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The Enzyme Treatment of Cancer – Dr John Beard

Cancer

The Enzyme Treatment of Cancer – Dr John Beard

This is a complete transcript of Dr. John Beard’s book, The Enzyme Treatment of Cancer and Its Scientific Basis

CONTENTS

PART 1

THE PROBLEMS OF CANCER

INTRODUCTION page 1

I. EMBRYOLOGICAL ASPECTS AND ETIOLOGY OF CARCINOMA page 48

II. THE EMBRYOLOGY AND ETIOLOGY OF TUMOURS page 67

III. THE PROBLEMS OF CANCER page 95

IV. THE CANCER PROBLEM page 108

V. THE INTERLUDE OF CANCER page 122

VI. THE ASYMMETRY OF THE CYCLE OF LIFE, BEING “THE END OF THE THREAD” page 143

PART II

THE PANCREATIC OR ENZYME TREAT OF CANCER

RETROSPECT page 166

VII. GENERAL DIRECTIONS FOR THE PANCREATIC OR ENZYME TREATMENT OF CANCER

IN ITS VARIOUS FORMS page 188

VIII. TWO RECENT CASES page 209

IX. ON THE RELATIONS OF TRYPSIN AND AMYLOPSIN page 223

X. A PUBLISHED TEST OF “THE TRYPSIN TREATMENT OF CANCER” page 230

XI. THE CRUCIAL TEST OF THE NATURE OF CANCER page 235

XII. “SCIENCE IS PREVISION” page 243

xvii

APPENDIX A : THE LIVERPOOL LECTURE—GERM-CELLS AND THE CANCER PROBLEM page 247

APPENDIX B: PICK: IN THE “DISCUSSION ZU DEN VORTRАGEN ЖBER DIE ЃTIOGIE DES CARCINOMS,”

IN “BERLINER KLIN. WORCHENSCHRIFT,” 1905, NO. 13. ABSTRACT OF THE REMARKS

CONTRIBUTED BY THE PATHOLOGIST DR. L. PICK TO THE DISCUSSION ON THE

ETIOLOGY OF CANCER, IN BERLIN, MARCH 15, 1905 page 252

APPENDIX C: THE LIFE-CYCLE OF THE HIGHER ANIMALS AND ALTERNATION OF GENERATIONS page 255

APPENDIX D: THE NAPELS CASE OF EPITHELIOMA OF THE TONGUE page 265

APPENDIX E: THE FUNCTION OF THE CORPUS LETEUM page 267

APPENDIX F: THE TREATMENT OF TUBERCULOSIS IN SANATORIA page 271

APPENDIX G: SOME OF THE SUCESSFUL CASES REPORTED IN PAST YEARS, ALL OF WHICH WERE TREATED

WITH GENUINE PREPARATIONS OF TRYPSIN AND AMYLOPSIN page 273

APPENDIX H: NEGATIVE RESULTS IN SCIENCE page 277

APPENDIX K: SCIENTIFIC PRIORITY page 279

APPENDIX L: “ENCEPHALOID” CANCER OF THE BREAST page 280

APPENDIX M: THE GERMAN PREPARATIONS page 281

INDEX page 283

xviii

ILLUSTRATIONS

FIGS. FACING PAGE

I-4. ILLUSTRATING THE GERM-CELLS OF FISHES AND THEIR MIGRATIONS INTO THE EMBRYONIC

BODY page 58

5. DIAGRAM OF THE LIFE-CYCLE OF A BACK-BONED ANIMAL page 124

6. AFTER FOUR MONTHS’ TREATMENT, SHOWING NECROTIC TUMOR IN SITU. JULY 15, 1909

page 208

7. AFTER REMOVAL OF DEAD TUMOUR EN MASSE. TUMOUR LIFTED OUT WITH DISSECTING

FORCEPS WITHOUT BLEEDING OR OOZING. JULY 15, 1909 page 208

8. NO TUMOUR LEFT: PARTS HEALED AND CLEAN, SEPTEMBER 17, 1909

page 210

9. PHOTOGRAPH TAKEN OCTOBER 14, 1910, FIFTEEN MONTHS AFTER THE SLOUGH ( SHOWN

IN FIG. 6) HAD BEEN LIFTED OUT OF THE CHEEK WITH FORCEPS page 210

10. PHOTOGRAPH OF THE SLIDE OF THE TUMOUR WHICH WAS PREPARED BY A PATHOLOGIST

OF THE ROYAL ARMY MEDICAL COLLEGE. THE PATIENT’S NAME, WRITTEN ON IT BY

CAPTAIN LAMBELLE, HAS BEEN ERASED page 212

11. MICRO-PHOTOGRAPH OF A PORTION OF THE SLIDE OF FIG. 10. PREPARED BY MR. A.

FLATTERS, F.R.M.S., MANCHESTER. THE MAGNIFICATION IS 360 DIAMETERS page 212

xix

THE

ENZYME TREATMENT OF CANCER

AND ITS SCIENTIFIC BASIS

INTRODUCTION

Some years ago a former fellow-student—M.D. (Lond.), Fellow of the Royal College of Physicians,

London, physician to a large hospital in London – remarked that a single case of cure of undoubted cancer

would establish the truth of the writer’s published statements, and bring the whole world to his feet. Not

long after then, here and there cures were published; but to these I will not refer; for, unlike those of the

York case, the scientific proofs of them are not in my possession, and in one way or another it may be

said of many of them, that the evidences in their favour were incomplete or inconclusive, which latter

was, indeed, the verdict pronounced, without adducing scientific evidences, upon “trypsin” by Sir Henry

Morris, Bart., late President of the Royal College of Surgeons, London, as recently as 1908. To a

profession such as the medical one, which does not yet grasp the nature of the scientific evidences, the

results of the pancreatic or enzyme treatment, even in the most favourable cases, might easily have been

taken to be “inconclusive.” The scientific facts that certain tumours had yielded to the stereo-chemical

test—the highest court of appeal—and thereby had shown their malignant

1

nature, were not evidences to those, who knew nothing at all of modern embryology or of stereochemistry,

and who relied implicitly upon the microscopical examination and appearances of a portion of

the growth taken before or after operation. Then there were the countless failures,* many of them due, as

I am now convinced, to faulty preparations, or to injections which were very much too weak for their

work. In this way great difficulties had to be surmounted, quite apart from what has been termed the

“conservatism” of the medical profession. Apart from the latter, these difficulties seem now to have been

removed. Definite statements can be made concerning the requirements of really efficacious preparations

for the treatment, and a successful case of cure, not standing isolated, can be, and is, produced in the

present writing.

*For the sake of the scientific truth, the published opinion of Professor F. Blumenthal, of the University of

Berlin—certainly a competent judge—regarding these should be noted. The vast majority of the cases hitherto

treated (usually with very weak injections and with small does of these) were in an advanced phase of cancer.

Oftener than not they were some of the failures of surgery. Professor Blumenthal remarks—rightly and

scientifically—that the cases as yet handed over for medical treatment, as opposed to surgical, wee nearly all such

that no possible treatment could have saved them. Lest this should be supposed to be exaggerated, Professor

Blumenthal’s actual words may be cited. He writes: “Die innere Behandlung des Carcinoms ist heute lediglich

beschrКnkt auf die verzweifelten, nicht operablen FКlle. Wir haven jetzt daran festzhalten, dass jede bЪsartige

Geschwulst, so lange sie operabel ist, auch durch Operation entfernt werden muss. Es handelt sich also für die

innere Behandlung um eine Kategorie von KrankheitsfКllen, welche vergleichbar sind mit verallgemeinerter

Tuberculose, disseminierter Eiterung. Man stellt an die innere Therapie die Anforderung, nicht die beginnenden

FКlle zu heilen, sondern überl.sst ihr fast nur solche FКlle, die wohl niemals gerettet werden kЪnnten, auch wenn es

eiene innere Methode gКbe.” Ferdinand Blumenthal, “innere Behandlung und Fürsorge bei Krebskranken,” in

Zeitschrift f. Krebs forschung, vol. X., pp. 134-148 (1910); loc. Cit., p. 134.

2

In the eighth section of “The Belfast Address” the physicist, Professor John Tyndall, wrote: “But

there is in the true man of science a desire stronger than the wish to have his beliefs upheld—namely, the

desire to have them true. And this stronger wish causes him to reject the most plausible support if he has

reason to suspect that it is vitiated by error.” That is the writer’s position to-day. Six years ago he stated

publicly that, in the secretion of that important digestive gland, the pancreas, Nature had furnished a

potent means of coping with cancer. Even though there had been no other successes at the hands of

Captain Lambelle, R.A.M.C. or of other, the successful issue of the case of the York ex-drummer,

described in Chapter VIII., demonstrates for all time the scientific truth of the foregoing conclusion. The

army surgeon who treated the patient, and the writer of these lines, both invite the fullest investigation of

this case. The tumour was recurrent immediately after two operations upon it, and it had become

inoperable. The diagnosis was confirmed by microscopical examination of a portion of the tumour-mass

removed at the second operation by a pathologist of the Royal Army Medical College. A section which

he made is in the writer’s possession, and from an examination of it he is able to say that the diagnosis

given is not open to the slightest question. The patient is alive and well, free from recurrence, and his

address is written across the copy of the ten charts of the case, all certified and signed by the surgeon, and

which, like the photographic negatives, copies of the official documents, and all other particulars, I owe to

my friend, Captain F. W. Lambelle, M. D., R.A. M.C., now stationed in Central India. All the evidences

are open to the most searching investigation, and this in the interest of scientific truth as well as in those

of humanity, is invited.

3

A surgeon, who published as a “scientific report” an account of the failure of the enzyme

treatment at his hands in a large series of (mostly very advanced) cases, remarked to the writer not long

ago that a single case of success would not prove his thesis. The exact opposite of this assertion has been

maintained quite recently by the Moseley Professor Surgery in Harvard University, Boston, Dr. Maurice

H. Richardson. In the Journal of the American Medical Association, February 4, 1911, in an article upon

“The Operative Treatment of Cancer of the Breast” (p. 315), he write: “And yet I am full of enthusiasm in

the hope that the near future or the next method will solve the problem. One single total disappearance of

undoubted breast cancer under any form of non-operative treatment will presage success, just as surely as

a successful man-flight presaged aviation.” A little further on he adds: “One varies, perhaps, in the

positiveness of one’s opinion. One’s diagnosis may be an absolute conviction. I have often said—and I

here repeat—that the diagnosis of cancer by gross appearance, plus the history, made by an experienced

man is more worthy of credence in some cases than the microscopic examination alone.” Everything of

import here named by Professor Richardson has been fulfilled to the letter. In 1908 Captain Lambelle

gave the enzyme treatment, as laid down by him further on in this book, in a case of “encephaloid”*

cancer of the breast The patient was a Yorkshire lady of social position. The diagnosis was made by

“experienced men,” as well as by Lambelle himself. There was no operation and no microscopical

examination. In his last letter to me, dated December 1,

*”Encephaloid cancer,” a term used by pathologists to define soft cancer from hard cancer, or scirrhus.

Encephaloid cancer is so termed because of its brain-like softness. It is described as quick-growing and rapidly fatal

(see Appendix L).

4

1910, he writes concerning this case: “By the way, that case of encephaloid breast cancer is alive and free

from recurrence—diagnosed October, 1908. I saw her on November 29, as near as mortal man can say

‘cured.’” Further comment on the above is not needed.

I was well aware, as any scientific man is, that negative results in scientific experiments never

proved anything at all in science, but was also under the impression that very many scientific discoveries

of great moment had been the outcome of single successful experiments. The fall of an apple from a tree

revealed the law of universal gravitation to Newton. In our own day a single photographic impression of

some keys, etc., led the physicist RЪntgen, in 1895, to the discovery of the RЪntgen, or X rays; and,

strange to say, the find of a few stray ganglion cells in the development of an American lake-fish in 1888

led the writer ultimately to the discovery of the nature of cancer, and of much besides. The scientific

investigator knows, even if some surgeons be ignorant of it, that very many discoveries in science are the

outcome of what at first were of the nature of single successful experiments. Even the cures* of cancer

by

*Looking at the matter from the point of view of practical embryology, the so-called “cures” of cancer by

surgical operation are probably in all cases without exception examples of the “cure” of a benign tumour, a more or

less reduced “embryoma.” Naturally benign tumours are of common occurrence, and whether diagnosed by

microscopical examination or only clinically , the diagnosis of cancer is not one which can be regarded as

conforming to a scientific criterion. When one thinks of the extraordinary frequency of recurrence after surgical

operation, one can only conclude that, in the absence of the crucial stereo-chemical tests, either of adequate

injections of sufficiently potent preparations of trypsin and amylopsin, or of examination of the tumour albumins by

means of the polarimeter, at present there is no valid evidence extant that operation has ever cured a single case of

malignant disease, though it may quite well have induced it, as the X rays have often done. Sir James Paget. A

scientific

5

surgical operation are not in blocks of certain dimension; but assuming that surgery ever does cure even a

single case of cancer—a very big assumption which, as a scientific man, I make only for the sake of

argument—each case of cure would be of the nature of a single successful experiment. I do not for a

moment deny that surgery does, and has done, many very wonderful thing, but to assert that it ever

knowingly cures a single case of cancer is a scientific absurdity.

If ten, a hundred, a thousand, or ten thousand cases of cure be required—by the surgeons, not by

science—to establish truth of the scientific foundations of the pancreatic or enzyme treatment of cancer,

then from the particulars furnished in later chapters of this book, any of these numbers can be obtained,

always provided, as the lawyers say, that properly and scientifically standardized and guaranteed

preparations be employed and the treatment be carried out in the scientific fashion—letter and spirit—laid

down here by Captain Lambelle and the writer. Since the medical profession of Great Britain has,

through some of its members, been most careful to guard that the writer, who is a mere scientific man,

and “not even a medical practitioner,” should treat no cases at all—cancer being a natural phenomenon,

not “an incurable disease”—more than this single demonstration cannot be asked from me. There is, sad

enough to say, no dearth of cases, for in England and Wales alone annually nearly 40,000 people, some of

them surgeons, die from malignant disease.

(continued from page 5 footnotes)

man of high standing because of the extent and nature of his investigations, doubted whether operation was ever

advisable in case of cancer, and on the evening of my Liverpool lecture of 1905, I heard a prominent surgeon

declare that he would not be willing, even in the most favourable case of cancer in which he had operated, to stake a

sovereign against its recurrence.

6

It behooves me to add a few words of explanation of Captain Lambelle’s connection with the

work. In his address, “Science and Immortality” (London, 1904), Sir William Osler, in the finest written

compliment any of my researches had ever received, described (p.58) “the patiently worked-out story of

the morphological continuity of the germ-plasm” (i.e., the germ-cells) as “one of the fairy-tales of

science.” Shortly after then their author was to have an unexpected and much greater compliment,

because of a practical kind, paid to these investigations. As a scientific man the writer places his trust, in

true military fashion, in “divisions” and “brigades,” represented by the published records of observation

and experiment, and not in “fairy-tales of science.” The investigation, one of the most powerful of my

“divisions,” which immediately preceded the cancer work was into the history of the germ-cells, the

forerunners of eggs and sperms, from generation to generation. Some of the published results of these

researches found their way as far as China, where, in Hong-Kong, a Captain of the British Royal Army

Medical Corps happened to be stationed. These finds interested him so much that he endeavoured, on

human embryos, to make independent observations.

In the first instance these failed, as any experienced practical embryologist would have foretold.

This officer, Captain F. W. Lambelle, M.D., was shortly afterwards ordered home again, and, on reporting

himself to the Director-General at the War Office, he related the foregoing facts and his deep interest in

my scientific researches. This led the Director-General to station Captain Lambelle with the 2nd Light

Dragoons (The Royal Scots Greys), at that time in garrison in Edinburgh, so that he might learn more of

my work. From the day when, un-

7

announced, Captain Lambelle entered my little room in full uniform, and saluting, introduced himself, we

have been close friends. He worked for himself over much my material—a collection also, like the Scots

Greys, “Second to None!”—and he read all my published papers, which, unlike some scientific people, he

thoroughly understood and appreciated; in fact, he evinced the deepest interest in all the problems and

their solutions which had occupied my leisure hours during many years. At that time I happened to be,

noiens velens, in the thick on the cancer-business, and he often expressed his regrets that the nature of his

work, with young healthy soldiers, gave him no chances of looking into cancer-matters practically for

himself. Subsequently, his appointment as operating surgeon of the Military Hospital, York—the hospital

of the Northern Command—placed, one after the other, four cases of cancer in his way, and of these he

cured three, the fourth dying from hЊmorrhage as the treated dead sloughing tumour came away. One of

these cases fully recorded in this book. The other two successful cases are not laid stress upon by him,

simply because, although the clinical diagnoses of cancer were ample, the microscopical evidences, upon

which scientifically I personally lay no stres at all, were lacking.* In order to say the surgeons who have

set up this arbitrary stand of the microscopical appearances of cancer as a criterior—often a very

deceptive one—the requisite slides of sections of the tumour have to be produced as completing the

surgical diagnosis.

In his last letter to me before sailing to India, Captain Lambelle stated that the total number of

injections given in latest case was 120. Apparently, from the charts, the ferments exhibited March to

July, 1909, did not

*Compare Professor Richardson’s opinion as cited on p. 4.

8

amount to more than 60,000 tryptic units and 120,000 amylolytic ones. That is to say, for his last

published case the strengths and doses of injections employed during the vital period of the treatment can

be stated. This can be said also only of the report of Messrs. Ball and Thomas. Dr. Bainbridge, according

to his own statement, used injections of five strengths of trypsin, but in his report he does not discriminate

among these, or give figures, from which even approximate calculations, or any at all; can be made. All

of those in this country, or elsewhere, who, publicly or privately, have condemned the treatment, with the

single exception mentioned above, whatever its scientific value, have furnished no particulars of strengths

or doses and of the total number of injections exhibited; in fact, not one of them has given a scientific

verdict, for not one of them has produced any evidences that he ever employed any ferments whatever. In

1906 and 1907 the statement was often made by several very prominent London surgeons to private

patients that they had “tried” trypsin in cancer, but had found it “useless.” They themselvew knew

nothing at all about the preparations used, but actually this adverse verdict was given after the

employment of preparations containing at that time less than 10 tryptic units per cubic centimetre or

ampoule.* This should be

*The first injections of “trypsin” employed in 1906 were all, or nearly all, made up from Fairchild Brothers

and Foster’s “trypsin in powder.” This, which is no longer on sale anywhere, was a very potent preparation, and it

had been on the market for many years. At the beginning of April, 1906, the manufacturers of this “trypsin in

powder,” as they announced by advertisements in the chief British medical and chemical newspapers, withdrew it

from sale. Tis step placed others makers of “trypsin injections” upon their own resources, or very largely so. There

was already a “famine in the land” as regards “trypsin,” so much of one that I heard through friends of several

cancer patients who were being treated with raw sweetbreads,

9

compared with Captain Lambelle’s usual dose of one thousand (1,000) tryptic units plus two thousand

(2,000) amylolytic units, 1 ampoule or 1 c.c. of each.

A University Professor of Surgery, in support of his public statement of 1910, that the pancreatic

ferments were “futile” in cancer, recently sent me copies of Bainbridge’s report, and an author’s copy of a

paper by Sir Henry Morris, read before the Surgical Congress, Brussels, September 21 to 25, 1908. In the

latter it is written: “He noted the reports on the use of the latter “’trypsin’), and the fact that the evidences

in its favour could not be considered conclusive.” Trypsin alone, a most deadly remedy for cancer if

employed without abundant amylopsin, is mentioned. Nothing whatever is said about the conclusive or

non-conclusive character of the failing evidences, that adequate strengths and doses of trypsin, and any at

all of amylopsin, had been employed. No doubt the preparations wee said to be “potent.” Possibly to-day

Sir Henry Morris could no more produce any scientific evidences concerning the strengths and

compositions of the injections he was referring to in 1908 than the University Professor, mentioned

above, did do or could do when I asked him politely for some particulars as scientific evidences of the

truth of his published statement. It ought not to be necessary, but—leider!–it is, to remind surgeons that

in science it is a rule—as it also is in courts of justice—that no

(continued from page 9 footnotes)

or pancreas glands. I have always considered the withdrawal of this “trypsin in powder” as a very wise step, but one

of its direct consequences would appear to have been the extensive employment, especially in and about London, of

a “trypsin” injection possession at that time rather less than ten units of tryptic strength. The eminent surgeons

mentioned above had not, as a matter of fact, a ghost of an idea of the potencies of the injections they so glibly

condemned—the boxes of ampoules were labelled with the magic word “trypsin.”

10

assertion shall be made without at the same time the production of the evidences for it.

Of course, “trypsin” is not a cure for cancer, a fact stated by the writer in Nature four years ago.

The evidences for this, it may be added, are forthcoming in abundance whenever asked for. What has

destroyed cancer without injury to the patient in cases not too far advanced, and what will do the like

again and again, is the use of properly prepared injections of trypsin of a strength of at least a thousand

Roberts tryptic units of activity plus equal amounts of amylopsin of two thousand to two thousand four

hundred (2,000 to 2,400) Roberts amylolytic units of strength per cubic centimetre, and the doses of

injections and their frequency must be adapted to the needs of the particular case under treatment.

As “failure is easier of attainment than success in anything,” it would be possible to the end of

time for some surgeon, or official cancer researcher, to declare that trypsin and amylopsin were “useless,”

or “futile,” in the particular cases treated by him, and used as he employed them. Scientifically, all such

verdicts are worthless, unless the evidences for them be produced in full; and these must include the

previous history of the case, the duration of the treatment, the preparations used, definite statements as to

their purity, all necessary details as to their quantitative values, their doses, and the number of these.

Science, as a mistress, makes exacting demands upon the observer, and the mere designation of a

document as a “scientific report” does not alone confer any scientific value upon its contents.

The view generally accepted by mankind, even by all medical men, has long been that cancer is

“an incurable disease.” How often have I not heard this expression, even from very prominent surgeons!

Not only was

11

cancer incurable, but it was a disease of the nature and origin of which the whole of the medical

profession, by its own confession, often proclaimed by leading surgeons in public orations, knew nothing

at all about. Under such circumstances it could hardly be strange that it should not be in conformity with

the generally accepted, when a scientific man, who knew very well what he was speaking about, and who,

like Pasteur, had earned the right to an opinion by his investigations of many long year, announced that

cancer was not a disease, but a natural phenomenon, that it was germinal in origin and asexual

(trophoblastic) in nature. This was all something new, which had never been said before by anyone,

living or dead. As at the present time we were supposed, but possibly erroneously, to have outlived the

Dark Ages, and as, at all events, those who made me, the scientific Germans, who have advanced far

beyond the Dark Ages, had long advocated and practised “the freedom of science in the modern state,” it

was something to be examined scientifically. It is interesting to see how this was realized in Germany.

