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Annotations.

EXPERIMENTAL CANCER RESEARCH.

"Ne quid nimi9." "

IN the twenty-third annual report of the ImperialCancer Research Fund which we notice on anotherpage, Dr. J. A. Murray, F.R.S., the director, refers tothe publication in THE LANCET of July 18th, 1925,of the paper by Dr. W. E. Gye as the outstandingevent of the year. He summarises Dr. Gye’s concep-tion of the aetiology of cancer in the following terms :-

" The essence of Dr. Gye’s conception is that malignantgrowth results from the concurrence of two factors-anultra-microscopic microbe and an unstable chemical factorderived in his experiments from propagated malignanttumours of animals, and it would be erroneous to regardeither of these factors, singly, as the cause of cancer. Thedirect evidence of this dual origin of new growths has sofar only been furnished for the Rous fowl sarcoma and fora transplantable sarcoma of the mouse. For other tumoursthe evidence is indirect, cultures of these supplying theultra-microscopic microbe, the specific unstable chemicalfactor being supplied by an extract from the Rous fowlsarcoma, in which species of animal the two injected simul-taneously gave rise to progressively growing sarcoma.

Injected singly, they are inert. The delicate racial andtissue specificity governing the transmission of malignantnew growths therefore attaches to the labile chemical factor,and not to the microbe. One of the gravest objections topreviousformsof the parasitic hypothesis of cancer is therebymet. These experiments have only been possible by theuse of the propagated animal tumours which are sutlicientlyexempt from ordinary bacterial contamination, and it isa legitimate source of satisfaction to this Fund that theirprevision in maintaining this material over many years,including the war period, should have received its dueacknowledgment and reward."It is obvious that this dual conception of the aetiology

and pathology of cancer, should it be confirmed, introducesa new orientation in every aspect of the cancer problem :statistics, epidemiology, causation, prevention, and treat-ment."

Dr. Murray states that the workers of the Fund have,at Dr. Gye’s request, undertaken a critical repetitionof his fundamental experiment, and he deprecatespremature speculation and anticipation in view of thefact that the new problems are susceptible of directexperimental study. But we may perhaps be allowedto express the opinion that everybody interested inthe cancer problem-and there are many-will lookforward to the next annual report of the Fund with thekeenest interest.

Of the work published during the past year twopapers are specially referred to by Dr. Murray. It isnow recognised that cancer of the skin can beproduced at will in mice by repeated painting of alocalised area of the skin with tar. If this is repeatedover many months several times weekly about70 per cent. to 80 per cent. of the animals will afterfive to nine months develop a typical skin carcinoma.Dr. Findlay has found that even the single applicationof hot tar may, in exceptional cases, produce cancerafter a long period of time-about a year. The tarno doubt remained in the traumatised area for aprolonged period of time. But from the clinicalpoint of view it is interesting to have an experimentaldemonstration that a trauma due to a single extraneousintervention may be responsible for the genesis ofcancer. The second investigation referred to dealswith the theory which has been propounded thatcancer is due to a loss of nervous control overa group of cells. Malignant new growths are notefficiently innervated, if indeed they contain anynerves at all. The cells of the normal skin, on theother hand, are supplied with a very rich networkof fine nerve-fibres. It has been suggested, therefore,that the origin of cancer is to be found iu thisdifference; in other words, that normal cells becomecancerous or, at least, predisposed to cancer when theyescape for some reason or other from nervous control.This view was submitted to an experimental test byDr. W. Cramer, who denervated an area of skin and

then submitted it to chronic irritation by tar-painting.It was found that the denervated area responded totar-painting by the production of tumours not morerapidly but much more slowly. It is clear, therefore,that absence of nervous control does not predisposeto cancer. On the contrary, it seems to retard thegenesis of cancer. It would appear from theseobservations that in the production of a tar tumour weare dealing with the effect of a chronic irritant noton the epithelial cells only but on the tissue as a whole.Owing to the fact that these experiments necessarilyextended over many months and that during that timea gradual nerve regeneration took place in thedenervated area it was not possible to determinewhether a permanent absence of nerve control wouldcompletely inhibit the genesis of cancer. Theseresults would appear to be in keeping with the regressionor limitation of the growth of a cancer which hassometimes been obtained in man by denervation.To the superficial observer it may seem remarkable

that the production of cancer by the laborious applica-tion of tar should still occupy the time of investigatorswhile acknowledgment is made of the revolution incancer research introduced by the work of Dr. Gyeand Mr. Barnard. It is obvious, however, that anynew knowledge must be harmonised with what isalready known, and furnish a rational account of theway in which cancer arises from normal tissues, beforeit can be recognised as an adequate solution of theproblem of the aetiology of malignant new growth.

GASTRO-ENTEROLOGY IN SPAIN.

THE subject of special clinics and hospitals forspecial diseases is being discussed with increasingfrequency in medical circles in this country, and apoint seems to have been reached when the advocatesof so-called all-round knowledge have come to defendwith increasing vigour those portions of the humanbody whose study has not yet been seized from themby otologists, neurologists, dermatologists, cardio-logists, urologists, and other specialists. The outcomeis yet to be seen, but it has already become somewhatremarkable that special departments for diseases ofthe endocrine organs, the alimentary tract, andmetabolic diseases are not to be found in London.Opinion may differ as to whether this is desirable ornot. Advocates of further specialisation will, how-ever, be interested in a recent Spanish publicationwhich we have just received. 1 The MadinaveitiaInstitute at Madrid was recently created for the closerstudy and appropriate teaching concerning gastro-enterology, endocrinology, and the disorders of

nutrition. It comprises a large, out-patient clinicand 12 wards, where upwards of 400 severe cases aretreated in the course of each year. The X ray andlaboratory equipment are of the latest pattern, andthe yearly reports contain matter of high scientificinterest. The article on the surgical treatment ofgastric ulcer, by Dr. Urrutia, contains a learned surveyof the present opinion of surgeons in all countrieson this subject, and it is instructive to note thegrowing interest in the operation of gastrectomy,and the increasing suspicion as to the ultimate valueof gastro-enterostomy prevalent in Spain. Dr.Carrasco Cadenas has contributed an article on thediagnosis and treatment of diabetic coma, and hisinsistence on the diagnostic value of estimation ofthe alveolar 002 tension is sufficient proof of the deepattention being given to the subject. Dr. Cadenasis emphatic concerning the necessity of giving largeand repeated doses of insulin during coma, and sharesthe scepticism of other authorities concerning the valueof bicarbonate administration. The laboratory exami-nation of cases with deranged gastric, pancreatic, orhepatic function is conducted by Dr. H. G. Mogena,who contributes three excellent articles to the annalsof the Institute. By a special technique, carried outwith the aid of the X rays, this observer has been

1 Anales del Instituto Madinaveitia. By Drs. Urrutia, CarrascoCadenas, Madinaveitia, and Mogena. Vol. I. Madrid : EditorialParacelso. 1925.