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.

In the large majority of cases, except those who had been surgically operated on, the diagnosis was clinical only, as it is an accepted fact that it is very unwise to make a biopsy, even before surgical removal, and manifestly improper where this is not undertaken; but in most of the cases there was the independent diagnosis of one or more other medical men, and many of the patients came to me on account of threatened operations by prominent surgeons, and even after these had been arranged for; in 27 cases there had been previous surgical removal with recurrence, and in several cases more than one operation, with again recurrence.

The exact duration of cancer before coming under observation is always an uncertain item, for undoubtedly a tumor starts in an individual cell or group of cells, and has probably been forming some time before being noticed by the patient or attracting attention in any way. The average stated duration of the disease was 1.6 years before coming under observation.

Surgeons are fully agreed that the earlier a tumor is recognized and removed the better the prospect of ultimate success, and this is eminently true in regard to remedial measures other than surgical: for as we have seen, after a cancerous process is well under way its cells secrete a something which hastens the general depravement of the system, and quickens the growth of the neoplasm, and naturally greatly increases the difficulty of overcoming the dyscrasia.

Thus in the effort to get at and remove all possible or prospective cancerous lesions, many innocent or non-malignant adenomata, etc., are operated on, which are afterwards found to be such microscopically. In the same way it is quite possible that some of the small breast tumors which have disappeared under the dietetic and medical measures here described were still non-malignant, and should not be grouped with carcinoma.

It is fair to say, therefore, that among my notes are also 22 cases of breast tumors which have been excluded from the carcinoma list, and entered with other titles, such as abscess, cyst, chronic mastitis, adenoma, etc. But I claim that even if some of these also disappear under the measures we are considering, as they frequently have done, it is a better and more desirable result than if they had been removed by the knife: for in the former case the cause which induced the unnatural growth has been overcome, whereas by surgery only the obnoxious mass has been dislodged, and perhaps with it adjoining tissue and glands, but nothing has been accomplished toward checking the cause producing the offending lesion. But the very fact of the frequent recurrences after operation, in the neighboring skin or elsewhere, demonstrates the fact that surgery is but an attempt to rectify past errors, which might or might not have been prevented by careful medical foresight and action; we must, however, be thankful for the measure of success which has followed the noble efforts of our distinguished surgeons, only it is to be hoped that hereafter other measures will also be more commonly adopted, looking towards a prevention of the recurrence of carcinoma after operation.

Not to detain you too long with these clinical considerations, I would like to give the details of a few of the cases which have been most striking.

Mrs. B. E. C., aged 44, was first seen on account of trouble in the right breast, on September 19, 1892. She then had a flat tumor in the outer lower segment, an inch and a half in diameter, rather sharply defined, and tender on pressure at the sides, which she had noticed about two months. Not satisfied with the diagnosis of cancer, and hesitating at the thought of medical treatment, she consulted a well known, prominent surgeon, who pronounced the tumor as undoubtedly cancer, and urged its instant removal; this I did not know until she informed me of it some time later, after the tumor had entirely disappeared under treatment. I saw her at frequent intervals for six months, and the breast became entirely normal. Four years later she was again seen in regard to the menopause, which she was undergoing, and the breast was found still to be normal: she was maintaining her diet. Nearly three years later I learned from her husband that she was in perfect health, with absolutely no breast trouble, and for eight years later, while he himself was under occasional treatment, I learned repeatedly that she remained still perfectly well, over sixteen years after beginning treatment, with no recurrence of the breast tumor.

Miss B. M. L., aged 45, was first seen on January 4, 1894, with a tumor in the left breast, which had been diagnosed as cancer by three medical men, and one of them, a surgeon of prominence, had arranged for immediate surgical removal the next day. The mass was situated in the upper and outer quadrant, well defined, not painful on moderate handling, but subsequently she experienced pain in it. Two months later the lump was recorded as less distinct and flatter, and within eleven months it had entirely disappeared. A month or two later she had some pain in the breast, in connection with the menstrual disturbance accompanying the menopause, but no trace of the tumor. On Nov. 8th, 1905, she called, bringing a relative for treatment, and the breast was found perfectly normal, and again five years later she called, with another trouble, the breast still remaining perfectly well, also sixteen years after first coming under treatment.

Miss J. M. A., aged 45, was first seen October 12th, 1905, with a tumor of the left breast, above, toward the median line, near the nipple, not painful on handling, though there was some pain afterwards, and it had been awaking her with pain at night for some months, with also a numb, shooting pain in the daytime. She had seen a number of medical men always with the diagnosis of cancer, but she had declined operation. Two months later, Dec. 15th, 1905, it was recorded that there was very little to be felt in the breast, and there was no pain at any time, and on January 5th, 1906, both breasts were the same on palpation, with no sign of the former tumor. For one reason or another she has been seen from time to time, almost up to the present date, and remains perfectly free from her former trouble, a period of over nine years. She has been a most faithful patient, adhering strictly to diet and more or less medication, except when on certain occasions I have let up on the same; and all the time from the first she has been under great strain of work, mental and physical, as a city missionary.

Another very similar case was in the person of Miss G. M., aged 44, who has been under constant observation and treatment off and on for various troubles from November 13, 1905, until yesterday. Fifteen years previous to her first visit she had fallen and struck the left breast which was bruised, but the effects wore off in some months, and there was no sensation in the breast for some years. Then 7 or 8 years later she began to have pain in the breast, aggravated before and during menstruation, which had continued until her visit, and for the last months she had been kept from her work in school, the pain being severe in the breast, and more recently in the axilla: in July there had been bleeding from the nipple. She had seen a number of medical men, with the diagnosis of cancer, and one surgeon of prominence in one of the large hospitals had strongly pressed for an immediate operation.