A recent part of the German Journal of Cancer Investigation (vol. x., part 1) contains the report

of a special Cancer Congress, held in May, 1910. Here Professor C. Neuber, well known for his

researches into the chemistry of cancer, writes on p. 70 regarding the position of chemistry in cancer

research in words which recall Duclaux’s declaration concerning chemistry and medicine. Neuberg

affirms that where the problems of the nature of tumours are in question, chemistry will never retreat from

the field of conflict. Duclaux said: “With Pasteur chemistry took possession of medicine. It is easy to

foresee that she will never loosen her hold upon it.”” As a study of

12

the following pages will show, my fundamental discoveries of the nature of cancer, and of the places of

the two all-powerful ferments, trypsin and amylopsin, in the treatment of this natural phenomenon, not

disease, were founded in the first instance in the science of embryology. This is as true for the separate

reasons advanced for the employment of trypsin and of amylopsin as it is for those urged in 1902 as

demonstrating the asexual (trophoblastic) nature of cancer.* Afterwards, from 1906, the chemical

evidences—the stereo-chemical ones—began to reveal themselves to the observer, who was not like that

genius Pasteur, “a mere chemist,” but a practical embryologist, who had chanced to have some sort of

elementary chemical education at the hands of Sir Henry Roscoe and of that pioneer of comparative

physiological chemistry, the late Professor C. F. W.

*Sexual and Asexual, Sexual Generation and Asexual Generation.—In animals and in plants two modes of

reproduction are recognized, the sexual one, by means of germ-cells, eggs, and sperms, and the asexual by budding,

which is really a process of continuous indefinite cell-division, with no eggs or sperms. In an animal or plant a

sexual generation is one which bears reproductive organs, in which eggs or sperms, or both, arise. On the other

hand, an asexual generation of an animal or plant is one which never bears reproductive organs, eggs or sperms, or

both, but which reproduces in the way indicated above, really by cell-division. In plants the asexual generation is

the flowering plant, which is capable of indefinite unrestricted increase, as, for example, a Gloire de Dijon rose or

the fine white chrysanthemum, Niveus. Origianlly there was but one plant of each of these. The sexual generation

of a flowering plant is a small microscopic entity contained with the flower. In animals all the individuals which

bear sexual organs belong to the sexual generation, which the asexual generation are represented in various ways.

Thus, in the sea-ploypes, by the colony of polypes, while here the medusЊ or “jelly-fish” are sexual; in worms,

starfish, etc., but what are known as larvЊ, while here the wor, starfish, etc., are sexual; and lastly, in the highest

animals or mammals the asexual generation is present only during uterine life, as what Hubrecht termed the

trophoblast. This latter used to be regarded as one of the “foetal membranes” under the name of chorion.

13

Krukenberg. Thus it came about that, while the line of first advance was purely embryological, later a

junction could be effected with the science of stereo-chemistry, and a further base for operations obtained

in the fundamental discoveries of Pasteur on the asymmetry of naturally occurring organic compounds.

The following remarks* (literally translated), by Professor F. Blumenthal, of Berlin, concerning

“trypsin” and cancer are of interest: “For a long time the trypsin-therapy of Beard awakened greater hope.

This depends upon the quick digestion of the cancerous tumour by trypsin. If trypsin or pancreatin be

injected into a cancer, one notes a fairly quick softening of the same, leading to a liquefaction, which is

aseptic, not made up of pus. In some cases it appears that in small and readily accessible tumours it has

been possible with the help of trypsin to cause the tumour to disappear. I will recall only the case in the

aural clinic of Munich. In larger tumours, especially with metastates, I have only had failures. Successes

also seem to be lacking in mouse-tumours, as Bashford reported. † In the treatment with

* Blumenthal, F., “Innere Behandlung und Fürsorge bei Krebskranken,” in Zeitschr. F. Krebsforschung,

1910, vol. X., pp. 137-138.

† It would appear not to have occurred to Professor Blumenthal that this statement might have reference to

inert ferments. Since the experiments, which must be supposed to have led to this erroneous conclusion, have never

yet been published, and since they are, indeed, not mentioned in a single word in the Third Scientific Report of the

Imperial Cancer Research Fund, published in 1908, and, lastly, since there are no scientific or other evidences extant

to show that ferments of any kind or sort had ever been employed in these unpublished experiments, I feel bound to

ask Professor Blumenthal to explain, as a scientific man, why he cites these unpublished experiments, and nonexistent

evidences? It is common enough to note in scientific publications that published experiments or evidences

have been ignored by the author, but it is something quite new to find unpublished experiments and mythical

evidences cited in a

14

trypsin I have also noticed a disagreeable complication, which consists in this, that often the digestive

power of the trypsin passed over also to sound tissue, and a disagreeable destruction of this came to pass.

Recently Sticker and Falk have improved the trypsin-therapy in that they have united the action to trypsin

to charcoal, by which means, after a single injection, this action persists much longer, since this

carbenzyme is not so quickly used up as ordinary trypsin.”

Regarding the foregoing, only a few words need be added. It will be noted that Blumenthal also

confirms the “liquefying” action of trypsin on cancer. This has now happened in London, Berlin, New

York, and elsewhere. The researcher of the Imperial Cancer Research Fund denied some years ago that

trypsin had any action at all upon cancer-cells. Looked at scientifically, either trypsin acts upon living

cancer-cells, and

(continued from page 14 footnotes)

scientific paper. Moreover, as Professor Blumenthal is quite aware, the results of his own experiments with

“tryspin” are in direct contradiction with the verdict pronounced, without the production of any evidences, by

officials of this cancer research. It reminds one of the reception accorded to von Siebold’s discovery of two sorts of

spermatozoa in a fresh-water dioecious snail, Paludina vivipara, in 1836. Within an easy walk of Würzburg, this

snail is readily found in great numbers, and the first time that these two sorts of sperms were seen by me was in

1882, in living material obtained not far from Würzburg. None the less, when von Siebold published his find, the

professor of Anatomy in the University of Würzburg, the celebrated anatomist and embryologist, Alber von

KЪlliker, interposed the weight of his authority, and, without taking the trouble to examine the facts for himself in

the animal concerned, disposed of von Siebold’s finds…simply by denying the correctness of his observations.

Since that time an extensive literature has sprung up concerning twofold sperms in Paludina and many other

animals, including man, and the well-known cytologist, F. Meves, has published a minute account of the

development and histology of these two sperms of this snail, the wormlike and the hairlike forms.

15

ultimately, if used in solutions of sufficient strength, liquefies them, as maintained by myself,

Blumenthal, and—“in some cases”—by Bainbridge, or it has no action upon them, as stated in 1906, and

again in 1907 by official researchers. One or other of these statements must be false. The official

assertion was unsupported by the production of any evidences whatever, the former rests upon the

independent testimony of four* different observers, situated as widely apart as London, Edinburgh,

Berlin, and New York. The official statement is untrue. Already, in Nature (January 10,1907), I called

upon the executive of the Imperial Cancer Research Fund to substantiate the assertions made under their

auspices, or to withdraw them. I now repeat this unsatisfied demand, merely adding that, if they wish

their finds still to stand, they must complete the statements scientifically by the addition that inert trypsin†

had been employed, and that the assertions challenged related to such inert trypsin, and not to trypsin in

an active form.

In the later pages of this book I have explained why it comes about that in some cases trypsin

may act upon

* As I recognize, while finally reading through this manuscript before sending it to press, a fifth observer

of the formation of “liquid cancer” can be cited. From the charts of Captain Lambelle’s case of sarcoma, and from

his description on a subsequent page of the course of his case of lympho-sarcoma, it is clear that in what he speaks

of as “sero-purulent fluid” in the one case, and “purulent fluid” in the other, he was really dealing with liquefied

cancer.

† The General Superintendent of this cancer research himself writes as follows: “It is surprising how many

people are unconvinced that the scientific examination of such claims presupposes exact knowledge of the

ingredients of the remedy. In the absence of this knowledge, negative conclusions could always be ascribed to

error” (British Medical Journal, May, 27, 1911, p. 1221). One wonders whether he knew this when the unpublished

experiments with “trypsin” were carried out, if so, why he failed to act upon it.

16

“normal” somatic tissues. It is in very advanced cancer cases, where the tissues have been much acted

upon by the ferments and toxic products of cancer, and have thereby been injured. In this connection the

finds of Yoshimoto and Neuberg concerning the auto-digestion of cancerous liver, and of portions

bordering upon the cancer, are of much import.

As to the improvements in the treatment brought about by Sticker and Falk, I content myself with

the record of them, and make no comment beyond saying that, in my opinion, no “trypsin-therapy” which

is unaccompanied by abundant animal amylopsin will be, or can be, satisfactory in the long run.

In the long, interesting article, summing up what he considers to be our present knowledge of the

chemistry of cancer, published in the “Ergebnisse der Physiologie” (1910), Professor F. Blumenthal, of

Berlin, has a reference to “trypsin” in cancer. Recalling his own investigations with Wolff, published in

1905 (Med. Klinik, No. 5), he states that (in the test-tube!) all the tumours, five in number, wee very

easily attacked and pulled down by trypsin, and in a footnote he adds: “These finds were the basis of the

trypsin-therapy of cancer.” In a more recent publication (German Journal of Cancer Investigation, vol.

X., p. 137), he makes a similar statement in these words: “For a long time the trypsin-therapy of Beard

awakened greater hope. This depends upon the fact that the cancerous tumour is quickly digessted by

trypsin” (in the test-tube!). On the other hand, the writer of the brief article upon cancer in the new

eleventh edition* of the “EnclopЊdia Britannica” assigns as

*The prospectus states that “this new edition represents the results of a fresh survey, undertaken

in every department of knowledge by the most eminent authorities, up to the year 1910.”

17

the reason of my advocacy of trypsin in cancer that the pancreas-gland was believed to be a t fault in

cancer patients. Versions of the reasons similar to these two have been given in other places—thus, in the

Münchener Medizinische Wochenschrift. They are both quite incorrect. My only connection with the

first was in publishing in the Lancet of April 29, 1905, a summary and translation of some recent German

cancer work, including that of Blumenthal and Wolff upon the chemistry of cancer, and the citation of

this relation of trypsin to the cancer-cell as a certain support of my views. As to the second reason,

neither the writer of the article in the “EnclopЊdia Britannica” nor anyone else can find in any of my

published writings even a hint of this statement. Moreover, it has been supposed that my affirmation of

the germinal origin of cancer meant that it was embryonic or somatic, and my name has been quoted as

that of a supporter and advocate of “embryonic theories,” such as the Remak-Cohnheim one of

“embryonic rests.” In the first article referred to (“Ergebnisse der Physiologie”) Blumenthal considers

these embryonic theories as refuted from the chemical side by the chemical fact mentioned in his paper,

such as the discovery by Abderhalden and Pincussohn that the ferments contained in extracts of mousetumours

pull down silk peptones and polypetids atypically. With this conclusion I agree absolutely, and

would add that ever since 1902, and before then, I have been an opponent of the Remak-Cohnheim theory

of “embryonic rests” upon grounds of embryological observation, leading to the conclusion that these

“rests” are mere figments of the imagination. The Remak-Cohnheim theory of embryonic rests is,

therefore, now untenable on decisive chemical and embryological grounds, and must be abandoned.

18

My theories of cancer, its origin and nature, differ toto coelo from those advanced by any other

observer, living or dead. The theory of the germinal origin of cancer, which says that a cancer arises

primarily from a latent germ-cell, does not mean that cancer is embryonic in origin or character. Germcells,

such as fertilized eggs, give rise to something else than embryo or soma: they produce on occasion

trophoblast (asexual generation). I know that some embryologist, for whom chemistry and physiology

have no existence in their researches, describe the trophoblast of Hubrecht as merely another name for

what they term “extra-embryonic epiblast.” To use the latter term does not signify anything more than

where in normal development the supposed portion of epiblast lies—i.e., beyond the embryo. I do not

agree with them that trophoblast is epiblastic (embryonic skin) in character, or that their description of it

as “extra-embryonic epiblast” in any way defines it embryologically. Their account is merely descriptive,

and it gives no information whatever concerning the chemical, physical, or physiological characters of

this “extra-embryonic epiblast” or trophoblast, which, quite unlike ordinary epiblast or embryonic skin,

eats and erodes the maternal tissues.

In very simple words I will now endeavour to summarize what is meant by the germinal origin

and the asexual or trophoblastic nature of cancer. To these shall be added brief accounts of the reasons

advanced six years ago for employing “the secretion of that important digestive gland, the pancreas,”

including the two ferments, trypsin and amylopsin, in the scientific treatment of cancer. It is appropriate

that this should be written down on January 20, 1911, the sixth anniversary of the scientific lecture in

Liverpool, in which the more important of these reasons were first announced publicly.

19

One of the most remarkable of the many brilliant things done by the illustrious French chemist,

Louis Pasteur, was the giving of two public scientific lectures, in 1860, “On the Asymmetry of Naturally

Occurring Organic Compounds,” which include the albumins, sugars, starches, etc., found or formed in

animals or plants. In a scientific instrument, known as a polarimeter, these compounds always rotate the

plane of polarized light to the right or to the left. Therefore, by chemists they are described briefly as

dextro- or lЊvo- (d- or l-) compounds—for example, dextrose, or d-sugar, and lЊvulose or 1-sugar. That

is, as they occur in living nature, animals or plants, they are never “compensated mixtures” of both stereoisomers—

never, for instance, of dextrose, and lЊvulose—and in such “compensated mixtures” all rotation

is absent, because the one compound twists the plane of polarized light as much to the right as the other

does to the left. When the chemist is able to manufacture any of these compounds in the laboratory, he

has never been able to make the one compound, the 1- one, without an equal amount of the other, the done.

To get them separated he has had to employ expedients, such as fermentation by yeast, etc., when

one of the two might be attacked and pulled down, but not the other. The fact that all living organisms,

whether animal or plant, manufacture or contain invariably only the one stereo-isomer, and not the other,

has often been commented upon. Thus, by Professor W. J. Pope, who writes that while d-glucose (dsugar)

is a valuable foodstuff, we should be unable to digest its opposite or anithesis, 1-glucose, although

they have the same chemical composition—that is, are isomers or stereo-isomers. Humanity is, therefore,

according to him, composed of dextro-men and dextro-women; and, putting his words, which will

20

be found in Chapter VI., in simpler language, just as we ourselves should probably starve if provided with

food of organic compounds the opposites in light-rotation of those to which we are accustomed, so our

opposites, the lЊvo-men, if they were to come among us now, when we have not yet succeeded in

manufacturing the more important foodstuffs artificially, would find our food, even our bodies, not

suitable for their nourishment. That is, these foodstuffs would require to be changed, or “inverted.” If we

our-selves had to digest compensated mixtures, we should need a double digestive apparatus. He

supposes that in course of time the one set of compounds as articles of food has vanished. If it were

scientifically true, as well as “generally accepted,” that the fertilized egg gave rise directly to an embryo

or individual, then one of the sets would have vanished from the nutrition of all higher animals. Now,

one of my discoveries has been that Pope’s hypothetical lЊvo-men do exist, and that they are represented

by, among other things, the cancers. In this way the second set of nutritive compounds has not vanished,

but at its basis the antithesis of two sets of things—compounds of carbon, defined by Pasteur—is the

same antithesis as that of two sets of living things, asexual and sexual respectively, discovered and in the

researches of more than twenty years described by me as occurring in the cycle of life of a fish, a frog, or

a man, etc.

The fertilized egg, and any of the (primary) germ-cells which arise later on, possess the intrinsic

property (potentiality) of developing in the one direction or the other; in the asexual, with the cleavage of

the fertilized egg, when trophoblast first raises, as in every normal development; in the sexual, when a

primary germ-cell, which itself is

21

derived ultimately from the fertilized egg, unfolds as an embryo or individual. What I found was that

Nature employed this peculiarity of the antithetic or opposite character of certain naturally occurring

compounds, all containing carbon, and many of them also nitrogen, as the chemical basis of the cycle of

animal life. She did not attempt to unite both sets of the compounds, the 1- ones and the d- ones, in any

one form, animal or plant; neither did she dispense with one of the sets. Had she done either of these

things, had she been able to do it, she would have carried out the “generally accepted” view of direct

development, egg leading directly to embryo. Then the egg would produce the hen, and the hen the egg,

and so on ad infinitum. On the contrary, in order to get back to the fertilized egg again, Nature had found

it necessary to separate the “compensated mixtures” into their components, to use at one time the one set,

made up of certain 1- and other d- compounds, and then to use the other set, made up of the opposite

ones; that is, she swings the pendulum of life first in the one direction, and then in the other, and in this

way brings it back again to the starting-point—the fertilized egg.

As pointed out in Chapter VI., in connection with the account of Professor Pope’s lecture, by

means of two generations, asexual and sexual, which alternate in the life-cycle from egg to egg. Nature

not only utilizes two of the apparent possibilities afforded by the existence of stereo-isomeric compounds,

but also she is thereby enabled to bring round again and again the cycle of life to its starting-point. Under

the orthodox and “generally accepted” view of direct development these things have not been explained,

but they have simply been ignored. The like orthodox views have also, notoriously, been

22

impotent to elucidate cancer, and the reasons for this failure lie on the surface.

Normally, in development, the fertilized egg, by forming trophoblast (asexual generation), swings

the pendulum in the direction of dextro-albumins, lЊvo-starches, and 1- sugars, etc., and later the primary

germ-cell, by unfolding as a sexual individual or embryo (sexual generation), in which new eggs or

sperms arise, reverses the swing of the pendulum in the direction of the formation of lЊvo-albumins,

dextro-sugars, d-starches, etc. Abnormally, some primary germ-cell, originally destined to give rise to a

twin identical with the individual harbouring it, either, ab origine, does this by producing a monstrosity,

or a benign tumour—an “embryoma”—or, remaining latent, anon it swings the pendulum in the opposite

direction, and produces a cancer, which is trophoblastic (asexual) in nature—that is, is the same product

as would arise normally from a fertilized egg. A cancer thus is not somatic, not embryonic, not

“gametoid tissue” (Farmer, Moore, and Walker), not derived from an “embryonic rest” (Remak-

Cohnheim), but it is trophoblast (asexual generation), the very antithesis or opposite of embryo or soma

(sexual generation), embryologically and chemically.

When Professor Pope spoke of dextro men and women, he would, in my opinion, have done

better to have used the terms “lЊvo-men” and “lЊvo-women.” For while the sugars and starches of our

foodstuffs are d-compounds, the nitrogenous or albuminous constituents are 1-compounds. This leads

one also to point out to the non-chemical reader that the one generation—say the sexual one, man—does

not use exclusively compounds of one rotation, 1- or d-ones, but these stereo-isomeric compounds form

series, some of them being 1-compounds,

23

others d-compounds. The like is true of the ferments, which certain of the albumins give rise to as

modifications of themselves. Trypsin is like the albumin from which it is derived lЊvo-rotatory; it

converts d-starches into d-sugars, among other things, but not 1-ones, and thus not the 1-glycogen or

animal starch of cancer. It acts upon and pulls down certain d-compounds of cancer. On the other hand,

the proteolytic or albumin-attacking ferment of cancer is a dextro-rotatory body, like the (dextro-rotatory)

of cancer, from which it is derived. It attacks and pulls down, not the living dextro-totatory albumins of

cancer, but the living lЊvo-rotatory albumins of the human body.

The conception I have formed of one action of amylopsin in the enzyme treatment of cancer is

briefly as follows: Acting upon the living d-albumins of cancer, trypsin pulls them down in the chemical

scale a certain distance, but not into simple harmless products. On the contrary, some of the products of

its action are very poisonous, and to all appearance these are dextro-rotatory, like cancer albumin. As

compounds of this rotation they can be acted upon and reduced to simple harmless compounds by the

ferment amylopsin, owing to its configuration, its lЊvo-rotatory character. †

* For an opportunity of determining these facts concerning the rotations of trypsin and amylopsin I am

indebted to Mr. P. W. Squire, London. At my request he kindly sent me freshly prepared and strong solutions of

both trypsin and amylopsin, as well as a bottle of the “menstruum” in which they were dissolved. In my polarimeter

the latter showed no rotation at all, while both tyrpsin and amylopsin were strong lЊvo-rotatory.

It was not my purpose to calculate their “specific rotations.”

† The following natural question was recently put to the writer by a surgeon keenly interested in these

matters: “If

24

The first and only reasons advanced by me publicly at Liverpool, now six years ago to the day,

for the use of pancreatic ferments in cancer, were that at a certain period of development every normal

embryo, or soma, or sexual individual, commenced to suppress the trophoblast or asexual generation of

normal development. This came to pass by the initiation of the functioning of the sweetbread or

pancreas-gland, with its powerful ferments, the two chief of which are trypsin and amylopsin.

Some imaginary relation of diabetes to cancer, or some suspected failure or “fault” on the part of

the sweetbread or pancreas gland, had nothing at all to do with the reason—as little as had the discovery a

little later on, by Blumenthal and Wolff, that trypsin easily digests

(continued from page 24 footnotes)

trypsin acts upon dextro-albumins, of what use is it in the ordinary adult body, seeing that the albumins of human

food are lЊvo-albumins?” No more than Nature does would I separate amylopsin in its action from trypsin, for, like

Nature, we must associate the two ferments. Trypsin and amylopsin, acting upon the dead lЊvo-albumins of our

food-stuffs: Trypsin only pulls these down to a limited extent, converting them into substances capable of

absorption, and on these amylopsin has no action. These are built up again into living lЊvo-albumins by cell

ferments in the body-cells. Trypsin and amylopsin acting upon the living dextro-rotatory albumins of asexual

generation or cancer: Trypsin at once attacks these, and pulls them down into quite other bodies than those which its

forms from dead lЊvo-albumins. These bodies, or some of them, are rank poisons to the human body, but, as they

are further acted upon amylopsin, and by it pulled down into simple, harmless products, the two ferments, trypsin

and amylopsin, acting here together, pull down the cancer-albumins, these products of the action of trypsin are

chemically relatively highly organized and can be used as food by the cells of the body. This not the case with the

products, to which the action of trypsin and amylopsin on cancer-albumins, living or dead, gives rise. He who

doubts the truth of the above had better, before publishing his doubts, study the recent work of Professor

Abderhalden and his pupils.

25

cancer cells (in the test-tube). Nor have I ever held, as some have done, that because they supposed,

erroneously, that trypsin had some action in “splitting up” glycogen or animal starch, that it “dissolved”

glycogen, therefore it should be used in cancer cases. From the start I wished all the ferments—trypsin,

amylopsin, and steapsin—of the pancreas gland to be used in the injections employed.* The import of

trypsin was, of course, clear, for it was known, since the work of Corvisart and Kühne, to attack and pull

down dead 1-albumins, and I anticipated—rightly, in spite of all the contradictions extant, which are

false—that it would, and scientifically regarded must, pull down the living d-albumins of cancer or

trophoblast. † The special reasons for the employment of very potent injections of amylopsin, which

normally converts starch into a d-sugar, termed “glucose,” came later on. It was found that the injections

first used, which were very deficient in amylopsin, being sometimes, indeed, almost chemically pure

trypsin, produced after some six to eight weeks, according to the strengths employed, very bad symptoms.

