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Show IS 1311 Causes ore Than One n Every Thirty Deaths and Carries Off More Victims Than All the Contagious' OBRS I fat WmSk - Diseases Put Together Is Not Fatal if Treated in Time and Is Not on the Increase - fEll fin 2 Copjrlfflit. 3012. by the New Torlc Uerald Co, All J .111 rights referred.) jj " "" HERE is naturally very great f if I popular interest In cancer. The l'2i f I disease causes more tlinn one 1 iu thirty deaths, it Is said, and 'if ' ' carries off more victims than typhoid fcvi.-, if ! Binallpox, scarlet fever, measles, whooping m cough and all the coutngious diseases put i , togctbor. There arc very few people one ; 3r' : may meet in our time who have not lost j ; ' tome friends by cancer. Information with 1 1 regard to it has been looked for anxiously J j nd the supply from many sources has 1 been almost equal to the demand. Some ml ) Df the information, however, has proved 3 l to be merely hasty jumping to conelu- j j lions not justified by real knowledge. HI Much more of it ban turned out to be JJ wmsational seeking after notoriety for If : one reason or another, either on the part 19 of scientific investigators, or much of tenor II on the part of those whose only idea is II , to make money by their supposed dls- 91 j ' coveries. jll j Scarcely a month passes without the tm announcement of a new and wonderful ? I discovery with regard to the cause and w I cure of cancer, yet the cancer' deaths con- 6 tinue and very little that is practical (S f seems to have been accomplished Every c J now and then the high character of the j ource of the news seems to indicate that II r tho mystery has surely been solved, but !; : we find after a time that it is just as great a mystery as ever, and cancer con-; con-; ' tinnes to be one of the most serious fac- tors in the human death rate. In spite V, ; of all the accumulation of medical scicn- I K tific knowledge in Teecnt years there ' have even been declarations, apparently IB founded on reliable statistics, that can- l ccr was increasing rather than decrcas- I : ing. This, of course, is mainly due to I the fact that with better knowledge can- I ! cer is now more frequently and surely I1 ; diagnosed. Many a patient died from obscure internal ailments In the past whose death was set down to some con- stitutional disease of a general character ' it to some complication or even to old I age that now is definitely recognized as i t death from cancer. Population is so much more crowded and news bettor re- ported that we hear much more fre- I qucntly of deaths from cancer, hut the ft only real incrense has come from the I 1 fact that our better hygienic conditions t re keeping people alive longer than a i few generations ago, and cancer is a dia- i ; rase particularly of the time after mid- i die life. More people live to the cancer j age and death inevitably comes to a cer- j tain number of them in this form. ' Cause Not Known. In spite of the scarcity of such definite information as would enable us to prevent or cure cancer hi general, we now know enough about it to be able to point out I certain conditions that favor its appeat- 1 ance in people who arc predisposed to it ' so as to be able to suggest general pro- 1 pbylaxis and, still more important, to be ' able to quiet many fears and dreads with 1 regard to cancer which make some sensi- 1 jig i tive people almost as miserable as If the i , disease were actually developing. i ifi ; I Probably the most important source of 1 I Information with regnrd to cancer has i been the investigation made by the In.- i periol Cancer Research Fund of England under the direction of the Koyal College of Physicians of London and the Royal i tlS ' College of Surgeons of England. Their l- fourth scientific report published not lpng i gtj since makes another valuable contnbu- I bjj; ' tion, not to the theory of cancer, of which : we have a surplus, but to such actual l 5- l knowledge of the disease as may be help- 1 m j While we do not know the cause of i I . cancer, as has been said, there are many : I Interesting conditions that have beon dis- : M covered in which it develops very fre- Ijj3 queutly. It is particularly likely to orig- i laE; inate in areas of chronic irritation; that ; 0 'a is, portions of the body wheru some irri- . taut has been producing that tendency to ; -. congestion in the miflst of which nerves ( l ' are more sensitive and vital processes : II are more uctivc than they are anywhere I! else. Many of these chronic irritations' II arc due to occupations or popular habits.1 JSj ! It was because of the frequent occurrence fllw cancer in connection with certain1 jl trades that this peculiarity of cancer was I life nrfit recognised. 