The Cancer Problem:
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theason in the Republic of the sony
By WOODS HUTCHINSON, M.D.
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THE CANCER PROBLEVI:
Or,
Treason in the Republic of the Body
***
By
WOODS HUTCHINSON, M.D.
Office of publication :
Rooms 2128-29-30-31, Park Row Building



THE CANCER PROBLEM."
A man’s worst foes are “they of his own household.”
Successful and even invigorating warfare can be waged against
enemies without, but a contest with traitors within dulls the -
spear and paralyzes the arm. Against the frankly foreign
epidemic enemies of the race a sturdy and, of late years,
highly successful battle has long been fought. We have ban-
ished the plague, drawn the teeth of small-pox, riddled the
armor of diphtheria, and robbed consumption of half its ter-
rors. In spite of the ravings and gallery-play of the Lom-
broso mountebanks, anent “degeneracy,” our bills of mor-
tality show a marked diminution in the fatality of every im-
portant disease which afflicts humanity—save one.
And, as the deaths per thousand living from this malady
have almost doubled in England, and nearly trebled in the
United States, during the last thirty years, if official statistics
are to be taken at their face value, the contrast is a suffi-
ciently striking one. To find that, in spite of our utmost en-
deavors, cancer has apparently doubled the number of its vic-
tims in the very same period that even the widespread and in-
tractable “white plague of the north,” consumption, has been
baulked of more than a third of its yearly death-tribute is
enough to give the most heedless of us pause. What wonder
that the conviction is rapidly crystallizing in the medical mind
Originally printed in the “Contemporary Review,” July, 1899.
3

4. THE CANCER PROBLEM
that, since the tuberculosis question has been set in a fair
way towards solution, the coming problem, the riddle of the
Sphinx for the twentieth century, is that of cancer? To a
twelfth of us who have passed the age of forty it is indeed a
riddle of the Sphinx, for, unless we solve it, it will destroy us.
The first step in our approach to the consideration of this
problem is, of course, a clear idea of the nature and tenden-
cies of the cancer process. Here we are upon firm and fa-
miliar ground, for two reasons. First, that cancer is one of
our oldest, deadliest, and most-studied diseases; and, second,
that it has a distinctness, an individuality, I had almost
said a personality, -such as is possessed by no other disease.
Like all other vital processes, whether morbid or healthy, it
can only be described or grasped in terms of the cells. And
this is peculiarly true, because the essential element in cancer,
the literal soul of the process, is warfare between a certain
group of cells and the rest of the body. Its most accurate
definition, as well as most graphic characterization, is, in the
words of a great English surgeon-philosopher, “a rebellion of
the cells,” an imperium in imperio.
A cancer is a biologic anomaly. Everywhere else in the
cell-state we find each organ, every part, strictly subordinated,
both in form and function, to the interests of the whole. Here
this relation is utterly disregarded. In the body-republic,
where we have come to regard harmony and loyalty as the al-
most invariable rule, we suddenly find ourselves confronted by
anarchy and revolt.
The process invariably begins in one great class of cells,

THE CANCER PROBLEM 5
the epithelium of the secreting glands. This is a group of
cell-citizens of highest rank, descended originally from the
great primitive skin-sheet by a process which will be de-
scribed later, which have organized themselves into chemical
laboratories, ferment-factories for the production or the va-
rious secretions required by the body, from the simplest
watery mucus, as in the mouth, or mere lubricant, as in the
fat-glands of the hair-follicles, to the most complex gastric or
pancreatic juice. They form one of the most active and im-
portant groups in the body, and their revolt is dangerous in
proportion. The movement of the process is usually somewhat
upon this order. After forty, fifty, or even sixty years of
loyal service, the cells lining one of the tubules of a gland—
for instance, of the lip, or tongue, or stomach—begin to grow
and increase in number. Soon they block up the gland-tube,
then begin to push out in the form of finger- or root-like
columns of cells into the surrounding tissues. These columns
appear to have the curious power of either turning their nat-
ural digestive ferments against the surrounding tissues, or of
secreting new ferments for the purpose, closely resembling
pepsin, and thus literally eating their way into them. So
rapidly do these cells continue to breed and grow and spread
resistlessly in every direction that soon the entire gland, and
next the neighboring tissues, become packed and swollen, so
that a hard lump is formed, the pressure upon the nerve-trunks
gives rise to shooting pains, and the first act of the drama is
complete.
But these new columns and masses, like most other results