When first seen there was a tumor between two and three inches in diameter, in the upper, inner segment of the left breast, hard, sharply defined, and more or less nodular on the surface: there were some enlarged glands in the left axilla. She had long been constipated and was passing about 60 per cent. of the amount of urinary solids proper for her weight. Under very active treatment it was recorded four weeks later that there had been hardly any sensations in the breast during the previous week, that the tumor had diminished materially in size, with only moderate hardness, and that she was now out doors every day, and feeling much better. One month later it was recorded that the breast was very well and on examination was almost the same as the other, there being some general caking in both: she had had no pain for some time. One month or so later she was again at her duties as a public school teacher, which she has continued at since, with rare exceptions, when some temporary ailment prevented: the lump in the breast did not wholly disappear for a month or two later, but on April 7th it was recorded that the left breast was the same as the other, and no glands could be felt in the axilla.

From that time to the present she has had a variety of troubles, rheumatic and other, and it has been difficult to keep up a proper action of the bowels and kidneys; but in spite of strenuous and often exhausting work as a New York City public school teacher, she has had no return of the breast trouble, now for over nine years. A sister, aged 60, has just died with cancer of the stomach in a distant country town.

I could multiply these histories but do not want to tire you, though I do want to mention one more patient, to show what can be done in the case of recurrent carcinoma, after operation, of which I have had a number of cases with varying results, according to the duration and severity of the disease.

Miss H. M., aged 61, came to me June 21st, 1913, with the following history: About two years previously a lump appeared in the outer, lower segment of the left breast, which was removed in August, 1911; this healed soon, leaving a good axillary scar, and there was no thought of trouble until two months before her visit, when a small red spot appeared near the edge of the sternum. This enlarged and hardened and others appeared around the scar, until, when seen there were a dozen red nodules up to half an inch in diameter, near the center of the former site of the breast, with others, not red, above; with the tense skin and rapidly developing, multiple nodules here and there, further surgical operative procedure was out of the question.

Since that date she has been under strict vegetarian diet and medication, including thyroid from time to time, with repeated application of X-rays, and under all these measures together many of the nodules have disappeared; although some new ones have formed, several of which have been removed under local anæsthesia, the wounds healing kindly. As she resides some distance from the city she has not been seen since October 7th, 1914, she wishing to take the X-rays nearer home, but she was earnestly charged to continue also the dietetic and other treatment. In this instance the patient has lived comfortably and without pain for almost sixteen months after coming under treatment, and, although she has lost some flesh, the active cancerous process, which would otherwise have carried her off long ago, has been in a measure checked. What will be the further history of the case one cannot tell, for it is quite possible that being away from my care she may neglect dietetic and medicinal treatment, trusting only to the X-rays, which, of course, cannot influence the real nature and course of the disease.

Reference was made to certain cases of recurrent cancer in the Hospital which had been under active medical treatment during the past year, with careful laboratory studies, but it is naturally too early to report anything very definite in regard to them, especially as most of them were desperate cases, which had advanced far beyond any possible operative relief. Moreover several of them remained but a short time under treatment, as it is very difficult to convince this class of patients that any possible benefit can accrue from anything but an operation, and this being impossible they often give up and leave, preferring to die at home; moreover the dietary restraint seems also very irksome and useless to them and their friends. In one particular patient, however, there was such a remarkable improvement that it is worth reporting to you.

Mrs. C. M. was first seen February 12th, 1914. Nineteen years previously she had an abscess of the right breast, which healed and left a tumor the size of a pigeon’s egg in the inner, upper quadrant of the breast; this remained quiescent until it began to enlarge, eleven months before it was removed at the New York Skin and Cancer Hospital, November 14th, 1912. The tumor was then about the size of a hen’s egg, with an area of skin the size of a quarter, attached to it: a second tumor was felt just below the nipple, which was not retracted, and the axillary glands were involved: there were no signs of metastases in the abdomen. A complete operation was then performed, with dissection of the glands in the axillary and supra-clavicular regions, and she was discharged January 16th, 1913.

On February 9th, 1914, she returned to the Hospital and was placed under medical treatment, with vegetarian diet. There was then an ulceration along the line of incision, from the second to the fourth rib, with many nodules around it, averaging a third of an inch in diameter, raised and reddened. The liver extended two inches below the edge of the ribs, with a hard and nodular margin; the right arm was enormously swollen and helpless. When she left the Hospital, June 20th, 1914, the ulcer had entirely closed, many of the cutaneous nodules had entirely disappeared, the arm had returned to normal size, like the other, by measurement, and the liver had retracted to a trifle below the margin of the ribs, with hardly any nodules to be felt. The treatment had included twenty-five X-ray exposures, from 8 to 10 minutes each, about twice a week, over three areas each time.

While in the Hospital careful laboratory investigations were made, according to a definite schedule. The blood, studied weekly, maintained a hæmoglobin of 80+ for over two months, then fell a little, and again rose. The erythrocytes were 3,262,000 on entering, and rose within two months to 4,282,000, then fell a little and rose again to almost 4,000,000: the leucocytes were 9,000 on entering, and fell to 5,200 just before leaving, the poly-nuclear 69 per cent. on admission, fell to 60 per cent., and again rose a little, and the proportion of the other forms remained about normal. The urine, volumetrically analyzed every three days, was kept a little below the normal acidity, and the specific gravity a little low, with a free daily amount of excretion, largely by Bethesda water: in spite of the vegetarian diet the urea excretion was not much below normal, and sometimes above, the chlorides were diminished, owing to the rather small amount of food taken, the phosphates varied a little above and below normal, there was never any indican, and the sulphates averaged a trifle below normal. The saliva, tested before and after each meal, was acid at first, but became neutral and alkaline off and on. The weight, taken weekly, fell a little from the first, but maintained a good level, and rose a little before she left the Hospital.

This was a very difficult patient to manage, as she was a very ignorant Polish woman, who often rebelled at the diet, and wearied of the routine and restrictions imposed; she left the Hospital June 20th, 1914, against my wish, but with as great a change in her physical condition and disease as could be imagined, after about four months and a half treatment, carried out under disadvantageous circumstances.

One other case, seen recently, where the disease was recurrent after three operations, deserves mention, although it will be some time before any decisive result can be reported.

