It is also not a little remarkable that during the year 1915, when there was a special effort made to educate both the laity and the medical profession in regard to the advisability or necessity of early operations in cancer, the actual death rate rose by 1.7 persons per 100,000 living, whereas the average yearly rise for the preceding five years had been only 1.2 persons per 100,000!
What, then, is the real problem of cancer? Surely it is not to increase the surgical activity, which has resulted only in a steadily ascending scale of mortality, which in reality is greater than that observed in any other malady! For the increase in the death rate from cancer throughout the United States from 1900 to the present time has been coincident with the greatest activity both in laboratory research, and in the advanced surgery of the disease. I repeat, is it not time for us to stop and consider whether our laboratory work with the microscope on morbid tissues, and our experimentation on rats and mice are truly serving to solve the real problem of cancer? Or whether we had not better turn our attention to human beings, and by careful clinical study of our patients, discover where the fundamental error lies, which first induces the formation of an aberrant cell mass, which we call cancer, and then continually feeds it by the same deranged blood stream, so that it becomes utterly uncontrollable and invades and destroys other tissues; while at the same time the anemia, pernicious and progressive in character, gradually saps the life of the patient to a lethal end? For repeated and most careful laboratory studies have demonstrated great and significant changes in the blood in cancer. I hope to satisfy you that the mass which is excised is only the product of a far deeper systemic change, which has probably already produced other, more or less similar masses or deposits elsewhere—in the bones and internal organs or lymphatics. So that surgical removal of the one often stimulates the development of others.
It is seen, then, that it is here denied that the local lesion which we call cancer is the first and only cause of disease. It is also denied that the surgical removal of the offending lump and adjoining glands and tissues, however early it is performed, is a sure and only cure for cancer.
In the recent cancer propaganda, urging the very early and complete removal of everything which could possibly be called pre-cancerous, it is interesting to observe that most of the pictures shown and arguments presented relate to cutaneous epithelioma, which the United States Mortality Statistics show to be the cause of only 2.7 per cent of all deaths included under cancer! Moreover, those of us who see epithelioma daily know that, if properly treated early by other means than the knife, it is commonly a relatively innocent affection. It is acknowledged, however, that by meddling and wrong treatment, as with nitrate of silver, it can be goaded on so as to become a serious affair. In our present consideration of cancer as a disease it is to be understood, therefore, that cutaneous epithelioma is excluded, and that reference is made to the serious malignant disease known as cancer, affecting various other organs of the body. However, many cases of what might be called epithelioma of the lip and oral cavity are of such malignity that they are properly ranked as carcinoma.
Looking at cancer, therefore, as a general disease of which the local lesion, which is ordinarily excised surgically, is simply the result or product of a previous, perhaps long-standing, blood or nutritive disorder, we can readily understand why the simple excision of the tumor and surrounding tissues cannot be expected to eradicate the malady permanently. We can also see why the disease recurs so readily in the scar tissue after operation; for all recognize and admit that cancerous degeneration is apt to develop on any scar tissue. It is also well known that occasionally a tumor which after removal has been proved microscopically to be only a simple adenoma, has eventually been followed by true carcinoma in the cicatrix or elsewhere, under the stimulation of surgical procedure.
Metastatic development, after or without operation, can also be readily understood on the ground of the disease being a constitutional disorder. For, as far as I have observed, there is seldom or never any continuous attempt made after an operation to alter the dyscrasic condition producing the tumor, but the patient is dismissed with the vain hope that there will be no more trouble. It is quite natural, therefore, that the transference of cancerous cells by the lymphatics or blood vessels, will form foci which are readily made to grow further by the vitiated blood stream.
Regarding, then, cancer as a systemic disease, of which the tumor is but a local expression, often or perhaps always the result of local injury or irritation, possibly of one or more “embryonic rests,” let us briefly review the evidence in support of this view, and the measures found successful in combating the basic cause of the disease.
First let me remind you of the negative and positive results of laboratory and other study, which are pretty well conceded by those who know most about the disease; and in presenting these I cannot do better than to quote what I have collected in a former article.[[4]] There are eight of these in each group.
1. Clinically and experimentally cancer is shown to be not contagious or infectious; although under just the right conditions certain malignant new growths can be inoculated in some animals of the same species, but not in other species, and human cancer cannot be transplanted on animals.
2. Although microörganisms of many kinds often have been found and claimed as the cause of cancer, there has been no concurrence of opinion in regard to them, and it is now pretty conclusively agreed that cancer is not caused by a microörganism or parasite.