Lucius Duncan Bulkley

“ The cancer problem is by no means yet solved, but I think that you will all agree with me that we are on the right track, and I cannot do better than to close with a remark I made to you two years ago: “Scientific research 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.” ”

“ Having now seen how very much can be accomplished in primary cases, that is, in those who have not been submitted to an operation, let us consider what can be done for those truly pitiful cases where surgery has been tried and failed, and where one or many successive recurrences after repeated operations has left the patient even worse than before; and, as some surgeons tell us, worse than the patient would have been if the disease had been left to nature, without operation and with only ordinary medical guidance. ”

“ Climate and Locality.—There is no evidence to prove that climate has any influence in the production of cancer, nor is it affected by locality; the disease occurs in hot, warm, temperate, and cold climates, and in every possible location on the earth. But it is undoubtedly most prevalent in temperate regions, for the reason that it is in these that modern civilization, with all its faults and foibles, is most highly developed. ”

“ As yet we know little or nothing in regard to actual cancer-genesis; no one has ever demonstrated, and probably no one ever will demonstrate, the absolute beginning of the change in some normal cell or cells, in the breast or elsewhere, which eventuates in their taking on the rampant or malignant feature which we call cancer. But this change does occur, and though the exact alterations in the polarity of the cells and the disturbance of their centrosomes and nuclei, which have been described, may not be perfectly understood, there is some definite cause for their occurrence. ”

“ But, gentlemen, many great surgeons, in past and present time, as quoted in my former lectures, have acknowledged verbally and in writing their inability to cope with cancer as a disease, and have recognized time and again that they operated only because they knew of nothing better to do. Often it is acknowledged that the operation is only palliative, in the hope, alas, how often futile, that some good might result from it, in the chance that the dread disease would not return. ”

“ From our study of inoperable and recurrent cancer, and of metastasis and the blood conditions in the disease, we see what a formidable task is before one who would attempt to lessen its morbidity and mortality. We see also how blind all have been who have so long looked to surgery to stay its progress. In my former lectures I collected and quoted statements from many surgeons of prominence in times past, and even some in quite recent times, all expressive of a belief in a constitutional origin of cancer, and many of them looking to a dietary cause. ”

“ Most careful and prolonged study of the patient in every respect has shown a certain uniformity in regard to particular deviations from health, the correction of which has been followed by a complete disappearance of tumors classed as malignant, so that the connection must seem obvious to an unprejudiced mind. And yet it cannot be claimed that the exact, single cause of the cancerous growth has been demonstrated, 262and from the nature and character of the systemic disorders found, it is evident that there can never be any single remedy which can be rightly claimed as a cure for cancer. ”

“ There is, of course, no single medicine which can cure cancer, but proper medication plays a very important part in overcoming the disease and should never be neglected or interrupted in any case; indeed, one suffering from or threatened with cancer should be under the most careful medical guidance indefinitely, and this is especially true after the surgical removal of the tumor, or local manifestation of the morbid process, as Abernethy so strongly asserted, nearly a hundred years ago. ”

“ When we speak, therefore, of the influence of food in the production of cancer it must be understood that it is not claimed that the diseased process depends wholly and exclusively on the character of the food, including drink, taken. In my former lectures I tried to show that cancer was the result of a deranged nutrition, and we know that one of the greatest elements in inducing this latter is erroneous metabolism, depending again on the diet, to a very great extent. ”

“ Unfortunately it must be acknowledged that many claims, quack and other, have been put forth in times past for remedies and measures which would control or remove, and even cure, the disease in all stages. But the failure of each in turn has very naturally discouraged many from accepting any new proposition, and the profession and laity have almost given up the hope for a real cure of cancer. ”

“ It may happen, therefore, that in treating a cancer patient over the long time necessary to effect a cure, the greatest number and variety of remedies may be employed from time to time, as intelligent observation and experience may indicate, to restore and hold the metabolism and nutrition in a perfectly normal state: the erroneous action of certain individual body cells which in the aggregate we call cancer, will then cease to exist, as is seen in cured cases. ”

“ We have seen in the former lecture that cancer is not a definite something, from without, that attacks the human frame, but that it is only a faulty development and action of certain body cells, which were once normal, with a steady decline in bodily health which tends to a fatal issue in a very large proportion of those once affected with the disease. ”

“ We see, thus, that cancer is not primarily a surgical affection, and that the mere ablation of an offending portion of the body which has become diseased can never preclude a new portion from becoming affected, or prevent a recurrence in the same location; indeed, this often seems to be stimulated and increased by the trauma and by the deranged lymphatic and vascular circulation caused by the operation and the dissemination of actively growing cancer cells through these channels. ”

