[CANCER RESEARCH 28, 2268-2271,
November 1968]
Plants Associated with Esophageal
Cancer Cases in Curacao
Julia F. Morton
Morton Collectanea, University of Miami, Coral Gables, Florida 33146
The island of Curacao in the Netherlands Antilles lies 60
miles north of northwestern Venezuela. The island is 38 miles
long and 7 miles wide at its broadest point, 2tëmiles at the
narrowest. The population is roughly 120,000; 75% are
locally born negroid. Autopsy records for the period
1936-1960 showed esophageal cancer to be the most com
mon malignant tumor for both men and women among these
native people (5, 7). A comparison of the number of cases in
that 24-year span with the 115 cases among this group in the 6
years 1960-1965 showed an unchanged crude incidence rate
of 20.9 per 100,000(6).
Local pathologists have considered and abandoned various
environmental and food factors as contributory to this unusual
health problem (7). At least one field remained unexplored:
the possible ingestion of carcinogens through the use of plant
"teas" for self-medication and refreshment.
In 1965, under Grant ROI CA-07966 from the National
Institutes of Health, I began to investigate the extent of this
practice, the plants employed, and which ones occurred most
frequently in the histories of esophageal cancer victims (8).
The environmental conditions can be briefly summarized as
follows: There is a large oil refinery in the midst of the heavily
populated city of Willemstad, but the prevailing winds gener
ally carry the fumes offshore in a southeasterly direction. At
times when the refinery is said to be "burning off the bad oil,"
the open flames from the stacks belch black smoke which
hangs over the central area.
Curacao was once well forested, but it has suffered severe
deforestation and erosion and has become an arid land where
thorny scrub and cacti predominate (1, 2). The rainfall
averages 20 inches a year.
The refinery has a vast fresh water requirement for cooling
the machinery and has been blamed for pumping up much of
the ground water and causing salt intrusion. Most of the wells
are now salty. From the early 1930's until 1964, river water
from the United States was taken to Curacao in oil tankers
which had conveyed crude oil from Venezuela to Curacao and
refined oil to the United States. This water was stored in
empty oil tanks on the island and mixed as needed with the
sparse supply of well water and distilled sea water and
distributed by pipe and truck as drinking water for most of the
population. People complained of the oily taste. The oil
content may have contributed to susceptibility to esophageal
cancer. At least, it contributed to the common consumption
of plant "teas" to mask the objectionable flavor. Today
enlarged facilities provide adequate distilled sea water to
nearly every part of the island.
There are still remnants of old tropical fruit groves, and
vegetables arc raised in small truck gardens by a few Chinese
2268
and Portuguese. But most of the fresh produce consumed in
Curacao is brought by sailboat from Venezuela and the
Dominican Republic and sold in the picturesque "floating
market."
"Funchi," a dish midway between cornmeal mush and
cornbread, is eaten every day by most native Curacaons (3, 5).
It is usually made with cornmeal imported mainly from the
United States, to a lesser extent from Venezuela. Most of the
people prefer to make it from sorghum, but, because of the
perennial drought, sorghum is not grown much anymore.
Another indigenous dish is cadushi soup ("sopi cadushi")
made of the fresh or dried and powdered flesh of a tall,
columnar, wild cactus (Cereus répandus).It forms a mucilagi
nous soup stock resembling that made with okra (9). Of 44
esophageal cancer victims investigated, only 5 were recorded as
nonconsumers of cadushi.
Basil (Ocimum sanctum), locally called "yerba hole" or "hole
blancu," is very popular as a fresh herb for flavoring and is
occasionally steeped for "tea."
Sesame seed cakes are a favorite sweetmeat and sesame oil is
often used for cooking. In the last 5 years, these products have
come mainly from Venezuela. The oil may be reused 5 or 6
times for frying.
Hot peppers (called "promente") are common on the native
market in the fresh state and are also preserved in brine with
the West Indian gherkin. This pickle is known as "pica." Of 44
esophageal cancer cases investigated, 16 were recorded as
nonindulgers in promente or pica.
In the dark, covered, native market in Willemstad where
local produce is sold, equal space is occupied by the herb
vendors who do a lively business in small bundles and heaps of
fresh or partly dried weeds and leaves used for home remedies.
There is no indication that the practice of folk medicine (10)
is dying out. Apart from tradition, the gathering and sale of
wild plants is a means of livelihood for some, and to their
customers self-medication seems much less costly than consult
ing a physician. As long as the economy of the island remains
at the present low level, with 10,000 unemployed draining the
resources of the employed, this situation is likely to remain
much the same.