Mrs. W. C., aged 45, was first seen September 17th, 1914. Nearly four years previously she had noticed a lump in the left breast which was removed on January 6th, 1911, but it soon regrew, and a complete operation was performed at the New York Skin and Cancer Hospital, May 30th, 1911. Two years later there was some return, and she was again operated on at the Hospital, May 30th, 1914. About two months before her first visit, September 17th, 1914, a swelling of the sternum was noticed, and soon another above it, both of which increased pretty rapidly to the time of her visit. When seen there was a hard mass in the scar over the sternum, about an inch and a half long, raised a quarter of an inch or so, reddened and immovable: an inch or so above it was another, smaller one, not reddened: they were not particularly painful on moderate handling, but painful when at hard housework. When last seen, December 7th, both lumps had subsided fully one-half, there was no pain at any time, and her general condition had improved immensely, she feeling better than she did four or five years ago, that is, before the beginning of the cancerous development: she has been working all the time, unusually hard, as janitor of four buildings and also going out scrubbing and washing. She weighed 157¼ pounds when first seen, then ran down to 154, but is again gaining, being 155½ at her last visit. The outcome of this case it is, of course, impossible to conjecture, for one can seldom be sure that patients will be absolutely faithful to treatment, for a long enough time, but certainly the change in the woman and in the lesions in this two months and a half has been remarkable, compared with the increasing development of the disease in the two months previous.

I must mention one more case, which, although fatal, exhibited some of the good results of careful medical treatment even when a primary case had advanced far beyond the possible aid of surgery.

Mrs. M. B. J., aged 68, a private patient, was first seen on February 17th, 1914. Two years previously she noticed a lump in the upper part of the right breast, after great and repeated mental distress from the death of a number of very near relatives, and a sister’s mental derangement; the great nervous strain had been attended with various bilious attacks and nervous indigestion. The mass increased steadily in size and was kept concealed even from her family, until the day before she called, when her family physician who was consulted saw that it was far beyond the possible hope from any operation, in which view a surgeon concurred.

When seen the whole breast was involved, was double the size of the other, hard, immovable, and with an adherent crust over an ulcerating surface on its lower half, several inches in diameter, from beneath which was a moderate discharge: the axillary glands were enormously enlarged, as also the supra-clavicular, and she was strongly cachectic. She was placed on an absolute vegetarian diet, with no coffee or tea, and appropriate medical treatment, and the breast kept painted with fifty per cent. ichthyol and water, care being taken not to disturb the adherent crust. In a very short time the discharge ceased, and the protective crust adhered until her death from exhaustion, with pulmonary œdema, on September 9th, 1914. On August 15th it was recorded that the breast had done very well, that it was soft and movable, and not larger than the other breast, with no discharge, and no pain since a short time after beginning treatment: the axillary glands had diminished three-quarters in size, and the supra-clavicular glands were also very much smaller.

And now, gentlemen, my task is done. I have tried to let you see cancer through my spectacles, as I have seen it for very many years past, and to share with me my optimism in regard to the prophylaxis and cure of cancer, if only there can be sufficient enlightenment in the profession and public: and I must tell you that in collating and preparing the material to support my long held views I have expended very much more time and labor in study, for some months past, than I could have believed possible. But as the subject developed, and as I discovered more and more support for my thesis, there was a fascination about the work which I could not resist; and if I have tried you with the many details of proof presented I beg that you will pardon me: for I wanted to present the subject so strongly that my hearers, at least, would accept the propositions I have developed, and believe what I have said in regard to my own experience with the terrible disease under consideration, and act upon both, and thus aid some sufferers with cancer.

From my recent article on “The Relation of Diet to Cancer” many medical journals have quoted me as ascribing the disease wholly to the use of meat, but you who have heard these lectures now know that animal proteids are only one of the contributing causes.

I have tried to make it plain that metabolic errors, inducing a vitiated blood stream, are the basic cause of the aberrant action in the cellular elements of the body which may ultimately lead to malignant disease; and I have tried to show that there are many elements connected with modern so-called civilization which conspire to effect this end. I have quoted many who were well acquainted with cancer, who believed that luxurious living, which includes much animal food, coffee and tea, and alcohol, with indolence or want of sufficient muscular activity to burn up the waste products, and the persistent neglect of hygienic laws, should be placed first among the causes of cancer: but I have also mentioned that the refining and preparation and cooking of food prevented a proper supply of the mineral and other elements of nutrition, and also that nervous influences could so disturb the action of the organs of the body that they could not perform their functions perfectly in the elaboration of nutritive material, etc.

But I cannot go over again all the matter already given in these lectures, and only mention these to remind you that there is no one single cause of cancer, and consequently that its prophylaxis and cure can never be found in any one single remedy; hence I can never believe in the sole use of thyroid, much less in the idea that sero-therapy can overcome a disease dependent upon the continued operation of so many causes; and still less can I believe that the mere cutting out of an already diseased portion of the body is the proper and only means of overcoming such a malady as cancer.

I have acknowledged that local irritation of many kinds may be the proximate cause for the development of a malignant tumor in any particular locality, as Ewing has so clearly shown in his excellent resumé on pre-cancerous lesions; but I have also contended that we should withal look into and overcome the cause; why, when once started by local injury the cells should pursue such a progressive, aggressive, and invasive course; and this is found, I believe, in the disturbed character of the fluids which provide them with nourishment for their abnormal growth.

From this study of cancer in regard to its nature, frequency, geographical distribution, metabolism, dietetic relations, medical treatment, and clinical considerations, what conclusions can be drawn? Have we solved the problem of cancer? Far be it from us to make any such claim. Scientific research and study must still go on in the laboratory, but clinical research and study, with laboratory work, on the human subject, which have not been hitherto sufficiently cultivated, should be pushed, so that by a mass of carefully recorded observations the truth or falsity of what has been here quoted and said may be refuted or confirmed.