'Jilt "c tDC carnest f these was the so- II I railed chimney sweep's cancer. The soot III Iroin the chimueys clenued by thebc work-fl work-fl men gathers )u various creaecs of the body 3i tnd, being vcrj' line, is ditiicult of entire 9111 removal by washing. Besides, such la- Mill borers seldom take much trouble to becurcj IliL tompltjic cleanliness.. As a conscqiicucej 111 manifestly, of the chronic Irritation set up I Hi v l Iir(-'s:,lci; f 'his dirt it was noted IISI thnt cancer was particularly likely to de-j lit velop iu certGlu folds and creases of ilie, (I 'kin surface, though practically never seen W' m other people In the same nitiMtiuus. sjjj After this came a scries of similar ob- (e1 erruUon, It was found that people who' I I i work iu tar and parallin may lmrc cau-l Si i v I W cer deTkp on portions of the skin sur- I ''face aitbjccfcd to constant irritation from t these products. Apparently al that is needed in certain persons is the constant c presence of an irritant, and then cancer 2 is likely to develop. It does not develop 1 in all of the workers in a particular trade, ' nor even in a large proportion of them, I biit It is seen Only in those who work at t such trades, and the origin of it, particu- : larly in parts of the body where irritants are constantly present in workers, though 1 cancer almost never occurs in other pcr-' pcr-' sons in such localities, makes it evident 1 that the disease is due to the prolonged ' local irritation. Any form of chronic irritation, however, may prove the basis for the development of cancer. Sailors, who handle ropes and whose hands and arms are much exposed to the inclemencies of the weather, develop de-velop certain chronic skin diseases, in the midst of which cancer has been known to develop, which by German authorities has been spoken of as sailor's cancer. The customs of many nations furnish the basis of chronic irritation in which cancer develops. For instance, in Ceylon and India the people have the habit of chewing a preparation of betel nut. This consists of the nut of the betel tre wrapped in the leaves of the betel pepper plant. It is very hot and rather acrid, and it is not a little difficult to understand just why the custom of chewing the preparation became eo common. Apparently Ap-parently any strong sensation can after a time become a source of plensure because be-cause of the attention that it arouses. The gum chewing habit, after all, is foundrd on the same principle, a certain low grade pleasure being derived from an occupation of the jaws and tongue and teeth. Apparently such occupation lessens les-sens worries in some people and keeps such mind as they have from being a burden (o them. Betel Nut Chewing. Some years ago It was noted that spe cial forms of cancer of the tongue were much more frequent in Ceylon and India than elsewhere, and eventually the origin ori-gin of these cancers was traced to the chronic irritation set up during the process proc-ess of betel nut chewing. The inhabitants inhabi-tants Tecognize the danger now, but as only a small proportion of those who have the habit develop cancer the habit continued con-tinued to be popular and doubtless will remain for many years. There is no doubt about the connection between the irritant and the subsequent cancer, but people seem quite williug to face the risk so long as the danger is not inevitable and attacks only comparatively a few of those who have th,c IiabiL In China the people in many of the country districts have acquired the Jiabit of eating rice very hot. This is sometimes some-times so hot that it would he quite impossible im-possible for one unused to it to hold the material in the mouth at all. -Apparently rice has so monotonous a taste when used as a staple .article of diet that those who consume it in large quantities are very glad to have even the change of sensation that is induced by the intense stimulation of very hot food. Cancer of the tongue and of the mouth structures is commoa in regions where such hot materials aro eaten, nnd there is no doubt of tho direct connection between the dirunic irritation produced by the hot rice and the cancer development. A very enrious custom prevails in Kashmir, Kash-mir, a district In the Himalaya Mountains, Moun-tains, which gives origin to a specially , localized cancer. The cold is often extreme ex-treme in the mountains and the varia- , tlons of temperature very marked. As a , consequence of this many of the people in this district are in the habit during the cold weather of wearing under their rather loose dress a small portable charcoal char-coal stove. This Is usually fastened round the waist by a girdle and Is applied ap-plied directly to the abdomen in frout. As a consequence of the intense irritatiou set up by this heating apparatus cancer develops In these persons rather frequently