VOL. XLII

No. 2

Cancer is recognized by laboratory workers as only a departure of healthy normal body cells from their former in tegrity of being and action, and the taking on of an excessive, riotous overgrowth, with a tendency to break down and ulcerate. No longer being in their natural and proper relations of nutrition, owing to a deranged blood current from disturbed metabolism and erroneous diet, they have renounced their allegiance to physiological control, and, though not functioning by secretion or otherwise, they still possess the power of multiplying indefinitely, and then produce harmful and heterologous tissue.

In regard to no other disease has there been such persistent, exaggerated, and unreasonable demands for the discovery of a definite laboratory proof of the actual cause as in regard to cancer. Many will therefore agree with Deaver* who says that, after all the work that has been expended "has been sifted, we find ourselves very much where our forefathers were, as far as any clear idea of the cause and nature of cancer is concerned-we still do nothing to cure it." It may therefore be safely concluded that laboratory work alone, with experimentation on animals, will never solve the problem of human cancer and its cure, for it has covered about every possible ground with only negative results.

The mystery of carcinosis, however, disappears when we look at cancer in a rational light, as studied clinically, and

*Deaver, Mc Farland and Herman, Breast and its Anomalies, Phila., 1917, p. 476.

observed on a large scale in human beings, with proper laboratory study of the blood, secretions, excretions, etc. With this there is no need of experimentations on rats, mice, guineapigs, etc., but only the closest scrutiny and study of the individual affected, in every aspect, and the application of sound and experienced judgment in rectifying the errors of life and system on which carcinosis depends; for the local lesions to which the name of cancer is given are 'but its manifestations and products. All clinical and pathological investigations have about decided that cancer is not due to a parasite, is not contagious or infectious, is not hereditary, and is not due to local irritation alone, as has been abundantly presented elsewhere.'

The nature of the metabolic disturbances on which carcinosis depends, and the manner in which the cancerous lesions develop may be better understood when we consider closely and know the manner in which the body cells behave in health and multiply in malignant tumors. All this has been so accurately and scientifically studied by Roger Williams in his excellent book on "The Natural History of Cancer," which seems to be too little known, that I would like to quote his words largely in elucidating our subject, but space forbids.

While much work, even up to the present time, has been expended upon en

*Bulkley, Cancer and its Non-Surgical Treatment, Wood & Co., New York, 1921.

Williams, W. Rogers, The Natural History of Cancer, New York, 1908.

deavoring to learn just how the normal processes of cell life are carried on, and how the production, destruction, and regeneration of cells are effected, it must be recognized that we are far from a perfect knowledge of the same. We know, however, that the cell itself, through its nucleus, with the chromosomes and other contents, and its centrosomes, has wonderful powers of mitosis and reproduction of new cells, and that the cells themselves possess a marvelous amount of intelligence, as Quevlit has so clearly and irresistibly shown. Beginning with a single impregnated cell, division takes place through mitosis, and each new cell is provided with its centrosomes and nucleus containing the proper quota of chromosomes and other constituents, which make up the working powers of the cell. The centrosome is acknowledged by all cystologists as the presiding genius of the activities of the cell and its contents, which proceed to form the various portions and organs of the body, including the brain and nerves, which are made from the same cells as are

other organs. And Quevli argues very cleverly, from the behaviour of the cells throughout nature, that, as the cells of the brain, through the senses, can perceive, think, and act, so by the constitution of all the cells, and the manner in which they perform their functions, they also are intelligent and work in harmony in building up, maintaining, and operating the various structures of plants and animals. This is too large a subject to elaborate here, but has definite relations to the pathological development of neoplasms, benign and malignant.

A study and knowledge of the manner in which cells proliferate in carcinoma, whether by mitosis or amitosis, and the rapidity in which these alterations in the nuclei take place, usually in one half to three quarters of an hour, enables us to understand how with their intelligence they can rebel or mutiny when the pabulum or nutriment afforded by the blood is not such as they can use in their anabolism and katabolism. And even as in a regiment, when food and all conditions of life had become intolerable, the

Quevli, Nils, Cell Intelligence, etc., Colwell Press, Minneapolis, 1917.

soldiers would mutiny when some provocation had aroused their ire, so a local injury may excite a group of cells to refuse to perform their usual vocation and enter upon a riotous and destructive course. When, however, all the dietary and other conditions of life are fully rectified the soldiers will naturally return to their former allegiance and duties, and it is exactly the same with the body cells which have rebelled and formed cancer in any part of the system.

