Cancer: disease of civilization?: An anthropological and historical study

Following up Back, let us turn to his colleague Richard King's Narrative of a Journey to the Shores of the Arctic Ocean in 1833-35 ... (2 vols., London, 1836). We fail to learn anything pertinent about cancer on Lake Superior; but the expected Lake Athabaska reference turns up on page 108 of the first volume:

“... I proceeded (from Fort Chipewyan) to the woods with my gun and vasculum in search of specimens of botany and natural history; in which employment, and in administering relief to the sick people at the fort, my time was entirely engaged. Amongst those who daily came for medical advice was a half-breed woman with her upper lip in a highly cancerous state. It was a case wherein a surgical operation was absolutely necessary, to which the poor woman readily submitted. She bore it with much fortitude, fully justifying the character imputed to these people.”

During the early summer of 1833, the future Admiral Sir George Back, after whom Back's River in arctic Canada has since been named, was on his way from Britain to discover it. With his later equally famous surgeon-naturalist companion, Dr. Richard King, Back traversed the St. Lawrence River and followed the north shore of Lake Superior westward before crossing northwest to the Mackenzie system at Fort Chipewyan, both doctor and captain interested in what they could learn about disease. Most pertinent to our study of frontier beliefs related to cancer, is an extract which begins on page 187 of Back's Narrative of the Arctic Land Expedition (London, 1836):

“While at Chipewyan, Mr. King had performed a successful operation on a woman's upper lip, which was in a shocking state from cancer, brought on, as he thought, from the inveterate habit of smoking, so common among the half-breeds. He had met with two or three cases of it before; one, at Fort William, was incurable, and very loathsome. His presence was hailed with delight at every post beyond Jack River, either by the natives or those who resided with them; and it surprised me to learn how much disease has spread through this part of the country.”

Back's saying that it surprised him “to learn how much disease had spread through this part of the country” is, of course, confirmatory of the general belief of the time, that in their native state the Indians of northern Canada were healthy; and that most sicknesses which he found among them were of European introduction.

Professor John LeConte (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 ...”

Report of Dr. Philip R. White on his Tanchou Inquiry

On February 13, 1959, Carol and Phil White wrote from Paris. Phil's part of the letter said:

“Yesterday I sent you a packet of papers on the Tanchou affair. Today ... Carol urged me to write a little squib of a different sort [for possible use in a magazine]. I have written one; but clearly it should have your approval, if forthcoming, before being submitted.” It received my approval and I present it here:

“There is probably no more august body of savants in the world than that created by Descartes and Pascal, sanctified by Richelieu and the Roi Soleil, abolished by the French Revolution, rejuvenated by Napoleon; the Académie Française and its associated academies which make up the Institut de France: ‘The Immortals.’ Under the dark dome of the institute, on the Left Bank of the Seine, in the old Palace of the Four Nations, these men meet to ponder the problems of the world ...

“A year ago one of the youngest old men I know, Vilhjalmur Stefansson, arctic explorer, authority on Eskimo life, teetotal carnivore at eighty (he eats only [fat] meat), still exploring new trails, set me on one which has led me a merry chase. The Eskimos seem not to have had cancer under their primitive way of life. Neither do certain South American Indians, so the tale goes. Nor do the natives of Central Africa.

“A century ago a French doctor, Stanislas Tanchou, who had served with Napoleon in Russia and at Waterloo, retired to Paris and private practice after the wars. At the end of a lifetime of experience and study of the statistical distribution of cancer, by peoples, by profession, by sex, age, and habits, Tanchou propounded the theory that cancer was a disease of civilization. Coming to the attention of Californians ... the idea impressed itself upon the minds of doctors and sea captains in the Alaska trade so that the early observations on the Eskimos were more than casual notations; these men were looking for cancer. That they did not find it gives their data added weight.

“But this information in the hands of Arctic ship surgeons was second or third hand. Just what had Tanchou himself said, and what was the basis for his conclusions? My friend Stef wanted to know. And the Surgeon-General's lists, the Archives of the Library of Congress, were rather reticent. A few brief notes but nothing like the extensive papers which the British and American medical journals of the 1840's had ‘reviewed.’ Where were the originals? Perhaps somewhere in Paris, where one can find anything if one looks long enough. I was going for some months to Paris. Would I see what I could find?

