3. Remote Origins Of The Frontier Search For Cancer

So far, this story has been told from memory, from diaries kept in the field, from other documents, and from the cogitation of fifty-four years. I have told of northern Indians, chiefly Athapaskans and Eskimos, and of Europeans who dealt with them.

I have steadily wanted to retain, as my two heroes, the Church of England missionary Bishop William Reeve and the New England whaling captain George Leavitt. And I have wanted the Canadian story to begin in 1869, when Reeve got to his post at Fort Simpson on the middle Mackenzie, and the Alaskan story in 1884 when Leavitt reached the coal mine on the western north coast at Cape Lisburne.

I have not, however, been able to dismiss my curiosity over the detail that in Leavitt’s case the idea of looking for cancer among the Eskimos had come from his half-brother, who was a doctor and who disclaimed being an originator, saying instead that he knew from medical journals the eagerness of the profession for information from travelers on whether malignant disease did or did not exist among primitive peoples. I found myself hankering more and more to find out who in the medical journals which Dr. Knight had a chance to read was the originator of the idea that cancer is a disease of civilization. I think I have found out:

As an anthropologist who dabbles in nutrition, I have acquired a lot of friends who are doctors, some of them cancer specialists. I asked one of these to recommend some book as a good world survey of theories and facts related to cancer. I learned that probably the best even now available was published in 1915 at Newark, New Jersey, by the Prudential Insurance Company of America. This I secured and found it to be an 846-page compendium, The Mortality from Cancer Throughout the World, by Frederick L. Hoffman, chairman of the committee on statistics of the American Society for the Control of Cancer. On page 23 I discovered a promising clue, a reference to “M. Tanchou's idea that mortality from cancer is in direct ratio to the intensity of human civilization ...”

“M. Tanchou's idea” was clearly Bishop Reeve's idea, and Leavitt's. Then who was Tanchou? First I looked in the index of the Hoffman book and found “Tanchou, cancer theory of, 23.” This, of course, merely referred to the passage I had been reading. Next I looked in Hoffman's more recent and equally huge book, Cancer and Diet (Baltimore, 1937), since the inference seemed to be that Tanchou believed in a nutritional cause for malignant disease; but I drew a blank in its index and in its bibliography as well. Then I consulted several of the standard encyclopedias but found nothing.

Baker Library of Dartmouth College, where I do my writing, is good at ferreting out difficult sources. I just passed a note along and waited. But the wait lengthened, and finally came the bothered complaint: We cannot seem to get started. What nationality was this man? Presumably French, for that is the usual inference when you use “M.” instead of “Mr.” However, our medical library was going ahead and might turn up something.

With a habit of sponging on my friends, I thought of one who was Sterling Professor of the History of Medicine at Yale and wrote to Dr. John B. Fulton. My letter found him on vacation; but I heard from Miss Madeline Stanton, Librarian of Historical Collections. On June 2, 1957, Miss Stanton wrote concerning three queries of mine that Professor Fulton had referred to her by letter. After disposing of the first and second, she went on: “(3) Stanislas Tanchou, about whom I judge you are particularly concerned, gave me the most trouble — in part because I did not go about my research very intelligently! The first gentleman of that name whom I found was born in 1791 and died in 1850; and as he seemed to be concerned about cutting for the stone, I feared he was not your man. Finally, in the second volume of the first series of the Catalogue of the Surgeon General's Office (p. 674) I came upon your man and found the two following items:

“Recherches sur la fréquence du cancer. Gaz. d. hop. Par., 1843, 2. s.v., 313.

“Sur la fréquence croissante des cancers. Compt. rend. Acad. Sci. Par., 1844, 18, 878.

“I am sorry to say the library does not have either one of the journals quoted ...”

The Tanchou who was dismissed by Miss Stanton for having been born in 1791 turned out to be the right man, and he was also the Tanchou of the other two references. Our Tanchou, as I was to learn, was old enough in 1815 to serve with Napoleon during the Waterloo campaign.

In the hands of the Dartmouth research staff, Miss Stanton's information proved fruitful. In three months we had secured both her references, and much more; but as yet we had not found what we supposed to be Tanchou's most important works — which seemed to be in manuscript.

