Cancer and Diet - With facts and observations on related subjects E-Book

Frederick L. Hoffman

• Herausgeber: David De Angelis
• Kategorie: Fachliteratur
• Sprache: Englisch
• Veröffentlichungsjahr: 2017

Beschreibung

When I was reaching the end of my extended study of the cancer data and observations collected in connection with my San Francisco Cancer Survey, my thoughts regarding cancer causation, treatment and prevention became concentrated upon the dietary aspects of the disease to which I had previously given only incidental consideration.
For twenty years or more, the subject of diet has received my attention culminating in a fixed determination to initiate in due course an original study based on extended facts regarding living cancer patients and of course the required number of noncancerous controls. The method first adopted in connection with my San Francisco Cancer Survey, had yielded fairly promising results but I soon reap fized that a more useful study would have to have for its sole objective the ascertainment of the actual dietary experiences of cancer patients collected by special research assistants operating on the basis of definite instructions.

Leseprobe

Cancer and Diet

With facts and observations on related subjects

Frederick L. Hoffman

First digital edition 2017 by David De Angelis

CONTENTS

PUBLISHER'S PREFACE

PREFACE

PART I. DIETARY THEORIES OF CANCER

PART II. THE MODERN DIET - GENERAL PRINCIPLES

PART III. CANCER METABOLISM

PART IV. DIETARY FACTS CONCERNING CANCER PATIENTS

PART V. GENERAL SUMMARY AND CONCLUSIONS

PUBLISHER'S PREFACE

Comparison of the list-prices placed on books of several sorts must, if the comparer is of an inquiring turn of mind, be extremely puzzling. Sometimes a large book bears a price actually less than that charged for a smaller one. In general there seems to be a lack of uniformity between price charged and physical entity.

Indeed the relationship between price and size may be set down as being so diverse that size as a criterion of price is quite valueless. Too many modifying factors enter in to permit a stable relationship. One book has a potential market of 10,000 copies; another of 500. Thus in the one case 10,000 cooperators putatively take part in the enterprise; naturally their contribution may be proportionately less than if only 500 join in. Or again, the cost of composition varies widely: one book may cost more than another to compose, even though it has only half as many pages.

Still other factors, unseen and unguessable, enter in. In the case of this book for instance, a list price of $5.00 is no more than half of the price justified by its cost. This price has been made possible by a generous subvention, made with a view to giving the book as wide a distribution as possible. The book is, in part, a gift to every purchaser.

PREFACE

Early in 1931 when I was reaching the end of my extended study of the cancer data and observations collected in connection with my San Francisco Cancer Survey, my thoughts regarding cancer causation, treatment and prevention became concentrated upon the dietary aspects of the disease to which I had previously given only incidental consideration. I have reference to my remarks on this phase of cancer research as set forth in my Cancer Mortality Throughout the World, 1915, my address on Cancer and Civilization read before the Belgian Cancer Congress, 1923, my address on the Causation of Cancer delivered before the American Association for Cancer Research, Buffalo, 1924, Cancer in Native Races, 1926, Cancer in Mexico, 1927, Cancer and Overnutrition, Health Congress of the Royal Institute of Public Health, Ghent, Belgium, 1927, etc. I therefore included in my Eighth San Francisco Cancer Report such data as I had available at the time under the title Cancer in Relation to Diet and Nutrition which, in extended form, constitutes the second section of this work.

Thus for twenty years or more, the subject of diet has received my attention culminating in a fixed determination to initiate in due course an original study based on extended facts regarding living cancer patients and of course the required number of noncancerous controls. The method first adopted in connection with my San Francisco Cancer Survey, 1924-25, had yielded fairly promising results but I soon reap fized that a more useful study would have to have for its sole objective the ascertainment of the actual dietary experiences of cancer patients collected by special research assistants operating on the basis of definite instructions.

