RECENT DEVELOPMENT IN SCIENCE AND INVENTION

Cancer, The Unconquered Plague

LEONARD KEENE HIRSHBERG, M.D., IN THE AMERICAN MAGAZINE March 1 1907
RECENT DEVELOPMENT IN SCIENCE AND INVENTION

Cancer, The Unconquered Plague

LEONARD KEENE HIRSHBERG, M.D., IN THE AMERICAN MAGAZINE March 1 1907

Cancer, The Unconquered Plague

RECENT DEVELOPMENT IN SCIENCE AND INVENTION

BY LEONARD KEENE HIRSHBERG, M.D., IN THE AMERICAN MAGAZINE

This dread disease has up till the present baffled all medical sk'll. All treatments of it have proved nothing more than experiments. Dr. Hirshberg discusses the different theories advanced relative to the cause of i ancer and outlines the precautions to be taken against the disease.

NEW cancer cures are flung before us just about as often as new murder mysteries. Every time a German savant discovers another ray in the spectrum, some other savant is delivered of the idea that it will consume and annihilate cancers. Every time a new element or a new bacillus or a new ferment swims into our ken, someone hails it as the long sought specific. The X-rays, radium, oxgall, the Finsen light, quack “absorbents,” soap, caustics, trypsin— all of these things have had their day. They have aroused physicians and the laity ; they have fanned the spark of hope in the breasts of melancholy sufferers. And with what result ? Simply that we know very little more about cancer to-day than Hippocrates knew, and that when the disease has gone far we are just as helpless before it.

In the United States, during the census year of 1900, a few less than 33,000 men and women died of cancer. Two-thirds of them were more than 40 years old and under 70. Thirty-three thousand ! A death roll indeed, to stagger humanity ! And,

day by day, year by year, generation by generation, it is increasing !

Consumption, pneumonia and typhoid fever stand before cancer on the list of civilized mankind’s mortal foes, but their terrors are fast disappearing. We have learned that fresh air and pure food will conquer consumption ; we know how to aid nature in combating pneumonia ; we have devised means to protect ourselves against tj^phoid. The tiny germs that cause these diseases are revealed by our microscopes ; we may study them and fight them. As a result, we are reasonably sure that, within the lifetime of men full-grown to-day, consumption will lose its old terrors, pneumonia will give up its secret, and typhoid will go the way of smallpox and malaria. But cancer remains a dark and gloomy mystery. We don’t know what causes it and we don’t know how to cure it. All we know about it, in truth, is that it begins with some sort of mysterious disarrangement of the tiny cells that make up the body, that this disarrangement spreads, and that in the end the whole body

becomes impregnated with a virulent poison and dies.

Of course, there is the knife. If we discover it in time, it is possible to cut out a cancer and save the rest of the body from the grasp of its horrible tentacles, but that is something which is often impossible. The cancer, for instance, may be in the walls of the stomach—30 per cent, of them are—or it may not be recognized until its baneful secretions have invaded all parts of the frame. At the start it may seem to be only a wart or a mole, or, if internal, it may be so obscured by other things that its true nature is long in debate. Your average family physician very naturally, is not a cancer expert, and it very often happens that he is doubtful or deceived. In the end, by the time he gets his patient on the operating table and a surgeon begins work, the cancer is beyond all magic of surgery. Its roots have struck deep down ; its murderous poisons are coursing through the blood. And so, a month or a year or five years after the superficial tumor is removed, another one appears, and eventually the patient dies.

There are more opinions about the cause of cancer than there were in the Middle Ages, about the cause of fossils. The New York State Cancer Laboratory at Buffalo persists in maintaining that it is caused by parasites, like hydrophobia and typhoid fever. There are learned men who say that it is caused by mechanical irritation. There are others who hold to the ingenious theory that it is the product of certain lingering reproductive tissue, which, under normal conditions, disappears soon after birth. The advocates of the parasite idea are divided into

those who believe the parasitic organism to be an animal, like the protozoon of malaria, and the amoeba af dysentery, and those who hold that it is a vegetable, like the yeast plant or the bacillus of tuberculosis. The Harvard Cancer Commission, the Paris Pasteur Institute, the German Imperial Institute for Infectious Diseases,, at Frankfort, and the British Imperial Cancer Research Fund stand opposed to all of these notions. The case, they say, remains unproven ; we have yet to truth.

In the face of this fact it would seem to the laj^man to be useless to seek a cure for the disease, because it appears only reasonable that we should first find out what we propose to cure before we essay to cure it. But this is scarcely sound logic, for it is evident that many diseases were cured day after day for centuries before anyone in the world had a very accurate idea of the cause of any disease. Jenner was rather hazy in his notion of smallpox, but he proved the utility of vaccination ; Hippocrates knew very little about the nervous system, but he relieved toothaches ; and out modern faith-curists, though their ignorance of pathology is abyssmal, often cure hysteria, and so it is not quite so vain as it may seem to seek a cure for cancer before we have framed a definition of the disease.

