The Use of Betelnut as a Cause of Cancer in Malabar

Sir,?Finding that a great deal of interest is now displayed in investigating the caus^ and prevention of cancer, and that bacteriologists are hard at work isolating the micro-organism, I venture to write to you the following, hoping that it may be of some service to those who are interested in the investigations. It must have been noticed by any and all of the medical profession, who had t!>e chance of working in the various districts of the Presidency that cancer is a great deal more common in Malabar than :n any other districts. Close study of the cases has led me to the inference that cancer of the mouth is confined to those who chew betelnut. It is a habit tliat I have often seen among betelnut-chewers in Malabar to keep the chewed substance under one or other side cf the mouth. But this habit is not confined to the people of Malabar, and, therefore, it is open to the question why the disease should'have found a better nidus in the Malaylese in preference to other nationalities. I have to believe that the difference in the constituents of the betelnut would explain to a great extent the cause of such a difference, basing, that irritability is one of the immediate causes of cancer. It will be noted that in all districts except Malabar the usual ingredient that go into the composition of betelnut are betel-leaf (Piper-betel) areca nut and lime, and in Malabar tobacco in addition and aromatic substances adding to the luxury of it. Lime that is used for this purpose in Malabar and other districts differ a great deal in the mode of manufacture and quality. In Malabar it is prepared first by calcining shells of molluscs such as cockles, and rarely of oysters and snails, &c., and then slaking the product. The resultant is much more alkaline and caustic in character than the slaked lime that is used in other districts, and which result from slaking lime that was produced by calcining chalk. Owing to the excessive alkalinity of M labar lime when it becomes mixed with the oil of betel leaves in the process of chewing, a more caustic substance chavicol (Paraallyl-Phenol) is produced. This substance cannot be so easily separated from the oil of betel leaves if treated with lime of the strength that results from slaking calcined chalk. The tobac co when combined with the moist betel and nut, must also bring out those powerful and equally irritant oily alkaloids, nicotine and nicotidine. And therefore the resultant from the betelnut "a la mode malabari " (Betel leaf, areca nut, slaked lime and tobacco) form a much more irritant substance than the ones from the betelnut of other people. I believe the increased irritant condition, coupled with the peculiar habit of keeping the substance in one or the other cheek and the constant use of betelnut constitute the condition to generate a nidus in the cheek for the production of