady decline in bodily health which tends to a
fatal issue in a very large proportion of those once affected with the
disease.

We have seen that the cancer patient, both in the very earliest stages
and during the whole period of the disease, gives evidence of departures
from the ideal normal life, and presents functional disorders of various
organs, with derangements of metabolism; these point to errors of
nutrition, which latter are of significance in connection with the
development and continuance of the malignant disease. The conclusion
offered was that cancer is a medical affection, due to systemic causes,
and that the simple surgical excision of a certain diseased portion
cannot be expected to check or remove such a malady, or to prevent
recurrence. And this has been abundantly demonstrated by the history of
the disease, with its steadily increasing mortality under increasingly
active surgical treatment during the last fifteen years, as was shown in
my former lectures and will be further illustrated later.

Recognizing, then, that cancer is a great and widespread disorder of
nutrition, let us consider some of the facts regarding its extension and
some of the influences concerned in its production.

SEX.—Cancer is much more frequent in females than in males. In the
United States Mortality Reports for 1914 there were 31,138 females to
21,282 males; thus, in a total of 52,420 deaths from cancer 59.4 per
cent were in females, with a preponderance of 9,856. This excess is
largely due to cancer of the breast, from which there were 5,423 deaths,
and cancer of the female genital organs, causing 8,152 deaths, of which
7,470 were from cancer of the uterus.

The death rate in males, however, seems to be increasing of late years;
in the United States in 1912 males formed 39.7 per cent; in 1913, 40.1
per cent; and in 1914, 40.6 per cent. In England, according to Williams,
the proportion of males to females is increasing much more rapidly. This
greater mortality of males is due to the greater number of deaths from
cancer of the stomach and liver, buccal cavity, and skin. In 1914 there
were 19,889 deaths from cancer of the stomach and liver, or 37.9 per
cent of the whole number; of these 10,122 were in males to 9,767 in
females, or an excess of 355 males, whereas in 1912 the females were 87
in excess. In the United States the cancer death rate for males has
increased since 1901 31.8 per cent and for females 25.3 per cent.

AGE.—Carcinoma is exceedingly rare under 20 years of age, most malignant
tumors at that period being sarcomata. After 25 the number of deaths
from cancer about doubles each five years up to 40, and then increases
steadily, until the actually greatest number of deaths, 6,909 (3,071
males, 3,838 females), occurred between 60 and 64 years of age, after
which they decreased steadily; there were 267 deaths at 90 and over, 8
of them being 100 years and over. At no period did the deaths of males
exceed that of females, and from 35 to 39 years of age the latter were
almost three times that of males.

OCCUPATION.—Many attempts have been made to trace the influence of
occupation upon the incidence of cancer, but thus far very little of
practical interest has been demonstrated; the difficulties concerning
this investigation are immense, owing to absence of essential and
accurate data. There have been many lists presented, but few of which
agree as to details, and all need to be corrected as to the proportion
of those living at different ages. There is also the question as to the
effect of local or general agencies; thus, as to the result of local
injuries on the skin, and also in regard to other agencies, whatever
they may be, which produce internal cancer; for tables of occupation do
not generally refer to sex, age, or location of the disease.

First, to dismiss the question as to the direct result of local injuries
in inducing cancer of the skin, which, at the most, caused only 3.7 per
cent of all cancer deaths in 1914, we may cite a few instances in which
this appears to be pretty well established.

The occurrence of epithelioma as a direct result of repeated and
protracted exposure to X-ray is familiar to all, and is particularly
interesting because it occurs commonly among younger persons, and at a
time of life when epithelioma is rare; and especially also because the
X-ray is constantly effective in curing epithelioma. The rarity of
epithelioma resulting from X-ray, considering the enormous amount of
exposure which must have occurred in making and using X-ray tubes,
implies, however, that there must be some other cause also at work. It
has been urged, therefore, that the skin tissue being altered and
weakened from repeated and protracted exposure to X-rays, more readily
falls prey to some of the chemical or other irritating agencies which
have been observed to be followed by epithelioma.

Time does not permit even a mention of the various elements, which are
many, that have been credited as excitants of cutaneous epithelioma; but
brief allusion may be made to one which formerly attracted much
attention, mainly in England; this refers to chimney-sweeps cancer, the
mortality from which was at one time at least 5 times greater than that
from cancer in males generally, at the same age. This is now, however,
of relatively infrequent occurrence, owing to the adoption of other
methods of cleaning chimneys. The epithelioma, which more commonly
developed on the scrotum, was believed to be due to the long continued
irritation caused by the constant presence of soot on the part; other
products of combustion and tar derivations have also been accredited
with the same result.

The question of the influence of occupation along other lines is really
more interesting, because more obscure; but a careful study of available
data tends to show the correctness of the thesis on which my former
lectures and these are based. This, as you know, is that our so-called
advancing civilization, with all its errors of life, in many directions,
is at the bottom of the steady increase in the mortality from cancer.

One of the most interesting contributions to this was the investigation
made by Dr. Latham, Registrar-General, in a study of cancer returns in
England; this showed that the mortality from the disease was more than
twice as great among well-to-do men having no specific occupation as
among occupied males in general, the respective mortality ratio being 96
for the former and only 44 for the latter. The same observation has been
made elsewhere.

Moreover, it is reported from several reliable sources that the death
rate from cancer in many cities is proportionately greater among the
rich and those in easy circumstances than among the poor, wage-earning
element of society. This would seem to show that occupation in general
acts favorably against the development of cancer. This fact is quite
understandable when we consider that those engaged in active work are
less liable to suffer from the effects of gluttony and indolence, with
their concurrent metabolic disturbances, than the well-to-do with ease
and luxurious habits. It is remarkable, however, that in asylums, homes
for the aged, prisons, convents, monasteries, etc., where the inmates
are relatively unoccupied, many writers confirm the fact that cancer is
very seldom seen; but this again is explained by the simple and frugal
diet enforced, with very little meat, which agrees with our thesis.

Statistics from life insurance companies show that cancer is decidedly
more common among persons of over-weight than among under-weights.

In regard to the occupations of those dying from cancer it is
interesting to note that standing among the highest per 100,000
population, in English statistics, come brewers, inn-keepers, and
butchers, whose metabolism can be greatly disturbed by alcohol and meat;
also indoor servants are more apt to be affected, while those of more or
less sedentary occupation, such as school teachers, clergymen,
physicians, and tailors, likewise stand very high on several lists. On
the other hand, those engaged in active physical exercise, such as
miners, farm laborers, carpenters, blacksmith, mail-carriers, and
others, are among those least frequently attacked.

RACE.—Cancer has been observed in every race, though the proportion of
cases is observed to vary greatly among different peoples; but it is
interesting to note that it is universally agreed by those that have
studied the subject that the difference in frequency relates very
largely to the degree of civilization involved. The blond Nordic race,
however, seems to be more susceptible to the disease than the darker
races, originally of Asiatic origin; and it is the former who have
pushed forward modern civilization, with all its errors of life.

Thus cancer is everywhere reported to be rare, and sometimes almost
absent, in primitive, uncivilized peoples, but it has been repeatedly
observed, in many localities, that as these same people mix with
Europeans and adopt their diet and mode of life, cancer is sure to
increase, until its frequency often about equals that in their highly
civilized neighbors. I went over this matter pretty fully in my former
lectures and cannot dwell on it now, or give examples. I can only
emphasize the fact that this furnishes a strong support to the
contention that cancer depends upon disorders of metabolism, which are
certainly increasing under the various elements which compose what is
called advanced civilization.

CLIMATE AND LOCALITY.—There is no evidence to prove that climate has any
influence in the production of cancer, nor is it affected by locality;
the disease occurs in hot, warm, temperate, and cold climates, and in
every possible location on the earth. But it is undoubtedly most
prevalent in temperate regions, for the reason that it is in these that
modern civilization, with all its faults and foibles, is most highly
developed.

The subject of the topical distribution of cancer, or its occurrence in
certain regions, has been the subject of much controversy in England and
France especially, and to read certain statements one would be inclined
to believe that certain telluric conditions were of influence in its
production, as along certain water courses, etc. But a more careful
analysis of all these statements shows that such elements can act only
as contributing causes, as, for instance, through a rheumatic influence,
which is known to be found in so many cancer patients.

The same may be said in regard to so-called “cancer houses” concerning
which there are still occasional references. A careful investigation of
these houses has commonly found them to be old, moldy, damp, badly
ventilated, and otherwise unsanitary; also that such old houses are
commonly tenanted by old people in succession, so that there are more at
a cancer age to be affected. With our present knowledge of the causes
which lead up to cancer we cannot but conclude, therefore, that the
occurrence of the disease in groups, with some apparent connection, has
been only the result of all living under the same conditions of ill
health, including wrong diet, etc.; for we know that cancer is not
contagious or infectious, and there is no other reasonable explanation
which can be sustained.

FOOD AND MODE OF LIFE.—In my former lectures I presented very fully the
evidence that cancer was certainly a disease of civilization, its
frequency and mortality advancing steadily in proportion as various
tribes or peoples, previously exempt, have come more or less under its
influence and adopted its manners and customs.

When we speak, therefore, of the influence of food in the production of
cancer it must be understood that it is not claimed that the diseased
process depends wholly and exclusively on the character of the food,
including drink, taken. In my former lectures I tried to show that
cancer was the result of a deranged nutrition, and we know that one of
the greatest elements in inducing this latter is erroneous metabolism,
depending again on the diet, to a very great extent. In a later lecture
I shall hope to develop this subject further, and indicate more
completely than on the previous occasion, the elements of causation and
the measures which can be successful in overcoming the disease.

In order to understand rightly the rôle which diet may have in the
production of cancer I may have to briefly repeat, more or less, some of
the matters brought forward in my lectures two years ago, and shall
treat of the correction of diet in a later lecture.

We understand, of course, that the body is a vast laboratory, wherein,
by exceedingly complicated processes, material from the outside world is
appropriated to the needs of the economy, and after its use is cast out
in very different and elementary forms. To effect the various changes
necessary in this material we have a very considerable number of what
are called organs of secretion and excretion, whose functions are
combined and correlated in a marvelous manner, which is even yet very
imperfectly understood.

The actual biochemical processes by means of which the transformation of
external food elements into living tissue and force, physical and
mental, takes place are known as: 1. Anabolism, or the process of
assimilation of nutritive matter and its conversion into living
substance; and 2. Catabolism, or the breaking down of complex bodies of
living matter into waste products of simpler chemical composition. These
together constitute 3. Metabolism, or the sum of the chemical changes
whereby the function of nutrition is effected. The actual procedure by
which most of these activities is carried on is one of oxidation, by
means of the oxygen supplied largely by the lungs, which constitutes
about 65 per cent of the human body.

Now to make up for the daily waste of the other 15 elements, which form
35 per cent of the body tissues, and to support the necessary activities
of the system, mental and physical, it is necessary every day to take a
more or less even supply of substances, which we call food and drink,
which should contain about the proper proportion of the requisite bodily
components. Under normal conditions of healthy living the appetite
ordinarily serves as a proper guide for health in man and beast, serving
to regulate the selection of material to preserve the balance of
nutrition. But man especially has temptations to gratify the _taste_,
which is quite a different thing from satisfying the _appetite_, and all
are familiar with the many forms of disaster and disease which arise
from gratifying the taste in food and drink; moreover, the temptations
to this seem to increase continually with the so-called refinements of
civilization.

The actual nutritive elements which are required are relatively few, and
fall mainly under three classes: 1, Protein; 2, Carbohydrates; and 3,
Fats. Of these the latter two furnish most of the 18 per cent of carbon
in the body, and the animal or vegetable protein furnishes the nitrogen,
which forms only about 3 per cent of the body tissues: all these
substances are, of course, used up constantly in providing heat and
energy, physical and mental, day by day, the protein being concerned
chiefly in replacing wasted tissue. The combustion of the carbohydrates
and fat is relatively simple, and the waste products pass off
harmlessly, mainly by the lungs, as carbonic acid and water.

But the course of the protein, or nitrogenous and sulphur and other
mineral elements, is quite different. In the anabolism and catabolism of
protein there are a vast number of intermediate changes, and various
products are elaborated which we know to be of great significance in the
system, and which when imperfectly completed are the source of much
disorder and disease in the economy. Of this the gouty state is a
notable example, with a long list of secondary disorders.

But few realize, however, that cancer is another disease which is quite
as striking in its relation to faulty nitrogenous and sulphur
metabolism. In my former lectures I developed this subject pretty fully
and need not repeat it here, but could adduce more recent proof, did
time permit. Suffice to remind you that many independent observers have
recorded very important and significant errors in the nitrogen and
sulphur partition in cancer, both in its early and late stages, some of
which I have verified in hundreds of volumetric urinary analyses. As
these errors are made to disappear by proper dietary and medicinal
treatment the carcinomatous lesions have steadily improved, and in many
cases have disappeared entirely, as I hope to demonstrate in a later
lecture.

We must, therefore, accept the fact that cancer has very close relations
to the elaboration of protein in the system, and the rational deduction
of this is that an overconsumption of nitrogenous food has something, if
not everything, to do with the production of cancer. As yet we know
little or nothing in regard to actual cancer-genesis; no one has ever
demonstrated, and probably no one ever will demonstrate, the absolute
beginning of the change in some normal cell or cells, in the breast or
elsewhere, which eventuates in their taking on the rampant or malignant
feature which we call cancer. But this change does occur, and though the
exact alterations in the polarity of the cells and the disturbance of
their centrosomes and nuclei, which have been described, may not be
perfectly understood, there is some definite cause for their occurrence.
Some have suggested the hypothesis that the mononuclear leukocyte, by
conjugation with disturbed cells, gives them an abnormal reproductive
power by which they eventually develop the tumor and invade other
tissues. But back of all this there is still some activating cause,
which is found in the fluids which bathe every tissue, namely the blood
and lymph, which we shall see later are deranged in cancer.

The fact that with innumerable injuries occurring everywhere and at all
times cancer develops from them very rarely, should teach us something.
We must conclude, therefore, that there is some constitutional
condition, or rather some state of the blood, which nourishes the cells
and which favors this continued malignancy—some fuel which feeds the
malignant process and at the same time induces a progressive lowered
vitality, ending fatally. For we have already seen in these and former
lectures that the local lesion which we call cancer is but one
manifestation or result of a pernicious anemia, which, if not checked,
may end life in a relatively short time.

As cancer is not contagious or infectious, this anemia, with all its
concomitants, including the local trouble which we call cancer, must be
autotoxic, and evidence is strong that it is of a nitrogenous origin. We
look naturally, therefore, to see if there can be found any relationship
between an augmented consumption of protein-bearing food and the steady
increase in cancer mortality which is reported on every side.

England has furnished more fully and for a longer period than any other
country the mortality and dietary statistics of its population, and from
these we can learn a great deal of value in our study.

According to a carefully prepared table by W. R. Williams showing the
total population in England during the years from 1840 to 1905, cancer
deaths had increased from 17.7 per 100,000 population in 1840 to 88.5 in
1905, or five times in numbers, and in 1913 there were 105.5 deaths from
cancer in 100,000 population. During this time the meat consumption had
more than doubled, to 130 pounds per capita in 1904; so that, according
to Williams, it is estimated that among the adult well-to-do population
the per capita meat consumption was from 180 to 330 pounds per year, in
addition to large quantities of game, poultry, eggs, fish, etc.

The United States Report of the Meat Situation, 1916, also furnishes
some valuable information to aid in this inquiry.

The Argentine Republic stands next in the consumption of meat, with 140
pounds per capita, and with a cancer mortality of 91 per 100,000 in
1900.

The United States comes next, with a per capita consumption of meat at
201.1 pounds in 1909 and a death rate from cancer of 73.8 per 100,000 in
that year, which, as previously stated, was 79.4 in 1914 and 81.1 in
1915.

New Zealand exceeds the United States a little, with a meat consumption
in 1902 of 212.5 pounds per capita, and an increase in cancer mortality
from 32 in 1877‒1888 to 60 per 100,000 in 1900 and 71 in 1903. This
increase is mainly among British and other immigrants, whereas the
aborigines, living simple lives, are seldom affected.

Australia stands first in the consumption of meat, with the enormous
rate of 262.6 pounds per capita in 1902, and the increase of deaths from
cancer there is most striking. In 1851 the death rate per 100,000 living
was 14, in 1900, 62.6, and in 1913, 75 per 100,000 living. The most
striking difference is exhibited between those who are native born, who
in 1900 had a cancer death rate of only 22 per 100,000, while the
British born had a mortality from cancer of 203, or nine times as great;
a still higher ratio was found among immigrants of other nationalities.
Those who have written there on the subject ascribe this proclivity to
cancer to the gluttonous habits of immigrants, who have meat for
breakfast, lunch, dinner, tea, and supper (MacDonald, Williams).

Italy, consuming the least quantity of meat, 46.5 pounds per capita, in
1901, has the lowest cancer death rate, but the present meat consumption
cannot be learned. In Italy, however, the mortality from this disease is
steadily rising, from 50.9 per 100,000 in 1860 to 1900 to 63.6 per
100,000 from 1906 to 1910.