frequent-ly just beneath where the little stove is worn. Cancer in this location in the'skiu surface is almost never seen anywhere except in Kashmir, though it is not at all iufrcquent there. There can be no doubt, then, of the connection between the chronic irritatiou and the development of cancer. Cancer of the Tongue. Some bimilar causative conditions have been studied among our own people. Over and over again it has been noted that men who s'rnoke short pipes, which they keep almost constantly in their mouths, j drawing hot smoke directly against the 'end or side of tho tongue, the mouthpieco of this pipe often being rough and itself a second source of irritation, develop can-jeer can-jeer at the irritated point. Nearly all of lhc mouth cancers M-cn In this coiiutrj'i develop In men; ouly rarely are thoy scenj In women. Men indulge in many irritunH 'of Jhe oral mucous membranes smoking, "chewing tobavco,. tho use of alcoholic -liquors, especially undiluted, and the like, J Thcie irritations do uo't cuuse erxe-. gg BY JAMES J. WALSH, M. D., PH. a, LIT. D. M but they produce conditions in which those who are predisposed to malignant diseaso develop It. Only a comparatively small percentage of men have this tendency ten-dency to cancer, less than one in twenty, and as a consequence most men may continue to indulge in these irritants with Impunity. No one caTi tell beforehand, however, just who has or has not a cancer predisposition, so that there is a certain amount of danger for all who become the subjects of such habits. It is quite sure now that without these habits cancer can-cer of the mouth 'chat is. the lips, the tonguo and the tonsils and the larynx generate into cancer, but on the edge of the lips, and especially In the middle or at either angle of the mouth, or at the angle of the eyelids, suspicion is a much better attitude of mind than neglect. It is surprising how many people will permit a sore thai proves to be cancerous cancer-ous to run on for months without giving it proper attention. To do so Is neatly aLwnys fatal, because the glands beneath be-neath the angle of the jaw and deep iu the tissues become affected, and after this it is often practically impossible to remove the cancer completely. In very recent times certain special in- elderly people. A pigmented spot that is quiescent and is superficially situated in the skin need not .give any solicitude, but if it Is adherent to the underlying tissues, or begins to be, or if it shows any tendency ten-dency to extend -its borders, these are danger dan-ger signals. Pigmented warts in older people are similarly dangerous. Warts in young people peo-ple have no significance and are not dangerous, dan-gerous, unless for any reason they should b: very frequently irritated, or made to bleed often, when sometimes they takej on malignancy that has a caucerous tendency. ten-dency. AYarts on the face that are par- would be much less ficquent than it Is at present. Whether this lessening of cancer In thc-facinj thc-facinj region would not be compensated for by the occurrence of the disease in other parts of the body is not quite sure. Only such persons as indulge in the irritant irri-tant habits to' a great excess are Hkclj to set up euough chronic irritation to oc, casion cancer. The man from whose mouth a cigar is almost never absent dining the day develops cancer of the tongue or tonsils or larynx. Tho mn. with a short pipe, who hns worn down a tooth in a particular place or lakes advantage ad-vantage of a bioken tooth iu order to accommodate ac-commodate it, gets cancer of the tongue or of the lip near the broken, jagged tooth. Watch Irritations, There are other forms of chronic irritations irri-tations that may prove the origiu of cancer, can-cer, or at least furnish a site for it. Certain Cer-tain lesions, sores, chronic eruptions nnd the like need to be watched carefully if they have continued to exist for a considerable con-siderable period in spite of reasonable care of them. This is particularly true of sores on the eyelids aud the lips. It is at points where skin nnd mucous membrane mem-brane meet that is, where one form of covering of the ourfuce, the dry skiu, passes over into the moist, softer mucous membrane that there is particular .likelihood .like-lihood of the development of these dia-turbauces dia-turbauces of cell growth that vo call cancer. Sores on the lipn that refuse to heal in spite of ordinary treatment are always bUspicious and ;nuat not be ul-lowed ul-lowed io continue for-more than a weelr without consulting a physician. 