Cancer Crusade

(See front cover)

Mankind's three most implacable enemies are Heart Disease, Pneumonia, Cancer. And the most baffling of these is Cancer, which is rapidly overtaking the other two for the rank of World's Worst Disease. Mankind's war of defense on Cancer has only recently begun. Last week was marked by five notable maneuvers in that war.

Book. The Annals of Surgery appeared last week with every one of its 54 articles devoted to discussion of Cancer.

The authors were the 54 foremost cancer combatants, the world's leading specialists in cancer pathology, biology, surgery, X-ray therapy, radium therapy. They wrote in tribute to a great teacher, Professor James Ewing of Cornell Medical School, Manhattan, the man who spent ten years writing Neoplastic Diseases, prime textbook on Cancer. What the 54 authorities wrote comprises a compendium of all current knowledge of Cancer, its causes, treatment, prevention. Because Professor Ewing has always taught that the specialists must depend on the family doctor to discover early signs of cancer, this issue of the Annals of Surgery will be republished at the end of this month as a book, Cancer.* Editor of the book is Dr. Frank Earl Adair, 43, Ewing disciple, attending surgeon at Manhattan's Memorial Hospital for the Treatment of Cancel? and Allied Diseases. Dr. Adair is also coauthor of a chapter in the book, on treating skin cancer with mustard gas.

Journal. Last week, too, appeared the first issue of The American Journal of Cancer, a thick quarterly which supersedes The Journal of Cancer Research begun in 1916 by the American Association for Cancer Research. Continuing editor is Dr. Francis Carter Wood, director of Columbia University's Institute of Cancer Research. The Chemical Foundation supplied the money for the new publication. Its purpose is reporting current work on the cancer problem--its research, clinical, educational and public health aspects. One-third of each issue will contain abstracts of reports published in U. S. and foreign journals.

Cinema. Also last week, 60 surgical pathologists assembled at Johns Hopkins University School of Medicine for a postgraduate course on Cancer. Professor Joseph Colt Bloodgood taught them how to distinguish cancer growths by showing them representative specimens from among his 45,000 microscopic slides. Only a few were allowed to see the first moving pictures taken of cancer cells growing under glass. Cell growers and picture-takers were Mr. & Mrs. George Otto Gey of Pittsburgh, working at Johns Hopkins' Garvan Cancer Research Laboratory, which the Chemical Foundation and Mr. & Mrs. Francis Patrick Garvan finance.

Conference. First formal presentation of the Johns Hopkins cancer film was to be this week at the National Institute of Health, Washington, before a Cancer conference summoned by Surgeon General Hugh Smith Cumming of the U. S. Public Health Service.

Weapon. Also last week, Professor Major Gabriel Seelig of Washington University School of Medicine, St. Louis, took charge of the enlarged Cancer research program of Barnard Free Skin & Cancer Hospital in St. Louis. Last June Dr. Seelig, 56, retired from active practice. He is devoting the rest of his able life to fighting Cancer and to making Barnard Hospital one of the six $10,000,000 centres which Dr. Ewing says are the essential weapons for eradication of this omnipresent scourge of humans (and other animals) and plants.

What Cancer Is. When the frog of the fable, trying to grow as big as the ox, inflated himself until he burst, he exhibited what might be called cancer of ambition. His ambition grew beyond restraint.

Cancer is unrestrained growth of cells in one or more parts of the body. Something, no one knows what, starts the cells growing riotously. They grow so abundantly that they choke and kill normal cells nearby. Often they leave a framework of blood vessels, which the ancients thought resembled the claws of a crab (hence the zodiac sign). Vigorous cancer cells from the main growth eat into the lymph and blood streams and drift away until they find some hospitable spot in the body. There they set up a secondary cancer.

Every part of the body is susceptible to Cancer, bones as well as flesh. One out of eight women who reach the age of 40, and one out of twelve men, develop Cancer. Women develop Cancer most often in the uterus and its appendages,* next most frequently in the breasts. Cancer of the stomach attacks men most often. When and where clay pipes, which conduct the heat of smoking, were popular, men often developed Cancer of the lips or tongue. Emperor Frederick II of Germany (a pipe smoker) and President Ulysses Simpson Grant of the U. S. (a cigar smoker) had cancer of the throat. President Grover Cleveland had cancer of the mouth, caused probably by the irritation of an ill-fitting dental plate rather than by heavy smoking.

Cancer does not at first cause the victim pain. It gives no warning. Hence its insidious danger. But when Cancer flourishes in a body, and the body begins to waste away, the pain passes description. Only drugs, fortitude of soul or aversion to suicide will keep the patient alive during the few months that a flourishing cancer allows him.

However, most cases of Cancer can be cured, if attacked early.

Signs of Cancer. Of every hundred deaths in the U. S., eight are caused by Cancer. Third most deadly U. S. disease, in some European countries it is Death's prime agent. It definitely is increasing in civilized countries.

Because Cancer can be cured, if attacked in its early stages, the great effort of men like Professor James Ewing is to teach the public to be calmly suspicious (but not afraid) of body irregularities and to teach doctors to diagnose such irregularities properly and early.