6 THE CANCER PROBLEM
of such rapid cell-breeding in the body, are literally a mush-
room-growth. Scarcely are they formed than they begin to
break down, with various results. If they lie near a surface,
either external or internal, they crumble under the slightest
pressure or irritation, and an ulcer is formed, which may
either spread slowly over a surface from the size of a shilling
to that of a dinner-plate, or deepen so rapidly as to destroy
the entire organ, or cause death by hemorrhage. The cancer
is breaking down in its centre, while it continues to grow and
spread at its edge. Truly a “magnificent scheme of decay.”
Then comes the last and strangest act of this weird tragedy.
In the course of the resistless onward march of these rebel
cell-columns, some of their skirmishers push through the wall
of a lymph-channel, or even by some rare chance a vein, and
are swept away-by the stream. Surely now the regular leuco-
cyte-cavalry have them at their mercy, and can cut them
down at leisure. We little realize the fiendish resourceful-
ness of the cancer-cell. One such adrift in the body is like
a ferret in a rabbit-warren; no other cell can face it for an
instant. It simply floats unmolested along the lymph-chan-
nels, until its progress is arrested in some way, when it
promptly settles down wherever it may happen to have landed,
begins to multiply and push out columns in every direction,
into and at the expense of the surrounding tissues, and be-
-
hold, a new cancer or “secondary nodule '' is born.
--
In fact, it is a genuine “ animal spore,” or seed-capsule,
capable of taking root and reproducing its kind in any favor-
able soil. And, unfortunately, almost every inch of a cancer-

THE CANCER PROBLEM 7
patient’s body seems to be such; it is merely a question of
where the spore-cells happen to drift and lodge. The lymph-
-
nodes, or “settling-basins,” of the drainage area of the
primary cancer are the first to become infested, probably in
an attempt to check the spread of the invaders, but the
“ spores” soon force their way past them toward the central
citadels of the body, and one after another the great vital
organs—the liver, the lungs, the spleen, the brain—are rid-
dled by the deadly columns and choked by decaying masses
of new cells, until the functions of one of them are so seriously
interfered with that death results.
Not that the cancer-cells can be said to have any special
preference for these in their plan of attack, for they also over-
run every other structure which lies in their path—fat, bone,
muscle, binding-stuff, skin—but simply because all blood- and
--
lymph-roads lead ultimately to the “Rome'' of one or more
of the great central organs. Indeed, grimly ferocious as this
ruthless march upon the body-fortresses appears at first sight,
it is really the most merciful process of the scourge, for these
secondary growths in vital organs are usually almost painless,
and kill quickly, instead of leaving the sufferer to be gradu-
ally eaten alive by the cancer-cells, and slowly poisoned by
their waste-products. Indeed, we often frankly advise an
operation, in cases where cure is practically hopeless, for the
sake of relief from the awful pain of the growth at the sur-
face, which can be completely removed, and the almost cer-
tainty that, if the disease returns, it will be in one of the
central organs—thus lengthening life by the period of six

