Part 1

THE CONQUEST OF CANCER

TO-DAY AND TO-MORROW

A List of the Contents of this Series will be found at the end of this volume

THE CONQUEST OF CANCER

BY H. W. S. WRIGHT, M.S., F.R.C.S.

With an Introduction by F. G. CROOKSHANK, M.D., F.R.C.P.

“Malum immedicabile cancer.” (OVID, Met. x, 127)

LONDON KEGAN PAUL, TRENCH, TRUBNER & CO., LTD. NEW YORK: E. P. DUTTON & CO. 1925

Printed in Great Britain by F. Robinson & Co., at The Library Press, Lowestoft

THE CONQUEST OF CANCER

INTRODUCTION

The phrase “Conquest of Cancer”, though perhaps emotive rather than scientific, nevertheless implies the existence of a very real and important problem. And this problem, it may be confidently affirmed, is one that will never be solved, in action, by the efforts of the medical profession alone. Whatever be the future, and as yet reserved, revelations of Science, and whatever the further developments of Art, cancer will not cease to exact its toll unless medical science and art obtain the intelligent co-operation of an instructed public. It is for this reason that it has been thought useful to place before the public this little book, written by a practical surgeon who has given special attention to the problems of the laboratory. The book itself, which not only states in simple language the essential points that should be comprehended by the public, but puts forward a plan for concerted action, is based upon one of a series of University Extension lectures given during the winter of 1922–23, at the Shantung Christian University, Tsinan, China, where Mr Wright is actively engaged in the Surgical Department of the School of Medicine.

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The task of prefacing this essay by some words of introduction has devolved upon the present writer, not because he either has, or desires to present, any claim to speak with special authority concerning Cancer, but by reason of a close personal and professional friendship that has led him to appreciate very warmly the knowledge, the sincerity, and the disinterestedness that characterize Mr Wright’s thought and work. And he is confident that we may accept what has been said about Cancer at Shantung as an honest and candid attempt to instruct and to construct, in detachment from the pribbles and prabbles that have sometimes confused discussion nearer home.

Now, although the public has the undoubted right to demand information on this subject, and although, as has been suggested, without admission of the public to the arena of discussion little can be done to diminish the present mortality from Cancer, yet is there real difficulty in communicating knowledge, without engendering unnecessary fear and alarm and sending the hypochondriac to those quacks and charlatans who diagnose non-existent disease in order that they may reap reward by announcing its cure.

Some weaker minds there will always be: so, whenever attention is directed towards some public danger, there are those who adopt the possible contingency as a peg on which to hang some ragged vestment of distracted emotion or thought. Thirty years ago, the insane feared the telephone: during the Boer War, many thought that the “scouts were after them”; now-a-days lunatics babble of persecution by wireless, by Bolsheviks, or even by psycho-analysts. So, in Victorian times, the malades imaginaires who then thronged consulting rooms spoke with bated breath of Bright’s disease: to-day, the hysterical secretly hope to hear the blessed word “Colitis”, and the hypochondriac as secretly dread the verdict of “Cancer”!

The task of the medical profession is to enlighten the laymen, that their help may be enlisted, and yet to avoid alike exaggeration and smooth sayings, false hopes and false fears. Macaulay, in a familiar passage, once said that there is nothing more ridiculous than the British public in one of its periodical fits of morality. At present, the British Public is less concerned than formerly with questions of morality, but is very much concerned with questions of health. Perhaps it is not so much health that is sought and desired as absence of pain and avoidance of death――which is not quite the same thing. But, though there is nothing intrinsically ridiculous in seeking the “advancement of morality” or the “conquest of disease”, the one, no less than the other, may be pursued in a ridiculous and dangerous manner.

The adoption of ill-conceived measures, designed to improve morals or to abolish disease, may, and often does entail consequences that are even less desirable than the evils it is hoped to combat. While the prohibition of the consumption or sale of alcoholic drinks may diminish certain ills, it has yet to be shewn that the casting out of devils in the name of Beelzebub may not be followed by possession with others yet more violent. A few years ago we were adjured to boil all milk, lest we became poisoned by certain microbes: we are now told that, if all milk be boiled, we are as if deprived of vitamines, and must suffer accordingly. Instances might be multiplied; but it should be obvious that moral and physical health must be considered, not as physical objects, but as relations, or states of equilibrium. Like all states of adjustment or equilibrium, they are the result of accommodation: of poise and counterpoise. They are not always and everywhere to be secured by the throwing of a certain weight into one or other scalepan, or by the cutting-off so many inches from the table-leg that seems the longest. So much, at least, should be recognised by a seriously disturbed public told by the daily press that so many more people than formerly now die of cancer; that science has not yet discovered the “cause of cancer”; but that all may be well if only we live on Nebuchadnezzar food washed down by paraffin.