For this intent the U. S. has its American Society for the Control of Cancer (founded 1913). The League of Nations has a Cancer Commission under its Health Organization. Great Britain has a Cancer Committee of its Ministry of Health. The British Empire has a Cancer Campaign. There are an Association Franc,aise pour I'Etude du Cancer, a Komite fur Krebs-forschung, and similar bodies in Japan, Belgium, The Netherlands, Austria, Switzerland. Besides teaching public and profession to recognize Cancer, these organizations also promote Cancer research.

Campaigners against Cancer try to avoid scaring the public about Cancer. They feel there is already enough hysteria on the subject. Clarence Cook Little, who since his resignation as University of Michigan's president directs both the Roscoe B. Jackson Memorial Laboratory (heredity & cancer) at Bar Harbor, Me., and the American Society for the Control of Cancer, remarks in Cancer: "By the publication of quack cancer 'cures' and the premature, unintelligent and overenthusiastic publicity on many 'new treatments' the press has built up unfounded hopes to be followed by a bad mental reaction in thousands and tens of thousands of people. . . . The better journals are not so much to blame."

Publisher Adolph S. Ochs of the New York Times intends to devote the first six pages of his paper to Cancer news, when a Cure for Cancer is discovered -- no matter if the U. S. is being defeated in a war!

What the Public Can Do is to go promptly, fearlessly to a doctor with the first sign of what might be Cancer. Such signs include: any unusual lump in the flesh, especially in the breast; any persistent sore; any queer acting mole, wart or other skin peculiarity; any dribble of blood from the mouth or other body openings.

As for doctors, the educators urge them to be alert for early signs of Cancer. Prefessor Ewing's Ncoplastic Diseases, which codifies all information accepted as reliable up to 1928, is the outstanding reference book for doctors.

Then there is Cancer, published this month, a tribute to Professor Ewing by his eminent fellows in North America and Europe.

Cancer is a supplement to Neoplastic Diseases. It contains four sections: Cancer in its General Relations, Cancer Research, Regional Cancer, Radium and Roentgen Ray Therapy of Cancer.

Contributors to Cancer include:

In America: William James Mayo, Howard Atwood Kelly, John Miller Turpin Finney, George Washington Crile, Joseph Colt Bloodgood, Dean DeWitt Lewis, Maude Slye, Aldred Scott Warthin, George Edward Pfahler, Evarts Ambrose Graham, Dallas Burton Phemister.

In England: William Sampson Handley, Walter Sydney Lazarus-Barlow, Sir George Lenthal Cheatle, Sir Charles Gordon-Watson.

In France: Claudius Regaud, Gustave Roussy, Antoine Lacassagne.

In Sweden: James Heyman.

In Italy: Raffaele Bastianelli.

In Germany: Ferdinand Blumenthal, Hermann L. Wintz, Otto Warburg.

In The Netherlands: H. T. Deelman.

In Belgium: J. Maisin.

Cause of Cancer. Sir George Lenthal Cheatle (Kings College Hospital, London) says in Cancer: "Turning to this question of the genesis of carcinoma [one of the several ways Cancer manifests itself] it is one in which I have a completely open, not to say vacant, mind." Nor does any one else know for certain what causes Cancer.

Almost positively, no germ is blamable.

There are two schools of thought on what may be the cause:

1) The "localized" school thinks that, since Cancer always appears in connection with prolonged irritation (bruises, unhealed wounds, sores, chemicals, heat, burns) it is the irritation which is the important cause of the Cancer. The mechanism is supposed to be this: the irritation kills certain body cells; new cells replace the dead ones; the irritation kills the new ones, and continues to kill succeeding new crops; eventually the body becomes vexed, as it were, and rushes the production of new cells; those hastily created cells grow so fast that they get beyond control of that mechanism in the body which regulates growth; and there is the Cancer.

2) The "generalized constitutional" school thinks that the system as a whole gets out of kilter over a long period of time. It gets so that it cannot manage itself with normal efficiency. Along comes an irritation which disables one of its parts, say the breast. The body hastily drafts its defense forces. Like Falstaff's paltry men, they are unhealthy, poorly armed. They scurry to the site of the injury, stumble hither and thither, heedless of leadership, out of control -- Cancer.

Supporting Theory No. 2 is the fact that the blood and other body fluids of cancerous people is more alkaline than the fluids of normal people.

Cancer in all probability is not hereditary. But it may be that the predisposition to Cancer is hereditary.

Treatment. Until the cause (or causes) of Cancer is known there can be no specific prevention. But eminent students like Professor Ewing already know sufficient to warn the public against needless irritants -- tight brassieres, ragged teeth, ill-fitting dental work, foods too hot or spicy, too much smoking, burns, wounds which do not heal. One should not pick at warts or moles. A woman should see that she is thoroughly repaired after child birth.

The earlier a cancer is attacked the better the chance for cure. Indeed, cancer experts aver they can cure every case of cancer which they can reach if they get at it in its early stages. Trouble is, most cancer victims delay until the disease has started to invade their bodies.

