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national Health Series 
In order to provide the general public with authoritative 
books on health at low cost, the National Health Council has 
arranged with the Funk & Wagnalls Company, 354-360 Fourth 
Ave., New York, for the publication of The National Health 
Series. This series contains twenty books on all phases of 
human health, written by the leading authorities in the United 
States. 
Man and the Microbe: How 
Communicable Diseases are Con- 
trolled. By C.-E. A. Winslow, 
Dr. P. H.: Professor of Public 
Health, Tale School of Medicine, 
A description of germs and 
germ diseases and how they are 
spread, together with practical 
methods of disease prevention by 
means of sanitation. 
The Baby’s Health. By Richard 
A. Bolt. M»D., Gr. P. H-: Di- 
rector, Medical Service, Ameri- 
can Child Health Association. 
How to care for the baby so 
that it will be healthy, and de- 
velop properly, and be strong and 
free from disease. 
Personal Hygiene: The Rules 
for Right Living. By Allan J. 
McLaughlin, M.D.; Surgeon. 
United States Public Health 
Service. 
Practical suggestions as to how 
to apply personal hygiene to pro- 
mote health and get the most, out 
of life. 
Community Health: How to 
Obtain and Preserve It. By D. 
B. Armstrong, M.D.; Sc.D.: As- 
sistant Secretary. Metropolitan 
Life Insurance Company. 
An outline of what the com- 
munity should do for the health 
of Its citizens and what each 
person should do to make his 
community a healthy place. 
Cancer: Nature, Diagnosis, and 
Cure. By Francis Carter Wood, 
M.D.; Director, Institute for 
Cancer Research, Columbia Uni- 
versity. 
The best statement about ean- 
eer ever written for the laity. 
It tells what It is and how to 
know It and have it cured. 
Tha Human Machine: How 
Tour Body Functions. By W. H. 
Howell. Ph.D., M.D., LL.D.. 
So.D.; Associate Director, School 
of Hygiene and Public Health. 
Johns Hopkins University. 
A non-technical, literary de- 
scription of the anatomy and 
physiology of the human body, 
the most wonderful machine of 
all. 
The Young Child’s Health. By 
Henry L. K. Shaw, M.D.; Clin- 
ical Professor, Diseases of Chil- 
dren, Albany Medical College. 
How to care for the health of 
the runabout child from two to 
six years of age. 
The Child In School: Care of 
Its Health. By Thomas D. Wood, 
M.D.; Professor of Physical Edu- 
cation, Teachers College, Colum- 
bia University. 
Promotion of health habits In 
children of school age and ex- 
actly how to go about it, 
Tuberculosis: Nature, Treat- 
ment, and Prevention, by Linsly 
R. Williams, M.D.; Managing 
Director, National Tuberculosis 
Association. 
Covers the whole field of tuber- 
culosis, the cause, spread, treat- 
ment, prevention and duties of 
citizens, patients, and the com- 
munity. 
The Quest for Health: Where 
It Is and Who can Help Secure 
It. By James A. Tobey, M.S.; 
Former Administrative Secretary, 
National Health Council. 
A statement of what health is. 
how It may be obtained, and a 
description of the actual help 
which the government. States, 
municipalities, physicians, and 
voluntary health agencies can 
give to individuals. National health Seizes 
Love and Marriage: Normal 
Sex Delations; By T. W. Gallo- 
way. Ph.D., Litt.D.; Associate 
Director of Educational Measures, 
American Social Hygiene Asso- 
ciation, 
The various elements, biologi- 
cal, social, and sexual, which 
make up a successful and happy 
married life. 
Food for Health’s Sake: What 
to Eat By Lucy H. Gillett, 
A.M., Superintendent of Nutri- 
tion, Association for Improving 
the Condition of the Poor, New 
York. 
An outline of what and how to 
eat for maximum efficiency and 
health building. 
Health of the Worker: How to 
Safeguard It. By Lee K. Prankel, 
Ph.D.; Chairman, National Health 
Council. 
Hygiene and sanitation In 
factory and shop and how In- 
dustrial workers can protect and 
promote their health. 
Exercises for Health. By Lenna 
L. Meanes, M.D., Medical Direc- 
tor, Women's Foundation for 
Health. 
Illustrative material giving to 
individuals the type of exercise 
best suited to each one's per- 
sonal needs. 
Venereal Diseases: Their Med- 
ical. Nursing, and Community 
Aspects. By W. P. Snow, M.D., 
General Director, American So- 
cial Hygiene Association. 
A non-technical discussion of 
cause, spread, treatment, cure, 
and prevention of each of these 
diseases and related social hy- 
giene questions. 
(Continued) 
Your Mind and You: Mental 
Health. By George K. Pratt, 
M.D., Medical Director, Massa- 
chusetts Society for Mental Hy- 
giene, Boston. 
Describes how your mind can 
be a friend or enemy and how 
it can be enlisted as your ally. 
Taking Care of Your Heart 
By T. Stuart Hart. M.D., Presi- 
dent, Association for the Preven- 
tion and Belief of Heart Disease, 
New York. 
How to avoid and prevent heart 
troubles, which form the lead- 
ing cause of death in this 
country. 
The Expectant Mother: Care of 
Her Health. By B. L. DeNor- 
mandie, M.D.; Instructor in Ob- 
stetrics, Harvard Medical School. 
The health care needed during 
pregnancy in order that both 
mother and baby may be healthy 
and well. 
Home Care of the Siek: When 
Mother Does the Nursing. By 
Clara D. Noyes, B. N.: Director 
of Nursing, American Bed Cross. 
What to do in the homo when 
illness is present. Practical sug- 
gestions for the care of the sick. 
Adolescence: Educational and 
Hygienic Problems. By Maurice 
A. Bigelow, Ph.D.; Professor of 
Biology and Director, School of 
Practical Arts, Teachers College, 
Columbia University. 
The scientific and sociological 
aspects of adolescence to explain 
the proper transition from child- 
hood to adult life. 
THE NATIONAL HEALTH SERIES 
20 Volumes. I8me. Flexible Fabrlkoid. Average number of pages, 70. 
Per copy, 30c, net; 33c, post-paid. Five or more volumes, 
30c each, post-paid. Per set, $6. 
FUNK <& WAGNALLS COMPANY, Publishers 
NEW YORK and LONDON NATIONAL HEALTH COUNCIL 
Active Members 
American Child Health Association, 
370 Seventh Avenue, New York City. 
American Heart Association, 
370 Seventh Avenue, New York City. 
American Public Health Association, 
370 Seventh Avenue, New York City. 
American Red Cross, 
17th Street between D and E, Washington, D. C. 
American Social Hygiene Association, 
370 Seventh Avenue, New York City. 
American Society for the Control of Cancer, 
370 Seventh Avenue, New York City. 
Conference of State and Provincial Health Authorities of 
North America, 
Care of State Department of Health, Lansing, Mich. 
National Committee for Mental Hygiene, 
370 Seventh Avenue, New York City. 
National Committee for the Prevention of Blindness, 
130 East 22d Street, New York City. 
National Organization for Public Health Nursing, 
370 Seventh Avenue, New York City. 
National Tuberculosis Association, 
370 Seventh Avenue, New York City. 
Advisory Members 
United States Public Health Service, 
Washington, D. C. 
United States Children’s Bureau, 
Washington, D. C. 
Associate Members 
American Association of Industrial Physicians and Surgeons, 
Care of Dr. W. A. Sawyer, Eastman Kodak Co., 
Rochester, N. Y. 
Women’s Foundation for Health, 
370 Seventh Avenue, New York City. 
OFFICERS 
Lee K. Frankel, Chairman. 
William F. Snow, M.D., Vice-Chairman. 
James L. Fieser, Recording Secretary. 
Linsly R. Williams, M.D., Treasurer. 
STAFF 
A. J. Lanza, M.D., Executive Officer. 
Thomas C. Edwards, Business Manager. 
Elizabeth G. Fox, Washington Representative. 
Offices of the National Health Council 
Administrative:—370 Seventh Avenue, New York City. 
Washington:—17th and D Streets, N. W., Washington, D. C. CANCER 
NATURE, DIAGNOSIS, AND CURE 
BY 
FRANCIS CARTER WOOD, M.D. 
Director, Institute of Cancer Research, Columbia University, 
New York; Director, Radiotherapeutic Depart- 
ment, St. Luke’s Hospital, New York 
THE NATIONAL HEALTH SERIES 
EDITED BY 
THE NATIONAL HEALTH COUNCIL 
FUNK & WAGNALLS COMPANY 
NEW YORK AND LONDON Copyright, 1923, by 
FUNK & WAGNALLS COMPANY 
Printed in the United States of America 
Published, October, 1925 
Copyright Under the Articles of the Copyright Convention 
of the Pan-American Republics and the 
United States, August 11, 1910. INTRODUCTION 
An acquaintance, begun twenty-five years ago in 
the College of Physicians and Surgeons in New 
York and association in the conduct of the organ- 
ized effort to control cancer in America, offers me 
exceptional opportunity to speak appreciatively of 
the author of this little book. 
It has been remarked that scientific experts are of 
two types: those who are able to carry on successful 
researches of their own and those who can make 
successful use of the researches of others. Dr. Wood 
is of both types. And it is well that he is so, for the 
conditions which lead to the formation of cancer 
need investigation by persons of the greatest skill 
and the application of this knowledge to the pre- 
vention of suffering and death calls for a rare en- 
dowment of knowledge and practical ability. 
It would be difficult to say in which of these two 
fields the author is the more distinguished. He is 
the head of the greatest institution for the investi- 
gation of cancer in existence—the Institute for 
Cancer Research of Columbia University—and the 
director of the department of radiotherapeutics of 
St. Luke’s Hospital, one of the largest and best 
equipped hospitals in New York. He is a member 
of the executive committee of the American Society 
for the Control of Cancer, which is the foremost 
organization seeking to protect the public at large 
through the utilization of helpful facts about cancer. 
In perusing this interesting book the reader may 
feel confident that he is being led to view the sub- INTRODUCTION 
ject of cancer in a most authoritative and unprej- 
udiced way. 
George A. Soper, Ph.D., 
Managing Director, 
American Society for the Control of Cancer. 
New York, September, 1923. CONTENTS 
I—Foreword i 
II—Occurrence of Cancer 6 
III— What Is Cancer? 8 
Classification of cancer—Nature of cancer 
—Diagnosis of cancer—Origin of cancer— 
Contributory causes of cancer: Irritation, 
Age, Race, Congenital defects, Heredity, 
Sex, Contagion. 
IV— Experimental Study of Cancer . . .21 
V—Varieties and Symptoms of Cancer . . 24 
Cancer of the skin—Cancer of the lip—Can- 
cer of the tongue—Cancer of the mouth and 
gums—Cancer of the nose and throat—Can- 
cer of the tonsil—Cancer of the larynx— 
Cancer of the breast—Cancer of the womb 
—Cancer of the stomach—Cancer of the 
liver and gall-bladder—Cancer of the in- 
testine—Cancer of the rectum—Cancer of 
the bladder—Cancer of the prostate—Can- 
cer of the kidney—Cancer of the bones. 
VI—Treatment of Cancer 47 
VII— Quacks 57 
VIII— Can Cancer Be Prevented? 62 CANCER: 
CHAPTER I 
FOREWORD 
IN the year 1920 the United States contained some 
106,000,000 people. The health rate is constantly 
improving and is surpassed by only a few countries 
in the world. While the total number of deaths 
among the whole population is known with fair cor- 
rectness, the causes of such deaths are accurately 
known only for a population of 87,000,000 compris- 
ing the people in the States of the so-called Registra- 
tion Area. The records of the remaining States, 
fourteen in number and occupying half the area of 
the country, are so incomplete that they do not war- 
rant deductions as to the causes of death occurring 
in their population. But in the Registration Area 
itself there were 72,931 deaths from cancer and other 
malignant tumors, a rate of 83.4 persons per 100,000 
of the population. There is, however, no valid rea- 
son why these figures representing 82 per cent, of 
the population should not be applied to the whole 
population, which means that at least 88,400 persons 
died of cancer in the United States in 1920. This 
death rate represents an increase of nearly 10 per 
cent, over that of 1910. 
In the rural districts many cases of cancer escape 
detection because of the lack of physicians and 
facilities for making accurate diagnoses. Also, even 
1 2 
in the better hospitals with excellent professional 
staffs and equipment, it has been shown that when 
post-mortem examinations are made as a routine, 
cancer is found in some 20 per cent, of those in 
whom the disease was not previously suspected. 
It may be very properly assumed that city records 
furnish more accurate figures of the cancer death- 
rate than the country districts, because physicians 
and hospitals are more numerous and special facil- 
ities for diagnosis are available. The average city 
rate in 1920 was 99.8 deaths per 100,000. If this 
rate is possibly still 20 per cent, too low, as stated 
above, the correct death rate for the country at large 
would be at least 120 per 100,000, or the deaths from 
cancer in the United States may be assumed to be 
close to 125,000 persons in 1920. 
If the further fact be mentioned that cancer is one 
of the most important causes of death in persons 
over the age of 45 in this country, the seriousness 
of the situation which now confronts us needs no 
further illustration. The exact figures for the 
Registration Area in 1920 for both sexes are: 
chronic heart disease, 104,360; cancer, 61,857; 
Bright’s disease, 61,643; tuberculosis, 26,801. 