“I love a hunt. Starting from the Surgeon-General's list I went first to the Library of the Académie des Sciences. Yes, Tanchou had presented many papers before the Academy, on a variety of subjects; in fact he had three times presented himself as a candidate for election to that body, and three times failed. Among the papers published in the Comptes rendus des séances hebdomadaires were two which dealt with distribution of cancer, presented in 1843 and 1844. I asked to see them. No, these were only brief notes: ‘M. Tanchou summarized as follows. ...’ And no bibliography, no cross references. Perhaps at the library of the École de Médecine? The Surgeon-General listed four papers there by or about Tanchou. One was clearly wrong: it said 1844 but the journal named didn't start publishing until 1847. Another proved to be only an obituary notice. A third was also partly wrong — the journal had twiced changed its name in 100 years — but by persistence we tracked it down, only to find that the particular weekly number which should have contained Tanchou's article was missing from the file. That left only one, an English journal of 1843. Not very promising. But here we were in better luck, for the Lancet appeared to have translated almost literally the missing article from the Gazette des Hôpitaux Civiles et Militaries. But this again was clearly an abbreviated version of a longer paper which Tanchou said he had published elsewhere. Where?

“On a hunch I went back to the Academy and asked if Tanchou might perhaps have filed a manuscript with them, a manuscript which he had hoped to publish but had not done so. Into the archives again, this time not just to their index but into the actual files for 1840 to 1845. There were many items; twenty-two case histories gleaned from the literature of the world, drawings of operations for cancer of the breast, notes on dissolving bladder stones without operation and, ah, yes, two of interest. One was a twenty-page manuscript which appeared to be, in fact, what I was looking for, though upon closer study it proved disappointing, adding nothing essential to the material in the shorter summaries. The other, however was intriguing. It was simply a notation: ‘Tanchou, deposited June 5, 1843, a sealed packet.’ That was all.

“Early in its existence the Academy took upon itself the responsibility of serving as custodian of ideas, public or private. In the seventeenth and eighteenth centuries in particular, ideas might be dangerous, and since plagiarism was common, even perfectly safe ideas might be hoarded. If a man had such an idea and wanted to establish his right to it without making it public, he could deposit it with the Academy. Thereafter he could, during his lifetime, request the return of his deposition; after his death his heirs could request that it be opened and read but could not have it relinquished to them; and, after 100 years, if requested by anyone not an heir, the Academy reserved the right to open such a packet and decide whether its contents should be published, should be destroyed, or should be returned to the archives for another century. In practice they never destroy anything.

“Was this another manuscript? It had been sealed for 116 years, I could at least see it. This required a formal letter ... A letter was dispatched and permission duly granted to ‘examine’ the packet. On my next visit to the Academy the librarian brought it to me. No, this could not be a long manuscript; it was too small, no larger than a letter, probably only a single sheet of paper. But permission to ‘examine’ did not include permission to open ... So I sat down to write a second letter ... Official approval was granted and a date set for the formal opening.

“Such occasions are impressive. The long paneled hall, a central podium for the president and the two secretaries, an oval series of desks with six transverse lines seating the eighty Immortals, benches along the walls for visitors (the sessions are open to the public), to the left, right, and front statues of Molière, Racine, and Corneille, between these, busts of Buffon, Lamartine, Pascal, Chateaubriand, Laplace, and others. The Immortals file in, sign the register, take their places. There is the usual reading of minutes; a paper is presented ... And then the announcement, ‘The Academy has before it a request from an American colleague, M. White, that a sealed packet deposited in 1843 by M. Tanchou, physician to the King, be opened ... Do I hear any objections? If not it will be done ... In that case we will open the packet.’ An officer beckoned to me to step forward ... He broke the seal and with some difficulty opened the brittle folded paper. It contained a second sealed paper. This seal was also broken and a double sheet of paper spread out ... The ink was dim and the writing ancient ... There was a word underscored in the second line, a short word. What was it? ... It was ‘SEXE’! The paper had nothing to do with cancer.

“My search was ended. I am not sure my friend Stefansson will be content with the result ...”

In a way, I am content with the result. Dr. White's search has, for one thing, indicated what sorts of difficulties may have hampered Dr. John Le Conte in a search for the Tanchou memoir which, it is hard to doubt, he must at some time have made — perhaps in the 1880's, with all the dignity of a university president, preparing for his third statement on Tanchou, the one he issued in 1888.

The more formal report from Dr. White was dated February 11, 1959, two days earlier than the one just quoted. It is to the same effect, and concludes: “... Tanchou had a good idea on the effects of civilization ... He should be remembered for having tried to deal with the question on a statistical basis. His idea of the influence of civilization was fruitful in pointing to facts which need to be studied ...”

With the Dead Sea Scrolls throwing unexpected light on the founder of Christianity, with family revelations throwing expected light on the founder of Darwinism — with such portents, the expected or unexpected may happen to throw new light on Tanchou. But it will then probably be too late for use in this book. Therefore I shall summarize and add further bits.

Though Tanchou is now forgotten in his homeland, and though Africa may be fulfilling his prophecies without knowing they are his, it was not always thus.

