H. W. S. Wright

“ And, even if research work demonstrated that, in every case now called cancer, some parasite or growth-form, some irritating factor that can be isolated, does actually obtain, unless it could be shewn that this parasite or factor is never found except [19] where there is cancer as we now define it, we should have to proceed to investigate why and how cancer does not always occur when this factor is present. Just so are we at present seeking to explain why and how, of so many persons exposed to infection by Koch’s bacillus, only certain ones do become diseased. ”

“ If we agree that to live rightly is the best insurance we can make against cancer, we are probably stating, as compendiously as possible, all we do and shall ever know, in respect of the causation of cancer. ”

“ The simple injunction to eat greens and take paraffin is the physiological counterpart of seeking to make people moral by act of Parliament, religious by church-going, and intelligent by attendance at evening lectures. But even if we make all possible effort, we cannot all hope to escape, and the necessity for seeking early diagnosis when things go not well is as imperative as is true the maxim that “A stitch in time saves nine”.
There is perhaps one more question that may be touched upon: that of the so-called increase of cancer. ”

“ It may turn out to be that the causal agent in cancer [54] formation is a parasite either visible under the microscope, or, what is more likely, belonging to the group of ultravisible, or filter-passing, organisms; but even if this be so, there are two other factors of immense importance, found so constantly associated with the disease, that their significance cannot be underestimated by anyone whose outlook is any wider than that of the mere purveyor of prescriptions. ”

“ What is one man’s meat is another man’s poison. Adjustment to our surroundings, right living here and now is what we need. Though Papuans and Sikhs may be very properly adjusted in their contexts, it is not their adjustments that may best suit our cases.
This problem—that of right living—is the problem of prevention of cancer [26] put upon the broadest basis. But, until or unless we work this out, we have to consider how best to avail ourselves of the knowledge already in our possession. Herein is one merit of Mr Wright’s plan. ”

“ Let us come back again from theory to fact, and consider some of the factors which we know constantly to be associated with cancer, and which we are justified in regarding as being, in many cases, more than predisposing causes. ”

“ At any rate, if the facts relating to Cancer are plainly stated, every man has but himself to blame if he shrink from obtaining such diagnosis and treatment, as is now available, at the earliest moment. ”

“ 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 [13] 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. ”

“ 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. ”

“ 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. ”

“ Cancer of the uterus is in many cases preceded by precancerous lesions, all amenable to various kinds of treatment. Again, the only way to deal with it is not to wait and see whether a woman has got cancer but to look and see that she has not. Until this is our attitude, the results are not likely to be much better, whatever the means at our disposal for its cure.
Finally, turning to another great group of cancers which make up thirty per cent. of all in men (and in women too, if we exclude the two previously mentioned types) , we find exactly the same condition of affairs. ”

“ So far the evidence which has been brought before you, that chronic irritation has a causal connection with cancer, has been of a circumstantial nature: it has often enough been found in what we may call suspicious circumstances, but that does not prove that by itself it can directly cause the disease. If a man is seen hanging about the place where a burglary has been committed, it does not prove that he participated in it. ”

“ Effort in the path of right living—if steadily pursued—and the intelligent utilization of what Science and Art and Experience have to teach, will undoubtedly make for healthier and longer lived communities, and will lessen, for each individual, the probability of dying otherwise than in the fashion thought of by the doctor when he ascribes death to “old age”. The problem we are considering becomes indeed swallowed up by a still greater one; but, those who profit by what [32] Mr Wright has had to say about Cancer, will profit in respect of this greater problem as well. ”

“ Its relevance to the question of cancer is this: that the proof of the production of cancer in men or in animals under one set of circumstances does not warrant us in saying that that set of circumstances as known to us involves all the factors without which cancer cannot occur. ”

“ Cancer is practically always preceded by chronic irritation of some kind or other. There may be, and in fact are, other factors which enter into the problem, but there can be no doubt that in nearly all cases there is what may be called a precancerous stage, which, if adequately dealt with, will often prevent cancer appearing at all. It is moreover a longstanding chronic condition which, as a rule, gives rise to very little inconvenience on the part of the patient. ”

“ The only thing we can [46] do for the patient is either to find some means to kill them—an end which has not yet been achieved, as what will kill them will also kill the patient—or to cut away the tissue in which they have grown, leaving a wide margin around the farthest palpable edge of the ulcer. If this is done, the patient can be assured of a permanent cure. But if he will not believe you, as he often will not, possibly because you are not willing to stake your reputation on the ulcer being malignant, or the certainty of its cure by surgery, he will go away for another year or so. ”