Meantime, with both Yale and Dartmouth having trouble, I decided to try more sponging on friends, this time turning to France. I wrote to Dr. Alexander Berglas, member of the Cancer Research Foundation of the Pasteur Institute, whose book Cancer has been one of my most valuable sources. Like Fulton, Berglas proved not to be at home when my letter reached his address; but his research associate, Mrs. Edith Herschel, spoke with him by long-distance telephone and wrote me on May 29, 1958:

“Regarding the works of Stanislas Tanchou, who is unknown to us, we have as yet not been able to obtain any information.”

When this letter reached me, I thought of Miss Stanton's remark that she had difficulty locating Tanchou because she had started wrong. Had I got off to a wrong start too — perhaps in searching for Tanchou direct, and not through his sponsor in the United States, whose name was given in our references as “Dr. John Le Conte”? I had assumed Le Conte to be a less prominent figure than Tanchou, his principal. Appropriately it now struck me that Huxley was far from obscure when he sponsored Darwin. So I took down from its shelf the “L-Mac” volume of the Dictionary of American Biography. And there I found three Le Contes. No wonder the Le Conte name had sounded familiar — all three were among the foremost scientists of their generation! One of them, the required John, had been president of the University of California. When he died, the memorial published by the National Academy of Sciences of the United States said of him, “More than any other man he was the father of the university.”

The reading of the Le Conte biographies — those of John, John Lawrence, and Joseph — bore doubly intriguing witness in relation first to Tanchou and then to the Leavitt cancer search. For Tanchou and his views were French; the Le Contes were Americans of French descent; and John, a doctor of medicine, thus a superfit sponsor to a controversial French doctor such as I was beginning to suspect Tanchou of having been. Second, and in a way more intriguing — Tanchou's sponsor wrote for medical journals, such as my Dr. Knight could well have read; and he was one of the most popular and distinguished figures of Captain Leavitt's home port, San Francisco!

No wonder, in the light of this, Leavitt found, as he told me, that San Francisco doctors were particularly searching questioners when they learned that the Eskimos — in Siberia, Alaska, and Canada — were in his opinion literally without cancer, thus appearing to confirm what were the well-known, if controversial, views of California's leading scientist-citizen.

As to Le Conte's special qualifications for the role of Tanchou's Huxley:

John Le Conte (1818-91) received his degree in medicine in 1841 from the College of Physicians and Surgeons in New York and was preparing himself for graduate medical study in France when circumstances changed his plans and he took up instead a general practice in his native Georgia. There he read, in French and British medical journals, summaries of a memoir on cancer which had been submitted by Stanislas Tanchou in 1843 to the Academy of Sciences in Paris. No doubt Le Conte's interest and approval were strengthened through his discovery that the Parisian scientist had independently reached conclusions in regard to malignant disease that were similar to those Le Conte had himself published eight months ahead of Tanchou, in a “Monograph on Cancer” which he read before the Society of Alumni of the College of Physicians and Surgeons of the State of New York on October 18, 1842.

Now from his Savannah address where he was a beginner in the practice of medicine, Le Conte sent to the Southern Medical and Surgical Journal of Augusta, Georgia, to be printed in its issue for May 1846, the paper that introduced the views of Tanchou to the United States: “Statistical Researches on Cancer.” Among the points of agreement between the unpublished Tanchou memoir of 1843 and a published Le Conte paper of 1842, were that (1) cancer, while found in children, is pre-eminently a disease of middle and old age; and that (2) its incidence is greater in cities than in rural districts.

The Tanchou pronouncement, which Le Conte seemingly expected would be startlingly novel to his readers, and in which Le Conte does not claim to have himself preceded Tanchou, is broached first on pages 273-74:

“M. Tanchou is of opinion that cancer, like insanity, increases in a direct ratio to the civilization of the country and of the people. And it is certainly a remarkable circumstance, doubtless in no small degree flattering to the vanity of the French savant, that the average mortality from cancer at Paris during 11 years is about 0.80 per 1,000 living annually while it is only 0.20 per 1,000 in London!!! Estimating the intensity of civilization by these data, it clearly follows that Paris is 4 times more civilized than London!!

“Seriously, however, the greater frequency of carcinoma in France, as compared with England, is a very curious fact.” Le Conte discusses whether differences in registration methods can account for this difference in figures and concludes that there could be some difference; but he decides that “it is totally inadequate to account for the remarkable disparity in the mortality from this cause (cancer) in the two countries.”

