824 



NATURE 



[February 24, 192 1 



The Methods of Cancer Research. 



Some Conclusions on Cancer. By Dr. Charles 

 Creighton. Pp. xiii + 365. (London: Williams 

 and Norg-ate, 1920.) Price 425. net. 



" npHERE is something common to all tumour- 

 _£ malignancies, which I take to be cells 

 feeding on the substance of blood to their own 

 aggrandisement, instead of metabolising it, stor- 

 ing it, or transmitting it to an ulterior end. But 

 that risk arises in various ways. In all cases 

 there must be an unfortunate occurrence of a 

 number of factors, of which one may be preroga- 

 tive in one case, another prerogative in another " 

 (P- 83). 



In these words Dr. Creighton summarises his 

 conclusions on the nature and mode of origin of 

 cancer. It is necessary to add that the cells in- 

 volved are only rarely the cells of the specific 

 parenchyma of the organ in which cancer arises. 

 In most cases they are endothelial cells or plasma 

 cells. The apparent reproduction of the structure 

 of the specific parenchyma in the cells of the new 

 growth is a mimicry, a pseudo-differentiation 

 which it may at once be confessed has deceived 

 three generations of pathologists. Metastases 

 arise by a similar transformation of cells of dis- 

 tant organs, and not by embolism as currently 

 believed. The similarity in structure to the 

 primary growth which they present is mysterious 

 ■ — "mystical" — and no explanation is offered or 

 suggested. 



The credibility of a hypothesis is judged by the 

 number of different observations which it har- 

 monises : its utility by its power to suggest new 

 methods and lines of work. In both directions 

 Dr. Creighton 's book is of little value. The 

 author recognises that his views do not harmonise 

 with the observations of others. He has a short 

 way with them. The other observers are wrong. 

 This is particularly well exemplified in his dis- 

 cussi^in of the histogenesis of carcinoma of strati- 

 fied squamous epithelium. It is stated to arise 

 from cells of a cambium layer lying between the 

 basal layer of the stratum Malpighii and the 

 corium in squamous cell carcinoma of the skin 

 and tongue. In the oesophagus the same type 

 of growth arises from capillary loops which pene- 

 trate the superjacent squamous epithelium. The 

 evidence for these remarkable statements is based 

 on rough semi-diagrammatic figures of large 

 growths, several of which are ulcerated. A labori- 

 ous summary is given of the earliest work on the 

 subject by Thiersch and Waldeyer. The beauti- 

 fully illustrated monographs of Ribbert and 

 Borrmann on the same subject, in which new 

 growths of microscopic size are analysed, almost 

 NO. 2678, VOL. 106] 



cell by cell, are not mentioned. There is one 

 short reference to the confirmatory work of Butlin 

 in this country. The whole argumentation i& 

 irrelevant, and does not shake in the least the 

 evidence that squamous cell carcinoma arises in 

 minute circumscribed areas in stratified squamous 

 epithelium. Once the primary transformation has 

 been accomplished, no evidence can be found for 

 increase in size by transformation of surrounding 

 cells into cancer. 



The origin of metastases is dealt with in the 

 same way. Large nodules with vascular connec- 

 tions with the surrounding tissues are adduced in 

 illustration of a transformation of the surround- 

 ing cells into new growth. The earliest stages 

 in which cancer cells lie among unaltered blood 

 corpuscles, such as are familiar to every working 

 pathologist, are unknown to the author. The 

 confirmatory evidence furnished by the experi- 

 mental reproduction of blood-stream metastasis 

 and by subcutaneous inoculation of cancer in 

 laboratory animals is too damning to ignore, and 

 a chapter and a half are devoted to the subject 

 of "mouse-cancer." Here the author is com- 

 pletely out of his depth. Where the facts are too 

 patent, they are passed over in silence or simply 

 contradicted, as, for example, the absence cf 

 cancer in selected families inbred for generations^ 

 and the occurrence of cancer in female mice which 

 have never borne young and in wild mice. 



The origin of grafted tumours from introduced 

 cells is denied, and the figures in which the con- 

 tinuity is traced day by day are described as show- 

 ing an origin from nuclear debris lying in a form- 

 less mass of disorganised protoplasm. The adja- 

 cent intact cells in which mitosis proceeds are 

 regarded as having nothing to do with the forma- 

 tion of the new tumour. The general confirmation 

 in the rat, rabbit, guinea-pig, and dog of the 

 observations on new growths of the mouse is not 

 even mentioned. 



It is unnecessary to review in detail the other 

 chapters on chorion-epithelioma, glioma, cancer 

 of the mamma, stomach, and rectum. It is only 

 too evident that the author has approached the 

 subject with vague preconceived ideas, any illus- 

 tration of which can be made to function as rhe- 

 torical proof. As he naively remarks in the pre- 

 face, " he can imagine nothing better for the future 

 progress of these studies than that others, bring- 

 ing their own prepossessions, should resort to the 

 same cabinets [of slides in the pathological depart- 

 ment of a great hospital] to find in the infinite 

 variety of phenomena the proofs which they seek." 

 As may easily be imagined, a work conscientiously 

 written throughout in this spirit contains little 

 that is suggestive for new investigations, whether 



