Time does not permit us to go into the matter of the X-ray, which undoubtedly has often been of great service in certain cases of cancer: it should be carefully but systematically employed, once or twice a week in connection with other medical treatment; radium can also be of real service in these cases. In some inoperable cases a mild surgery, especially with the actual cautery, in the way of removing exuberant masses, which would have to slough off, can add much to the good progress of the case, and the occasional excision of cutaneous nodules removes just so much cancerous tissue, which by its secretion would poison the system.

In our study thus far we have seen that there is much to be done for cancer besides the surgical removal of the offending mass, the existence of which is an opprobrium to medical science, which has not thus far guarded mankind against it: and until time has passed, and by right living and proper medical attention cancer has ceased to be produced, or become greatly diminished, surgery will probably be a great factor in its treatment, as its mortality statistics are constantly improving. But there can be no question but that with the adoption of proper dietary and medical treatment, even from the first suspicion of a malignant growth, and before, as also after operation, the final results of operative procedure will be even far better than have been yet attained.

LECTURE VI
CLINICAL CONSIDERATIONS AND CONCLUSIONS

The test of everything lies in the results obtained. Theories, discussions, and arguments are all unavailing unless results show their truth. In medicine, however, it is sometimes difficult to demonstrate results until after the lapse of time, as was well illustrated by the preposterous claims first put forth for “606,” which is gradually attaining about its correct status. The same is true in regard to the surgery of carcinoma, where operations which formerly were attended with very bad results have gradually been improved, so that, while the late Dr. Agnew of Philadelphia once said, toward the close of his life, that he did not know if he had ever been justified in any operation he had performed on this disease, the best surgeons are now claiming notable successes, with relatively good percentages of recovery: but here again, time comes in, and while the three-year limit of freedom from recurrence is valuable, it is still said that fully 90 per cent. of those who have once been affected with true cancer, die of the disease, and its general mortality is still increasing in spite of all surgery. Dr. John B. Murphy of Chicago, has also repeatedly expressed himself most pessimistically in regard to the ultimate results of the surgical treatment of carcinoma, especially in those patients who are fat, and with lax tissue, that is, exhibiting evidences of imperfect metabolism.

Dietetic and medical treatment of cancer, in the fullest sense, have never yet been given a fair and fully intelligent trial on a scale large enough to produce general conviction in regard to their value. Many cases have occurred here and there which have recovered spontaneously, that is, without surgical interference, and often really to the surprise of the medical attendant: this of itself shows that under certain circumstances something may occur in the system which causes the malignant process to cease, and the cells to return to a normal function. This certainly should be a stimulus to discover what the reason is for this beneficial change, and we believe that it is to be found in what has preceded in these lectures.

When the New York Skin and Cancer Hospital was founded, over thirty years ago, Cancer was included with Diseases of the Skin, in the hope and expectation that in studying the internal causes of the latter light would be thrown on the etiology of carcinoma, which, as we know, is a disease of epithelial elements; and the earlier Report of the Hospital shows but one department, including Cancer with Skin Diseases, with operating surgeons and a gynæcologist to assist, whenever their services were requested by the physicians in charge. Before long, however, for reasons which cannot now be given, and against the judgment of the present speaker, the plan was changed, and a separate cancer department was erected under the exclusive charge of surgeons. A Prize Fund was also early established, which has been slowly increasing, for the discovery of a cure for cancer by other than surgical removal.

For thirty or forty years I have held very much the same views regarding cancer which have been presented in these lectures, and have acted on them more or less strongly, and in later years very stringently, and have rarely seen cause for regret. For one reason or another I have also had many hundreds of patients, with various affections, on a vegetarian diet over varying periods: in a number of cases I have records extending over many years, in which I have observed the patients from time to time (one psoriasis patient having continued it for over twenty years) and with only the best results, so I trust that you will accept and test the validity of my statements.

In looking over my case histories in private practice I find that I have more or less complete records of 96 cases of carcinoma, mostly of the breast (two of them having Paget’s disease), 29 of sarcoma in various situations, and 619 of epithelioma of different degrees of severity, of which four others had Paget’s disease; a total of 744 patients with these forms of neoplasm. Some of these patients were seen in consultation, others only once or for a brief period, but many of them were under care and observation for a greater or less length of time. During the past year I have also treated on the plan here indicated a number of cases of recurrent carcinoma in the New York Skin and Cancer Hospital, which have been submitted to very careful laboratory study, some of whom have exhibited decidedly favorable results: some of these will be referred to later, but they are too recent to afford positive data, and I prefer to confine my consideration mainly to private patients, in regard to whom more reliable evidence can be obtained.

I will not weary you with any full analysis of these cases, nor will I consider any of them except those of carcinoma: for while I believe that sarcoma is of the same nature and origin, save that it relates to connective tissue cells, but few of the cases were submitted long enough to a vigorous treatment calculated to yield efficient results. I may say in regard to the cases of epithelioma, mainly of the skin, that some of the more severe ones showed very markedly the benefit of dietetic and medicinal measures of the character now being considered, and that it is my custom to treat such in the same manner; for reason would seem to show that the same causes would produce abnormal proliferation of epithelial elements on the cutaneous surface as well as in other parts of the body.

In regard to the cases of carcinoma there were 6 in males and 90 in females; of these the right breast was affected 42 times, the left breast 45 times, and both breasts 3 times. In 28 cases the patients were operated on surgically before adequate treatment had been employed; many of these were earlier cases, or those seen in consultation. In seven instances it seemed wise to have an operation, after a more or less faithful trial of medical treatment. There were no cases of cancer of internal organs, except metastases, as these would not naturally come to me. The average age of the breast cases was 51.8 years.