THE NATURE AND ORIGIN OF CANCER
BMJ (Clinical Research Edition)
a 1G25 germ plasm, and atavistic clharacters such as cancer cells possess can onily be explained in terms of the hereditary substance. I suggested that the cells witlh exlhausted energy of cell division now began to exert an attraction-a positive chemiotaxis for germ cells or for their specific idioplasm-iithe germplasm. Now, although the active iigration of germ cells is not ulnknown in nature, yet it hardly seems likely under the circumstances we are discussing; the only alternative
... ternative assumption is that some special "1 carrier leucocyte " takes up the germinal idioplasm and migrates towards the somatic cell, beiilg attracted thither by chemniotaxis. The conjugation of two such cells miglht account for the cancer cell witlh properties of both-that is, witlh the reproductive power of germinal cells, but domninated by its own specific idioplasm, and therefore retainiug imiore or less it own specific clharacter. So far as the animiial body is concerned, this process of auto-fertilization would presumably result in a new species of cell (not a protozoan or new independent living creatuLre as Sir Henry Butliii supposes), but a sort of lhybrid cell witlh r-enewed power of muiltiplication, anid which in the vigour of youth ruins riot alnd devours all before it, thlus constituting the rapidly multiplying canicer cell. It will be seen that otl this germ-plasm theory tlle cancer cell is tlLus closely related to the spermnatozoon of tlle same host, llence, perhaps, its analogy to' the livinig parasite. The conditions wlichl predispose to the exhaustioln of the energy of cell division, and whicih indirectly predispose to cancer are (1) age, and (2) prolonged reproductive activity of cells, whether as a niormal process of repair oft repeated, or as a direct response to some irritant; for it is niow kniown that somne physical, chemical, and patlhological agents lhave tlhe specific power of inducing Iroliferative activity directly. It is impossible to go into detail lhere, but I ml-ay say tllat miiost of the prinmary pheinomena of cancer can be accounted for on this germ-plasmi theory, and, like Sir Henry Butlin, I would say a diligent search is required to find the two or three essential phelnomena of cancer which are not explained by it. In conclusion, if this germ-l-plasm theory is aln approaclh in the right direction, it mnight suggest new means of attaking the cancer problem-i, suclh as a sttudy of the relative behaviour of cells from tlle point of view of chemiotaxis.-I am, etc.. Londoni, E., Dec. 8th. F. B. SKERRETT. SiP,-I tlhinl tlle standpoint fromn wlicih Sir Heniry Butlin approaclhes the problemii of cancer is the only logical one. The lhunlan body mnay be compared to a lhuge arm-y of soldiers-eaclh cell a soldier-arranged inl methodical groups, eaclh group kniowing and ldoing exactly the work expected of it. Biut there miiust be a controller of this huge army, otherwise disorganization results. Sir Alfred Pearce Gould, in hiis Bradshaw Lecture, stated that the knowledge of the law wricll governls cell growtlh is thee power required to prevent, to control, and to curie cancer. There muls-t be a governor of cell activity somewh-liere in tlle body, and tlle fact of carcinomatous growtlh occuirring after iniddlc age makes one wonder in wllicl part of the anatomy the governor exists, also affected by the lapse of timl-e, degellerating, and th-us losing its governing power. Mr. Kenniietlh Campbell, ill a letter published in the JOURNAL (Jalnuary 28tlh, 1911), asks: " What hidden force is it which lashes the epitlhelial cells into such unwonted reproductive activity ?" I rather ask: "SWhat hlidden force is it, now absent, wlichl, up to the present, lhas prevented the epithelial cells, lashecl into uniwonted reproductive activity by continued local irritation, fromi becoming mutinous and going far beyomid the reparative process?" It is surely a secretioln, which is absorbed into the blocd and acts chemically oni cell lrocesses. Drs. Ross and Cropper have induLced cell divisioni in humian leucocytes and in epithelial cells by the agency of certain chemical substanees namely, kreatin, xantlhine, annd suibstances containina the amidine groupingl. For this secretion, this reguLlator of cell growthl, we laturally look to glands whlicl are comparatively large in the young. Suclh