But all these phenomena are of secondary importance compared with the great problem of medical science—the yet undiscovered cause of malignant disease. During recent years the study of cancer has been conducted with scientific enthusiasm in many laboratories. Vast sums of money have been given, in the hope that these studies may one day lead to the discovery of a cure. One whom I knew in his youth became the heir of great wealth; lived to see one whom he loved perish from the disease; was struck down himself, and dying, left a fortune for the purpose of promoting research concerning cancer. And yet to-day the problem, as attacked in the various laboratories of Europe and America, is apparently as far from solution as it was forty years ago. Sir Henry Butlin, ex-President of the Royal College of Surgeons, England, is said to have operated on as many cases of cancer as any surgeon of his day. Yet, speaking in October, 1911, he said:
"I have been associated with the Imperial Cancer Research and in touch with its staff from the foundation of the Research, and have been a member of the publication committee of all its scientific reports. IT HAS DONE NOTHING ON THE LINES IN WHICH OBSERVATION HAS BEEN SO USEFUL. It has not unfolded the life-history of a single variety of cancer, so that we can base our operations on the information. It has not even discovered whether spontaneous cancer of a particular part of the body in the rat or mouse runs a similar course to spontaneous cancer of the same part of the body in the human subject. These problems are not suited for experimental investigation; they are determined by observation."[1]
[1] Lancet, London, October 7, 1911.
No "serum," no drug, no curative agency of any kind, has thus far been discovered upon which the slightest dependence may be placed. The only measure of relieve which medical science can now suggest is early and complete extirpation. Of what proportion of cases even this insures immunity we cannot tell.
Without decrying what has been done in the laboratory, may it not be that we have gone in that direction as far as there is any hope for success, and that all effort should now be directed TO THE DISCOVERY OF THE CAUSE OF MALIGNANT DISEASE IN HUMAN BEINGS? That great secret still eludes us, but until we can penetrate that mystery, it is difficult to perceive how we may hope to prevent the increasing prevalence of the great destroyer . Yet there is one method of investigation which (speaking from a study of cancer statistics for more than twenty-five years) seems to me to offer, more than all others, a reasonable hope of ultimate success. It is independent of all sacrifice of animal life. It involves, however, an expenditure far greater than is possible for any private investigator, and probably only by the co-operation of the Government can it be undertaken with any chance of success. Yet, if Society can once be aroused to a recognition of the need for the completest possible investigation concerning malignant disease, and particularly the reasons for its differing prevalence among people of different nationalities, habits, and general environment, that inquiry will take place, even though it cost the price of a battleship.
The subject is so vast and involved that it cannot be discussed with any approach to completeness in a single essay. Suppose, however, that we glance at the theory which regards cancer as due to a microbe which in some mysterious ways gains admission into the human body, lying for a time dormant, but liable under appropriate stimulation to be awakened into malignant activity. We know at the outset that if any such germ of disease exists, it has thus far escaped visual recognition. No human eye can be said with certainty to have seen it, even when aided by the most powerful microscope; but this may be due to the fact that, like the germ of certain other diseases, it is so minute that it lies beyond the range of human vision. There are, however, certain facts pertaining to the disease which have significance. We have already seen that in a given country there is a kind of uniformity in the number of those dying from the disease from year to year; but another phenomenon relates to the unequal pressure in difference countries of the causes of the disease.
1. THE DEATH-RATE FROM CANCER APPEARS GREATLY TO VARY ACCORDING TO RACE AND ENVIRONMENT.
CANCER DEATH-RATE IN DIFFERENT COUNTRIES PER 100,000 POPULATION
———————————————————————————————- | Five-Year Periods. | Switzerland. | England. | Italy. | |—————————————|———————|—————|————| | 1886-1890 .. .. | 114 | 63 | 43 | | 1891-1895 .. .. | 122 | 71 | 44 | | 1896-1900 .. .. | 127 | 80 | 51 | | 1901-1905 .. .. | 128 | 87 | 55 | ———————————————————————————————-
Here is the record of a period of twenty years. These differences of proclivity to cancer are exceedingly curious. Can the reader perceive why they exist?