8 THE CANCER PROBLEM
months to three years that the disease lies dormant, and sub-
stituting a swift and painless death for a lingering and ter-
rible one.
The most unique and distinctive mark of the cancer-process
lies in these colonies or secondary growths. No matter where
they lodge, the spore-cells “breed true,” and so accurately
imitate their parents that it is not infrequently possible to
say, by microscopic examination of the colony, in what gland
it originated. It is a startling experience to find in the liver
or lung an imitation of a gland from the lower bowel. And
not only will it look like the parent gland, but may secrete the
same digestive juice, as shown by Stewart, in secondary
growths from cancer of the pancreas.
In fact, the conclusion is irresistible that a cancer is a
gland turned parasite, growing and spreading at the expense
of the rest of the body.
This is further confirmed by the curious way in which it
produces its fatal effects. The first noticeable effect of can-
cer upon the general health is a peculiar sallowness or ashy
tint of the skin. This is neither the transparent paleness of
consumption, nor the greenish tint of anaemia, nor the yellow
mask of jaundice, but a combination of the three. So char-
acteristic is it that, when well developed, it enables a case of
cancer to be recognized across the room, or even across the
street, by an expert eye. It is accompanied or soon followed
by wasting, failure of appetite, spirits, and strength, in
short, a general depression of the vital powers, which steadily
deepens until it proves fatal, usually by heart-failure.

THE CANCER PROBLEM 9
This condition, which is the ordinary cause of death in can-
cer, unless one of the great vital organs be seriously in-
volved, or an artery eaten across, was for long a great puz-
zle, until it dawned upon us that the cancer cell-masses, hav-
ing no ducts or proper excretory channels, were pouring their
abundant waste-products into the blood and lymph, thus poison-
ing the entire body, precisely as those vegetable parasites the
bacteria do with their secretions or toxins.
If the imitation-process went far enough to form a duct or
discharge-channel, cancer would lose half its dangerousness.
In fact, cancer grows, spreads, and poisons just like a
parasite—only it happens to be born in and of the body
itself.
The wide and fundamental difference between cancer and the
bacterial invasions, such as tubercle (consumption) and syphi-
lis, lies in the fact that the growths or nodules which spread
all over the body in them are simply local reactions against the
bacilli on the part of the different tissues, and have no inde-
pendent vitality, powers of reproduction, or character of their own
whatever.
Now comes the question: “Has this remarkable process
any analogue in either health or disease, or is it entirely
unique?”
Certainly none in pathology, with the possible exception of
the infective inflammations, but in physiology we have not far
to seek for not merely a likeness, but a blood-relationship.
The whole process from start to finish is simply a repetition
of the earlier stages of gland-formation in embryonic life. Like

10 THE CANCER PROBLEM
most long-lived disease-processes, it is a health-process gone
wrong. This is the secret of half its deadliness and all its
unmanageableness.
The epithelial cells of the great skin-sheet.(blastoderm),
which cover our entire surface, whether external as skin, or
internal as stomach-lining, which carry out all our processes
of absorption and of secretion, which form alike our glands
and our sense-organs—conduct, in fact, all communications of
every sort whatever between the body and the world without—
are deservedly the dominant class in the body-community.
For the soundest of reasons of state they have been given the
traditional right of way, hereditary “right of eminent do-
main,” everywhere in the territory of the republic of the
body. A conflict between them and the plebeian cells of the
body-mass (mesoblast) is like a war between Arabs and Fella-
heen, or of white men against negroes.
For countless generations the epithelial cells have driven
their hollow columns in every direction through the living but
unresisting masses of the mesoblast, their only pass-word a
haughty “For the good of the State.” Watch them forming
a gland, say in the lining of the stomach, about the fourth
month of embryonic life. Drawn up at first in serried, pave-
ment-like ranks upon the surface, glancing along the face of
their formation, we catch sight of a little knot of them form-
ing here on the front of the line.
The knot swells to a group, and the group to a column,
which begins to move slowly, but with disciplined steadiness
and in perfect order, into the interior, with true strategic