But, as I have tried to show you all along, it is some derangement of
metabolism which is at the bottom of neoplastic growths, and that
derangement is not necessarily due to any one single cause, as diet.
There are other elements of disturbance besides the nitrogenous
malassimilation which is due to the intake of an excessive amount of the
proteid of the animal kingdom; for cancer is said to have been seen in
vegetarians, although I have never met with such a case. We know,
however, that some or many articles from the vegetable kingdom, such as
the pulses and some nuts, contain a very large proportion of proteid;
thus dried peas contain 21 per cent, haricot beans 23, lentils 23.2,
dried lima beans 26.4, soy bean flour, 39.5, butternuts 27.9, black
walnuts 27.6, peanuts 25.8, and almonds 24 per cent of proteid, all more
than is contained in beef and mutton. Thus a large supply of any of
these might produce the same error in the blood stream as that induced
by meat.

In my former lectures I pointed out also that coffee and alcohol were
found by statistics and clinical experience to have a prejudicial effect
on cancer, and therefore must be considered as elements in its
production. In a later lecture I shall deal more specifically with these
matters, in reference to the prophylaxis and treatment of the disease.

At the present time I will only remind you of what I have so often said
before: that it is the complex of modern civilization, with all its
temptations and errors in regard to eating and drinking, and living,
including the nervous strain felt everywhere, that in some way produces
alterations in nutrition which account for many of our diseases. This
operates through the blood current, which ministers in such a way to the
tissues that under some slight provocation a heterologous growth of
certain tissue cells occurs, with malignant tendencies, instead of the
normal homogeneous and stabile structures which compose healthy tissues;
and this departure from normal cell action we call cancer.




                              LECTURE III
       THE MORTALITY FROM CANCER; ANALYSIS OF SURGICAL STATISTICS


As has been already shown in these and previous lectures, the death rate
from cancer has been steadily and alarmingly increasing in almost every
locality, ever since statistics have been collected. The attempt has
been made from time to time to show that this increase is not real, but
is apparent, and that the error arises from three main causes. These
are: 1. The increased longevity in general, leading to the existence of
more people of the cancerous age; 2. Improved diagnosis; and 3. More
careful death certification.

Time does not allow us to go into this matter very fully, but this
erroneous impression is so widespread, and one so constantly meets it in
conversation, that it is desirable to present briefly the grounds and
proof for an absolute denial of the assertion that there has been very
little or no real increase in the mortality from cancer.

First, it may be stated that most of the arguments quoted against the
correctness of statements regarding the steadily rising death rate of
cancer date back to King and Newsholme, who, in 1893, some twenty-three
years ago, attempted a study of early statistics and drew certain
conclusions from them. This was long before the era of careful research
and reliable diagnosis and statistics, and can have little, if any,
weight. Bashford and Murray in the Second Scientific Report of the
Imperial Cancer Research Fund, in 1905, attempted to show the same
thing. But even this was eleven or twelve years ago, and the utter
fallacy of the sophistical arguments appears in the absolute, steady
increase in the death rate of cancer as shown by official tables from
many countries, and as especially collected and seen in the remarkable
book by Hoffman on “The Mortality from Cancer Throughout the World.”

It is impossible in a brief lecture to give even a faint idea of the
immense and valuable amount of research represented, and consequently
the most useful information furnished in this monumental work; the
material is taken from original documents with new information, freshly
obtained from original sources. All is given with an impartiality and
clearness which are refreshing when compared with some recent writings
on the subject. With the immense accumulated data on record, some of
which will be referred to, all showing a steady rise of mortality up to
the present time, and that during a period of especial study of cancer
such as the world has never known before, it is quite unreasonable and
impossible to believe that this advance is only apparent, and that it is
influenced by the three suppositions mentioned. While accuracy of
diagnosis may be important in early cancer, it is certain that in late
stages and at death, from which the various mortality tables are taken,
there is rarely any question as to the diagnosis. There is evidence,
however, to show that cancer is increasing even more rapidly than
appears from mortality statistics.

In 1900 the recorded mortality from cancer in the registration area of
the United States was 63 per 100,000 living, and in 1914 it had risen to
79.4, or an increase of 16.4 per 100,000 living, or over 26 per cent.
While in 1915 there were 54,584 deaths from cancer against 52,420 in
1914 in the registration area of the United States, or 2,164 more
deaths. The total number of deaths in the entire United States is
estimated at about 80,000 last year. The death rate in 1915 was 81.1 per
100,000, or a rise of over 28.7 per cent since 1910. The increase during
this past year has been 1.7 per 100,000 living, while the gross increase
for the preceding five years was but 5.6 per 100,000, or less than an
average of 1.2 per 100,000 each year. So that the great activity in
cancer education and in operative surgery during that year has succeeded
in raising the death rate from cancer by .5 per 100,000 over the average
of the preceding five years!

It is to be noted that this increasing mortality from cancer has been
steady and constant, though with slight diminution occasionally, some
years ago, before the great activity in cancer research, cancer control,
and cancer surgery. All this would certainly indicate some deep-seated
cause of the malady which had not been recognized; indeed the mortality
during the last five years was as follows: 1911, 74.3; 1912, 77; 1913,
78.9; 1914, 79.4; and in 1915, 81.1 per 100,000.

It may be of interest to know that the mortality from cancer varies very
greatly in different portions of the United States, and it would be
instructive to investigate the cause; but the data for this do not
exist. The highest death rate for 1914 was in Vermont, 109.9; Maine had
107.6; Massachusetts, 101.8; New Hampshire, 100.8; California, 97.9; all
against the general average of 79.4 per 100,000 inhabitants in the
registered area of the United States. The lowest among the registration
States was Utah, with 45.8 per 100,000 living. In New York State the
deaths from cancer in 1914 were 88 per 100,000 population in the cities
and 96.1 in rural districts.

Many cities, of course, show a higher death rate from cancer than the
average, owing in part to the number of patients coming for treatment,
and also to the more complex life of the cities, with the greater
temptations leading to the disturbances of metabolism causing cancer.
Thus, the average of twenty large cities gives a rise in death rate of
cancer from 48.6 from 1881 to 1885, to 89.3 per 100,000 living in 1913.

The following table gives the average cancer mortality from 1906 to 1910
per 100,000 in certain American cities:

                       San Francisco        102.5
                       Boston                99.4
                       Providence            96.9
                       Los Angeles           94.9
                       Cincinnati            93
                       Hartford              91.9
                       New Haven             89.8
                       Dayton                88.5
                       Rochester             88.2
                       Springfield           86.9
                       District of Columbia  86
                       Baltimore             85.8
                       Omaha                 85.7
                       Buffalo               84
                       New Orleans           82.2
                       Philadelphia          81.9
                       Hoboken               80.7
                       Columbus              79.5
                       Manhattan and Bronx   78.4
                       St. Louis             78.4
                       Denver                77.9
                       Newark                76.9
                       Chicago               76.5
                       Greater New York      74.1
                       Richmond              73.9
                       Kansas City, Mo       71.1
                       St. Paul              71.1
                       Indianapolis          70.4
                       Borough of Brooklyn   68.9
                       Milwaukee             68.4
                       Nashville             68
                       Pittsburgh            66.4
                       Minneapolis           65.3
                       Detroit               64.5
                       Cleveland             62.9
                       Louisville            61.1
                       Jersey City           60.5
                       Charleston            53.6
                       Seattle               50.2
                       Augusta (Ga.)         49.1
                       Memphis               48.7
                       Savannah              47.1

In the city of New York, as given by the Board of Health Bulletin, there
were from July 1, 1915, to June 30, 1916, 4,672 deaths from cancer, or
an average of just 12.8 persons per day; in the last six months, July 1
to December 31, there were 2,264 deaths from cancer, 990 males and 1,274
females, with a daily average of a little higher than last year.

It is readily understood that many factors enter into the study and
proper understanding of the statistics of cancer, such as age, sex,
location of the lesion, etc., and the limits of a lecture do not permit
any adequate presentation of the subject, but a few points may be
mentioned.

Thus, in regard to age, the States which represented the greatest number
of deaths from cancer, Vermont with 109.9 and Maine with 107.6, show
that the proportion of individuals over 45 years of age was over 27 per
cent, compared with 17.7 per cent for Kentucky and 16.2 per cent for
Montana, which latter gave almost the lowest mortality from cancer.

The same is true somewhat in regard to sex, although sufficient data are
not at hand to show the relative number of living males and females in
the different States. We know, of course, that the great preponderance
of cancer in females is due to that affecting the breast and uterus, and
where females preponderate in the population the total cancer mortality
would be the highest.

The location of the lesion has also a bearing upon the understanding of
statistics. Thus in Norway, for some unexplained reason, cancer of the
stomach caused the great mortality of 60 per cent (66.9 males, 52.9
females) of all cancer mortality, while cancer of the breast caused but
7.6 and of the uterus 16.2 per cent of the whole, the general rate being
93.9 per 100,000 inhabitants. In the United States, in 1914, cancer of
the stomach and liver caused the deaths of 37.9, cancer of the breast
10, and cancer of the female genital organs 14.2 per cent of all deaths
from cancer.

There are other points also to be taken under consideration in
connection with cancer statistics which we cannot even touch on and can
only mention one, namely, the physical condition; for the disease is
known to be more frequent proportionately among the better nourished and
well-to-do classes, etc.

Turning to other countries, we find abundant confirmation of the
persistent and considerable increase in the mortality from cancer, in
many cases much greater than has occurred in the United States; and in
nearly all of them the increase can be recognized as commensurate with
the progress or advance of so-called civilization, especially as
emphasized in city life.

England and Wales afford us about the most satisfactory statistics in
this regard. W. R. Williams has given a valuable table, already referred
to in connection with food, showing the prevalence of cancer and its
relative increase in England and Wales from 1840 to 1905. In 1840 the
cancer death rate was 17.7 per 100,000 living, with a proportion of 1 to
129 of total deaths. The deaths from cancer increased with almost a
perfect regularity until in 1905 there was a mortality of 88.5 per
100,000 living, and 1 in 17 of the total deaths was due to cancer, as
against 1 to 129 in 1840. The total proportion of deaths from all causes
is given for each year, and while the population has only a little more
than doubled in these 65 years, the deaths from cancer have increased
from 2,786 to 30,221, or over ten times the number; the rate of cancer
deaths per 100,000 living had increased five times, while the ratio of
deaths from cancer to total deaths had multiplied more than seven times.
Since 1905 the cancer death rate in England and Wales has advanced to
99.3 per 100,000 in 1911, and to 105.5 in 1913, and in London the cancer
mortality is 114.9 per 100,000 population.

Statistics from other countries, collected by Hoffman, show the same
steady increase. I will not weary you with much more of statistical
detail, but it is interesting to record a few of the more striking
facts, illustrating the universal increase in the cancer death rate
during these later years of cancer research and active surgery. The data
are from 1896 to 1910, and the countries will be arranged according to
proportionate increase in the death rate per 100,000 population. Thus,
Ireland comes first, with an increase of 20.7, which is explained in
part by the emigration of younger persons, leaving more of the cancer
age; next comes Denmark, increased from 118.9 to 137.3, or 18.4 per
100,000 population; then the German Empire with an increase of 13.4;
Hungary, 12.9; Italy, 12.7; Holland, 11.6; Norway, 10.9; Austria, 9.4;
and France from 97.3 to 102.7, or only 5.4 per 100,000 population.
During this same period the deaths from cancer in the United States have
increased about 18 per 100,000, or almost as much as the highest of the
countries mentioned.

In regard to the bearing of all these figures upon the alleged apparent
and not real increase of cancer, I may quote from Hoffman: “The evidence
is so convincing” as to the reality of the increase of cancer “that it
may be safely maintained that no other statistical conclusion in
medicine is so concisely and incontrovertibly established as this: in
any event, no satisfactory evidence is available to successfully
contradict this conclusion at the present time. If all this evidence,
however, is inconclusive and worthless, then no alternative remains but
to discredit the statistical returns of every country in the world with
regard to any single disease or group of diseases, although the returns
are accepted as approximately accurate in regard to every other
important cause of death.”

[Illustration:

  Death Rate per 100000 Population
  From United States Mortality Statistics 1915
]

In order that the real increase in the mortality from cancer may be
readily understood, the accompanying chart (now hanging before you) has
been copied from that given in the volume of the United States Mortality
Statistics for 1914, and it will help to visualize what has just been
stated. The data for 1915 have been added through the courtesy of Mr.
Rogers, Director of the Census, in a personal communication.

The striking fact brought out in this chart is the comparison between
the steadily diminishing death rate of tuberculosis, through careful
medical supervision, and the steadily increasing death rate of cancer,
under surgical care. While the mortality of tuberculosis has fallen from
201.9 persons in 1900 to 145.8 in 1915, or 56.1 less deaths in each
100,000 population, or over 27.7 per cent, the cancer death rate has
risen in the same time from 63 to 81.1 per 100,000, or over 28.7 per
cent. They have therefore approached each other by 56.4 per cent, and
unless this rate of progression is changed in some way, the lines will
have crossed one another in less than fifteen years more, even as that
for organic heart disease has already crossed that of tuberculosis, it
having risen almost 27 per cent.

Another interesting lesson to be drawn from this chart is that the death
rate from organic heart disease, nephritis, and apoplexy have all risen
coincidently with that of cancer, only that the rate of the latter has
outstripped them all. If we accept the fact that the increasing death
rate of these three diseases is largely the result of modern
civilization, especially from erroneous eating and drinking, it would
appear that cancer is due to the same cause.

Realizing, then, that the mortality of cancer is materially and steadily
rising, in spite of most diligent research by innumerable honest and
capable scientists, with the expenditure of vast sums of money and
countless animal lives, and in spite of the work of ardent, earnest, and
capable surgeons, who have failed to stay the terrible progress of the
disease, let us briefly study some of the reported statistics in regard
to the results of operative interference in cancer.

It may be first stated that this is a most difficult task, so different
are the reports from different surgeons. There are many elements which
affect the statistics relating to the surgery of cancer. First of these
is, perhaps, the stage of the disease at which the operation is
performed. Second, the results vary, of course, immensely with the
knowledge and skill of the operator and the excellence of the technique.
Third, the class of cases operated on has much to do with favorable or
unfavorable results reported. Fourth, the length of observation after
operation is always to be considered in connection with surgical
statistics. Finally, the optimism of the reporter must be regarded in
weighing the true value of reports as to ultimate results. We will
briefly consider these points.

First, as to the stage of the disease at which the operation was
performed. We have seen in this and previous lectures that the lesion
which we call cancer is but a _result_ of a deranged blood state, and is
not a purely local process, a something simply to be removed surgically
in order to have the patient get well and remain well. For one sees
plenty of cases where there were recurrences even after the very
earliest operations possible. But the claims put forth that favorable
results are conditioned on very early operations are so strenuous and
persistent that we must believe that a measure of the favorable results
can be thus accounted for. We know, of course, that very late in the
disease operations are out of the question. It is a little curious,
however, that most of the pictures shown, statistics presented, and
arguments adduced by these ardent advocates of early operation relate to
cancer of the skin, especially about the face, which cause hardly 2 per
cent of all the deaths from cancer in various countries; whereas those
who see much of cutaneous epithelioma know that if properly handled it
is generally a comparatively mild affair and relatively easily cured
without surgical operation, as you have so constantly seen in this
clinic in past years. But mortality statistics are greatly influenced by
the class of cases which the operator takes, and so if epithelioma of
the skin is included, the ratio of cures will be high. Selected cases
also always give more favorable statistics.

Second, the knowledge and skill of the operator and the perfection of
technique undoubtedly influence surgical statistics. The ordinary
practitioner or surgeon cannot hope for as favorable results in many
operations on cancer as can those who are past masters in this line, and
these latter are the ones who furnish the favorable statistics.

Third, the class of cases operated on affects surgical statistics very
greatly. While epithelioma of the face, and even of the lip, when well
removed, may yield most favorable statistics, cancer of the breast,
uterus, stomach, intestines, gall bladder, etc., yield increasingly
unfavorable statistics, as will be presently seen.

Fourth, the duration of observation after operation affects very
seriously the validity of statistics. Not long ago three years’ freedom
from disease was considered the time to regard a cancer as permanently
cured; but this time has been lengthened more and more, by the
observation of any number of cases where the disease has recurred even
long afterwards, and reliable observers are now very chary in expressing
an opinion as to the final cure of a cancer. This will be more fully
considered in another lecture.

Finally, the optimism of the reporter seems often to have something to
do with the reliability of surgical statistics. This need hardly be
discussed. The older and more experienced the surgeon the less confident
he is of having actually cured cancer with the knife. At a discussion in
the New York Academy of Medicine, some years ago, Dr. Robert F. Weir
said that the late Dr. Agnew, a celebrated surgeon of Philadelphia, had
remarked, just before his death, that he doubted if he had ever been
justified in an operation upon cancer, and he, Dr. Weir, stated that he
could almost say the same.

Turning now to the actual statistics of operative surgery on cancer, we
will find that the percentage of reported cures varies very greatly, in
accordance with the points just stated. It is understood, of course,
that no accurate statements can be made from statistics in reference to
the actual mortality of cancer in any location, partly owing to the
paucity of figures, and partly because the stages and extent of the
disease differ so greatly, and the results vary with the previous
duration of the lesion and the period of observation after the
operation.

