Part 22

Cancer tends to advance steadily to a fatal termination, but its duration varies in different cases according to the part affected and according to the variety of the disease. Soft cancer affecting important organs of the body often proves fatal in a few months, while, on the other hand, cases of hard or epithelial cancer may sometimes last for several years; but no precise limit can be assigned for any form of the disease. In some rare instances growths exhibiting all the signs of cancer may exist for a great length of time without making any progress, and may even dwindle and disappear altogether. This is called "spontaneous cure."

Cancer research.

Cancer has been the subject of observation from time immemorial, and of the most elaborate investigation by innumerable workers in recent years; but the problems of its origin and character have hitherto baffled inquiry. Modern scientific study of them may be said to have begun with J. Muller's microscopic work in the structure of cancerous tissue early in the 19th century. A great impetus to this line of investigation was given by the cellular theory of R. Virchow and the pathological researches of Sir J. Paget, and general attention was directed to the microscopic examination of the cells of which cancer is composed. This led to a classification, on which much reliance was once placed, of different kinds of cancer, based on the character of the cells, and particularly to a distinction between _carcinoma_, in which the cells are of the epithelial type, and _sarcoma_, in which they are of the connective tissue type. The distinction, though still maintained, has proved barren; it never had any real significance, either clinical or pathological, and the tendency in recent research is to ignore it. The increased knowledge gained in numerous other branches of biological science has also been brought to bear on the problem of cancer and has led to a number of theories; and at the same time the apparently increasing prevalence of the disease recorded by the vital statistics of many countries has drawn more and more public attention to it. Two results have followed. One is the establishment of special endowed institutions devoted to cancer research; the other is the publication and discussion of innumerable theories and proposed methods of treatment. Popular interest has been constantly fanned by the announcement of some pretended discovery or cure, in which the public is invited to place its trust. Such announcements have no scientific value whatever. In the rare cases in which they are not pure quackery, they are always premature and based on inadequate data.

Organized cancer research stands on a different footing. It may be regarded as the revival at the end of the 19th century of what was unsuccessfully attempted at the beginning. As early as 1792, at the suggestion of Mr. John Howard, surgeon, a ward was opened at the Middlesex hospital in London for 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 Comite fur Krebsforschung_ was organized in Berlin, receiving an annual subsidy of 5000 marks (L250) 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 Charite hospital in Berlin, with a state endowment of 53,000 marks (L2560) 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 L120,000, subscribed by private munificence and producing an income of about L7000 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 (L3000). 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 confe