These were first reported to me by French and Italian physicians, and I told them that, as this treatment

followed the lines of what happened in a normal human gestation from the seventh week onwards, they

* For evidence of this, reference need only be made to the following fact: Early in 1906, when the London

representative of a well-known firm of manufacturing chemists, specialist in the ferments, called upon me, I

requested him to inform his firm that in my opinion the injections for use in cancer ought to contain all the ferments.

† The evidences of the truth of this will be found in the text under the description of the course of the York

case. The like facts wee also witnessed in the very similar course of the Naples case, and these scientific finds are

confirmed up to the hilt by the facts concerning the “liquefaction of cancer” in the living human body, as detailed

subsequently.

26

should treat these symptoms as they would the vomiting of pregnancy. I then found that for this and for

the covulsive illness sometimes happening in pregnancy, and known as “eclampsia,” there was no rational

treatment extant in medicine. So once again a new problem had to be solved embryologically. It was,

What induced these bad symptoms in pregnancy, leading up to eclampsia, and in cancer ending with the

continued injected of trypsin, in something identical with eclampsia? With continued improvements in

the treatment, especially in the preparation of the injections, when put up scientifically, these bad

symptoms do not now arise to anything like the extent that they die in 1906, for example. They were, in

an ascending sereies, nausea, vomiting, pain in the back, “sleeping in any position,” drowsiness, mental

and physical torpor, high arterial tension, and albuminuria, culminating on occasion in convulsions,

lasting several hours, with complete unconsciousness (coma). Only one case of the latter (mentioned

farther on) was ever reported to me. It happened that there was an extensive experimental study of

eclampsia in one of the German medical journals for 1905 by Professor Zweifel, as well as the report of a

lecture by him in the Munich Medizinische Wochenschrift (February 13, 1906). He concluded that

eclampsia was due to sarco-lactic acid in the foetal blood and placenta, but the conclusions appeared to

rest upon thin ice, and there may well have been other substances. Professor Zweifel’s name awakened

recollections of a former discovery of his, to the effect that amylopsin was not produced in the human

pancreas gland until some months after birth. I had never before had occasion to consider the import of

this fact embryologically, although I had worked over the whole course of gestation, studied its span, the

cause of birth, the

27

milk nutrition, etc., from the standpoint of the embryologist. Certain of my researches, published some

ten years earlier, when applied to the problem, furnished the solution with ease. One German medical

man has described the following advocacy of amylopsin in cancer as “fantastic,” which is merely a pious

“opinion,” not a scientific argument; but I am willing to admit that sometimes Nature may do things

which to some people, like a certain King of Spain, may appear to be “fantastic.” Whether it be a

“fantastic” fact or not, genuine amylopsin always does its work in the scientific treatment of cancer.

In the days of long ago, in our ancestry, as in that of all mammals, and as now happens in most

marsupials, like the kangaroo, opossum, etc., birth took place at what I have termed the “critical period.”

This is the moment in development when the embryo is first complete in all its parts. In a rabbit it is after

some fifteen days out of a total gestation of thirty; in a human being in the seventh week of pregnancy,

out of the total of nine months. With birth at this period the milk-nutrition was initiated. In this

amylopsin is not of any use, and can be dispensed with. When, as she did, Nature prolonged the

gestation, in order to bring the young into the world in a more perfect form, she deferred in so doing more

and more the start of the milk-nutrition. In prolonging the gestation, she forgot, or omitted to introduce,

amylopsin at an earlier period and not the “unconscious memory” remained that it was not needed until

the milk-period had passed. Consequently there is an absence of amylopsin during all foetal life. Usually

the difficulties caused by this can be surmounted if the mother produce sufficient amylopsin, but from the

seventh week of gestation pregnancy is a sorry business, owing to

28

This absence of amylopsin in the foetus. To this day, to my knowledge, such is the

“conservatism” of the medical profession, amylopsin has not been employed as an injection in

any case of threatened eclampsia.* But in cancer it has for some years past been used along with

trypsin, and it has never failed to perform its task of removing the bad symptoms. The first case

in which it was injected, in 1906, was that of a very distinguished artist and art-critic, who was

suffering from an advanced cancer, recurrent after three operations. I had previously told his

physician—a London one of high standing—when, almost to the day, his patient would develop

the bad symptoms. The first intimation was in a friendly letter written from the patient’s club by

himself, in the course of which he complained of being drowsy, and said finally that he could

hardly hole his pen for this reason. Then his physician wrote that the patient showed high arterial

tension and albuninuria, and that he was about to inject amylopsin. Under the influence of this

ferment all the symptoms vanished in two days. Had trypsin been as successful hitherto as

amylopsin in its mission in the treatment of cancer, very many who are now dead would still be

among us.

How the term “tryspin treatment” came to find its

*This is a very remarkable fact. To many physicians of both sexes the writer has explained the

scientific reasons for concluding that the source of eclampsia was to be sought and found in an absence or

deficiency of amylopsin in the maternal blood, to be remedied, of course, by hypodermic or intramuscular

injections of genuine amylopsin of 2,000 units of activity per cubic centimetre. So far as he is aware,

though more than one of these has expressed intentions of “trying” this scientific remedy, there is no single

case of actual or threatened eclampsia, in which such injections were made. Instead thereof, the barbarous

remedy of stripping the capsules of the kidneys is still often resorted to, and only recently a new device has

been sug-gested seriously—to wit, amputation of the breasts.

29

way into general use is still a mystery to me. It was, I believe, first employed by an anonymous

writer—still quite unknown to me—in the Daily Mail, somewhere about the end of January,

1906. It caught on, and nothing I could do ever altered the name of the treatment. But with

certain other happenings this use of the term “trypsin treatment” was a disastrous occurrence.

Since early in 1906 I have always used the designation of “the pancreatic or enzyme treatment.”

An “enzyme” is another name for a ferment. Again and again I have insisted upon the fact that a

“trypsin treatment” of cancer was about the most deadly remedy which could be devised. It is

impossible to estimate how many treated cases all over the world have failed from toxЊmia

owing directly to this use of trypsin without abundant amylopsin.

Particular attention may be directed to the following: The scientific treatment of cancer or

malignant disease advocated by me is not, and it never was, a “trypsin treatment.” From the days

of its first annunciation—December 13,1904, and January 20,1905—it was meant to be of

injections of “the secretion of that important digestive gland, the pancreas”—that is to say, of

pancreatic ferments, including both trypsin and amylopsin. I lay no claim what ever to have

“discovered” such a scientific absurdity as “that tryspin dissolved glycogen”—as water also

does—or the equally ridiculous one that it was a “property [of trypsin] without doubt of breaking

up glycogen in living tissues” (The Hospital, January 26, 1907, p. 297). I do not and have not,

“suggested” the use of secretin, or erepsin, or enterokinase, alon with one or both of the

pancreatic ferments mentioned above, just as little as that of soap or chian trupentine. I deal in

science, not in domestic commodities. None of these

30

things are in conformity with the enzyme treatment of cancer.

Moreover, it is not suggested in this book that the injection of 60,000 genuine tryptic

units and 120,000 amylolytic units in the space of four months will cause any and every

malignant tumour to shell out or encapsulate. At times a cancer may shell out on less, as

happened, for exaple, in the Naples case of inoperable cancer of the tongue. In others, again, a

much more vigorous treatment, for all I know, may be needed. Thus, the case in which, to my

knowledge, the greatest number of tryptic units was ever injected in a given time was one of

multiple scarcoma. In this case, in eight weeks, according to my calculations, 84,000 tryptic

units, and only about 16,800 amylolytic units, of the strongest injections then on sale, wee given.

Several of the tumours did, indeed, disappear, but, so far as I am aware, the patient was not cured

of sarcoma. Attention may be directed to the comparatively small amount of amylopsin

employed, and it is my suspicion that the case failed from toxЊmia, due to this lack of amylopsin.

This case was treated in the early1907, and at that time the very great importance of large

injections of amylopsin had not been recognized. The trypsin injection used in this case of

multiple sarcoma contained 500 tryptic and 100 amylolytic units per cubic centimetre or ampoule.

Owing to these facts, the course of treatment, doses, etc., cannot be compared with that adopted

by Captain Lambelle which such conspicuous success. At all events, genuine trypsin was

injected, and Dr. H.O.S. did not condemn the treatment. If a malignant tumour posses an enzyme

(ferment) totally different from that (trypsin) widely present, according to Vernon, in traces in

normal tissues, surely that is a fact of supreme significance and import. Since

31

1904 one of my main theses has been that, just as in normal development there was an antithesis

or opposite character, of two generations—sexual and asexual respectively—so the like antithesis

obtained, of necessity, in the ferments employed by these for their nutrition. The ferments of the

asexual generation or trophoblast were therefore the antitheses or opposites of the pancreatic

ferments, trypsin and amylopsin; and as cancer was in nature asexual generation (trophoblast), so

its ferments mush be identical with those employed by the trophoblast of normal development.

All life-processes take place through the action of ferments, and without these there would be no

life, such as we know it. It follows from this that the action of cancer ferments upon substances

on which trypsin and amylopsin, or normal cell-ferments, will also act, cannot be the same as that

of the latter; that is, the products of the fermentation must be different when used upon the same

sub-stratum. The proof of this, and the answer in the affirmative to the above question, has really

been furnished quite recently by German scientific chemists. In the paper by Professor Neuberg,

already cited (p. 12), he writes that “Comprehensive investigations into unusual ferment

phenomena of tumours have been made by E. Abderhalden, with P. Rona, A.H. Koelker, F.

Medigreceanu, and L. Pincussohn. They showed that often, but not constantly in human and

animal tumours enzymes can be detected which split up polypeptids and peptones quicker than

normal cell-ferments do. In addition, it was established that extracts of caner (die KrebssКfte)

split up polypeptids in entirely atypical fashion. While, for example, normally cell-ferments

hydrolize d-alanyl-glycyl-glycin to d-alanin and glycyl-glycyl, tumour fluid splits it into glycocoll

and d-alanyl-glycin. The pulling

32

down (Abbau) of cancer (carcinoma) takes place thus at quite other points (Stellen) of the animoacid

compounds that those at which all other peptolytic ferments attack.” All this is in complete

accord with the scientific foundations of the enzyme treatment of cancer, and it is exactly what

one might expect under the view of the trophoblastic or asexual nature of cancer, advocated by

me. As Blumenthal urges, it alone, apart from all other considerations, is sufficient to refute and

render untenable the “embryonic views,” such as the Remak-Cohnheim one. Professor

Abderhalden, in speaking of the foregoing finds, remarks that it is improbable that the atypical

pulling-down of the silk peptone is accidental, and he describes the enzymes concerned in this al

“atypical ferments of tumours.” Again, Yosimoto found that the proteolytic autolysis

(albuminous self-digestion) of cancerous liver was much increased over the normal, not only in

the tumour portion, but in those free from tumour. Neuberg, studying the like self-digestion of

liver-cancer, discovered a characteristic produce—fiz., reducing pentose, which in the selfdigestion

of normal liver is not produced.

In the Third (and latest) Report of the Imperial Cancer Research Fund (1908) the word

“ferment” occurs but twice in its 440 pages. Dr. W. Cramer writes (p. 433): “The effect which a

growing tumour produces on a normal organism* is a problem of nutrition similar to the growth

of a foetus in a pregnant animal. It cannot be explained by attributing to a cancer-cell the

formation of pathogenic substances of a hypothetical nature, such as a ‘cancer ferment,’ or a

‘cancer toxin.’” The reader will not how this is rendered in the Introduction to the Report by the

Editor: “Dr. Cramer’s paper shows how

*A “normal position” is here understood to mean a rat inoculated with a malignant tumour.

33

precise bio-chemical methods can now be applied to the study of the growth of cancer, and brings

new and exact information as to the nature of the relations existing between the tumour and the

animal bearing it. The effect which a growing tumour produces upon a normal organism is the

problem of nutrition similar to the growth of a foetus in a pregnant animal; it cannot be explained

by assuming the formation of pathogenic ‘cancer ferments’ or ‘cancer toxins.’” In the foregoing

the italics are mine, and they are introduced to draw attention to the method of citing the “new

and exact information.”

As demonstrating the exact opposite of this information, one may cite the following

recent words of Blumenthal and Neuberg: “Moreover, we consider the question of the abnormal

enzymatic (ferment) processes in tumours as completely cleared up, since it has also been

answered in a positive sense by Abderhalden and his colleagues, working with quite other

methods.” The original German of this passage will be found in a short article by Blumenthal

and Neuberg on “Proteolytische Fermente der Krebszelle,” in 1909; also to the same author, in

Zeitschr. F. Kresborchung, vol. X., 1910; and to Blumenthal, “Ergebnisse der Physiologie,” “Die

chemische VorgКange bei der Krebskrankeit,” pp. 363-428, 1910; separate edition of the memoir

(Asher-Spiro, Berlin), 1910.

In a review of Bainbridge’s report, the Lancet (October 9, 1909, p. 1079) states: “A

negative result of this kind has the great value we have indicated, in that the medical profession

have before them chapter and verse

34

for their placing no faith in trypsin, and none in persons who persist in advocating its use by

repeating stories of alleged ‘cures’ when, as a matter of fact, the patients referred to have been

proved to have died from the disease.” Scientifically, it is not necessary to do more than insist on

the fallacy of lying any stress at all upon “a negative result,” and in the present instance this

happens to be specially true, for “the medical profession,” if it were “placing faith” in the

evidences furnished by Bainbridge’s report, would find it now difficult, but impossible, to cite

from it any real scientific grounds for this. The “chapter” may be found easily, for the “scientific

report” has been scattered broadcast, but the “verse” is a present blank. In the chemical

experiment the observer must satisfy, not only himself concerning his reagents, but also the

requirements of science.

As Bainbridge employed five different strengths of trypsin injections, of which the

strongest is stated to have been six time the strength of the weakest, and as he furnished no

particulars to show in which cases each of these injections had been employed, or the total

number and sizes of the doses in a given time, the “chapter and verse” of his evidence can carry

no sort of conviction to any logical mind. The reference to patients “proved to have died from the

disease” in the citation above is, of course, to the single case of Miss K. H., which has never once

been cited by me as a “cure,” or even believed for a moment to have been “cured.” This case

(No. 7 of Bainbridge’s report) furnishes a far more useful and instructive object-lesson of the

value of surgery in cancer than of trypsin and amylopsin.

The following is the history of this case as give on pp. 20 and 21 of Bainbridge’s report:

“Duration of disease previous to enzyme treatment: about three

35

years. Previous treatment: removal of growth from left breast, June 4, 1904 (Dr. Edward W.

Peet); radical operation refused. About one year later thirty-two X-ray treatments (Dr. William J.

Morton); trypsin, 5 to 10 minim doses, April 27, to October 31, 1906 (Dr. Morton). Radical

operation, November 3, 1906 (Bainbridge). Removal of enlarge nodules and secondary deposits

in skin, January 22, 1907 (Bainbridge). Condition when enzyme treatment was begun: full

enzyme treatment instituted twenty-four days after radical operation. Recurrent, irremovable

cancer of left side of chest and glands of neck; liver enlarge, probably cancerous; general

condition poor.” This is a fair sample of what surgically is understood by “a thorough, scientific

test.” According to the above the cancer of the breast had existed for not far short of three years,

and the case had failed twice surgically before a real enzyme treatment was, as a last resort,

undertaken.

Dr. Morton’s treatment with 5 to 10 minims of “trypsin” thrice weekly during some six

months in 1906 may be dismissed as no treatment at all. I doubt whether with the strengths then

on sale, which no endeavours of mine could persuade manufacturers to increase, the patient

received in all more than one of the doses mentioned in this book—viz., 1,000 tryptic units.

According to Bainbridge’s report, and its author, as the surgeon concerned, perhaps knows the

facts better than any anonymous critic, the order of events was the very opposite of that usually

assumed. The knife failed twice before Bainbridge evoked the ferments. There might, indeed, be

some point, if little truth, in the statement here referred to, had the patient derived any benefit at

all from “submission to the knife.”

Looking back over the field of my researches since the

36

summer of 1888, twenty-three years ago, at various phases of the journey, it was all a lonely

pilgrimage

“Towards the unknown region,

Where neither ground is for the feet,

Nor any path to follow.”

WHITTIER

New problems, entailing fresh, patient labours, constantly arose, and the solutions of these

brought, invariable, new surprise in their train. The start of the work was the discovery of a

transient nervous apparatus in the development of a fish; this was the one end of the slender

thread. Its unravelling was always intensely interesting and absorbing to the observer, and the

thread went on, and on, and on, always continuously, unlike any other thread of research known

to me in the whole history of embryology. Then, at last, the other end came in sight, twenty-five

years after the observer first began, in Semper’s old research institute in the ancient University of

Würzburg, to learn from the master how research problems were to be approached, dealt with,

and solved. The story of this is told in Chapter VI.

The first piece of work upon the thread occupied some five or six years; for that time was

required to work out, night after night, and put together the results, which are recorded, with eight

plates, in the memoir upon “The History of a Transient Nervous Apparatus” (1896). This was

clearly an asexual structure, the work upon it a prelude to the cancer investigations. There are,

indeed, published researches extant, such as Professor A. Goette’s immense monograph upon the

development of a toad, Bombinator, which took a longer time; but, so far as I know the literature

of embryology, there is no other embryological monograph which covers so long a period of

development, or span of time, some seventeen

37

months, as this. It is nearly twice the length of time of a human pregnancy from conception to

birth.

But this is not the place to write a history of a quarter of a century’s researches in

embryology. Suffice it to say that the chain of researches is now a complete one, every link has

been tested, and no flaw discovered. As one outcome of this systematic investigation, a single

case of successful cure of malignant disease, quite apart from others recorded in the published

literature, is brought before the whole work, and the invitation is give that any test of its truth be

applied to it. All the methods employed are published in full. The remedies suggested and the

modes of using them may be rejected or ignored; but the truth, if scientific truth have any place at

all in this world, must be admitted. The facts are: that in a case of malignant disease, termed by

the pathologists a “round-celled sarcoma”—named by me, scientifically, irresponsible trophoblast

or asexual generation—which was recurrent and inoperable after two extensive surgical

operations upon it; the remains of the tumour, under the influence of the all-powerful ferments,

trypsin and amylopsin, finally shelled out, leaving the patient free from all trace of malignant

disease, and, in fact, “cured.” I ask that these scientific fact, which cannot be denied, be admitted,

and that with this the tardy acknowledgment be made, that when, on January 20,1905, a scientific

man, whose sole object was the revelation of the truths of Nature, stated publicly that “in the

secretion of that important digestive gland, the pancreas,” Nature had provided a potent remedy

for cancer: what he then said was nothing more than scientific truth, which is the greatest of all

truth.

This, Nature’s remedy, may be taken or left; but the truth may be denied no longer. It is

beyond my power

38

to prevent mankind, in happy ignorance of what the cycle of life really is, from awaiting some

other solution of the problems. In doing this futile thing mankind may watch, and hope, and pray,

until the crack of doom; but all in vain. Even if the scientific solution were to dawn upon official

research, it could—in this universe, at all events, and as it is constituted—be none other than that

offered by Nature! No denial can any longer have the smallest value against the supreme truth,

that when properly—that is scientifically-applied, the pancreatic ferments, trypsin and amylopsin,

being the most powder things in the whole range of organic nature, are efficacious agents against

cancer.

At the present time science and scientific research are not things to be made light of, to be

scoffed at and jeered at in the market-place, or to be ignored. With the publication of the facts

contained in this book, the responsibility is shifted to other shoulders than those of the scientific

observer. All I ask is, that these truths of Nature, which she has given as a revelation of

boundless and priceless import to a world which was not ready for them—that these shall not be

denied, but be received reverently as what they are—true facts of Nature. Cancer is a natural

phenomenon, not a disease; although it may bring disease in its train. Its treatment—that of a

natural phenomenon—has been committed legally, logically, rationally, and scientifically not to

the hands of the scientific observer, who has discovered its origin and nature. It is the business of

the scientific observer, not that of the medical man or surgeon, to study and elucidate natural

phenomena. Let the truth be acknowledged

39

for its own sake. As the writer is “not even a medical practitioner,” the adoption of the treatment

in all or any cases of cancer is not compulsory; but it may not for a moment be imagined that

scientifically it is intended to make good the failures of surgery.*

The statement made in this book that cancer is a natural phenomenon, not a disease is

unassailable. It rests upon scientific evidences, which are impregnable against all attacks; but it

may be questioned whether civilized mankind as a whole has any real conceptions of the nature

of natural phenomena in general. Some are beneficent. The sun rises, and its heat and light

render this earth habitable to man. Owing to natural phenomena, the seasons return in orderly

fashion, bringing, among other things, spring, with its fresh, new green; summer, with its wealth

of flower; and autumn, with its harvest of fruit and grain. Other natural phenomenon are

maleficent—malignant. The volcano, also a natural phenomenon, has in the past buried or

destroyed countless cities; and even in our own day this has happened. Some naturalists have

been of opinion that the fossil remains of innumerable animals, now extinct—often found in great

multitudes heaped together-owed their present existence, as imperfect records of past events, to

catastrophes which were also

*While for the sake of humanity the enzyme treatment may be refused to no case of cancer,

recurrent after one or more operation, if such cases fail, from the point of view of pure science, they may

not be regarded and cited as “test cases”; for in them there always lies the possible source of error of

experiment of previous operative interference. With a positive result, as in the York case, such a case

becomes, on the other hand, a test one of the severest description; for in it success has been obtained, in

spite of the existence of the possible source of error.

40

natural phenomena. Last, cancer, with all its malignancy—a thing which laughs to scorn the

impotence of the surgeon’s knife, which yearly claims its thousands upon thousands of human

victims *–is at its scientific basis only a maleficent natural phenomenon, such as these. We come

into being and exist as human beings because of beneficent natural phenomena, and as human

beings we continue, for a span of time, to subsist, in spite of maleficent natural phenomena. The

course of some natural phenomena is unalterable by human agency; others, again, by a

knowledge of the working of Nature, of science, can have their maleficent action stemmed and

averted; and, as a scientific man, I affirm that cancer belongs to the category of these.

To those, surgeons and others, who have not, like the writer, foolishly devoted their lives

to scientific research and experiment, but wisely to more mundane pursuits—such as the

acquirement of wealth—let the following warnings be uttered: “If you wish to set up what you

term ‘test cases,’ pray let them be such as shall fulfil in every way the requirements of science.