It was not so in 1850, the year Tanchou died. That year, pages 487-90 of the Revue Médicale Française et Étrangére carry an affectionate, heartbroken, laudatory appraisal by Boys de Loury, secretary general of the Paris Society of Medicine. However, though the memorial praises Tanchou as a soldier and citizen, and is full of admiration for him as a leading and inspiring figure in the domain of medicine, it says of him in relation to cancer only, “Tanchou's researches on the diseases of women stand out particularly, and especially those on cancer.”

The “Memoir on the Frequency of Cancer,” which Tanchou in 1843 “addressed to the Academy of Sciences,” appears to have made the following points, among others:

According to the Hospital Gazette (Civilian and Military) for July 6, 1843, charts show that cancer is much more frequent in Paris proper than in its suburbs: “... [the like] has been noticed in Berlin and in England ... we know that the number of cancer cases is increasing ... this disease seems to be very old in the civilized world. The first example is that of Atossa, daughter of Cyrus and wife of Cambyses, in 521 B.C. ... many cancers have been found among the mummies of Egypt; and M. Homem ... who spent 14 years in the service of Mahomet Ali, never saw cancer among the peasant women but only among the [aristocratic] Turkish women.

“Cancer is like insanity, found most often in the most civilized countries ... in the Orient it has been found more frequent among Christians than Moslems. Fabrice de Hilden believed that cancer appeared more often in the temperate zone than in the other zones. M. Rouzet says that it is very rare in Africa.

“We have gathered information on this last point that leaves no doubt. Dr. Bac, surgeon-in-chief of the Second African Regiment, never found a case in Senegal, where he practiced medicine for six years. Many other health officers of our brave army have told us the same thing. M. Baudens, surgeon-in-chief at Val-de-Grâce, who practiced civilian medicine in Algiers for eight years, said he met only two or three cases. Finally: Dr. Puzin established a civilian hospital in 1835, 10 leagues from the front; out of 10,000 sick whom he examined there was only one cancer case, the breast cancer of a woman.”

So far as it is possible yet to tell from the documents studied, Tanchou's chief material for arriving at his law came from North Africa, and involved a higher observed cancer rate among the dominant French than among the lowly peasants. The main observations Tanchou bolstered with like Asiatic testimonies, and with statistics comparing metropolitan with suburban Paris, and Paris with England and Wales, also Paris with London. In Europe this all seemingly passed without creating emotional flurries.

 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.” 

"Before Europeans came, Bishop Reeve thought, his Athapaskans must have been among the healthiest peoples in the world. But many of them died young nevertheless. At childbirth the mortality was high, especially for babies but also for mothers. Accidents were many in childhood and youth, indeed throughout life. Though famines came seldom, the wiping out of small groups by starvation was frequent. Murders occurred, but not as often as among whites. Women who survived the childbirth period, and their male contemporaries, would more likely die from old age than from disease.

The problem of whether old age descended upon Indians sooner or later than upon whites, the bishop thought, could be discussed only with regard to probabilities, since undisputed facts were hard to come by. He had read in the books of some explorers, and in some Hudson's Bay Company reports from early traders, that old age was supposed to afflict the native prematurely. But himself he was unable to see how those writers could have found this out, even if their interpreters were of the best. For the very idea of counting years, to keep track of a person's age, was foreign to native thinking and had been brought into the Athapaska country by these same Europeans. The only fact that a Mackenzie River Indian could know about anybody's age, and the only thing he could have told anybody, was which of his neighbors were older than others.

By the time he discoursed with us in 1906, Bishop Reeve had been pondering matters of northern Canadian native health and longevity for thirty-seven years, starting in 1869. During the scores of hours in which the bishop shared his knowledge and thinking with us, I gradually came to understand how he classified the diseases and derangements which he believed were derived from Europe and which he chiefly blamed for changing the Athapaskans from healthy to sickly, and for reducing the population of the northern third of our continent from several millions to fewer than one hundred thousand. His grouping of these presumed imports seemed to be:

1. Cataclysmic germ afflictions that swept away the robust and the weak indiscriminately.

2. Insidious germ infections to which the strong were resistant.

3. Sicknesses which probably were not due to a germ freshly introduced by Europeans but which likely were caused by a deleterious way of life introduced from Europe.

Diseases of Europeanization. These included a dozen maladies such as cancer, rickets, scurvy, and tooth decay. Their recent appearance among the Athapaskans was charged by the bishop to the introduction of such foods as bread and sugar, and to such new food-handling methods as the preservation of meats with salt and the overcooking of fresh foods."

Bishop Reeve seemed a little doubtful about the heroic Marsh technique when it was used against a germ disease like tuberculosis. But against another group of ills he felt sure the native life was a panacea, preventing those derangements which he believed to be caused by eating the wrong foods or by not eating the right ones. This baker’s dozen or so of diseases he thought nutritional. I consider his full list farther on, along with some additions contributed by Alaskan and Canadian medical missionaries. I shall now select three from this lot, because in 1906 everybody along the Mackenzie River system was talking about them, as part of what they had to say about the Klondike Gold Rush.

