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.