Do not vitiate your experiments from the very start, as has happened, by choosing some 66 per

cent. Of the cases, in which there lay the pernicious ‘error of experiment’ of previous surgical

operation, once or several times over. Remember also that if your cases be chosen rightly—that

is, scientifically—even then there remain the reagents employed, and how used. Do not forget

that in this, as in every scientific chemical experiment, the observer must not only satisfy himself

regarding his reagents, but be prepared,

*On the basis of the present population of the United Kingdom of Great Britain and Ireland

(45,000,000), the tribute exacted by malignant disease in a single century would be not less than 3,875,000

human lives, or over 100 daily; for India 27 millions.

41

if called upon to do so, to produce scientific evidences concerning their nature and composition.*

Above all, do not for a moment imagine that you ‘have tried trypsin in cancer, and have found it

useless,’ when to all intents and purposes you might just as well have been testing the effects of a

solution of glycerine and water. Do not think it is ‘science’ to perform mere elementary

qualitative experiments upon your injections, showing that they have some action upon starch and

upon white of egg. Lastly, under the erroneous idea that it thereby makes the thing a scientific

document, do not publish any account of your negative experiments with trypsin and amylopsin

with the sub-title, “A Scientific Report,’ unless the document in question fulfil, like my scientific

memoirs and like this book, in all respects the requirements of science.”

The greatest exaction of science is truth. This is why the expression, “scientific truth,” is

so far-reaching and invincible. In the opening passages of this Introduction two points were

referred to, and to them at its close I return. “There is,” said Tyndall, in somewhat different

words, “in the true scientific man a desire far greater than to have his conclusions ‘generally

accepted’: it is the ardent wish to see them verified in fact.” Again, it was pointed out that the

problems of the origin, nature, etc., of cancer formed but a special case, a side-issue, of the

application of a general principle. This general principle, revealed by my researches of more than

twenty years, was of an antithetic alternation of generations with a continuity of germ-cells from

generation to generation as the basis of the cycle of life. This, the law of animal development,

waw what during many years of research Carl Ernst von Baer groped for, but in vain. In this

*Apparently this rule of science has no applications in official cancer research.

42

connection a confession on p. 451 of von Baer’s “Autobiography” (second edition, 1886) is of

great interest. Here, in a review of his own published embryological researches, he writes: “Und

der Generations-Weschsel schleuderte mich ganz zurück” (And the alternation of generations

threw me right back). As the reader will find a subsequent chapter, there are grounds for

supposing that the like difficulties connected with alternation of generations interfered with the

researches of another great embryologist, Johannes Müller. It required, in fact, the later botanical

investigations of Hofmeister and others to furnish a new basis for attacking this fundamental

problem of alternation of generations in animals. Sixty years after von Baer published his

investigations I began mine—in the summer of 1888. These researches certainly lasted far longer

than his, and their completion only came nearly twenty years later, with the final overthrow and

rout of cancer. This latter, including the physical fact of the actual liquefaction of living cancer in

the living human body, and embracing the true cure of malignant disease in the single case—a

test one for all time—of Lambelle’s ex-drummer in York has a far wider import and deeper

bearing than its applications in medicine, and for the welfare of humanity. The scientific

investigator is bound, on occasion, to divest himself of his humanity, and to look at his problems

and their solutions in cold-blooded fashion. He must draw the conclusions, even though the

heavens fall. This I shall now proceed to do in brief, reserving a fuller treatment for some other

place and occasion.

For the past century, to go no farther back innumerable attempts have been made—all in

vain—to solve the problems of cancer, or malignant disease. In Dr. Jacob Wolff’s monumental

work, “Die Lehre

43

von der Krebskrankheir,” vol. i., the list of investigators given includes more than a thousand

names—to be exact 1,004. Why, of these, did 1,003 fail, and but a single on succeed? The

answer to this is not far to seek, and, indeed, it is contained in the true solution which is detailed

in the following pages. All scientific research, to be successful in the end and enduring, must

start in correct principles, or, at any rate, not in false ones. Until in recent years a practical

embryologist of long-working experience applied the general principle of an antithetic alternation

of generations to the problem of cancer, it had always been attacked from the standpoints of three

embryological dogmas, which have this in common—that they are false, though “generally

accepted.” These are epigenesis, or direct building-up of the embryo from the products of the

fertilized egg (Harvey and Wolff); somatic origin of germ-cells, as “chips” of the “old block”

(Huxley); and recapitulation in development, as maintained by Haeckel and his followers. If

these doctrines, which are pretty “generally accepted,” were true, if they contained a particle of

truth, the solutions of the problems of cancer would follow inevitably out of them. If they were

false, as they are, their applications to cancer could but lead to failure, and this has been the case.

Years ago, as opposed to these dogmas and as scientifically true, I set up, on grounds of

observation, the three doctrines of evolution with predestination (Weismann anticipating me in

this), a morphological continuity of germ-cells, and an antithetic alternation of generations.

This trilogy of doctrines is in reality one and indivisible. If this trilogy were scientifically

correct, its application to the problems of cancer must end in their resolution, and this has, in fact,

happened. It would not have

44

taken place under any constitution of the visible universe other than the one which includes this

general principle of an antithetic alternation of generations as the basis of the cycle of life of

animals and plants. It would have been lacking, were this general principle untrue, had my

researches since 1888 been false as well as “heterodox.” Were direct development or epigenesis,

somatic origin of germ-cells, etc. Nature’s method, cancer would not, could not, have been

liquefied by injections of pancreatic ferments in London, New York, Berlin, and York; no

malignant tumours at all would have disappeared under the influence of injections of pancreatic

ferments; and Lambelle’s ex-pensioned drummer would long ago have perished miserably from

the ravages of malignant disease, as countless other cases still do every day, week, and year all

over this earth. It follows that the current dogmas of direct development or epigenesis, set up in

the eighteenth century by the researches of Harvey and Caspar Friedrich Wolff, somatic origin of

germ-cells, and recapitulation in development which are taught in all, or almost all, the

Universities of the civilized world, and which are supposed to underlie the sciences of

embryology, zoology, and anatomy, not to mention physiology and pathology, etc.—that these

are false, even though they be “orthodox.” Therefore, the general principle of an antithetic

alternation of generations has not only resulted in the overthrow and rout of cancer, but its

decisive success in this has demonstrated how necessary it is, in the interest of truth itself, that

without further delay—unless scientific truth have ceased to be a requirement of science—the

scientific house be put in order, the false dogmas be cast out and rejected as worthless, and the

Golden Rule of an antithetic alternation of generations be set up as a fundamental scientific

general principle of the sciences of

45

life—embryology, biology, etc. Orthodoxy will not in science render false doctrines true, and

Tyndall’s words become a mere mockery and delusion unless they apply to the embryologist and

biologist, as well as to the physicist and chemist.

Twenty years ago my general principle—an antithetic alternation of generations with a

continuity of germ-cells from generation to generation as the basis of the cycle of life—was

almost within my grasp; that is, had almost been established by facts of observation. After a few

more years of patient research this was so—at last. Those, and those only, who know and

appreciate the history of the growth of human scientific knowledge—“The Growth of Truth”

(Osler) can realize the true import of this. Two of the greatest scientific investigators of the

nineteenth century were Hermann von Helmholtz and Louis Pasteur. As investigator they were

incomparable, beyond comparison with others or with each other. What the latter thought about

general principles in scientific research is cited, else in this book, and it may be found in full in

his live, “La Vie de Pasteur,” written by Vallery-Radot. The illustrious physicist and

physiologist, Hermann von Helmholtz, wrote his view in the following beautiful lines: “When,

from a correct general principle, one develops the conclusions in special case of its application,

new surprises, for which one was not previously prepared, always make their appearance. And

since the conclusions unfold, not according to the author’s caprice, but after their own laws, it has

been made the impression upon me that really it was not my own work which I wrote down, but

merely the work of another.”*

* “Wenn man aus einem richtigen Allgemeinen Principe die Folgerungen in den einzelnen FКllen

seiner Anwendung für sich entwickelt, so kommen immer neue Жberraschungen zum Vor-

46

The general principle of an antithetic alternation of generations has now been applied to

the special case of the natural phenomenon knows as “cancer,” or “malignant disease.” Even

though this had been in the York case alone, at the hands of Captain Lambelle, it has proved itself

to be capable of solving the enigmas of cancer, of explaining it scientifically, and of coping with

it successfully. Not only so, but in the sequel it has turned out—and it is no accident—that at its

basis this general principle merges into a certain other one, laid bare by the researches of

“Pasteur, van t’Hoff, and Le Bel. This, which relates to the asymmetry of naturally occurring

organic compounds, rests upon a foundation-stone of the visible universe, the asymmetrical

carbon atom. It is this which is the true and only scientific basis of the science of stereochemistry,

and, as my researches have shown for all time, of the sciences of life, embryology and

biology. The problems of cancer were vulnerable along two different lines of attack—

embryology and stereo-chemistry. While official cancer research has failed hitherto to follow up

either line of attack, the writer, in his private cancer studies, has developed both of these—the

only possible points of attack—and along both the “divisions” and “brigades” have achieved the

complete overthrow and decisive rout of Cancer.

(footnotes from page 46)

schein, auf die man vorher nicht gefasst war. Und da sich die Folgerungen nicht nach der Willkür des

Autor, sondern nach ihren eigenen Gesetze entwickeln, so hat es mir oft den Eindruck gemacht, als wКre es

gar nicht meine eigene Arbeit, die ich niederschreibe, sondern als ob ich nur die Arbeit eines Anderen

neiderschriebe” (From a letter written to Sir William Thomson [Lord Kelvin] in 1860).

47

PART 1

THE PROBLEMS OF CANCER

CHAPTER 1

EMBRYOLOGICAL ASPECTS AND ETIOLOGY OF CARCINOMA*

At a time when so much is being attempted in the investigation of the problem of the nature of

cancer, it may appear presumptuous on the part of an embryologist to express opinions and

conclusions regarding this grave question. It has long been a subject of earnest research by

physicians and pathologists, who naturally are familiar with actual facts and finds concerning

carcinoma, foreign to the embryologist. But hitherto the physician and the surgeon, the

pathologist and the gynЊcologist, have failed utterly to establish anything concerning the etiology

of cancer, and without the intervention of the embryologist success may be as distant in the future

as in the past.

As indicated by the above title, the present chapter is intended to deal with aspects of

carcinoma as they strike an embryologist, and not every embryologist, but one particular

investigator. At the outset it may be asked, “Is the etiology of carcinoma an embryological

problem?” As the thing itself and its manifestations demonstrably fall within the province of the

surgeon and the pathologist, for it confronts them almost daily, it is possibly not

*The Lancet, June 21, 1902.

48

very clear why the problem of the nature of cancer should be an embryological one at all. It is a

disease carrying with it death and destruction. On the other hand, the problems of the

embryologist, as generally understood, treat not of disease, but of the blossoming-forth of life

itself—of the phenomena which culminate in the appearance of new living beings. Death and

decay would seem to be things of which, from his researches, the embryologist might be expected

to obtain no practical knowledge. He is supposed to be concerned with “das Werden,” while das

Vergehen” is beyond the scope of his researches. Would that it were so! Unless he shut his eyes

to plain facts, “das Vergehen” in the midst of das Werden”—death in budding life itself—is

continually before him.

The conviction impressed upon the writer’s mind from many years devoted to the study

of the mode of the development of the higher animals, the vertebrata, is that everywhere and at

any point atrophy and death and degeneration of cell, of organs, of organism, of embryos

themselves, are among the commonest phenomena under the eyes of the embryologist. His

textbooks, even his published researches, may be silent of these; for, as a rule, he believes himself

to be concerned solely with the coming-into-being; and the opposite aspect, the decline of life, he

leaves severely alone. It is not, in his tacit opinion, a theme of the science of embryology. This

view of the problems of the science has for many years failed to commend itself to the writer, and

in his own researches he has endeavoured to take account of everything happening and capable of

being observed during the developmental cycle, whether progressive or retrogressive.

49

The manifestations of life present themselves under the headings of either form and

structure, or function. Embryological research deals largely with form and structure, or, more

exactly, with the coming about of these. And as, according to the testimony of pathologist,

cancer, when it appears, is something new to the organism,–a neoplasm, a foreign thing, not

growing and functioning after the manner of the individual containing it, increasing by celldivision

after unknown laws, which appear to defy all law, carrying with it widespread eroding

destruction, only comparable to that dealt out by some parasites—the phenomena of cancer would

have analogies at least to many such lying within the domain of the embryologist. Cancer is

something with a beginning; it increases like a developing embryonic germ by cell-division; it

invades territory at first foreign to it, and it differs only from a parasitic organism in the fact that

its mode of reproduction is what may be defined as asexual. And thus, while as a rule its cycle is

limited to the individual harbouring it, carcinoma is something with for itself an indefinite lifecycle,

which is only bounded by the life of its host, but which cannot be carried directly over, by

germs or fertilized gametes, to another organism.* That the resemblance between the life-cycle

of a cancer and that of a higher animal should be incomplete is natural; for the former is an

abnormal product, and it is in the nature of such to differ in some or other important details from

the typical or normal.

The problem of the nature of cancer has long been before the writer in his investigations;

in fact, ever since

*It has, however, been shown by Hanau and Wehr to be possible to transplant cancer from one

individual—e.g., the dog—to another.

50

he learnt, from the researches of Welms* and other, that it had been encountered occasionally

along with those curious tumours, the “dermoid cysts” of ovary or testis—the “embryomata,” or

rudimentary embryos of Wilms. The latter speaks of this occasional connection † of the two—it

had in 1902, according to Wilms, been observed some nine times—as a remarkable fact (p. 86),

in that, in an organism of one or two years of age, the development of carcinoma can happen. As

this relates to the presumed age of the embryoma, and not to that of the individual harbouring the

latter, the validity of the conclusion is not apparent. On his part the writer must reject it. For the

past two year, from time to time, in researches upon the germ-cells, observations have been made

which appeared to have bearings upon the nature of carcinoma. ‡ This period may not seem a

long one; but beyond it life the investigations of other twelve years, without which the standpoint

of to-day would be an impossibility. If, therefore, no study of cancers underlie the present

chapter, the approach of the problem is not a sudden one; but it as been preceded by prolonged

observation, and, moreover, animal life is the same whether it be that of a hyroid polype upon a

shell of the seashore, or that of a cancer within an individual of the human race.

The immediate cause of the present writing was as follows: In a recent paper, dealing

with the understudy theory of heredity, in an altogether different connection,

* Wilms, Max, “Жber die Dermoidcysten und Teratome,” etc. in Deutsches Archiv f. klin. Med., v.

55,1895, pp. 1-108, Pl. 3; also Martin, “die Krankheiten des Eierstockes,” etc., Leppzic, 1899, pp. 576-614.

† Chorio-epithelioma, even in the male, and usually in the testis, has, of recent years, turned out to

be not uncommon.

‡ Some years ago, at Liverpool, Mr. H. J. Styles, F.R.C.S., published figures of all the supposed

“cancer-parasites,” and showed what they really wee. All of these have been seen by the writer in

degenerating germ-cells of development.

51

a few comments had been written down upon the mode of growth exhibited by certain organisms,

and a comparison drawn between this and the pernicious growth of the human chorion in certain

cases.* And it was not until long after the proof had been returned that is was seen how in this

comparison the key to the problem of the nature of cancer had been given away. If the pernicious

growth of the chorion be really carcinomatous—and it is recognized † as such by pathologists

under the names of malignant placentoma, deciduoma, chorio-epithelioma or destructive

placental ploype ‡–the nature of cancer is clear as the light of day. And it has seemed desirable

to offer the present essay, in order that at least a warning note might thereby be uttered, and an

earnest attempt made to point to the futility of investigation in the direction of a cul-de-sac, such

as the probable one of cancer, as due to unicellular organisms.

In the following, the facts concerning carcinoma, as

*The passage in question is as follows: “It should be mentioned that De Vries and

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ЪЪЪЪЪЪЪЪЪЪЪЪЪЪЪЪЪЪЪЪЪЪЪЪЪЪЪЪЪЪЪЪЪЪw the mammals;* the animal lowest in the scale in

which it has been recored being the short-headed phalanger (Belideus breviceps).† The disease is

a corollary to uterine gestation.

If the cycle of development of the higher animals really be that concluded by the writer,

if his interpretation of the phenomena of mammalian development—which are not in the least

based upon facts or factors noted in cancer, but upon normal development here—if these be

correct, the nature of carcinoma is not hypothetical at all, but is actually known. More than one

font cannot be assumed, and it one fountain-head be shown, all other

* See. However, the closing lines of this chapter.

† Bland-Sutton. J.: “Evolution and Disease,” London, 1890, p. 247, Fig. 123. The case is one of

cancer in the marsupial pouch.

63

explanations become superfluous. In certain cases in human development, where either no

embryo arises within the chorion, or when the embryo becomes aborted or dies prior to the

suppression of the asexual generation, the latter—the chorion—may go on gowing indefinitely,

and may give rise to what pathologists and gynЊcologists recognize to be a form of cancer,

placentoma, or chorio-epithelioma (Marchand). For years now I have recognized, and, in

homologizing this structure with the larval skin of an amphibian, Hubrecht has gone a long way

in the like direction, that the human chorion represents the main portion or whole of the asexual

generation here. In certain cases, therefore, we here witness the conversion of the chorion—i.e.,

of the asexual generation—into a malignant tumour, a carcinoma.

What other proof could be asked for? That this proof of the nature of cancer is not in

agreement with accepted views of normal development cannot be set down to the fault of the

writer. He holds, and has long maintained, such views to be false and unfounded in fact, and

moreover, it has been attempted to indicate the right way. The arguments and conclusions have

been neither refuted nor confirmed, but they have been ignored. But embryologists, are living,

and have long been existing therein, in a mental universe, where but a tithe of the facts observed

are explicable under their views. Under the conception of development as an antithetic

alternation of generations—especially as laid down in “Hereditary and the Epicycle of the Germ-

Cells” *–all the known facts of development fit in, all are capable of easy and natural

explanation. And the elucidation of the etiology of carcinoma follows as a natural corollary to

the law of the

*Bilogisches Centralblatt, 1902, vol. xxii., pp. 321-328, 353-360, and 398-408.

64

development cycle. The embryologist and pathologist may ignore and neglect the plain and

palpable fact, but on no theory of direct development—a thing only existing for the higher

animals in the human imagination—can any explanation whatever of the nature of carcinoma be

advanced. This would have been recognized clearly long ago had some embryologist taken the

trouble, as the writer has done since 1888, to trace out in full the details of the life-cycle of one of

the higher animals from egg to egg. The idea of direct development, accepted without

examination of the evidences, and the erroneous belief in the somatic (body) origin of germ-cells,

have retarded the advance of knowledge to an extent difficult to estimate.

The nature of the argument employed in the present writing may be summarized as

follows: Granted the facts of the origin, migrations, and history of the germ-cells of vertebrates,

and assuming the course of the life-cycle to be that previously indicated, by hypothesis cancer is

derived from vagrant primary germ-cells, which, instead of forming a more or less complete

embryo or embryoma, skip this, and give rise to an asexual generation of indefinite unrestricted

powers of growth. This is, of course, purely hypothetical, but it becomes the true explanation by

the following facts: On the one hand, as my researches have shown, the hypothetical verirrte

Keime, or “lost germs,” of pathologists not only exist, but they are numerously represented, and

by things capable of abnormal development—the vagrant primary germ-cells. On the other hand,

the carcinomatous nature of such an abnormal growth of an asexual generation has been

demonstrated abundantly by Marchand for the instances of the pernicious growth of the chorion,

chorio-epithelioma. If such a chorion, or trophoblast, the representative more

65

or less complete of the asexual generation, when robbed of its embryo, or when it fail to form

such, can—and this is established—give origin to a malignant carcinomatous tumour, the nature

of cancer is clear. The vagrant primary germ-cell is the seed, while its fruit, sometimes

represented by an embryoma, may, on occasion, take the form of a carcinoma.

In the foregoing pages, written in 1902, cancer is spoken of as “a disease,” for not until

the researches had advanced much farther did it become clear that cancer was a natural

phenomenon. The origin of a cancer from “a vagrant germ-cell” is urged; but on grounds, given

later, it soon became necessary to restrict this power of independent development to some few

only of the vagrant germ-cells. Its asexual nature is clearly defined in the foregoing, and while at

that time its restriction to mammals seemed clear (although in 1895 its occurrence in some other

vertebrates had been recorded, as I found later on), below the mammals it is still anything but

common. Even now (1911) no case is known in reptiles, and but a few instances have been found

in birds, while in many thousands of frogs examined the writer has only encountered on

undoubted case of epithelioma. Considering its frequency in mammals, especially in man, the

statement made above of its connection with uterine gestation would still appear to have a basis

of fact under-lying it. The adaptation of the asexual generation (trophoblast) to uterine life,

shown by the occurrence of uterine gestation, favours its abnormal development in mammals as a

parasitic cancer, as in no other class of back-boned animals. In the following chapter an attempt

will be made to show how the tumours are related among themselves, and to the individual

harbouring such a new formation.

66

CHAPTER ll

THE EMBRYOLOGY AND ETIOLOGY OF TUMOURS

A. THE EMBRYOLOGY OF TUMOURS.

The etiology of tumours is one of the darkest regions of pathology. This is by no means due to

lack of hypotheses, rather to the absence of material basis for any of those current. It cannot fall

within the scope of the work to treat of anything like all the different ideas at some time or other

maintained.*

The writer’s purpose will be served best by referring only to views as to the nature of

pathological growths, based in some form or other upon embryology. † One cannot read the

writings of the pathologists of the twenty-five years without being struck by the un-

* For these, and their name is legion, see Wolff, Jacob: “Die Lehre von der

Krebskrankheit,” Jena, Gustav Fisher, part i., 1907, and part ii., 1911.

† To account for tumours the two views most advocated at present appear to be that of

“embryonic rests” or displacements, and that of metaplasy. Under “metaplasy” pathologists

understand change in the character of tissue-cells, even in later life. Both are purely hypothetical,

and each of them, has been described as savouring of the miraculous. From the modern

embryological standpoint both of them may be said to be impossibilities. Regarding

“metaplasy,” as little as a man can return to his childhood, so little an any of the cells of his body

take on embryonic characters, or change their nature. If any one small part of the body can do

this, why not grant the same superhuman power to the whole?

67

doubted tendency on the part of, at any rate, many of them to assign some sort or other of

embryo-logical basis to very many, if not all, tumours. I should be the last person in the world to

deprecate this, convinced as I am that far more tumours than almost any pathologist now living

possibly imagines to be explicable embryologically have such a basis. I only differ from many

pathologist in regarding these neoplasms from an embryological standpoint which is as strange to

them as it is to the majority of embryologists. The pathologist who is an exponent of a

developmental etiology of tumours naturally endeavors to bring them under the laws of

embryology, as given in current textbooks. Since my work of many years past has clearly

brought home to me the erroneous, baseless, and impossible nature of many of the tenets and

doctrines of modern embryology—e.g., direct development, somatic origin of germ-cells, and

epigenesis—it must, of course, be equally clear than an “embryology of tumours” founded on

these can only be fallacious.