Cancer of the skin presents the best operative statistics of any region,
and the claim is made that all cases are curable if operated on early
enough and rightly. While this is not wholly true, it is certain that if
all lesions which one chooses to call “pre-cancerous” are thoroughly
extirpated very early, and included in the statistics, the percentage of
cures can be reported as very high. So that it may be said that, taking
all statistics together, including very small as well as large lesions,
the favorable results, that is permanent cures of lesions which can be
truly called cutaneous epithelioma, may run as high as 75 per cent. But
against this is to be set the fact that a very large share of these
cases, taken early and by competent persons, are equally amenable to
cure by lighter measures, without the horrible disfigurement which one
sometimes sees after purely surgical procedures.

Cancer of the lip, when taken early and treated radically, including
gland extirpation, also yields a fairly satisfactory result, depending,
of course, on the stage of the disease, or amount of involvement of
tissue and glands, and the completeness of the operation. But while some
operators have claimed 75 per cent of cures, Hertzler makes the
percentage of permanent cures not much over 25 per cent. And here again,
if taken very early and treated correctly, many of these cases yield
without the knife, whereas very late cases may be practically
inoperable.

When, however, we come to cancer within the mouth, the tongue, etc., it
is quite a different story, and the end results of surgery are commonly
unsatisfactory. Certain European surgeons have reported an operative
mortality in cancer of the tongue as high as 36 per cent, while
recurrences are the rule, and really permanent cures the very great
exception.

As before stated, it is extremely difficult to give any true and
accurate estimate of the real end results from operative surgery as
ordinarily performed in cancer affecting various regions. The obvious
reason of this is that most of our statistics are from those who are
especially occupied with the disease under most favorable hospital
facilities, and also certain statistics may be from selected cases;
moreover, operators are naturally inclined to report mainly satisfactory
results, while the other aspect of the case is seldom presented. Aside,
then, from superficial epitheliomata, about the only locations in which
there is even a fair chance for the patient under the knife are the
breast, uterus, and rectum, and for these large statistics are
available; but again these are unsatisfactory, as they vary so greatly.

The reported statistics of cancer of the breast are very provoking.
Individual operators have claimed as high as 50 and even 70 per cent of
cures (Rodman). Murphy, on the other hand, on a basis of end results
states that the plump woman invariably succumbs, and that Paget’s
disease ends fatally in 90 per cent of cases. Hildebrand mentions 606
operations in which the percentage of permanent cures varied from 15 to
23 per cent; late recurrence is not uncommon in cancer of the breast. He
thinks that 35 per cent is the maximum possibility for permanent cures.
He would be very suspicious of any higher figure. Judd reports that of
266 cases of carcinoma of the breast in the Mayo Clinic, which could be
traced, 39.8 per cent were reported as alive at the end of five years,
although there was recurrence in 6 cases.

Lubhardy, in an article on recurrence, in 1902, states that 1,321
recurrences were known to have occurred after 2,107 operations, or
nearly 63 per cent, 4 per cent of which were late recurrences; he does
not mention the number “cured” nor the number of patients untraced.
Unfavorable results in breast cancer are seldom published. Dr. H. C. Coe
in a discussion quotes the experience of a friend who had operated on
between 200 and 300 cases of cancer of the breast with exactly 13
recoveries.

Levin (_Med. Record_, Jan. 27, 1917, p. 175) has recently made some
startling statements in regard to the recurrence of carcinoma after
breast operations. While granting that early cases without lymphatic
involvement yielded good results, he states that these represented at
the utmost only 25 per cent of the cases operated on: 75 per cent were
advanced cases with involvement of the skin and lymph glands. Of these
barely 25 per cent could be cured by radical operation, and in 52 per
cent of the advanced cases operated on metastases appeared in distant
organs without local recurrences. The longer the period after the
operation the greater was the number of recurrences.

He quoted Heurtaux, a French surgeon, who had followed up 284 cases
which he himself had operated on during the previous 20 years. H. stated
that four years after operation 43 per cent remained free of the
disease, eight years after only 16 per cent, and 20 years after only 2.5
remained free from the disease. There were a great many cases of
carcinoma of the breast reported in which the patient died from
metastasis in different organs without local recurrence 10, 15, and 20
years after the operation. The late metastases most frequently took
place in the skeleton, which was due to the fact that skeletal lesions
might continue a long time without causing clinical symptoms.

Dr. Levin confirmed the skeletal involvement by roentgenograms of ten
cases of carcinoma of the breast observed during the last two years, in
which it was found that the metastases must have been present at the
time of operation.

Dr. Willy Meyer in the discussion said that physicians had long been too
prone to consider carcinoma a local disease, and when he found signs of
metastatic infection he never felt that he could expect anything from an
operation.

We can only state with Hartwell and others that every especially
favorable series of cancer cases, and this applies particularly to the
breast, should be subject to close scrutiny. Why did this or that
operator get marvelous results and an equally efficient man get very
poor ones?

There are also many factors to be considered. How many cases were of the
senile or scirrhous type? How many of the tumors removed were proved
microscopically to be cancer? If one operates radically on every tumor
or swelling in the breast, however small, the end results will, of
course, be more favorable; for undoubtedly many innocent lesions,
chronic mastitis, adenoma, cystic tumors, etc., are often removed
unnecessarily. The question also arises as to what was the after care,
and what steps were taken to prevent recurrence? In view of the
statement of Hildebrand, just quoted, that 35 per cent is the maximum
possibility for permanent cure, and considering the terrible pain and
miserable death one so constantly sees in recurrences, it really becomes
a question as to the advisability of surgical interference.

The opinion has been expressed more than once by those who have watched
the disease, that if left alone, with ordinary medical care, the entire
average of 100 cases would be better, as to length of life and
suffering, than if submitted to operation. I shall hope to show you in a
later lecture that a greater proportion of breast tumors, diagnosed as
cancer by competent surgeons, have recovered completely for years, under
proper dietary and medical care than the percentage yielded by operative
procedure.

There is a wealth of statistics regarding operations for cancer of the
cervix uteri. Despite the figures obtained by radical operators like
Wertheim, the vast majority of those surgeons who practise either
vaginal or abdominal hysterectomy have obtained far inferior results to
those of Byrne, with his cautery, which is still in use. Wertheim once
reported the astonishing figure of 61 per cent of 5‒year recoveries. In
a later report, however, Wertheim stated that only about one half of the
cases that come to him are operable, and of these about one half are
cured by operation, that is, about 25 per cent of all cases. But
experience shows that if these cases could be followed up there would be
very many late recurrences. The claims of Wertheim and others must be
offset, however, by the high operative mortality reported by many; as
the cases must have been incipient in order to be operable, it is
possible that Byrne with his cautery could have done nearly as well, and
Byrne never lost a patient. But Klein of Munich, by circular letters
compiled many statistics, and concluded that the percentage of cure was
but 4.5 per cent, and Klein himself obtained only 3.6 per cent. Reinecke
asserted that only 10 per cent of cases of cancer of the cervix can be
cured.

Fredrick (_Trans. Gynæcol. Soc._, 1905, p. 136) collected the records of
500 hysterectomies for cancer of the cervix performed by prominent
colleagues and himself. Of this entire material there had been but 13
five-year cures. In discussion Henrotin stated that he had practically
given up abdominal hysterectomy. Currier stated that surgery was a
failure as a cure for cancer.

At an earlier session of the Society, 1900, in a discussion of Pryor’s
paper, Van de Warker asserted that surgery had done nothing for cancer;
Lapthorne Smith said that many women did better if left alone. J. Byrne
stated that hysterectomy for cancer was a crime. Engleman thought that
cancers left alone may insure a longer survival than those treated
surgically.

In a discussion before the same Society in 1896 (on Byrne’s paper)
vaginal hysterectomy was discussed. While Boldt, Dudley, and Baldy
claimed excellent results, Segond is known to have had but 5 relative
cures (2‒5 years) in 80 cases. Mundé saw a rapid return in all his 25
cases. Polk had recurrence in every one of 50 cases. Byrne collected
notes of 283 operations by ten men, and the results were as follows:
died, 7 per cent; life prolonged, 11 per cent; and became worse, 82 per
cent.

In the Transactions for 1912 (Discussion of Neal’s paper, Wertheim’s
operation) Bovee stated that only 10 per cent of cancers of the cervix
were operable. Polak had no survivors from operations, although four
were living from Byrne’s cautery method. Chalfant had 3 cures (6 years)
in 30 cases. In general the saving of life was offset by the high
operative mortality. Later I shall report two remarkable cases of very
extensive cancer of the cervix which have entirely recovered, with
normal cervix, without operation.

In regard to operative results in cancer of the stomach there are
relatively few satisfactory statistics. W. J. Mayo reported recently
(Levin, Hoffman “Statistics of Mortality,” etc., 1915, p. 210) on 996
cases of carcinoma of the stomach. Of these 344 cases only were operable
and of the latter 25 per cent remained cured five years and over, after
operation. In other words, about 9 per cent of cases of carcinoma of the
stomach can be cured by surgery at the hands of Mayo, how much less in
the hands of most other surgeons? Against such success must be opposed
the analysis of 1,000 cases of cancer of the stomach by Friedenwald
(_Amer. Jour. Med. Sci._, November, 1914). He states “of the entire
number, operations were performed in 266 instances; of these there is
not one patient living.” But few lived more than a year after operation;
the majority died within the first six months.

In cancer of the gall bladder several good operators have reported that
there have been absolutely no good results.

In cancer of the rectum there is a high operative mortality and very
questionable ultimate curative results; indeed, there are very few
reliable statistics in regard to this. In 27 perineal and sacral
operations Mayo reports 7 per cent primary mortality, and in 44
abdominal and combined abdominal and perineal operations 20 per cent
operative mortality. Tuttle reports a higher operative mortality. While
there are no available data in regard to the duration of life after
operation, it is well known that the disease usually recurs, and in many
a colostomy is performed, with all its distressing features and very
intangible results.

Time does not admit, nor is it necessary for me to go further into the
brave but futile attempts which have been made by surgeons to cure such
cases of cancer as can be reached by the knife, which, as we have seen
by the testimony of many foremost in their ranks, has been found
ineffective to a very great degree. In addition to the locations just
mentioned there are many others where the attempt has been made to
eradicate the disease surgically, but either with results quite as
unsatisfactory as those mentioned, or much worse. Thus cancer of the
tongue, palate, esophagus, cardiac orifice of stomach, liver, gall
bladder, pancreas, small intestine, bladder prostate, etc., also of the
brain and spinal cord, are most unfavorable, and both the operative
mortality and end results are disheartening. All surgeons agree that at
least 50 per cent of all cancers are inoperable, so that in all the
reports concerning the results of operations this must be taken into
consideration, and the real percentage of cures of cancer by surgery
must be divided into at least one half. Thus, if operative surgery
yields an average of 25 per cent of apparent cures in all cases operated
on, this would mean only 12.5 per cent of all cases of cancer. This,
considering the late recurrences often not traced, bears out the
commonly received opinion that about 90 per cent of all patients once
attacked by cancer die of the disease.

Surely the outlook for surgery, borne out by the steadily rising general
mortality from cancer, is most unpromising, and one naturally turns to
medicine, to know if there is not some means of modifying the system so
that there shall not be this tendency to malignant tissue change, so
destructive to life. In my former lectures I attempted to show that all
experience and biochemical laboratory studies looked this way, and in a
later lecture I shall hope to show that by dietary, hygienic, and
medicinal measures the disease can be and has been checked repeatedly,
and cancer cured without surgical operation. The permanence of the cure
depends, of course, upon the continued faithful adherence of the patient
to the means and measures which caused the dissipation of the tumor. For
no one can doubt but that, if the real cause is met and kept in check by
prolonged proper measures, the disease will not and cannot redevelop.

Do not misunderstand me and think that I claim that each and every case
of cancer, in any stage, can be cured. Alas, my sad experience with the
many deaths from recurrent and inoperable cancer, especially in the New
York Skin and Cancer Hospital, has taught me the contrary, and I have
often been appalled at the impotence of human endeavor; although even
these patients have often been grateful for the amount of benefit and
relief afforded by proper measures, and in my former lectures I reported
to you several such cases. But I do assert that the total percentage of
cures in reasonable cases is far, far greater under the line of
treatment I am presenting to you than under that most commonly employed.




                               LECTURE IV
    INOPERABLE AND RECURRENT CANCER; METASTASIS; THE BLOOD IN CANCER


We saw in our last lecture that surgery had failed to check the rising
mortality of cancer, and that during the year 1915, in the United States
Registration Area, the death rate had augmented from 79.4 to 81.1, or an
increase of 1.7 persons in every 100,000 living; this was a greater
increase than the average rise in the death rate for the preceding five
years which was only 1.2 points. This, moreover, occurred during a still
active period of laboratory research, with wide publicity as to cancer
control, by education as to the benefit of early operation, and with
active and skilful surgery.

We saw that fully 50 per cent of all cases of cancer were quite
inoperable when first seen by competent surgeons, while the average end
result, or cure, in the cases operated on, for all kinds together, good
and bad, slight and severe, did not total as much as 25 per cent; this
makes but 12.5 of the entire number who applied for surgical relief. We
quite naturally asked, therefore, if some form of medical treatment,
including diet and hygiene, could not afford a better prospect of
arresting this fearful mortality. It is especially in regard to the
large number of inoperable and recurrent cases, comprising over 60 per
cent of the whole, that this inquiry is particularly important. We will
briefly consider these latter sad conditions.

Looked at from its broadest aspect, in connection with what I have tried
to show here and on former occasions, all cancer will be inoperable, or
rather, not needing operations, when the principles I have tried to
develop are fully elaborated by the wide experience of others, and when
they are firmly established, and correctly carried out. For when it is
universally realized that it is the errors of life, determined and
accentuated by advanced civilization, so-called, which lead up to and
cause cancer, and when public education has been advanced along correct
lines, the tendency to cancer will diminish and there will be fewer
cases, either operable or inoperable. The former will melt away under
correct internal and external measures, and the latter will be helped
by, or slowly yield to the same, unless the malignant process has
already progressed beyond the possibility of retrogressive metabolism.
But, of course, it is too much to expect that such longed for results
will be fully attained within a generation or two.

INOPERABLE CANCER is truly a most distressing condition, especially
after it has become so after one or more surgical operations. The
hopelessness and despair of the patient when told that no operation is
possible is bad enough. But when with recurrence, time and again after
repeated operations, it is decided that no further relief by the knife
is possible, the despondency is indeed pitiful—especially as ordinarily
one can only look forward to a sure and most painful death, at a not
very distant day. It is very difficult to convince many of these
patients that medical treatment, including diet, can do any good, so
firmly fixed is the idea that an operation is the only possible remedy;
many, therefore, get weary of the restraint necessary when immediate
results are not seen. And yet in my previous lectures I gave several
such cases to show that much can be done medically along these lines,
even in these distressing cases, and later shall hope to narrate other
instances, similar to those reported in my lectures two years ago.

It is undoubtedly true that some of these cases which are inoperable
when first seen could have been operated on at a much earlier period,
with as much success as follows in those in which this is tried. But we
have already seen in the last lecture how small a proportion of these
selected cases survive a long time; for we have yet to find statistics
regarding those who have been traced even as long as ten years. In my
previous lectures I reported concerning two patients with undoubted
cancer of the breast who had been watched for sixteen years, with no
trace of the trouble remaining, and two others who had been seen each
for nine years; these latter have been watched since, and have been seen
recently, eleven years after beginning treatment, with the same results,
all without operation. These cases had all been diagnosed as undoubted
cancer by competent surgeons, some eminent, and had refused operation,
which had been urged. Later I shall hope to relate other similar
instances of early cancer.

Inoperable cancer, comprising at least 50 per cent of all cases applying
to the surgeon, presents many features of interest and worthy of
consideration. The reasons for inoperability may be grouped as follows:

1. Those occurring in regions quite inaccessible, as in the brain,
esophagus, liver, pancreas, etc.

2. Those otherwise accessible, but which have advanced too far before
seeking surgical relief, occurring in many locations.

3. Those in accessible regions where experience has shown that
recurrence is pretty sure to take place, such as advanced cases in the
oral cavity, bladder, prostate, etc.

4. Those which have recurred after repeated operations, with extensive
spreading of the disease, as in many cases of the breast, uterus, etc.

5. Those with already very great metastatic involvement, in many
regions, presenting a true carcinosis.

6. Those in close proximity to or involving vital organs, blood vessels,
ureters, etc.

7. Those in which there are other reasons, such as advanced age, lowered
vitality, great cachexia, etc.

8. Those who absolutely refuse to be treated with the knife.

There is no necessity of troubling you with details as to the character
or appearance of inoperable cancer, which are dwelt on in standard
works, as our study relates rather to the causes of the disease and the
means of arresting its progress.

Nor need I dwell much further on this distressing aspect of cancer, for
I believe that all see the necessity of seeking some other measures than
operative surgery to aid in solving the question of relieving the
present condition of affairs. It is for this mass of otherwise hopeless
cases that any reasonable method of treatment is worthy of serious
consideration, both for the measure of relief which may be secured along
many lines by exactly the proper care, and especially for the
possibilities of its value in regard to prophylaxis.

Unfortunately it must be acknowledged that many claims, quack and other,
have been put forth in times past for remedies and measures which would
control or remove, and even cure, the disease in all stages. But the
failure of each in turn has very naturally discouraged many from
accepting any new proposition, and the profession and laity have almost
given up the hope for a real cure of cancer.

