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Cancer and Diet - With facts and observations on related subjects ebook

Frederick L. Hoffman  

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Opis ebooka Cancer and Diet - With facts and observations on related subjects - Frederick L. Hoffman

When I was reaching the end of my extended study of the cancer data and observations collected in connection with my San Francisco Cancer Survey, my thoughts regarding cancer causation, treatment and prevention became concentrated upon the dietary aspects of the disease to which I had previously given only incidental consideration.For twenty years or more, the subject of diet has received my attention culminating in a fixed determination to initiate in due course an original study based on extended facts regarding living cancer patients and of course the required number of noncancerous controls. The method first adopted in connection with my San Francisco Cancer Survey, had yielded fairly promising results but I soon reap fized that a more useful study would have to have for its sole objective the ascertainment of the actual dietary experiences of cancer patients collected by special research assistants operating on the basis of definite instructions.

Opinie o ebooku Cancer and Diet - With facts and observations on related subjects - Frederick L. Hoffman

Fragment ebooka Cancer and Diet - With facts and observations on related subjects - Frederick L. Hoffman

Cancer and Diet

With facts and observations on related subjects

Frederick L. Hoffman

First digital edition 2017 by David De Angelis

CONTENTS

PUBLISHER'S PREFACE

PREFACE

PART I. DIETARY THEORIES OF CANCER

PART II. THE MODERN DIET - GENERAL PRINCIPLES

PART III. CANCER METABOLISM

PART IV. DIETARY FACTS CONCERNING CANCER PATIENTS

PART V. GENERAL SUMMARY AND CONCLUSIONS

PUBLISHER'S PREFACE

Comparison of the list-prices placed on books of several sorts must, if the comparer is of an inquiring turn of mind, be extremely puzzling. Sometimes a large book bears a price actually less than that charged for a smaller one. In general there seems to be a lack of uniformity between price charged and physical entity.

Indeed the relationship between price and size may be set down as being so diverse that size as a criterion of price is quite valueless. Too many modifying factors enter in to permit a stable relationship. One book has a potential market of 10,000 copies; another of 500. Thus in the one case 10,000 cooperators putatively take part in the enterprise; naturally their contribution may be proportionately less than if only 500 join in. Or again, the cost of composition varies widely: one book may cost more than another to compose, even though it has only half as many pages.

Still other factors, unseen and unguessable, enter in. In the case of this book for instance, a list price of $5.00 is no more than half of the price justified by its cost. This price has been made possible by a generous subvention, made with a view to giving the book as wide a distribution as possible. The book is, in part, a gift to every purchaser.

PREFACE

Early in 1931 when I was reaching the end of my extended study of the cancer data and observations collected in connection with my San Francisco Cancer Survey, my thoughts regarding cancer causation, treatment and prevention became concentrated upon the dietary aspects of the disease to which I had previously given only incidental consideration. I have reference to my remarks on this phase of cancer research as set forth in my Cancer Mortality Throughout the World, 1915, my address on Cancer and Civilization read before the Belgian Cancer Congress, 1923, my address on the Causation of Cancer delivered before the American Association for Cancer Research, Buffalo, 1924, Cancer in Native Races, 1926, Cancer in Mexico, 1927, Cancer and Overnutrition, Health Congress of the Royal Institute of Public Health, Ghent, Belgium, 1927, etc. I therefore included in my Eighth San Francisco Cancer Report such data as I had available at the time under the title Cancer in Relation to Diet and Nutrition which, in extended form, constitutes the second section of this work.

Thus for twenty years or more, the subject of diet has received my attention culminating in a fixed determination to initiate in due course an original study based on extended facts regarding living cancer patients and of course the required number of noncancerous controls. The method first adopted in connection with my San Francisco Cancer Survey, 1924-25, had yielded fairly promising results but I soon reap fized that a more useful study would have to have for its sole objective the ascertainment of the actual dietary experiences of cancer patients collected by special research assistants operating on the basis of definite instructions.

In 1931 the outlook for such a project seemed far from encouraging but during the early part of the winter of that year help came to me from an unexpected source. Mr. Samuel S. Fels of Philadelphia who had requested some of my cancer publications expressed the desire to discuss the situation with me, and later agreed to finance the necessary field operations of such a study as I had in mind. Mr. Fels has for many years taken an intelligent and constructive interest in cencer research, particularly with reference to gastric and intestinal cancers, their diagnosis, treatment, causation and possible prevention. I therefore submitted to him a tentative project for an extended study of the dietary aspects of the cancer problem which, subject to modifications suggested by him, was adopted. I agreed to devote much of my time to the subject during a long contemplated trip to Europe and Northern Africa (1932), and the present work is the result. During this journey I met many of the outstanding authorities on cancer and nutrition in Great Britain and on the Continent with whom I discussed the details of my projected study on the basis of my questionnaire which I had brought with me. My journey, however, was limited to England, Scotland, Holland, Germany, Switzerland, Spain and the French possessions of North Africa where I made a brief study of the dietary customs of the native populations.

On my return I started the work in Philadelphia at several hospitals, gradually extending my field operations to Boston, St. Louis, San Francisco, San Antonio and other parts of Texas. I watched the results carefully, analysing the first thousand eases, then the second, when I felt that the intrinsic consistency of the data justified the assumption that the number of cases was sufficient for a complete analysis in all matters of detail. In the meantime I had read exhaustively many standard works on diet and nutrition, and treatises on biochemistry and physiology to make sure of a sound scientific background for the final consideration of the data collected. I amplified such studies with personal interviews with many authorities and by world wide correspondence on debatable questions. All of those whom I approached on the subject gave me their whole hearted support and many valuable suggestions which increased materially the practical value of the study as it finally developed and as set forth in what follows.

The questionnaire method adopted for the present purpose is the result of much similar experience in other fields of medical statistical research. It falls short of being fully satisfactory in that certain dietary items were accidentally omitted due chiefly to the fact that I adopted for my guidance the dietary statistics as tabulated in the report on Vitamins of the British Ministry of Health. But the omissions are not of serious importance and can easily be allowed for. On the whole the results of the method are so thoroughly consistent that I feel sure they may be accepted with confidence.