In 1931 the outlook for such a project seemed far from encouraging but during the early part of the winter of that year help came to me from an unexpected source. Mr. Samuel S. Fels of Philadelphia who had requested some of my cancer publications expressed the desire to discuss the situation with me, and later agreed to finance the necessary field operations of such a study as I had in mind. Mr. Fels has for many years taken an intelligent and constructive interest in cencer research, particularly with reference to gastric and intestinal cancers, their diagnosis, treatment, causation and possible prevention. I therefore submitted to him a tentative project for an extended study of the dietary aspects of the cancer problem which, subject to modifications suggested by him, was adopted. I agreed to devote much of my time to the subject during a long contemplated trip to Europe and Northern Africa (1932), and the present work is the result. During this journey I met many of the outstanding authorities on cancer and nutrition in Great Britain and on the Continent with whom I discussed the details of my projected study on the basis of my questionnaire which I had brought with me. My journey, however, was limited to England, Scotland, Holland, Germany, Switzerland, Spain and the French possessions of North Africa where I made a brief study of the dietary customs of the native populations.

On my return I started the work in Philadelphia at several hospitals, gradually extending my field operations to Boston, St. Louis, San Francisco, San Antonio and other parts of Texas. I watched the results carefully, analysing the first thousand eases, then the second, when I felt that the intrinsic consistency of the data justified the assumption that the number of cases was sufficient for a complete analysis in all matters of detail. In the meantime I had read exhaustively many standard works on diet and nutrition, and treatises on biochemistry and physiology to make sure of a sound scientific background for the final consideration of the data collected. I amplified such studies with personal interviews with many authorities and by world wide correspondence on debatable questions. All of those whom I approached on the subject gave me their whole hearted support and many valuable suggestions which increased materially the practical value of the study as it finally developed and as set forth in what follows.

The questionnaire method adopted for the present purpose is the result of much similar experience in other fields of medical statistical research. It falls short of being fully satisfactory in that certain dietary items were accidentally omitted due chiefly to the fact that I adopted for my guidance the dietary statistics as tabulated in the report on Vitamins of the British Ministry of Health. But the omissions are not of serious importance and can easily be allowed for. On the whole the results of the method are so thoroughly consistent that I feel sure they may be accepted with confidence.

Originally I had contemplated only a detailed study of the vitamin aspect of the problem, subsequently enlarged to include nearly all the organic and inorganic compounds of practical importance. In discussing technical or otherwise involved scientific questions I have quoted at length the recognised authorities rather than rely upon my own imperfect methods of interpretation, for I am neither a biochemist nor a food chemist and cannot therefore speak with authority upon these aspects of the many problems and questions under consideration. I have had the great advantage of frequent discussions with Dr. Ellice McDonald, Director of this Laboratory, and many of his technical assistants. Then, too, I was most fortunate in my research assistants who collected the questionnaires from cancer patients and controls in different parts of the country. The work in Philadelphia was done by Mrs. Frances Stark of Ventnor, N. J., and by my daughter, Miss Virginia Hoffman, who also collected questionnaires in Boston and San Francisco. The work in southern Texas was done by Miss Lucille Stuart of San Antonio, while the work in St. Louis was done by Miss Mary Worrall of Kirkwood, Missouri. The control cases in San Francisco were collected by Mrs. Virginia Ring. All the tabulations and calculations of countless rates and ratios were done by Miss Nora Powell, statistician and mathematician employed by this Laboratory. Many other technical questions more or less beyond my full understanding I have discussed with Dr. Stanley Reimann of the Lankenau Hospital, Philadelphia. Thus I have tried to guard myself against personal bias quite common in work of this kind Finally, I am under sincere obligations to my secretary, Miss Agnes Lennon, who has prepared the manuscript for the printer and aided me in countless ways in the handling of the large amount of data and observations, as well as in the preparation of the index.