Here Le Conte introduces a table, apparently copied from Tanchou, comparing cancer deaths in England and Wales with the French, and concludes that “after making due allowance for the difference in the systems of registration, the mortality from cancer in the department of the Seine is nearly quadruple what it is in England and Wales. Hence it is clear that the general preponderance of the disease on the continent cannot be reasonably ascribed to any diversity in the classification of kindred diseases.”

On page 275 Le Conte asks, “How will we account for the supposed fact that carcinomatous affections are on the increase? To some extent, the augmentation may be only apparent ...” This he considers, and his verdict is that “if this is the true cause of the increase in frequency, it must indeed be co-extensive with the progressive advancement of civilization, unless some countering influences are brought to bear ...”

Apart from his clear way of writing, Le Conte's 1846 support of the Tanchou Doctrine cannot have been material; for he was then but a recent medical graduate practicing in a small town and writing for one of the smaller medical journals. But his adherence was to prove staunch and was to continue active through a long career in which he rose in popularity and in scientific prestige. Though his general interest shifted from medicine through physiology and chemistry to physics, and eventually to organizing and running a university, he continued gathering and publishing cancer statistics and reiterating the Tanchou idea that “native” people have little or no malignant disease but that they succumb to it when they become Europeanized.

After holding professorships at various colleges in the South and East, including the chair of chemistry at the College of Physicians and Surgeons in New York, Le Conte found himself by 1869 in the far West as professor of physics and also the first (acting) president of the University of California.

San Francisco had been, since the days of ’49, the U.S. gateway to the North Pacific. In 1867, two years before Le Conte's arrival, it had become in a special way the portal to that Russian America which was changed by purchase into Alaska. Thus San Francisco was also the home port for the two northwestern activities that concern us most, those of the Alaska missionaries and of the Alaskan and northwest Canadian whaler traders, from which two groups is derived much of the information used in this book that bears on the Tanchou-Le Conte view of cancer’s relation to the Europeanization of native populations.

After having been acting president of the University of California through its first year, Le Conte reverted to a mere professorship, and to writing (and perhaps lecturing?) upon the incidence of cancer. In his third San Francisco year he published, through the local Western Lancet, for March 1872, an article in which he again put forward “Tanchouism,” this time in connection with an appeal for more frontier information bearing upon the doctrine. This article is “Vital Statistics: Illustrated by the Laws of Mortality from Cancer.”

Presumably this second article, published in between Le Conte's two presidencies of the university, was the one which — directly or through notice in other medical journals — reached Dr. Knight and thus may have initiated the Leavitt frontier search for malignant disease.

Apart from that problematic special effectiveness, still more effective in supporting Tanchouism was no doubt Le Conte's further return to the charge, in 1888. By then he had been re-elected president of the University of California; and now his medium of publication was the Tenth Biennial Report of the California State Board of Health (Sacramento). On page 181 of the report, President Le Conte uses almost the same words he had used forty-two years before as a young doctor in Georgia: “It is the opinion of M. Tanchou that cancer, like insanity, increases in a direct ratio to the civilization of the country and of the people ...”

On page 182 of the Board of Health report there is a mixture of the old wording and a new, and there are new statistics: “Perhaps the habit of making necroscopic examinations may be more common in the French metropolis than it is in England, and thus a greater number of internal cancers may be detected and registered. But it is hardly reasonable to suppose that the disparity growing out of this circumstance would amount to the enormous proportion of 4 to 1.

“In view of M. Tanchou's idea, that the mortality from cancer is in direct ratio to the intensity of human civilization, it may be to some extent consolatory to the inhabitants of England to discover that their recent mortuary records, from 1860 to 1867, indicate a very remarkable increase in the death rate from this disease.”

An indication of the wide and respected circulation of the Tanchou idea, through Le Conte, is found in the fact that Prudential Insurance Company of America issued in 1915 its aforementioned The Mortality from Cancer Throughout the World, and that this book, though it quotes all sides, is sympathetic to what I think of as the frontier doctor position on malignant disease. As for Le Conte on Tanchou, Hoffman mentions all three of Le Conte's main publications — those of 1846, 1872, and 1885; but he uses chiefly the wording of the last.