Naturally enough, every man seeking the great specific works along lines suggested by his private notion of the nature of the malady. Dr. John Beard, of Edinburgh, believes that cancer is caused by the lingering reproductive cells before mentioned, and so, when he set out to discover a cure, he sought something to absorb these cells and cast them

out. Long research led him to believe that this something was trypsin, a ferment secreted by the pancreas. The result was a beautiful theory, and so far it has got no further. Nowhere in the world is there a man of whom it may be truthfully and unquestionably said that he had cancer and that the cancer was cured by trypsin. In brief, practical experience has knocked Dr. Beard’s theory into a cocked hat. It is still beautiful, but it is not art.

Inasmuch as this notion of lingering reproductive cells is not itself damaged by the sad failure of trypsin, and in view of the fact that a great many scientists who disagree with Dr. Beard in other matters agree with him in this. It is based, in brief, upon a modification of the old idea regarding the way life is handed down in the world from generation to generation.

It happens, unluckily, that some of the life-cells now and then fail to find their right place in the embryo. These waifs, in fact, often turn.up in all sorts of odd nooks and corners. In fishes, where they are best studied it has been found that, when thus astray, they usually break down and disappear at about the time the organ called the pancreas begins to grow active. But sometimes, instead of breaking down and disappearing, they make brave efforts to live their lives and reproduce their kind in the inhospitable places to which fate has exiled them. The result is the disturbance which we call cancer.

Such is the theory held by Dr. Beard and many other investigators. Practically stated, it means that a cancer on the tongue, for example, is a mass of life-cells placed, by an accident of nature, on the tongue in-

stead of in their proper place. If a surgeon is called in before they make much of a disturbance, he may cut them out and so cure the cancer. But if he delays they will continue to multiply, the blood will carry some of them into other organs, and the poisons secreted as the result of their battle with normal cells around them will go coursing through the whole body and cause death.

Other investigators, while maintaining that embryonic cells cause cancer, differ as to the modus operandi. It would be impossible, in a short space, to set forth the hairsplitting of these sages in comprehensible form. Indeed, there is reason to suspect that a good many of them are in some doubt themselves as to what they mean. Suffice it to say that one group holds that cancer cells are normal cells which have reverted or degenerated to the embryonic form, while another group seeks to prove that they are merely lowly organized cells which have been stimulated into baleful activity by excessive nourishment. This last idea in some measure supports the doctrine that local irritation causes cancer. If the tongue, for example, is irritated by a broken tooth or a pipe-stem, Nature pumps and excess of blood (i.e. nourishment) i To it, and to the superficial eye it becomes inflamed. There is plenty of g to and for believing that tongue cancers are often caused in this way.

Pathologically, a cancer is merely one of two score or more varieties of tumors, some of which are comparatively harmless and others of which are very dangerous. In the harmless class belong warts, moles, strawberry birthmarks, the troublesome growths which appear in that nasal passages, and the ordinary

tumors of women. To the latter class belongs cancer. The difference between the two, stated briefly, is that the former never infect surrounding tissues, do not secrete poisons, and unless they grow large and injure the vital organs by their mere bulk, do not cause death ; while the latter, unless they are cut out very early, reach out their tentacles in all directions, send poisons near and far, and interfere with the functions of nearly all the important organs. The beneficent tumor thrusts aside the neighboring tissues and remains an outlaw easily removed. The malignant tumor destroys the neighboring tissues and takes their place.

The chief danger of beneficent tumors lies in the fact that they may become malignant. How this transformation occurs is still one of the mysteries that enshroud cancer, but that it does occur is plain. Warts and moles sometimes (though very rarely) develop into cancers, and so, too, does scar tissue. The exact influence of blows or other injuries is still in doubt. Out of 10,000 breast cancers studied by one observer, ten per cent, showed histories of blows, but this evidence is not to be taken too seriously, for many imaginative patients, when asked if they have suffered such an injury, readily recall or invent one. The influence of diet, climate and heredity are also in doubt. We know that in some families cancer seems to be a prevalent disease, but we know that the children and grandchildren of victims usually escape.

Cancer is a malady of civilization. White men are more prone to it than yellow men, and yellow men more than negroes. It is unknown among the Eskimos and rare in the East Indies. Here in America it is more

prevalent than in Europe, and, unluckily, its ravages seem to be constantly increasing. In the last fifty years of the nineteenth century the mortality rose from 9 in 100,000 to 33)>. More accurate diagnosis and investigation may account for part of the increase, but certainly not for all. It is a matter of common knowledge, in truth, that cancer is spreading.

Whether diet and climate have anything to do with it is largely a matter of speculation. Some investigators hold that it is a disease of meat-eaters, and yet they must face the fact that the Eskimos, who live on meat entirely, do not have it. Others blame it on fish-eating, and still others on bad drainage. T. W. Nunn, who made a most elaborate investigation of cancer in England, came to no certain conclusion at all. He noted that districts with a badly drained subsoil seemed to produce more cancer than better drained sections, and he decided that the grouping of cases was due to more than mere coincidence. But further than that he reached no positive opinion.

