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176
CANCER

the special benefit of persons suffering from cancer. It was fitted up and endowed anonymously by Mr. Samuel Whitbread, M.P. for Bedford, and according to the terms of the benefaction at least six patients were to be continually maintained in it until relieved by art or released by death. The purpose was both philanthropic and scientific, as Mr. Howard explained in bringing forward the suggestion. Two principal objects, he said, presented themselves to his mind, “namely, the relief of persons suffering under this disease and the investigation of a complaint which, although extremely common, is both with regard to its natural history and cure but imperfectly known.” This benefaction was the origin of one of the most complete institutions for the scientific study of cancer that exists to-day.

In 1804 a Society for Investigating the Nature of Cancer was formed by a number of medical men in London, Edinburgh and other towns at the instigation of John Hunter. The aim was collective investigation, and an attempt was made to carry it out by issuing forms of inquiry; but the imperfect means of communication then existing caused the scheme to be abandoned in a short time. Subsequent attempts at collective investigation also failed until recently. About 1900 a movement, which had been for some time gathering force, began to take visible shape simultaneously in different countries. The cancer ward at the Middlesex hospital had then developed into a cancer wing, and to it were added special laboratories for the investigation of cancer, which were opened on the 1st of March 1900. In this establishment the fully equipped means of clinical and laboratory research were united under one roof and manned by a staff of investigators under the direction of Dr W. S. Lazarus Barlow. In the same year the Deutsche Comité für Krebsforschung was organized in Berlin, receiving an annual subsidy of 5000 marks (£250) from the imperial exchequer. This body devoted its energies to making a census of cancer patients in Germany on a definite date. A special ward for cancer was also set apart at the Charité hospital in Berlin, with a state endowment of 53,000 marks (£2560) per annum, and a laboratory for cancer research was attached to the first medical clinique under Professor Ernst von Leyden at the same hospital. A third institution in Germany is a special cancer department at the Royal Prussian Institute for Experimental Therapeutics at Frankfort-on-Main, which has been supported, like the Imperial Cancer Research Fund in England, by private contributions on a generous scale. The fund just mentioned was initiated in October 1901, and its operations took definite shape a year later, when Dr. E. F. Bashford was appointed general superintendent of research. The patron of the foundation was King Edward VII., and the president was the prince of Wales. It had in 1908 a capital endowment of about £120,000, subscribed by private munificence and producing an income of about £7000 a year. The central laboratory is situated in the examination building of the Royal Colleges of Physicians and Surgeons in London, and the work is conducted under the superintendence of an executive committee formed by representatives of those bodies. In the United States a cancer laboratory, which had been established in Buffalo in 1899 under Dr Roswell Park, was formally placed under the control of New York state in June 1901, and is supported by an annual grant of $15,000 (£3000). There are other provisions in the United States connected with Harvard and Cornell universities. At the former the “Caroline Brewer Croft Fund for Cancer Research” started special investigations in the surgical department of the Harvard Medical School in 1900 or the previous year, and in connexion with the Cornell University Medical School there is a small endowment called the “Huntingdon Cancer Research Fund.” There appear to be institutions of a similar character in other countries, in addition to innumerable investigators at universities and other ordinary seats of scientific research.

Some attempt has been made to co-ordinate the work thus carried on in different countries. An international cancer congress was held at Heidelberg and Frankfort in 1906, and a proposal was put forward by German representatives that a permanent international conference on cancer should be established, with headquarters in Berlin. The committee of the Imperial Cancer Research Fund did not fall in with the proposal, being of opinion that more was to be gained in the existing stage of knowledge by individual intercourse and exchange of material between actual laboratory workers.

In spite of the immense concentration of effort indicated by the simultaneous establishment of so many centres of endowed research, and in spite of the light thrown upon the problem from many sides by modern biological science, our knowledge of the origin of cancer is Theories
of cancer.
still in such a tentative state that a detailed account of the theories put forward is not called for; it will suffice to indicate their general drift. The actual pathological process of cancer is extremely simple. Certain cells, which are apparently of a normal character and have previously performed normal functions, begin to grow and multiply in an abnormal way in some part of the body. They continue this process so persistently that they first invade and then destroy the surrounding tissues; nothing can withstand their march. They are moreover carried to other parts of the body, where they establish themselves and grow in the same way. Their activity is carried on with relentless determination, though at a varying pace, until the patient dies, unless they are bodily removed. Hence the word “malignant.” The problem is—what are these cells, or why do they behave in this way? The principal answers put forward may be summarized:—(1) they are epithelial cells which grow without ceasing because the connective tissue has lost the capacity to hold their proliferative powers in check (H. Freund, following K. Thiersch and W. Waldeyer); (2) they are embryonic cells accidentally shut off (J. F. Cohnheim); (3) they are epithelial cells with a latent power of unlimited proliferation which becomes active on their being dislocated from the normal association (M. W. H. Ribbert and Borrmann); (4) they are stimulated to unlimited growth by the presence of a parasite (Plimmer, Sanfelice, Roncali and others); (5) they are fragments of reproductive tissue (G. T. Beatson); (6) they are cells which have lost their differentiated character and assumed elementary properties (von Hausemann, O. Hertwig). The very number and variety of hypotheses show that none is established. Most of them attempt to explain the growth but not the origin of the disease. The hypothesis of a parasitic origin, suggested by recent discoveries in relation to other diseases, has attracted much attention; but the observed phenomena of cancerous growths are not in keeping with those of all known parasitic diseases, and the theory is now somewhat discredited. A more recent theory that cancer is due to failure of the normal secretions of the pancreas has not met with much acceptance.

Some generalizations bearing on the problem have been drawn from the work done in the laboratories of the Imperial Cancer Research Fund. They may be summarily stated thus. Cancer has been shown to be an identical process in all vertebrates (including fishes), and to develop at a time which conforms in a striking manner to the limits imposed by the long or short compass of life in different animals. Cancerous tissue can be artificially propagated in the short-lived mouse by actual transference to another individual, but only to one of the same species. Cancerous tissue thus propagated presents all the characteristic features of the malignant growth of sporadic tumours; it infiltrates and produces extensive secondary growths. Under suitable experimental conditions the aggregate growth of a cancer is undefined, of enormous and, so far as we can judge, of limitless amount. This extraordinary growth is due to the continued proliferation of cancerous cells when transplanted. The processes by which growing cancer cells are transferred to a new individual are easily distinguishable and fundamentally different from all known processes of infection. The artificial propagation of cancer causes no specific symptoms of illness in the animal in which it proceeds. Under artificial propagation cancer maintains all the characters of the original tumours of the primary hosts. Carcinoma and sarcoma agree