I do not remember Captain Leavitt's ever mentioning Tanchou or Le Conte in telling me what his doctor brother had said of the medical profession's division over whether “natives” are free from malignant disease or not. But his presentation, as I remember it, was so much in the Le Conte spirit that I feel inclined to believe, as I say, that Dr. Knight got from the Western Lancet article of 1872, or from its equivalent, the arguments which he used with Leavitt in 1885 to urge upon him a search for cancer among the Eskimos. In any case, paraphrases of the Tanchou doctrine, and of the Le Conte presentation of it, are frequent in the medical literature of the frontier. This I shall now proceed to indicate by quotation.

Summarizing under “Cancer among Primitive Races” such reports from the frontier as were available to him up to 1914, Hoffman says on pages 146-47: “The rarity of cancer among native races suggests that the disease is primarily induced by the conditions and methods of living which typify our modern civilization ...

“... a large number of medical missionaries, and other trained medical observers, living for years among native races throughout the world, would long ago have provided a more substantial basis of fact regarding the frequency of occurrence of malignant disease among the so-called uncivilized races, if cancer were met with among them to anything like the degree common to practically all civilized countries.

“Quite to the contrary, the negative evidence is convincing that, in the opinion of qualified medical observers, cancer is exceptionally rare among the primitive peoples, including the North American Indians and the Eskimo population of Labrador and Alaska.”

Hoffman's Cancer and Diet has a section on “Dietary Theories of Cancer.” From his sketches of these theories I have selected a number which bear, to my mind the impress of Tanchou, directly or through an intermediary such as Le Conte. The page references below, are from the Williams and Wilkins (Baltimore) edition of 1937:

Page 18: “... in 1865 there was published in London interesting volume on The Antecedents of Cancer by Charles H. Moore ... In brief, he connects the progress of civilization with the increase of cancer, which has remained an incontestable theory to the present day.”

Page 25: “In 1882, Dr. W. Mitchell Banks ... published in Edinburgh an important paper ... [which includes] ‘Cancer is on the increase in this country. Is it possible that this is coincident with our full habit of living, as a people?’”

Page 28: “In1896 D. A. Babagliati ... published in London a small treatise on Air, Food and Exercise ... [He was] the first to establish the dietary origin of cancer, and his various books gave abundant evidence in support of his contentions.”

Page 40: Hoffman quotes from Dr. Charles Powell's The Pathology of Cancer (Manchester, 1908): “There can be little doubt that the various influences grouped under the title of civilization play a part in producing a tendency to Cancer.”

Pages 46-47: “In 1914 there was published in New York by Dr. William Seaman Bainbridge, surgeon at the New York Skin and Cancer Hospital, an outstanding contribution of The Cancer Problem [in which Dr. Bainbridge, says] ‘... (man) in his primeval condition ... has been thought to be very little subject to new growths, particularly to those of malignant character. With changed environment, it is claimed by some, there came an increase in susceptibility to cancerous disease, this susceptibility becoming more marked as civilization develops; in other words, as environment changes.’

“With particular reference to the nutritional theory, Bainbridge observes that ‘It is held by some that cancer and cancer-like growths, whether in plants, animals or man, are due to changes in nutrition which cause altered growth and impaired development, the fundamental physiological and pathological processes being the same in plants and animals ... The influence upon cancer incidence of climate, soil, diet and habits of life, has not been proved. In other words, it has not been established that any of these factors are potent to absolutely prevent the occurrence of cancer.’”

Pages 49 ff.: Here are numerous quotations from Dr. L. Duncan Bulkley, senior surgeon at the New York Skin and Cancer Hospital. One quotation may be in its phrasing an echo of Theodore Roosevelt's campaign for the Simple Life. Says Bulkley: “‘The simple life, with the avoidance of the dietetic and other causes which have been found to induce cancer in nations and individuals, promises the best hope for the arrest of the rapidly increasing development of cancer throughout the world.’”

But the Theodore Roosevelt slogans invoking the Strenuous Life, the Simple Life, Plain Living and High Thinking, were replaced by slogans extolling the Full Dinner Pail, Two Chickens in Every Pot, the High Standard of Living. And, perhaps as a mere coincidence, the malignancy rates maintained their steady rise.

Page 59: Hoffman quotes J. Ellis Barker's 1924 book, Cancer: How It Is Caused, How It Can Be Prevented, to the effect that the rates of cancer death and of sugar consumption were going up together.

