Read Ebook: Cancer: Its Cause and Treatment Volume 2 (of 2) by Bulkley Lucius Duncan

Font size: 10 px 15 px 20 px 25 px 30 px 35 px

Background color: BlackWhiteGrayLight GrayDark GrayDim Gray

Text color: BlackWhiteGrayLight GrayDark GrayDim Gray

Apply/Save settings

Ebook has 611 lines and 52529 words, and 13 pages

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 r?le 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.

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 .

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.

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 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 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.

Share on: WhatsApp @Hash Facebook Tweet