Cancer: Its Cause and Treatment, Volume 2 (of 2)

by Lucius Duncan Bulkley

The highest red cell count made was 5,400,000, in a case of cancer of the uterus, in a patient aged 52, the count being 4,064,000 on entering the hospital. The highest hemoglobin index was 90 in a number of severe cases, and 100 in one case of sarcoma, to be detailed in the next lecture. In one recurrent case of cancer of the left breast, which was very distressing at first, the patient died peaceably and without pain, with a hemoglobin index of 90, and 4,900,000 red cells, and 7,400 white cells, of which 75 per cent were polynuclears, 17 per cent small lymphocytes, and 7 per cent mononuclears. Her hemoglobin had been 70 per cent on entering the hospital with 3,360,000 red cells. The highest leukocyte count observed was 18,600 in a case of inoperable cancer of the right breast, not long before death, in an unmarried female of 53; but in the course of treatment it had fallen to 6,200, about normal, from 10,520 before beginning treatment.

I will not weary you with more of these figures, which are interesting and instructive as one studies them week by week in connection with the physical condition of the patient. However much can be done for these distressing and inoperable cases of cancer, one has to acknowledge that when general carcinosis has set in we are still helpless in arresting the lethal progress of the disease, although very much can be done in prolonging life and alleviating suffering; and this does not mean with morphia or codeia which in the end does harm, and was very seldom administered to the patients referred to.

Forbes Ross, after ten years of constant microscopic clinical and surgical research, has made some interesting observations, covering many pages, on the blood of cancer patients, which have a close bearing on our subject, and to which I can only briefly allude, and I do not know if I can make it clear in the time I can give to the subject. By long study of sections of carcinomatous tissue he claims that the mononuclear leukocyte behaves in a very different manner from the polynuclear. Briefly he charges the mononuclear white corpuscles with actually producing the disease, by conjugating with certain epithelial cells, thereby giving them the reproductive capacity which enables them to push forward on their destructive career. The polynuclears seem to come up to the defense of the body, but are overcome by the poison secreted by the rapidly growing tumor cells.

The red blood cells he also finds, with other observers, nucleated more frequently in cancer than in any other form of secondary anemia, and subject to a change of composition, and deficient in lecithin and nuclein. He shows the importance of potash, which we shall later find clinically of such great value in cancer, and I cannot do better than quote some of his words: “How vitally important potassium salts are to the red corpuscles is shown by the following: One thousand parts of red corpuscles are found to contain six hundred and eighty-eight parts of water, three hundred and eight parts of organic solids, and eight parts of mineral. Of these eight parts three and one half are of potassium chlorid, two and one half are potassium phosphate, and decimal one potassium sulphate; the remaining 1.9 parts are divided between the iron, sodium, calcium, and magnesium, comprising the rest of the corpuscles. More than three quarters of the total mineral ash of the red corpuscles is, therefore, composed of potassium. This fact is an important one, and the reader is earnestly requested to bear it in mind.” Later we will again see some of the valuable clinical suggestions which arise from his researches.

From our study of inoperable and recurrent cancer, and of metastasis and the blood conditions in the disease, we see what a formidable task is before one who would attempt to lessen its morbidity and mortality. We see also how blind all have been who have so long looked to surgery to stay its progress. In my former lectures I collected and quoted statements from many surgeons of prominence in times past, and even some in quite recent times, all expressive of a belief in a constitutional origin of cancer, and many of them looking to a dietary cause. I also gave biochemical laboratory and experimental evidence showing the medical aspects of cancer. I then remarked that it seemed strange that the medical profession and the public had been so slow in accepting and acting on the accumulated evidence which I have tried to put before you in these and the former lectures.

The reason for this seems to be that the medical profession, being occupied largely with acute disease and apparently definite and speedy results, became readily discouraged with the unsatisfactory course commonly observed in cancer; as in the case of tuberculosis, until the revival of an interest in the latter in recent years, with the well known beneficial consequences. They, therefore, turned the cancer cases over to the surgeons, in the hope that they could do better.

By the brilliant advances in modern surgery along many lines, the laity also have become obsessed with the idea that it has limitless power in many directions, and have yielded to the knife in spite of the rising mortality of late years. The glamour of modern surgery and its often spectacular results have quite blinded the eyes of many to real facts.

It is not a little interesting to note that the period to which we have referred, 1910 to 1915, in which the mortality of tuberculosis has fallen so steadily while that of cancer has so steadily risen, even in greater proportion, is that in which active laboratory work has also dazzled the public and professional mind. The enormous activity with the microscope in regard to the minute structure of the diseased tissues, and the elaborate and extensive work done in animal experimentation, have turned the thoughts of many from the homely and practical studies of the human frame in its various departures from health; thus too little attention has been given to the deranged activities of its various organs, and the perverted metabolism which, has resulted from the stress and strain, with the temptations and errors accompanying the present intensity of human civilization.

Matters being as they are it is hardly to be expected that the surgeons would incline to any other treatment than by the knife, especially since good pathologists have asserted that cancer is only a local affair and have urged its early removal. Nor would one expect that the surgeon would think along medical lines and investigate metabolic conditions, when the immediate results of operation seemed often to be so satisfactory. Neither would one expect the surgeon to seek from statistics the unfavorable aspects of this line of treatment, but rather those from which he could draw encouragement in trying to overcome so dire a disease.

But slowly light is beginning to shine, and you have seen and heard enough to realize that the simple removal of the product of the cancerous process, and surrounding tissues, can never check greatly the morbidity and mortality of cancer. You know now what the real cancer problem is. It surely is not the sole continuance of a line of treatment under which the death rate has steadily risen from 63 to 81.1 persons in each 100,000 living, or 28.7 per cent since 1900, with a mortality of about 90 per cent of those once affected with the disease.