THE CANCER PROBLEM ll
instinct in the direction of food and water. After penetrat-
ing a certain distance the column opens ranks in the centre,
and thus establishes a line of communication with the surface,
along which are passed the portable portions of the booty
which it has captured upon its march. In the language of .
physiology, a simple tubular gland has been formed and be-
gun to secrete.
At this stage, to the eye of the observer, it looks just as if
some invisible finger had dimpled down the pavement-layer of
surface-cells into the tissues below, so as to form a simple
pouch with widely open mouth.
If the secretion required be but a simple one, the process
may stop here, but, if a more complex product is demanded,
the main column only halts and begins to throw out smaller
columns in all directions, like the sticks of a fan; these again
become, hollow and open up communication with the central
tube, and behold a branched or fingered gland capable of
secreting pepsin or acid for the gastric juice.
Let the branches give off smaller branches, and these again
twigs, and so on for ten or twenty generations, and a massive
“racemose ’’ gland—like the pancreas, the parotid, the liver
—is formed. In short, every gland in the entire body is
formed by this simple process of pouching and re-pouching.
It is, perhaps, also worth noticing in passing that this trick
of pouching is not only the secret of gland-formation, but of
animal organization as distinguished from vegetable. The
stomach was originally just such a pouch of the surface epi-
thelium, dipping into the interior for protection, warmth, and

12 THE CANCER PROBLEM
moisture. The nerve-axis, with its swelling at the head-end
which we call the brain, is at first but a long furrow of the
dorsal epiderm (in plain English “skin of the back ’’) dip-
ping into the body-stuff to form a longitudinal tube. Animals
have learned the trick of burying their most vital parts deep
in their interior, where they can be protected, warmed, and
fed by the entire body-mass. Plants still keep theirs upon the
surface exposed to all elements—literally “wear their hearts
upon their sleeves’’—and, as a slight offset to many resulting
disadvantages, have no cancer.
What wonder, then, that, when a process which has been
the very keystone of successful organization for countless gen-
erations once turns against the body, the result should be the
deadliest and most uncontrollable of known diseases?
So much as to the nature of cancer; what can be said as to
its cause? Here, unfortunately, we leave the solid grºund of
established fact, and enter the realm of, at best, reasonable
conjecture. In spite of the antiquity, enormous frequency,
and dramatic interest of cancer; in spite of the immense
amount of laborious research which has been expended upon
the question for more than two centuries past,--we are still
almost completely in the dark as to the actual causation of
cancer. And the number of theories and the vigor with
which each observer champions his own are, of course, in
proportion to the darkness. Nearly all, however, which are
worthy of serious consideration may be grouped under three
heads: (1) Local irritation; (2) Parasites; (3) Disturbances of
balance within the organism itself. It will probably be observed

THE CANCER PROBLEM 13
with some sense of disappointment that neither of these in-
cludes the celebrated “tomato” theory. But unfortunately
the only evidence that has yet been adduced in favor of this
attractive explanation is that both tomatoes and cancer have
become much more common in the last twenty-five years, which
is hardly conclusive. The argument might with equal force
be applied to postage-stamps or the suffrage, or, as Dr. Ara-
bella Kenealey has actually done, to the athletic over-develop-
ment in the new woman, none of the victims of which have
yet reached the cancer age. In regard to the first theory of
causation, it may be briefly said that the decided balance of
expert opinion no longer regards local injury as more than a
secondary or determining cause of cancer. A blow or chafe
falling upon a part already predisposed to cancer may precipi-
tate the outbreak of the process, or even determine the spot at
which it shall begin, but it can never originate it in a healthy
part or organ.' The most striking instance of the power of
local irritation is found in the well-known “smoker’s cancer ‘’
of the lip and tongue, where the pressure of the mouthpiece of
the pipe appears to decide the point of origin of the disease.
More than this, however, it would be unsafe to say, for, al-
* It is quite true that a considerable portion of cancer patients come to us
with some history of injury, but, when we remember that most cancers begin
near the surface, and that these injuries date back anywhere from three
months to seven years, it will be seen at once what an immense part must be
played by mere coincidence. It would hardly be possible to find any part of
the body surface upon which some blow or injury has not fallen in seven
years' time, and the majority of our surgical experts now regard the bulk of
stories of injuries as a starting cause but as examples of the familiar post hoc
ergo propter hoc fallacy.

