What Could We Do about Cancer in 1913?

WHAT COULD WE DO ABOUT CANCER IN 1913?

Educating the Public

By 1910 advances in public health began to bring many deadly communicable diseases under control. But it would be the chronic illnesses such as heart disease and cancer that would pose the most alarming and challenging medical problems of the century. Cancer was a mysterious and feared disease, but as the professional standing of physicians rose, they began to define cancer as a problem solvable by medical management. In May 1913 the Ladies' Home Journal published an article titled "What Can We Do About Cancer? The Most Vital and Insistent Question in the Medical World," by Samuel Hopkins Adams, famous from the preceding decade for his work against medical fraud and patent medicines. This was the first publication about cancer aimed at the general public, and it reflected the level of knowledge about the disease at that time. When Adams asked a group of specialists, "What causes cancer?" everyone made the same reply: "I do not know." But when he asked, "What is to be done about it?" the answer was again unanimous: "Educate the people save themselves." For Americans in the 1910s cancer had risen to the fifth or sixth leading cause of death and in some areas was as high as third, surpassed in the number of its victims only by tuberculosis and pneumonia. According to Dr. Thomas S. Cullen, the chairman of the Cancer Campaign Committee of the Congress of Surgeons of North America, cancer was in its early stages a "local process" and not a blood disease. When the cancer was still small, the surgeon could totally remove it and "with one-fourth the amount of labor, accomplish ten times the amount of good." The task, as Adams framed it, was to educate the public;

No cancer is hopeless when discovered early. Most cancer, discovered early, is curable. The only cure is the knife. Medicines are worse than useless. Delay is more than dangerous; it is deadly. With recognition of and prompt action upon early symptoms, the death rate can be cut down at least a half, probably more. The fatalism which says "If it's cancer I might as well give up" is foolish, cowardly and suicidal.

The Nature of Cancer

Some scientists believed cancer was caused by a germ. Others believed it could be attributed to diet or the environment or heredity. But there was no proof. AJÍ that was really known in 1913 was that for some inexplicable reason one of the many cells of the human body got out of its proper place and lodged among the cells of another kind, where it multiplied abnormally, destroying the structures around it and forming a malignant tumor. The growing tumor spread through the lymphatic glands until death inevitably resulted. Irritation, the medical profession erroneously suggested, started the trouble by weakening the tissues and leaving them unable to resist the onslaught of the invading cell. It was falsely claimed that no skin cancer ever developed except at a spot where there was some previous and persistent irritation. As proof, they pointed out that men who smoked clay pipes were peculiarly liable to cancer of the lip. This form of lip cancer was rare in women, unless the woman was a smoker. Cancer of the tongue was said to develop from the slight chafing of a jagged tooth, suggesting that a visit to the dentist could well be a life-saving measure. By analogy, doctors inferred that internal cancers developed only after some prolonged irritation and warned that no irritation internal or external, should be permitted to last for a long time. Today, physicians consider a sore that does not heal to be a warning sign of cancer.

Signs of Cancer

Since early detection and surgery were thought to be the keys to survival, cancer victims had to be suspicious enough to realize they needed expert advice. The danger signs were weight loss and weakness, an abnormal growth, a persistent irritation, or a suspicious discharge. Breast self-examination was recommended for women as "simply a matter of laying the hand flat upon the surface and pressing firmly in upon the chest." To wait for the occurrence of pain was "the gravest of errors. Pain is a late symptom in cancer. It may come only when the damage is beyond repair."

Postsurgical Survival Rates

The most common cancer for both men and women was cancer of the stomach. In their parents' generation stomach cancer was inoperable, but victims of 1913 could be reassured that their surgeon knew his business better. He no longer had to be afraid to cut out enough of the cancer for fear that the small portion of the stomach left could not function. Although only a third of these surgical patients survived, Adams again warned that many of those who died came to the operating table in the late stages of the disease, "when there is perhaps only one chance in a hundred." For women, breast cancer was the most likely cancer after stomach cancer, followed by cancer of the uterus. In its very early stages the survival rate after surgery for breast cancer was 50 to 75 percent. Surgeons removed the lump, and if a microscopic examination determined it to be cancerous, the entire breast was removed while the woman was still under anesthesia. Surgery survival rates for uterine cancer were lower. A woman had only a 25 percent chance of surviving if a tumor was removed from the womb, but the survival rate increased to 70 percent if the entire uterus was removed. Carcinoma of the lip was the most curable, because it was the most obviously seen and therefore easiest to excise at an early stage. More than 90 percent survived. Half of intestinal cancer victims survived after surgery. Surgery in 1913 was much less painful than it had been ten years earlier. Readers were assured the pain following the operation was negligible compared to the slow and gnawing agony of the cancer itself.

Three 1913 Truths about Cancer

There were, said Adams, three general truths always to remember about cancer: "First, cancer usually develops from previous and continued irritation. Second, if the cause of that irritation be removed in time the cancer will be averted. Third, if the development of cancer be determined in the early stages the patient can probably be cured by operation, but not by any other method." Remember, Adams told his readers, the words of Dr. Charles H. Mayo, one of the greatest surgeons in America: "The risk is not in surgery, but in delayed surgery." In 1913 the only solutions to cancer were the patient's self-awareness and the surgeon's knife.

Current Thinking on Cancer

Cancer is not one single disease but more than one hundred different diseases with a common outcome: abnormal cellular growth that can spread throughout the body, invading and destroying normal organs and tissues. Scientists have identified several causes of cancer, including certain chemicals, viruses, and some rare, genetically determined cancers. There are three effective forms of treatment: surgical removal of the cancer, X ray and other controlled forms of radiation treatment, and chemotherapy. Cure rates vary according to the different types of cancer. As in 1913, the outlook is much more favorable if the tumor is removed or treated while still localized. Physicians consider a cancer "cured" if a patient survives at least five years after treatment without recurrence of the disease. The percentage of cancer patients who survive five years after diagnosis is about 49 percent. Cancer has become a leading cause of death in the United States, second only to heart disease.

CHEMOTHERAPY AND WORLD WAR I

Ironically, the mustard gas attacks of World War I led to the use of chemotherapy for cancer. When autopsies were performed on mustard gas victims, pathologists noted that their lymph glands were destroyed and their bone marrow wiped out. Because bone marrow makes white and red cells for the blood, there were few white cells remaining. Around 1930 James Ewing, a cancer specialist at New York's Memorial Hospital, suggested to colleagues that they try mustard gas on various cancers. It was too toxic for internal use, but it did work on skin cancer.

Source:

Edward Shorter, The Health (Century (New York: Doubledav, 1987). p. 1 84.

Sources:

Samuel Hopkins Adams, "What Can We Do About Cancer? The Most Vital and Insistent Question in the Medical World," Ladies' Home Journal, 30 (May 1913): 21-22;

James T. Patterson, The Dread Disease. Cancer and Modern American Culture (Cambridge, Mass.: Harvard University Press, 1987).