Cancer is almost invariably a disease of the middle-aged and elderly. In the United States, in 1990, but two out of each 5,000 cancer victims were less than one year old. The great majority were more than 45. Among women the years between 55 and 60 were the most dangerous, and among men those between 60 and 65. In both sexes the disease seems to grow virulent at the period of those changes which take place during the middle forties. From that time on, until 95, and even 100, it is seriously to be reckoned with.

As has been mentioned, the knife

is the only considerable weapon against cancer. Unfortunately, its aid is seldom sought in time. If it were possible always to recognize the tumor at its first appearance, and then cut it out at once, with a liberal sacrifice of the apparently sound flesh around it, most cancers might be destroyed before they were dangerous. But it so happens that patients seldom consult a physician until severe pains give evidence that the cancer has begun to spread. By the time a patient is conscious of an internal cancer, it is usually too late to do much. When an operation is delayed, it is at best a mere means of relief. The cancer poisons have been sent broadcast through the blood and, sooner or later, another tumor appears. Another operation may then afford more relief, but in the end the patient will succumb.

Luckily, there is no disease, no matter how^ virulent, that Nature herself cannot cure ; and so even in the worst cases of cancer it is well not to abandon hope. I have myself seen several cases of spontaneous cures. One patient was a wealthy Baltimorean, whose malady was diagnosed by an operation as cancer of the stomach three years or more ago. Three prominent American surgeons saw the cancer, which was inoperable because of its location. He submitted to a serum treatment and last summer a second operation revealed the fact that his cancer had entirely disappeared, leaving a scar. Here was an undoubted case of cure, but did the serum do the work ? Its advocates maintain that it did, but a great manjr very learned and scientific physicians hold that it did not. One cure, it is obvious, by no means establishes a specific’s efficacy. Coincidence gives more support than

that to even the worst of patent medicines.

Nature, indeed, is the only doctor whose skill is capable of combating cancer. Ehrlic and others have observed that, of a given number of mice displaying symptoms of cancer, a certain portion recover. The same thing is true of human beings. Every community has a saved sufferer, and as a rule this same sufferer is a perambulating and very vociferous bellman for some sort of “mental” treatment or quack medicine. It is the same with cancer as with other diseases. When Nature, by her mysterious processes, effects an eleventhhour cure, the credit goes to the doctor in attendance, or to some patent elixir.

Cancer patients are great patrons of the sure-cure sharks. The more ignorant fight against the knife until it is too late, and then, when their physicians tell them that they are beyond hope, they consult all sorts of advertising fakirs and long-whiskered frauds. The newspapers are heavy with the advertisements of such grafters. Without exception, they are swindlers, liars and thieves.

All the same, a great many very capable physicians believe that time will develop latent virtues in a number of proposed cancer cures. Upon superficial cancers, experiments are being made with the Finsen light, with the X-rays and with radium. No doubt the action of these agents is purely destructive, and the same effect might be obtained by the knife or by caustics. The X-rays have been used with great promise of success. For small skin cancers, they may eventually prove their value. But that they constitute a specific or teach us anything about the cause of cancers is far from true.

In brief, then, what do we know about cancer ? To-morrow, perhaps, we may know a great deal, but today, if we would be honest with ourselves, we must admit that we know next to nothing.

We don’t know the cause of the disease.

Except in a small proportion of very early cases, we,don’t know how to cure it.

We don’t know whether it is hereditary.

We don’t know whether it is induced by peculiarities of diet.

We don’t know to what extent it depends upon elimare.

We don’t know whether it is contagious or infectious.

We don’t know why it reserves its attacks for oldish people.

We don’t know whjT it is increasing.

All we ma}T do at present, is to keep a sharp lookout for incipient cancers, and cut them out ruthlessly.

In brief, we must try to kill the cancer before it really exists. The preliminary spot or pea-like growth must be removed at once. We must keep a weather eye upon inflamed

places and have them looked after without delay. No one fears the removal of such tiny growths these days. Not even children are scared by small operations.

It is not sufficient that a family physician remove the suspected growth with lancet or caustic. He has done his share if he merely sounds the warning m time. The cutting out should be done by a thoroughly competent surgeon—one who has served an apprenticeship under a master of the art, and not one who has merely dabbled in surgery while attending cases of pneumonia, typhoid and measles.

A good surgeon of this soi t does not temporize with a cancer. He knows that the operation must be performed immediately, and that there must be no fatuous endeavor to conserve healthy tissue. It is far better to remove two inches of sound flesh than to err on the cautious side and leave behind one microscopic cancer cell. It is only by such radical and merciless surgery that we may combat cancer. We must take it in time, and we must cut deep and wide.

And even then we are never sure.

No man has any right to expect to live differently to-morrow from the way in which he is living to-day. What he chooses to-day he chooses for to-morrow. What he overcomes to-day he is overcoming for to-morrow. What he yields to to-day he is still more likely to yield to to-morrow. Yet most of us live as though we did not believe this, and we try hard to persuade ourselves that we are safe in so living.