14 THE CANCER PROBLEM
though cancer of the lip is almost confined to men (less than
2 per cent of the recorded cases being in women), and in
more than half of the cases begins at or near the angles of the
mouth, in one of which the pipe, of course, is usually held,
yet, on the other hand, it must be remembered that 90 per
cent. of all men smoke, while only about 2 per cent, develop
cancer of the lips or tongue, that in a majority of instances
the disease begins upon some other part of the lip than that
on which the pipe actually rests, that a fairly proportional
number of cases in non-smokers is now recorded, and that, as
will be discussed later, there are probably sexual factors
adequate to account for a large part of its preference for the
male lip.
The theory of a parasitic origin of cancer has always been
a most attractive one, partly on account of the delight of the
human mind in assigning concrete, definite causes for phenom-
ena, and partly because of the immensely improved prospects
for cure which the discovery of a specific germ would open
up. And so important is the problem, and so striking to the
bacteriological eye the superficial resemblance between cancer
and the infections, that ever since the foundation of the sci-
ence the search for cancer-germ has been the favorite quest of
the bacteriological world. Fully a third of the bacteriologists
living have had a tilt at the problem in one form or another.
And yet, after all the laborious and often most ingenious re-
search expended upon it, the cancer-parasite is still undis-
covered; indeed, the majority of pathologists are, strangely
enough, becoming more and more doubtful as to its probable

THE CANCER PROBLEM 15
existence. Scores of observers have announced the discovery
-
of “parasites” in cancers, but scarcely any two of them
agree in their descriptions, their findings ranging all the way
from the animal to the vegetable kingdom, from protozoa to
bacteria. And, with few exceptions, the first work of each
new discoverer is to demolish the theories and disprove the
existence of the parasites which have preceded his own. And
this part of his work is usually a success. Most of the bodies
described as parasites have been shown to be degenerated
cells of the body itself, others nuclei or cell-granules, and are
so regarded by the majority of conservative pathologists to-
day; very few of them have proved, like most other germs,
capable of cultivation outside the body, and none can produce
cancer in animals when injected into their tissues. Indeed,
no parasite yet can be said to have survived a second or
“check” investigation by competent and entirely independent
pathologists. So that we are obliged for the present to find,
in re the germ-theory of the causation of cancer, the Scotch
verdict, “ Not proven.”
The third theory regards cancer as a result of the internal
struggle for existence between the different parts and organs
of the body. This struggle is continual, and results in the
success of certain groups of cells and the placing of others at
a disadvantage. These latter consequently diminish in size
and vigor, and even completely disappear. As is well known,
cancer is emphatically a disease of late middle life and com-
mencing old age. In other words, it occurs at the period
when many parts of the body are being placed at a disadvan-

16 THE CANCER PROBLEM
tage and beginning to decay. And it shows a marked prefer-
ence for just those organs which are undergoing the most rapid
decline,—the breast, the uterus, the lip. The mammary
gland and uterus after the change of life, the lip after the de-
cay of the teeth, have done their work, outlived their useful-
ness, and are being placed upon a starvation pension by a
grateful country. Nineteen out of twenty accept the situation
without protest, and sink slowly to a mere vegetative state of
existence, but in the twentieth some little knot of cells rebels,
reverts to an ancestral power of breeding rapidly to escape
extinction, begins to ravage the territory of the ungrateful re-
public, and cancer is born.
This theory of causation is chiefly supported by two great
groups of facts relating, first, to the age at which cancer is
most prevalent, and, second, to the parts which it most fre-
quently attacks. Its age-preferences are well marked. Rare
before thirty-five, not common before forty, rapidly reaching
its maximum in both sexes between forty-five and fifty-five, de-
clining after sixty, by seventy it becomes almost as rare as
before thirty-five. It is emphatically a disease of senility,
of age, but, as Roger Williams has pointed out in his admi-
rable monograph, not of “ completed '' senility.
To express it in percentages, barely 20 per cent of the
cases occur before forty years of age, 60 per cent, between
forty and sixty, and 20 per cent. between sixty and eighty.
Thus the early period of decline, the transition stage between
full functional vigor and declared atrophy (wasting) of the
glands, is clearly the period of the greatest danger, from the