From the enormous work which has been done on cancer with the microscope and the test tube, it would seem sometimes that research workers have become somewhat myopic, and not farsighted enough to recognize the true value of statistical studies and clinical observations. In these lectures we have attempted to make a brief synthetic study of some of the work which has been done in connection with cancer, and from this we believe that certain conclusions can be drawn; if these are correct and followed, it is hoped that much more can be accomplished in regard to the prophylaxis and cure of this more than threatening, fatal malady. In order that you may hold clearly the points which have been made I want to give you a synopsis or conclusions of them, as they have been brought out in this and preceding lectures.

1. Cancer is but a deviation from the normal life and action of certain of the ordinary cells of the body, which, for some as yet unexplained reason, take on an abnormal or morbid action; with this there is a continued tendency to a malignancy which invades contiguous tissue, and in the end tends to destroy life.

2. There is some reason to believe that this action first takes place in what are known as “embryonic rests,” or pre-natal, wrongly placed tissue elements, which, however, are now shown to exist in every one, in many localities: but the reason why they take on this malignant action, and form cancer, has not been satisfactorily explained.

3. Cancer is not wholly due to traumatic causes, although those play a not inconsiderable part in its occurrence in certain localities and cases.

4. It is pretty conclusively decided that cancer is not caused by a micro-organism, or parasite.

5. It is also known clinically and experimentally that it is not contagious.

6. Nor is it hereditary in any appreciable degree.

7. Occupation has not any very great influence on the occurrence of cancer, although it is more frequent in some pursuits than in others.

8. Cancer is not altogether a disease of older age, although its incidence is greatly increased with advancing years.

9. It does not especially belong to or affect any particular sex, race, or class of persons.

10. It is not confined to any location or section of the earth, but has been observed in all countries and climates.

11. No single cause of cancer has yet been demonstrated, nor is it likely that this will ever be the case, as the experimental and other investigations have covered almost every possible line of research, with only negative results.

12. The exclusion of almost every other possible cause of cancer, as well as its pathological history, leads to deranged metabolism as the only remaining possible etiological element; this acts by inducing changes in nutrition, which latter depends on diet and the proper action of the secretory and excretory organs, which, still further, may be affected by nervous influences.

13. While the bio-chemistry of cancer throws little light on its true nature, enough is known to show that the morbid changes in the cells are largely associated with deranged metabolism.

14. The blood, in advancing cancer, manifests changes which indicate vital alteration in the action of the organs which form blood and control the nutrition of the body and its cells.

15. Clinical and experimental evidence demonstrate that the secretions and excretions of the body exhibit departures from normal, which, while not pathognomonic of cancer, indicate metabolic disturbances involving the nutrition of the cellular elements, which disturbances are of importance.

16. The evidence seems certain that the cancer mass itself, when fully developed, secretes a poison which tends to augment its own growth and hastens the lethal progress of the disease.

17. Cancer mortality is undoubtedly on the increase in every portion on the globe.

18. This increase seems to vary inversely with the decline of tuberculosis, in many localities.

19. The incidence of cancer seems to follow closely along the lines of modern civilization.

20. This extension of cancer seems to depend largely upon the altered conditions of life, particularly along the lines of self-indulgence in eating and drinking, and indolence.

21. The augmentation in the consumption of meat, coffee and alcoholic beverages appears to be coincident with a very great, and proportionately greater, augmentation of the mortality from cancer.

22. The nerve strain of modern life seems to be an element of importance, both through disturbance of metabolism, and by direct action on morbidly deranged cells.

23. No single remedy for cancer will probably ever be discovered, since it is conceded that there is no single cause for the disease.

24. Surgery has improved materially the statistics relating to the mortality of operative cases; but the total achievements along this line are insignificant compared with the general ultimate mortality of over 90 per cent. of those once afflicted with cancer.

25. Surgery has had, and may long have its function to perform in removing the products of the disease, more or less efficiently, curing some and prolonging the life of others, but it can never hope to lessen greatly the morbidity of cancer.

26. The X-ray and radium, as also caustics, are in the same position as surgery, and can do relatively little more than cause to disappear lesions which have developed from causes which they cannot reach.

27. With all these means the measure of success, aside from the technical skill of the operator, largely depends on the time or period of development of the malignant tumor before treatment; the earlier the removal is undertaken, other things being equal, the greater the possibilities of success.

28. The same is true in regard to the treatment of the disease by means other than those mentioned: the earlier the morbid process leading to tumor formation is attacked by dietetic, hygienic, and medicinal measures, the greater the promise and expectation of success, present and permanent.

29. The prevention of cancer, therefore, or the checking of its increasing occurrence, depends largely upon the early enough adoption of such measures as will limit the agencies which induce a derangement of the body juices which tend to bad nutrition and derangement of the body cells.

30. The simple life, with the avoidance of the dietetic and other causes which have been found to induce cancer in nations and individuals, promises the best hope for the arrest of the rapidly increasing development of cancer throughout the world.

31. It is more than possible, however, that the long continued operation of many baneful causes has produced such a degeneration of tissue in the human race, that it will take a generation or more of proper living to make the beneficial impression on the general incidence of cancer which is so longed for.

