THE CANCER PROBLEM

Dominion, Volume 14, Issue 43, 15 November 1920, Page 8

THE CANCER PROBLEM

DEFECTIVE MEDICAL " EDUCATION (By Herbert Snow, M.D., in "Nineteenth Century.")' In the year ISM there were 8117 deaths from onncer throughout England nud Wales. By 1871 tho rate, had increased to 11,011; in 1884 to 15,108; in 1890 to 19,4311. The ratio per million of living person.9 was, in 1801, only 385; in 1874, 4fil; in 1881, 563; in 1890, 1)70; in 1901, 812; in 1917 (the hist for which returns have been issued) it had risen to the almost astounding number of 1210 deaths per million. With n, slight and temporary decrease, in 1865, every year since lias seen a steadily progressive- augmentation in tho death rate. The same sad story comes from every part of tho civilised world for which statistics are procurable. Moreover, as every doctor of long experience inows, the figures for which our Registrar-General is. responsible, rather understate the case than otherwise. A good many internal cancerous growths in old people pass •unrecognised; their docense being assigned 'to other causes. Also there h a desire to spare tho feeling's of royal and distinguished persons, a class which furnishes its quota to tho mortality, yet sli rinks from the uiiplea.s. nnt notoriety attaching to tho phrase "oancer in tho family." I could mention rather numerous royalties, from tho great Napoleon down to the Kaiser's mother and father, who have succumbed to this curse in the past 100 year 3, with an illustrious English Primo Minister. The Causes of Cancer, Tho exciting caii.«os of malignancy (i.0., the growth of any cancerous tumor) tiro supposed to be highly mysterious, if not altogether unknown." I believe I read a statement to that effect by a distinguished specialist and medical author o few weeks ago. And it is certainly tho cur. rent view of tho general public, as-of nil tho doctors who have devoted no particular study to the question', and have no special interest therein. Nothing could be more remoto'from the actual truth. The exciting causes or every kind of "cancer" have long' been recognised, and more qr less' precisely formulated by every medical practitionor of eminence who has had' occasion to treat on this wide class of disensos; notably by the late Sir James Paget nnd Br. Walsiie. They were most elaborately discussed .and stntr<l in a general "Treatise on Cancers and the Cancer Process," published by Messrs. Chureli-ill in 1893. Only—and here comes in that colossal element of fallacy which serves to vitiato not only tho general conception of cancer, but also nearly all' the published articles or papers thereon—in order scientifically to discuss cancer causation you miist first place each variety of the foil scourge under H.separnto category, and not confound all together under the single term. Evory kind has its own causation process, distinct from all tho rest. Cancer is not one malady, but a host of such. There are ten primary kinds, or genera; at lmst twenty secondary .varieties, or species. Without tho fullest recognition of this essential fact, any ostensible discussion on the causes of cancer fs no more than frivolous chatter—what comrade Tommy iUldns would nptly describe as "talking through your hat." The Reason of .the Annual Increase. The reasons why cancer is everywhere increasing throughout tho civilised world "turn mainly on the fact that womon axe tho principal sufferers, and possess special organs whose cell-structures normally undergo a process of involution, of withering up and shrinking when their natural work is done. That process is perturbed and distorted by nervous causestrouble, anxiety, worryj nnd general wear and tear. , These organs if is thnt furnish the larger number by far of the recorded deaths. The cancer species which attacks Hfßm is almost invariably brought on by trouble and worry.; and this for well-as-certained physiological reasons. Men are not exempt from its ravages, but suffer in a far minor degree. ... , Increasing civilisation has for the past 70 years or more denoted enormously increased worry ntid sorrow, augmented mental nnd physical friction of all kinds, most felt bv the poor, nnd toil in? classes, vet in hardly less degree by tho ranks above, who all now do their share, even to the liigbest. in energetic lnbour for the general good; but who are also more sensitive, and more apt to give way to brooding sorrow, and are often seen to make for themselves unnecessary troubles which stronger folks would tlifirepcnra This yearly increase m deaths irom cancer is no more than a measure of the annually augmented wear and tear modern rivilwntio-i involves, and which nearly all of us, under existing conditions, havo to undergo. It will not entirely, cense until tho conditions of .life become far ensi-r than now-sny in another 500 rears, if all go well. "But even ns matters stand a great deal can bo done to lessen and prevent it. .... ,~• From what has been said it follows that cancer in the female »-Ml» extent in tho mnle-may be prevwiU* by greater equanimity and chcerfuln«. Commonly it is easier to preach this gospel than to practise it But for all that the effort could often bo made with complete success, nnd it won d be an excellent thing to cultivate early in life the habit of not yielding to small nnd passing worries-or not going out to meet trouble half way. ,• ■ Further than this everything that tends to sustain physical health and well being materially aids in preventing the onset of enncer. People don t need to be always Hying to the doctor. On the contrary, all they need study is the general laws of health, which are largely individual, varying in the different cases. Tho forms of malignant growth which attack men are usually due, in tho first instance, to somo very palpable .breach of nature's laws, such as chronic alcoholism, to «>y nothing of unsavory maladies which niig'lit easily alive been prevented, and for which the patient is culpably responsible.

