Cancer study 23 decades too late

1Advice to the feeble, feckless and stout from an eighteenth-century doctor of physick

Millions of cancer deaths in industrialized countries could be avoided if the public paid more attention to diet, exercise and weight. That is the conclusion of the newly released study, Food, Nutrition, Physical Activity, and the Prevention of Cancer: A Global Perspective, which made headlines in many countries. The Globe and Mail shouted "Poor diet ratchets up cancer risk." The Winnipeg Free Press weighed in: "Study isolates cancer causes: weight, red meat, booze increase risk." The Economist noted: "To avoid the big C, stay small," adding in its usual wry manner that when it comes to cancer risks "many a mickle makes a muckle, and in total they add up to something significant."

The research took six years. Nine research institutes participated. More than half a million publications were examined — finally whittled down to 7,000 relevant ones. The crushing conclusion: there are close links between lifestyle and cancer, red meat is bad, fat is poison, drink worse, and everyone should stay as slim as possible "without being underweight" — good they threw that in, or all the work being done to get anorexics off fashion runways will have been in vain. These results should bring much rejoicing to those who would prefer to see the lower classes return to their proper lifestyle of heavy labour, weak beer, and gruel.

Exhausted and understandably distracted after reading hundreds of thousands of research papers, the study's authors did not realize that their scientific conclusions had been anticipated 250 years ago by the Scottish physician and poetaster extraordinaire, John Armstrong (1709-1779). In his long and industrious career Dr. Armstrong distinguished himself as physician to the British Army in Germany, as well as being a man of considerable literary ambition. In 1737 he published A Synopsis of the History and Cure of the Venereal Disease, immediately followed by a mildly salacious first book of poems entitled The Oeconomy of Love, which, though said to have been designed as merely a burlesque upon certain didactic writers, was, it has been recorded, justly condemned for its warm and alluring pictures and its tendency to inflame the passions of youth. Indeed, Dr. Armstrong's admiration of Milton was passionate beyond all natural bounds. Inspired by the blind bard, he could not resist the urge to express himself on paper just as he did on biliary dyspepsia and carbuncles, thereby adding fresh uneasiness to his patients' normal misgivings by indulging himself in the arts of poesy. In his free moments, when he was not sawing off arms or sewing up sabre wounds, he would write epic stanzas on peristalsis and purging.

John Armstrong's defining work, The Art of Preserving Health, was published in 1744 to much acclaim. This didactic poem in blank verse, extending through four books, has enriched our literary heritage with its peerless lyrical analysis of the healthy conduct of creaturely life, comessation, and the gastrointestinal system, all under the guidance of the meat-eschewing muse Hygeia. With every stroke of Armstrong's precocious quill the vast apparatus of Miltonic metre and metaphysics is brought to bear on phlegm and flatulence, black bile and swelling blood, with results that can gratify the seeker of salubrity and connoisseur of unique literary phenomena. At least so says Bruce Boehrer in a pithy review of Armstrong's work in the Milton Quarterly. As a critic of his day wrote of this eighteenth-century practitioner in viscera and verse: "He thinks boldly, feels strongly, and therefore expresses himself poetically. When the subject sinks, his style sinks with it." (Source: Significant Scots on the ElectricScotland website.)

Now, as a hospital librarian I am interested in John Armstrong's influence on modern science, not the quality of his iambic pentameter. Through my own research in standard library resources, I have discovered remarkable parallels between the health prescriptions of Scotland's medical versemaker and those of today's expert team of cancer researchers. In fact, their monumental study, the most comprehensive of its kind ever undertaken, showing that diet, lack of exercise, and body weight appear critical in causing many cases — perhaps up to one-third — of all cancers, is, I say, but a lengthy commentary on Dr. Armstrong's own work. Little did this intrepid band of scientists realize that their conclusions are a mere reprise of the discoveries made by this unassuming man of medicine. Moreover, his extraordinary prescience and irrepressible prognosticatory skills are limned in the noble cadences of heroic blank verse, a welcome change from the arid and monotonous prose of contemporary science.

In the following I shall demonstrate conclusively the truth of this assertion. Let us begin with an excerpt from Book II of The Art of Preserving Health, through which stream forcefully Dr. Armstrong's enunciations on diet and the dire risk of excess fat, "the gummy nutriment":

The languid stomach curses e'en the pure
Delicious fat, and all the race of oil:
For more the oily aliments relax
Its feeble tone; and with the eager lymph
(Fond to incorporate with all it meets)
Coyly they mix, and shun with slipp'ry wiles
The woo'd embrace. Th'irresoluble oil,
So gentle late and blandishing, in floods
Of rancid bile o'erflows: what tumults hence,
What horrors rise, were nauseous to relate.
Choose leaner viands, ye whose jovial make
Too fast the gummy nutriment imbibes. (The Art of Preserving Health, Bk. II)

Although the poet's advice to those of "jovial make" (i.e, the obese) is perceptibly tinged with gloomy pleasure at their sufferings, he rightly makes his case for avoiding fatty foods. His opinions on the "oily aliments" are quite vehement, with dire predictions of "tumults" and "horrors" when the "rancid bile o'erflows." How does this compare with our current knowledge? Armed with years of diligent research, the authors of our imposing cancer study can do little more than repeat Dr. Armstong's recommendation to "choose leaner viands" in order to stay lean.