Originally I had contemplated only a detailed study of the vitamin aspect of the problem, subsequently enlarged to include nearly all the organic and inorganic compounds of practical importance. In discussing technical or otherwise involved scientific questions I have quoted at length the recognised authorities rather than rely upon my own imperfect methods of interpretation, for I am neither a biochemist nor a food chemist and cannot therefore speak with authority upon these aspects of the many problems and questions under consideration. I have had the great advantage of frequent discussions with Dr. Ellice McDonald, Director of this Laboratory, and many of his technical assistants. Then, too, I was most fortunate in my research assistants who collected the questionnaires from cancer patients and controls in different parts of the country. The work in Philadelphia was done by Mrs. Frances Stark of Ventnor, N. J., and by my daughter, Miss Virginia Hoffman, who also collected questionnaires in Boston and San Francisco. The work in southern Texas was done by Miss Lucille Stuart of San Antonio, while the work in St. Louis was done by Miss Mary Worrall of Kirkwood, Missouri. The control cases in San Francisco were collected by Mrs. Virginia Ring. All the tabulations and calculations of countless rates and ratios were done by Miss Nora Powell, statistician and mathematician employed by this Laboratory. Many other technical questions more or less beyond my full understanding I have discussed with Dr. Stanley Reimann of the Lankenau Hospital, Philadelphia. Thus I have tried to guard myself against personal bias quite common in work of this kind Finally, I am under sincere obligations to my secretary, Miss Agnes Lennon, who has prepared the manuscript for the printer and aided me in countless ways in the handling of the large amount of data and observations, as well as in the preparation of the index.

It had been my intention, had space limitations permitted, to have enlarged upon the historical development of modern dietary practices or eating customs, but this I have had to omit since to do the subject justice would have materially extended the size of the book already grown to almost forbidding proportions. But I cannot omit a very brief reference to the dietary and gastronomical observations in Burton's Anatomy of Melancholy, first published in 1621. Burton, in discussing customs of diet, refers briefly to the immense range in dietary practices among the various peoples of the old and new world, observing with regard to America that:

In America in many places their bread is roots, their meat palmitos, pines, potatoes, etc., and such fruits. There be of them too that familiarly drink salt sea-water all their lives, eat raw meat, grass, and that with delight. With some, fish, serpents, spiders; and in divers places they eat man's flesh raw and roasted, even the Emperor Metazuma himself. In some coasts, again, one tree yields them coco-nuts, meat and drink, fire, fuel, apparel with his leaves, oil, vinegar, cover for houses, etc., and yet these men, going naked, feeding coarse, live commonly an hundred years, are seldom or never sick; all which diet our physician forbid.

Thus finding fault with dietary habits is not new and the same conclusion applies to food modifications or departures from the natural form of food consumption. To those who wish to pursue the changes in dietary practices, I cannot too strongly recommend the reading of this volume of exceedingly interesting observations.

It had also been my intention to have brought into the discussion the extremely interesting observations on diet among the English labouring classes at the end of the eighteenth century, contained in a magnificent treatise in three volumes on The State of the Poor, by Sir Frederic Morton Eden, London, 1797. This work is one of the greatest of British economic classics and the first in which the subject of diet receives statistical and practical consideration. The book, unfortunately, does not lend itself to convenient abbreviation and must be consulted in the original for a vast amount of useful observations.

It includes for example, extended remarks on potatoes as a staple article of food, including a quotation from the Report of the Board of Agriculture "that potatoes and water alone, with common salt, can nourish men completely." There are extended observations on the different varieties of bread eaten at the time, including barley bread eaten in Gloucester, oat bread eaten in Scotland and the northern part of England, particularly in Yorkshire, sago bread used in the East Indies, and corn bread used in America. This is followed by extended observations on the dietaries of American Negroes during the slave period, concerning which it is said: "That men may live, and be strong to labour, with little or no animal food, is evinced by the field negroes in the Middle states of North America, who are an healthy and hardy race of people; and whose labour is constant, and sometimes severe,

although they are fed almost entirely on vegetables."

The foregoing remarks are amplified by experiments and observations

on flour and bread delivered by Dr. Irving to a Committee of the House of Commons. Finally there are observations on drinking habits, particularly beer, ale, stout and porter, disproportionate to the general family budget. I quote the following quaint statement: "there is hardly a labouring man, of any account whatever, who does not think it necessary to indulge himself, every day, in a certain quantity of malt liquor; and if taxed, at any time, with drinking too much, he thinks it a sufficient, and by no means an unbecoming, apology for himself, to allege, that, excepting on a Saturday evening, or occasions of festivity, he rarely allows himself more than a pint, or, at most, a pot of beer a day."

I would also liked to have discussed critically an important work entitled Good Cheer, by Frederick W. Hackwood, London, 1911. This is a treatise on the romance of food and feasting, in marked contrast to the work of Eden, having reference to the eating habits of the rich and prosperous. He discusses the food impulse, the vice of gluttony, discovery of salt, progress of culinary art, antediluvian vegetarianism, the foods and culinary practices of the ancients, a Roman banquet, early Rnglish fare, monastic culinary influences, dietary changes, home grown food, the roast beef of Old England, bread, the staff of life, the cook and his art, national foods and national prejudices, influence of diet on national character, curiosities of diet, vegetarianism, cannibalism, diet and health, food adulteration, etc.

I may mention in this connection that early in 1934 I presented jointly with the Prudential Insurance Company, my entire library of cancer books and data to what was then the Cancer Research Laboratory, Graduate School of Medicine, University of Pennsylvania, now the Biochemical Research Foundation of the Franklin Institute. All the references cited in this work are in my own library, with the exception of a few works loaned to me by the Army Medical Library, Washington, D. C.

Throughout the investigation which actually commenced in March, 1933, when the first questionnaires were collected, Mr. Fels has maintained an active interest in the project and many special questions were fully discussed with him. I also had an interview with Professor Sherman who made several important suggestions, while I was in correspondence with Professor Sure of the University of Arkansas, Professor Mendel of Yale University, Professor Benedict of the Carnegie Laboratory of Nutrition who sent me many valuable reprints, and Miss Hawley of the Department of Agriculture who favored me with many useful suggestions. The Department of Commerce placed me under obligation for much new data on per capita food consumption, while agricultural experimental stations throughout the country favored me with highly important bulletins. To all of these and many others I wish to express my profound gratitude with the assurance that but for their aid and assistance this work could never have emerged out of the vague conception of an idealistic undertaking.

The present work is divided into four distinct parts. The first reviews the historical development of dietary conceptions as a therapeutic factor in cancer, covering the entire literature available to me since 1777 down to 1935. I fully realise its inadequacy but feel that on the whole the subject matter presented is sufficient for the purpose. The second part outlines the dietary changes during recent years and makes certain international comparisons to emphasise racial or national differences in dietary habits and food consumption. The third section reviews the observations, experiments and conclusions, mostly on small animals of the rodent type, as to tumor effects in altering the normal metabolism in traceable directions. I have drawn freely in this section upon the literature of biochemistry and food chemistry, as well as upon the cancer periodicals, particularly the American Journal of Cancer, the British Cancer Review, and the German Journal for Cancer Research.*

The first three sections are entirely independent of the fourth which is concerned with the facts regarding cancer patients and non-cancerous controls collected under my direction in selected population centers of this country, giving what I believe is a reasonably satisfactory cross-section of the nation. This section is divided into two parts, the first of which is concerned with the more general facts of a social, clinical or medical nature otherwise, while the second part is limited to dietary factors as such.