BIBLIOGRAPHY

1. ABDERHALDEN—Defensive Ferments. New York, 1914.

2. ABERNETHY—Surgical Observations on Tumors. Lond., 1816, 221.

3. BAINBRIDGE—Medical Record, 1909, LXXVI, 85.

4. BAINBRIDGE—The Cancer Problem. New York, 1914.

5. BANKS—Lancet, 1900, I, 684.

6. BEARD—The Enzyme Treatment of Cancer. Lond., 1911.

7. BEEBE—New York Medical Journal, 1910, LXXXII, 1058.

8. BELL—Cancer: Its Causation and Its Curability Without Operation. London, 1903.

9. BENEKE—Berl. Klin. Wochenschr., March 15, 1880.

10. BENRATT—Indian Med. Gaz., 1908, XLIII, 452.

11. BIEDL—The Internal Secretory Organs. New York, 1913.

12. BLUMENTHAL—Handb. d. Spezial Pathol. d. Harns., 1913, 263.

13. BRAITHWAITE—Lancet, 1902, I, 400.

14. BRAITHWAITE—Plainer Food and Less of It. London, 1908.

15. BRISTOL—Medical Record, 1913, LXXXIII, 787.

16. BULKLEY—Relations of Diseases of the Skin to Internal Disorders. New York, 1906.

17. BULKLEY—Some Problems in Metabolism, Jour. Cutan. Dis., 1911, XXIX, 217.

18. BULKLEY—Diet and Hygiene in Diseases of the Skin. New York, 1913.

19. Bureau of Agriculture, 28th Annual Rep. Washington, 1911.

20. BURNHAM—Hæmocytes and Hæmic Infections, 1913; 92; 138.

21. BUTTNER—A Fleshless Diet. New York, 1910.

22. CAHEN—Deut. Zeitschr. f. Chir., 1909, CXIX, 415.

23. CHITTENDEN—Physiological Economy in Nutrition, 1904.

24. COHNREICH—Folia Hæmatologica, 1913, XVI, 307.

25. COOPER, SIR ASTLEY—Lectures on Surgery, Boston, 1825.

26. DE BLOEME, SWART, and TERWEN—Munch. Med. Wochenschr., 1914, LXI, 1718.

27. DEGREZ—Gaz. Med. de Paris, 1913, LXXXIV, 400.

28. EINHORN, KAHN and ROSENBLUM—Arch. f. Verdauungskr., 1911, XVII, 557.

29. EWING—Cancer Problems, Report of the C. P. Huntington Fund for Cancer Research, Vol. II, 1908.

30. EWING—Medical Record, 1914, LXXXVI, 951.

31. GRUNER—Biology of the Blood Cells, 1913, 153; 260.

32. GWYER—Ann. of Surgery, 1907, XXXXVI, 86; 643, 1908, XXXXVII, 506; 631.

33. HAIG—Uric Acid as a Factor in the Causation of Diseases. Phila., 1908, 420.

34. HAIG—Brit. Med. Jour., 1912, II, 81.

35. HARROWER—Practical Hormone Therapy, 1914, 29.

36. HISLOP AND FENWICK—Brit. Med. Jour., 1909, II, 1222.

37. HUTCHINSON—Food and Dietetics. New York, 1911, 324.

38. ISENBERG—Monotschr. f. prakt. Wasserheilk, 1910, XVII.

39. JANEWAY—Sajous’ Anal. Cyclopedia of Pract. Med., 1912, II, 753.

40. JOHNSON—Brit. Med. Jour., 1900, II, 982.

41. JONES—Arch. Middlesex Hosp., London, 1911, XXIII, 72.

42. KAHLE—Munch. Med. Wochenschr., 1914, LXI, 752.

43. KEITH—Cancer: Relief of Pain and Possible Cure. New York, 1908.

44. KEITH—British. Med. Jour., 1909, II, 140.

45. KESSLER—New York Medical Journal, 1912, XVIC, 1122.

46. LAMBE—Additional Reports on the Effects of a Peculiar Regimen of Cancer. London, 1815.

47. LITTLE—Boston Med. and Surg. Jour., 1914, CLXXI, 587.

48. MAYO, W. J.—Annals of Surgery, 1914, LIX, 805.

49. MCCANN—Starving America. New York, 1912.

50. MCGREGOR—Brit. Med. Jour., 1900, II, 982.

51. MERRIAM—St. Louis Courier of Med., 1884, XII, 385; New York Medical Journal, 1912, XVIC, 378.

52. Mortality Statistics, Bureau of the U. S. Census, 1911, 1912.

53. MURPHY’S Clinics, Aug. 1912, Dec. 1912, Aug. 1913, Oct. 1913, Dec. 1913, Feb. 1914, June 1914.

54. NOWELL—New England Med. Gaz., 1914, XLIX, 461.

55. PACKARD—Boston Med. and Surg. Jour., 1912, CLXVI, 452.

56. PAGET—Lectures on Surgical Pathology. Philadelphia, 1854, 632.

57. PARKER—Cancer. New York, 1885.

58. REID—Cancer Research Laboratory, Manchester Medical Chronicle, Nov. 1912, and April 1914.

59. RENNER—Brit. Med. Jour., 1910, II, 587, also 1911, I, 110.

60. ROBERTS—Lectures on Dietetics and Dyspepsia. London, 1886, II Edition.

61. ROBIN—Bull. Gen. de Therapeutique, 1913, CLXVI, 433.

62. ROHDENBURG, BULLOCK, and JOHNSON—Arch. of Int. Med., 1911, VII, 491.

63. ROSS—Cancer, Its Genesis and Treatment. London, 1912, 88.

64. ROUS—Jour. of Exper. Med., Lancaster, Pa., 1914, XX, 433.

65. RUSSELL—Preventable Cancer. London, 1912, 96.

66. SAJOUS—Monthly Cyclop. and Med. Bull., 1912, V, 219.

67. SAJOUS—Internal Secretions, Vol. I, 785.

68. SALEEBY—The Conquest of Cancer. New York, 1911.

69. SANDWITH—Clinical Journal, 1910, XXXV, 409.

70. SCHMIDT—Medizin Klinik, 1910, VI, 1690.

71. SHERMAN—Chemistry of Food and Nutrition. New York, 1911, 260.

72. SHERRINGTON and COPEMAN—Brit. Med. Jour., 1910, II, 787.

73. SHIRLAW—Liverpool Medico Chir. Jour. 1913, XXXIII, 398.

74. SOEGARD—Zeitschr. für Krebsforsch, 1913, XIII, 89.

75. STUART-LOW—Lancet, 1909, II, 1138.

76. SWEET, CORSON, WHITE, and SAXON—Proceed. Soc. for Exper. Biol. and Med. New York, Vol. X, 175.

77. THOMPSON—Practical Dietetics, 1909, 256.

78. TROISIER—Gaz. des Hospiteaux, 1913, LXXXVI, 2221.

79. TUKE—Illustrations of the influence of the mind upon the body in health and disease. London, 1872.

80. TURCK—Vorlesungen Über Klin. Hæmatologie, 1912.

81. VENUS—Centralbl. f. d. Grenzenb. d. Med. u. Chir., 1910, XIII, 209.

82. VINCENT—Internal Secretions and the Ductless Glands. London, 1912.

83. WAKEFIELD—American Medicine, 1904, VII, 659.

84. WALSHE—The Anatomy, Physiology, Pathology, and Treatment of Cancer. Boston, 1844.

