The task of the medical profession is to enlighten the laymen, that their help may be enlisted, and yet to avoid alike exaggeration and smooth sayings, false hopes and false fears. Macaulay, in a familiar passage, once said that there is nothing more ridiculous than the British public in one of its periodical fits of morality. At present, the British Public is less concerned than formerly with questions of morality, but is very much concerned with questions of health. Perhaps it is not so much health that is sought and desired as absence of pain and avoidance of death—which is not quite the same thing. But, though there is nothing intrinsically ridiculous in seeking the “advancement of morality” or the “conquest of disease”, the one, no less than the other, may be pursued in a ridiculous and dangerous manner.
The adoption of ill-conceived measures, designed to improve morals or to abolish disease, may, and often does entail consequences that are even less desirable than the evils it is hoped to combat. While the prohibition of the consumption or sale of alcoholic drinks may diminish certain ills, it has yet to be shewn that the casting out of devils in the name of Beelzebub may not be followed by possession with others yet more violent. A few years ago we were adjured to boil all milk, lest we became poisoned by certain microbes: we are now told that, if all milk be boiled, we are as if deprived of vitamines, and must suffer accordingly. Instances might be multiplied; but it should be obvious that moral and physical health must be considered, not as physical objects, but as relations, or states of equilibrium. Like all states of adjustment or equilibrium, they are the result of accommodation: of poise and counterpoise. They are not always and everywhere to be secured by the throwing of a certain weight into one or other scalepan, or by the cutting-off so many inches from the table-leg that seems the longest. So much, at least, should be recognised by a seriously disturbed public told by the daily press that so many more people than formerly now die of cancer; that science has not yet discovered the “cause of cancer”; but that all may be well if only we live on Nebuchadnezzar food washed down by paraffin.
Mr Wright’s essay, combining as it does a well-balanced and sufficient statement of what is known, with the outline of a constructive proposition that merits careful consideration, and at least indicates to the public the kind of way in which relative safety may be obtained under present conditions, seems one that is eminently suitable for what may be called general reading. The problem is fairly and lucidly presented: the resources of surgery are quietly and reasonably demonstrated: and the advantages are shown of exhibiting that kind of prudence which leads the business man to seek auditing of his accounts and the sportsman to enquire how his score stands. But some words may perhaps be added from the standpoint of one who is a physician, and no surgeon.
Cancer is a class name given to certain kinds of growths, otherwise spoken of as tumours (or swellings) and ulcers, which are, as we say, characterised by malignancy. A growth, tumour, or ulcer which is not malignant is not called a cancer. By malignancy we mean a tendency to spread, by local and direct extension (as spreads a fire), or by convection, as when sparks fly from a locomotive to a haystack. Malignant tumours or ulcers tend to recur when removed, and, in the long run, to destroy life.
These general features are associated with certain microscopical characters found in the tumours or ulcers, so that the nature of any growth—whether malignant or otherwise—can be sometimes determined by the surgeon or physician, and sometimes by the pathologist or microscopist alone, but, as a rule, is most certainly settled by the physician or surgeon acting in conjunction with the microscopist. Yet, and this is important, not every cancer does actually destroy life. Surgeons of the greatest experience, such as the late Sir Alfred Pearce-Gould, have affirmed that undoubted cancers do occasionally undergo spontaneous cure, or at least arrest of growth, even in the absence of any treatment. Again, if excision is practised early, and sufficiently extensively, recurrence does not happen, in a certain proportion of cases. Finally, pain is no necessary or inevitable concomitant of cancer. In many cases pain is absent, or almost so; death may be due to mechanical consequences entailed by the growth rather than to destruction of any vital or sensitive part.
Now, medical men are in the habit of splitting up the group or class of malignant growths (or “cancers”) into two subsidiary groups or classes. One of these is named Sarcoma; the other Carcinoma. Sarcoma is the name given to a group of malignant growths taking origin in the structures and tissues developed from the “middle layer” of the embryo: the growths themselves—sarcomata—partake the nature of the tissues formed from this middle layer. The other group, of carcinomata, consists of growths taking origin in, and partaking the nature of one or other of the two remaining embryonic layers and the structures developed from them.
These two layers form respectively:
(1) The skin and related structures, and