The people are enthusiastic about their medicinal plants, for
they have little else, and they readily adopt introductions from
other islands. In the fall of 1967, one vendor was proudly
selling Vernonia menthaefolia by its Cuban name rompezaraguey. In the last few years, Cuban refugees have been growing
this much-esteemed herb in South Florida as an indispensable
remedy.
An elderly priest, Father Paul Brenneker, published in 1962
a small book entitled Jerba (4), in which he had assembled
CANCER RESEARCH VOL. 28
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Esophageal Cancer in Curacao
Table 1
useGroup
by esophageal cancer
victims (44 victims or
rare)survivors
survivors interviewed)Status
Curacao
Availability in CuracaoPrincipal
I: Traditionally administered to infants and older children.
theirAnnonaceaeAnnona
(It may be assumed that esophageal cancer victims were given these in infancy, but they and
glabra L.
CajudaApocynaceae
PlumerÃ-aobtusa L.
DiBonaireBoragjnaceae
Oleander
Heliotropium angiospermum Murr.
CocolodeEuphorbiaceae
Jatropha gossypifolia L.
FlairaScrophulariaceae
Capraria biflora L.
TanchiZygophyllaceae
it.)6
would not be aware of
use;most
of 44 admitted
babies."Considered
said "for
ArubaUnknown
in
common vermifuge: 4 drops
of
milk.Leaf
sap in coconut
dangerous;
secretly given. Use
admitted.All
not
ArubaCommon
in
wild weed.
Dried plant sold in
market.Common
decoction always given to
babies when "changing skin."
babies."10
said "for
weed but only
root decoction given
rarely to children as
diuretic.Root
wild weed.
market.Common
Not sold in
infusion always given for
infant diarrhea. Leaf decoction
for diabetes and gall bladder
trouble.Leaf
of 44 admitted use.
babies."All
Most said "for
decoction used
as gargle. Decoction
of peeled, mashed
stem said to
"curethroat
cancer."Common
wild weed.
Sometimes in
market.Common
decoction with decoction
of Cocolode (above) given to every
baby when "changing skin." Also
babies."Not
said "for
weed but only
2 old women knew of
rare use for urinary
trouble.Common
coastallocations;
in a few
leaves sold
in market, usually
dried.Common
diarrheaand
decoction for infant
children's stomachache.
"tea."Formerly
for
cultivated
towns.Common
ornamental in
Also
Also
jaundice.Leaf
for
taken
stomachache.Root
for colds and
L.AngloGroup
Tribulus cistoides
wild weed.
used.dministered
Not seen in market.Leaf
decoction given to children
when teeth hurt, without fever.Use
aLamiaceae
II: Commonly
adults.Native
to children; also taken by
Hyptis suaveolens Poit.
SanguraWild
weed. Sold
fresh and dried in
market.Weak
CompositaePorophyllum
weed; espe
macro-cephalum
rainyperiods.Common
cially common in
DCMampurituBoraginaceacCardia
cylindro-stachya
Seh.Basora
R. &
PretuBignoniaceaeCrescentia
L.KalbasAnnonaceaeAnnona
cujete
decoction a popular "tea (3),"
for appetite. Given to children for
breakfast. Taken for indigestion25
and stomachache. Often combined
with Mampuritu. (below)
(3)Often
decoction a popular "tea."
bychildren
taken morning and night
Commonlygiven
and adults.
andstomach
for childhood ills
complaints.Leaf
on questionnaire.Unknown
as in Curacao.
May be taken every
morning.
use.Others
of 44 admitted
givenit doubtless
childhood.22
in
sparselyintroduced
in Aruba;
recenttimes.Common
in
use.Others
of 44 admitted
givenit doubtless
childhood.15
in
butused wild shrub
abortion.Same
only for
Curacao.Leaf
as in
"tea."Considered
decoction drunk as
allover
wild tree
Sirupsold
island.
market.Cultivated
in
fromseeds)
from pulp (sometimes
colds.Leaf
is standard remedy for
egg,taken
decoction, with beaten
leastoneto loosen phlegm. At
(StropDì
physician gives the sirup
children."Tea"
Kalbas) to his own
use.Others
of 44 admitted
beengiven
may have
childhood.1
it in
popular.Often
of sundried leaves
use.Others
5 of 44 admitted
beengiven
may have
it in childhood.Rare
Alsotaken good for children.
menstrualcramps.
for diarrhea and
(black),forStrong decoction
abortion.Sirup
morning,or
given to children in
Takenwith
at night to induce sleep.