A tumour, whether simple or complex, is a living thing, and, like everything living, it

comes gradually into being, it unfolds and manifests itself, and in this way it has its own

developmental history. This statement may appear somewhat metaphorical, but its meaning is

clear enough if it be said that very many tumours, from the most complicated teratomata down to

cancer (carcinoma and sarcoma), are but bizarre manifestations of some portion of an animal lifecycle.

The truth of this could not become apparent hitherto for two reasons: on the one hand, the

views maintained as to the normal cycle of development were erroneous; and, on the other, the

true science of embryology is as yet almost a terra incognita to pathologists. But, just as there is

a science of normal

68

development waiting for recognition in our Universities, *–one whose continued neglect and

exclusion will continue to revenge itself upon mankind, as it has already done in the past, by a

corresponding retardation of priceless knowledge—so there is also (a branch of the foregoing,

and only to be understood in the light of it) an important field of abnormal embryology, largely

represented by the tumours and their problems—a knowledge of which can only be advance by

aiding and fostering the former.

In his magnificent monograph upon tumours Borst writes eloquently of this pathological

embryology as a large and interesting region of knowledge, through whose mystical portals we

penetrate at the moment with feebly burning torches of comprehension (Erkenntniss), but with the

highest expectations. The torches here spoken of may be identified as those of the science of

normal embryology, than which there is possibly no department of knowledge of more moment to

mankind, and by whose light alone these dark, but to mankind gravely important, regions can be

illumined adequately.

In studying the views presently advocated as to the etiology of tumours, the following

points are apparent to the embryologist. In their basis, so far as this is embryological, they are but

modification of the Remak-

*The writer seeks no such post, although aware that in the last two years of his life the

creation of such a University Chair in London for him was the cherished wish of the late George

Bond Howes, Professor of Zoology in the Royal College of Science, South Kensington. But it

may be pointed out that, unlike Germany and the United States, Great Britain has to-day not a

single University Chair of Embryology. Had such posts been as common for the last fifty years

as those in many other subjects of infinitely less important to mankind and to medicine, the

problems of cancer might have been solved long ago, and possibly thousands of human beings

saved from the torments of malignant disease.

69

Cohnheim theory of embryonic rests,* and the descriptions and classifications of the tumours

usually adopted have no embryological groundwork whatever, proceeding, as they do, from the

simple to the complex, instead of from the most complicated teratomata—the embryomata of

Wilms—to the simple tumours represented by but one tissue—a “connective tissue” or an

epithelium. †

The “rest-theory” of Remak-Cohnheim, and their followers is a natural corollary of

epigenesis as the mode of the development; and so little as the possibility of this mode of

development can be admitted, as little can the existence of such rest of embryonic tissues, organs,

or structures, be allowed. ‡ With the rejection of the Remak-Cohnheim theory, the modification

suggested by Ribbert also falls to the ground. If the embryo be not gradually built up from a pile

of material, as a house is erected, there can be no superfluous bricks or other structures to ball

back upon as the seed of later tumours. Even were the development epigenetic—and this is

certainly not the case—the actual existence of such rests has never yet been demonstrated; nor is

it shown by the occasional appearance of a supernumerary or accessory organ or structure, such

as an extra kidney, thymus,

* The theory of “embryonic rests” as the source of tumours is almost invariably attributed

to the pathologist Cohnheim. As shown in another chapter, it was first enunciated by the

embryologist Remak, and for this reason and for clearness it will be referred to in these pages as

the “Remak-Cohnheim” theory.

† To his knowledge Wilms and C. P. White are the only authors who, like the writer,

regard the neoplasms in this “inverted” fashion. It may help to support their attitude in this

important matter to add that the writer arrived at the conclusion that, as a rule, the tumours were

approached in the wrong order, before seeing their writings.

‡ The recognition of the impossibility of epigenesis as the mode of the development was

first made by Weismann in his “Germplasm” (1893).

70

adrenal, ovary, or spleen. In no embryological sense can such be considered to represent the

missing hypothetical rests. Such structures have not been known to give rise to tumours.

Perhaps the theory of embryonic rests has undergone its most important and most

scientific alterations at the hands of Wilms,* of whose views—to some extent, at the least—

Borst† is also an exponent. Of Wilms’s researches on tumours, and especially of the facts laid

bare by them, it is not too much to say that they are epoch-making. But of his embryological

conclusions it must be added that they are necessarily false, because based on the premisses of an

impossible embryology.

The lost germs or rest of Remak-Cohnheim are replaced by Wilms by what he terms

“germinal shuntings” (Keimausschaltungen). Essentially, Wilm’s theory is almost as simple as

that to be here advocated, and, like the later, the hypothesis of germ-shuntings will readily explain

many tumours. The germ-shuntings of Wilms are conceived as follows: At various periods of

the development, from the earliest to undefined later ones, prior to the completion of the parts of

the embryo, there are single cells or little groups of such, set apart to furnish some structure of the

embryo. These are often serially repeated (metameric segmentation) in great numbers. Some on

or more of these may be shunted out of the normal connection ( ? by what ) at almost any period

of the devlopment. According to Wilms, this shunting is not to be regarded as a displacement, for

the thing shunted actually remains in the organ to which it really

*Wilms, Max: “Die Mischgeschwülste,” Leipzic, 1899-1903, 3 Hefte.

`† Borst, Max: “Die Lehre von den Geschwülsten,” Wiesbaden, 1902, 2 vols.

71

belongs.* If this hypothetical shunting—which, to may mind, in a normal development is

physically impossible without disaster to the developing embryo—happen in the earliest periods,

it will be in connection with cells of the cleavage, and one or more of these may become the

abnormally placed seeds of a tumour or tumours. As an example, to be commented upon later in

its true bearings, Wilms himself found in one case not less than five embryomata or rudimentary

embryos in one ovary! These represent under Wilms’s views five blastomeres of the cleavage. I

do not know whether or not there be any upholder of epigenetic development who is prepared to

grant the subtraction of this number of cleavage-products without utter disaster to the further

development. As will be seen anon, the experimental researches of Driesch, Herbst, and other—

Bonnet notwithstanding—do not in the least support Wilms and Bonnet in their extravagant

suppositions. Again, according to Wilms, if the happening be at a later period, it may concern,

for instance, a part of one or more mesoblastic somites, and, as we know the fate of these, the

structure of a tumour arising subsequently can be foretold. Thus a tumour in the region of the

vertebral may be made up of “embryonic mesenchyme,” or formative tissue, cartilage, and bone;

or of the first, or of the first and second of these. Such a tumour Wilms derives from a “shunted”

mesoblastic somite, because such a somite gives rise normally to these tissues. Now that, for

example,

*On closer examination, contradictions in Wilm’s statements may be found. Thus, to

account for some tumours, or parts of such, Wilms requires “germs” from mesoblastic somites,

and these may, according to him, be displaced physically into—for example—the kidney or

uterus. In this way Wilms’s theory is seen to have very much in common with the earlier one of

Remak-Cohnheim.

72

somites may be shunted, actually or but physiologically, from the normal connection is purely

hypothetical, and nothing of the kind has ever been witnessed. Rudimentary somites occur even

in the trunk region in some animals, but these are rudimentary, and probably always disappear.

Wilms regards his germs as things destined in reality to form parts of “the embryo,” and

therefore as belonging to this.* Under his views cases of five embryomata in one ovary require

the shunting into this of five blastomeres during the early development; that is to say, in this

instance the original fertilized egg must have been divided up in some way or other into at least

six portions, one of which formed a normal embryo, while the remaining five retained at lease the

potentialities of each becoming an abnormal embryo or embryoma. It is open to doubt whether

any upholder of epigenesis will admit the possibility of the course of events happening in this

way. As it would seem a new hypothesis is needed to account for each of the five embryomata,

with an additional one to explain the continued normal character of the development after such a

shaking and shunting.

Equally formidable difficulties are furnished by the well-known instances of multiple

tumours, of various kinds, in one individual. Indeed, the doctrine of epigenesis as the mode of

the development labours under quite sufficient insuperable intrinsic difficulties without having to

bear the burdens imposed upon it by such

* As decisive against the origin of tumours from cells, or tissues, of the individual in

which they develop, may be cited the facts that very many of them are encapsulated from the

surroundings—thus, tumours of the kidneys, breast, and parotid; and that various observers—

thus, Wilms and Borst—deny any passage or transition of normal tissues into them. The

encapsulation of many tumours is of embryological interest, because many of the aberrant germcells

exhibit this feature.

73

serious tamperings with the development , as Wilms’s theories demand. Nor should it be

forgotten that, while on the one hand Wilms speaks of an embryonic “over-production” (!), he

states that the germs of his tumours develop in exactly those organs to whose edifice under

normal circumstances they ought to have contributed.

Underlying the doctrine of the shunted germs are the dogmas of epigenesis and somatic

origin of germ-cells. The latter is an absolute necessity to the former. Since the founder of this

(Professor Waldeyer) has seen reason to reject his former conclusions in favour of a

morphological continuity of germ-cells, the greatest stronghold of epigenesis has fallen.*

Brilliant as are Wilms’s actual investigations of the tumours, when regarded from the objective

embryological standpoint, the “shunted germs,” evoked to account for the facts, are just as

hypothetical and chimerical as any other “lost germs” ever conceived of by pathologists.

Wilms’s theory, ingenious, and enticing though it be, is but a clearer defined modification

of that of embryonic rests. As with the latter, epigenesis and hypothesis are its main bases; and as

to the Remak-Cohnheim theory, the objection can be urged that it is an unnecessary

multiplication of causes. This is well illustrated by Wilms’s and Borst’s distinctions of

monogerminal and bigerminal tumours. Double monsters and certain teratomata are regarded as

bigerminal, and, placed in contrast

*See Waldeyer, W.” “Die Geschlechtszellen,” Abdruck aus dem “Handbuch der

vergleichenden und experimentellen Entwickelungsgeschichte der Wirbeltiere,” von Dr. Oscar

Hertwig, vol. i., 1903, pp. 404-405. With the “prevision,” of which Pasteur so often spoke, on p.

405 Waldeyer writes: Die” Folgerungen aus dieser Lehre von der KontinuitКt der

Geschlechtszellen sind fast unbsehbar für die gesamte Biologie” (The consequences of this

doctrine of the continuity of germ-cells are almost incalculable for every branch of Biology).

74

with the remaining complicated “three-layered” tumours, which, as due to developmental

abnormalities of a single embryo, are stated to be monogerminal. As, according to Wilms, all

possible transition between the most complicated embryomata and the simpler tumours exist,

there would appear to be no grounds for this and similar increases in the hypotheses.

Apart from its entirely hypothetical character, its lack of support in facts of embryology,

and its continual and unnecessary multiplication of causes, the theory of germ-shuntings labours

under other difficulties. It is not easy to conceive any adequate cause for such shuntings during

development, and the difficulty is greatly increased when cases of multiple tumours in very

different parts of the body, each of which requiring one or more shuntings at some period or

other, are taken account of; for with them a normal development would appear to be quite out of

question. But, granted the possibility of such shuntings, the real difficulties begin. What causes

such a shunted germ, ignoring all laws of differentiation, to embark upon a career of damage, riot,

and destruction of its own? To take an instance from Wilms, typical of many such: the germ of

an osteo-sarcoma will be a cell or germs of the periosteum of some bone. Normally, like its

fellows, it ought to have contributed to the formation of that bone. Instead, thereof, at some

period or other, after lying dormant, it breaks all bounds, and proceeds on a line of development

of its own. This is such that, unless brought to a stop by some extrinsic cause or other (operation

or death of the host), it may be the parent-cell of more progeny than all the other bone-producing

cells in the body! In find, Wilms ascribes to his shunted germs far greater embryological

potentialities than Nature ever endowed them with. On the other

75

hand, some of the aberrant and vagrant germ-cells described by the writer undoubtedly possess,

as was once remarked to the writer by a human anatomist, far greater potentialities for mischief

than any germs ever conceived of by pathologists.

Not only the embryonic rests and the germinal shuntings, but a host of subsidiary

hypotheses—among others, those of Borst, relating to the tumours of the sacral and cerebral

regions—become superfluous in the light of the much simpler theory of tumour-formation as due

to—(1) the abnormal development of a persistent primary germ-cell, and (2) the bizarre

pathological manifestation by this of some greater or less portion of a life-cycle. Under this view

most, if not all, tumours receive a simple explanation, and under it, also, it must be manifest that

previous attempts—that of Wilms excepted—to explain the tumours, in taking the simpler ones as

the starting points, have really begun at the wrong end of the scale. Neither in theory nor in

practice can the degree in greatest possible reduction of an embryoma or rudimentary embryo be

defined, and, in fact, in actual practice and theory a simple tumour will represent a low degree of

such reduction.

Certainly, regarded as pathological manifestations of some greater or less portion of a

life-cycle, all the peculiarities of very many tumours are fully explained. A germ-cell, developing

abnormally, may after its developmental unfolding has begun, undergo degenerative changes of

various kinds and degrees as to greater and smaller portions of its parts, or some foundations may

remain latent, wholly or in part; and in this way a single cell, or a larger or smaller group of such,

endowed with certain well-defined potentialities, may be left as the actual seed, as the origin, of

the tumour thereby arising

76

Matters would appear to be complicated in some cases by the existence of two wellmarked

portions in a normal life-cycle: the asexual one, represented by the chorion (trophoblast);

and the sexual one, taken up by an embryo, or Metazoon. Some tumours—some ovarial

teratomata, described by Wilms—exhibit attempts to include the whole life-cycle, in that, along

with a pathological bizarre embryo, cancer, representing the asexual generation, is encountered.

In other tumours, again, there would appear to be nothing of the asexual generation; and still

others, the malignant cancers, confine themselves entirely to being abnormal manifestations of

the asexual portion—the first part of the life-cycle.

The comparative embryology of tumours may now be considered more in detail. The see

or seeds of tumours are unquestionably some or other of the vagrant (or if in ovary or testis,

persistent) primary germ-cells, treated of at greater length in the writer’s works upon the germcells.

So far (1911) they have only been found from fishes to reptiles; but from various

considerations it is not open to doubt that they occur even in the highest vertebrates, and in man

himself. Apparently they have been noted by Roux and Barfurth in the frog, and by me in the

salamander (S. maculosa). In all the embryos yet studied by me under a certain age—i.e., with

the limits during which germ-cells are easily found in embryos—no single embryo examined has

been devoid of them.

The mode of the development and the life-cycle, in practically all its details, are the same

in mammals as in fishes, and unquestionably the whole organization and development of man

follow closely along, but along higher lines than, those of a fish. It is therefore concluded that,

could one but hit upon some easy method of distinguishing germ-cells during the early

development of man and

77

mammals, the occurrence of vagrant ones in various parts of the body, skin, pericardium, pylorus,

rectum, liver, kidney, etc., would be as common a phenomenon here as in the fishes.

The germ-cells of vertebrates generally are, since 1900, beginning to be regarded as

undoubted products of the egg-cleavage.* Since Wilms, Bonnet, Marchand, and Borst consider

certain teratomata, at any rate, to be the offspring of cleavage-products, there would appear to be

an identity between their conclusions and my own in this respect. Nothing could well be farther

from the true facts. Taking Wilms as the leading exponent of the one side, the divergences

between the two views work out as follows;

By Wilms and other certain tumours, not by any means all, are referred to cleavage-cells,

not identified as germ-cells, but really destined to form some part of the embryonic body. These

cleave-cells are “shunted” from the normal connection at some very early, but not defined, period

of the development. As so derived, they are parts of the organism in which they occur. Against

the above, the writer’s conceptions may be stated in the following:

Most, if not all, true tumours are pathological manifestations of some portion of a lifecycle,

and they are due to abnormal attempts at development on the part of aberrant germ-cells,

derivatives of the cleavage, and destined, not for the embryonic body, but for future generations.

Such vagrant or persistent germ-cells are the sister-cells of the one by whose unfolding the

“embryo” or individual arose, and, developing pathologically alongside and within another

(sister) form,

*Compare the recent monographic works on Embryology by Korschelt und Heider, and

by Waldeyer.

78

with degeneration of some of their products, they leave as the basis of a tumour a greater or less

number of cells, endowed with more or fewer potentialities. As so derived, they are not parts of

the organism, but are its sisters or brothers, identical with it in ultimate characters.

As indicating the amount of agreement between my conclusions and those of Wilms, and

the extent to which I have adopted his views, except in so far as these are embryological, the

following passage from his latest work (1903) may be cited: “The groups of tumours are of equal

value in their etiology; they differ among themselves only in that the one groups arises from cells

of the earliest period of development—the time of the cleavage; the other, from cells of somewhat

later time—the period of the formation of the germinal layers” (p. 270). This I would amend as

follows: “In their etiology the tumours are of equal value, and they are the results of pathological

bizarre attempts at development on the part of aberrant primary germ-cells, originally identical, in

characters, and, in fine, in all respects, with that primary germ-cell, by whose unfolding the

individual harbouring such a tumour arose. As the offspring of primary germ-cells, they may be

referred to cells of the cleavage, but not to such appertaining to the embryo. They never arise

from cells of the period of embryo-formation (Zeit der Keimblattbildung).

The comparison sufficiently emphasizes the divergences, and, be it added, the existence

of ovarial and testicular embryomata is decisive against their derivation from cleavage-cells in the

sense of Wilms and Bonnet; for none such appertaining to the embryo can find their way into

these organs, but instead thereof there are germ-cells, which originally go back to the cleavage.

In passing, Wilms’s denial of the possible origin of an embry-

79

oma from a germ-cell of the testis may be cited as an instance of a refusal to recognize the plain

and simple facts of the writer’s researches upon the germ-cells.

As further evidence for the origin of embryomata from cleavage-cells (of the embryo),

Wilms refers to the unilateral nature of many of them. This is supposed to indicate something

corresponding to the results of Roux’s well-known experiments upon the egg-cleavage of he frog,

which many years ago were believed to demonstrate the “prospective destinies” of, say, the first

four products of the cleavage. It must always be difficult to determine what the researches into

so-called “experimental embryology” really demonstrate, more especially in view of the

discrepancies in the results of the different observers; but to most of them it would probably be

more correct to apply the term “experimental pathology,” for the finds border on pathology

rtather than upon embryology. Normal larvЊ of reduced size may have been obtained by such

experiments; normal embryos—Roux’s “hemi-embryods” are not such—have never been a result.

Roux’s particular finds probably ensued not because he had experimentally halved the cleaving

germ, but because in trying to do this he had induced pathological changes. If the hemembryomata

referred to by Wilms be hem-embryos in Roux’s sense, this ought also to apply to

the individual harbouring them. As a matter of fact, it is a pathological change in the

embryomata which induces the halving, as evidenced by several pathological skate embryos,

described by me, in nearly all of which there were marked reductions, either in the head-end or on

one side of the body.

Marchand and (formerly) Wilms have been disposed to derive the embryomata from

fertilized polar bodies. The writer must emphatically reject this view. Wilms

80

relinquished it, because in one instance he found not less than five embryomata in a single ovary,

and, of course, this number of polar bodies has been met with nowhere in the animal kingdon.

Even two embryomata, a tera-toid in the cranial cavity and an ovarian embryoma—a condition

recorded—suffice to negative the possibility; for it has been pointed out to me that nowadays it

would appear to be the rule in mammals that only one polar body should be formed.*

Wilms (loc. Cit., p. 250) sums up his ideas pretty clearly in the following: “In other

words, double monstrosities, foetal inclusions, and embryomata are all, indeed, to be referred back

to an over-production (!) in the early development, but only in the double formations (Bildungen)

do the cleavage-cells (Furchungskuglen) and the formation proceeding from them develop at the

same time; in the other cases the one of the two only attains development at a later period.”

Before treating of the comparative embryology of the tumours at length, one or two other

things call for notice. Marchand, and finally Wilms, consider all the teratomata as of equal value

morphologically. With this I would express cordial agreement. A vagrant germ-cell, developing

pathologically in pericardium, abdomen, sacral region, or elsewhere, to form a more or less

rudimentary embryo, in doing this is giving rise to something exactly comparable to an

embryoma of ovary or testis. On p. 251 of “Die Mischgeschwülste,” Wilms writers: “A series

of sacral teratomata is remarkably completely developed. An embryo en miniature in the most

exquisitve fashion may be developed.” He goes on to say that he himself possesses

*This was written in 1903, but now (1911) more recent researches of Sobotta, Burckhard,

van der Stricht, Lams, Doorme, and J.P. Hill, have shown that in certain mammals the first polar

body is formed in the ovary, and afterwards disappears.

6

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microscopical preparations of a sacral teratoma from the Giessen collection, with brain, mouth,

trachea, oesophagus, stomach, gut, and large pancreas gland present. The teratomata or

embryomata undoubtedly pass gradually over into the teratoids of the sexual organs, in which,

according to Wilms, along with more or less normal development of embryonic organs, one

encounters in other parts of the tumour riotous pathological growth. While, on the one hand, the

teratoid tumours pass gradually into the highly organized embryomata, on the other hand,

according to Wilms, “we have certainly also in the testis, as I have already sufficiently

emphasized for the mixed tumours of the kidney and the parotid, all possible transitions, from the

most complicated embryoid forms down to the simple ones.”

The mixed tumours here referred to by Wilms—the tumours into whose nature and

characters he has carried out such brilliant observations—furnish the key to the general problem

of the etiology of the tumours in general. Wilms’s writings upon the mixed tumours of the

kidney, vagina, uterus, mammary gland, and parotid, are of intense interest, even to the

embryologist. To my mind they justify completely his conclusion that they and the embryomata

are of like etiology (loc. Cit., p. 279). In his further attempts to trace their embryological history

one cannot agree with him; for, just as he derives the embryomata from blastomeres (of the

embryo), and not from vagrant germ-cells, so he assigns as the origin of the mixed tumours

“shunted germs” of later and later periods. Certain of the vagrant germ-cells, defined later on,

amply suffice to account for the mixed tumours also; indeed, the basis for these and other

tumours may be found in (1) the actual existence of vagrant and aberrant germ-cells, and (2) the

embryological fact that

82

each and every primary germ-cell (those of the ovary and testis, of course, included) possesses

the faculty of that primary germ-cell, which unfolded as an embryo, of doing likewise.

Of great significance with reference to the question of the germ-cell origin of tumours are

the comparatively frequent instances of tumours arising in multiple centres. Some of the

recorded cases may be cited from Borst (Iloc. Cit., p. 57, A, et seq.). In the same individual,

tumours have been found in liver, uterus, ovary, kidney, skin, etc.; or, again, in the paired organs

of the two sides. Babesiu found in the uterus, in the middle of a myoma, a columnar eqpithelial

cancer, and Niebergall recorded a complicated uterine tumour of myoma, polypes, sarcoma, and

cancer. Equally important and significant to the embryologist are the facts relating to the

occasional presence of different tumours at the same time in different parts of the body. Borst

(loc. Cit., p. 58) gives the following instances:

1. Cancer of the stomach with ovarial cystoma and fibroma of uterus.

2. Cancer of skin and of rectum.

3. A teratoid of the cranial cavity and an ovarian embryoma.

4. Uterine myoma, lipoma of kidney, enchondroma of lung.

5. Cancer of the thyroid, and multiple fibromata of kidney and uterus, with large

papillomata of skin.