1 i10y are somewhat indurated, then this warning warn-ing la particularly important. Somc-liuies Somc-liuies ,Io'lig continued sores are due to duul siuuscs thai lead down lo" the root of ii tooth', Hiid -these do not readily de- tense forms of irritation are known to produce cancer. A pcries of physicians and electrical experts who have devoted themselves t6 X-ray work have developed chronic skin diseases in the midst of which cancer has developed. Sometimes there has been a series' of cancer developments 50 that in spite of a succession of amputations amputa-tions death finally took place from further deelopment of cancer. At first when the X-rays, which had been hailed as a cure for cancer, began to cause that disease the world was startled, but we know now that it Is ouly the intensely Irritant effect that ( brings about the development of the canker. can-ker. The scar of an X-ray bum is onlj moic intensely irritam thau the scar of any hum, aud it-' is this that proves the occasion for cancer development Any other form of intense Irritation, as, for instnnce, that set up by radium, will do the same thing. '-l'ven radium carried iuj the vest pocket h'as been reported to have! produced a hurn'of the skin surface of the abdominal region, with subsequent deel-opment deel-opment of cancer. Auj caustic, however, might, if its actibu wro prolonged, produce pro-duce a similar eft'ect. The hums made by auds produce scars in which cauccr often dexelops. This 'Is particularly true of the jscnrs that develop iu the throat as- a consequence con-sequence of "Wallowing by ncciden some strongly caustic fluid. Danger of Pigmented Spots. Other areas where chronic irritation is 'set up over prolonged periods may readily develop cancerous tendencies. Pigmented spots, for instance' are particularly likely to be the scat of external cancer. Sometimes Some-times theso are congenital moles or birthmarks, birth-marks, as they are called, and sometimes thev arc pigmented areas that develop later. "V licnfivor siien spots aro very dark In color and, show any tendency to spread they shpuld;rhc promptly removed. This is pjrtictflarlyHuJI'ortant advice for ticularly rich in blood supply may become dangerous in this way with advancing years, but as u rule need give no anxiety. Moles on other parts of the body than on the face seldom give rise to cancer. Apparently Ap-parently the irritation of light and heat nnd the vnriutious of temperature, as well as washing wiii: soap and the irritation of dust, make these birthmarks more liable to degenerate malignantly. Results of Scars. Scars almost anj where in tho body arc rather frequently tho site of cancer, through malignant developments come about, as a rule, only iu scars Unit have a tendency to contract and that, thcrc-ifore. thcrc-ifore. are constantly a source of irritation to the tissues in the midst of which they aie situated. The scars after a burn, for instance, becoinu the site of cancer frequently fre-quently enough to have attracted special attention to them. Deep ulcers that have existed for a good while, healing and then breaking down again, arc often slte.s of cancers. Cancer of the stomach very frequently develops on the site of an old ulcer. The presence of gall stones sets up a chronic irritation iu the gull bladder often followed by cancer. Cancers in (he digestive tract usually occur at the points most subject lo irritation. irrita-tion. For instance, in. the esophagus cancer can-cer occurs particularly just where the swallowing tube is narrowest us it passes through the diuphrjgin. Iu the stomach it occurs with the greatest frequency at the pylorus, or gateway; that is, the place of exit for food from the stomach. It is here that uuchewed portions of food with rough edges or pieces of bone or other hard materials are likely to produqo frequent fre-quent ureas of irritation. All through the ' Intestinal tract it Is at (ho curvature ! where irritation from rough materials in ' the food is likely to be most noted that : cancer occur with greatest frequency, i G Practically all the sui.uiires of the human body that are especially liable to cancer have a history of frequently repeated re-peated irritations, and these seem to form a basis of that change which comes over tho tissues and produces what we know as cancer. , The essence of that change is a tendency ten-dency for certain kinds of cells to overgrow. over-grow. There arc two kinds of malignant disease, or cancer, as It is popularly called. One of these is sarcoma, which develops in the connective tissues aud is seen particularly par-ticularly during the younger years before full growth has been attained. The other is carcinoma, which develops in the epithelial epi-thelial or glandular Ussues; that Is, those structures which produce various substances sub-stances for the use of the body. Health consists to a great extent in a state of peace and co-operation between these two kinds of tissues, the connective tissues and the glandular tissues. Whenever either of them overgrows at the