85. WATSON, CHALMERS—Food and Feeding in Health and Disease. New York, 1912. Appendix.

86. WELLS—Chemistry of Tumors, Chemical Pathology, 2nd Ed., 1914.

87. WILLIAMS—The Natural History of Cancer. New York, 1908.

88. WOLF—Zeitsch. für Krebsforsch., 1905, III, 95.

89. WOLFF—Die Lehre von der Krebskrankheit, Jena, 1913.

90. WOLTER—Chemistry of Cancer, Brockesn. Zeitschr., 1913, LV, 260.

INDEX

Abderhalden, defensive ferments in cancer, 78

Abernethy on vegetarian diet, 136

Aborigines, freedom from cancer of, 48, 116

Abstemiousness, effect on cancer, 139

Acid, amino nitrogen, increased in cancer, 91

Acid intoxication in cancer, 77

Acidosis in cancer, 80

Acids, oxyproteic, in the urine, increased in cancer, 90

Addison’s disease, 97

Adrenals, relation to cancer, 98

Africa, absence of cancer in, 50, 52

Agamogenesis, relation to cancer, 72

Age affecting cancer, 22

Ages of patients with cancer, 176

Agnew on surgery in cancer, 170

Alcohol, relation to cancer, 120

Alkalinity of blood, diminished in cancer, 77

Amino-acid nitrogen, increased in cancer, 91

Ammonia fraction of nitrogen, increased in cancer, 91

Amylopsin in cancer, 99

Anabolism and cancer, 33

Anæmia in cancer, 74

Animal food a cause of cancer, 50, 51, 52, 55, 63, 69, 110, 113, 116, 117, 132, 138, 141

Animals, cancer in, 43

Argentine Republic, cancer in, 57

Australia, cancer in, 48

Auto-intoxication and cancer, 155

Autonomous action of cells, 33

Bainbridge, local nature of cancer, 30

Baltimore, cancer in, 65

Banks, Sir William, on diet in cancer, 61

Bashford, 55

Beard, trypsin in cancer, 99

Beatson’s operation, 102

Beebe, diet and cancer, 80

Beirut, rarity of cancer in, 56

Bell, cancer from neglect of hygienic laws, 132

Beneke, diet in cancer, 115

Benratt, rarity of cancer in India, 53

Betel chewing cancer, 54

Biedl, hormone formation, 163

Bio-chemistry of cancer, 39, 79, 83

Blood changes in cancer, 74, 191 frequent study of, in cancer, 160

Blumenthal, oxyproteic acids increased in cancer, 90

Boston, cancer in, 65

Bowel action and cancer, 155, 157

Braithwaite, plainer fare and less of it, 154 salt and cancer, 129

Brazil, rarity of cancer in, 57

Breast, carcinoma of, 176 non-cancerous tumors of, 178

Bristol, disturbance of chemical equilibrium causing cancer, 143

British Guiana, rarity of cancer in, 50

Burnham, blood changes in cancer, 76

Butter, valuable in cancer, 153

Buttner, a fleshless diet, 154

Cachexia in cancer, 74, 77

Caffeine, nitrogen in, 119 percentage of, in coffee, 119

Cahen on Beatson’s operation, 102

Calcium salts, effect on cancer, 101

Cancer in the occupied and unoccupied, 130 personal statistics of, 176 problem, 201

Carcinoma, personal statistics of, 174

Casein sometimes allowable in cancer, 153

Cases, personal, of cancer, 180‒197

Catabolism and cancer, 33

Causes of cancer, 27

Centrosomes in cancer, 34, 85

Cheese sometimes allowable in cancer, 154

Chemistry of cancer, 39, 79, 83 of cancer tissue, 78, 82 of the body, 107

Chicago, cancer in, 65

China, rarity of cancer in, 55

Chittenden’s experiments on nutrition, 112

Chlorides in the urine, diminished in cancer, 92

Cholesterin, relation to cancer, 83

Chromosomes in cancer, 85

Civilization, cancer a disease of, 44, 46, 50, 68, 109, 117

Clinical considerations, 170 study of cancer, 17, 18

Coffee, consumption in United States, 118 nitrogen in, 119 relation to cancer, 117

Cohnreich, blood in cancer, 76

Cold storage, relation of, to cancer, 109

Composition of human body, 107

Conclusions, 170, 203

Constipation and cancer, 157

Contagiousness excluded, 19

Cooper, Sir Astley on constitutional nature of cancer, 139

Creoles in Africa, freedom from cancer of, 52

Cytology of cancer, 74

Danger from thyroid in cancer, 164

Deaths from cancer in New York City, 145 in United States, 144

De Bloeme, Swart, and Terwen, imperfect nitrogen partition in cancer, 90

Defective urinary excretion and cancer, 158

Deficiency of urinary solids in cancer, 88

Definition of cancer, 30

Degrez, imperfect nitrogen disintegration in cancer, 91

Denmark, cancer in, 82

Demineralization and cancer, 113

Diabetes, relation of to cancer, 95

Diet, effect of simple, in cancer, 121 relation of, to cancer, 46, 51, 53, 55, 57, 61, 63, 67, 80, 106, 115, 116, 133, 198

Dietetic treatment of cancer, 171

Disordered metabolism the cause of cancer, 74

Ductless glands in cancer, 97

Duration of cancer before treatment, 177

Early treatment of cancer, medically, 147, 178, 208 surgically, 177

Eating, wrong- and over-, and cancer, 152

Egypt, rarity of cancer in, 51, 57

Ehrlich, effect of diet on cancer, 37

Einhorn, Kahn, and Rosenblum, imperfect nitrogen partition in cancer, 90

Embryonic rests in cancer, 23, 25, 72

Endocrinous glands, relation of, to cancer, 100

England, cancer in, 51, 57, 61 increase of cancer, with meat consumption, 116

Environmental change and cancer, 59

Enzymes, autolytic, in cancer tissue, 83

Equilibrium of tissue elements, 111

Esmarck and Oldehop, vegetarian diet in cancer, 115

Etiology of cancer, 74

Ewing, change in polar axis of cells in cancer, 34 relation of cholesterin to cancer, 83