Mr Wright’s essay, combining as it does a well-balanced and sufficient statement of what is known, with the outline of a constructive proposition that merits careful consideration, and at least indicates to the public the kind of way in which relative safety may be obtained under present conditions, seems one that is eminently suitable for what may be called general reading. The problem is fairly and lucidly presented: the resources of surgery are quietly and reasonably demonstrated: and the advantages are shown of exhibiting that kind of prudence which leads the business man to seek auditing of his accounts and the sportsman to enquire how his score stands. But some words may perhaps be added from the standpoint of one who is a physician, and no surgeon.

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Cancer is a class name given to certain kinds of growths, otherwise spoken of as tumours (or swellings) and ulcers, which are, as we say, characterised by malignancy. A growth, tumour, or ulcer which is not malignant is not called a cancer. By malignancy we mean a tendency to spread, by local and direct extension (as spreads a fire), or by convection, as when sparks fly from a locomotive to a haystack. Malignant tumours or ulcers tend to recur when removed, and, in the long run, to destroy life.

These general features are associated with certain microscopical characters found in the tumours or ulcers, so that the nature of any growth――whether malignant or otherwise――can be sometimes determined by the surgeon or physician, and sometimes by the pathologist or microscopist alone, but, as a rule, is most certainly settled by the physician or surgeon acting in conjunction with the microscopist. Yet, and this is important, not every cancer does actually destroy life. Surgeons of the greatest experience, such as the late Sir Alfred Pearce-Gould, have affirmed that undoubted cancers do occasionally undergo spontaneous cure, or at least arrest of growth, even in the absence of any treatment. Again, if excision is practised early, and sufficiently extensively, recurrence does not happen, in a certain proportion of cases. Finally, pain is no necessary or inevitable concomitant of cancer. In many cases pain is absent, or almost so; death may be due to mechanical consequences entailed by the growth rather than to destruction of any vital or sensitive part.

Now, medical men are in the habit of splitting up the group or class of malignant growths (or “cancers”) into two subsidiary groups or classes. One of these is named Sarcoma; the other Carcinoma. Sarcoma is the name given to a group of malignant growths taking origin in the structures and tissues developed from the “middle layer” of the embryo: the growths themselves――sarcomata――partake the nature of the tissues formed from this middle layer. The other group, of carcinomata, consists of growths taking origin in, and partaking the nature of one or other of the two remaining embryonic layers and the structures developed from them.

These two layers form respectively:

(1) The skin and related structures, and

(2) The lining of the tube passing through the body; its backwaters, out-growths and appendages.

It is these two layers which, as Mr Wright so aptly remarks, are in direct contact with the outer world. Now, while the carcinomata (which constitute the class of cancers chiefly discussed in this book) in general affect people who have passed the midpoint of life――those for whom, as Rabelais says, it is midi passé――the sarcomata, which are less common than the carcinomata, are rather more frequently, yet not exclusively, found in young people; in those indeed, who have not reached life’s apogee. It is important that these facts should be borne in mind, for generalisations founded upon the study of carcinomata alone cannot be necessarily true in respect of all Cancer, unless the use of the term cancer be restricted to the class technically known as carcinoma. To say that Cancer can be prevented if constipation is avoided is clearly misleading, when we remember that quite young children, nay, infants, may be the subject of sarcoma; unless of course we define cancer, as some would do, as the kind of growth that, ex hypothesi, is prevented when constipation is avoided. It is confusion of this sort, bred by slovenly expression out of loose thinking, that is in great part responsible for the present bewilderment of the public.

Another fertile source of confusion is the obscurity that attends both the popular and the professional use of the words “cause”, “causation”, and the like. The public demands that “the” cause of cancer be discovered, and is prepared to pay generously that this discovery be made. Unfortunately neither the public, nor men of science, care overmuch to discuss what they mean by cause and causation. This is no place in which to trench upon a province unsuccessfully explored by Locke, by Hume, and by Kant. Yet it is of vital importance that all doctors, scientists, and laymen should recognise two different uses of these words.