Among women above 45, the cancer proportion is 
higher, 34,598 dying during 1920 of that disease, and 
48,517 of heart trouble. The general death rate, on 
the other hand, is diminishing, for it was lower in 
1920 than in any year except 1919. Hence it is 
evident that if the cancer rate is rising, the rates for 
other causes of death are falling. This is especially 
evident in diseases like tuberculosis, typhoid, and 
other infectious conditions in which the results of 
public health education and the application of sani- 
tary methods have produced a decided effect. 
The facts just cited are so important that a re- 
newed impulse has been given not only to the statis- 
CANCER FOREWORD 
3 
tical study of cancer from a public health aspect, 
but also experimentally in research laboratories. 
Great interest has also been concentrated upon at- 
tempts to find a cure for cancer, especially as the 
introduction of radium and X-ray has given us two 
agents of great value in the treatment of the disease, 
even tho not necessarily curative. 
It is generally conceded that one of the most im- 
portant reasons for the high mortality from cancer 
is that the disease is permitted to reach an advanced 
stage without recognition, because of the ignorance 
of people in general concerning the symptoms of 
cancer combined with a widespread pessimism as re- 
gards the possibility of a cure; a belief which inhibits 
those who know they have cancer from applying for 
medical assistance. Consultation with a physician is 
therefore postponed for either of these reasons until 
the disease is in such a stage that it can not be cured 
except in a few instances. The combined powers of 
surgery, X-ray, and radium have therefore as yet 
made no impression on the recorded cancer death 
rate, the continued rise of which in the last twenty 
years has masked the beneficial results of surgery 
and other forms of treatment. This serious situation 
is not confined to the United States, but exists the 
world over. The success of publicity campaigns de- 
voted to informing people of the symptoms and 
nature of tuberculosis having resulted in such a 
marked fall in the death rate of that disease, the 
same method is now being used with cancer. 
In the United States, the American Society for 
the Control of Cancer, founded in 1913, has been 
conducting an active campaign of information to in- 
struct people as to the nature of the disease, the 
symptoms, and the importance of consulting a physi- 
cian at the earliest possible moment, when any sus- 4 
CANCER 
picion exists of a cancer anywhere in the body.1 The 
results of the efforts of this Society have been very 
strikingly effective in increasing the number of appli- 
cations for treatment by persons with early cancer, 
but the evidence is clear that this improvement is 
confined chiefly to the population of the larger cities 
where people can be reached more easily by pub- 
licity methods, and has not yet become effective in 
the country districts. The Society through its 
“Cancer Week,” the observance of which has now 
become general throughout the United States, is en- 
deavoring to overcome this handicap. Many of the 
European countries are carrying on similar cam- 
paigns with equally good results, but the benefit 
which is obtained for the few is masked still by the 
great natural increase in the number of recorded 
cases. A diminution in the cancer death rate, there- 
fore, can not be expected until the entire population 
of the United States is prepared to take advantage 
of the knowledge which the Society and the physi- 
cians who collaborate with it offer to the oublic. 
All improvement must be due to individual, per- 
sonal effort. Cancer is not an epidemic disease 
which can be controlled by public health or police 
methods: it is rather a question of personal hygiene 
and personal understanding of the conditions under 
which cancer arises. The individual himself must 
take the necessary preliminary steps to place himself 
in proper hands in order that he may be cured of 
the disease when it is still in an early stage. Co- 
incident with these educational efforts there has been 
great improvement in the methods of diagnosing 
internal cancer, which is the most frequent and 
dangerous type of the disease. But despite all efforts 
’The publications of the Society and details of its organiza- 
tion may be obtained by writing to The American Society for 
the Control of Cancer, 370 Seventh Avenue, New York City. FOREWORD 
5 
of physicians to improve the diagnosis of this type 
of tumor, the mortality is still extremely heavy. The 
National Health Council has therefore thought it 
wise to have prepared a pamphlet which will give 
sufficient information concerning the nature, symp- 
toms, and the treatment of cancer to enable anyone 
to inform himself and benefit thereby. This is the 
motive for the preparation of this small volume. OCCURRENCE OF CANCER 
CHAPTER II 
THE wide prevalence of cancer is not confined to 
the United States. It occurs in all peoples, 
for despite the frequent statement that cancer is 
a disease of civilization, investigation reveals that 
even the tribes which we designate as uncivilized 
suffer from it. 
The occurrence of numerous types of tumor in 
both wild and domesticated animals also points out 
that it is not necessarily the result of what we call 
civilization. Cancer was reported as not occurring 
in wild animals or in the uncivilized races by early 
travelers who did not know that cancer is a disease 
of age. Few wild animals or wild people survive to 
old age. Those who are diseased disappear and die. 
The same difference is seen in the cancer rates in 
highly civilized and less civilized countries. For 
example, Switzerland, Denmark, and Holland have 
the highest cancer death rates. Russia, on the other 
hand, has one of the lowest. Must we necessarily 
assume that it is more frequent among the Swiss 
than among the Russians? Not at all. There has 
never been a complete census taken in Russia, so 
that it is not known exactly how many people are 
alive in that country. Nor is the age distribution of 
the population known, that is, the number of people 
alive between the ages of 40 to 45, or between the 
ages of 45 to 50. Now if Russia is made up largely 
of young people and Switzerland of older people, say 
above the age of 45, obviously, tho the cancer rate 
6 OCCURRENCE OF CANCER 
7 
for the given ages would not differ, the total number 
of cancers as reported would be very different, 
Russia having a very low percentage rate, and 
Switzerland a very high one. The same reasoning 
can be applied to certain anomalous situations in 
this country where the states of Maine, Vermont, 
New Hampshire, and Massachusetts have an ex- 
tremely high cancer rate, obtained by comparing the 
number of cases of cancer to the total population, 
while states like Montana, Utah, Idaho, have a very 
low rate. But if the distribution of the ages of the 
population was studied, it would be found that there 
were no more cancer cases in the New England 
States among people between the ages of 40 and 45, 
or 45 and 50, than there are among similar groups in 
the great Western frontier states, where, however, 
the population on the average is young. 
These are some of the sources of error which have 
led physicians to erroneous conclusions—for ex- 
ample, that the Hindus who eat rice never have 
cancer. As a matter of fact, now that modern hos- 
pitals exist in India in which there is opportunity 
for care and the chance to study the incidence of 
cancer, it has .been found that between the meat 
eaters in India and the vegetarians the cancer death 
rate does not differ. In one book it has been said 
that cancer is rare in China, based upon the report 
of some old explorer, while the recent missionary 
physicians who have gone to China will tell you 
that if you want to see cancer in all its phases there 
is no place where tumors are more remarkable and 
abundant than this. CHAPTER III 
WHAT IS CANCER? 
Classification of Cancer 
THE word “cancer,” as popularly used, is a gen- 
eral name for a great variety of malignant 
tumors—malignant meaning that they ultimately de- 
stroy life by their growth. The word “tumor” is 
used for any lump or new growth in the body, which 
may or may not be malignant. There are many 
varieties of harmless or benign tumors and also 
many varieties of malignant tumors. The most re- 
cent book on the subject describes twenty-two main 
classes, each class being subdivided into various 
groups. 
Benign tumors are not especially considered in this 
book. They rarely cause the death of those who 
carry them but merely bring discomfort or disfigure- 
ment. If sufficiently annoying, they can be removed 
surgically. The benign tumors are composed of 
either bone, cartilage, fat, muscle, or fibrous tissue. 
They differ from cancer not only in their origin but 
also in their course, growing usually to a limited 
size and not spreading to other portions of the body 
as does cancer. 
Nature of Cancer 
Malignant tumors vary greatly in their appearance, 
structure, and rate of growth. They have, however, 
one constant quality, they do not cease growing until 
they destroy the life of the patient. 
8 WHAT IS CANCER? 
9 
In a few instances, probably not more than three 
hundred in the last twenty years, physicians have 
reported that a malignant tumor has ceased to grow 
or has apparently disappeared, leaving the patient 
in good health. But doubt has been cast upon the 
correctness of the records of many of these cases, 
and in the meantime millions of people have died of 
cancer which did progress. 
Death from cancer may be very rapid, sometimes 
a matter of a few months if the tumor spreads 
quickly; or a patient may carry a small, local tumor, 
usually of the skin, for twenty years or more and 
even die of some other disease. Death is not caused 
by a “poison” from the cancer. There is no such 
poison. It is caused by interference with the proper 
functions of one or more of the organs of the body. 
Sometimes, if the cancer ulcerates, the resulting 
infection may kill the patient. Pneumonia is a fre- 
quent cause of death in the late stages. But the 
astonishing thing is that in very rare instances a 
patient may have cancer growing in all parts of the 
body and still have a good color and not lose weight 
until shortly before death. This shows only that no 
vital function happens to be interfered with by the 
growth. 
Diagnosis of Cancer 
The diagnosis of cancer depends chiefly upon the 
discovery of a growth somewhere in the body. Such 
a growth may be due to inflammation, may be a 
benign tumor, or may be a cancer. Long experience 
is necessary to determine which of these things the 
lump is. Sometimes it is absolutely necessary to 
take out a small piece and examine it under the 
microscope before a final diagnosis can be made. 
Internal cancers can sometimes be felt or seen in 
X-ray pictures. Their only other characteristics are 10 
CANCER 
those of a growing mass in some place where such 
growths ought not to be. The symptoms which such 
internal cancers give are not due to the cancer itself 
so much as to interference with the function of the 
organ in which it is situated. It is obvious that the 
diagnosis of such internal cancers is extremely diffi- 
cult and sometimes impossible. 
As cancer is part of the body it does not cause 
any changes in the blood, except such as are due to 
interference with nutrition. Anemia is therefore a 
frequent symptom of cancer. But there are no blood 
tests, of the sort which are so useful in the diagnosis 
of infectious diseases like typhoid or syphilis, which 
reveal the presence of cancer. 
Further details as to diagnosis will be found in 
Chapter V on varieties and symptoms of cancer. 
Origin of Cancer 
Cancer is divided into two main groups called by 
physicians “carcinoma” and “sarcoma.” These 
groups are then subdivided into many others which 
are recognizable only by the expert and therefore 
need not be considered here. Carcinoma is some ten 
times as frequent as sarcoma. The various kinds 
of cancer differ in their appearance, their methods 
of growth, and in their causation. 
In order to explain the nature of cancer it will be 
necessary to describe some of the normal structures 
of the body. As every one nowadays knows, our 
bodies are made up of cells. These are minute par- 
ticles of various shapes and structure so small that 
they can be seen only under the microscope. Great 
masses of these cells collected together form the 
organs of the body. For example, the brain, liver, 
kidneys, heart, lungs, etc., are made up of different 
kinds of cells which form regular tissues and can be 
recognized as such under the microscope. WHAT IS CANCER? 
11 
The first minute cell or ovum divides and redivides, 
thus forming different kinds of cells which- grow 
and develop special characteristics, and finally 
arrange themselves as the organs of the body. When 
the child is born all the billions of cells which com- 
pose the body are ready to perform the mysterious 
functions which are necessary to continue the life of 
the individual. So special is the development of 
some of them that they would hardly be recognized 
unless we knew their origin. For instance, it is 
difficult to think of the teeth or hair as beinig derived 
from the skin, yet both these structures are made up 
of cells modified from those which go to form the 
protecting surface of our bodies. 
In the healthy body all these cells remain through- 
out life where they were originally deposited, with 
the exception of the blood corpuscles which circulate 
around in the vessels to carry oxygen and food, to 
remove waste products, or to fight germs. The others 
stay strictly within the boundaries of the region in 
which they were originally deposited and there carry 
on the work for which they were predetermined. So 
long as they stay in place and at work, the body re- 
mains perfectly healthy. When the cells stray from 
their normal boundaries and grow throughout the 
other tissues we have a cancer. The causes under- 
lying the escape of the cells are but vaguely known. 
Enough has been learned by experiments on animals 
and study of human tumors, however, to show that 
the chief cause of the setting free of these cells from 
their normal restraints is chronic inflammation. 
Now inflammation is essentially merely the killing 
of a certain number of cells and their replacement 
by other cells. If a small, clean cut is made through 
the skin, hundreds of thousands of cells die from the 
injury, but immediately others begin to grow to re- 
place those which have died. Thus, the space in the 12 
CANCER 
deeper tissues is filled up and then the surface- 
©overing cells, called the epithelium, finally grow over 
the cut to form a new skin and thus heal the injury. 
When a bone is broken, blood is poured out at a 
point where the fracture has occurred, new bone and 
cartilage grows from the bone membranes, and a 
large block of bony tissue, called a callus, forms at 
the spot of the fracture. As time goes on the excess 
of this callus, which is larger than is necessary for 
a merely reparative job, is absorbed, until finally no 
trace of the fracture may be found. This is what we 
call normal repair. 
When, however, the skin of a man or an animal is 
irritated for a long time by coal-tar, for example, 
which causes the destruction of the cells, there is 
replacement of the cells killed by the poisonous 
action of the tar. But if these replaced cells are 
then again destroyed by the tar and replaced, and 
such irritation is continued for a long period, some 
of the cells may escape into the deeper tissues and 
instead of a harmless reparative process we have the 
development of a cancer. 
Such tar cancers, cited here as examples, are occa- 
sionally seen in human beings and are easily pro- 
duced in some animals. The process is slow, how- 
ever, requiring a good many years of irritation in 
man or a corresponding period of months in the 
shorter lived animals. 