In the present instance, however, there is no attempt to present or urge
any single means or measure as a cure-all for cancer. But there has been
an endeavor to study the fundamental causes of the disease along
biochemical lines, and to meet intelligently the errors found. We have
seen cancer developing more and more as the ill effects of modern
civilization have manifested themselves, and have found that its
increase has kept pace coincidently with and even exceeded that shown by
certain other diseases, cardiac, arterial, and renal, which are
recognized as due to errors of living; and there is every reason to
believe that cancer is of the same origin. In a later lecture I shall
hope to show how some of these errors may be overcome, with the
consequent cessation of the cancerous process and even the disappearance
of the malignant lesion already formed.

RECURRENT CANCER represents only the continuance and further operation
of the internal or systemic causes which induced the formation and
development of the first lesion, and are a natural sequence therefrom.
Otherwise why should there be such an almost universal tendency of the
disease to redevelop either in the same or other localities? It is
granted, of course, that the very complete ablation of an early tumor
and its surroundings removes a focus in which disease has started, and
from which is generated a hormone or poison which tends to further lower
the vitality of the blood. But this does not by any means reach the
basic cause, as we saw in the former lectures.

In estimating, however, the real value of an operative procedure, which
has seemed to be successful for some period of time, we must also
inquire if there has not been some other cause which may account for the
absence of further cancerous deposits? It is more than likely, in
successful cases, that the previous occurrence of the disease and the
fear of recurrence have so modified the life of the patient in many
respects, that the primal cause is more or less removed. It is
incredible to believe that the mere removal of the portion of tissue in
which the systemic disorder has localized can forever prevent a new
focus from developing. As well might we expect that the removal of a
gouty toe, a tubercular deposit, or a late syphilitic gumma would
inhibit further manifestations of the disease.

Recurrent cancer, then, is but the result of a continuance of the
operation of the same causes which produced the first local lesion, and
need surprise no one, if those causes are left entirely unchecked and
the system unchanged. Undoubtedly in many instances the recurrence, or
increased production of the disease, is made more certain by the
operation itself; it is also recognized that handling or manipulation
then or at any time may also contribute to this, as may be understood
from the following:

1. Cancer cells, which have a reproductive capacity, may be forced into
the adjoining tissue, or find entrance into blood vessels or lymphatics
severed during operation, and there continue their activity and produce
new lesions.

2. By implantation, cancer cells, already started on their reproductive
career, may be transferred to freshly cut surfaces, and there may
develop new lesions, favored by the continued derangement of the blood
current.

3. Cancer cells may have existed outside of the immediate area which was
removed surgically, and so may continue to develop new lesions, being
further stimulated thereto by the manipulations attending the operation.

4. We know, finally, that the occasional removal of lesions which are
afterwards shown microscopically to be benign, such as adenoma, cysts,
chronic mastitis, etc., will sometimes be followed by the development of
true cancer, which will then pursue a malignant course.

On the occurrence, therefore, of any lump or lesion which might possibly
be or become cancer, the greatest caution should be exercised to avoid
all manipulation, lest a spread of the disease should render it more
rebellious to treatment. For in the medical management of cancer it is
naturally more difficult to cure a patient when there are large numbers
of diseased cells, in one or various locations, which are already giving
forth their poisonous hormone, vitiating the blood stream.

The New York Board of Health has recently inaugurated a service for the
examination of specimens excised from suspected cancer, in order to
establish the diagnosis microscopically before surgical operation. There
could hardly be devised a more effective plan to increase the mortality
from cancer and to render many more cases really inoperable than this
one would surely be; for by thus cutting into cancerous tissue and
opening lymphatic channels and blood vessels, with the opportunity for
absorption of cancerous elements during the necessary delay, metastases
would certainly be induced which would render a surgical removal or a
dietary and medicinal treatment immeasurably less effective. It is to be
hoped that this scheme will be immediately abandoned.

Recurrence of cancer is far more common during the first year after
operation than in any other single year, but, as we shall see shortly,
there is no time limit when the disease may not manifest itself anew. It
is understood, of course, that recurrence depends also largely on the
previous duration, extent, and malignancy of the tumor, and exact
statistics are very few and imperfect in regard to these matters.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

The cancer problem is by no means yet solved, but I think that you will
all agree with me that we are on the right track, and I cannot do better
than to close with a remark I made to you two years ago: “Scientific
research must still go on in the laboratory; but clinical research and
study, with laboratory work, on the human subject, which have not been
hitherto sufficiently cultivated, should be pushed, so that by a mass of
carefully recorded observations the truth or falsity of what has been
here quoted and said may be refuted or confirmed.”




                               LECTURE V
          DIETETIC AND MEDICAL TREATMENT OF CANCER PROPHYLAXIS


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

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

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

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

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

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

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

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

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

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

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

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

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


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

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

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

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

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

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

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

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

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

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

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

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

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


                            DIET FOR CANCER

                               FIRST DAY

                               Breakfast

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

                                Dinner

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

                                Supper

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

                              SECOND DAY

                               Breakfast

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

                                Dinner

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

                                Supper

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


                               THIRD DAY

                               Breakfast

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

                                Dinner

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

                                Supper

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

                              FOURTH DAY

                               Breakfast

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

                                Dinner

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

                                Supper

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

                               FIFTH DAY

                               Breakfast

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

                                Dinner

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

                                Supper

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

                               SIXTH DAY

                               Breakfast

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

                                Dinner

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

                                Supper

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

                      Repeat this bill of fare on
                           successive days.

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

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

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

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

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

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

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

No milk is to be taken unless specially ordered.

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

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

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

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

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

                  *       *       *       *       *

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

I would not have you to understand that this is all that is to be done
medically for cancer patients; on the contrary, as the case goes on over
a period of time, a thousand changes may be necessary to meet symptoms
as they present themselves. And here arises the difficulty of making
exactly plain wherein lies the successful internal treatment of cancer;
for unless just the proper care is given at the right time all may not
go well. For this reason these patients should be seen at least once a
week, and for months, and the exact state of the system learned by
volumetric analyses of the urine and occasional studies of the blood, in
addition to the ordinary watching of the pulse, tongue, sleep, mode of
life, exercise, fresh air, absence of worry and nerve strain, diet, etc.

Iron is a very important element in the treatment of these patients,
though sometimes it will be found difficult to have it rightly taken and
properly assimilated. I have come to use largely the pyrophosphate of
iron in powder, in five grain capsules after meals, in conjunction with
the mixture referred to, half an hour before meals. Sometimes dialyzed
iron, half to one teaspoonful in water, taken in the middle of the meal,
acts best, though I prefer the pyrophosphate, as phosphorus in some form
should always be given for some time to these patients; it is to be
remembered that the iron, potassium and other elements of the blood
cells are united as phosphates. Occasionally I have to give the acetate
of potassium with nux vomica and infusion of quassia after meals, in
place of the other mixture, which after a while may be distasteful. But
remember that potassium is the sheet anchor, and also that in some way
the solids in the urine must be kept up to the standard of health, as I
mentioned in a former lecture, which I occasionally accomplish by adding
sweet spirits of nitre, etc.

I have emphasized imperfect intestinal action as a most important
element in the probable causation of cancer, and the regulation of this
function will often require the very greatest care, patience, and often
even ingenuity on the part of the physician. The stools should really be
frequently inspected. It is not enough to inquire at each visit if the
“bowels are regular,” but the matter must be patiently investigated, as
to the character, quantity, color, odor, hour of defecation, which
should be after breakfast, etc. Nor is it enough just to order
purgatives or laxatives from time to time, but such attention should be
given, and such remedies and measures applied, as will secure the best
possible performance of this most important function. The mixture just
spoken of, altered as required in regard to its cascara content, will
often suffice, but many of my patients also secure a full and free
intestinal relief each week, by means of the old pills which you hear me
order so often in this clinic: ℞ Massæ hydrargyri, Extr. Colocynth.
Comp. āā gr. x, Pulv. Ipecac. gr. ii. M. Div. in capsules No. IV. Take 2
at bedtime and 2 the second night after. I also use greatly the
excellent combination of ℞ Podophyllin, Cascarin, Aloin, āā gr. ¼, M.
one or more of these at bedtime, as needed. I do not approve of mineral
waters or saline laxatives in these cases, nor of mineral oil, and never
employ enemata, except for emergencies.

I hope I have not wearied you too much with these homely details, but I
assure you, gentlemen, that they are not in vain, and I only wish I
could go over these and other matters yet more minutely. My experience
with cancer for years has taught me well its seriousness, which I have
no desire to minimize. Its dietary and medicinal treatment is no small
matter to undertake, and should never be lightly entered upon. When the
diagnosis of cancer has been definitely made by one or more medical men
or surgeons competent to do so, the patient unfortunately is fully
imbued with the very serious character of the malady, and most of them
know well of the very slim chances of a permanent cure offered by
surgery.

Few know, however, of the hope of a cure which can be extended to them
by dietary and medical means, if they are perfectly faithful for an
indefinite length of time, and if the case receives adequate and proper
medical attention. It is for those of you who have heard these and the
former lectures, and have seen the cases, to act with confidence and
assurance, and give the utmost diligence and attention to details in
order to obtain similar results; for I assure you, gentlemen, that
thereby you can secure a success in cancer which is many times that
following the practise of surgery, judging from the distressing and
steadily rising mortality records up to the present time.

Do not be discouraged with apparent want of success at first, especially
when you are treating inoperable or recurrent cases—for those are always
depressing. But with more recent cases, such as I have reported in the
former lectures and will mention in my next lecture, you may be pretty
sure that if every feature of treatment is perfectly carried out you
will attain a measure of success which is very gratifying.




                               LECTURE VI
                        RESULTS: PERSONAL CASES


Two years have elapsed since I said to you in the last lecture of the
former course, “The test of everything lies in the results obtained.
Theories, discussions and arguments are all unavailing unless results
show their truth.” I can now repeat the same phrases after two years’
further observation and experience. And I can also speak much more
strongly than I did at that time, not only after testing the matters
then presented further, in private and hospital practise, but also after
an amount of study of literature which I should hardly have thought
possible some years ago.

First I want to recall to you the report of the interesting and
remarkable case which was made at our last lecture by Dr. C., one of
your number, who promised that if possible the patient would be
presented at a later lecture. This was in the person of a lady, now
about fifty, seen nearly ten years ago, who presented a great mass of
disease in the lower abdomen. On consultation it was decided to attempt
an operation, which was performed by Dr. ——, a well known surgeon. On
opening the abdomen there was found an amount of malignant tissue,
involving many organs to such a degree that it was decided that no
removal was possible, and the wound was closed, after securing a section
for microscopic study. This was examined by Dr. H., a well known
pathologist, and found to be sarcoma.

About that time, nine or ten years ago, I had briefly spoken in one of
my lectures about the value of an absolutely vegetarian diet and medical
treatment in cancer, and Dr. C., thinking, as he told us, that it might
possibly be of advantage to her, in prolonging life or perhaps making it
more comfortable, placed her upon it. He has followed the case up to the
present time, and stated to us that there was now no evidence of the
disease, the abdomen being normal under every examination possible.
Surely one such case should be sufficient to direct serious attention to
a plan of treatment capable of securing such a result in a patient who
is now living in comfort, nine years and more after the surgical removal
of the tumor was found to be impossible, and who would otherwise have
been dead long ago.

In my former lectures I detailed eight cases of undoubted breast cancer,
verified by surgeons, some of them well known, in which the results
obtained by the methods I have been presenting were most gratifying, and
I need but refer you to the account of them given in my book in which
the lectures were published.

You will perhaps remember that the first two cases had been followed up
for sixteen years and had remained well, without operation; the next two
cases, curiously enough, had each been observed for over nine years, and
as they are still under my medical care for various complaints I can add
two years more, making over eleven years that they have remained well,
without operation.

In those lectures I stated that I had recorded on my books in private
practise a total of 744 patients with Epithelioma, Carcinoma, and
Sarcoma. I now find recorded in private and hospital practise a total of
196 cases of carcinoma, 36 of sarcoma, and 685 of epithelioma, a total
of 917 cases of malignant disease. There are also records of some dozens
of cases of adenoma, cysts and chronic mastitis, etc., of the breast,
besides fibroma, lipoma, angioma, papilloma, etc., generally benign in
character, in various locations, all of which are, of course, excluded
from our study.

EPITHELIOMA.—Although epithelioma of the skin is included with cancer in
the Mortality Tables of the United States and elsewhere, I do not
purpose to admit it in connection with the results of treatment of
cancer, for several reasons. First, Because cutaneous epithelioma
occasions but a very small proportion of the deaths from cancer,
something over three per cent. Second, Because its cause and treatment
are almost entirely local, and so it does not relate greatly to our
general inquiry as to the internal or constitutional cause and treatment
of real cancer. Third, Because dietary and medicinal treatment seem to
have relatively little, if any, effect on cutaneous epithelioma, except
in the later stages, where the disease has caused great ravages, and
lastly, Because if the proper treatment of cutaneous epithelioma is
begun early and carried out faithfully it need never, or exceedingly
seldom, acquire a severity such as is often depicted by overzealous
surgeons who advocate only the knife.

In regard to epithelioma on the skin and also on the tongue, lip, and
oral cavity, however, I want to give you one word of caution, and that
is in regard to the use of nitrate of silver. I have seen so many
epitheliomatous lesions in these regions which have been goaded on to a
severe degree of ulceration by the injudicious and meddlesome “touching
up” of the same with nitrate of silver, that I would make it an axiom to
never use this superficial caustic at any time in connection with
anything which may possibly be epithelioma. I would almost consider it
criminal to do so. On another occasion I may take up the subject of
epithelioma very fully, but already I have shown you many interesting
cases, demonstrating how it can be cured by intelligent and faithful
treatment without surgical operation. Some of you may recall the
enormous ulcerating epithelioma on the left ear of a man of about fifty,
who showed himself repeatedly after the disease had been entirely cured
by the thorium paste, which you have often seen me use. You may remember
that the upper portion of the pinna was gone, but presented a thin,
delicate cicatricial surface, freely movable; the last time he was here
was fully two years after it had been entirely well.

It is not worth while to attempt to analyze here the 685 cases of
epithelioma mentioned, many of which were small and very superficial,
and easily cured. There were, however, many cases which were originally
classed as epithelioma which sooner or later, either with or without a
previous surgical operation, took on such a malignant action, with a
destruction of tissue, as would at once class them with carcinoma. In
reality, as you know, carcinoma is but an aggravated or malignant new
growth of epithelial cells, from the skin or glandular organs,
infiltrating the surrounding tissue; while sarcoma is a somewhat similar
malignant proliferation of connective tissue cells.

The ordinary distinction between epithelioma proper and carcinoma is,
therefore, vague and not scientific, and for the present will probably
have to rest on the basis of a superficial, or deep cellular,
disturbance. But, for the reasons already given, I protest against
including all instances of epithelioma under cancer, as in the
propaganda for early operations, and I do not include the mass of them
in my studies as to the results of treatment. Inasmuch as the border
line between the superficial and deep epithelial misbehavior is often so
indistinct, it is difficult to designate as carcinoma all that might
possibly belong there, but certain of them should be mentioned. In
looking over the records of my patients in private and public practise I
find at least 80 with the diagnosis of epithelioma whose disease was so
malignant in its course that they should certainly be included in the
carcinomatous class; these, therefore, appear in the following table,
which gives also the sex and location of the cases, both of carcinoma
and sarcoma:

                      PRIVATE AND HOSPITAL CASES

                  _Carcinoma_      _Male_ _Female_ _Total_
             Breast                     1      147     148
             Uterus                              8       8
             Stomach                    7        5      12
             Liver                      2        2       4
             Lip                       19        3      22
             Mouth and tongue          17        3      20
             Pharynx and esophagus      2        1       3
             Jaw and neck              10               10
             Nose                       5        3       8
             Orbital region             3        1       4
             Penis                      5                5
             Other localities          12       17      29
                                      ———      ———     ———
                                       83      190     273

                   _Sarcoma_
             Head, face and neck       12        6      18
             Trunk                      5        6      11
             Extremities                3        4       7
                                      ———      ———     ———
                                       20       16      36
             Totals                   103      206     309

CARCINOMA OF THE BREAST.—Of the 147 cases of carcinoma of the breast in
females the right breast was affected 64 times, the left breast 77
times, and both breasts 6 times. Of these cases 74 had never been
admitted to surgical operation; 59 had been operated on once, 12 twice,
1 three times, and 1 four times, with recurrence, or rather with
continued development of the disease. In 28 cases a surgical operation
was advised and performed by various surgeons, either before internal
treatment or after a trial for a greater or lesser period; in eight of
these it seemed wise to have an operation after a more or less faithful
trial of medical treatment. I may here remark that it is very difficult
to hold all patients firmly to the dietary and medical requirements
necessary to remove the disease, and many dropped off after a short
trial, while quite a number, 77, were seen only a few times or in
consultation, and were thus lost sight of. There were 101 married or
widowed females with cancer of the breast and 41 single, and 5 unknown.
The average age was almost 50.