It had been my intention, had space limitations permitted, to have enlarged upon the historical development of modern dietary practices or eating customs, but this I have had to omit since to do the subject justice would have materially extended the size of the book already grown to almost forbidding proportions. But I cannot omit a very brief reference to the dietary and gastronomical observations in Burton's Anatomy of Melancholy, first published in 1621. Burton, in discussing customs of diet, refers briefly to the immense range in dietary practices among the various peoples of the old and new world, observing with regard to America that:

In America in many places their bread is roots, their meat palmitos, pines, potatoes, etc., and such fruits. There be of them too that familiarly drink salt sea-water all their lives, eat raw meat, grass, and that with delight. With some, fish, serpents, spiders; and in divers places they eat man's flesh raw and roasted, even the Emperor Metazuma himself. In some coasts, again, one tree yields them coco-nuts, meat and drink, fire, fuel, apparel with his leaves, oil, vinegar, cover for houses, etc., and yet these men, going naked, feeding coarse, live commonly an hundred years, are seldom or never sick; all which diet our physician forbid.

Thus finding fault with dietary habits is not new and the same conclusion applies to food modifications or departures from the natural form of food consumption. To those who wish to pursue the changes in dietary practices, I cannot too strongly recommend the reading of this volume of exceedingly interesting observations.

It had also been my intention to have brought into the discussion the extremely interesting observations on diet among the English labouring classes at the end of the eighteenth century, contained in a magnificent treatise in three volumes on The State of the Poor, by Sir Frederic Morton Eden, London, 1797. This work is one of the greatest of British economic classics and the first in which the subject of diet receives statistical and practical consideration. The book, unfortunately, does not lend itself to convenient abbreviation and must be consulted in the original for a vast amount of useful observations.

It includes for example, extended remarks on potatoes as a staple article of food, including a quotation from the Report of the Board of Agriculture "that potatoes and water alone, with common salt, can nourish men completely." There are extended observations on the different varieties of bread eaten at the time, including barley bread eaten in Gloucester, oat bread eaten in Scotland and the northern part of England, particularly in Yorkshire, sago bread used in the East Indies, and corn bread used in America. This is followed by extended observations on the dietaries of American Negroes during the slave period, concerning which it is said: "That men may live, and be strong to labour, with little or no animal food, is evinced by the field negroes in the Middle states of North America, who are an healthy and hardy race of people; and whose labour is constant, and sometimes severe,

although they are fed almost entirely on vegetables."

The foregoing remarks are amplified by experiments and observations

on flour and bread delivered by Dr. Irving to a Committee of the House of Commons. Finally there are observations on drinking habits, particularly beer, ale, stout and porter, disproportionate to the general family budget. I quote the following quaint statement: "there is hardly a labouring man, of any account whatever, who does not think it necessary to indulge himself, every day, in a certain quantity of malt liquor; and if taxed, at any time, with drinking too much, he thinks it a sufficient, and by no means an unbecoming, apology for himself, to allege, that, excepting on a Saturday evening, or occasions of festivity, he rarely allows himself more than a pint, or, at most, a pot of beer a day."

I would also liked to have discussed critically an important work entitled Good Cheer, by Frederick W. Hackwood, London, 1911. This is a treatise on the romance of food and feasting, in marked contrast to the work of Eden, having reference to the eating habits of the rich and prosperous. He discusses the food impulse, the vice of gluttony, discovery of salt, progress of culinary art, antediluvian vegetarianism, the foods and culinary practices of the ancients, a Roman banquet, early Rnglish fare, monastic culinary influences, dietary changes, home grown food, the roast beef of Old England, bread, the staff of life, the cook and his art, national foods and national prejudices, influence of diet on national character, curiosities of diet, vegetarianism, cannibalism, diet and health, food adulteration, etc.

I may mention in this connection that early in 1934 I presented jointly with the Prudential Insurance Company, my entire library of cancer books and data to what was then the Cancer Research Laboratory, Graduate School of Medicine, University of Pennsylvania, now the Biochemical Research Foundation of the Franklin Institute. All the references cited in this work are in my own library, with the exception of a few works loaned to me by the Army Medical Library, Washington, D. C.