By adopting this arrangement I feel I have escaped the risk of being unduly influenced by my own previous conclusions since each of the first three sections was completed and in final form before the main part of my work, having to do with actual dietary and nutritional facts, was written. The statistical method adopted may be found fault with but I could conceive of no other method of presenting essential facts for critical consideration. In emphasising excessive nutrition, I have been guided by the evidence which fully supports the important and chief conclusion that cancer is an excess nutritional disease and not, as is sometimes asserted, the result of dietary deficiencies. The degree of excess, in a general way, may not be very pronounced, but sufficient, I feel, to justify the conclusion advanced in the present study.

I have avoided the use of mathematics as entirely uncalled for and most likely to prove seriously confusing to the nonmathematical mind. I prefer strict conformity to the statistical law of large numbers to the speculative results of the law of probability. Of course, in many instances of minor detail, the number of cases considered is too small but this has been absolutely unavoidable, for if I had continued the col lection of cases until I had say five thousand, another year or more would have been necessary to complete the field operations.

Zeiteebrift ftir Krebeforschung, Berlin, Germany.

In my interpretation I have tried to conform to the wholly admirable philosophical observations contained in the first volume of the outstanding work on Inorganic and Theoretical Chemistry by J. W. Mellor, London, 1927, from which I quote the following illuminating remarks.

Untutored minds are very prone to mistake inferences for observations, and prepossessions for facts; their observations and their judgments are alike vitiated by dogma and prejudice; they do not seek to investigate, they seek to prove. The old proverb is inverted, believing is seeing. The student of science must pledge himself to do his best to eliminate prepossession and dogma from his judgments, and he must spare no pains to acquire the habit of recording phenomena as they are observed; and to distinguish sharply between what is or has been actually seen, and what is mentally supplied. It requires a mind disciplined like a soldier to avoid the natural inclination to look away from unwelcome facts.

Whether my work deserves to be considered a contribution to the ascertainment of the true cause or causes of cancer, more competent minds than mine must determine. I have presented the evidence as I have found it, without undue enlargement and explanation, to make the matter more intelligible. As regards myself, I am fully convinced that profound dietary influences in cancer are to be looked upon as a causative factor if the constitutional or systemic theory of the disease is to be accepted. Here again I touch upon a debatable question with the utmost reluctance. I certainly do not wish to add to the prevailing confusion concerning the causative factors in cancer which, at times, makes the search for the full truth of the situation an almost hopeless task.

FREDERICK L. HOFFMAN.

Biochemical Research Foundation of the Franklin Institute, 13.1 South 36th Street, Philadelphia, Pa.

PART I. DIETARY THEORIES OF CANCER

Before I enter upon a discussion of dietary facts and details, derived either from the literature or based upon my own investigations, it seems advisable to review briefly some of the essential observations of authorities on cancer regarding the general dietary aspects of cancerous diseases, both from the causative and the therapeutic point of view. For whatever substance may be administered for therapeutic purposes, it stands to reason that it must have some effect, be it slight or far-reaching, upon the metabolism of the body in a cancerous condition. It goes without saying that food in any form must invariably have a more or less profound effect on the human economy, while in deficiency or excess, it may according to particular circumstances result in definite and traceable pathologic results. As observed by Sir Frederick Gowland Hopkins in a recent address on The Study of Human Nutrition: The Outlook Today (British Medical Journal, March 23, 1935).

Among all the demands which the body makes on its environment that for its food is of outstanding importance, and it is to-day becoming well recognized that right nutrition, and especially right nutrition early in life, may profoundly affect the well-being and social value of the individual. Throughout all the earlier and most prolonged stages of his evolution man depended for guidance in the search for food, or later in its production, on instinct, aided by very slowly growing transmitted experience. He depended no less upon instinct and appetite for choice of the right food.

EARLY PERIOD

At least vaguely, the dietary factors in cancer, and the ameliorating or curative effects of certain substances in cancer treatment, have been recognized from the earliest times of recorded medical history. Thus Hippocrates advised the administration of sulphur in skin cancer, while Galen advised special dietary regimen in considerable detail. As stated by Wolff, in a free translation, in his monumental treatise on cancer, (Vol. 1, p. 13), Galen was familiar only with external cancers but nevertheless laid particular stress on a special diet precluding a number of forbidding substances which, in his opinion, were sources of black bile, at the time considered the chief cause of cancer. He prohibited the taking of wine, vinegar, cabbage, aged cheese, walnuts, and pickled meats, particularly goat, deer and rabbit. Permissible foods, among others, were vegetables, milk, young goat's flesh, veal, fowl, oysters, and light white and red wine.*

Galen also encouraged fasting from time to time and warned against emotional excitement. He considered cancer a constitutional disease. For external treatment he would use a salve containing lead.

The next authority mentioned by Wolff is Lanfranchi (1250-1320), who laid great stress on dietary treatment, although not mentioned in detail. For external treatment he employed a salve containing white lead.

Jean Tagault (died 1545), an outstanding authority on cancer at the time, advised dietary treatment in inoperable cancers, also the use of narcotics and compression by means of lead plates.

Ambroise Pare (1510-1590) also endorsed the Galen theory of dietary treatment, while opposed to the administration of arsenic, with which at the time much harm was being done in cancer treatment. He was one of the first to call attention to the high mortality of women from cancer compared with men.

Another follower of Galen was Walter Ryff (born 1539). He was of the opinion that a causative factor in cancer was hemorrhoids and menstrual suppression. His therapy depended almost entirely upon Galen's, including the omission of garlic, onions, and the avoidance of emotional depression. For specific treatment he used vinegar (opposed to Galen) and thyme containing whey or honey, but in what proportion it is not stated.

Paracelsus (1493-1541) brought about the overthrow of the Galen theories. He held that cancer was the result of an excess of salts in the blood, giving various medical preparations as a means of specific treatment. He also used caustics of a complicated chemical composition.

Another follower of the dietary theory was van Belmont (1577-1644). Friedrich Hoffman (1718) was a further advocate of the dietary theory. He was one of the first to connect the suppression of secretions and erroneous nutrition, while at the same time a believer in the heredity of

"Die Lebre von der Hrebakrankheit" by Dr. Jacob Wolff, in four volumes, Jena, Germany, Gustav Fischer, publisher.

the disease, illustrated by numerous instances. He employed various salves for external treatment, aside from plasters. One of the latter he made out of soap. Among other authorities, Wolff mentions Schu-

macher who held that cancer could be cured by starvation.

