Krebs

“ Or whether we had not better turn our attention to human beings, and by careful clinical study of our patients, discover where the fundamental error lies, which first induces the formation of an aberrant cell mass, which we call cancer, and then continually feeds it by the same deranged blood stream, so that it becomes utterly uncontrollable and invades and destroys other tissues; while at the same time the anemia, pernicious and progressive in character, gradually saps the life of the patient to a lethal end? ”

“ Too often when a cancer is suspected or discovered it is taken as a foregone conclusion that the malady is hopeless, except as the results of the disease, that is the new growth, may be removed by the knife, X-ray, radium, caustics, etc. And after a surgical operation, as far as my observation goes, the patients are invariably left entirely to their own resources, with the hope, alas, too often futile, that the tumor will not regrow, but with no attempt to so guide the life that there shall not be the same tendency to a recurrent malignant new-formation. ”

“ To sum up, the tissues from which cancer grows, in their normal process of repair tend to reproduce themselves more or less exactly, or if the injury is too gross, they are replaced by scar tissue; but when we reach the age at which their biological work is done, there is a tendency to atypical reproduction, in which an atypical cell continues to reproduce itself atypically and grows at the expense of the organism, eating into or eroding it as it enlarges, till it finally kills the host on which it preys. ”

“ 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. ”

“ Once symptoms of this disease have recurred after efficient treatment, there is only one good reason for not looking and making certain, and that is when the risks of [76] looking exceed those of the lesion being malignant—that is to say, somewhere between ten and twenty per cent. At present, the risks of looking are about one in a thousand, and the risks of removal of a cancer about three per cent., taking all cases, most of which are at an advanced stage. ”

“ Although the cancer cells constantly attack the walls of the adjacent veins and spread into their interior at a comparatively early period, secondary growths due to dissemination by the blood-stream rarely show themselves clinically until late in the course of the disease. It is probable that many of the cancer cells which are carried away in the blood or lymph stream undergo necrosis and fail to give rise to secondary growths. Secondary growths present a faithful reproduction of the structure of the primary tumour. ”

“ Yet we are not without gruesome echoes of this lost power of regeneration in that our whole brood of tumors, including the deadly cancer and sarcoma, are due to a strange resumption, on the part of some little knot of our body-cells, of the power of reproducing themselves or the organ in which they are situated, without any regard to the welfare of the rest of the body. Cancer is, in one sense, a throwing off of the allegiance to the body-state and a resumption of amphibian powers of independent growth on the part of certain groups of our body-cells—literally, a "rebellion of the cells." ”

“ We see, then, that thus far no satisfactory cause has been established for the occurrence of cancer, much less for the steady and great increase of the disease of late years. And as far as can be learned, 29no measures are recognized, or at least generally adopted, to prevent its occurrence or recurrence; although, as already stated, modern surgery has seemed to improve the statistics in regard to its mortality in certain forms or locations, and the X-ray and radium have certainly also been able to remove, perhaps temporarily, some of the products of the disease. ”

“ 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. ”

“ 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. ”

“ Some have suggested the hypothesis that the mononuclear leukocyte, by conjugation with disturbed cells, gives them an abnormal reproductive power by 67which they eventually develop the tumor and invade other tissues. But back of all this there is still some activating cause, which is found in the fluids which bathe every tissue, namely the blood and lymph, which we shall see later are deranged in cancer.
The fact that with innumerable injuries occurring everywhere and at all times cancer develops from them very rarely, should teach us something. ”

“ Eoughly we may however classify the various cancers in those derived from epithelial tissue (for instance of the skin, stomach, uterus, the various glands) which we call carcinomata and those derived from proliferating connective tissue cells. Connective tissue in any part of the body may give rise to cancer. These connective tissue cancers are called sarcoma. The growth of a cancer exerts injurious influences on the organism as a whole. ”

“ 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 have also seen that while there has not been demonstrated any very definite and specific change in the bio-chemistry of tumors, and no specific enzymes or poison secreted by cancer cells which can communicate 104the disease, there is evidence that the disordered cells secrete a something which deranges the blood and ultimately tends to end life; for the blood in advancing cancer undergoes very radical, degenerative changes, some of which improve decidedly when a cancerous mass is removed surgically, but return with the regrowth of the tumor. ”

“ Cancer is an uneven swelling, rough, unseemly, darkish, painful, and sometimes without ulceration (which Hippocrates called also concealed cancer) , and if operated upon, it becomes worse, and sometimes with ulceration, for it derives its origin from black bile, and spreads by erosion; forming in most parts of the body, but more especially in the female uterus and breasts. It has the veins stretched on all sides as the animal the crab (cancer) has its feet, whence it derives its name. ”

“ Cancer may arise on any surface covered by epithelium or in any of the secreting glands of the body, but it is much more common in some situations than in others. It is frequently met with, for example, in the skin, in the stomach and large intestine, in the breast, the uterus, and the external genitals; less frequently in the gall-bladder, larynx, thyreoid, prostate, and urinary bladder. ”

“ We noted also that some attributed cancer to independent cell action, relating to the polarity of cells, etc.; but it is inconceivable that a cell or cells can idiopathically start out on a rampant course and pursue it with increasing severity, even until death results, without, at least, some definite pre-disposing cause, even though diligent and earnest work has not as yet determined just what that cause may be. The error has been, we believe, in searching too exclusively by the microscope and by certain laboratory methods, and not sufficiently along clinical and bio-chemical lines. ”

“ 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. ”

“ 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. ”

“ 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. ”

“ 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. ”

“ We now know that so-called secondary cancers are the result of the spread of cancer cells from the original seat of the cancer to other parts of the body, and that this spread is much hindered by the ability of the lymph nodes to catch the cancer cells and hold them. Unfortunately sooner or later some of the cells will escape beyond the lymph nodes and so spread the malignant growth throughout the body, but until this happens the cancer is confined to the region where it started, and it is during this period that complete cure by surgical means is possible. ”

“ The chemistry of cancer has been studied in most varied directions, and the literature relating thereto is very voluminous and can be hardly more than alluded to here. It is unfortunate, however, that most of the researches have been made in connection with patients who have advanced cancer, and very commonly with the disease affecting internal organs, which of itself interferes very greatly with their function, and so causes many of the perturbations of metabolism observed. ”

“ The disease does not always return to the part where the former tumour was taken away, but more frequently in the neighbourhood, and sometimes at a considerable distance. Upon a relapse, the disease in those I saw was more violent, and made a much quicker progress than it did in others on whom no operation had been performed."—I believe the whole medical profession are of the same opinion; in fact, those gentlemen are candid enough to acknowledge that cancer is a disease over which their art has no control. ”

“ In Cancers we have but little Reason to expect a Cure in a Person that is old, if the Cancer has been of many Years standing, and is firmly fixed to the Ribs; but if the Patient be not so far advanced in Years as to be uncapable of receiving the Benefit of Nature by the regular Discharge of the Menses and the Cancer be loose; notwithstanding, it be Ulcerated, over-spread with fungous Flesh, discharge a filthy Matter, and smell very offensively; we do upon Experience affirm that such a Patient may be cured. ”

“ 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. ”

“ 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. ”