The intimate nature -of these changes which occur 
when repair ceases and the cells begin to run away 
we do not yet know. Apparently the cells of a 
cancer are not very different from the cells of the 
healthy tissues except in their ability to grow freely, 
and it is often impossible to tell the beginnings of a 
cancer except by microscopic examination of the 
diseased tissue. Such study reveals the fact that 
the cells have grown down from the skin to places WHAT IS CANCER? 
13 
where normal cells never penetrate. We then know 
that we are watching the beginning of a cancer. 
That some change must have taken place in these 
cells tho they may look like healthy ones, is shown 
by the fact that if we transplant healthy skin into 
the deeper tissues either in man or animal such 
healthy skin is quickly destroyed by the tissues of 
the body and no cancer is produced. 
Apparently there has to be a long preparatory 
period of inflammatory growth in order that this 
cancerous change in the cells may take place. Never- 
theless the cancer cell is so little changed that the 
body not only does not recognize it as a foreign 
creature but welcomes it and feeds it with its best. 
That its nature is but little changed may be seen 
when a particle from a cancer of the liver escapes 
from the main growth and is carried to a man’s brain 
(metastasizes is the technical word) and there forms 
a miniature liver which secretes bile and ferments 
just as if it were a normal liver. 
A single blow or injury never causes cancer so 
far as we know, because following such injury 
normal repair occurs. Broken bones, cuts, scratches 
or blows, such as an average child receives in plenty 
never result in the production of a cancer. 
Contributory Causes Of Cancer 
But in addition to chronic inflammation, it has 
long been known that there are other conditions 
which must exist in order that a cancer may arise. 
Some people seem more susceptible to chronic irrita- 
tion than others, and they possibly have an hereditary 
susceptibility to cancer, a question which will be 
dealt with later in the section on heredity. 
Not every one who works in tar, for instance, gets 
the chronic irritation which always precedes the 14 
CANCER 
appearance of cancer and not every one who develops 
the skin trouble which follows such irritation gets a 
cancer. Furthermore, some people can continue al- 
most indefinitely working with this substance and 
suffer no injury. Again cancer is easily produced 
in mice by tar-painting but not in guinea-pigs. Thus, 
tar can not be considered as the first cause of cancer, 
otherwise everybody using it would get the disease. 
It is merely a contributory cause, effective when 
other conditions are fulfilled.. 
Beside the concrete example of irritation produced 
by tar leading to the formation of cancer, there are 
many other irritants which have also been found to 
be effective in this regard. Many parasites have 
been found to cause cancer in human beings; for 
example, in Egypt the egg of the worm Bilharzia is 
found in the bladder and the rectum, and cancer is 
sometimes found in these regions produced by the 
irritation of the pointed eggs of the worm. Workers 
in anilin factories have been found to have a greatly 
increased frequency of cancer of the bladder. A hill 
tribe in the Kashmir wear small baskets containing 
an earthenware jar in which lighted charcoal is 
kept. Burns which result from this practise not in- 
frequently develop cancer. There are also many 
reported instances of cancer due to a variety of 
burns either from lye, acid, or hot water. When the 
Roentgen rays act on the skin for a long period a 
chronic inflammation is produced which may be fol- 
lowed by cancer, but only after a period of six or 
eight years have elapsed since the skin inflammation 
developed. That is, the X-ray itself does not cause 
cancer, but gives rise to a chronic inflammation 
which may give rise to cancer. Radium will do the 
IRRITATION WHAT IS CANCER? 
15 
same thing. Fibiger of Copenhagen has been able 
to produce cancer of the stomach in rats by feeding 
them with a parasitic worm which burrows into the 
mucous membrane of that organ and sets up a slow 
irritation. Bullock and Curtis, of the Institute of 
Cancer Research of Columbia University, by infest- 
ing the liver of rats with a parasite, have been 
able to produce a large series of sarcomata of the 
liver, now numbering nearly a thousand examples. 
Cancers of the liver have also been seen in man, 
especially in Japan and China, due to the presence 
of a certain parasite. 
Many more examples of such irritation-cancer 
could be cited but do not concern us here. Those 
given amply demonstrate that a chronic irritation 
may give rise to cancer in suitable subjects, other 
conditions, however, such as age and possibly a spe- 
cial susceptibility being necessary. 
The causation of many human tumors, however, is 
much more obscure, because the chronic inflamma- 
tory process which precedes these growths is not so 
evident as in the examples just cited. For instance, 
there is no question but that an ulcer of the stomach 
may be followed by cancer if this ulcer remains un- 
healed for a long period in a person around the age 
of 45, but whether all cancers of the stomach are 
produced by ulceration as the primary factor is by 
no means certain. However, small ulcerated areas 
may occur in the stomach without giving symptoms, 
and it is quite possible that cancers may arise in 
these. 
Tumors of the breast in women are almost always 
preceded by chronic inflammation of the gland struc- 
tures of that organ, as may be demonstrated micro- 
scopically when the breast is removed by operation. 
More than a third of the tumors of the lower bowel 
are preceded by chronic inflammatory changes con- 16 
CANCER 
nected with a condition known as chronic diverticu- 
litis. Tumors of the skin and face are particularly 
common in farmers and seamen, who are exposed to 
the vicissitudes of the weather. 
AGE 
One of the factors which predisposes to cancer is 
age. If a large number of cases of cancer is studied, 
sufficiently large to eliminate those accidental fluctu- 
ations which occur in all records of this type, it will 
be found that the occurrence, of cancer is rather 
sharply limited to people of middle or old age. Very 
few cases occur before the age of 40. After this 
period cancer becomes more and more frequent as 
age goes on. But age is not the only factor, for not 
every old person has a cancer. 
RACE 
Race seems also to have some part, for cancer of 
the skin, for example, is common in the white and 
rare in the brown or negro races. 
Some very rare tumors in man seem to have a spe- 
cial origin. Most of these appear in early childhood 
and are formed of a great variety of tissue. For 
example, tumors of the kidneys are occasionally seen 
in very young children in which there is a mixture 
of kidney substance, nerve tissue, cartilage and mus- 
cle fiber. This implies that during the formation of 
the body the tissues, instead of taking their normal 
regular places assigned for each of them, have in 
some way been displaced, and having no definite 
function to perform, turn into a cancer. Such highly 
complex tumors have also been found in other parts 
CONGENITAL DEFECTS WHAT IS CANCER? 
17 
of the body, the only explanation for them being that 
they are remnants of cells or groups of cells left dur- 
ing fetal development of the child in the womb. 
Why these cells change into cancer is not yet fully 
understood. Thus, while chronic irritation or 
chronic inflammation of some sort is usually con- 
sidered to be an antecedent or preparatory condition 
to the appearance of cancer, there are some tumors 
for which this explanation can not be brought for- 
ward, but it is very certain that in most human 
tumors an irritation factor is present. 
HEREDITY 
While tissue and organ defects may be inherited, 
the disease cancer, as such, is not. In the United 
States, in 1920, there were, for example, only 289 
deaths from cancer in children under the age of five 
years, while the total recorded number was 72,931. 
If cancer itself were hereditary, it might be expected 
that the children of cancerous parents would be born 
with the disease. 
Whether the liability to develop cancer is inherited 
is quite another question. Definite proof does not 
exist that such inheritance is possible in man, yet 
there are many experimental observations on animals 
and some statistical studies which suggest that it may 
occur. 
The results of breeding special types of domestic 
animals have long since proved that certain gross 
structural abnormalities are inherited, and at present 
we know of a good many such defects which are 
transmissible in human beings. 
If, however, this factor is an important one in man, 
we would expect a large number of families in which 
cancer was extremely frequent, and other families in 
which it did not occur at all. But as a matter of 
observation, cancer families are extremely rare, and 18 
CANCER 
the records of those which have been published are 
not as accurate as is desirable for so important a de- 
cision, because the diagnosis of cancer is difficult 
and there is no certainty that the deaths in the 
earlier generations were really cancer. 
The insurance companies have studied the question 
with care and find from their observations that the 
presence of cancer in one or both the parents does 
not increase the liability to cancer in their descend- 
ants, at least as far as regards that portion of the 
population which is insured. 
At present, therefore, the conclusion is warranted 
that there is no definite basis for the belief that the 
heredity factor in man plays a very large part in the 
production of cancer as it occurs in the human race. 
SEX 
Sex also plays a part, many more women having 
cancer than men. But this is chiefly because cancer 
of the womb occurs only in women; cancer of the 
breast is a hundred times as frequent in women as 
in men. Cancer of the stomach is a little less fre- 
quent in women than it is in men; that of the gall- 
bladder four times more frequent in women. Can- 
cer of the lip, tongue, and mouth is much more 
common in men than in women. This is probably 
due more to habits and social customs than any- 
thing else. Men smoke more than women and are 
less apt to keep their mouths clean and their teeth 
in good order. When women subject their mouths 
to sufficient irritation they also have cancer. For 
example, in the East Indies, women who chew an 
irritating substance known as the betel-nut and re- 
tain it in their mouths during sleep frequently de- 
velop cancer at the point where the masticated nut 
is kept. WHAT IS CANCER? 
19 
CONTAGION 
A hundred years ago it was thought that cancer 
was contagious, but recently it has been definitely 
shown that no such thing as contagion occurs. In 
fact, it is almost impossible to transfer a cancer from 
one person to another. No case has been recorded 
of a surgeon operating on a cancer where the growth 
was transplanted to a cut in his hand, nor is there 
any record of a nurse getting the disease from a 
patient whom she attended. 
There is also no evidence that cancer is due to a 
germ, for altho germs can be found in cancer, just 
as they can always be found in the skin, yet when 
these germs are cultivated and injected back into 
the body they do not cause cancer. Hence they are 
merely present without playing any part in the 
causation of the disease. 
As cancer is not contagious nor due to a germ, 
there is no reason to believe the stories so often told 
of cancer villages, cancer districts, or cancer houses. 
The appearance of a large number of cases of can- 
cer in a single house has been often shown to be 
due to the fact that such a house had been occupied 
for years by a series of old people. As cancer is a 
disease more frequent in advanced age, there will 
obviously be more cases of the disease in such a 
house than in one which has been occupied by young 
persons. 
The so-called cancer villages will usually be found 
to be small country towns from which most of the 
young people have emigrated elsewhere in order to 
obtain work while the old folks have remained at 
home. 
There has been much newspaper talk about germs 
producing cancers in plants, but these plant cancers 
are quite different from the human disease. It has 20 
CANCER 
also sugges'tM that human cancer comes from 
eating these plant cancers, all of which is plain 
rubbish. From time to time the statement appears, 
that the eating of uncooked vegetables which have 
been manured is the cause of cancer. This is also 
rubbish. CHAPTER IV 
EXPERIMENTAL STUDY OF CANCER 
MUCH concerning cancer has been learned 
through the study of the human patient, both 
individually and statistically, but there are certain 
aspects of the problem which can be solved only by 
the use of experimental methods. This necessitates 
the employment of animals, in certain species of 
which, cancer can be readily transplanted by graft- 
ing or produced by artificial means. Examples of 
only a few of the results obtained by such experi- 
mental work can be described here. 
One important discovery was that by gently 
massaging a tumor it could be distributed all about 
the body of the animal, thus showing that any rub- 
bing of a human tumor is extremely dangerous. 
Other experiments have shown that the cutting into 
a tumor in an animal and the removing of a small 
piece does not distribute the tumor about the body. 
This is important, for it shows that it is permissible 
to cut into a human tumor in order to determine its 
nature. This is sometimes necessary in order to 
avoid a mutilating operation in cases where the 
malignant nature of a growth can not otherwise be 
diagnosed. 
Another important result obtained by the use of 
animal tumors has been the establishment of the 
necessary dose of X-ray or radium that is required 
to kill all the cells of a cancer, thus giving an idea 
of the amount of these agents which must be em- 
ployed in human beings to destroy the whole growth. 
21 22 
CANCER 
Using animal tumors, a large number of tests of 
various suggested remedies for cancer have been 
checked and found, unfortunately, to be of no value. 
Many thousands of drugs, chemicals, dyes, vegetable 
extracts, and serums have been tested in this fashion, 
and all without exception have been found to be 
worthless. 
Carefully conducted experiments on animals have 
shown that diet, also, does not influence tumor 
growth. 
It has been found, further, that injecting or paint- 
ing the skin of certain animals with tar will produce 
a cancer. Thus, it is possible to observe the changes 
which take place during the irritation of the skin 
before the cancer begins, and to study the very 
earliest stages of the growth, a matter which is help- 
ful in the diagnosis of very early human tumors. 
Breeding experiments with animals possessing 
cancer have shown that the susceptibility to the de- 
velopment of cancer is hereditary, but that tumors 
do not appear unless the conditions necessary for 
cancer, such as age and irritation, are also present. 
That is, the mere susceptibility to cancer does not 
necessarily make the animal have cancer. 