One of the earliest original publications on cancer is A Dissertation on Cancerous Diseases by Ber. Peyrilhe, M.D., London, 1777. It is an interesting little volume with numerous references to diet or dietary principles, from which I quote a few. Peyrilhe was one of the first to undertake experimental research into the nature of tumor fluids which seemed to prove that the exhalations were of an alkaline nature. As regards the nature of cancer, he observes,

We shall not think it necessary to say much in refutation of those, who have asserted that the cancerous virus is of an acid nature.—A false appearance of truth seems to have deceived.them, even while they fought it in their experiments.—An earthy substance, say they, effervesced with this virus:—this earthy substance must then, either have been truly absorbent, and have given this appearance of effervescence, by its readiness to drink up the humidity; or was a saline earthy compound, and then a true effervescence might indeed be produced, when the volatile alkali of the virus came to attack the acid of the earth, or when the same acid drove out the weaker acid of the sal ammoniac, mixed with the virus.

He exposed cancer patients to the emanations of a mixture of water and potash and a small quantity of camphor, apparently with good results. He advised surgeons to expose cancers, and cancerous, and other putrid ulcers, to this vapor. He also used potash in a dressing in the case of external cancers, and apparently with good results. He speaks of irregularities in diet as constantly hastening the process of the disease, while with reference to a special diet, he remarks,

We moderate the effects of Cancers in every stage, by an antiphlogistic diet; and by an infusion of slightly bitter plants, such as chamepitys for example, which was much esteemed by Albertini, who had often experienced its great virtues.

And furthermore, with reference to a special regimen.

The regimen may be easily directed to aliments that are succulent, easily susceptible of fermentation, and which abound, at the same time, with fixed air.—They must likewise be such, as are likely to keep the belly gently open:—for drink; cyder, which has been long in bottles, and which is susceptible of the vinous fermentation; wort, will likewise be very useful:—we would also recommend the decoction of ripe fruit, or the following preparation, from the celebrated De Haen. "Boil eight ounces of barley, in water, reduce the decoction to two quarts; and add to each of these, one or two drachms of cream of tartar, or as much nitre; and let this be used as common drink."

With respect to medicinal aliments; barley, rice, etc. will be of great use.—The food should be acidulated with lemon or orange juice, cream of tartar, sorrel, etc. The patient should eat liberally of fruit; and if his strength is not sufficiently supported by these, white bread may be added, that is well fermented; with sweetmeats, etc. and when the putrid diathesis is somewhat moderated, a milk diet will be of great utility.

Amongst a variety of antiseptic medicines, the peruvian bark, seems to claim the preference.—We have used it with no little profusion, in the way mentioned by Dr. Archer of Dublin, giving the patient a drachm of the cortex every hour, and washing it down with four ounces of the infusum smarm of the London Dispensatory, sometimes acidulated with the acid elixir of vitriol. from ten to thirty drops; and sometimes without acid.

In 1790, Dr. Adair Crawford contributed a paper on Experiments and Observations on Cancer, to the Proceedings of the Royal Society, which is apparently one of the earliest experimental studies into the nature of malignant new growths. He made a chemical analysis of body fluids and noticed that the appearance of the discharge was frequently varied by internal remedies or by external applications. He discovered in every instance the presence of an alkali, observing that, "The matter of cancer is impregnated with an alkali which is in such a state as to change the colour of vegetable tincture." He studied the air extricated from cancerous matter, and from other animal substances, by distillation. The paper commends itself to those who are interested in the theory of alkalosis, but does not permit of being abbreviated to advantage.

In 1794, Dr. John Ewart published The History of Two Cases of

Ulcerated Cancer of the Mamma, treated by a new method of applying carbonic acid air. This also is a highly involved discussion, difficult

to abbreviate. It is illustrated by a sketch of the apparatus employed for the purpose. The effects of the experiment were complicated by the internal use of white arsenic, to the extent of one-sixteenth part of a grain, dissolved according to Dr. Fowler's formula, three times a day. The second case was likewise complicated by internal remedies, including a decoction of Peruvian bark and also a mixture composed of salt of steel, myrrh, and vegetable alkali, in doses of four grains of the first article twice a day. This case, for the time being at least, recovered and a marked degree of comfort was secured after months of suffering. In defense of his method, Dr. Ewart makes mention of the fact that it is quite probable the carrot poultice, and the poultices of fresh animal dungs, which had been in use, acted in consequence of carbonic acid being extracted from them. He furthermore asked the question, "Did the carbonic air, therefore, act merely by excluding the atmosphere, or more properly the oxygen of the atmosphere, which is known to be highly stimulant to the living fluid, and has been supposed, by some modern theorists, to be the principle of irritability, and of life itself?" He quotes another case in which "by exposing his hand for nine hours to six ounces of carbonic gas, the quantity of the latter was reduced to less than three ounces." He remarks with respect to the possible combination of the carbonic acid with the matter of cancerous ulcers, "The discharge from cancers has been supposed to be corrosive. I do not know that this is a fact. If it be true, and if the acrimony of the discharge be of an alkaline nature, the carbonic acid may neutralise it, and deprive it of its causticity." Dr. Ewart was apparently one of the first authorities to recognise the importance of chemical therapeutics and his work is deserving of consideration.

In 1795, Dr. William Nisbet contributed an extremely :mportant work on An Inquiry into the History, Nature, Causes, and Different Modes of Treatment Hitherto Pursued in the Cure of Scrophula and Cancer. It contains numerous references to the therapeutic effects of different forms of treatment but the number of observations is too limited to yield really useful results. Nisbet discussed different types of cancer, including observations on autopsies, as well as on the general state of the blood in cancer patients. He refers to the experiments of Dr. Crawford, previously mentioned at some length, and discusses the question of the possible contagious nature of cancer. He remarks that, "It was Chemistry that afforded the most ready solution for the deleterious nature of the poison; and to the chemical era of medicine, are we indebted for the principal theories of this disease."

According to an observation of particular interest, "Alkalis, instead of having influence in counteracting the effects of the poison, rather aggravate the disease, while acids themselves, applied as remedies, evidently check its progress somewhat, and resist, for a while, the putrefactive tendency." There are many additional observations of great interest but they cannot be dealt with in abbreviated form. Finally he defines cancer as "A poison produced by a partial vascular obliteration, generated in a certain state of acrimony, for the most part of the fluids of the system at large, and under a vitiated action of the remaining vessels of the part."

The work of Nisbet includes extended observations on treatment of unusual interest. Among various substances, I may mention iron, mercury, arsenic, antimony, tin, muriated barites (originally recommended by Dr. Crawford), borax, hemlock, deadly nightshade, henbane, laurel water, nux vomica, electricity, and lizards which are said to have been commonly used in Guatemala, limited to a small green lizard common to that country, two or three of these animals to be swallowed daily, on an empty stomach, being first prepared by skinning them, and cutting off their heads and tails. (The therapeutic use of lizards and frogs is discussed at some length by Wolff in his treatise on Cancer, Volume 111, p. 436-7.)

