Part 17 (1/2)
While both these pus-organisms can breed and flourish freely only in wounds or sores, this is but their starting-point where they gather strength to invade the entire organism. We used to make a distinction between those cases in which their toxins or poison-products got into the blood, with the production of fever, headache, backache, delirium, sweats, etc., which we term _septicaemia_, and other cases in which the cocci themselves were carried into the blood and swept all over the body by forming fresh foci, or breeding-places, which resulted in abscesses all over the body, which we call _pyaemia_. But now we know that there is no hard and fast line to be drawn, and that the germs get into the blood much more easily than we supposed; and the degree and dangerousness of the fever which they set up depend, first, upon their virulence, or poisonousness, and, second, upon the resisting power of the patient at the time. Anything which lowers the general health and strength and weakens the resisting power of the body will make it much easier for pus-germs to get an entrance into it, and overwhelm it; so that, after prolonged famines for instance, or among the population of besieged cities, or in armies or exploring expeditions which have been deprived of food and exposed to great hards.h.i.+p, the merest scratch will fester and inflame, and give rise to a serious and even fatal attack of blood-poisoning, erysipelas, hospital gangrene, etc. Famines and sieges in fact are not infrequently followed by positive epidemics of blood-poisoning, often in exceedingly severe and fatal forms.
It was long ago noted by the chroniclers that the death-rate from wound-fever among the soldiers of a defeated army was apt to be much greater than among those of the victorious one, and this was quoted as one of the stock evidences of the influence of mind over body. But we now know that armies are not beaten without some physical cause, that the defeated soldiers are apt to be in poorer physical condition to begin with; that they have often been cut off from their base of supplies, have made desperate forced marches without food or shelter in the course of their retreat; and, until within comparatively recent years, were never half so well treated or well fed as their captors.
As the invading germs pa.s.s into the body, they travel most commonly through the lymph-channels and skin; are arrested and threatened with destruction by the so-called lymphatic glands, or lymph-nodes. This is why, if you have a festering wound or boil on your hand or wrist, the ”kernels” or lymph-nodes up in your armpit will swell and become painful. If the lymph-nodes can conquer the germs and eat them up, the swelling goes down and the pain disappears. But if the germs, on the other hand, succeed in poisoning and killing the cells of the body, these latter melt down and turn to pus, and we get what we call a ”secondary abscess.”
The next commonest point of attack of these pus-germs, if they once get into the body, and by far the most dangerous, is the heart, as in rheumatism and other fevers. Some will also attack the kidneys, giving rise to alb.u.min in the urine, while others attack the membranes of the joints (_synovia_) and cause suppuration of one or more joints in the body, which is very apt to be followed by very serious stiffening or crippling. So that, common, and, in many instances, comparatively mild as they are, the pus-germs in the aggregate are responsible for a very large amount of damage to the human body.
This is the way the _streptococcus_ and _staphylococcus_ behave in an open wound, or sore; but they have two other methods of operating which are somewhat special and peculiar. One of these is where the germ digs and burrows, as it were, underground, in a limited s.p.a.ce, resulting in that charming product known as a boil, or a carbuncle. The other, where it spreads rapidly over the surface just under the skin, after the fas.h.i.+on of the prairie fire, producing _erysipelas_. In the first of these he behaves like the famous burrowing owl of our Western plains, who forms, with the prairie-dog, the so-called ”happy family.” He never makes his own burrow, he simply uses one which is already provided for him by nature, and that is the little close-fitting pouch surrounding the root of a hair. Whether the criminal is a harmless native white coccus which has suddenly developed anti-social tendencies, or a Mongolian immigrant who has been accidentally introduced, is still an open question. The probabilities are that it is more frequently the latter, as, while boils are absolutely no respecters, either of persons or places, and may rear their horrid heads in every possible region of the human form divine, yet they display a very decided tendency to appear most frequently in regions like the back of the neck, the wrist, the hips, and the nose. One thing that these areas have in common is that they are liable to a considerable amount of chafing and scratching as by collars and stocks on the neck, and cuffs on the wrists, or of friction from belts, or pressure or chafing from chairs or saddles. When the tissues have been bruised or chafed after such fas.h.i.+on, especially if the surface of the skin has been at the same time broken, and any pus-organism is either present in the hair-follicle, like the white coccus, or rubbed into it by a finger or finger-nail which has just been sucked in the mouth, used to pick the nose, or possibly engaged in dressing some wound, or cutting meat, or handling fertilizer, then all the materials for an explosion are at hand.