expense of the other the whole organism or-ganism suffers. The connective tissues arc much less important than the glandular glandu-lar tissues, for they only support and help to move the body, while the glands -perform the wonderful chemical work with its fine adjustments on which human hu-man nutrition depends. During the growing period the connective tissues are very important and receive an abundant nutritive supply, and consequently sometimes some-times overgrow locally with the production produc-tion of malignant tumor, the so-called sarcoma. Later in life the glands get most of the nutrition and then they may overgrow, with the production of true cancer. The Fatal Delay. It is not surprising, then, that cancer I should have been described as a sort of rebellion or revolution in the tissues. When the supporting cells, which may I well be compared with the working I classes, receive their .due amount of nutrition nu-trition and carry on their work, without wishing to absorb more than their share ,of the nutrition of the body, then all is .well. When the glands, the aristocracy, 'a3 Jt were, of the body, the chemists and 'other professional men, tho directors and administrators of various functions, arc j williug to take their proper share, but no more, then the body is healthy. In the younger years sometimes the connective tissues claim more than their share, overgrow over-grow at the expense of the neighboring I tissues nnd usually kill the organism to .which they belong. Later in life the glandular cells may make a similar mistake, mis-take, and, insisting on more than their share, may produce like serious effects, j We know that heredity has a certain ,vcry definite but limited place in predisposition pre-disposition to cancer. It is evident that the equilibrium between the various tissues tis-sues in the body which represents health may be disturbed by some defect In the tissues. Disease is not hereditary, but defects are. Certain defectiveness In cell equilibrium may be transmitted from one generation to another, and this represents the predisposition to cancer which evidently evi-dently must be present before the malignant malig-nant process is set up. , An English imperial research commission commis-sion has dwelt particularly on the quo tion of the increase of cancer. This reported re-ported increase id cnusing great solicitude among sensitive people- I" its last report the commission says: "For tho first time it is fully demonstrated that it Is erroneous errone-ous to make statements of a disquieting nature about the increase of cancer in geueraL" Cancer in some parts of the body, as for iustanco in the tongue In men, Is apparently ap-parently increasing, but the editor of the report ventures to doubt the significance of the figures and thinks that they rcquir further study and elucidation. A significant signifi-cant increase has come in tho digestive tract, but this is evidently due to the fact that tho diagnosis is better than St used to be aud tha1: cancer U now recognized where not so long ago mucti more general diagnoses were made. Cancer on the skin surface, where it has .ilwuys been easy to recognize it, shows little or no increase. In general, wherever cancer may be observed ob-served locully the increase In cases is no more than might be expected from the growth of population aud the fact thut people are generally nw living longer lives and pass more years in the higher cancer ages. Every year after thirty that a person lives increases the liability of death from cancer. Unfortunately, after all the investigation investiga-tion very little can be said as to the cure of cancer. A few cures are (supposed ( to have been discovered by serious medical investigators, but experience with them has proved a disappointment The only c-re for cancer that has yet been found is the knife. That seems a , rather rough way of putting it, but-It h . the only true way. And since cancer Is i an affair of life and death vo must not mince mattcis. External cancer cau ( surely be cured by the knife completely t if it only b taken in time. Unforiu- 1 nately, people hesitate and delay and tern. jH porizc In various ways and fear to know H the worst, until often the cancer rcachc! such a stage that it cannot be removed M completely, and then death is practically M f inevitable. The report of the Cominis. fl sion on Cancer of the State of Pcnnsyl- M vania for last year covers the statistics M of four hundred patients from various M parts of the State. When the cases ol external cancers presented themselves for treatment less than seven out of ten M were suitable for operation. MaDy ol M the patients had been aware of the pres- 1 once of the condition for considerably H uore than a year before they applied to he .urscon for relief. Delay probably l"ds to the fatal termination of at least one-half of nl, catJcer CMflt H ; lhc condition is MltaWe for op H ZV becQ a,,owed to pr far that infection has taken place deep " lie tissues, so that, though the exter- ; Ml tumor can be removed, recurrences , take p,ace in other parts of the body. . Best Medicine Is Knife. H , Many a cured cancer patient owes his , I" bfaVely fadD t,lc Z. . . ' to p,lt off in coardly fash;on H the knowledge of the worst, and then , having the operation performed promptly M , Some of (he external cancers can be H t trCat?d cusflly by plaStcrs and H Pastes nnd caustic applications of va- "JH ; nous kinds. Indeed, some good author!