A very interesting essay on Observations on the Treatment of Scirrhous Tumours, and Cancers of the Breast by Dr. James Nooth, was published in Bath, England, in 1804. Dr. Nooth was Surgeon Extraordinary to H.R.H. The Duke of Kent. He was a strong defender of surgical operation for cancer and bitterly opposed to medical treatment, and defended the theory of cancer being a local disease as opposed to its being a constitutional affection. He had no faith in arsenic, nor in caustics. He mentions Wiseman as having, in 1674, adopted a new mode of treatment, he having held that, "This disease might arise from an error in diet, a great acrimony in the meats and drinks meeting with a fault in the first concoction, which, not being afterwards corrected in the intestines, suffered this acrimonious matter to ascend into the blood; where, if it found vent either in the menstrua in women, or by the hemorrhoides or urine in men, the mischief might have been prevented."

Nooth was one of the first to advance the conclusion that women in a state of celibacy, as well as upon the change of life, are peculiarly liable to cancer and much more so than those married and having had children. At that time, it was held that cancer of the breast was the principal form of cancer, and malignant affections of the stomach and other internal organs were rarely diagnosed as such. Nooth expressed the opinion that cancer never originated in the lymphatic glands, but he could give no explanation as to why this disease should be so common in advanced years of life. He was courageous enough to experiment upon himself and introduced small particles of cancerous substances into his arm on several occasions without suffering any harmful results. He refers to Storck as having introducted cicuta, or hemlock treatment, apparently, in some cases at least, with good results. He also speaks of antimony as having been found useful in some cases. He refers to the Russian theory of belladona being used as a substitute for hemlock, but the results were not satisfactory. Reference is made to a publication by Dr. R., in which it is stated that, "A recent scirrhus must yield to bleedings, antiphlogistics, metallic alteratives, extreme abstinence from fluids, and a proper diet; but the inveterate one, or second species, requires a long perseverance in the use of penetrating aperient metallic remedies, to give an additional force to the diseased vessels, to resolve the viscid impacted matter, or change its quality and prepare it for absorption; and thus gradually reduce the tumour by the expulsion or mutation of the causes; but should it prove obstinate, and become the third species, or occult cancer, the patient must be contented with a precarious relief from medicine only."

Nooth gives many details of cases treated, mentioning a woman patient with a small tumour in her right breast, for which the cicuta was prescribed by her physician, who also enforced a very abstemious diet, and occasionally ordered the application of leeches to the part affected. Nooth stated that he entertained no very favourable opinion of the treatment by medicine, diet, or topical applications, and remarked that in his experience of thirty years, only a small fraction, or about one in thirty, ever had any return of the disease, in any shape whatever, after they had submitted to an operation.

Dietary restrictions are frequently mentioned but with few definite references as to dietary preferences. Incidentally, Nooth voiced strong opposition to the use of corsets or stays as a predisposing cause in cancer of the breast, referring to the custom as an absurdity. For external treatment, he recommended poultices of linseed meal, carrots and oatmeal combined with yeast, and from the latter he suggested the carbonic acid gas should be extricated. The use of arsenic, he considers at some length, concerning which he remarks, "If arsenic had been really found to be such a sovereign remedy for cancerous affections, as it has been repeatedly asserted to be, in almost every state in Europe, it is to be wished that the cases had been collected and publicly produced for the sake of humanity."

There is a curious reference to a powder used by Dr. Jaenisch of Petersburgh, the composition of which was as follows: "Take white lead three ounces, and rub it in a leaden mortar, with a pestle of the same, till it double its weight: then add, by little at a time, six ounces of Goulard's extract, and rub on till they are intimately mixed, and form a dry powder. This powder must be sprinkled on the cancerous sore every morning and evening " This is one of the earliest references to the value of lead in cancer treatment with which I am familiar.

In far advanced cases of cancer, Nooth emphasises proper attention to a non-stimulating and a non-constipating diet. He closes with a reference to carbonic acid gas treatment, previously mentioned as having been inaugurated by Dr. Ewart, with whom Dr. Nooth was apparently associated for he quotes at length from Ewart's statements and reproduces the illustration of the machine used for the purpose. In closing, Dr. Nooth remarks, 'Whether the discharge from a cancerous ulcer be of an alkaline nature, as is by some supposed, I shall not presume to determine; but if it really be so, the carbonic acid gas, probably, may neutralize it, and deprive it of its causticity."

In 1805, Dr. Everard Home published some Observations on Cancer Connected with Histories of the Disease in which he makes mention of a few substances, particularly arsenic and cinchona. He expressed the opinion that at that time surgery was in disrepute on account of its failure to accomplish satisfactory results and quackery, no doubt, flourished on a large scale.

Dr. William Lambe, in 1809, published Reports on The Effects of A Peculiar Regimen on Scirrhous Tumours and Cancerous Ulcers, in which he essayed upon the dangers of fluid intake and emphasised the value of distilled water. This curious but intensely interesting report presents many original views amplified by a series of actual cases which he himself had treated. He introduces his views with the statement that "the custom of constantly introducing fluid matter into the body, so far from being a useful and a natural habit, is, on the contrary, a noxious, and therefore an unnatural one." He had published a previous work entitled Inquiry into the Origin, Symptoms, and Cure of Constitutional Diseases which I regret not to have seen. Lambe starts out with the assertion that "A cancerous ulcer, which had been spreading for five months, became immediately stationary upon using distilled water; and, as it subsequently appeared, continued so till the last moment of life." This experience seemed to justify the conclusion that "It seemed clearly to follow from it, that the perpetual and progressive increase, which so strongly marks this cruel disease, (cancer) is to be ascribed to the perpetual and never ceasing activity of the fluid matter, which we are hourly taking in."

Following these observations there is a lengthy article concerning vegetarianism, opposing the intake of animal food and arguing to the effect that in cancer the utility of abstaining from animal food had been remarked and that, according to Mr. Benjamin Bell, "A diet consisting almost entirely of milk and vegetables, I have found to answer best." (This quotation is from Bell's Surgery, Vol. 11) Lambe continues with the remark, "But that such a regimen has effected a cure, or that it has had any great influence over the habits of the disease, has never been pretended. Indeed, there being tribes of people, whose diet consists entirely, or almost entirely of vegetables, it could not possibly have escaped observation, if they had enjoyed any exemption from the horrors of this disease." He argues against heavy meals, the use of spirits, tobacco, tea, and coffee. He refers again to water and points out that,

In the form of water we are constantly taking in a poison, which affects every fibre of the body. It is the direct and immediate agent in the production of Cancer, and may therefore be fairly suspected to be operative in the generation of all diseases, attended with a solution of the continuity of parts. Besides this, it is perpetually exciting increased secretions, which produce a perpetual sense of debility and exhaustion; and it may be readily supposed, that it must be the cause of much uneasy feeling, of which the seat will be various, as various organs are principally affected.