The total number who were under dietary and medical treatment for a
sufficient time to form any judgment from, amount to 41, while a
considerable number are still under treatment and improving. It may be
noted that the first case of carcinoma I find recorded was on September
29, 1879, the second on October 31 of that same year. Many of the early
cases were noted accidentally, in patients coming for various diseases
of the skin.

Time does not permit my dwelling on many interesting points concerning
some of the cases represented in the foregoing table, but I want to
relate and present some cases illustrating the beneficial effect of
carefully directed treatment in this class of affections.

Before doing so, however, I want you to inspect a private patient, Mrs.
R. F. C., aged 50, who has only to-day for the first time come on from a
distant city for treatment, and has kindly consented to come before you,
veiled. The case presents many features well worthy of consideration,
and I hope on some future occasion to be able to report favorably
concerning her; although, as you see, it is quite an inoperable case, or
at least one in which the disease would certainly recur if treated with
the knife. The entire left breast is greatly enlarged, like half a
melon, hard, firmly attached, and with the axillary glands greatly
involved. It is interesting to know that she was first conscious of a
lump in the breast on September 1st, only thirteen weeks ago, and all
this has developed since. She presents the usual picture commonly seen
in these cases, namely, constipation, urine scanty and deficient in
solids, and the saliva acid. She still appears to be in robust health,
as is so common early in the disease.

The first case showing the effect of dietetic and other non-surgical
treatment to which I would call your attention is the private patient
who so kindly exhibited herself, veiled, at our lecture week before
last. I showed it then purposely as a case undergoing treatment, now for
eight months, in which there was still evidence enough of the disease,
with the history presented, for those who examined it to confirm the
diagnosis of unquestionable cancer.

_Case I._—Miss T. M. M., aged 37, consulted me on March 23rd of this
year, for a mass in the left breast which a surgeon of great eminence
had diagnosed as cancer, and urged most strenuously an immediate
operation, and from its rapid development had said that she would die
within six months if not operated on. She had had a neurasthenic
breakdown the preceding autumn, and for some months had now been under a
very great nervous strain, with a father aged 71, who was slowly dying
of Bright’s disease. Two years ago she had suffered severely from
uricacidemia, for which she had dieted six months.

The mass in the left breast was noticed only a month or two previous to
her visit and had increased rapidly; when seen there was a hard,
lobulated mass about two inches in diameter, in the outer, upper
quadrant of the left breast, attached to the puckered skin over an area
of more than an inch; there were also a number of enlarged, hard
axillary glands. There was considerable pain at times, which had been
increased considerably by the rather rough handling of the surgeon.

She was placed on an absolutely vegetarian diet, following what I call
the green card menu, which I gave you in my last lecture, and a mixture
of acetate of potassium, nux vomica, fluid extract of cascara and fluid
extract of rumex root, which I also mentioned to you at that time.

For eight months she has been under my constant observation every week
or two, and the improvement in her general condition and in the breast
tumor is very marked; you heard her say that she felt a thousand per
cent better. Her color is excellent, she has held her weight, 153
pounds, which is a trifle above that called for by her height and age,
and all this in spite of daily office work and very great trouble and
anxiety in nursing her sick father for thirteen weeks, who died in
October.

The breast, as you see, has still a lump in it, but it is soft and
hardly half the original size, the area where the skin was attached has
decreased, so that there is now only this slight dimpling or puckering,
and the enlarged lymphatic glands in the axilla have disappeared.

It is impossible in a brief lecture to enter upon all the details of
treatment followed out during these eight months, for they have been
varied according to the principles laid down in these and the previous
lectures. The former habitual constipation has been overcome and the
urine, which exhibited a great shortage of solid constituents, with
occasional indican, etc., has attained more nearly a normal character,
and in various ways she has regained better metabolism. To accomplish
all this there have been many remedies used from time to time to meet
various indications, as are shown by my voluminous notes every week or
two. I may add that the affected breast and axilla have been kept
painted with ichthyol, 50 per cent solution in water, which for some
years I have found to aid in the absorption of malignant lesions. The
patient is not well, by any means, and it will be some months before the
mass in the breast has entirely disappeared; but instead of being dead
within the six months, as prophesied, she is as healthy, happy, and
hearty a woman as one could wish, after eight months, under very adverse
circumstances, without pain, not having lost a day from work, and with
the tumor steadily diminishing.

I am often asked if the cure is permanent after this line of treatment?
In answer I can only refer to the cases reported in my former lectures,
where two were observed well after sixteen years and two after eleven
years. I may add also that if there is recurrence, and if the principles
which I have long advocated are correct, the recurrence would be due to
the same causes which produced the original trouble, possibly a neglect
of full treatment, and one would expect that a perfect following out of
proper treatment would again check the trouble, which is more than can
be said of surgery. Personally I have never seen recurrences, though, of
course, this may have happened and the patient being discouraged may
have yielded to the solicitation of friends and to the knife.

_Case II._—Mrs. J. J. T., aged 38, was first seen August 11, 1914. She
had been confined with her first child 4 months previously, but had not
nursed the baby at all, and had no trouble with the breasts. Four weeks
before her visit she had noticed a tumor in the upper left segment of
the left breast, which had increased steadily, with considerable pain.
When seen there was a mass the size of an egg, hard, and well defined,
somewhat tender on manipulation, with some glandular enlargement in the
axilla. She was placed on an absolutely vegetarian diet, with no coffee,
and the same mixture as the preceding case, the bowels being
constipated, and the breast was kept painted with the 50 per cent
ichthyol, which was afterwards changed to iodid of lead in Hebra’s
Diachylon Ointment. Later she took thyroid extract, also iron, etc., and
maintained her weight and strength perfectly. The mass in the breast
disappeared rather slowly, and it was not until just a year later that I
find it recorded that the breast was perfectly normal, with no trace of
the tumor, nor axillary adenopathy. She was again confined of a healthy
child in June, 1916, and the surgeon who had made the original diagnosis
of cancer reported the breast perfectly normal. Seen recently she still
remains absolutely free from trouble.

_Case III._—Mrs. I. T. G., aged 43, first noticed a lump in the left
breast two weeks before her first visit, May 17, 1905; this had been
diagnosed as cancer by at least four medical men, one of them a
prominent surgeon in Hartford, who urged immediate operation. When seen
there was a hard, sharply defined mass an inch and a half in diameter in
the left breast, above the nipple; it gave pain and was painful on
pressure. Beginning with the same treatment as the other cases mentioned
the change in the tumor was most remarkable, and eight weeks later it
was recorded that there was no trace of the tumor, that both breasts
were alike. She was a large, flabby woman, weighing 207½ pounds, the
kind who do so badly after operation. She maintained her treatment
faithfully, with an absolute vegetarian diet, and when seen two years
later weighed still 199 pounds, with no return of the breast trouble.
She was seen last for quite another trouble five years and a half after
her first visit, and the breast was found perfectly normal.

There is no necessity of illustrating this part of our subject further,
but I wish to make a remark about this last case, especially in
reference to the desirability of early treatment. We hear much from the
advocates of the knife that it should be used early, and yet we all meet
cases where lumps are removed from the breast almost as soon as they are
discovered and yet there is recurrence. Early dietary and medical
treatment, in this instance two weeks after discovery of the lump, was
observed to be followed by perfect freedom for five and a half years,
and beyond question permanently, if she continues to live along proper
lines.

Having now seen how very much can be accomplished in primary cases, that
is, in those who have not been submitted to an operation, let us
consider what can be done for those truly pitiful cases where surgery
has been tried and failed, and where one or many successive recurrences
after repeated operations has left the patient even worse than before;
and, as some surgeons tell us, worse than the patient would have been if
the disease had been left to nature, without operation and with only
ordinary medical guidance.

In regard to the cases with recurrent cancer after operation of which
there were 72, it can be readily understood that one cannot speak with
enthusiasm. But in my former lectures I reported three such cases in
which the benefits were certainly very remarkable. I also reported from
private practise another totally inoperable cancer of the breast, of two
years’ previous duration, with great cachexia, in which the enormous,
hard, ulcerating breast was reduced to about half the extent, with a
diminution in the large axillary and supraclavicular glands to fully one
half their size. The patient suffered no pain from soon after beginning
treatment until she peacefully died six months later, of exhaustion and
pulmonary edema.

In many cases, both in private and hospital practise, the beneficial
effect of a dietary and medical treatment have been very striking, even
after recurrences following repeated surgical operations; but it would
be unreasonable to expect any startling effects in cases which had
become so saturated with the poisonous hormone generated by repeated new
developments of cancerous tissue that there were numerous metastases,
not only in internal organs and lymphatic glands, but also with
cutaneous nodules produced in various parts of the skin through
capillary infection.

And yet in most of these cases there has been a betterment of condition
in nutrition, color, weight, etc., which sometimes seems to encourage
one that the real disease would be conquered. But although life has
frequently been prolonged far beyond what might be expected, and
discomfort and distress have often been greatly lessened, we have not
yet reached the position of checking and curing far advanced cancer at
all comparable with what can be accomplished in its early stages. I
dislike to weary you with the narration of cases, but a few instances
may help you to understand what is meant.

_Case IV._—Mrs. D. S., aged 53, first seen July 6, 1916, is a rather
recent case of recurrent cancer of the left breast, in private practise,
but it is instructive. Over five years ago a small pimple, as she called
it, appeared on the left side, which was left alone for five years. Then
on January 21, 1914, the left breast was removed by a surgeon of
prominence, and all seemed well for six months, when there was some
return and a second operation was performed in January, 1915; there was
again a third removal in April, and a fourth in August, 1915, all by the
same excellent surgeon, and the wound has never healed since. There had
never been any attempt at dietary or medical treatment or any effort to
check the causes producing the malignant growth.

Since January, 1916, there have been many cutaneous nodules developing
around the open sore, which when first seen presented a characteristic
ulceration eight inches long, by two or three inches irregularly wide.
The axillary glands were enlarged and the left arm, which had been
greatly swollen since the first operation, was hard, tense, and painful,
and, of course, helpless. The forearm measured 13 inches and the upper
arm 14 inches, the right arm being 8½ and 9½ inches, respectively. Her
weight, which had been 168 three years ago, was reduced to 133; she was
always very constipated and her urine deficient and irritating, calling
her also at night; she had long suffered from rheumatism, and also
severe headaches up to the menopause, seven years ago.

Under a rigid “green card diet” and the mixture already referred to,
with a larger amount of cascara, she began to improve at once in her
feelings, the arm became softer, and somewhat flabby, and the nodules,
which had been painted with 50 per cent ichthyol, were less prominent.
Later thyroid extract being added after meals, brought her weight down a
little, but during the last months it had been maintained steadily at
about 120 pounds. The urine which at the first was sometimes only 26
ounces in the 24 hours, with great deficiency in solids, has been
brought up some days to 45 ounces, with the proportion of solids to the
body weight about right. The saliva, which was very acid, is much less
so, though still acid and scanty, and the mouth dry.

Not to dwell too long on the case I may say that I find a recent note to
the effect that she said that she feels very well and friends think that
“there cannot be much the matter with me.” But she still has a
considerable ulcerating surface, though with islands of healing; she
still has many metastatic nodules in the skin in various places, and the
arm, which is still swollen, though no longer tense, is smaller, and,
really, the flesh shakes when the arm is quickly moved.

This is certainly a desperate case, after four operations, but the
difference between her present condition and what she would have been
without treatment can hardly be imagined. For in these five months she
probably would have been in her grave, whereas, during all this time she
has been traveling back and forth from her home, some distance away in
New Jersey, to my office, a happy woman. What the end will be I cannot
foretell.

I want you now to see and examine a Bohemian woman who has been treated
in my medical clinic for cancer at the hospital since July 26, 1916,
something over four months.

_Case V._—Mrs. P. A., aged 46, noticed a lump in the left breast two
weeks before it was removed, in this Hospital, two years previous to her
first visit to me at the medical clinic for cancer in the hospital.
Three months later the right breast was also removed on account of a
lump found there. All seemed to go well until about a year ago, when
cutaneous nodules appeared on the chest, first around the site of the
former operations; these increased till seen, when, as she now tells
you, there were fully fifty of them, forming a veritable _cancer en
cuirasse_, absolutely inoperable, of course. She was habitually
constipated, depending on medicine.

Being placed on the “green card” diet and the same mixture, though with
considerable cascara in it, and all the affected area painted night and
morning with Thiol in olive oil, fifty per cent, she seemed to improve
at once, and it was recorded that, after removing a crust which had
formed with the thiol and talcum powder over it, all the nodules were
less red and much less elevated. A small raw surface had formed, which
was touched with thorium paste, diluted to 25 per cent. This surface was
found entirely healed two weeks later, but other larger raw surfaces
have formed from time to time, which, however, have all healed
completely and perfectly, as you can see, with the occasional use of the
diluted thorium paste.

As you see her now the entire surface over both sides of the chest is
perfectly healed, and passing my hand over all the surface there is
hardly a trace of the nodules which once were so abundant. All who know
anything about the ravages of cancer will realize the difference between
her present condition and what would have happened under ordinary
circumstances. She has had no pain since soon after beginning treatment.

I could multiply these histories indefinitely, with, of course, varying
degrees of benefit, but I will trouble you with only one more case, that
of one of the many patients in the wards of the hospital. In this case
there were at first very satisfactory results, but after a long and
brave fight on the part of the patient she at length succumbed to the
dire disease.

_Case VI._—Miss J. M., aged 53, was admitted to the New York Skin and
Cancer Hospital, July 16, 1914. One year before there was an enlargement
of the right breast, with a general hardness. Later it became discolored
and a blue ring appeared around the whole breast, and some purulent
discharge from the nipple. Three months before entering the hospital the
breast softened in one place and ruptured, discharging pus and blood.
There had been some pain from the beginning, and latterly it was more
constant and severe. On admission the tumor involved the whole breast,
which was hard and immovable, with an ulcerating surface over almost the
whole extent, with an offensive discharge, and axillary glandular
enlargement. There were also small cutaneous nodules near the sternum.

She was transferred as inoperable from the surgical to my service on
August 26, 1914; she weighed then 106½ pounds, and presented a great
fungous mass on the right side about six inches in either diameter, with
a profuse and very offensive discharge; she was very weak, with a septic
temperature running up to 101 and over, and complained greatly of pain
in the tumor. She had been having X-ray once a week, which was continued
for a while twice a week, for twenty-four exposures, but without
apparent effect. She was very constipated and passed a small amount of
urine.

She was placed at once on a vegetarian diet (green card) and the same
mixture as the other patients, for a while, and a little later was given
dialyzed iron during the meals; the wound was dressed with a one per
cent solution of permanganate of potassium, later with Russian oil, with
some use of peroxid of hydrogen to check the suppuration.

For a while she seemed to do remarkably well, the color and strength
improving, with less pain and very comfortable nights, without an
hypnotic. In a week her weight had increased to 110¾ pounds, but then it
fell off a while, but on October 28th it had risen to 111¼ pounds. As
there was still a great mass of fungating tissue, helping to keep up the
toxic condition, quite a portion of it was excised on September 29th,
just after which the hemoglobin rose from 75 to 80 per cent, which was
maintained for six weeks, the red blood corpuscles increased to
3,490,000 and the leukocytes diminished to 8,500 from 10,000 when she
first came under my care.

The general condition had improved so greatly that she was out of bed
all day, but the body weight dropped quite a little, to 104½ pounds,
only to rise again four weeks later to 111¼ pounds. By October 10th the
wound was secreting very little, she slept well with no opiate, and
complained little of pain, day or night, and by October 28th it seemed
as though the disease was being overcome, as there was some evidence of
cicatrization in certain portions of the wound. All this continued for a
month or more, when she had a number of severe hemorrhages from the
wound and the hemoglobin fell to 60 per cent and the red corpuscles to
2,100,000. From this, however, she rallied under an intravenous saline
injection and Murphy drip, and the hemoglobin rose to 75 per cent, and
on May 21st the red corpuscles were actually 4,110,000.

I must not weary you with too many of these details, nor can I indicate
to you the varied treatment which was employed from time to time. I can
only add that she had her ups and downs, but finally succumbed on July
3rd, 1915, about a year after entering the hospital.

The case was a very interesting one and exhibited certainly some of the
beneficial results of treatment, although in such a hopeless case, with
such a mass of ulcerating cancerous tissue as she presented, secreting
its poisonous hormone, any other end could hardly be expected. There is
no question, however, but that life was greatly prolonged and much
comfort secured, as to sleep, diminution of pain and offensive
discharge, etc. The case was watched with interest by members of the
attending staff, and careful laboratory studies of the blood and
volumetrical analyses of the urine were made weekly; the latter was
generally scanty, running even as low as nine ounces a day, though of a
fair specific gravity, and it was very difficult to raise the total
solid urinary output to anywhere near a normal standard. The saliva,
tested and recorded before and after each meal, was commonly acid, often
strongly so, though at periods it would be neutral and occasionally
became alkaline for a while under active treatment.