But, because no one knows the cause (or causes) of Cancer, no exact method of prevention exists.

No drugs -- neither galenicals, minerals, chemicals, vitamins nor hormones -- pre vent the growth of Cancer.

Surgery, X-rays, and radium are the standbys for treatment and cure. In sur gery, of course, some sound flesh goes with the bad. The cancer surgeon can no more avoid some waste than the housewife when she reams the eyes out of potatoes.

Another and more serious surgical diffi culty is that microscopic bits of cancerous tissue may hide in some unseen pocket.

Then the Cancer regrows.

Since William Clark (Philadelphia) perfected surgery with the clean-burning electric knife and needle, many surgeons are now using the electric cautery in preference to what Howard Atwood Kelly (Johns Hopkins) in Cancer calls "knife & fork" surgery. The cautery reaches places which the scalpel cannot touch.*

X-rays and radium are potent weapons against the Cancer Ogre. They burn the turbulent, riotous cancer cells to death. But they may also kill healthy cells. Only expert technicians should fight cancer with X-rays or radium. (The same warning applies of course to the scalpel or cautery wielder./-) Research. Although the causes and ra tional treatment of Cancer are undetermined, a vast amount of research on the subject has piled up. Most of it is recent accumulation. First important international conference was held at Lake Mohonk, N. Y. in 1926. The U. S. has nine first-rate research centres, three in Manhattan, one each in Boston, Baltimore, St. Louis, Philadelphia, Cleveland, Chicago. The experimental clinic of Drs.

Coffey & Humber in San Francisco, for which Federal backing was sought by Hearstpapers and ambitious politicians (TIME, Feb. 24 et seq.) is regarded by authorities as an example of the earnest but unfinished independent effort which should be drawn into large, securely financed carefully directed institutions. Professor Ewing thinks the U. S. is far from being properly mobilized for its cancer war. He wants mightier weapons than any now available -- six cancer research institutions each endowed with $10,000,000. He would have them scattered across the country, fortresses whither crusaders might rally, whence they might sally.

Homage Volume. There is a code of ethics for a homage volume like Cancer. "The dedicatee should be recognized as an international leader in his field of research. He should be an eminent trainer of scholars, as well as himself an eminent scholar. . . ." By emphasizing the teacher a homage book differs from the Nobel prize in Medicine, which emphasizes the discoverer of medical fundamentals. Professor Ewing is of course both.

Not many men have received such formal homage while they were alive. Among the few are: the late William Osier when he was teaching at Johns Hopkins; Harvey Gushing, Harvard's brain surgeon; the late Abraham Jacobi of Columbia, founder of pediatrics (children's diseases) ; Carl Gustaf A. Forssell, radiologist of Sweden; Albert Sigmund Gustav Doederline, gynecologist of Germany. And now Cancer Man Ewing of Cornell.

The Man. Professor Ewing was 64 Christmas Day. He is a tireless worker, now more important in medicine, especially in the cancer field, than ever before. During the years when he was writing Neoplastic Diseases, he worked holidays, nights and weekends. And all the time he was racked by paroxysms of facial neuralgia.

Dr. Frank Earl Adair, editor of the homage-book, describes his master thus:

"As a man Ewing is simple in habits and tastes; sincere; intensely loyal; helpful to colleagues; possessing a subtle humor; a lover of competitive sports; tactful in the handling of men and opposing forces; scientifically resourceful and imaginative; optimistic always; idealistic in his belief in men; indulgent to a fault; having an unusual sense of fairness; scientifically aggressive and persistent; one who welcomes and encourages new avenues of approach to problems; a tireless worker; a severe but constructive critic; discriminating in his estimate of scientific contributions; a stimulating teacher; a forceful lecturer; an indefatigable contributor to scientific movements; a scholar; beloved by students and colleagues; a physician of the highest ideals."

Professor Ewing's tennis approaches professional dexterity. At his home at West Hampton, L. I., he plays the game steadily over the weekends on his own court. Meticulous in attending his classes at Cornell Medical School, he demands meticulous attendance of his students. Only matters of rare importance keep him from a lecture. One of those rare matters occurred some few years ago. Three fearful, truant students beheld him at a baseball game between the Pittsburgh (his home town) Pirates and the New York Giants, waving his hat when Honus Wagner made a homerun.

* Lippincott; $10.

* WiIliam James Mayo (the elder brother) remarks in Cancer: "Inasmuch as the testis is the primitive organ of procreation from which the ovary is derived, it has a protective heredity behind it." Similarly the small intestine is less susceptible to Cancer than its newer connections, the stomach and large bowel.

* TIME in its Oct. 17 issue reported that Dr. Allen Buckner Kanavel, president of the American College of Surgeons, said that "The coagula tion caused by the [electro] cautery is more likely to scatter malignant growths than to retard or destroy them." TIME was misinformed. President Kanavel's opinion is "quite the opposite."

/- The American Association for the Advance ment of Science last week gave its annual prize to the inventor of a huge new ray tube (see p. 41).

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