The Cure of Cancer. Much gossip is always current about reputed medicinal cancer cures. Of late years, I regret to say, doctors havo talked rather largely of "spontaneous disappearance." That has never occurred since the world began; all the cases so described proving ou investigation to bo duo either to mistakes in diagnosis or to "terminological inexnotitudo"—"bless Mr. 'Winston Churchill for that uhrase-Jiy somebody or other. Whenever a true cancerous growth appears nothing will eradicate it but the surgeon's knife or tho c«u r tery, in olio form or another. Occasionally, however, nature will hold ;t in check, and will not allow it to kill. And proper treatment by drugs will aid natiuo in doing this. t Some—alas, comparatively few—of these operations ore completely successful, and the patient lives for many years afterwards in comfort and haalth. Too many, unfortunately, fail, and that for reasons always apparent in each instance. "Why this?

The main reason is the auto-infection which is apt to take place. The malady lends to extend from the spot where it appeared first, to other tissues and organs; wherein it cannot bo surgically reached.

Tho crux of surgery is to rcmoro in tho first stage, though most ofton that is not attempted until the second has commenced. Then comes in the necessity for special training. Tho maxims of ordinary surgery do not apply, and are hero wall-nigh useless.

A large number of doctors educated on existing lines cannot immediately recognise a cancerous growth -when they sco ono; and so lose invaluable time in malting up their minds about its character, Timo is vital towards the success of all operative measures here—the least delay is commonly fatal. In every instance there is a special time limit, nftor which a surgical operation is no more than harmful meddling—which the conscientious and prudent surgeon would carefully avoid.

Cancer, of course, may attack organs in which no question of surgicnl interference can arise. But on this topic of eradication, it is important to observo that every cancerous growth, whatever its kind or site, is at first purely local in character—abnormal changes in n single cell or group of cells. This solitary focus becomes usually multiple within _a Sow weeks, sometimes months; by diffusion of tho peccant cells by way of the blood or lymphi When that hits oc-

currcd cure is difficult, if not impossible. But in Iho first stage you can as confidently prouiiso permanent freedom from the trouble, as you can predict the cessation of a- toothache ivhon tho offending tusk has been, extracted. To Losson the Annually Increasina Mortality. I. havo no hesitation in saying that defective medical education' fa n source which materially contributes to tlio total of deaths each year. And that to lessen this total Dvouer training would do much. Onco qualify your doctors to diagnoso quickly and then properly to treat these cancer cases, and a considerable part of the battle would at once bo won. At present tho very opposite is the ease: not only here, but in Germany. America and everywhero else. Tho students novor receive special instruction in 'cancer. What is far more disastrous, thoy are never taught that any such instruction is needed—on the contrary, are Jed in the schools everywhere to regard it with contempt. No less eminent a modern practitioner than £>ir Janies Mackenzie has lately remarked, on the present system of medical education, that ignorance itself is had; but that want of knowledge J of tho fact that there is this want of knowledge becomes disastrous. The London Cancer Hospital—and therewith tho similar institutions now scattered over these islands—are wholly outside the pale of tho educational curriculum, and there is no present sign of their prospective inclusion. For all scientific and generally useful purposes the clinical experience, and practical knowledge of cancer they convey are set aside and wasted. Hence in great measure the yearly augmented mortality. Per contra, in no department of disease is elaborate scientific study and preparation more necessary for the class wlio will be called on to treat practicallv tho scourge. In none is the present absence of all provision for this study more palpably disastrous to the community. But medicine—as embodied in those gentlemen who direct medical education—will not recognise the gap; much less set itself to fill it. To that end I would suggest the following slops, whose vital necessity hns been apparent for years. .First, select or produce b, text book on tho entire field of cancerous maladies. (Only two treatises covering the whole ground liavo ever been published—a point demonstrating the superficial manner in which cancer is habitually dealt with in professional literature.) Compel the medical aspirant to master this, and finally to nam an examination in its contents. That is the sine qua non. Then every medical college or school should institute a course of lectures by a thoroushlv competent expert. Clini' «n\ attendance at the special hospitals referred to should be rewarded.arid encouraged. There might he special prizes for essays. Finally, and as an expression of the principlo involved—our aim should be, not the erection of a class of specialists, but the education of the average practitioner, to the standard required by the danger a.nd the facts. We want a- raco of doctors, witli full scientific equipment, competent to deal practically with a terrible disease scourge; working havoc enough in the present generation,' threatening much greater among those to come.