THE CANCER PROBLEM 17
point of view of this theory, -precisely the period in which
the gland-cells, though losing their function—and income—
have still the strength to inaugurate a rebellion, and a suffi-
cient supply of the sinews of war, either in their own posses-
sion or within easy striking distance in the tissues about
thém, to make it successful.
Equally significant is its preference for particular organs.
This differs notably in the two sexes from the fact that it
is the secondary sexual structures in both which are most
strongly liable to attack.
Though of late years the balance is being equalized some-
what, cancer is more than twice as common in women as in
men, and the whole of this excess is due to the frightful vul-
nerability of the breast and the womb. According to Roger
Williams, Gross, Bland Sutton, and the bulk of authorities,
these two organs are the site of no less than 65 to 75 per
cent of all cancers in women. Nor is this due in any way to
the strain of child-bearing and lactation, for the disease is
quite as common among the unmarried and childless; indeed,
many authorities declare it to be more so. The only sugges-
tion which throws any light upon this fearful susceptibility is
that of our present theory, -that we have here two organs
unique in this respect, that they invariably lose their function
and begin to atrophy between the fortieth and fiftieth years.
In other words, begin to decay twenty years before the rest of
the body, precisely the condition which it regards as most
favorable to the birth of cancer.
Of the remaining 30 per cent. of cancers in the female,

I8 THE CANCER PROBLEM
nearly half begin in the stomach and rectum, and the re-
mainder are scattered all over the body.
In men there is no such striking preponderance of any one
organ or system, and yet from 50 to 70 per cent. of all can-
cers begin in two great groups of organs, the mouth-parts and
stomach.
The, at first sight, extraordinary and almost complete im-
munity of the reproductive organs explains itself, upon a mo-
ment’s consideration, by the fact that the reproductive powers
in man persist practically as long as life itself, instead of
dying twenty years sooner. The male stomach is attacked
three times as frequently as the female (25 per cent to 40
per cent of all situations), but this is probably chiefly due to
the fact of there being other organs in the female organism
in which the cancerous process so much more easily originates.
It is a curious fact that cancer of the stomach, which, after
the female secondary sexual organs, is the commonest form
of disease in both sexes, begins in 70 per cent of all cases in
one limited region of the organ, the pyloric, which develops
into the gizzard, or grinding-stomach, in birds, some reptiles,
and a few primitive mammals, and is quite unnecessarily
thick and strong in the human stomach.
The only other part in the male which can vie with the
stomach in the “bad eminence” of cancer-liability is the
group of structures comprising the lips, the tongue, the
throat, and larynx, and known collectively as the “mouth-
parts.” In these from 25 per cent. to 38 per cent. of all
cancers originate in the male, and their great susceptibility,

THE CANCER PROBLEM 19
as compared with their almost complete immunity in the fe-
male, is a puzzle to pathologists, except with those who are
content to regard smoking as its sole cause. There is only
one suggestion which can be offered, and which may have lit-
tle or no bearing upon the problem, and this is that all this
group of parts undergo a distinct secondary sexual modifica-
tion in men at and after puberty, while they remain unchanged
in woman. The enlargement of the teeth, especially the ca-
nines, the larger and heavier jaw, the lengthening of the vocal
cords, causing the deeper tone of the voice, the enlargement
of all the resonance cavities to match, the growth of the beard
—are all changes peculiar to the male. On the other hand,
the actual increase in size is so comparatively small, and the
relatively greater proportion of decline in old age so slight,
that it is difficult to believe it capable of exerting any ap-
preciable influence upon the liability of the parts. It is
merely an interesting coincidence that the parts in each sex
which undergo the most marked secondary sexual modifica-
tions are overwhelmingly the most liable to cancer, and that,
if we strike out the cases occurring in the mammary gland and
uterus in women, and the mouth-parts in men, we reduce the
mortality in both sexes to almost precisely the same figure.
The distribution of cancer in the lower animals, both as to
age and organs, confirms the “balance’’ theory in a negative
way. In the first place, the disease is not more than a tenth
as common in them as in our own species. All who have
studied the subject practically agree in this, and that the
main reason of this discrepancy is that the vast majority of