Many other experiments have lead to interesting 
and valuable results which are applicable to human 
beings, tho it must always be kept in mind that 
facts derived from such experiments in animals can 
not always be wholly and directly applied to human 
beings. They are very suggestive and often of the 
greatest value in planning various studies on human 
cancer. Inasmuch, however, as tuberculosis in 
guinea-pigs, pneumonia in rabbits, and anthrax in 
dogs are entirely different diseases from those due 
to such bacteria in man, it is probable that mouse, 
rat, and rabbit cancer also differ somewhat from the 
cancers found in human beings. Since we can not EXPERIMENTAL STUDY OF CANCER 
23 
experiment on human beings, however, the only way 
in which progress can be made in the understanding 
of the true nature of cancer is through such animal 
experiments, which may some day bring a final solu- 
tion of the great problem in the form of a cancer 
cure. CHAPTER V 
THE VARIETIES OF CANCER, THEIR 
SYMPTOMS AND DIAGNOSIS 
AS the diagnosis of superficial cancer is not al- 
ways easy, and that of internal growths except 
in the last stages often impossible for even the most 
expert physician, no layman need expect to be able 
to make a diagnosis of cancer. What he should and 
can do is to keep watch for anything which resem- 
bles a tumor as described in this chapter and then 
immediately consult a physician to find out whether 
it is a cancer or not. It may prove not to be one. for 
only about one-tenth of those who visited cancer 
clinics in response to the “Cancer Week” publicity 
during the last two years had cancer, the rest had 
lumps or ulcers of various types, which in most 
instances proved to be relatively harmless. 
But people should not be ashamed of having con- 
sulted a physician in the belief that they have cancer 
only to be told that they have not. On the contrary, 
they are to be congratulated on not having so serious 
a disease. 
In the diagnosis of cancer, certain general prin- 
ciples may be laid down. In the first place, as the 
disease is extremely infrequent under the age of 
forty, the likelihood of cancer occurring in a young 
individual is slight. In 1920 in the United States 
Registration Area 4,739 people under forty are re- 
corded as having died of carcinoma and 1,220 of 
sarcoma, making a total of 5,959, leaving 66,972 
24 25 
THE VARIETIES OF CANCER 
dying after that age. Thus, after forty, cancer be- 
comes ten times as frequent as before that period, 
and the liability increases with advancing age. Can- 
cer of certain organs, for example, of the rectum, 
breast, and womb, is relatively more frequent in 
younger persons between forty and fifty, while can- 
cer of the skin is usually seen late in life. 
Those in certain trades and occupations should be 
especially cautious, for in them cancer is more fre- 
quent. Chimney-sweeps in England up to 1910 still 
had the highest death-rate from cancer, sharing this 
undesirable position with seamen and brewers, while 
the lowest rate in 1902 was that of clergymen, about 
a third of that of the chimney-sweep, and a half 
of that of the brewers and sailors. But by the year 
1912, the chimney-sweeps had fallen from their high 
estate in the cancer world, and the rate, while much 
below that of the brewers and bar-keepers, and 
about that of the general laborer, is still twice as 
high as the lowest group of the population—the 
clergymen. Evidently the chimney-sweeps are im- 
proving in personal cleanliness, with resulting elimi- 
nation of irritation from soot, for, as has been long 
known, the chimney-sweep’s cancer is due to the 
irritating effect of this substance. Seamen and 
farmers are exposed to the weather and hence fre- 
quently develop cancer of the skin. Brewers and 
bar-keepers have a high rate of cancer of the stomach 
and liver, probably due to the excessive consumption 
of alcohol, to which they have ready access. 
While every one is subject to cancer, those en- 
gaged in physical labor seem to be more liable to 
this disease than the other classes. This is probably 
because of the greater opportunity for irritation and 
injury which lead to slow healing sores. Further 
details concerning these occupational irritations are CANCER 
26 
given in the chapter on the causation and prevention 
of cancer, and need not be repeated here. 
Little can be said of the general symptoms which 
may be expected to indicate the presence of a cancer. 
The healthy and the feeble are attacked with equal 
frequency. Pain is always a late symptom, due to 
the involvement of the nerve filaments by the tumor 
and not specifically due to the growth itself. Anemia 
is also a late symptom pointing to involvement of 
the bone marrow by metastasis, by which expression 
is meant the transfer of tumor particles to remote 
portions of the body through the lymph and blood 
stream, thus giving rise to secondary growths. The 
symptoms depend very greatly upon the type and 
situation of the cancer. If, for example, the growth 
occurs in the breast, it may reach a large size with- 
out causing any disturbance in the bodily health. 
Cancer of the spleen, of the kidney, and liver, or 
even of the lung may reach a considerable size with- 
out causing any symptoms. On the other hand, a 
very small cancer of the stomach will cause distress 
because it interferes with the passage of the food 
to the bowel. In cancer of the brain also the symp- 
toms depend almost entirely upon the portion of the 
brain involved by the tumor or those parts which 
are pressed upon by the growth as it expands within 
the rigid cavity of the skull. Some portions of the 
brain may be occupied by a tumor for a long period 
without a symptom, in other portions a minute tumor 
no larger than a bean may cause death by pressure 
on a vital part of the nervous system. Usually 
tumors of the spinal cord are small because they 
produce paralysis, usually of the lower limbs, and 
thus are diagnosed early. 
We will now consider the special symptoms of the 
most frequent types of cancer. THE VARIETIES OF CANCER 
27 
Cancer Of The Skin 
Cancer occurring in the skin is known by a special 
name, “epithelioma/’ and is of two varieties. Can- 
cers which occur on the face above the level of a 
line drawn through the upper lip to the lobe of the 
ear are generally of the basal-cell variety and are 
often very slow growing and not extremely danger- 
ous. They do not give off particles to other parts 
of the body and unless neglected, rarely cause death. 
Such tumors are easily cured by radium, by X-ray, 
or by cutting out, or in many instances by the use 
of caustics. No one should ever die of this type of 
tumor, because in its early stages it is always curable. 
This form of skin tumor usually develops after fifty 
and is increasingly frequent as age progresses. It 
begins as a small, round or flat-topped slightly raised 
area, which may increase in size very slowly and 
is yellowish or brownish in color. After a time a 
scab may form. This scab is easily pulled off by 
slight rubbing and the underlying tissue may bleed. 
A new scab will form, and is again knocked off. 
Finally, instead of a scab, a little hollow, bare, area 
with raised edges will form which is an ulcer. This 
ulcerated tumor may heal up for a time and then 
break down again. Anything of this sort on the 
face indicates that a person should immediately go 
to some competent physician and have the growth 
properly treated. The smaller it is, the easier the 
final cure. The most dangerous place for a tumor 
of this sort is on the eyelid, where unless the tumor 
is taken very early it necessitates a difficult oper- 
ation or even the removal of the eye. Hence it is 
usual to treat these tumors with radium or X-ray. 
But if a cure is not promptly obtained, surgery 
should be resorted to. Another frequent spot is on 
the side of the nose where glasses rest, or at the CANCER 
28 
lower end in the groove between the nose and cheek. 
Here very prompt treatment is needed, because if 
the growth gets into the cartilage of the nose it is 
very difficult to cure by radium or X-ray, and may 
have to be cut out. It is difficult to avoid bad 
scarring from such an operation. 
Skin tumors occurring on the face below the level 
of the nose or on the skin of the body elsewhere 
are usually of another type, called the squamous-cell 
epithelioma, and are much more dangerous to life 
than the basal-cell form. The squamous-cell variety 
may also occur on the upper portion of the face, on 
the scalp, or on the neck, and are dangerous tumors 
from the start. They should not be treated by 
radium or X-ray, but should be cut out immediately 
because it is very difficult to cure them by these 
means, and the scarring is often worse than that 
resulting from surgical treatment. Under no circum- 
stances should caustics be applied to this type of 
tumor. This variety begins as a warty patch or a 
crusted area like the basal cell, but ulcerates early 
and also promptly gives off particles which swim 
about in the blood or lymph vessels and form new 
centers for tumor growth. 
A small proportion of the cancers of the skin occur 
under the hair (about one in twenty), and it is very 
important that any warty or ulcerated growth on the 
scalp be promptly attended to. They are very much 
more common in the old, and as they are likely to be 
concealed by the hair, especially in women, they 
may grow to a considerable size before they are 
noticed. Their chief danger is that they grow very 
quickly through the scalp into the bone, and are then 
incurable. Most of the large tumors seen on the 
scalp in old people, however, are not cancers at all, 
but wens, which are cysts containing fatty material. 
These are in general perfectly harmless, but some- THE VARIETIES OF CANCER 
29 
times cancer arises in them, and they should be re- 
moved if any evidence of growth is noticed. 
A dangerous variety of skin cancer occurs in 
workers in brass foundries and machine shops. It 
appears on the hands or forearms and is probably 
due to oil or metallic irritants with which the skin 
becomes soiled. Any scaly or rough patches which 
do not heal over with simple ointment or other treat- 
ment within a short time in a person over the age 
of fifty should be promptly shown to a doctor. 
There is no type of growth which gives clearer 
evidence of the relationship between irritation and tu- 
mor production than does cancer of the skin. Moles 
may be irritated and become cancerous during the 
use of electric or caustic treatment by those who 
pose as beauty specialists. Have the tumor cleanly 
cut or leave it alone. 
Cancer Of The Lip 
Cancer of the lip occurs far more frequently in 
men than in women. It almost always appears on 
the lower lip, malignant disease of the upper being 
infrequent. Lip cancers have been seen in young 
boys not over fifteen years of age; but usually they 
are rare under the age of thirty-five, and then only 
when irritation has existed for a long time. 
The most common form of such irritation is from 
a rough or hot pipe-stem, hot cigar or cigaret 
smoke, or from the practise some men have of stick- 
ing a cigaret to the lip while smoking. When this 
practise is persisted in for a long time a rough area 
appears which is slightly elevated or flat. It is 
redder than the rest of the lip and bleeds a little. 
At first it is soft, but later feels as if under the thin 
skin of the lip there is a small cake of wax, which 
can be taken between the fingers. Or the tumor may 30 
CANCER 
begin as a small painless spot like a cold sore which, 
however, does not heal quickly. If ointments or 
other simple applications do not result in prompt 
healing within a couple of weeks the question of 
cutting out the tumor should be seriously taken up. 
If not cared for a scab forms over the area, falling 
off from time to time, leaving a fresh raw spot. 
Gradually this becomes larger, the tissue about it 
harder and bleeding is not uncommon. If allowed to 
continue without treatment, the cancer eats its way 
into the lip and may form a large, ragged ulcer with 
hard edges. By this time, usually, lumps can be felt 
under the chin and in the side of the neck. These 
are extensions of the cancer down into the lymph 
glands. When this stage is reached treatment is 
extremely difficult, while if it is cut out in the early 
stages a very large proportion never return. The 
best treatment therefore is removal of the tumor 
and its extensions by a competent surgeon. 
Yet over 6,000 people died of this disease in 1920 
in the United States and these figures probably repre- 
sent only a portion of those w,ho refused to avail 
themselves of modern methods of treatment. 
Cancer Of The Tongue 
Cancer of the tongue killed about one per cent, of 
those who died from cancer during the year 1920 in 
the United States. The vast majority were men, 
cancer of the tongue occurring in women with great 
rarity. 
The disease is frequently preceded by a whitish 
thickening of the tongue which may remain for a 
good many years before it changes into cancer. It 
is most often seen in those who have had syphilis, 
and who also smoke a very great deal. Persons with 
this trouble should have a physician watch them THE VARIETIES OF CANCER 
31 
carefully, and examine the tongue at least once a 
year for any beginning ulceration or excessive thick- 
ening of the white area. 
Many cases of cancer, however, develop without 
this precancerous condition. A small ulcer, often 
treated with contempt only, appears on the edge or 
tip or near the base of the tongue and may be due at 
first to the repeated biting of the tongue during the 
chewing of food, or it may result from continued 
friction of a jagged tooth, or ill-fitting or sharp 
edged dental plates. Those most competent to judge 
believe that cancer of the tongue is a disease of 
people who do not keep their mouths clean, such 
uncleanliness preventing the healing of simple ulcers. 
After the above mentioned area has remained un- 
healed for a month or so, it gradually spreads in 
size and becomes thicker and harder and extends 
more deeply into the tongue. The raw surface is 
often covered with a yellowish coating. Gradually 
the tumor penetrates into the substance of the tongue 
which then becomes stiff and interferes with speech. 
Finally a large part of the tongue may be involved, 
and often a deep crater-like opening extends into the 
tissue from the surface. In this stage it is past all 
hope of cure. In the first stage pain is usually ab- 
sent ; in later stages, common; the odor of the breath 
is very offensive and saliva flows freely, the glands 
in the neck begin to swell and finally reach a very 
large size. The tongue is an unfavorable site for 
the cure of cancer, because people refuse operation 
at an early stage when it is amenable to treatment, 
preferring to wait to see what happens. When the 
wait-and-see period is past the growth is usually 
beyond any cure. Tongue cancer is a condition in 
which haste in diagnosis and speed in treatment is 
absolutely necessary, and is one of the sites where 
it is justifiable to take out a small fragment to make 32 
CANCER 
a microscopic diagnosis and protect the patient. It 
is quite possible in the early stages to remove the 
tumor and a sufficiency of the surrounding tissue 
with it to produce a cure, without the patient’s speech 
being interfered with nor the tongue greatly muti- 
lated. In the later stages so much has to be removed 
that the victim is unable to speak clearly and has 
difficulty in the chewing and swallowing of food. 
X-ray is useless and radium applied to the substance 
of the tongue in the form of needles may produce 
temporary relief, but not a cure. 