I have taken up so much of your time with cancer of the breast that
little is left for consideration of the disease in other localities, and
I will be as brief as possible:

CANCER OF THE UTERUS.—Two cases, in private practise, among the eight of
cancer in this location which are on my list, are so interesting and
remarkable that I must give them somewhat in full. I may say that the
other cases had little or no satisfactory treatment. One of these two
would gladly present herself for your inspection, that you might verify
her present condition of excellent health, but she lives in Bangor,
Maine, and now only comes on periodically; this is in order to be sure
that she continues in the straight and narrow road necessary to keep her
free from her previous distressing condition. The case is as follows:

_Case VII._—Mrs. F. L. A., aged 48, weighing 105 pounds, was first seen
on March 21st, 1916. She had had four children aged 22, 20, 17, and 12
years, and had had a miscarriage 9 years ago. There had never been any
trouble with confinements, and never laceration of the cervix. The
menopause had occurred suddenly two years previously, but she had had
some vaginal discharge since October, and had felt weak for some months.
She had, however, never suspected any serious trouble until there was a
slight hemorrhage, consisting of only a few drops of bright blood, on
February 24th. That afternoon she was examined by a surgeon at home, Dr.
McCann, of Bangor, Maine, who sent her to me. He discovered that she had
already an inoperable cancer of great extent, which diagnosis was
confirmed by others, who refused to operate. The report which came to me
from the department of Pathology and Bacteriology of Bowdoin College
was, “About one third of the cervix destroyed, vaginal wall involved.
Right broad ligament infiltrated.” Curettings were made then, which from
“numerous slides show squamous cell carcinoma. From histological
appearance I judge that the cancerous process is developing rapidly,”
signed F. N. Whittier. The slides which were brought to me were
submitted to Dr. H. H. Janeway, who confirmed them to be “rapidly
growing, malignant epithelioma.” Those who saw the patient on February
24th gave the opinion that she would hardly live six months.

She had been following an absolutely vegetarian (green card) diet for a
week or two, and had been taking some compound cascarin tablets, which I
had sent her (℞ Podophyllin, Aloin, Cascarin, āā gr. ¼), as she had
always been very constipated, and since this treatment had felt much
better in every way. I gave her douches morning and night, of carbolic
acid and biborate of soda, ℨss and ℨii ad Oi hot water.

I then sent her to Dr. H. H. Janeway, who confirmed the physical
condition and gave her one single treatment with emanations of 300
milligrams of radium, for 16 hours, on March 25th, dilating the os, but
not curetting. She was then given ℞ Potass. acetatis ℥i, Tinct. Nuc.
Vom. ℨiv, Extr. Cascara fld. ℨii, Ext. Rumicis rad. fl. ad ℥iv,
Teaspoonful in water half an hour before eating, which she has taken
more or less continuously ever since, alternated with other remedies as
indications arose. Later she took pyrophosphate of iron, five grains
after meals, in conjunction with the mixture. For some time she had
suffered from severe neuritis in the neck and arm, which yielded
completely to aspirin, five grains every two hours, taken also again on
several occasions when it recurred.

I will not burden you with the many details recorded on her case paper,
but can only say that to-day she is as well a woman in every way as one
could wish. Her color is good, and a recent examination of her blood
showed hemoglobin 80 per cent, red blood cells 4,500,000, leukocytes
5,800, of which polynuclears 64 per cent, lymphocytes 27 per cent,
transitionals 8 per cent, and eosinophiles 1 per cent. She has made the
trip back and forth from Bangor, Maine, half a dozen or more times,
without fatigue, recently walked several miles, eats and sleeps well, is
no longer constipated, and has a good urinary excretion, with rather an
excess of solid contents; on December 6th she weighed 110½ pounds; her
normal weight before her sickness had always been 93 pounds.

On June 2nd she was examined by Dr. Janeway, who reported: “I find no
ulceration whatever on the cervix or vagina, the uterus is movable and
of normal size. There are no evidences of any disease remaining which
can be detected by examination.” On July 7th he wrote: “I have examined
Mrs. F. L. A. again and find that there has been no return of the
evidences of her disease.” On October 20th he wrote: “Mrs. F. L. A.
appears to be absolutely free from disease.” Her surgeon, Dr. McC.,
confirmed all this by examination. It is now over 9 months since she was
given 6 months to live, with an inoperable uterine cancer, and to-day is
in better health than she has been for years.

This patient had one single application of radium, as mentioned, on
March 25th, which probably aided in modifying the local disease, but it
would be beyond human credulity to believe that this was a very large
factor in restoring her to her present condition of health. The cure is,
of course, a very recent one, but there is no reason why the same
measures would not be effective should there be any return, as they are
directed against the real cause of the disease. Nor is there any
likelihood that there will be any possible relapse, as she is a most
intelligent patient who adheres strictly to the treatment and diet, and
will undoubtedly do so until directed otherwise.

Strangely enough another very similar case was also sent to me from
Bangor, Maine, which I will mention very briefly:

_Case VIII._—Mrs. H. F. J., aged 52, weighing 102 pounds, was first seen
August 3, 1916. She had been under an absolutely vegetarian diet (green
card) since July 17th, and was feeling better than before. She had had
three children, 27, 25, and 16 years of age, the menses had been regular
up to April 15, then nothing up to July 1st, when there was a clotted
flow, checked by treatment, which had returned in two weeks, with pain,
after an auto ride. On July 14th she was examined by two physicians who
found cancer of the cervix, which was confirmed by Dr. Janeway on July
31st, who reported “cancer of the cervix and vaginal canal, with some
cauliflower excrescence; the uterus was not much enlarged or fixed.” She
received one application of radium on August 1st, 300 mil. Curies to the
canal, and 120 to the cervix, for 12 hours.

She was given the same mixture as Mrs. F. L. A. and the “green card
diet,” and the injection of carbolic acid and biborate of soda. Briefly,
to report further, on September 30th it was recorded that she had
improved every day; she had gained steadily, and again on September 30th
that she had improved every day. She had a good appetite and was getting
back her strength, and seemed “quite like herself again.”

On October 20th Dr. Janeway reported that Mrs. H. F. J. was “free from
disease, although the healing is not quite complete.” This is, of
course, a very recent case, but the progress has been so satisfactory
that in view of the former case and the results so often obtained when
all proper measures are carefully carried out, there is reasonable
expectation that this will also result in a cure.

I will not dwell longer on carcinoma, though if I had time I could
relate many other interesting and instructive cases, showing
satisfactory results of treatment. My experience has naturally been
principally with the disease as it affects the breast, and many of the
patients affected elsewhere I have seen in consultation, or only a few
times, though some have been faithful to prolonged treatment.

But if the thesis which I have tried to establish in these and my former
lectures is correct, then sooner or later we will be able to apply the
same principles, more fully developed and more perfectly adjusted, to
cancer in other locations. And as the public and profession are better
educated along these lines patients will apply earlier, and the
pre-cancerous constitutional relations will be recognized and treated
before the cancerous mass has gained such headway. There can be little
doubt but that the same principles of treatment and prophylaxis apply
equally to the cancerous process wherever the primary lesion has first
developed.

SARCOMA.—Of the 36 cases of sarcoma, of various types and in different
situations, which enter into our list of malignant neoplasms, very few
can be mentioned as illustrations of the value of dietary and medicinal
treatment; many of them were seen only in consultation, or once or
twice, and it is very difficult for those afflicted with such affections
to be persuaded of the value of prolonged internal treatment when
surgery apparently offers such brilliant immediate results.

But there is one patient with sarcoma of the upper jaw, whom you saw a
while ago in an ulcerative condition, with a great hole in the cheek and
a cavern within, whose improvement is so phenomenal that I now present
her to you again to-day, as she is about to leave the hospital, after a
little over four months’ stay.

_Case IX._—Miss R. L., aged 19, entered the New York Skin and Cancer
Hospital, in my service, July 24th, 1916, weighing 89½ pounds. She had
formerly weighed 120. About three years ago a small lump developed
beneath a pigmented mole which had long existed, an inch or so below the
right eye. This grew rapidly until it was about an inch in diameter, and
was movable and painless. About January 1st a tooth in the right upper
jaw became loose and three teeth were extracted; a radiograph was taken,
and she was advised hospital treatment. She then entered another
hospital and the gum was incised and radium applied for 18 hours on
March 1, 1916. After this operation the face became swollen and very
painful, and an extensive operation was performed in May, the right
upper maxilla being removed, together with the tumor. Four weeks before
entering the New York Skin and Cancer Hospital a pin hole opening was
noticed in the scar on the cheek, which increased in size up to the time
of admission. She remained in that hospital until she came to us. The
microscopic examination of the portions removed showed the disease to be
sarcoma.

On entering the hospital there was an opening in the right cheek
something over an inch in diameter with ulcerated edges, and a cavity
extending down to the tongue, the superior maxilla having been removed
surgically. From the upper margin of the opening there was a mass of
dead bone hanging, nearly three quarters of an inch long by half an inch
wide. The interior of the cavity presented a mass of ulceration, giving
forth a foul odor. She was thin, pale, and anemic with 85 per cent
hemoglobin and 3,620,000 red blood corpuscles.

She was placed on an absolutely vegetarian diet (green card) and began
with the same mixture as the cases of carcinoma mentioned. The cavity
and opening were kept packed with absorbent cotton, saturated with the
following solution: ℞ Acidi Carbolici ℨss, Listerine ℥i, Liquor sodæ
chlorinatæ ℥i, Glycerin ℥ss, Aquæ hydrogenii dioxidi ad ℥iv, M., changed
several times daily. Under this treatment there was almost from the
first a remarkable change in her condition. The discharge ceased shortly
and also the foul odor. Within a few weeks the cavity and edges of the
opening showed a healthy condition and evidences of cicatrization could
be seen. The tongue of dead bone, which was soaked several times daily
with muriatic acid, separated entirely within three months, leaving a
healthy granular surface. By the end of four months the entire edge of
the opening on the face had cicatrized perfectly, and the interior
appeared in a healthy condition, with no ulceration whatever, as you saw
when she was presented the second time, a few weeks ago.

From the first her general condition improved and she began to gain
weight, even several pounds a week, being weighed every week in the same
hospital wrapper, by several nurses, who took great interest in the
case. I could hardly believe that she weighed 128 pounds on a Monday, as
reported, and on the following Wednesday I weighed her myself and found
that she weighed 130, which was quite a little over that called for by
her height and age, and ten pounds more than she had ever weighed
before. She had been taking for some time pyrophosphate of iron, five
grains after eating, in addition to the mixture mentioned, which had
hardly been changed since she entered.

The blood, which was carefully studied weekly, steadily improved until,
on September 18th, the hemoglobin stood 95 per cent, with 4,600,000 red
blood corpuscles and 8,000 white, and on November 10th the hemoglobin
reached 100, and the red corpuscles 4,700,000. The urine, which
presented albumen and granular casts on admission, had lost these, and
on November 10th she passed 1,000 cc., with a specific gravity of 1.025,
and normal in every respect, except a faint trace of indican.

You will now, however, be specially interested when you see the change
which has been wrought in her face by Dr. Semken, one of our attending
surgeons, who performed a plastic operation on her, beginning Nov. 14,
with the preparation of a flap on the right arm. This flap was lined
with a Thiersch skin graft from the leg, so as to secure a proper mucous
lining in the mouth, and left _in situ_ until Nov. 24, when it was
attached to the face, after the scar tissue had been cut away. The arm
was held in place by a plaster of Paris dressing until yesterday, when
the attachment to the arm was finally severed, after several partial
separations. The skin graft took from the first, without any drawback,
and now you see the opening entirely and perfectly covered. You will
notice that the ectropion, which was so marked when you first saw her
with the ulcerating surface, has about disappeared, and Dr. Semken
believes that there will be still further improvement in this respect.

I must not keep you longer, though I should have liked to narrate other
cases of carcinoma in other locations which are of interest. I trust,
however, that you have heard and seen enough to be quite satisfied as to
the correctness of the principles I have tried to lay down, and also as
to the success following their proper and careful application. How far
they will serve for cancer in general, as it affects various organs and
parts of the body, remains to be seen, when many others have reported
their results. Whether also this line of thought will apply to sarcoma
in general remains to be seen, for sarcoma is really of much the same
nature of malignant cell growth, only affecting the connective tissue
elements instead of the epithelium.

In closing I must again remind you that it is no trifling matter to
undertake the treatment of cancer by dietary and medicinal means, even
though from what you have seen and heard you may think otherwise. Each
case requires the utmost careful study and adaptation of remedies as may
be indicated to bring the patient into a condition of perfect health.
Diet alone will not accomplish this, but without the proper diet, as
already indicated, all other efforts are unavailing to check the dire
disease. With the proper carrying out of every detail the success is
certainly much greater than with surgery, and with advancing knowledge
and practise along these lines we shall undoubtedly see a satisfactory
diminution in the deaths from cancer, whose death rate has so steadily
risen under the measures heretofore employed.




                                SUMMARY
                       THE REAL CANCER PROBLEM[2]


Cancer has long been a problem over which master minds have wrestled,
and to read much that is written it would seem that we were yet as far
from its solution as ever. Countless able men, at the expense of
millions of dollars, have labored faithfully in the laboratory, and it
may safely be said that more effort and time have been expended in
investigations on cancer, and more has been written concerning it, than
ever in connection with any other disease affecting humanity. And yet
its mortality is steadily increasing pitifully, in spite also of active,
skilful, and faithful surgical treatment.

Is it not possible, therefore, that there is something wrong in our
conception of cancer and its treatment? If any other disease presented
such a steady and alarming increase in its death rate would we not stop
and consider if our treatment were the best possible? If with the
introduction of antitoxin the mortality from diphtheria had steadily
risen until it was about 90 per cent of all cases, would we persist in
employing it? And yet the profession and the laity go blindly on, with
the idea that surgery offers the only hope of reaching cancer, when the
Mortality Statistics of the United States show that under this line of
treatment the death rate has _risen steadily_ from 63 per 100,000 of the
population in 1900 to 81.1 per 100,000 in 1915, or 28.7 per cent.

Surely the lesson taught by the steadily and greatly _decreased death
rate_ of tuberculosis should teach us something of the value of most
careful dietary, hygienic, and medical control of other diseases. For
the great white plague, which a while ago threatened even the
destruction of the race, shows now a mortality which has steadily
_fallen_ 27.8 per cent since 1900, and that even with the continued
presence of the tubercle bacilli. I realize that the comparison is not
quite correct in all respects, for it is well established that cancer is
not due to a microörganism; but it does show us that nutritive errors
are at the bottom of the ravages of tuberculosis, and efficient
biochemical studies in cancer have satisfied many that the same,
although different in character, are true of this disease.

In other words, erroneous nutrition, which is productive of disease of
the kidneys, heart, and blood vessels, with their steadily rising
mortality of ten to twenty per cent since 1900, as shown on the chart
before you,[3] is operating to steadily increase also the morbidity and
mortality of cancer, in spite of active and intelligent surgical
treatment. And yet the profession and laity seem to be blind to this
fact.

It is also not a little remarkable that during the year 1915, when there
was a special effort made to educate both the laity and the medical
profession in regard to the advisability or necessity of early
operations in cancer, the actual death rate rose by 1.7 persons per
100,000 living, whereas the average yearly rise for the preceding five
years had been only 1.2 persons per 100,000!

What, then, is the real problem of cancer? Surely it is not to increase
the surgical activity, which has resulted only in a steadily ascending
scale of mortality, which in reality is greater than that observed in
any other malady! For the increase in the death rate from cancer
throughout the United States from 1900 to the present time has been
coincident with the greatest activity both in laboratory research, and
in the advanced surgery of the disease. I repeat, is it not time for us
to stop and consider whether our laboratory work with the microscope on
morbid tissues, and our experimentation on rats and mice are truly
serving to solve the real problem of cancer? Or whether we had not
better turn our attention to human beings, and by careful clinical study
of our patients, discover where the fundamental error lies, which first
induces the formation of an aberrant cell mass, which we call cancer,
and then continually feeds it by the same deranged blood stream, so that
it becomes utterly uncontrollable and invades and destroys other
tissues; while at the same time the anemia, pernicious and progressive
in character, gradually saps the life of the patient to a lethal end?
For repeated and most careful laboratory studies have demonstrated great
and significant changes in the blood in cancer. I hope to satisfy you
that the mass which is excised is only the _product_ of a far deeper
systemic change, which has probably already produced other, more or less
similar masses or deposits elsewhere—in the bones and internal organs or
lymphatics. So that surgical removal of the one often stimulates the
development of others.

It is seen, then, that it is here denied that the local lesion which we
call cancer is the first and only cause of disease. It is also denied
that the surgical removal of the offending lump and adjoining glands and
tissues, however early it is performed, is a sure and only cure for
cancer.

In the recent cancer propaganda, urging the very early and complete
removal of everything which could possibly be called pre-cancerous, it
is interesting to observe that most of the pictures shown and arguments
presented relate to cutaneous epithelioma, which the United States
Mortality Statistics show to be the cause of only 2.7 per cent of all
deaths included under cancer! Moreover, those of us who see epithelioma
daily know that, if properly treated early by other means than the
knife, it is commonly a relatively innocent affection. It is
acknowledged, however, that by meddling and wrong treatment, as with
nitrate of silver, it can be goaded on so as to become a serious affair.
In our present consideration of cancer as a disease it is to be
understood, therefore, that cutaneous epithelioma is excluded, and that
reference is made to the serious malignant disease known as cancer,
affecting various other organs of the body. However, many cases of what
might be called epithelioma of the lip and oral cavity are of such
malignity that they are properly ranked as carcinoma.