He next argues against the consumption of fish, as to which he remarks that there are strong reasons to suspect that fish is still more noxious to the human body than animal food, and quotes Haller to the effect that, "The frequent use of fish produces a noxious kind of acrimony, from . which are produced itchings, an altered epidermis, the morbus pedicularis, leprosy, scurvy, malignant ulcers, and fevers." Following this Lambe considers milk as being a suspicious article in the diet although he grants that the substitution of milk for animal food has been followed by very beneficial results. Bid granting its value he advises that it should not be greatly indulged in.

Lambe concludes his introductory observations with the remark that, The spreading of the cancerous disease into the contiguous parts is completely prevented by the use of pure distilled water; cancerous tumours can by the same practice be removed by absorption; cancerous ulceration can be prevented; cancerous ulceration can be completely closed up by the basis of the ulcer becoming covered by the surrounding sound skin; in one ease, which proved fatal, a part of the ulcer has been brought to cicatrix°, but the cicatzisation was not permanent; in another, of which the event was simile' r, all the parts surrounding the principal ulcer were made perfectly sound, and some ulceration firmly cicatrized; that by uniting the use of distilled water to a vegetable diet, life may probably be prolonged to air indefinite extent, even in certain cases of ulcerated Cancer of long standing; and it must follow as a direct consequence of these facts, that if the disease be incipient, and the patient in good health, the Cancer may be prevented from ever becoming a serious disease at all.

To the foregoing observations the author adds in detail a dozen cases of cancer treated by the use of distilled water, with more or less success. It would carry me too far to enlarge upon these details which now are only a matter of curious interest.

In 1815, Lambe published a larger work entitled Additional Reports on the Effects of a Peculiar Regimen in cases of Cancer, Scrofula, Consumption, Asthma, and other Chronic Diseases in which, however, he adds little to his observations regarding cancer and therefore need not be examined in much detail. He enlarges upon his endorsement of the vegetable theory and reemphasises his objection to fluid intake. He argues strongly for abstemious habits and warns against the danger of excess in food consumption, particularly meat and other protein products. His conclusions regarding this point are summarised in the statement that, "In persons living very grossly, eating largely of animal food two or three times a day, the abbreviation of life will be proportionately greater; such persons, perhaps, cutting off one-fourth, one-third, or even, perhaps, one-half their days by their excesses."

He cautions against drinking tea and coffee, and also milk, and complains of the indifference of medical writers with regard to matters of diet and nutrition in the following sentence; "It is much to be regretted that so little can be found in medical writers on the subject of the connection of the diseases with the food, circumstances and occupations of different nations or classes of society; and still more, that the greater part of what has been said on these subjects is probably erroneous."

In addition to general observations on diet, Lambe gives details concerning nine cases of chronic diseases, including one carcinoma in general, and one carcinoma of the uterus. He introduces his remarks regarding carcinoma by stating that his theories have been accepted by well known authorities, particularly with regard to the use of distilled water, and quotes a statement by Abernethy to the effect that, "I believe general experience sanctions the recommendation of a more vegetable, because less stimulating diet, with the addition of so much milk, broth, and eggs, as seem necessary to prevent any declension of the patient's strength."

He also quotes from Howard's Practical Observations on Cancer the following interesting statement; "Except when a stimulus is required, in chlorosis, the diet in cases where there is a cancerous tendency cannot be too strictly cooling. If it consisted wholly of vegetables, farinaceous substances, and milk, many lives might be saved, or at least prolonged; but, on the contrary, the majority of patients in this predicament have an unnatural appetite for luxurious eating,—and this exasperates the disease." I have quoted Lambe at some length because of the extraordinary extent to which he applied his theories to actual cases.

In 1810, an important work on cancer by Christopher Turner Johnson was published in London as a prize essay of the Royal College of Surgeons. It discusses in detail cancer of the breast, uterus, testicle, skin, eye, and tongue, and mentions cancer of the internal organs, particularly of the stomach, pancreas, prostate, etc. He discusses at some length cancer as a constitutional disease, and the influence of climate in favouring or retarding the appearance of cancer. The treatment of cancer he considers at length, also the question of recurrence, and makes extended observations on operations. He closes his remarks with suggestions for the prevention of cancer, and palliative treatment of cancer.

In 1811 Howard's Practical Observations on Cancer was published in London, from which I quote the following suggestive statement. After an extended discussion on various aspects of the cancer problem, he remarks,

An abstemious diet is also of the utmost importance; and of equal necessity is—due attention to the state of the bowels. Without these, very little progress can be made in our attempts to keep a scirrhous tumor quiet, or prevent its speedy progress towards a cancerous state. The same practice which the late Dr. Russel found necessary, of purging thoroughly with sea-water, and thereby emptying the intestinal canal, and setting the absorbent lacteals at liberty, in obstructions of the mesenteric glands, and in scrofulous tumors, would be of great use in all scirrhi and in all tumors having a cancerous tendency And what is remarkable, and which has been shown in many of the preceding cases, there is an obstinate costiveness, absolutely requiring this counteraction.

I regret that I have not the space for additional observations, particularly on the use of leeches which, however, is no longer relevant in present day discussions.

An important work on diet in relation to disease was published in 1831 by Dr. Charles Whitlaw under the title, A Treatise on the Causes and Effects of Inflammation, Fever, Cancer, Scrofula, and Nervous Affections. The author places the weight of his authority in favour of the vegetarian theory of diet conceding, however, the harmlessness of a small meat intake. He was the originator of a patent medicated vapour bath which, at the time, gained widespread favour in England, as well as in America and elsewhere. Passing over much interesting matter, I limit myself to the following quotation concerning cancer which I give in full.

The next fatal disorder is cancer—Mr. Lawrence says, "If the most respectable part of the medical profession were asked their candid opinion, if they thought cancer could be cured, they would, without hesitation, say it could not, in any stage of the disorder." I can, however, assert and prove, that it can generally be cured in its first or incipient stage; but when the secondary symptoms are fully established, a cure can never be effected; that is to say, when the liver, and other organs of the body, become affected. I have, in the secondary stages, succeeded in curing a number of internal cancers, where the air can be excluded. As to the chief cause, I boldly assert it to be the buttercup, and pledge myself to prove it, and will challenge the faculty to produce a case of cancer where the buttercup does not grow. I could immediately excite inflammation and cancer, in cases that are now cured, as readily as the application of a blister would act on the body, by giving them buttercup-butter and butcher-meat to eat. The horrible smell the patients are affected with, is caused by that detestable creature called the fluke, a species of leach that breeds in sheep's livers; the hepatic duct, one of the principal ducts in the liver, is completely choked up with them. They suck up the blood in its passage through the liver; and a large portion of the blood that passes into the circulation to furnish the body of the sheep, is the excrement of the fluke; which has the power of decomposing the albumen and alkaline properties:, of the blood, and passing through it the buttercup oil, which loads the sheep with acrid fat, and no lean: this is the reason that such meat has a loathsome smell when roasting. It becomes part of the bodies of the people of a peculiar temperament and produces cancer; and if the use of such food is continued, a cure can never be performed.