But it is quite impossible for merely a local irritation alone to account for the persistent and terrible malignancy accompanying cancer in various organs, without an underlying cause which, so to speak, feeds the fire, causing the disease to spread through the whole system and ultimately to destroy life, whether the first lesion is removed surgically or by X-rays, radium, thermotherapy, caustics, or whatnot. (It is understood that cutaneous epithelioma is excluded from our study, as that is a local affair, generally easily and permanently_removed by various local measures. Real cancer of internal organs is quite a different matter, as all recognize.)

"Those who maintain that cancer is commonly caused by trauma must explain how it is that men, who suffer from trauma three times as often as women, are nevertheless only about half as liable to cancer. Still more cogent is the reasoning of this kind when applied to cancer of the breast, for whereas men are quite three times as liable to trauma of this part as women, yet they suffer from mammary cancer only in the proportion of 1 to 116. Again, if the traumatic theory of the causation of cancer were true, those parts of the body more subject to injury, as the upper and lower extremities, the scalp, etc., would be the commonest seats of the disease, but its actual localization is totally different. Moreover, of all parts of the hand, the palm, which is most exposed to traumatism, is least liable to cancer. I regard the relation of traumatism to cancer-to borrow a Darwinian simile-as resembling that of a spark in contact with combustible matter, the result depending on

*Bulkley, Cancer a Mutiny of Body Cells, Medical Record, October, 1921.

the nature of the latter, rather than on the spark itself" (Williams). Moreover, in many internal sites, as the body of the uterus, kidney, liver, brain, etc., there can be no suggestion of trauma in these locations; and even in the case of the gall bladder, in some 4000 operation on the gall bladder and biliary ducts, in the Mayo clinic, only about 2.5% were for malignant conditions, and in some instances gall stones remain in the bladder many years.

This is not the place to enter upor the very large subject of the non-surgical treatment of cancer, which has been abundantly considered elsewhere, but only to say that this may and commonly does involve such a careful, patient, and long continued study of the patient in all relations of life, and such assiduous attention to minute details, and such a rectification of metabolic processes, as influenced by diet, hygiene, and medication, as will often tax the perception, and knowledge, and judgment of the physician to the uttermost. But that most gratifying results in both early and late, and recurrent cases, especially in the former, has been and can be obtained, is evidenced by the many successful cases already reported, and by the hundreds of letters from able physicians which have come, endorsing this action.

There is not, and probably never will be found, any single remedy for cancer, such as quinine for malaria, mercury for syphilis, antitoxin for diphtheria, thymol for uncinariasis, etc., for carcinoma is a complex condition, in the production of which there are many contributing factors, even a neurotic one, as has been repeatedly shown elsewhere. If a single remedy could be found and satisfactorily presented, the three or four hundred thousand cancer patients now existing in the United States would rapidly be placed upon it, and the 80,000 to 90,000 deaths from cancer would be speedily diminished, and there would no longer be the 90 per cent of deaths in those once affected with cancer, which has so long been the case.

Wrong living, especially in the way of indulgence in eating and drinking, and indolence, is undoubtedly the basic cause of carcinosis, as of other diseases of adult life, such as kidney disease, heart disease, apoplexy, etc. But a non

meat diet alone will not cure cancer, though exactly the proper diet is at the bottom of all good and successful treatment of the disease, with proper medication, which latter is otherwise inert, just as a gouty patient could not be permanently cured if Port and Madeira wine were as freely indulged in as formerly.

The cure of cancer depends on the perspicacity, assiduity, and patience of the physician, proceeding along the proper lines, and the absolute obedience of the patient, in carrying out to the minutest particular all the necessary requirements of the case, and for a great length of time, as in the instance of tuberculosis. The patient may weary of the restrictions imposed, and may tire of the constant medication, but patience and perseverance will be rewarded in the end. Eternal vigilance is the only price of liberty.

The physician and patient must both be hopeful and confident of the correctness of the position taken, and not be discouraged at occasional setbacks, for which there will often be found a cause. And if so, the ultimate results, lasting even for many years, will be infinitely superior to anything obtained by the measures employed in the treatment of cancer for the last twenty years.

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