Looking at cancer, therefore, as a general disease of which the local
lesion, which is ordinarily excised surgically, is simply the result or
product of a previous, perhaps long-standing, blood or nutritive
disorder, we can readily understand why the simple excision of the tumor
and surrounding tissues cannot be expected to eradicate the malady
permanently. We can also see why the disease recurs so readily in the
scar tissue after operation; for all recognize and admit that cancerous
degeneration is apt to develop on any scar tissue. It is also well known
that occasionally a tumor which after removal has been proved
microscopically to be only a simple adenoma, has eventually been
followed by true carcinoma in the cicatrix or elsewhere, under the
stimulation of surgical procedure.

Metastatic development, after or without operation, can also be readily
understood on the ground of the disease being a constitutional disorder.
For, as far as I have observed, there is seldom or never any continuous
attempt made after an operation to alter the dyscrasic condition
producing the tumor, but the patient is dismissed with the vain hope
that there will be no more trouble. It is quite natural, therefore, that
the transference of cancerous cells by the lymphatics or blood vessels,
will form foci which are readily made to grow further by the vitiated
blood stream.

Regarding, then, cancer as a systemic disease, of which the tumor is but
a local expression, often or perhaps always the result of local injury
or irritation, possibly of one or more “embryonic rests,” let us briefly
review the evidence in support of this view, and the measures found
successful in combating the basic cause of the disease.

First let me remind you of the _negative_ and _positive_ results of
laboratory and other study, which are pretty well conceded by those who
know most about the disease; and in presenting these I cannot do better
than to quote what I have collected in a former article.[4] There are
eight of these in each group.

1. Clinically and experimentally cancer is shown to be _not_ contagious
or infectious; although under just the right conditions certain
malignant new growths can be inoculated in some animals of the same
species, but not in other species, and human cancer cannot be
transplanted on animals.

2. Although microörganisms of many kinds often have been found and
claimed as the cause of cancer, there has been no concurrence of opinion
in regard to them, and it is now pretty conclusively agreed that cancer
is _not_ caused by a microörganism or parasite.

3. Cancer is _not_ wholly a result of traumatism; although local injury
may have much to do with its development in some particular locality,
even as in connection with the late lesions of syphilis.

4. Cancer is _not_ hereditary in any appreciable degree; although some
tendency in that direction has been demonstrated in certain strains of
mice.

5. Occupation has _not_ any very great influence on the occurrence of
cancer; although it is more frequent in some pursuits than in others.

6. Cancer is _not_ altogether a disease of older years; although its
occurrence is decidedly influenced by advancing age.

7. It does _not_ especially belong to or affect any particular sex,
race, or class of persons.

8. Cancer is _not_ confined to any location or section of the earth, but
has been observed in all countries and climates.

But while laboratory and other investigations have not demonstrated any
single cause of cancer and have yielded only negative results, they
have, by elimination, cleared the way for a study of its cause along
other lines, which are bright with promise. They have also established
certain facts which confirm the views which from time to time have been
briefly expressed by many who were best acquainted with cancer; namely,
that, because of its constant recurrence, and from the failure of
surgery to check its rising mortality, it must be of a constitutional
nature, intimately associated with dietary or nutritional elements, as I
have elsewhere shown.[5]

The _positive_ results of laboratory investigation are more encouraging:

1. We know now that the local mass, which we call cancer, represents but
a deviation from the normal life and action of the ordinary cells of the
body. These once normal cells, for some as yet unexplained reason, take
on an abnormal or morbid action, with a continued tendency to malignancy
which invades and destroys contiguous tissue, and is associated with a
progressive anemia which destroys life.

2. Microscopic study has shown that there is a certain change in the
polarity of cells about to be cancer-genetic, with an altered relation
of the centrosome to the nucleus. These changes have been well
attributed to an alteration in the enzyme contained in the cell, which
further depends on the nutrition of the cell as influenced by a faulty
metabolism of food elements.

3. The exclusion of all other possible causes leads us naturally to look
to a disordered metabolism as a cause of the disturbed action of the
hitherto normal cells; and we find much to confirm this view both in
laboratory studies on the biochemistry of cancer, and also in clinical
and statistical observations.

4. The blood in advancing cancer has repeatedly been shown to exhibit
many manifest changes, which indicate vital alteration in the action of
the organs which form blood, and so control the nutrition of the body
and its cells.

5. Laboratory and clinical evidence demonstrate that the secretions and
excretions of the body, both in early and late stages of cancer, exhibit
departures from normal which deserve consideration. Although not one of
these has as yet been established as pathognomonic of cancer, they all
indicate metabolic disturbances which influence the nutrition of the
cellular elements, and so these secretory and excretory disturbances are
of importance in connection with its causation.

6. As all healthy cells of the body, by their catabolism and anabolism
contribute a hormone or something to the general circulation, so
experimental evidence shows that the cells of a cancer mass itself, when
fully developed, secrete a hormone or something which is poisonous to
animals, and which probably hastens the lethal progress of the disease.

7. Repeated laboratory experiences have demonstrated, in a most
remarkable manner, the absolute controlling effect of diet on the
development of inoculated cancer in mice and rats, so that the process
was inhibited almost entirely with certain vegetable feedings.

8. We thus see that as the laboratory has eliminated the local nature of
cancer, it has also, in a measure, established the fact that there are
medical aspects of the disease which further studies will show to be of
the utmost importance. These all tend to demonstrate its constitutional
origin, that is, its relation to deranged metabolism, which is now
recognized as the basis of so many diseases of more or less serious
character.

But clinical and statistical studies come in with overwhelming force to
confirm the correctness of this position.

1. We have already seen that with utter medical neglect the death rate
of cancer has steadily and greatly increased in the United States, of
late years, in spite of the prodigious advances of surgery during the
same time. This is also true in all the countries from which we have any
accurate statistics. We know also that tuberculosis, as a result of
careful medical attention, has decreased in mortality by almost as great
a percentage as cancer has increased. The same is reported by reliable
observers all over the civilized world.

2. Any number of observers, in many lands, have recorded the almost
entire absence of cancer among aborigines, living simple lives, largely
vegetarian; they have also shown the definite increase in the disease,
and in its mortality, in proportion to their adoption of the customs and
diet of so-called modern civilization.

3. This increase of cancer mortality seems to depend largely upon the
altered conditions of life attending advanced civilization, particularly
along the lines of self-indulgence in eating and drinking and in
indolence.

4. Statistics from many countries show that increase in the consumption
of meat, coffee, and alcoholic beverages, appears to be coincident with
a very great and proportionately greater augmentation of the mortality
from cancer.

5. Clinical observation has time and again shown the effect of specific
nerve strain and shock in the development of cancer; and there seems to
be little question but that the enormous nerve strain of modern life is
an element of importance in this direction, both through metabolic
disturbance and by direct action on living cells.

6. At present no clear demonstration is possible of the direct method by
which errors of metabolism effect the changes in cells to which we give
the name malignant, any more than we know how other alterations on the
body are produced; such as arterial degeneration, bone changes, obesity,
etc., which are recognized as due to metabolic derangement.

7. The results which have been observed in connection with the
starvation of cancer, by ligature of vessels, illustrate the relation of
the blood supply to growing cancer.

8. Finally, the repeated observation and report of the spontaneous
disappearance of cancer, by careful and competent medical men, shows
that conditions of the system may arise which are antagonistic to
malignant growth, even when it has begun to take place; just as there
are other conditions of the system which favor the aberrant action of
previously normal cells, resulting in cancer.

The medical aspects of cancer thus loom large, and appear in quite a
different light from that in which they have been commonly viewed. We
now begin to see some of the reasons why cancer is not primarily a
surgical disease, and some of the lines along which observation and
investigation should proceed; namely, biochemistry, secretory and
excretory derangements, metabolic disturbances, diet, etc., etc. The
subject is too new a one to afford a great amount of corroborative proof
at present, other than the long personal experience of the writer and
others, who have seen tumors disappear under means other than surgical,
X-ray, and radium. More clinical and laboratory investigations of human
beings are needed, and not simply microscopic studies and experiments on
animals, valuable as these have been in the advancement of medical
science in connection with other diseases.

We will now consider briefly some of the practical points in regard to
the successful treatment of cancer by means other than the knife. I will
not take time to review or even to mention the various methods and means
which have been proposed and advocated for the cure of cancer, only to
end in disappointment for the reason that they did not reach the basic
cause of the complaint. The very multiplicity of the suggestions proves
their futility.

The line of thought and practise to which I would devote your special
attention is not entirely new, but has been hinted at by many careful
observers during the past hundred years or more, though it has never
before been fully developed or strongly urged. But the experiences of
over forty years, together with much study, has so convinced me of the
correctness of the principles and practise which I advocate that I
cannot too strongly urge you to consider them fully and without bias,
and to put them to a satisfactory test, although I quite realize that
they are contrary to the generally accepted views of the profession and
laity.

The fundamental principle of my thesis lies in the fact that with the
so-called advance of modern civilization, certain diseases, for the last
fifteen years at least, have showed a steadily increasing mortality. The
deaths in the United States from apoplexy, nephritis, and heart disease
have steadily increased over ten, fifteen, and twenty per cent
respectively, and those from cancer 28.7 per cent. We all realize that
the results in the three former diseased conditions are from errors in
the mode of life, including eating and drinking, and indolence, and
careful study shows that cancer has the same origin. On the other hand,
as already stated, the deaths from tuberculosis have steadily declined
27.8 per cent under rational medical treatment, directed mainly along
the lines of correct nutrition: the death rate of tuberculosis and
cancer have thus approached each other 56.5 per cent, and at this rate
in fifteen years more the mortality from cancer will exceed that from
tuberculosis!

Careful and prolonged studies of cancer patients, both in the earlier
and later stages of the disease, as I have recorded elsewhere,[6] show
that there are always departures from normal metabolism, as is shown by
the condition of the blood, and in the excretion from the bowels,
kidneys, and skin, and in the salivary and hepatic secretions, and
possibly in those of the ductless glands. Time does not permit here of
elaborating this subject, which has been done elsewhere, but it is
evident that some combination of internal systemic disorders must be
recognized as the basic cause of the complaint, although at the present
time it is difficult to point to a single causative element, if, indeed,
it will ever be discovered.

But a broad view of metabolism and nutrition recognizes that all cell
changes, whether good or bad, depend on the character and composition of
the blood furnished to the tissues, although little definite may be
known concerning it. Thus, no one has demonstrated the single causative
change in the blood in arteriosclerosis, gout, rickets, scorbutus, etc.,
but no one questions that it exists, and we direct our therapeutic
measures accordingly, largely from experience.

The same is true in cancer. Most careful and prolonged study of the
patient in every respect has shown a certain uniformity in regard to
particular deviations from health, the correction of which has been
followed by a complete disappearance of tumors classed as malignant, so
that the connection must seem obvious to an unprejudiced mind. And yet
it cannot be claimed that the exact, single cause of the cancerous
growth has been demonstrated, and from the nature and character of the
systemic disorders found, it is evident that there can never be any
single remedy which can be rightly claimed as a cure for cancer.

But that cancer can be cured by medical means and without the knife is
absolutely certain, as the experience of many testify, and as the writer
has observed in so many cases during the past 30 and more years. Many of
the instances in the hands of others have occurred unexpectedly, and
without definite or careful study and record of the measures employed.
But in some way the condition of the blood and system has become altered
so that there has occurred a retrogressive process which resulted in the
absorption of the tumor. I may say that this was the case in regard to
the earlier patients in my own practise, when I observed that tumors of
the breast, which had been diagnosed as cancer by surgeons, disappeared
under dietetic and other measures given for some skin affection; later
observation and study have crystallized my views and confirmed my
methods of procedure, which I hope to make plain, as briefly as
possible, lack of time to explain everything must make me a little
dogmatic.

An absolutely vegetarian diet is the first requisite in the treatment
and prophylaxis of cancer, for, as mentioned, this has been found
experimentally to inhibit, often to a remarkable degree, the production
of artificially produced cancer in rats and mice, and experience
throughout the world has shown cancer to be extremely rare in
vegetarians. This diet, which should be maintained indefinitely, must be
rigorous and absolutely vegetarian, excluding animal protein, even eggs
and milk; butter is the only article allowed which does not grow, and of
this one quarter of a pound is to be taken daily, by a person weighing
150 pounds. Cereals are to be freely employed, eaten slowly, with a
fork, and with butter, and not with milk and sugar, though the latter
may be used moderately, where it seems necessary and where it perfectly
agrees with the patient.

Perfect mastication, with thorough insalivation, is very essential, and
I insist on at least half an hour being taken for even the lightest
meal. Coffee, chocolate, and cocoa are excluded from the diet, only weak
tea being allowed, with some postum or other artificial substitute for
coffee.

Alcohol in each and every form is absolutely excluded, as it always has
a very harmful effect on cancer. Sufficient water, not iced, should be
taken to answer to the needs of the system, and I commonly give half a
pint with each meal, and half a pint, hot, one hour before both
breakfast and the evening meal.

Cancer being a disease of advancing civilization, with all its
temptations and errors in living, it is essential that the cancer
subject lead a very simple and healthy life, with regular hours of
eating and sleeping, with a reasonable amount of exercise, and the
avoidance of everything which could disturb normal metabolism.

There is, of course, no single medicine which can cure cancer, but
proper medication plays a very important part in overcoming the disease
and should never be neglected or interrupted in any case; indeed, one
suffering from or threatened with cancer should be under the most
careful medical guidance indefinitely, and this is especially true after
the surgical removal of the tumor, or local manifestation of the morbid
process, as Abernethy so strongly asserted, nearly a hundred years ago.

Medical treatment lies mainly along the lines of elimination, which is
always found to be faulty, both by the bowels and kidneys. My records of
large numbers of private patients show that there is imperfect
intestinal secretion, both in the very early stages and late in cancer,
even before morphin is taken. Therefore I have long come to look upon
intestinal auto-intoxication as a prime factor of causation, and lately
Sir Arbuthnot Lane has spoken of cancer as a terminal result of
intestinal stasis. This constipation, however, is not to be met with
occasional purgatives, but by measures which will secure a good normal
evacuation once or oftener daily. My principal reliance for this is
cascara, in combination with other remedies, although I also very often
give once a week, on alternate days, two good laxatives of blue mass,
colocynth, and ipecac. Mineral waters, Russian oil, etc., are not
desirable, and enemata are resorted to only in emergencies.

The kidney secretion in early and late cancer is always faulty. This
does not refer to albumen and casts, or sugar, which are searched for
but seldom found. But very careful and repeated volumetric analyses of
its many normal ingredients reveal errors in its composition which are
of significance and which serve as a guide in therapy. There is always a
faulty nitrogenous partition, and in that of sulphur; indican is
commonly in excess, often very greatly so, and the chlorids and
phosphates and sulphates deranged. The urinary secretion will constantly
be found to be extremely deficient, both as to the actual quantity
passed in the 24 hours, and in its total solid contents, which are often
hardly one half of that called for by the body weight of the patient;
this I have verified by hundreds of analyses. As these errors are
corrected by proper treatment there will be a coincident improvement in
the vitality of the patient and in the tumor.

The remedy which I have largely relied on in these cases for many years
is acetate of potassa, and it is interesting to note that Ross[7] of
London claims that a cause of cancer is found in a disturbance in the
mineral contents of the blood, and that there is a lack of potassa, and
he gives as high as 90 grains of phosphate and carbonate of potassa in
the day, with excellent results. I commonly give the acetate in
combination with other remedies, thus ℞ Potass. acetatis ℥i, Tinct. Nuc.
Vom. ℨiv, Ext. Cascara fld. ℨi-ℨiv, Extr. Rumicis radicis fld. ad ℥iv,
M. Teaspoonful in water ½ hour before eating.

But in the long treatment necessary for these cases before the malignant
growth has quite disappeared, and possibly for a good while afterward,
there may be many remedies used with advantage to secure and maintain
that healthy metabolism requisite to overcome the cancerous habit. Iron
and arsenic, phosphates and strychnin, and even cod liver oil and many
reconstructive remedies and measures may bear their share in overcoming
this dire disease. Thyroid extract sometimes assists materially in
removing the malgrowth, but must be given with caution, and in
connection with other proper remedies; for sometimes it will promote
catabolism and disintegrate the diseased tissue faster than the
emunctories can remove the effete products, and these may poison the
system.

It has been difficult in a single address to present such a vast
subject, which is more or less new to many, in a clear and concise form,
and I fear that I have trespassed too greatly on your patience, and have
yet only imperfectly made matters clear. But I shall be satisfied if I
have excited your interest sufficiently to cause you to investigate the
medical aspects of cancer, in which lies the real problem of its
prevention and cure. Surgery has been tried faithfully by many brilliant
and honest men, some of whom now and then acknowledge the failure of the
knife to arrest the steadily increasing mortality from the disease,
which is now about 90 per cent of all those once attacked.

But I fully realize that there is danger in my strenuous advocacy of
other lines of treatment, lest these should not be fully and perfectly
carried out, with such intelligence, patience, and persistence, on the
part of the physician and patient as is requisite to accomplish the end
desired. For I must say that it is extremely tedious and tiresome to
care minutely for these patients, who should be seen at least weekly,
and even for months or years, with careful and accurate records,
innumerable urinary and blood analyses, etc., etc.