In addition he remarks, Cancer, in its incipient stage, that is to say, in a state of tumour, I have not, as yet, lost a case; and I believe that they have been equally successful at other establishments connected with me in this country, and especially in America. In some of the states in the latter country the agriculturists had sown their fields with English hay seed, which introduced a plentiful crop of buttercups and other poisonous seeds; they soon observed that the people who lived in these districts were much afflicted with cancer, and more particularly the females who were in the habit of milking the cows: their fingers were first affected, which communicated the virus to the glands in the arm-pit, and subsequently to the breast."

The author visited America in 1817 and 1825 and claimed to have cured a large number of cancer cases. He makes strong claims for the medicated vapour bath as a cure of cancer, but in recommending the vapour bath he remarks "The diet is of great importance; very little animal food is allowable." The book includes a large number of specific observations regarding particular dietary factors which at the time seemed to have attracted considerable attention.

A very scholarly work on tumours was published in Berlin in 1842 by Dr. Joh. Nep. Rust, entitled Helkologie. It includes extended observations on cancer following a bibliography of ninety-three items, in the German, Latin, French and English languages. The author defends the constitutional or systemic theory of cancer as opposed to the theory that it is a local disease in its origin. He claims that purely local treatment will never eradicate the disease for the true cause thereof is not removed. He denies there is a specific remedy for cancer but that it is possible such a one will be discovered.*

Regarding cancer therapeutics he speaks favourably of arsenic, belladonna, prussic acid and iodine. He also speaks of the value of iron, and the flowers calendula, digitalis, cicuta, and many others. He defends the theory that cancer is an infectious disease and warns against the touching of the cancerous patient and the necessity for the most scrupulous attention to cleanliness. He advises hunger cures and bloodletting, aside from a strict diet, the details of which, however, are not given. He however, advised meat extracts, and praised the theory of a Dr. Pons advocating milk, grapes and spa treatment, particularly waters containing iron, but he admits that all such treatments yield only palliative results and that a cure is quite out of the question.

An important work on cancer entitled The Anatomy, Physiology, Pathology and Treatment of Cancer by Dr. Walter Hayle Walshe, Professor of Pathological Anatomy in the University College, London, was published, American Edition, in Boston in 1844. It treats at length of nearly every aspect of the cancer problem with some observations on causation and numerous obscure references to nutrition which it would serve no practical purpose to enlarge upon. I quote, however, one interesting reference to diet as follows.

The diet of cancerous patients should be regulated by their capabilities of digestion; the mere cramming of food into a stomach incapable of aiding in its assimilation is as positively deleterious, as the system of starvation enforced by the practitioners of the Broussaisian school. The advantages of rigid abstinence have, it is true, been enforced on purely practical grounds: Pouteau flattered himself he had radically cured several patients by limiting their nourishment to five or six pints of ice water daily for a period of about two months; Pearson and Lambe in this country and Hufeland in Germany were also advo cater for extreme restriction in diet. At the present day starvation is frequently enforced as an adjunct to the local antiphiogistic treatment; but though patients are by these means rapidly reduced to a state of marasmus, their cancers flourish as before.

Helkologie oder Lehre von den Geschwuren, von Dr. Joh. Nep. Rust, Berlin, 1842.

Such treatment promotes the rapid occurrence of debility and sinking, which unfit the organism wholly for combating with the destructive influence of the disease. Suffice it to say that experienced practitioners in this country are agreed as to the appropriateness of a light, easily digestible, succulent diet, where no special circumstance exists to contraindicate it. Stimulants of all kinds are decidedly injurious.

In another part of the work there is brief mention of a patient who was "strictly confined to a milk diet." There is an extended discussion on internal remedies including the administration of aconite, Bella-dons, arsenic, iodine, potassium, conium (hemlock), opium, iron, mercury, animal charcoal, etc. As to mercurial preparations, it is said that, "No fact is more clearly ascertained than that mercury always exasperates the disease, especially after ulceration." Finally reference is made to chloride of zinc, chloride of gold, and various preparations of lead. As to the latter, the author quotes Goulard as having affirmed that he had cured ulcerated cancer with them. The book is an excellent exposition of what was known regarding cancer at the time, but is singularly deficient with regard to cancer of the stomach and cancer of the uterus, which are hardly referred to, most of the attention having been concentrated upon external cancers.

This treatise by Walshe was amplified by a more extended work on The Nature and Treatment of Cancer, published in London in1846. This is, as far as I know, the most exhaustive study of the subject in any language at the time but it contains nothing further of importance regarding diet which needs to be quoted. His views are rather empirical and not based on a thorough study of dietary therapeutics.

Another interesting work on Cancerous and Cancroid Growths by Dr. John Hughes Bennett was published in Edinburgh in 1849. This work is an admirable series of descriptive accounts of cancer in detail for different organs and parts, indicative of a high standard of observational and descriptive powers on the part of the author. There is a separate chapter on the chemistry of cancerous and cancroid growths and a discussion of albumen principles and fatty principles. He quotes Cruveilbier as having pointed out that, "cancer always depended upon a constitutional disorder, that local disease was the effect and not the cause, and to remove the first, while the latter was allowed to remain, was an irrational practice." He discussed various internal remedies for cancer but pointed out that, "The universal failure of all such remedies not only exhibits their inutility, but the erroneous notions which led to their employment." With reference to fat, he observes, An excessive cell development must materially be modified by diminishing the amount of fatty elements, which originally furnish elementary granules and nuclei; the circumstances which diminish obesity, and a tendency to the formation of fat, would seem a priori to be opposed to the cancerous tendency. Fat, however, is essential to a healthy nutrition in the economy, and there will always be a difficulty in so regulating ingests, as while, on the one hand, we prevent such an excess of adipose formation as not to favour excessive cell-growth, on the other, we may sufficiently contribute to the healthy nutrition of the tissues. In most cases of cancerous and cancroid growths, however, it seems to me a prudent step to diminish all those dietetic substances easily converted into fat, including not only oily matters themselves, but starch and sugar.

And furthermore,

But there is another source of fat in the economy, originating in the secondary digestion of the tissues, which we may operate upon with greater chance of success. By preventing accumulation from this source, we not only invigorate the system and keep the functions in order, but cut off one of the supplies of that material which keeps up excessive growth. This we can only do by taking care that the excretory organs properly perform their functions, and that the matter excreted bears a full or even increased proportion to the ingesta. By paying attention to the function of the lungs, skin, liver, and kidneys, and by promoting their action, we shall accomplish what is most necessary to obviate a cancerous tendency, and the disposition of the disease to return. It may be stated that this is only saying in other words, attend to the general health. But health is too often judged of by the appetite, amount of ingesta, and robustness of an individual, rather than by a due amount of the excretions, and a spare but active constitution. If a tendency to fat be an antidote to tubercle, as I believe it is, spareness may possibly be considered opposed to cancer. In the one case, we should do all we can to bring the nutrition up to and above the average; in the other, down to and below it.