Borst looks upon all these and other recorded cases as accidental! They are interesting,

however, in the light of—(1) the hypothetical germ-shunts; (2) the various places in which

vagrant germ-cells, may be found, and (3) the probably necessity of a certain physiological

condition or nidus for the development and growth of a tumour of a certain character.

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In the comparative account of the tumours I shall follow the lines laid down by Wilms,

and, therefore, it is his summary of them, not mine. His account of their comparative anatomy

appears to me to be logical and convincing; and in giving his results in tabular form I should like

to say with what intense interest and instruction I have studied his writing. As elsewhere stated,

the highest and most complicated tumours—the cystic embryomata of ovary and testis (Wilms)—

are at the basis instances of identical twins with one abnormal embryo, the enbryoma. If nothing

else would account for their pathological development, the circumstance that neither they nor any

of the less complicated tumours can, from their mode of origin, contain sexual organs might

suffice. They are, therefore, sterile embryos; and in other directions my researches have

convinced me that embryonic sterility may be the source of pathological changes.

From the facts established concerning the tumours by pathologists, it is clear to the

comparative anatomist and embryologist that in certain respect they present certain analogies to

instances of parasitism among animals. They differ, however, markedly in being, from the mode

of their development, sterile organism, even in the best-developed cases. The resemblances

between tumours and parasitic Metazoa or higher animals may be exemplified by a short account

of certain snails parasitic upon Echioderms (starfish and the like). The series is derivable from

free-living Eulima species. It may be taken as beginning with Mucronalia eburnea, which is an

external parasite, and possesses the full organization of a snail. Stylifer linckioe is also an ectoparasite,

but it is partially encapsulated upon the host. In this case the foot is rudimentary, and

the radula is absent.

84

Through other species of Styifer, Entocolax ludwigii is reached. This is parasitic in the bodycavity

of a seacucumber (a Holothurian), and with the endoparasitism the shell, mantle, gills, and

sense organs disappear. The series culminates in Entoconcha mirabilis, parasitic in the sexual

organs of a sea-cucumber (Synapta digitata). This is nothing but a worm-like sac, containing

(hermaphrodite) sexual organs. In its organization there is nothing whatever of molluscan

characters, and its true nature can only be made out in one or other of two ways: by the

comparative anatomy of the series of such parasitic mollusca, which reveals all the stages from

highly organized forms down to absolute reduction of most or all of the organs, or by the study of

the development; for, as Johannes Müller showed in one of his classic works, Entoconcha is a

true gasteropod, with shell and other organs.

As it is impossible to follow the whole development of a tumour from its first start, and

as many of them attain only a very low degree of embryonic differentiation, the series of forms in

them, leading from the highest to the lowest, from the most organized to the simple onles, can

only be followed after the method of comparative anatomy, and this is the plan adopted by Wilms

in his researches. From the results of a study of tumours made in this way, and with the facts

established by the writer’s researches upon the germ-cells, and the course of the cycle of

development of the higher animals, the following conception* of the true nature of a neoplasm or

tumour is obtained.

A tumour is a more or less reduced, more or less incom-

*It should be specially noted that in this definition malignant tumours (carcinoma and

sarcoma) are excluded—only tumours representing the sexual generation are included.

85

pletely differentiated sterile Metzaoan or higher animal organism, which, starting by the abnormal

development of a vagrant primary germ-cell, and growing under conditions unfavourable to the

complete and normal differentiation of all its parts, unfolds and develops those things, for whose

growth the nidus is suitable, the rest degenerating. And, exactly as identical twins are the

offspring of two sister or brother germ-cells, identical in ancestry from the same primitive germcell,

and identical in all ultimate characters, so also any higher animal, and a tumour within it,

stand in the same relations of ancestry from one primitive germ-cell, have the like ultimate

characters (identity) at the starting-point of their development; but, unlike fully-developed

identical twins, the individual and its tumour develop in different directions: the one upwards

along the track of higher and higher organization, the other downwards, along the roadway of

abnormality, of degeneration, of arrest, even at times—when the asexual generation is

represented—of riot, destruction, and disaster.

The highest tumours, then, are (1) the cystic embryomata. On these follow (2) the solid

embryoid or teratoid tumours of the ovary, containing skin, gut, and “mesoderm” and derivatives

of these. (3) The less highly developed ones of the testis. Like the foregoing, these are “threelayered,”

the skin is scanty, they contain gut and trachea, the head-region is rudimentary, and

their growth is unlimited. Borst has recorded in them ganglion cells and sympathetic ganglia.

(4)Teratoid tumours, where the “embryonic” tissue is mainly sarcomatous (cancer or asexual

generation). (5)Teratoid tumours of the testis with the epidermal layer lacking. (two-layered

tumours of Wilms). There teratoids lead to (6) the more complicated sacral and parotid tumours,

and

86

as in them, there are, according to Wilms, all transitions down to the simplest, these latter being

sarcoma (cancer, or asexual generation). (7) Mixed tumours of the breast, kidney, cervix, uterus,

vagina, and parotid. These are sometimes, not often, two-layered (epidermis), and they are

usually made up of tissues, which can best be described as sarcamatous (cancer, or asexual

generation).

B. THE ETIOLOGY OF TUMOURS.

The foregoing really forms a continuation of extension of the section on “Dermoid Cysts

and Teratomata,” in a memoir* published by me some years ago. On p. 671 it was written,

“How, it may be asked, shall one limit the possible reduction of an embryoma? Where shall the

line be drawn?” The present chapter offers an answer to that question. As the writer suspected in

1900, no line can be drawn between an embryoma and a simple tumours. In this connection,

apart from the references to the writings of Wilms, it may be of interest to quote from another

writer and able pathologist, L. Pick. † On p. 1193, in discussing the bearings of his finds, Pick

writes: “As I have already shown elsewhere, it would be false to identify in an embryoma that

which, of sorts of tissue or organs, is finally preserved with that which was originally laid down

in it in the germ. We know that here occasionally only a certain kind of tissue attains

development, that alongside this all other tissues wither in their development—indeed,

completely vanish—or by the one-sided tumour-like growth

*Beard, J.: “The Germs Cells,” part. I., Raja batis,, in Zool. Jahrb., Anat. Abteil., 1902,

vol. xvi., pp. 615-702; loc. Cit., p. 669.

† Pick, L.: “Zur Kenntniss der Teratome: Blasenmolenartige Wucherung in einer

“Dermoidcyste” des Eierstocks,” in Berliner klin. Wochenshr.,m Dec. 22, 1902, pp. 1189-1193.

87

of the one sort of tissue may be actually destroyed, or ‘suffocated.” In this way at one time a true

embryoma may be found in the curious form of an isolated tooth, at another time, perhaps, as a

sort of glioma, or as an ovarian true thyroid-struma, or, again, as a chorio-epithelioma with

metastases.”

In other respects Pick’s communication is of great interest. His researches have

established for, at any rate some, ovarial teratomata, as Schlagenhaufer’s* had already done for

the like tumours of the testis, the occurrence of a choiron or trophoblase—in the instance

recorded in a more or less degenerate condition. Their finds throw a considerable amount of

welcome light upon the (according to Wilms†) frequently malignant character of the testicular

embryomata, and the cases—some nine in 1902, to which Pick’s instance furnished a tenth—

other the occurrence of cancer in connection with an ovarian embryoma. As in the ordinary

chorio-epithelioma of gestation, in embryomata of ovary and testis, carcinomatous growth, when

present, is now (1903) recognizable as having arisen from the asexual generation (chorion or

trophoblast). These words were actually read to a large audience, as occurring in a paper on “The

Embryology of Tumours,” by me, on February 16, 1903. Before the Royal Society, Edinburgh.

This was the last occasion on which I communicated anything of my researches to the learned

society. Practically the whole of that paper is given in this book as it was originally written.

Publication of it was refused by the Royal Society, Edinburgh. Shortly afterwards I made a full

abstract of it in English,

*Schlangenhaufer, Fr.: “Жber das Vorkommen chorio-epithelioma and traubenartiger

Wucherunger in Teratomen,” in Wiener klin. Wochenshr., 1902, Nos. 22-23.

†Wilms, M.: “Die mischgeschwülste,” 1902, iii., p. 242.

88

and this included the above words, and sent it to the editor of Ziegler’s BeitrКge, and of the

Centralblatt für allgemeine Pathologie, the celebrated pathologist and man of science, the late

Geheimrat Dr. Ernst von Ziegler, Professor in Ordinary of Pathology in the University of

Freidburg in Breisgau, with the request that he would publish it in the latter scientific journal. He

replied that not only would he do so, but that he would have it translated into German, so that

more people might read it. It appeared in full in vol. xiv., pp. 513-520, 1903. In March, 1905,

some two years later, a discussion took place in Berlin upon cancer. This is reported in the

Berliner klin. Wochenschrift, 1905, No. 13. The same number contains the brilliant speech

contributed to the discussion by Dr. L. Pick.* In the course of this Pick proved, step by step, in

actualy instances and on actual specimens, the scientific truth of the statement that an ordinary

cancer (carcinoma) may, on occasion, arise from the chorion or trophoblast, that at times this

exhibits the structural appearance of chorio-epithelioma, at others of ordinary cancer—“das

gewЪhnliche Carcinom.” In this place I cite the opinion of Dr. L. Pick as that of one fully

competent, not only to give a judgment of a great scientific value on this question, but to defend

it.

Embryologists and pathologists might have been expected to have taken the following

words † by the late

*For a summary and translation of this, see Appendix B.

†Giacomini, C.: “Probleme aus Entwickelungsanomalien d. menschlichen Embryo,” in

Ergebn. Anat. U. Entwickelungsgesch, in 1894, vol. iv., pp. 615-649; loc. Cit., p. 640. The actuall

words are: “Das Chorion ist von allen Bildungen des Eies diejenige, welche vor jeder anderen

entsteht, sich bald von den anderen Teilen unabhКngig macht, und indem es frühzeitig seine

Zellen entwickelt, in den Stand gesetzt wird, zu leben und zu entwickeln, auch wenn alle anderen

Teile des Eies durch irgend welchen Umstand aufgehЪrt haven, zu existieren.”

89

Professor C. Giacomini seriously to heart, instead of ignoring them: “Of all the structures of the

egg, the chorion is that which arises before every other, quickly makes itself independent of the

others, and, by the quick development of its cells, is placed in a position to live and to develop

even when all other parts of the egg, through some cause or other, have ceased to exist.”

In recent years the writer has urged again and again that in researches upon animal

development two things must be kept sharply separate: the embryo or sexual form and the

asexual foundation—in human development the chorion or trophoblast—upon which it arises.

According to orthodox embryology this chorion or trophoblast is a part of the embryo, although it

is invariably present before any part of an embryo; although it may persist after the complete

disappearance of the embryo; although it is never formed from or by an embryo; and although

ultimately it never makes any part of the embryonic body! Logically, how can it be maintained

that a structure which arises before an embryo, and out of no part of it, and which never goes to

form any part of any organ of the body, is embryonic or foetal in nature? What is there to

prevent, as Pick suggest, the total disappearance of all parts of an ovarian or testicular embryoma

except the (pathological) chorion or trophoblast? The persistence and further growth of this

would but, and does, result in cancer (carcinoma). He who doubts this had better read the facts as

they were described in 1905 by Dr. L. Pick and as they are given in abstract in the Appendix. As

the chorion is always present before an embryo, nothing in the abnormal development of a

vagrant or aberrant germ-cell would appear to forbid the arrest of this prior to the appearance of

any trace of an “embryoma,” with the natural sequel—a carcinoma.

90

But, surely, now, the etiology of cancer is as clear as that of the tumours in general!

Very shortly after the date of writing the above, a little further light was obtained in

another direction. It is a natural question to ask, “Can any and every primary germ-cell undergo

abnormal development, or is this power limited to certain of them?” A full reply to this would

entail prolonged investigation into the developmental problems of identical twins, triplets, etc.

For a long time now (1911) this matter has engaged the writer’s attention more or less, but though

some landmarks can be recognized, the end is not yet in sight. So far as I can see, the whole

doctrine of the tumours and cancer centres in the problems of identical twins, triplets, etc.—in

fine, in the question of the number of embryos which may arise from one egg, and therefore be

contained in one chorion or trophoblast.

A full discussion of identical twins, etc., must be reserved for another occasion, in a

projected book upon heredity. Here it need only be stated that their occurrence is probably more

frequent than has been supposed hitherto. By competent authorities it has been estimated that in

man identical twins form 25 per cent. of all twins. Their comparative frequency alone is against

the idea of their occurrence being due to, say, a chance division of the developing egg. The

absurd supposition of their etiology by “the splitting of a germ” was exposed by me in a letter in

the Lancet, January 7, 1905, p. 56. Extremely improbably, if not impossible, is the origin of one

of them from a fertilized polar body. As little can hold this as accept the idea of “chance” in the

development. In some other mammals identical twins would appear to be very common. Thus,

in the sheep, where the total number of young is usually two or three,

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the writer has several times come across them in utero. There exists, however, a case in literature

of embryology, published in three different scientific journals of high standing—that of an

armadillo, the “tatu” (Prapus hybirdus) where, according to von Jhering,* from seven to twelve

young are formed within one chorion—that is, as products of one egg. The observation tallies

with, and is allied to, that already recorded by A. von KЪlliker † in 1879, of four foetuses within

one chorion in a related species, Dasypus (Prapous) novemcinctus (the nine-banded armadillo).

Not long after the above was written, aided by a small grant from the Carnegie Trust, I was able,

with the kind assistance of Professor von Jhering, to obtain from Brazil two small sending of

pregnant uteri of both of these species. An examination of some of the material amply confirms

the statements of both von Jhering and von KЪlliker. As von Jering remarks, the observation

shows how little reason there is for the common belief that it is an invariable rule, or even law,

for only one embryo to arise from a single egg. The occurrence and comparative frequency of

identical twins, triplets, etc., in man, taken along with the above observations and other

considerations, point to a former multiplicity of embryos, formed as the progeny of one egg, even

in the ancestry of man.

A further step may now be taken, and it may be insisted that the tumours, including

cancer, date back to this condition as their source. In the course of ages, one or more of the

former identical twins, triplets, etc., has become rudimentary; but it, or they, may reappear

*von Jhering, H.: “Жber ‘Generationswecjsel’ bei SКugetieren,” in Biol. Centralblatt, in

1886, vol. vi., pp. 532-539; also in Berliner Sitzungsberichte and Arch. F. Physiologie, 1886.

† von KЪlliker, A.: “Entwicklungsgeschichte des Menschen,” II. Augl., 1879, p. 362.

92

in the form of embryomata, finally of tumours, even of cancer. In this way it comes to be

recognized that there must be a vast difference among the various vagrant and aberrant germ-cells

in potentialities for mischief. Some few, and not all—how many in each case it is at the moment

impossible to say, and it may never be determined—possess the potentiality of developing like

the embryo containing them. If they do this normally, identical twins, triplets, etc., may result. If

they do not degenerate, and degeneration is probably often their fate, they may come to lie

somewhere or other in the embryo, even in its sexual organs. Here they may be encapsulated for

a longer or shorter time, and, finally, one or more of them may commence (abnormal)

development, and form an embryoma, or other tumour even, by attempting to begin the whole

cycle anew, with arrest in the embryonic portion—a cancer.* Vagrant germ-cells in development

are, I imagine, far too numerous for anything like all to be required to account for the tumours

and for cancer. Probably it may be regarded as sufficient if there be in every development at least

one, three, or seven such, which, if they do not degenerate, may become the seed of later tumours.

To the embryologist it is of great interest to establish that, as in the upward direction the

embryomata pass step by step into identical twins, triplets, etc., so as gradually in the downward

one

*It should be mentioned that pure embryomata, as true, benign tumours, are probably in

all cases congenital—that is, commencing their development at the same time as the individual

harbouring them. Apparently, this does not invariably exclude the appearance of malignancy in

some of them at a later time. On the other hand, malignant disease (carcinoma and sarcoma) is

not congenital, but the seed of such a tumour is to be found in certain of the latent germ-cells, as

described in the text. Of course, cancer is hereditary, no matter what all the official cancerresearchers

in the world may say. The true nature of heredity is as far from their thoughts as the

principles of modern embryology.

93

they merge into the simple tumours, and that any portion of the life-cycle of normal development

may manifest itself as a tumour.

From the above it may have become manifest that for the elucidation of the nature of the

tumours two things are needed: pathology, a much fРted and daily more and more endowed

branch of learning; and embryology, the science of the coming-into-being of life, at present the

handmaid of many sciences, and almost without a habitation to call its own.* This despised and

rejected branch of human knowledge, whose task it is to treat of the “Werden und Vergehen” of

living things, is in importance second to none. Without its light, much possible knowledge in

other sciences is enshrouded in thick pitchy darkness; without it one branch of pathology at least

could have no real scientific existence. In certain direction we may turn to pathology for the

collection of the facts, but to embryology for their explanation. The pathologist may know the

facts, but that knowledge gives him no key to their solution; for this lies in the study of the

normal development of living things—embryology.

*Eighteen years ago there died an English embryologist, a wealthy man, who had for

years devoted some of his means towards the advancement of science. In the medical faculty, in

which he taught, embryology was lectured upon by five different medical professors to large

classes of students, while he, a specialist, had practically no students. His course was not

prescribed in the regulations. Embryology is to-day (1911) in Great Britain not one of the

courses laid down in the curriculum for medical students. In scientific Germany it is otherwise,

and in my own University of Freiburg-in-B., although the medical faculty contains fewer students

than in more than one British medical school, my old friend Professor Franz Keibel has as many

as 150 medical students every summer in his lectures upon comparative embryology. His

laboratory for practical embryology is so crowded with medical students that a year ago, when

visiting Freiburg, I was informed that he was at his wits’ end what to do with them.

94

CHAPTER III

THE PROBLEMS OF CANCER*

Under this title the following remarks were published in the Lancet in 1904 as a summary of a

University lecture. The objects in view were to throw some embryological light on the possible

lack of import of a practical kind attaching to certain recently published observations on so-called

“heterotypic” mitoses or cell-divisions in cancer-cells; to point to the futility of regarding

carcinoma as due in origin to some sort of “conjugation” of leucocytes of the body; and, lastly,

while insisting upon the fundamental identity of carcinoma and sarcoma, to indicate how the

problems of cancer finally ended embryologically in those identical twins and their origin. The

import, or absence of import, of the first two—the “heterotype” mitoses and the supposed

“conjugation”—has now been generally recognized, and the original position taken up regarding

these has been abandoned by official cancer research in Great Britain. As pointed out by Dr.

Jacob Wolff (“Die Lehre von der Krebskrankheit,” vol. i., p. 438), this view of the “conjugation

of resting nuclei”—one of them that of a leucocyte—was enunciated originally by Auerbach in

1890, but this fact escaped the notice of the official researchers.

*The Lancet, October, 29, 1904.

95

The fundamental problem, the very basis of embryology, is the course of the life-cycle in

the higher animals, including man. This question of the mode of the development far exceeds in

import all other problems of pure embryology. It touches upon, without at present offering any

explanation of, the nature of life itself. But while the latter is now beyond human grasp, and may

elude it for ever, the solution of the great problem of the life-cycle, seemingly so complex, albeit

so simple, furnishes results of overwhelming import for all the sciences of life. The history of

embryology tells us how for centuries the fight, whether epigenesis or preformation, went on;

how, on the one side, the development was regarded as analogous to the building of a house,

“part being added to part,” and how, on the other, men like Haller denied any coming into being,

the embryo being preformed in all its parts. So slow is real progress in a science like

embryology, and so greedily receptive of error is the human mind, that in our day we hardly dare

hope to see the last of the two rival erroneous doctrines of epigenesis and preformation. Like the

chameleon of the story, “the creature’s neither one no t’other.” Underlying the phenomena of

development in the higher animals there are an antithetic alternation of asexual and sexual

generations, a morphological continuity of germ-cells, which, paraphrasing Robinson’s eloquent

words, go back to a beginning so remote as to be utterly beyond our knowledge, and pass to a

future of which we can form no conception whatever. Under the phenomena presented by the

germ-cells in their cycle direct development and epigenesis can find no places. Looked at in the

light of the facts, they are impossibilities

96

and, like the recapitulation theory, merely illusions of the human imagination. An antithetic

alternation is seen to be an iron necessity of the development as soon as it is perceived that an

organism, an asexual one, must develop upon which germ-cells can arise; while the sexual

generation, “the embryo” of embryologists, is called forth from one of these germ-cells to contain

and to nourish the rest for a certain brief span of time. Moreover, the facts of development,

which to some extent have been unearthed during the past fifteen years within this city, throw a

flood of new light upon the crude materialism of modern embryological textbooks. The

biophores of Weismann and the pangens of De Vries become shadowy entities of the real

existences of which there are no evidences. And while with humility admitting that to say it is to

furnish no explanation of the riddle of life, it must be recognized that the characters or qualities of

animals or plants are certainly not present in the germ in the shape of ultra-microscopic particles

of chromatin, the pangens or biophores, but that all the wonderful and infinite variety of animate

nature has its fount in unconscious memories of germ-cells.*

Modern embryology, not to be confused with that extant in textbooks, claims as its own

two vastly important regions of human knowledge. These are the facts and nature of heredity and

genetic variation and

*For a fuller account of the theory of heredity based in the unconscious memories of

germ-cells, set up by Professor Ewald Hering, now Director of the Physiological Institute in the

University of Leipzic, in 1870, see Beard, J.: “Philosophical Biology,” in Ainsworth Davis’s

“Science of To-Day,” vol. ii., 1909, pp. 37-64, with list of literature, which should also include

Samuel Butler’s “Unconscious Memory,” first edition, 1880, revised edition, 1910 (Fifield,

London), and the presidential address to the British Association for the Advancement of Science,

1908, by Professor Francis Darwin.

97

that portion of pathology treating of the tumours or neoplasms, benign and malignant. The

phenomena termed “heredity” are germinal in nature, and in this way they fall within the province

of the embryologist, not in that of the mathematician. But at first sight it is, perhaps, not so clear

that neoplasms—living things possessing simple or complicated structures, but devoid of any

useful functions—should be entities about whose nature the embryologist need concern himself at

all. As recently as four years ago—that is, in 1900—but few of the higher teratomata were

recognized as embryonic in nature. Now almost the other extreme has been reached, and possibly

there are few tumours, benign or malignant, the embryonic nature of which has not been

advocated by some observer or other, usually a pathologist. By embryonic is meant that their

tissues would be identical with—even, according to some observers, derived from—some of

those making up an embryonic body, that they would be, in the word employed by Wilms,

“embryomata.” As to their origin, apart from the so-called “parasitic theories,” which are more

remarkable for the things they leave untouched than for the “facts” they explain, for benign or

malignant tumours, or for both, certain erroneous views, not really based in embryology, have

within the last year been advocated at home and abroad. Malignant neo-plasms, such as cancer,

have been supposed to arise from somatic cells of the individual, either with or without a

conjugation of such. To my mind there is a little evidence—and that is none at all—to show that

somatic cells could, or do, conjugate with their fellows or with other cells, such as leucocytes.