On the other hand, however, we have the alternatives of leaving the
patient to suffer and die, or to submit to a surgical operation with the
expectation of recurrence in a considerable proportion of cases,
attended often with greater suffering and final death.

My experience with the disease for forty years or more in private
practise, and for the last few years in my medical clinic for cancer, in
the New York Skin and Cancer Hospital, and in the wards of the hospital,
have so fully convinced me of the correctness of the views I have stated
here and elsewhere that I cannot too strongly beg you to give them due
consideration, and not simply to class them with the various passing
claims and suggestions regarding cancer, which have so often proved
illusory. For along the lines which I have presented lies the real
cancer problem, as I can demonstrate by many cases more or less similar
to those detailed in my little book.




                                 INDEX


 Acidity of saliva in cancer, 44, 146, 164, 199, 213, 221

 Activity, increased surgical, not the solution of cancer problem, 242

 Age as related to cancer, 50

 Agnew on surgery in cancer, 93

 Alcohol harmful in cancer, 157

 Alkalescence of the blood in cancer, 132

 Amino-acid nitrogen, increased in cancer, 42

 Anabolism, 62

 Anemia of cancer, 130

 Appetite and taste, 63

 Approach of death rate of cancer and tuberculosis, 87, 259

 Argentine Republic, cancer in, 69

 Australia, meat eating and cancer in, 70

 Austria, cancer mortality in, 85


 Bashford and Murray, 75

 Basic cause of cancer, 147

 Biopsy, danger of, in cancer, 123

 Blindness as to results of surgery in cancer, 139, 240, 243

 Blood in cancer, 131, 134, 137, 219, 235

 Bones, cancer of, 130

 Bovee on cancer of the uterus, 104

 Breast, cancer of the, 97, 197
   cancer mortality, 82
   frequency of cancer in, 49

 Butter, caloric value of, 166
   value of, in cancer, 166, 263

 Byrne, on cancer of the uterus, 102, 104


 California, cancer mortality in, 79

 Calories, daily amount of, in menu, 163

 Cancer, anemia, 130
   and civilization, 57, 72, 83
   and dietary and medical treatment, results in, 188, 200‒237
   and meat eating, 68‒71, 149

 Cancer, and nitrogenous matter, 37, 150
   and rice eating, 168
   and tuberculosis, approach of death rate of, 87, 241, 259
     comparative death rates of, 241
   basic cause of, 147, 261
   blindness as to results of surgery in, 139, 240
   blood in, 131
   cases, personal, 196
   conception of hitherto wrong, 240
   daily amount of calories in, 163
   diet for, 157
   dietetic and medical treatment of, 144
   disappearing under general medical treatment, 175, 200‒237
   en cuirasse, 131
   hemoglobin in, 134, 219
   houses, 59
   inoperable, benefited by medical treatment, 209, 217
   medical treatment of, patience necessary in, 170
   mortality, chart showing, 87
     increased, since educational propaganda, 78, 88, 242
   not a local disease, 67
   of bones, 130
   of the breast, 49, 97, 197
   of the gall bladder, 106
   of the lip, 95
   of the liver, 129
   of the lungs, 130
   of the mouth, 95
   of the rectum, 106
   of the skin, 130
   of the stomach, 105
   of the tongue, 95
   of the uterus, 102
     cured by medical treatment, 200‒237
     vegetarian diet in, 224, 228
   patients, directions for, 155
   primary, removed by medical treatment, 200, 208
   problem, not settled yet, 143
     not solved by greater surgical activity, 242
     the real, 149, 239
   recurrent, 119
     and medical treatment, 208
     benefited by medical treatment, 209, 211, 214
   red blood cells in, 134, 137, 219
   relation of climate to, 58
   research, negative results of, 248
     positive results of, 250
   saliva acid in, 44, 146, 199, 213, 221
   specialists, 155
   the real problem of, 239
   tissue, a product of systemic changes, 142, 244
   urinary excretion imperfect in, 173, 146, 218
   urinary solids deficient in, 39, 172
   urine deficient in, 146, 173, 218, 221
   weight of patients in, 219, 226, 235
   white blood corpuscles in, 219
   wrong conception of, 240

 Carcinoma cases, personal, 196

 Carcinoma or epithelioma, 194, 195

 Carcinosis, 130, 136

 Catabolism, 62

 Cause, basic, of cancer, 147, 261

 Cereals, how cooked and eaten, 162, 164

 Chalfant on cancer of the uterus, 105

 Chart showing mortality of cancer, 87

 Chewing, importance of, in cancer, 164

 Chimney sweeper’s cancer, 53

 Chocolate harmful in cancer, 157

 Cities, cancer mortality in, 79

 Civilization, and cancer, 83
   cancer a disease of, 57, 72, 83

 Climate, relation of, to cancer, 58

 Clinic, medical, for cancer, 153

 Clinical and statistical studies, results of, 254

 Codeia, harm from, in cancer, 136

 Coe, H. C., on breast cancer, 98

 Coffee harmful in cancer, 157

 Comparative death rates of cancer and tuberculosis, 87, 241

 Conception of cancer hitherto wrong, 240

 Conclusions, 139, 269

 Confidence of patient to be secured, 170

 Constipation very common in cancer, 173

 Contagion of cancer, 21

 Cure of cancer, time of, 124

 Currier on cancer of the uterus, 103

 Cutaneous epithelioma, excluded, 94, 192


 Danger from excising specimens for diagnosis, 123
   from nitrate of silver in epithelioma, 193
   from thyroid extract in cancer, 212, 269
   of imperfected medical treatment, 270
   of spreading cancer, 122

 Death rate of cancer and tuberculosis compared, 87, 241, 259

 Deaths from cancer in New York City, 80

 Deficiency of urine in cancer, 146, 173, 218, 221

 Definition of cancer, 20, 47

 Denmark, cancer mortality in, 85

 Diabetes, relation of, to cancer, 147

 Diet and cancer, 55
   for cancer patients and prophylaxis, 157
   relation of, to cancer, 61

 Dietary card for cancer patients, 154

 Dietetic and medical treatment of cancer, 144
     duration of, 151
     results from, 188
   in sarcoma, 231

 Difficulty in carrying out medical treatment, 114, 152, 186

 Directions for cancer patients, 155

 Duration of dietary and medical treatment, 151
   of observation affecting cancer statistics, 92


 Educational propaganda increasing cancer mortality, 78, 88, 242

 “Embryonic rests” in cancer, 20

 End results of cancer cases, 108, 112

 England, increase of cancer in, with increased meat eating, 69

 England and Wales, cancer mortality in, 83

 Engleman on cancer of the uterus, 104

 Epithelioma, 192
   of the skin,
     excluded from present study, 192
     statistics of, 94
   or carcinoma, 194
     warning against use of nitrate of silver in, 193

 Error as to non-increase of cancer mortality, 74

 Erythrocytes in cancer, 134, 137, 219

 Exact diet for cancer, 157

 Exercise, relation of, to cancer, 56


 Females, relative frequency of cancer in, 49, 50

 Fletcherizing, importance of, in cancer, 164

 Food, relation of, to cancer, 60, 149, 152

 France, cancer mortality in, 85

 Fredrick on cancer of the uterus, 103

 Frequency of cancer in males and females, 49

 Friedenwald on cancer of the stomach, 106


 Gall bladder, cancer of, 106

 German Empire, cancer mortality in, 85

 Good health and cancer, 35


 Handley permeation theory, 126

 Hartwell on breast cancer, 100

 Hemoglobin in cancer, 134, 219
   in sarcoma, 235

 Henrotin on cancer of the uterus, 103

 Heredity and cancer, 21

 Hertzler on cancer of the lip, 95

 Heurtaux on breast cancer, 99

 Hildebrand on breast cancer, 97, 101

 Hoffman on mortality from cancer throughout the world, 76
   on real increase of cancer, 86

 Holland, cancer mortality in, 85

 Hormone of cancerous tissue, 133

 Hungary, cancer mortality in, 85


 Imperfect medical treatment, danger of, 270

 Importance of plasma of blood, 132
   of proper mastication in cancer, 164

 Increase of cancer in England, 68
   in cancer mortality, 74
     in the United States, 77
     throughout world, 76

 Inoperable cancer, 113
   benefited by medical treatment, 209, 217

 Intestinal elimination, faulty in cancer, 43, 173
   relation of, to cancer, 43

 Ireland, cancer mortality in, 85

 Iron, value of, in cancer, 182

 Italy, cancer mortality in, 85
   meat eating and cancer in, 71


 Kentucky, cancer mortality in, 81

 King and Newsholme, 75

 Klein on cancer of the uterus, 103


 Leucocytes in cancer, 134, 219, 235

 Levin on breast cancer, 98

 Limit of time of cure of cancer, 125

 Lip, cancer of, statistics, 95

 Liver, cancer of, 129

 Locality, relation of, to cancer, 58

 Lubhardy on breast cancer, 97

 Lungs, cancer of, 130

 Lymphatic system and cancer, 128

 Lymphocytes in cancer, 135


 Maine, cancer mortality in, 79, 81

 Males, relative frequency of cancer in, 49, 50

 Malignant disease, personal statistics of, 191

 Massachusetts, cancer mortality in, 79

 Masticating, importance of, in cancer, 164

 Mayo on cancer of the breast, 97
   on cancer of the rectum, 106
   on cancer of the stomach, 105, 106

 Meat eating and cancer, 69, 149

 Medical and dietetic treatment, of cancer, 144
     results from, 188, 200‒237
   of sarcoma, 231

 Medical clinic for cancer, 153

 Medicinal treatment of cancer, 169, 175
     imperfect, danger of, 270
     patience and perseverance needed in, 170
   in inoperable cancer, 209, 217
   in recurrent cancer, 209, 211, 214

 Menu for treatment and prophylaxis of cancer, 157

 Metabolism and cancer, 34, 62

 Metastases, 126
   by inoculation, 127
   mode of occurrence of, 126

 Meyer, Willy, on breast cancer, 100

 Mode of life and cancer, 60

 Modes of development of recurrent cancer, 121

 Montana, cancer mortality in, 81

 Morphia, harm from, in cancer, 136

 Morphine less often needed under dietetic and medical treatment, 174

 Mortality from cancer, 74
   about 90 per cent, 143
   chart of, 87
   in cities, 79
   in different States, 79
   increased since educational propaganda, 78, 88, 242

 Mouth, cancer of, 95

 Mundé on cancer of the uterus, 104

 Murphy on end result of operations on breast cancer, 97


 Negative results of cancer laboratory research, 248

 New Hampshire, cancer mortality in, 79

 New York Board of Health and cancer diagnosis, 123

 New York City, cancer death rate in, 80

 New Zealand, meat eating and cancer in, 69

 Nitrate of silver, warning against, in epithelioma, 193

 Nitrogenous matter, relation of, to cancer, 37, 150
   metabolism and cancer, 65
   partition, imperfect, in cancer, 37, 42

 Norway, cancer mortality in, 82, 85

 Nuts, protein content of, 72


 Obesity, cancer with, 33, 55, 97

 Occupation, and cancer, 51

 Optimism of physician necessary, 170

 Origin of cancer, 119, 147

 Oxyproteic acid, relation of, to cancer, 42


 Paget’s disease, 97

 Parasites and cancer, 21

 Patience and perseverance necessary in medical treatment of cancer, 170

 Permanent cure of breast cancer, 97

 Permeation theory of Handley, 126

 Perseverance necessary in medical treatment of cancer, 170

 Personal carcinoma cases, 196
   sarcoma cases, 196

 Phosphorus, value of, in cancer, 183

 Plasma of blood, importance of, 132

 Polak on cancer of the uterus, 105

 Polk on cancer of the uterus, 104

 Polynuclears, activity of, in cancer, 137

 Positive results of cancer laboratory research, 250

 Potassium, value of, in cancer, 138

 Precancerous lesions, 94

 Primary cancer removed by medical treatment, 200‒208

 Problem, cancer, not solved by greater surgical activity, 143, 242
   the real, 239

 Product of systemic changes, cancer tissue a, 142, 244

 Propaganda, educational, increasing cancer mortality, 88, 242

 Prophylaxis of cancer, 144, 167

 Protein and cancer, 37, 64
   content of certain vegetables and nuts, 72


 Quack claims of cure of cancer, 118


 Race, relation of, to cancer, 56

 Real cancer problem, 149, 239

 Reasons for adherence to surgical treatment of cancer, 140
   for inoperability of cancer, 116

 Rectum, cancer of, 106

 Recurrence of cancer, time of, 124

 Recurrent cancer, 119
   and medical treatment, 208
   benefited by medical treatment, 209, 211, 214
   of rectum, 107

 Red blood cells in cancer, 134, 137, 219
   in sarcoma, 235

 Reinecke on cancer of the uterus, 103

 Research, cancer, negative results of, 248
   positive results of, 250

 Results of clinical and statistical studies, 254
   of dietary and medical treatment, 188, 200‒237

 Rheumatism and cancer, 33

 Rice, relation of, to cancer, 168

 Ross, Forbes, on cancer, 136
   on potassium in cancer, 176, 179


 Salivary secretion, acid, in cancer, 44, 146, 164, 199, 213, 221

 Sarcoma, and medical treatment, 231

 Sarcoma cases, personal, 196, 230
   cured by dietary and medical treatment, 189, 236

 Segond on cancer of the uterus, 104

 Sex, relation of, to frequency of cancer, 49

 Skin, cancer of the, 130
   excluded from the present study, 192
   statistics of, 94

 Smith, Lapthorne, on cancer of the uterus, 104

 Solids, urinary, in cancer, 39, 172

 Stage of disease affecting cancer statistics, 90

 Statistical and clinical studies, results of, 254

 Statistics of cancer, affected by duration of observation, 92
   affected by stage of disease, 92
   surgical, 74

 Statistics, elements affecting, 89
   personal, of malignant disease, 191, 196

 Stomach, cancer of, 105
   frequency of, 50
   mortality of, 82, 106

 Stools, importance of inspecting, 184

 Sulphur partition, imperfect, in cancer, 43

 Summary, 239

 Surgery in cancer, blindness as to end results
 of, 139, 240, 243

 Surgical activity, greater, not the solution of cancer problem, 242

 Surgical statistics of cancer, 74

 Systemic changes, causal relationship of, to cancer, 142, 244


 Taste, gratification of, 63

 Thyroid extract, danger from, in cancer, 212, 269

 Time of recurrence of cancer, 124

 Tongue, cancer of the, 95

 Touching up epithelioma with nitrate of silver dangerous, 193

 Trauma of lymphatics, increasing cancer, 45

 Traumatism and cancer, 21

 Treatment of cancer, dietetic and medical, 144

 Tuberculosis and cancer, comparative death rates of, 87, 241, 259

 Tuberculosis, decline of mortality of, 87
   lessons to be learned from, 241

 Tuttle on cancer of rectum, 106


 United States, cancer statistics in, 77, 87

 United States, meat eating and cancer in, 69

 Uric acid and cancer, 37, 201

 Urinary acidity in cancer, 41

 Urinary solids deficient in cancer, 39, 172

 Urine, in cancer, 37
     deficient, 146, 173, 218, 221
   volumetric analysis of, guiding treatment, 172

 Utah, cancer mortality in, 79

 Uterus, cancer of the, 102
   cured by medical treatment, 222, 228
   frequency of, 49
   mortality in, 82
   vegetarian diet in, 224, 228


 Van de Warker on cancer of the uterus, 104

 Variety of medical treatment necessary, 151

 Vegetable soup, how made, 162, 165

 Vegetables, protein content of, 72

 Vegetarian diet, arresting inoculated cancer, 253
   for cancer, 153
   in cancer of the uterus, 224, 228

 Vegetarians and cancer, 71

 Vermont, cancer mortality in, 79, 81

 Vitamines and cancer, 165

 Volumetric analysis of the urine, 172


 Warning as to nitrate of silver in epithelioma, 193

 Waste in preparation of certain foods, 165

 Water, how taken in cancer, 161

 Weight of cancer patients, 219, 226, 235

 Wertheim on cancer of the uterus, 102

 White blood cells in cancer, 134, 219
   in sarcoma, 235

 World statistics of cancer, 76

 Wrong conception of cancer, 240


 X-ray causing cancer, 52

-----

Footnote 1:

  “Cancer, Its Cause and Treatment,” Hoeber, 1915.

Footnote 2:

  This address, which has been delivered before several medical
  societies, is added as giving a summary of the subject elaborated in
  the first volume and this one. It presents the argument more concisely
  and definitely than occurs in any single lecture, and may thus aid in
  properly understanding the whole matter.

Footnote 3:

  This chart appears opposite page 87.

Footnote 4:

  Bulkley: _New York State Medical Journal_, 1916.

Footnote 5:

  Bulkley: “Cancer, Its Cause and Treatment,” Hoeber, 1915.

Footnote 6:

  Bulkley: “Cancer in Relation to Body Elimination,” _New York Med.
  Jour._, July 3, 1915.

Footnote 7:

  Ross: “Cancer, Its Genesis and Treatment.” London, 1912, p. 88.

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




                          TRANSCRIBER’S NOTES


 1. Silently corrected typographical errors and variations in spelling.
 2. Retained anachronistic, non-standard, and uncertain spellings as
      printed.
 3. Enclosed italics font in _underscores_.