Stefansson 1960

After having been acting president of the University of California through its first year, LeConte 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 LeConte'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.

 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?’” 

Before the ninety-eighters came, everybody along the Slave and Mackenzie rivers had at least heard of both toothache and scurvy, and some knew one or both from their own experience. As to scurvy, it was well known that Company people did have it at the ocean ports on Hudson Bay, where victuals were cooked European style and where most of the food came from Europe by ship. 

At these seaports the Indian wives of white men got scurvy nearly as often as the white wives of others. But at the inland trading posts, where flesh foods alone were to be had, and where they were not overcooked, neither whites nor their Indian affiliates ever had scurvy. The like was the case with tooth decay — nobody suffered tooth decay on the Mackenzie except those who had brought decay with them in their mouths from some such place as Hudson Bay or Scotland.

It was all a matter, the bishop thought, of what food you ate and of how it was stored and cooked. Scurvy cured itself when you left the Bay for the interior. Decayed teeth were not exactly cured by the all-flesh diets of the inland posts, but the tooth cavities ceased growing larger.

This was what everyone formerly believed on the Mackenzie about toothache and scurvy. Many of the Athapaskans had never seen an active case of either; but with the gold rush a lot of people came into the fur lands who not merely had rotten teeth already but who also brought with them quantities of the sort of food that would help continue the decay processes and, as the event showed, would also produce in the Mackenzie District the sort of scurvy they had heard of as suffered by the Company's people on Hudson Bay.

Dr. J. Lyman Bulkley was born at Sandy Creek, New York, in 1879. He studied medicine from 1896 to 1900 and was graduated with the latter year's class from the medical school of Syracuse University. That year, or the next, he went to Alaska, where, after vicissitudes, he settled down to the practice of medicine at Valdez for some ten years, his last known address there being on McKinley Street. In 1927 he was associate editor of the New York City journal Cancer, under chief editor Dr. L. Duncan Bulkley. To the July issue of 1927 Dr. J. Lyman Bulkley contributed an article, “Cancer among Primitive Tribes,” in which he wrote:

“The observations, which the author of this article has used, principally ... are the result of the experiences of others ... His own personal observations on the subject were gathered during a sojourn of about twelve years among several of the different tribes of Alaskan natives, during which time he never discovered among them a single true case of carcinosis ...

“In the nearly twelve years which the writer of this article spent in Alaska, during which he came into contact with many of the different tribes of the natives living there (although not all), he never found a true case of cancer among the full-bloods and but very few among those of mixed blood. The food of these people consists almost exclusively of fish and some shell fish, with cereals, berries and some vegetables ...

“... the writer feels that the conclusion can be safely drawn that to civilization and all its influences may be attributed in a very large measure ... the increase in frequency of malignancy among primitive races.”

The territory most specifically observed by Romig is Temperate Zone southwestern Alaska, south of the Yukon River and west of a line drawn north from Seward and Anchorage to Fairbanks. The Europeanization of these parts started in the 1740's, soon after Bering's visit, and was intense in the Aleutians and along mainland Alaska's south coast and the southern west coast. There were little-touched sections, particularly the west coast farther north than the Kuskokwim; and then the interior, which is forested and chiefly inhabited by Athapaska Indians. So there were districts and families that had been “modernized” even before Romig first came; but there were others still so primitive that we might consider them untouched by such influences as those of European foods and food-handling methods. Which these little-influenced spots were, the medical missionary, when of sympathetic temper, would soon know. The total population, before the 1900 measles epidemic, would have been considerably more than 10,000; after the measles, considerably less.

During his first seven years, 1896-1903, Romig worked from Bethel, the Moravian mission on the lower Kuskokwim. He traveled considerably, by dog team in winter and canoe or launch in summer. His patients were chiefly Aleuts, Eskimos, and Athapaskans; but there was a scattering of Russian and other European whites, and of Chinese, Japanese, and Negroes. Some native women were married to these immigrants. They and their children were the chief modernized elements among whom — as among the immigrants themselves — Romig was now and then discovering malignancy cases.

Infant nutrition, Dr. Marsh argued, could perhaps show its effects well into adult life. A child was usually at the breast for as long as three years. Marsh had seen cases of more than six years — so had Leavitt; and so have I, since. At the age of a few days Eskimo babies started receiving, along with their mothers' milk, food masticated by the parent and passed directly from mouth to mouth. Thus she fed the child on what she herself liked best — always, of course, lean and fat meats, except in case of famine, when vegetables might be included and when the child and mother fared alike — neither of them well but the child a little better than the parents. 

Chapter 12 contains a great deal of information about Eskimo's Way of Life.