Negotiating Disease: Power and Cancer Care, 1900-1950 9780773569355

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Negotiating Disease Power and Cancer CAre, 1900–1950

Criticism of conventional medicine is often regarded as a product of the 1960s. Before then, “scientific medicine” enjoyed uncontested cultural prestige, with kindly but strict doctors wielding unquestioned authority over grateful patients while “quacks” flogged dubious remedies to the poor and credulous – or so go popular perceptions and, for the most part, received scholarly wisdom. But the very nature of cancer – mysterious, capricious, and deadly – challenged medical authority in the past as much as it does today, and in Negotiating Disease Barbara Clow lays to rest old assumptions about the monopoly of health care by doctors in the first half of the twentieth century. Her detailed analysis of popular beliefs and behaviours reveals the compelling logic of personal decisions about health and healing. Experience and expectation, not fear and ignorance, shaped the health care choices of both cancer sufferers and the “healthy” public. A close examination of three unconventional practitioners in Ontario demonstrates the importance and vitality of alternative medicine. By presenting treatment options that were congenial and plausible to cancer sufferers, these healers contested the authority of conventional medicine. An investigation of government cancer care policy, particularly the activities of Ontario’s Commission for the Investigation of Cancer Remedies, exposes the difficulties of defining legitimate health care and the limits of state support for the medical profession. This is, ultimately, a book about who held power in medical encounters in the past. With masterful assurance and a highly readable style, Clow portrays the disputes between sufferers and healers, practitioners and politicians, and legislators and laity that coloured perceptions of medical authority and constrained the power of the profession. barbara clow is a social historian of medicine. She is currently working on a history of thalidomide in Canada and the United States, and on the history of infertility in Canada.

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m c gill-queen’s associated medical services (hannah institute) Studies in the History of Medicine, Health, and Society Series Editors: S.O. Freedman and J.T.H. Connor Volumes in this series have financial support from Associated Medical Services, Inc., through the Hannah Institute for the History of Medicine program. 1 Home Medicine The Newfoundland Experience John K. Crellin 2 A Long Way from Home The Tuberculosis Epidemic among the Inuit Pat Sandiford Grygier

7 A Young Man’s Benefit The Independent Order of Odd Fellows and Sickness Insurance in the United States and Canada, 1860–1929 George Emery and J.C. Herbert Emery

3 Labrador Odyssey The Journal and Photographs of Eliot Curwen on the Second Voyage of Wilfred Grenfell, 1893 Edited by Ronald Rompkey

8 The Weariness, the Fever, and the Fret The Campaign against Tuberculosis in Canada, 1900–1950 Katherine McQuaig

4 Architecture in the Family Way Doctors, Houses, and Women, 1870–1900 Annmarie Adams

9 The War Diary of Clare Gass, 1915–1918 Edited by Susan Mann

5 Local Hospitals in Ancien Régime France Rationalization, Resistance, Renewal, 1530–1789 Daniel Hickey 6 Foisted upon the Government? State Responsibilities, Family Obligations, and the Care of the Dependant Aged in NineteenthCentury Ontario Edgar-André Montigny

10 Committed to the State Asylum Insanity and Society in Nineteenth-Century Quebec and Ontario James E. Moran 11 Jessie Luther at the Grenfell Mission Edited by Ronald Rompkey 12 Negotiating Disease Power and Cancer Care, 1900–1950 Barbara Clow

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Negotiating Disease Power and Cancer Care, 1900–1950 ba r ba r a c l ow

McGill-Queen’s University Press Montreal & Kingston • London • Ithaca

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© McGill-Queen’s University Press 2001 isbn 0-7735-2210-7 (cloth) isbn 0-7735-2211-5 (paper) Legal deposit fourth quarter 2001 Bibliothèque nationale du Québec Printed in Canada on acid-free paper This book has been published with the help of a grant from the Humanities and Social Sciences Federation of Canada, using funds provided by the Social Sciences and Humanities Research Council of Canada. McGill-Queen’s University Press acknowledges the financial support of the Government of Canada through the Book Publishing Industry Development Program (bpidp) for its activities. It also acknowledges the support of the Canada Council for the Arts for its publishing program.

National Library of Canada Cataloguing in Publication Data Clow, Barbara Natalie, 1959– Negotiating disease: power and cancer care, 1900–1950 (McGill-Queen’s/Associated Medical Services (Hannah Institute) Studies in the history of medicine; 11) Includes bibliographical references and index. isbn 0-7735-2210-7 (bound) isbn 0-7735-2211-5 (pbk) 1. Cancer – Treatment – Ontario – History – 20th century. I. Title. II. Series. rc279.c3c58 2001 c2001-900126-6 362.1′96994′097130904

This book was typeset by Dynagran Inc. in 10/12 Sabon.

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For John

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Contents

Acknowledgments

ix

Introduction: Framing a Response to Disease

xi

1 Health Begins at Home: Lay Perceptions of Illness, Disease, and Doctors 3 2 The Problem of Cancer: Doctors, Scientists, and the Dread Disease 36 3 The Contours of Legitimate Medicine: Doctors, Alternative Practitioners, and Cancer 60 4 Cancer Patients Take Care: Sufferers, Healers, and Illness Experiences 89 5 Negotiating a Response to Disease: Politics and Cancer 119 Conclusion: Authority, Legitimacy, and the Problem of Cancer 147 Notes

163

Bibliography Index

233

209

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Acknowledgments

It gives me the greatest pleasure to thank all those who contributed – intellectually, emotionally, and materially – to the completion of this book. My thesis supervisor, Michael Bliss, provided me with a remarkable model of professional integrity, being constantly supportive of my work even as I questioned, sometimes volubly, his views on history and scholarship. Jim Connor’s insights and expertise encouraged me to refine the arguments advanced in my dissertation: I am immensely grateful both that he asked probing, difficult questions about my work and that he assumed I would find answers to those questions. Jim also deserves my thanks for pointing me in the direction of Wisconsin when I began applying for postdoctoral fellowships. It was an absolute joy to spend two years learning from Ron Numbers and watching him at work: every young scholar should be so lucky. This book and I have benefitted enormously from his rare ability to provide critical commentary in a gracious manner. Most recently, I have had the privilege of working closely with Gina Feldberg at the Centre for Health Studies, York University. Her vision and energy, her warmth and encouragement have helped to sustain me while finishing revisions to this work and embarking on new research. During the various stages of researching, writing, revising, and publishing this book, I was fortunate to enjoy financial support from many agencies: the Social Sciences and Humanities Research Council of Canada, Associated Medical Services/The Hannah Institute for the History of Medicine, the Canada-us Fulbright Program, and the Aid to Scholarly Publishing Program. I would also like to acknowledge the support

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x Acknowledgments

of the history department at the University of Toronto: their willingness to let me teach the same courses two years in a row, and to pay a sessional lecturer through the summer months – while I was not teaching – enabled me to continue revising the manuscript. Such an enlightened attitude is surely noteworthy in the “contracting” world of academic employment. A portion of chapter 1 appeared in Social History of Medicine 14(2). I am grateful to the editors and publishers for permission to use this material. Many other colleagues and friends helped to make this book a reality. The graduate students at the University of Toronto and at York University were a constant source of encouragement and stimulation. I am especially grateful to Jane Harrison, whose unstinting friendship and prodigious intelligence have made an indelible impression on me and this book. Students and faculty in the history of science and medicine at the University of Wisconsin-Madison also contributed to this work by welcoming me into their intellectual and social lives. I found it vastly illuminating to move from a history department in central Canada, where the history of medicine is a marginal enterprise, to a history of medicine department in the American midwest, where the study of Canada elicits surprising enthusiasm, albeit in a peripheral way. Finally, the history department at Dalhousie University – students, faculty, and staff – provided me with a caring, stimulating environment in which to complete this book. The staff of McGill-Queen’s University Press were ever gracious and helpful as they guided me through the bewildering process of publishing a first book. It was far less painful, I am sure, than it might have been. My copy editor, Lesley Barry, is owed special thanks for her extraordinarily careful reading of the manuscript. Her observations and suggestions helped to strengthen and clarify both the arguments and the evidence presented here. Last, but not least, I want to thank my family. My mother provided me with a compelling model of intellectual curiosity and, along with my father, encouraged me to pursue my education. Their unreserved faith and pride in me has been a precious gift. My sister Dorothy, her husband Don, and their two children, Ian and Barbara, helped in so many ways. I am most grateful for their willingness to open their hearts and their home to me when I needed it most. Finally, words cannot possibly convey my love and admiration for John and Harry: without them, I would be lost.

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Introduction: Framing a Response to Disease

Cancer, in all its various manifestations, has been among the most lethal and feared diseases of the twentieth century. Indeed, in many respects it is a quintessentially “modern” affliction: although previous generations endured the ravages of cancer, they more often succumbed to contagious than to neoplastic diseases. After the turn of the century, however, improvements in sanitation, public health, and medical care vanquished many infectious agents, leaving the population open to the depredations of chronic disease. Since the 1920s, cancer has consistently claimed more lives in North America each year than any other illness except heart disease. Moreover, few maladies in the modern era seem as dreadful as neoplastic disease: it not only kills its victims with distressing frequency, but also inflicts enormous suffering in the process. The spectre of cancer consequently looms large in the popular imagination as well as on professional and political agendas. Given the prominence and persistence of cancer in the twentieth century, we might well expect to find a multitude of books devoted to the history of the disease. In 1937, Hayes Martin, a noted American cancer specialist, anticipated that scholars would take a lively interest in the subject. “Some future medical historian,” he wrote, “will, in all probability, refer to the present era as being marked by a rapid growth in the general interest in cancer, by both the medical profession and the laity.”1 While historians have studied various aspects of neoplastic diseases in the past, their number remains small, as does the corpus of work on the history of cancer.2 Ironically, infectious diseases in the modern era – from tuberculosis to aids – have received far more

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attention from historians than either heart disease or cancer, the major killers in North America. As a result, our understanding of the history of cancer, one of the most dreaded afflictions of our time, is frustratingly meagre. One of the simplest purposes of this book is to extend our knowledge and deepen our appreciation of the complex history of cancer by exploring popular, professional, and political reactions to the disease in Ontario during the first half of the twentieth century. Drawing on Arthur Kleinman’s model of “health culture,” which asserts that “in all societies health care activities are more or less interrelated,” this study examines not only the diversity of perspectives in Ontario, but also the dynamic among them.3 The book opens with a discussion of popular and professional attitudes, and their impact on the management of neoplastic diseases. As we might expect, doctors and patients often espoused incompatible interpretations of health, illness, and healing, thereby complicating the medical encounter. But medical and lay opinion also showed surprising affinities: shared perceptions of cancer, in particular, had profound implications for the diagnosis and treatment of the disease. In the middle section of the book, we turn from a comparison of perspectives to confrontations between perspectives. Chapter 3 describes the encounter between regular and alternative practitioners in Ontario while chapter 4 explores specific sufferers’ experiences with conventional and unconventional medicine. Although regular and alternative medicine appeared to embody disparate approaches to illness and healing, these chapters reveal the confluence as well as the clash of these two views. Chapter 5 examines the state’s role in the provision of cancer care, particularly the Ontario government’s efforts to create policies and programs acceptable to the laity, to alternative healers, and to the medical profession. This chapter deals most explicitly with the holism of health culture described by Kleinman, tracing the complex interactions between popular, professional, and political perspectives that ultimately defined the collective response to the problem of cancer. While the following chapters reveal a good deal about neoplastic diseases in the first half of the last century, this study is more than just another history of cancer: it is also a book about power. Much has been written in recent decades about the nature and exercise of power in the realm of health and healing, particularly the authority wielded by medical practitioners. Some scholars have lamented the decline of professional influence since the end of the Second World War, claiming that dwindling patient confidence in doctors has seriously compromised the efficacy of conventional care.4 Others have criticized the persistence of medical authority, arguing that too often patients’ rights are trammelled

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and their welfare sacrificed during encounters with physicians.5 Although these interpretations have enriched our understanding of the doctor-patient relationship past and present, neither view alone does justice to the complexity of medical authority. As Deborah Lupton has pointed out, “power in the medical encounter may be both productive and oppressive.”6 Moreover, these accounts have tended to reinforce the view that doctors have dominated health care in the twentieth century; whether the exercise of power is considered salutary or pernicious, it is generally regarded as the prerogative of the medical profession. In his seminal study, The Social Transformation of American Medicine, Paul Starr eloquently elaborates the growing influence of conventional practitioners in the United States. In contrast to some scholars, Starr carefully distinguishes between the different kinds of authority available to and attained by doctors in the twentieth century. Although regular practitioners acquired considerable “cultural” authority, the power to define health, illness, and healing, they frequently lacked “social” authority, the ability to compel patients or the public to accept their advice. Nonetheless, Starr concludes that the growing cultural authority enjoyed by the medical profession sufficed to consolidate its position by the 1930s. “Lay deference [to] and institutionalized forms of dependence” on medical opinion, he claims, provided the basis for “high incomes and status.”7 Private and professional discourse about cancer confirms that doctors enjoyed enormous cultural authority in early twentieth-century North American society. Sufferers regularly turned to physicians and surgeons for the diagnosis and treatment of neoplastic diseases while the public expected conventional researchers to devise solutions for the problem of cancer. The state similarly relied on medical experts to formulate and implement policies for the control of neoplastic diseases. Even alternative healers sometimes modelled their therapies on the latest conventional theories of cancer causation or hoped the medical authorities would sanction their work. But the history of cancer in Ontario reveals that the power of the profession, cultural as well as social, was by no means uncontested in the first half of the twentieth century. Popular definitions of health and illness, which frequently diverged from those of doctors, determined when and if sufferers would seek medical attention. Lay experience with conventional cancer therapies likewise shaped the health care choices of patients: information gleaned from family, friends, neighbours, and even the media could outweigh the advice offered by physicians and surgeons. Personal and social experience further fostered strong support for alternative cancer care as well as firm convictions about how to judge the merits of new therapies. Political deference to public opinion in turn curtailed

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state and professional interference with unconventional practitioners. Thus, this book offers a revised interpretation of medical power, one in which the influence of the laity and alternative healers moderated, and sometimes even mastered, the authority of the medical profession and the state. As the case of Ontario demonstrates, the health culture of North America during the first half of the twentieth century was pluralistic, rather than monopolistic. In his influential essay on “framing disease,” Charles Rosenberg stresses the importance of disease concepts in history, arguing that “in our culture a disease does not exist as a social phenomenon until we agree that it does.”8 In early twentieth-century North America, a broad consensus about the biological reality of cancer prevailed in both popular and professional circles: no one disputed the existence of a disease that claimed thousands of lives annually. Its management, however, provoked considerable debate. Although the public, the medical community, and various government agencies recognized the need for a concerted campaign against cancer, they could seldom agree about how best to conduct the battle. Conflicting ideas about neoplastic diseases undoubtedly contributed to the controversy. Sufferers and healers sometimes proposed radically different solutions for “the problem of cancer,” based on divergent explanations of the causes and course of the disease. Yet ideas about cancer represented only a small portion of the beliefs and behaviours that shaped personal, professional, and political reactions to the disease. Definitions of health and illness, experiences with medical care and personnel, and convictions about social responsibility and personal autonomy profoundly influenced health care choices and policy. Therefore, rather than focusing only on disease concepts, this study frames the complex perspectives of sufferers, healers, and legislators confronted with the growing threat of neoplastic diseases. “Frame-work,” if you will, provides the framework for the book. “Scientific medicine” has provided one of the most obvious and compelling frames for cancer in the twentieth century. Not surprisingly, much of the literature on the history of neoplastic disease chronicles professional achievements, reflecting and reinforcing perceptions of the primacy of conventional medicine. To some extent, scholars have focused on these aspects of the story because sources are readily available to document institutional initiatives as well as theoretical and technical strides in diagnosis and treatment. But historians have also emphasized professional attitudes and actions because the importance of scientific medicine is undeniable. Clinicians and researchers have not always agreed about the nature of neoplastic disease or its treatment, but their approach to illness and healing has been extraordinarily influential in modern Western society. As a result, no book on the history of cancer

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would be complete without some consideration of conventional medical care. Chapter 2 builds on extant studies of the history of neoplastic diseases, describing professional views as well as their implications for doctors and patients. But whereas previous studies have tended to celebrate advances in science and medicine, this book documents the confusion and frustration of practitioners and researchers struggling to manage one of the most perplexing diseases of the modern era. Although doctors and scientists have been integral to the history of cancer, the professional medical perspective is not the only, nor perhaps even the most important frame for the management of neoplastic diseases. Because sickness usually begins at home, long before sufferers consult a practitioner, popular perceptions of health and healing are fundamental to the interpretation of illness. At the same time, personal and social experience with disease and treatment frequently determine the extent of patient confidence in and compliance with medical care. Despite the importance of the popular perspective, however, the social history of cancer, “the view from below,” remains seriously underdeveloped. Lay attitudes and actions often receive short shrift in histories of medicine because appropriate sources are scarce as well as difficult to interpret. This book draws on medical and educational literature available in Canada and the United States as well as a rich supply of popular articles and patient correspondence to explore the lay perspective: chapter 1 examines the nature and impact of popular ideas about illness, cancer, and medical care; chapter 4 delves into the experiences of cancer sufferers, describing their reactions to treatment and the practitioners who dispensed it. Together these chapters not only recapture the voices of the laity, but also demonstrate the potency of popular opinion and the logic of health care choices grounded in personal and social experience. Unconventional practitioners have similarly received little systematic or sympathetic attention in histories of cancer. With notable exceptions, scholars interested in alternative medicine have tended to ignore the interwar period, preferring to concentrate on medical sects popular in the nineteenth century or on the revival and proliferation of unconventional therapies since the 1960s.9 But, like neoplastic diseases themselves, alternative medicine has been a persistent phenomenon throughout the twentieth century. Although organized sects, such as chiropractic, enjoyed limited appeal and influence prior to World War ii, a veritable cornucopia of proprietary treatments emerged in this era, offering relief for all manner of chronic and intractable conditions: from arthritis and cancer to tooth decay and obesity, each affliction had its own peculiar remedies. Alternative medicines such as these deserve serious scholarly attention not only because they constituted a

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significant and enduring health care option for multitudes of sufferers in North America, but also because they posed a serious challenge to the tenets and practitioners of “scientific medicine.” Chapter 3 examines the confrontation between doctors and the three most popular unconventional healers in Ontario in this period, revealing the difficulties associated with distinguishing credible from fraudulent therapies. These alternative practitioners figure prominently in chapters 4 and 5 as well, in relation to the experiences of sufferers and the actions of the state. Although the medical profession frequently condemned unconventional cancer care, patients and the public found that alternative healers provided a congenial and compelling frame for the problem of cancer. Unlike sufferers or alternative healers, government initiatives have attracted considerable attention from historians, particularly since the us Congress declared “war on cancer” in the 1970s. Scholars writing about the history of cancer policies and programs have described a formidable alliance between the medical profession and the state in the twentieth century.10 Through legislative and financial backing, politicians have increasingly sided with doctors in the battle against neoplastic diseases. But in the process of describing the collaboration between the medical profession and the government, historians have largely ignored the impact of public opinion. Although state support for conventional practitioners permeates the history of modern medicine, it has never completely eclipsed political deference to the laity because elected officials have seldom had the luxury of ignoring the demands of their constituents. Chapter 5 examines the relationship between the government, the medical profession, and the laity in Ontario, focusing on the controversy aroused by alternative cancer care. Although the political authorities continued to rely on the medical profession throughout the first half of the twentieth century, lay confidence in unconventional healers and popular convictions about patients’ rights seriously constrained the medical-political alliance. Public opinion persuaded some politicians to adjust their frame for cancer. As with many books, this one has temporal and regional boundaries that require explanation. Although a discussion of cancer in the modern era might conceivably cover most of the nineteenth and twentieth centuries, this study deals with the period between 1900 and 1950. During these decades, cancer first assumed alarming proportions in North America, eclipsing other ailments as the bête noire of the medical profession, the laity, and the state. As a result, private and public discourses on cancer were uncommonly rich in these years, especially in the interwar period. Governments became actively involved in the provision of cancer care and cancer control programs, and while conven-

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tional cancer care remained relatively constant throughout this period, unconventional cancer care diversified, reaching a peak of vibrancy in the 1930s. Therapeutic stability within the medical profession juxtaposed with therapeutic ferment at the margins of or outside the profession provides an incomparable view of contests over medical authority and legitimacy. After 1950, by comparison, treatment innovations such as chemotherapy, and the creation of public and private health insurance schemes helped to shift the balance of power decisively in favour of conventional medicine. In other words, we find in this period an unprecedented intensity of concern about cancer as well as a degree of ambiguity about medical authority that waned in later years. For these reasons, I have chosen to focus on the early twentieth century, hoping that other scholars will write those other chapters of the modern history of cancer. “Location, location, location” is not the watchword of realtors alone. Historians must also consider the import of national boundaries, regional influences, and local conditions on the experiences of men and women living in the past. Yet the scholarly community, especially in recent years, has been deeply divided about the merits of local, regional, and national histories.11 Some historians have questioned the significance of work based on case studies. What do we learn about the past from a single example or a restricted sample? Is it advisable or even possible to generalize limited or local experience to larger contexts? Other scholars have suggested that case studies may provide more reliable or relevant views of history. Can we reach a greater degree of certainty or complexity by concentrating on discrete portions of historical experience? Do we mistake the past when we imbue political borders with cultural or social significance? I have tried here to exploit the advantages of the case study method while compensating for its limitations: each chapter is laden with rich detail about the beliefs and behaviours that constituted Ontario’s response to the problem of cancer; each chapter situates the Ontario experience within the context of North American society, drawing on both primary and secondary sources for Canada and the United States. Some readers may find this method distressing or unconvincing, but I believe that the questions I have posed here cannot be pursued as meaningfully in a different context because the provision and regulation of health care in North America generally took place at the provincial or state level. Negotiations over medical authority and therapeutic legitimacy, even those that originated with intensely private experience, were consequently played out on a regional stage. Moreover, this approach has the virtue of acknowledging the specificity of personal and local experiences while asking where those experiences are located in the larger cultural, social, and political landscape of the past.

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As I was researching and writing my doctoral dissertation, the original incarnation of this book, one of my advisers, Jim Connor, hounded me with a question: “What is the one thing you want readers to remember when they finish your thesis?” For many PhD candidates and not a few professional historians, this is a perplexing question and, at the time, I responded predictably: “I want to tell them about illness experiences and alternative medicine and doctor-patient relationships and the politics of health care and …” Finally, a friend, Phil Zachernuk, suggested helpfully that the best response might be: “Where they left it.” It has taken me a good deal of reflection both to appreciate the importance of the question and to devise a satisfactory answer. Although it is true that this book traverses many topics and confronts many issues in its exploration of the history of neoplastic diseases, it is ultimately a book about power, about whose views of health, illness, and healing have prevailed in medical encounters, in health care policy, in health culture. In addition to providing a revised interpretation of the past, the book has implications for our understanding of contemporary health culture. As long as we accept the premise that doctors monopolized health care in the last century, we will continue to believe that criticism of and opposition to conventional medicine is a recent phenomenon. And as long as popular disenchantment with the medical profession is seen as a product of the 1960s counter-cultural revolution, we will continue to formulate “solutions” to the current health care crisis that ignore enduring traditions of independence, self-help, and anti-authoritarianism. I hope, therefore, to convince readers to revisit and re-evaluate scholarly assumptions about the cultural and social authority of conventional medical practitioners in the twentieth century. Of course, I also hope readers will remember “where they left it.”

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1 Health Begins at Home: Lay Perceptions of Illness, Disease, and Doctors

In 1924, Beatrix Leacock, wife of famed humourist Stephen Leacock, found herself in the grip of constant fatigue.1 Although distressed by her malaise, neither Beatrix nor her family was alarmed about her health; they assumed that she was simply tired rather than really ill. Consequently, instead of urging his wife to see a doctor, Stephen arranged for her and their small son to winter in the Bahamas in the hope that a vacation would restore her vitality. When she returned to Montreal in the spring of 1925, however, Beatrix felt no better. By then she was losing weight and her spirits were flagging along with her energies as she was forced to relinquish many of her social commitments. Still the Leacocks remained unperturbed, expecting Beatrix to recover during a restful summer spent at the family home in Orillia, Ontario. When weariness continued to plague her through the fall, she finally sought medical advice. Beatrix apparently approached the consultation with some trepidation, asking one of her closest friends to accompany her. After more than a year of exhaustion and ennui, her anxiety was well founded: she emerged from the doctor’s office “white but calm,” having learned that she suffered from breast cancer. Surgery performed shortly thereafter revealed that Beatrix’s condition was advanced far beyond the stage when conventional medicine might offer hope of a cure; a year spent resting in anticipation of recovery from fatigue had given the disease ample opportunity to become firmly established. Although Beatrix seems to have accepted the finality of this prognosis, her husband could or would not. Distraught, Stephen cast about frantically for treatment alternatives, rejecting any suggestion that his

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wife’s case was hopeless. From their family doctor, the Leacocks learned about an experimental cancer therapy developed by an English physician, Blair Bell.2 Based on the administration of colloidal lead, the treatment was highly controversial: some practitioners were intrigued by early reports of promising clinical results while others feared that the toxic effects of lead would outweigh the potential benefits of its use in cancer patients. Notwithstanding this divergence of medical opinion and the gloomy predictions of their own physician, Stephen became convinced that his wife might respond to Bell’s therapy. According to family tradition, Beatrix pleaded with her husband to be allowed to die at home, among her loved ones, but Stephen would brook no opposition, not even from the patient, and they set sail immediately for Liverpool. Unfortunately, the Leacocks arrived in England too late for Beatrix to even try Bell’s therapy, let alone benefit from it; with her health undermined by the disease, she was simply too weak to withstand the rigours of treatment. To his credit, Bell did all he could to make his patient comfortable, but on 14 December 1925, only weeks after her initial diagnosis, Beatrix Leacock died. She was forty-five years old.3 In recent decades, a growing number of scholars have ventured into the realm of patient experiences, challenging old assumptions about agency in medical encounters, and offering new insights into the lay management of illness.4 Despite these studies, however, the image of the doctor continues to dominate many histories, especially those dealing with the twentieth century. Even the use of the term “patient” implies a practitioner lurking somewhere in the vicinity, not only giving meaning to sickness through diagnosis and treatment, but also conferring a particular status or identity upon the sick. Through the simple act of seeking health care advice the sufferer is thus cast semantically in a passive or subordinate role while the practitioner becomes the salient figure in the medical encounter. Yet Beatrix Leacock’s story reminds us that the experience of illness and initial attempts at diagnosis and treatment often precede contact with a practitioner. In Roy Porter’s words, “Sufferers often took care before they took physik.”5 Weeks of tiredness accumulated before Beatrix thought of herself as sick; many more months of debility passed before she became a patient. Even after her doctors diagnosed her condition, their prognostications and prescriptions took a back seat to the needs and wishes of the Leacock family. Beatrix Leacock’s experience thus exposes the decisive importance of the lay perspective. In early twentieth-century North America, the management of cancer was shaped first, and perhaps foremost, by popular perceptions of illness, of neoplastic diseases, and of medical care. Historians have been slow to follow the trail of lay and patient perspectives at least partly because these paths are notoriously elusive.

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5 Health Begins at Home

With the exception of diaries and journals written by a privileged elite, documentary evidence of lay actions and attitudes is frequently in short supply. Consequently, we know a good deal about the experiences of prominent people, such as Ulysses S. Grant, Babe Ruth, Humphrey Bogart, and Lester B. Pearson, while the attitudes and actions of the vast majority of cancer sufferers remain obscure.6 Moreover, as the case of Beatrix Leacock demonstrates, the experiences of the elite are seldom representative of the general population. A literary celebrity as well as a prominent professor at McGill University in Montreal, Stephen Leacock enjoyed a degree of influence denied to most cancer sufferers and their families. For example, his friendship with Sir Edward Beatty, president of Canadian Pacific Railways and chancellor of McGill University, facilitated the trip to Liverpool: not only did Beatty book passage for the Leacocks at extremely short notice but he also arranged for their state rooms to be converted into a small infirmary.7 Similarly, Beatrix’s appointment with Blair Bell was orchestrated by George Adami, vice-chancellor of Liverpool University, who had known the Leacocks during his days as a pathology professor at McGill. Even Stephen’s reaction to Beatrix’s death was exceptional, shaped as much by his social and economic position as by his distress. After returning to Montreal to bury his wife’s ashes, Leacock launched a one-man crusade against cancer: he personally donated money to cancer research; he made dozens of speeches urging others to join the fight; he lobbied tirelessly for the formation of cancer control organizations, both at home and abroad.8 Stephen Leacock thus converted his rage and pain into activism while those with less power and prestige had fewer treatment alternatives as well as fewer outlets for their grief. Despite the undeniable advantages that set Beatrix and Stephen Leacock apart from other sufferers and families, their experiences were neither wholly unusual nor entirely exceptional. Evidence from medical journals, popular periodical literature, and personal correspondence suggests that the Leacocks’ perceptions of illness and medical care were more typical of lay attitudes than were their connections and financial resources. They, like many other sufferers, tended to regard some ailments as innocuous, at least until such time as symptoms persisted or escalated. Similarly, the family’s management of Beatrix’s health reflected a general reluctance to consult a physician; many sufferers regarded medical attention as either unwarranted or unwelcome. The Leacocks’ reaction to cancer likewise spanned the spectrum of popular responses: for some, dread gave way to resignation, as it did for Beatrix, while others railed against their fate, as did Stephen. For all its peculiarities, then, Beatrix Leacock’s story has the virtue of bringing us face to face with the lay perspective. More important, it exposes the ground on which

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popular perceptions of health, illness, and healing were raised. Although doctors complained about the mistaken assumptions that led patients to neglect their health, lay reactions were neither illogical nor uninformed. Instead, popular beliefs and behaviours were formed by experience and expectations.

sick or tired? popular definitions of illness In 1934, E.E. Shepley, director of radiotherapeutics for the Saskatchewan Cancer Commission, surveyed his patients to learn why so many of them had advanced lesions at the time of diagnosis. Like other doctors of the period, Shepley wanted to understand this situation because he knew that lives were at stake: in its earliest stages cancer could be treated with some hope of relief or recovery, but as the disease progressed the patient’s chances of survival dwindled. “Approximately seventy-five percent of all cancer cases,” observed Shepley, “come under treatment with a late diagnosis, and, as a direct consequence, with a hopeless prognosis.”9 He consequently questioned his patients closely about the ideas and emotions that kept them from seeking or receiving care. His survey uncovered a variety of reasons for late diagnosis, including financial impediments and misdirection, but he focused on “ignorance” as the main and most remediable cause of delays. “Not only is the average patient not cancer-minded,” he lamented, “but neither is he in any reasonable measure familiar with those common danger signals … that definitely suggest the possibility of malignancy.” These findings convinced Shepley of the pressing need for a public education campaign, an opinion shared by many other members of the medical community in Canada and the United States.10 Motivated by a genuine concern for the plight of cancer sufferers, Shepley nonetheless fundamentally misunderstood the popular response to illness. He blamed “ignorance” for most cases of delayed diagnosis, observing through his survey that nearly fifty per cent of patients had not appreciated the “significance of departures from normal physiological function.”11 Yet Shepley’s conclusion glossed over important subtleties in the explanations offered by his subjects. Alongside sufferers who admitted, “I never thought of cancer” were those who concluded that their symptoms arose from a “commonplace condition” or who “didn’t think it was serious.” These patients may indeed have been ignorant of the warning signs of cancer, but they also had their own explanations for non-specific symptoms, such as fatigue, weight loss, and indigestion, which were indicative of many minor health conditions. For example, fully ten per cent of Shepley’s patients reported that they had not con-

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sulted a doctor earlier because they had initially regarded their ailments as “just natural.”12 These sufferers had not interpreted their symptoms as evidence of any disease, let alone a serious one, such as cancer. Under the circumstances, it is not surprising that they had felt no need for a physician. By lumping together these varied responses, Shepley missed a crucial feature of lay attitudes to illness: for many of his patients, health included some degree of alteration in bodily form or function. Historian John Harley Warner has argued that patients and practitioners in early nineteenth-century America used the term “natural” to describe the ideal state of well-being.13 This standard was highly subjective and intensely personal because the same condition might be “natural,” and therefore healthy, in one individual while being pathological in another. By extension, alterations in form or function became illness because they represented a departure from the usual state of the body. During the middle years of the century, however, conceptions of wellness and illness were recast in statistical rather than personal terms. Doctors no longer explained disease as an imbalance or alteration in a particular body: instead they understood it as a physiological change that could be linked to a specific cause and identified by a specific set of symptoms in any body. According to Warner, a change in vocabulary accompanied this transformation in ideas. Whereas patients and practitioners had previously used the word “natural” to describe their state of health, increasingly physicians used the term “normal,” referring to quantifiable patterns in human anatomy and physiology, or in the incidence and appearance of disease. This new way of characterizing and naming both health and disease gradually filtered out to the laity. Interestingly, Shepley’s survey revealed that as late as the 1930s some patients continued to describe their health and explain their health care choices in terms of what was “natural” for them.14 As one woman remarked after treatment, “I have regained my lost weight, and am feeling very much like my old self again.”15 Although they used the same language as their predecessors, however, sufferers in the early twentieth century did not necessarily embrace the same definition of health. Many patients questioned by Shepley had clearly recognized changes in the way they looked or felt without concluding that they were really ill. Beatrix Leacock belonged to this group of sufferers: laid low by fatigue, she assumed she needed rest rather than a doctor. Although these people experienced bodily conditions that were “unnatural” for them, and therefore evidence of illness in nineteenth-century terms, they apparently regarded many of these changes as commonplace. The meaning of the word “natural” had thus evolved into a hybrid of nineteenth and twentieth-century meanings: it not only referred to a personal standard of health, but also a predictable or

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acceptable degree of physical deterioration. Some symptoms, some types of sickness appeared “natural” to these patients because they fell within the ordinary experience of many people. From the popular perspective, pain marked the dividing line between innocuous conditions and disease. Close to eight per cent of Shepley’s patients had not consulted a physician earlier simply because they had felt no pain.16 Growths, weight loss, even discharges could be tolerated or dismissed as long as they did not hurt, but once discomfort set in, they were transformed into symptoms of illness.17 As one clinician observed, “In his concept of disease the average person accepts pain as the index of its severity or gravity.”18 Hygeia, a popular American health magazine, used the experience of a young Italian boy to warn the public that painless conditions could be dangerous. Although “Tony” had “a smooth swelling the size of an orange in the right armpit,” his family remained unconcerned because he did not complain of any discomfort.19 When they finally consulted a physician, the tumour had grown so large it could not be removed surgically and “Tony” had to undergo radiation therapy. In the case of cancer, popular conceptions of illness could be decidedly dangerous because the disease often advanced without causing any distress, but for many other common complaints, such as ulcers or colds, pain was probably a reasonably reliable gauge of sickness. Although pain generally defined illness, sufferers did not necessarily conclude that every uncomfortable condition required medical attention. More than thirty per cent of Shepley’s patients experienced symptoms and knew they were sick, but concluded that their ailments were trivial or temporary.20 They attributed abdominal pain to an ulcer or indigestion and blamed rectal bleeding on constipation or haemorrhoids. Indeed, five per cent of those surveyed admitted that they had never even considered cancer as a plausible explanation for their symptoms. Moreover, sufferers who believed their ailments were minor might seek the advice of a physician, but they were just as likely to try home remedies. One patient, R.K.A., ascribed her stomach trouble to indigestion and dosed herself with patent medicines. “About a year ago,” she wrote, “I suffered as I thought from nervous indigestion. I tried Bisma Rex and Belle Ann Tablets, but did not get much relief.”21 Nearly five per cent of Shepley’s patients fell into this category. Only when they had exhausted their own therapeutic resources did these sufferers turn to the medical profession. As D.M. wrote, “I began being troubled with indigestion, as I thought. I was trying different home remedies but it seemed to be getting worse until last winter my stomach would turn almost every day. Then finally I could not keep my food down. So I decided to consult our family doctor.”22 Tales like these

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forced Shepley to conclude that “self-diagnosis and contempt for apparently trifling symptoms are the most common errors that frequently lead to terminal disaster.”23 Yet in many illness episodes, this approach worked well, sparing sufferers additional discomfort and unnecessary expense at the hands of practitioners who had few effective therapies to offer. Some experts admitted as much. In an article written for Hygeia, one author noted that “Nine times out of ten the symptoms that worry them [patients] don’t mean a thing; they may indicate only nervous indigestion or a harmless cyst.”24 Popular definitions of health and sickness thus framed both the onset of illness and its nature. Many people refused to see themselves as sufferers, let alone as patients, despite the advent of symptoms that we would probably now interpret as evidence of disease. They believed that some complaints could be safely ignored as “natural,” part and parcel of daily living, while other signs of sickness might be treated as trifling or mundane. Even in the presence of acknowledged illness, many sufferers accepted the need for medical intervention only with great reluctance. They preferred to treat their own ailments whenever possible, rather than incur the expense, inconvenience, or distress of medical care. From the point of view of doctors, lay definitions of sickness were a result of ignorance, but to ordinary people, they were a logical extension of experience and expectations. Unfortunately, in the case of cancer, popular willingness to rationalize symptoms contributed to delays in diagnosis, making treatment that much more of a challenge.

the dread disease: cancer in the popular imagination Perceptions of specific diseases overlaid popular definitions of health and illness, shaping social reactions as well as personal experiences. The public reacted strongly to a number of diseases for a variety of reasons. Syphilis, for instance, carried connotations of filth and immorality, while tuberculosis implied, among other things, a certain delicacy of body and mind.25 Yet none of these diseases preoccupied the laity more than cancer. In the years before World War ii, the spectre of neoplastic diseases haunted North Americans. A 1939 Gallup poll revealed that seventy-six per cent of Americans feared cancer more than tuberculosis, heart disease, or pneumonia.26 Canadians likewise dreaded the disease. Six per cent of Shepley’s patients had not consulted a physician earlier precisely because they suspected they had cancer.27 So pervasive were popular fears of cancer in these decades that doctors felt they exacerbated the threat of the disease: anxiety not only prevented the public from absorbing accurate information about neoplastic diseases, it

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also encouraged sufferers to neglect symptoms that might lead to early diagnosis and cure. One woman ignored a lump in her breast for nearly two years, dreading that her doctor “would tell me I had cancer.”28 Moreover, medical and lay educators worried that shameful connotations attached to cancer compounded dread of the disease as well as the tendency to ignore salient symptoms. “There seems to be a widespread idea,” wrote one author, “that cancer, somehow, is a disgraceful disease touched with a certain stigma. Families still implore doctors to keep what they think is a dread name off the death certificates of their lost ones.”29 Educational literature urged the public to eschew these kinds of hysterical or “phobic” attitudes in favour of a healthier, more rational response to the disease.30 “This senseless but nevertheless terrifying fear of cancer,” intoned one author, “must be eradicated, and the importance of early diagnosis in all questionable cases must be constantly emphasized.”31 Scholars writing later in the century about the culture of cancer similarly portrayed the popular response to the disease as excessive and pernicious. Drawing on her own experience with cancer in the 1970s, Susan Sontag argued that sufferers are typically weighed down by shame as well as fear. “I discovered that many patients … are embarrassed about being sick,” she observed. “The doctors also treated the cancer as if it were something more than an illness: It wasn’t like having a heart attack … there was a taboo about it.”32 Indeed, Sontag penned her influential book Illness as Metaphor in response to these experiences, hoping to save lives by eradicating the disagreeable and disabling attitudes evoked by neoplastic diseases. In his history of cancer in modern America, James Patterson develops and reinforces Sontag’s central thesis that patients have long suffered in silence as a result of the stigma attached to neoplastic diseases. “The popular dread of cancer,” he concludes, “was in all ways a little irrational.”33 Yet just as physicians sometimes misunderstood patients’ ideas about illness, so contemporary and later observers misjudged and, to some extent, misrepresented popular reactions to cancer. Although North American anxiety was undoubtedly acute, it was not for that reason illogical. As the incidence of cancer increased through the early decades of the century, more people came face to face with the reality of neoplastic diseases. During the 1930s, for instance, 10,000 to 12,000 Canadians died of neoplastic diseases each year. In the more populous United States, cancer deaths ranged from 120,000 to 160,000 annually.34 Most of these victims were surrounded by a network of family, friends, neighbours, and colleagues. As knowledge of their illnesses and awareness of their misery rippled out across their social circles, popular dread of neoplastic diseases spread and deepened. Intimate acquain-

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tance with cancer, rather than hysteria, bred legitimate fears among the public. At the same time, neither sufferers nor the public reacted uniformly to neoplastic diseases. Cancer horrified and paralyzed some people while it prodded others into action. In other words, North Americans contemplating the causes and course of cancer found ample grounds for their fears, but dread did not predictably reduce them to a state of silence or disgrace.

th e g e n e s i s o f c a n c e r One of the most obvious sources of popular anxiety about cancer was the lack of certainty about its causes, particularly in a society that had become accustomed to understanding the etiology of many illnesses. Doctors might not be able to cure tuberculosis or typhoid, but they could explain and sometimes even prevent such diseases. In contrast, years of clinical and laboratory research failed to unlock the mysteries of cancer. Moreover, neoplastic diseases seemed capricious as well as inscrutable, an impression that public-health literature did little to dispel. Intent on reassuring readers that cancer should not be considered shameful, one author described the disease as “universal.”35 “No species, no climate, no country, no family tree is free of it,” he wrote. “It is so widespread through all classes of society that there can be no reflection on any one because a case of it appears.” Rather than calming the fears of the public, these kinds of observations reinforced a sense of vulnerability. As one writer concluded, “Everyone fears cancer because everybody, regardless of age or social station, is a potential victim.”36 Popular dread of cancer grew from the accurate impression that the disease attacked randomly, often without warning. In the absence of a satisfactory explanation for neoplastic diseases, patients and the public along with the medical profession grasped at various theories. Diet, environmental conditions, and even personality traits or emotions, such as jealousy, won some measure of popular support, but prior to the Second World War, three main explanations for cancer prevailed in the lay population: contagion, heredity, and chronic or acute tissue trauma.37 Doctors and educators denounced infection and inheritance, arguing that these doctrines were not just erroneous, but dangerous; they made sufferers and their families feel ashamed, thereby encouraging them to delay consulting a physician.38 Contagion theory, for instance, turned patients into social pariahs as the carriers of infectious disease, while heredity exposed them to humiliation as the product of “diseased” stock. Educators implored the public to shed their fear and hesitation along with their misconceptions about cancer.

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“Do not seek for a taint in the blood or fear the passing of it [cancer] on to your children,” advised one author. “So far, the medical profession has exonerated heredity.”39 Another writer assured readers that “Cancer is not contagious. … ‘Cancer houses,’ ‘cancer villages’ and ‘cancer belts’ are myths.”40 Despite professional opinions, a significant minority of North Americans believed that contagion and heredity accounted for many cases of cancer. A Gallup poll conducted in 1939 revealed that twenty per cent of Americans regarded cancer as contagious while a second survey the following year ranked heredity as the second most common cause of neoplastic diseases.41 Canadians likewise blamed neoplastic diseases on germs or genes. Ontario Department of Health pamphlets published in 1933 tried vainly to persuade readers that cancer “is not a ‘blood disease,’ and it is not ‘catching.›42 Although many doctors dismissed these explanations of cancer as ridiculous, to the laity they did not seem far-fetched. People had only to look around them to appreciate that neoplastic diseases plagued some families while sparing others.43 Beatrix Leacock, for instance, was the first but not the last member of her family to suffer with cancer. Her mother-in-law and possibly her sister-in-law developed and then recovered from the disease while her husband, Stephen, eventually succumbed to it.44 Similarly, an American woman watched her father, three brothers, one sister, and a nephew die of cancer.45 Given these kinds of familial patterns, it is not surprising that infection and inheritance theories appeared credible to many North Americans: they provided a compelling explanation of a conspicuous phenomenon. Observation and experience, rather than ignorance or superstition, taught the laity to believe that cancer could be passed on through “the blood” or through contact. In contrast to the first two explanations of cancer, the third theory, tissue trauma, received the rousing endorsement of the medical profession. According to Joseph Colt Bloodgood, a noted American specialist, “Cancer never begins as cancer, … In that spot there are at first normal cells; then, as a result of injury or chronic irritation, the normal cells become abnormal. … Then the spot changes to cancer.”46 In promulgating this theory of cancer causation, doctors stressed that the disease was predictable and therefore preventable.47 Although no one could be expected to control acute tissue damage, such as a blow or a laceration inflicted by childbirth, everyone could attend to these injuries immediately. Moreover, many educators accentuated the potential for prevention by focusing on irritation rather than injury. Indeed, one author hastened to reassure readers that they need not worry after every hit or fall because “accidents and single injuries play only a rare part in the development of cancer.”48 Most public-health literature

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admonished the laity to ward off the threat of cancer by maintaining suitable personal and social habits. If jagged, dirty teeth or excessive exposure to sunlight caused cancer, then the best defense against the disease lay in avoiding these irritants.49 “Human beings have cancer of the oesophagus,” chided one author, “largely because they use too hot and imperfectly masticated food, [or use] tobacco and alcohol too freely, and fail to keep their mouths clean.”50 Popular confidence in this theory of cancer causation ran high. In two surveys, conducted in 1939 and 1940, Americans ranked “bruises, injuries, and constant irritation of the tissues” as the leading causes of neoplastic diseases.51 Specific types of irritation and trauma, including smoking, neglected teeth, and childbearing, appeared further down the list as well. As with the inheritance and infection explanations, the tissue trauma theory appealed to the laity because it was consonant with experience. A woman stricken with skin cancer, for instance, attributed her illness to a puncture wound from a steel corset ring.52 Others associated cancer with chronic tissue irritation.53 In a letter to the American Society for the Control of Cancer (ascc), one person observed: “Many of my acquaintances are now troubled with stomach ulcers and of course fear cancer.”54 Perhaps this explanation also appealed to the public because it contained a message of hope: through care and vigilance they might reasonably expect to evade the clutches of cancer. Doctors and lay educators alike portrayed the theory of tissue trauma as a more plausible and benign explanation of cancer than either contagion or heredity. Beliefs that neoplastic diseases were “catching” or “in the blood” inevitably stigmatized sufferers, they argued, while the tissue trauma explanation released victims from the influence of shame.55 Yet this theory of cancer, especially the emphasis on chronic irritation, had a dark side that many writers blithely ignored. Although tissue trauma offered the possibility of reprieve for the healthy public, to sufferers it too frequently conveyed condemnation, both tacit and explicit. Bloodgood, for instance, assumed that women who smoked escaped the ravages of mouth cancers because they observed meticulous standards of oral hygiene.56 Men, who were ostensibly less fastidious, tended to develop lesions of the tongue, lips, and gums. In a more pointed commentary on personal responsibility, a 1933 pamphlet published by the Ontario Department of Health declared, “The habits and hazards of life have much to do in promoting the growth of cancer.”57 By focusing on tissue irritation, doctors and lay educators created an atmosphere in which sufferers might well feel responsible for and therefore ashamed of their illnesses. Indeed, in 1939 an American businessman who had survived cancer found it necessary to counter the destructive implications of irritation theory as well as those associated

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with contagion. “There is nothing shameful about it [cancer],” he assured his readers. “Its occurrence does not indicate reprehensible habits or carelessness. … Nor is it contagious.”58 Popular faith in the theory of tissue trauma did not translate predictably or consistently into shame because sufferers responded selectively to this explanation of cancer. Although educational literature focused on chronic damage rather than acute trauma, sufferers who sought an explanation for their illnesses most often referred to specific injuries.59 When diagnosed with cancer, one patient remembered a knock on the head that had left him with a lump. Several women developed cancerous growths after birthing problems.60 The Leacocks similarly traced Beatrix’s breast cancer to a “hard tee shot” on the golf course.61 Clearly, not all cancer sufferers could or would have found solace in this explanation of neoplastic diseases: those whose lesions were more obviously linked to specific irritants or habits, such as chewing tobacco, might well have felt responsible for their own misfortune. Yet for many other victims of the disease, injury provided a satisfactory explanation for their illness that did not expose them to censure or disgrace.

the cancer experience If confusion and controversy over the causes of cancer heightened anxiety, the pathology of the disease cemented popular dread. In his essay “Framing Disease,” historian Charles Rosenberg argues that almost any diagnosis can help to allay patient fears. “Even a bad prognosis,” he suggests, “can be better than none at all; even a dangerous, but familiar and understandable, disease can be emotionally more manageable than a mysterious and unpredictable affliction.”62 But for most people a diagnosis of cancer did little to alleviate their anxiety because the disease seemed to combine all of the most negative aspects of illness; not only was it indiscriminate and insidious, but its course was exceedingly unpleasant and its prognosis altogether too predictable. As A.G. Nicholls, editor of the Canadian Medical Association Journal (cmaj), observed in 1931, “Cancer … is in some of its aspects a loathsome disease; its ravages are spectacular; and its course is ruthless.”63 Today it is difficult to imagine the ways in which cancer can deform and corrode the human body. Because the disease is treated early, often to good effect, we are generally shielded from its more gruesome aspects. Earlier in the century, however, many patients found themselves dealing with truly appalling lesions, massive growths and festering wounds that were difficult to behold as well as endure. As one Ontario doctor recalled, “In the 1920s there were always several people in the area with offensive looking lip cancers.”64 Tumours of the face, mouth,

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breast, and skin were especially devastating, not only because they caused horrific damage but also because they were impossible to disguise. Moreover, prior to the discovery of antibiotics, infection added to the misery of these patients, hastening the destruction of tissue and turning open lesions into stinking, running sores. Some educators tried to defuse popular revulsion by minimizing the physical effects of cancer. One author claimed that “with modern methods of dressing wounds and asepsis there need be nothing offensive about even an advanced incurable case.”65 Another insisted that the public “must be made to understand that cancer is not necessarily a foul, unsightly disease.”66 These well-meaning assurances did little to moderate the dread of cancer because they defied experience. A woman with skin cancer recognized that her appearance was upsetting: “this awful face, … would be a dreadful shock to anyone else.”67 Similarly, when Life magazine ran an article on cancer in 1937, complete with photographs of lesions, some readers were appalled. “Shocking and repulsive!” wrote one woman. “I tore out the pages and burned them to spare my family the disgusting sights.”68 Given the impact of neoplastic diseases upon the body, popular revulsion was neither surprising nor unreasonable. North Americans feared not only the physical devastation but also the anguish of cancer. “The word [cancer] is a leper in the common vocabulary,” concluded an American writer, “conjuring up the picture of long-drawn agony and slow death.”69 Educators, trying to calm popular fears, argued that neoplastic diseases frequently caused little or no discomfort. As we have seen, they cautioned the public against relying on pain as a gauge of their health. “It would be invaluable to the human race,” wrote one author, “if pain were characteristic of cancer.”70 Yet in its advanced stages, neoplastic diseases often inflicted considerable discomfort, a fact that was not lost on the families and friends of cancer patients. A Manitoba woman recalled the death of her neighbour at the end of the 1930s: “This young woman refused to leave her home and as the disease progressed the pain was excruciating. … Her screaming and suffering lasted for two months.”71 Opiates and other analgesics could dull the pain, but often only at the cost of coherence. A patient thus had “little hope of relief from the worst of his pain except under conditions that kept him practically unconscious.”72 Fear of the agonies of cancer may have been exaggerated, but it was by no means groundless. Financial considerations further heightened popular anxiety about neoplastic diseases. In the years before the creation of public and private health insurance, cancer care was an expensive proposition. Doctors’ services, diagnostic tests, hospitalization, surgery, radiation treatment, and nursing care exacted an enormous toll on personal and

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family resources. For sufferers living outside of major urban centres, the expense of travel and accommodation further increased the costs of care as well as their debts. Moreover, cancer often inflicted greater economic hardship than other illnesses because it advanced slowly, requiring prolonged and intensive treatment. In some cases, the government and the medical profession tried to ease the burden of cancer care, making services available at reduced costs or even free to the indigent.73 Educators also urged the public to banish the image of the surgeon “as a gangster holding you up at the point of the scalpel while he rifles your pockets.”74 Yet access to public and private largess generally required sufferers to admit and demonstrate their poverty, something that many North Americans were not prepared to do even during the Great Depression. Confronted with the choice of accepting charity or beggaring their families, some sufferers simply ignored their symptoms or declined treatment after a diagnosis of cancer. Close to ten per cent of Shepley’s patients in Saskatchewan did not consult a physician for sickness because they felt they “couldn’t afford to have it attended to.”75 One cancer sufferer did without hospitalization and painkillers in order to save her husband “the debt of medical care that would have ruined him.”76 Although many families were prepared to invest in the relief or recovery of loved ones, their sacrifices often proved futile. A woman whose mother was being treated for colon cancer concluded, “My father has spent so much money on the operation and medicine that he is getting pretty hard up which he wouldn’t mind if it had done any good but it just breaks our hearts to see her getting worse every day.”77 And so we come to the last and most obvious cause of lay fears: the perception that cancer was inevitably fatal. As one doctor remarked, “Some words in our language have … the significance of a death knell.”78 Undoubtedly, pessimism about neoplastic diseases was disproportionate, given that other diseases, particularly heart and circulatory ailments, routinely claimed more lives than cancer. Moreover those who developed neoplastic diseases did not invariably succumb to them, a message that educators hammered home at every opportunity. “The most unfortunate myth about cancer,” observed one writer, “is that it is incurable.”79 Indeed, in 1938 the ascc founded a “Cured Cancer Club,” enlisting the aid of survivors in the ongoing effort to convince the public that cancer could be beaten.80 Surveys conducted in Canada and the United States at the end of WW ii suggest that these kinds of educational efforts bore fruit: more than sixty per cent of Americans and nearly fifty per cent of Canadians polled felt that some cancers were curable.81 Nonetheless, a significant proportion of North Americans remained convinced that cancer killed, and experience sup-

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ported their beliefs. Although patients with skin or oral lesions had fairly good recovery rates, sufferers with gastro-intestinal cancer were typically not so fortunate; only twenty-five to thirty per cent of them could hope to survive for more than five years.82 Cervical cancer cases were likewise “salvaged” only about twenty per cent of the time, while patients with prostate cancer had a five-year survival rate of ten to twenty per cent. Among women with advanced breast cancer, the death toll reached as high as ninety-four per cent.83 Perceptions of cancer as a deadly affliction were consequently justified.84 Although James Patterson maintained that fears of the disease were exaggerated, even he was forced to admit that “the large majority (probably four-fifths) of cancer patients did die from the disease, sometimes slowly, miserably, and at enormous emotional and economic cost to their families.”85 Despite the wealth of reasons for anxiety about neoplastic diseases, contemporary observers remained perplexed by the alleged excesses of the laity, especially when they compared reactions to cancer with perceptions of other illnesses. Canadian physician Helen MacMurchy observed that “We don’t bully ourselves into a condition of abject fear and dread over diseases of the heart and blood vessels which cause about twice as many deaths as ca [cancer].”86 Scholars such as Susan Sontag also noted, later in the century, the divergent reactions to cardiovascular and neoplastic diseases. “Someone who has had a coronary,” she maintained, “is at least as likely to die of another one within a few years as someone with cancer is likely to die soon of cancer,” yet heart disease seemed relatively benign while cancer appeared “illomened, abominable, repugnant to the senses.”87 Neoplastic diseases eclipsed most other ailments in the popular culture of North America because they inflicted an especially grievous form of suffering. Although cardiovascular diseases were more deadly, they did not elicit the same visceral reactions as cancer because they did not render the body “repugnant to the senses.” Moreover, heart attacks and strokes seemed to strike swiftly, sparing patients the prolonged agony and expense of cancer. Franklin Delano Roosevelt’s final illness is a case in point.88 Suffering from severe hypertension, his health had been deteriorating for some months prior to his death. Nonetheless, he carried on with his presidential duties, taking an active hand in the peace negotiations at Yalta in the final days of the Second World War in Europe. Then on 12 April 1945, the American president complained of an excruciating headache, quickly lost consciousness, and was dead two hours later. The experience of cardiovascular diseases, like many other afflictions, compared favourably with that of cancer.89 One Canadian physician described pneumonia as “a kindly old fellow who takes us quickly and more or less painlessly, while cancer is a slow, miserable, torturesome

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old crank who eats up our substance and wears us away to death.”90 In light of these kinds of comparisons and the experiences that gave rise to them, the special dread reserved for cancer seems neither extravagant nor unreasonable. As with the causes of neoplastic diseases, educators worried that popular perceptions of the cancer experience paralyzed people and rendered them mute. “You are so frightened,” wrote MacMurchy, “that you don’t want to hear or know anything about it. The word Cancer is enough to shut up your mind tight.”91 Disgraceful connotations ostensibly compounded popular fears of cancer, deepening the distress of sufferers as well as the silence that surrounded the disease. Sontag insisted that “having cancer has been experienced by many as being shameful, therefore something to conceal.”92 Although some contemporary observers explicitly linked shame with “misconceptions” about the causes of cancer, others treated it as an amorphous and irrational phenomenon that, like fear, contributed to popular dread. “Taboo and terror,” wrote one author, “have long invested cancer.”93 Whether they focused on fear or shame, however, educators agreed that popular reactions to cancer exerted a pernicious influence on public health by interfering with candid, competent care: “Until cancer can be talked about freely and openly, without discomfort or restraint, no real progress will be made in cancer control.”94 Shrouded in secrecy, neoplastic diseases were allowed to flourish, extending their hold over the bodies as well as the minds of North Americans. In the early decades of the twentieth century, sufferers undoubtedly felt the stigma of cancer, especially when the effects of the disease and its treatment were deeply inscribed upon their bodies. One writer for Hygeia tried to convince patients to wear their scars as “a decoration, as an accolade of knighthood” in the ongoing war against cancer, but this approach offered little comfort to those mortified by the ravages of the disease.95 Moreover, the many references to shame in the publichealth literature cannot be ignored: some patients, some portion of the public, clearly regarded cancer as a disgraceful affliction. For the same reason, it seems indisputable that many people were reluctant to discuss neoplastic diseases. Educators regularly remarked upon the “conspiracy of silence” surrounding cancer.96 Doctors hesitated to mention the disease because they believed it would deepen the suffering and hasten the deaths of their patients. In turn, many sufferers who knew they had cancer allegedly tried to hide it, fearing for their jobs or their relationships. According to James Patterson, “most of those who developed cancer before the 1940s were either not told they had it or tried to keep the news out of the papers.”97 Motivated by the desire to improve cancer care, educators and commentators tried to expose the fallacies they believed underpinned the

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popular dread of cancer. By encouraging the laity to confront the disease, they hoped to mount a more effective defense against cancer. In the process, however, these authors ignored a variety of attitudes and experiences that did not fit the pattern of silent suffering. Writing about the past, both Patterson and Sontag generalize one illness experience to most, if not all, victims of neoplastic diseases. Yet a close analysis of private and public discourse from the first half of the twentieth century reveals a more complex portrait of lay reactions than that painted by contemporary observers and later scholars. Although North Americans regarded cancer with considerable apprehension, many were neither palsied by fear, nor ashamed of their illnesses. Similarly, though people shrank from a frank discussion of the disease as well as knowledge of a devastating diagnosis, their reticence was seldom absolute, as implied by the term “silence.”

an unspeakable affliction? The term “shame” conveys not only a sense of personal responsibility, but also of dishonourable conduct or immoral behaviour. According to Sontag, “Patients who are instructed that they have, unwittingly, caused their disease are also being made to feel that they have deserved it.”98 In the prewar era, educators blamed sufferers not only for the onset of the disease, but most especially for delays in diagnosis. Since doctors maintained that cures depended on early diagnosis of the disease, blaming sufferers in this way was tantamount to blaming them for their own deaths. For example, a 1939 article published by Hygeia entitled “When Cancer is Not Guilty” outlined the various ways in which patients contributed to their own ill health. “‘Cancer’ is written on many a death certificate,” the article began, “when ‘suicide’ would be far nearer the truth.”99 Pointed and painful as these comments may have been, they were not unique to cancer sufferers or to the subject of neoplastic diseases. In the first half of the twentieth century, almost any life experience, from child-rearing to epidemic disease, could become an occasion for assigning fault.100 In her book on educational literature aimed at mothers, Katherine Arnup points out that physicians frequently held women responsible for the health of their children, berating them for real or perceived mistakes.101 Similarly, Judith Walzer Leavitt explores the discourses on Typhoid Mary, exposing the ways in which guilt and disease could be conflated by the public and the medical profession.102 If cancer sufferers were made to feel responsible for and therefore ashamed of their disease, they were not the only patients held hostage by medical opinion. At the same time, despite the censure evident in the public discourse on cancer, the public did not necessarily embrace punitive or pejorative

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notions of the disease.103 In magazine articles and letters to editors, patients described the personal and social distress occasioned by cancer, but they recounted their experiences in simple language devoid of foul images and guilt. One sufferer admitted he was afraid, but claimed that his experience with cancer had brought other worries into proper perspective. “Not that I am an unusual or a shining example case,” he wrote. “There is no more ‘will to live’ in me than there is in many others I have seen or met under treatment for cancer. Lots of them who suffer more than I, have learned how to live for the day, including some who can never get out of bed even for a short time, and mix with their fellows.”104 With a few notable exceptions, patient correspondence was similarly calm and measured in tone. A woman with a lump in her breast wrote to the ascc to ask “Can you tell me where to go to have a slice taken for diagnosis?”105 Another woman wrote to the Ontario government about her husband’s battle with testicular cancer: “You will of course understand, without need of further discussion on my part, the nature and course of this type [of cancer]. … his case is considered hopeless.”106 Finally, the results of a public opinion poll conducted by Gallup in 1940 contradicted easy assumptions about popular attitudes to cancer. In response to the question “Do you think there is anything shameful in having cancer?” a resounding ninetyeight per cent of those polled said “No.” Ten years later, a second survey elicited similar opinions from the American public.107 Although some people regarded neoplastic diseases as shameful, they appear to have been in the minority.

a conspiracy of silence? While some North Americans declined to see cancer as a disgrace, many also refused to be silenced by the disease. Public and private discourse from the first half of the twentieth century bears witness to considerable interest in neoplastic diseases. Popular literature ranged from outrageously lurid to wildly optimistic, neither extreme being particularly helpful for sufferers or the public.108 Yet most of the articles and correspondence embodied a more measured response to the problem of cancer. Moreover, the sheer volume and variety of writing on the subject of neoplastic diseases challenges contemporary and historiographical assumptions about lay reactions to cancer. Although the disease was not discussed easily or eagerly in the years before World War ii, doctors, sufferers, and the general public were frequently prepared to read, write, and talk about cancer. Consider, for example, the content of obituaries and death notices, which supposedly provided the strongest evidence of cultural taboos

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against cancer. According to Patterson, as late as 1949 “obituaries for thousands of people [who died of cancer] … still used familiar euphemisms to avoid the stigma of the disease.”109 Phrases such as “a lingering illness” or “a prolonged illness,” he claimed, routinely signified cancer deaths. Although this interpretation may seem both familiar and persuasive, it is fraught with problems. Even if we concede a direct correlation between the use of the phrase “a lingering illness” and cancer deaths, we cannot therefore conclude that relatives were intent on concealing the disease by neglecting to name it. Euphemisms are employed precisely because they facilitate discussion of a delicate, private, or difficult subject, such as sex or death. Consequently, if euphemisms were used habitually, as Patterson and others insist, families who chose to describe a relative’s demise in this fashion would actually be announcing rather than hiding the cause of death. At the same time, there is currently little support for the assumption that every “lingering illness” referred to in obituaries was cancer.110 Many afflictions, including heart disease and diabetes, claimed lives slowly, over the course of many years, and these illnesses might well have been described as “lingering” or “protracted.” For example, Isabella Wallace’s death came “after many years of suffering borne patiently,” while Albert E. Bavidge passed away “after a gallant fight for life.”111 Were these prolonged, painful deaths due to neoplastic diseases or to some other affliction? Moreover, cancer deaths did not always follow an extended period of suffering. In 1910, a Toronto man with leukemia died “suddenly,” following an operation.112 When Stephen Leacock succumbed to throat cancer in 1944, his obituary characterized the cause of his death as “a brief illness.”113 Without meticulous and exhaustive cross-referencing of death certificates with death notices, we simply cannot be sure which phrases, if any, served as euphemisms for cancer. Even this kind of painstaking research might prove fruitless because death certificates were not always reliable; misdiagnosis and deliberate falsification together contrived to obscure many cancer deaths.114 Moreover, death notices are difficult to interpret. An example drawn from the pages of a Toronto newspaper reveals the decided ambiguity of obituary evidence. On 8 August 1930, the death of H. Otto Scott was attributed to “a lingering illness.”115 A veteran of the First World War, Scott had been gassed and “had not recovered from the effects of the war,” being forced by ill health to give up his work as a bookkeeper two years before his death. At first glance, this obituary is strongly suggestive of cancer. Not only did Scott’s parents use the phrase “a lingering illness,” but also the reference to mustard-gas exposure conjures up images of lung damage and pulmonary neoplasm. Yet such a conclusion would be premature.

