ON CANCER:

ITS ALLIES AND COUNTERFEITS.

CHAPTER I.

THE NATURE AND PRIMARY CAUSE OF CANCER.

CANCER is the quaint term applied to a growth which is alien to the natural tissues of the body, and does not undergo those morphological changes which belong to the healthy structures of man. The reason for the term and who applied it are questions of the smallest import. Who will derive any benefit from an enquiry as to whether a crab with its claws gave a name to a tumour which in reality has only occasionally any suckers or offshoots to justify the typical epithet; or whether Hippocrates indicated the peculiar disease to which we now restrict the term cancer, by the word xapxívos? The Sanscrit karka' is no doubt the root of the word used by the Greek father of physic, and that is understood to mean an eroding ulcer of any kind. Our learned modern pathologists have appropriated the Greek expression, and carcinoma is now the accepted classical substantive, to which however many adjectives have to

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be attached. The Latin word cancer undoubtedly means both the shell-fish and an ulcer of a virulent character. Celsus makes frequent mention of cancer, but not with sufficient distinctness to assure us that he was enabled to diagnose that which we now recognise as cancer, from other tumours and indurated ulcers. Our insular vanity might perhaps induce the assertion that the old Anglo-Saxon word 'scanca,' a sore, an open wound, was the remote root of the term, canker being the intermediate popular expression, from which, of course, cancer would be a natural and legitimate descent. It is curious that the German 'schanker' and the French 'chancre,' indicating an ulcer of an eroding character, should be so near in phonetic and orthographic similitude to the Anglo-Saxon word above mentioned, and to the Latin word cancer. These resemblances point to the conclusion that, in former times, two utterly distinct diseases were confounded; and if they were treated alike, I could venture to parallel the obliquity, by instances of a similar character, even in the present day. It behoves us, however, to be humble in the estimate we give of the knowledge of our forefathers, seeing that we ourselves with all the aid afforded by the wonderful improvements in the microscope, which gives us the advantage of observing the operations of nature in the construction and destruction of tissues-have yet much to learn respecting the origin, and nature, and diagnosis, and treatment of the various tumours, which either are allied to or are in reality cancer.

The feature of the present time, in reference to this class of diseases, is just the opposite of that which pre

vailed in the time of Celsus, and for many hundred years after. Formerly many clearly distinct diseases were classified as cancer, and now that term is restricted to growths which exhibit only a particular form of cellformation, although, to the unassisted eye and the sense of touch, the tumour may be in all respects similar. Perhaps it is not surprising that pathologists of the present day insist upon this microscopic evidence as all-important in the diagnosis of tumours, seeing that even so late as the times of Abernethy and Sir Astley Cooper, much confusion existed in the definition of a cancerous growth. To no one, within this century, are we more indebted for enlightenment respecting this disease, than the distinguished Physician, Dr. afterwards Sir Richard Carswell, who was selected by the astute Prince Leopold as his body-physician when called to the throne of Belgium.

Since the publication of the great work of Dr. Carswell in 1833, we have all had the opportunity of studying the aspect of cancer, in its complicated and varying conditions. This elaborate work, in a great measure, supplies the place of that large experience which is necessary to acquire correct diagnostic powers in the disease; except that, whilst showing what is cancer, it of course does not portray tumours, which the public, and certain charlatanic personages, believe, or pretend to believe, to be cancerous, but which have none of the malignant qualities appertaining to that form of disease.

Many scattered essays, especially those by Mr. Travers and Mr. Cæsar Hawkins, have helped on the definition of a cancer. M. Velpeau in Paris, and Dr. Walshe in

London, have published large tomes on the subject, without however exhausting the enquiry, either as to diagnosis or treatment. More recently, high expectations have been entertained of the benefits to be derived from the microscopic investigations of Kolliker, Virchow, Wedl, Lebert, Paget, Bennett, Beale, and others; and these labours have doubtless been of the utmost value in showing in what degree cancer differs from other abnormal growths, and in what measure its ultimate cell-structure has deviated from that of the normal tissues.

When a cancer cell was first announced, it was proclaimed from all the chairs as the one thing needful for diagnosis. Ecce signum! Tested however by further enquiry, it was shown by Virchow, Wedl, and others, that many parts of the healthy structures of the body would be found to yield the peculiar nucleated irregularly formed cell, which had been obtained from carcinomatous growths.

The present state of our knowledge of the cell-structure of cancer appears to be this: that in all the forms of cancer, excepting the epithelial, we may find cells approaching the globular form, but deviating from it in some particular, as though the globe had been submitted to pressure, and its walls had bulged out, giving it the appearance of a tadpole in one, of a kidney in another, whilst a third may be so branched as almost to resemble the well-known fish called five-fingers. Whatever shape it may have attained, the cell always contains one or more nuclei, and these again nucleoli. The cell of Epithelial Cancer is an irregularly shaped epithelial cell. It has lost its natural circular appear

ance, has probably obtained branches like the cell of the other cancers, or has the appearance of having been bitten round its border. It also has its nucleus and nucleoli.

When these deviations from a healthy cell are found in a tumour, we may positively pronounce the case to be one of cancer; but the value of this diagnostic sign is unfortunately marred by two significant circumstances, viz., the necessity to form a decided opinion as to the nature of a tumour before it is possible to place it under the microscope; and the fact that tumours which have been removed and have not yielded under the microscope the especial cancer cell, have nevertheless returned, and destroyed the patient in the very same manner that cancer does its direful work.

Although there are these two great and important deficiencies in the completeness of the diagnostic value of the microscope, the information it affords enables us to devise and pursue a plan of treatment, which has for its basis an exact knowledge of how this destructive disease is propagated in the system-a knowledge which was only guessed at by our forefathers.

The minute anatomy of the structure of tissues, studied at the expense of precious eye-sight, and with great cerebral exhaustion to its devoted enquirers, has shown that the pabulum vitæ, after passing through the lacteals and absorbents, becomes, as Dr. Beale has christened it, germinal matter,' more generally known as cellular structure. This germinal matter, the immediate result of the deposition of the pabulum, takes on first a globular or cellular form, it then bursts, and its walls become a part of the previously formed

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