GroupIII)
decoction of Laraha (see
relievenervousness.23
every morning to
weed but not
of 44 admitted use.
Others doubtless given
it in childhood.Same
shrub.Driedwild
inmarket.Common
plant sold
fruit tree.Weak
L.SorsacaNative
nutricata
in Aruba (where
esophageal cancer is
popularbeverage,
"tea" a
inCuracao. as
NOVEMBER 1968
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2269
Julia F. Morton
Table 1 - Continued
LoasaceaeMentzelia
L.Dal aspera
PegaEuphorbiaceaeCroton
cancervictims
by csophagcal
orsurvivors
(44 victims
interviewed)12
useDecoction
weed.Sold wild
partlydry
fresh or
market.Very
in
asmorning may be given children
peopletakebeverage. Young
Forbiliousness,
to clear up pimples.
gallbladder liver and
togetherwith
ailments, taken
(above).Leaf
Sangura
use.Others
of 44 admitted
beengiven
may have
children.10
it as
notused.
native weed but
hairinessconsidered
Rough
irritatingto
skin.Common
Pretu(above)
decoction with Basora
birth.Leafgiven every child at
tochildren
"tea" often given
use.Others
of 44 admitted
beengiven
may have
children.7
it as
and"tea" wild shrub,
populartonic.Common
is a
admittedinternal
of 44
Othersmay
use.
givenithave been
children.29
as
butnot
wild vine
use.Often
for internal
externallyon
applied
andwounds.Same
rash, measles,
admitteduse,
of 44
enthusiasm.26
with
Curacao.Little
as in
admitteduse,
of 44
with enthusiasm.Status
sparselyintroduced
known;
asremedy and used
for stomach
trouble and syphilis.
(Aruban "orégano"is
wildshrub.
common
inmarket.Common
Not seen
L.WelensaliPassifloraceaePassiflora
flavens
Curacao
(whereesophageal
in Aruba
rare)A
cancer is
CuracaoCommon
in
beverage(3).Often
as morning
tonic,ortaken by adults as
rheumatism.Leaf
remedy for fever or
vine.Dried wild
plant some
foetidavar.
market.taken
times in
MoritzianaKillipKleistubomGroup
tochildren
"tea" often given
andtaken as morning beverage
afterimbibing
by men and women
Takenby too much liquor.
ofillness,
all ages at first sign
doctor.Leaf
before seeing
onprickly
extract commonly applied
rash.Plantheat
by
adults.Cultivated
CommonlyGramineaeCymbopogon
III:
homegardensin
citratusStapf.LamoengrasVerbenaceaeLippiaalba
fewtruck and by a
Soldfresh
gardeners.
market.Cultivated
in
homegardens.
in
N.E. Br.Availabilityfreshor Sold
dried in market.Principal
"tea,"drunk
decoction a favorite
forcoldshot or cold. Also taken
fever.Plant
and
"tea."Also
decoction is a popular
stomachacheand
taken for colds and
as a digestive after overeating.Use
Orégano
(Commercial orégano
from Mexico is
usually Lippia graveolens; from Europe,
usually a species of
Origanum).
Coleus amboinicus).
somehome in
RutaceaeCitrus
L.LarahaKrameriaceaeKrameria
aurantium
insmallgardens; and
plantationsfor
inCuracao
peel oil used
Liqueur.Fresh
inmarket.Wild
leaves sold
L.Cadia ixina
PerroLeguminosaeAcacia
Del
plentifulin
and
coastallocations.
certain
freshor
Sold
market,in
dried in
quantity.Very
oftenout
"tea" taken when feeling
"tea."pressure.
of sorts; also for high blood
(above)for Taken with Sorsaca
fornervousness;
gall bladder trouble and
inducesound also to
sleep.Men
20 of 44 admitted use.
Leaf decoction
drunk as
Aruba.imbibing
and women take infusion after
takeevery too much liquor; some
betakenmorning. Decoction may
"livertrouble."
several times daily for
decoctiontoWomen take weak
10 of 44 admitted
use.
Not found in
10 of 44 admitted use.