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Several studies of war veterans in the United States demonstrate only a marginal increase of lung cancer among the victims of mustard-gas poisoning.116 Although a “single combat exposure” would invariably leave these men suffering from severe asthma or chronic, debilitating bronchitis, it did not significantly increase their chances of developing cancer later in life. Otto Scott may well have succumbed to lung cancer, but he may also have gasped away his last moments of life in the grip of some other pulmonary condition. In other words, the relationship between euphemisms and causes of death was neither obvious nor predictable. Before we leap to conclusions about how cancer deaths were reported, we must also compare them to announcements of other causes of death in the same period. A survey of one Toronto newspaper revealed that fewer than fifteen per cent of obituaries specified any cause of death, and this figure was often inflated by media coverage of accidental deaths, especially car wrecks and drownings, which doubled as news.117 Moreover, many commonly fatal conditions were underrepresented in obituaries and death notices: diabetes, puerperal fever, poliomyelitis, and a multitude of other lethal ailments were rarely mentioned. Even cardiovascular diseases, the number one killer in North America, received scant attention, appearing, on average, in fewer than three per cent of obituaries and death notices. Although cancer deaths were seriously under-reported in obituaries, figuring in only a handful of announcements, reticence about the disease must be understood in the context of a culture that valued privacy in matters of illness and dying. Indeed, the most common descriptor used in obituaries of the period was “suddenly,” suggesting that a public explanation was generally unnecessary except in the case of unexpected deaths. Firm conclusions about the conventions governing death announcements must await a comprehensive review of obituary evidence, yet even this preliminary analysis casts doubt on the conclusion that cancer deaths were uniquely subject to concealment or disguise. Prior to the Second World War, relatives of the deceased apparently “tried to keep the news out of the papers” regardless of the cause of death. Although the tenor of obituaries and death notices was frequently restrained, the same cannot be said of the wider public discourse on cancer. In the early decades of the twentieth century, a variety of volunteer and public-health agencies in Canada and the United States began to disseminate information about neoplastic diseases in order to educate the public and the medical profession about symptoms, diagnosis, and treatment. Patterson argues that much of this literature was aimed at countering the fear and shame that silenced cancer sufferers.118 Yet more to the point is the fact that educational efforts such as these

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would have been pointless had not the public been willing to read about cancer. In the same way, editors of newspapers and popular magazines increasingly assumed that stories on the “dread disease” would find an avid audience. A survey of articles indexed in The Readers’ Guide to Periodical Literature reveals that media coverage of cancer outstripped the attention devoted to other ailments, such as heart disease, which were allegedly easier to discuss. Patterson interprets this imbalance of reportage as evidence that Americans were in the grip of “cancerphobia.” Whatever else the public discourse on cancer may have signified it surely did not add up to Sontag’s “conspiracy of silence.”119 Prior to the Second World War, neoplastic diseases were allegedly excluded from private as well as public discourse. “Since getting cancer can be a scandal,” Sontag argued, “patients who know what they have tend to be extremely prudish, if not outright secretive, about their disease.”120 Although the laity was afraid of cancer, it is less clear that sufferers and their families felt constrained to hide the disease. Large numbers of cancer patients contacted public and private agencies, as well as medical specialists and alternative healers, for advice and assistance. Between 1935 and 1938, for example, the ascc received close to 50,000 letters from sufferers and their families.121 Officials at the Ontario Department of Health likewise corresponded with hundreds of patients in these years, advising them about suspicious symptoms and suitable therapy.122 Perhaps the most telling evidence of popular reactions to cancer comes from the patients themselves. Sufferers frequently remarked that their own decisions about cancer care were informed by the experiences of others within their social circles. For example, a woman with carcinoma of the cervix refused radiation therapy after listening to the stories of her neighbours. “Three of my friends,” she wrote, “had similar treatment and they told me they were dying a death of [a] fiery internal furnace. Knowing of their untimely deaths and awful agony, I was determined to die comfortably, if needs be by the inroads of cancerous growths.”123 Sufferers were not necessarily bound by social conventions of silence; faced with a serious, potentially life-threatening disease, many shared their experiences – and knowledge of their illness – with friends and relatives as well as with health care providers and government officials. Even in the doctor-patient relationship, secrecy was neither an uncontested nor an uncomplicated phenomenon. To be sure, many physicians preferred to dissemble about cancer, while the victims of the disease shunned a diagnosis that they felt was equivalent to a death sentence. Yet for every example of concealment, there was a comparable case in which patients and practitioners favoured candour over

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silence or deception.124 One patient claimed that his doctors “were not a bit backward about telling me it was Cancer” while another demanded that his physician be “completely truthful” after discovering a large lump in his abdomen.125 Moreover, reticence in the medical encounter, like euphemisms in obituaries, served more complex purposes than simple evasion of the truth. Consider a situation described by a doctor practicing in rural Ontario.126 His patient, a man with rectal cancer, had refused a colostomy and was dying. Rather than contemplate this dismal prognosis at regular intervals, the patient and his physician “evolved a little game” to avoid mentioning the disease. At each visit, the man would ask if he was well and the doctor would assure him that he was on the mend. Meanwhile, the patient was fully aware of his impending death and its cause; he wrote up his will, set his business affairs in order, and bid farewell to his closest friend. Actor Humphrey Bogart adopted similar tactics when he was dying from esophageal cancer. According to his widow, Lauren Bacall, Bogart never deceived himself about the nature of his affliction, insisting that cancer was a “respectable” disease. Nonetheless, the two of them, as Bacall wrote, “continued the game of its being nothing more than a bad virus.”127 Thus, when patients, their families, and their doctors enacted bedside rituals, they were not always intent on concealing the nature of the disease; instead, they were seeking ways to manage a terrifying situation. Of the myriad reactions to neoplastic diseases evident in Canada and the United States during the first half of the twentieth century, only fear was nearly universal. A few educators acknowledged the legitimacy of popular anxiety about cancer. “We have good reason for this feeling [of dread],” wrote one author, “because … the amount of pain and suffering, mental and physical, of the afflicted ones themselves and the grief and distress, not to mention the financial loss … cause[d] to their families and communities, are almost incalculable.”128 These writers tended to encourage the public not so much to abandon anxiety as to moderate and use it. “Fear the beginning of cancer,” wrote one physician, “and not the end; a little fear in the beginning will bring you to an examination earlier; any fear at the end will add to your discomforts.”129 Yet the vast majority of doctors and lay educators remained perplexed by public reactions to neoplastic diseases. A 1932 article published in Hygeia depicts a fictional specialist bullying an interviewer about popular perceptions of cancer: the dialogue beautifully captures professional frustrations. “We doctors are combating this medieval secrecy on the part of you human ostriches,” the physician declares. When the woman finally gathers her courage to ask about a small spot on her chin, the specialist “snorted indignantly” and dismisses her as “no better than the rest of them.”130 Authors who viewed

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public reactions as excessive and irrational had little patience with popular theories of cancer causation or reluctance to confront the disease. But North Americans dreaded cancer for sound and compelling reasons: familiarity with the disease, rather than hysteria, taught the public the meaning of fear.

doctors, cancer, and the public In addition to lay perceptions of illness in general and of cancer in particular, popular impressions of the medical profession and personal experience with doctors shaped the management of disease. Many scholars writing about medical professionalization have described the dominance of regular practitioners in the twentieth century. In one of the most influential books on this subject, The Social Transformation of American Medicine, Paul Starr explores the diverse and complex processes by which physicians forged a “monopoly” in health care. By the end of the 1920s, he concludes, “Physicians finally had medical practice pretty much to themselves.”131 Many historians have shared Starr’s views, assuming or arguing that regular physicians came to monopolize health care early in the twentieth century. Certainly contemporary educators reflected and reinforced the central role of the medical profession in health care and in the management of cancer: they extolled the virtues of periodic examinations and advised the public to consult a physician at the first sign of suspicious symptoms. Moreover, the doctor emerged in public-health literature as a heroic figure, a general leading the assault against a dreadful foe. “Surgery and the science of radiology have joined hands,” wrote one author, “to give a battle royal to King Cancer and his vulpine army. They are now attacking the enemy on all fronts and the cancer horde is yielding and retreating slowly but surely.”132 In contrast, those outside the profession appeared as dupes and collaborators. While the public unwittingly advanced the cause of neoplastic diseases through ignorance and fear, unconventional practitioners aided and abetted the enemy by luring sufferers from the benefits of regular therapies. “It is important that advice should be sought from a medical man trained in a regular medical school,” concluded a Canadian physician. “No attention should be paid to advertising ‘specialists,’ herbalists, quacks, and irregulars.”133 To some extent, support for regular doctors and attacks on alternative practitioners arose from the preponderance of physicians in public and private agencies devoted to the control of cancer, such as the ascc. Moreover, doctors contributed regularly to the educational literature on cancer, stressing the value of conventional treatments as well as the dangers of self-dosing and unproven cures.134 Yet,

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as Starr pointed out, the cultural authority of the medical profession rested not only on careful organization and shrewd management of its resources, but also on growing popular confidence in medical science.135 Advances in diagnosis and, to a lesser extent, treatment in the late nineteenth and early twentieth centuries had dramatically improved the public image of the doctor, lending a lustre and legitimacy to the profession that had previously been lacking. Faith in the abilities of the physician infused much of the popular writing on cancer. One sufferer lauded the efforts of the medical profession: “Probably few of the fighting men in the front line of battle against cancer to-day, realize what an inspiration they are to those on whose behalf they fight; the contest is so absorbing.”136 But although the public frequently turned to regular doctors for the diagnosis and treatment of neoplastic diseases, confidence in the medical profession was neither absolute nor uncomplicated. As we have seen, financial considerations sometimes soured relations between doctors and patients, keeping sufferers from seeking medical aid, but popular scepticism about the medical profession ran much deeper than mere matters of money. Beatrix Leacock, for instance, neglected to consult a doctor for more than a year, despite having ample resources to pay the finest specialists. Perceptions of illness undoubtedly played into her decision, but her reluctance may have arisen from other sources as well. In the early decades of the twentieth century, nagging doubts about the abilities and integrity of physicians plagued the public. Quite simply, many patients did not expect to get a straight deal or the straight story from their doctors. To some extent, these fears and suspicions represented the vestiges of nineteenth-century attitudes, which included little respect for the medical profession. But unpleasant and frustrating encounters with physicians continued to mar faith in the profession through the first half of the twentieth century. As with popular reactions to cancer, reservations about the medical profession were neither wholly irrational nor ridiculous. When it came to the management of cancer, sufferers could not rely on a timely, accurate diagnosis or a frank discussion of their health and treatment. Consequently, while people continued to seek the aid and advice of regular doctors, many did so with a good deal of ambivalence. According to historian Edward Shorter, diagnostic prowess formed the backbone of medical prestige in this period. New equipment and techniques as well as considerable accuracy in the identification of diseases “gave the modern doctor his power and influence.”137 Perhaps diagnostic expertise enhanced the reputation of the medical profession, but in the case of neoplastic diseases, popular confidence was not necessarily well founded. Medical wisdom held that cancers in their early

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stages were most amenable to treatment. Advanced lesions, those that had grown or spread, seldom responded fully to either surgery or radiation therapy, with the result that patients usually died. The “gospel of early detection” consequently formed a constant refrain throughout the medical and educational literature.138 “It is your job,” one physician informed the laity, “to tell your doctor of your symptoms early in their course.”139 Yet early diagnosis embodied one of the deadliest paradoxes of cancer care: early lesions could be treated most successfully, but they were among the most difficult to detect and identify. Consequently, even when patients heeded the advice of educational literature and consulted doctors for suspicious symptoms, they could not be assured of an accurate diagnosis. More than six per cent of Shepley’s patients in Saskatchewan had this experience. “I had previously been advised that nothing was wrong,” they reported.140 A 1934 survey of cancer care in Michigan revealed similar findings: “It is unfortunately true that the greatest single cause of delay between first consultation with a physician and the institution of treatment is poor advice on the part of the attending physician.”141 Doctors and educators tried to rationalize these results, arguing that the family physician who had limited experience with neoplastic diseases was most often responsible for diagnostic failures. But early lesions baffled specialists as well as general practitioners. William Deadman, a noted Canadian pathologist, admitted that as many as ten per cent of tissue samples submitted for analysis would challenge even the most accomplished expert.142 As with popular perceptions of neoplastic diseases, experience alerted the public to the limits of professional competence. For example, one woman who developed uterine cancer following “a chronic condition of unhealed lacerations at childbirth” reported that her doctors had treated her pain and discharges for more than three years without recognizing the real cause of her suffering. Owing to the advanced state of her lesions at the time of diagnosis, she had “only 20% chance of a cure” after surgery and radiation therapy.143 At the other extreme of misdiagnosis were the patients who submitted to needless procedures. A 1938 article published in Hygeia recounted the experience of a young woman who discovered a lump in her breast “only as big as the tip of my little finger.”144 She immediately consulted her physician, as dictated by the gospel of early detection, and a biopsy of the lump indicated sarcoma, a virulent form of cancer. Her doctors, one of whom was an eminent cancer surgeon, advised immediate action; at the age of twenty, this woman faced the prospect of a double radical mastectomy to ensure complete eradication of the disease. As it turned out, the patient was saved from mutilating surgery by the sudden decision of the attending physician to consult “the greatest cancer

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specialist in this country and … in the world.” This expert concluded that the tumour was not cancer at all. Naturally, the woman rejoiced in her good fortune and her lucky escape, but other patients were not so favoured by the fates. In 1934, an Ontario woman developed a lump in her breast and decided to consult her family doctor. He advised surgery and when she agreed, he removed the breast which contained the lump as well as the healthy breast on the grounds that “it would only be in the same condition in a year or two.”145 Weeks later, when the pathology report came back, she learned that she did not have cancer. The surgery, though well intentioned, had been unnecessary. As word of these kinds of experiences filtered out to the general public, confidence in the medical profession faltered. “The information is apt to reach friends and relatives,” observed one author, “and the word spreads that the first physician was incompetent, that he did not follow the plain rules of intelligence and make a thorough examination, which might have revealed the condition earlier and at a time more favorable for treatment.”146 Educational literature inadvertently reinforced popular doubts about the abilities of doctors by exposing the complexities and contradictions of cancer diagnosis. “With the increase in popular knowledge,” observed one author, “diagnosis is becoming more difficult either because the patient comes in an earlier phase, in which the growth is more difficult to diagnose, or, what is harder still, requests a definite assurance that the symptoms which he has do not indicate a beginning internal neoplasm. Here indeed is judgment difficult, experience fallacious, and delay dangerous.”147 At the same time, educators voiced reservations about the proficiency of specific practitioners. Criticisms of the profession were sometimes very subtle. One author merely advised patients “to consult a reliable physician” at the first sign of cancer.148 But other writers openly acknowledged the reality of medical incompetence. “It is necessary,” warned one doctor, “for a woman to go not only to a physician but to a good physician.”149 General practitioners bore the brunt of these criticisms, being variously portrayed as uninformed, inexperienced, and even negligent: “What a sad reflection it must be that a woman loses her life because the [family] doctor failed to exhaust every means of diagnosis in order to make sure.”150 Education campaigns, designed to inform the public and calm fears about cancer, sometimes backfired. An Ontario man, whose wife was being treated for a cervical condition, began to question the abilities of their family physician after reading a pamphlet on cancer. “We have always had complete confidence in [our doctor],” he wrote to the Ontario Department of Health, “[but your publication] suggests that the average physician is not competent to diagnose early cases of certain types of cancer.”151 Doubt and anxiety had replaced this man’s confidence.

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The uncertainty of cancer diagnosis created a special dilemma for the public. In addition to the risk of misdiagnosis or late diagnosis, patients faced the problem of permanent insecurity. In other words, if doctors could not be relied upon to diagnose cancer, then patients could never be sure they were free of the disease. For example, a man troubled by persistent abdominal pain worried that he had cancer, despite repeated reassurances from a variety of physicians that he only had ulcers.152 A woman suffering from chest pain likewise refused to be comforted by her doctors’ conclusions that she did not have cancer. “I did not believe them,” she wrote.153 Even the woman who had endured a double mastectomy did not feel safe. Rather than flying into a rage at the needless mutilation of her body, she remained convinced that she had cancer. Her fears seemed to be confirmed when she subsequently developed the disease. “I was told it was not cancer,” she recalled, “yet a few years later, three more small growths were removed from the same place, … and the report came back as positive cancer.”154 Popular suspicions that physicians concealed cancer from their patients exacerbated these kinds of misgivings.155 Disclosure was an issue of considerable contention among doctors and lay educators. The vast majority favoured open dialogue because they believed that knowledge and candour would lead to better control of neoplastic diseases. Yet even these authors recognized that not every sufferer would be able to bear up under a diagnosis of cancer. “It is, of course, true,” admitted one writer, “that there may be exceptional cases or peculiar situations which make it advisable that the patient be kept in ignorance.”156 As a result, though many doctors discussed cancer with their patients, some deliberately misrepresented the disease.157 Canadian physician A.I. Willinsky employed elaborate means to keep one patient from learning that she had breast cancer. He explained the amputation of her breast as “a mistake” and later convinced her to undergo a hysterectomy by telling her that she had arthritis. “I made up my mind,” he wrote, “she would never know.” In the meantime, Willinsky explained the real problem to the patient’s family: “Her husband, of course, had learned the truth from me right at the beginning.”158 The tendency on the part of some physicians to conceal a diagnosis of cancer led later scholars like Sontag and Patterson to conclude that the disease was unmentionable. Clearly, this was not the case. Many sufferers, including Beatrix Leacock, learned the truth from their doctors. But enough physicians practiced deception to cast doubt on the integrity of the profession and the veracity of diagnoses. Stephen Leacock represents one of the most fascinating examples of popular ambivalence towards the medical profession. Once Beatrix received a diagnosis of cancer, doctors moved in and out of her days until

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her death a few weeks later. She seems never to have questioned the diagnosis or prognosis of her family physician. Stephen reacted less stoically to the bad news, but he too seemed to retain considerable confidence in the medical profession. He would not accept his wife’s impending death, but he nonetheless valued his doctor’s opinions about Blair Bell’s lead therapy. Stephen’s decision to consult Bell further attests to his continued faith in medical science: although Bell’s therapy excited controversy, even sceptical doctors styled it as an experimental treatment rather than a quack cure. Moreover, despite his desperation, Stephen was never tempted to try truly unconventional therapies, those developed and endorsed by healers outside the ranks of the medical profession. When his sister begged him to take Beatrix to a Christian Science practitioner, he refused.159 After his wife’s death, Leacock’s antipathy to unconventional medicine gathered momentum. In an address to the 1926 International Cancer Symposium held in New York, he “made a vehement appeal for war on quacks and fakers who deal in pretended cancer cures. … ‘If you as medical men cannot rid the community of them, we will with whip and prison cell.’”160 In his personal life, Stephen Leacock exhibited an unwavering devotion to medical science. Yet in his satirical prose, Leacock exhibited far less reverence for the medical profession. In his 1910 collection, Literary Lapses, he portrays a bruising encounter between doctor and patient. The patient enters the consulting room. “Doctor,” he says, “I have a bad pain.” “Where is it?” “Here.” “Stand up,” says the doctor, “and put your arms up above your head.” Then the doctor goes behind the patient and strikes him a powerful blow in the back. “Do you feel that,” he says. “I do,” says the patient. Then the doctor turns suddenly and lets him have a left hook under the heart. “Can you feel that,” he says viciously, as the patient falls over on the sofa in a heap. “Get up,” says the doctor, and counts ten. The patient rises. The doctor looks him over very carefully without speaking, and then suddenly fetches him a blow in the stomach that doubles him up speechless.161

Eventually the doctor stops beating the patient long enough to prescribe bed rest. Leacock’s cynicism about medical knowledge and professional conduct becomes obvious in the next few lines and pages. “In reality, of course,” he writes, “the doctor hasn’t the least idea what is wrong with the man; but he does know that if he will go to bed and

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keep quiet, he’ll either get quietly well or die a quiet death.” The author’s scorn for medical science was probably well deserved in 1910, but risible images of the physician surfaced in later works, even after Beatrix’s death and his attack on unconventional cancer treatments. In a 1944 collection of essays, Leacock depicts a patient, referred to as “the Contraption,” as the meek victim of a callous and contemptible practitioner. “Don’t be alarmed,” [trills the doctor]. “You may blow up on the street. But I don’t think so. I’m not much afraid of that. It’s possible that your brain will burst open at the sides. But I’m not alarmed if it does. If your eyes fall out on the street, let me know. … And above all,” concludes the doctor with a sudden burst of geniality that he had forgotten to use sooner, “don’t worry. You may blow up at any time, but don’t let that worry you. You may fall dead in a taxi, but I’m not alarmed if you do. Come back in next week.”162

When tests reveal nothing wrong, the doctor calls to cancel the appointment, only to learn that the patient has committed suicide. Although Leacock’s personal commitment to scientific medicine remained intact, he clearly knew that his audience would recognize and appreciate these unflattering images of the physician. Although regular practitioners enjoyed unprecedented respect and authority in the early twentieth century, their reputation suffered when it came to the management of neoplastic diseases. Doctors’ inability to diagnose cancer with any degree of certainty engendered doubts and fears among the laity, while deception, even when practiced by a limited number of physicians, diluted public confidence in the profession. Perhaps the words and experience of one sufferer, R.C., best capture the essence of popular ambivalence. Worried about a lump on one arm, the patient had consulted several physicians without finding relief or satisfaction and eventually wrote to the Ontario Department of Health for advice. R.C. continued to rely on the expertise of regular doctors, but was plagued by doubts about the ability and integrity of the medical profession: “I find either the Dr. dont like to tell you to [sic] much or they are not serious enough about it.”163

c h a n g e , c o n t i n u i t y, a n d c o m p l e x i t y : from beatrix to stephen leacock Throughout this chapter we have explored the contours of the lay perspective in order to better understand both its force and logic. Although lay attitudes often puzzled and frustrated educators, the public generally responded to illness in ways that were reasonable, if not

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always beneficial. The experiences and expectations of life informed popular perceptions of health, illness, and healing, and these perceptions, in turn, prescribed reactions to illness, to cancer, and to the medical profession. Because people expected to fall sick, for example, they were not immediately alarmed by illness. Instead, sufferers tolerated symptoms, sometimes dosing themselves with home remedies, until such time as pain or debility shattered their equanimity. In contrast, the prospect of cancer sent the public into a panic because many people assumed, quite rightly, that the disease was deadly. At the same time, the laity viewed the medical profession with a good deal of ambivalence, especially when it came to the management of neoplastic diseases. Many people worried that their doctors could neither diagnose cancer accurately nor treat it successfully. As with perceptions of illness and anxiety about cancer, doubts about the competence of physicians were frequently well founded. Experience and expectation thus forged broad patterns of belief and behaviour among the laity of early twentiethcentury North America. By focusing on the general outlines of the popular perspective, however, we have not yet come to terms with the particular experiences of the laity. As we might expect, the attitudes and actions of specific sufferers seldom conformed perfectly to the patterns described here. A fine example of the complex interplay of social attitudes and personal outlook can be found in the stories of Beatrix and Stephen Leacock. Although Stephen shared his wife’s battle with cancer before confronting the disease himself twenty years later, his views and reactions did not consistently mirror Beatrix’s, either in the midst of her illness or during his own. Differences in their reactions underscore the absolute centrality of personal experience, and may also hint at broader changes in the popular response to illness, just as affinities between their experiences may suggest the persistence of specific lay convictions about neoplastic diseases. In 1944, Stephen Leacock fell victim to cancer: a lifetime of pipe smoking had taken its toll and on 9 March he died of throat cancer.164 Much had changed in the years since Beatrix’s death. Researchers had gained a better understanding of cellular growth and metabolism while practitioners had improved diagnosis and refined treatment. Judging by Stephen’s reactions, some lay attitudes had evolved in response to these developments. Beatrix’s final illness spanned a long period of uncertainty, more than a year, during which time she and her family remained convinced that persistent fatigue was “normal.” They assumed that her symptoms would eventually disappear with sufficient rest. In contrast, Stephen’s sickness and his suspicions lasted a few weeks, per-

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haps a couple of months at most, before he sought the advice of a physician. Although he explained his initial fatigue as influenza, in much the same way that earlier sufferers attributed stomach pain to ulcers, he quickly recognized the seriousness of his condition. Moreover, Stephen was no longer content, as he had been during Beatrix’s illness, to endure debilitating symptoms in the expectation that rest would cure them. By the time a sore throat had become “something terrible in my throat,” he was in the care of his family doctor. Stephen’s prompt resort to medical aid bore the imprint of his experience with Beatrix’s illness: he would not make the same mistake with his own health that they had made with hers. But presumably twenty years of public education and thousands of intimate experiences with the suffering caused by cancer had had a similar effect on others. Stephen’s response thus suggests that the laity as a whole had become more aware of the threat of neoplastic diseases as well as far less willing to define illness as a “natural” part of life. His reliance on doctors could also imply greater popular confidence in the abilities of the medical profession. Yet popular fears about cancer and scepticism about conventional treatment persisted even in the face of new knowledge and better care. Despite the enormous efforts by doctors and agencies to convince the public that neoplastic diseases were curable, Stephen remained convinced that cancer killed. “They’re coming up here to tell me I’m finished,” he apparently told his son when a specialist arrived to examine him in January. Consistent with his deference for the medical profession and his faith in scientific medicine, Stephen submitted to the full arsenal of conventional treatments, but he held out little hope of recovery. Like many sufferers before him, he also seems to have drawn little comfort from his doctors’ efforts to combat the disease. “I know the death sentence is on me,” he told his son on the eve of a throat operation in March. “Oh, if only I can get used to the truth that I am going to die.” Popular dread of neoplastic diseases remained as keen in the 1940s as it had been in the 1920s. Moreover, Stephen’s experience with cancer justified the tenacity of popular fears and doubts. Twenty years earlier, Beatrix had died ostensibly because she waited too long to consult a physician about her health. By the time she appeared on her doctor’s doorstep, her days were already numbered, and exploratory surgery only served to reinforce the futility of further treatment. But Stephen faithfully followed the advice of educators: he consulted his family doctor when his health deteriorated; he accepted a referral to a specialist; he submitted to the full array of conventional treatments. In the end, however, he fared no better than his wife had done. Surgery and radiation therapy provided

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him with relief and the brief illusion of recovery, but he succumbed to the disease very swiftly, in a matter of months. Indeed, cancer seems to have claimed him more quickly than it did Beatrix. Thus, popular anxiety about neoplastic diseases persisted for very good reasons. Advances in the scientific understanding of cancer, improvements in both diagnosis and treatment, and years of public education did not save Stephen Leacock from the ravages of cancer. One of the most intriguing differences between Beatrix Leacock’s story and that of her husband is found not in their experiences of illness but in the handling of their deaths. In 1925, Beatrix’s obituary was one of a small handful that named cancer as the cause of death. In an era when obituaries generally preserved the privacy of the deceased and their families, this announcement was exceedingly unusual. Given his frankness about Beatrix’s death, we might have expected a similar candour to characterize Stephen’s obituary. But when the celebrated author passed away in 1944, death announcements and obituaries made no mention of the disease that claimed his life. Thus, twenty years after Beatrix’s death, when popular reticence about cancer was allegedly on the wane, Stephen’s final illness was treated with greater delicacy than his wife’s had been. To some extent, the differences between the two sets of obituaries say more about the families than they do about the victims. An intensely private person who had hoped to die at home among her loved ones, Beatrix might well have preferred to keep quiet about her illness. But in 1925, it was Stephen’s wishes that fashioned her obituary. We can only speculate about the reasons behind his decision to name the disease that killed his wife, but it is surely suggestive that within months of Beatrix’s death he had launched a campaign to drum up support for cancer research and education, and to drum “quacks” out of the business of cancer care. In announcing the death of his wife, Stephen may have felt that the demands of the public good should prevail over the dictates of privacy. Similarly, Stephen’s views on cancer and his own death took a back seat to the needs of his relatives and, as a result of his considerable fame, to the views of the press. Neither the Leacock family nor the journalists who reviewed Stephen’s life and death felt inclined to discuss the disease that had killed him. Whereas Beatrix’s obituary had been exceptional, Stephen’s reflected prevailing attitudes. In 1944, the desire for privacy and to celebrate the accomplishments of a lifetime still tended to eclipse the urge to disclose the cause of death of a loved one. The stories of Beatrix and Stephen Leacock provide us with a last glimpse of the lay perspective in all its captivating complexity. Although they illuminate the patterns of popular belief and behaviour,

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they also embody the limits of those patterns. More important, the Leacocks’ stories, like those of countless other sufferers, remind us that popular reactions had their roots in lived experience. Indeed, personal and social experience together endowed the lay perspective with legitimacy as well as extraordinary potency in the health culture of early twentieth-century North America. In the final analysis, the management of health and illness was a profoundly personal affair.

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2 The Problem of Cancer: Doctors, Scientists, and the Dread Disease

In 1924, the same year that Beatrix Leacock began to feel unwell, William Victor Johnston started to practice medicine in a small rural community in southwestern Ontario, not far from the shores of Lake Huron.1 He had completed his medical degree at the University of Toronto the previous spring, but like other physicians of his generation, he found that his formal training had given him only a rudimentary appreciation of disease and its management. Consequently, he spent the year following his graduation in the offices of two seasoned doctors, learning to diagnose and treat illnesses using a limited repertoire of techniques and agents. Established in his own practice, Johnston was soon absorbed by the relentless pace of rural medicine: he spent hours on the road in all kinds of weather, tending to patients in their homes, often in very primitive conditions. During thirty years of practice, he treated a wide variety of complaints, including some unusual ones, but a small array of ailments and accidents customarily claimed the bulk of his attention. In addition to a vast number of obstetrical cases, “the average rural physician … dealt with countless colds, much indigestion, many anemias, chronic bronchitis, and urinary infections. … [the] occasional suicide and abortion, a little madness, and much personal misery from worry and anxiety.” Rarely, very rarely indeed, did family doctors like Johnston encounter neoplastic diseases among their patients. We “might succeed in detecting [cancer] every three years,” he later recalled, “whereas nearly every day some patient complained of headache.” Despite his lack of exposure and experience, Johnston felt competent to manage the disease. Presented with suspicious symptoms, he some-

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times ordered x-rays, but more often relied on physical examination to make a diagnosis. Even in highly questionable cases, such as cancers of the digestive tract which were notoriously difficult to identify, Johnston placed great faith in palpation.2 After a single examination he once concluded that a patient with “a lump in his upper belly as large as my fist” probably suffered from “an incurable condition.” In the same way, Johnston approached the treatment of cancer with confidence. Difficult cases, those requiring extensive surgery or intensive radiation therapy, he sent to specialists, but many discrete or accessible lesions he treated in his office. He claimed, for instance, that the introduction of electro-cautery in the 1930s gave him such mastery over skin cancers that he “ceased to refer them to others.” Although Johnston believed in the value of conventional cancer treatments, he knew that none of them offered a sure cure. Indeed, much of the care he gave to cancer patients consisted of palliation of symptoms in the final stages of the disease. He stressed the importance of physical relief for the terminally ill, including “a well-made bed, a well-managed bath, appetizing meals, the careful rationing of visitors, cheerful surroundings, the relief of pain, the privilege of sleeping as long as desired and the best place to spend the last days.” Johnston also appreciated the value of emotional support for sufferers. In one case, he claimed that “my resources were taxed to the limit” by a patient dying from prostate cancer, but “I increased the frequency of my visits because I must not intensify his feeling of isolation and loneliness.” By his own account, Johnston succeeded in alleviating the worst suffering of his patients, helping a few to live and most to die with cancer. As with the Leacocks and public reactions to cancer, Johnston’s beliefs and behaviour cannot be construed as typical or representative of the medical community at large. Within the framework of conventional medical opinion and practice, ideas about neoplastic diseases and decisions about treatment varied greatly from one doctor to the next. Specialists, for example, approached the problem of cancer from a different angle than did general practitioners. Even other family physicians did not necessarily adopt the same tactics for diagnosis and treatment as did Johnston: personality and experience as well as the complement of available medical resources shaped each practitioner’s response to sufferers and their illnesses. Moreover, Johnston’s experience, like that of Stephen Leacock, was influenced by his elite status. Although he began his medical career as a country doctor, he eventually assumed a place of prominence in the medical community.3 He became the president of the Ontario Medical Association (oma) in 1949 and then led the drive to establish family medicine as a specialty, serving as the first executive director of the College of Family Physicians of

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Canada. Whereas most general practitioners worked in solitary obscurity, Johnston reaped the benefits of professional prestige and abundant collegial connections. Finally, we must approach physicians’ memoirs with a good deal of caution. Johnston wrote mainly about the early years of his medical practice, but his autobiography, published in 1972, bears the imprint of decades of subsequent experience. For all its drawbacks, however, Johnson’s account provides us with an illuminating introduction to modern medical culture and the management of neoplastic diseases in the early twentieth century. Although he portrayed himself as undaunted by cancer, he nonetheless appreciated the challenges it posed. In a chapter devoted to the subject of cancer, Johnston acknowledged the limits of medical understanding of neoplastic diseases.4 “We are in almost complete ignorance,” he wrote, “of how the normal body cell becomes cancerous and how it passes on its ungovernable powers of growth.” At the same time, Johnston regularly alluded to the shortcomings of conventional treatments. One of his most eloquent observations pertained to a man dying of rectal cancer: “He was one of many patients who did more for me than I could do for them.” Yet Johnston, like many other practitioners, refused to admit defeat, especially as a growing number of sufferers consulted him. Unable to cure the disease, he cast about for other ways to ease the distress of his patients. Gradually, he became convinced that his authority as a physician endowed him with special power to help victims. Sometimes he would discuss the disease candidly with patients and their families, offering them advice and kindly reassurance. Much of the time, however, Johnston concealed the diagnosis, arguing that by doing so he preserved the optimism of sufferers and enhanced their recuperative powers. He never doubted that he had both the right and the responsibility to decide what was best for patients. Indeed, he implied that professional identity as well as the welfare of patients hinged on the judicious exercise of medical authority: “The personal physician from his place on a pedestal must replace some of the fears with hope – even when all seems hopeless – or he is no physician at all.” Although this approach may have worked well for some doctors and their patients, it exemplified a more general dilemma facing the medical profession. Trust in doctors might benefit cancer sufferers, but such faith could be sustained only if practitioners disguised the limits of their expertise along with the disease. Johnston’s rather sanguine view of medical authority thus exposed one of the deepest incongruities of medical culture in the early twentieth century. In an era of expanding medical knowledge and expertise, in a period of growing support for scientific medicine, cancer undermined professional confidence and

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challenged medical authority. As one doctor observed, “In the wealth of medical literature in relation to cancer, there is great virtue; in the complexity of viewpoints which are constantly advanced, great weakness is manifest.”5 Authors writing about cancer for the general public usually depicted a calm, smooth pool of medical opinion. Even close scrutiny of this literature reveals only the tiniest eddies of doubt and discord. According to educators, most doctors believed that irritation, rather than heredity or infection, caused cancer; most agreed that early diagnosis, followed by surgery and/or radiation therapy, offered the best hope of recovery; and most maintained that, under the right circumstances, cancer could be cured. Undoubtedly, public-health literature emphasized the strongest currents of medical opinion in order to instill trust in the profession and ensure lay compliance with medical directions. A simple message, forcefully presented, could save sufferers by convincing them to consult a physician: a more complicated portrait of medical ideas might disturb and distract patients, thereby endangering their lives. But beneath the tranquil surface depicted in educational literature, the waters of medical opinion were turbulent. As clinicians and researchers discussed every aspect of the cancer problem, from the incidence and nature of the disease to the best methods of treatment, consensus proved exceedingly elusive. The uncertainty and disagreement evident in the medical discourse compromised professional authority as well as the management of neoplastic diseases. As we explore professional ideas and attitudes in this chapter, we will also consider the complex intersections of lay and medical perspectives. Some historians have treated popular and professional cultures as distinct, even adversarial. Writing about the history of the hospital, Charles Rosenberg describes the growing social and intellectual gap that separated doctors from their patients.6 Sheila Rothman likewise pictures a vibrant lay culture among tb sufferers, developing separate from and in opposition to the professional culture of public-health officials, doctors, and institutional staff.7 In the case of neoplastic diseases, however, the medical discourse reveals some intriguing affinities between the perspectives of doctors and patients. On the one hand, medical discourse sometimes supported lay beliefs. Although educators dismissed and derided popular convictions about contagion and heredity, for instance, both of these theories of cancer causation found their advocates in the ranks of the profession. On the other hand, professional reactions to neoplastic diseases sometimes mirrored those of the laity. Educators habitually berated the public for abandoning hope at the first sign of cancer, but practitioners treating the disease also

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struggled with despair. Patients and doctors certainly did not agree about every aspect of cancer care, but the synergy of their views shaped both the personal and the social response to neoplastic diseases.

medical interpretations of cancer statistics At the turn of the twentieth century, neoplastic diseases did not pose a serious threat to public health, at least not by comparison with the dangers of infectious diseases such as tuberculosis, diphtheria, and pneumonia. By the late 1920s, however, cancer and heart disease had overtaken contagious ailments as the leading causes of death in North America.8 “While we can legitimately claim that the death rate from tuberculosis has been halved during the past thirty years,” wrote a professor of pathology, “in a similar period the death rate from cancer has been increased by at least one-half.”9 Although there were periodic shifts in the prevalence of one type of cancer over another, total mortality climbed steadily. In 1925, for example, 3,000 cancer sufferers in Ontario died; ten years later, the annual total had risen to more than 4,000.10 Nor was this increase merely a function of an expanding population because death rates as well as the death toll mounted throughout the first half of the twentieth century. In 1900, neoplastic diseases killed an average of 55 people for every 100,000 residents living in Ontario; thirty years later the annual rate of cancer deaths in the province had doubled.11 American statistics followed the same trend. Between 1900 and 1930, the death rate from cancer in the United States rose from 64 to nearly 100 per 100,000 residents.12 The rising tide of cancer deaths contributed to the sense of panic among the laity. “It is a disease that is gaining ground every year,” wrote one woman, “and it seems there has never been a cure found for it yet and I would be right glad if there was.”13 The medical profession likewise viewed the soaring death toll with alarm. Doctors and researchers began to devote more attention to neoplastic diseases and their findings appeared more frequently in the medical journals. From a few dozen articles at the turn of the century, the international literature on cancer mushroomed by the middle of the 1920s to include hundreds of studies and reports annually.14 Professional concern coupled with spiralling death rates seemed to offer conclusive proof that cancer was increasing, but the significance of statistical evidence became the subject of heated debate in both Canada and the United States. As one doctor observed, “In the light of all that is being said and written about this subject, it seems platitudinous to assert that cancer is increasing and that something ought to be done about it. Nevertheless, this

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statement needs reiterating and pressing home … [because] whether the increasing number of deaths from cancer is merely statistical or represents the actual state of affairs has been and still is being debated.”15 Two main interpretations of cancer statistics prevailed in medical literature. Some clinicians and researchers maintained that the increase in cancer mortality was more “apparent” than “real”: they argued that neoplastic diseases were not actually claiming more lives than they had in the past, but improvements in diagnosis and record-keeping made the medical profession and the public more aware of cancer deaths.16 The Ontario Department of Health explicitly endorsed this explanation of mortality statistics in a pamphlet published in the early 1930s: “It goes without saying that the increase in recorded incidence [of cancer] is due to some extent to better diagnosis of the disease, rendered possible by the wider use of diagnostic aids [such] as X-Ray, et cetera.”17 Other doctors and scientists disagreed with this interpretation, claiming that cancer statistics accurately reflected the spread of neoplastic diseases. Frederick Hoffman, one of the leading medical statisticians in North America, argued that cancer was on the rise in both Canada and the United States. “It lies outside the realm of reasonable probability,” he insisted, “that this increase as indicated by statistics would not be in approximate conformity to the actual facts of the situation.”18 Alexander Primrose, a surgeon and dean of the Faculty of Medicine at the University of Toronto, concurred, urging his medical colleagues to intensify their efforts to combat cancer in light of statistical evidence that the disease was gaining ground. “We cannot close our eyes to the fact that cancer is unquestionably on the increase,” he concluded. “We must strengthen our effort to fight the dire enemy of humanity with all the resources at our command.”19 In the years leading up to World War ii, the conflict between these two interpretations of cancer statistics remained unresolved. Historian James Patterson concluded that as early as the 1930s in the United States, “statisticians had apparently debated the question to a standstill. Those people who took the trouble to follow the arguments, which appeared mainly in specialized journals, could not easily determine which side was correct.”20 While medical reactions to cancer statistics exposed a rift in medical opinion, they also captured a certain defensiveness among practitioners and researchers confronted by the proliferation of the disease. Countless other ailments, from tuberculosis to diabetes, yielded to medical expertise in the early twentieth century, but cancer stubbornly resisted every effort to understand or cure it. Professional failure to control the disease seemed to demand an explanation. Interestingly, whether doctors accepted cancer statistics as evidence of a “real” increase in the disease or dismissed the numbers as

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misleading, they adopted a similar strategy to explain cancer mortality. On the one hand, W.A. Scott, chief of obstetrics and gynecology at Toronto General Hospital, maintained that cancer seemed to be spreading because physicians were getting better at identifying it. Although more and more people died each year from neoplastic diseases, he also insisted that therapeutic innovations had improved the chances of surviving cancer. “The prognosis of the disease,” he wrote, “is better to-day than at anytime in the past.”21 On the other hand, Madge Thurlow Macklin, a geneticist at the University of Western Ontario, argued that cancer was actually increasing, but only because doctors and scientists had succeeded in eliminating many other causes of death. People “are not dying of infectious diseases as they would have done formerly,” she observed. “Therefore they have to die of something else.”22 Thus as the rising tide of cancer deaths cast doubt on the power of scientific medicine, clinicians and researchers sought to salvage their authority by invoking the rhetoric of progress. “Cancer is increasing as a cause of death,” concluded Macklin, “because we are preventing people … from dying of the many forms of death that formerly claimed them.”23

e e n y, m e e n y, m i n e y, m o : medical views on the causes of cancer As we saw in chapter 1, educators pounded home the message that cancer arose from tissue damage, and since competing explanations of neoplastic diseases rarely surfaced in popular and public-health literature, readers had the impression that doctors understood and agreed about the causes of cancer. But while the largest proportion of practitioners and researchers subscribed to the theory that neoplastic diseases began as local conditions in tissues weakened by chronic irritation, a minority believed that additional or different factors played a role in the onset of cancer. These physicians and scientists suspected that constitutional flaws or systemic disorders rendered some people prone to neoplastic diseases. As a result, a lively debate over the finer points of cancer causation took shape in the medical literature. And just as the public based its beliefs on observation and experience, so the medical and scientific communities marshalled empirical evidence to support conflicting interpretations of neoplastic diseases. According to the local theory, cancer began when cells subjected to chronic irritation developed a capacity for excessive growth.24 As these abnormal cells proliferated they interfered with adjacent tissue, eventually producing a cancerous lesion. Left untreated, the disease could spread as cells migrated from the original growth to other parts of the

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body.25 Indeed, manuals advised doctors to handle tumours with extreme gentleness, lest in the course of an overly enthusiastic examination they dislodged some of these renegade cells.26 In support of their views, proponents of the local theory pointed to a wealth of data linking cancer with chronic tissue damage: bad oral hygiene and the use of tobacco created an environment conducive to neoplasms of the lips, tongue, and gums; cancers of the uterus and cervix appeared more often in women whose reproductive organs had been damaged while giving birth.27 Moreover, the connection between chemical exposure and neoplastic diseases justified concern about local irritants. As early as the eighteenth century, investigators had noticed that chimney sweeps developed cancerous lesions of the scrotum much more often than did men employed in other industries. Workers exposed to tar and aniline dyes likewise showed elevated rates of skin cancer.28 Although they stressed the importance of local factors, advocates of this theory were not unmindful of other influences, particularly heredity, in the inception of neoplastic diseases. James Ewing, one of the most prominent cancer experts in North America, observed rather wryly that “If the incidence of cancer is not affected by heredity then cancer is one of the few diseases not so influenced.” Nonetheless, like many others, Ewing maintained that in the absence of localized tissue damage, heredity could not be considered a significant causative agent. “Clinical observations,” he wrote, “are practically uniform in the conclusion that a family history of cancer does not materially add to the liability to the disease … subjects will not develop cancer if they escape exposure to these exciting factors.”29 On the other side of the debate was a smaller group of physicians and researchers who believed that systemic factors figured prominently in the etiology of cancer. Their scepticism about the local theory arose in part from the limits of its explanatory power: trauma and chronic irritation alone, they argued, could not account for variations in the incidence of neoplastic diseases. For instance, occupational carcinogens, such as tar, did not consistently produce cancer. Although workers in specific industries appeared to be at greater risk, many endured massive and prolonged exposure to noxious chemicals without developing neoplastic diseases. Similarly, smokers did not succumb predictably to lung or lip cancer, nor did all mothers develop lesions of the uterus or cervix.30 Moreover, these doctors and scientists pointed out that local agents could not account for the preponderance of cancer in certain families. “Chronic irritation may be a good talking point,” concluded Madge Thurlow Macklin, “if we explain its limitations, [but] it is a dangerous one if we lay all the stress upon that to the exclusion of other factors.”31 Proponents of the systemic theory argued

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that metabolic disorders or constitutional defects better explained the etiology of cancer. Studies of animal and human subjects, they claimed, revealed the importance of inheritance. At the University of Chicago, geneticist Maud Slye observed from her experiments with mice that “hereditary predisposition bears a definite relation both to the tendency to be exempt from cancer and the tendency to be susceptible.”32 Macklin reached a similar conclusion from her investigation of neoplastic diseases in human twins.33 At the same time, research on growth and reproductive hormones suggested that an endocrine disturbance might contribute to excessive, aberrant tissue growth in some patients.34 Medical interest in contagion theory, which fit neither the local nor the systemic paradigm, further complicated the bewildering array of explanations for cancer. As we have seen, educators vigorously denied the notion that neoplastic diseases began with an infection. They promised the public that contact with a sufferer could not result in contamination. “There is no case recorded,” wrote one author, “in which a surgeon has contracted cancer from operating on a patient suffering from it or a nurse has contracted it after months of the closest care of a patient. This being true, it does not stand to reason that members of the family or friends are in any danger.”35 Despite these calm assurances, however, the medical discourse on cancer contained a wealth of data and opinion in support of infection.36 Indeed, given the enthusiasm for the germ theory that prevailed in scientific and medical circles, it would have been curious not to find doctors and scientists searching for carcinogenic microbes. Although bacteriological studies proved disappointing, investigators explored the possibility that an ultramicroscopic organism, a virus, was responsible for cancer. Early research by Peyton Rous, an investigator at the Rockefeller Institute in New York, suggested that a virus caused chicken sarcoma. His work garnered little attention, however, until the 1920s when William Gye of the Imperial Cancer Research Fund in England claimed to have cultured a microorganism capable of stimulating tumour growth. According to historian Joan Austoker, “At a time when the study of tumour viruses was considered to be nothing but an esoteric pursuit, his theories … stimulated a revival of interest in the subject.”37 Canada’s Frederick Banting, for instance, joined the search for carcinogenic microbes after a visit to Gye’s laboratory. For several years, he studied chicken sarcoma, hoping for a conceptual or technical breakthrough comparable to the discovery of insulin.38 As with every other explanation for cancer, contagion theory did little to clarify or unify medical opinion because it attracted both critics

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and adherents. However, the discourse on infection did expose the fluid, even erratic, nature of medical ideas about cancer. James Ewing, for example, wrote eloquently and at length about the role of local irritants in neoplastic diseases. He had little patience for hereditarian explanations and none at all for contagion theory. But Ewing was not content merely to attack the theoretical and methodological flaws of bacteriological studies: instead, he chose to reinterpret them, without obvious justification, in light of his own views on carcinogenesis. “It may well be,” he concluded, “that various microorganisms play a part in the complex types of chronic irritation which we know give rise to cancer in various parts of the body.”39 More dubious still were the mental gymnastics of William Gye. Engaged in research on transmissible tumours, Gye discovered that the solutions of virus he used for inoculation did not always produce cancer. Faced with this challenge to his theory, he “hastily concluded” that the disease developed only in the presence of a second “specific chemical activator” that undermined cellular defenses.40 He maintained that the virus itself was universal to all neoplasms, but argued that the constitutional element was specific to species, individuals, and perhaps even tissues. In other words, while a virus obtained from a mouse would only produce cancer in another mouse unfortunate enough to possess the second factor, the same virus could induce cancer in a chicken that harboured the element specific to avian tumours. Without any evidence whatsoever, Gye tried to marry hereditarian notions of cancer with contagion theory in an effort to explain discrepancies in his research as well as the variable etiology of neoplastic diseases. While the causes of cancer remained a mystery, rampant speculation flourished alongside serious, meticulous study of the disease. Every extant model of somatic disease, from germ theory to genetic theory, was invoked to explain cancer, but because none proved entirely satisfactory, doctors and scientists fought endlessly about competing interpretations. Deep, sometimes bitter, divisions emerged in the medical and scientific communities as allegiances and reputations were called into question. In a 1925 review, for instance, Ewing mocked those who continued to believe in cancer contagion, warning his readers not to “forget the hazards which encompass anyone who nowadays ventures to espouse the parasitic theory.”41 Moreover, controversy and confusion about the etiology of neoplastic diseases sapped the confidence of doctors and their research colleagues. As one physician concluded, “In the dark shadow of our ignorance as to the cause of new growths, … a feeling of despair [has] paralyzed our endeavour along this melancholy road.”42

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t h e ory v e rs u s p r ac t i c e Doubt and disagreement about the causes of cancer, in turn, compromised clinical management of the disease. As one Ontario doctor wondered, “How on earth are you going to treat these cases if you have no idea what the cause is?”43 Some practitioners took an active interest in the discourse on cancer etiology, contributing their own speculations or observations, but most simply found themselves wading through the mire of ideas and opinions presented in professional journals. Like the laity, doctors favoured explanations that made sense of their own experience with neoplastic diseases. Theories with immediate clinical relevance consequently won the approbation of the profession while more abstract interpretations attracted scant attention. At least some physicians must have shared the popular conviction that cancer ran in families because educational literature aimed at the profession repeatedly denounced the role of heredity. A manual for practitioners, produced by the ascc and adopted by the Ontario Department of Health in 1922, instructed doctors that “inheritance may, as a rule, be disregarded.”44 Although it is impossible to know whether or not physicians bowed to these kinds of injunctions, it is clear that they had little time for a theory with limited clinical significance. Maud Slye’s research pointed up the serious limitations of genetic explanations for cancer. Through a series of selective matings, she managed to establish a strain of mice resistant to neoplastic diseases, thereby demonstrating conclusively the influence of inheritance. Carried away by enthusiasm, Slye prescribed similar techniques for the control of cancer in human subjects. “By the right matings,” she wrote, “just as I have eliminated the disease from hundreds of families in the laboratory, so it may be possible to eliminate cancer from human families.”45 Slye’s solution had dubious clinical value: even if doctors had dared to ask patients to breed selectively, most would have reproduced before it was known whether they were prone to cancer. Madge Thurlow Macklin offered a more practical application of inheritance theory.46 She argued that individuals susceptible to cancer could be identified through genetic studies, monitored by their family physicians, and treated at the earliest opportunity, thereby improving their chances of recovery. Yet Macklin’s views also generated little enthusiasm in the ranks of the medical profession, at least partly because doctors privileged curative over preventive measures. In the end, pragmatic considerations probably sealed the fate of genetic explanations for cancer. As one doctor concluded, “Whatever view may be taken regarding the part played by heredity in the production of cancer, it becomes obvious that this factor may be ignored. It is beyond our control.”47

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In the same way, contagion theory attracted few adherents because it offered few solutions for the problem of cancer. Belief in the infective nature of neoplastic diseases inspired some doctors to explore the therapeutic potential of vaccines and anti-toxins. At the turn of the century, William Coley, an American practitioner, experimented with solutions of the bacterium responsible for erysipelas.48 In the 1920s and 30s, Canadian physician Thomas Glover claimed to have discovered a “pleomorphic” organism responsible for neoplastic diseases. For a time, his serum treatments excited considerable interest as well as controversy in scientific and medical circles.49 Rous and Gye, as we have seen, encouraged enthusiasm for viral studies. Yet none of these investigations or speculations provided physicians with a reliable weapon to treat neoplastic diseases. Research on the viral origins of cancer seemed promising, but it remained confined to the laboratory and experimental animals. Investigation of the bacterial origins of cancer, in contrast, generated a host of treatments, but none of them provided consistent relief to patients.50 Although contagion theory intrigued many practitioners, it did not serve as a guide for clinical care. Some of the same limitations diminished professional interest in the metabolic theory of cancer. One of the most promising lines of research to emerge in the 1920s and 30s dealt with the carcinogenic properties of growth and reproductive hormones.51 Estrogen, in particular, was implicated in the onset of breast cancer. But endocrine therapy involved serious complications for practitioners. While it might be acceptable to remove the ovaries of an experimental animal in the interests of protecting her against breast cancer, neither women nor their doctors would easily countenance the same course of action. Moreover, hormones were essential for normal growth and function; even dangerous ones could not simply be eliminated without serious health consequences for the patient. Indeed, a 1938 manual on cancer, published by the Canadian Medical Association (cma), hastened to reassure physicians that “there is no danger in the use of oestrogenic hormones in practice, since large doses over a longer period of time are necessary to produce a tumour.”52 Perhaps as a result of these problems, hormonal treatments for cancer remained largely experimental prior to the Second World War.53 Metabolic theory encouraged physicians to ply a baffling assortment of chemicals in the treatment of cancer. Doctors prescribed vitamins and minerals to redress deficiencies allegedly associated with neoplastic diseases, and administered noxious substances, such as gold, arsenic, and benzene, in the hopes of interrupting the metabolic processes that supported tumour growth.54 Although some researchers and practitioners described remission of the disease following these treatments,

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generally chemotherapy caused as many problems as it claimed to cure. Blair Bell’s lead treatment, which Stephen Leacock tried to secure for his wife, Beatrix, exemplified many of the problems associated with metabolic therapies. According to early reports, most of Bell’s patients responded to the intravenous administration of colloidal lead: twenty per cent allegedly recovered from cancer, while another eighty per cent enjoyed temporary improvement.55 When other researchers tried to duplicate these experiments, however, their results were far less encouraging. Most patients suffered “severe symptoms of poisoning,” including nausea, vomiting, fevers, anemia, and exhaustion, before they succumbed to the disease.56 Metabolic studies, like research on infection and inheritance, aroused little lasting interest because they produced few reliable treatments for cancer. As with patients and the public, professional support for the theory of tissue trauma eclipsed interest in every other explanation of neoplastic diseases. According to Macklin, “We find the idea that injury is a basic factor deeply ingrained in the profession as well as in the laity.”57 Even more than injury, chronic irritation loomed large in the medical discourse on cancer etiology. In some ways, it is difficult to decipher medical enthusiasm for this theory because it was no more plausible than any other explanation. Indeed, much of the time, doctors and scientists presumed rather than proved that a link existed between tissue trauma and neoplastic diseases. As with popular reactions, professional convictions arose from observation and experience. Physiologist James Miller noted that experimental work with laboratory animals and epidemiological studies of carcinogenic chemicals solidified medical confidence in the role of irritants in neoplastic diseases. Yet extreme variations in the incidence and onset of the disease should have cast doubt on the theory of tissue trauma. Among “mule spinners,” Miller noted, the time from first chemical exposure to the development of the disease could be as short as ten years or as long as sixty-three.58 Moreover, the mechanism that ostensibly triggered the transformation from benign to malignant conditions remained obscure.59 The evidence in support of tissue trauma hardly warranted the confident, commanding tone adopted by educators of the public and the profession. Despite its weaknesses, however, this explanation of neoplastic diseases appealed to doctors at least partly because it restored some semblance of medical authority. If cancer began as a local disorder in tissues long traumatized by chemical or mechanical irritants, then both prevention and cure theoretically fell within the grasp of the medical profession. Practitioners could counsel their patients to relinquish dangerous habits that might provoke cancer; they could also remove suspicious lesions that might eventually mature into neoplasms. At the same

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time, doctors could treat cancer effectively through early diagnosis and the rapid, radical elimination of diseased tissue. As the cma’s Handbook on Cancer declared: “while admitting that up to the present we do not know what causes the body cells to take on the characteristics of malignancy, and also that we do not know the antidote to those influences, we do know that if all the malignant cells can be removed or destroyed cures can be established that will allow our patients to live in comfort through the normal span of life.”60 Medical support for the theory of chronic tissue damage was thus thoroughly pragmatic. Competing interpretations of cancer offered little guidance for physicians confronted by a relentless killer, but local tissue trauma provided a rationale for surgery and radiation therapy, the only weapons against cancer available in the years before World War ii 61 A.G. Nicholls, editor of the cmaj, consciously endorsed the local theory because it represented the most “rational” response to neoplastic diseases. “There can be no doubt also,” he concluded, “in the light of our present knowledge, or, rather, ignorance, that this is the most useful position to take.”62

from diagnosis to prognosis: the medical management of neoplastic diseases In 1926, an article in the Canada Lancet and Practitioner urged doctors to keep abreast of theoretical developments in the field of cancer research. “While practicing physicians are primarily interested in the diagnosis and treatment of disease,” wrote the author, “they should constantly keep in mind that the etiology is of the greatest moment, since if the cause is discovered the cure will surely and quickly follow.”63 As we have seen, although scientists and some doctors were deeply interested in questions of cancer causation, most physicians ignored the debate over etiology because it had limited clinical relevance. Moreover, while researchers and practitioners worked or waited for a cure, the threat of cancer continued to grow. Eager to find new and better ways to control the disease, the medical profession debated the relative merits of diagnostic and therapeutic techniques. As with discussions of incidence and etiology, the discourse on cancer care revealed deep uncertainty as well as deep fissures in medical opinion. Diagnosis In the absence of a sure cure for cancer, early detection became the mantra of the medical profession. Doctors routinely proclaimed the

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importance of early diagnosis when addressing their colleagues as well as the general public. “It is only by having cancer as our first thought,” wrote one physician, “that headway can be made in the cure of malignant diseases.”64 Yet many factors militated against the possibility of early diagnosis. The disease itself made definitive diagnosis difficult. Developing slowly and insidiously, neoplastic lesions often assumed threatening proportions before sufferers appreciated the presence of disease. Moreover, early symptoms of cancer mimicked those of more benign conditions. Roscoe Graham, a prominent Toronto surgeon, reported an eighteen per cent error in the identification of gastric carcinoma because doctors assumed they were dealing with ulcerative conditions rather than neoplastic diseases.65 General practitioners like William Victor Johnston probably had the most trouble diagnosing early lesions because their training and experience did not prepare them for the task. Medical schools and textbooks, Johnston recalled, taught doctors only “the distinctive and typical symptoms of cancer, and by the extent to which they are typical they are the symptoms of cancer which is no longer early.”66 Medical practice did not improve the skills of family physicians, at least when it came to the diagnosis of neoplastic diseases. “Even the busiest of them,” observed Nicholls, “may not see more than two or three cases of cancer in a year. Their recollection and appreciation of the early symptoms of cancer may consequently have become dim.”67 Yet specialists also faced serious obstacles to the early identification of neoplasms. Graham remarked that “All surgeons have been humiliated by their inability, even with the abdomen open and the opportunity to palpate the ulcer, to state definitely whether they are dealing with a benign or malignant gastric ulcer.”68 Although doctors continued to proclaim the “gospel of early detection,” many elements combined to undermine the possibility and therefore the value of this approach to cancer.69 According to a 1922 medical manual on cancer, “the more certain the diagnosis the less the probability of cure.”70 Unfortunately, the limits of medical knowledge and expertise were not the only professional obstacles to the diagnosis of cancer: differences of opinion and tensions among practitioners also interfered. Three diagnostic methods prevailed or emerged in the first half of the twentieth century: clinical examination of patients; radiological examination of organs; and histological examination of tissues. As with theories of cancer causation, each of these approaches had supporters and detractors. Clinical evaluation, the oldest method, consisted mainly of observation and palpation: doctors would examine lesions and feel lumps in an effort to assess the nature of a patient’s condition. Practitioners like Johnston relied heavily on physical examination in part be-

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cause they lacked ready, easy access to more sophisticated techniques. Although Johnston himself seemed unperturbed by the limits of his diagnostic resources, other physicians worried a good deal about dependence on clinical examination, particularly among general practitioners. E.M. Eberts, a surgeon at Montreal General Hospital and lecturer at McGill University, concluded that late diagnoses often arose from the negligence or ineptitude of family physicians. “In a large percentage of cases,” he wrote, “the prognosis [for cancer] rests with the man who first sees the case yet how often the examination to which the patient is subjected is perfunctory and inadequate, and the advice given wholly worthless … [with the result that] a fair prospect of permanent cure has been blotted out because the practitioner to whom the patient applied did not appreciate his responsibility.”71 Although Eberts’ attack was unusual in the medical discourse on cancer, it nonetheless exposed the frustrations engendered by neoplastic diseases as well their impact on collegial relations. After the turn of the century, x-rays gained popularity as a diagnostic tool. Radiological tests allowed practitioners to peer inside the bodies of their patients without resort to anesthesia and surgery. One article described radiological diagnosis as a superior technique: “The more one sees of the x-ray the more convinced one becomes that it will often provide information with an accuracy to which the physical examination does not attain.”72 Radiography seemed especially promising for the diagnosis of internal cancers, such as those of the digestive tract which were among the most common and most lethal.73 But despite the apparent advantages of x-ray diagnosis, not all doctors approved of it. The reliability of radiographic diagnoses depended to a large degree on the quality of films taken and the interpretive skills of the radiologist. Despite improvement in the technology and mounting experience among practitioners, the veracity of a radiographic diagnosis could not be taken for granted. As one surgeon concluded, x-rays were not “infallible.”74 Some practitioners consequently chose to play it safe, recommending exploratory surgery regardless of the results of radiography. “I feel very strongly,” wrote one doctor, “that in all cases of chronic gastric disorder appearing after the age of forty, … the abdomen should be opened and the stomach exposed.”75 Professional rivalries further complicated disagreements about the use and value of radiography. While specialists like Eberts derided the abilities of general practitioners, many family doctors were sceptical about the skills of the radiologist. “It has been said,” quoted one physician, “‘Don’t believe all that the roentgenogram says, nor all that the roentgenologist says that it says.’ We all know that patients have been sent to the operating table because some roentgenologist … diagnosed appendicitis,