- , ties prefer these modes of treatment H t for forms of external cancer. It Is ex- . tremely important however, to have H , these applications made by expert hands. M It is always suspicious when tho appH- M cations arc made by those who insist on M r how much can be accomplished for the f treatment of cancer without tho use of the M . knife. Any one who knows cauccr well H r must recognize that the cleanest, best ; medicine we have for it is the knife. H Those who pretend to any other opin- H t.ion are likely to use their various appli- H ;. cations under circumstances where they i cannot do gocd, and unfortunately death jH , Is the penalty for a mistake of this kind, IH I and the wnsting of precious time means !H I an inevitable fatal termination. Soma jH ; external cancers must be treated by the j knife. The physician who takes up their M el treatment then- had better be one who ej is ready, judiciously and judiciaUy, to ,'H -select that mode of treatment which is ; likely to do niost good. He must not bo ) wedded to any one form of treatment vEven the man who is too ready to use H - the knife may make mistakes, and he H r should he willing to employ other means iH where they may do good. As a rule, sur H i gery fs the least painful, the quickest, tl the surest, the most satisfactory form of M t treatment of cancer, and it -leaves tha H - least car. H The Death Kate. M -j The most serious factor in the death l : rate from cancer at the present time is jH I undoubtedly delay in the proper treatment. jH , Probably three-fourths of all cancers jH could be radically cured if treated in H time. Nine-tenths of all external cancers ' could surely be eradicated. Most of the ,H delay is due to tho fear to know the H . worst and the failure to realize the awful H ; significance of the condition, but not a H little is due to the use of fraudulent so- IH called cancer cures, advertised as such, IH ' promising results without paiu and with- H ! out operation. These frauds are allowed H by our laws to appeal through the various H advertising mediums, and those who are H utlllcted with cancer, or fear that they are H so afflicted, grasp at a straw and the hope H of easy cure, and by the time they have H been undeceived it is too late to have a IH radical operation done. Not a few people H who are not sufferers from true cancer, H but who have some form of tumor or IH swelling or chronic sore, apply to theso H cancer curcrs and in the course of time H their condition passes away. These are H the so-called cured cases so much adver- H tised. They were not true cancers, but H only some lesion thought to be a cancer H by a timorous patient aud pronounced H such by some ouc cither incapable of judging or whose personal interest die- H tuted agreement with the patient in the H mutter. Many of thec people after ' tho H cure" is over go around for years with the burden of drend over them lest their H cauccr should return. jH It is evident thut cancer Is a condition IH that cannot be temporized with, and that if its treatment is put off will surely IH have u fatal termination. Just as soov as that fact is brought home to the great H muss of the people and the additional one H tli at there are no simple, painless cures for cancer, and that any one who promises H such is a fraud, scheming to make money, H but not to do 'any good, then our death H rate from cancer will fall to a marked H degree. We have any number of cases now on record of patients who uudoubt- edly "had cancer, who wore operated upon IH or properly treated by some caustic oi H other adequate method, who are aliv H fromtcn to twenty yean after their can- H cerous condition was first diagnosed, H There are many who died after operation under ten years, but whose deaths wcr H due to something quite different from can- H cer and whose lives were evidently uol H shortened by their malignant disease. In H a word,' cancer in bj no incfiiu the hope- H le.ss condition it i sometime? declared U H be, and we need only ths preir diffusion M of our present iufomatiov. wit: regard lo H the disease to malic its mortaUiv mncl M lc? than it Ijm bwii. H |