Part 55

“Is there no cure but the knife?” inquired Mrs. Clyde.

“Not for the cancer. For the gastric ulcer, yes. Careful medical care and diet often cure it. The trouble is that patients insist on diet and drugs in cases where they have proved themselves ineffectual. Those cases should come to the surgeon. But it will take long to educate the public to the significance of long-continued abdominal pain or indigestion. The knife is the last thing they are willing to think of.”

“But stomach operations are terribly dangerous, aren’t they?” inquired a member.

“Not any more. They were once. The operation for gastric ulcer in the early stage is simple. Even developed cancer of the stomach can be cured by the knife in from twenty-five to thirty per cent of the cases. Without the knife, it is sure death. I’m glad we got to the stomach first, because that is the most obscure and least hopeful of the common locations of the growth. In carcinoma of the breast, the most prevalent form among women, there is one simple, inclusive rule of prevention and cure. Any lump in the breast should be regarded, as Blood-good of Johns Hopkins puts it, ‘as an acute disease.’ It should come out immediately. If such growths come at once to the surgeon, prevention and cure together would save probably ninety per cent of those who now die from this ‘creeping death,’ as our parents called it.

“Now, I’ll ask you to imagine for the moment that I am conducting a clinic, for I’m not going to mince words in speaking of cancer of the womb, the next commonest form. Any persistent irritation there is a peril. If there is a slight, steady, and untimely discharge, that’s a danger signal. The woman should at once have a microscopical examination made. This is simple, almost painless, and practically a sure determination of whether there is cancer or not. The thing to do is to find out.”

“But if it is cancer, is there any chance?” asked the lady of the hatpin.

“Would you regard tuberculosis as hopeless?”

“Of course not.”

“Your parents would have. But you have profited by popular education. If the public understood what to do in cancer as thoroughly as they know about tuberculosis, we’d save almost if not quite as many victims from the more terrible disease. Fatalism is as out of place in the one as in the other. The gist of the matter is taking the thing in time. Let me read you what the chairman of the Cancer Campaign Committee of the Congress of Surgeons of North America, Dr. Thomas S. Cullen, of Baltimore, says: ‘Surgeons are heartsick to see the many cancer patients begging for operations when the disease is so far advanced that nothing can be done. Cancer is in the beginning a local process and not a blood disease, and in its early stages can be completely removed. When the cancer is small the surgeon can, with one fourth the amount of labor, accomplish ten times the amount of good.’”

“Does that always mean the knife?” asked a timid-looking woman.

“Always. There is no other hope, once the malignant growth has begun. But the knife is not so terrible. In fact, in the early stages it is not terrible at all. Modern surgery has reduced pain to a minimum. The strongest argument against dread is a visit to a well-equipped surgical hospital, where one can see patients sitting up in bed and enjoying life a few days after a major operation. Even at the worst, the knife is less terrible than death, its certain alternative.”

“Why do you call it the certain alternative?” asked the minister’s wife. “I have seen facial cancer cured by concentrated ray treatment.”

“That wasn’t cancer; it was lupus,” replied Dr. Strong; “a wholly different thing. True cancer of the face in its commonest location, the lips, is the most frequently cured of any form, but only by operation. Now here’s an interesting and suggestive point; taking lip-cancer patients as they come to us, we get perhaps sixty-five per cent of complete cures. With cancer of the womb, we get in all not more than forty per cent of recoveries. Perhaps some of you will be able to suggest the explanation for this contrast.”

“Because cancer of the lip isn’t as deadly a disease,” ventured some one.

“Cancer is cancer, wherever it is located. Unless it is removed it is always and equally deadly.”

“Then it is because the internal operation is so much more dangerous,” offered another member.

“No; uterine operations are easy and simple. It is simply because the sore on the face is obvious, plain, unmistakable evidence of something wrong; and the patient ordinarily gets into the surgeon’s hands early; that is, before the roots of the growth have spread and involved life itself. The difference in mortality between carcinoma of the lip and carcinoma of the womb is the difference between early operation and delayed operation. If uterine cancer or breast cancer were discovered as early as lip cancer, we’d save practically as many of the internal as we do of the external cases. And if all the lip cancer cases were noticed at the first development, we’d save ninety-five per cent of them.”

“Isn’t it the business of the physician to find out about the internal forms?” asked Mrs. Sharpless.

“Often the physician hasn’t the chance. The woman ought to do the first diagnosing herself. That is, she must be taught to recognize suspicious symptoms. In Germany there has been a campaign of education among women on cancer of the womb. The result is that more than twice as many Germans come to the operating table, in time to give a fair chance of permanent recovery in this class of cases, as do Americans.”

“How is the American woman, who knows nothing about such matters, to find out?” queried the minister’s wife.

“There is a campaign of education now under way here. Publications giving the basic facts about cancer, its prevention and cure, in simple and popular form, can be had from the American Society for the Control of Cancer,—Thomas M. Debevoise, secretary, 62 Cedar Street, New York City; or more detailed advice can be had from the Cancer Campaign Committee of the Congress of Surgeons of North America, Dr. Thomas S. Cullen, chairman, 3 West Preston Street, Baltimore; or from Dr. F. R. Green, 535 Dearborn Avenue, Chicago, Illinois, secretary of the Council of Health and Public Instruction of the American Medical Association.”

“Why not more easily and readily one’s own physician?” asked Mrs. Clyde.

“Women don’t go to their own physicians early enough. It is necessary that they be trained to understand symptoms which do not at first seem serious enough for medical attention. Besides, I regret to confess, in this matter of cancer our physicians need educating, too. They are too prone to say, if they are not sure of the diagnosis, ‘Wait and see.’ Waiting to see is what kills three fourths of the women who succumb to cancer. Let me illustrate this peril by two cases which have come under my observation: The wife of a lawyer in a Western city had a severe attack of stomach trouble. Her doctor, a young and open-minded man, had the courage to say, ‘I don’t know. But I’m afraid it’s cancer. You’d better go to such-and-such a hospital and let them see.’ The woman went. An exploratory incision was made and carcinoma found in the early stage. It was cut out and to-day she is as good as new.

“Now, this same lawyer had a friend who had been treated for months by a stomach specialist of some reputation. Under the treatment he had grown steadily thinner, paler, and weaker. ‘Indigestion, gastric intoxication,’ the specialist repeated, parrotlike, until the man himself, in his misery, began to suspect. At this point the lawyer friend got hold of him and took him to the hospital where his wife had been. The surgeons refused the case and sent the man away to die. Indignant, the lawyer sought the superintendent of the hospital.

“‘Why won’t you take my friend’s case?’

“‘It is inoperable.’

“‘Isn’t it cancer of the stomach, like my wife’s?’

“‘Yes.’