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Preventive Measures.—Having reviewed the various conditions that predispose to malignant
growth formation, we are now in a position to consider what methods may be adopted to avoid the
onset of the disease. It will be clear that the effective prevention of the disease depends upon the cooperation
of the patient and the doctor, both of whom must be instructed in their own part. Here we
are at once met by the difficulty that the patient cannot be expected to recognise in himself all the
various conditions that call for prophylactic measures, many of these Conditions being difficult or even
impossible of detection by the trained observer. Consequently in practice a method must be adopted
whereby the patient is brought at frequent intervals under the observation of the doctor. The only
method by which this could be accomplished would be for everyone to submit themselves to periodic
systematic examinations by a doctor, who would then be in a position to recommend such treatment
as might be indicated for any possible predisposing condition found by him. Certain large insurance
companies in the United States have made an annual medical inspection one of the conditions on which
their life policies are granted. I am afraid, however, that at present the British public, as a whole,
are far from being educated to the point of accepting such a suggestion. We should not for this reason
be deterred from making this our aim and taking every opportunity of pointing out the advantages
of such a scheme. After all a considerable portion of the public have by now realised the importance
of submitting to a yearly or even half-yearly dental examination as a prophylactic measure. In the
meanwhile much may be done by the physician keeping the possibility of Cancer pre-disposition
constantly in his mind, whatever may be the complaint for which he has been consulted. In this
connection the importance of the very careful supervision of labour and the injuries that may occur
during this process can hardly be over emphasised. At the same time the public should be informed
of the possible danger of such conditions as jagged teeth or ill-fitting plates, sore lips or tongue from
smoking, chronic constipation, etc.
As I have indicated in discussing the cause of Cancer, various special precautions must be taken
by those pursuing certain occupations, such as chimney sweeping, mule-spinning, tar, aniline or
paraffin working, etc.
6. Diagnosis.—We must recognise at the outset that the certain diagnosis of Cancer, at any
rate in its operable stage, is often impossible, yet as will be shewn when discussing treatment, early
diagnosis is of the very greatest importance. It is clear, therefore, that in the interests of the patient
the medical adviser should err on the side of safety. For as Rodman says in writing of Cancer
of the breast, " it is better to take away a breast unnecessarily than that the patient should die a
hopeless death."
Now early diagnosis implies not only the diagnosis of actual Cancer, but even more important,
the diagnosis of predisposing conditions. This, as pointed out above, depends upon the co-operation
of doctor and patient. It is not sufficient for this purpose that the public should be instructed in the
danger signals of this disease, they must also be advised and encouraged, if uneasy as to their condition,
to consult a properly qualified medical practitioner. The danger to the Cancer patient from
charlatans was forcibly expressed by Sir Charles Bell in 1823, who wrote, " By much the larger portion
of patients received into the Cancer Ward of the Middlesex Hospital have spent their last penny, and,
what is worse, they have lost that precious time in which they might have been cured in attendance
on a set of the most unfeeling wretches that ever disgraced a country."
Now there is one dread character of Cancer which militates more than anything else against
early diagnosis on which so much depends. This character is its almost constant painlessness in its
early stages, and sometimes throughout its course. This most insidious danger is responsible for the
death of a very large proportion of those patients who seek medical advice too late to be cured. The
painlessness of Cancer is one of the facts about this disease which should be brought to the attention
of the public, who should be urged to seek medical advice for any of the following conditions
(i.) A lump in the breast or an abnormal and persistent swelling anywhere in the body.
(ii.) An ulcerated condition of the lip, tongue, cheek, gums or skin which persists for more than
a few days.
(iii.) A mole or wart shewing a tendency to grow.
(iv.) Blood or mucus passed in the stools.
(v.) A bloody or offensive discharge at other times than the normal monthly periods, especially
at or after the change of life.
(vi.) Persistent hoarseness.
(vii.) Chronic indigestion or constipation with loss of weight and general weakness.
Such conditions call for treatment in any case, and only after careful and skilled examination
can decide whether they are actually associated with Cancer or are only liable to become cancerous.
7. Treatment.
(i.) Surgical.—In studying the literature of Cancer one is met everywhere by the complaint
of the surgeons that patients come to them too late for effective treatment, and one cannot help being
surprised at the number of cases in which the patients were relatives of doctors, and yet appeared
in an almost inoperable condition. This frequent delay in seeking medical advice is partly to be
accounted for by the failure of patients to realise the seriousness of a painless condition, partly by
their fear that the condition may be Cancer and that an operation will be necessary. In the case
of a disease with such an insidious mode of growth and with such indefinite limits in the tissues, no
surgeon would feel justified in guaranteeing a permanent cure from operation, however early, but the
extremely hopeful results of early operation in most forms of Cancer are not sufficiently riealised by
the general public.