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gall bladder trouble, duodenal ulcer, etc, when nothing of the kind existed.”76 At the same time, radiologists found it frustrating to watch doctors dabbling with x-ray technology. They complained that films submitted by general practitioners were often “so poorly taken that it is almost impossible to make from them any trustworthy observations.” Although technological shortcomings limited the value of x-rays in the diagnosis of cancer, disputes among physicians also compromised the use of radiological examination.77 By the 1920s, histological examination had joined the list of diagnostic techniques available to physicians. Doctors would perform a biopsy, surgically extracting a small portion of the questionable lesion for evaluation by a pathologist. According to proponents, “the accurate diagnosis of malignancy must, in the present state of our knowledge, depend upon a study of the histological characteristics of the tumour.”78 Yet as with every other diagnostic procedure, tissue analysis became the subject of debate. Although pathologists insisted on the safety of biopsy, many doctors hesitated to cut into growths, fearing that any disturbance of the lesion would encourage the disease to spread.79 Moreover, tissue analysis did not always provide a definitive diagnosis: even at the cellular level, early cases of cancer could be puzzling. Consequently, some physicians questioned the value of biopsy. At the same time, professional attitudes coloured reactions to histological examination. W.L. Robinson, a pathologist at the Toronto General Hospital, noticed that many practitioners submitted tissue samples without a case history, hoping to get an “objective” assessment of their patients’ health.80 The end result, however, was not so much an unprejudiced as an uninformed opinion because the absence of clinical information hindered the pathologist’s efforts to reach a decision in difficult cases. Robinson roundly criticized such practices, arguing that “the diagnosing of tumours should not be allowed to degenerate into a game of mental gymnastics or a battle of wits between the clinician and pathologist.” Even when practitioners accepted the advisability of biopsy, they did not always accept the pathologist as a partner in the management of neoplastic diseases. The Dynamic Duo: Medical Discourse on Cancer Therapies During the first half of the twentieth century, only two treatments, surgery and radiation, received the official sanction of the medical profession. Many experimental and unconventional therapies emerged in these years, sometimes exciting considerable professional interest, but doctors invariably fell back on surgical procedures and radiological techniques. Educational campaigns aimed at the profession privileged

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these therapies while public-health literature warned readers to avoid all other remedies.81 In this way, medical opinion on cancer therapies appeared seamless and unruffled. As with theories of cancer causation, however, the medical discourse on treatment exposed the doubt and discord that plagued the management of neoplastic diseases. Although doctors routinely utilized surgery and radiation to treat their patients, they knew that neither offered a sure cure for cancer. Consequently, they engaged in heated debates about the strengths and weaknesses of these therapies. “The discussion of the appropriate treatment for cancer,” observed one practitioner, “is a subject fraught with difficulty because of the room that exists for great divergence of opinion.”82 Disagreements about treatment sometimes degenerated into professional wrangling, undermining the credibility as well as the authority of regular doctors. For centuries, surgeons had virtually monopolized the treatment of neoplastic diseases and they continued to dominate in the years leading up to World War ii. According to Douglas Quick, a surgeon at Memorial Hospital in New York, “operative surgery plays a role somewhere in the course of the average case of cancer.”83 Radical surgery, involving extensive excision of diseased and healthy tissue, was widely advocated and practiced in this period. Surgeons dealt with breast lesions, for instance, by removing “a wide area of skin, the underlying breast, both pectoral muscles, fascia and the axillary contents.”84 Similarly, doctors prescribed complete ovario-hysterectomy for cervical and uterine cancers, and routinely treated cancers of the large intestine with colostomy, the creation of an artificial opening in the abdominal wall for the evacuation of the bowels.85 In cases of bone tumours, one physician declared, “I favour prompt amputation.”86 Surgeons treated cancer aggressively in the hope of eradicating the disease before it could spread, but even in advanced, terminal cases, surgery had palliative value. Gordon Murray, a renowned Canadian surgeon, developed an operative technique for esophageal cancers: although patients still succumbed to the disease, many could at least swallow and eat in the last months of their lives.87 By comparison with surgery, radiation therapy was a brash upstart, appearing only at the very end of the nineteenth century.88 Nevertheless, practitioners quickly appreciated the therapeutic potential of radiation. Within months of William Conrad Roentgen’s discovery of x-rays in 1895, doctors had appropriated the new technology for the treatment of cancer. Three years later, Marie Curie isolated radium, giving practitioners yet another weapon against neoplastic diseases. Radiation therapy took a variety of forms. X-rays, produced by passing highvoltage electrical currents through vacuum cathode tubes, required

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large and sophisticated equipment. Patients typically reclined on a table underneath the machine for varying lengths of time with the cone of the x-ray tube pressing on their bodies. Radium treatments could be applied in a similar manner, by means of a “pack” or “bomb” containing a considerable quantity of the element. More often, however, small amounts of radium and radon, a gaseous emission of the element, were compressed into capillary tubes of glass, silver, gold, or platinum, and applied to the lesions. Depending on the nature of the cancer, these “seeds” might be driven directly into the growth or embedded in molds or plaques to be affixed to the patient’s body. Although doctors could not explain the action of radiation, they watched it work miracles in some types and cases of cancer. Moreover, like surgery, radiation therapy sometimes provided palliative relief to sufferers in the final stages of the disease, eliminating foul discharges and easing pain. As a result, one practitioner concluded that “the role played by radiation in the treatment of malignant disease is one of increasing importance, both on the preventive and curative sides.”89 In a number of ways, radiation therapy and surgery had much in common. Although surgeons removed cancerous cells while radiotherapists destroyed them in situ, both used treatments that directly attacked neoplastic lesions, in keeping with the local theory of carcinogenesis. Moreover, in some instances, these therapies could be complementary. For example, x-rays could help to reduce the size of growths prior to surgery, making thorough excision easier. Radiation could also be applied post-operatively to destroy cells missed by the scalpel. At the same time, radiotherapists depended on the surgeon’s skill to give them better access to lesions. Radium needles implanted directly in growths, on the surface or deep within the bodies of patients, proved more effective than surface application of radiation for certain types of cancer. Some doctors clearly appreciated the potential of professional cooperation in the management of neoplastic diseases. One physician insisted that the treatment of cancer “is a joint problem. It requires the close collaboration of the physician, the surgeon, and the radiologist in the earliest diagnosis, … and resultant joint decision as to how best to treat the individual.”90 Yet, once again, not all practitioners shared one perspective. Reservations about the safety and efficacy of each therapy led many doctors to endorse one treatment approach over the other. Professional competition also figured in medical disputes about cancer care. Having long dominated the treatment of neoplastic diseases, surgeons naturally regarded radiation therapy with some suspicion. Enthusiasm for the new technology, they argued, had led to the indiscriminate use of x-rays and radium. One doctor claimed that

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promising reports had prompted practitioners “to treat promiscuously every type of disease known, with results that are either negative or harmful in the great majority of cases.”91 Moreover, excitement about this new technology tended to overshadow both the limits and dangers of radiation therapy. Many cancers simply did not respond to x-ray or radium treatment, being inaccessible or insensitive to the action of radiation. One radiotherapist admitted that fewer than fifty per cent of all neoplasms could be treated successfully with radiation.92 The effects of exposure could be exceedingly unpleasant as well: patients commonly experienced nausea, vomiting, diarrhoea, inflammation, burns, and pain. In most cases, these symptoms subsided during the course of treatment, but occasionally they persisted for weeks, months, and even years. For example, radiation therapy sometimes interfered with healing once the cancerous lesion had disappeared. One woman struggled for years with an open wound following treatment of a growth on her back.93 In the most extreme cases, radiation could transform a relatively benign condition into a virulent neoplasm.94 Ultimately, those who preferred surgery for the treatment of cancer argued that radiation should not be relied upon because its action was mysterious, unpredictable, and dangerous. As one surgeon told his colleagues: “I would not use radium upon any consideration whatsoever, because I know nothing about its use, and I am satisfied that very few individuals do.”95 Practitioners convinced of the value of radiation bridled at these criticisms because, as they argued, surgery entailed many of the same hazards and shortcomings. In cases of gastric carcinoma, for instance, a significant proportion of patients died from the operation rather than from the effects of cancer.96 Although radiation therapy demanded a considerable degree of knowledge and skill, surgery also required extensive training and experience to be safe as well as successful. Moreover, as with radium and x-rays, surgery was neither possible nor advisable in every case of cancer: growths had to be accessible to the surgeon’s knife as well as discrete enough for complete extirpation. Supporters freely admitted that radiation therapy was based “largely upon experience gained from empirical dosage and upon knowledge acquired through trial and error,” but they insisted that the advantages of this technology frequently outweighed its dangers.97 Cancers of the lip, for instance, proved especially responsive to radiation therapy.98 Indeed, proponents of this treatment argued that radiation sometimes offered superior results to those of surgery. Radiologists ran less risk of disseminating the disease because they did not cut into growths or lesions, and the therapy generally caused less mutilation or functional impairment than operative techniques. Whereas surgeons treated lesions of the larynx by radical resection, robbing patients of the ability

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to speak or even swallow, radiation therapy had the potential to save the voices as well as the lives of these sufferers.99 One clinician claimed that the outcome of surgery seriously impeded patient confidence and compliance: “There is little doubt, … that if it were generally known that surgery is not the only treatment for cancer, there would be less hesitation amongst the laity in seeking medical advice at earlier stages of the disease.”100 To some extent, these competing perspectives arose from legitimate doubts and disagreements about the relative merits of cancer treatments. In the absence of a cure, doctors discussed and debated which methods offered the best hope of remediation and palliation. Yet professional sensitivities also served to complicate the management of neoplastic diseases. G.E. Richards, the leading radiotherapist in Canada, defended radiation therapy by attacking surgeons. “All too frequently,” he wrote, “the dice are loaded against any successful radiotherapy by unwise or inadequate preliminary surgery … and then radiotherapy is condemned for the failure which was inevitable.”101 More often, however, professional hostility emanated from surgeons. W.E. Gallie, professor of surgery at the University of Toronto, admitted that some of his colleagues felt threatened by the introduction of radiation therapy. “Radium was becoming a recognized form of treatment,” he recalled, “and certain doctors and surgeons began to think that their cancer practice was going to be injured by the invasion of their field.”102 Surgeons consequently questioned and criticized the use of radiation in the treatment of cancer. As interest in radiation continued to mount, however, they eventually tried to appropriate the new technologies, especially radium. In 1928, one prominent Canadian surgeon claimed: “Clearly radium should be in the hands of surgeons and be exclusively used by them, except for superficial growths, when dermatologists or radiologists may be called upon to use it. … It should be the handmaid of the surgeon and a part of his armamentarium.”103 Even when surgeons continued to question the value of radiation therapy, they nonetheless envisioned the technology as subordinate to the surgeon’s craft. “At present,” concluded one doctor, “radium is like a wild horse, which first must be tamed before it can be harnessed to the surgeon’s team. Whether it will take a place as a leader, or wheeler, or as a spare, remains to be seen.”104 Prognosis One of the most serious checks to professional confidence and authority came from the prognosis associated with neoplastic diseases. Although educational literature celebrated the successes of modern cancer

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care, although doctors and scientists debated the meaning of cancer statistics, the rising death toll made it impossible to look upon neoplastic diseases with optimism. For example, in 1938 the ascc founded the Cured Cancer Club and signed up nearly 30,000 members, but in the course of that same year, an estimated 15,000 Americans succumbed to the disease.105 Not surprisingly, many doctors regarded cancer with considerable dread: “The general conception of the disease, … by a large percentage of our own profession, is that it is an inevitably fatal disease, and that the most any therapeutic measure can offer is a poor attempt at palliation.”106 Unable to cure cancer or even offer much relief, some practitioners simply retreated from their patients as well as the disease. As a Toronto specialist concluded, “many physicians and surgeons make no serious attempt to diagnose the disease in its early stages, believing that their best efforts will produce nothing but an unhappy issue.”107 In this way, professional attitudes sometimes mirrored popular reactions to neoplastic diseases. Patients and their doctors shared the conviction that cancer killed, with the result that both avoided a diagnosis of devastating proportions. Even apparent cures of cancer did little to offset the fatalism of the profession because the disease could be exceedingly tenacious, reappearing after many years to claim the lives of patients. Prior to the 1920s, the medical community agreed upon a three-year interval as a requirement of cure: cancer sufferers who recovered and remained free of the disease for more than three years might safely be considered survivors. By the early 1930s, the disease-free period had been stretched to five years, but it remained an arbitrary and inadequate gauge of recovery. Frederick Starr, a prominent Toronto surgeon, recounted an exceptional case in which a woman battled several different types of cancer over the course of several decades. “Many years ago,” he recalled, “I removed a scirrhous cancer of the breast; ten years later from the same patient I removed the clitoris and inguinal glands for epithelioma; ten years afterwards I operated for a malignant papillary adeno-cystoma of the ovary, with secondaries in the mesentery and the omentum.” Not surprisingly, these kinds of experiences made doctors like Starr “hesitate about claiming cures.”108 At the same time, recurrences of cancer underscored the essential impotence of the medical profession: doctors not only failed to control the disease, but also to devise a functional standard for successful treatment. “The term ‘fiveyear cures’ should not be misunderstood,” warned one physician. “Because the patient is still alive without any signs of the disease at the end of that time does not mean that she may not subsequently die of cancer … It is, however, the most satisfactory method we have to-day of evaluating our results.”109

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To complicate matters further, medical explanations of recurring cancers hinged on medical opinions about the nature and causes of the disease. As we have seen, local theory dictated that cancer began in tissues damaged by chemical or mechanical irritants, rather than in bodies predisposed to neoplasia. Secondary lesions, in turn, arose from cells migrating through the blood vessels or lymph channels to take root elsewhere in the body. Indeed, the term “metastasis,” used to describe this phenomenon of cell migration, literally meant “a removal from one place to another.” Whether secondary lesions appeared in conjunction with or long after the original growth, local theory explained them as evidence of metastasis. In contrast, systemic theories suggested that many types of cancer could develop independently in the same body because each was a manifestation of an underlying metabolic or constitutional disorder. Subsequent lesions consequently appeared as new reactions to general dysfunction rather than as the progeny of the original tumour. The discourse on recurring cancers exposed not only the divisions within the medical community, but also the complex blending of opinions that characterized professional responses to neoplastic diseases. Even committed supporters of the local theory found their convictions about recurring cancer taxed by the great lapses of time between the appearance of initial and subsequent growths. Frederick Starr, for instance, adamantly endorsed the local theory of carcinogenesis, yet in discussing cases of multiple cancers he wondered if there might be “in each of us some body fluid that under some sort of stimulus becomes cancer-producing.”110 An Alberta doctor writing about the concept of metastasis, which was inherently localist, argued that local and systemic factors must act together to cause recurrences. He speculated that “cancer, like septicaemia, is a constitutional disease, that a want of immunity predisposes to the formation of the primary lesion as a result of trauma or irritation and to the metastatic episodes that follow in its train.”111 The debate about neoplastic diseases came full circle as recurrences of cancer led doctors to speculate afresh about carcinogenesis.

th e p r o b l e m o f c a n c e r As doctors and scientists discussed the causes, course, and cure of neoplastic diseases, they routinely described “the cancer problem” as one of immense proportions. Probably no other phrase appeared more often in the medical literature on cancer. Certainly no other phrase better captured the challenge that the disease posed for the scientific and medical communities: while researchers delved ever deeper into the mysteries of cellular metabolism and the causes of aberrant growth, the

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etiology of cancer remained an enigma; as technological innovations and educational reforms improved diagnosis, many cancers still escaped early detection; refinements in cancer care prolonged some lives and saved others, but the death toll from neoplastic diseases continued to mount. As a theoretical problem, cancer proved baffling; as a therapeutic one, it was deeply troubling. At the same time, neoplastic diseases created disturbing professional dilemmas. Unable to discover the causes of cancer or devise a cure, physicians and scientists engaged in endless, acrimonious debates about the best ways to explain and manage the disease. Although educational literature presented medical opinion as unified and assured, medical discourse revealed deep confusion and deep divisions within the scientific and medical communities. Uncertainty and controversy, in turn, combined to leech away the confidence of doctors, undermining their authority. Two American physicians, writing in 1915 about gastric carcinoma, described the disease as “a horrible reproach to the medical profession.”112 Thirty years later, at the end of the Second World War, clinicians and researchers had learned a good deal about the disease and its management, but cancer continued to challenge medical authority by exposing the limits of medical knowledge and expertise.

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3 The Contours of Legitimate Medicine: Doctors, Alternative Practitioners, and Cancer

In 1932, an Ontario woman, M.S., learned that she had cancer.1 Surgeons removed the diseased tissue from her colon in October, leaving her with a permanent colostomy – an artificial opening in the abdomen for evacuation of the bowels. Although the operation went well, M.S. was back in her doctor’s office a few months later complaining of renewed pain. His examination revealed that the disease had spread to her vagina and he advised her to have radiation therapy. In September 1933, a radiation specialist at Toronto General Hospital implanted radium needles in the lesion for five days, then administered a series of x-ray treatments, followed by another round of radium therapy in December. Initially, the cancer seemed to recoil under this barrage, but M.S. was still in considerable pain. Moreover, by April 1934, the disease had begun to grow again, spreading to her uterus and bladder. At this point, her doctors decided that morphine was the only thing they had left to offer. “I was given up by the surgeon and radiologist expert … as incurable,” wrote M.S., “and I was told by my physician that nothing more could be done except to make me as comfortable as possible until the end.” With less than six months to live by the reckoning of medical experts, this patient decided to try a popular, unconventional treatment for cancer. M.S. was only one among many thousands of cancer sufferers across North America who turned to alternative practitioners and therapies in the early decades of the twentieth century. Driven by fear, frustration, or desperation to look beyond conventional care, these patients found a broad spectrum of treatment alternatives. “Natural” medicines, those

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based on plant and mineral extracts or animal products, were ubiquitous in North America, as were escharotics, caustic pastes for the treatment of skin lesions. Healers also recommended spiritual intercession as well as special diets, devices, and rituals for the cure of cancer. Alongside these more “traditional” treatments for cancer was an equally formidable array of remedies modelled on the latest “scientific” theories and technologies: several practitioners marketed products that allegedly contained radium while others developed various biological and chemical remedies for cancer. Medicinal treatments – in pill, liquid, or injectable form – were especially attractive to cancer sufferers in these decades.2 Alternative cancer therapies were not only varied, but also numerous in the years prior to World War ii. In 1926, for example, when American industrialist W.L. Saunders offered a handsome reward for the discovery of a cure for cancer, thousands of people from around the world submitted their claims.3 Ten years later, in his famous survey of “quackery,” Arthur J. Cramp, director of the Bureau of Investigation of the American Medical Association (ama), remarked on the volume of cancer remedies available in the United States: “for years hardly a week has passed when the Bureau … has not received one or more letters in which writers stated that they had discovered, or had in their possession, a ‘sure cure’ for cancer.”4 Canadians were likewise inundated with hundreds of unconventional treatments for cancer in these years.5 Some, such as William Frederick Koch’s “Glyoxilide,” were imported from the United States, but many were homegrown. Indeed, a few Canadian cancer therapies became very popular south of the border; in the 1920s and 30s, Toronto physician Thomas J. Glover attracted the attention of American doctors, patients, and entrepreneurs with his serum treatment for cancer.6 Not surprisingly, this apparent epidemic of “quack” treatments for cancer raised an alarm in the regular medical community. During its long crusade against unconventional medicine in the United States, the ama’s deepest antipathy was reserved for cancer “cures,” which, doctors argued, threatened to rob sufferers of their lives as well as their money. Morris Fishbein, fiery editor of the Journal of the American Medical Association (jama), concluded that “Of all the ghouls who feed on the bodies of the dead and dying the cancer quacks are the most vicious and the most unprincipled.”7 Canadian reactions to “quackery” were typically more understated than those of Americans, but the medical community in Canada expressed equal concern about the potentially devastating impact of alternative cancer treatments: “Time is the great factor in the treatment of cancer; it is precious; of vital importance; a matter of life and death. Patients who discover the

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disease in its early stages and resort promptly to skilled treatment have a chance to get well, but if they delay in order to find and try an advertised remedy, … the disease takes such a hold upon them that its irradication [sic] becomes impossible.”8 Like their American counterparts, Canadian physicians sought to curb or eliminate practices they felt endangered the health and welfare of sufferers. Although these efforts to expose cancer “quackery” were undertaken in the interests of public health, they were also based on two important assumptions: first, that legitimate treatments and practitioners were clearly distinguishable from fraudulent or fallacious ones, and second, that the regular medical profession was equipped to render objective and reliable judgments about new therapies. In this way, professional claims to authority were rooted in the presumption of superior competence, which rested to some extent on the rhetoric of “scientific medicine.” Doctors frequently juxtaposed the “wild buffooneries” of the “quack” with the “splendid history of the advancement of medical science,” implying that alternative treatments were not reputable or reliable because they were not “scientific.”9 Powerful as these assumptions and rhetoric were, however, they do not bear up under close scrutiny: not only was the regular medical community divided over the merits of alternative treatments for cancer, but also it lacked a consistent, efficient set of criteria with which to evaluate therapeutic innovations. As J. Rosser Matthews has argued in his history of statistically based research, “For both the medical practitioner and the medical researcher, the amorphous concept of ‘medical judgement,’ … cannot be reduced to a set of explicit rules. … [It] is a form of ‘tacit knowledge.›10 Although official conclusions about specific cancer remedies may have been correct, they were not based on systematic investigations or clear scientific standards, but rather on haphazard, ad hoc assessments, some of which at least were highly subjective. In Ontario, professional reactions to alternative medicine followed this pattern. By the 1930s, three practitioners dominated the field of alternative cancer care: Hendry Connell, John Hett, and Rene Caisse.11 Although these practitioners seemed able to provide relief to cancer sufferers, the provincial authorities responded differently to each of them: Connell won the confidence of the organized profession and the support of health officials in the government; Hett’s medical colleagues tolerated his activities for a time before condemning him; Caisse’s work found favour with the public but engendered suspicion and hostility in the medical community. In other words, professional assessments of new cancer therapies were determined less by clinical effects than by the identity of the practitioners involved and the methods they used to investigate, promote, and administer their treatments.

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Before we explore medical reactions to therapeutic innovations in this era, we must stop to consider the meaning of “alternative medicine” in this context. Often scholars use the term to denote systems of healing that are philosophically as well as therapeutically distinct from regular medicine: homeopathy, reflexology, rolfing, macrobiotics, and spiritual healing, to name a few, embody interpretations of health, illness, and healing that are not only different from, but also at odds with conventional medical opinion. Indeed, there is sometimes little else to justify lumping such therapies together under the rubric of “alternative medicine” beyond their “socio-politically defined marginal standing in the health care system.”12 Although we have learned a great deal about medicine, past and present, from studies of distinctive systems of healing, in the process we have overlooked practitioners who – like Connell, Hett, and Caisse – operated on the very borders of regular medicine, in contested territory. They were not easily dismissed with the epithets of “quack” or “charlatan” because they often had much in common with regular doctors, yet they came under professional scrutiny because their theories and therapies departed, to a greater or lesser degree, from the mainstream of medical thinking and practice. Eclectic in their beliefs, often eccentric in their behaviour, these practitioners deserve serious scholarly attention because they challenge our definitions of “legitimate” medicine, just as they challenged the assumptions and authority of the medical profession in the early twentieth century. Moreover, we find in their stories the clash and confluence of ideas and actions that characterized contemporary health culture. Any number of labels can and have been applied to such practitioners: “unconventional,” “unorthodox,” “irregular,” “marginal,” “fringe.” I have chosen to refer to them primarily as “alternative practitioners,” for though they seldom embraced radical approaches to healing, their remedies nonetheless represented genuine therapeutic alternatives for desperate and disillusioned patients like M.S. In this sense, Connell, Hett, and Caisse were as much “alternative healers” as were the proponents and practitioners of chiropractic or Christian Science – and as important in the social history of medicine.

h e n d ry c o n n e l l Calvin Hendry Cameron Connell was born in Kingston, Ontario, on 28 August 1895. He enrolled in the Bachelor of Arts degree at Queen’s University in Kingston, graduating in 1915, though “judging from his marks, only just.”13 Connell’s performance improved dramatically when he entered Queen’s University’s Faculty of Medicine; he was elected president of his class in 1917 and awarded the University Medal in Clinical

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Surgery at his convocation the following year. After graduation Connell joined his father in medical practice, specializing in the treatment of ailments of the eyes, ears, nose, and throat. Although Connell soon acquired an excellent reputation as a clinician, like many other physicians in this era he was not content with the practice of medicine alone; in the early 1930s, he embarked on his first research project, a study of cataracts.14 The standard treatment for cataracts was “needling,” a procedure that involved rupturing the capsule surrounding the lens of the eye in order to establish contact between the aqueous humor and the lens; the fluid released attacked the opaque protein that had developed in the lens – a process referred to as “proteolysis” – enabling the body to absorb it, and thereby removing the impediment to normal vision. Unfortunately, subjects did not respond predictably to this treatment: while younger cataract patients often recovered completely after the procedure, older patients improved slowly or sometimes not at all. Connell came to believe that these clinical variations were due to different enzyme concentrations in the aqueous fluid of each patient; his first experiments seemed to confirm this hypothesis. Not satisfied with having explained the limits of conventional cataract therapy, Connell determined to develop a better treatment. “We have positive clinical proof that absorption [of the lens] does occur in certain eyes,” he wrote. “It is then the primary object of this research to procure enzymes of this nature and to get them in such a state that they could be used therapeutically.”15 Connell decided to inject extracts of blood enzymes directly into the lenses of laboratory animals in the hope of enhancing the absorption process. Since these enzymes were not specific to the cataractous protein, however, they sometimes attacked the lens itself or even the entire eye. “At this point,” he concluded, “it became apparent that if any satisfactory result were to be obtained, some source of enzyme, possessing specificity, must be found.”16 Connell hypothesized that an appropriate enzyme might be produced if a microorganism that was naturally proteolytic, such as Clostridium histolyticus, was cultured on a substrate of lens protein; the bacteria would produce an enzyme specific to the protein, which could then be used to treat cataracts. To test this theory, he acquired a supply of fresh pig’s lens, macerated and suspended it in physiological saline, then inoculated it with bacterial culture. After forty-eight hours incubation at body temperature, the suspension was centrifuged and the supernatant tested for specificity. According to Connell, “We found that this enzyme solution would digest fresh insoluble lens protein in vitro, but would not digest gelatine or caseine [sic].”17 Although there is no evidence to suggest that Connell ever administered this treatment

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to human subjects, tests on laboratory animals revealed that the enzyme solution, called “Ensol,” retained its selective action in vivo. During his study of cataracts, Connell began to think that proteolysis might prove useful in the treatment of cancer. “It is easy to see,” he wrote, “why we applied this principle to the cancer problem. If we could do this with insoluble lens protein, why could we not do the same thing with foreign protein of any sort, provided that we could get the proteolytic microorganisms to grow on the protein we wished to attack?”18 American and South African researchers had previously explored and rejected proteolytic enzyme therapy because it proved too difficult to control tissue digestion: the enzymes indiscriminately attacked both cancerous and normal cells.19 Moreover, laboratory animals quickly developed immunity to the treatment. Apparently unfamiliar with these earlier discouraging results, Connell not only proceeded with his experiments, but also claimed considerable success. Tissue samples taken from mice before and after treatment with Ensol allegedly demonstrated specific action against cancer; tumour cells perished while adjacent healthy cells escaped damage. Encouraged by these initial findings, Connell moved quickly to human experimentation, again with very promising results: his subjects and their doctors reported pain reduction as well as weight gain and improvement in appetite following the administration of Ensol. Connell claimed that in several cases “visible growths have shown arrest, with softening and absorption, … [while] in the internal growths a similar process is apparently going on, since a great deal of clinical improvement has been noted.”20 By the summer of 1935, he felt he had amassed enough evidence of Ensol’s potential to make an announcement to the press, which caused considerable excitement. Besieged with requests for Ensol from both doctors and patients, Connell established the Hendry-Connell Research Foundation to oversee the production and distribution of his therapy.21 A few months later, Connell presented his findings to the medical and scientific communities in an article published in the cmaj.22 Although he outlined his theory and methods in this report, it was obvious that Connell’s knowledge of the nature and action of Ensol was far from complete. Even without an adequate explanation of the therapy, however, he defended its use in humans on the grounds that patients benefitted from treatment. “What is of vital interest,” Connell wrote, “is what happens in the cancer patient when such a solution is injected in the system.”23 At least some of his medical colleagues agreed with this perspective. A.G. Nicholls, editor of the cmaj, found the clinical effects of Ensol sufficiently compelling to support Connell’s work.

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“Those who have seen the cases of cancer under his treatment,” he concluded, “have been impressed with the results he can show, which, to say the least, are encouraging. Certainly, his work cannot be lightly passed by.”24 Indeed, Nicholls’ comments indicate that he privileged clinical over laboratory evidence: “Until the fluid has finally proved its merits it would be idle to waste time in speculating as to what it is and how it acts.” At this stage, presumably on the same evidence and for the same reasons, the oma also encouraged professional cooperation in the investigation of Ensol.25 Excited by the possibilities of Connell’s research, officials in the Ontario Department of Health likewise supported his work in a variety of ways: Jason Hannah, a prominent neurologist, arranged a steady supply of human cancer tissue for the production of Ensol while J.A. Faulkner, the minister of health, announced that the therapy would be tested on a group of psychiatric patients suffering with cancer.26 Moreover, with only a preliminary report on Ensol in hand, the provincial government apparently decided to suspend further purchases of radium in the hope that “the research now being conducted by Dr. H.C. Connell of Kingston, may lead to a better and cheaper treatment of cancer.”27 B.T. McGhie, deputy minister of health, cautioned the public and the profession that these arrangements did not signify official endorsement of Ensol. “He hasn’t got to the point yet where the Government has put the stamp of approval on it as a cure,” McGhie told the press, “but he’s going about it in the right way.”28 Implicit in McGhie’s statement was the assumption that Connell’s research adhered to recognized norms that would, in time, either validate or refute the claims made for Ensol. Indeed, this same assumption pervaded the discourse on “quackery,” as the regular medical community tried continually to persuade or coerce practitioners into submitting their therapies to “scientific” investigation.29 Although the medical profession placed its confidence in science, it is not at all clear what constituted reputable, rigorous research in this period. Historians have devoted little attention to the standards and methods of research, preferring to focus instead on the cultural, professional, and medical significance of science in the twentieth century. Consequently, we know little about the nature of research, beyond the barest essentials that it was largely unregulated and unsystematic prior to World War ii.30 For a fuller elaboration of research methods and standards in this period, we must turn to Hendry Connell’s critics. They did not necessarily endorse a single standard of medical research, any more than they embraced a single definition of “science” or “scientific medicine,” but their reactions embodied contemporary opinion about what constituted legiti-

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mate research. Ultimately, by the standards of these doctors and scientists, Connell was not, in fact, “going about it in the right way.” From the start, alongside the bubbling enthusiasm for Connell’s work, there ran a strong current of professional scepticism and criticism. True to form, Morris Fishbein was the first to cast public aspersions on the research being conducted in Kingston. In a scathing editorial, published in jama in October 1935, he compared Connell’s claims and methods to those of “other cancer quacks.” Most disturbing to him were Connell’s dealings with the popular press, which he characterized as “more like those of the charlatan than of the scientific investigator.”31 Fishbein was not unconcerned about Connell’s theories and methods, but clinical exigencies strongly influenced the editor’s definition of legitimate research; because premature proclamations of “promising” new therapies could endanger the lives of patients, reputable researchers waited for other investigators to corroborate their findings before making proclamations to the laity. In Fishbein’s opinion, Connell’s statement to the press in the summer of 1935 branded him as an unethical researcher and clinician. Although few critics were as outspoken or as vehement as Morris Fishbein, other practitioners shared his views on research. Arthur Cramp, director of the ama’s Bureau of Investigation, wrote “I have been struck so many times with the cruelty of letting the public believe that a cure for cancer has been definitely discovered by a man who, on the face of it, seems to have some professional respectability.”32 Doctors and scientists engaged in research tended to approach the evaluation of Ensol from a different angle: they were not unmindful of the clinical implications of Connell’s work, but they concerned themselves more with assessing the theoretical and methodological aspects of the research. Consequently, their opinions about the nature of reputable, reliable research were rather different from those of practitioners. For example, investigators considered animal experimentation to be an important component of legitimate scientific inquiry; it lent credibility as well as reliability to medical research. Yet animal experimentation in this period was apparently pursued in the absence of specific standards and regulations. The discovery of insulin, for example, widely hailed in Canada as the benchmark of research excellence, was founded in part on animal testing of dubious merit.33 In the case of Ensol, the mere fact of animal experimentation seems to have overshadowed concern about the design and execution of these tests: no one questioned Connell’s conception of animal research; no one criticized his methods; no one demanded more information about his original experiments on mice, though these received cursory attention in his initial

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report. Ultimately, the outcome of the investigation rather than the method was more important to researchers; whereas insulin lived up to its promise in animal and human trials, Connell’s claims for Ensol proved elusive. In July 1935, aware of the importance of animal experimentation, Hendry Connell invited James Miller, a professor of physiology at Queen’s University, to review the evidence of tumour regression in mice. Miller agreed, but was unable to corroborate Connell’s conclusions that Ensol halted or reversed the course of cancer in experimental animals.34 Apparently unwilling to challenge Connell at his stage, Miller sought the aid of a former classmate, J.A. Murray, who was then director of the Imperial Cancer Research Fund in England. About to resign, Murray referred the investigation of Ensol to his successor, William Gye, who agreed with Miller’s suspicion that Connell’s therapy had no demonstrable effect on cancer. In an October issue of the British Medical Journal (bmj), Gye concluded that “In no case has the growth of a tumor been checked or affected in any way.”35 Upset by the report and convinced that Gye’s conclusions were incorrect, Connell asked for the opinion of yet another physiological expert at Queen’s University, G.H. Ettinger.36 Along with other researchers, Ettinger was unable to find any evidence of tumour regression in mice following treatment with Ensol. Amid the initial excitement over Ensol, E.G.D. Murray, chief bacteriologist at the Royal Victoria Hospital in Montreal, was one of the few observers to raise doubts about the clinical investigation underway in Kingston. Asked by the governors of his hospital to evaluate Connell’s work, Murray expressed reservations about the research. He pointed out that no attempt had been made to standardize Ensol therapy, with the result that the potency of each batch of enzyme solution – and the reactions of patients – varied markedly. Moreover, Connell based his therapeutic claims almost exclusively on anecdotal reports, which Murray considered unreliable: “the evidence of clinical improvement in the conditions of patients amounts only to impressions and support from pathological examinations is not yet available.”37 Not only was Murray’s reaction a counterpoint to the uncritical enthusiasm of doctors such as A.G. Nicholls, but also it highlighted the importance of pathology in clinical investigations. In Murray’s definition of reputable research, cases and cures of cancer had to be substantiated by tissue analysis. As we have seen, not everyone accepted the role of pathology in cancer care or in cancer research, but it was fast gaining ground as the gold standard of diagnosis and cure.38 Finally, the theoretical foundations of Connell’s work aroused concern and criticism. Although several commentators had misgivings

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about Connell’s initial hypothesis, Norman Horner, editor of the bmj, launched the most effective assault on the theory, stressing that “the specificity of the enzymes is the central question.”39 He argued that Ensol probably could not target cancer cells as Connell maintained; not only was such activity contrary to experience, but also “contrary to all expectation.” Along the same lines, Horner wondered “how a remedy injected intramuscularly in small empirical doses comes to be concentrated in a distant growth to a sufficient extent to exert this effect.” In short, because he considered Connell’s theory implausible, he cautioned against the use of Ensol. According to Sigismund Peller, medical investigators in this period did not welcome novel theories: “A researcher who in the 1930s or ’40s presented completely new ways of looking at and combating cancer was ignored, pushed aside, and if this did not help, he was marked as a crack-brain.”40 Although Peller’s conclusions are overly pessimistic, given the multiplicity of cancer theories in circulation among conventional doctors and scientists, his observations highlight the importance of theoretical considerations to the research community. Along with his research methods and conclusions, Connell’s theory lacked credibility, at least according to this small group of researchers and clinicians. “It should be clear,” concluded Norman Horner, “that several large gaps have to be filled up before the arguments in [Connell’s] paper can be accepted, and very much more evidence is needed before any hope can be entertained that a new and effective treatment for malignant disease has been discovered.”41 Although these criticisms seem substantial enough in retrospect, in the fall of 1935 they were little more than cracks in the edifice of support for Hendry Connell: patients flocked to his clinic or badgered their doctors for Ensol therapy, while the medical authorities in Ontario rallied around the Kingston practitioner. Moreover, as newspapers in Canada and the United States caught wind of Fishbein’s attack, they joined the campaign to promote Connell’s work.42 The greatest boon to Ensol research in this period, however, was undoubtedly money. In the early 1930s, Connell personally financed the study and production of Ensol, but the sudden surge of interest in his work severely taxed his resources.43 Fortunately, the largess of an American businessman saved both Connell and the research: in November, the doctor signed an agreement with the du Pont Company of Wilmington, Delaware that provided $250,000 for Ensol research, to be divided between the Hendry-Connell Research Foundation in Kingston and the Biochemical Research Foundation of the Franklin Institute in Philadelphia.44 In return, the du Pont Company acquired the us patent rights on Ensol. Although negative assessments of the research and therapy

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continued to trickle in during 1936, the immediate future of Ensol and its creator looked bright. Connell devoted himself to the investigation and production of his enzyme therapy, publishing a series of progress reports under the title The Bulletin of the Hendry-Connell Research Foundation (hcf Bulletin).45 Yet the question that remains to be answered is on what grounds was popular, professional, and entrepreneurial enthusiasm for Ensol raised, if not on solid research methods and plausible theories. Probably no amount of “academic” criticism could have quenched the early excitement over Ensol because the results of treatment seemed so captivating and compelling. Connell’s first report, published in the August 1936 issue of the hcf Bulletin, apparently justified confidence in the research.46 He claimed that of 382 cancer patients who had received Ensol in the preceding year, 202 or fifty-three per cent had survived. Connell attributed the large proportion of failures, forty-seven per cent, not to his therapy, but to the grave, even hopeless condition of many of his patients. “With few exceptions,” he wrote, “cases treated have been far advanced in the progress of the disease. … In this way the test of the value of ensol treatment has been a severe one.”47 Moreover, Connell argued that even terminal patients benefitted from his therapy: “Ensol should not be withheld in advanced cases where permanent changes are not likely [because] it will, in 95% of cases, palliate pain and render fatal termination less distressing.”48 Yet therapeutic potency alone was not a sufficient explanation of Connell’s privileged position in the ranks of alternative cancer care: other practitioners, reporting comparable clinical results, were derided or dismissed by the medical and political authorities in the province. Ultimately, Connell’s credentials, his connections, and his astuteness earned him the approbation of his colleagues and government officials. Although Connell’s research methods were sometimes suspect, his practice of medicine generally was not. He wisely cautioned patients not to eschew radiation therapy or surgery in favour of his treatment, as “quacks” supposedly did: “It is not suggested or intended that the use of ensol should replace presently accepted methods of treatment. Rather it should be added to them.”49 Moreover, though Connell developed his own cancer practice in Kingston, he generally tried to channel his therapy to patients through their own doctors. Not only did he provide Ensol freely to other physicians, asking only for progress reports in return, but also he made sure that sufferers treated in Kingston were directed to report to their family practitioners for further care.50 Consequently, though Ensol was used widely in the 1930s – nearly 2,000 patients had received this treatment by 1938 – Connell’s practice

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did not alienate his medical colleagues; his methods for disseminating his product kept professional anxiety and hostility to a minimum. Connell’s credentials and professional connections contributed to professional tolerance as well. Granted, he lacked special training in medical research, but he was not alone in this regard: Frederick Banting, for example, played a major role in the discovery of insulin, despite his limited aptitude for and experience with research. Moreover, Connell had an exemplary record as a medical practitioner, which afforded him a certain degree of protection not available to healers outside the profession. Consequently, though several Canadian physicians and scientists expressed reservations about the value and validity of Connell’s work, these concerns almost invariably remained private. This response was consistent with the general reaction of the medical profession in Canada to questionable medical practices: not only were doctors indisposed to criticize their colleagues in public but also, prior to the 1960s, medical sanctions applied only to professional misconduct rather than to medical negligence or incompetence.51 And Connell had clearly maintained contemporary standards of professional decorum. Canadian critics may have been especially reluctant to voice their concerns in this case because Connell had formidable connections within the medical and scientific communities. His father, J.C. Connell, had been dean of the Faculty of Medicine at Queen’s University for many years and, according to one journalist, was “one of the most respected members of the profession in Canada.”52 Moreover, many prominent doctors and scientists were involved in the investigation of Ensol at various stages. Indeed, A.G. Nicholls stressed the importance of these connections to soothe fears about the reliability of Connell’s research. “A number of competent men associated with Queen’s University are collaborating with Doctor Connell,” he noted, “so that we can feel assured that the problem is being attacked from various sides in a thoroughly scientific manner.”53 Thus, Connell’s status as a doctor as well as his association with prominent medical men served to curtail criticism of his work. Connell’s position was further strengthened by his shift away from the enzyme theory, originally the focus of many objections to his work. In his critique of Connell’s research, bmj editor Norman Horner had suggested an immunological explanation for the action of Ensol as a more plausible alternative to the enzyme theory. “There is, of course, another possibility altogether,” he wrote, “apparently not considered by Dr. Connell – namely that he is immunizing the body against the growth by injecting the products of its decomposition.”54 For some reason, Connell initially resisted this hypothesis, but as it became

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apparent that the enzyme theory was untenable or at least undemonstrable, he was forced to reconsider his objections to the immunological explanation.55 By 1938, with the publication of the third issue of the hcf Bulletin, he had become firmly convinced that Ensol’s power over cancer was the result of antibody production.56 Thus, in contrast to many alternative healers in these decades, the theoretical underpinnings of Connell’s therapy became more rather than less conventional as his work progressed. Although the immunological explanation of cancer, supported by William Gye among others, was not without its critics, it was definitely more familiar and more credible in scientific and medical circles than the original enzyme theory.57 All seemed to be going well for Hendry Connell when disaster struck in the spring of 1938. A doctor in Florida, T.A. Neal, had been using an Ensol preparation to treat cancer when several of his patients became ill. Within a few days, it was evident that they were suffering from tetanus and eventually eleven of Neal’s patients died.58 The United States Food and Drug Administration and the National Institute of Health in Washington, dc, launched an immediate investigation of the facilities in Philadelphia and – in cooperation with the Canadian government – Kingston, while the Canadian minister of health, C.G. Powers, ordered a halt to all distribution of Ensol until an explanation of the deaths was found. Investigators eventually traced the source of the problem to the laboratories of the Biochemical Research Foundation at the Franklin Institute, where a batch of “Rx,” the American counterpart to Ensol, had been contaminated with tetanus toxin. Connell tried to dissociate himself from this tragedy, stressing that the product responsible for the deaths in Florida “was not from our laboratory or of the same nature as that made here.”59 Although Canadian and American officials absolved the Hendry-Connell Research Foundation of responsibility for these deaths, criticism of Ensol research resurfaced in the American and British medical press. “As we predicted in discussing the Hendry Connell cancer treatment,” wrote Morris Fishbein, “the use of such methods will inevitably bring grief to those concerned with their employment. … How many more human guinea pigs are to be sacrificed by exploiters of unestablished and virtually untested drugs, serums and cosmetics?”60 On a more restrained note, Norman Horner echoed Fishbein’s concerns: “although this disaster has, of course, no bearing whatever on the possible usefulness of this treatment properly applied and safeguarded, it will doubtless, and rightly, serve as a setback to the indiscriminate application of treatments which have been insufficiently tested and are not under adequate control.”61 Despite these warnings from abroad, however, interest in Ensol and support for Connell’s research remained strong in Ontario for many

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years.62 Although his clinical results helped to sustain support for his work, ultimately Connell’s success depended more on his personal and professional credibility than on his methods and theories. His medical credentials and professional connections were impeccable. His ideas were communicated in language both familiar and acceptable to the scientific and medical communities. Although the medical authorities continued to reserve judgment on Ensol, refusing to endorse it as a cure for cancer, they enfolded Connell in the embrace of legitimate medicine by labelling his work “experimental.”63 As we shall see, other alternative practitioners were not so fortunate, meeting opposition and derision where Connell found support and encouragement.

jo h n h et t Born on 2 May 1870 in Berlin, Ontario, John Hett attended the University of Toronto, graduating with a medical degree in 1891.64 In contrast to Hendry Connell’s performance in medical school, Hett’s academic record was unremarkable. He received passing grades throughout his medical education with the exception of first-class honors in two final year courses, one of which, perhaps significantly, was medical psychology. After graduation, Hett set up practice in his home town, becoming an active member of the community and the medical profession. He served for many years on the Board of Education and the City Council, and in 1915 was elected mayor of Berlin; influenced by the war, citizens of Berlin voted that year to change the name of their community to Kitchener. Moreover, Hett held the position of secretary in the local medical society for more than twenty-five years and, in his early days of practice, wrote on various aspects of health and medicine. Along with many of his contemporaries, Hett became enamoured of the clinical possibilities of x-rays.65 In 1900, a mere five years after Roentgen’s discovery of x-rays, Hett purchased equipment and began to treat a variety of ailments, including cancer, with x-rays; one of his patients claimed to have been cured of cancer and Hett maintained that he had successfully treated a uterine fibroid with radiation.66 Despite his initial enthusiasm, however, Hett soon lost confidence in the therapy, concluding that though x-rays had great diagnostic value, they provided only symptomatic relief of cancer because they did not attack the source of the problem.67 “Cancer,” he wrote, “is not a local growth, but an outgrowth [of] a general cancerous condition in the system.”68 In other words, Hett agreed with proponents of the systemic explanation of cancer, thereby identifying himself with the minority position in scientific and medical circles. Connell, in contrast, espoused the more common medical opinion that cancer was a disease of local origin.69

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In the hope of discovering an alternative to x-ray therapy, Hett undertook an investigation of cancer and its treatment.70 He allegedly visited a number of clinics in Europe, consulting many experts on the problem of cancer, and upon his return to Canada, began to develop a serum. In 1930, the same year that Connell became involved in cataract research, Hett administered his treatment to cancer patients for the first time, apparently after a limited number of preliminary tests on animals. Following a year of clinical experimentation, he announced to the press that he had devised a cure for early cases of cancer. Hett further claimed that his serum had diagnostic and palliative value. Alerted to this new therapeutic option, cancer sufferers began to clamour for treatment.71 Yet surprisingly, the medical authorities did not caution Hett about his actions or his claims at this stage. Indeed, when questioned by reporters, Minister of Health John Robb merely disavowed knowledge of Hett’s work and its alleged therapeutic value. “I hope it’s true,” he commented, “but we haven’t any information about it.”72 Like Hendry Connell’s credentials, Hett’s professional status earned him a certain amount of latitude; in other words, the medical authorities in Ontario assumed that Hett was “going about it in the right way.” Hett’s credibility was further enhanced by the theoretical foundations of his work. He argued that cancer arose from the interaction of three factors: irritation, endocrine imbalance, and viral infection. It is my belief that this virus, or ultra-microscopic germ, is transmitted from cancer patients to persons in contact with the patient. I believe that a person may have this virus in his system all his life and be free from cancer all his life, providing his endocrine glands are functioning normally. When, however, there are certain imbalances of the endocrine glands, cancer develops. On the other hand, I do not believe it is possible that cancer develops without a virus. As for irritations, it is universally admitted that they play a very important part.73

Hett’s hypothesis was highly eclectic, based on several of the most common and influential theories of cancer etiology extant in the 1920s and 30s. As we have seen, physical or chemical irritation was commonly regarded as a precipitating factor in the onset of cancer, while the viral theory was an important, if not uncontested, explanation for the origins of the disease. Similarly, Hett’s conviction that endocrine imbalance was implicated in tumour growth mirrored the opinions of researchers interested in metabolic disorders. It is true that he made little allowance for the influence of heredity in the development of neoplastic diseases, but in this respect, Hett’s work was also consistent with the attitudes of the medical profession in general.

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Hett’s therapy was similarly based on a combination of ideas and methods prevalent in scientific and medical circles in this period. His treatment consisted of a combination of two sera: the first was designed to restore endocrine balance in afflicted patients, thereby eliminating the precipitating factor in the onset of disease; the second was supposed to attack the underlying cause of the disease, the virus, which Hett believed was present in all cases of cancer.74 Like vaccines, these sera were produced by injecting extracts of mammalian endocrine glands and human cancer tissue, respectively, into a healthy horse. Six months later, blood samples were collected and the serum removed for administration to patients. According to Hett, one serum contained hormones that corrected endocrine imbalances while the other stimulated the production of antibodies, endowing the patient with passive immunity against cancer. Although his understanding of endocrinology and immunology were crude by contemporary standards, Hett’s theories and methods resembled those of established medical researchers, thereby setting him apart from “quack” practitioners. His preoccupation with glandular extracts, for example, reflected the interests of celebrated investigators such as Frederick Banting and Bertram Collip, while his ideas about cancer viruses resembled those of researchers William Gye and Peyton Rous. Indeed, Hett maintained that he had visited Gye’s laboratory in 1926, finding his own theory of viruses “substantiated to a great extent” by Gye’s work.75 As with his theory of cancer, Hett’s therapy depended on ideas and language familiar to the medical and scientific communities. Combined with his status as a regular practitioner, these features of his work helped to ensure that his treatment would receive consideration, if not necessarily commendation. At the same time, Hett’s clinical results sparked professional interest in his work and helped to defuse criticism. Many of his patients reported symptomatic relief following treatment: they ate more, gained weight, and reduced or relinquished their dependence on analgesics.76 In some cases, tumours and other cancerous lesions allegedly diminished in size. Although these results did not convince the authorities that Hett had discovered a cure for cancer, they were sufficiently promising to warrant further investigation. In 1934, John Robb told the press, “I have personally investigated the history of 15 cases treated by Dr. Hett [and] we are prepared to give further consideration to the work which he has been doing.”77 As with Hendry Connell, Hett’s apparent success in the treatment of cancer won him a measure of professional tolerance. Despite these considerable advantages, however, Hett’s position was far from secure. In the early 1930s, the medical community briefly bristled with outrage when Hett sent out form letters to Canadian and American doctors describing his work and offering advice in the

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treatment of cancer.78 Arthur Cramp of the ama denounced Hett as “a charlatan and a quack,” while the oma suggested that the doctor’s “advertising” should be brought to the attention of the medical authorities.79 By 1937, professional reservations such as these had blossomed into overt opposition: in April, Hett was summoned before the discipline committee of the College of Physicians and Surgeons of Ontario (cpso) to answer a charge of “infamous or disgraceful conduct in a professional respect.”80 It is not entirely clear why the medical authorities chose this moment to act. After all, Hett had by then been in the business of alternative cancer care for more than six years without being taken to task. Officially, the College maintained that Hett was in trouble because he claimed to have “discovered a cure for cancer, which claim was unsubstantiated.”81 But this explanation was bogus. Hett had introduced his therapy as a cure for cancer in 1931; if the medical authorities had been concerned mainly about these claims, they would have acted against him much earlier. Moreover, they would have called Hendry Connell to account as well. Although Connell was more circumspect in his dealings with the media, studiously avoiding the use of the word “cure,” he was no less certain than Hett that he had uncovered a “solution to the cancer problem” – a fact that was obvious to many medical observers.82 Ultimately, the real sticking point for the cpso and the profession in general was the issue of secrecy. Once the medical authorities became aware of Hett’s work, they tried several times to arrange an investigation of his serum. Although he professed interest in an official inquiry, Hett refused to disclose the details of his therapy, suggesting instead that doctors consider the clinical evidence in support of his claims.83 Moreover, he refused to allow other doctors to administer his serum, insisting that “inexpert use of his serum” could have tragic consequences.84 Initially, the medical authorities indulged Hett’s preferences, arranging to examine and question some of his patients, because they assumed that he would eventually share his ideas and methods for the treatment of cancer. Hett encouraged this confidence. “When the proper time comes,” he wrote in 1932, “I shall keep no secrets but will lay all my cards on the table for the benefit of the Profession and the Public.”85 But six years of stubborn silence shattered professional complaisance about Hett’s intentions. His attitude was both puzzling and disturbing to a community that considered secrecy to be wholly incompatible with the tenets of “scientific medicine.” In this regard, Connell’s management of his therapy was far superior to that of Hett; his willingness to cooperate with other doctors combined with his openness about his research gave his colleagues a sense of security. In contrast, Hett’s intransigence raised doubts about his motives as well as the merits of his therapy.

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By the time he appeared before the discipline committee, Hett faced the choice of sacrificing his commitment to secrecy or his career in medicine.86 The Medical Act stipulated a range of penalties for professional misconduct, from fines and suspensions to the complete loss of medical privileges, and the medical authorities generally preferred to rely on milder sanctions.87 Indeed, in Hett’s case, the committee members hinted that the doctor could escape censure altogether if he agreed to cooperate.88 When Hett refused to divulge his formula or moderate the claims made for his therapy, however, the College felt it had no choice but to invoke the strongest measures against a practitioner who seemed to threaten not only the reputation of the profession, but also the health of his patients.89 In April 1937, the discipline committee voted unanimously to erase Hett’s name from the medical register, barring him from medical practice.90 As the medical profession became increasingly disenchanted with Hett, the Kitchener doctor lost faith in his medical brethren as well. Hett claimed that he was a victim of professional jealousy. “Little did I think when I set out on my cancer researches that I would be subjected to persecution,” he told the press. “I realize as one who is trying to give the world the benefit of my cancer work that I am only beginning to walk the bitter path against the unsympathetic attitude of those who should be giving me support rather than opposition.”91 Convinced that he would not receive fair treatment from the profession, Hett took his case to the Supreme Court of Ontario, an option available to practitioners under the terms of the Medical Act.92 Unfortunately for Hett, the presiding judge, Chief Justice Rowell, felt that the doctor had not only misrepresented his treatment, but also compounded his sins by refusing to submit the serum for testing. Rowell agreed that Hett was guilty of a breach of professional ethics, and he upheld the cpso’s decision.93 When the courts refused to grant his appeal for reinstatement, Hett turned to the government as a last resort. In January 1938, he announced his intention to petition the provincial legislature for reinstatement.94 “It will not rest at this point,” vowed Hett, “it is too important a matter.”95 His decision was not unprecedented for, according to Elizabeth MacNab, other unregistered practitioners “often legitimized their position by having a private act passed which authorized them to practice.”96 But Ontario Premier Mitchell Hepburn was adamant that Hett would get no satisfaction from the government while his treatment remained secret. Hepburn told the press, “So long as he declines to reveal his serum formula, Dr. Hett need expect no assistance from the government or the legislature in his fight for reinstatement.”97 At this point the cpso again exerted pressure on Hett, reminding him that

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his name would not be restored to the medical register until he submitted his formula for investigation. By 1938, John Hett’s fortunes had diverged dramatically from those of Hendry Connell. Both members of the medical profession, apparently in possession of promising new treatments for cancer, these two men were nonetheless treated quite differently by the medical and political authorities in Ontario. Connell enjoyed the support of the government and the profession because he seemed able and willing to play by the rules. In contrast, Hett flouted one of the most basic precepts of contemporary medical research and practice, thereby undermining the confidence and tolerance of his colleagues. Neither his professional status nor his results could offset the anxiety caused by his determination to keep his work secret. Ultimately, the medical profession, the judiciary, and the government of Ontario concluded that Hett was not “going about it in the right way.”

rene caisse Born on 11 August 1888 in Bracebridge, Ontario, Rene Caisse98 trained as a nurse in private hospitals in Ontario and Connecticut. She first became interested in the treatment of cancer in the early 1920s when one of her patients told her about an herbal remedy for cancer.99 Afflicted with breast cancer and reluctant to submit to surgery, the woman had turned to a native Canadian healer who offered her an infusion of herbs. She recovered from the disease, convinced that her life had been saved by the tea. Much impressed by this story, Caisse asked for the recipe. “I knew doctors threw up their hands when cancer was discovered in a patient,” she said, “it was the same as a death sentence just about. I decided that if I should ever develop cancer, I would use this herb tea.”100 Caisse’s career as an alternative cancer practitioner was thus inaugurated; whereas Hett and, to a lesser extent, Connell set out to find an effective treatment for cancer, Caisse apparently stumbled upon one. Her first opportunity to test the remedy arose two years later when her aunt was diagnosed with inoperable cancer. Caisse suggested the herbal tea, and when her aunt’s condition improved markedly after only two months of treatment, she began to think she was on to something important – as did the attending physician, Robert Fisher.101 Indeed, the doctor was so impressed that he proposed another test on a patient with cancer of the mouth and throat who was not responding to conventional treatment. Fisher apparently decided that the remedy would be more effective if it was injected directly into the diseased tissues rather than ingested as a tea. The patient reacted badly to the

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sublingual injection, however, struggling to breathe as his tongue swelled dramatically. Fisher saved the patient from suffocation only by holding down the man’s tongue until the reaction subsided twenty minutes later. Despite this harrowing experience, the patient apparently took further treatments, finding some relief of his pain and symptoms before he finally succumbed to the disease. Although Fisher was encouraged by these results, Caisse was shaken by the episode and resolved to study the tea further before attempting other treatments. She set up a rudimentary laboratory in the basement of her mother’s Toronto home in order to test various combinations of herbs on mice: “I took a list of the things the Indian [had recommended], I began to think about them, and gradually discarded what I thought would not be essential.” Eventually Caisse was satisfied with a solution based on four herbs: burdock root, sheep sorrel, rhubarb root, and slippery elm bark.102 As with Ensol, the results of animal experimentation were very promising: according to Fisher, Caisse kept the mice “alive long after the time they could be kept by ordinary means.”103 Moreover, Caisse went beyond animal trials to test the herbal tea on herself. In a recent study of human experimentation in the United States, Susan Lederer argues that prior to World War ii regular doctors engaged in self-experimentation to quell suspicions about their motives and methods of research.104 In contrast, Caisse was more intent on proving that her treatment was innocuous. “I know it is perfectly harmless,” she assured reporters, “because when I was nursing cancer cases, I used to take a dose every once in a while myself and it never did me the slightest harm.”105 In this way, Caisse not only acknowledged the importance of laboratory investigations and animal experimentation, but also set her own standards of research higher than those of Connell or Hett, neither of whom felt obliged to take a dose of their own medicine. At the same time, Caisse’s stint in the laboratory had a formative influence on her perceptions of herself and her remedy; her research experience transformed her from a mere ward nurse into a scientific investigator, at least in her own mind, while the “recipe” for an herbal tea, acquired through the kindness of a patient, became a “formula,” discovered and developed through investigation and experimentation. Indeed, Caisse’s foray into the world of research became a touchstone for her in later encounters with medical opponents because she felt that it established her as a legitimate, reputable researcher.106 In 1935, for example, she told a government official that her test results with mice were superior to those of “any other worker.”107 Moreover, her new identity as a cancer researcher was intimately connected with the herbal treatment: “Caisse” spelled backwards became “Essiac,” the cancer cure.