Cancer of the inner surface of the cheek and the 
floor of the mouth resembles cancer of the tongue 
in all appearances, but it is far harder to remove 
successfully because of the difficulty of getting be- 
yond the diseased tissue. Cancer of the gums is 
not infrequent. There are two types of tumor which 
can occur here. One form, often seen about the 
roots of diseased teeth or in a cavity from which 
the tooth has been removed, is known as a giant-cell 
sarcoma or epulis. It is easily curable. An epulis 
looks like a reddish mass of proud flesh; it fre- 
quently bleeds freely and small pieces can easily be 
picked off. All that is necessary is to remove the 
tumor thoroughly, and in a large majority of the 
cases no return ever takes place. The other type of 
cancer, the epithelioma, is far more dangerous; it 
forms hard, projecting, or ulcerating areas on the 
gum, on the inside or the outside of the line of the 
teeth-, or sometimes in an area where the teeth have 
been removed. Ill-fitting plates are often responsible 
for the trouble. When such epitheliomata occur on 
the roof of the mouth they may become ulcerated or 
grow as large, warty, cauliflower-like masses. The 
Cancer Of The Mouth And Gums THE VARIETIES OF CANCER 
33 
latter are perhaps a little less dangerous than the ul- 
cerated type and can often be removed very satisfac- 
torily, but they should never be neglected if it is pos- 
sible to treat them in their early stages. Smooth, 
rounded, hard, bony tumors form on the borders of 
the jaws and on the roof of the mouth and are quite 
harmless, but should be shown to a competent sur- 
geon in order that they may be removed if necessary. 
Cancer Of The Nose And Throat 
A great variety of cancers appears in the nose, or 
the sinuses communicating with the nose, or in the 
upper part of the throat. Such cancers are always 
extremely serious. The causes are unknown and 
usually their symptoms are very obscure. 
The first thing noticed as a rule is swelling which 
interferes with the passage of air through the 
affected sides of the nose with increased discharge 
of mucus and sometimes blood. Neuralgic pain in 
the nerves of the face is common; headache, loss of 
appetite, and, in the later stages, anemia and loss 
of weight may occur. Very frequently these symp- 
toms appear only one at a time, and the patient and 
even the physician may be deceived into thinking 
that there is some inflammation of the sinuses of the 
face. Frequent bleeding from the nose or mouth, 
especially accompanied by change in the voice, sug- 
gests the possibility of a tumor of the back of the 
throat. A definite diagnosis requires more experience 
than is possessed by the average practitioner and as 
soon as the symptoms are noticed a throat specialist 
should be consulted, if possible, so that all of the mod- 
ern methods of illuminating the pharynx and the 
sinuses and also the examination of X-ray pictures 
may be done by an expert. All of the symptoms, it 
will be noticed, are not characteristic of cancer, but 34 
CANCER 
may also be due solely to inflammatory conditions in 
the nose and the pharynx. 
Cancer Of The Tonsil 
Cancer of the tonsils also appears without symp- 
toms. No pain or any other phenomenon may be 
noted except the appearance of a swelling in the 
throat. Later pain and difficulty in swallowing are 
evident. Sometimes the swelling is simply due to 
inflammation, but if it persists, especially if the sur- 
face of the tonsil becomes ragged and irregular, ex- 
pert advice should be obtained. Swelling of the 
tonsil is not infrequent in some types of blood dis- 
ease, known as leukemia, which is unfortunately 
absolutely incurable. 
A special form of cancer known as lymphosarcoma 
occurs in the tonsil, but is rarely limited to this 
region, and when present in other parts of the body 
is inevitably fatal after a longer or shorter period. 
This type of tumor is best treated by X-ray. The 
epithelioma type of cancer of the tonsil should be 
cut out if possible, but a partial operation is worse 
than none at all. Cures are extremely rare and some 
surgeons are recommending that no attempt be made 
to cut the growth out, but that the patient be given 
the relief which is obtained from radium. 
Cancer Of The Larynx 
The relative frequency of cancer of the larynx is 
not very high, forming about 0.7 per cent, of all cases 
of carcinoma. It is very rare in young people, most 
of the cases occurring between the ages of forty and 
seventy. It is three times as common in men as in 
women. Its causation is uncertain, but the chronic 
laryngitis resulting from excessive smoking or strain- 
ing the voice in public speaking may have something THE VARIETIES OF CANCER 
35 
to do with the occurrence of the disease; but these 
factors are not present in all cases. 
The first symptoms are a change in the quality of 
the voice, roughness and hoarseness and difficulty in 
speaking, with a sense of discomfort in the throat 
and occasionally a slight cough. Pain is usually not 
present, but if noticed is sharp and shooting in char- 
acter and is felt in the larynx itself. Some or all of 
these symptoms may accompany a warty condition 
of the vocal cords, which is not cancer but can not 
always be differentiated without microscopic exami- 
nation of an excised fragment. Finally, in true 
cancer, complete loss of voice occurs, with difficulty 
and pain in swallowing, due to pressure on the gullet 
from the extensions of the cancer involving the sur- 
rounding muscles and glands of the neck. In this 
stage no treatment is of any avail. Radium and 
X-ray are dangerous, for if large doses are given, 
the lining membrane of the larynx may swell and 
the patient be suffocated unless the throat is promptly 
opened. When recognized very early, and usually 
such recognition implies the diagnostic skill of a 
specialist, and the disease is confined to a small por- 
tion of the larynx, it is possible to remove the tumor 
with permanent benefit and yet not sacrifice the 
patient’s ability to talk. More advanced cases re- 
quire expert judgment to decide whether the whole 
larynx should be excised or whether an operation 
can be done from the inside. So many questions 
arise concerning the ability of the patient to continue 
his work without the capacity for speech that the 
proper treatment of. cancer of the larynx may be one 
of the most delicate and painful decisions which a 
physician is called upon to make for his patient. 
Cancer Of The Breast 
Over 8,000 deaths in the United States occur 36 
CANCER 
yearly from cancer of the breast, of which 99 per 
cent, are in women, and 1 per cent, in men. A large 
proportion of these deaths is needless and prevent- 
able. This type of cancer occurs fairly frequently 
in the age groups below forty-five. 
The important symptom is a lump or thickening 
anywhere in the breast. Such a lump or thickening 
is by no means necessarily a cancer, in fact, is fre- 
quently not a cancer, but when discovered, should be 
promptly examined by a competent surgeon. Occa- 
sionally when the tumor is near the nipple, there will 
be a bloody discharge from that orifice. If the tumor 
is near the surface of the breast, a dimpling or draw- 
ing in of the skin is commonly seen in cancer, but is 
not necessarily a proof of this disease, as it may 
occur with benign tumors. 
The reason why all of the breast tumors should 
be promptly examined is that many of the cases 
of cancer originate in old inflammatory areas, which 
have persisted for a good many years before a 
malignant change .takes place. It is important 
therefore to have the tumor examined; its hardness 
estimated, and its shape and dimensions measured 
and recorded. Then, some three to six months later, 
if there is no evidence of growth, the patient may 
rest assured that the process is not active. If there 
is any swelling of the glands under the arm or in 
the neck, it suggests that the cancer may have spread 
to this portion of the body. The condition is not yet 
hopeless, because surgical removal of the breast and 
of the glands under the arm not infrequently pro- 
duces a permanent cure. However, it must be re- 
membered that swollen glands under the arm are not 
necessarily an evidence of cancer; the swollen glands 
may be due to tuberculosis or other types of in- 
flammation and have nothing at all to do with cancer. 
Cancer of the breast is practically never painful, THE VARIETIES OF CANCER 
37 
except in late stages when the nerve trunks are in- 
volved by the pressure of the growth; but one of the 
most common stories which a surgeon hears is that 
a woman has delayed coming, as the tumor was not 
painful. In young women the question of removal 
of a small tumor depends a great deal upon the site 
and nature of the growth. Very few of these are 
cancer and only a small proportion of them ever 
turn into cancer. After women reach the age of 
forty-five or fifty, the question is an entirely different 
one. Then it is wise to remove all lumps which are 
hard by a non-mutilating operation, because this is 
the age when the inflammatory or hyperplastic 
growths begin to turn over into cancer. 
Records of the large hospitals show that cancer, 
when it has been operated upon at an early stage be- 
fore the glands under the arm are involved, give at 
least 50 per cent, of permanent cures. When these 
glands are involved, the percentage falls to some 20 
to 25. The publicity campaigns carried on by the 
Society for the Control of Cancer have done much 
to improve the conditions under which cancers of 
the breast are now operated upon; but there are 
still many women who appear much too late for suc- 
cessful surgery. This is not always their fault. They 
may have been advised by physicians who have not 
appreciated the dangers of the situation to delay until 
it was certain that the growth was cancer. But 
when it is “perfectly certain” that a breast tumor is 
cancerous, the condition has so far advanced as to 
render a permanent cure doubtful. 
Cancer Of The Womb 
In women cancer of the womb is, next to that of 
the stomach, the most frequent type of the disease. 38 
CANCER 
In 1920, 9,848 cases were recorded in the Registra- 
tion Area, or about 12,000 for the entire country. 
Of two types, that of the cervix or neck of the 
womb attacks chiefly women who have borne chil- 
dren. The other form, involving the interior of the 
organ, is seen in both those who have borne chil- 
dren and those who have not; it is much less serious, 
as it is curable in a high percentage of the cases by 
surgery. Cervix cancer, the most frequent type, 
owing to its situation, early involves the bowel and 
bladder causing a great deal of physical suffering. 
It is therefore especially important that women learn 
to recognize the very obvious symptoms of this 
disease. 
The first and most frequent symptom is blood or 
a blood-tinged watery discharge appearing between 
the periods. Such a symptom is quite sufficient evi- 
dence to warrant a woman consulting a specialist 
immediately. It is obvious that such bleeding may 
also be due to other conditions, as a fibroid tumor 
or irregularities of menstruation or the changes in 
flowing which occur at the beginning of the meno- 
pause. But the only way to settle the question is 
to have a careful physical examination with a direct 
ocular examination of the neck of the womb. If 
necessary, a small fragment of tissue should be re- 
moved for microscopic examination. This can often 
be done without an anesthetic. 
In the later stages the discharge continues bloody 
but may become very offensive. Even if no blood is 
present, a malodorous discharge warrants an exam- 
ination. Pain is a late symptom and may be referred 
to the bladder or the rectum or may radiate down 
the legs. This indicates invasion of the walls of the 
bladder or rectum or pressure on the nerves in the 
pelvic region and indicates, therefore, advanced and 
hopeless cancer. THE VARIETIES OF CANCER 
39 
While splendid results follow the treatment of 
early cases either by surgery or radiation, in general 
the treatment of cancer of the womb is, at the present 
time, in a very unsatisfactory condition because very 
few women come sufficiently early. Among the more 
intelligent classes we rarely find more than one can- 
cer in ten of this type which is suitable for operation. 
Among women of the laboring class it is rare ever to 
see a case early enough to permit of an operative 
cure. In this dilemma the only recourse is radium 
or X-ray. Proper radiation treatment is peculiarly 
effective and there are now on record a number of 
inoperable cases which have gone from three to 
five years without return of the growth, following 
radiation treatment only. 
Cancer Of The Stomach 
The stomach is the seat of about half the cases 
of cancer occurring in men and one-third of the 
cases occurring in women. In 1920 in the United 
States 32,000 people died of this disease alone. Un- 
fortunately it is one of the most difficult types of 
cancer to diagnosticate and to treat. 
The only symptom may be a fairly rapid loss of 
weight in persons over fifty years of age. Pain after 
eating is unfortunately a symptom of ulcer, of dys- 
pepsia of a certain type, and also of cancer. Blood 
in vomited material is likewise a symptom of can- 
cer and ulcer as is also blood in the passages from 
the bowels. A chemical analysis of the secretion of 
the stomach may afford useful information, but it 
by no means enables us to make a certain diagnosis 
of cancer or to eliminate the possibility of cancer 
in any given individual. Belching of gas or vomit- 
ing large quantities of food is a late symptom of 
cancer, but also may occur in benign stricture of 40 
CANCER 
the outlet of the stomach. When a tumor can be 
felt, the patient is usually beyond any possibility of 
cure. The careful study of X-ray pictures taken 
after the giving of a meal containing barium sul- 
fate so as to cast a shadow of the cavity of the 
stomach, is also extremely valuable, but not neces- 
sarily decisive, for the pictures given by ulcer and 
cancer are somewhat similar. If the cancer is not 
ulcerated, the X-ray may give no aid in the diag- 
nosis. As the symptoms are so vague and the di- 
sease so fatal, every person who has symptoms of 
indigestion or a slight loss of weight or slight anemia 
accompanying symptoms of indigestion or severe 
pain in the stomach before or after eating, should 
have a careful examination by a physician. And 
after the age of 40, if these symptoms persist, the 
stomach condition should be examined at least once 
a year, as cancer may arise on the base of an old 
ulcer or chronic inflammatory processes of the mu- 
cous membrane. When the diagnosis is suggestive 
it may be wise for the patient to have an exploratory 
operation in order to clear up the situation. If an 
ulcer is present, it should be excised in order to re- 
duce the possibility of a cancer developing from it. 
If the cancer is small and in a suitable position, it 
can be removed with every possibility of a perman- 
ent cure. If it is in such a place, or is so large, that 
it can not be removed, then a short-circuiting opera- 
tion often brings relief and prolongs the life of the 
patient in fair comfort, sometimes for a period of 
years. X-ray and radium in their present develop- 
ments are of no value in the treatment of carcinoma 
of the stomach. 
Cancer of the liver and gall-bladder are usually 
Cancer Of The Liver And Gall-bladder THE VARIETIES OF CANCER 
41 
classed together in the Census Reports. They caused 
the death of about 10,000 persons in the United 
States in 1920. A large number of the cases re- 
corded as cancer of the liver, however, are actually 
cancer of some other part of the body, with trans- 
plantation or metastasis to the liver. As the symp- 
toms of the liver cancer are apt to predominate over 
those of the primary growth, a correct diagnosis is 
often impossible during life. Cancer of the liver is 
always incurable. 