“ I recognize that it is often very difficult to persuade patients to adopt and faithfully follow out this course of procedure for a long enough time to secure perfect results, so obsessed is the medical profession and the laity with the idea that surgery offers the only hope of cancer. ”

“ In a long experience I have seldom, if ever, come across a patient with cancer who had had any intelligent and prolonged attempt to check its development by dietary, hygienic, and medicinal means; invariably the knife, X-ray, and radium have been the only measures under consideration. Also, after an operation the patient is dismissed, or watched for a recurrence and again operated on, with no prolonged effort to so modify the constitution that the same causes shall not reproduce the malady in the same or other localities. ”

“ The enormous activity with the microscope in regard to the minute structure of the diseased tissues, and the elaborate and extensive work done in animal experimentation, have turned the thoughts of many from the homely and practical studies of the human frame in its various departures from health; thus too little attention has been given to the deranged activities of its various organs, and the perverted metabolism which, has resulted from the stress and strain, with the temptations and errors accompanying the present intensity of human civilization. ”

“ The blond Nordic race, however, seems to be more susceptible to the disease than the darker races, originally of Asiatic origin; and it is the former who have pushed forward modern civilization, with all its errors of life.
Thus cancer is everywhere reported to be rare, and sometimes almost absent, in primitive, uncivilized peoples, but it has been repeatedly observed, in many localities, that as these same people mix with Europeans and adopt their diet and mode of life, cancer is sure to increase, until its frequency often about equals that in their highly civilized neighbors. ”

“ Coming down, then, to the actual and practical facts relating to the dietary and medical treatment of cancer, we readily see 149that the real cancer problem relates to placing the patient in such a normal or ideal state of life that the function of nutrition is performed in an exactly proper manner, as nature intended, and from which man has erred through the manifold temptations incident to our artificial existence, in the presence of our so-called advanced civilization; for we have seen that all over the world cancer has steadily increased with the intensity of human progress. ”

“ I repeat, is it not time for us to stop and consider whether our laboratory work with the microscope on morbid tissues, and our experimentation on rats and mice are truly serving to solve the real problem of cancer? ”

“ I explained at the time that any attempt to excise portions of tissue for such study would at once endanger the patient and imperil the success of treatment, by giving occasion to metastases, from the opening of blood vessels and lymphatics. This matter is treated of more fully in the present lectures. It is to be remembered that the vast majority of operations for cancer are undertaken upon a purely clinical diagnosis, and it may be undeniably stated that not one half of them are confirmed subsequently by competent microscopic evidence, except, of course, in properly equipped hospitals. ”

“ Turning to other countries, we find abundant confirmation of the persistent and considerable increase in the mortality from cancer, in many cases much greater than has occurred in the United States; and in nearly all of them the increase can be recognized as commensurate with the progress or advance of so-called civilization, especially as emphasized in city life. ”

“ Recurrence of cancer is far more common during the first year after operation than in any other single year, but, as we shall see shortly, there is no time limit when the disease may not manifest itself anew. It is understood, of course, that recurrence depends also largely on the previous duration, extent, and malignancy of the tumor, and exact statistics are very few and imperfect in regard to these matters. ”

“ We all realize that the results in the three former diseased conditions are from errors in the mode of life, including eating and drinking, and indolence, and careful study shows that cancer has the same origin. On the other hand, as already stated, the deaths from tuberculosis have steadily declined 27.8 per cent under rational medical treatment, directed mainly along the lines of correct nutrition: the death rate of tuberculosis and cancer have thus approached 260each other 56.5 per cent, and at this rate in fifteen years more the mortality from cancer will exceed that from tuberculosis! ”

“ Unless much time, thought, study, and effort can be given to each case of cancer, I should deprecate any attempt to treat it medically, and rather risk at once the chances of surgery, poor as they are. ”

“ Patients with a cancer just beginning will often, or even generally, seem to be 35in excellent health. It is indeed remarkable to observe how commonly patients with beginning breast cancer will seem to be in a splendid condition of health. They are ruddy and blooming in appearance, and when the lump is first discovered it is hard indeed to believe that if the erroneous life processes which caused the cancerous lesion to develop are not checked, the patient will before long succumb to the direful disease. ”

“ Now to make up for the daily waste of the other 15 elements, which form 35 per cent of the body tissues, and to support 63the necessary activities of the system, mental and physical, it is necessary every day to take a more or less even supply of substances, which we call food and drink, which should contain about the proper proportion of the requisite bodily components. Under normal conditions of healthy living the appetite ordinarily serves as a proper guide for health in man and beast, serving to regulate the selection of material to preserve the balance of nutrition. ”