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Despite the importance of her research, Caisse found the clinical effects of her therapy far more compelling. Consequently, she did not linger in the laboratory, but returned promptly to the treatment of cancer patients. As with Connell’s and Hett’s subjects, Caisse’s patients reported pain relief, weight gain, and healing of chronic lesions as well as tumour regression following a course of treatment with Essiac.108 Moreover, Caisse maintained that even sufferers with advanced disease found a measure of relief in her care. Some members of the medical and scientific communities were impressed with the clinical results of Essiac therapy. In 1926, while Hett was allegedly touring the laboratories of Europe, a small group of doctors led by Robert Fisher petitioned the Canadian government to investigate Caisse’s work. “To the best of our knowledge,” they wrote, “she has not been given a case to treat until everything in Medical and Surgical Science had been tried without effect, and even then, she was able to show remarkably beneficial results, on these cases, at that late stage.”109 Ten years later, investigators at the Medical School of Northwestern University in Chicago undertook a clinical trial of Essiac.110 Thus, Caisse’s therapy interested doctors and researchers for the same reasons that Connell’s and Hett’s did: all three seemed to have value in the treatment of cancer. Unfortunately for Caisse, this modicum of professional support for her work was often undermined by official opposition. In 1935, after a decade of being hounded and harassed by the medical authorities, Caisse returned to Bracebridge to set up a cancer clinic; the town council had offered her the use of an old building, the British Lion Hotel, and applied to the provincial government for a hospital license.111 Officials at the Department of Health maintained that the clinic could not be licensed nor could Caisse treat patients without a regular doctor in attendance; accordingly, they discouraged professional cooperation with the nurse.112 Edward Ellis, a Bracebridge doctor, asked the deputy minister of health, B.T. McGhie, what consequences he might face if he agreed to act as resident physician in Caisse’s clinic: “Would you advise me, if I took this position, would I, or would I not, endanger my license to practice?”113 When McGhie responded noncommittally, Ellis refused the job and Caisse was denied a license for her clinic. Similarly, though newspapers frequently referred to medical endorsements of Essiac, the doctors quoted were seldom identified; fear of professional reprisals apparently served to blunt the edge of medical support for Caisse’s work.114 Caisse professed to be puzzled by official opposition to her work. In 1935, for example, she protested her treatment at the hands of the medical authorities:

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The fact that I have been trying to do this work without assistance from anyone, and that I have succeeded in even a small way, should command the respect of the medical world but instead of that … I was threatened with arrest. The College of Physicians and Surgeons sent an Inspector down to make me close up my place … Had I been exploiting the public I could understand, but if I wanted to go and see you [today] I would have to ask my mother to pay my way.115

Implicit in Caisse’s comment was the assumption that since she was not making a profit she should be left to work unmolested. Although she was probably saved from criminal prosecution by the fact that she did not charge for her services, many other factors beyond monetary considerations militated against official acceptance of her work.116 Her lack of medical credentials was one of the most obvious strikes against her. Indeed, in their eagerness to reject her application for a license, several officials at the Department of Health implied that Caisse was not qualified even to nurse, let alone operate a private hospital, because she was not registered in Ontario.117 At best, this issue was a red herring because, unlike medical registration, nursing registration was an educational rather than a legal designation; unregistered nurses might be less well trained than registered ones, but they were not barred from practice or subject to prosecution.118 Official slurs on Caisse’s qualifications masked professional prejudice against practitioners who were not medical doctors. As one Ontario physician told the press, “there might be some skepticism because the treatment was discovered by a nurse and not by a medical practitioner.”119 American medical reactions to Caisse were even more explicit. In a 1937 letter to the Ontario Department of Health, Frank Clancy, director of the ama’s Bureau of Investigation, confidently asserted that “it is inconceivable that any hospital on the approved list of the American Medical Association would allow such a serious condition as cancer to be treated by a nurse.”120 Upon learning of the trials at Northwestern University, Clancy expressed his shock, concluding that the dean of the medical school was apparently prepared to test any remedy, “regardless of the source from which it emanates.” Although the medical authorities assumed that Connell and Hett were qualified to conduct clinical research by virtue of their medical education, they clearly believed that Caisse could not be a legitimate practitioner because she was not a doctor. In the same way, Sister Elizabeth Kenny, an Australian nurse who claimed that her treatment for poliomyelitis was superior to conventional therapies, spent long years battling for the acceptance and recognition of the medical establishment.121

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Caisse’s explanations of cancer and Essiac therapy reinforced professional reservations about her credibility. As a result of her laboratory and clinical experience, Caisse maintained that Essiac attacked cancer in two ways: one herb destroyed the diseased cells while the other three purged the patient’s body of toxins.122 In this way, Caisse not only assumed a degree of specificity for her therapy that was implausible on theoretical grounds, as Hendry Connell had done, but also she implied that cancer was a systemic disorder, a belief she shared with John Hett and a minority of doctors. More important, Caisse seemed to be clinging foolishly or naively to an outdated form of medicine as she plied her patients with herbs and explained her work in the language of humoral medicine. According to Sigismund Peller, the research community of the interwar period paid attention “only to those who joined the philosophical bandwagon or could be taken aboard.” Although Connell and, to a lesser degree, Hett could be accommodated on the “bandwagon” of conventional cancer research, Caisse could not be easily taken aboard. Consequently, the medical authorities were not prepared to suspend judgment about her work as they were with some other practitioners.123 Although the claims made for the curative value of Essiac did much to alienate the medical profession, secrecy was the real bone of contention between Caisse and her opponents. In 1935, Minister of Health John Faulkner proposed an official investigation of Essiac and arranged for Frederick Banting to evaluate the therapy. In return, he asked Caisse to supply full details of her work, including “the exact nature of the materials suggested for use, the manner in which they are to be used including dosage and the experience which has attended their use with such detailed reports on pathological diagnosis, treatment and present condition of patients as exist.”124 While eager to convince the medical and political authorities that she had an effective treatment for cancer, Caisse, like Hett, had no intention of surrendering her formula to do so.125 At the core of her intransigence was a deep and enduring suspicion of the medical authorities: when she was not fretting over plots to appropriate her therapy, Caisse worried about plans to suppress it. “I was just afraid that it would not be given a fair test,” she said, “and I thought if I cured enough people that it could not be disputed, and I would be sure that when I handed it over to the Medical Profession that it would be made available to the cancer sufferers.”126 In order to protect her own interests, and those of her patients, Caisse proposed a compromise, just as John Hett had done: she promised to reveal the details of her therapy once the authorities had acknowledged its value. “Then they could not shelve it,” she concluded, “and suffering humanity would have to get it.”127 As was the case with Hett,

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Caisse’s attitude did nothing to endear her to the medical community and opposition to her work began to gather momentum. Ironically, Caisse herself provided her medical opponents with ammunition to attack her work. Although she was prepared to challenge medical authority by prescribing treatment, Caisse never dared assume the role of diagnostician. In this way, she embodied some of the most enduring tensions in the history of nursing, seeking the approbation of doctors even as she resented and resisted their authority.128 Throughout her long career as an alternative healer, Caisse insisted that patients provide her with a certificate of diagnosis from a regular doctor before she would agree to treat them. In 1935, for example, she assured Minister of Health John Faulkner that if he approved her hospital license, she “would just treat cases sent to me by the medical profession, when nothing known to medical science could be done for them.”129 Caisse no doubt adopted this position to enhance her credibility; it not only demonstrated her deference to medical authority, but also ensured, at least in theory, that she was treating – and curing – bona fide cases of cancer. Within two years, however, her self-imposed restrictions began to backfire. As doctors grew increasingly concerned and upset about her activities, they began to refuse patients’ requests for certificates of diagnosis. In August 1937, one patient complained to Premier Mitchell Hepburn: “I would like to try Miss Caisse’s treatment, but the Doctors are not in favour of her Cancer treatment and I am unable to procure from them the necessery [sic] written diagnosis which she requires.”130 Whether these actions were part of a campaign against Caisse, as some of her supporters charged, or simply the response of individual physicians was a moot point because, organized or not, they effectively curtailed patient access to Essiac.131 In the 1930s, Caisse was one of the most successful alternative healers in Ontario, attracting thousands of patients as well as a good deal of popular support. Although her popularity heightened medical scepticism and opposition, it was also a potent defense against professional interference. At any time in the 1920s and 30s, the medical authorities could have prosecuted Caisse for practicing medicine without a license, but they never dared exercise this prerogative in the face of public opinion. Consequently, in the summer of 1937, as doctors increasingly interfered with her work, Caisse rallied her forces: she gathered thousands of signatures on petitions, she talked to the press, she encouraged patients to complain to the government and, when she got no help from the minister of health, she turned to Premier Mitchell Hepburn.132 Reluctant to become embroiled in controversy during an election year, Hepburn repeatedly dodged Caisse’s requests for an appointment until he had no choice but to grant her an interview or risk alienating voters. Caisse claimed

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that the meeting went well, with Hepburn promising to support legislation on her behalf.133 Indeed, she was so gratified by the Premier’s response that she threw her support behind her local Liberal candidate, Frank Kelly.134 Twenty thousand posters, complete with Caisse’s picture, flooded the Bracebridge region that summer, each one describing how she had been helped by the Liberal government. There is no telling what Hepburn thought of this manoeuver, but he made no effort to dissociate himself from the publicity. Caisse, perhaps encouraged by his silence, appealed to him again in September when the cpso allegedly threatened to close her clinic. “I hate to worry you with this at the present time,” she wrote, “but I know that if this is done to me, that the Liberal Candidate would never be elected in this riding. I hope to help the Liberal Candidate but if the Medical Profession take drastic measures, I will have no control over the situation.”135 Although Caisse may have had some clout with the premier prior to the election, once his leadership was confirmed, her influence evaporated. Hepburn made no effort to promote her cause, and after a couple of months, she wrote to him demanding to know if he still intended to support her. His answer appeared in the newspapers a few weeks later when he denied ever having suggested a private bill. Hepburn told reporters that “What I promised Miss Caisse was to have her treatment investigated by a proper, authorized committee.”136 The premier may have been telling the truth about his conversation with Caisse – though it is surely significant that his disclaimer was not made public until after the election – but any promises he may have made were nullified by his statements to the press. Disappointed and disillusioned by this setback, Caisse nonetheless felt her work with cancer patients was too important to abandon and, like Hett, she decided to petition the Legislative Assembly for a special license. Her request was referred to the Private Bills Committee in March 1938, where a heated discussion ensued.137 Several members of the committee favoured passage of the bill on the grounds that Essiac seemed to help cancer sufferers. Having enjoyed Caisse’s support during the election, Frank Kelly took up the Essiac cause during the debate. “I am not claiming Miss Caisse has a cancer cure,” he told the committee, but “I do want to give this fact, that I know people who were sick and now are well.”138 On the opposite side of the debate was Daniel Lang, lawyer for the cpso, who delivered a lengthy critique of Caisse’s work and urged the committee to reject her request.139 Ultimately, the members of the Private Bills Committee were not prepared to endorse an alternative treatment for cancer by granting Caisse a special license to practice medicine; in a split decision, they voted down her request.140 By 1938, Connell was firmly established as a legitimate researcher while Hett was no longer even a legitimate practitioner. In the eyes of

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the medical authorities, Rene Caisse had never been either; her clinical results, which resembled those of Hett and Connell, could not compensate for her lack of medical credentials, any more than animal experimentation could offset her seemingly outmoded approach to the treatment of cancer. Even her popularity was a two-edged sword, heightening the scepticism of the medical profession even as it protected her from prosecution. Moreover, Caisse played into the hands of her critics, as Hett had done, by keeping her remedy secret, a practice considered inimical to reputable research and practice. Consequently, while Connell was described as an experimenter and Hett was depicted as maverick, Caisse was considered a quack. According to the medical and scientific communities, she did not, indeed could not, “go about it in the right way.”

d e f i n i n g m e d i c a l l e g i t i m a c y, defending medical authority The actions of alternative practitioners – and the reactions they provoked from the regular medical community – tell us a good deal about the nature and extent of medical authority in early twentieth-century North America. The sheer volume and diversity of alternative medical care available challenges scholarly assumptions about the dominance of regular medicine. Many historians have argued or asserted that, from the early decades of the twentieth century, doctors were able to monopolize the practice of medicine. By the late 1920s, Paul Starr has contended, “physicians finally had medical practice pretty much to themselves.”141 Even if we consider only the proponents of sects such as chiropractic, Christian Science, and osteopathy, this interpretation of medical history is clearly untenable in the North American context. According to a 1932 report of the Committee on the Costs of Medical Care, sectarian healers represented nearly twenty-five per cent of all medical practitioners operating in the United States.142 Moreover, the proportion of alternative practitioners at work swells further if we include healers such as Connell, Hett, and Caisse, who offered alternatives to conventional cancer care without offering alternative philosophies of healing. Notwithstanding the legal, institutional, and organizational advantages acquired by the medical profession after the turn of the century, regular doctors were simply not able to monopolize health care. At the same time, alternative cancer practitioners in Ontario posed a significant challenge to contemporary medical authority, not only through their numbers and popularity, but also by casting doubt on professional definitions of legitimate medicine. Alternative healers did not

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necessarily set out to undermine the authority of regular medicine. Indeed, they often reinforced it by seeking the approbation of the medical community and appropriating, with varying degrees of success, the theories, techniques, and language of “scientific medicine.” Rene Caisse was a perfect example of this phenomenon among alternative healers: lacking medical credentials and scientific training, she nonetheless accepted the importance of laboratory and animal experimentation in the development of new treatments. Ironically, though this kind of imitation and emulation sprang from the cultural authority of scientific medicine, it weakened professional claims to legitimacy by diminishing the differences between regular and alternative medicine. In other words, the medical profession’s efforts to draw a clear line between “legitimate” doctors and “disreputable” practitioners were confounded by the similarities between regular and alternative medicine. The difficulties of defining legitimate medicine were further complicated by the presence of alternative healers within the ranks of the regular medical community. Official reactions to Caisse suggest that medical or science education was integral to professional definitions of reputable practice and research. Yet orthodox credentials, though necessary, were not a sufficient sign of legitimacy.143 Hett’s case demonstrates that even regular practitioners could fall from grace if their actions did not conform to professional expectations. The medical community not only maintained its claim to authority by casting out “Judases” like Hett, but also tried to salvage medical training as a measure of legitimacy.144 In his 1936 report on cancer “quackery,” Arthur Cramp cast doubt on the work of several practitioners by questioning the quality or veracity of their medical credentials. This tactic was of dubious value because it relied on highly subjective judgments about “reputable” medical education. For example, Cramp felt that, in general, sectarian medical education lacked merit, despite the fact that homeopaths and eclectic practitioners were members of the licensed medical community.145 Moreover, it meant that the medical community was forever adjusting its definition of legitimate medicine, easing it forward to include one practitioner, snapping it back to exclude another. In its bid to define legitimate medicine, the medical profession sometimes invoked other criteria, such as motivation and therapeutic efficacy. Neither provided a satisfactory defense of medical authority. Therapeutic efficacy, the most obvious criterion, had limited value as a guide to medical legitimacy; as we saw in chapter 2, the medical community could scarcely agree about the merits of “accepted” cancer therapies – x-rays, radium, and surgery – let alone reach a consensus about new treatments. Moreover, the types and rates of success reported by alternative healers often closely resembled those of “legitimate” healers, as was the case

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with Connell, Hett, and Caisse. Secrecy sometimes afforded the opportunity to attack the motives of specific practitioners.146 A report on Hett’s work, drafted by the ama Council on Pharmacy and Chemistry, concluded that “the secrecy surrounding the serum ‘cure’ … can only be condemned as outright chicanery. … Obviously, the real reason for secrecy lies in the fact that Dr. Hett has no cure.”147 Yet as Arthur Cramp pointed out, even good intentions provided no guarantee of reliable treatment: “a person with cancer can die just as surely by relying on an honest but misguided enthusiast as by submitting to the malpractice of the most blatant ‘cancer cure’ swindlers.”148 In the absence of more compelling criteria, professional credibility hinged largely on the issue of disclosure. Antipathy to secrecy was firmly entrenched in the medical community. In the United States and Britain, campaigns waged against patent medicines in the early twentieth century highlighted the dangers of secrecy for public health.149 Moreover, professional codes of ethics frequently prohibited members from using or promoting secret remedies.150 At the heart of professional opposition to secrecy was the conviction that legitimate practitioners and researchers shared their findings because they wanted their ideas and conclusions to be tested and verified by their colleagues. “That is the great advance of science,” commented one Ontario scientist, “because it is checked from all quarters.”151 By extension, practitioners who refused to divulge the details of their work were presumed to have something to hide and they were duly scrutinized, criticized, and, in some cases, ostracized. Despite their promising clinical results, Caisse and Hett incurred the wrath of the medical community because they insisted on secrecy; despite the flaws in his theory and methods, Connell published his results, albeit belatedly, thereby winning the support of his medical colleagues. Although the regular medical community frequently relied on the issue of disclosure to distinguish reputable from illegitimate practices, it was not a secure foundation on which to base medical authority. For one thing, secrecy itself was power, a form of passive resistance to professional meddling: though it virtually guaranteed a hostile reaction from the medical authorities, it also allowed alternative practitioners to retain control over their therapies. For another, therapeutic efficacy, rather than secrecy, was the overriding concern of patients and the public. In other words, professional confidence in this criterion of legitimacy was not reflected in lay attitudes to alternative healers. Indeed, the authority and credibility of regular medicine was increasingly called into question by professional attacks on Caisse and Hett. As Paul Starr has argued, “authority signifies a potential to use force or persuasion, though paradoxically authority ends when either of these is openly employed.”152

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Contrary to scholarly assumptions, the health culture of North America in the early twentieth century was not monopolistic, but pluralistic, characterized by a wide variety of treatment alternatives as well as by shifting and competing definitions of medical authority. In this way, it resembled Irvine Loudon’s description of medical practice in England during the eighteenth and nineteenth centuries: “At opposite ends of the spectrum the physician with his md and the itinerant quack of the market-place were clearly delineated. At the centre, however, was a blurred grey area in which the identification of an individual as a ‘regular’ or ‘irregular’ practitioner was often impossible, for it depended on the observer.”153 To be sure, the medical profession exerted considerably greater influence on medical practice in twentieth-century North America than it had in Loudon’s England, yet the boundary between legitimate and disreputable medicine remained blurred and difficult, if not impossible to define while the credibility of specific practitioners and therapies continued to depend on the observer.

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4 Cancer Patients Take Care: Sufferers, Healers, and Illness Experiences

In 1931, five years after Beatrix Leacock consulted a physician about her ill health, another Ontario women, M.A.M., learned that she also had breast cancer.1 Though about the same age and suffering from the same affliction, these two woman had vastly different experiences with the disease and its treatment. Bothered by a collection of vague complaints, Beatrix delayed consultation with a physician, hoping to regain her health and strength with rest. In contrast, M.A.M. hurried to a doctor after discovering a single, ominous symptom – a lump in her left breast. Beatrix arrived too late for treatment; her cancer had advanced beyond the stage when conventional treatment might hope to cure her. M.A.M.’s prognosis proved more promising. Because she had detected the lump at an early stage, when it was still small and discrete, doctors felt her chances of recovery were good and they deployed all the resources of conventional medicine to root out the disease. During the next six years, M.A.M. spent a great deal of time in the offices of physicians, surgeons, and radiologists as well as on the wards of hospitals. Although sufferers tended to approach their family doctors first, M.A.M. ignored the local medical talent, preferring to consult a Toronto physician, F.W. Leech. She contacted him in the fall of 1931, soon after finding the lump in her breast. Judging by the medical standards of the day, which stressed the need for speed in cases of cancer, Leech decided on an exceedingly conservative course of action: he observed the growth in M.A.M.’s breast for many weeks, trying to evaluate its nature and virulence. In January, having finally determined that the lesion demanded more specialized attention, Leech sent his patient

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to Toronto surgeon F.A. Clelland. Where Leech had adopted a waitand-see attitude, Clelland advised immediate treatment, suspecting neoplasia. On 14 February 1932, four months after her initial consultation, M.A.M. had her left breast amputated and underwent radium treatments post-operatively to ensure the complete eradication of cancer cells. Tissue analysis of the lump later confirmed the diagnosis. According to M.A.M., this treatment “was apparently a success,” but within the year she found herself facing the prospect of further surgery. In November 1932, Dr Clelland operated a second time, “finding a cancer the size of a small English walnut” in her uterus. Once again, tissue analysis corroborated the diagnosis and, once again, the treatment seemed to have eradicated the disease. For the next year and a half, M.A.M. enjoyed freedom from further symptoms of cancer. Then in June 1934, she noticed “a little lump on the muscle just above the incision of [the] first operation.” At this point, for the first time, M.A.M. hesitated to consult a doctor. While the initial growth had galvanized her into action, this one seemed to paralyze her. For more than a year after she discovered the new growth, she simply watched and waited, perhaps hoping that the lump would vanish spontaneously. By November 1935, however, M.A.M. had accepted the need for further treatment because the lesion had grown “considerably.” Returning to Dr Leech, she learned that her breast cancer had recurred. This time, Leech referred her to G.E. Richards, head of radiology at Toronto General Hospital. Richards prescribed radium therapy: one hour a day for two weeks. Although the lump subsided, a second growth appeared less than three months later. Again M.A.M. balked at the prospect of further treatment. Six months passed and the second lump grew larger before she sought medical attention. In September 1936, she finally made another appointment with Dr Richards. Like Leech before him, Richards concluded that the cancer had returned. After consulting with a surgical colleague, Robert Janes, Richards recommended excision of the growth and more radiation therapy. Although M.A.M. recovered well from the surgery, the radium upset her stomach, causing her to lose weight. Moreover, when she returned for a check-up in November, Janes “insisted” on further radiation. By the time she left the hospital a few weeks later, M.A.M. had not only lost more weight, she had also suffered burns severe enough to compromise the integrity of her incision. On the day of her discharge, Richards’ final examination revealed a large open sore under her arm where the growth had been removed. He sent her home with medication and instructions to bathe the wound in peroxide. M.A.M. suffered keenly from the side effects of treatment. She recalled that within five days “the awful odour of this [wound] was driving my family out of the

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house and I’d lost several pounds. Could neither sleep nor eat. In a week this [sore] had become such a hole I could pack a yard and a half of inch gauze in it.” This time, M.A.M. turned to a local doctor for advice. When he had nothing to offer except more radiation therapy, she abandoned conventional medicine. “I was already burned to the bone,” she wrote, “and terribly weakened by the effects [of radiation] and if the Drs. idea of radium was my only help then I was dying on my feet.” One week later, on 5 December, M.A.M. turned to an alternative healer, Rene Caisse. She seems to have approached the consultation with a certain amount of scepticism. “By this time,” she claimed, “I had quite given up the idea of having any sort of decent health again.” Yet she hoped that Caisse’s therapy might help and believed that it could not be any worse than the treatments she had already endured at the hands of physicians. “I was so burned and sick,” she wrote, “I decided to give Miss Caisse a trial.” Despite her doubts, M.A.M. flourished on Essiac therapy, steadily gaining weight and strength: “I went down to less than a hundred pounds and was a green-yellow colour, but from the first of March I began to pick up and by July I was feeling almost back to normal.” Even the wound in her side responded to Caisse’s ministrations. By December 1938, the patient reported that the sore had “almost healed … and I am quite able to keep house again.” Moreover, she watched as dozens of other sufferers seemed to improve or recover while in Caisse’s care. Looking back on her illness experience, it is hardly surprising that M.A.M. praised Essiac therapy over conventional treatments for cancer. “I am only sorry I didn’t go sooner,” she concluded, “as I would have saved a good bit of suffering and expense.” A comparison of the stories of M.A.M. and Beatrix Leacock exposes the dangers and difficulties of reaching general conclusions about the patient perspective. Their vastly different experiences with breast cancer and its treatment were shaped by the nature of their individual lesions as well as by the values and opinions that prevailed in their lives. Beatrix’s cancer surfaced only gradually and very ambiguously, blunting the edge of her anxiety. In contrast, M.A.M.’s earliest symptoms strongly suggested cancer. Beatrix’s outlook or perhaps that of her husband kept her from resorting to an alternative healer when physicians pronounced her cancer incurable. M.A.M. did not hesitate to use an unconventional remedy after regular treatments failed to alleviate her suffering. With no hope of relief from surgery or radiation, the Leacocks turned to Blair Bell and his experimental lead therapy. Even if M.A.M. had wanted to try Bell’s treatment, she probably lacked the means and opportunity to consult an eminent British physician

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working thousands of miles away. The stories of these two women remind us that illness, then as now, was a singular as well as a generic experience. Nonetheless, these two encounters with cancer shed new light on the patient perspective by encouraging us to re-examine the relationship between conventional and unconventional medicine in the past. Traditionally, physicians and scholars have tended to regard regular and alternative medicine as competing, mutually exclusive systems of healing. One is described as credible and reliable, based on scientific investigation; the other is depicted as questionable, perhaps even dangerous, rooted in popular superstitions. Moreover, clients often share the reputation of the treatments they use and the practitioners they consult. Patients in the care of doctors are portrayed as rational, intelligent, and informed while sufferers who turn to unconventional healers are perceived as desperate, ignorant, or naive. Although some of these conclusions have been moderated in recent years by a growing body of literature that describes regular and alternative medicine as “complementary” rather than competitive, older assumptions about “quacks” and their supporters persist in medical and scholarly circles.2 In some respects, the experiences of Beatrix Leacock and M.A.M. seem to justify these perceptions of alternative and regular medicine. Although we cannot be certain of M.A.M.’s social or economic background, it seems likely that her status was inferior to that of Beatrix. Thus, as we might predict using the traditional paradigm, the more educated, affluent woman remained committed to conventional medicine while the woman with fewer social and economic resources placed her faith in an unconventional healer. But a closer examination of the experiences of these two patients reveals far more interesting and complex patterns of health care consumption than can be accounted for by a simple, dichotomous interpretation of regular and alternative medicine. Although M.A.M. eventually turned to an alternative practitioner, initially she shared Beatrix’s belief in the power of conventional medicine: both women relied on doctors to diagnose their ills; both accepted the prognosis and the prescriptions of regular practitioners. Indeed, M.A.M.’s trust may have outstripped that of Beatrix Leacock, who underwent only a single operation as opposed to the gruelling rounds of surgery and radiation endured by M.A.M. Nor were the treatment choices of these women as utterly different as they might appear. Admittedly, neither Beatrix nor her husband ventured beyond the bounds of regular medicine, but they headed into highly questionable territory when they elected to try an unproven and controversial therapy. Moreover, M.A.M. consulted an alternative practitioner only after she had exhausted the potential of conventional remedies. In other words, suf-

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ferers responded to neoplastic diseases in subtle and diverse ways. Some patients, like Beatrix Leacock, relied mainly on one approach to healing, while others, including M.A.M., employed the entire range of conventional and alternative treatments in their battle against the diseases. Indeed, long before scholars and practitioners began to appreciate the compatibility of regular and unconventional medicine, many cancer patients experimented with both approaches to healing, hoping for greater comfort or even a cure. For these sufferers, alternative and regular medicine represented not the antipodes of health care, but a therapeutic continuum from which they could choose treatments and practitioners according to their needs, experiences, and expectations. Before we explore the contours of patient experience with conventional and alternative medicine, a word about sources is in order. The scarcity of records left by sufferers has often forced historians to infer the lay perspective from medical discourse. Fortunately, medical journals and textbooks, educational literature, doctors’ memoirs, and case histories reveal a good deal about the nature of conventional care and the experiences of patients. I have relied on selected documents from each of these categories to fill in gaps and round out my understanding of the conventional medical encounter. But although these sources are helpful, even the most skilful analysis of them provides an incomplete picture of regular medical care and, in some cases, a distorted impression of alternative medicine. Only the testimony of patients can provide us with a clearer view of cancer care in the past. While researching the history of cancer, I compiled a collection of 220 letters written by sufferers to the press, to the government of Ontario, to regular and unconventional practitioners, and to fellow victims of the disease. Some consist of only a few lines while others provide lengthy, discursive accounts of the intimate details of illness and treatment. As with documents generated by the government and the medical profession, the use of these records poses a challenge for the historian. Because it is often impossible to ascertain the occupation, class, marital status, ethnicity, or religious affiliation of the authors, we can only guess at the influence of these factors on illness experience and treatment choices. Even the gender of sufferers may be obscured in these letters, unless the location of the disease makes the sex of the correspondent indisputable, as in the case of prostate or breast cancer. At the same time, those dissatisfied with regular treatments or enamoured of alternative therapies were more likely to write to the government and the newspapers than patients satisfied with regular care. As a result, these records reveal more about the unconventional than the conventional end of the therapeutic continuum. Although we cannot learn everything about illness experience from this sample of letters, however, we can learn much about

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when and why sufferers turned to alternative healers. Ultimately, it is the voices of cancer patients, captured in this correspondence, that suggest we have sometimes misunderstood the motives and experiences of those who tried or relied on unconventional medicine.

conventional cancer care In the years before World War ii, Canadian and American doctors fumed and fretted about the pernicious influence of alternative cancer remedies. Many feared that the blandishments of unscrupulous practitioners would lure sufferers from the benefits of conventional medical care. Consequently, leaders in the medical community routinely warned the public against the use of therapies other than surgery and radiation for the treatment of neoplastic diseases. In 1935, for example, John McCullough, chief inspector of health for Ontario, reminded a group of graduating nurses that “quacks do not cure. All a quack will do for you is to delay the opportunity of gaining early and proper treatment.”3 But while the medical authorities worried about the popularity of unconventional remedies, the vast majority of sufferers actually began their confrontation with cancer in the offices of regular practitioners. Some patients already suspected they had cancer while others were taken by surprise, but most first heard the diagnosis from a doctor. Initial attempts to manage the disease consequently took shape within the conventional medical encounter. Whether patients continued to rely on regular doctors or resorted to alternative healers depended to a large degree on the quality of that medical encounter. Many factors combined to influence patients’ decisions about health care: the attitudes and actions of practitioners; popular perceptions of cancer and its treatment; familiarity with regular treatments. Some sufferers, like Beatrix Leacock, elected to remain in the care of doctors, but those, like M.A.M., who deserted conventional medicine to try alternative remedies generally did so for compelling reasons. As with popular perceptions of health and healing, personal and social experience set the boundaries of patient confidence and compliance.

medical discourse and the medical encounter Students and practitioners of modern health care have often assumed that the laity is baffled by the abstruse vocabulary of medical consultation and care: because patients cannot or do not understand the technical language of scientific medicine, they are frequently confused or simply uninformed about their health and treatment. Historian Charles

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Rosenberg has argued that “in earlier centuries … shared knowledge tended to structure and mediate interactions between doctors, patients, and families,” but in the twentieth century, “knowledge is increasingly specialized and segregated.”4 Moreover, confusion and frustration allegedly give rise to alienation, encouraging many patients to try alternative medicine because unconventional healers appear more attuned to lay values and vocabulary.5 At times, medical discourse undoubtedly complicated communications between patients and doctors. In 1937, for example, a woman wrote to the Ontario government for advice about a young relative who had been diagnosed with cancer. “The patient knows it is sarcoid,” she remarked, “but is not aware of the fact that there is any malignancy associated with it.”6 In this instance, physicians apparently deployed unfamiliar terms to satisfy the patient’s need for a diagnosis while obscuring the real nature of the affliction. In other cases, medical language could have just the opposite effect, raising unwarranted fears in the minds of sufferers. In February 1938, doctors at the Lockwood Clinic in Toronto examined W.J.O., informing him that he suffered from “benign hypertrophy of the prostate.”7 The doctor in charge of his case recommended surgery to remove the offending gland. W.J.O. refused, turning instead to Rene Caisse and her herbal treatment for cancer. Clearly, this patient failed to appreciate that he suffered from a non-threatening enlargement of the prostate, assuming instead that a growth requiring immediate surgery must be cancer. Yet medical discourse did not consistently confuse or disable patients in the care of regular practitioners. In the early 1930s, for example, J.H.B. underwent a hysterectomy for a uterine growth and when she had regained consciousness after the surgery, she asked the matron of the hospital if she had cancer. According to J.H.B.’s letter, the matron told her she “had a growth called a Myopa.”8 Unacquainted with this term, the patient apparently modified it to “Myopia,” a word she seemed to recognize. When she got home and looked up the meaning of the word, however, she discovered that her recently dispatched uterus was short-sighted! She finally cleared up the mystery when she wrote to the provincial authorities for further information, and doctors at the Department of Health assured her that her condition, actually called “myoma,” was a benign growth of the uterus. At first glance, this patient’s experience seems to support Rosenberg’s conclusions about medical terminology. What is most striking about this case, however, is not the confusion displayed by J.H.B. but rather her determination and capacity to elicit information about her health and care. Not only did she keep a medical handbook at home for reference, but she also continued to ask questions until she was satisfied that she understood her diagnosis and treatment. Other sufferers – whether

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highly articulate or barely literate – exhibited a similar grasp of the most salient features of their condition and care.9 Although medical discourse sometimes worked to the disadvantage of patients, many cancer sufferers proved themselves able to understand and make informed decisions about health and healing. Experience with conventional care, rather than medical vocabulary, alienated many sufferers, persuading them to look elsewhere for support and treatment.

d oc to rs an d pat i e nt s Professional perceptions of neoplastic diseases exerted a profound influence on the quality of the medical encounter. As we have seen, while sufferers and their families dreaded the implications of cancer, doctors often found it a deeply frustrating disease. Years of clinical and laboratory investigation failed to yield a definitive explanation for cancer or consistently reliable treatments. Although the limitations of conventional care spurred some practitioners to search for new therapies, or at least to provide excellent palliative care for their dying patients, other physicians simply retreated from the disease and its victims. Two doctors writing for the cmaj in 1932 noted that “When the medical practitioner is confronted by a case of far advanced and apparently incurable cancer, he is apt to be seized with a feeling of hopelessness. Often the patient is dismissed with the verdict that nothing can be done for him.”10 D.M., for example, never got the chance to try conventional remedies: by the time she consulted a physician, her cancer had advanced beyond the stage where it might respond to surgery or radiation therapy. Rather than offering her hope or comfort, however, her doctor advised her that “there was nothing more could be done and I would be dead in six months.”11 Even if the physician did not use these exact words, he nonetheless left the patient with no doubt about his callous disregard for her well-being. Such experiences could be devastating for sufferers. Some, like D.M., sought the advice of an unconventional practitioner rather than accept a grim prognosis or brutal insensitivity from a disheartened physician. Professional perceptions of the laity also coloured the medical encounter. Any number of angles might provide us with a view of doctors’ attitudes, but I want to focus here on the gendered management of neoplastic diseases. Professional reactions to female cancer patients sometimes reflected broad social attitudes that tended to disparage women. Medical and educational literature, for instance, often portrayed female sufferers as shallow or foolish.12 On the one hand, doctors criticized those who neglected suspicious symptoms, arguing that these women sacrificed their health, even their lives to “false mod-

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esty.”13 On the other hand, women who consulted physicians might appear self-centred. “A beautiful woman rarely, if ever, is observed with cancer of the skin,” noted a prominent American practitioner, “because the vanity of a beautiful woman urges her to seek the advice of her physician the moment she observes the skin defect.”14 Moreover, medical opinions about “female” cancers compounded negative reactions to women patients. During the early decades of the twentieth century, men most often developed lesions of the alimentary canal, particularly oral and gastric cancers, while women suffered primarily with cancers of the breast, cervix, and uterus.15 Because doctors tended to regard these latter lesions as more “accessible” to examination and therefore more “curable,” they were more likely to blame female patients for late diagnosis and, by implication, for their own deaths.16 Many women in the care of regular physicians probably received excellent care, but some undoubtedly suffered as a result of chauvinistic attitudes. At the same time, the medical management of cancer could be especially discomfiting for female patients. One doctor’s description of a thorough breast examination hints at the experiences of women sufferers: The patient, stripped to the waist, should be examined in the sitting position and in a good light. Inspection should be first from in front. The size of the breasts, their comparative symmetry, the comparative level of the nipples, and the presence of any visible deformity of either the nipple or the body of the gland, should be noted. One should then stand behind the patient and observe the relative fullness of the breasts from above: and passing the hand over the shoulder, manipulate and draw out the nipples, noting any difference in pliability or degree of prominence when erect. … Then, by rolling the base of the nipple between the thumb and forefinger, one should ascertain whether there is thickening.17

For many women, the medical encounter involved a distressing invasion of privacy and personal space. As one surgeon noted, “many women have an aversion to breast examination.”18 Pelvic examinations for cervical and uterine conditions elicited even stronger reactions from female sufferers. An educational manual for physicians, published in 1922, noted that “Too often the disinclination of the patient and the indifference of the physician combine to postpone this examination until too late for cure of the disease.”19 To some extent, medical imperatives forced doctors to ignore the finer feelings of their female cancer patients; they could not afford to tread lightly with a potentially life-threatening disease. Yet it is also

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true that practitioners sometimes seemed more willing to perform invasive procedures, such as biopsy, on women than on men. In 1938, for example, doctors working at government-sponsored cancer clinics in Ontario performed biopsies on ninety-one per cent of women with suspicious cervical lesions, a figure that vastly exceeded biopsy rates for any other type of neoplasia.20 Admittedly, the technique was less useful for some of the cancers most commonly found in men, such as those of the stomach. Yet even highly accessible lesions, such as those of the mouth which afflicted men far more often than woman, were less likely to be diagnosed by tissue analysis. At provincial cancer clinics, only sixty-six per cent of patients with oral cancers underwent biopsy. Moreover, doctors seldom relied on tissue analysis to diagnose prostate cancer, a uniquely “male” lesion.21 Treatment of neoplastic diseases involved further assaults on the bodies and sensibilities of female patients. For example, a sufferer receiving radiation therapy for cervical cancer might be asked to lie in a recumbent position for hours while a probe inserted into her vagina bombarded the cancer with x-rays.22 Alternately, doctors might pack her vagina with radium or implant radium needles directly in the cervix. Although some practitioners undoubtedly tried to help sufferers overcome the humiliation of cancer treatments, others displayed a shocking disregard for the emotional implications of conventional care. As late as 1945, two doctors claimed that women with breast cancer suffered more from uncertainty than medical intervention: “Truly remarkable is the peace of mind that descends on these patients as soon as treatment is underway, and how little it is disturbed by positive biopsy and radical mastectomy.”23 Despite the potential for unhappy experiences, not all women found the medical encounter unbearable. Beatrix Leacock, for instance, apparently registered no complaints about her doctor’s care. In the same way, not all cancer sufferers were mistreated by regular practitioners. Judging by their compliance with medical advice, some patients consulted caring and considerate physicians in whom they placed their trust. Yet many sufferers were not so lucky. Some encountered a degree of pessimism among doctors that deprived them of help as well as hope. Others tolerated brusque manners and negative attitudes in the belief that doctors might cure them of cancer. William Victor Johnston’s experience as a young practitioner underscores the impact of professional attitudes on the medical encounter. In his first year of practice, Johnston encountered a man with a suspicious abdominal lump.24 When the patient, Tom, demanded to be told the truth, saying “I can take it,” Johnston was brutally honest. Tom never returned, choosing to consult another local physician. “I had been tricked into

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being too hasty,” concluded Johnston. “My conscience had made me inhumanely stupid.” Fortunately, Johnston’s other patients benefitted from the grievous experience of one man: thereafter, he used greater tact when discussing a diagnosis of cancer and his patients seemed pleased with his services. A positive encounter with Johnston thus encouraged confidence and compliance among sufferers while Tom’s negative experience convinced him to find a different practitioner.

pati en ts a nd c o nv e nt io n al cancer care Although historians have painstakingly documented professional culture and its impact on patients, much less attention has been devoted to the laity.25 A dearth of sources has sometimes stymied scholars studying doctor-patient relations, but a tendency to regard sufferers as victims has also encouraged historians to privilege the professional over the patient perspective. Even Sheila Rothman’s study of tuberculosis, a seminal work in the history of illness experience, depicts patient culture primarily as a response to medical beliefs and behaviours. In her account, sufferers confined to the sanatorium in the early twentieth century were reduced to cunning manipulation of institutional rules that curtailed and diminished their lives.26 My investigation of the experiences of cancer patients reveals a more active role for the laity in the medical encounter. As we saw in chapter 1, popular views of illness, neoplastic diseases, and conventional medicine exerted a decisive influence on the timing and quality of the initial medical encounter. As the relationship between patient and doctor evolved, the lay perspective continued to inform sufferers’ decisions about and reactions to treatment. A small proportion of patients, on learning that they had cancer, rejected conventional treatments altogether. Dr R.J. Mannion, for instance, recalled that his own father “repulsed my suggestion that he go to the Mayo clinic or to Chicago for treatment” of bladder cancer.27 Some of these sufferers made their decision based on the conviction that regular medicine could not cure them. According to Mannion, his father refused treatment because “he noticed that most of those who went away to be treated did not come back.” Apparently this patient shared the pessimistic attitude of some members of the medical profession. Rather than endure painful, expensive, and ultimately pointless treatment, he chose to die on his own terms. Four months later, the older Mannion was “carried off” by cancer without ever having tried to beat the disease. Although other sufferers responded differently to the threat of neoplastic diseases, many exhibited a similar underlying scepticism about the value of regular medical care.

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Aversion rather than pessimism led other sufferers to decline conventional treatments for cancer. In this era, most therapies had the power to inspire fear, but surgery provoked an especially strong reaction among the laity. Like some other patients, G.M. seemed to feel that surgery demanded a degree of stamina he did not have. “I hated the thought of an operation,” he concluded, “as I am a man over 60.”28 Other sufferers could not bring themselves to contemplate the effects of surgery. One female patient, F.M., balked at the prospect of colostomy. “A week ago,” she wrote, “[the doctor] told me he had discovered cancer of the rectum. The only thing, he said, to do was to operate and remove the growth, that would mean removing the rectum, as well as making an artificial opening in the lower side of the abdomen. I would rather die than have this done.”29 According to Susan Sontag, shame explains such negative reactions. “Having a tumor generally arouses some feelings of shame,” she observed, “but in the hierarchy of the body’s organs, lung cancer is felt to be less shameful than rectal cancer.”30 Although it is undoubtedly easier to discuss lung than bowel function, it is also apparent that the repercussions of treatment, rather than shame about the disease, accounted for popular aversion to surgical procedures. One doctor’s description of life after colostomy helps to explain lay reactions: Managed in any way so far devised, colostomy is never without some odour and is not completely controllable, and for that reason it is usually an unending source of embarrassment and trouble to the owner. The advocates of the procedure describe it as satisfactory for a patient who is appearing in public, doing a normal job, and taking a usual part in the life of the community; but the vast majority tend to hide out … so that they will not be embarrassed by some of its [the colostomy’s] misadventures and misconducts.31

According to historian Edward Shorter, advances in surgery “more than any other single factor, elevated the doctor in the public’s eye to demigod status.”32 Perhaps cancer sufferers did regard the surgeon with awe, but some of them at least feared the surgeon’s knife as well. Social experience likewise encouraged patients to avoid conventional therapies. For example, H.R. declined surgery because of his familiarity with the effects of treatment in other sufferers: “I had seen so many others that have had operations that I just refused.”33 For the same reason, T.D. rejected radium therapy for cervical cancer. “Three of my friends, neighbour women,” she wrote, “had similar treatment and … told me they were dying a death of fiery internal furnace.”34 Moreover, conventional cancer care seemed to exact a heavy toll in suffering while offering little hope of recovery. Weeks, months, even years of agonizing

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and mutilating treatment might well end in death. Indeed, T.D. felt she had learned an important lesson while watching her friends suffer and die. “Knowing of their untimely deaths and awful agony,” she concluded, “I was determined to die comfortably if needs be by the inroads of cancerous growths.” Familiarity with the realities of conventional treatments made these sufferers reluctant to submit to uncomfortable and potentially unsuccessful procedures. Although some patients turned their backs on regular medicine without ever putting it to the test, many more, like M.A.M., accepted the recommendations of their physicians. A fortunate few were cured of cancer after a single surgery or several rounds of radiation therapy, but the vast majority suffered through long battles, involving many operations and repeated exposure to x-rays or radium. Whether or not they survived the disease, most, perhaps all, of these patients endured agonizing torment at the hands of regular practitioners, not because their doctors were uncaring or insensitive, but because conventional treatments for cancer were exceedingly harsh. As one sufferer commented, “the treatment in itself is enough to kill a person, without such a damaging disease added to it.”35 Intimate experience taught many cancer sufferers to loathe conventional medicine. In the years before World War ii, surgery was the procedure most often endured by cancer patients. Some sufferers submitted to minor surgical procedures, such as a biopsy or the implantation of radium needles, while others underwent major operations involving amputation of limbs or resection of bowels. But, as Douglas Quick, a surgeon at Memorial Hospital in New York, observed, “operative surgery plays a role somewhere in the course of the average case of cancer.”36 Moreover, some cancer patients went through a series of surgeries. One man reported that his wife had undergone “three major operations … during the past five years.”37 Although surgery aimed to cure patients or at least alleviate their worst discomforts, the outcome could cause a good deal of suffering. For example, surgeons treated throat cancer by removing the vocal chords and larynx with the result that sufferers who survived the operation and conquered the disease might never speak or swallow again.38 Surgery for breast cancer likewise exacted a considerable toll from patients. Because doctors regarded breast lesions as exceptionally virulent, they routinely prescribed radical mastectomy, a procedure that involved removing the entire breast and the underlying muscles as well as nearby lymph nodes and vessels.39 As a result of the massive excision of tissue, sufferers had to deal not only with the drastic alteration in their appearance, but also with the loss of upper body strength and mobility. Moreover, the surgery often interfered with lymph drainage, leaving women with a grotesquely swollen arm.

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Radiation therapy generally provided better cosmetic results than surgery, but its use could be uncomfortable as well as hazardous. Practitioners gauged the dosage and the effectiveness of radiation by the reaction of the patient’s tissues.40 Referred to as an “erythema dose” because of its effects on the skin, the exposure involved “a superficial burn, which is satisfactory evidence that the irradiation has penetrated the tissues.”41 Radiologists advised other doctors not to refer to these reactions as “burns” for fear it would have an adverse effect on the patient or even result in litigation.42 But experience left little doubt in the minds of cancer sufferers that they had been burned. At the same time, tissues exposed to radiation lost some of their recuperative power. A patient treated for carcinoma of the bladder claimed that the “wound in the bladder and abdominal wall did not close for about a year” after treatment.43 Indeed, some sufferers never completely recovered from radiation exposure. According to a 1932 article in the cmaj, one patient still had an open incision ten years after surgery and radiation therapy for a growth on her back.44 In addition to local burns, radiation therapy compromised the health of patients by provoking systemic reactions. Prolonged or intensive exposure usually induced nausea, vomiting, and diarrhoea.45 Consequently, sufferers already debilitated by disease found their health deteriorating further as they lost weight and strength. Radiation also attacked healthy tissue as well as neoplastic cells, disrupting normal structures and functions. Treatment of gynecological cancers, for example, sometimes produced vaginal fistula, an opening between the vagina and the rectum that predisposed the patient to unpleasant discharges and dangerous infections.46 Menopause could also begin suddenly and stormily in the wake of radiation therapy for uterine or cervical cancer. Even without these kinds of serious sequelae, sufferers usually endured intense irritation of the bladder and rectum following exposure for gynecological cancers. “This irritation,” observed one clinician, “is often transient, but it sometimes lasts for months despite all treatment, and the patient has exchanged painless haemorrhage for continuous pain and discomfort.”47 Uncomfortable experiences such as these not only distressed sufferers, but also raised doubts about the value of radiation therapy. As we saw in chapter 1, the laity frequently associated the onset of pain with illness and, by extension, the cessation of pain with recovery or improvement. When x-ray and radium treatments produced painful side effects patients sometimes concluded that their cancers had worsened or returned. A.R., for instance, gave up on radium therapy for cervical cancer after encountering painful irritation of the rectum as well as bleeding. According to one of her physicians, “the patient stated to us that she had a recurrence of cancer.”48

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The doctor tried to reassure A.R. that these side effects would eventually subside, but she remained convinced that the treatments had exacerbated rather than improved her condition. Moreover, some practitioners shared her view of radiation therapy. One doctor commented that some physicians added insult to injury by intensifying the treatment regimen when patients developed distressing side effects. “Too often,” he wrote, “these … reactions are interpreted as malignant invasions which call for further radiation.”49 It is not surprising that while the medical profession in Canada and the United States worried that unconventional healers hoodwinked and endangered the public, the correspondence of cancer patients suggests that the laity was not so much lured as driven from conventional medicine. M.R.F., for instance, underwent a colostomy for bowel cancer. When the disease continued to spread and her doctors advised additional surgery, she declined to “suffer further mutilation,” declaring that she would prefer to “surrender myself to experimentation rather than the proposed operation.” Similarly, a man whose mother submitted to radiation therapy concluded that the treatment had caused her more harm than the disease. “She has had fifteen XRay Therapy treatments,” he wrote, “which made her suffer far more than the cancer itself. She has had to take capsules to deaden the pain every day for the past six months.”50 Although these sufferers, like M.A.M., began with a great deal of confidence in their doctors, repeated exposure to painful, disfiguring, and apparently unsuccessful therapies eroded their faith in conventional medicine. As a result, some of them began to explore the world of alternative cancer care.51

unconventional medicine According to some scholars, reliance on unconventional medicine in the early twentieth century pales by comparison with the popularity of medical sects in the nineteenth century and the resurgence of interest in alternative therapeutic systems in recent years. Edward Shorter, for instance, has argued that “the relative number of irregulars was nowhere near as great as it had been early in the nineteenth century, when the rival sects and self-styled doctors outnumbered the graduates of regular medical schools … [and] alternative healers reach out today to a far wider percentage of the population than the quacks of the 1920s and 1930s ever embraced.”52 While it may or may not be true that alternative systems of healing had lost a good deal of their appeal and influence by the turn of the twentieth century, interest in unconventional treatments remained an important social and medical phenomenon.

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As we saw in chapter 3, alternative healers multiplied in both Canada and the United States during the early decades of the twentieth century. Practitioners such as Norman Baker, Harry Hoxsey, and Frederick Koch thrived south of the border while Hendry Connell, John Hett, and Rene Caisse flourished in Canada during the 1920s and 30s. In the summer of 1935, for example, sufferers swarmed into Kingston, Ontario after Hendry Connell announced his preliminary results with Ensol therapy. Students attending Queen’s University the following autumn complained that they could not find rooms to let because “Cancer patients, who have come from all parts of the continent to take the ‘ensol’ treatment of Dr. Hendry C. Connell, have taken many of them.”53 In the same year, John Hett’s therapy generated interest among the laity. “Demands of sufferers for treatment,” wrote one journalist, “became so pressing in the Toronto area that the doctor was compelled to make this city his headquarters, and now spends four days a week here.”54 Caisse enjoyed even more attention than either Connell or Hett: more than 55,000 people signed petitions on her behalf in the 1930s.55 Shorter’s conclusion that patients were not “seeing irregulars for diseases like cancer” does not apply in Ontario, nor in the broader North American context.56 Scholars have frequently misunderstood not only the extent but also the basis of popular support for alternative medicine. In his study of cancer in modern America, James Patterson repeatedly describes proponents of unconventional medicine as mainly poor and uneducated. In the twentieth century, many Americans of means came to believe the claims of the [conventional medical] experts. They could afford to see physicians and to pay for hospital rooms, and they agreed to be treated there. They accepted the modern medical culture. Millions of Americans, however, were not so ready to accept it, among them some in the middle classes as well as masses of recent immigrants, blacks, impoverished farmers, blue-collar workers, and others who did not have the means or desire to embrace middle class medical values. Many continued to rely on folk remedies and patent medicine; others clung to religious beliefs and turned to faith healers. Uninformed about new scientific developments, unable to afford modern medical care, these Americans rarely saw a physician or went to a hospital.57

James Harvey Young likewise maintains that the ignorant and impoverished most often succumbed to the wiles of health “quacks.” “No one,” he claims, “can afford complacency, thinking himself forever immune from the quack’s ingenious appeals. Yet there are not enough errant intellectuals among us to keep quackery flourishing. The poorly educated do after all pay most of the bills.”58 Although it is undeniable

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that economic and educational status played into the health care choices of cancer sufferers, Patterson and Young presume rather than proved the identity of consumers of unconventional medicine. In fact, alternative treatments for cancer attracted sufferers and supporters from most, if not all, segments of society. According to Patterson, the costs of conventional medical care encouraged poor patients rather than rich ones to rely on alternative healers. Prior to the introduction of public and private health insurance plans, doctors’ fees and hospital charges ostensibly made patent medicines and the services of neighbourhood healers more accessible and attractive to sufferers with meagre resources. In the 1930s, for example, surgeons charged upwards of $100 for a colostomy while the price of a radical mastectomy began at $150.59 Fees for diagnostic procedures, an anesthetist, and recovery time on the hospital wards pushed the costs of treatment even higher. Clearly, economic considerations sometimes diminished access to conventional cancer care. During this period, statistics from Ontario’s cancer clinics revealed that private patients – those with funds to pay for their care – tended to be diagnosed and treated at an earlier stage than patients treated at public expense.60 The provincial government tried to overcome this obstacle to early diagnosis and treatment by defraying the costs of conventional cancer treatment for impoverished patients. But some sufferers in straitened circumstances declined to be classed as “indigent” in order to receive care. As one clinician remarked, “Although unable to pay, their pride prevents their appealing to the municipality, and they delay from day to day, or even from month to month, in the hope that the diagnosis is wrong and that the trouble may clear without treatment. And every day diminishes their chance of cure.”61 Yet the fact that private patients increasingly outnumbered public patients at the cancer clinics does not prove that indigent cancer sufferers turned instead to unconventional treatments. Contrary to scholarly assumptions, unconventional practitioners were not always more affordable than doctors. Because Rene Caisse apparently did not charge for her services, relying instead on voluntary contributions from patients, her therapy may have been more accessible to sufferers with limited financial resources. As one supporter noted, her treatment “is within reach of the poor as well as the rich.”62 But John Hett’s therapy was quite expensive: he charged $25 per injection, often recommending between thirty and fifty doses of serum. Occasionally he administered his treatment free, “from sympathy,” but more often he made concerted efforts to collect his fees. In 1937, for example, Hett tried unsuccessfully to recover a debt of more than $1,000 from a former patient. The following year, he sued the estate of C.L. for $600, claiming that this amount represented

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the balance of the account owed him for forty-four injections he had administered to the patient between July 1935 and November 1936.63 (The judge ruled against Hett, saying, “I must come to the conclusion that Dr. Hett knew that [the patient], who was 72 years of age, was not responding to his treatments, that payment of his charges was money wasted, and a charge of $1,100 in the circumstances was an unconscionable one.”64) Although Caisse’s therapy may have attracted needy sufferers, Hett’s serum was far beyond the reach of the poor. At the same time, contemporary opinion directly challenges historical assumptions about proponents of unconventional medicine. In a series of studies of medical care conducted in the United States during the 1930s, researchers discovered that the wealthy consulted alternative practitioners four times more often than the poor.65 Canadians reached similar conclusions about consumers of alternative medicine. According to one journalist who attended Rene Caisse’s clinic in Bracebridge, “The patients who presented themselves … while mostly middle-aged or older, were drawn from almost every class of society.”66 Although doctors frequently complained about the naivety and ignorance of the public, they did not regard these qualities as the exclusive preserve of the lower classes. As one physician remarked, “observant medical practitioners must have noticed how easily people generally – rich and poor, educated (in some respects) and uneducated – are misled, duped and fooled. Witness the multitudes who have taken up with so-called Christian (?) Science (?), Osteopathy, Chiropractic and other humbuggery.”67 Contemporaries might well conclude that supporters of conventional medicine were gullible without assuming that they were either impoverished or uneducated. Patient testimony further reinforces the conclusion that sufferers from all walks of life consulted unconventional practitioners. In 1935, for example, the deputy minister of health for Ontario wrote to Hendry Connell on behalf of a sufferer in Manitoba interested in Ensol therapy. “I told Mr. B.,” he concluded, “if you were able to do this at all, you would surely do it for an old Queen’s [University] grad.”68 Three years later, M.M., a professor of chemistry, expressed interest in Connell’s treatment because his father had developed bladder cancer. “Under the circumstances,” he admitted, “it was the only straw at which to grasp and … I came to the conclusion that it was a pretty substantial straw.”69 Similarly, Hett enjoyed the confidence of a titled noblewoman and a fellow physician.70 Caisse likewise attracted a wide variety of patients. In 1935, her supporters gathered close to 3,000 signatures on a petition to the provincial legislature; virtually every class and occupation was represented, from wage labourers through tradespeople and those in commercial enterprise to professionals such as law-

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yers, bankers, ministers, and politicians.71 Thus, interest in alternative cancer care was as much the privilege of the wealthy and literate as it was the prerogative of the poor and uneducated. Although economic and educational status figured in illness experiences, these factors did not exert a predictable influence on health care decisions. As a result, we must consider additional or alternative explanations for interest in unconventional cancer care. Patterson has claimed that distrust of authority in general and of the medical profession in particular encouraged support for alternative healers. “Though enormously different from one another in their beliefs and backgrounds,” he concludes, “these Americans together constituted what I call a cancer counterculture, skeptical about orthodox medical notions of disease and about the claims made to expert knowledge by what they came to call the Cancer Establishment.”72 In other words, unconventional practitioners in the United States used popular “resistance to centralized, paternalistic authority” to generate support for their work. Norman Baker, for instance, capitalized on his image as a man of the common people; Harry Hoxsey attracted attention as an opponent of governmental and professional hegemony.73 Ontarians interested in alternative medicine often questioned the motives of the medical and political authorities. For instance, when the cpso voted in 1937 to bar John Hett from practice, a reporter suggested that professional prejudice and intolerance for new ideas rather than concern for public welfare explained the decision.74 Another supporter implied that the medical authorities sought to monopolize health care: “Organized medicine has frequently announced the great need of protecting the people … [but] To date this protection would seem to have taken only the form of preventing the cancer victim from having recourse to any treatment … other than the knife and radium, which alone carry the seal of approval of the profession.”75 Hett seems to have shared these suspicions concerning the motives of his medical colleagues – or at least he had no qualms about encouraging public resentment of official interference with his work. On several occasions he suggested that professional jealousy rather than professional misconduct lay at the heart of his disagreement with the College.76 Indeed, Hett succeeded in stirring up public animosity to such a degree that the medical authorities felt obliged to publish an account of the proceedings against him, circulating it to every physician in the province.77 In the same way, supporters often perceived Rene Caisse as an innocent victim. Upset by official opposition to Caisse’s work, one supporter criticized the actions of the government: “It is difficult to understand the tyrannical treatment Miss Caisse has received.”78 Another sufferer complained, “It certainly does not seem like British justice.”79

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The medical profession came in for its share of hostility and suspicion as well. “Miss Caisse is getting results and often in cases given up by doctors,” wrote one patient to the minister of health. “Do not allow a tight, smug organization to sentence hundreds to death.”80 Like Hett, Caisse seems to have shared popular doubts about medical authority. In a letter to Premier Mitchell Hepburn, she wrote, “You know that I have been fighting alone against the most powerful organization in the world, not for myself but for suffering humanity.”81 Like Hett, Caisse also fanned the flames of popular animosity. In a 1938 interview she told the press, I know that I have a discovery that will cure cancer. I have proved it. I want the world to have it. I do not care a hoot about any monetary consideration … Whatever the Government or the Medical Council may think to the contrary, my ambition is to spread the benefits of my discovery at once to every afflicted person and without any financial strings to it. This can be delayed by red tape; it can be disallowed by official obstinacy, but I want to tell you that there are in this province over forty thousand people whose names to petitions testify to their faith in me and my treatment and who are just as anxious as I am that the red tape be cut, and this professional prejudice and hindrance cast aside.82

Official opposition to unconventional therapies antagonized patients and supporters: like Baker and Hoxsey, Caisse and Hett apparently won the sympathy of the public by trying to challenge the government and the medical profession. As one journalist concluded, “If scientific knowledge is to be permitted to dominate all phases of human action, and life-long freedom in the use of what nature has supplied for mankind is to be subjected to the control of scientific organizations, the implication will be that we have travelled a lot faster than is good for us.”83 Although “antibureaucracy, antigovernment, and antiregulatory” sentiments figured in popular perceptions of governmental and professional actions, it is less clear that such views influenced the health care choices of cancer patients.84 Sufferers did not turn to alternative healers because they despised conventional medical authority or political power; instead, they resisted official decisions that threatened to limit access to treatments or practitioners they found helpful. In some cases, patients limited their criticism to specific physicians. One sufferer bitterly resented his doctor’s refusal to refer him to Rene Caisse: “He shows out very much what his heart is but it is a good job they aren’t all like him … He could not do anything himself and would not let anyone else help. Selfish, oh how.”85 Other patients condemned professional attitudes in general. For example, after the College stripped Hett

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of his license to practice, one supporter condemned the exercise of medical power over the public. “We are inalienably entitled,” he insisted, “to [the] continuation of the Hett or any other treatment which our intelligence, and particularly our specific experience, indicates cannot possibly be of less benefit than the alternatives so graciously conveyed to us by the Medical Council.”86 Although this man framed his arguments in the rhetoric of democracy, his prime concern was his wife’s health. “We are apparently,” he concluded, “about to be robbed of the one reasonable hope my wife has for extended life and relief from the characteristic effects of carcinoma.” Other sufferers, sharing this man’s fears, wrote to the government for help. “Oh please Sir,” pleaded one sufferer, “what am I going to do. I am nearly cured and now I can get no more treatments, no more medicine. There are several hundred of us in the same plight. It is like giving us a death sentence just when we have health within our grasp.”87 Thus, the laity invoked principled objections to authoritarianism and monopoly as a strategy to deal with the practical implications of governmental and professional restrictions on alternative medicine. Judging by the testimony of cancer sufferers in Ontario, decisions about cancer care had less to do with poverty, ignorance, or populist sentiments than they did with personal and social experience. Although class influenced the attitudes of sufferers and their families, as suggested by the divergent histories of Beatrix Leacock and M.A.M., the ravages of cancer and the deep distress inflicted by conventional therapies frequently overwhelmed social and economic differences between patients. As a result, wealthy and educated sufferers appeared alongside impoverished and illiterate patients at the offices of unconventional healers. At the same time, experience with unconventional remedies and practitioners convinced many of these sufferers that alternative medicine had a role to play in the management of neoplastic diseases.

illness experience and unconventional cancer care Although doctors sometimes referred patients to unconventional practitioners, usually as a last resort, sufferers more often learned about alternative remedies from popular sources.88 Newspapers, in particular, frequently carried sensational accounts of new and unusual therapies for neoplastic diseases. For example, one newspaper report hailed Hett’s therapy as a cure for cancer: “Patient after patient has responded to his serum. Some have risen from deathbed pronouncements and have become well again. The results almost look miraculous.”89

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Patient testimony figured prominently in many of these articles, lending credibility to the claims made for specific therapies. O.L., for example, told the press that Essiac had saved her life. “It took a whole year for this treatment to cure me,” she claimed, “but I began to improve after the third treatment, and never suffered a moment after the fourth treatment … [I] am looking forward to a long and happy life with my husband and little daughter.”90 Such poignant and compelling accounts of personal experience often sparked popular interest in alternative therapies. According to Caisse, newspaper accounts of her work with cancer patients brought a rush of people to her door.91 Media coverage of Hett’s and Connell’s treatments likewise started a stampede of sufferers.92 At the same time, patients frequently relied on the intimate knowledge of family, friends, and neighbours to make decisions about alternative care. One sufferer, for example, began treatment with Hett “as a result of information received from a friend.”93 A woman with breast cancer “was advised by friends to try Miss Caisse.”94 Another patient contacted Caisse after watching friends recover from neoplastic lesions. “I know of two or three people … that you had cured,” she wrote, “so if you can cure cancer for them why I stand a pretty good chance.”95 Just as familiarity shaped popular perceptions of regular therapies, convincing some patients to forego treatment altogether, so social experience persuaded some sufferers to try alternative remedies. As one journalist observed about Hett’s practice, “By word of mouth the news of what he had accomplished in individual cases spread: patients claimed that pain had been removed, the disease apparently cured and prophecies of certain death discounted by the fact that they were alive and well and so far as they could tell free from the disease.”96 Personal experience, in turn, convinced many sufferers of the value of alternative medicine. While conventional cancer care often inflicted considerable pain on sufferers, unconventional therapies generally involved little discomfort. Connell’s patients sometimes reported greater distress following the administration of Ensol, especially if they suffered from a painful cancer, but most described only a mild tingling or pulling sensation. In either case, the reaction subsided swiftly, usually within twenty-four hours of the initial injection.97 Sufferers responded differently to Hett’s serum and to Essiac, experiencing chills or a slight fever. As with reactions to Ensol, however, these symptoms abated quickly: Hett’s patients usually recovered within six hours while Caisse’s began to feel better half an hour after the first treatment.98 For sufferers who had already undergone conventional treatments, the relief could be intense. One of Caisse’s patients explicitly contrasted Essiac therapy with conventional remedies. “I have had lip cancer,” he

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wrote, “one cut out, which was to say the least very painful and expensive, the other cured painlessly and completely.”99 Although greater comfort made alternative treatments more palatable than conventional care, even painless therapies could not retain the allegiance of the public if they failed to cure the disease or at least alleviate its worst symptoms. One patient, disappointed with the results of Ensol therapy, decided to try a different treatment. According to R.A., his wife “took some months of treatment at the Kingston General Hospital Hendry Connell Foundation but this did not seem to be saving her right arm from amputation … At this stage she went to Dr. Hett … with remarkable results.”100 Yet dissatisfaction with unconventional therapies rarely surfaced among these sufferers. Many felt that alternative practitioners had helped them to regain their health after doctors had abandoned them or tortured them with futile treatments. One man, for instance, claimed that Essiac had saved his mother’s life. “Three physicians pronounced her ailment cancer of the liver,” he explained, “and held out no hope whatever. She might live a month, two at the outside. … She took nine [Essiac] treatments and at Thanksgiving time went back to her former home well.”101 Similarly, a woman with breast cancer attributed her recovery to Hett’s treatments. “I owe my life to you,” she wrote, “as otherwise I would have been gone long ago.”102 Many of Connell’s patients extolled the curative powers of Ensol as well.103 To these sufferers, alternative therapies appeared not simply more tolerable but more successful than regular cancer care. In general, contemporary physicians dismissed popular reports of cancer cures, concluding that patients were mistaken about their recovery or had misunderstood its causes. One clinician attributed Caisse’s apparent success to spontaneous remissions of the disease. “In some cases,” he wrote, “cancers actually cure themselves, or are cured through the operation of natural influences in the body, dissolving and disappearing, as it were, of their own accord. … There is no question several cases have improved following visits to Bracebridge but whether due to treatment given or nature alone we cannot say.”104 Other doctors felt that the latent effects of conventional treatment explained the relief experienced by these sufferers. As G.E. Richards of Toronto General Hospital concluded, “It is obvious that if anyone wished to claim credit for other methods of treatment, the easiest way to establish a case would be to treat a suitable number of patients … following radium [treatment] and then to assure the patients that the benefits derived were due to the subsequent treatment and not to the radium itself.”105 More often, however, doctors worried that unconventional healers conveyed psychological rather than physical benefits to sufferers. A 1928 article for the cmaj concluded that faith healers