Not found in
strongfor
induce menstruation;
abortion.Root
wildshrub
common
Willd.Watapana
villosa
overisland.
all
ShimaronCultivated soldin Roots
market.Leaf
2270
very
Aruba.Root
chewed to relieve sorethroat.
kidneydisease;
decoction taken for
ofvinegar,also, with a dash
toloosen is a much used gargle
esophagealcancer
phlegm. Used by
theirdiscomfort.
victims to relieve
leavesor
Decoctions of
peeled branch similarly used.
CANCER RESEARCH VOL. 28
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Esophageal Cancer in Curacao
Table 1 - Continued
Use by esophageal cancer
victims (44 victims or
interviewen;8
Status in Aruba (where
curaçaoCultivated
in
use-Leaf rmcipai Curacao
Cajanus
indicasSpreng.WanduCliricidia
gardens.Fresh
in
inmarket.Cultivated
leaves sold
pregnantwomen
decoction drunk by
easydelivery;
for 7 or 8 months for
relievecolds.Leaf
also taken to
use.6
of 44 admitted
inin evidence of use
Aruba.Leaf
sepiumSteud.Raton;
homeyards in
alongroads.
and
inmarket.Cultivated
Not seen
fatigueand
decoction taken for
mixedwith
for severe colds. Also
loosensphlegm.
beaten egg for coughs;
orboiled Leaves also chewed raw
remedy.Leaf
in milk as a cold
use.5
of 44 admitted
takenfor
decoction
betterknown
colds, but
externalremedy
as
skineruptions
for
fever.Leaf and
bloodpressure,
decoction drunk for high
aday.
2 cups a day, 3 times
everyday.Weak
Some take the "tea"
use.2
of 44 admitted
oftentaken
"tea"
RatonAnacardiaceaeMangifera
Mata
homeyards. in
L.MangoBoraginaccaeToumefnrtia
indica
Sundriedleaves
inmarket.Common
sold
in'
1Sold
ananhalodes
Br.TaR.
Kam
shrub
on
freshti
market
Pli
Pìc/-arirtrtvauaoiiity
Twenty-three
Itas
leaf
for1decoction taken
A'
Wth
a beverage.
takei Pregnant women
AVendors A i
i-Decoction
t(
?i r
tosell
refuse
to young girls.i
CadiaDel taken liberally with
strongabortifacient.survivors
Perro (above) is a
of
admittedf
44
Krassed
M
of!*•'abortifacient.
because
takenfr>
decoction
«rnncssometimes
IciHnrv
for abortion.
i
Someusers
didnotprobably
admit it.No
plants of Curacao commonly used for remedies and for "tea."
notes (in the Dutch language) on the folk uses in Curacao of
approximately 104 plants which he identified only by 500
Papiamento names. Roughly half of these plants have been
found to be in quite common use by the native inhabitants.
In contrast with this active practice of folk medicine in
Curacao, the island of Aruba, just 42 miles away, has no herb
market and no printed literature on home remedies. On this
island, the limited pathologic data indicate that the incidence
of esophageal cancer is unremarkable, only 7 cases having been
diagnosed in the 3 years 1963-1966. Aruba is half the size of
Curacao and has roughly half the population.
In a survey of medicinal plants of Aruba, I assembled
information on 60 species more or less employed in folk
medicine.
Comparing these findings with those obtained in Curacao,
there appeared several striking differences between plants and
practices of the two islands. Of the 23 most used plants of
Curacao, only 10 are similarly employed in Aruba. The other
13 are either (a) unknown or rare in Aruba, (b) present but
not used, or (c) used differently i.e., externally instead of
internally or only by elderly people and not given to children
(8).
The 23 plants most commonly employed for remedies and
for "tea" in Curacao can be presented in 3 major groups as
shown in Table 1. Test quantities of these plants and 27 other
species collected in Curacao and lyophilized at the University
of Miami have been supplied to Dr. Roger O'Gara, Laboratory
NOVEMBER
t\
colds.Leaf
for
of Pathology, National Cancer Institute, for administration,
orally or by injection, to rats and mice. In addition, lyophi
lized material of several species has been furnished to pharmacognosists interested in pursuing their phytochemical study.
REFERENCES
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22(1): 87-102, 1968.
9. Morton, J. F. Cadushi (Cereus répandusMill.), a Useful Cactus of
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10. Van Meeteren, N. Volkskunde van Curacao. Curacao: Drukkerij
Scherpenheuvel, 1947.
1968
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2271
Plants Associated with Esophageal Cancer Cases in Curacao
Julia F. Morton
Cancer Res 1968;28:2268-2271.
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