CHAPTER XVI
CANCER, OR TREASON IN THE BODY-STATE
The imagination of the race has ever endowed Cancer with a peculiar individuality of its own. Although it has vaguely personified in darkest ages other diseases, like the Plague, the Pestilence, and _Maya_ (the Smallpox), these have rapidly faded away in even the earliest light of civilization, and have never approached in concreteness and definiteness the malevolent personality of Cancer. Its sudden appearance, the utter absence of any discoverable cause, the twinges of agonizing pain that shoot out from it in all directions, its stone-like hardness in the soft, elastic flesh of the body, the ruthless way in which it eats into and destroys every organ and tissue that come in its way, make this impression, not merely of personality, but of positive malevolence, almost unescapable.
Its very name is instinct and bristling with this idea: _Krebs_, in German, _Cancer_, in Latin, French, and English, _Carcinoma_, in Greek, all alike mean ”Crab,” a ghastly, flesh-eating parasite, gnawing its way into the body. The simile is sufficiently obvious. The hard ma.s.s is the body of the beast; the pain of the growth is due to his bite; the hard ridges of scar tissue which radiate in all directions into the surrounding skin are his claws.
The singular thing is that, while brus.h.i.+ng aside, of course, all these grotesque similes, the most advanced researches of science are developing more and more clearly the conception of the independent individuality--as they term it, the _autonomy_--of cancer.
More and more decidedly are they drifting toward the unwelcome conclusion that in cancer we have to deal with a process of revolt of a part of the body against the remainder, ”a rebellion of the cells,” as an eminent surgeon-philosopher terms it. Unwelcome, because a man's worst foes are ”they of his own household.” Successful and even invigorating warfare can be waged against enemies without, but a contest with traitors within dulls the spear and paralyzes the arm. Against the frankly foreign epidemic enemies of the race a st.u.r.dy and, of late years, a highly successful battle has been fought. We have banished the plague, drawn the teeth of smallpox, riddled the armor of diphtheria, and robbed consumption of half its terrors. In spite of the ravings and gallery-play of the Lombroso school anent ”degeneracy,” our bills of mortality show a marked diminution in the fatality of almost every important disease of external origin which afflicts humanity.
The world-riddle of pathology the past twenty years has been: Is cancer due to the invasion of a parasite, a veritable microscopic crab, or is it due to alterations in the communal relations, or, to speak metaphorically, the allegiance of the cells? Disappointing as it may be, the balance of proof and the opinion of the ablest and broadest-minded experts are against the parasitic theory, so far, and becoming more decidedly so. In other words, cancer appears to be an evil which the body breeds within itself.
There is absolutely no adequate ground for the tone of lamentation and the Ca.s.sandra-like prophecy which pervade all popular, and a considerable part of medical, discussion of the race aspects of the cancer problem. The reasoning of most of these Jeremiahs is something on this wise: That, inasmuch as the deaths from cancer have apparently nearly trebled in proportion to the population within the last thirty years, it only needs a piece of paper and a pencil to be able to figure out with absolute certainty that in a certain number of decades, at this geometric ratio, there will be more deaths from cancer than there are human beings living.
There could be no more striking ill.u.s.tration, both of the dangerousness of ”a little knowledge” and of the absurdity of applying rigid logic to premises which contain a large percentage of error. Too blind a confidence in the inerrancy of logic is almost as dangerous as superst.i.tion. s.p.a.ce will not permit us to enter into details, but suffice it to say:--
First, that expert statisticians are in grave doubt whether this increase is real or only apparent, due to more accurate diagnosis and more complete recording of all cases occurring. Certainly a large proportion of it is due to the gross imperfection of our records thirty years ago.