Throughout the investigation which actually commenced in March, 1933, when the first questionnaires were collected, Mr. Fels has maintained an active interest in the project and many special questions were fully discussed with him. I also had an interview with Professor Sherman who made several important suggestions, while I was in correspondence with Professor Sure of the University of Arkansas, Professor Mendel of Yale University, Professor Benedict of the Carnegie Laboratory of Nutrition who sent me many valuable reprints, and Miss Hawley of the Department of Agriculture who favored me with many useful suggestions. The Department of Commerce placed me under obligation for much new data on per capita food consumption, while agricultural experimental stations throughout the country favored me with highly important bulletins. To all of these and many others I wish to express my profound gratitude with the assurance that but for their aid and assistance this work could never have emerged out of the vague conception of an idealistic undertaking.

The present work is divided into four distinct parts. The first reviews the historical development of dietary conceptions as a therapeutic factor in cancer, covering the entire literature available to me since 1777 down to 1935. I fully realise its inadequacy but feel that on the whole the subject matter presented is sufficient for the purpose. The second part outlines the dietary changes during recent years and makes certain international comparisons to emphasise racial or national differences in dietary habits and food consumption. The third section reviews the observations, experiments and conclusions, mostly on small animals of the rodent type, as to tumor effects in altering the normal metabolism in traceable directions. I have drawn freely in this section upon the literature of biochemistry and food chemistry, as well as upon the cancer periodicals, particularly the American Journal of Cancer, the British Cancer Review, and the German Journal for Cancer Research.*

The first three sections are entirely independent of the fourth which is concerned with the facts regarding cancer patients and non-cancerous controls collected under my direction in selected population centers of this country, giving what I believe is a reasonably satisfactory cross-section of the nation. This section is divided into two parts, the first of which is concerned with the more general facts of a social, clinical or medical nature otherwise, while the second part is limited to dietary factors as such.

By adopting this arrangement I feel I have escaped the risk of being unduly influenced by my own previous conclusions since each of the first three sections was completed and in final form before the main part of my work, having to do with actual dietary and nutritional facts, was written. The statistical method adopted may be found fault with but I could conceive of no other method of presenting essential facts for critical consideration. In emphasising excessive nutrition, I have been guided by the evidence which fully supports the important and chief conclusion that cancer is an excess nutritional disease and not, as is sometimes asserted, the result of dietary deficiencies. The degree of excess, in a general way, may not be very pronounced, but sufficient, I feel, to justify the conclusion advanced in the present study.

I have avoided the use of mathematics as entirely uncalled for and most likely to prove seriously confusing to the nonmathematical mind. I prefer strict conformity to the statistical law of large numbers to the speculative results of the law of probability. Of course, in many instances of minor detail, the number of cases considered is too small but this has been absolutely unavoidable, for if I had continued the col lection of cases until I had say five thousand, another year or more would have been necessary to complete the field operations.

Zeiteebrift ftir Krebeforschung, Berlin, Germany.

In my interpretation I have tried to conform to the wholly admirable philosophical observations contained in the first volume of the outstanding work on Inorganic and Theoretical Chemistry by J. W. Mellor, London, 1927, from which I quote the following illuminating remarks.

Untutored minds are very prone to mistake inferences for observations, and prepossessions for facts; their observations and their judgments are alike vitiated by dogma and prejudice; they do not seek to investigate, they seek to prove. The old proverb is inverted, believing is seeing. The student of science must pledge himself to do his best to eliminate prepossession and dogma from his judgments, and he must spare no pains to acquire the habit of recording phenomena as they are observed; and to distinguish sharply between what is or has been actually seen, and what is mentally supplied. It requires a mind disciplined like a soldier to avoid the natural inclination to look away from unwelcome facts.

Whether my work deserves to be considered a contribution to the ascertainment of the true cause or causes of cancer, more competent minds than mine must determine. I have presented the evidence as I have found it, without undue enlargement and explanation, to make the matter more intelligible. As regards myself, I am fully convinced that profound dietary influences in cancer are to be looked upon as a causative factor if the constitutional or systemic theory of the disease is to be accepted. Here again I touch upon a debatable question with the utmost reluctance. I certainly do not wish to add to the prevailing confusion concerning the causative factors in cancer which, at times, makes the search for the full truth of the situation an almost hopeless task.

FREDERICK L. HOFFMAN.

Biochemical Research Foundation of the Franklin Institute, 13.1 South 36th Street, Philadelphia, Pa.