For it all comes down to the stomach, Dr. Armstrong would say. In the following excerpt, in which the poet can no longer hold back, but must urgently find relief in calling upon his gastric muse in this churning paean to intestinal integrity, he warns uncompromisingly of the terrifying consequences of vile viands and ill-chosen nutriments:

Half subtilis'd to chyle, the liquid food
Readiest obeys th'assimilating powers;
And soon the tender vegetable mass
Relents . . . .
The stomach, urged beyond its active tone,
Hardly to nutrimental chyle subdues
The softest food: unfinished and depraved,
The chyle, in all its future wand'rings, owns
Its turbid fountain; not by purer streams
So to be cleared, but foulness will remain. (Ibid., Bk. II)

Foulness, indeed, is all that remains. On the matter of drink, while as suspicious of "the colliquation of soft joys" as our international team of experts, Dr. Armstrong occasionally qualifies his lofty disapproval of bacchanalian imbibing, even expostulating at one point on "that divinest gift, / The gay, serene, good-natured Burgundy." In an eruption of ascetic rigour that goes far beyond even the stern admonishments of their predecessor, our cancer and lifestyle experts condescend to allow as permissible only a miniscule amount of alcohol — and that reluctantly — with long-suffering women cruelly restricted to a single drink per day.

On exercise, Dr. Armstrong is uncannily contemporary in his views. Lauding those "whose blood / Impetuous rages through the turgid veins," he regards with abhorrence "pale and bloated sloth," which must needs bring on the unhappy superflux of "rancid byle." Exercise contributes to the augmentation of good digestion and is the best remedy for constipation, "the stubborn aliment." Recommending the avoidance of "the full repast," our physician-poet advocates sufficient daily activity to stimulate the alimentary tract:

. . . His daily labour thaws,
To friendly chyle, the most rebellious mass
That salt can harden, or the smoke of years;
Nor does his gorge the luscious bacon rue . . .

Washing is acceptable, in moderation: "The warm ablution just enough to keep / The body sacred from indecent soil." Those brave enough to wash in cold weather are deserving of special notice:

Against the rigours of a damp cold heaven
To fortify their bodies, some frequent
The gelid cistern; and, where naught forbids,
I praise their dauntless heart. (Ibid., Bk. III)

While his suggestions for physical exercise are innocent of Bowflex brochures and Pilates publicity (in fact, they are more reminiscent of the pastimes of the fallen angels in Milton's Pandemonium), Dr. Armstrong, it can be said with confidence, profoundly understood physical activity's role in the maintenance of good health, even to the point of foreseeing the advent of the sweat shirt. Not a few contemporaries, however, were critical of his excessive trust in "vacant fancy,"and his enthusiastic endorsement of frolicking in "naked stubble" must have troubled concerned parents and clergy:

Whate'er you study, in whate'er you sweat,
Indulge your taste. Some love the manly foils;
The tennis some, and some the graceful dance.
Others more hardy, range the purple heath,
Or naked stubble; where from field to field
The sounding coveys* urge their labouring flight; * partridges
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
He chuses best, whose labour entertains
His vacant fancy most. (Ibid., Bk. III)

Special derision is reserved for feather beds ("the blandishments of down"), which are fit only for "the lean projector, of dry brain and springy nerves" (the information specialist?) and "the buried bacchanal" (the drunkard), exhaling his surfeit "in prolixer dreams." For those who would wean themselves from sloth, it were best to extend the limbs upon "the hard mattress or elastic couch."

So much for the feeble and the feckless. What, then, of the stout — those "of jovial make?" We have already seen Dr. Armstrong's withering disapprobation of "the languid stomach." Towards the adipose and pinguitudinous he is implacable, relentless and remorseless. In short, he is not one to suffer fools lightly. Though long dead, truly he is a man of our time:

. . .But ye of softer clay,
Infirm and delicate! and ye who waste
With pale and bloated sloth, the tedious day!
Avoid the stubborn aliment, avoid
The full repast . . .

Gluttony, and the obesity that results, is a sin utterly Mephistophelian in its bestial depravity and degradation. For those unable to avoid "the pure delicious fat, and all the race of oil" special horrors are reserved, including severe periodontal disease. The doctor counsels: "let sagacious age / Grow wiser, lesson'd by the dropping teeth."

Could any now disagree that a close reading of John Armstrong's complete opus is the foundation for any future research on cancer and lifestyle? His foresight is prodigious, his diagnosis accurate, his prescription astute. It is nothing short of astonishing how, alone with his muse and unassisted by teams of trained assistants and years of accumulated data, an obscure, eighteenth-century doctor of physick, toiling amongst amputated limbs, bleeding bowls and unwashed lancets, should have anticipated so accurately the results of a heavily funded, internationally backed research project of the 21st century. Twenty-three decades after his death, Dr. Armstrong's disrelish for the slightest human weakness and uncompromising scorn for fat in all its forms seems completely up to date. Much like the authors of Food, Nutrition, Physical Activity, and the Prevention of Cancer, he had, as James Beattie wrote to his friend and biographer William Forbes, "a rooted aversion against the whole human Race, except a few Friends, which it seems are dead."