20 THE CANCER PROBLEM
animals die before reaching the cancer age. Such cases as
do occur—and it is only a relatively rare disease—are found
almost invariably in old or ageing animals. Another im-
portant factor is that very few animals either survive or are
permitted to survive their reproductive powers. The only
animals in which this does cocur—the horse, the dog, and the
cat—are the only species in which cancer is at all frequent,
and in them it again affects the mammary gland, the repro-
ductive organs, and the rectum. We are speaking, of
course, of the domesticated animals, for so far, in spite of
most careful search, cancer in wild animals is practically
unknown. Bland Sutton, in 3000 post-mortem examinations at
the Zoological Society’s Gardens, found only one doubtful
case, and my own much more limited experience of some 300
autopsies there the past winter discovered only one tumor of
suspicious character, in the gizzard of a pheasant.
The much lower frequency of cancer in the negro–less
than half the white rate in the United States—and in savage
and barbarous races generally is probably also due to their low
average longevity, and the fact that the women do not survive
their reproductive powers half as long as in civilized races.
Space permits us but a word upon the interesting question
of the prospects of the disease: is it increasing, and, if so,
what can be done to offset it? Upon the first question author-
ities differ. Dr. Roswell Park, in his startling paper in the
recent “Cancer Number” of “The Practitioner,” declares
that it is advancing at such an appalling rate that, at the
present rate of progress, in ten years it will cause more deaths

THE CANCER PROBLEM 21
in the State of New York than consumption, small-pox, and
typhoid fever combined! On the other hand, Dr. Newsholme,
who is an experienced vital statistician, states in the same
journal that the marked increase shown by vital statistics is
only apparent and due to increased accuracy of diagnosis and
record. After a very careful examination of the figures, he
comes to the reassuring conclusion that cancer is really no
more frequent than it was thirty years ago.
A death-rate per million living, which has nearly doubled
in the past thirty years, and quadrupled in the last fifty years,
and which is larger than that of any other disease with the
exception of tuberculosis, bronchitis, and pneumonia, is, how-
ever, sufficiently serious, although it is certainly not increas-
ing at all as rapidly as would appear from the face of the
registrar-general’s reports. Those of the profession who see
the most of cancer are almost unanimously of the opinion that
it is slowly increasing, and almost equally so that this is
due to the greatly diminished death-rate from the diseases of
infancy, childhood, and young adult life, such as bowel-
troubles, bronchitis, tubercle, and typhoid, and hence the
much larger number of individuals which reach and pass
adult life. In short, to use a Hibernicism, cancer is increas-
ing because more people are living long enough to die of it.
Thus, paradoxical as it may sound, its greater prevalence
is a symptom of increasing longevity and vigor on the part of
the community. Cancer is the price paid for longer life.
The most hopeful phase of the problem is the prospect of
cure, which is already most favorable and improving every