Far East, rarity of cancer in, 55, 56

Fiji Islands, rarity of cancer in, 50

Fletcher, imperfect insalivation and cancer, 94

France, cancer in, 62

Frequency of cancer, 43

Functional kidney derangement and cancer, 158

Geographical distribution of cancer, 43

“Germ of cancer,” 19

Gigantism, 97

Gout, relation to cancer, 72, 81

Gratifying the taste, a cause of cancer, 108

Gruner, toxicity of cancer juice, 78

Gwyer, thymus feeding in cancer, 101

Haig, cures of cancer by dietary restrictions, 141 uric acid and cancer, 125, 141

Harrower, relation of ductless glands to cancer, 97

Heredity, influence of, 20

Heterologous elements in cancer, 41

Highest cancer mortality, 62

Hislop and Fenwick, diet and cancer, 50

Holland, high cancer mortality in, 118

Hormones, relation of, to cancer, 100

Hormone therapy in cancer, 162

Hungary, low cancer mortality in, 118

Hutchinson, amount of caffeine in tea and coffee, 119

Hygienic laws, neglect of, a cause of cancer, 132

Hyperacidity and cancer, 33

Ichthyol locally in cancer, 166, 167

Ideally correct blood stream and cancer, 149

Increase of cancer, 47 in the United States, 66

Incurable cancer, 146

Independent cell action, 73

Indians, North American, rarity of cancer in, 67

India, rarity of cancer in, 53

Infectious diseases and cancer, 29

Inoperable cancer, 146

Insalivation, thorough, importance of in cancer, 95

Internal secretions in cancer, 96‒103

Intestinal fermentation in cancer, 92, 155 stasis and cancer, 155 toxins and cancer, 155

Intolerance of certain articles a cause of disease, 127

Intoxication, intestinal, and cancer, 155

Iron, value of, in cancer, 161

Irritation, local, and cancer, 124

Isenberg on vegetarian diet in cancer, 142

Italy, low cancer with low meat consumption, 63

Jones, blood in cancer, 76

Kahle, silica retention in cancer, 98

“Kangri burn” cancer, 54, 126

Keith, Skene, iron in cancer, 161

Kellogg, absence of cancer with normal metabolism, 151

Kerry, Ireland, low cancer mortality, 64

Kessler, sulphur partition in cancer, 122

Kidneys, faulty excretion and cancer, 157

Korea, rarity of cancer in, 57

Laboratory study of cancer, 175, 191

Lambe on vegetarian diet, 136

Lane, Sir Arbuthnot, intestinal stasis and cancer, 155

Latham on cancer of the unoccupied, 61

Leucocytosis in cancer, 75

Lithæmia, relation to cancer, 72

Liver, condition of in cancer, 91

Local irritation and cancer, 21, 124 medical treatment, 165

Lott, Beatson’s operation for cancer, 102

Lowest cancer mortality, 60, 64

Lucerne, cancer in, 62

Luxurious living a cause of cancer, 68, 138, 199

McCann, erroneous preparation of foods, 123

McGregor, absence of cancer in Fiji Islands, 50

Madden, absence of cancer in Africa, 50

Malaria and cancer, 21

Mastication, thorough, importance of in cancer, 95

Mayo, acidity and cancer, 124

Meat consumption, in England, 116 in the United States, 69

Meat, relation to cancer, 51, 53, 55, 57, 63, 116

Medical treatment of cancer, 135, 154

Melanesians, exempt from cancer, 50

Mental depression, influencing cancer, 86 strain, relation to cancer, 81, 85

Merriam, meat diet a cause of cancer, 141

Metabolism, disordered, the cause of cancer, 74 of cancer, 70 perverted, and cancer, 150

Mineral disturbances in the system in cancer, 122

Mitosis, cell, relation to cancer, 85

Mortality from cancer 90 per cent., 144

Murphy on surgery in cancer, 171

Myxœdema, 97

Nature of cancer, 15, 29

Negroes, rarity of cancer in, 52, 67

Nervous strain, relation to cancer, 85

New York City, deaths from cancer in, 65, 145 negro death rate from cancer, 67

New York Skin and Cancer Hospital, 8, 172

New Zealand, cancer in, 50

Nitrogen disintegration, imperfect in cancer, 91 increase in colloid, in cancer, 90 partition in cancer, 90 small amount needed in the economy, 114

Nitrogenous diet and cancer, 51, 53, 55, 57, 63, 81, 116

Non-cancerous tumors of breast, 178

Normal body cells and cancer, 31, 41, 70

Nowell, serum therapy, 165

Nuclei of cells, in cancer, 84

Nucleo-proteids in cancer, 82

Nutrition and cancer, 35, 36

Occupation and cancer, 28

Ovaries, internal secretion of, relation to cancer, 102

Over-eating and cancer, 152

Over-indulgence, effect of, 68

Oxyproteic acid, relation to cancer, 90

Packard, disturbance of mineral elements in blood, in cancer, 122

Paget, Sir James, on constitutional nature of cancer, 140

Paget’s disease, 174

Pancreas, relation of, to cancer, 98

Parasitism excluded, 19

Paris, cancer in, 63

Parker, Willard, on constitutional cause of cancer, 137

Patience required for medical treatment of cancer, 134, 152

Perseverance required for medical treatment of cancer, 134

Personal cases of cancer, 180‒197

Perverted metabolism and cancer, 74, 150

Philadelphia, cancer in, 65

Philippines, rarity of cancer in, 57

Phosphates in the urine, diminished in cancer, 94

Pittsburgh, cancer in, 65

Pituitary secretion in cancer, 97, 99

Plants, cancer in, 43

Plasma of blood in cancer, 77

Pluriglandular extracts in cancer, 164

Polarity of cells in cancer, 34, 73

Polynesians, exempt from cancer, 50

Potassium acetate in cancer, 159 phosphate in cancer, 160

Precancerous conditions, 89

Prevention of cancer, 148

Prize fund for cure of cancer, 173

Problem of cancer, 201

Prophylaxis of cancer, 148

Prosperity and cancer, 48, 68, 109

Protein foods, harm from, 113 metabolism, disturbed in cancer, 89 requirement of the body, 112 sufficient in vegetarian diet, 133