Finally he advances the remarkable conclusion that, "These are points which, although at present unknown, will, I trust, erelong be investigated and understood, and then we shall begin to have glimpses of what ought to constitute a sure and certain guide to the constitutional treatment of numerous diseases of nutrition, and, among the rest, of cancer." This, as far as I know, is the first definite indication of the recognition of cancer as a nutritional disease.

In 1857, Dr. J. Weldon Fell of the University of New York, published in London, A Treatise on Cancer and Its Treatment. Fell at the present time would probably he looked upon as a quack. He claimed to have discovered the therapeutic value of puccoon, or Sanguinaria Canadensis, in use among the North American Indians, for tumour treatment. He succeeded in securing the approval of the Cancer Ward of the Middlesex Hospital and the cooperation of the surgical staff who extended to him all the required facilities. He, in confidence, communicated the nature of his remedy and its mode of preparation to hospital authorities, and twenty-five patients were subjected by him to treatment during a period of eight months. He wrote essays upon these twenty-five cases, but unfortunately it was not possible to ascertain the average duration of the benefits conferred by the treatment or whether there was a return of the disease.

Fell considered the question of the constitutional origin of cancer stating, that in his opinion, it exists in the system for some time before it appears externally. In some cases he believed the disease to be purely local, but gives no evidence to substantiate his views. He had no faith in the belief of spontaneous cures of cancer, having himself never seen a case of self-cure. He quotes - Druitt as having held the view that.

Neither temperament, mode of life, civilization, previous disease, nor moral effects have been proved to have any special predisposing influence. The dark and the bilious are not more subject to cancer than the light and florid. The rich are rather more liable than the poor; but this is because they are not so often cut off before by other diseases. The healthy and the well-fed, the happy and the prosperous, are as liable as their less fortunate brethren.

He mentions conium (hemlock) as a factor in treatment, and refers to 341 cases of cancer treated with conium, of which 46 were cured, 28 benefited, and in 267 instances no beneficial effects were produced. He makes an interesting reference to alkalies, or antacids, and states that they "were at one time in vogue, I suppose, upon the idea that cancer was the effect or result of acids. Alliot says:—"The cure of cancer consists in the mortification of acids by alkalines and absorbents." And furthermore that,

Alkaline substances, which have also enjoyed some popularity, merit nothing more than the obscurity into which they have fallen. No one now-a-days seriously recommends, as curative in cancers, the waters of Vichy or the bicarbonate of soda.

Notwithstanding Velpeau's opinion of antacids, yet we find that there are still men who believe in their efficacy. For within the last year I. have had several patients who had been treated by means of alkalies used internally and externally.

He refers to animal charcoal as having been tried and found worthless, also milk in which figs have been boiled which, he remarks, "may appear an absurd one, yet it is not more so than the recommendation of boiled carrots as a diet." The author describes at length methods of treatment and gives the formulas for the composition of his preparations, in connection with which he used iodide of lead ointment, applied each twelve hours alternately with the sanguin' aria paste. I regret that it would carry me too far to enlarge upon his treatment which apparently was successful for the time and less painful than other methods. I quote one of his concluding statements which reads.

These are the external means of treatment I employ, which, although in themselves eminently successful, yet I am not content with them alone, but also pay particular attention to the general health, ordering a nourishing and sustaining diet, besides giving internally the puccoon in small and repeated doses. A remedy that exerts so much influence when applied externally, must be exhibited with caution, I therefore seldom exceed half-grain doses, three times daily. This is given in the powder or decoction; in the former cases I give it either along or combined with the sixteenth or twentieth of a grain of the iodide of arsenic and one grain of the extract of cicuta made into a pill; or, if given in decoction, I generally combine it with the fluid extract of taraxacum.

But I must not omit a further statement which reads, "The first patient suffering from cancer and treated with the puccoon of whom I have any knowledge is still living, in the enjoyment of good health, although the disease was removed fifteen years since."

The work by Dr. Fell was made the subject of a special report by the surgical staff of the Middlesex Hospital, published London, 1857. It is one of the most admirable illustrations of impartial research with which I am familiar. The descriptions of some fifty cases are suggestive of the thoroughness with which every aspect of the disease was studied, subject to the limitations of strictly scientific methods of research, and of course, the state of medical science and surgery at the time.

The treatment by Dr. Fell was unconditionally approved as superior to any other method known at the time. It was limited to external cancers or almost entirely to cancer of the breast and skin. As regards constitutional treatment, it is said that, "All the patients took, twice daily, a pill, composed of the root (rhizoma) of the Sanguinaria Canandensis, and Iodide of Arsenic, in the proportions of gr. of the former to gr. it of the latter. Eaeh pill contained also one grain of the Extract of Conium." Local treatment is described as follows.

The topical remedy was sometimes supplied by Dr. Fell, and sometimes made by us from materials which we had ourselves procured. Its effects were the same in both cases. It was composed of a strong decoction of Sanguinaria Root, Chloride of Zinc, and Flour, and was usually brightly coloured by the admixture of Cochineal The chloride of zinc was the largest ingredient in the compound.

For want of space I cannot further enlarge upon the method of treatment followed which, however, is well deserving of study. It certainly appealed to medical men at the time, since it reduced pain and produced results, set forth in great detail in the appendix. For 41 cases, the average age was 50.4 years, and the average duration of the disease on admission to treatment, 26.8 months. There was only one case in which any reference was made to diet, concerning which it is said that,

"The diet is meat and vegetables, with strong beef tea, and a pint of porter."

The hospital authorities did not hesitate to say that, "All the cases have followed known habits of cancer; and the inference from this fact necessarily is, that the sanguinaria root exerts no curative power over the constitutional nature of Cancer." The value of the treatment apparently was in the method of preparing the location of the tumor for better direct effects of the paste applied following the removal of the skin by nitric acid. I have quoted at length from this report and the book by Fell as an illustration of a method of procedure desirable in testing so-called cancer cures by medical means, as to which the public is entitled to fair treatment by a man free from bias and prejudice.

Some years later, in 1865, there was published in London, an interesting volume on The Antecedents of Cancer by Charles H. Moore, one of the members of the Middlesex Hospital Committee investigating Dr. Fell's claims. The book is an admirable illustration of the extent of cancer knowledge at the time and reflects the attitude of an organized mind of a high order. The author asked the question, "Are there any Antecedent Conditions influencing the production of Cancer?" This question, in his judgment, "is one passing all description in the importance of its bearing upon the treatment of the disease." He must have had in mind what is now known as a precancerous condition. He observes, by way of illustration that, "There must be a preliminary fault in the blood; but chemistry and the microscope have alike failed to show any, even after the disease has begun."