Indeed, the appearances described and figured as conjugation in a cancer are capable of other and

simple explanations. Certainly, if

98

they represent a real conjugation, the preparation ought to carry conviction to the minds of

embryologists and cytologists, such as, to name three Würzburg ones, StЪhr, Schultze, and

Sobotta. This is improbable, for the true nature of the preparations shown last July* at Oxford

appears to me to be fairly clear.

Very common among pathologists is a modification of the Remak-Cohnheim theory of

embryonic rests as the basis of neoplasms. This doctrine of “shunted germs,” only possible under

the erroneous dogma of epigenesis, has many followers, especially in Germany. The apparent

manifold variety of the malignant tumours, which fortunately is not real, led to the conclusion

that they were made of a embryonic or somatic cells; that, for example, a primary cancer of the

liver or kidney was composed of liver or kidney cells, and so on. The embryological conclusions

to be advanced here, and which are based on research, do not permit of that explanation. A

malignant tumour is such in virtue of the facts, among others, that its cells are not embryonic

(though they may mimic such, or even resemble no other cells in the human body), and, that, like

cells of the trophoblast or chorion of normal that, like cells of the trophoblast or chorion of

normal development, the neoplasm eats or erodes its way through other structures, even through

living bone. On the other hand, a benign tumour does consist solely of somatic or embryonic

cells. Its tissues are normal in structure, for it is a true embryoma, or more or less rudimentary

embryo, in Wilms’s sense. A neoplasm is, in short, a futile attempt to repeat a greater or less

portion of the cycle of normal development. A true embryoma recites merely some greater or

less piece of the embryonic portion; a pure cancer or sarcoma—for these are one and the same

thing under different disguises—may attempt

*1904.

99

to produce the whole life-cycle, with the exception of the embryonic part. In an unmixed cancer

or sarcoma there is absolutely nothing whatever of an embryo; there is not a vestige of a somatic

cell.

To reinforce their attitude several supporters of the doctrine of shunted germs have

invoked the aid of fertilized polar bodies. Every elementary student knows these, and is aware

that nowhere in the animal kingdom have they ever been known to exhibit any potentialities

worth of the least notice. To the embryologist versed in recent advances the theory of fertilized

polar bodies, with its allied assumptions of all sorts of embryonic rests or germinal shunts, must

seem to be one of the most absurd ideas ever enunciated in science. Like the somatic origin and

the supposed “conjugation,” this must be rejected. Fortunately or unfortunately, the number of

polar bodies formed by the mammalian egg is far too limited to permit of their introduction into

the question. No mammal is known in which more than one polar body* arises; while, for

example, Wilms found as many as five embryomata in one ovary, and Baart de la Faille †

recorded a case of quadruplets where three of the foetuses hung as more or less incomplete

parasites from the palate of the fourth. On the present occasion a few words more must suffice

regarding the manifold embryological aspects

* 1911. No mammal is known in which more than one persistent polar body is formed.

† Vide Schatz: “Klinische BeitrКge zur Physiologie des Foetus,” Archiv für GynКkologie,

1900. The original paper, by Baart de la Faille, is said to be very rare. The specimen is described

(p. 252) with some others by E. Schwalbe in Ziegler’s “BeitrКge zur Pathologischen Anatomie,”

1904, vol. xxxvi., pp. 242-272, “Der Epignathus und seine Genese.” This case is illustrated by an

excellent figure in Schwalbe’s “Die Morphologie der Missbildungen des Menschen und der

Tiere,” part ii., Jena, Gustav Fischer, 1907, p. 147, Fig. 139, and p. 325, Fig. 356.

100

of neoplasms. They form, and this requires emphasis, only one set of many degenerative and

retrogressive phenomena encountered at all sorts of stages of the cycle in comparative

embryology. Truly, in dealing practically with embryology, “in the midst of life we are in death.”

“Das Werden” is ever accompanied by “das Vergehen.”

The whole doctrine of the tumours centres in the problems of identical twins. Than these

latter there is nothing more replete with interest in embryology. Of vast import is the recognition

of the existence of two kinds of these. There are identical twins, which come as it were out of the

same mould, and there is a second and rarer kind—the “looking-glass-image” twins.* The

occurrence of the latter throws welcome light upon various zoological and anatomical

questions—on the right-handed and left-handed snails, fishes, etc.—as well as upon the

phenomena of reversed viscera. Ion other direction identical twins pass gradually into double

monsters, and these in their turn into the higher tumours or teratomata. At the basis of the

tumours is the fact that from one fertilized egg a multiplicity of embryos may arise, just as from

one such in a sea-polype a legion of jelly-fish may take their birth. As in the polar bodies of

oЪgenesis (egg-formation) we have rudimentary or abortive gametes (conjugating-cells), so in the

development of the higher animals we meet with rudimentary or

*These looking-glass image twins are the greatest wonder in animate nature. Along with

Captain Lambelle and a former pupil, Dr. M. M. Morrison, a few years ago the writer had a

unique opportunity of examining and photographing two of these (twin boys) in the south of

Scotland. Both were very degenerate, and both suffered from club-foot. The deformities in the

right foot of the one were in the left foot of the other, and so on. One of the two exhibited the

phenomena of reversed viscera, with right aortic arch, stomach and spleen transposed, etc. The

actual finds and photographs will be published elsewhere.

101

abortive germ-cells, originally really destined to form embryos. In other words, in the history of

the race there has been a reduction in the number of actual normal embryos arising, but with the

persistence of such “embryonic” germ-cells (embryonic in destiny) and the retention by these of

more or less of the “memories” needed to unfold an individual of the species. As shown two

years ago in the Lancet,* a malignant tumour—and this is true of both cancer and sarcoma—is

nothing more than an irresponsible trophoblast or chorion, the asexual generation, which in every

normal development is the forerunner of an embryo. Though not recognized, or, at all events, not

stated by them, the researches of Farmer, Moore, and Walker, † as well as those of Bashford and

Murray,‡ have confirmed the truth of this view, and to the hilt. For it is an inalienable property

of the trophoblast of normal development that upon it germ-cells arise. Once these have come

into existence, it is but a

*Lancet, June 21, 1902, p. 1758.

† Farmer, Moore, and Walker: “Resemblances Exhibited by the Cells of Malignant

Growths in Man and those of Normal Reproductive Tissue,” Lancet, December 26, 1903, p. 1830.

‡ “The Zoological Distribution, the Limitations in the Transmissibility, and the

Comparative Histological and Cytological Characters of Malignant New Growths” (Scientific

Reports of the Imperial Cancer Research Fund, No. l, London, 1904). First of all, cancer was

“embryonic,” and then it was not; it arose, for the second or third time in history, from a

“conjugation” of body-cells, and then it did not; the “infective venereal tumour of bull-dogs” was

an infective granuloma, and then, on the very same evidences, it was a true sarcoma, because like

the writer, Mr. Shattock said it was. It is given to official research to change its opinions as often

as it sees fit. The above paper was put out with a great flourish as a confirmation of the work of

Farmer, Moore, and Walker, and I was assured that the original discovery could have been made

by official research. Then at a later period this confirmation was withdrawn, for which see the

Proceedings of the Royal Society, London, B, vol. lxxvi., 1906.

102

question of a certain limited number of cell divisions before they present the phenomena

associated by many embryologists with the reduction of chromosomes. In short, the proof

furnished by the researches of Farmer, Moore, and Walker, of the occurrence of divisions in

cancer and sarcoma cells usually associated with the maturation of germ-cells, was the one thing

lacking to establish beyond question the true nature of a malignant tumour as the pre-embryonic

portion of the life-cycle, the asexual generation. While at present it would be wrong to assume

that such cell divisions must of necessity occur at some time or other in all malignant tumours—

for even a malignant tumour may conceivably be so reduced or retrograded as to be unable to

repeat the whole cycle of the germ-cells, just as no tumour is known to form actual sperms—it is

now beyond doubt that the occurrence of such division in certain cases proves a malignant

neoplasm to be the pre-embryonic portion of the life-cycle. It is a life-cycle with the embryo

omitted. Germ-cells never do arise, and never could have arisen, from somatic or embryonic cells

or tissues.

The true science of the tumours, then, has its embryological basis in the facts and

phenomena of identical twins, triplets, etc. The facts of normal development, as seen in identical

twins, as well as in certain armadillos, many sheep, etc., demand that we should recognize that

just prior to the unfolding of an embryo there are “n” divisions of germ-cells, resulting usually in

one embryonic cell and a certain as yet undefined number of retrograde or rudimentary gametes,

these have now lost to a greater or less degree—this varying in different cases—their powers of

undergoing a completely normal development. They are not to be confused with those

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germ-cells destined for the sexual organs of the individual. A malignant neoplasm, due to the

spontaneous development of such a retrograde germ-cell, which in the days of long ago would

have given rise to an identical twin, has lost to a greater or less degree those potentialities, those

unconscious memories, which would have permitted it to complete the full life-cycle of normal

development, ending in the formation of a normal embryo. The memories which it retains

condition the character of the tumour to which it will give rise, and it is these rudimentary

memories, stimulated by its environment in some particular organ, which result now in a

sarcoma, now in a carcinoma, mimicking the structure in which it lies. This explains why in one

development a certain germ-cell will produce an identical twin, while the corresponding germcell

in another instance develops into a monster, or into an embryoma, or into such with a

malignant tumour, or into a mixed and malignant neoplasm, or, lastly, into a simple sarcoma or

carcinoma. All depends upon the amount of unconscious memory retained by those retrogressive

germ-cells, which formerly gave birth to normal embryos, identical twins, triplets, etc. Nay, one

may safely take a further step in the like direction. Chorio-epithelioma, a deadly form of cancer

in pregnancy, usually rises in instances where either no embryo has been formed (hydatid mole),

or it has been aborted at the critical period* as a monstrosity. Is it at all unlikely that here, for

some reason or other, either the wrong germ-cell had developed, or, at any rate, that such a one

had early usurped the place of the developing

*For a full account of the “critical period” and its peculiarities see J. Beard, “Certain

Problems of Vertebrate Embryology,” 1896, and “The Span of Gestation and the Cause of Birth,”

1897, both published by Gustav Fischer, Jena.

104

one? This would be one the memories of which could but result in a malignant tumour—that is to

say, one mimicking the structure of correct chorion. If this be true, we have in chorioepithelioma

merely a form of cancer arising very early in the life of the individual, and invading a

new host, the unfortunate mother.

The things that we have been dealing with are startling enough, and it may be asked.

What steps are being taken to apply them in practice and to carry our embryological knowledge

of the malignant neoplasms still further? Practically none. Beyond the boundaries of Edinburgh,

I am not aware that at the present time the embryological aspects of the malignant tumours (in the

sense of my conceptions of that science as opposed to the utterly erroneous fairy-tales of the

textbooks) are receiving any particular attention. Abroad, for example, the leading investigators

appear to be hopelessly at sea.* In cancer research, momentous as it is for human welfare and

hopes, there is far, far too much industrious but futile digging in culs-de-sac. But there is a gleam

of hope for the immediate future. Authorities connected with a great institution which is

distinguished for its rapid and wonderful advances in scientific research have for some little time

been considering and elaborating a scheme by which cancer research within its walls may be

placed shortly under the direction of an able embryologist. † If this be done, the first important

step in Great Britain will have been taken towards the proper recognition and

*Judging by the recent investigations of Abderhalden and his pupils, and those of

Blumenthal and Neuberg, as described in the Introduction, this is now (1911) not the case. As it

has turned out in the sequel, cancer was vulnerable along at least two lines of attack, the

embryological one, and the stereo-chemical one. It is really along the latter that the above

observers are, slowly but surely, advancing.

† This did not take place.

105

independent establishment of a science of the utmost moment to mankind—the true science of

life, embryology. In these condition, and given abundant material of the right sort, we may hope

to witness soon advances in our knowledge of the malignant neoplasms of which we can now

form no conception, and the vast importance of which it is impossible to gauge.

The three most important points in the above chapter appear to be the recognition that the

problems of cancer finally merge into those of identical twins, triplets, etc., of the fundamental

identity of sarcoma and carcinoma, and the mimicry of the tumours. The latter, of course, was

not new, but it was a revival of a doctrine enunciated early in the nineteenth century by

Fleischmann, and later on advocated by the late Sir James Paget. At the time this chapter was

written down (October, 1904) the writer was deeply engrossed in the microscopical study of

malignant tumours. This work was interrupted by a controversy with Mr. Roger Williams,

F.R.C.S., which was started by the latter in the Lancet, and the letters of both sides will be found

in that journal of the closing months of 1904 and early in 1905.

In the course of this, in a reply to my opponent, I wrote down the words: “The

mammalian embryo solved the problem of cancer ages ago.” After writing this, I looked at it, and

said to myself, “Yes, it is quite true, but—how?” Then the thought came, Why are you bothering

about the microsocical details of these tumours? You ought to be working at the things which

occupied you ten years ago. Without further loss of time I got out all my material relating to the

critical period, and the two papers, “On Certain Problems,” etc., and “The Span of Gestation,”

which

106

I had published on these problems, and sat down again to study all. Then—at once—it was seen

that the problem of the “how” had been solved ten years earlier, but that no great stress had been

laid upon the solution—the commencing activities of the pancreas gland at the critical period.

This was the starting-point of Chapter IV., dealing with the chief problem of cancer.

107

CHAPTER IV

THE CANCER PROBLEM*

In the following simple story the correctness will be assumed of all the conclusions as to the

etiology and nature of cancer which were advanced in, for example, the abstract of my lecture on

the “Problems of Cancer,” published in the Lancet of October 29, 1904. The appended

classification of neoplasms—an extension and inclusion of the “embryomata” of Wilms—may

serve to make clear here what a malignant tumour is defined to be.

1. Enbryomata (benign neoplasms). –Pathological manifestations of some greater or

less portion of an embryo. They are composed of real tissues—that is, normal or

somatic (“embryonic”) cells or tissues. At its basis each is a greater or less portion of

a twin, triplet, quadruplet, etc., identical with the individual containing it. They are

not endowed with indefinite powers of growth, and they nourish themselves like

other normal tissues.

2. Amphimyxomata (malignant neoplasms). –Combinations of embryomata and

trophoblastomata. Pathological manifestations or attempts to reproduce the whole

life-cycle, including trophoblast and embryo. They are transitional forms. (The

mixed tumours of Wilms are not all malignant, some being merely embryomata.)

3. Trophoblastomata (malignant neoplasms). Pathological manifestations of the

asexual

portion (trophoblast) of the life-cycle and sometimes—whether or not always is not at

present known—attempting to repeat the germ-cell portion of the life-cycle, as shown

by the researches of Farmer, Moore, and Walker. They are not known to differentiate

actual functional gametes, eggs or sperms. They never include or repeat any part of

an

embryo. They are never composed of somatic (“embryonic”) cells, though they may

mimic such or even resemble no other cells in the body. As Sir James Paget pointed

out long ago,* they are “imitation tissues.” They exhibit powers of unlimited growth

and increase, and they nourish themselves by eroding and destroying normal cells and

tissues in a manner exactly like that of the trophoblast of normal development.

To illustrate the points to be considered, I have put out

*The designation of a malignant neoplasms as an “imitation tissue” was first used by the

writer about a year ago (1903) in an address to the Edinburgh pathological Club. The clear

recognition of the existence of such “imitation tissues,” as well as of the close resemblance,

amounting to identity, of benign tumours to normal tissues, will, however, be found in Sir James

Paget’s classic work, “Lectures of Surgical Pathology,” 1870, third edition, pp. 382 and 387.

This book is a veritable treasure-house of valuable information. History does indeed repeat itself,

and, according to Virchow, in 1815 Fleischmann explained that the tumours were “only copies of

normal organic parts of the very same body in which they arise and subsist.” The authority of J.

F. Meckel, according to Virchow, prevented the acceptance of this most important conclusion;

indeed, this anathema has persisted or been renewed since that time, for to-day (1905) the

condlusion, rightly drawn by Fleischmann ninety (!) years ago, is not accepted, so far as I am

aware, by any living pathologist. Eppur si muove!

109

certain microscopical preparations of transient ganglion cells, parts of the asexual generation of a

dogfish. These may be taken to typify the trophoblast of a mammal or the cells of a malignant

tumour. The preparations show: (a) cells in full functional activity prior to the critical period, and

(b) cells which, with the passing of the critical phase, have entered upon their long, slow course

of degeneration by simple atrophy. It would have been preferable to exhibit preparations of

trophoblast, but those made after this method some years ago are now faded. The facts in the two

cases, the mammal (sheep, pig, and others) and the fish (Scyllium, Raja, and others), are,

however, quite similar. There is, indeed, only one mode of development in vertebrate animals.

Freshly made preparations of human trophoblast of, say, the fifth and ninth weeks of gestation

would display the like bloom on the one side of the critical period and the same decay on the

other. Such figures of mammalian trophoblast have, indeed, been published already in the

writings of my friend Dr. J. P. Hill.

The question which I wish to discuss is one which interested me exceedingly some years

ago, long before its significant bearings upon the cancer problem were obvious. In a nutshell it is

this: Why do these and certain other cells of a fish development, like those of the mammalian

trophoblast, go on flourishing for a certain definite portion of the early development, whilst the

parts of the sexual generation, “the embryo,” are unfolding, and then with an almost tragic

suddenness commence to degenerate and die? What brings this remarkable change to pass, one

which in human development is lacking, if “the embryo” be absent or very abnormal?

Cancer is an irresponsible trophoblast. The unfolding

110

of an embryo would stay its growth just as the formation of the sexual generation ends the growth

of a shoot of a flowering plant. How does “the embryo” bring about this result? It does not

devour the trophoblast, but it must produce something which, as was pointed out two years ago,*

brings the degeneration to pass. Only in ordinary chorio-epithelioma is the malignant neoplasm a

persisting portion and derivative of the trophoblast of the immediately previous gestation. Any

ordinary cancer or sarcoma is anew development of trophoblast, due to the attempt of a germ-cell

to start the cycle anew. Except in mode of nutrition, this irresponsible trophoblast does not

resemble normal trophoblast, but it often mimics the structure in which it lies or it is like no other

organ or tissue in the body. In any and every higher mammalian (Eutherian) development there is

the potentiality of a malignant tumour, † chorio-epithelioma, and this danger exists until the

degeneration of the trophoblast is an assured but not completed fact. As researches made some

years ago, but never published, demonstrated,

* The Lancet, June 21, 1902, p. 1758.

† So far as is at present known, chorio-epithelioma does not occur in any mammal except

man. The multiplicity of embryos in most other cases is against its happening. In almost every

gestation in the pig, and often in the rabbit, there are abortive embryos, from the trophoblast of

which a malignant tumour might arise but for the presence and influence of the other embryos. In

the course of the discussion the case of a full-time anencephalic (headless) human foetus was cited

as against the validity of the conclusions advanced. In this the entire alimentary canal and

pancreas were absent. A little cross-examination elicited the information that nothing was known

as to its foetal membranes, and that it was one of twins. The latter point is decisive in explaining

how this monster had escaped the weeding-out of the critical period. Had it been a single

embryo, not a twin, it would undoubtedly have been aborted at the critical period, and, moreover,

hydatid mole or chorio-epithelioma would very possible have followed.

111

in the pre-critical period the staining of the trophoblast cells resembled that of the function

transient ganglion cells-with methyl-blue eosin they took on an exquisite blue stain. With the

passing of the critical period the cells of the trophoblast, as Hill has shown for the bandicoot

(Perameles), no longer took on the blue stain, but absorbed ever more and more the red eosin.

The like change will be noticed in the transient ganglion cells of the fish; it is also seen in the

merocytes* of the yolk.

Rather less than two years ago I really commenced to work at the problems of malignant

neoplasms from their embryological aspects. The starting-point for research here was obtained

from certain results of prolonged investigations into the mode of vertebrate development. From

these it had been established beyond question that in the normal life-cycle of development in any

of the higher animals there were two generations—an asexual one, the “larva,” or phorozoon, and

a sexual one, “the embryo”—that the former was mainly, if not entirely, represented in

mammalian development by the trophoblast, and that in every normal development the

trophoblast was suppressed by the sexual generation, its de-generation commencing at the critical

period with the completion of all the parts of the embryo. For the past eight years it had been

recognized that at the critical period a change in nutrition always occurred. In 1902† the

conclusion was advanced that cancer was an irresponsible trophoblast, the continued and

unbounded

*”Merocytes” are certain curious nuclei, or, perhaps cells, with no particular cellsubstance

around them as a rule, which occur in the yolk-sac of many fishes. Often they are

much elongated and branched, due to incomplete cell-division (pluiripolar mitoses). Apparently

they are asexual structures. The writer has, as yet, not published all his observations upon these

merocytes.

† The Lancet, June 21, 1902, p. 1758.

112

growth of which was favoured by the absence of an “embryo” or sexual generation.

At that time there appeared to be one hopeful outlook for cancer research along the lines

of embryology. It was that in every normal development the trophoblast, which in the absence of

a completed embryo might become a malignant tumour, chorio-epithelioma, was invariably

suppressed and degenerated. The task was to find out how this came about; for there appeared to

be good reason for the hope, if not for the sure belief, that the factor or factors which brought

about this result in normal development might also be potent when directed against an

irresponsible trophoblast or cancer. To find these factors would be the solution of a general

scientific problem of which apparently cancer was but a special case. These factors have now

been found, and in consequence cancer ceases to be a problem for the embryologist. A scientific

solution of a certain problem has been obtained; whether or not this be at the same time a solution

of the cancer problem in its medical aspects would not be for the embryologist to predict. He can

only guarantee the truth of the embryological findings and conclusions, and maintain that these

would remain, even though they should fail utterly when applied in the treatment of malignant

tumours.

The change in nutrition initiated at the critical period in vertebrate animals, from fishes to

man, is based in the commencing functional activities of the pancreas-gland or sweetbread. This

introduces an alkaline digestion by means of the pancreatic juice with its various ferments. But

what of the pre-critical nutrition? There are many ways in which this might be investigated. One

might examine normal trophoblast, cancer or sarcoma, blastoderm of a fish—such as the skate—

cleaved eggs of an amphibian, or

8

113

blastoderm of a bird, all these being in the main homologous structures or asexual generations.

What is found to obtains in the one must hold good in the others, for there is but one mode of

vertebrate development. In this direction, when dealing with the yolk and merocytes or fishdevelopment

and with the mammalian trophoblast in past years, some results had already been

obtained; and in taking up the thread anew one’s thoughts reverted naturally to the chick and frog.