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“often succeed in putting patients in the right attitude for a cure – making them determined to be well.”106 In such cases, patients might feel better while the disease carried them inexorably toward death. Historians such as James Harvey Young and Edward Shorter have likewise explained the apparent power of alternative therapies by reference to the placebo effect. Patients appear to improve in the care of unconventional healers because they are enjoying psychological rather than physiological or pharmacological benefits. As Young observed, “An injection of confidence may indeed give the patient a better appetite, let him gain weight, enhance the way he looks, improve his morale. If he has been suffering from side effects … perhaps nausea and the loss of hair, a switch to unorthodoxy may end these unpleasant conditions.”107 Certainly there is ample evidence of emotional relief among the cancer sufferers who relied on unconventional practitioners. One of Caisse’s patients, for instance, seems to have profited from the atmosphere of the clinic. “I have only been a patient of Miss Caisse for a short time,” wrote S.J.M., “but I wish you could sit among her patients as I have, and just listen to them, and see their bright faces, because they are feeling so much better.”108 A.J.W. was equally impressed by the ambience of Hett’s office. “No one could have left that gathering,” she claimed, “without being convinced of the fact that Dr. Hett’s serum is a sure cure.”109 But if we stop with the psychological benefits conferred by unconventional healers, satisfied that we have accounted for the power and appeal of alternative medicine, we would do a serious disservice to these patients as well as to the past. Scores of sufferers insisted that they had been cured of cancer by unconventional therapies. These men and women would surely bridle at any suggestion they had been duped by foolish or dishonest practitioners. Rather than simply dismissing their reports of relief and recovery, we need to understand why they reached conclusions that have astonished physicians and scholars alike. Often the laity began with definitions of health, illness, and healing that diverged from those of doctors. As a result, sufferers were not so much mistaken about the state of their health as they were judging it by different standards. From their perspective, alternative treatments had unquestionably improved or even cured their cancers. Although patients routinely claimed that alternative medicine had value in the treatment of cancer, the meaning of “effective” treatment could be construed in a variety of ways. Members of the scientific and medical communities emphasized the importance of tumour regression as an indicator of therapeutic merit: treatments that caused lesions to soften, shrink, or become more mobile were generally considered to be making an impact on the disease. Some cancer sufferers embraced this

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view, noting changes in the size and consistency of growths when describing improvements in their health. A.R., for instance, had a large lump in her breast when she first consulted Rene Caisse. Fourteen treatments later, she began to “notice a difference in the size of the growth; it continued to get smaller and smaller until after taking treatments for about a year the growth had completely dissolved and disappeared.”110 J.N.M. was also impressed with the obvious benefits his mother had enjoyed under Hett’s care. “Fourteen months after Dr. Hett’s first treatment,” he wrote, “the wound was completely healed and the lump in the abdomen had disappeared.”111 Connell likewise described many patients who experienced shrinkage of growths and other lesions following the administration of Ensol.112 Doctors discounted many of these “cures,” arguing that patients who improved in the care of alternative healers either did not have cancer or had recovered spontaneously. But for sufferers, as for the medical profession, tumour regression provided compelling evidence of healing. Cancer patients who embraced a different conception of disease and healing tended to employ other standards to evaluate treatments as well as their own recovery. In several cases, sufferers described a sudden or violent discharge, which marked the beginning of their recovery. R.S., a patient with rectal cancer, claimed his health started to improve once he had “passed several pieces of substance after about six or seven treatments [of Essiac].”113 Another patient with intestinal cancer wrote, “the cancer has broken and is discharging.”114 Similarly, one of Hett’s patients, a physician, reported improvement in his condition as a result of discharge from his lungs. “Shortly after the commencement of these treatments,” he wrote, “I expectorated some thick fibrous clots of blood from the lungs and had a steady discharge of bloody serum lasting two months and then entirely disappeared and this has not reoccurred [sic]. In my judgement, this came from the breaking down of cancer tissue in the lung.”115 Many physicians would have recognized serious deterioration in these descriptions of tissue necrosis and sloughing, but for these patients emissions signified cleansing. As M.F.P. wrote, “I have cancer of the breast and a few weeks ago this broke and is now discharging, taking all the poison from my system.”116 Moreover, these accounts suggest that many sufferers regarded cancer not as a derangement of their own physiology, but as a foreign, corrupting element. Once the invader had been expelled, recovery could commence. “Now the cancer tissue is leaving me,” concluded one patient, “and I am rapidly getting back to good health.”117 In the same way, some sufferers espoused a definition of health that diverged from the one accepted by the medical profession. In their quest to rid sufferers of cancerous cells, regular practitioners tended to

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focus on the ailment rather than on the patient. Consequently, therapies that eradicated the disease were dubbed “successful,” regardless of the temporary or permanent suffering inflicted on patients by these treatments. Cancer patients, not surprisingly, took a different view of medical care. Disfigured or debilitated by conventional therapies, many felt decidedly unwell, despite the alleged success of treatment. As a result, these patients found it difficult to accept their doctors’ assurances that they had been cured of cancer. In contrast, sufferers in the care of alternative healers routinely described a sense of health and well-being following treatment. In particular, these patients stressed their ability to resume former duties and responsibilities as evidence of cures. J.H.S., a patient with cancer of the uterus, wrote to thank Caisse for the benefit she had received from Essiac treatment: “Words cannot express how much I owe to you for I am now able to do any kind of work, look after five cows, over 100 hens and cook for six and seven of a family. I bake all my own bread, pies, cake and make my own butter, so you know for seven of a family my work is not easy.”118 One of Connell’s patients, a woman with esophageal carcinoma, used similar terms to describe the benefits of Ensol therapy. She wrote to tell Connell that she was “getting on well, doing my own work.”119 Recovery tended to be described not only in functional but also in personal terms. Hett, reporting that one of his patients had survived cervical cancer as a result of his therapy, noted that “She goes to concerts and attends social functions, as has been her custom.”120 Another sufferer wrote, “I am happy to say that my condition is 100 per cent better. I am able to do all my own work, which before taking treatments from Miss Caisse I was unable to do.”121 For some cancer sufferers, then, the value of a specific treatment was determined not so much by tumour regression or achieving a “normal” set of physiological values as by the return to a state of health they considered “natural” or usual. As H.D. wrote after her experience with Essiac, “I have regained my lost weight, and am feeling very much like my old self again.”122 At the same time, some sufferers accepted a strictly empirical definition of health, equating remission of symptoms with cure. “I feel just fine,” concluded one patient, “I haven’t any pain and as far as I know I am cured.”123 Other patients understood that improvement might occur in the absence of complete recovery, but they often trusted that a cure was in progress even if it had not yet been achieved. As M.H. observed, “I am only one of many hundreds for whom the medical men could do absolutely nothing, yet Miss Caisse’s treatments have proved to be marvellously beneficial, and if continued will, in my own case eventually be a complete cure.”124 Similarly, a man whose wife had rectal cancer concluded that she would recover because her symptoms had

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diminished. “These facts indicate to me,” he wrote, “that the Cancer is dying instead of the patient.”125 These patients and their families tended to be most upset by official interference because it seemed to jeopardize their lives. As one sufferer observed, “I have been a patient of Miss Caisse for sixteen months and am practically cured. My cancer is clearing away and I feel wonderful. My husband and I were so happy to think that I was getting cured, and now the clinic is closed. We are heartbroken.”126 Even without the prospect of cure, sufferers valued symptomatic relief, especially analgesia. While Hett continued to rely on morphine to alleviate the suffering of his cancer patients, both Caisse and Connell reported significant pain relief without the use of narcotics.127 Indeed, Ensol and Essiac treatments enabled some patients to dispense with morphine altogether or at least reduce their dependence on narcotics. One patient told a journalist that he felt better after only five weeks at Connell’s clinic. “I got cancer of the stomach,” he said. “Pain got so bad I couldn’t get along without morphine. Now I don’t use any drugs. I eat anything I like. And I sleep like a horse for five-six hours at a stretch.”128 Similarly, L.C.F. reported that his mother had been taking large doses of pain killers until she began Essiac therapy. “After taking two of Miss Caisse’s treatments,” he wrote, “she could go two days without taking a capsule.”129 Although many of these patients finally succumbed to cancer, they remained grateful for an easier, more dignified death, as well as the opportunity to remain with family and friends until the end. One woman wrote to Caisse after the death of her father to express her appreciation. “I am sorry to have to tell you that my father died on Monday last and was buried yesterday,” she said. “He died at 2.30 p.m. very easily and with the priest and all the family around the bed. We want you to know Miss Caisse that we think you did your utmost for him and we feel that the treatments gave him ease from pain and that while they did not save him at least buoyed him up with hope.”130 Patients frequently relied on alternative medicine because it alleviated rather than exacerbated the pain and suffering of neoplastic diseases. Writing about his early years of practice, William Victor Johnston recalled his surprise upon learning that one of his cancer patients had prospered in the care of an unconventional healer. “Here was a quack,” he wrote, “doing much more for an incurably ill man than I could. He had given him a month of comfortable living, when with me he couldn’t eat.”131 Johnston should not have been shocked by the success of an unconventional healer. Although practitioners and scholars have tended to dismiss the claims made for alternative medicine, patient testimony reveals a rational basis for popular confidence in

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unconventional cancer care. Because many sufferers began with expectations of health and healing that diverged markedly from those espoused by the regular medical community, they frequently reached different conclusions about the value of conventional and unconventional medicine. For the public, cures involved not only the elimination of disease, but also the return of wellness. Sufferers consequently shunned regular therapies that left them feeling wasted and devastated, turning instead to alternative treatments, which seemed to revitalize their bodies while restoring their optimism. Physical and emotional improvement in turn became evidence of recovery as well as proof of the potency of unconventional medicine. In other words, popular perceptions of health and healing, rather than ignorance or credulity, prompted these patients to rely on alternative therapies for cancer. As W.S., a patient with carcinoma of the breast, concluded, “Dreading surgery again with all its uncertainties, also the use of radium, I chose what was to me the only wise course … I began the Essiac Treatment.”132

a continuum of care In 1931, the same year that M.A.M. discovered a lump in her breast, another Ontario woman learned she also had breast cancer. W.J.J.’s experience bore a striking resemblance to that of M.A.M.: both women underwent a radical mastectomy and post-operative radiation after a biopsy revealed carcinoma; both consulted alternative healers when conventional therapies proved unsatisfactory.133 W.J.J.’s story, like that of M.A.M., seems to embody the beliefs and behaviours of many proponents of alternative medicine. Initially she trusted her doctor to diagnose and treat her ills, but exposure to conventional therapies prompted her to cast about for therapeutic alternatives. As Rene Caisse observed of her own clientele, “People only come to me when they have had everything that the medical profession can do for them.”134 Caisse’s conclusions together with W.J.J.’s experience convey the impression that sufferers moved predictably, almost inexorably from conventional to unconventional medicine as their frustration and desperation deepened. In fact, lay correspondence reveals much more complex patterns of health care consumption among cancer sufferers. Although some patients endured every conceivable conventional treatment – not just once, but many times – others deserted doctors long before they had exhausted regular therapies or themselves. Moreover, sufferers who resorted to alternative medicine did not necessarily sever all ties with conventional healers. Instead, they moved back and forth between reg-

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ular and alternative practitioners as need and desire dictated. For example, J.T., a patient with rectal carcinoma, decided to try Essiac when regular therapies offered no hope of a cure. His doctor informed him that his cancer, which had metastasized to neighbouring tissues, would claim his life in a matter of weeks. Nine months later, however, when J.T. felt better, he returned to his physician for a re-evaluation of his condition. Despite earlier dire warnings, the doctor gave him a clean bill of health.135 In contrast, H.R. decided to forego conventional treatments in favour of Caisse’s herbal remedy, shunning the experience and uncertainty of surgery. After many months of treatment, however, H.R. returned to his regular doctors for a check-up. “Two of the best medical men examined me well,” he wrote, “and to my great joy, they told me I was a free man from the dreaded disease, cancer.”136 Although these patients had rejected or forsaken regular medicine, they still expected their physicians to monitor and assess their progress with unconventional remedies. Moreover, some patients sampled the entire panoply of remedies for cancer available in the first half of the twentieth century. J.S., for instance, considered every therapeutic option in his battle against cancer. His family doctor advised surgery after diagnosing his condition as lymphosarcoma. J.S. rejected this option, turning next to Hendry Connell on the advice of his physician. When Connell “replied that he had nothing that would give us the least hope,” J.S. decided to try Essiac. In Caisse’s care, he enjoyed steady improvement in his health. Not surprisingly, J.S. became convinced that healing was not the exclusive preserve of conventional medicine. “I am still alive,” he proclaimed, “owing to Miss Caisse’s good service after the Doctors had failed.”137 Indeed, this patient became one of Caisse’s most outspoken advocates, defending and promoting her work at every opportunity. Yet neither his experience with nor his convictions about alternative medicine kept him from consulting conventional practitioners for confirmation of his cure. “I have been examined by three different doctors,” he announced proudly, “who have pronounced me O.K.”138 Regular and alternative medicine thus represented a continuum of care for many cancer patients: they chose treatments and practitioners – singly or in combination – based on their expectations of health and recovery, on their experiences with disease and healing. The illness experiences of cancer sufferers call into question scholarly assumptions about the dominance of regular medicine in the early twentieth century. Doctors could not monopolize health care because several factors combined to dilute professional influence over the victims of neoplastic diseases. Conventional cancer care itself strained the confidence of the laity: sufferers exposed to unpleasant and unsuccessful

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treatments – directly or indirectly – frequently found it difficult to trust their doctors or comply with medical advice. Unconventional cancer care further eroded popular dependence on regular medicine by providing credible alternatives to surgery and radiation. By lay standards, these therapies were not only more palatable, but also more effective than conventional treatments. At the same time, professional opinions about cancer care sometimes took a backseat to popular wisdom. The experiences of fellow sufferers, the suggestions of family and friends, even stories from the popular press could persuade patients to ignore the recommendations of conventional practitioners. In other words, doctors shared authority with alternative healers as well as with the laity. As one observer concluded, “We are not, as guinea pigs, the exclusive laboratory property of any one school of medical thought or organization and any law which places us in that position must be altered.”139 In the early decades of the twentieth century, cancer patients drew on all the therapeutic resources at their command, demanding the right to be the final arbiters of their own health and health care.

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5 Negotiating a Response to Disease: Politics and Cancer

Throughout the 1920s and 30s, as alternative remedies for cancer became more numerous and more popular, the medical profession pressured legislators to curb the activities of “quacks.” In 1927, Toronto’s medical officer of health argued that “it would be difficult to conceive of anything more criminal or more deserving of action on the part of our … legislators than the advertising in ‘cancer cures.›1 Although the government sympathized with the profession, lay enthusiasm for alternative treatments generally dissuaded officials from taking decisive action against unconventional practitioners. In 1935, for example, the Department of Health refused Rene Caisse’s application for a hospital license, thereby placating the medical community, but allowed her clinic to remain open, thereby avoiding a confrontation with her patients and supporters.2 In this way, the provincial authorities walked a tightrope between professional and public opinion, determined to remain aloof from the dispute over alternative medicine. In the absence of effective governmental intervention, however, the medical community in Ontario adopted its own strategies to battle unconventional cancer cures: the cpso barred Hett from practice while private practitioners hampered Caisse’s work by refusing to refer sufferers to her clinic. As the profession stepped up its opposition to alternative medicine, the laity in turn began to object loudly. In 1937, one woman complained to the premier that the hostility levelled at unconventional healers was unconscionable. “It seems unbelievable in these modern times,” she

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wrote, “that anyone with such a priceless boon to offer should be treated as an outlaw.”3 When the conflict between the public and the medical profession came to a head at the end of the 1930s, the government found itself drawn inexorably into the debate over alternative cancer care. After years of planning and promising to take action, in 1937 the provincial authorities finally announced their intention to conduct a probe of cancer treatments. The Cancer Remedy Act, passed by the legislature in the spring of 1938, established a commission “to investigate, approve, disapprove, encourage or report upon any substance or method of treatment which is believed to be, or likely to be, or is advertised, held out to be or used as a remedy for cancer.”4 To facilitate the inquiry, the government empowered the commissioners to compel the cooperation of practitioners. They could demand samples, detailed descriptions, and even the formulae of therapies under review. Moreover, failure to comply with the directives of the commission involved stiff sanctions: initial infractions carried fines of up to $500 or thirty days in jail; repeat offenders faced penalties of up to $2,500 or six months in jail. In addition, the legislation protected the commissioners and their staff from charges of libel or slander, allowing them to reach “objective” conclusions without risk of unpleasant legal action. The government stopped short of granting the commission the power to proscribe treatments or practitioners, in part because it feared a popular backlash. But legislators and administrators also assumed that the work of the commission would make forceful intervention unnecessary: the investigation would curb popular support for alternative cancer care by exposing worthless or dangerous therapies. Rather than easing tensions, however, the Commission for the Investigation of Cancer Remedies (cicr) exacerbated the conflict between the laity, the medical establishment, and the government. Because the Cancer Remedy Act represented a political compromise between professional and public opinion, it proved disappointing to all concerned. In other words, flaws in the original design of the legislation hampered the investigation. Even with a firmer, clearer mandate, however, the commission would have faced serious obstacles to its work because the laity and the profession espoused incompatible principles for the evaluation of new therapies. As a result, the public and the medical community expected different results from the investigation. For several years, the commissioners tried valiantly to reconcile these competing perspectives, but in the end the cicr became a casualty rather than an arbitrator in this contest for authority.

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practitioners, legislators, and the public In previous chapters, we examined the beliefs and behaviours of health practitioners and the laity, striving for a better appreciation of their reactions to the threat of neoplastic diseases. Separate examination of these views and experiences offers many advantages, not least of all the chance to tease out the complexities of popular and professional discourse. But this approach ultimately produces an incomplete portrait of health culture because it neglects the dynamic among perspectives. The essence of health culture resides not only in the discrete perspectives of patients, healers, and legislators, but also in the synergy of popular, professional, and political culture. As Charles Rosenberg has observed, “in reality, we are describing and trying to understand an interactive system.”5 The cicr, or Cancer Commission, provides an unparalleled opportunity to examine the web of ideas, values, and relationships that constituted the health culture of early twentieth-century Ontario. During its most active years, the commission evaluated dozens of unconventional treatments for cancer, but the investigation ultimately revolved around the most popular or controversial alternative practitioners of the period: Rene Caisse, John Hett, and Hendry Connell.6 In the course of examining the claims made for and by these practitioners, the commission became entangled in a mass of conflicting conceptions of health and healing. Moreover, the issues of authority and legitimacy appeared at every intersection between patient and practitioner, practitioner and legislator, legislator and voter. Although the government and the medical profession ostensibly held the balance of power in the investigation, public opinion proved extraordinarily potent in the controversy over cancer care. The history of the Cancer Commission thus offers further and compelling evidence that the health culture of Ontario was pluralistic rather than monopolistic. It is surely a daunting as well as a delicate task to trace the threads forming the weave of health culture. Not only is the pattern complex, but also it is subject to change. In an effort to understand the process rather than simply the product of culture, we must sometimes abandon the clear lines of chronology in favour of a more convoluted narrative, one that moves forward, doubles back on itself, pauses, and sometimes veers off in unexpected directions. Although I have imposed structure on the following account of the Cancer Commission, a certain degree of untidiness remains because disorder is inherent in the story as much as in the culture. The discussion begins with an exploration of early reactions to the commission, from its conception in 1937 to its formal inception in the fall of 1938. From the moment the government

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announced its plans to investigate cancer remedies, the commission became the focus of controversy. The second section revolves around the interactions between Rene Caisse, John Hett, and the Cancer Commission in the period from 1938 to 1940. Hett and Caisse appear together because they shared many of the same fears and adopted many of the same strategies to deal with the commission. Moreover, the experiences of one practitioner often influenced the actions or reactions of the other. The chapter closes with a detailed discussion of Hendry Connell’s encounter with the Cancer Commission. Never as vulnerable as Hett or Caisse, Connell responded more positively to the proposed investigation, thereby ensuring years of support for his work. In the end, however, his opinions about research and treatment more closely resembled the views of Hett and Caisse than those of the commissioners. While Hett’s and Caisse’s relations with the political and medical authorities exposed the limits of compromise, Connell’s experience revealed the limits of collaboration.

l ov e l e s s t r i a n g l e : pati en ts , p rac t itio n ers, a n d t h e ca n c e r r e m e dy ac t In the months before the formal inauguration of the Cancer Remedy Act, the medical community brimmed with enthusiasm for the proposed legislation.7 In February 1937, the oma commended the Department of Health for its efforts to combat cancer quackery.8 The following October, oma Secretary T.C. Routley pledged the support of the profession in the investigation of cancer remedies.9 During these preliminary discussions, the medical authorities invariably assumed that the commission would not only evaluate but also control unconventional therapies. As the registrar of the cpso wrote in March 1938, “If ever the saying that ‘in unity there is strength’ were true, it has been clearly demonstrated in our recent victories over secret cancer remedies, which, in future, will be controlled by a Government measure known as ‘The Cancer Remedy Act.›10 For the medical community, the Cancer Commission represented the triumph of reason over the forces of ignorance and superstition. In contrast, the laity evinced considerable ambivalence about the investigation of cancer remedies. Some people sided with the medical profession, applauding the government’s intention to restrict the use of therapies deemed worthless. “There has been too much exploiting those who have had or thought they had cancer,” wrote one man. “Golden time was wasted, and the opportunity for proper treatment thrown away!”11 Others felt that the investigation would provide definitive

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conclusions about the merits of cancer treatments. As one journalist observed, “Either Miss Caisse is curing patients or her work is altogether spurious. It should not be difficult to find out.”12 But the vast majority of lay observers who ventured into print regarded the investigation with suspicion or scepticism. Some questioned the ability of the government to conduct an impartial evaluation. “Men who speak of a remedy as a ‘quack’ remedy before its merits are examined,” concluded one reporter, “are not likely to prove disinterested if they have anything to do with the investigation.”13 Meanwhile proponents of alternative medicine feared or resented official interference by the government and the medical profession. One of Hett’s supporters complained that “There are two groups concerned with the practice of medicine … they are the members of the profession and the public. For some unknown reason the profession has complete control of the situation and the people are in no way represented.”14 Professional enthusiasm pitted against popular apprehension made conflict a real possibility, which the actions of alternative practitioners transformed into open confrontation. Because Rene Caisse felt and appeared extremely vulnerable to professional and political coercion, she and her supporters were among the most strident critics of the commission. In the winter of 1937–38, Caisse’s anxiety remained muted. She hoped that the legislature would grant her a special license to treat patients, supposing that governmental sanction for her work would exempt her from investigation. At the same time, she knew from experience that popular opinion could work powerfully on the political authorities. “I am not worrying,” she told reporters in February. “The general public is with me.”15 But when the government denied her request and passed the Cancer Remedy Act in the spring of 1938, Caisse panicked. In a form letter sent to every patient at the end of May, she explained that she could not and would not tolerate official interference. “The Kirby Bill passed through the Legislature of the Ontario House becomes law on June 1st,” she wrote. “In order not to become subject to this law, I have been obliged to close my clinic, because the bill authorized them to take my discovery from me. The only way I will open my clinic again will be at the request of the Premier.”16 Although Caisse did not urge her followers to write to the government, they took the hint from her announcement. Outraged patients and supporters swamped the Department of Health, the premier’s office, and the lieutenant-governor’s office with letters of protest. Whether they feared for their own health or simply objected to the infringement of personal liberty, these correspondents felt that Caisse should be allowed to continue her work unmolested by the medical profession or the Cancer Commission.

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Minister of Health Harold Kirby, taken aback by popular perceptions of the Cancer Remedy Act, hastened to defend the legislation. He told Caisse and her supporters that the government had no intention of restricting access to Essiac. Responding to a worried cancer patient, Kirby wrote: I am somewhat surprised at your fear that it is my intention to interfere in any way with the cancer treatment given by Miss Rene Caisse. Your suggestion that my Bill will prevent Miss Caisse from carrying on her work is entirely wrong. … The Bill merely authorized the Government to set up a commission to thoroughly investigate all cures. This will protect the public and expose any fake cures and, if any person … [has] a treatment which is beneficial and will help persons suffering from this disease, they will be allowed to continue giving their treatments and thus helping suffering humanity.17

Kirby’s attempt to defuse popular antagonism was, at best, disingenuous. Although the commission could not prohibit Caisse from treating patients, the investigation implicitly threatened her work as long as she kept her remedy secret. Attorney-General Gordon Conant confirmed Caisse’s vulnerability under the new law.18 According to his interpretation, Caisse could not evade the commission’s summons to relinquish her formula simply by closing her clinic. Conant hastened to assure Kirby that the government could remit penalties for failure to cooperate with the commission in exchange for a guarantee that the proprietor would cease to administer the therapy. Not surprisingly, the minister of health chose not to release this information to the public as it would only serve to corroborate popular fears and suspicions. Backed into a corner by Caisse’s deft manipulation of public opinion, the government tried to retaliate. In dozens of letters and several interviews with the press, Kirby sought to deflect popular hostility away from the commission by holding Caisse responsible for the closure of her clinic.19 “If Miss Caisse was half as humane as she claims to be,” he told reporters, “her clinic would be open today.”20 Premier Hepburn chimed in with his own accusations. “I fail to understand,” he wrote to Caisse, “why you are so reluctant to submit your remedy. … This will not in any way jeopardize your ownership of your remedy, nor will it interfere with your treatment of your patients. … Surely from a humanitarian point of view one would naturally expect you would give every co-operation to the Government whose only effort is to render some assistance to the people suffering from the dreaded disease of cancer.”21 This strategy only served to antagonize Caisse’s patients and supporters, who continued to cast the government in the role of villain. “Patients believe that the fault is in the Cancer Act,” concluded one man. “If they

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thought Miss Caisse was being unreasonable they would surely make representation to her.”22 By mid-summer, Caisse had gained some ground in her battle with the political authorities. Although Kirby continued to vacillate between conciliation and castigation, he had been forced into making some concessions. At the end of June, he told reporters, “I would frown on any commission walking in and demanding the formula until they have investigated the so-called cures.”23 Nothing in the Cancer Remedy Act required the commissioners to evaluate the clinical results of treatment before learning the composition of a therapy. By imposing further conditions on the investigation, Kirby hoped to counter public perceptions of the law as “arbitrary and unfair.”24 Caisse continued to fret and hedge throughout July, refusing to treat patients while the spectre of the commission loomed over her head. But in August, she announced her decision to re-open the clinic, citing concern for cancer sufferers as the reason.25 Although Caisse’s supporters rejoiced at the news, her explanation was hardly credible: for months, she had willingly ignored the welfare of her patients in a blatant attempt to extort some measure of protection or recognition from government officials. As Harold Kirby pointed out, “She hoped to throw the suffering of the poor people she has been treating on the doorstep of the government in the hope the government would weaken … and meet her views on the situation.”26 A more plausible explanation for Caisse’s change of heart can be found in the strength of public opinion; having successfully rallied her supporters, she simply felt more secure at the end of the summer than she had at the beginning. As one journalist concluded, “It [is] unlikely that any commission investigating Cancer treatments will think it wise to provoke a province-wide wave of indignation by demanding Miss Caisse’s secret formula.”27 Rene Caisse’s experiences in the months leading up to the formation of the Cancer Commission exposed the balance of public and political power. Although the provincial government was responsible for the preservation and improvement of public health, including the investigation of cancer remedies, lay attitudes and actions inevitably influenced the politics of health care. Legislators simply could not afford to ignore the expectations or demands of the voting public. As a result, the commission began to bear the marks of political compromise beneath the mantle of governmental authority. John Hett’s reaction to the commission resembled that of Caisse. He viewed the possible appropriation of his formula with alarm and encouraged his supporters to object to official interference with his work. But Hett’s experiences, in contrast to Caisse’s, were also influenced by his position within the medical community. As a doctor he was subject

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to the rules of his profession as well as the laws of the land. The cpso, the body regulating medical practice, initially proved resistant to popular opinion, refusing to sanction Hett’s work simply because his patients demanded it. Eventually, however, the College backed down from this tough position rather than risk the consequences of political capitulation to public pressure. The tug-of-war between the laity and legislators over Rene Caisse became, with John Hett, a three-way contest between the public, the profession, and the government. Medical and lay opinions clashed following Hett’s eviction from the medical profession in the spring of 1937. According to the College, Hett had been barred from practice because he claimed to have a cure for cancer; he was therefore guilty of unprofessional behaviour.28 As we have seen, however, subsequent events revealed that the medical authorities also took exception to Hett’s refusal to divulge the formula of his serum. Although Hett hesitated to discuss the nature of his work, fearing that his treatment would be stolen from him, he consistently professed his desire for a thorough review of his work. He asked only that the authorities consider the clinical merits of his therapy before demanding further details. “If they say [I] have something,” he told the press, “then I will disclose the formula, and if they say I have nothing, I will cease using it.”29 Hett’s solution had much to recommend it: it would shield him from the arbitrary seizure of his remedy while satisfying the medical community’s goal of eliminating bogus cures. At the same time, acceptance of Hett’s terms would have calmed popular anxiety about professional motives. When the College refused to cooperate, however, public opinion hardened against the medical authorities. According to one reporter, “no one reading the evidence in the Hett case with an open mind can reach the conclusion that the Medical Council has exhausted every effort to test the Hett methods.”30 Another observer complained that values deeply entrenched in the medical community presented the real obstacle to Hett’s work. “Emerging from this discussion,” one journalist concluded, “is the fact that medical authority is frequently unreceptive to new thought. It too often refuses to investigate theories or methods which are not laid down in medical books and medical schools.”31 Just as Kirby had been surprised by popular resistance to the Cancer Remedy Act, so the cpso was shocked that anyone would question its motives. The members of the discipline committee protested: “We have no vindictive feeling against anybody, our only duty and the only function of medical ethics is to protect the innocent sufferer from being exploited.”32 But Hett’s supporters remained convinced that he had not been treated fairly. As his lawyer told the cpso, “Council may not be vindictive, but the public think[s] so.”33

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According to newspaper reports, the ongoing dispute over Hett’s treatment during the fall and winter hastened government plans to investigate cancer remedies. In February 1938, Premier Hepburn raised the stakes further by trying to intimidate the doctor. “If we have the power,” Hepburn told the press, “it is the duty of the Government to take action to compel Dr. Hett to disclose his formula … even if it requires special legislation.”34 Like Caisse, Hett hoped to circumvent both political and medical sanctions by petitioning the legislature for a special license to practice medicine. Hepburn warned Hett not to expect any help from the government while his formula remained secret, but the application itself gave the doctor considerable leverage with the College. The Private Bills Committee, staffed mainly by lay members, tended to have greater sympathy with public than medical opinion. As the cpso’s lawyer warned, they “are not all doctors, they are not lawyers, they are not all professional men, … they are a cross-section of every walk of life … they are not particularly interested in the details about any medical practitioner or any lawyer … they look at things in a very general way.”35 Moreover, unregistered physicians had often received a favourable hearing from the Private Bills Committee in the past, leaving the College doubtful about Hett’s defeat.36 Rather than allow the legislature to sanction the doctor’s activities, thereby undermining the reputation of the profession, the medical authorities adopted a more conciliatory posture. In February, while the premier chided and threatened the doctor, the medical council recommended that “a compromise with Dr. Hett be reached and that he be reinstated if he will agree to an investigation of his alleged cure and that these steps be taken to avoid the introduction of a Private Bill on his behalf.”37 Subsequent negotiations between Hett and the cpso produced a satisfactory settlement: the doctor withdrew his request for a special license and provided a written guarantee to the minister of health that he would cooperate with the Cancer Commission; in return, his name was restored to the medical register.38 Initially, the College felt it had struck a good bargain. It had averted a confrontation between the profession and the government over Hett’s reinstatement, salvaging good relations as well as the authority of both the legislature and the medical council. At the same time, by forcing Hett to disclose his formula, the College had affirmed “the principle that a doctor who makes use of a secret remedy is guilty of infamous or disgraceful conduct in a professional respect.”39 Yet the medical authorities soon learned to regret their compromise. The discipline committee had agreed in April to reinstate Hett, assuming that the Cancer Commission would materialize shortly. The doctor would then be forced to relinquish his secret formula. But

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administrative and political snags postponed the investigation until the fall of 1938. In the interim, Hett lawfully treated patients and collected fees, despite the fact that some of his medical colleagues considered him a charlatan. In contrast to the medical authorities, Hett was exceedingly pleased with the outcome of negotiations. By the end of the summer, he had apparently shed all objections to the Cancer Commission. As he told the chair, “Personally I am pleased that my method of treatment is to be investigated.” Indeed, Hett’s enthusiasm for the investigation led him to offer his assistance to the commission. “I have acquired considerable knowledge and experience in years engaged in cancer research work,” he wrote, “and if my services … will at any time be of value to the Commission, I willingly offer to assist in any way I can, not only when my treatment is being investigated but in the investigation of any other treatment. As there is no precedent for this type of investigation, I feel that I might be of some service in suggesting methods, ideas and information for the furtherance of the investigation.”40 Hett’s altered attitude, like that of Caisse, coincided with a greater sense of security. Although the commissioners might eventually demand more information about his serum, for the moment he was back in business plying a secret remedy for cancer. Hett’s experience with the cpso and the government reinforced the lesson taught by Caisse and her followers: public opinion was a crucial element in Ontario’s health culture. Although the medical authorities initially rejected lay demands, they eventually accepted Hett’s reinstatement because they feared the political authorities would bow to public pressure. Popular support for Hett and Caisse not only brought the College and the government to heel, it also fundamentally altered the nature of the investigation of cancer remedies. The original legislation, conceived by the Department of Health in 1937, had clearly reflected the views and aims of the medical community. Entitled “An Act for the Investigation and Control of Remedies of Cancer,” this draft legislation proposed a commission with the authority to regulate as well as evaluate alternative treatments.41 But public outcry on behalf of Caisse and Hett forced the government to amend the terms of the investigation, and by the time the minister of health introduced the new bill to the legislature in 1938, the commission had lost much of its influence. Although the commissioners could still require practitioners to cooperate, they could no longer impose their conclusions on the laity by restricting or outlawing the use of specific remedies. Caisse and Hett extracted further concessions from the government by marshalling popular support for their work. After the summer of 1938, the commissioners could not easily demand information about any remedy before investi-

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gating its clinical merits. Public opinion had transformed the Cancer Commission from a regulatory into an advisory agency. Hendry Connell’s experience further illuminates the relationship between the laity, the medical community, and the government. Although Connell attracted and treated many patients, because he enjoyed professional and political patronage, he had never felt the need to incite popular criticism of the government or his medical colleagues. His congenial attitude, in turn, helped preserve interest in and support for his therapy. Much as this strategy worked to his own advantage, however, Connell’s privileged position undermined the credibility of the commission as well as the reputation of the medical and political authorities. The government’s choice of commissioners only made matters worse, deepening the controversy surrounding the investigation of cancer remedies. While Caisse and Hett resisted official interference with their work, Connell looked forward eagerly to the evaluation of his therapy.42 “My only desire,” he wrote, “is to secure a well-considered verdict upon the results of work carried on during the past five years … and to receive authoritative encouragement to continue investigations that appear to me to hold a prospect of important advances in our fight for control of cancer.”43 Given Connell’s previous experience with the government and the medical community, it is hardly surprising that he anticipated a favourable report from the commission. For years, professional, political, and even entrepreneurial enthusiasm had virtually eclipsed reservations about his work: private practitioners referred hundreds of cancer patients to his clinic in Kingston; government officials orchestrated a supply of tissue for the production of Ensol; American industrialist Irénée du Pont pledged financial support for his research. Moreover, on the same day that Minister of Health Harold Kirby announced the names of the commissioners, Premier Mitchell Hepburn explicitly endorsed Connell’s work. “I am prompted to write this letter,” he informed the doctor, “in order to commend you for the outstanding work which I consider you are doing in connection with cancer research. I know of many individual cases which have benefitted as a result of your treatment. While it is true you cannot guarantee a cure, there is no doubt in my mind that your remedy has been the means of relieving great distress and suffering.”44 With this kind of encouragement, Connell’s cooperation was almost a foregone conclusion. Although official support gave Connell confidence in the outcome of the investigation, it jeopardized the integrity of the commission. By promoting Ensol, even privately, Hepburn had already compromised the government; by urging the commissioners to give top priority to the evaluation of Connell’s work, he discredited the investigation itself.45

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When the press caught wind of the premier’s interest in Ensol, reporters demanded an explanation. The chair of the Cancer Commission flatly denied rumours of bias, assuring the public that each therapy would be given the same careful consideration.46 Despite these disclaimers, however, Ensol did receive special attention. In October, the commissioners struck a sub-committee to investigate the research, production, and treatment being carried out by Connell.47 They further enlisted the aid of D.T. Fraser, associate director of Connaught Laboratories in Toronto, to help evaluate the technical aspects of Connell’s work. Meanwhile, Caisse and Hett assumed secondary importance in the investigation. Like Connell, they first addressed the commission in October, but serious consideration of their work and their workplaces lagged months or even years behind the examination of Connell’s therapy and facilities.48 At the same time, the membership of the commission cast doubt on the credibility of the investigation. With the exception of the chair, Ontario Supreme Court Justice John G. Gillanders, and one other lay member, Ernest A. Collins, doctors and scientists dominated the commission: Robert C. Wallace, principal of Queen’s University and a distinguished geologist; William Deadman, an influential pathologist from Hamilton; George S. Young, a professor of medicine at the University of Toronto; and two surgeons, Thomas Callahan and R. Eugene Valin.49 The complexion of the commission ensured that the methods and standards of “scientific medicine” would prevail in the investigation. Moreover, by relying so heavily on conventional clinicians and researchers, the government appeared more sympathetic to the medical than the lay perspective. As one of Caisse’s supporters concluded, “The living proof she is now able to present will not be sufficient, in itself, for the Commission. Their own course of procedure will have to be followed … the whip hand is with the government.”50 Despite efforts to appear impartial, the commission forfeited a measure of credibility as a result of its membership and its prompt consideration of Hendry Connell’s work. Although the government and the medical profession expected the investigation of cancer remedies to proceed swiftly and smoothly, according to scientific principles, they soon had to adjust their assumptions as well as their methods to accommodate lay expectations and political exigencies. From the start, even before the commission had been formed, public opinion had constrained political and medical authority. As the investigation gathered momentum through the winter of 1937 and the summer of 1938, it revealed more than just the rivalry between powerful constituencies. The work of the commission also exposed profound differences of opinion about the management of

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neoplastic diseases and the evaluation of unconventional remedies. While doctors, including the medical members of the commission, insisted on the primacy of professional expertise, patients and unconventional healers stressed the importance of social experience and personal autonomy. The investigation of cancer remedies eventually foundered on the rock of competing perspectives.

irreconcilable differences: c a i s s e , h e t t, a n d the cancer commission The confrontation between the laity and the medical profession took shape during Caisse’s first encounter with the commission in the fall of 1938. Her lawyer explained that Caisse would gladly cooperate with the investigation provided the commissioners considered the results of her therapy before she handed over her formula.51 “I do not say that you have to acknowledge it as a cure,” she said, “but that it has benefitted … patients.”52 In this way, Caisse hoped to prevent the appropriation or suppression of her work. John Gillanders, the committee chair, tried to make Caisse see reason. He pointed out that he and his colleagues could not evaluate her work while her therapy remained a secret. “It would be impractical,” he wrote, “to make any investigation without first knowing what substance or method of treatment was being dealt with.”53 But what Gillanders and the other commissioners failed to realize was that Caisse thought she was being reasonable. “It would seem to me,” she chided them, “that you are taking the attitude of men standing on the shore of a lake who see a man drowning. They see another man throw him a rope and haul him in to safety. They see him safe and well, but they say to the man who saved him, ‘We saw it but we will not acknowledge that you saved him unless you can show us what the rope was made of.›54 Moreover, many sufferers shared Caisse’s conviction that the effects of treatment should take precedence over every other consideration. In a wonderfully clear echo of the Caisse’s words, a reporter summed up the opinion of her supporters. “The general feeling,” he observed, “is that the sole test of her treatment should be ‘Does it cure?’ and that if it cures it should be nobody’s business ‘how’ or ‘why’ it cures … When people take a train all they want is to get to their destination and they don’t care whether the locomotive runs by steam, electricity or diesel power.”55 Public pressure finally forced the commissioners to examine Caisse’s clinical evidence as a first step in the evaluation of Essiac. But they adopted this approach with obvious reluctance because it contradicted their conception of a legitimate scientific inquiry. As the commissioners noted, “While [we]

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would gladly receive and give due consideration to such case histories as [Caisse] had to offer … it was felt that a proper investigation could not be made, and that no report, either favourable or unfavourable, should be made without knowledge of the formula, and the contents of the serum.”56 Hett’s encounter with the commission in the fall of 1938 mirrored Caisse’s experience, deepening the disagreement between lay and medical opinion. Despite his promises to the minister of health earlier in the year, Hett balked at the prospect of relinquishing his formula. Instead, he too asked the commissioners to study the results of his treatment before demanding further information. “From the work I have accomplished,” he claimed, “I am positive that I can convince any rational man, if his mind is not twisted by prejudice. All I ask is that my results accomplished so far be fairly evaluated, due consideration being given to the difficult cases that I had to contend with.”57 As with Caisse’s patients, many of Hett’s supporters shared his views about the evaluation of cancer treatments. According to one reporter, “Patients are not concerned with the question [of] whether or not Dr. Hett has conformed to the ritual of the medical priesthood. Neither is the effectiveness of the Hett method to be improved by the approbation of the Medical Council. The essential point is whether it is of value.”58 Given Hett’s history with the medical authorities, the commissioners were loath to accept his terms. Not only had the cpso rejected the same proposition earlier in the year, but also the medical community was clamouring for an early and decisive report on Hett’s serum.59 But public opinion and prior concessions to Caisse forced the commissioners to extend the same courtesy to Hett. By December 1938, they had agreed to review a selection of case histories. Although this arrangement placated Hett and his supporters, it distressed the commissioners, who declared their unwillingness “to proceed to any extent [in Hett’s case] without full revelation of all relevant facts including disclosure of the formula.”60 One crucial issue emerged in these early encounters between the Cancer Commission and unconventional practitioners: authority. As the commissioners waded through the evidence for each therapy, they brought to bear the opinions of the scientific and medical communities. They believed that doctors should set the terms of the investigation, including the standards of proof necessary to establish the efficacy of an unconventional treatment. Consequently, the commissioners rejected testimony they deemed unreliable. But the patients and practitioners who presented evidence to the commission argued that sufferers could or should evaluate the worth of unconventional therapies. They were shocked, angry, and dismayed when the commission dismissed their experiences. As the investigation proceeded, it became painfully appar-

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ent that the commission would not be able to reconcile popular and professional opinion. On 3 February 1939, commissioners Robert Wallace and Thomas Callahan arrived at Caisse’s clinic in Bracebridge. They spent two days inspecting the premises, interviewing Caisse and her staff, and examining patients. Wallace and Callahan conceded that many sufferers reported symptomatic relief following treatment with Essiac. Moreover, both men remarked on the exceedingly positive atmosphere that pervaded the clinic. “We could not fail to note,” they observed, “the feeling of confidence in the Caisse treatments and the sense of well-being on the part of the patients.”61 Despite glowing reports from dozens of sufferers, however, neither Wallace nor Callahan believed that Caisse had hit upon a cure for neoplastic diseases. They maintained that many of her patients did not have cancer while those who did suffer with the disease had already benefitted from conventional treatment. These factors, they concluded, made it unlikely that Essiac had any genuine, lasting therapeutic value. As Callahan and Wallace reported, “We were unable to ascertain any positive evidence in connection with any single case that the Caisse treatments had actually cured cancer. We cannot help feeling that over-confidence in the Caisse treatment before it is a proven cure will only lead to neglect of those cases which might be benefitted by recognized procedures.” The Cancer Commission judged Hett’s work by the same standards and reached the same conclusions about his therapy. Rather than travelling to Kitchener to observe Hett in action, the commissioners based their evaluation of his therapy solely on the clinical evidence provided by the doctor. In December 1938, Hett submitted forty-four case histories, encompassing a variety of lesions and illness experiences.62 A few of these sufferers also appeared before the commission in Toronto to be examined and to testify on Hett’s behalf. When other practitioners had been involved in the diagnosis and treatment of these patients, the commissioners sought their opinions as well. As with Caisse’s clients, many of Hett’s patients described symptomatic relief following treatment with his serum. Others believed that Hett had cured them of cancer when conventional care had failed them. But the commissioners remained sceptical about the value of the serum. More than half of these sufferers had been diagnosed by clinical or radiological examination rather than tissue analysis, casting doubt on the nature of their illnesses. The remainder, who had been diagnosed by tissue analysis, had all received conventional treatment. In these cases, the commissioners assumed that improvements in health arose from surgery or radiation therapy rather than from Hett’s serum. Medical opinions from other doctors connected with these sufferers reinforced the commission’s

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convictions.63 According to Hett, a patient who had been declared incurable by specialists had recovered following administration of his serum. But the attending physician concluded otherwise: “in spite of the patient’s feelings in the matter, I do not see how the possible benefits of radium can be set aside.”64 Proponents of unconventional care, healthy and otherwise, found these conclusions astonishing. As one of Caisse’s supporters demanded, “Now in the name of humanity, what more proof do the Medical Association and the Government want than a patient fully cured? There are hundreds more who can give you the same proof. Why will you not give this woman what she requires to continue her good work?”65 Popular reactions to the commission at this stage exposed the conceptual gap that separated the laity and alternative healers from the medical community and the government. On the one hand, patients and unconventional practitioners accepted the centrality of experience in health and healing. Caisse believed her patients when they claimed that Essiac had helped them. Hett trusted the reports of sufferers who felt better in his care. On the other hand, the commissioners privileged medical opinion over personal testimony. In evaluating unconventional treatments, they demanded a diagnosis confirmed by tissue analysis as well as indisputable evidence of remission of the disease. As Gillanders informed the minister of health, the value of a particular remedy as well as the state of a patient’s health were “questions to be considered in the light of much more evidence than the patient’s own belief.”66 The commission’s critical approach was commendable: the insidious and intractable nature of neoplastic diseases made doctors and the government unwilling to trifle with unconventional therapies or the hopes of sufferers. But the Cancer Commission also demanded of alternative healers a standard of practice and proof that eluded most conventional physicians in this period. Diagnosis was a case in point. Time and again, the commissioners questioned and then dismissed patient histories in which a diagnosis of cancer had not been confirmed by tissue analysis. But doctors routinely diagnosed neoplasia without resorting to biopsy or the aid of a pathologist. In 1938, for example, only sixtynine per cent of sufferers treated at the provincial cancer clinics had undergone biopsy: in the rest of the cases, the attending physician had relied on clinical or radiological examination to reach a diagnosis of cancer.67 Moreover, many of the diagnoses challenged by the commission had been provided by conventional practitioners. One of Hett’s patients, for instance, underwent radiation therapy in the early 1930s, after his doctor informed him he had cancer. When this physician appeared before the Cancer Commission in 1938, however, he testified that “this is not a case of ‘cancer’ in the ordinary sense.”68 Similarly,

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two practitioners who had treated Caisse’s patients later admitted to the commission that their original diagnoses had been questionable or even wrong.69 Despite the shortcomings of conventional cancer care exposed by the investigation, the commission never questioned the merits of regular therapies or the methods of regular practitioners. Indeed, the commissioners worried that their failure to mention surgery and radiation might be misconstrued by the public. Consequently, in 1940 they issued a formal statement endorsing these treatments: “The value of surgery, X-ray and radium in the treatment of cancer of various types is too well recognized by medical science to need investigation or comment by this Commission.”70 Thus the Cancer Commission not only rejected the values and testimony of the laity, it also accepted a double standard for regular and alternative cancer care. Caisse complained about this bias in a letter to Premier Hepburn: “[The commissioners] are demanding that I give an account of every patient I have been unfortunate enough to lose … [though many of] these patients are dying before they ever come to me and are given up by the Medical Profession as hopeless … If [doctors], had to given an account of the number of patients who die under radium and deep X-ray treatments [they] would have work to do for the rest of [their lives].”71 Her point was well made, but it did not convince the medical or political authorities to adjust their criteria for the evaluation of unconventional treatments. From the perspective of the commission – and, by implication, the medical community – secrecy presented the major stumbling block in the investigation of Caisse’s and Hett’s therapies. Because neither practitioner would reveal the details of their work, the commissioners questioned their motives, their methods, and their results. Commissioner Wallace tried to explain to Caisse that disclosure was accepted practice among conventional researchers. “If I [am] working on a scientific problem,” he said, “I want very much for someone else to check up entirely on his own on the kind of work I am doing. That is the first idea of the scientific man before he is willing to let it go out in the world … Now you are asking us to do something without the possibility of checking it up.”72 At this point, the commissioners were willing to continue the investigation of Essiac provided that Caisse divulged her formula. When she continued to require an endorsement of her work prior to disclosure, the investigation of Essiac ground to a halt. As Wallace told Caisse, “You are tying our hands, that is the unfortunate part of it.” Disillusioned and embittered, Caisse accused the commissioners of prejudice. “I thought that when I went before you with my evidence that you could not help but see the benefits derived from Essiac. However I found that you were more interested in trying to prove that it

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hadn’t any merit than in trying to see the merits derived from it.”73 After more than a decade of trying to win acceptance and recognition, in 1941 Caisse finally retired, closing her clinic in Bracebridge.74 Hett’s experience likewise underscored the importance of disclosure, albeit in a different way. Committed to secrecy and headed down the same dead-end road as Caisse, Hett’s fortunes took a dramatic turn when he decided to surrender his formula. In July 1939, after months of futile negotiations with the commission, the doctor handed his formula over to John Gillanders.75 One newspaper announced that “It is expected the commission – with the formula in its hands – will select patients with cancer and submit them for treatment … The results of these treatments will be studied and classified by the commission with a view to deciding whether Dr. Hett’s claims can be accepted.”76 Although Hett’s cooperation appeared to facilitate the investigation, he had, in fact, managed to hobble the commission by demanding absolute confidentiality.77 Consistent with the terms of the Cancer Remedy Act, no one outside the commission would be allowed to learn the details of his work. Because the commissioners had neither the time nor, in most cases, the training to evaluate Hett’s therapy, his conditions stalled the investigation once more. In 1940, the Department of Health tried to rectify this problem by amending the legislation to allow the commission to appoint experts.78 For more than a year, while the new provision worked its way through the legislature, Hett continued to administer his treatment. The medical authorities, deeply frustrated by repeated delays, urged the commissioners to push forward with the investigation: they continued to hope that Hett’s therapy would be exposed and eradicated.79 But the doctor’s shrewd manoeuver forestalled punitive action and revived official interest in his work. Hett’s and Caisse’s experiences with the commission seem to suggest that ultimately the views of the government and the medical community prevailed over those of the laity. Despite tremendous public support for their work and considerable popular sympathy with their fears, both practitioners had been forced to choose between disclosure and disinterest. By electing to keep her treatment secret, Caisse marginalized her work. By cooperating with the investigation, Hett saved his therapy from obscurity. Despite its apparent triumph, however, the commission did not, perhaps could not, escape the influence of public opinion. Although Caisse had brazenly disobeyed the directives of the commission, thereby contravening the provisions of the Cancer Remedy Act, the government never seriously challenged her work with cancer sufferers. She was never fined or jailed for her failure to cooperate with the investigation because lay support for her work continued to restrain the political and medical authorities. At the same time, the

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commission became the victim of competing popular, professional, and political expectations. Subsequent encounters between Hett and the commission revealed the growing futility and aimlessness of the investigation. The decline of the commission may be partly attributed to World War ii. The war claimed the attention of the government, the medical profession, and the laity, but also it complicated the work of the commission by syphoning off a reserve of technical experts. But after 1940 the investigation increasingly suffered from simple inertia as well. Once the Cancer Remedy Act had been amended, the commission immediately scheduled laboratory tests on Hett’s serum, but a series of unexpected events created further delays. The first researcher assigned to evaluate Hett’s work abandoned the task after becoming involved in war work. In 1942, the commissioners postponed the investigation when Hett was charged with a narcotics violation, perhaps hoping that an indictment would silence the troublesome physician.80 After the courts acquitted Hett, a second researcher embarked on the study of his serum, only to die suddenly in 1944, before reaching any useful conclusions about the therapy. By then, the war effort had absorbed every researcher or clinician who might have become involved in the commission’s work. In 1944, the commission finally asked one of its own members, William Deadman, to take a hand in the investigation. Deadman travelled to Kitchener in January 1945, where he made a superficial inspection of Hett’s facilities and engaged the doctor in conversation about his work.81 On the basis of Deadman’s report and a review of case histories, the Cancer Commission at last issued a definitive statement about Hett’s serum: “On the material presented to the Commission and from investigation made to the present time, there is nothing to justify a claim that the substance and method of treatment in question has merit or value as a remedy for cancer.”82 The commission’s report represented a sorry end to an inquiry that had originally inspired high hopes and deep fears. After years of professional, political, and public wrangling over John Hett’s therapy, the investigation of his work fizzled out without any serious attempt at evaluation. Moreover, as with Caisse, the commission’s conclusions had little impact on Hett’s practice. Patients continued to endorse his therapy while neither the government nor the medical profession dared interfere with his work.83 Meanwhile the commission, unable to reconcile lay and medical opinion, and forbidden to impose its views on the public, had been reduced to irrelevance. As the registrar of the cpso concluded, “It is becoming more and more recognized in the profession that the ‘Cancer Commission Act’ has not sufficient teeth in it to carry out the prime function for which is was formed. This I feel has been a

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great disappointment.”84 The investigation of cancer remedies had languished for want of power or purpose.

s t r a n g e b e d f e l l ow s : connell and the cancer commission Hendry Connell’s encounters with the Cancer Commission also undermined the integrity of the investigation, albeit in a different way. Within months of the formation of the commission, the provincial authorities abandoned all semblance of impartiality. While Hett and Caisse bargained for consideration from the commission, the government showered Connell with attention. Indeed, official interest eventually transformed the investigation of Ensol into a collaboration between Connell and the government, complete with financial aid. Although Connell flourished in this environment, at least initially, his close association with the Department of Health cast a shadow over the commission. Rather than an independent and objective inquiry, the investigation appeared to be a weapon, wielded by the medical and political authorities in their desire to suppress or promote specific therapies. Official support for Ensol was a puzzle. Although the medical community and the government harboured great hopes for Connell’s research, from the start his work had inspired doubt as well as zeal in professional circles. When Connell first announced his results in 1935, researchers at home and abroad pointed out weaknesses in his theory and method. The political authorities and, to a lesser extent, the medical authorities ignored these misgivings, pledging their support for Connell’s research. But three years later, as the investigation of cancer remedies proceeded, professional opposition resurfaced. In January 1939, after several weeks spent evaluating Connell’s research, D.T. Fraser of Connaught Laboratories submitted his report to the commission. Fraser openly criticized the work being done at Kingston. “My personal view of the research,” he wrote, “is that the quality in general is very mediocre and … the bacteriological work is not as broad or fundamental as one would expect to find from the point of view of research.”85 Moreover, Fraser concluded that Connell’s methods were as flawed as the design of his research. Reservations about Connell’s work extended to his clinical practice as well. In January, commissioners George Young and William Deadman investigated the therapeutic claims made for Ensol. Although they encountered many patients who had enjoyed symptomatic relief, they noted that most sufferers had already been treated surgically or with radiation. As with Caisse and Hett’s work, the commissioners refused to discount the potential bene-

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fits of conventional therapies when assessing the merits of Ensol. Young and Deadman consequently concluded, “we are not convinced of the curative value of ‘Ensol,’ or that its use definitely brings about relief of pain and amelioration of symptoms or prolongation of life.”86 Connell, stung by these negative assessments, struck back at the commission and its representatives. “It is unfortunate,” he wrote, “that a more thorough investigation and explanation of evidence at hand was not carried out since the reports are unfair, misleading and in some respects entirely wrong. At least the facts should have been acquired and reported. … This was not done.”87 Connell questioned not only the methods but also the motives of those sent to evaluate his work. In particular, he complained about Fraser’s behaviour. “The Commission should know,” he noted, “that Dr. Fraser was unfriendly, hostile and contemptuous in his manner, attitudes and expressions throughout his visit.” In light of his experience and expectations, Connell’s reaction was understandable; he had assumed that the commission would favour his work and was put out by professional criticism. But subsequent events revealed that Connell’s irritation was unnecessary. Despite persistent medical and scientific qualms about Ensol, despite serious criticisms of Connell’s work, the government remained interested in the therapy. In April 1939, the provincial authorities committed themselves to an elaborate and expensive investigation of Ensol.88 Under the terms of a research contract, the government agreed to furnish staff, equipment, and stock for the clinical and laboratory investigation of Ensol; in return, the Hendry-Connell Research Foundation would ensure an adequate supply of solution for the work.89 According to Minister of Health Harold Kirby, the purpose of the Ensol investigation was “to satisfy ourselves as to the merit of this product and to be in a position to submit scientific proof of the decisions arrived at.”90 In fact, the government’s involvement in Ensol research represented a tacit endorsement – albeit a provisional one – of Connell’s work. By comparison, the Cancer Commission had not been willing to expend the funds necessary to acquire Caisse’s formula, let alone subsidize her work.91 At the end of April, E.P. Johns, chair of the department of pathology and bacteriology at the University of Western Ontario, headed up the investigation of Connell’s research. Walter T. Connell, a prominent pathologist at Queen’s University, agreed to evaluate the clinical results of Ensol therapy. Their preliminary review of Ensol convinced both investigators of the need for further study. In a report to Kirby they concluded that “the clinical and experimental evidence to date substantiates the findings of the Ontario Cancer Commission and quite definitely indicates the need for more extended investigations.”92 Over the

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next few years, with the aid of government money, these two men worked assiduously to unlock the mysteries of Ensol.93 Johns undertook to purify and standardize the serum. He also conducted serological assays to determine the antigenic properties of Ensol and tested its therapeutic potency on mice. Walter Connell reviewed an extensive collection of case histories and tried to organize clinical experiments with Ensol. Meanwhile, Hendry Connell devoted his energies to further research, producing a series of reports on the clinical effects of Ensol for the Cancer Commission.94 In 1939, the Cancer Commission remained sensitive to charges of bias, having already fielded accusations that Ensol would receive special consideration. When Walter Connell joined the investigation, the commission took care to explain that he was not related in any way to Hendry Connell. But even the appearance of impartiality became difficult to maintain as the government energetically promoted Connell’s work. In a flagrant breach of neutrality, the provincial authorities orchestrated several applications for a license to market Ensol, hoping that the research would become self-supporting through sales of the solution. Despite these efforts, Connell’s financial house was in disarray by the end of the year; not only had the federal government denied his request for a license, but also the du Pont family had withdrawn pecuniary support for the research. Rather than allow the work on Ensol to falter, the provincial authorities once more assumed a partisan position; in December, the Department of Health granted Connell $4,000 to help him through the economic crisis.95 Harold Kirby made political capital out of this decision. He told the press that the government had only supported Connell’s work in order to ensure an adequate supply of Ensol for needy cancer sufferers.96 Although this explanation satisfied the public, it angered other practitioners whose work was under investigation by the Cancer Commission. Hett’s lawyer contacted the minister of health in February to demand equal treatment. “We think that your department should in some way assist or facilitate [Hett’s] work,” he wrote, “particularly in view of the fact that it was done in the Connell case.”97 Caisse’s frustration with the commission deepened into bitterness when she learned that the government was funding Connell’s research. She complained to the premier that the commission “recommend[ed] Dr. Connell for support from the Government in spite of the fact that he hasn’t a cure to his credit. I think with the thousands of dollars he has had donated to his cause, he has had ample time to prove or disprove his theory.”98 In fact, the political authorities never intended to subsidize Connell’s work on a permanent basis.99 But as the government became more deeply involved in the investigation and as other sources of revenue

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failed to materialize, the research depended increasingly on funds from the provincial Department of Health. In January 1940, Connell began receiving regular monthly grants of $3,000 after Mitchell Hepburn committed the government to finance the research indefinitely.100 Two years later, the Department of Health had expended more than $200,000 on Ensol.101 In the early days of the investigation, many members of the government and some of Connell’s medical colleagues clearly hoped or believed that Ensol would emerge as a potent new treatment for neoplastic diseases. Professional and political expectations encouraged investment as well as interest in the therapy. As the commission amassed evidence that discredited Connell’s claims and methods, however, the authorities grew increasingly uncomfortable with their supportive role. As early as 1940, the investigation of Ensol began to produce negative or, at best, inconclusive results.102 Because Connell frequently relied on family practitioners to administer his therapy and to record the results of treatment, he was at the mercy of his medical colleagues. Many doctors simply did not comply with requests for blood tests or case histories.103 As a result, only a few case files contained adequate information to formulate an opinion about Ensol, despite the fact that Connell had treated more than 1,700 cancer patients between 1935 and 1940.104 Even with complete histories in hand, however, the investigators still found it difficult to evaluate the effects of Ensol. As with Caisse’s and Hett’s patients, many of Connell’s clients had unconfirmed diagnoses or had already received conventional treatments. Furthermore, the commissioners worried that sufferers derived as much benefit from the psychological as the physiological effects of Ensol therapy: “in the case of a cancer patient who has been led to believe his case is hopeless, a new treatment creates hope, and alleviates mental stress. We feel that it is probably a factor in the early stages of treatment with Ensol.”105 Hoping to come up with better results, Walter Connell tried to organize a trial with human subjects. In 1940, he arranged for cancer patients at the Ottawa Civic Hospital to receive Ensol and for inmates at a local psychiatric institution, the Rockwood Hospital, to serve as a control group.106 These tests provided little evidence of the curative value of Connell’s therapy. As the commissioners concluded, “it has not yet been demonstrated that ‘Ensol’ or any derivative thereof yet studied has more than temporary or palliative value.”107 In 1943, after more than four years of tests and trials, George Young still felt that “the clinical investigation of Ensol … so far does not warrant any conclusion as to its value.”108 E.P. Johns had no better luck with laboratory studies. Serological tests demonstrated that antibody production stimulated by Ensol had

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as much to do with bacteria in the solutions as with some mysterious cancer factor.109 As a result, the commission acknowledged in 1940 that the investigation had revealed “no substantiation of the essential theory underlying the use of Ensol in malignancy, namely that it contains an antigenic substance specific to malignant cells.”110 Animal experiments proved equally disappointing. In 1941, Johns reported that “treatment with Ensol was unsuccessful in controlling the continuance of tumour growth. In almost all cases under observation, regardless of whether treatment was commenced before or after the appearance of the tumour, the animals ultimately died as a result of the malignancy.”111 Two years later, he was no closer to demonstrating the impact of Ensol on transplantable tumours in mice.112 By 1943, Johns had come to the same conclusion reached by other investigators eight years and many thousands of dollars earlier: Ensol was not a cure for cancer. As the clinical and laboratory investigation of Ensol settled into disappointing patterns, relations between Connell and the government began to deteriorate. Although Connell had initially cooperated with the commission, by 1940 he had lost patience with the government’s insistence on laboratory tests and animal experimentation. When clinical demand threatened to outstrip the supply of Ensol, Connell made it clear that he would honour his commitment to sufferers rather than his contract with the Department of Health. “The interest of cancer patients,” he wrote, “is the most important consideration.”113 Discord between the doctor and government investigators deepened when Connell’s staff claimed to have isolated a specific cancer antigen. Johns naturally expected to be apprised of any important findings: both he and Walter Connell became perturbed and then angry when the doctor refused to share the details of his research.114 In 1942, Johns and Walter Connell again commented on the doctor’s impatience. “We are aware,” they noted, “that Dr. H.C. Connell feels that the Department laboratory has done sufficient confirmatory work … but we cannot agree with him in this regard. In our opinion sufficient work has not been done to confirm the presence of a specific cancer cell antigen in Ensol.”115 Finally, the two investigators complained to the minister of health about Connell’s recalcitrance. “It is our opinion,” they informed Kirby, “that further successful investigation re Ensol demands a complete disclosure of recent developments of fractionation and concentration of Ensol … Failing this we doubt the wisdom of continuance of further investigation.”116 The minister of health responded by threatening to terminate support for the research unless Connell agreed to cooperate. The doctor hastily assured his sponsors that he was only acting in the best interests of cancer sufferers. Although Kirby relented,

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Connell remained thoroughly resentful, both of his dependence on the government and of official interference with his work.117 Connell’s reaction revealed a good deal about his expectations and perceptions of the investigation. Although he acknowledged the limitations of his treatment as well as the importance of basic research, he nonetheless relied on patient testimony to justify his work. As early as 1938, Connell had observed that “There are some who hold that no clinical use should be made of any remedy until its action has been fully demonstrated in the laboratory. Experimentation upon patients has been condemned recently when the use of Ensol was being reviewed … In this case, if the bacterial filtrate known as Ensol had not been used clinically in the human patient it could never have been discovered that pain alleviation is an outstanding effect of its use. Medical research confined to the laboratory has been greatly overdone while the clinical aspects of the problem have been neglected.”118 Despite carefully couched claims about Ensol, Connell nonetheless believed his treatment was a genuine cure. In a 1935 letter to an American doctor, he stated that “I think I have the solution of the problem.”119 Initially, Connell’s cooperation with the medical and political authorities camouflaged his views: because he appeared to be playing by the rules, neither the provincial government nor the medical community delved too deeply into his opinions. As the investigation of Ensol dragged on, however, Connell made his position painfully clear. “I believe,” he explained to Mitchell Hepburn in 1942, “that what has been done in the past eight years has surely earned me the right to sufficient financial support, so that I may devote my time and thought to the Research without constant anxiety as to whether I can pay my staff and at the same time provide materials for the treatment of patients … I should be permitted to carry on in my own way in my own laboratory and on my own responsibility, finally submitting my results to the medical profession at large, whom I believe to be the actual court of final judgment as to the value of any new therapy.”120 Although Connell had opened his laboratory, his clinic, and his files to official scrutiny, he was more eager for an endorsement than a genuine evaluation of his work. His attitudes and assumptions, if not always his actions, thus bore a striking resemblance to those of Rene Caisse and John Hett. Despite mounting evidence against Ensol and the disintegrating relationship between Connell and the commission, the government supported his work for several more years.121 Having invested heavily in Ensol research, morally as well as monetarily, the Department of Health found itself backed into a corner: it could either admit its mistake or continue to subsidize the research. In 1942, the deputy minister of health outlined the difficult choice facing the political authorities:

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“If we do not meet [Connell] on the subject [he is] likely to intimate to patients at present getting treatment that the supply has been cut off by the Provincial Government and we will have another parade of these unfortunates to your door.”122 While Caisse and Hett skillfully deployed public opinion to wring concessions from the commission, Connell allowed popular pressure to work powerfully on a government already compromised by its interest in his therapy. Rather than face political humiliation or public outcry, the provincial authorities chose to pay, quite literally, for their association with Ensol. Moreover, official collaboration with Connell, like official opposition to Hett and Caisse, undermined the investigation of cancer remedies: where Hett’s and Caisse’s experiences revealed inconsistencies in the commission’s standards of evaluation, Connell’s experience exposed glaring prejudices in the commission’s methods. As a result, the investigation of cancer remedies suffered a crisis of credibility. Although the commission continued to function erratically for many years, by the end of the Second World War it had been relegated to the medical and political sidelines.

cancer, culture, and commissions: o nta ri o an d b eyo nd In the first half of the twentieth century, a variety of cancer commissions popped up across Canada and the United States. Most, if not all, of these agencies were designed to assess and, where necessary, augment conventional cancer care. Organized cancer services first appeared in North America in 1898, when the New York state legislature funded new diagnostic and therapeutic services as well as epidemiological studies of neoplastic diseases.123 Nearly three decades elapsed before another government followed suit. Then in 1926, Massachusetts embarked on an audacious program of cancer services, including a tumour registry to collect information about the incidence of different lesions. Provincial legislatures likewise established commissions and policies to combat neoplastic diseases.124 In 1930, the Saskatchewan government organized the first Canadian agency responsible for cancer care. The following year, Manitoba established a similar board and Ontario joined the trend in 1931, setting up the Royal Commission on the Use of X-rays and Radium in the Treatment of the Sick. The members of the Cody Commission, as it was popularly known, travelled to the United States, Britain, and Europe to study various approaches to the problem of neoplastic diseases. In 1932, the commission recommended a series of diagnostic and treatment centres across the province as well as programs of research and education that resembled cancer care services in other parts of Canada and in the United States.