glands are the ductless glands. AWe know that the tlhyroid, the pituitary body, and the adrenals are intimiiately associated with tlle m-etabolism of the organisni. Thepbhysiology of-the thyroid is *ell kno'own; tlhe pituitar-y body lhas been. desiginated by Woods, Hutcihinson the growvthi-centre; htyper-pituitarism resuilts in acromlegaly and gigalitism; lhypo-pituitarismii in infantilisim. Experimental evi(lence also is in favotur of the view that the adrenals fuirnislh an internal secretioni essential to normiial metabolism. Havinig these facts in miiind, I aslied BuLrrouglhs, Wellcom-Le, and Co. to rei-rove fromii a slheep the tlhyroid, adrenals, alnd the elntive pituitary body-for it is tlle secretion of the aniterior lobe of this body whlichl is concerned in tissuie mlietabolismn-to tioroughly triturate tlhemll. anid make s;ome tabloids. This' they carried out carefuLlly. witlh thle result that eaclh tabloid colntained glanidulac thyroidei grains 6, glandulae suprarelnalis grain :, anid corporis pitulitariaclgranll j. Oni June 23rd last I ivas conisuilte(d ly a lady, aged 46. Shle comiplainie(l that for the last few miiointhls there had b)eeii gradually increasing difficulty in swallowing, aii( that she could now only take liquids very slowvly. With the linger onie could feel ani irregular ol)struction at the upper part of the gtiiltet; b)eyon(l this it couldi Inott pass. Tbe breatli was offeisive, and( occasi(lially slhe 'hawkled " up phlegm-i tinlged witlh bloo(l. Shle was wveak, alnd trembffled at the kniiees. The diagnosis was that of carcinomia of the oesopliagfus. In the course of a few weeks shle got much worse, lhad attacks of fainting frolmi shieer weaklness, looked ill, witlh slhrunklheni, listless eyes, anid evidences of the cancerous cachexia. I senit her at this time to a Liverpool surgeoin with a view to, at anyv rate, a partial removal. He conilirmed my diagfnosis, confesse(d hiis inability to operate, and gave a hopeless prognosis. On July 31st I put lher oni these tri-glaiid tabloids-onle niight and morning. Sihe didlnot improve; neither, however, di(d slhe get worse. It was at this time I had the utmost difficultv in disstuading the relations from taking her to a quack. In tlhe course of two m--ouitlhs, h-owever, oile could see a very slow, gradual improvement, an(d this was more rapid during thie followi-ng two moniths. Slhe gathered strengtlh and weiglht, lost her we'arv look and became miiore animated, anid lhad nIot such difficulty in swallowingr liqulids-the grainis of B3eniger's Food, as she calledl themii, still gave hier trouible. A monitlh ago I increasedl the dose of tabloids to tlree a (lay. Slhe was tlhe able to swallow bread anid butter well masticated. On Decemiiber 2nd I founid lher, as slhe declared, "A As well as ever I was, anid cani swallow everything except butcher's miieat' -indeed, I have a shrewd suspicioni that slhe was anxious to dispense witlh ml-y services altogether, being an lhoniest womana, anid afraid of lher liability to me. Thiie breath is nio longer offenisive, and( shie (loes niot now uise the spray (mentlhol). Thle tabloids produced nio ill effects whiatever. But after all, an ounice of practice is worth a toln of thieory. I (lo not get mainy cases of carcinomlla, and I sllotld likc others, mnore fortulnate, to try tllis treatment.-I ai, etc., Wi,gan, Dec. 3rd. J. THOMISONT SHIRLAW. SIR,-WAith1 reference to Sir Hnelry Butliii's suggestioon as to the fins?s ct oriqo cancri miiay I be permuitted to quote a paragraplh frolml The Present Evolutioii of Manz, written miiore tlhau fifteen years ag,o by Archdall Reid? Sometimes, tlhoIugh rarely, this or that cell-descendant of the ,germ reverts to the very remote unicellular aincestral type, in so far that it does Inot miultiply at a rate hearing a detinite pro-L)oirtioln to tlhe rates of mu-nltiplicationi of its other co-descenldanits of the germl-cell, hut at a rate that has nio definite l)roportioli to them, anid is onily proportionate to its supply of nultrimelnt and powers of assimilatioli. T'lhere tlheni results the morl)id condi-tioIn wlhichl is knownasa tumour '(cancer), in which the celldescendants of a cell whichi hasg so reverted to the remote ancestral type form at m-iiore or less spherical mass lvhic lerforms ilo dlefiniite functionis hbeneficial to the whole mass of the cell-commiiiiunity, lbut is ratlher a deadly encumbrance.