Psoriasis, lessons from, in cancer, 128

Putrefaction, intestinal, and cancer, 155

Radium, value in cancer, 29, 145, 168

Recurrent cancer, 146, 187‒195

Red corpuscles in cancer, 76, 77

Refinement of food, relation of, to cancer, 109

Reid, increase of amino-acid nitrogen in cancer, 91

Relation of diet to cancer, 198

Renner, rarity of cancer among creoles, 51

Requisites for development of cancer, 25

Rheumatism, relation to cancer, 72

Ribert, beginnings of cancer, 30

Roberts, disturbance of salivary digestion from tea, 119

Robin, relation between chlorine and nitrogen in cancer, 92

Rohdenburg, Bullock, and Johnson, thymus gland in cancer, 101

Rome, cancer in, 63

Ross, thymus and calcium, harm from in cancer, 101 relation of potash salts to cancer, 160

Rous, cancer in rats checked by diet, 39

Russian oil as a dressing in cancer, 166

Saleeby, trypsin and amylopsin in cancer, 99

St. Louis, cancer in, 65

Sajous, adrenals in relation to cancer, 98

Salivary secretion, acid in cancer, 94, 95, 161

Salt, effect of, on cancer, 129

Sarcoma of same origin as carcinoma, 175

Scandinavia, cancer in, 125

Schmidt, infectious diseases and cancer, 29

Serum therapy, 164

Sherman, composition of the human body, 107, 154

Sherrington and Copeman, reproductive glands inhibiting growth of cancer, 103

Shirlaw, pluriglandular extracts in cancer, 163

Silica, retention of, in pancreas, in cancer, 98

Simple diet, effect of, in cancer, 121

Soëgaard, stomach cancer frequent in Norway, 125

Solids in the urine, deficient in cancer, 87, 88

Spontaneous disappearance of cancer, 36

Stasis, intestinal, and cancer, 155

Stuart-Low, relation of thyroid to cancer, 100

Sub-oxidation and cancer, 132

Sulphates, increased in cancer, 92

Sulpho-cyanic acid, increased in cancer, 92

Sulphur elements, altered in cancer, 92

Supra-renal glands, relation of, to cancer, 97

Surgery, operative, in cancer, 145, 147, 168, 179

Surgical aspects of cancer, 7, 9, 10, 25

Sweet, Corson, White, and Saxon, effect of diet on experimental tumors, 38

Switzerland, cancer in, 62

Syphilis and cancer, 22

Taste gratified, a cause of cancer, 108

Tea, relation to cancer, 117

Telluric influences in cancer, 22

Testicles, internal secretion of, relation to cancer, 102

Thompson on consumption of coffee and tea, 118, 154

Thymus gland in cancer, 101

Thyroid, danger from in cancer, 164 relation to cancer, 97 value of in cancer, 99, 163

Tobacco, influence of, in cancer, 126

Toxicity of urine, increased in cancer, 91

Toxic secretion from cancerous mass, 70, 78, 104, 206

Toxins, intestinal, and cancer, 92, 155

Transmission of cancer, 20

Traumatism and cancer, 24

Trypsin in cancer, 99

Tuberculosis and cancer, 16, 44, 45

Tuke, influence of the mind on morbid processes, 86

Türk, cytology of cancer, 74

United States, cancer in, 16, 64, 68 consumption of coffee in, 118 consumption of meat in, 117

Urea excretion, deficient in cancer subjects, 89

Uricacidæmia, relation to cancer, 72

Urinary disturbance, functional, and cancer, 158

Urinary solids, deficient in cancer, 87, 88

Urobilin, increased in cancer, 90

Vaccine-therapy in cancer, 164

Valais, cancer in, 62

Vegetable protein, 133

Vegetable tumors, 43

Vegetarian diet affords sufficient protein, 133, 153

Vegetarian diet and cancer, 50‒53, 55‒57, 63, 115, 123, 128, 136, 142, 180‒197

Venus on vegetarian diet in cancer, 142

Vincent, quoting Ehrlich on resistance to athreptic influence, 163

Virchow, on tumor formation, 31

Voit’s dietary standard, 111

Volumetric analysis of urine in cancer, 87, 94, 159

Wakefield on hyperacidity of the blood plasma in cancer, 33

Wales, cancer in, 57

Walshe on the cause of cancer, 137

Watson, effect of meat diet on tissue cells, 114

Wealth, relation to cancer, 48, 68, 109

Weight in cancer, 161, 192, 195

Wells, nuclear proteins in cancer cells, 83

Well-to-do men and cancer, 130

West Indies, cancer in, 57

Williams, cancer problems, 36, 45, 47, 50, 58, 72

Wolf, cancer in Australia, 47, 48

Wolter, nucleo-proteids in cancer tissue, 82

Wrong eating and cancer, 152

Xanthin bases, increased in cancer, 90, 91

X-ray, value in cancer, 29, 145, 167

-----

Footnote 1:

According to the United States Mortality tables for 1912 there were 44,531 deaths from cancer that year, or 77 per 100,000 living, while the rate in 1911 was 74.3, an increase of 2.7. Tuberculosis has shown a steady decline, the death for 1912 being the lowest on record, 149.5 per 100,000, it having fallen from 200 per 100,000 in 1900, or over 25%.

Footnote 2:

No attempt has been made to collect an extensive bibliography, which might cover many pages, and a list is only given of those books and journal articles which I have been able to personally consult and to refer to in the text.

BY THE SAME AUTHOR.

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