“ The early signs of cancer may now be summed up as those of a lesion of some kind, extending over a number of years, giving rise to very little trouble or inconvenience, and followed by a small hard lump or ulcer. If the latter is present, it is often characterised by bleeding. Again, practically no symptoms. To find it we must look and see; often an operation involving [52] practically no suffering and a very small mortality is necessary. But the penalties of failure to do this at the proper time are that ten per cent. of the population die of cancer. ”

“ 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. ”

“ Let us take, for instance, the case of cancer of the lip. We see an old man who for years has been smoking a clay pipe. The stem of the pipe gets shorter as the years go by, and consequently, as he smokes it, hotter and hotter. One day he notices that his lip is cracked, the crack being just on that part with which he habitually holds his pipe. If we were to look at this under the microscope we should just see that the mucous membrane was broken at this point. Perhaps he stops smoking for a day or two till his lip has healed, and then continues to smoke again. ”

“ The first is that cancer is necessarily painful. This is responsible for much of the late diagnosis, operative mortality and the bad results. Only late cancer, and it would not be far wrong to say only incurable cancer, gives rise to pain. If only pain were an early sign of cancer the whole aspect of the cancer problem would be changed.
Another very widespread delusion productive of great harm is that cancer is constantly associated with wasting, and makes rapid progress. These two symptoms are constantly associated with the disease in its latest stages but are not seen at all in early cases. ”

“ 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. ”

“ It has been known for a great number of years that certain skin cancers are constantly found in people whose occupations necessitate their skin being in contact with certain chemical irritants. For instance, the workers in shale oil are often afflicted with cancer of the skin. In the spinning industry, when reaching over to deal with the machinery, a place on the worker’s leg is always rubbing up against an oily spindle. This process goes on for years at the same spot, and these people are found frequently to get cancer, beginning at the irritated place. ”

“ 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 [15] 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. ”

“ We are, indeed, again confronted with the old problem of the one and the many, under one of its numberless aspects. From the point of view of the statistical bureaucrat, cancer is increasing. That is to say, an increasing number of deaths, and an increasing proportion of deaths, are every year presented to him, both absolutely and in relation to the population. ”

“ Cancer of the breast also is constantly associated with preceding chronic inflammation, this condition itself producing, as one of its by-products, a highly acid substance, further to irritate the delicate cells already near the end of their tether. Mechanical irritation, beyond a doubt, is an important factor. Although in civilised countries the disease is distressingly common, in those countries where the breasts are habitually uncovered, cancer of this organ is extremely rare. ”

“ Out of every hundred people in our community, ten will in all probability die of cancer; and, of those ten, seven or eight could be cured, or their disease prevented with the present methods at our disposal. All that is required is an intelligent facing of the facts concerning this disease, and efficient medical attention.
The average annual deaths during the last eleven years in the United Kingdom were 466,000,—nearly half a million people. Of these, 43,000 were due to cancer; 19,000 males and 24,000 females. Moreover, although taken altogether ten per cent. ”

“ For so long as indiscriminate medicine-taking has precedence over exact methods of investigation and treatment, so long will cancer of the [77] stomach continue to make up thirty per cent. of all cancers. Again the question is largely out of the hands of the doctors. As long as patients come to a doctor wanting “a bottle of medicine, doctor, just to help me carry on”, so long will they get it, as the doctor finds it hard to refuse. For he knows the patient will go from doctor to doctor till he gets what he wants. ”

“ If all persons over forty years of age were routinely examined once every six months to see that they had not cancer, or a precancerous condition, and if these when found were promptly dealt with, then cancers of the rectum, tongue, lip, breast, skin and uterus would cease to be the plagues they are at present. ”

“ Now, our population is an older one than it was: the birth-rate is falling: so many youths who would now be vigorous men of thirty-five to forty lost their lives in the war; and lives are, on the whole, longer than they were, owing to a diminishing liability to suffer from certain ailments other than Cancer. ”

“ Nothing could be a greater error. In matters of health what is advantageous for the individual is often not so, or even grossly disadvantageous, for the State.
Let every member of the State have the opportunity to avail himself or herself of what Science and Art can do for him: let none who has the will [27] suffer because he has not the means. ”