1904.
Society
on
March 17th,
930
(
from her." Dr. E. Hooper May 3 also wrote : "In
glans penis, and one of the margin of the anus, cases forming contracted
an interesting group on which to found a clinical lecture.
1883 a patient of mine, aged 53, died with cancer of the
It is easy to surmise why the cancerous process favoursuterus and I have since been informed that in 1886 her
these situations since the covering is there tender and at husband,
I
aged 57, had to submit to amputation of the penis
the same time more exposed to injury and infection than ifor cancer, of which complaint he died a few months ago."
other parts of the body. The facts that cancer of the lower Since that time I have operated on one case of epithelioma.
<
the penis in a man who stated that his wife died
lip rarely occurs except in pipe smokers and that epithelioma of
of the prepuce is commonly associated with phimosis or else from
J
cancer of the womb some time before his disease
commences in the scar of an old chancre give further commenced:
These cases present a strong probability of contagion by
support to the same view. Pagets eczsma of the nipple
preceding cancer of the breast and chimney-sweeps cancer iinoculation where the circumstances are peculiarly favouri
for such a mode of transmission. Against contagion
attacking the scrotum, where the large sebaceous glands haveable
i has been urged that cancer cannot be inoculated in
long been choked with soot, are both well-recognised it
1
incidents in causation.
the
lower animals from man and, though this appears to be
Relation of syphilis to cancer.-I should like now to 1true, recent observations clearly ,how that cancer occurring
be inoculated
point out how frequently syphilis is the forerunner of cancerin the lower animals can with great certainty
4
in various situations where it leaves its injurious effects,into another animal of the same species. In 1889 Hanau,
and possibly one of the many causes contributing to thefinding a rat suffering from cancer, was the first to prove that
increase of cancer is the unchecked distribution of this the disease could be conveyed by inoculation to other rats.
disease. I have already alluded to epithelioma attacking Moran in 1894 conveyed the disease from a cancerous
the sites of old chancres on the penis.
In two cases of mouse to other mice. Jensenof Copenhagen has made some
of
the
for
that
I
have performed hundreds of transmissions of cancer from mice to mice, and
cancer
amputation
penis
within the last few months the patients declared that the these observations have been confirmed in this country quite
growth commenced in the scars of old chancres. Next the recently by Dr. E. F. Bashford and Dr. J. A. Murray.7 The
chronic glossii.is cf the tongue, which commences with the tumours sent over sterile from Copenhagen were used here
secondary stage of syphilis and is kept up by smoking and five days after posting and reproduced the disease in mice.
by foul, irregular, and decayed teeth, is the most frequent According to these observers the cells inoculated grow and
I hold it most the tumours produced arise from the actual cells introduced
precursor of epithelioma of the tongue.
9
to
advice
insist
on
important
patients giving up smoking without any participation of the cells of the host. Borrel
of
the
Pasteur
Institute
has
further
and
has
shown
that
the
of
the
of
treatment
gone
during
secondary stage
syphilis,
lest this affection should iun on into that incurable stage the disease may be conveyed by natural means. He placed
of white scarring and thickened epithelioma, which has two cancerous mice in a cage with several sound ones and as
been described under many names, such as leucoplakia, a result found that five or six of the latter became cancerous.
psoriasis, and ichtbyosis, and for which in the advanced In the human subject there are often seen cases of metastasis
stage, being struck by the resemblance it presents to the by transplantation or self-inoculation where one surface
appearance of a parrots tongue, I suggested many years ago affected with cancer has been allowed to rub against a sound
the term I I psittacosis. Epithelioma may attack the cheek, surface. I have several times seen patches of epithelioma
tonsil, palate, and larynx long after the ulceration due to on the inside of the cheek immediately opposite to, and
syphilis in these situations has healed. Epithelioma of the independent of, a cancer of the jaw or tongue produced
tongue, which is so common in men as compared with apparently by inoculation. But the most striking cases of
women, is probably in the main attributable to these two this kind are one by Williamsof cancer of the thigh
causes-syphilis and smoking. In all my professional spreading to the opposite thigh and one by Cripps of cancer
experience I have only once removed a tongue from a of the skin of the arm caused by contact with an ulcerating
cancer of the breast.
woman for epithelioma and in this case there was a distinct
It would follow from these observations that cancer is
had
been
She
infected
with
on
syphilis
syphilitic history.
marriage about 15 years before and had suffered from transmissible by direct inoculation from one part of a
recurrent ulceration of the tongue ever since, followed by cancerous person to another part, that it is inoculable in
leucoplakia. At the time I operated upon her she had an animals of the same species from one suffering from cancer,
epitheliomatous ulcer of the tongue and enlarged glands in and that sound animals mixed with cancerous animals of the
the neck which 1 removed at the same time. I have met same species may in this way acquire cancer. It seems
with three cases in which cancer of the rectum followed highly probable therefore that it is in some degree both
syphilitic stricture of this part of the bowel ; two of these inoculable and contagious among human beings. This
In the latter case I leads me to speak of infection or transmission among
were in women and one was in a man.
operated on the syphilitic stricture when it had contracted persons living under the same roof and under similar conditions.
as a cicatricial valve, so small that it did rot admit the tip
Cancer houses.-I think my own observation of three
of ones forefinger, by incising and then dilating with large
bougies. The patient was told to keep the stricture dilated persons living together in the same house was the first to,
by passing a bougie twice a week. About three years later he direct attention to cancer spreading in this way which Mr.
began to suffer from blood and slime with his motions and DArcy Power 10 has done much to elaborate since. My
observation was published in THE LANCET of Nov. 12th,
on re examining him I found a new growth in the circumference of the bowel.