Page 66: Here Hoffman quotes a paraphrase of his own 1923 lecture. This includes a statement to the effect that “cancer is extremely common among all civilized peoples and ... the rate is increasing practically everywhere. And he pertinently asks what are the conditions peculiar to civilized peoples, and absent from primitive races, which are associated with its prevalence and increase in the former, and its almost entire absence or relative infrequency in the latter?”

Page 67: “In 1926 Dr. Morley Roberts published in London a treatise on Malignancy and Evolution [this includes] ‘... I take the view commonly held that, whatever its origin, cancer is very largely a disease of civilization ...’”

On the same page Hoffman quotes himself as having published among others, these conclusions: “Cancer is unquestionably very rare in native races not in contact with the customs and habits of civilized populations ...” On page 666, summarizing the preceding pages of Cancer and Diet, Hoffman says that “far reaching changes are called for in the normal dietary habits of the American population as a means of preventing the increasing loss of life due to cancer ...”

When we turn from Hoffman to other sources, especially if these are dated after 1926, we find a chorus of approval for the new animal experimentation. The trend of these favorable opinions is well known, because they triumphed. But there were a few dissident cries, less noticed because they were on the losing side; they are the more in need of repetition now. I shall pick up and use a few.

In October 1926, the frequently dissident New York journal Cancer published an article from London by Dr. Stanton Hooker, “Eclecticism in Cancer Therapy.” This, in effect, was favorable to the nineteenth-century, or medical-missionary, approach and deplored concentration upon producing cancer in beasts artificially and then watching them sicken and die — all with the hope, of course, of finding out how to stop the trouble the experimenters themselves had started, they talking optimistically meanwhile. Said Dr. Hooker:

“There is, as a matter of fact, a growing group of independent thinkers — both lay and professional — who are anything but impressed with the story of the discovery and isolation of the ‘cancer germ’ ... Mr. Ellis Barker has also written reiterating his views in common with those of Sir Arbuthnot Lane, my own, and many others, that cancer is a disease of civilization, caused by wrong eating, drinking, and other factors ...”

Hooker quotes Sir Arbuthnot Lane: “‘Possibly some cancer research institution may find a cure for cancer, but the chance of their doing so is infinitely small.’” Implying that we already know that cancer is prevented or retarded by certain diets, promoted by others, Hooker says, “The medical slogan of the near future will be: ‘Prevention is better than cure ...’” Hooker paraphrases Dr. Hastings Gilford: “His general statement is that civilization is the cause of cancer.”

In the July 1927 issue of Cancer is an article by Dr. William Howard Hay of Buffalo, N.Y., “Cancer a Disease of Either Election or Ignorance.” The trend is the same as that of Hooker's article, favoring the nineteenth-century approach to the cancer problem and with a strengthened attack upon the twentieth-century version:

“Think back over the years of cancer research, of the millions spent, the time consumed, the pains expended ... and where are we today? Is it not time to take stock of our basic conception, to see if there is not something radically wrong with this to account for the years of utter and complete failure to date? ... Cancer has been consistently on the increase ... since the advent of the Society for the Control of Cancer; with the millions of endowed effort, this increase has been accelerated ...

“A study of the distribution of cancer, among the races of the entire earth, shows a cancer ratio in about the proportion to which civilized living predominates; so evidently something inherent in the habits of civilization is responsible for the difference of cancer incidence as compared with the uncivilized races and tribes. Climate has nothing to do with this difference, as witness the fact that tribes living naturally will show a complete absence of cancer till mixture with more civilized man corrupts the naturalness of habit; and just as these habits conform to those civilizations, even so does cancer begin to show its head ...

“Is it possible the cause of cancer is our departure from natural foods? It would surely look so to any man from Mars; but we have so long lived on processed foods ... that we are in a state of unbalanced nutrition from birth ... we have come to regard these foods as the hallmark of civilization, when it is a fact that these very foods set the stage for every sort of ill, including cancer ...”

Up to this point we have been dealing with Tanchou’s theories as they have been echoed in the United States and Britain, which echoing we think may have been started by the 1846, announcement of the “Tanchou Law,” which is, in Dr. John Le Conte's wording, “The mortality from cancer increases in a direct ratio to the civilization of the country and the people.”

Now let us turn to a similar Old World review of Tanchou's ideas, beginning with France.

Chapter 4 >>