22 THE CANCER PROBLEM
year. The more our knowledge of cancer widens, the more
carefully we study its processes, the firmer becomes our con-
viction that it is in the beginning emphatically a local disease.
Hence complete and radical removal at an early stage will
cure nearly 80 per cent. of all cancers. And this result has
almost been attained in actual practice, where the percentage
of cures ranges from 30 to 70, in reasonably early cases.
The most important requisite is early recognition of the dis-
ease. But the removal must be most thorough, not merely of
the diseased tissues, but the entire gland in which it is be-
ginning, with the sound tissues for an inch all round. And,
of course, nothing but the knife can effect such a removal,
cleanly, quickly, and painlessly. In spite of a most exhaust-
ive search, for at least five centuries past, by both doctor,
patient, and quack, no drug, paste, caustic, or reagent of any
sort has yet been discovered which can be relied upon to even
destroy the diseased tissue with any certainty whatever. If
strong enough to act at all, they eat away remorselessly cancer
and healthy tissue alike, producing the most frightful mutila-
tions; most of them contain either arsenic or corrosive subli-
mate, and are extremely liable to cause fatal poisoning by
absorption; and, as they take weeks to destroy a growth of
any size, and are extremely painful, the cumulative agony in-
flicted by them is something fearful. To see patients suffer-
ing literally the tortures of the damned for weeks and even
months at a stretch in the futile attempt to “eat away ’’ a
cancer by zinc chloride or arsenic paste, when they can have
it removed in twenty minutes under chloroform with absolute

THE CANCER PROBLEM 23
certainty and safety, and without a single twinge of pain,
solely from sheer panic at the very name of the knife, is one
of the most astonishing experiences in medicine. The
‘‘ knife-dread '' is one of the most unreasoning and unreason-
able superstitions which lingers on into the nineteenth century.
The same thing must be said of internal remedies. Myri-
ads of drugs have been vaunted as cures—arsenic, sulphur,
golden seal, blood-root, condurango, clover-tea, each has been
tried by hundreds of eager physicians and thousands of anx-
ious victims ready to clutch at any straw, but not one has been
found which has the slightest permanent effect upon the course
of the malady.
So that the remorseless logic of events thus far seems to
have practically limited us to operation as a means of cure.
Fortunately it is a fairly effective means and rapidly improv-
ing, while, under aseptic surgery, its risks have been reduced
almost to the vanishing point. Fifty years ago we operated
chiefly with the hope of prolonging life or relieving pain; now
we expect to cure from 30 to 60 per cent of our cases, if we
can see them early enough. This great improvement is due
partly to the wonderful advances of modern surgery, but more
to greater skill in recognizing the very earliest stages of the
disease, and to a wider and more intelligent recognition on the
part of our patients of the importance of an early diagnosis.
It cannot be too strongly emphasized that cancer in its early
stages is a distinctly curable disease; in its later, almost
incurable.
As by a merciful coincidence, indeed in the very nature of

24 THE CANCER PROBLEM
the malady, it usually attacks superfluous and declining or-
gans, it is possible to remove it completely, without danger to
life, in the great majority of cases. Indeed, almost the only
organs in which cancer at all commonly begins, which cannot
be themselves removed entirely or in part, if necessary, are
the stomach and liver, And even these are rapidly coming
within the field of operation, for large portions of each, indeed
the entire stomach, have already been removed for malignant
disease with complete, though so far only temporary, success."
If the disease returns after operation, or has spread too
far to permit of removal, before it is seen by the surgeon, we
have still a palliative left, the greatest gift of the gods to
suffering humanity—opium, which will render the sunset
hours of life not only almost painless, but even comfortable.
Cancer, ruthless as it is, has one redeeming feature: it
does not threaten the existence of the race, nor ruin the in-
dividual life. The best of the life-work is done, the family
reared, the vantage-ground for the world’s progress won, be-
fore the dart is launched. Between dying of consumption at
twenty-five and of cancer at fifty lies practically an entire
lifetime. Few of us would hesitate for a moment, if given
our choice. Surely even two years of suffering is not too
much to pay for fifty of vigorous, successful life.
Schlatter's celebrated case lived fourteen months after removal of the
entire stomach for cancer of the pylorus, and gained twenty pounds in weight,
but died ultimately of a recurrence of the disease in the liver.