Second, that the apparent increase is little greater than that of deaths due to other diseases of later life, such as nervous, kidney, and heart diseases. Our heaviest saving of life so far is in the first five-year period, and more children are surviving to reach the cancer and Bright's disease age.
Third, that a disease, eighty per cent of whose death-rate occurs after forty-five years of age, is scarcely likely to threaten the continued existence of the race.
The nature of the process is a revolt of a group of cells. The cause of it is legion, for it embraces any influence which may detach the cell from its normal surroundings,--”isolate it,” as one pathologist expresses it. The cure is early and complete amputation of not only the rebellious cells, but of the entire organ or region in which they occur.
A cancer is a biologic anomaly. Everywhere else in the cell-state we find each organ, each part, strictly subordinated, both in form and function, to the interests of the whole.
Here this relation is utterly disregarded. In the body-republic, where we have come to regard harmony and loyalty as the invariable rule, we find ourselves suddenly confronted by anarchy and revolt.
The process begins in one great cla.s.s of cells, the epithelium of the secreting glands. This is a group of cell-citizens of the highest rank, descended originally from the great primitive skin-sheet, which have formed themselves into chemical laboratories, ferment-factories for the production of the various secretions required by the body, from the simplest watery mucus, as in the mouth, or the mere lubricant, as in the fat-glands of the hair-follicles, to the most complex gastric or pancreatic juice. They form one of the most active and important groups in the body, and their revolt is dangerous in proportion.
The movement of the process is usually somewhat upon this order: After forty, fifty, or even sixty years of loyal service, the cells lining one of the tubules of a gland--for instance, of the lip, or tongue, or stomach--begin to grow and increase in number. Soon they block up the gland-tube, then begin to push out in the form of finger-or root-like columns of cells into the surrounding tissues.
These columns appear to have the curious power of either turning their natural digestive ferments against the surrounding tissues, or secreting new ferments for the purpose, closely resembling pepsin, and thus literally eating their way into them. So rapidly do these cells continue to breed and grow and spread resistlessly in every direction, that soon the entire gland, and next the neighboring tissues, become packed and swollen, so that a hard lump is formed, the pressure upon the nerve-trunks gives rise to shooting pains, and the first act of the drama is complete.
But these new columns and ma.s.ses, like most other results of such rapid cell-breeding in the body, are literally a mushroom growth. Scarcely are they formed before they begin to break down, with various results. If they lie near a surface, either external or internal, they crumble under the slightest pressure or irritation, and an ulcer is formed, which may either spread slowly over the surface, from the size of a s.h.i.+lling to that of a dinner-plate, or deepen so rapidly as to destroy the entire organ, or perforate a blood-vessel and cause death by hemorrhage. The cancer is breaking down in its centre, while it continues to grow and spread at its edge. Truly a ”magnificent scheme of decay.”
Then comes the last and strangest act of this weird tragedy. In the course of the resistless onward march of these rebel cell-columns some of their skirmishers push through the wall of a lymph-channel, or even, by some rare chance, a vein, and are swept away by the stream. Surely now the regular leucocyte cavalry have them at their mercy, and can cut them down at leisure. We little realize the fiendish resourcefulness of the cancer-cell. One such adrift in the body is like a ferret in a rabbit warren; no other cell can face it for an instant. It simply floats unmolested along the lymph-channels until its progress is arrested in some way, when it promptly settles down wherever it may happen to have landed, begins to multiply and push out columns in every direction, into and at the expense of the surrounding tissues, and behold, a new cancer, or ”secondary nodule,” is born (_metastasis_).
In fact, it is a genuine ”animal spore,” or seed-cell, capable of taking root and reproducing its kind in any favorable soil; and, unfortunately, almost every inch of a cancer patient's body seems to be such. It is merely a question of where the spore-cells happen to drift and lodge.