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Established in 1938, Ontario’s Cancer Commission represented a radical departure from these earlier organizations. Rather than dealing with regular treatments for cancer, the commission was charged with the task of evaluating unconventional therapies. In the process, the political authorities expected the commission to resolve the controversy associated with alternative medicine by identifying promising new treatments and exposing worthless remedies. But the investigation rapidly became mired in contradictions. Although the government openly identified itself with scientific medicine, relying mainly on commissioners trained in that tradition, it also deferred to the laity, imposing many restrictions on the investigation to satisfy public opinion. For several years, the Cancer Commission struggled under these constraints, hoping to meet the divergent expectations of the laity, the medical profession, and the government. That it failed miserably in this task speaks directly to the nature of the health culture in early twentieth-century Ontario. Instead of a single perspective dominating the management of neoplastic diseases, we find a variety of approaches to the problem of cancer. Rather than an exclusive preserve of authority and legitimacy, we see an equilibrium between competing claims. Social expectations and personal experience, for example, tempered popular confidence in conventional medicine as well as patient compliance with regular practitioners. At the same time, political sensitivity to public opinion moderated government support for the medical profession, giving alternative healers an unexpected degree of protection. From the popular perspective, doctors frequently shared therapeutic credibility with purveyors of unconventional remedies. While the work of the commission thus exposed the contours of health culture, the nature of that culture, in turn, dictated the fate of the investigation. When authority and legitimacy are concentrated or uncontested, consensus may be possible: when power and prestige are dispersed, however, even compromise may prove elusive. Although the cicr appears to have been unique in North America, at least prior to the 1950s, the conditions that prompted and then strangled the investigation were not.125 Alternative healers prospered elsewhere in Canada as well as in the us, attracting huge numbers of patients and supporters. Moreover, medical societies, north and south of the border, actively campaigned against these practitioners. Indeed, Canadian and American doctors sometimes cooperated to expose or oppose questionable cancer treatments. When John Hett began sending pamphlets to physicians in the United States, for instance, the ama immediately approached the cpso for information.126 Similarly, Canadian officials contacted the ama after hearing rumours that Northwestern University in Chicago had embarked on a clinical

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investigation of Caisse’s work.127 In the end, doctors practicing outside of the province had no better luck than those in Ontario. Unable to discredit unconventional remedies or to convince governments to intervene, they watched helplessly as growing numbers of sufferers turned to alternative cancer care. While the Cancer Commission embodied the tensions inherent in the health culture of Ontario, it also symbolized broader trends in North American society. Whether they worked in Ontario or Manitoba, whether they practiced in Canada or the United States, regular practitioners failed to corner the market in health care during the first half of the twentieth century.

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Conclusion: Authority, Legitimacy, and the Problem of Cancer

In January 1952, Dorothy Morrow of Portage La Prairie, Manitoba, wrote a letter to Chatelaine magazine, describing her experiences with cancer and conventional care.1 Three years earlier, as the Western world recovered from the ravages of war, Morrow had begun her battle with cancer. Suffering severe, repeated bouts of vaginal bleeding, she apparently heeded the warnings of educational literature and consulted her physician. Rather than conducting a thorough examination, however, the doctor brushed off her complaints as nothing more serious than the symptoms of menopause. He consequently sent her on her way with “a prescription for a huge bottle of pills that looked like the chocolate bridge mixture the girls used to keep on the card table.” Although Morrow continued to experience bleeding and pain, she readily accepted this peremptory diagnosis. “I had such faith in you, Doctor,” she recalled, “because you were rated as one of the best in the city.” Even when her husband pressed her to seek other opinions, Morrow remained confident about her physician’s skills as well as compliant with his advice. “The doctor says everything’s okay,” she reassured her husband, “it’s just that I’m at a difficult age, so don’t worry about me.” Unfortunately, Morrow’s faith in her practitioner proved to be seriously misplaced. In the months following her initial consultation with him, her health deteriorated dramatically. Finally, her family rushed her to the hospital. “The bleeding wouldn’t stop,” she wrote, “but I didn’t know anything about that. I was drifting away into a world of lovely black fleecy clouds.” After hospital staff revived her, Morrow learned she had cancer. Four operations and many rounds of radiation therapy

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later, she found herself debilitated and bereft of hope: the tumour in her uterus had rapidly metastasized to surrounding tissues, making it impossible for doctors to combat the disease. She was dying, leaving behind a husband and a young son saddled with debt. Despite the cruelty of her situation, despite the incompetence of her care, Morrow resisted the temptation to indulge in bitterness and recriminations. Instead, she wrote to Chatelaine, hoping that her experience might save other women from a similar fate. Ever so gently, she admonished her own, unnamed physician as well as the medical profession at large. “Please, Doctor,” she observed, “when you are tired and hurried, don’t skimp in that examination. I know how weary and fed up you must become, but you are God’s hands … and you won’t forget that, will you, Doctor?” In many respects, Morrow’s short missive characterized lay reactions to the medical profession in the decades following the Second World War. Although her experience might well have given her cause to distrust conventional practitioners, she continued to hold doctors in the highest regard. In a note attached to her letter, Morrow assured the editors at Chatelaine that “I sincerely admire the medical profession and have had wonderful doctors here in Portage.” Other sufferers shared her sentiments. In a stimulating analysis of illness narratives, Anne Hunsaker Hawkins notes that patients writing about their experiences in the 1960s and 70s “almost always project a positive attitude towards [conventional] medicine.”2 To some extent, then, these accounts indicate that popular attitudes in the postwar era diverged from views common among the laity earlier in the century. I am not implying that sufferers uniformly doubted the medical profession prior to the war, any more than I am arguing that patients invariably trusted physicians after the war. Rather, I am suggesting that deference to and dependence on conventional medicine displaced scepticism and self-determination in the health culture of postwar North America. In other words, the balance of power shifted decisively in favour of doctors and their political allies. It is not my intention to draw a detailed portrait of the history of cancer in the last half century. Nor am I about to embark on an elaborate discussion of the popular, professional, and political developments that transformed the medical management of health and illness in the years since World War ii. Other scholars have already applied their considerable talents to these subjects, providing us with keen insights about postwar health culture. After more than fifteen years, Paul Starr’s work The Social Transformation of American Medicine is still one of the most fascinating and provocative discussions of professional medical authority in the modern era, describing the factors that

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pumped up and then deflated confidence in the medical profession. According to Starr, doctors enjoyed an unprecedented degree of power and prestige in the 1950s and 60s, but disillusionment set in during the 1970s as it became increasingly obvious that science and medicine had not, perhaps could not, live up to their promise.3 James Patterson reaches the same conclusion about the changing status of the “cancer establishment” after the war: “The millions of Americans who grew frustrated by [the] gap between hopes and realities posed a threat to the authority of doctors by the early 1980s.”4 Similar patterns emerged in the Canadian context.5 Instead it is my aim to emphasize the plurality of medical authority in the first half of the twentieth century by describing the differing fortunes of Hendry Connell, John Hett, and Rene Caisse following World War ii, and by comparing prewar and postwar reactions to them. The enormous public support that these practitioners enjoyed in the early decades of the twentieth century secured a degree of official acceptance or tolerance for their work. In the 1950s, however, popular confidence in science and medicine frequently outstripped support for alternative medicine. Unconventional healers, including Connell, Hett, and Caisse, suffered a loss of status while regular practitioners gained influence with the public and the state. By the time the laity renewed its interest in alternative cancer care and its scepticism about the medical profession, the cultural authority of scientific medicine had become firmly entrenched. Despite the rising tide of criticism of doctors in the 1970s, despite the proliferation of patient advocacy and self-help groups in the 1980s, North Americans had to a considerable degree assimilated the views and values of the medical and scientific communities. In other words, the diversity of perspectives that had shaped the management of neoplastic diseases in the first half of the twentieth century was supplanted by the overwhelming influence of a single perspective after the Second World War.

m e d i c a l m o n o p o ly : jo h n h e t t, h e n d ry c o n n e l l , and the cancer commission The retreat from plurality in postwar North America was neither instantaneous nor absolute. In the 1940s and 50s, unconventional healers continued to attract legions of cancer sufferers, particularly in the United States. Harry Hoxsey’s “Hoxide treatment” and William Koch’s “Glyoxilide,” both developed in the 1930s, remained enormously popular after the war while new therapies, notably “Krebiozen,” attracted professional and lay support in the 1950s. Although

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the public remained enthusiastic about alternative treatments, professional and political reactions to cancer “quackery” underwent a transformation after the war. Doctors and legislators proved more willing to join forces against unconventional healers, even when faced by outraged patients and supporters. According to James Patterson, the pleas of sufferers “did not change the minds of government officials or the ama. Indeed, the authorities gathered for a mounting attack on quackery, in general.”6 In the early 1960s, for example, the California government and the us Congress took aim at the makers of “Krebiozen,” prosecuting them for food and drug law violations as well as for tax evasion.7 If such efforts to expose and curb the use of alternative cancer treatments were not entirely successful, they were nonetheless evidence of alterations in the health culture. Backed by the power of the state, conventional practitioners of science and medicine increasingly challenged alternative healers for control of health care. Because John Hett and Hendry Connell were active both before and after the war, their stories provide an excellent view of a health culture in transition. Prewar beliefs and behaviours still figured in their experiences, but postwar attitudes and actions ultimately determined their fate. In the early 1940s, for example, Connell collected a good deal of money from the provincial government, financing his research and the treatment of cancer sufferers. But as the war drew to a close so did official support for his work. Hett’s fortunes also declined precipitously in the postwar era. Although the laity remained interested in his therapy, professional and political opposition to his work swelled in the 1950s. By the end of the 1960s, both of these practitioners and their therapies had faded into obscurity, their views on health and healing no longer having the same currency in postwar North America as they had earlier in the century. If ever the medical profession was able to monopolize health care, this was the moment. During the war, the Ontario government embarked on a massive restructuring of cancer care. In 1943, Minister of Health Harold Kirby announced plans to extend diagnostic and treatment facilities in the province, and to embark on a program of cancer research.8 The province subsequently created the Ontario Cancer Treatment and Research Foundation (octrf) to formulate and implement cancer care policy.9 Recognizing the potency of popular opinion, Ontario’s political leaders made some effort to ensure popular representation by appointing lay members to the board of directors of the octrf.10 Ostensibly the board set the agenda for the foundation, but, in fact, doctors dominated the daily operation of the agency, from the position of managing director, filled by leading Ontario radiologist G.E. Richards, to the various advisory committees, staffed by prominent physicians and sur-

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geons.11 As a result, the perspectives of scientific medicine infused the policies and programs of the octrf. At the same time, the government returned to its old habit of relying on the medical profession to lead the health administration: in 1943, after Mitchell Hepburn departed from the premier’s office, R. Percy Vivian, a doctor, replaced Harold Kirby as minister of health. By the end of the war, the medical profession had assumed control of cancer care in the province, creating an environment inhospitable to unconventional healers. Although Connell’s relationship with the provincial authorities had already begun to falter by the early 1940s, the transformation of the health administration hastened the demise of his therapy. Richards’ appointment to the octrf, for instance, enshrined a deep intolerance for alternative treatments and practitioners. As leaders in the medical community noted, “no new radical changes in cancer management will be promoted, or accepted by the new director before these are first thoroughly debated in Foundation Committees.”12 Moreover, financial support for the Hendry-Connell Research Foundation grew more tenuous during these years. Although the new minister of health continued to approve monthly stipends for Connell, he did so with great reluctance. In December 1943, Vivian cautioned Connell, “I do not want the Profession anywhere to assume we have endorsed ensol as a cure.”13 The following summer, the minister of health delegated responsibility for Ensol research to the fledgling octrf.14 Although Connell received small grants for the next two years, the money was never enough to sustain the work.15 Support for his research ceased abruptly in 1945 when the provincial authorities informed him that neither the octrf nor the Ontario Department of Health would provide further financial aid. Connell reacted predictably to this gradual withdrawal of monetary and moral support. In June 1944, he appealed to the minister of health for help, hinting at the dire consequences that would follow any interruption of services. “If no funds are available,” he wrote, “it will be necessary for me to immediately give my staff notice and to notify all patients and doctors that a further supply of Ensol will not be available. I sincerely hope that such a drastic measure will not be necessary for it is really a serious matter for many people who are at present depending on this material to keep them alive.”16 At the same time, he broadened his studies to include investigations of cancer metabolism, perhaps hoping that a shift to more conventional research would secure further grants from the government.17 In an attempt to finance the work himself, Connell also renewed his application to the federal authorities for a license to sell Ensol to physicians.18 Every strategy to prolong the life of his work failed: patients and practitioners as well as

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the government had lost interest in Ensol. Sufferers did not object when the government cut off Connell’s funding and physicians did not rush to buy Ensol when the Canadian government approved it for sale. By the end of the 1940s, Connell had abandoned his cancer research, returning to private practice in Kingston, Ontario. When he died in 1964, at the age of sixty-nine, Ensol died with him.19 John Hett’s experiences after the war proved more complicated than those of Hendry Connell. Whereas support for Connell eroded steadily in the 1940s and 50s, interest in Hett’s work persisted until the late 1960s. Hett’s success in these years may be partly attributed to continued popular enthusiasm for his therapy. Because he was less dependent on official largess than Connell, he was also more able to survive changes in the administration of cancer care. At the same time, Hett adopted shrewd strategies to circumvent political and professional objections to his activities. After the war, he hitched his fortunes to the rising star of “scientific medicine,” thereby preserving his work from extinction. But the postwar health culture ultimately proved as uncongenial for Hett as it had for Connell. Lay support for his work never again reached the heady proportions of the 1930s while professional and political opinion hardened against the Kitchener doctor in the 1950s and 60s. Although Hett’s fall took longer than Connell’s, his work also became marginal in the health culture of postwar North America. In October 1946, after the Cancer Commission finally rejected the claims made for his therapy, Hett applied to the federal government to incorporate his new clinic in Windsor, Ontario. G.D.W. Cameron, deputy minister of health for Canada, opposed Hett’s request after reading the commission’s report, but the state department had no legal grounds for refusing the application, especially after Hett’s lawyer pointed out that Hendry Connell had been granted a charter for his clinic more than ten years earlier.20 Hett consequently won the right to manufacture and market his serum treatment in accordance with business as well as food and drug legislation. As in the past, Hett had deftly manipulated the authorities into providing some semblance of official sanction for his work. Robert Noble, registrar of the cpso complained in August 1947, “letters patent create a false impression and … lead the average person to believe that there is something worth while … in this so called discovery of Dr. Hett’s.”21 Even more interesting was Hett’s decision to name his new clinic “The Hett Cancer Treatment and Research Foundation,” a clear and resounding echo of the government’s own agency, the Ontario Cancer Treatment and Research Foundation. Clearly, he hoped to capitalize on the growing prestige of scientific medicine. When the medical and political authorities in Ontario

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learned of the proposed name, they protested strenuously, arguing that sufferers would mistake Hett’s therapy for the legitimate, scientific treatments available at provincial clinics.22 Although federal officials sympathized, their hands were tied: unless the Ontario government could demonstrate popular confusion arising from the similarity of names, the Canadian government was powerless to rescind Hett’s charter or to force him to rename his enterprise. Once again, the Kitchener doctor had outmanoeuvered his professional and political opponents.23 In the years following World War ii, the medical and political authorities hesitated to interfere with Hett, convinced that official action against the doctor would incite a backlash to rival the furor of the 1930s. As Robert Noble observed in 1952, “Dr. Hett has many ‘satisfied customers’ in both Ontario and the United States and the voice of the public is hard to combat.”24 But although Hett remained popular in the postwar period, the College and the government had vastly overestimated the extent and intensity of lay interest in his work. During the 1940s and 50s, his support came mainly from sufferers in the United States rather than from cancer patients in Ontario.25 On the one hand, American enthusiasm was not insignificant because it seriously complicated efforts to curtail Hett’s activities. The medical authorities found it difficult to gather evidence against the Kitchener doctor, including witnesses to testify against him.26 At the same time, the College’s failure to discipline Hett angered doctors in the us. An official at the ama concluded that “Dr. Hett has been enabled, by inept legislation and political pressure, to victimize Americans who may or may not be sufferers from cancer.”27 On the other hand, the lack of domestic support for Hett eventually rendered him vulnerable to sanctions. In February 1952, the cpso’s discipline committee summoned Hett to answer various charges of infamous and disgraceful professional conduct.28 When the doctor could not satisfy the committee, the medical council barred him from practice. In contrast to the 1930s, the laity seemed indifferent: sufferers did not swamp government offices with letters of protest; the press did not cast aspersions on the medical or political authorities. Three years later, when the medical authorities prosecuted Hett for practicing medicine without a license, the public again remained mute. Although popular enthusiasm for alternative therapies did not vanish in the postwar era, it was no longer potent enough to protect or sustain John Hett’s work. One of the more bizarre twists in Hett’s story followed his death in September 1956. After more than twenty years of dealing with Hett, the medical and political authorities must surely have breathed a collective sigh of relief when a stroke claimed the eighty-six-year-old doctor.29 But to their surprise and chagrin, Hett’s niece, Beatrice L’Esperance, took

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over the management of the Windsor clinic. “Dr. Hett died in 1956,” Minister of Health Matthew Dymond observed later, “but his spectre still seems to stalk us.”30 For the next dozen years, the provincial government and the cpso tried various tactics to eradicate Hett’s serum treatment for cancer: the Ontario Cancer Commission reaffirmed its earlier verdict against the therapy; the ministry of health amended the Public Health Act to outlaw secret remedies for cancer; the provincial authorities demanded the repeal of Hett’s charter.31 In 1968, thoroughly exasperated, Dymond finally ordered his staff to “find a way to stop this woman from dispensing this stuff. I do not care how, just get it done, and get this place closed up once and for all.”32 All supplies of the serum were seized, the clinic closed, and a guard posted to ensure that L’Esperance did not try to resume her work with cancer patients. The tenacity of Hett’s therapy suggests the enduring appeal of alternative healers and the importance of the lay perspective, rather than the dominance of conventional medical opinions and practitioners. But the crusade against Hett’s therapy in the postwar era differed fundamentally from earlier campaigns because Hett’s status as well as that of the medical community had changed in the intervening three decades. In the 1930s, popular sympathy for alternative healers and political deference to the laity combined to make Hett a formidable medical rival; by the 1960s, popular and political confidence in scientific medicine had reduced him to a minor irritant. Doctors were no longer defending their authority by opposing Hett; they were using their power and prestige to root out a small, nagging thorn from the body of modern health culture. Perhaps the most compelling evidence of declining interest in and tolerance for alternative cancer care can be found in the fate of the cicr. Although the commission evaluated dozens of treatments in the 1930s, the outbreak of war distracted the public, the profession, and the government from the problem of neoplastic diseases. As A.H. Sellers, director of medical statistics for the Ontario Department of Health, concluded, “In consequence of [the] pressure of more urgent work, no further progress had been made … in the analysis of cancer cases.”33 By the late 1940s, when the commissioners resumed their work, far fewer treatments and practitioners demanded their attention. In 1951, responding to a request about John Hett, the secretary of the oma noted that “the Cancer Commission is not actively working at this time.”34 As the original commissioners began to die or retire, they were not immediately replaced.35 Moreover, the government assured new members that their duties would not be onerous. In 1957, Minister of Health Mackinnon Phillips told a prospective commissioner, “As you know, there are not too many people coming forward with cancer remedies … [so] I do not think you would be asked to take much time

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away from your busy practice.”36 In the early 1960s, as the medical and provincial authorities mounted their final assault on Hett’s therapy, the Cancer Commission was disbanded. Like Hett and Connell, it had become obsolete in a health culture dominated by practitioners of scientific medicine.

medical hegemony: the saga of essiac By the 1970s, the alliance between doctors and legislators had begun to show signs of strain. Proponents of conventional science and medicine had promised more than they could deliver, thereby alienating their political backers as well as the public. As patients organized themselves into self-help and advocacy groups, as sufferers turned again to alternative healers, regular medical practitioners endured a spectacular crisis of confidence. “For the first time in a century,” Paul Starr concludes, “American physicians faced a serious challenge simultaneously to their political influence, their economic power, and their cultural authority.”37 In fact, as this history of cancer demonstrates, doctors had faced many challenges to their authority in the first half of the twentieth century when the laity, alternative healers, and even the state contested the profession’s right to dictate the terms of cancer care. This latest challenge may have been more distressing because it followed a period of unprecedented power and prestige, but it was not, for that reason, a novel experience. Moreover, while doctors relinquished some of the status they had previously enjoyed, the cultural authority of scientific medicine remained largely intact. Rene Caisse’s experiences in the postwar era illuminate the transformation of health culture. By the time her therapy regained popularity in the 1970s and 80s, conventional science and medicine had made an indelible impression on the public and the government. In the immediate aftermath of the Second World War, Caisse’s story closely paralleled those of John Hett and Hendry Connell. She treated small numbers of sufferers, most of whom came to her clinic from the United States, and she periodically petitioned the authorities for an endorsement of her work.38 According to octrf Director K.J.R. Wightman, Caisse approached the Queen, the prime minister, and “every new minister of health … It has become a sort of hobby to keep writing to people of higher and higher ranks.”39 In 1960, R.M. Taylor, head of the National Cancer Institute of Canada (ncic), expressed his willingness to reopen the investigation of Essiac, but his conditions were even more stringent than the terms laid down by the Department of Health in the 1930s. Taylor not only insisted that Caisse supply details and samples of her therapy, but also that she grant the scientists who

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conducted the investigation the right to publish their conclusions.40 When Caisse rejected these demands, official interest in her work subsided as quickly as it had surfaced. As with Hett and Connell, Caisse’s work suffered in the postwar milieu. Late in the 1970s, however, long after Hett’s serum and Connell’s Ensol had disappeared, Caisse’s fortunes began to improve. In the summer of 1977, Sheila Snow Fraser and Carroll Allen published a lengthy article on Essiac in Homemaker’s Magazine, a popular Canadian periodical.41 Eleanor Sniderman, wife of a prominent Toronto businessman, read the account and became convinced that Essiac had value in the treatment of cancer. Moreover, she found herself worrying that Caisse, who was eighty-nine years old, might die without sharing the details of her work. In August, Sniderman travelled to Caisse’s clinic in Bracebridge, hoping to convince the nurse to entrust the formula to someone, anyone.42 After more than fifty years of jealously guarding her secrets, Caisse finally agreed to deposit her formula with Pauline McGibbon, Lieutenant-Governor of Ontario.43 This small concession to security seems to have breached Caisse’s defenses because, a few months later, she sold her treatment to Resperin Corporation, a Toronto-based company.44 “I am old, and very tired of trying to battle the medical group alone,” she explained, “and I did believe that [Resperin] … would have the means and the power to make it available to many, many cancer sufferers.”45 The following year, in December 1978, Caisse died. But her decision to relinquish her formula saved her work from oblivion: in the ensuing decades, Essiac developed into one of the most common and controversial alternative treatments for neoplastic diseases in North America.46 Disagreements over Essiac in the 1970s and 80s resembled the debates of the 1930s. Professional hostility to Caisse’s work, for example, surfaced soon after the publication of the Homemaker’s article. In September 1977, a journalist reported that “neither the Canadian Medical Association nor the Health Protection Branch is amused or impressed with the revival of the Essiac story.”47 Official opposition derived partly from the persistent assumption that alternative therapies diverted sufferers from the benefits of conventional treatment.48 As in the 1930s, the medical authorities also criticized Caisse’s reluctance to divulge the details of her therapy. The director of the ncic told the press that Essiac had never been properly tested because “the woman refused to fork over the formula.”49 Although political and professional criticism became more muted after Resperin Corporation acquired the formula, the medical community remained sceptical about the value of Caisse’s herbal treatment. When preliminary trials with Essiac proved disappointing, the head of the octrf concluded, “The

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result isn’t surprising to me … There’s something strange about the whole story.”50 Popular enthusiasm for Essiac in the 1970s and 80s likewise resembled lay interest earlier in the century. Sherry Bate’s experience, for example, mirrored that of many cancer sufferers at Caisse’s clinic in the 1930s. A victim of breast cancer, Bate turned first to conventional medicine for diagnosis and treatment, enduring surgery and facing the prospect of chemotherapy. But like other cancer patients before her, Bate remained sceptical about her chances of recovery. In 1978, she decided to try Essiac. When her health improved, she not only became a firm advocate of Caisse’s remedy, but also a vigorous political activist. “If I can get my people together,” she told the press, “we’ll go to Ottawa and camp outside the House of Commons.”51 Ten years later, Bate continued to pressure the government for access to Caisse’s therapy. Although her experience failed to convince federal officials about the value of Essiac, just as patient testimony had not persuaded the provincial authorities in the 1930s, her story nonetheless fired the hopes of sufferers and the imagination of the public. As one journalist observed, “Bate is part of a growing groundswell of Ontario residents who feel they have nothing to lose by trying Essiac.”52 Moreover, Bate’s campaigns embodied enduring convictions among sufferers that they had the right to make their own health care choices, unfettered by doctors or legislators. “The medical profession should stop playing God,” concluded one man, “and allow us cancer patients to use the treatment of our choice.”53 Despite the similarities between prewar and postwar attitudes, however, Caisse’s therapy faced serious new challenges in the 1980s and 90s. Although many patients continued to rely on the testimony of fellow sufferers when making decisions about treatment, others seemed increasingly uneasy about accepting only anecdotal evidence of Essiac’s therapeutic value. Like many doctors, these sufferers and supporters looked for “scientific” proof to justify the use of Caisse’s herbal remedy. In 1984, for example, Vancouver radio personality Elaine Alexander became interested in Caisse’s work and determined to establish the merits of Essiac according to scientific standards. Five years later, she signed a contract with Flora Manufacturing and Distributing Ltd, a natural products company in British Columbia, to investigate and produce Essiac under the label Flor*essence. “Hopefully, we’ll prove its efficacy,” she told a reporter, “and we’ll do it the right way.”54 In the early 1990s, Sheila Snow, one of the authors of the enormously influential Homemaker’s article, adopted a similar approach. In The Essence of Essiac, she pointed out that many of the ingredients in Caisse’s formula had scientifically proven antineoplastic activity.55 Other proponents have shied

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away from tests and trials conducted by the “medical establishment,” arguing that a natural remedy such as Essiac cannot be evaluated by conventional researchers and clinicians.56 Nonetheless, the standards and vocabulary of scientific medicine subtly inform the alternative medical discourse on Essiac. In a recent publication, The Essiac Report, author Richard Thomas described the “ultramodern technical equipment” and the “research department and impressive laboratory facilities” at Flora Manufacturing, which allowed the company to run “laboratory tests” on herbs and botanicals in order to maintain “the strictest quality control standards” in their products.57 The recent history of Essiac demonstrates the extent to which the medical perspective has become firmly embedded in postwar society. The state’s reaction to Caisse’s therapy likewise underscores the changes that have taken place in the health culture of modern North America. In 1978, Resperin Corporation received permission from Health and Welfare Canada to conduct clinical trials of Essiac.58 Four years later, federal officials cancelled the investigation “in the interest of public health,” claiming that the results were “inconclusive.”59 Bowing to public pressure, the government agreed to allow sufferers access to the therapy on “compassionate grounds”: those in the terminal stages of neoplastic diseases, who could not benefit from conventional therapies, would be permitted to continue or begin treatment with Essiac. But in order for these patients to receive a supply of the herbal treatment, they had to convince a regular practitioner to make a request to the Canadian government on their behalf.60 Physicians, in turn, were required to submit a lengthy medical history as well as details about the administration of Essiac. In this way, the state raised formidable barriers around Caisse’s therapy. Sufferers became utterly dependent on the goodwill of doctors, many of whom were loath to support the use of alternative treatments for cancer, while sympathetic practitioners had to wade through a morass of bureaucracy to assist their patients. As one journalist observed in 1989, “If you have been diagnosed as having cancer and you want to try Renee [sic] Caisse’s herbal treatment, Essiac, you’ll need to persevere if you wish to obtain it through approved channels.”61 At the same time, the government adopted other strategies to curtail access to Caisse’s treatment. In 1988, when the “approved” source of Essiac threatened to evaporate, proponents began to explore other ways of making the herbal remedy available to sufferers. “Why not take Essiac out of the arena of the Medical Establishment all together?” some asked. “By simply selling Essiac through health food stores as nothing more than what it actually is, a harmless herbal detoxifying tea. Make no claims.”62 Federal authorities swiftly

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squashed this ingenious plan to circumvent professional and political opposition. Although the “investigational new drug” status assigned to Essiac had expired five years earlier, the government insisted that restrictions still applied to the therapy. According to Minister of National Health and Welfare Jake Epp, “Essiac is considered a ‘New Drug’ … This means that scientific evidence of the safety and efficacy of Essiac must be submitted to the Health Protection Branch of my Department, reviewed and found adequate before [it] can be marketed in Canada.”63 In the 1930s, Caisse would have been thrilled to see her therapy classified as a “drug,” recognizing that the term connoted therapeutic potency as well as scientific legitimacy. But in the 1980s and 90s, the designation became a trap, a blatant ploy to restrict access to Essiac. In the end, professional and political manoeuvering proved only partially successful because cancer sufferers continued to learn about and acquire Essiac through informal channels.64 Yet official deterrents did make an impact: by forcing Caisse’s therapy underground, the authorities deepened the controversy and confusion associated with it. Various imitations of Essiac, such as “Easy-Ac” and “S.-C. AC,” have appeared on health food store shelves as manufacturers have tried to capitalize on the familiarity and popularity of Caisse’s work. Moreover, there is now a great deal of debate about who possesses the “real” formula for Essiac.65 Elaine Alexander claims that she alone holds the original recipe, having acquired it from an American physician, Charles Brusch, who allegedly obtained it from Caisse in the 1950s. Gary Glum, a California chiropractor and Caisse’s biographer, maintains that he has the genuine formula for Essiac, which he purchased from a Michigan woman in the 1980s. This patient, like Brusch, asserts that she received the recipe directly from Rene Caisse. At the same time, Essiac International, an Ottawa-based revival of Resperin Corporation, asserts its ownership of the authentic recipe. According to promotional literature, “If the label does not have the Essiac and Resperin Corporation name, it is not Rene Caisse’s extensively-tested and proven herbal formula, to which Resperin Corporation has sole, legal rights.”66 In 1995, Bracebridge resident Mary McPherson, a longtime friend of Caisse and keeper of the nurse’s files, made available a copy of the formula. She hoped not only to settle the controversy over the recipe, but also to make it available to sufferers. “The trouble with Essiac today,” she explained to a reporter, “is that people aren’t following the recipes and some places aren’t selling the right herbs.”67 Although Essiac has continued to excite interest among the laity in the 1990s, it has not emerged easily or unscathed from its encounter with the medical and political establishment.

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Recent legislative developments in Canada and the United States further demonstrate the dominance of conventional science and medicine in postwar health culture. In 1991, the us Congress approved plans to create a special branch of the National Health Institutes, the Office of Alternative Medicine (oam), devoted to the study of alternative systems and techniques of healing.68 Eight years later, Canada’s minister of health, Alan Rock, announced the establishment of the Office of Natural Health Products, an agency designed to formulate and implement policy relating to alternative medicine.69 Federal authorities in both countries thus recognized and responded to the mounting importance of unconventional therapies and practitioners in the medical marketplace. Although these initiatives moved alternative medicine from the wings closer to centre stage, they nonetheless ensured that it would remain an understudy to conventional science and medicine. The oam, for example, has been staffed consistently by regular practitioners and researchers, albeit ones with some sympathy for alternative medicine. Moreover, the agency has typically employed the methods of scientific medicine, such as double-blind clinical trials, whether or not they are appropriate for the evaluation of alternative therapies.70 Major research projects funded by the oam have also been based in conventional medical schools and research institutes. For alternative medicine to find recognition in this system, it must meet the standards and expectations of the regular medical community. It is less easy to comment on the Office of Natural Health Products because it is only now taking shape. If federal authorities implement the recommendations of the Standing Committee on Health, the new agency will embody the opinions of the laity and the alternative medicine community as well as those of regular practitioners. The appraisal of natural health products will also involve “unscientific” criteria, including “traditional references [and] professional consensus,” as well as conventional methods, such as clinical trials and laboratory tests.71 Only time will tell to what extent the government’s avowed commitment to openness, flexibility, and “freedom of choice” for Canadian consumers will find institutional expression. Even at this preliminary stage, however, it seems clear that conventional science and medicine will furnish many of the regulatory principles for alternative healers and therapies. In its final report, the committee proposes that natural health products should be accompanied by standardized monographs similar to those issued with prescription drugs. In this way, consumers will be better equipped to make informed choices about their health care. Although sensible and reasonable, this recommendation is also inimical to alternative medicine because much of the data required in product inserts cannot be readily furnished by natural health products

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manufacturers. For example, it is frequently impossible to pin down the active ingredients or their concentrations in herbal and botanical remedies while dosages may vary widely from one patient to the next. Elsewhere in the report, the power of the conventional medical model is less subtle. Discussing standards of efficacy, the committee suggests that products not tested by conventional research methods should be labelled with “a disclaimer that the effectiveness of this product is not supported by the usual scientific evidence.” Despite a new appreciation of and sensitivity to alternative medicine, the cultural authority of conventional medicine seems secure.

the transformation of health culture In 1950, the National Film Board of Canada, in conjunction with the Association of American Medical Colleges, produced a short documentary entitled “Science Against Cancer.” Crammed with somber whitecoated doctors, pretty young nurses, gleaming equipment, and imposing buildings, the film epitomizes postwar optimism about the power of scientific medicine. As a weary investigator leaves his darkened laboratory, for example, the narrator intones: “Men like this, in places like this, are carrying the fight to the mysterious territory of the cell. The lights of science are piercing its darkness and as the problems are exposed and the answers emerge so is hope revealed. And because of the hope science has given him in the steady progress of its attack, a man can approach the thought of treatment with confidence. Whole areas have already been recaptured from the territory of death.”72 Although the movie acknowledges the seriousness of the threat posed by neoplastic diseases as well as the magnitude of the task facing researchers intent on solving the riddle of cancer, it nonetheless emphasizes the might of modern medicine. According to host Clyde Gilmour, the film is “a sober, but immensely encouraging progress report.” The cure for cancer, if not yet at hand, was surely just around the corner. In many respects, the 1950s and 60s represent the zenith of professional power and prestige. Prior to the Second World War, doctors enjoyed considerable influence over patients and with the government, but their authority was always tempered by popular beliefs and behaviours as well as by political deference to public opinion. Then in the 1970s, the medical profession began a precipitous fall from grace as the laity and the state became disillusioned with conventional science and medicine. Although these two periods of scepticism resemble one another, they differ in important ways. In the early decades of the century, cultural authority over health care resided not only with the medical

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community, but also with the laity and alternative healers. The cicr beautifully illustrates the equilibrium of power that characterized the prewar health culture. Although the commissioners tried to resolve the controversy over unconventional cancer care, they failed ultimately because they could not reconcile the perspectives of patients, practitioners, and politicians, all of which had some degree of authority and legitimacy. After the war, however, the potential of scientific medicine – real and imagined – eclipsed other sources of authority. Even when the consensus of the 1950s and 60s began to show signs of strain, the medical perspective remained sovereign. The Office of Natural Health Products today provides a convenient foil for the Cancer Commission: although we cannot yet predict the fate of the new agency, we can see the influence of conventional medicine in its formation. At the end of the twentieth century, the standards, methods, and vocabulary of the regular medical profession dominate the culture of health and healing in a way that they did not, perhaps could not before the end of World War ii.

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Notes

abbreviations ama American Medical Association ao Archives of Ontario ascc Bulletin The Bulletin of the American Society for the Control of Cancer bmj British Medical Journal cicr Commission for the Investigation of Cancer Remedies cjms The Canadian Journal of Medicine and Surgery clp The Canada Lancet and Practitioner cma Canadian Medical Association cmaj The Canadian Medical Association Journal cpso College of Physicians and Surgeons of Ontario hcf Bulletin The Bulletin of the Hendry-Connell Research Foundation hhfam Collection Historical Health Fraud and Alternative Medicine Collection hpb Health Protection Branch, Bureau of Human Prescription Drugs jama The Journal of the American Medical Association na National Archives of Canada ncic National Cancer Institute of Canada octrf Ontario Cancer Treatment and Research Foundation oma Ontario Medical Association qua Queen’s University Archives uh University Hospital, Medical Museum and Archives, London, Ontario

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164 Notes to pages xi–xvi introduction 1 The statement was first made in 1937 and reprinted in this 1938 article. Martin, ‹Malignancies’ and ‘Cancers,› 296–7. 2 James Olsen’s annotated bibliography, The History of Cancer, creates the impression that an enormous collection of works is available to document the history of neoplastic diseases. Although doctors have written scores of articles and a few books on the subject, few historians have devoted serious scholarly attention to it. The following books constitute almost the entire corpus of English language works on the history of cancer: Richards, Vitamin C; Austoker, Imperial Cancer Research Fund; Patterson, The Dread Disease; Ross, American Cancer Society; Peller, Cancer Research Since 1900; Rather, The Genesis of Cancer; Rettig, Cancer Crusade; Strickland, Politics, Science and Dread Disease. 3 Kleinman, Patients and Healers, 24. Kleinman uses the phrase “health care system” to denote “the totality of these interrelationships.” Because this phrase may cause confusion, being generally equated with the theories, therapies, and institutions endorsed by doctors in Western societies, I have substituted the phrase “health culture,” which, in my opinion, better captures the essence of Kleinman’s paradigm. 4 Edward Shorter’s works, such as Bedside Manners and From Paralysis to Fatigue, are prime examples of this interpretation of medical authority. 5 In Medicine as Culture, Deborah Lupton provides an excellent overview of historiographical, philosophical, and sociological interpretations of power and health care. Especially fine are the chapters entitled “Power Relations and the Medical Encounter” and “Feminisms and Medicine.” 6 Lupton, Medicine as Culture, 130. 7 Starr, Social Transformation, 13–21, 79–144. 8 Rosenberg, “Framing Disease,” xiii. 9 The literature on alternative medicine is really too vast to enumerate, but among the most influential studies are Saks, Alternative Medicine in Britain; Cooter, Studies in the History of Alternative Medicine; Kirkland et al., Herbal and Magical Medicine; Haller, Medical Protestants; Young, American Health Quackery; McGuire, Ritual Healing; Porter, Health for Sale; Cayleff, Wash and Be Healed; Kaufman, Homeopathy in America; Bynum and Porter, Medical Fringe; Gevitz, Other Healers; Risse et al., Medicine without Doctors; Rothstein, From Sects to Science; Young, Medical Messiahs. The majority of these authors concentrate on the periods before or after the first half of the twentieth century. 10 See, for example, the work of Michael Shimkin, a research scientist involved with the American National Cancer Institute in its formative years, or Stephen Strickland’s book, Politics, Science and Dread Disease.

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165 Notes to pages xvii–8 11 These issues were debated most conspicuously in the now famous (infamous) exchange between Michael Bliss and a group of four women’s historians, Linda Kealey, Ruth Pierson, Joan Sangster, and Veronica StrongBoag. See Bliss, “Privatizing” and Kealey et al., “Whose ‘National’ History.” chapter one 1 This account of Beatrix Leacock’s final illness and death is drawn from a number of sources: Doyle, Sage of Orillia, 58–9; Moritz and Moritz, Leacock, 217–18; Legate, Stephen Leacock, 147–9; Kimball, Panama Hat, 81–2; and Curry, Humorist and Humanist, 167–8. 2 “A Treatment for Cancer,” Hygeia 1 (July 1923): 252; “The Blair Bell Cancer Treatment,” Hygeia 4 (January 1926): 50; “The Lead Treatment of Cancer,” Campaign Notes of the American Society for the Control of Cancer 11 (March 1929): 1–2. 3 “Mrs. Leacock Died in Liverpool Home,” Montreal Gazette, 15 December 1925. 4 Some of the most important works dealing with the history of patient experience include Porter, Patients and Practitioners; Leavitt, Brought to Bed; Beier, Sufferers and Healers; Herzlich and Pierret, Illness and Self in Society; Rogers, Dirt and Disease; Hawkins, Reconstructing Illness; Rothman, Living in the Shadow of Death; Leavitt, Typhoid Mary. 5 Porter, “The Patient’s View,” 175–6, 181–2, 194. 6 Patterson, The Dread Disease, 1–11, 151–8; Bacall, By Myself, 243, 251; English, The Worldly Years, 390–1. 7 Legate, Stephen Leacock, 147–8; Moritz and Moritz, Leacock, 221–2. 8 Legate, Stephen Leacock, 151; Curry, Humorist and Humanist, 183–4; Kimball, Panama Hat, 58; “International Cancer Symposium,” clp 67 (November 1926): 217. 9 Shepley, “Why Late Diagnosis,” 406–8. 10 Bates, “Division of Pathology,” 1931, 79, ao; Gallup, “Survey,” 7–8; Patterson, The Dread Disease, 71–6. 11 Shepley, “Why Late Diagnosis,” 407. 12 Ibid. 13 Warner, The Therapeutic Perspective, 85–93. 14 Shepley, “Why Late Diagnosis,” 407. 15 “Case History of H.D.,” Wallace Papers, Series 1024b, Additions, Box 1, File 9, Case Book 3, 13, qua. 16 Shepley, “Why Late Diagnosis,” 407–8. 17 Behrend, “Do You Fear Cancer?” 712; Kennedy, “Myths About Cancer,” 400. 18 Eberts, “Cancer of the Breast,” 9.

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166 Notes to pages 8–12 19 Tyler, “Tony Did Not Forget,” 1022. 20 Shepley, “Why Late Diagnosis,” 407. See also Eberts, “Cancer of the Breast,” 9, and Eberts, “Lump in the Breast,” 228–33. 21 “Case History of R.K.A.,” Wallace Papers, Series 1024b, Additions, Box 1, File 9, Case Book 4, 1, qua. 22 “Case History of D.M.,” Wallace Papers, Series 1024b, Additions, Box 1, File 10, Case Book 6, 14, qua. 23 Shepley, “Why Late Diagnosis,” 408. 24 Castle, “Are You Afraid, Too?” 701. See also Bloodgood, “Courageous Fear,” 15. 25 The following works, among others, provide insight into the configuration of meanings attached to diseases and the impact of disease symbols on patients and the public: Feldberg, Disease and Class; Lupton, Medicine as Culture; Rothman, Living in the Shadow of Death; Rosenberg and Golden, Framing Disease; Rogers, Dirt and Disease; Cassel, The Secret Plague; Brandt, No Magic Bullet. 26 Gallup, The Gallup Poll, 1:150. 27 Shepley, “Why Late Diagnosis,” 407. 28 Murphy, “This Thing Called Cancer,” 444. 29 Marcosson, “Common Sense and Cancer,” 9. 30 Steward, “A Psychological Approach,” 7–9. See also MacMurchy, “A Thousand a Month,” 12. 31 Kennedy, “Myths About Cancer,” 399. 32 Susan Sontag quoted in Marithelma Costa and Adelaida Lopez, “Susan Sontag: The Passion for Words,” reprinted in Poague, Conversations, 151. 33 Patterson, The Dread Disease, 112. 34 “Series b35–50. Average Annual Number of Deaths and Death Rates for Leading Causes of Death, Canada, for Five-year Periods, 1921 to 1974,” in Leacy, Historical Statistics of Canada; “Series b149–166. Death Rate, for Selected Causes: 1900 to 1970,” Historical Statistics of the United States, 58; Patterson, The Dread Disease, 112. 35 Kennedy, “Myths About Cancer,” 399. 36 Marcosson, “Common Sense and Cancer,” 7. See also Girvan, “Cancer, Its Possible Causes,” 4. 37 Gallup, The Gallup Poll, 1:217; Gallup, “Survey,” 7. 38 Roe et al., “Cancer Can Be Cured,” 8–9; Bloodgood, “Courageous Fear,” 15; What Everyone Should Know About Cancer, 1–2, ao. Bernard Behrend penned one of the few educational articles that acknowledged the veracity of familial patterns of cancer. Appearing in the September 1941 issue of Hygeia under the title “Do You Fear Cancer?,” Behrend’s article noted that “families in which cancer has occurred live in constant fear of the disease. These people should be all the more alert to symptoms and obtain medical advice early” (712). 39 “Facing Cancer with Courage,” Hygeia 9 (May 1931): 421.

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167 Notes to pages 12–14 40 Kennedy, “Myths About Cancer,” 399–400. 41 Gallup, The Gallup Poll, 1:150, 216, 495; Cantril, Public Opinion, 89. 42 What Everyone Should Know About Cancer, 1, ao. See also other Ontario Department of Health pamphlets, ao: The Doctor and the Cancer Patient, The Prevention of Cancer, and Important Facts for Women About Tumours. 43 A.B.D to J.H. Hett, Kitchener, Ontario, 10 July 1944, rg 10–138, Accession 14576/12, ao. 44 Moritz and Moritz, Leacock, 320; Curry, Stephen Leacock, 235. 45 “Please Send Me,” ascc Bulletin 20 (November 1938): 9. 46 Bloodgood, “Courageous Fear,” 14–15. 47 Dukes, “Taking the Fear Out of Cancer,” 3. 48 Kennedy, “Myths About Cancer,” 400. 49 The Prevention of Cancer, 1–5, and What Everyone Should Know About Cancer, 1–2, both ao. 50 Simpson, “Procrastination,” 1–2. 51 Gallup, “Survey,” 7; Gallup, The Gallup Poll, 1:217. 52 I.H. to George Henry, Premier, Ontario, 30 March 1931, rg 3–8, Box 136, File 03–08–0–060, ao. 53 J.D.C. to Rene Caisse, Bracebridge, Ontario, 10 November 1939, Cancer Records, File 13.13, ao. 54 “Please Send Me,” ascc Bulletin 20 (November 1938): 9; my emphasis. Further examples of the popular tendency to equate ulcers with cancer can be found in four case books in the Wallace Papers, qua. 55 See, for example, Kennedy, “Myths About Cancer,” 399; Marcosson, “Common Sense and Cancer,” 5; and Girvan, “Cancer, Its Possible Causes,” 4. 56 Joseph Colt Bloodgood quoted in Gardner, “Vanity, Modesty and Cancer,” 300. 57 The Doctor and the Cancer Patient: 7, ao. See also Accepted Truths and Opinions of the Modern Scientific World. 58 Roe et al., “Cancer Can Be Cured,” 8. 59 J.W.H. to Department of Health, Ontario, 6 November 1935, Cancer Records, File 25.1, ao. 60 R.C. to J.W.S. McCullough, Chief Medical Officer, Ontario, 15 February 1933, Cancer Records, File 24.9, ao; A.J.W. to Harold Kirby, Minister of Health, Ontario, 6 January 1941, Cancer Records, File 13.13, ao; ‹I’m Not Afraid of Cancer,› Hygeia 16 (February 1938): 138–40, 174, 191. 61 Legate, Leacock, 140; Moritz and Moritz, Leacock, 7. 62 Rosenberg, “Framing Disease,” xvii. 63 Nicholls, “The Cancer Problem,” 478. 64 Johnston, Before the Age of Miracles, 171. See, for example, L.F. to Harold Kirby, Minister of Health, Ontario, 10 June 1938, Cancer Records, File 13.11, ao.

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168 Notes to pages 15–17 65 Kennedy, “Myths About Cancer,” 399. 66 Brines, “The Education of the Public,” 5. 67 E.D. to Rene Caisse, Bracebridge, Ontario, 23 January 1938, Wallace Papers, Series 1024b, Additions, Box 1, File 9, Case Book 3, 15, qua. 68 Georgia Richards McRoberts, South Euclid, Ohio, to Life 2 (22 March 1937): 75. 69 Marcosson, “Common Sense and Cancer,” 9. 70 Kennedy, “Myths About Cancer,” 400; my emphasis. See also Marcossan, “Common Sense and Cancer,” 9 and Upham, “How to Escape Tuberculosis and Cancer,” 156. 71 Charters, Life Before Medicare, 79. 72 “What a Cancer Patient Thinks,” Saturday Night 45 (1 November 1930): 5. 73 For information on the disposition of cancer control programs in Canada and the United States, consult the following sources: Ontario’s Programme for Cancer Control, 8, ao; “Outline of Cancer Control Programme for Ontario Department of Health,” n.d., Cancer Records, File 11.4, ao; Cunningham, “Division of Industrial Hygiene,” 1937, 156, ao; “Radium Centres for Cancer,” Saturday Night 45 (31 May 1930): 1; “Cancer Progress in the West,” Saturday Night 45 (28 June 1930): 1; History of Cancer Control Project, Cancer Control in the United States, 499–515; Patterson, The Dread Disease, 114–36. 74 “Facing Cancer With Courage,” Hygeia 9 (May 1931): 422. 75 Shepley, “Why Late Diagnosis,” 407. 76 Charters, Life Before Medicare, 79. For other examples of the economic constraints on cancer care, see pages 49, 73, 87. 77 C. to J.W.S. McCullough, Chief Officer of Health, Ontario, 29 September 1933, Cancer Records, File 24.9, ao. 78 “The Patient as a Person,” clp 80 (May 1933): 141. 79 Kennedy, “Myths About Cancer,” 7. See also Dukes, “Taking the Fear Out of Cancer,” 3; Marcosson, “Common Sense and Cancer,” 9; Clute, “Talk on Cancer,” 2; and Upham, “How To Escape Tuberculosis and Cancer,” 155. 80 Marcosson, “The Cured Cancer Club,” 694–6. 81 Gallup, The Gallup Poll, 1:495, 2:901; Cantril, Public Opinion, 89. 82 Richards, “Radiological Treatment, Carcinoma of the Lips,” 490–502; MacFarlane, “Cancer of the Rectum,” 467–9; and Appleby, “Postoperative Survival Periods,” 481–4. 83 Scott, “Cervical Cancer,” 290–3; Barringer, “Carcinoma of the Prostate,” 502; Important Facts for Women About Tumours, 3, ao. 84 Statistical information about death rates in the us and Canada can be found in “Series b 149–166. Death Rate for Selected Causes: 1900 to 1970,” Historical Statistics of the United States, 58, and “Series b 35–50. Average Annual Number of Deaths and Death Rates for Leading Causes of Death, Canada,” in Leacy, Historical Statistics of Canada.

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169 Notes to pages 17–20 85 Patterson, The Dread Disease, 113. 86 MacMurchy, “A Thousand a Month,” 12. 87 Sontag, Illness as Metaphor, 8–9. See also Patterson, The Dread Disease, 82–4, 97. 88 Bumgarner, The Health of the Presidents, 213–18. 89 Pinell, “How Do Cancer Patients Express,” 26–7. 90 Alan Skinner, “The Little We Know,” 2. 91 MacMurchy, “A Thousand a Month,” 12. 92 Sontag, Illness as Metaphor, 112. 93 Marcossan, “Common Sense and Cancer,” 9. 94 Brines, “The Education of the Public,” 5. 95 “Facing Cancer with Courage,” Hygeia 9 (May 1931): 421. 96 Examples of contemporary articles that used the phrase “conspiracy of silence,” or something like it, include Roe et al., “Cancer Can Be Cured,” 8–9; Marcosson, “Common Sense and Cancer,” 8–9; and Steward, “A Psychological Approach,” 7–9. 97 Patterson, The Dread Disease, 30, 69, 151; my emphasis. See also Sontag, Illness as Metaphor, 7–8, 103–4. 98 Sontag, Illness as Metaphor, 57. 99 Ferguson, “When Cancer is Not Guilty,” 893. Some of the more extreme examples of educational literature that blamed cancer sufferers for their ill health are Soiland, “Cancer Incorporated,” 6–8; What Everyone Should Know About Cancer and The Prevention of Cancer, both ao; Anonymous, “Cancerphobia,” ascc Bulletin 16 (July 1934): 10–12; Skinner, “The Little We Know”; and Anonymous, “Cancer: The Great Darkness,” Fortune 15 (March 1937): 112–14. 100 Among the most important discussions of health, disease, and blaming are Kleinman, Illness Narratives; Nelkin and Gilman, “Placing Blame,” 361– 78; Rogers, Dirt and Disease, 52–3, 66–9, 125–31; and Rothman, Living in the Shadow of Death, 228–31. 101 Arnup, Education for Motherhood; See also Ladd-Taylor and Umansky, Bad Mothers. 102 Leavitt, Typhoid Mary. 103 Patterson, The Dread Disease, 111–13, 167–70. 104 “What a Cancer Patient Thinks,” Saturday Night 45 (1 November 1930): 5. See also “Letter to the Editor,” Bracebridge Gazette, 25 June 1936; “Was Cancer Patient,” Muskoka Herald, 4 June 1936; and “Letter to Editor,” Hygeia 15 (August 1937): 754. 105 “Please Send Me” ascc Bulletin 20 (November 1938): 9. See also Roe et al., “Cancer Can Be Cured,” 8–11. 106 J.D to Harold Kirby, Minister of Health, Ontario, 12 November 1938, Cancer Records, File 25.2, ao. See also F.K.C. to Kirby, 28 July 1940, Cancer Records, File 13.13, ao.

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170 Notes to pages 20–3 107 108 109 110

111

112 113 114 115 116 117

118 119 120 121 122

Gallup, The Gallup Poll, 1:217 and 2:901. Patterson, The Dread Disease, 84–6, 97. Ibid., 30, 151, 157. See also Sontag, Illness as Metaphor, 103. Sontag, Illness as Metaphor, 103; Patterson, The Dread Disease, 151, 157. Both Sontag and Patterson assume the link between this phrase and death from neoplastic diseases. Indeed, Patterson maintains that relatives of those who died at Memorial Cancer Hospital, one of the oldest and most prestigious cancer treatment centres in the United States, relied heavily on euphemisms. Unfortunately, his footnotes do not provide evidence to support this conclusion. Death Notice, Isabella Deans Wallace, Toronto Mail and Empire, 20 August 1925; Death Notice, Albert E. Bavidge, Toronto Mail and Empire, 20 January 1920. “Died After Operation: Walter Plumstead Passed Away Suddenly at Hospital,” Toronto Mail and Empire, 13 August 1910. “Stephen Leacock Dies After Throat Operation,” Toronto Globe and Mail, 29 March 1944. Leuceutia and Weller, “The Cancer Problem in Michigan,” 2; Marcosson, “Common Sense and Cancer,” 9. Death Notice, H. Otto Scott, Toronto Mail and Empire, 8 August 1930. Beebe, “Lung Cancer in World War i Veterans,” 1231–51; Norman, “Lung Cancer Mortality in World War i Veterans,” 311–17. In order to evaluate the reporting of deaths, I surveyed two months of the Toronto Mail and Empire (which became the Toronto Globe and Mail in 1936) at five-year intervals between 1900 and 1945. January and August were the months chosen, in order to cover a wide variety of terminal illnesses, including contagious diseases, such as pneumonia, which took their greatest toll in the winter months, and accidental deaths, such as drownings, which frequently occurred during summer vacations. Casualty lists published during the war years were not included in my enumeration or analysis of obituaries. Patterson, The Dread Disease, 69, 82–4, 97. See also Sontag, Illness as Metaphor, 7, 103. Sontag quoted in Kahn, “Alone Against Illness,” 52. Sontag, Illness as Metaphor, 8. “Please Send Me,” ascc Bulletin 20 (November 1938): 8–10. The Cancer Records, ao, and the Wallace Papers, qua, provide many examples of lay correspondence about cancer, but information about popular inquiries is also available from other documents. See, for example, H.R., “Letter to the Editor,” Bracebridge Gazette, 11 June 1936; “Case History of T.D.,” Wallace Papers, Series 1024b, Additions, Box 1, File 10, Case Book 6, 4–5, qua; J.W.S. to Premier of Ontario, 23 February 1931, rg 3–8, Box 136, File 03–08–0–060, ao; L.H. to

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171 Notes to pages 23–8

123 124

125 126 127 128 129 130 131

132 133 134 135 136 137 138 139 140 141 142 143 144 145 146 147

Ontario Cancer Research Council, 23 February 1933, Cancer Records, File 24.9, ao. “Case History of W.C.,” Wallace Papers, Series 1024b, Additions, Box 1, File 9, Case Book 3, 11, qua. Many physicians advocated honest discussion with cancer sufferers as well as their families. See, for example, Starr, “The Cancer Problem,” 48; “Shall We Tell the Cancer Patient the Truth?” ascc Bulletin 17 (August 1935): 9–11; Pierce, “The Management of the Cancerous Patient,” 119– 20. “Letter to the Editor,” Bracebridge Gazette, 11 June 1936; Johnston, Before the Age of Miracles, 168–9. Johnston, Before the Age of Miracles, 168–9. Bacall, By Myself, 243, 251. Bloodgood, “Courageous Fear,” 14. Clute, “Talk on Cancer,” 3. Castle, “Are You Afraid, Too?” 702. Starr, Social Transformation, 127. Other works that deal explicitly or implicitly with medical monopoly include Connor, “Minority Medicine in Ontario, 1795–1903”; Shorter, Bedside Manners; Rothstein, American Physicians; Burrow, Organized Medicine; Shryock, The Development of Modern Medicine; Stevens, American Medicine and the Public Interest; and Burnham, “American Medicine’s Golden Age.” Soiland, “Cancer Incorporated,” 7. Nicholls, “The Cancer Problem,” 491. See, for example, Kress, “The Cures for Cancer,” 2; Tobey, “Cancer Quacks,” 6; and Patterson, The Dread Disease, 72, 171–9. Starr, Social Transformation, 127–44. “What A Cancer Patient Thinks,” Saturday Night 45 (1 November 1930): 5. Shorter, Bedside Manners, 78, 82, 85–92. Patterson, The Dread Disease, 66–8. Clute, “Talk on Cancer,” 2. Shepley, “Why Late Diagnosis,” 407. Leuceutia and Weller, “The Cancer Problem in Michigan,” 3. Deadman, “Cancer – The Pathological Aspect,” 241. See also Robinson, “The Role of the Pathologist,” 300. M.T. to Rene Caisse, Bracebridge, Ontario, 9 December 1938, Wallace Papers, Series 1024b, Additions, Box 1, File 10, Case Book 6, 4–5, qua. ‹I’m Not Afraid of Cancer,› Hygeia 16 (February 1938): 140, 174, 191. A.J.W. to J.H. Hett, Kitchener, Ontario, rg–138, Accession 14576/12, ao. Anonymous, “Cancerphobia,” ascc Bulletin 16 (July 1934): 11–12. Ibid., 12.

