July 21, 1923] 



NA TURE 



lOI 



The Problem of Cancer. 



/^NCE again the public is being made to focus its 

 ^-^ attention on cancer through the activities of 

 the recently constituted British Empire Cancer Cam- 

 paign. The object of this so-called campaign is to 

 collect large sums of money which will be devoted to the 

 further study of this disease^ which annually sweeps 

 away about 40^000 people in England and Wales alone. 

 The new campaign is taking place under the direction of 

 a committee which has been described as infiuentialj but 

 we search in vain for evidence that the committee, as a 

 whole, possesses the necessary qualifications to direct 

 or to suggest research on what is admittedly one of the 

 most difficult problems in biology. There can be no 

 harm in raising money for medical research — it is, in 

 fact, a highly praiseworthy object — but in the interests 

 of those who have provided the money, it is essential 

 that it should be used in the best way, and it does not 

 appear that the new committee, composed largely of 

 medical men practising among the political, wealthy, or 

 aristocratic sections of the community, is a suitable one 

 to direct cancer research. 



The raison d'etre of the new committee is indeed 

 obscure, for there already exists an Imperial scheme — 

 the Imperial Cancer Research Fund — which has been 

 hard at work with the problem of cancer for twenty 

 years. This committee is under the presidency of the 

 Duke of Bedford, who, as a Fellow of the Royal vSociety 

 and a man of science, has associated himself very closely 

 and practically with the problem for many years. In 

 addition to a large general committee of Imperial 

 flavour, there is also an executive committee specially 

 composed of men in the highest ranks of the profession, 

 practical and scientific. The work of the Imperial 

 Cancer Research Fund is universally admitted to be of 

 a very high order, and, although it has not been possible 

 to elucidate the cause or causes of malignant growths, 

 a flood of light has been thrown and many foolish views 

 have been exposed and confuted by the researches 

 first of Bashford and later of Murray, who have been 

 the scientific directors of the Imperial Cancer Research 

 Fund. Their work has placed the Fund in the forefront 

 of institutes devoted to the special study of cancer. 



It is difficult to understand why a second cancer fund 

 — also Imperial — should be started to do the same work 

 as that which has already been admirably done by the 

 first and older Imperial Cancer Research Fund. From 

 several sides comment has been made on this apparent 

 anachronism, and it has been suggested that, while the 

 new campaign might collect money, its distribution 

 should not be left in the hands of the new committee 

 but should be dealt with by scientific bodies like the 

 Royal Society or the Medical Research Council, acting 

 alone or in co-operation with the Imperial Cancer 

 Research Fund ; for, after all, the problem is one of the 

 most difficult now being studied in science. 



The Position of Cancer Research. 



The subject has passed beyond the realms of clinical 

 observation, and clinicians do not possess the requisite 

 education either to add to or even to supervise work 

 which demands highly-trained biologists. It is, indeed, 



NO. 2803, VOL. 112] 



becoming more and more apparent that cancer is 

 not merely a human problem but one of general 

 biology. 



There was a time when the word " tumour " was used 

 to include almost every kind of abnormal swelling that 

 was more or less circumscribed. A great many such 

 swellings have now been separated off, as they have 

 proved to be of inflammatory nature. Even among 

 true tumours a distinction has been made into those 

 that are benign and those that are malignant. Formerly 

 tumours were classified according to their shape or con- 

 sistence, and many terms employed in this period still 

 prevail, although with an altered significance. Examples 

 of this kind may be cited in such names as " fungus," 

 " polypus," " encephaloid," and " sarcoma." Even 

 the word " cancer " is derived from the supposed 

 resemblance of the cut surface of the tumour to the 

 spreading limbs of a crab. 



Up to the first third of last century it was commonly 

 held that cancers and suchlike tumours were something 

 foreign to the body ; but with the discovery of the cell, 

 Theodore Schwann showed that there was nothing in 

 any tumour that was really heterologous. His re- 

 searches, continued by Lebert, were immensely ex- 

 tended by Virchow in his great work " Die krankhaften 

 Geschwulste " (1863-67), to which but little has been 

 added or subtracted from a purely pathological view- 

 point. He showed that every tumour is the result of 

 a tissue-forming function derived from the constituents 

 of the body, and the real problem of tumour formation 

 to-day is to find what starts this and causes the tissues 

 to behave in an abnormal way. Every tumour repre- 

 sents a breach in the continuity of some tissue, so that, 

 although arising in a tissue and due to the proliferation 

 of that tissue, the new growth, tumour, or blastoma, as 

 it is called, is really inimical to the well-being of the 

 tissue. Its growth is progressive and unlimited. The 

 cells of which every tumour is composed are bolshe- 

 vistic, anarchical, or autonomous in varying degree. 

 The laws that govern the behaviour of the cells of a 

 tissue towards each other or other cells are violated. 

 The tumour cells are in some mysterious way set free 

 from restraining influences, and, having attained their 

 liberty, behave in a riotous rather than an orderly 

 manner. Although it is common to speak of cancer as 

 something special, there is the same process at work in 

 all tumours, but the degree of autonomy varies in each. 

 If left to themselves, even the most innocent tumours 

 grow progressively, and may become harmful in virtue 

 of their magnitude. Some of the largest tumours 

 known are benign in a clinical sense, while some 

 of the smallest in point of size may be of deadly 

 malignancy. 



Basing the classification of tumours on their origin — 

 histogenesis — Virchow separated them into three great 

 classes according to their components. In his first 

 group— simple histioid tumours — there was only one 

 tissue, whereas in the second or organoid tumours two 

 tissues were involved, one being connective tissue, the 

 other epithelial. In his third group — teratoid tumours 

 — the new growth was composed of several tissues 

 arranged in organ-like fashion. Whatever starts the 