Cancer confined to the gall-bladder is a rarer 
form, causing the death of about 1,000 persons in the 
United States. It is usually so far advanced when 
discovered that it is incurable. The symptoms are 
often the same as those of gall-stones. 
Gall-stones are related to the production of can- 
cer, for they are frequently found with carcinoma of 
the gall-bladder. Therefore, as women have gall- 
stones much more frequently than men, cancer of 
the gall-bladder is nearly four times as frequent in 
females as in males. 
Cancer Of The Intestine 
This form of malignant disease is practically 
limited to the large intestine and fortunately is only 
about one-fifth as frequent as cancer of the stomach. 
It is a disease of advanced life. About one-third of 
the cancers of the large intestine occur in the lower 
portion, the rectum. The most frequent site is in 
that curved part of the lower bowel on the left side 
just above the rectum, called the sigmoid flexure. 
The disease occurs with about equal frequency in 
both sexes. 
The symptoms differ somewhat, depending upon 
the portion of the bowel that is involved. In the 
large intestine the growth tends to form cylindrical 42 
CANCER 
masses surrounding the gut or involving the wall, 
and often in consequence producing a narrowing of 
the channel. The patients may only notice at first 
that they are constipated or that they bloat easily 
after taking food. Cancer of the large intestine is 
occasionally recognized in patients who have no 
symptoms by the mere feeling of the abdomen, for 
the thickening of the gut wall forms a lump which 
can be felt. After a barium sulfate meal, the X-ray 
frequently reveals a narrowing or partial obstruction 
of the intestine due to the constriction by the tumor. 
Visible blood or mucus in the passages is rarely 
seen. 
When the patient becomes thin and pale the dis- 
ease is usually very far advanced and only a pallia- 
tive operation can be done. In general, however, 
cancer of the bowel is a fairly favorable type, as 
symptoms are produced early by the constriction of 
the gut and the surgical removal is often fairly easy. 
Cancer Of The Rectum 
Cancer of the rectum is even more easily diag- 
nosed, but frequently escapes recognition because the 
physician does not take sufficient pains to make a 
careful and thorough rectal examination. It is a 
form of cancer seen both early and late in life. 
Sometimes it occurs in young children. In this type 
of cancer, in contrast to that higher up in the intes- 
tine, the passage of blood and mucus is quite fre- 
quent, constipation is early in the disease, and pain 
is rather more frequent than in cancer elsewhere. 
Alternating constipation and diarrhea is one of the 
important signs. 
Many cases may pass unrecognized because they 
are supposed to be merely piles, and a proper rectal 
examination is not made by the attending physician, THE VARIETIES OF CANCER 
43 
for many of the rectal cancers may be felt by in- 
serting the finger into the bowel. Others are higher 
up and require the insertion of a tube so that the 
tumor can be seen. Total obstruction is rather late, 
as cancer of the rectum often involves only a part 
of the wall of the gut. X-ray pictures after a barium 
meal often give very valuable information. 
If the growth can be removed it should be cut out 
by surgical methods. If too far advanced, the bowel 
may have to be opened above in order to permit free 
passage of the intestinal contents. After this opera- 
tion, even if the growth can not be removed, life 
may be prolonged in some instances for six or seven 
years; for as soon as the tumor is relieved of the 
irritation of the passage of fecal matter over its 
surface, it quiets down and does not grow so rapidly. 
X-ray checks the growth somewhat, but there is no 
evidence that cures are obtainable with our present 
technique. If the growth is low down and inoper- 
able, radium needles may be inserted into it after the 
bowel has been opened from above. This may cause 
a very great shrinkage of the growth, but probably 
no permanent cure. 
Cancer Of The Bladder 
Cancer of the bladder is fairly frequent, forming 
about 3 per cent, of the total cases of cancer in the 
United States, which means that at least 2,000 peo- 
ple die every year from cancer of this region. The 
disease is five times as frequent in men as it is in 
women and rarely occurs before the age of forty. 
Most of the patients are from sixty to seventy years 
of age. 
Cancer of the bladder is an extremely difficult type 
of cancer to diagnose, because the tumor may reach 
a considerable size without giving any symptoms. 44 
CANCER 
Blood in the urine is the most important sign and 
when this is noticed a physician should be immedi- 
ately consulted. The mere presence of blood, how- 
ever, does not of itself diagnose a cancer of the blad- 
der. The blood may be due, among other things, to 
kidney disease, to a tumor of the kidney, or to a stone 
in the bladder. Modern methods of examination per- 
mit the insertion of an illuminated instrument into 
the bladder so that the tumor can be easily seen. In 
the later stages the urine becomes foul smelling, very 
cloudy, and filled with mucus, blood, and pus. In- 
flammation of the bladder not infrequently coexists, 
with severe pain and a feeling of bearing down or 
straining as urine is passed. Frequency of urination 
also occurs later. 
There are types of tumor of the bladder called 
papilloma which are not highly malignant, or may 
even be benign, but cause many of the symptoms of 
cancer. The distinction can only be made by a careful 
examination with an instrument or, preferably, by ex- 
amining a piece of the tumor under the microscope. 
These benign tumors are easily cured by electrical 
treatment without opening the bladder. Cancer can 
only be cured by removal of the tumor itself after 
opening the bladder. In early cases the results are 
good, one-fifth of the patients remaining perman- 
ently cured. Late cases are hopeless. 
X-ray and radium often check the growth for a 
long time, stop the hemorrhage, relieve the pain, 
and put the patient into a very comfortable condi- 
tion, but no guarantee of a cure can be made. 
Cancer Of The Prostate 
Cancer of the prostate which caused some 1,800 
deaths in 1920, gives many of the symptoms of can- 
cer of the bladder, but usually only in its later stages. THE VARIETIES OF CANCER 
45 
The growth can be felt as a hard mass projecting into 
the rectum, and the diagnosis is usually easily made 
in this simple manner if the patient is properly ex- 
amined. The disease, however, is almost never seen 
in an operable stage. Palliation with X-ray may 
bring relief from all, or most, of the symptoms for 
a period of from one to three years. 
Cancer Of The Kidney 
Cancer of the kidney is, fortunately, a very rare 
disease, about 1,000 deaths occurring annually from 
this form. Its only symptoms are a lump in the 
abdomen and blood in the urine. Sometimes a 
shadow may be demonstrated by X-ray pictures. 
Pain is also very rare unless the tumor is large and 
presses on the surrounding tissues. Operation is the 
only possible cure and this fortunate result is but 
very rarely obtained. 
Cancer Of The Bones 
The bones are affected by a type of cancer known 
as sarcoma which differs from the carcinomata which 
occur in most of the other portions of the body. A 
number of types of sarcoma occur in the bone. Some 
of these are highly malignant; others are very much 
less dangerous. 
The symptoms of sarcoma of the bone are very 
obscure. If it is on the outside of the bone it may 
produce a swelling which is painless, or painful if it 
stretches or presses on the nerves. It may grow very 
slowly or rapidly and finally may ulcerate through 
the skin. If it is inside the bone, the only symptom 
is pain until the tumor has been in existence for a 
considerable period of time. These patients are 
often thought to have rheumatism. Then it begins 46 
CANCER 
to eat away the bone and the X-ray demonstrates 
■extensive absorption of the hard bone. Sometimes 
the bone breaks spontaneously after very slight in- 
jury, and this may be the first symptom of a sar- 
coma. 
Fortunately sarcoma of the bone is rare, only 
about 4,000 people dying of this disease in the United 
States in 1920, as compared with the large number of 
deaths from carcinoma. CHAPTER VI 
THE TREATMENT OF CANCER 
THIS chapter is not intended to enable the pa- 
tient or his family to determine the scope and 
method of treatment of any individual case of can- 
cer. Such decision often needs the combined expe- 
rience of the surgeon, radiologist, and pathologist in 
order to reach a proper conclusion, and hence is far 
beyond the ability of the layman. The intention is 
rather to show how many factors enter into such a 
decision, the difficulties and complexities of the 
problem even after a correct diagnosis has been 
made, and to indicate the necessity of obtaining the 
best medical opinion rather than a reliance upon 
home remedies or the advice of quacks. 
The successful treatment of cancer implies a cor- 
rect and early diagnosis followed by the total removal 
or destruction of the tumor and any metastatic de- 
posits anywhere in the body. In practise this most 
desirable achievement is infrequent, because by the 
time the existence of a cancer is recognized by the 
patient, the growth has often extended so far that 
it is impossible to remove it completely. 
Such complete removal can only be accomplished 
by either cutting out or destroying the tumor by 
chemical or physical methods. As might be expected 
from the nature of cancer, being merely a part of 
the body, no other method of treatment has been 
found to be effective. Until, therefore, some differ- 
ence is found between the cancer cell and the normal 
cell, and as yet no such difference has been dis- 
47 48 
CANCER 
covered except the ability of the cancer cell to grow 
more freely than the body cell, there is no hope for 
the cure of cancer by medicine. 
The cure of cancer implies, therefore, as has just 
been said, the physical or chemical destruction of 
the growth at its beginning. The easiest way to 
destroy it is to cut it out, either with a knife or 
a cautery, and such methods have produced and are 
continuing to produce large numbers of permanent 
cures of the disease. For cancer is not a blood 
disease, but is local in its beginnings, and is always 
curable if it can be diagnosed when it is very small 
and promptly removed. 
Unfortunately, none of the internal cancers can 
be diagnosed early, and the external ones are usually 
allowed to go for a long period without care, owing 
to the ignorance of the public concerning the im- 
portance of the prompt treatment of every suspicious 
growth. 
The exact way in which the operation is done, and 
its extent, must be determined by the surgeon and 
is often modified by conditions found during the 
operation itself. It is therefore impossible to make 
any general statement completely covering this 
method. Whether the cautery or knife be used is 
also a matter of judgment in which the layman need 
not concern himself. 
The destruction of cancer by chemical means has 
been practised for many thousands of years and is 
still being used in the removal of small skin cancers. 
A number -of caustic substances, the formula for 
which can be found in writings of the time of the 
Pharaohs, are still being employed. But, in general, 
such caustics are difficult to control and are apt to 
leave rather a bad scar, often far worse than does 
surgery, and their use is being more and more re- 
stricted with the development of improved methods THE TREATMENT OF CANCER 
49 
of treatment, such as radium and X-ray, which in 
time will no doubt entirely replace such chemical 
caustics. 
The electric spark is also being used to destroy 
cancer tissue and is valuable in skilled hands, but, of 
course, is limited to accessible growths such as those 
of the skin or mouth. It can only dry up or char the 
tissues and does not destroy any deep-seated exten- 
sion of the cancer. Its application is limited to small 
superficial growths, and if properly used in suitable 
cases, is very effective. 
Radium and X-rays fall into an entirely different 
category. They are used in two ways: one to slow 
the growth *of a tumor or prevent its return and thus 
prolong the life of a patient; the other to attempt 
the total destruction of the growth by their caustic 
effect. The first is a means of aiding surgery or of 
benefiting the patient when surgery is impractic- 
able; the second is the attempt to replace surgery. 
Whether a sufficient number of cures are obtained 
at present to warrant the hope of their replacing 
surgery, is very doubtful. The weight of opinion 
among conservative students of the question is, that 
while radium and X-rays are extremely beneficial in 
many ways, there is no proof that, if all varieties 
of cancer are included, they offer any number of 
permanent cures as compared with surgery. The 
basal-cell epitheliomata and cancer of the womb may 
prove to be exceptions to this rule. 
Each of these physical agents has some inherent 
advantages. The especial value of radium is that 
it can be placed in the diseased tissue by the inser- 
tion of small needle containers, thus utilizing its full 
destructive action. These needles contain varying 
doses of radium, usually small quantities. They can 
be placed close together in a tumor so that all the 50 
CANCER 
intervening structures are thoroughly influenced by 
the radiation and in many instances destroyed. 
The problem as yet unsolved is the destruction of 
the outlying portions of the tumor not connected 
with, or at a distance from, the main growth, without 
at the same time seriously damaging nearby healthy 
tissues. In other words, we meet the same condi- 
tion that confronts the surgeon; if the tumor is 
already widely spread, radium will not effect a cure 
any more than surgery will. 
Proper application of radium in this manner re- 
quires a good deal of surgical knowledge and manual 
dexterity, wide experience to avoid destruction of 
the healthy tissues, and a large amount* of radium 
to produce the best effects. As radium is extremely 
expensive, this limits the treatment of tumors of any 
size to such institutions or individuals who possess 
these large quantities of radium. There are only a 
very few places in the United States at present where 
all these requisites obtain. 
The X-rays are invisible light rays which have the 
power to penetrate substances which are opaque to 
ordinary light; they can therefore enter the body 
and destroy cells at any depth. Theoretically any 
cancer can be cured by X-rays, but practically the 
situation is vastly different, for the dosage necessary 
to kill the tumor is often so high that the normal 
tissues through which the rays have to pass to reach 
the growth may be seriously damaged, and even the 
death of the patient may result if an attempt is made 
to destroy the whole tumor. In inaccessible tumors, 
such as growths of the chest or abdomen, X-ray is 
better than radium because it can penetrate through 
the skin, muscles, and fat of the body and reach 
the tumor. 