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172 Notes to pages 28–36 148 Marcosson, “Common Sense and Cancer,” 6; my emphasis. 149 Gardner, “Vanity, Modesty and Cancer,” 302. 150 What Everyone Should Know About Cancer, 2–3, 10, ao. See also The Doctor and the Cancer Patient, 1–2, 11–12, ao, and “Delay and Cancer,” ascc Bulletin 20 (November 1938): 7. 151 H.W.T. to Ontario Department of Health, 26 January 1938, Cancer Records, File 25.2, ao. 152 K.D. to the Ontario Department of Health, 4 February 1936, Cancer Records, File 25.1, ao. 153 E.C. to Ontario Department of Health, 9 March 1936, Cancer Records, File 25.1, ao. 154 A.J.W. to John Hett, 16 July 1944, rg 10–138, Accession 14576/12, ao. 155 “Shall We Tell the Cancer Patient the Truth?” ascc Bulletin 7 (August 1935): 9–11. 156 Duguid, “Some of the Problems Encountered,” 3–5. 157 See, for example, Castle, “Are You Afraid, Too?” 2 and H.J.M. to J.W.S. McCullough, Chief Inspector of Health, Ontario, 9 August 1933, Cancer Records, File 24.11, ao. 158 Willinsky, A Doctor’s Memoirs, 70–1. 159 Kimball, Panama Hat, 81. 160 Stephen Leacock quoted in “International Cancer Symposium,” clp 67 (November 1926): 217. 161 Leacock, Literary Lapses, 57–8. 162 Leacock, Stephen Leacock’s Laugh Parade, 112. 163 R.C. to J.W.S. McCullough, Chief Inspector of Health, Ontario, 17 February 1938, Cancer Records, File 24.9, ao. 164 This description of Stephen Leacock’s battle is drawn from the following sources: Doyle, Sage of Orillia, 74; Moritz and Moritz, Leacock, 318–19; Legate, Stephen Leacock, 243–4; Curry, Humorist and Humanist, 330–1. Obituaries for the Leacocks include “Mrs. Leacock Died in Liverpool Home,” Montreal Gazette, 15 December 1925; “Stephen Leacock Dies After Throat Operation,” Toronto Globe and Mail, 29 March 1944; “Stephen Leacock, 74, Succumbs; Noted Humorist and Economist,” Montreal Gazette, 29 March 1944; “Stephen Leacock, Humorist, Is Dead,” New York Times, 29 March 1944. chapter two 1 The details of William Victor Johnston’s experience as a physician are drawn from his autobiography, Before the Age of Miracles. I have quoted here from pages 4 and 73. For further information about general practice in Canada during the first half of the twentieth century, see Shortt, ‹Before the Age of Miracles,› 123–52. Shortt’s study underscores the limits of

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173 Notes to pages 37–43

2 3 4 5 6 7 8 9 10

11 12 13 14

15 16

17 18 19 20 21 22 23 24 25 26 27 28

medical education and practice in these decades as well as the rigours of country practice. Johnston, Before the Age of Miracles. In this paragraph I am quoting from pages 172 and 175. E.K. Lyons, “Foreward,” in Johnston, Before the Age of Miracles. Johnston, Before the Age of Miracles, 166–77. The quotations in this paragraph are found on pages 166, 171, and 173–5. Shepley, “Effective Offensive,” 674. Rosenberg, Care of Strangers. Rothman, In the Shadow of Death. McCullough, “Review of Ten Years’ Progress,” 50–1, ao. Miller, “Present Position, Part i,” 16. Manchester, “The Registrar-General’s Branch,” 36–7, ao; Sellers, “Division of Medical Statistics,” 21, ao; Hoffman, Cancer Problem of Canada, 4–5; Cunningham, “Division of Industrial Hygiene,” 1939, 194, ao. Bruce, “Treatment of Cancer,” 136. “Death Rate, for Selected Causes: 1900 to 1970,” Historical Statistics of the United States, 58. J.W.S. to George Henry, Premier, Ontario, 23 February 1931, rg 3–8, Box 136, File 03–080–0–060, ao. The growing list of entries under the subjects “cancer” and “tumour” in the Index Medicus demonstrates the rising interest and concern of both researchers and clinicians. Nicholls, “Early Diagnosis” 540. “The Prevention and Control of Cancer,” cmaj 5 (1915): 1000–2; Nicholls, “The Chance of Death,” 195; “Cancer in Ontario,” cmaj 40 (January 1939): 84–5; Deadman, “Cancer: The Pathological Aspect,” 238. Ontario’s Programme for Cancer Control, 7, ao. Hoffman, Cancer Problem of Canada, 6. See also Patterson, The Dread Disease, 79–81. Primrose, “Cancer,” 237. Patterson, The Dread Disease, 96. Scott, “Cervical Cancer,” 290. Macklin, “Increase in Cancer,” 192. Ibid., 195; my emphasis. Austoker, Imperial Cancer Research Fund, 10–12, 15–19. See, for example, Mayo, “The Cancer Problem,” 787. Miller, “Present Position, Part i,” 17; Starr, “The Cancer Problem,” 48–9; What Everyone Should Know About Cancer, 1, ao. Nicholls, “Early Diagnosis,” 541; Primrose, “Cancer,” 234–5. Curry, “Cancer of the Tongue and Lip,” 50; The Prevention of Cancer, 1, 4–5, ao, Whytock, “Carcinoma of the Uterine Cervix,” 522. Austoker, Imperial Cancer Research Fund, 9–10, 118–21.

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174 Notes to pages 43–6 29 Ewing, “Etiology of Cancer,” 129–30. See also Ewing, Neoplastic Diseases, 97–114 and McCullough, “Preventive to Curative Medicine,” 12. 30 Macklin, “Human Tumours,” 182–3. Until the early 1930s, medical concern about tobacco use was confined mainly to chewing and pipe-smoking, both of which seemed linked to cancers of the mouth, lip, and tongue. Researchers and clinicians began to speculate about a possible connection between cigarette smoking and lung neoplasms, but because other types of cancer posed a greater health threat than any of those associated with tobacco use, the campaign against smoking did not gather momentum until after the Second World War. See Nicholls, “Cancer of the Lung,” 64–5 and Patterson, The Dread Disease, 205–7. 31 Macklin, “Human Tumours,” 182–3. See also McLaren, Our Own Master Race, 133. 32 Slye, “Relation of Heredity to Cancer,” 114. 33 Macklin, “Monozygous and Dizygous Twins,” 606; Report of the Royal Commission on the Use of Radium and X-Rays in the Treatment of the Sick, 29 February 1932, rg 18–95, Box 1, 25–6, ao. 34 Oertel, “Cancer Development,” 188; Beregoff-Gillow, “Internal Secretions,” 614; Nicholls, “Role of the Pituitary Body,” 419–21; Thomson, “Carcinogenic Substances,” 307–9; Lacassagne, “Hormones and Cancer,” 112–17; Gruner, “Blood-Culture as an Aid,” 63–4; Noble et al., “Mammary Tumours,” 413–17; “Cancer,” clp 73 (September 1929): 81–5; Boyd, “Growth, Innocent and Malignant,” 124–30. 35 Kennedy, “Myths About Cancer,” 399–400. 36 See, for example, “Editorial Comments: The ‘Cause’ of Cancer,” cmaj 15 (1925): 954 and Miller, “Present Position, Part ii,” 158–60. 37 Austoker, Imperial Cancer Research Fund, 16, 62–3, 92–8. See also Rather, The Genesis of Cancer, 168–9; Peller, Cancer Research Since 1900, 55–6; Patterson, The Dread Disease, 16, 59, 98–9. 38 Bliss, Banting, 157–8, 211–12; “Banting on Cancer,” Canadian Comment 7 (February 1938): 22–3. 39 Ewing, “Etiology of Cancer,” 119–20. 40 Austoker, Imperial Cancer Research Fund, 95–6. See also “Editorial Comments: The ‘Cause’ of Cancer,” cmaj 15 (1925): 954–5; Miller, “Present Position, Part ii,” 158–60; and “Editorial: The Causation of Cancer,” cjms 58 (September 1925): 58–9. 41 Ewing, “Etiology of Cancer,” 117. 42 Scrimger, “Carcinoma of the Rectum,” 388. 43 Minutes, Advisory Cancer Committee, 23 November 1934, Cancer Records, File 11.7, 52, ao. 44 What We Know About Cancer, 10. See also “Heredity and the Causes of Cancer,” clp 69 (July 1927): 5–7. 45 Slye, “Relation of Heredity to Cancer,” 115.

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175 Notes to pages 46–9 46 Macklin, “Human Tumours,” 186–7; Madge Thurlow Macklin to J.W.S. McCullough, Chief Inspector of Health, 29 September 1932, Cancer Records, File 32.14, ao. See also McLaren, Our Own Master Race, 135–45. 47 Primrose, “Cancer,” 234. 48 Nicholson, “The Non-Surgical Cure of Cancer,” 76–80; Patterson, The Dread Disease, 63; Hixson, Patchwork Mouse, 138–41. 49 Glover, “The Bacteriology of Cancer,” 92–111; “Cancer,” clp 73 (September 1929): 81–5; Loudon and McCormack, “Preliminary Report on the Glover Microorganism,” 13–29; Loudon and McCormack, “Evidence in Favour,” 154–68; Glover and White, The Treatment of Cancer in Man. 50 T. Noonan, “Carcinoma of the Cervix,” 30–5; Ewing, “Etiology of Cancer,” 117–20; MacGregor, “The Search for a Chemical Cure,” 379. 51 McComb and Pearse, “Our Experience with the Hormone Treatment,” 266–71; Harris, “The Coffey-Humber Extract,” 1–2, 8; Hall, “Histological Changes,” 441–2. 52 Handbook on Cancer, 7–8. 53 McComb and Pearse, “Our Experience with the Hormone Treatment,” 266–71; Hall, “Histological Changes,” 441–2. See also Austoker, Imperial Cancer Research Fund, 100–2. 54 Bruce, “Treatment of Cancer,” 136–51; “Cancer and Acidosis,” clp 78 (April 1932): 105–6; Wright, “The Use of Magnesium Sulphate,” 404–6; McComb and Pearse, “Our Experience with the Hormone Treatment,” 266–71; Hendrick and Burton, “A Case of Hodgkin’s Disease,” 519–20; Nicholls, “Vitamins and Cancer,” 175–6 and “The Part Played by Vitamins,” 381–3. See also MacGregor, “The Search for a Chemical Cure,” 379 and Peller, Cancer Research Since 1900, 215. 55 “A Treatment for Cancer,” Hygeia 1 (July 1923): 252; “The Blair Bell Cancer Treatment,” Hygeia 4 (January 1926), 50; Bruce, “Treatment of Cancer,” 137–8; Miller, “Present Position, Part ii,” 161. 56 “The Lead Treatment of Cancer,” Campaign Notes of the American Society for the Control of Cancer 11 (March 1929): 1–3. 57 Macklin, “Human Tumours,” 182. See also Nicholls, “Constitutional or Local,” 67–8; Shepley, “Effective Offensive,” 673; Mayo, “The Cancer Problem,” 789–90; What We Know About Cancer, 10–11. 58 Miller, “Present Position, Part i,” 20–2. 59 “The Relationship Between Trauma and Cancer,” cmaj 27 (August 1932): 179–80; Eberts, “The Evolution of Cancer,” 17–24; Handbook on Cancer, 5–11. 60 Handbook on Cancer, 19. 61 Gurd, “Modern Methods,” 784–5; Starr, “The Cancer Problem,” 48; Primrose, “Cancer,” 234. 62 Nicholls, “Constitutional or Local,” 67; my emphasis. See also Kearns, “Etiological Factors,” 43–6.

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176 Notes to pages 49–53 63 “Cancer and the General Practitioner,” clp 72 (June 1929): 204. 64 Curry, “Cancer of the Tongue and Lip,” 53. 65 Graham, “Carcinoma of the Stomach,” cmaj 18 (January 1928): 25–30. Other physicians continued to report similar rates of misdiagnosis well into the 1930s. See, for example, Carter, “Cancer of the Large Bowel,” 167; Balfour, “Alimentary Canal,” 245–6. Even “accessible” cancers, those practitioners could see without cutting into the body, were likewise subject to inaccurate or delayed diagnoses. See Curry, “Cancer of the Tongue and Lip,” 50–3 and Whytock, “Carcinoma of the Uterine Cervix,” 522–4. 66 Johnston, Before the Age of Miracles, 73. 67 Nicholls, “Early Diagnosis,” 541. 68 Graham, “Carcinoma of the Stomach,” cmaj 30 (April 1934): 396. 69 Historian James Patterson introduced the phrase “the gospel of early detection,” which I am using here. See Patterson, The Dread Disease, 68. 70 What We Know About Cancer, 15, 18. 71 Eberts, “Lump in the Breast,” 232–3. See also Eberts, “Cancer of the Breast,” 10–11; Balfour, “Alimentary Canal,” 246; MacDougall, “Carcinoma of the Breast,” 567; and What We Know About Cancer, 18–20. 72 “Our Growing Dependence on the X-ray,” cmaj 23 (October 1930): 563–4. 73 George and Gerber, “Gastric Carcinoma,” 197–8; Balfour, “Alimentary Canal,” 246; Goldie, “An Analysis,” 486–7. 74 Graham, “Carcinoma of the Stomach,” cmaj 30 (April 1934): 396–7. 75 Eberts, “Carcinoma and Ulcer of the Stomach,” 145–6. See also Notkin, “Early Diagnosis of Cancer,” 8–13. 76 Gray, “Uses and Abuses of X-Rays,” 687. 77 Agnew, “X-Ray Equipment,” 282. 78 Deadman, “Cancer – The Pathological Aspect,” 241. 79 What We Know About Cancer, 16–17; Macklin, “Modern Histology,” 193–6; Simpson, “Biopsy,” 62–3; The Doctor and the Cancer Patient, 3, ao; Nicholls, “Early Diagnosis,” 541; “Biopsy in Suspected Cancer,” clp 82 (May 1934): 155–6. 80 Robinson, “The Role of the Pathologist,” 298–301. 81 See, for example, What We Know About Cancer, 11–18 and Handbook on Cancer, 19–24. 82 Primrose, “Cancer,” 235. 83 Quick, “Irradiation Therapy,” 686. See also Raven, Theory and Practice of Oncology, 1–15 and MacGregor, “The Search for a Chemical Cure,” 378. 84 Cutler, “Cancer of the Breast,” 384. 85 Whytock, “Carcinoma of the Uterine Cervix,” 524; Carter, “Cancer of the Large Bowel,” 170. 86 Coley, “Some Brief Notes,” 526. 87 Murray, “A Method of Palliative Treatment,” 271–5. See also Bruce, “Treatment of Cancer,” 145.

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177 Notes to pages 53–7 88 Information about the development of radiation therapy can be found in the following sources: Patterson, The Dread Disease, 64–5; Brecher and Brecher, The Rays; Eisenberg, Radiology; Handbook on Cancer, 25– 37; McGuffin, “Physics and Biophysics” 679–84; Leitch, “Radium,” 684–90. 89 Brodeur, “Radiotherapy,” 467. 90 Pierce, “The Management of the Cancerous Patient,” 123. See also Craver, “Some Aspects,” 464–9; Carter, “Cancer of the Large Bowel,” 170; Whytock, “Carcinoma of the Uterine Cervix,” 524; Bruce, “Treatment of Cancer,” 139–42; Quick, “Irradiation Therapy,” 688–9. 91 Gray, “Uses and Abuses of X-Rays,” 687. See also Quick, “Irradiation Therapy,” 687. 92 Gordon Richards quoted in Minutes, Advisory Cancer Committee, 23 November 1934, Cancer Records, File 11.7, 26, ao. 93 Carter and Cromarty, “What Can Be Done,” 304. 94 “X-ray Pioneer Suffers Arm Amputation,” clp 75 (December 1930): 229; Findlay, “Complications and Disappointments,” 154–61; Gordon, “The Surgical Treatment,” 622–4; Starr, “The Cancer Problem,” 49. 95 George E. Wilson quoted in Minutes, Advisory Cancer Committee, 23 November 1934, Cancer Records, File 11.7, 23, ao. 96 Hunt, “The Curability of Carcinoma,” 26; Bruce, “Treatment of Cancer,” 146; Appleby, “Postoperative Survival Periods,” 481–4. 97 Shepley, “The Rationale of Radiotherapy,” 521. See also Shepley, “The Role of Radiotherapy,” 252–8. 98 Richards, “Radiological Treatment, Carcinoma of the Lips,” 490–502; Paterson, “Malignant Conditions of the Skin,” 371–3. 99 Pentecost, “The Treatment of Cancer,” 411–15; Patterson, “Carcinoma of the Larynx,” 7–10. 100 “Radium Therapy in Cancer,” cmaj 19 (September 1928): 352. 101 Richards, “Radiological Treatment, Methods and Results,” 299. 102 W.E. Gallie quoted in Minutes, Advisory Cancer Committee, 23 November 1934, Cancer Records, File 11.7, 24, ao. 103 Bruce, “Treatment of Cancer,” 147. 104 “Deep X-ray Therapy and Radium in the Treatment of Cancer,” clp 78 (February 1932): 34. 105 Marcossan, “The Cured Cancer Club,” 694–6; “Death Rate for Selected Causes: 1900 to 1970,” Historical Statistics of the United States, 8, 58. 106 Graham, “Carcinoma of the Stomach,” cmaj 18 (January 1928): 25. See also What We Know About Cancer, 31–3, 35–6; Berry, “Some Observations,” 571. 107 Graham, “Carcinoma of the Stomach,” cmaj 18 (January 1928): 25. See also Thorlakson and Hay, “Carcinoma of the Rectum,” 107. 108 Starr, “The Cancer Problem,” 49.

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178 Notes to pages 57–62 109 Scott, “Cervical Cancer,” 291. See also Forsdike, “Radium in Gynecology,” 792; Prowd, “Radiation Treatment,” 182. 110 Starr, “The Cancer Problem,” 48. 111 Pope, “Metastasis and Metastases,” 244–9. See also Handbook on Cancer, 15–16, 23–4. 112 George and Gerber, “Gastric Carcinoma,” 197. chapter three 1 This patient’s experience is drawn from the following documents: M.S., Toronto, Ontario, to Harold Kirby, Minister of Health, 23 November 1937 and M.S. to John Hett, Kitchener, Ontario, 22 July 1944, both rg 10–138, Accession 14576/12, ao; “Case History of M.S.,” 22 February 1939, Wallace Papers, Series 1024b, Additions, Box 1, File 2, qua. I have quoted from M.S.’s 1944 letter to John Hett, the unconventional practitioner she first consulted in 1935. 2 Cramp, Nostrums and Quackery, 7–20; Soper, “Saunders Cancer Awards,” 31–5; Fishbein, “Cancer Quacks,” 8–9; Kaplan, “Cancer Cures,” 210–13; Patterson, The Dread Disease, 39–43, 106–11; Cassileth and Brown, “Unorthodox Cancer Medicine,” 176–9. 3 Soper, “Saunders Cancer Awards,” 31. 4 Cramp, “Cancer ‘Cures,› 997–9. See also Fishbein, “Cancer Quacks,” 8 and “Quacks and Quackery,” 584–8. 5 John M. Robb, Minister of Health, to W.A.M., 16 September 1931, rg 3– 8, Box 136, File 03–08–0–060, ao; J. G. Cunningham, Director, Division of Industrial Hygiene, to B.T. McGhie, Deputy Minister of Health, 8 February 1937, Cancer Records, File 12.4, ao; “List of Cancer Cures, 1938– 40,” Cancer Records, File 19.5, ao. 6 Fishbein, “History of Cancer Quackery,” 139–66; Young, Medical Messiahs, 361–2; Patterson, The Dread Disease. 7 Fishbein, “Modern Medical Charlatans,” 23. See also Burrow, ama, 107– 26; Castle, “Are You Afraid, Too?” 701–2; Gellhorn, “Cancer is Curable,” 204; Kennedy, “Myths About Cancer,” 400. 8 John W.S. McCullough, “Cancer: The Greatest of Public Health Problems,” 22 May 1935, Cancer Records, File 34.3, ao. See also “Canadian Medical News: Committee to Investigate Quackery,” jama 86 (9 January 1926): 126; “The Attraction of Quacks,” cmaj 18 (February 1928): 215; Teevens, “Proprietary and Patent Medicine Act,” 70; “Fraudulent Cancer Cures Are Scored [sic] by Dr. Bruce,” Toronto Star, 19 September 1936; “Planning to Curb ‘Quack’ Treatment,” Toronto Star, 2 March 1937. 9 “Address Given by His Honour, Dr. Herbert A. Bruce, Lieutenant-Governor of Ontario, before a Joint Meeting of the Kiwanis Club, and other Service Clubs, at a Luncheon in the Royal York Hotel, Toronto, 22 November

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179 Notes to pages 62–6

10

11

12

13

14

15 16 17 18 19 20 21

22 23 24 25

1933,” clp 82 (May 1934): 137–49. See also Wallace and Callahan, “Proceedings of a Sub Committee,” cpso; Starr, Social Transformation, 12, 15. Matthews, Quantification, 4. For a splendid discussion of works dealing with the science-medicine complex in history, see John Harley Warner’s essay “Science in Medicine.” McGhie to K.G. Gray, Solicitor, Department of Health, Ontario, 15 January 1937; J.G. Cunningham to McGhie, 8 February 1937, both Cancer Records, File 12.4, ao. Among the most important works on alternative medicine, in its broadest definition, are the following: Saks, Alternative Medicine; Porter, Health For Sale; McGuire, Ritual Healing; Gevitz, Other Healers; Cooter, Studies in the History of Alternative Medicine; Bynum and Porter, Medical Fringe; Salmon, Alternative Medicines; Risse et al., Medicine without Doctors; Young, Medical Messiahs. I am quoting here from Saks, “Introduction,” 3, in Alternative Medicine. “Hendry Cameron Connell,” in Roberts and Tunnell, Canadian Who’s Who, 25; “Calvin Hendry Cameron Connell,” Student Registers, a.arch 1161, qua. Although Queen’s University restricts access to student records, the records archivist, Paul Banfield, has given me a general impression of Connell’s performance while at university. I am quoting here from his letter to me, dated 6 May 1993. Connell, “A Discussion of the Factors Concerned,” 124; cicr, “Annual Report,” 2 July 1940, 2468, ao. For further discussion of physicians’ interest in experimental work, see Lederer, Subjected to Science; Bliss, Discovery of Insulin; and Harvey, Science at the Bedside. Connell, “Cataract, Experimental Report,” 93–100. Connell, “Study and Treatment,” 364–70. Ibid., 364. Ibid., 364. Torrey and Kahn, “Bacterial Proteolytic Ferments,” 334–76; des Ligneris, “Dr. Connell’s Cancer Treatment,” 1280–1. Connell, “Study and Treatment,” 370. Connell to Morris Fishbein, Editor, jama, 13 July 1935, hhfam Collection, Series 166, Box 162, File 0162–06, ama; “Cancer Cure is Here at Last,” “Ensol for Cancer” (36–8), and “List of Hospitals Where Ensol is Being Used,” circa 1935, hhfam Collection, Series 166, Box 162, File 0162–05, ama; Doherty, “Cancer Conquered at Last?” 50–1; Connell, “Clinical Results of Ensol Therapy,” 24–41. Connell, “Study and Treatment,” 364–70. Ibid., 366. Nicholls, “A New Treatment for Cancer,” 428–9. “Cancer,” oma Bulletin 2 (October 1935): 126–7. See also “Medical Journal Endorses Work of Kingston Man,” unidentified press clipping, 1935,

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180 Notes to pages 66–8

26

27

28 29

30

31

32

33 34

Cancer Records, File 15.1, ao, and “Report of the Advisory Cancer Committee,” oma Minutes, 26 May 1936, 179, oma. J.A. Hannah, md to McGhie, 15 August 1935; Connell to McGhie, 15 August 1935; Hannah to McGhie, 22 August 1935; Connell to McGhie, 2 June 1936, all Cancer Records, File 15.1, ao; J.A. Faulkner to H.R.I., 11 December 1936, Cancer Records, File 14.7, ao. “News Items: Ontario,” cmaj 33 (November 1935): 584. See also “Government Offers Aid for Cancer Sufferers,” Toronto Mail and Empire, 19 September 1935, and “New Cancer Survey is Launched by Hepburn Government,” Toronto Globe and Mail, 27 November 1934. McGhie, quoted in “Ontario Will Aid New Cancer Test,” Toronto Mail and Empire, 23 August 1935. See for example “The Blair Bell Cancer Treatment,” Hygeia 4 (January 1926): 50; “The Glover Cancer Cure,” Hygeia 5 (January 1927): 42; “The Attraction of Quacks,” cmaj 18 (February 1928): 215; J.A. Faulkner, Minister of Health, Ontario, to Mitchell Hepburn, Premier of Ontario, 4 May 1935, rg 3–9, Box 184, File 139.2, ao; Cramp, “Cancer ‘Cures,› 999; Wallace and Callahan, “Proceedings of a Sub Committee,” 116–20, cpso. See, for example, Lederer, Subjected to Science; Li, “J.B. Collip”; Marks, “Notes from the Underground,” in Maulitz and Long, Grand Rounds, 297–338; Marks, The Progress of Experiment; Warner, “Science in Medicine,” 42–6, 50–4; Bliss, The Discovery of Insulin; Lilienfeld, “Ceteris Paribus,” 1–18; Harvey, Science at the Bedside. J. Rosser Matthews’ recent book, Quantification and the Quest for Medical Certainty, is a welcome contribution to the historiography of medical research because, in contrast to other historians, he grapples with the question of how statistical analysis and clinical trials have come to epitomize legitimate research today. His analysis of the debates over objectivity and quantification that raged in Europe and North America throughout the nineteenth and twentieth centuries demonstrates that, prior to World War ii, medical research was conducted not only in the absence of clear and accepted guidelines, but also with a positive distaste for statistics. Fishbein, “The Connell Cancer Cure,” 1122–3. See also Evarts V. DePew, md, San Antonio, Texas, to Morris Fishbein, 23 July 1935, hhfam Collection, Series 166, Box 162, File 0162–06, ama. Arthur Cramp, Director, Bureau of Investigation, ama, to T.C. Routley, Secretary, cma, 25 July 1935. See also Francis Carter Wood, md, to Morris Fishbein, Editor, jama, 30 September 1935, all hhfam Collection, Series 166, Box 162, File 0162–06, ama. Bliss, The Discovery of Insulin. James Miller, Professor of Physiology, to R.C. Wallace, Principal, Queen’s University, 13 October 1936, Wallace Papers, Series 1024b, Additions, Box 1, File 1, qua.

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181 Notes to pages 68–71 35 Gye, “Proteolytic Enzymes,” 760. 36 Ettinger, “Effects of Ensol,” “Action of Activated Ensol,” and “Action of Human Ensol,” hcf Bulletin 2 (January 1937): 71–6. 37 Murray, “Special Report,” ao. 38 Ewing, Neoplastic Diseases, 26–9, 64–6; Bates, “Division of Pathology Report,” 1933, ao; Simpson, “Biopsy,” 62–5; Deadman, “Cancer – The Pathological Aspect,” 238–44. 39 Horner, “A New Treatment for Cancer,” 791–2. 40 Peller, Cancer Research Since 1900, 267. 41 Horner, “A New Treatment for Cancer,” 791–2. Similar opinions were expressed by Murray, “Special Report,” ao. 42 “Dr. Connell Reports on Ensol for Cancer,” Detroit Saturday Night, 5 October 1935; “Dr. Fishbein’s Displeasure,” Winnipeg Free Press, 8 October 1935; “Listen Doctor,” Detroit Saturday Night, 12 October 1935. 43 Connell to McGhie, 10 December 1935, Cancer Records, File 15.1, ao. 44 “Du Pont Backs Connell on Cancer,” Detroit Saturday Night, 7 December 1935. 45 “Connell’s Cancer Remedy,” cmaj 79 (January 1936): 1–3; “Gave Resume of Work of the Connell Clinic,” Kingston Whig Standard, 1 June 1936; Phillips, “Connell Cancer Treatment,” 406–8; Rusch and Preston, “The Effects of Filtrates,” 581–4; Moppett and Goldsworthy, “Effect of ‘Ensol,› 754–5; “Ensol Research Gets Charter,” Toronto Globe and Mail, 28 December 1935; “Foreword,” hcf Bulletin 1 (August 1936), 3; cicr, “Annual Report,” 2 July 1940, 2470, ao. 46 Connell, “Clinical Results of Ensol Therapy,” 24–41. 47 Ibid., 24. 48 Ibid., 41. 49 Connell, “Ensol,” 7. 50 H.C. Connell, “A Solution of the Cancer Problem,” (circa 1936), Cancer Records, File 15.1, ao; Connell, “Clinical Results of Ensol Therapy,” 24, 41; Connell, “Editorial,” 128–31; “Five Years’ Research Produces New Weapon for Attack on Cancer,” Toronto Mail and Empire, (circa 1935), Cancer Records, File 15.1, ao; “News Items: Ontario,” cmaj 33 (November 1935): 584; “Ensol in the Treatment of Cancer,” 30 September 1935, oma Minutes, 15, oma. 51 MacNab, Legal History, 59–61. For a related example of professional reactions to unconventional practice, see Clow, “Mahlon William Locke,” 17– 39. 52 “Discoverer of Ensol Only 40 Years Old,” Toronto Mail and Empire, (circa 1935), Cancer Records, File 15.1 ao. 53 Nicholls, “A New Treatment for Cancer,” 429. See also “Crab Limbs,” Canadian Comment 6 (February 1937): 18. 54 Horner, “A New Treatment for Cancer,” 792.

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182 Notes to pages 72–3 55 Connell and Holsgrove, “The Precipitin Reactions of Ensol,” 83–6. 56 Connell, “The Antigenic Activity of Ensol,” 3–9, and “Complement Deviation,” 10–14; H.C. Connell, “A Solution of the Cancer Problem,” (circa 1936), Cancer Records, File 15.1, ao. 57 Austoker, Imperial Cancer Research Fund , 16, 92–9; Patterson, The Dread Disease, 98–9. 58 “Six Die After Use of Cancer Serum,” New York Times, 31 March 1938; “Six Deaths Put U.S. on Cancer Nostrum Trail,” Chicago Tribune, 31 March 1938; W.T. Harrison, Chief, Division of Biologics Control, United States Treasury Department, to Olin West, Secretary, ama, 5 April 1938, hhfam Collection, Series 166, Box 162, File 0162–06, ama; Fishbein, “Eleven Deaths,” 1183–5. 59 Connell, “Letter to the Editor,” 638. 60 Fishbein, “Deaths From Ensol-Rex,” 1195. 61 Horner, “Tetanus from Cancer Cure,” 1013. 62 B.T. McGhie to Harold Kirby, Minister of Health, 17 August 1938 and McGhie to File, 19 August 1938, Cancer Records, File 15.3, ao; Mitchell Hepburn, Premier of Ontario, to Connell, 19 August 1938, Wallace Papers, Series 1024b, Additions, Box 1, File 1, qua; cicr, “Report of the Committee Appointed to Visit,” 31 December 1938, qua. 63 “Ensol in the Treatment of Cancer,” 30 September 1935, oma Minutes, 15, oma; J.A. Faulkner, Minister of Health, Ontario, to G., 9 April 1936, Cancer Records, File 25.1, ao. 64 University of Toronto Class and Prize Lists, 20; Campbell, “Doctors in Waterloo County,” Kitchener Public Library Archives; Enns, “Waterloo North: Conscription 1917,” 61; Middleton and Landon, “John E. Hett,” 98–9; Chadwick, The Battle for Berlin; Hett, The Sexual Organs; “Nationalization of Medical Profession,” Kitchener Daily Telegraph, 30 November 1920; “Better Medical Service,” Kitchener Daily Telegraph, (circa 1921); “Dr. Hett Keeps Demanding State Control,” Kitchener Daily Telegraph, 13 June 1921. 65 Connor, “Adoption and Effects of X-Rays,” 92–106; “‘X’ Rays Machine,” Berlin News Record, 13 December 1900; “Advertisement,” Berliner Journal, 17 October 1901; “X-Rays as Cancer Cure,” Berliner Journal, 3 April 1902. 66 Hett, “Uterine Fibroid,” 521–2. 67 cicr, “Proceedings of the Commission, Exhibits (Doctor Hett),” 122, qua; J.E. Hett, “The Recurrence of Cancer,” (circa 1935), Wallace Papers, Series 1024b, Additions, Box 2, File 10, qua; “Dr. Hett Says 50% of Operations are Unnecessary,” Kitchener Telegraph, 25 January 1921; “Dr. Hett Says Misreported,” Kitchener Telegraph, 26 January 1921. 68 Hett, Cancer, 33. 69 Connell, “A Solution of the Cancer Problem,” (circa 1936), Cancer Records, File 15.1, ao.

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183 Notes to pages 74–6 70 “Kitchener Doctor’s Claim of Cancer Cure Attracts Province-Wide Attention,” Toronto Telegram, 15 January 1935; cicr, “Proceedings of the Commission, Exhibits (Doctor Hett),” 122, qua; Deadman, “Report on an Inquiry into the Laboratory Aspect,” 4, qua; Hett, Cancer, 90–4, 138–46. 71 “Cancer Treatment to Be Made Known, Dr. Hett Promises,” Toronto Globe and Mail, 28 October 1931; “Kitchener Doctor’s Claim of Cancer Cure Attracts Province-Wide Attention” Toronto Telegram, 15 January 1935; “Life Given to Patients through Cancer Serum but Finder Put on ‘Trial,› Toronto Telegram, 8 April 1937. 72 Robb quoted in “New Serum Cures Cancer Kitchener Doctor Claims,” Toronto Telegram, 27 October 1931. 73 Hett quoted in “Virus and Endocrine Upset Combine to Cause Cancer, Theory of J.E. Hett, M.D.,” Toronto Telegram, 25 July 1939. See also Deadman, “Report on an Inquiry into the Laboratory Aspect,” 2, qua; Hett, Cancer, 139–40. 74 Deadman, “Report on an Inquiry into the Laboratory Aspect,” 2–3, qua. 75 Hett, Cancer, 139–40. 76 “Serum Cure for Cancer Ontario Doctor’s Claim,” Toronto Telegram, (circa 1934), Grier Files, University of Toronto Archives. 77 Robb quoted in “Robb Ready to Test Hett Cancer Serum,” Toronto Globe and Mail, 9 March 1934; “Report of the Advisory Committee on Cancer,” (circa March 1934) oma Minutes, 218, oma; “Kitchener Doctor’s Claim of Cancer Cure Attracts Province-Wide Attention,” Toronto Telegram, 15 January 1935. 78 William Blount Turner, md, Wooster, Ohio, to ama, 31 January 1933, hhfam Collection, Series 355, Box 355, File 0355–03; Hett Form Letter, April 1932, hhfam Collection, Series 355, Box 355, File 0355–02; Hett Form Letter, 1 June 1934, hhfam Collection, Series 355, Box 356, File 0356–03, all ama. 79 A.J. Cramp to William Blount Turner, MD, Wooster, Ohio, 1 February 1933, hhfam Collection, Series 355, Box 355, File 0355–03, ama; “Enquiries re ‘Dr. Hett’s Cancer Cure,› 23 November 1932, oma Minutes, 23, oma. 80 “The Dr. J.E. Hett Case,” 2, Crane Collection, uh; “Report of the Discipline Committee,” 13 April 1937, 1, cpso. 81 “The Dr. J.E. Hett Case,” 2, Crane Collection, uh. See also “Report of the Discipline Committee,” 13 April 1937, 1, cpso; K.G. Gray, Memo to File, 12 January 1937, Cancer Records, File 19.5, ao; “Bars Dr. Hett as Practitioner within Ontario,” Toronto Evening Telegram, 20 April 1937; MacNab, Legal History, 30, 51. 82 Connell, “A Solution of the Cancer Problem,” (circa 1936), Cancer Records, File 15.1, ao; “Doctor Denies Clinic Offers a Cancer Cure,” New York World Telegram, 3 October 1935; Horner, “A New Treatment for

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184 Notes to pages 76–7

83

84 85 86

87 88 89 90

91 92 93

94

95 96

Cancer” 791. See also Hendry Connell to Morris Fishbein, 13 July 1935; A.J. Cramp to T.C. Routley, 25 July 1935; and Connell to J.F. Whelan, 26 July 1935, all in hhfam Collection, Series 166, Box 162, File 0162–06, ama. “Hett Treatments Will be Checked,” Kitchener Daily Record, 9 March 1934; “Robb Ready to Test Hett Cancer Serum,” Toronto Globe and Mail, 9 March 1934; “Dr. Hett re Cancer,” November 1933, 137, and “Report of the Advisory Committee on Cancer,” (circa March 1934), 218, both oma Minutes, oma; “Kitchener Doctor’s Claim of Cancer Cure Attracts Province-Wide Attention,” Toronto Telegram, 15 January 1935; “Doctor Sure He Has Cancer Treatment,” Kitchener Daily Record, 19 November 1935; “Patient Tells Profession of Dr. Hett Cancer Serum,” Toronto Evening Telegram, 2 January 1937; “Life Given to Patients Through Cancer Serum But Finder Put on ‘Trial,› Toronto Telegram, 8 April 1937. Hett quoted in “Impartial Test of Serum Not Rejected by Hett,” Toronto Telegram, 8 February 1938. “Cancer Treatment to Be Made Known, Dr. Hett Promises,” Toronto Globe and Mail, 28 October 1931. “Perfectly Appalling Said Mr. Justice Riddell,” Toronto Telegram, 8 April 1937; “Life Given to Patients through Cancer Serum but Finder Put on ‘Trial.› Toronto Telegram, 8 April 1937. MacNab, Legal History, 50. “The Dr. J.E. Hett Case,” 1, Crane Collection, uh. MacNab, Legal History, 42. “Report of the Discipline Committee,” 13 April 1937, 2, cpso; “Dr. J.E. Hett Case,” 14–17, Crane Collection, uh; “Bars Dr. Hett as Practitioner within Ontario,” Toronto Evening Telegram, 20 April 1937. “Won Prestige not Disgrace Says Dr. Hett,” Toronto Telegram, 24 April 1937. “Dr. Hett to Appeal Ouster to Courts,” Toronto Star, 23 April 1937; MacNab, Legal History, 23. “Appeal Court is Satisfied with Dr. Hett Case Facts,” Toronto Star, 17 June 1937; “Dr. Hett Appeal Dismissed Justice Riddell Disagrees,” Toronto Telegram, 30 June 1937. “The Dr. J.E. Hett Case,” 4, Crane Collection, uh; “Hett to Ask Gov’t for Reinstatement,” Toronto Star, 11 January 1938; “Dr. Hett Case to Legislature,” Toronto Globe and Mail, 19 January 1938; “Dr. Hett’s Application is to the Legislature,” Toronto Telegram, 31 January 1938; “Petition #1 to Lt. Governor of Ontario from John Emil Hett,” 18 January 1938, Department of the Provincial Secretary, rg 8–22, Box 20, File 800–640– 649, ao. “Dr. Hett Will Carry His Appeal Further,” Toronto Star, (circa 1938), Grier Files, University of Toronto Archives. MacNab, Legal History, 38.

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185 Notes to pages 77–80 97 Mitchell Hepburn quoted in “Ontario Will Make Hett Reveal Secret,” Toronto Star, 7 February 1938. See also “Hint Ontario Plans to Learn Cancer Remedy Dr. Hett Keeping Secret,” Toronto Telegram, 7 February 1938; “Hepburn to Order Provincial Probe of Cancer Claims,” Toronto Globe and Mail, 7 February 1938; “Reinstatement Favored Only if Ousted Doctor Reveals Serum Formula,” Toronto Telegram, 5 February 1938; “Ready to Reveal Formula ‘At Proper Time,’ Says Hett,” Toronto Star, 7 February 1938. 98 Caisse’s first name, though probably of French-Canadian origin, did not have an accent and was usually pronounced “rain” or, less often, “wren.” 99 “Doctors Back Nurse Claiming Secret Herb Aids Cancer Victims,” Toronto Daily Star, 23 January 1932; Wallace and Callahan, “Proceedings of a Sub Committee,” 8, cpso; W. Mosley, Inspector of Hospitals, Ontario, Memo to File, 9 July 1935, Cancer Records, File 14.1, ao; Fraser and Allen, “Could Essiac Halt Cancer?” 12. 100 Caisse quoted in Glum, Calling of an Angel, 16. 101 Fraser and Allen, “Could Essiac that Cancer?” 12; Glum, Calling of an Angel, 17–18; “Doctors Back Nurse Claiming Secret Herb Aids Cancer Victims,” Toronto Daily Star, 23 January 1932. 102 “Recipe for Essiac,” courtesy of Elene J. Freer, Curator, Bracebridge Historical Society, Bracebridge, Ontario; Snow, The Essence of Essiac; Yamamoto, “Essiac,” 158. 103 Fisher quoted in “Doctors Back Nurse Claiming Secret Herb Aids Cancer Victims,” Toronto Daily Star, 23 January 1932. 104 Lederer, Subjected to Science, 74. 105 Caisse quoted in “Doctors Back Nurse Claiming Secret Herb Aids Cancer Victims,” Toronto Daily Star, 23 January 1932. 106 Caisse, “Questionnaire for Cancer Commission,” 1, qua; Fraser and Allen, “Could Essiac Halt Cancer?” 14. 107 Caisse to McGhie, 21 May 1935, Cancer Records, File 14.1, ao. 108 Although samples of patient testimony are scattered throughout the archival collections used for this study, the largest concentration can be found in a series of case histories housed in Queen’s University Archives and in patient correspondence to the provincial Department of Health: Case Books 3–6, Wallace Papers, Series 1024b, Additions, Box 1, Files 9–10, qua; Cancer Records, Files 13.11–13.13, ao. See also Caisse, “Questionnaire for Cancer Commission,” 9, qua. 109 Fisher quoted in Fraser and Allen, “Could Essiac Halt Cancer?” 14 and Glum, Calling of an Angel, 19–20. 110 Frank J. Clancy, ama, to J.W.S. McCullough, Ontario Department of Health, 25 January 1937; Clancy to Lucia Stolp, State Medical Society of Wisconsin, 12 August 1937; John A. Wolfer, Director, Tumor Clinic, Northwestern University, Chicago, to Clancy, 17 September 1937, all hhfam Collection, Series 568, Box 556, File 0556–15, ama.

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186 Notes to pages 80–2 111 Wilbert Richards to Mitchell Hepburn, 10 May 1935, rg 3–9, Box 184, File 139.2, ao; “Petition,” May 1935, Cancer Records, File 14.2, ao; A.C. Salmon, Clerk/Treasurer, Corporation of Bracebridge to McGhie, 15 April 1935 and Caisse to Faulkner, 26 April 1935, Cancer Records, File 14.1, ao. 112 W. Mosley, Inspector of Private Hospitals, to J.W.S. McCullough, Chief Inspector of Health, 12 June 1935, McCullough to Mosley, 13 June 1935, and Mosley to File, 9 July 1935, Cancer Records, all File 14.1, ao. 113 Edward G. Ellis to McGhie, 18 July 1935, McGhie to Ellis, 19 July 1935, and McGhie to File, Cancer Records, all File 14.1, ao. 114 See, for example, “Believes Herb Cured a Cancer Defied Surgery,” unidentified press clipping, (circa 1932), Scrapbook, cpso, and “Doctors Back Nurse Claiming Secret Herb Aids Cancer Victims,” Toronto Daily Star, 23 January 1932. 115 Caisse to McGhie, 21 May 1935, Cancer Records, File 14.1, ao. 116 Glum, Calling of an Angel, 19–21; Fraser and Allen, “Could Essiac Halt Cancer” 14–16; “Essiac – An Ineffective Cancer Treatment,” Issues, 7 February 1989, hpb, Health and Welfare Canada; McGhie, Memo to File, 25 July 1935, Cancer Records, File 14.1, ao. 117 McCullough to Mosley, 12 June 1935 and Mosley to McCullough, 13 June 1935, Cancer Records, File 14.1, ao. 118 MacNab, Legal History, 119–20; Riddell, “Nursing and the Law,” 16–45; Kerr and MacPhail, Canadian Nursing, 310–15. 119 “Cancer Clinic,” Muskoka Herald, 18 June 1936. See also “Cancer Cure to be Probed,” Windsor Star, 15 March 1937 and “Should Investigate This Claim of Cancer Cure,” Port Arthur Evening-News Chronicle, 11 December 1937. 120 Clancy to McCullough, 25 January 1937 and Clancy to Stolp, 12 August 1937, hhfam Collection, Series 568, Box 556, File 0556–15, ama; “A Cancer Cure?” Charleston, West Virginia Mail, 2 July 1937. 121 Kohn, Sister Kenny; Kenny and Ostenso, And They Shall Walk. 122 Glum, Calling of an Angel, 18–19. Caisse described her theories in a later conversation with the members of the Cancer Commission as well as in a letter sent to Deputy Minister of Health W.G. Brown at the end of the 1950s. See Caisse to Wallace and Callahan, “Proceedings of a Sub Committee,” 6–7, cpso, and Caisse to Brown, 6 October 1958, Cancer Records, File 13.14, ao. 123 Peller, Cancer Research Since 1900, 267. 124 Faulkner to Caisse, 14 September 1935, Cancer Records, File 14.1, ao. 125 Caisse to McGhie, 21 May 1935; Caisse to Faulkner, 17 September 1935; Faulkner to Caisse, 25 September 1935, Cancer Records, all File 14.1, ao. See also “Cancer Remedy Claimed in Bracebridge: Goes to U.S.A.” Toronto Globe and Mail, 17 October 1936; “Cancer Cure to be Probed,”

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187 Notes to pages 82–4

126 127 128 129 130 131 132 133

134 135 136

137

138

139

140

Windsor Star, 15 March 1937; Fraser and Allen, “Could Essiac Halt Cancer?” 18; Glum, Calling of an Angel, 36–7. Caisse quoted in Wallace and Callahan, “Proceedings of a Sub Committee,” 3, cpso. Ibid. See McPherson, Bedside Matters, 3–18, 239–40; Reverby, Ordered to Care; Gamarnikow, “Nurse or Woman,” 110–29. Caisse to Faulkner, 26 April 1935, Cancer Records, File 14.1, ao. W.S. to Mitchell Hepburn, 5 August 1937, Cancer Records, File 13.11, ao. “Hints Cabal of Doctors Against Cancer Treatment,” Toronto Daily Star, 24 March 1938. Wallace and Callahan, “Proceedings of a Sub Committee,” 112, cpso; Cunningham to McGhie, 14 January 1937, Cancer Records, File 12.4, ao. Caisse to Hepburn, 15 June 1937, Cancer Records, File 13.11, ao; “Cancer Treatment By Nurse Allowed,” Toronto Daily Star, 30 July 1937; “Miss Caisse Sees Premier Hepburn,” Huntsville Forester, 5 August 1937; “Premier Hepburn Promises Help to Miss Caisse,” Peterborough Examiner, 5 August 1937. Caisse to Hepburn, 14 February 1938, Cancer Records, File 13.11, ao. Ibid., 3 September 1937, Cancer Records, File 13.11, ao. Ibid., 23 January 1938, Cancer Records, File 13.11, ao; “Denies Miss Caisse to Get Private Bill: But Can Practice if Cancer Treatment Held Beneficial, Hepburn Says,” Toronto Daily Star, 9 February 1938. For other accounts of negative reactions to Hepburn’s behaviour see “A Reminder to Mich” [sic], Bracebridge Gazette, 9 December 1937, and “Reject Bill Now to Come Before House,” Toronto Globe and Mail, 3 March 1938. Caisse to Hepburn, 25 February 1938, Cancer Records, File 13.11, ao; “An Act to Authorize Rene Caisse to Practice Medicine in the Province of Ontario in the Treatment of Cancer,” 1938, and “Response to Private Members Bill,” 1938, cpso; “I Want Humanity to Have My Cancer Cure,” Huntsville Forester, 24 February 1938. Kelly quoted in “Reject Bill Now to Come Before House,” Toronto Globe and Mail, 3 March 1938. See also “Miss Caisse Bill,” Huntsville Forester, 10 March 1938, and “Hints Cabal of Doctors Against Cancer Treatment,” Toronto Daily Star, 24 March 1938. “Committee Rejects Nurse’s Special Bill,” Toronto Globe and Mail, 25 March 1938 and “Laws Not Cancer Cures,” Toronto Globe and Mail, 24 March 1938. “Nurse Refused Doctor Permit in Cancer Care,” Toronto Evening Telegram, 24 March 1938; “Miss Caisse Loses and Wins,” Huntsville Forester, 31 March 1938; “Private Bills Committee Turns Down Miss Caisse’s Application,” Bracebridge Gazette, 31 March 1938.

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188 Notes to pages 85–92 141 Starr, Social Transformation, 127. Although many histories of modern Western medicine accept this interpretation of conventional care, the following works are examples of explicit endorsements or explorations of this theme: Mitchinson, “Medical Historiography,” 210–12; Connor, “Minority Medicine”; Stevens, “Times Past, Times Present,” 196; Shorter, Bedside Manners; Hamowy, Canadian Medicine; Burnham, “American Medicine’s Golden Age”; Rothstein, American Physicians; Shryock, Development of Modern Medicine. 142 Reed, The Healing Cults. 143 Starr, Social Transformation, 14–17. 144 Anonymous, “Miracles Yet,” clp 74 (March 1930): 84. 145 Cramp, Nostrums, 16–17, 19. 146 Fishbein, “The Connell Cancer Cure,” 1122; Reed, The Healing Cults, 110; Starr, Social Transformation, 12–13. 147 “Cancer and the Need for Facts,” jama 139 (8 January 1949): 95. 148 Cramp, Nostrums, 8. 149 Paul Vaughan, ‹Secret Remedies,’ in the Late Nineteenth and Early Twentieth Centuries,” in Saks, Alternative Medicine, 101–11; Burrow, ama, 71–83, 107–31; Fishbein, American Medical Association, 35–40. 150 See, for example, Ontario Medical Association Act of Incorporation, 30, 35. 151 Wallace quoted in Wallace and Callahan, “Proceedings of a Sub Committee,” 120, cpso. See also “The Dr. J.E. Hett Case,” 15, Crane Collection, uh. 152 Starr, Social Transformation, 9. 153 Irvine Loudon, “‘The Vile Race of Quacks with which this Country is Infested,› in Bynum and Porter, Medical Fringe, 106. chapter four 1 The following account is based on two letters written by the patient in December 1936 and March 1937, both of which can be found in the “Case History of M.A.M.,” Wallace Papers, Series 1024b, Additions, Box 1, File 10, Case Book 5, 12–14, qua. 2 In recent decades, a growing number of historians have re-examined the relationship between alternative and conventional medicine, concluding that these treatment modalities have seldom been clearly distinct or mutally exclusive. Among the most important of these studies are Risse et al., Medicine without Doctors; Bynam and Porter, Medical Fringe; Gevitz, Other Healers; Cooter, Studies in the History of Alternative Medicine; Kirkland et al., Herbal and Magical Medicine; McGuire, Ritual Healing; and Saks, Alternative Medicine in Britain. Despite the growing body of literature that depicts regular and alternative medicine as potentially complementary,

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189 Notes to pages 94–7

3

4 5

6 7 8 9

10 11

12 13 14 15

some scholars continue, tacitly or explicitly, to regard these approaches to healing as competitors. See, for example, Young, American Health Quackery; Moore, Chiropractic in America; and Lupton, Medicine as Culture. Although some health care professionals have evinced a growing interest in alternative therapies, many remain convinced that unconventional medicine is fraudulent and its victims gullible. See, for instance, E. Ernst, “Colonic Irrigation and the Theory of Autointoxication: A Triumph of Ignorance over Science,” Journal of Clinical Gastroenterology 24 (June 1997): 196–8; R.A. Gagliardi, “No Quacks or Fakes Need Apply,” American Journal of Roentgenology 160 (May 1993): 1004; S. Stokes, “Cancer Quackery: A Continuing Medical Problem,” Journal of the Tennessee Medical Association 79 (July 1986): 415–21; Brown, “The Deadliest Delusion,” 165–78; Hiratzka, “Knowledge and Attitudes of Persons,” 36. John W.S. McCullough, Chief Inspector of Health, Ontario, “Address to the Graduating Class, St. Joseph’s Hospital, Hamilton,” 22 May 1935, Cancer Records, File 34.3, ao. Rosenberg, “Framing Disease,” xviii. Examples of authors who espouse this interpretation of alternative practitioners include Taylor, “Alternative Medicine,” 191–228; Cayleff, Wash and Be Healed, 18; Porter, “Quacks,” 63–81; Young, American Health Quackery, 86. See Clow, ‹Swapping Grief,› for a more detailed critique of this view. M.R. to Ontario Department of Health, 18 December 1937, Cancer Records, File 25.1, ao. “Case History of W.J.O.,” Wallace Papers, Series 1024b, Additions, Box 1, File 9, Case Book 4, 16, qua. J.H.B. to J.W.S. McCullough, Chief Inspector of Health, Ontario, 14 February 1935, Cancer Records, File 24.11, ao. See, for example, M.S. to Harold Kirby, Minister of Health, Ontario, 23 November 1937, rg 10–138, Accession 14576/12, ao and W.C. to Rene Caisse, 19 February 1937, Wallace Papers, Series 1024b, Additions, Box 1, File 9, Case Book 3, 11, qua. Carter and Cromarty, “What Can Be Done,” 302. “Case History of D.M.,” Wallace Papers, Series 1024b, Additions, Box 1, File 10, Case Book 6, 14, qua. See also M.S. to Harold Kirby, Minister of Health, Ontario, 23 November 1937, rg 10–138, Accession 14576/12, ao. See, for example, Ferguson, “When Cancer is Not Guilty,” 894; Castle, “Are You Afraid, Too?” 701–2. Gardner, “Vanity, Modesty and Cancer,” 300–2. Bloodgood, “Courageous Fear,” 14. Tenth Annual Report of the Department of Health for 1934, 84; Thirteenth Annual Report of the Department of Health for 1937, 160; Fifteenth Annual Report of the Department of Health for 1939, 196, all ao.

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190 Notes to pages 97–102 16 17 18 19 20

21

22

23 24 25

26 27 28

29 30 31 32 33 34 35 36 37

38 39 40

Thirteenth Annual Report of the Department of Health for 1937, 161, ao. Eberts, “Cancer of the Breast,” 10. Janes, “Present-Day Methods,” 532. What We Know About Cancer, 38. Cunningham, “Division of Industrial Hygiene,” 1938, 188, ao. See also Scott, “Cervical Cancer,” 290–3; G.E. Richards and W.G. Cosbie, “The Radiological Treatment of Cancer: Methods and Results, 1928–1935, Part ii. Carcinoma Cervicis Uteri.” cmaj 35 (October 1936): 381–5. Cunningham, “Division of Industrial Hygiene,” 1938, 188, ao; Curry, “Cancer of the Tongue and Lip,” 50–3; Simpson, “Biopsy,” 62–5; and Barringer, “Carcinoma of the Prostate,” 506. See the following illustration: “Table and Attachment for Intravaginal XRay Therapy at 400 kv,” Sixth Annual Report of the Ontario Institute of Radiotherapy, Toronto General Hospital, 28. McClure and Fallis, “Management of Breast Cancer,” 15. Johnston, Before the Age of Miracles, 168–76. Porter, “The Patient’s View,” 175–98. Notable exceptions include: Porter, Patients and Practitioners; Warner, Therapeutic Perspective; Rosenberg, Care of Strangers; Rogers, Dirt and Disease; and Leavitt, Typhoid Mary. Rothman, Living in the Shadow of Death, 226–45. Mannion, Life is an Adventure, 88. “Case History of G.M.,” Wallace Papers, Series 1024b, Additions, Box 1, File 9, Case Book 5, 11, qua. See also “Case History of G.M.C.,” Wallace Papers, Series 1024b, Additions, Box 1, File 10, Case Book 4, 9, qua. “Case 34: F.M.,” quoted in Mundell et al., “Case Histories, Kingston Clinic,” 31. Sontag, Illness as Metaphor, 17–18. Murray, Medicine in the Making, 180. Shorter, Bedside Manners, 134. “Letter to the Editor,” Bracebridge Gazette, 11 June 1936. “Case History of T.D.,” Wallace Papers, Series 1024b, Additions, Box 1, File 10, Case Book 6, 4–5, qua. A.W. to Harold Kirby, Minister of Health, Ontario, 19 March 1943, Wallace Papers, Series 1024b, Additions, Box 1, File 4, qua. Quick, “Irradiation Therapy,” 686. A.B.B. to Department of Health, 20 June 1934, Cancer Records, File 24.10, ao. See also “Another Grateful Patient of Miss Caisse,” Bracebridge Gazette, 17 February 1938. Pentecost, “The Treatment of Cancer,” 411–15; Patterson, “Carcinoma of the Larynx,” 7–10. Cutler, “Cancer of the Breast,” 387; Murley, “Breast Cancer,” 49–58. Quick, “Irradiation Therapy,” 686; Quick, “Radiation in Cancer,” 410; Shepley, “The Role of Radiotherapy,” 252–7; Richards, “Radiological

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191 Notes to pages 102–5

41 42 43 44 45 46 47 48

49 50 51 52 53 54 55

56 57 58 59 60

Treatment, Methods and Results,” 299–305; Jones, “Points of Mutual Interest,” 152–7. Keynes, “Radium Treatment,” 27. Jones, “Points of Mutual Interest,” 154; Jones and Burr, “The Role of Radiology,” 433–7. “Case History of E.D.,” Wallace Papers, Series 1024b, Additions, Box 1, File 9, Case Book 3, 15, qua; Jones, “Points of Mutual Interest,” 154. Carter and Cromarty, “What Can Be Done,” 304. Keynes, “Radium Treatment,” 27. Carter, “X-Ray Treatment,” 583; Findley, “Complications and Disappointments,” 157. Forsdike, “Radium in Gynaecology,” 794–5. G.E. Richards, “Case History of A.R.,” (circa February 1939), Wallace Papers, Series 1024b, Additions, Box 1, File 2, qua. See also T.H. Callahan to R.C. Wallace, 23 February 1939; D.W. Clark, md, to Rene Caisse, 12 March 1937; and “Case History of W.P.R.,” 22 February 1939; all Wallace Papers, Series 1024b, Additions, Box 1, File 2, qua. Findley, “Complications and Disappointments,” 157. M.R.F. to Cancer Research Department, Toronto, 10 September 1937, Cancer Records, File 25.1, ao. L.C.F. to Harold Kirby, Minister of Health, 28 May 1938, Cancer Records, File 13.11, ao. Shorter, Bedside Manners, 128, 231. “Cancer Patients Oust Students,” Toronto Mail and Empire, 2 October 1935. “Kitchener Doctor’s Claim of Cancer Cure Attracts Province-Wide Attention,” Toronto Telegram, 15 January 1935. These names were collected on several petitions, some of which are extant in Department of Health records and some of which are only referred to in correspondence or secondary sources. See “Petition to the Prime Minister, the Minister of Health and the Attorney General of Ontario re: Miss Rene M. Caisse’s Cancer Treatment,” May 1935, Cancer Records, File 14.2, ao; “Living Evidence of Benefits of Nurse Caisse’s Cancer Treatment Deserves Consideration,” Toronto Evening Telegram, 2 April 1937; Rene Caisse to Mitchell Hepburn, Premier, 22 February 1938, Cancer Records, File 13.11, ao; Petition #38 to the Lieutenant-Governor of Ontario from Rene Caisse, 23 February 1938, rg 8–22, Box 20, File 800–650–659, ao; Glum, Calling of an Angel, 45–61; Snow, The Essence of Essiac. Shorter, Bedside Manners, 128. Patterson, The Dread Disease, 47. See also 69, 112, 167, 300. Young, Medical Messiahs, 428–9. “oma Schedule of Fees,” oma Bulletin 3 (December 1936): 226–8. Cunningham, “Division of Industrial Hygiene,” 1938, 186, ao.

