The Prevention of Cancer
FOUR years ago Mr. Ellis Barker wrote a book on cancer, which was independent, unorthodox, and was received with hostility by the medical journals. But the book has been widely read, and now he returns to the charge, with excellent reason and formidable weapons. He is to be con- gratulated on his courage and his devotion—at least by all of us whose only concern with cancer is that we wish to see the end of it.
The Registrar-General, in his decennial report, published a few months ago, affords his great authority in support of those of us who have taught for many long years that cancer is largely preventable. When we have said prevention, we have meant prevention : not early diagnosis followed by early operation, which is what the prevention of cancer has meant hitherto, in the minds of the surgeons. When the few people like Mr. Ellis Barker, who attack this subject because they feel impelled to, are condemped for saying that cancer inay be prevented, their first and best answer, in my judgment and experience, is to cite the case of X-ray cancer. It is known to everyone that chronic exposure to the X-rays is liable to be followed by X-ray cancer. This is not an hypothesis, nor a theory, nor a statistical inference, nor an experimental laboratory result : it is a known fact of observa- tion, comparable with the fact that if one is hit by a motor car one is liable to be knocked down. If we are not hit by X-rays, we do not get X-ray cancer. Thus X-ray cancer is preventable : in other words, at least one form of cancer is preventable, and is now actually being prevented everywhere. As I have written elsewhere, probably not one case of X-ray cancer is now being caused anywhere. In this instance of prevention our debt to surgeons and laboratories is nothing at all.
Can other forms of cancer be prevented ? Beyond all question, if one of the essential factors in their causation— as the X-rays in X-ray cancer—be excluded, they can be prevented. If social hygiene and the critics of tobacco have their way, there is less syphilis of the mouth, less smoking in such mouths, and less cancer of the tongue accordingly. If more care were taken of the womb at and after child-birth there would be less cancer of the womb, as I have been urging for several years, and as is now recognized and asserted by the Cancer Commission of the League of Nations. There are various forms of industrial cancer, such as those suffered by shale workers in Scotland and " mule-spinners " in Lancashire, which can be and are being prevented. That is to say, the locally acting causes, which play an essential part in the development of the disease, are excluded, and the disease does not develop.
In his invaluable Report, the Registrar-General shows that cancer of the skin and of the mouth is much commoner amongst people who do not habitually exercise such care for the cleanliness and freedom from irritation of the skin and mouth as is exercised in other classes of the community. The moral is obvious, and is explicitly drawn by the Registrar- General. As for the appalling incidence of cancer amongst persons -whose occupation predisposes them to chronic alco- holism, the facts have been known for decades. And Sir Arbuthnot Lane's contentions regarding the relation of cancer to constipation are now accepted by all students, at ;east as far as cancer of the colon is concerned, Yet only a few months ago; in a public lecture on cancer, a most eminent surgeon declared that diet had nothing to do with it : though he knows that there is a relation between diet and consti- pation and between constipation and sigmoid cancer. Almost in despair,. we remind ourselves that the word surgeon means manual labourer. -
Mr. Ellis Barker may be sometimes too dogmatic : his purview of the subject may not be complete, but he is omni- scient as compared with the typical pronouncements of the men who are officially or clinically connected with the cancer problem. The relegation of the treatment of cancer to the surgeons has been an appalling calamity, for everyone but the surgeons themselves, considered as money-makers. In this country the " lag " in the use of an alternative method of treating a dreadfully common and rapidly fatal form of cancer has been utterly inexcusable. It has now been proved, and is explicitly asserted in recent official publications of the Ministry of Health, that the treatment of cancer of the womb by radium is at least as successful in ultimate results as a surgical operation, which has against it a very heavy immediate mortality, whereas the application of radium has no such disadvantage. This is a wealthy country, and millions of money are being incessantly wasted, and worse. Yet, only the other day, a group of distinguished women had to make a public appeal for the radium which can confer such incalculable boom upon their hapless sisters. The records of the success of radium in this field are not a thing of yester- day, but go back fifteen years at least. But the surgical hold upon what has been regarded as a surgical monopoly is not yet relaxed. One is inevitably reminded of the surgical opposition to the movement for the cure of "surgical tuber- culosis," falsely so-called, by sunlight, compared with the results of which the best surgery is mutilation and the mediocre is murder.
CRUSADER.
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