I performed a colotomy and he lived 1887, p. 985. in a letter under the title, "Is Cancer Oonfor three years after, but eventually the growth penetrated tagious ?" I then wrote as follows : "The following curious
the os innominatum and formed a large tumour at the instance of three different forms of cancer, occurring in three
junction of the left loin and buttock and he gradually individuals living together in the same house may some day
receive an explanation other than that of mere coincidence.
sank.
Inoculation, contagion, and infeetion.-I now come to the In 1881 and again in 1883 I operated on a gentleman sufferquestion of contagion and infection in relation to cancer and ing from rodent ulcer of the eyelid and forehead. He is
I am inclined to think that if special investigation were still living but with a return of the growth. In 1884 I
directed to this subject it would not be difficult to arrange operated on his wife for scirrhus of the breast and during
the past week a partner who has always lived in the same
some very important facts in support of these modes of origin.
In THE LANCET of Oct. 8the, 1887, p. 727, the following para- house with them, has come under my care with epithelioma
graph appeared: I I M. Duplouy of Rochefort reports a case of the tongue. I would not suggest that there is of
where a man, who had for a long time carefully nursed his necessity anything more than accidental association between
wife, who was suffering from uterine cancer, became affected these cases, but the coincidence is the more interesting in
with epithelioma of the glans penis, necessitating amputa- that there is no blood relationship between them." The
tion. The question arises, Is this a mere coincidence, or three forms of cancer here alluded to are all of the squamodoes it point to the possibility of a cancer being transmitted epithelial variety and therefore not widely separated in
by contagion ?"A few weeks later Mr. T. G. Laslett2 wrote :
3 THE LANCET, Nov. 5th,
1887, p. 919.
In 1883 a man was admitted into the Liverpool Infirmary
4 Fortschritte der
Medicin, 1889.
5 Archives de Médecine
suffering from epithelioma of the penis. He stated that his
Expérimentale, 1894.
"
"
wife had died some time before of cancer of the womb and
he though this complaint was something which he had
2
THE
II
931
structure and may be conceived to be produced by the same
exciting cause modified by the tissue inoculated. Since
that time I have met with a good many cases in which two
cases of cancer have occurred in the same house.
Resemblances in cells of malignant growths to those of
reproductive tissues.- Within the last six months much
interest has been elicited by a paper showing that changes
which take place in the nuclei of cancer cells undergoing
multiplication exactly resemble the changes which take
place in the ripening of reproductive cells. This paper was
read before the Royal Society on Dec. 10th, 1903,11 and the
observations were confirmed by Dr. Bashford and Dr.
Murray in a paper before the same society read on Jan. 21st,
1904.12 To make this clear I may mention that" chromosomes " is the term applied to rod-like bodies within the
These have been
nuclei which stain with aniline dyes.
closely studied by von Hansemann (1893) who found thee
amount of chromatin to vary and to express which he used
the terms hyperchromatosis" and hypochromatosis" in
relation to the cells of malignant growths. But the value of
the work of Professor Farmer, Mr. Moore, and Mr. Walker
lies in the demonstration that the central cells off all
cancer growths entering into mitosis have the number of
chromosomes reduced to just half the normal number,
whilst the form of the chromosomes is changed from an
chromosome to a short ringlike form. This reduction to half the number of chromosomes is precisely what is observed in the reproductive cells
of both plants and animals undergoing mitosis, and has led
the observers to conclude that malignant growths are
virtually reproductive tissue occurring in abnormal situations. Whilst this power of reproduction illustrates the
manner in which cancer growths rapidly increase in size it
does not to my mind explain in any way why particular cells
of any organ of the body should start this heterotype mitosis
in imitation of the normal reproductive cells. Moreover,
the value of this observaticn as an explanation of cancer
causation is much weakened by the fact that the same kind
of cell division with reduced number of chromosomes is
observed in sarcomata-tumours which clinically as well as
microscopically are widely separated from true carcinomata.
I am inclined, therefore, to regard this valuable new
observation as serving to demonstrate to us the manner in
which the cells of sarcomata and carcinomata so rapidly
multiply by imitating the processes normal to the reproductive cells, but beyond this there must lie a cause which
compels them to take on this exceptional process. That
cause still remains to be demonstrated.
To sum up the points of this short paper : 1. I have demonstrated a site of origin of cancer dependent upon the
friction of the upper edge of a corset where it crosses the
anterior fold of the axilla. To this I have so far attached no
theory save that of chronic irritation, but supposing cancer
to be due to an organism introduced from without, the
rubbing in of such organism at this spot might aptly be
compared to the rubbing in of staphylococci on the back of
the neck by the collar in the production of boils and
carbuncles. 2. Allusion was next made to other recognised
sites of origin associated with irritation and especially to the
points of junction of mucous membrane with skin. 3. I
then attempted to show how syphilis, producing injurious
effects in numerous situations, often proved to be the forerunner of cancer.
4. Next inoculation and contagion were
considered ; the proved inoculability of cancer in animals
of the same species ; the self inoculation in the human
subject of parts in contact but not continuous ; and the
probable communication of the disease in certain cases
from wife to husband. 5. The infection of cancer was then
spoken of and my original observation of three persons
having cancer at the same time in the same house, published
in 1887, was quoted. 6. The recent observations of Professor
Farmer, Mr. Moore, and Mr. Walker as to the resemblance
of the mitotic changes of cancer cells to those normal in the
reproductive cells of plants and animals were alluded to as of
great interest, showing why in both cancers and sarcomata
there exists such an immense power of multiplication of
cells, but why the cells assume this heterotype mitosis still
remains to be demonstrated.
Wimpole-street, W.
FIBROIDS).
BY J. BLAND
diagram
known
as
intracervical
frequently they