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192 Notes to pages 105–7 61 George Young to R.P. Vivian, Minister of Health, Ontario, 5 February 1944, rg 10–138, Accession 14576/12, ao. 62 J.M.A. to Harold Kirby, Minister of Health, Ontario, 30 May 1938, Cancer Records, File 13.11, ao. See also “Kirby Cancer Act Put Into Force,” Muskoka Herald, 26 May 1938. 63 “Dr. John E. Hett Loses Suit to Recover $1,055,” Toronto Globe and Mail, 21 October 1937; R.A. to B.T. McGhie, June 1936, Cancer Records, File 25.1, ao; Russell Nesbitt, Solicitor, to D.G. Coffey, Solicitor, 16 February 1938, rg 10–138, Accession 14576/12, ao. 64 “Dr. John Hett Loses Case Over Cancer Serum Bill,” Toronto Telegram, 8 October 1938. 65 Falk et al., Incidence of Illness, 92–7. See also Reed, The Healing Cults and Midwives, Chiropodists and Optometrists. 66 “Patients Laud Nurse Caisse and Her Cancer Treatment At Inquiry By Committee,” Toronto Telegram, 3 February 1939. 67 “Miracles Yet,” clp 74 (March 1930): 83–4. See also “The Attraction of Quacks,” cmaj 18 (February 1928): 215 and “Address Given by His Honour, Dr. Herbert A. Bruce, Lieutenant-Governor of Ontario, before a Joint Meeting of the Kiwanis Club, and other Service Clubs, at a Luncheon in the Royal York Hotel, Toronto, November 22, 1933,” clp 82 (May 1934): 145. 68 B.T. McGhie, Deputy Minister of Health, to Hendry Connell, 5 December 1935, Cancer Records, File 15.1, ao. 69 M.M. to Harold Kirby, Minister of Health, Ontario, 22 February 1943, Cancer Records, File 17.4, ao. 70 cicr, “Proceedings of the Commission, Exhibits (Doctor Hett),” 157, 162, qua. 71 “Petition re: Miss Rene M. Caisse’s Cancer Treatment,” May 1935, Cancer Records, File 14.2, ao. 72 Patterson, The Dread Disease, ix. 73 Patterson, The Dread Disease, 106–8, 163. See also Cassileth and Brown, “Unorthodox Cancer Medicine,” 178. 74 “Medical Authority Often Unreceptive to New Thought,” Toronto Telegram, 11 May 1938. 75 “Life Given to Patients Through Cancer Serum But Finder Put on ‘Trial,› Toronto Evening Telegram, 8 April 1937. See also “Dr. Hett’s License,” Toronto Star, 23 December 1937 and “Perfectly Appalling Said Mr. Justice Riddell,” Toronto Telegram, 30 December 1937. 76 “Committee Suggested by Rowell,” Toronto Globe and Mail, 18 June 1937; “Feared Theft of Formula Dr. Hett Says of Silence,” Toronto Globe and Mail, 18 June 1937; “Fear of Jealousy Bars Cancer Disclosure by Dr. Hett,” Toronto Telegram, 13 August 1937. 77 “The Dr. J.E. Hett Case,” Crane Collection, uh. See also “Report of the Joint Advisory Committee,” Medical Council Minutes, 21 March 1938,

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193 Notes to pages 107–10

78 79 80 81 82 83 84 85 86 87 88

89 90 91 92

93 94 95 96 97

cpso; “Presidential Address,” Medical Council Minutes, 9 April 1940, cpso. Bracebridge Gazette, unidentified press clipping, 31 March 1938, Scrapbook, cpso. M.H. to A.E. Matthews, Lieutenant-Governor, Ontario, 15 March 1938, Cancer Records, File 13.11, ao. H.T. to Harold Kirby, 23 August 1939, Cancer Records, File 13.13, ao. Rene Caisse to Mitchell Hepburn, Premier, Ontario, 10 May 1938, Cancer Records, File 13.11, ao. “I Want Humanity to Have My Cancer Cure,” Huntsville Forester, 24 February 1938. “Nature Has Provided Her Remedies,” Huntsville Forester, 1 September 1938. Cassileth and Brown, “Unorthodox Cancer Medicine,” 178. J.S. to Rene Caisse, 3 December 1940, Cancer Records, File 13.13, ao. “Law Touching Medical Council in Need of Overhauling,” Toronto Telegram, 6 July 1937. M.F.P. to Harold Kirby, Minister of Health, Ontario, 28 May 1938, Cancer Records, File 13.11, ao. See, for example, testimony of E.M., 20 September 1944, and G.M. to Herbert Bruce, Lieutenant-Governor, Ontario, 12 January 1937, rg 10–138, Accession 14576/12, ao. “Kitchener Doctor’s Claim of Cancer Cure Attracts Province-Wide Attention,” Toronto Telegram, 15 January 1935. “Testimonial to the Benefits of ‘Essiac’ Treatments,” Huntsville Forester, 24 July 1941. See also “Was Cancer Patient,” Muskoka Herald, 4 June 1936. Fraser and Allen, “Could Essiac Halt Cancer?” 14; Glum, Calling of an Angel, 25–6. “Kitchener Doctor’s Claim of Cancer Cure Attracts Province-Wide Attention,” Toronto Telegram, 15 January 1935; “Cancer Patients Oust Students,” Toronto Mail and Empire, 2 October 1935. “Kitchener Doctor’s Claim of Cancer Cure Attracts Province-Wide Attention,” Toronto Telegram, 15 January 1935. “Case History of M.W.,” Wallace Papers, Series 1024b, Additions, Box 1, File 9, Case Book 4, 25, qua. “Case History of W.C.,” Wallace Papers, Series 1024b, Additions, Box 1, File 9, Case Book 3, 11, qua. “Kitchener Doctor’s Claim of Cancer Cure Attracts Province-Wide Attention,” Toronto Telegram, 15 January 1935. Connell, “Study and Treatment,” 370. See also Hendry-Connell Research Foundation, “Tumour Reaction Following Use of Ensol,” May 1940, Cancer Records, File 17.2. and Connell, “A Solution of the Cancer Problem,” (circa 1936), Cancer Records, File 15.1, both ao.

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194 Notes to pages 110–13 98 Wallace and Callahan, “Proceedings of a Sub Committee,” 7, cpso, Deadman, “Report on an Inquiry into the Laboratory Aspect,” 6, qua. 99 “Case History of J.M.,” Wallace Papers, Series 1024b, Additions, Box 1, File 9, Case Book 3, 24, qua. 100 R.A. to B.T. McGhie, 3 June 1936, Cancer Records, File 25.1, ao. 101 “A Testimony to Miss Caisse,” Huntsville Forester, 27 January 1938. 102 W.H.E. to John Hett, 20 September 1944, rg 10–138, Accession 14576/ 12, ao. 103 Doherty, “Cancer Conquered at Last?” 50–1. 104 “The Warfare on Cancer,” Port Arthur Evening News-Chronicle, 18 December 1937. 105 G.E. Richards, Director, Ontario Institute of Radiotherapy, Toronto General Hospital, to T.H. Callahan, Commissioner, cicr, 22 February 1939, Wallace Papers, Series 1024b, Additions, Box 1, File 2, qua. 106 “The Attraction of Quacks,” cmaj 18 (February 1928): 215. 107 Young, American Health Quackery, 58–9, 240–1. See also Shorter, Bedside Manners, 155–7. 108 S.J.M. to Harold Kirby, Minister of Health, Ontario, 28 May 1938, Cancer Records, File 13.11, ao. See also “Prominent American Doctor Studies Miss Caisse’s Cancer Treatment,” Bracebridge Gazette, 12 August 1937 and W.B.W. to A.E. Matthews, Lieutenant-Governor, Ontario, 18 March 1938, Cancer Records, File 13.11, ao. 109 A.J.W. to R.J. Kelley, Minister of Health, Ontario, 21 September 1946, rg 10–138, Accession 14576/12, ao. See also F.N. to Harold Kirby, Minister of Health, Ontario, 30 May 1938, Cancer Records, File 13.11, ao. 110 “Case History of A.R.,” Wallace Papers, Series 1024b, Additions, Box 1, File 9, Case Book 3, 28, qua. 111 J.N.M. to Harold Kirby, Minister of Health, Ontario, 17 January 1938, rg 10–138, Accession 14576/12, ao. 112 Connell, “Clinical Results of Ensol Therapy,” 24–41; Mundell et al., “Case Histories, Kingston Clinic,” 31–67. See also Hendry-Connell Research Foundation, “Clinical Histories of a Series of Cancer Cases Treated with Ensol Only,” April 1940 and “Clinical Histories of a Series of Cancer Cases Treated with Ensol,” July 1940, Cancer Records, both File 12.6, ao, and “Relief of Pain in Cancer by the Use of Ensol,” May 1940, Cancer Records, File 17.2, ao. 113 “Case History of R.S.,” Wallace Papers, Series 1024b, Additions, Box 1, File 9, Case Book 4, 20, qua. 114 C.J.M. to Harold Kirby, Minister of Health, Ontario, 9 June 1938, Cancer Records, File 13.13, ao. 115 cicr, “Proceedings of the Commission, Exhibits (Doctor Hett),” 157–8, qua. 116 M.F.P. to Harold Kirby, 28 May 1938, Cancer Records, File 13.11, ao.

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195 Notes to pages 113–18 117 H.T. to Harold Kirby, 23 August 1939, Cancer Records, File 13.13, ao. 118 “Case History of J.H.S.,” Wallace Papers, Series 1024b, Additions, Box 1, File 10, Case Book 5, 25, qua. 119 N.M. quoted in Connell, “Clinical Results of Ensol Therapy,” 37. 120 cicr, “Proceedings of the Commission, Exhibits (Doctor Hett),” 163, qua. 121 “Case History of J.C.F.,” Wallace Papers, Series 1024b, Additions, Box 1, File 10, Case Book 5, 4, qua. 122 “Case History of H.D.,” Wallace Papers, Series 1024b, Additions, Box 1, File 9, Case Book 3, 13, qua; my emphasis. 123 E.G. to Department of Health, Ontario, 10 March 1938, Cancer Records, File 13.11, ao. See also “Another Grateful Patient of Miss Caisse,” Bracebridge Gazette, 17 February 1938. 124 M.H. to A.E. Matthews, Lieutenant-Governor, Ontario, 15 March 1938, Cancer Records, File 13.11, ao. 125 G.S. to Harold Kirby, 8 April 1938, Cancer Records, File 13.11, ao. 126 C.W. to Harold Kirby, 28 May 1938, Cancer Records, File 13.11, ao. 127 “Hett Goes on Trial on Morphine Charge,” Toronto Star, 26 May 1942. 128 Doherty, “Cancer Conquered at Last?” 50. 129 L.C.F. to Harold Kirby, 28 May 1938, Cancer Records, File 13.11, ao. 130 R.M.B.L. to Rene Caisse, 23 April 1936, quoted in “Case History of P.B.,” Wallace Papers, Series 1024b, Additions, Box 1, File 9, Case Book 3, 5, qua. See also Connell, “Study and Treatment,” 366–9. 131 Johnston, Before the Age of Miracles, 167. 132 “Case History of W.S.,” Wallace Papers, Series 1024b, Additions, Box 1, File 10, Case Book 6, 18, qua. 133 “Case 464, W.J.J.,” reported in Hendry-Connell Research Foundation, “Clinial Histories of a Series of Cancer Cases Treated with Ensol,” July 1940, 29, Cancer Records, File 12.6, ao. 134 Caisse quoted in “Miss Caisse Terms Probe Laughable,” Toronto Telegram, 8 February 1938. See also Connell, “Clinical Results of Ensol Therapy,” 24–41; cicr, “Proceedings of the Commission, Exhibits (Doctor Hett),” qua; and Caisse’s Case Books 3–6, Wallace Papers, Series 1024b, Additions, Box 1, Files 9–10, qua. 135 “Letter to the Editor from J.T.,” Bracebridge Gazette, 25 June 1936. 136 “Letter to the Editor from H.R.,” Bracebridge Gazette, 11 June 1936. See also H.T. to Harold Kirby, Minister of Health, Ontario, 23 August 1939, Cancer Records, File 13.13, ao. 137 “Was Cancer Patient,” Muskoka Herald, 4 June 1936. 138 J.S. to Department of Health, Ontario, 12 March 1938, Cancer Records, File 13.11, ao. 139 “Law Touching Medical Council in Need of Overhauling,” Toronto Telegram, 6 July 1937.

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196 Notes to pages 119–23 chapter five 1 Charles Hastings, “Cancer is Not Incurable.” Health Bulletin 18 (May 1927). rg 29, Vol 188, File 311–c1–1, p + 1, na. 2 B.T. McGhie, Deputy Minister of Health, Memorandum, 25 July 1935, Cancer Records, File 14, ao. 3 M.H. to Mitchell Hepburn, Premier, Ontario, 25 October 1937, rg 3–9, Box 207, Correspondence: Department of Health, AO. See also “Life Given to Patients Through Cancer Serum But Finder Put On ‘Trial,› Toronto Evening Telegram, 8 April 1937; W.S. to Hepburn, 5 August 1937, Cancer Records, File 13.11, ao; “Will Report on Cancer: Bracebridge Nurse’s Treatment Still Not Recognized by Doctors,” Toronto Globe and Mail, 16 March 1937; “Law Touching Medical Council in Need of Overhauling,” Toronto Telegram, 6 July 1937. 4 “The Cancer Commission,” oma Bulletin 7 (January 1940): 7–9. 5 Although Arthur Kleinman proffers a similar interpretation of the health care system in Patients and Healers, I am here quoting from Rosenberg, “Framing Disease,” xxiii. 6 cicr, “Interim Report,” 31 December 1938, 2–3, na and “List of Cancer Cures, 1938–40,” Cancer Records, File 19.5, ao. 7 See also oma Minutes, 23 February 1937, “Bill to Control Cancer Quackery,” 94 and “Cancer,” 125, oma; “Recent Medical Legislation in Ontario,” cmaj 38 (June 1938): 612; “News Items: Ontario,” cmaj 39 (October 1938): 412. 8 T.C. Routley, Secretary, oma, to K.G. Gray, Solicitor, Department of Health, Ontario, 26 February 1937, Cancer Records, File 19.5, ao. 9 Routley to Mitchell Hepburn, Premier, 1 October 1937, rg 3–9, Box 271, ao. 10 Robert Noble, Registrar, quoted in “Report of the Joint Advisory Committee,” Medical Council Minutes, 24 March 1938, cpso; my emphasis. 11 J.F. to Harold Kirby, Minister of Health, 23 June 1938, Cancer Records, File 13.13, ao. 12 “Should Investigate This Claim of Cancer Cure,” Port Arthur Evening News-Chronicle, 11 December 1937. 13 “Fairness for Miss Caisse,” Huntsville Forester, 3 March 1938. 14 R.C. to Kirby, 15 February 1938, rg 10–138, Accession 14576/12, ao. Other examples of popular support for alternative healers may be found in the following documents: “Living Evidence of Benefits of Nurse Caisse’s Cancer Treatment Deserves Consideration,” Toronto Telegram 2 April 1937; W.S. to Mitchell Hepburn, Premier, 5 August 1937, Cancer Records, File 13.11, ao; M.H. to Hepburn, 25 October 1937 and O.M. to Hepburn, 20 November 1937, rg 3–9, Box 207, ao; M.S. to Kirby, 23 November

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197 Notes to pages 123–7

15 16

17 18 19

20 21 22 23 24 25 26 27 28 29 30 31 32 33 34

1937, rg 10–138, Accession 14576/12, ao; “A Testimony to Miss Caisse,” Huntsville Forester, 27 January 1938. “Miss Caisse Terms Probe ‘Laughable,› Toronto Evening Telegram, 8 February 1938. The Department of Health kept many of the letters it received on behalf of Caisse. See Cancer Records, File 13.11, ao. I am here quoting from Caisse to F.N., 25 May 1938. The cpso kept a scrapbook of news articles on Caisse that also captures the extent of popular support for her work in the summer of 1938. Kirby to F.B., 24 March 1938, Cancer Records, File 13.11, ao. G.D. Conant, Attorney-General, Ontario, to Kirby, 29 June 1938 and Conant to Kirby, 30 June 1938, Cancer Records, File 13.13, ao. Kirby received so many letters from irate patients and supporters that eventually his office adopted a standard format for his response. See, for example, Kirby to W.R., 2 June 1938, Cancer Records, File 13.11, ao. The press also reported popular outrage against the government. See, for example, “Nurse’s Patients Ask Clinic Closing Ruling,” Toronto Daily Star, 27 June 1938. Kirby quoted in “Patients Appeal for Reopening of Caisse Cancer Clinic,” Toronto Evening Telegram, 23 June 1938. Hepburn to Caisse, 2 June 1938, Cancer Records, File 13.11, ao. F.S. to Kirby, 23 June 1938, Cancer Records, File 13.13. “Nurse’s Patients Ask Clinic Closing Ruling,” Toronto Daily Star, 27 June 1938. “Miss Caisse’s Cancer Clinic Closed as New Law Takes Effect,” Bracebridge Gazette, 29 May 1938. “Miss Caisse to Re-Open Cancer Clinic,” Huntsville Forester, 28 July 1938. “Nurse’s Patients Ask Clinic Closing Ruling,” Toronto Daily Star, 27 June 1938. “Cancer Clinic Reopens Tomorrow,” Bracebridge Gazette, 4 August 1938. “Report of the Discipline Committee,” 13 April 1937, cpso. Hett quoted in “Dr. Hett Refuses to Disclose Formula to Independent Body,” Toronto Star, 17 June 1937. “Law Touching Medical Council in Need of Overhauling,” Toronto Telegram, 6 July 1937. “Medical Authority Often Unreceptive to New Thought,” Toronto Telegram, 11 May 1937. Frederick Etherington, Member, Discipline Committee, cpso, quoted in “The Dr. J.E. Hett Case,” 17, Crane Collection, uh. D.G. Coffey, Barrister, quoted in ibid. Hepburn quoted in “Hint Ontario Plans Law to Learn Cancer Remedy Dr. Hett Keeping Secret,” Toronto Telegram, 7 February 1938. See also

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198 Notes to pages 127–30

35 36 37 38

39 40 41

42 43 44 45

46 47

48

49

“Hepburn to Order Provincial Probe of Cancer Claims,” Toronto Globe and Mail, 7 February 1938; “Medical Council Opens File,” Toronto Globe and Mail, 8 February 1938; “Ontario Will Make Hett Reveal Secret,” Toronto Star, 7 February 1938. Daniel Lang, Solicitor, cpso, quoted in “Proceedings re Dr. John Emil Hett,” ao. MacNab, Legal History, 38–9. “Report of the Joint Advisory Committee,” Medical Council Minutes, 4 February and 12 April 1938, cpso. Medical Council Minutes, 2 April 1938 and 13 April 1938, cpso; “Medical Body to Lift Bar Against Hett,” Toronto Globe and Mail, 2 April 1938; “Hett Restored After Promise to Give Secret,” Toronto Telegram, 4 April 1938; “Dr J.E. Hett Reinstated,” Toronto Globe and Mail, 5 April 1938. “Presidential Address,” Medical Council Minutes, 12 April 1938, cpso. John Hett to Justice J.G. Gillanders, Chair, cicr, 30 August 1938, Wallace Papers, Series 1024b, Additions, Box 1, File 1, qua. “Bill to Control Cancer Quackery” and “Cancer,” 23 February 1937, oma Minutes, 94, 125, oma; “Bill 1937 – An Act,” 5 March 1937, Cancer Records, File 12.4, ao. “Connells Ask Early Probe of Cancer Treatment,” Toronto Star, 6 September 1938. Connell to Gillanders, 21 September 1938, Wallace Papers, Series 1024b, Additions, Box 1, File 1, qua. Hepburn to Connell, 19 August 1938, Wallace Papers, Series 1024b, Additions, Box 1, File 1, qua. Hepburn’s directions noted in a departmental memorandum written by Deputy Minister of Health McGhie, 19 August 1938, Cancer Records, File 15.3, ao. “Denies ‘Ensol’ First in Probe,” Toronto Telegram, 20 September 1938. Minutes of the Cancer Commission, 26 October 1938, Wallace Papers, Series 1024b, Additions, Box 1, File 1, qua; cicr, “Interim Report,” 31 December 1938, 1–5, na; cicr, “Report of the Committee Appointed to Visit,” ao. Caisse, “Questionnaire for Cancer Commission,” and Hett, “Questionnaire for Cancer Commission,” 1938, both qua; cicr, “Proceedings of the Commission, Exhibits (Doctor Hett),” qua; F. Egener, Secretary, to R.C. Wallace, Commissioner, cicr, 3 January 1939, Wallace Papers, Series 1024a, Box 6, File 55, qua. “Orders-in-Council,” cicr, 18 August 1938, Cancer Records, File 12.4, ao; “Cancer Commission Constituted,” Toronto Globe and Mail, 8 September 1938; Canadian Medical Directory and Physicians Handbook, 215,

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199 Notes to pages 130–5

50 51 52 53 54 55 56 57 58 59 60 61

62

63 64

65 66 67 68 69 70 71

232, 245, 252; Roberts and Tunnell, Canadian Who’s Who, 2:1107, 1165 and 3:184, 266. “Miss Caisse Loses and Wins,” Huntsville Forester, 31 March 1938. Gillanders to Caisse, 12 December 1938, Wallace Papers, 1024a, Box 6, File 55, qua. Caisse quoted in Wallace and Callahan, “Proceedings of a Sub Committee,” 119, cpso. Gillanders quoted in Minutes of the Cancer Commission, 26 October 1938, Wallace Papers, Series 1024b, Additions, Box 1, File 1. Caisse to Cancer Commission, 27 October 1938, Wallace Papers, Series 1024b, Additions, Box 1, File 1, qua. “Miss Caisse’s Cancer Clinic Closed as New Law Takes Effect,” Bracebridge Gazette, 26 May 1938. cicr, “Interim Report,” 31 December 1938, 6, na; my emphasis. John Hett quoted in cicr, “Proceedings of the Commission, Exhibits (Doctor Hett),” 125, qua. “Law Touching Medical Council in Need of Overhauling,” Toronto Telegram, 6 July 1937. See, for example, Grant N. Black to the Cancer Commission, 28 November 1938, Wallace Papers, Series 1024b, Additions, Box 1, File 2, qua. Minutes of the Cancer Commission, 29 December 1938, Wallace Papers, Series 1024a, Box 6, File 55, qua. Wallace and Callahan, “Report of Enquiry into the Caisse Cancer Clinic,” 3–4 February 1939, 2, Wallace Papers, Series 1024b, Additions, Box 1, File 2, qua. cicr, “Proceedings of the Commission, Exhibits (Doctor Hett),” qua; cicr, “Report of the Commission: re Doctor J.E. Hett,” 1–2, ao; cicr, “Interim Report,” 31 December 1939, 12–17, ao. See case histories and related correspondence from other doctors, Wallace Papers, Series 1024b, Additions, Box 1, Files 2, 9–10 qua. “Case History of G.P.,” Wallace Papers, Series 1024b, Additions, Box 1, File 2, qua. See also “Case History of E.J.P.,” quoted in cicr, “Proceedings of the Commission, Exhibits (Doctor Hett),” 111, qua. E.S. to Hepburn, 16 February 1938, Wallace Papers, Series 1024b, Additions, Box 1, File 10, Case Book 5, qua. Gillanders to Kirby, 27 February 1940, Cancer Records, File 13.13, ao. Cunningham, “Division of Industrial Hygiene,” 1938, 188. “Case History of W.P.R.,” Wallace Papers, Series 1024b, Additions, Box 1, File 2, qua. cicr, “Interim Report,” 31 December 1939, 35, ao. cicr, “Interim Report,” 31 December 1940, 1, ao. Caisse to Hepburn, 19 April 1939, Cancer Records, File 13.13, ao.

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200 Notes to pages 135–8 72 Wallace quoted in Wallace and Callahan, “Proceedings of a Sub Committee,” 120, 122, cpso. 73 Caisse to Cancer Commission, 3 December 1940, Wallace Papers, 1024b, Box 1, File 3, ao. 74 “Rene M. Caisse Close Cancer Clinic Here,” Muskoka Herald, 23 January 1941; Caisse to F. Egener, Secretary, cicr, 13 March 1941, Wallace Papers, Series 1024b, Additions, Box 1, File 3, qua. 75 “Hett Turns Over Formula for Cancer to Commission,” Toronto Star, 25 July 1939; “Dr. Hett Hands Cancer Remedy to Commission,” Toronto Telegram, 25 July 1939; cicr, “Interim Report,” 31 December 1939, 15, ao. 76 “Cancer Board to Test Treatment of Dr. Hett,” Toronto Globe and Mail, 26 July 1939. 77 Gillanders to Kirby, 4 October 1939; K.G. Gray, Solicitor, Department of Health, to Cecil L. Snyder, Deputy Attorney-General, 11 October 1939; and Kirby to Gillanders, 30 November 1939, all rg 10–138, Accession 14576/12, ao. 78 “Amendment to the Cancer Remedy Act,” 10 January 1940, Cancer Records, File 19.5, ao. 79 A.D. Kelly, Secretary, oma, to Egener, 12 December 1939, Wallace Papers, Series 1024b, Additions, Box 1, File 2, qua. 80 “Arraign Dr. Hett on Drug Charges,” Toronto Star, 9 May 1942; “Hett Goes on Trial on Morphine Charge,” Toronto Star, 26 May 1942; “Hadn’t Cancer, Got Morphine, Witness Says,” Toronto Globe and Mail, 27 May 1942; “Court Probes Substitution for Morphine,” Toronto Telegram, 28 May 1942. Hett was charged with having supplied narcotics to a patient, a drug addict, who did not have cancer. In addition, he had apparently exceeded the quota of morphine tablets he was legally allowed to order and keep in stock. Hett was acquitted of both charges, but some newspapers had a field day over the incident. The crown attorney told reporters that Hett was “running a racket. He sings a song of cancer with a pocket full of drugs.” See “’Was Hett Fooled?’ is Issue, Jury Told,” Toronto Star, 5 June 1942. 81 Deadman, “Report on an Inquiry into the Laboratory Aspect,”qua. 82 cicr, “Report of the Commission: re Doctor J.E. Hett,” ao. See also Wallace to Gillanders, 28 February 1945, Wallace Papers, Series 1024b, Additions, Box 1, File 4, qua. 83 A.J.W. to N.O. Hipel, mpp, 9 May 1943, Wallace Papers, Series 1024b, Additions, Box 1, File 4, qua; A.B.D. to Hett, 10 July 1944; W.H.E. to Hett, 20 September 1944; and E.M. to Whom It May Concern, 20 September 1944, all rg 10–138, Accession 1576/12, ao. 84 Noble to C.J. Telfer, Secretary, cicr, 21 April 1949, Wallace Papers, Series 1024b, Additions, Box 1, File 5, qua.

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201 Notes to pages 138–41 85 D.T. Fraser, Associate Director of Connaught Laboratories, “Report on Ensol,” 6 January 1939, Cancer Records, File 15.4, ao. 86 George S. Young and William Deadman, “Report of the Committee Appointed to Visit the Hendry Connell Research Foundation for the Commission for the Investigation of Cancer Remedies,” 6 January 1939, Cancer Records, File 15.4, 2, ao. 87 “Brief Prepared by the Hendry-Connell Research Foundation for Submission to the Cancer Commission,” 1939, Cancer Records, File 15.7, ao. 88 McGhie, Memorandum re Ensol Treatment, 3 April 1939 and A.L. MacNabb, Director of Laboratories, to McGhie, 14 April 1939, Cancer Records, File 15.5, ao; Kirby to Connell, 17 April 1939, Cancer Records, File 15.3, ao. 89 “Memorandum of Agreement between the Minister of Health for Ontario and Hendry-Connell Research Foundation Limited,” 25 May 1939, Cancer Records, File 15.3, ao. 90 Kirby to E.P. Johns, Head, Department of Bacteriology and Pathology, University of Western Ontario, London, 26 October 1939, Cancer Records, File 15.3, ao. 91 cicr, “Interim Report,” 31 December 1939, 25, ao. 92 Johns to McGhie, 24 April 1939, Cancer Records, File 15.5, ao. See also W.T. Connell and E.P. Johns, “Report of the Government Coordinators of the Ensol Project,” 5 September 1939, Cancer Records, File 15.3, ao. 93 cicr, “Annual Report,” 2 July 1940, 2555, ao; cicr, “Interim Report on Ensol,” 20 October 1940, ao; cicr, “Interim Report on Ensol,” 16 July 1941, ao. 94 Hendry-Connell Research Foundation: “Clinical Histories of a Series of Cancer Cases Treated with Ensol Only,” April 1940, Cancer Records, File 12.6; “Relief of Pain in Cancer by the Use of Ensol,” May 1940, Cancer Records, File 17.2; “Report of Hendry Connell Research Foundation to Cancer Commission,” 21 June 1940, Cancer Records, File 16.6; “Clinical Histories of a Series of Cancer Cases Treated with Ensol,” July 1940, Cancer Records, File 12.6, all ao. 95 cicr, “Interim Report on Ensol,” 16 July 1941, 2, ao; “Memorandum re Ensol Development,” 6 December 1939 and McGhie, Memorandum, 28 December 1939, Cancer Records, File 15.8, ao. 96 “Government Grant Will Aid Research,” Toronto Star, 12 January 1940. 97 Coffey to Kirby, 29 February 1940, rg 10–138, Accession 14576/12. ao, ao. 98 Caisse to Hepburn, 15 January 1940, Cancer Records, File 13.13, ao. 99 Kirby to Connell, 5 December 1939, Cancer Records, File 15.3, ao. 100 F.G. Beardall, Accountant to McGhie, 17 January 1941, Cancer Records, File 17.1, ao and Hepburn to Connell, 23 January 1941, rg 3–9, Box 312, ao.

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202 Notes to pages 141–3 101 “List of Expenditures for Ensol to 31 January 1943,” Cancer Records, File 17.4; “List of Expenditures by the Ontario Department of Health on Ensol,” August 1939 to 28 February 1942, Cancer Records, File 17.3, both ao. 102 W.T. Connell to J.G. Cunningham, Director, Cancer Control, 4 March 1940, Cancer Records, File 16.2 and cicr, “Interim Report on Ensol,” 16 July 1941, 3, both ao. 103 Johns and Connell, “Report re Ensol Study,” 1 November 1941, 2–3 and cicr, “Annual Report,” 2 July 1940, 2492–4, both ao. 104 cicr, “Annual Report,” 2 July 1940, 2495–7, ao. 105 Ibid., 2494, ao. 106 Ibid., 2555–63 and Johns and Connell, “Report re Ensol Study,” 1 November 1941, 151–3, both ao. 107 cicr, “Interim Report on Ensol,” 26 May 1942, 3, ao. 108 Young to Gillanders, 20 October 1943, Cancer Records, File 17.4, ao. 109 “Abstract of the Annual Report Upon Ensol to the Ontario Department of Health,” 1940, Cancer Records, File 16.3, ao. 110 cicr, “Annual Report,” 2 July 1940, 2576, ao. 111 Johns and Connell, “Report re Ensol Study,” 1 November 1941, ao. 112 Cunningham to McGhie, 17 September 1943, Cancer Records, File 17.6, ao. 113 “Brief Prepared by the Hendry-Connell Research Foundation,” 1939, 7, Cancer Records, File 16.3, ao. 114 Johns to McGhie, 20 December 1940, Cancer Records, File 16.3; “Report of Hendry Connell Research Foundation,” 21 June 1940, 2–4, 12, Cancer Records, File 16.6; “Research Programme, Ensol,” 20 November 1939, Cancer Records, File 15.4, all ao. 115 W.T. Connell and E.P. Johns, “Memorandum re Ensol Investigation,” 20 February 1942, Cancer Records, File 17.3, ao. 116 Johns and Connell to Kirby, 30 January 1942, Cancer Records, File 17.3, ao. 117 Kirby to H.C. Connell, 31 January 1942; Kirby to H.C. Connell, 16 February 1942; H.C. Connell to Kirby, 19 February 1942; H.C. Connell to Hepburn, 21 February 1942, all Cancer Records, File 17.3, ao. 118 Connell, “Editorial,” 128. 119 H.C. Connell to J.F. Whelan, jama, 26 July 1935, hhfam Collection, Series 166, Box 162, File 0162–06, ama. 120 H.C. Connell to Hepburn, 21 February 1942, Cancer Records, File 17.3, ao. 121 R. Percy Vivian, Minister of Health, to Hendry Connell, 14 January 1944; Vivian to Connell, 10 June 1944; K.G. Gray, Assistant Deputy Minister of Health, to Connell, 26 June 1944; and J.T. Phair, Deputy Minister of Health, Ontario, to G.B. Chisolm, Deputy Minister of Health, Canada, 7 September 1945, all Cancer Records, File 17.6, ao. See also octrf Annual Report, 1945, Cancer Records, File 27.7 and Ontario Cancer

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203 Notes to pages 144–51

122 123

124 125 126

127

Treatment and Research Foundation Balance Sheet, 31 May 1946, Cancer Records, File 27.8, both ao. McGhie to Kirby, 16 October 1942, Cancer Records, File 17.3, ao. Bigelow, “The Cancer Program in Massachusetts,” 1–4; “Organization of Service for the Diagnosis and Treatment of Cancer,” ascc Bulletin (November 1930), 1–3; History of Cancer Control Project, Cancer Control in the United States, 500–4, 733–50, 755–65. Hayter, “Medicalizing Malignancy,” 195–213. History of Cancer Control Project, Cancer Control in the United States, 762–5. Robert T. Noble, Registrar, cpso, to F.V. Cargill, Manager, Directory Department, ama, 7 October 1937, hhfam Collection, Series 355, Box 355, File 0335–03, ama. J.W.S. McCullough, Director of Industrial Hygiene, Ontario, to Morris Fishbein, Editor, JAMA, 19 January 1937, hhfam Collection, Series 568, Box 556, File 0556–15, ama. conclusion

1 Morrow, “A Letter to a Doctor,” 7. 2 Hawkins, Reconstructing Illness, 4. 3 For a quick summary of Starr’s argument, see Social Transformation, 335–8, 379–80. 4 In the second half of The Dread Disease, Patterson delves into the changing fortunes of the anticancer alliance. I am here quoting from page 266. 5 For a fuller discussion of Canadian developments in cancer care, see Clow, “Negotiating Disease,” 272–306 and Hayter, “Medicalizing Malignancy,” 195–213. 6 Patterson, The Dread Disease, 106–8, 162–7. 7 History of Cancer Control Project, Cancer Control in the United States, 762–5. 8 “News Items: Ontario,” cmaj 48 (May 1943): 468–9. See also “Report of the Committee on Cancer,” oma Minutes, 24 May 1943, (May 1942 to May 1944), 111, oma. 9 octrf Annual Report (1945), 4; “Memorandum on Cancer for the Chairman and Members of the Ontario Cancer Treatment and Research Foundation,” 4, rg 10–6, Deputy Minister’s Files, 1943–44, ao. See also Hayter, “Medicalizing Malignancy.” 10 octrf Annual Report (1946), 7. 11 “News Items: Ontario,” cmaj 52 (May 1945): 540. 12 “Report of the Committee on Cancer,” oma Minutes, 21 May 1945, 152, oma. 13 R.P. Vivian, Minister of Health, Ontario, to Connell, 17 December 1943, Cancer Records, File 17.6, ao. 14 Vivian to Connell, 10 June 1944, Cancer Records, File 17.6, ao.

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204 Notes to pages 151–3 15 Vivian to Connell, 15 June 1944, and Connell to Vivian, 23 June 1944, Cancer Records, File 17.6, ao. See also octrf Annual Report (1945), and octrf Schedule of Expenditures, 31 May 1946, Cancer Records, File 27.8, ao. 16 Connell to Vivian, 19 June 1944 and Connell to Vivian, 5 May 1944, Cancer Records, File 17.6, ao. 17 See, for example, Connell, “The Importance of Protein Intake,” 64–8; Connell and Munro, “A Possible Explanation of Conflicting Results,” 162–7; Connell, Munro, and Medley, “Restropin Factor in Cancer,” 161–4. 18 G.B. Chisholm, Deputy Minister of Health, Canada, to J.T. Phair, Deputy Minister of Health, Ontario, 31 August 1945 and Phair to Vivian, 13 October 1945, Cancer Records, File 17.6, ao; Memorandum, 24 February 1947, rg 29, Vol 1179, File 311–c1–24, na. 19 Canadian Medical Directory, 73; “MD’s Product Caused Cancer Controversy,” Toronto Globe and Mail, 1 February 1964. 20 G.D.W. Cameron, Deputy Minister of Health, Canada, to W.P.J. O’Meara, Assistant Under Secretary of State, Canada, 21 November 1946; D.J. Coffey, Solicitor, to O’Meara, 24 January 1947; Memorandum, 24 February 1947; Cameron to O’Meara, 27 February 1947, all rg 29, Vol 1179, File 311–c1–24, na. 21 R.T. Noble, Registrar, cpso, to Cameron, 21 August 1947; Cameron to Noble, 18 October 1947, rg 29, Vol 1179, File 311–c1–24, na. 22 G.E. Richards, Managing Director, octrf, to Cameron, 7 July 1947 and Cameron to Noble, 18 October 1947, rg 29, Vol 1179, File 311–c1–24, na; J.G. Cunningham, Director of Cancer Control, Ontario, to Phair, 16 July 1947, rg 10–138, Accession 14576/12, ao. 23 O’Meara to Arthur R. Ford, Chair, octrf, 12 July 1947, Wallace Papers, Series 1024b, Additions, Box 1, File 5, qua. 24 Robert Noble to Mackinnon Phillips, Minister of Health, Ontario, 10 September 1952, rg 10–138, Accession 14576/12, ao. 25 The ama archives contain many requests for information from doctors and sufferers in the United States: hhfam Collection, Series 355, Box 355, Folder 0355–0 to Box 356, Folder 0356–04, ama. Malcolm H. Merrill, Director of Public Health, California, to Matthew B. Dymond, Minister of Health, Ontario, 10 August 1961, rg 10–138, Accession 14576/12, ao. 26 cicr, “Report re The Hett Cancer Treatment and Research Foundation, Windsor,” 3 April 1959, 6, na. 27 Oliver Field, Director, Bureau of Investigation, ama, to C.I. Gibbon, md, Kellog, Idaho, 6 March 1952, hhfam Collection, Series 355, Box 355, File 0335–08, ama. 28 The details of Hett’s censure and public reaction appear in the following documents: “Report of the Discipline Committee,” 9 April 1952, cpso; Medical Council Minutes, 10 April 1952, cpso; “Bar ‘Cancer Serum’ MD

notes.fm Page 205 Wednesday, July 25, 2001 1:46 PM

205 Notes to pages 153–5

29

30 31

32 33

34

35 36 37 38

39

for ‘Infamous Conduct,› Toronto Telegram, 16 April 1952; “Bar Dr. J. Hett From Practice of Medicine,” Toronto Star, 16 April 1952; “Windsor Doctor Loses License,” Detroit Michigan Times, 16 April 1952; “Hett Defies Accusers,” Toronto Telegram, 16 April 1952; “Barred Doctor Requests Probe of College Action,” Toronto Globe and Mail, 17 April 1952; “Dr. Hett, 81 Won’t Give Up His Practice,” Owen Sound Daily Times, 17 April 1952; “Unlicensed Doctor Fined for Practicing,” Ottawa Citizen, 26 April 1955; “Not Licensed, Cancer Clinic Operator Fined,” Toronto Globe and Mail, 27 April 1955. “Dr. John E. Hett Fought 19 Years Over Treatment Used for Cancer,” unidentified press clipping, 26 September 1956, rg 29, Vol 1179, File 311– c1–24, na; Campbell, “Doctors in Waterloo County,” 119, Kitchener Public Library Archives; Zimmerman, “J.E. Hett, Spiritualist,” 158–60; Connor, “To Advocate, to Diffuse, and to Elevate,” 125, 175. Matthew Dymond, Minister of Health, Ontario, to J. Dawson, cpso, 8 June 1960, rg 10–138, Accession 14576/12, ao. cicr “Report re The Hett Cancer Treatment and Research Foundation, Windsor,” 3 April 1959, na; and M.B. Dymond, Minister of Health, Ontario, to Henri Courtemanche, Secretary of State, 16 October 1959; Courtemanche to Dymond, 30 December 1959; E.R.S. Wyatt, President and J.C.C. Dawson, Registrar-Treasurer, cpso, to Attorney-General of Canada, 29 June 1964, all rg 10–138, Accession 14576/12, ao. See also “Cotnam Shocked Hett Charter Not Revoked,” Toronto Globe and Mail, 4 March 1964; ‹Protect Gullible’ Close Down Cancer Clinic Coroner Urges Ottawa, Toronto Star, 4 March 1964. Dymond to K.C. Charron, Deputy Minister of Health, 6 March 1968, rg 10–138, Accession 14576/12, ao. Sellers, “Division of Medical Statistics,” 19–22, ao. See also McMaster, “The Cancer Campaign,” 389 and “Report of the Committee on Cancer,” May 1941, oma Minutes (May 1941 to May 1942), 25, oma. Henry S. Dunham, Executive Secretary, oma, to Oliver Field, Director, Bureau of Investigation, ama, 1 March 1951, hhfam Collection, Series 355, Box 355, Folder 0355–07, ama. J.T. Phair, Deputy Minister of Health, Ontario, to C.J. Telfer, Secretary, cicr, 10 August 1956, Cancer Records, File 12.1, ao. Mackinnon Phillips, Minister of Health, Ontario, to W.B. Phair, md, 13 July 1957, Cancer Records, File 12.1, ao. Starr, Social Transformation, 380. Fraser and Allen, “Could Essiac Halt Cancer?” 36; Glum, Calling of an Angel, 111–22; Rene Caisse to hrh Prince Philip, 16 June 1960 and Esmond Butler, Secretary to the Governor-General of Canada, to Cameron, 3 August 1960, both in rg 29, Vol 1175, File 311–c1–4, part 2, na. Wightman quoted in “Cancer ‘Cure’: Only 2 of 40 Show Signs of Improvement,” Ottawa Citizen, 7 September 1977.

notes.fm Page 206 Wednesday, July 25, 2001 1:46 PM

206 Notes to pages 156–7 40 R.M. Taylor, Executive Director, ncic of Canada, to Caisse, 31 August 1960, rg 29, Vol 1175, File 311–c1–4, part 2, na. 41 Fraser and Allen, “Could Essiac Halt Cancer?” 42 Sniderman to Pauline McGibbon, Lieutenant-Governor, Ontario, 6 July 1977; McGibbon to Caisse, 4 August 1977; Caisse to McGibbon, 9 August 1977; Memorandum, 16 August 1977, all in rg 24, Accession 24465, ao. 43 Caisse to McGibbon, 13 October 1977, rg 24, Accession 24465, ao. 44 “Lab to Test Secret Formula of Cancer,” Toronto Star, 25 October 1977; Glum, Calling of an Angel, 147. 45 Caisse to McGibbon, 17 January 1978, rg 24, Accession 24465, ao. 46 “Herb Cure for Cancer is Still Under a Cloud,” Toronto Star, 30 April 1984; “Cancer-treating Tea Still Draws Skeptics,” London Free Press, 2 July 1992; Unconventional Cancer Treatments, 71–5. 47 “MDs Defying Law to Try Cancer Cure,“Ottawa Journal, 6 September 1977. 48 W.G. Brown, Deputy Minister of Health, Ontario, to R.A. Farrell, Executive Officer, Office of the Prime Minister, 20 October 1958, Cancer Records, File 13.14, ao; “Indian Remedy, Cancer Chief is ‘Not Optimistic,› Ottawa Journal, 29 September 1977; “Summary of Progress on Caisse,” Diane Murdoch, Secretary to Pauline McGibbon, LieutenantGovernor, 14 October 1977, rg 24, Accession 24465, Box 1, File 1, ao; “Essiac Doesn’t Cure Cancer, 2 MDs Say,” Toronto Globe and Mail, 27 October 1977; P.L.D. Walde to Monique Bégin, Minister of National Health and Welfare, 15 January 1982 and “Briefing Information on Essiac,” 9 April 1981, both hpb, Health and Welfare Canada. 49 R.M. Taylor, Director, ncic, quoted in “Cancer ‘Cure’ Test Guinea Pigs,” Toronto Star, 24 August 1977. 50 K.J.R. Wightman, Director, octrf, quoted in “Essiac Doesn’t Cure Cancer, 2 MDs Say,” Toronto Globe and Mail, 27 October 1977. 51 Bate quoted in “Cancer Victim Wants Right to Herbal ‘Cure,› Toronto Star, 28 March 1978. 52 “Stan Darling is Still Fighting to Make Essiac Available,” Bracebridge Examiner, 17 February 1988. See also Sherry Bate, President, Cancer Club of Toronto, to Stan Darling, mp, 24 May 1988; E.S. to Ian W.D. Henderson, Director, Bureau of Human Prescription Drugs, 13 April 1982; Petition No. 332–4867 to Health and Welfare Canada, 27 June 1988; Stan Darling, mp, to Jake Epp, Minister of National Health and Welfare, 1 June 1988; and Darling to Richard C. Graham, Acting Director, Health Protection Branch, Health and Welfare Canada, all hpb, Health and Welfare Canada. 53 Ed Zalesky quoted in “Cancer Hope Reborn,” Vancouver Sun Saturday Review, 16 May 1992. 54 “Cancer Hope Reborn,” Vancouver Sun Saturday Review, 16 May 1992. See also “Essiac: Wonder Drug or Sham?” Ottawa Citizen, 19 June 1992.

notes.fm Page 207 Wednesday, July 25, 2001 1:46 PM

207 Notes to pages 157–9 55 56 57 58

59

60

61 62

63 64

65

66 67

Snow, The Essence of Essiac. See, for example, Lake, “The Essiac-Caisse Story,” 24–6. Thomas, The Essiac Report, 55–89. M.B. Dymond, President, Resperin Corporation, to Ian W.D. Henderson, Director, Bureau of Human Prescription Drugs, Health and Welfare Canada, 28 September 1978; A.B. Morrison, Assistant Deputy Minister of Health, Canada, to Dymond, 12 October 1978, both hpb, Health and Welfare Canada. Memorandum, J. Pater, Director, Clinical Trials Program, ncic, 26 February 1981, hpb, Health and Welfare Canada. See also “Briefing Information on Essiac,” 9 April 1981, hpb, Health and Welfare Canada. Monique Bégin, Minister of National Health and Welfare, to Dymond, 30 August 1982, hpb, Health and Welfare Canada. See also “Essiac – An Ineffective Cancer Treatment,” Issues, 7 February 1989, hpb, Health and Welfare Canada; Unconventional Cancer Treatments, 75. Pryke, “Essiac, Miracle Cancer Cure.” Thomas, The Essiac Report, 59; his emphasis. See also “Essiac is Nowhere,” Bracebridge Examiner, 7 February 1988; Yamamoto, “Essiac,” 158; Stan Darling to Maureen Law, Deputy Minister of National Health and Welfare, 2 March 1988 and E. Somers, Director General, Drugs Directorate, to R.C.B. Graham, Acting Director, Bureau of Human Prescription Drugs, Health and Welfare Canada, 5 July 1988, hpb, Health and Welfare Canada. Epp to Darling, 22 July 1988 and “Briefing Information on Essiac as an Herbal Tea,” 17 March 1988, both hpb, Health and Welfare Canada. Many popular works on Caisse have appeared since the end of the 1980s and information about Essiac continues to circulate through small newspapers and flyers, and also on the internet. See for example, Michelle Fletcher, “Thuna’s – Over a Century of Herbs on the Danforth,” Cabbagetown & Riverdale News, 17 January 1993; Lake, “The Essiac – Caisse Story,” 24–5; and Good Times Magazine, October 1993. Among the dozens of websites advertising Essiac at the time of going to press are the following examples: naturelink.net, mtenutrition.com, essiac-resperin.com, greencanyon.com, and essiacsource.com. The confusion over Caisse’s formula appears in the following sources: Bate to Darling, 24 May 1988; Darling to Bate, 31 May 1988; G. A. Mackay, Solicitor, to the Health Protection Branch, 23 August 1991, all hpb, Health and Welfare Canada; “Cancer Hope Reborn,” Vancouver Sun Saturday Review, 16 May 1992; Walters, Options, 114–16; Glum, Calling of an Angel, 156–63. Promotional brochure, Essiac International, Ottawa, Ontario, 1995; News Release, Essiac International, Ottawa, n.d. Mary McPherson quoted in Kimberley Hicks, “Mary McPherson Knows the True Essiac Recipe,” Bracebridge Examiner, 4 January 1995.

notes.fm Page 208 Wednesday, July 25, 2001 1:46 PM

208 Notes to pages 160–1 68 Young, “Office of Alternative Medicine,” 279–80. 69 “Minister Rock Accepts all 53 Recommendations,” News Release, 26 March 1999, Health Canada Online, www.hc-sc.gc.ca/hpb/onhp. 70 Some authors have argued that conventional clinical trials and laboratory tests may not be appropriate tools to evaluate alternative or traditional methods of healing. See, for example, David J. Hufford, “Folk Medicine in Contemporary America,” in Kirkland et al., Herbal and Magical Medicine, 25–30; Richards, Vitamin C, 216–40; Scott et al., “Captives of Controversy,” 474–94. 71 “Minister Rock Accepts all 53 Recommendations” and “Facts About the Office of Natural Health Products,” News Releases, March 1999, Health Canada Online, www.hc-sc.gc.ca/hpb/unhp; Canada, Standing Committee on Health, Natural Health Products, 18–44, 59–64. 72 Science Against Cancer, National Film Board of Canada, 1950. Jim Lebans of Quirks and Quarks, cbc Radio, brought this film to my attention and then kindly loaned me his copy for a very long time.

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Alexander, Elaine, 157–9 alternative medicine: appeal of, 104, 108–9, 112–16; and authority, 63, 85–8, 117–18; class and, 104–7; decline of, 152, 153; defined, xv, 61, 63; and doctors, xii, xvi; and historians, xv–xvi, 92, 103, 117–18; importance in history, 63, 88; and laity, 60–1, 65, 74, 103–16, 122–6, 131–4, 149–50, 151, 153, 156– 9, 160; prevalence of, 61, 85, 104; and science, 61, 62, 86, 128, 132–6, 152, 157–8. See also Caisse, Hendry Connell, Hett anti-authoritarianism, 107–9 Arnup, Katherine, 19 Austoker, Joan, 44 authority: and alternative medicine, 63, 85–8, 117– 18, 149, 152, 155; and cancer, 38, 39, 41–2, 45, 56–9; contested, 121, 132–3, 136–7, 145; defined, xiii; and histori-

ans, 25, 62, 85–8, 148–9, 155; and laity, 4, 35, 85, 95–6, 99, 117–18, 120– 1, 125, 128, 130, 131, 136–7, 144, 149; and medical profession, xiii– xiv, 4, 25–6, 31, 38, 39, 41–2, 45, 56–9, 62, 85– 8, 103–4, 122; shift in, post ww ii, 148–9, 150, 154, 155, 157–9, 160–2. See also health culture, monopoly, power Banting, Frederick, 44, 71, 75, 82 Bell, Blair, 4, 30, 48, 91 blame, 13–14, 19, 27, 96–7 Bloodgood, Joseph Colt, 12, 13 Bogart, Humphrey, 5, 24 Caisse, Rene: as alternative practitioner, 62–3; and medical profession, 79– 83, 107, 131–3, 133, 134, 135–6; background, 78; death of, 156; development of treatment, 78– 9; and government, 83–

4, 121–5, 129, 133, 156; and laity, 83, 104, 107– 8, 110, 123–5, 128, 131– 2, 134, 156; as nurse, 78, 81; postwar experience, 155–6; as researcher, 79; secrecy, 82–3, 124, 135– 6, 156; sells formula, 156; theory of cancer, 82. See also Essiac Callahan, Thomas C., 130, 133 cancer: compared to cardiovascular diseases, xi– xii, 10, 17–8; compared to contagious diseases, xi; costs of, 15–16; death rates, 10, 16–17, 56–8; experience of, 3–4, 14– 25, 31–5, 60, 89–94, 99– 103, 109–18, 147–8; fear of, 9–10, 11, 17–18, 23– 5, 33–4,100; and historians, xi, xiv, 164n2; incidence of, xvi, 40–2, 57; lay explanations of, 11– 14; medical explanations of, 11–14, 42–9; medical reactions to 40–1, 57, 96; recurrences, 58;

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shame and, 10–11, 13– 14, 17–20, 22–3, 100; silence and, 10, 18–25, 26, 29, 34, 38; statistics, significance of, 40–2. See also cancer diagnosis, cancer treatments, illness experience cancer commissions, 144–5 cancer “cures”: and Caisse, 82, 83, 131; and Connell, 76, 143; and Hett, 74, 76; lay definitions of, 111, 112–15, 131; medical definitions of, 57, 67, 133–6, 138–9 cancer diagnosis: by biopsy, 50, 52, 134–5; clinical, 50–1, 134–5; as criticism of alternative medicine, 133, 134–5, 141; delayed by disease, 29; delayed by laity, 3, 6, 15– 16, 19, 27–8; delayed by medical profession, 27– 8; double standards of, 134–5; early, 19, 27, 49– 52, 89, 147; and gender, 98; improved, 41; and medical profession, 94– 9; by x-rays, 50–2, 134– 5; uncertain, 29, 134–5 “cancerphobia.” See cancer, fear of Cancer Remedy Act (1938): amendments to, 125, 128, 136, 137; government defends, 124; lay perceptions of, 120, 122– 3, 124–5; medical expectations of, 120, 122; terms of, 120, 125, 136; earliest version of, 128 cancer treatments: alternative, defined, xv, 61, 63; alternative, described, 109–15; conventional, defined, 52–3; conventional, described, 53–5, 101–3; conventional, rejected, 99–101; conventional, unquestioned,

135; costs of, 105–6; double standard for evaluating, 135, 139–41; fear of conventional, 90, 99– 101, 103; lay standards for evaluating, 110–15, 126, 130–32, 134; medical standards for evaluating, 130–5, 138–40, 141–3; placebo effect and, 111–12; secrecy, 65, 82–3, 124, 135–6, 142, 156. See also Ensol, Essiac, Hett treatment cardiovascular diseases: compared to cancer, xi– xii, 10, 17–18 class: impact of, 5, 15–16, 91–2, 105–7; sources and, 5, 93 College of Physicians and Surgeons of Ontario (cpso), 119, 126–8, 145; and Caisse, 84; and the cicr, 122, 132, 137; and Hett, 76–8 Collins, Ernest A., 130 Commission for the Investigation of Cancer Remedies (cicr): constraints upon, 120, 125, 128–9, 130–1, 136–7, 138; decline of, 120, 137–8, 144, 145, 154–5; formation, 121, 130; and Caisse, 121–5, 129, 131– 7, 139, 140; and Connell, 129–30, 138–44; and Hett, 128, 125, 132– 8, 140, 152; lay perceptions of, 122–3; mandate, 120, 128; membership, 130, 154– 5; medical perceptions of, 122 Connell, Hendry Cameron: as alternative practitioner, 62–3; background, 63–4; death of, 152; financial support for, 69, 140–1, 143–4, 150–2; and government, 66,

129–30, 138, 140–4, 150–2; lay support for, 65, 70, 104, 110, 129; medical criticism of, 67– 9, 71–2, 138–9, 141–2; medical support for, 65– 6, 69–71, 72–3; as researcher, 64–6, 151; secrecy, 65, 142–3; tetanus scandal, 72. See also Ensol, Hendry-Connell Research Foundation Connell, J.C., 71 Connell, Walter T., 139–40, 141, 142 Cramp, Arthur J., 61, 67, 76 Deadman, William, 27, 130, 137, 138–9 disease concepts, xiv. See also health, illness, illness experience doctors. See medical profession du Pont, Irenée, 69, 129, 140 Dymond, Matthew B., 154, 207n58 Ensol: clinical effects, 65–6, 70; development of, 64– 5; doubts about, 67–9; named, 65; popularity of, 65, 70; tetanus scandal, 72; theory of action, 68– 9, 71–2. See also Hendry Connell, Hendry-Connell Research Foundation Essiac: clinical effects, 80, 91, 110–11, 112–15, 117, 157–8; confrontation with science after ww ii, 157–8; confusion over formula of, 159; cost, 105; development of, 78–9; named, 79; official access to, 158–9, popularity of, 83, 156–7; theory of action, 82. See also Caisse ethnicity, 93

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euphemisms, 21 Ewing, James, 43, 45 fear: lay, of cancer, 9–10, 11, 14–17, 24–5, 33; medical concerns about impact of, 17–9, 22–3 Fishbein, Morris, 61, 67, 69, 72 Fisher, Robert, 78–9, 80 Fraser, D.T., 138, 139 gender: and cancer, 13, 96– 8, 102; and sources, 93 Gillanders, John G., 130, 131, 134, 136 Glover, Thomas J., 47, 61 Glum, Gary, 159 government: and alternative medicine, xvi, 8, 66, 75, 77, 83–4, 108, 123– 5, 127, 129, 135, 140–1, 142–4, 150–3; and cancer education, 12–13, 20, 23, 28, 31, 144; and cicr, 120, 122–5, 130, 135, 136, 138, 140–1, 142–4; deference to laity, xvi, 119, 120, 125, 128–9, 130, 136, 143–4, 153, 157, 158; dependence on doctors, xvi, 119, 120, 130, 136, 150– 1; and historians, xvi, xviii, 148–9, 150 Gye, William, 44, 45, 68, 72, 75 Hawkins, Anne Hunsaker, 148 health: lay definitions of, 5–9, 33, 110–15; medical definitions of, 6–8, 113– 14 health culture: defined, xii, xvii, 164n3; importance of alternative medicine in, xv–xvi, 60–1, 63, 85– 8, 103–5, 109, 117–18, 119–20, 121; importance of laity in, 5–6, 31, 34–5, 92–3, 109, 116–18, 121;

importance of medical profession in, xiii–xv, 38–40, 148–9, 150, 152, 154–5, 161–2; transformation of, post ww ii, 148–9, 150, 152, 154–5, 161–2. See also authority, monopoly, power heart diseases. See cardiovascular diseases Hendry-Connell Research Foundation: founded 65, publications of, 70, 72. See also Hendry Connell, Ensol Hepburn, Mitchell: and Caisse, 83–4, 108, 124, 135; and Connell, 129, 143; and Hett, 77, 127 Hett, John Emil Heller: as alternative practitioner, 62–3; appeal to courts, 77; background, 73; barred from practice (1937), 77–8, (1952), 153; and cicr, 121–2, 125–6, 129, 133–4, 137; and cpso, 77–8, 119, 126–8, 152; death of, 153; development of treatment, 74; and government, 77, 127; lay support for, 104, 110, 126, 127, 128, 132, 153; medical criticism of, 75– 7; medical support for, 75; niece carries on work of, 153–4; as researcher, 73–5, 128; secrecy, 76–7, 126, 135–6; theory of cancer, 74. See also Hett treatment, Hett Research and Treatment Foundation Hett Research and Treatment Foundation, 152–3. See also Hett, Hett treatment Hett treatment: clinical results, 75, 110–11, 112– 15; cost of, 105–6; development of, 74; popular-

ity of, 74; theory of action, 75. See also Hett, Hett Research and Treatment Foundation Hoffman, Frederick, 41 Horner, Norman, 69, 71–2 Hoxsey, Harry, 104, 107, 108, 149 illness: defined by laity, xii, 5–9, 33, 110–15; defined by medical profession, 6–8, 112–13 illness experience: and alternative medicine, 60, 103–16; and cancer, 14– 20, 24–5; and conventional medicine, 26–9, 31, 94–103, 147–8; gendered, 96–8; impact on health care choices, xv– xvi, 3–4, 6–9, 23, 60–1, 89–92, 94, 99–103, 109– 11, 112–16; importance of, in history, 92–3, 94, 117–18; and historians, 4–5, 93–4; and language, 21, 94–6; pain in, 17–18, 102–3, 110–11, 115, 139 Imperial Cancer Research Fund. See Gye Johns, E.P., 139–40, 141–2 Johnston, William Victor, 36–9, 50, 98–9, 115 Kenny, Sister Elizabeth, 81 Kirby, Harold: and Caisse, 124–5; and Connell, 139, 140, 142–3; defends Cancer Remedy Act, 124; and octrf, 150, 151 Kleinman, Arthur, xii Koch, Frederick, 61, 104, 149 laity: and alternative medicine, 60–1, 65, 74, 92–3, 103–16, 119–20, 123–7, 131–2, 136, 143–4, 149– 50, 151–3, 156–8, 159,

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160; and cicr, 122–3; and conventional medicine, xii, xiii, 25–31, 33, 92–3, 94–103, 107–8, 126, 147–8, 157–8; definition of health, 113–15, 116; definition of illness, 6–9, 113; and fear, 9–10, 11, 17–19, 24–5, 33–4; and government, xvi, 123–5, 130, 132; and historians, xv, 4–5, 10, 93–4, 99; importance of in history, 5–6, 32, 92–3, 94, 117–18; and language, 94–6; logic of views, 6, 9, 10, 12, 14, 15, 25, 26, 31–2, 33, 35; and power, xv– xvi, 95, 99, 100, 107–9, 120, 121, 125, 128, 130–1, 136; and science, 131–6, 157–8; standards for evaluating treatments, 89–93, 116– 18, 131, 132–4; theories of cancer causation, 11–14 Leacock, Beatrix: cancer in family of, 12; compared to Stephen, 31–5; death of, 4, 34; delayed diagnosis, 3, 26, 29, 33; explanation of cancer, 14; explanation of illness, 3, 7; illness experience of, 3–6, 32–3, 36, 89, 91, 92–3, 94, 109; impact of class on, 4–5, 91–2 Leacock, Stephen: and alternative medicine, 48; ambivalence toward medical profession, 29– 31; compared to Beatrix, 31–5; death of, 21, 32, 34; illness experience, 32–4; impact of class on, 5, 37 Leavitt, Judith Walzer, 19 L’Esperance, Beatrice, 153–4 Lupton, Deborah, xiii

Macklin, Madge Thurlow, 42, 43, 44, 46, 48 MacNab, Elizabeth, 77 Matthews, J. Rosser, 62 medical profession: and alternative medicine, xii, 61–12, 94, 103, 108, 111–12, 115, 119, 126, 145–6, 151, 152–4, 155– 6; attitudes to cancer, 40–1, 57, 96; authority, xiii, 62, 85–7, 100, 117– 18, 148–9, 154, 161–2; and cicr, 122, 130–1, 136, 137–8, 145; competence of, 27–8,147–8; debates over cancer, 40– 56; definition of health, 6–8, 113–14; definition of illness, 6–8, 112–13; and government, xvi, 119, 120, 130, 136, 150, 160–1; and historians, xiv–xv, 25–6, 29–30, 85, 100, 148–9, 155; and laity, xii, 6, 10–1, 19, 24– 5, 27, 39–40, 42, 46, 96– 7, 98–9, 106–8, 123, 126, 128, 147–8; “monopoly” of, xii, xiv, 25, 85, 87–8, 103–4, 145–6, 149–50, 161–2; secrecy, 23–4, 26, 29, 38; standards for evaluating treatments, 112–15, 130–5; theories of cancer, 11–14. See also Caisse, Hendry Connell, Hett metastasis. See cancer, recurrences monopoly: concept of medical, among historians, xiv, xvii; challenges to idea of medical, in early twentieth century, xii, xiv, 25, 85–8, 103–4, 107–9, 117–18, 121: in postwar era, 145, 146, 149–50, 161–2. See also authority, power Murray, Gordon, 53

neoplastic diseases. See cancer Nicholls, Albert G., 49, 50, 65–6, 68 Northwestern University, Chicago, 80–1, 145 nursing. See Caisse, as nurse obituaries, 20–22, 34 Office of Alternative Medicine, 160 Office of Natural Health Products, 160–1, 162 Ontario Cancer Treatment and Research Foundation (octrf), 150–1, 152–3, 155 pain: and alternative medicine, 110–11, 115, 139; of cancer, 15, 17–18; and conventional medicine, 37, 53, 102–3; as indicator of illness, 8, 102–3; relief of, 110–11, 115, 139. See also cancer, fear of patients. See laity Patterson, James T.: on cancer statistics, 41; on “cancerphobia,” 22–3; on class, 104–5, 149–50; on shame, 10, 19, 21; on silence, 10, 18–19, 21, 29 Peller, Sigismund, 69, 82 placebo effect, 111–12 plurality. See monopoly Porter, Roy, 4 power: as focus of book, xii, xvii; of government, xvi; and historians, xii; of laity, xv–xvi; of medical profession, xvii. See also authority, monopoly radiation therapy. See cancer treatments, conventional radium. See cancer treatments, conventional

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research: clinical versus laboratory, 67–8; and historians, 66; “legitimate” defined, 62, 66–7, 69, 85–7; standards of, 66–7, 69, 78, 79, 85–7. See also Caisse, Hendry Connell, Ensol, Essiac, Hett, Hett treatment Resperin Corporation, 156, 158, 159 Richards, Gordon E., 56, 90, 111, 150, 151 Rosenberg Charles E., xiv, 39, 94–5, 121 Rothman, Sheila, 39, 99 Rous, Peyton, 44, 75 secrecy: anathema to medical profession, 76–8, 87– 8, 135–6; and cancer, 10,

18–25, 34, 38, 94–6; and treatments, 65, 73–8, 82–3, 124, 126, 128, 135–6, 142–43, 156 shame. See cancer, shame and Shepley, E.E., 6–9, 16, 27 Shorter, Edward, 26, 100, 103–4, 112 silence. See cancer, silence and Slye, Maud, 44, 46 Sontag, Susan: on cancer and blaming, 19; on cancer and shame, 10, 17– 19, 23, 100; on cancer and silence, 10, 23, 29 Starr, Frederick, 57, 58 Starr, Paul, xiii, 25, 85, 87– 8, 148–9, 155 state. See government

sufferers. See laity surgery. See cancer treatments, conventional Valin, R. Eugene, 130 Wallace, Robert C., 130, 133, 135 Warner, John Harley, 7 women. See gender X-rays. See cancer treatments, conventional Young, George S., 130, 138–9, 141 Young, James Harvey, 104– 5, 112

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