“ While the mortality of tuberculosis has fallen from 201.9 persons in 1900 to 145.8 in 1915, or 56.1 less deaths in each 100,000 population, or over 27.7 per cent, the cancer death rate has risen in the same time from 63 to 81.1 per 100,000, or over 28.7 per cent. They have therefore approached each other by 8856.4 per cent, and unless this rate of progression is changed in some way, the lines will have crossed one another in less than fifteen years more, even as that for organic heart disease has already crossed that of tuberculosis, it having risen almost 27 per cent. ”

“ Personally I believe that sooner or later it will be generally recognized that the starting point of cancer occurs in some cell or cells, previously normal, probably as the result of local irritation, in which there is a deposit of some of the elements of faulty nitrogenous partition, induced by undue ingestion of animal protein: and that the malignant, reproductive process in the cells is kept up by a continuance of the same supply of imperfectly disintegrated nitrogenous matter. ”

“ But we do know that what passes for good health is often fictitious, and is quite compatible with even grave disorders of various kinds. It is more than possible that the apparent well-being of the patient with beginning cancer, which is often observed to be associated with uricacidemia, points also to the correctness of our thesis in regard to its internal causation. As remarked in one of my former lectures, quoting 37Ribert, “no one has ever seen the beginning of mammary cancer” and no one will ever see the beginnings of cancer of internal organs. ”

“ A careful investigation of these houses has commonly found them to be old, moldy, damp, badly ventilated, and otherwise unsanitary; also that such old houses are commonly tenanted by old people in succession, so that there are more at a cancer age to be affected. With our present knowledge of the causes which lead up to cancer we cannot but conclude, therefore, that the occurrence of the disease in groups, with some apparent connection, has been only the result of all living under the same conditions of ill health, including wrong diet, etc. ”

“ 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 its rapidly increasing development and mortality throughout the world. ”

“ But, as I have tried to show you all along, it is some derangement of metabolism which is at the bottom of neoplastic growths, and that derangement is not necessarily due to any one single cause, as diet. There are other elements of disturbance besides the nitrogenous malassimilation which is due to the intake of an excessive amount of the proteid of the animal kingdom; for cancer is said to have been seen in vegetarians, although I have never met with such a case. ”

“ For when it is universally realized that it is the errors of life, determined and accentuated by advanced civilization, so-called, which lead up to and cause cancer, and when public education has been advanced along correct lines, the tendency to cancer will diminish and there will be fewer cases, either operable or inoperable. The former will melt away under correct internal and external measures, and the latter will be helped by, or slowly yield to the same, unless the malignant process has already progressed beyond the possibility of retrogressive metabolism. ”

“ All surgeons agree that at least 50 per cent of all cancers are inoperable, so that in all the reports concerning the results of operations this must be taken into consideration, and the real percentage of cures of cancer by surgery must be divided into at least one half. Thus, if operative surgery yields an average of 25 per cent of apparent cures in all cases operated on, this would mean only 12.5 per cent of all cases of cancer. ”

“ The hopelessness and despair of the patient when told that no operation is 114possible is bad enough. But when with recurrence, time and again after repeated operations, it is decided that no further relief by the knife is possible, the despondency is indeed pitiful—especially as ordinarily one can only look forward to a sure and most painful death, at a not very distant day. It is very difficult to convince many of these patients that medical treatment, including diet, can do any good, so firmly fixed is the idea that an operation is the only possible remedy ”

“ There could hardly be devised a more effective plan to increase the mortality from cancer and to render many more cases really inoperable than this one would surely be; for by thus cutting into cancerous tissue and opening lymphatic channels and blood vessels, with the opportunity for absorption of cancerous elements during the necessary delay, metastases would certainly be induced which would render a surgical removal or a dietary and medicinal treatment immeasurably less effective. ”

“ While accuracy of diagnosis may be important in early cancer, it is certain that in late stages and at death, from which the various mortality tables are taken, there is rarely any question as to the diagnosis. There is evidence, however, to show that cancer is increasing even more rapidly than appears from mortality statistics.
In 1900 the recorded mortality from cancer in the registration area of the United States was 63 per 100,000 living, and in 1914 it had risen to 79.4, or an increase of 16.4 per 100,000 living, or over 26 per cent. ”

“ Surgery has had, and may yet have, its function to perform in removing some of the products of the constitutional state causing cancer, more or less efficiently, curing some patients and prolonging the life of others; but from past experience it can never hope to lessen the morbidity of cancer. ”