The application of X-rays is relatively simple, and 
great benefit is often seen following its use. Un- THE TREATMENT OF CANCER 
51 
fortunately, this happy result is rarely permanent, 
altho the patient may remain in good health for a 
number of years; but if the tumor is of a highly 
malignant variety, it sooner or later returns. 
There is also another defect inherent both in 
radium and X-ray. If large doses of either of these 
physical agents are employed in treating cancer, for 
example of the stomach, the surrounding organs are 
invariably severely damaged. 
The very remarkable development of radiation 
therapy with X-ray and radium has, however, added 
several new phases to the question of the treatment 
of cancer. Employed in combination with surgery, 
radiation may be used to destroy small portions of 
a tumor which can not for any reason be completely 
removed. Such palliative use, especially of X-ray, 
is now becoming very general. In certain types of 
tumor also, where these rays are especially effective 
and where the operative surgical mortality is high, 
there has begun to be a balancing of the two methods 
of treatment. 
The radiotherapeutist may say to the patient: 
“I can not guarantee to cure this tumor, but I can 
promise you that without any risk to life, pain and 
other symptoms will disappear, and the growth of 
the tumor be arrested for a period of months or 
years. At the end of that time it may come back. 
The treatment is short and not especially painful.” 
The surgeon may argue on the other hand: “The 
surgical operation is dangerous. One-tenth of the 
people undergoing it die. Of the 90 per cent, of 
those who survive the operation, 25 per cent, are 
permanently cured. The other 75 per cent, ulti- 
mately die from a return of the disease, but often 
not for three or four years. During this time they 
may be in good health.” 
The facts of these two statements are equally valid 52 
CANCER 
and the patient is put into a position where a decision 
may be extremely difficult. The answer may depend 
a great deal upon the responsibilities and economic 
situation of the patient who has to make the decision. 
In a laboring woman who has a cancer of the womb, 
for example, and a family of small children to sup- 
port, the death of the mother would be a calamity and 
therefore she might elect to take her chances with 
radium treatment, hoping to get four or five years’ 
relief from the tumor and remain in physical health 
during that time, rather than risk the danger of the 
operation and the improbability of a certain cure. 
But there are some other factors which have to 
be considered. It is by no means certain in any 
individual case that radium or X-rays will cure a 
cancer of the womb. Some of these tumors behave 
very well and may disappear for a long time. Others 
do not seem to be very susceptible to radiation. It 
is impossible to tell beforehand which one will be 
favorably influenced, so that a radiation cure of a 
given tumor of any type can not be assured. On the 
other hand, the surgical operation may reveal what 
has previously been unsuspected, that the growth has 
extended beyond the limit of any possibility of re- 
moval and therefore surgery will fail and recurrence 
may take place within six months or a year with 
fatal results. 
Another woman suffering from the same trouble, 
but without family responsibilities, might prefer to 
assume the risk of surgery with the hope of getting 
a permanent cure. The surgical operation should 
be followed, if possible, by repeated prophylactic 
radiations to prevent recurrence of the growth. 
Definite answers can not be given as yet to this 
question of the best treatment for each case, for they 
are largely a matter for individual decision. But it 
must be admitted that high surgical skill is much THE TREATMENT OF CANCER 
53 
more generally available in the United States than 
a sufficient amount of radium with the necessary 
experience for its application. In general, there- 
fore, the patient should choose surgery. The situa- 
tion changes also with the type of tumor. For in- 
stance, cancer of the breast should never be rayed 
when operable, because such a growth is easily re- 
moved with excellent prospects of cure; far greater 
even than that claimed by those using radiation 
methods. The physician’s obligation to his patient 
is such that he must recommend that which has been 
tried and proved good, not that which is in the 
experimental stage. 
But we have been speaking of operable tumors of 
the breast. What is to be done with inoperable 
tumors of the breast? How can life best be pro- 
longed and without too much suffering? There are 
two points of view; one is to remove the tumor as 
fully as possible and then trust to X-rays to prevent 
its returning. Radium plays no part in such post- 
operative treatment as its action is too local. 
The other school believes that not enough is gained 
for the patient by surgery to warrant its use; that 
the operative procedure may open up lymph chan- 
nels and distribute the tumor cells in these advanced 
cases; that it is better to say to the patient that cure 
is impossible, but that the growth may be slowed 
for a very considerable period of time by X-ray, 
with, if possible, the insertion of radium needles in 
the larger tumor masses to help in their destruction. 
A final decision between these two situations is not 
yet possible owing to the limited experience avail- 
able as to the permanence of radiation cures. 
One thing is certain. The capacity of radium or 
X-rays to arrest a tumor like cancer of the breast is 
not invariable. Some tumors are extremely resist- 
ant, some are indifferent, and some are extremely 54 
CANCER 
susceptible. It is impossible to tell beforehand which 
one is going to yield. Some months are required 
to find out whether the tumor is susceptible or not, 
during which period there is always the possibility 
of a further distribution of the growth in the body 
which will render the case absolutely hopeless. If 
the tumor is already inoperable, this will not change 
the inevitable outcome, but if it is on the border 
line of operability much delay for the using of 
radiation methods is improper, for the operation 
should be proceeded with immediately. 
Cancer in other situations, especially of internal 
organs, offers no chance for debate. Cancer of the 
stomach and intestines should always be operated 
upon either to cure the patient by removal of the 
tumor or to relieve the symptoms by freeing the 
obstruction. For cancer of the stomach, radium and 
X-rays are practically of no value. The dosage re- 
quired is very heavy and other organs are apt to 
be damaged, so that it is possible that the life of 
the patient would be sacrificed to the treatment. 
Cancer of the stomach which can not be removed 
is often benefited by short-circuiting the obstructed 
portion, the patient sometimes living in good health 
four or five years after such an operation. Cancer 
of the bowel is of two types, carcinomatous and sar- 
comatous. The sarcomatous type can usually be 
palliated with X-rays after the removal of the tumor, 
but the carcinomatous type is very difficult to affect 
by any radiation. In the rectum the situation is 
somewhat different; a combination of radium and 
surgery may be of the greatest benefit. The surgery 
relieves the obstruction and the insertion of radium 
needles into the tumor to check its growth may give 
prolonged comfort and possibly an occasional cure. 
An active debate is now in progress regarding the 
treatment of sarcomata of the long bones. Most of THE TREATMENT OF CANCER 
55 
these tumors are invariably fatal because they are 
not recognized until a very late stage and also be- 
cause metastases to the lung occur very early. A 
group of radiologists is now recommending that all 
of these tumors be rayed ratrher than operated upon, 
pointing out that the chance of cure by surgery is 
very small. This every surgeon will grant. He also 
realizes that the amputation which he does is a 
mutilating operation. If the patient is dependent 
on his own exertions for support he may elect to see 
if radium or X-ray be of benefit to his tumor so that 
he may continue at work. Some radiologists object 
to radium in that it necessitates the opening of the 
tumor in order to insert this substance, and this dis- 
turbance of the tissues may set up a metastasis; 
hence, the tumor should be treated with X-rays 
alone and not by radium. There is no evidence, 
however, that a permanent cure has as yet been 
obtained with either X-rays or radium in cancer 
of the bone. 
The situation is very much complicated by the 
fact that there is a certain group of these sarcomata 
which apparently are not highly malignant; that is, 
they may involve the bone and possibly cause spon- 
taneous fracture, but they do not metastasize. They 
remain entirely local, and may be cured if thoroughly 
removed. This can be done in some cases without 
amputation. The difficulty lies in not being able to 
make a correct diagnosis in all cases without cutting 
into, and examining microscopically a fragment of 
the growth. Such tumors do very well with X-ray 
and radium; and when sufficient clinical experience 
is available so that their nature can definitely be 
determined by X-ray pictures or other means, many 
of them will undoubtedly be rayed and the patient 
escape an operation. Unfortunately that time has 
not yet come. Even expert pathologists and sur- 56 
CANCER 
geons disagree as to the malignancy of some tumors 
of this group, and it is probable that the nature or 
quality of the tumor in all instances can not possibly 
be determined even under the microscope. The 
general attitude, however, is still that it is wise 
to cut into the tumor and determine its nature micro- 
scopically, if possible, and to remove all that can be 
removed, and then treat it afterward with X-ray. 
To sum up the treatment of malignant tumors: 
It is best to remove them completely by surgery, if 
possible; if such complete removal is impossible, the 
tumor should be treated by X-rays or radium, or both, 
combined, if necessary, with such surgical assistance 
as may aid in prolonging life or giving comfort to 
the patient. The choice between the two depends 
upon the situation of the tumor, its nature, and many 
other circumstances. These have to be decided for 
the individual patient. 
It can not be repeated too often that diet, serums, 
or medicine of any sort does not influence the growth 
of cancer. The various forms of ultra-violet light 
and visible light have no effect upon tumors. 
Tumors should never be treated with ointments, 
plasters, or by massage. Ointments and plasters do 
nothing; while massage or manipulation rapidly 
spreads the tumor throughout the body. CHAPTER VII. 
QUACKS 
THE cancer quack is the most loathsome variety 
of quack, because he treats a disease which if 
not properly handled is inevitably fatal. He almost 
never cures any but small skin cancers and almost 
certainly takes all of the unfortunate victim’s money, 
for the quack never treats any one free. 
It is different with the quack who treats colds in 
the head or pains in the back or rheumatism, because 
these diseases are not so apt to prove fatal. The 
tuberculosis-cure quack is a little lower in the scale, 
for he may keep the patient from proper treatment, 
but the cancer quack is certainly the worst of the lot. 
He is of two varieties: one, inside the medical pro- 
fession, and the other, outside. The former is the 
more dangerous, for he shields himself behind the 
reputation of competent physicians and bears a li- 
cense to practise from State authorities. For this 
reason he is morally far worse than the ignoramus 
whose intelligence can be judged by the correspond- 
ence shown in the following extracts. The simple 
and amiable write me letters like this: 
“Dear Sir: 
Cancers are Caused and Controlled by the Bowell. 
Fruit, plain food and an honest mind, and you will 
see an improvement right away 
Yours truly 
Miss Sarah Jones 
18 Clinton Avenue 
Wadsworth, N. Y ” 
57 58 
CANCER 
Miss Sarah evidently has a leaning toward mind- 
cure methods; but, unfortunately, by taking thought 
one can neither add a cubit to one’s stature, nor 
cure a cancer. I can assert from an experience of 
over thirty years in hospitals that there are at least 
two things that faith is unable to cure; these are 
broken bones and cancer. 
The next variety comes from an engineer: 
“The Remedy and an absolute cure is 
1 lb Bird shot 
1 Pt Sweet milk 
Boil thoroughly and Strain off Shot through cheese 
cloth. 1/3 of this milk to be drank when sufficiently 
cool, & 
in 3 hours, 1/3 more & 
in 3 “ 1/3 “ 
These three doses are all that is necessary. 
Now Doctor don’t scoff and say there is nothing 
to it, try it and see.” 
An adherent of the phonetic method of spelling 
writes as follows: 
“Dear sur I see an aCCount in the Star that there 
is no cure has ever Bin found yet you are Badley 
mistaken I have A cure for canCers I no this I 
have tested it I tell you the truth and nohing But 
the truth I can -cure canCer of the stomaCh you 
can Eat my salve It will not hurt you mr. You say 
thare is 3 million dollar fund left for Any man that 
has A canCer cure 
I have the onley cure on earth.” 
The next one is a trifle more grasping, but equally 
phonetic in its spelling and weak in its punctuation. 
Dear sur I am not a student nor a doCtor but if 
you stace up 3 million dollar so it is mine when the 
cancer is cured Bring on your man or woman I do 
not care how Bad there ate up if the flesh is all gon QUACKS 
59 
off arm or leg or grate holes eat out But take a 
canCer when it is as big as half dollar it wont make 
a bad show dear surs I am ready to go to work 
Bring the patient and cheCk put it in the Bank so 
it is mine when canCer is cured 
from H. I. Kennedy 
Burlington, Kans 
answer at onCe.” 
How any intelligent person can be humbugged by 
such ignorant and rapacious creatures when he can 
go to an intelligent physician who has spent a large 
part of his life in attaining an education which fits 
him to make correct diagnoses and to offer suitable 
treatment, is one of the most puzzling phases of 
human psychology. 
Some of the quacks who are within the boundaries 
of the profession use a variety of caustic pastes or 
plasters, and they do sometimes cure small skin can- 
cers, tho the results are not as good as are obtained 
with radium or X-rays. Their advertisements tell the 
old story of “Curing Cancer without the knife” or 
“Taking it out by the roots”, altho cancer has no 
roots. But in general they do harm; for while they 
are destroying the superficial portion of a cancer, 
extension of the growth may take place into the 
deeper structures, or particles may break off and 
go to other portions of the body where they set up 
fresh tumors. When this has occurred a patient’s 
life has been sacrificed. 
It is rather important also not to take the written 
testimonials from “cured” cases at face value, for 
most of these men are not capable of making a cor- 
rect diagnosis or, for reasons of their own, do not 
want to make a correct diagnosis. They may treat 
many cases of simple ulcer or swellings which are 
not cancers, and when the thing is healed advertise 60 
CANCER 
that they have cured a cancer. Many of the good 
people who write testimonials to such quacks are 
unaware of the fact that by so doing they are betray- 
ing certain unpleasant facts concerning their own 
lives, for the tumor may be a swelling due to a far 
less creditable disease than cancer. 
Other medical quacks make their money by treat- 
ing patients with a diet, sometimes supplemented by 
ointments, pastes, or other type of local application. 
Dietary treatment is rather old, dating back 2,000 
years, when very little was known of the true nature 
of cancer. It has neither logical nor scientific founda- 
tion and has long since been shown to have no effect 
upon the growth of a cancer. In consequence the 
hospitals for incurables contain many of these un- 
fortunates who have tried dietary methods until the 
growth has reached such a size that operation or 
other treatment is impossible, and the patient, hav- 
ing spent all his money, is cast out of the quack’s 
office to become an object of charity. 
The advertising skill of some of these quacks is 
worthy of a better cause. They write letters to the 
newspapers pointing out that surgery has not di- 
minished the recorded death rate from cancer, a 
statement which is true, as explained elsewhere in 
this book; but they use the fact as an argument that, 
therefore, surgery is of no value, whereas it is well 
known that thousands of people are cured every year 
in the United States by surgery. They point out 
that the number of cases of cancer in a city is in- 
creasing from year to year despite the presence of a 
large number of hospitals, but the ordinary layman 
does not always recollect that inasmuch as the popu- 
lation of a city is obviously increasing, the number 
of cases of cancer also increases, just as the number 
of automobile accidents increases with the popula- 
tion, and the number of cases of appendicitis or QUACKS 
61 
pneumonia. But the true cancer rate remains the 
same. 
Some of the more crafty offer money in payment 
for lists of names of persons who have lumps of 
any sort. Then when the victim of cancer gets a 
personal and sympathetic letter from the quack tell- 
ing him that he can be cured for a certain sum, he 
is very apt to snap at the bait, especially if he has 
been told by a reputable physician that he is incur- 
able. Usually the money has to be paid in advance, 
and nothing more is heard of it; but occasionally the 
court-room reveals the sordid details of the contract 
when the family refuses to pay a large sum out of a 
dead man’s estate. The recent publicity campaigns 
in the United States concerning the nature of can- 
cer and its treatment have unfortunately increased 
the business of these gentry, for many people who 
read about the dangers of cancer and the proper 
means of cure, instead of taking this advice, go to 
the nearest quack, whose business is thereby in- 
creased. 
One of the most extraordinary examples of quack 
methods which is now much heard of in this country 
consists of diagnosing cancer by an electrical ma- 
chine which is some thousands of miles distant. If 
you were to tell one of these victims that a punc- 
tured tire on his automobile could be repaired by a 
man somewhere on the other side of the world work- 
ing an electrical apparatus, he would regard you as 
a fool, and probably say so; yet he will spend hun- 
dreds of dollars to have a cancer diagnosed and 
treated by the same means. But as long as a cer- 
tain portion of the population desire to be fooled 
and, as Barnum remarked, there is one of that por- 
tion born every minute, the quack will flourish, and 
people will die of maltreated cancer. CHAPTER VIII. 
CAN CANCER BE PREVENTED? 
IF, as has been shown, so small a proportion of 
permanent cures can be obtained in comparison to 
the great prevalence of the disease, it is very per- 
tinent to ask, “Can medical science offer any sugges- 
tion in regard to the prevention of cancer?” The 
answer is, “Yes, much can be done.” 
It is perfectly obvious that most of the industrial 
cancers can be prevented, that is, those due to the 
handling of irritating substances. The best example 
of this is the practical disappearance of chimney- 
sweeps’ cancer in England by 1910, owing to remedial 
legislation and changes in the method of cleaning 
chimneys. As long ago as 1775 an English surgeon, 
Percival Pott, described cancers arising in chimney- 
sweeps and gardeners. Laws were finally passed 
prohibiting certain methods of chimney sweeping and 
as the construction of buildings changed, the occupa- 
tion of the sweep, who used to go down the chimney 
naked and thus become thoroughly covered with 
soot, has ceased. With these changes soot cancer 
has become rare. 
On the other hand, the handling of tar has become 
an increasingly important occupation, both in the 
gas works and in the briquet factories where coal 
dust is compressed into cakes, using tar as a bind- 
ing medium. Cancer of the hand or forearm is not 
uncommon among such workers, and the only means 
of preventing it is to pick out those who develop 
chronic thickening of the skin and who are therefore 
62 CAN CANCER BE PREVENTED? 
63 
susceptible to this irritant and place them in some 
other trade. 
The anilin dye worker’s cancer, which is very fre- 
quent in the factories of Germany, has been par- 
tially controlled by transferring the workmen from 
certain processes, which have been found to be 
dangerous, to others, thus not keeping a man long 
in that part of the factory in which the irritating 
substance is produced. 
The irritation which causes chronic skin disease 
in those working with crude petroleum can also be 
controlled by suitable cleanliness and rotation of 
work. Prompt treatment of spatter burns, caused 
by the breaking or upsetting of crucibles containing 
fluid metal, has resulted in the diminution of cancer 
arising on the basis of the non-healing of such burns. 
Cancers which arise from social habits, such as 
those from the Kangri basket burns or betel-nut 
chewing, can also be controlled by suitable legisla- 
tion should the population be willing to subject them- 
selves to regulation. 
The dangers of Roentgen rays and radium in pro- 
ducing chronic dermatitis in those exposed in the 
manufacture or use of these two agents are now suf- 
ficiently well known so that in the future this type 
of injury, with the resulting cancer, will certainly 
disappear, for proper protection is now universal. 
The medical care of chronic leg ulcers, which are 
so frequent in old people who are employed in work 
which requires them to stand a great part of the 
time, will reduce the occurrence of cancer of this 
type. 
Proper dentistry will diminish cancer of the tongue 
and mouth by preventing irritation from rough sharp- 
edged teeth or from ill-fitting dental apparatus. In 
this connection, also, the active treatment of any 
syphilitic taint will reduce the liability of a person 64 
CANCER 
who has this disease to cancer of the tongue or 
mouth. 
Care in the use of tobacco and changes in the 
habit of smoking have already produced a diminution 
in epithelioma, the most common type of cancer, of 
the lip. The pipe smokers’ cancer, tho still seen both 
in men and women in Ireland, has practically disap- 
peared in this country, because short clay pipes are 
no longer used here. Those who are extremely 
sensitive to tobacco should avoid its use. Persons 
having moles or warts on the face where they are 
liable to be cut in shaving should have these pro- 
jections removed by surgery in order to avoid the 
irritation which occurs when they are injured re- 
peatedly. Warts and moles when they are in a situa- 
tion where they are constantly rubbed by the cloth- 
ing, occasionally change into cancer and therefore 
should be removed. Others not so situated may 
safely be left, but should be carefully watched and on 
the slightest appearance of an increase in size, should 
be cut out. They should not be treated by caustics, 
electricity, X-rays, or radium, as they are extremely 
resistant to this form of treatment. Any rough spot 
in the skin of the face in those over 50 should be 
very carefully watched; the small brownish thick- 
enings of the skin so frequent in old people should, 
if possible, be treated by radium or X-ray before 
they change into cancer. 
In the early stages, before cancer really begins, 
such pigmented thickenings are very easily cured 
by radiation, and this is the time to apply treatment. 
The patient should not wait until the growth ulcer- 
ates or grows deeply into the tissues of the face. 
It should not be picked or treated with salves. It 
should be cared for properly and by this means pre- 
vented from going on into a true cancer, which is 
then much more difficult to cure and may require an CAN CANCER BE PREVENTED? 
65 
extensive operation, or severe radium or X-ray treat- 
ment. 
Unfortunately, most types of cancer arise on the 
basis of irritations which are not so easily controlled. 
For example, cancer of the stomach unquestionably 
not infrequently begins in a small ulcer which does 
not give any symptoms to call attention to the condi- 
tion. Whether ulcers of the stomach are due largely 
to irritating food or whether they follow bacterial 
or vascular disease is not yet finally decided. But in 
any case highly spiced food and excessive quanti- 
ties of pepper and other condiments should be 
avoided. Symptoms suggesting ulcer should lead to 
very prompt treatment of the disease in any one 
over the age of 40. If medical treatment is not suf- 
ficient to cure in a short time, the ulcer should be 
removed surgically. 
Inasmuch as a considerable portion of cancers 
of the lower bowel are directly traceable to inflam- 
matory troubles in that region, prompt attention 
should be given to the cure of dysentery or of chronic 
inflammatory lesions such as diverticulitis. 
Women who have borne children are especially 
liable to cancer of the neck of the womb, and as this 
probably arises in tears produced by childbirth, such 
tears should be promptly sewed up at the time of 
delivery. If evidence of chronic inflammation such 
as leucorrhea or other types of discharge exist, the 
injury should be repaired by surgical means, in order 
to avoid such chronic irritation as may ultimately 
lead to cancer. Gall-stones are frequently associated 
with cancer and should be removed. Chronic in- 
flammation with the formation of irregular hard fi- 
brous masses in the breast, if present in a person over 
40, should be thoroughly examined at least once a 
year by a competent surgeon with the idea of having 66 
CANCER 
the masses removed if they start to grow, as cancer 
frequently arises in such inflamed tissue. 
As the cause of the sarcomata of the bones and 
other tissues is still unknown, except in rare in- 
stances, no advice as to possible prevention can be 
given. 
All these facts point to the necessity of careful 
medical examination at least once a year in persons 
over forty-five. Those who belong to a family in 
which cancer is frequent should be especially careful 
in having a routine examination by a competent 
physician. It is strange to see people who spend 
large amounts of time and money in obtaining elab- 
orate dentistry, or promptly employ a veterinary sur- 
geon to look over their pet animals in case they are 
diseased, or send their automobiles to a garage to 
have the cylinders cleaned or the brakes tightened, 
without a thought of the expense, but who do not 
consult a physician, who costs on the average much 
less than a garage mechanic, to see if their own 
bodies are kept in condition. 
It has been estimated that, assuming the total can- 
cer death rate in the United States as 90,000 persons 
per annum, 4,000 tumors occur in the mouth, 3,500 
in the skin, and 9,000 in the breast, a total of 16,500 
growths which are easily seen or felt. If cancer in 
any of these sites is treated within the first few 
weeks after its appearance, at least 90 per cent, of 
such persons can be permanently cured, and thus 
some 15,000 lives saved by the exercise of only rea- 
sonable intelligence. Yet the fact that such reason- 
able intelligence is not exerted is shown by the still 
rising total death rate from these superficial and ac- 
cessible cancers. True, the rate for cancer of the 
skin has not increased in recent years, and that of 
the breast only slightly, but cancer of the mouth 
shows a considerable elevation. People are evidently CAN CANCER BE PREVENTED? 
67 
beginning to take notice of warning signs; but des- 
pite this fact the death rate in these accessible groups 
is still much too high. The next ten years should 
demonstrate the effects of education. 
The chief facts concerning cancer which every one 
should keep in mind are: 
Conclusions 
Only early cancer is curable. 
The disease is universal; so every one is liable. 
The diagnosis is difficult; therefore consult a good 
physician as soon as symptoms are noticed. 
Surgery is still the most certain method of cure. By the Author of "The Psychic Treatment 
of Nervous Disordersetc. 
REASON AND 
SENTIMENT 
By Prof. PAUL DUBOIS, M.D. 
A charmingly written essay on the rela- 
tive value of reason and sentiment in de- 
termining the moral side of the springs of 
our everyday actions. When sentiment and 
when reason should determine our line of 
conduct is clearly set forth, and the effects 
of a well-regulated mind as the basis of a 
well-balanced judgment. It will be found 
especially helpful in formulating in the 
minds of parents proper sentiments in train- 
ing their children’s intellectual life. 
“An address emphasizing the value of suppressing 
mere feeling or animal instinct, and building in every 
human being an orderly system of morals, shaped by 
reason.”—Traveler, Boston, Mass. 
“Dr. Dubois reinforces a clearly stated argument 
with simple and convincing illustrations. With cus- 
tomary lucidity he develops his argument, and indicates 
its practical application.”—Times, Brooklyn, N. Y. 
“The argument is put so clearly, so concisely, and in 
such an amicable way that we believe there are few of 
Dr. Dubois’ readers who will not follow it with interest 
and pleasure.”—The Sun, New York. 
12mo, Cloth. 75c., net; 85c., post-paid. 
FUNK & WAGNALLS COMPANY, Publishers 
354-360 Fourth Avenue, New York, N. Y. The Influence of the 
Mind on the Body 
By DR. PAUL DUBOIS 
Author of “The Psychic Treatment of Nervous 
Disorders,” “The Education of Self," etc. 
Here is a book that no physician, nurse, 
or layman who wishes to be conversant with 
that all-important subject of mind over mat- 
ter can afford not to read. Few men have 
had the varied experience of Dr. Dubois in 
treating nervous disorders by psychic sug- 
gestion, and no one is better qualified to be 
able to appeal to the layman as well as to 
the professional man; his style is simple and 
the thought is easily grasped. One is not 
content with a single reading of this book, 
it contains such a wealth of inspiration and 
help. The Medical Counselor, Chicago, says 
of the volume: “A very valuable and inter- 
esting little book. There is food for thought 
in, above, below, and all around every line.” 
“Whatever the author states on the subject may be 
accepted as authoritative.”—Medical and Surgical 
Journal, St. Louis. 
Translated from the fifth French edition by 
L. B. Gallatin. 
12mo, Cloth, 64 pages. 7Sc., net; 85 c., post-paid. 
FUNK & WAGNALLS COMPANY, Publishers 
354-360 Fourth Avenue, New York, N. Y.