In a recent publication Professor M. M. Hartog* writes (p. 587): “One thing is clear as the result

of this: all probability henceforward is in favour of the view that in the animal, as in the plant, a

cell can only utilize its reserves secondarily and mediately—by the internal secretion of an

enzyme.” The author commences his paper by commenting upon the known facts that it has been

shown in every case examined that in the utilization of reserves in plants a ferment or enzyme is

always present, which in suitable circumstances can effect in vitro the same process—usually of

hydrolysis—which the living organism performs. He next proceeds to demonstrate that in the

early development of animals, in the cells of the frog’s egg, in which cleavage is ended, but no

embryo yet present, and in the blastoderm of the three or four day’s chick, there is a proteolytic

ferment present. Under proper precautions, this in acidulated solution (from 003 to 007 per cent

hydrochloric acid) gives the biuret reaction showing the presence of peptone. The reaction is

absent in neutral or slightly alkaline solution.

*Hartog, M. M.: “Some Problems of Reproduction—II.,” Quarterly Journal of

Microscopical Science, 1904, vol. xlvii., pp. 583-608.

114

On p. 587 he arrives at the important conclusion that the digestion in the frog’s egg (prior to the

appearance of an embryo) and in the blastoderm of the chick (with the embryo removed) must be

a purely intracellular acid one.* For comparative and other reasons I now apply this conclusion

to the trophoblast of a mammal and to the cells of a malignant neoplasm. No more than those of

the trophoblast do the cells of a cancer contain yolk. None the less, in both the digestion must be

the “ancestral” acid “peptic” (intracellular) one, characteristic of the asexual generation of a

vertebrate, for this has been handed down as an unconscious memory from the time when the

mammalian yolk-sac contained food material. Recent researches, especially those of Vernon,

have revealed the presence of traces of trypsin in many organs of the body. But this enzyme has

never be4n, and cannot be, demonstrated in any malignant tumour. On the contrary, the work of

Petry † on many carcinomata and sarcomata has proved the occurrence in these of a proteolytic

ferment. ion exception of pepsin; but the peptic digestion of the stomach, although important in

its action upon fibrous tissue, thus loosening such things as muscle-fibres (flesh), can on occasion

(after removal of the entire stomach by operation) be dispersed with. For shortness and clearness,

when this chapter was first published, I spoke of “acid-ferments” and “alkaline-ferments,”

meaning thereby ferments or enzymes acting respectively in acid and alkaline media. A certain

anonymous critic might note this, and in future be mindful of the maxim, “Teach not a parent’s

mother to extract the embryo juices of the egg by suction,” etc.

† petry, Eugen: “Ein Beitrag zur Chemie maligner Geschwüste,” Zeitschrift für

Physiologische Chemie, 1899, vol. xxvii., p. 398.

115

researches, this is evidently of an (? Intracellular) acid nature, like that recorded by Hartog for the

chick blastoder, etc. Petry’s work is cited in the latest edition (1903) of Hoppe-Seyler’s

“Handbuch der Chemicschen Analyse” 9p. 387) as proving the presence of enzymes in malignant

tumours.

In this connection it would be of interest to cite some of the discussions upon

“ExtrazellulКre und IntrazellulКre Verdauung” and upon the enzymes or ferments in Verworn’s

“Allegemeine Physiologie” (pp. 161 et seq.) In studying the history of the yolk-sack of fishes I

made many observations upon this question some years ago. At times one meets with cases in the

yolk sac which are more “extracellular” than “intracellular.” Ultimately, indeed, the latter passes

into the former. In the sequel therefore, the term “intracellular” will be used within brackets to

indicate not so much its actual nature nowadays as its origin in past times from a real intracellular

digestion occurring in the presence of yolk. In the chick or skate the yolk is contained in a yolksac;

in a frog, within the cells of the cleavage. None the less, the ferment is the like one.* The

trophoblast of normal

*It should not be forgotten that, as Verworn remarks (op. Cit., p. 171,) there exists a

“quite overwhelming abundance of ferments.” Hartog would seem to assume that the one

discovered by him in the cleaved frog’s egg and in the blastoderm of the chick, which must be

common to the asexual generations of vertebrates, is the same as, for example, the enzyme of the

mammalian stomach.. For present purposes it is not needful to insist upon this. Here it will be

maintained that this enzyme of the blastoderm trophoblast, or malignant tumour can only act in a

slightly acid medium, and that in all probability it is a much weaker one than that characteristic of

then the pancreas. The existence of the asexual enzyme and of the sexual one may account for

the necessary existence of a gastric and an intestinal digestion. The sexual generation is of later

origin in time than the asexual one, and its evolution has been bound up with that of a new

digestive gland and enzyme, the pancreas, etc.

116

development, like the trophoblastoma of chorio-epithelioma, nourishes itself by an (intracellular)

acid digestion. A malignant tumour, a cancer or sarcoma, nourishes itself in exactly the like

manner. Like the trophoblast, it eats and erodes its way, destroying tissues by an (intracellular)

acid digestion. Only by such could a cancer erode bone.* To describe in detail what should

follow would be to recite much of two papers † published long ago as well as some other points

noted since that time. The solution of the question is possibly the resolution of the problem of

cancer. The mammalian embryo solved this ages ago; indeed, it “inherited” the solution from

“ancestors” much lower down in the scale. The very existence of “the embryo” throughout the

higher animals is dependent upon the suppression, the degeneration and death, of the asexual

foundation upon which it came into being. In many invertebrata the sexual generation eats up

“often by phagocytes or wandering cells” the asexual foundation or “larva”; and it must be

recognized that in the higher forms it practically digests it. On the present occasion no account of

the work required to establish it need be given; much, not all, of it is contained in my published

memoirs. The fact may be stated briefly that in fish and mammal alike it is the

*This remark about the power of cancer to erode living bone was a trap for the unwary,

deliberately set by the writer. As had before happened, it caught its victim with certainty; for at

once it was asserted, as I had often before heard it, that the wall of an aneurysm could erode bone

also—thus, the vertebral column—and did I therefore mean to suggest that this was an aciderosion,

etc.? The reply to this is, that the pressure of the aneurysm here kills the bone, and that

the dead, not living, bone is then removed by the agency of some enzyme of the leucocytes or

white blood cells.

† Beard, J.: “Certain Problems of Vertebrate Development,” 1896, and the “Span of

Gestation and the Cause of Birth,” 1897, both published by Dr. Gustav Fischer, Jena.

117

commencing functional activity of the pancreas which initiates the degenerative changes in the

asexual generation. At this epoch, the critical period, the fish commences to feed itself on yolk,

not by an (intracellular) acid “peptic” digestion, but by an alkaline pancreatic one. In some of the

textbooks of physiology stands the statement that the human pancreas at birth “contains tryspin

and the fat-decomposing ferment, but not the diastatic one”* (Zweifel); but, as I know from my

comparative observations of years past, its activities really commence at the time the anus is

formed, early in the seventh week of gestation, at a period when in the days of long the organism

would have begun to digest the yolk of its now empty yolk-sac. The pancreas functions

throughout foetal life in a mammal, though it has nothing to digest except the trophoblast.

During foetal life the pancreas gland is pouring out its secretion into an intestine which at

the present day contains no food to be digested, for the food of the foetus has been prepared by the

pancreatic digestion of the mother. To the foetus in utero this alkaline digestion is of no direct

use, but it has an indirect import in acting upon trophoblast. The commencing activities of the

pancreas during foetal life initiate an alkaline digestion by means of the most powerful and

important of all the digestive juices. To which of its ferments the observed results be due does

not concern us. † If the secretion be

* The diastatic ferment is, of course, amylopsin. Here, therefore, on the first appearance

in a medical journal of an advocacy of pancreatic, ferments in cancer, amylopsin is noted, and its

absence at birth mentioned along with the name of Zweifel as the discoverer of this fact.

† The writer had intended, in correcting the proof for the Lancet, to insert the following

note, which was actually spoken at Liverpool on January 20, 1905: “As my work of past years

has revealed, at the critical period the embryo, complete in all

118

absent, neither the asexual structures of a fish development nor the cells of chorio-epithelioma do,

or can, degenerate.

Under the conclusion already advanced regarding the nature of cancer as an irresponsible

trophoblast, in consideration of the facts regarding the acid and eroding action of the trophoblast

and of carcinoma, and in respect of the fact that in the absence of a completed embryo or foetus

and its pancreatic secretion the trophoblast may become one of the most deadly of malignant

tumours—chorio-epithelioma—it must be clear that nature itself has possibly provided a remedy

for cancer and the pernicious (intracellular) cancerous digestion of the trophoblast in the secretion

of that important digestive gland, the pancreas. This structure, I understand, is very rarely the

seat of a primary carcinoma, and almost never of a sarcoma.* Moreover, it is very important

continued from page 118

its parts, begins to nourish itself by an alkaline pancreatic digestion, and with a ferment

known as trypsin. If this latter be wanting, the asexual generation, the trophoblast, may become a

malignant tumour of the deadliest description; in its presence it becomes harmless and slowly

degenerates. Clearly, then, since cancer is an irresponsible trophoblast, the ferment, which brings

about the degeneration of this in normal development ought to possess potency when directed

against the cells of a malignant tumour.” For reasons of scientific priority, which also led me to

read to the audience the abstract of Liverpool lecture, published next day in full in the Liverpool

Daily Post and Mercury, it seems desirable to draw attention to this matter here also.

* Two recently recorded cases of tumours of the pancreas may be cited. In the Berliner

klinische Wochenschrift, 1904, p. 479, Herr Ury, “Berichtet über einen Fall von Pancreascarcinom

mit Fett – Stühlen, wlche, durch Darrichung von Pancreon wesentlich gebessert

wurden,” and in the Journal of Medical Research, Boston, 1902, vol. viii., pp. 385-395, A. G.

Nicholls records a “simple adenoma of the pancreas.” The first shows that the pancreas was not

properly functioning, while the second in which the tumour was not larger than a marrowfat pea,

illustrates the difficulties encountered by tumours in this organ.

119

to note, that just as cancer is found everywhere in the vertebrata, just as there is one mode and

one only of vertebrate development, so the pancreas gland and its secretion are a common

heritage of vertebrate animals.

Briefly, as I conceive it, in normal development and in a malignant tumour the matter is

simply a question of the victory of a stronger enzyme over a weaker one. In view of all this, the

events in a malignant tumour—such as, for example, the “heterotype” mitoses—lose much of

their importance. They may still possess an interest for the cytologist and embryologist, and even

a passing one for the pathologist. But to the physician and surgeon these abortive attempts to

form gametes cease in treatment to have any import whatsoever.

Practically all that was sought after from my own researches regarding cancer has now

come to light. Embryologically, the problem of cancer has been to discover the antithesis of two

enzymes and in particular to find out the enzyme capacity of destroying a weaker one, and thus of

leading to the degeneration of the tumour by simple atrophy. The whole story is but another

example of that antithetic alternation which underlies all the phenomena of living things. The

solution of the problem of the functional relation of embryo and trophoblast—how the latter

nourishes itself by an (intracellular) acid “peptic” digestion and degenerates slowly by a

pancreatic digestion—becomes at the same time the embryological, if not the medical, resolution

of the problems of malignant neoplasms, as well as of chorio-epithelioma. As an embryologist,

who is not a physician or surgeon, my task is ended. The further applications of the scientific and

theoretical solution of the problem may safely be left in the hands of those who know far better

how to employ it. But they may not forget that in nature the degenera-

120

tion and disappearance of these asexual structures, sometimes quick are often exceedingly slow,

though sure. Not that it is likely that the surgeon has removed his last malignant tumour, but that,

as one of the results of the work* begun more than sixteen years ago, they physician has possibly

had forged for him a light and not dangerous weapon, only second, if not equal, in potency to the

surgeon’s knife. †

*Most of the work has been carried out in Edinburgh, latterly with grants from the Moray

Research Fund and Carnegie Trustees.

† As later events have proved, this estimate—with deference to certain transparently

anonymous critics—was much too modest. The pancreatic ferments, trypsin and amylopsin,

when direct scientifically against the living cells of cancer or sarcoma, are infinitely more potent

than the knife of any surgeon!

121

CHAPTER V

THE INTERLUDE OF CANCER*

“In preda al duol non mi lasciar!”

MAZZONI: Cavalleria Rusticana.

With the results of the preceding chapter, the writer regarded the problem as no longer one for the

embryologist. It seemed to him that any further problems of cancer were rather for comparative

physiological chemistry than for such a branch of science as embryology. This has, indeed,

turned out to be correct. As appeared in the sequel, cancer was vulnerable by two lines of

attack—embryology and stereo-chemistry. At the present time (1911) the scientific Germans—

wuch as Abderhalden, Blumenthal, Neuber, and others—are advancing slowly, but surely, along

the line of stereo-chemistry. That they have been anticipated in this advance is shown in the

following chapters of this book, as well as in the introduction. In the present chapter, therefore,

there is presented a connected account not merely of what is given in preceding pages, but also of

many things worked out in years now long past. The following lines contain an attempt to show

how various purely embryological problems and their solutions bear upon the problems of cancer.

*From the Medical Record

122

The embryologist never tells the story of his work in the order of his researches. He

cannot; for in these he pushes his way little by little, step by step, from the known to the

unknown, and at any given time he may be working in two directions—upwards from the

starting-point of the fertilized egg, and downwards from the finished embryo. Thus it happened,

that what, logically regarded, should have been the first investigation in 1888—the history of the

germ-cells—was actually the last, as it was also the coping-stone which crowned the work, and

made it lasting.

The actual cancer researches have been a mere interlude in the whole—an intermezzo.

“The prey of pain let me not be!” The solution of the problems of cancer was but a corollary of

what had gone before, and it followed naturally and irresistibly out of the germ-cell results, the

course of the life-cycle, and the conclusions as to the germinal continuity and heredity. Since the

embryological theories of the textbooks are, to apply the words of Pasteur, a mass of baseless

hypotheses, it follows that the solution of the problems of cancer can be grasped properly only by

a comprehension of the course of the cycle of life from generation to generation, as my researches

of past years have revealed it.

The starting-point of a new cycle is the fertilization of an egg, and the outline history of

the cycle is not complete until we have shown how new eggs, new reproductive elements, arise;

and until we have reached the point at which these are ready for fertilization, to start the cycle

anew. An egg is fertilized and development begins by its cleavage; an ever-increasing number of

cells is formed in this way, and anon we reach a point, at which the orthodox embryologist says

that the egg-cleavage is finished. What has then come into being? The usual

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reply is, “ A new organism, an embryo.” No such thing! At the close of cleavage, in none of the

higher animals is any trace of an embryo present. Something is there, but not an embryo. I will

ask the reader to regard this developing egg from the start of cleavage as a living organism, but

not an embryo.

The criterion of anything in embryology is the fate or destination of the cells. In a

worm’s egg, which has cleaved five times, giving 32 cells, or in a skate’s egg, which has

undergone ten division, resulting in 1,024 cells, there is not a single cell present which is

embryonic in destiny. Nearly all the cells are predestined to form portions of an asexual

foundation or larva, termed by me the “phorozoon,” or bearing animal. This is a transient

organism; for, as a rule, its life is very brief. It has a part to play in the cycle, and, like the Moor,

when it has done its appointed task, it can go. The results upon which, generally speaking, my

conclusions are founded have been obtained by what my late friend and teacher—Professor

George Bond Howes, Huxley’s assistant and successor—was wont to term the comparative

morphological (and physiological) method. Under it there is but one mode of development for all

the higher animals: in essentials the life-cycle is always similar, not only from fishes to man, but

from worms and even lower forms to fishes. These “phorozoa,” or asexual generations of various

marine organisms, have long been known. Often, and until a connection therewith was

established, they received names distinct from those of the sexual generations. Thus, the larva,

“phorozoon,” or asexual generation of a brittle star, is still known as a Pluteus, and so on.

The late Professor N. Kleinenberg first set up (1886) the doctrine of development by

substitution of organs. Under this, every organ of the larva (asexual generation)

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FIGURE 5 (two pages) GO HERE!!

was ultimately replaced by a corresponding, but differently developed, organ of the adult form

(sexual generation). For a variety of reason, into which space forbids entry here, it soon became

clear to the writer that Kleinenberg’s doctrine was inadequate, and that, instead of a substitution

of organs, there was in development in reality a substitution of organisms. The sexual organism

replaced the asexual one. This was seen to be an alternation of generation, and as there was no

homology or close likeness between the asexual form or its organs, it was an antithetic alternation

of generations.*

Now that we have the mention of the word “antithetic,” it may be permitted in passing to

point out how Pasteur’s researches started in the antithesis of the two sorts of tartrate crystals:

mine in that of two nervous systems in the life-history of a fish. Here we are dealing with

anatomical antithesis; later we shall come to recognize physiological antithesis—that of two

ferments.

The tracing of the asexual generation in the backboned animals or vertebrata, from fishes

to man, was not without its own special difficulties. These were due rather to expecting too

much, and to failing at first to realize that the higher one ascended in the scale of life, the greater

became the organization of the sexual form or generation, and the more insignificant the asexual

one, until in the highest animals, the mammals and man, the asexual generation became reduced

to the almost structureless chorion or trophoblast, as Professor A. W. Hubrecht named it in 1889.

Many people, quite ignorant of all the embryological advances of recent years, appear to imagine

that I not only introduced the

*See Appendix C, “The netazoan Life-Cycle and Alternation of Generation.”

125

name “trophoblast,” but also invented the thing, to which it is applied in embryology. These

things are not true. The name was invented for a thing defined by Hubrecht in 1889, and the

thing itself has existed for untold millions of years!

In 1895 the standpoint had been attained that in every life-cycle of a higher animal, such

as man, there were two generations: an asexual one—the trophoblast, and a sexual one—the

metazoan individual or person. The puzzle was not how the first of these arose, for clearly it

could be demonstrated any day in the week that it was the direct product of the cleaved or

segmented egg (vide Fig. 5, phorozoon or larva). Somehow or other there arose gradually upon it

the sexual generation by a process of evolution or unfolding.

How! Something resembling the spore mother cells of plants was required. That was

very apparent. (See the table of Revised Comparison.) It was not until towards the close of 1900,

when the firstharvest of the germ-cell researches had been reaped, that the problem was cleared

up. The germ-cell researches had been reaped, that the problem was cleared up. The germ-cells

arose before the embryo, as products of a single cell, the primitive germ-cell (U.K.Z. of the

diagram, Fig. 5), in a direct line from the fertilized egg. They came into being upon the asexual

generation or trophoblast. To contain and to nourish these germ-cells for a brief span of time

another organism was need, a sexual one, endowed with sexual organs.

How was the sexual organism obtained? In embryology things do not come into

existence out of nothing! True, there are embryologists who look upon holes or cavities as the

sources of important organs, but the writer at all events is not a “hole-morphologist”!*

*Any more than the author of this expression, the late Professor N. Kleinenberg, was.

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TABLE OF REVISED COMPARION OF ANIMAL AND PLANT LIFE-CYCLES.

ANIMAL PLANT

ASEXUAL GENERATION ASEXUAL GENERATION

Zygote or fertilized egg Zygote or fertilized egg

(2 n). (2 n).

| |

Phrozoon or trophoblast. Sporophyte or flowering

| plant (2 n).

| |

Formation of primitive Formation of primitive

germ-cell (2 n). spore mother cell (2 n).

| |

Formation of primary Formation of spore mothergerm-

cells (2 n). cells. (2 n). (Reduction

| and sex determination).

| |

“Apospory” (reduction Spore formation

postponed).

SEXUAL GENERATION SEXUAL GENERATION

A primary germ-cell (2 n). A spore (1 n).

| |

Origin of embryo by un- Origin of sexual generation

folding of a primary or gametophyte from one

germ-cell, inclusion of spore ( 1 n ).

rest in the individual |

of the sexual generation |

(2 n). |

| |

Ripening of germ-cells. Ripening of germ-cells.

Reduction and sex deter- Reduction previously

mination. effected.

t t

Sperm. Egg. Sperm. Egg.

6 6

Zygote. Zygote.

In the above table n equals the reduced number of chromosomes, and 1 n signifies the

emancipated cell, 2 n the duplicated or conjugated cell, the “conjugation” or joining together

being carried out at fertilization. The “reduction” is the undoing of the previous duplication

effected at conjugation. 127

The unit from which anything arises is the single cell. There was only one source from which

such a sexual generation could arise: this was by the evolution or unfolding—the sacrifice—of

one germ-cell for the well-being of the rest, and to contain. At the epoch of the formation of the

primary germ-cells all were alike in origin and potentialities. All were so many potential

individuals of the species. If two developed independently, the result would be identical twins; if

three, triplets, and so on.

Reviewing matters, starting with the fertilized egg, this gives rise to an asexual

generation—the trophoblast, upon which there arises an “apical cell”—the primitive germ-cell.

This latter divides a certain limited number of times, this number being a fixed one for the

species; but while it is n in the male, it is n plus 1 in the female. The products are 2, 4, 8, 16, 32,

64, 128, 256, 512, etc. In the diagram it is depicted as 128. These 128 germ-cells are the primary

germ-cells. It is they which enter the embryonic body (Fig. 4) when this arises, and it is some of

them which come to occupy all sorts of abnormal position. But all the line of primary germ-cells

are not destined for future generations. Some few of them, 1, 2, 4, or 8, are embryonic in destiny.

At least one of these must unfold to form an embryo. If any of the others do so, the result is

identical twins, triplets, etc. If any of these “embryonic” germ-cells lie dormant within the

developed embryo, they may become the seed of future tumours, as will appear later on. The line

of heredity, so far revealed, leads from fertilized egg to the primary germ-cells, and thence

through all the history of the germ-cells within the “reproductive glands” to new eggs and

sperms; that is, all things considered, the cycle is one of unicellular organism, the germ-cells, in

128

the history of which the sexual generation or individual is but an incident.

Another important question to be solved some fifteen years ago was the how and the

when of the suppression of the asexual generation. This latter, whether represented by the

transient nervous apparatus and other structures of a fish, or by the trophoblast of a mammal,

went on flourishing for a certain—not very long—space of time, and then, quite suddenly, all

growth was stopped, and its degeneration was initiated. In years long gone by how often have I

not watched these asexual structures under the microscope, seen them flourish and blossom, and

then—subito, as the Italians say—begin to fade away, as though blighted! The correlation of

phenomena is often of the greatest importance to the embryologist in his work; and when this

sudden fading away was first established, it was also noted that the commencing formation of the

posterior fissure of the spinal cord was a concomitant phenomenon. This led to one of the many

little research excursions I have made right up the back-boned series to the mammals, and to the

study of human embryos themselves. A whole array of interesting and connected events was

soon unearthed, and the putting together of these culminated in the discovery of the critical

period—one of the most momentous finds ever made!

“There is a period in the development of every vertebrate embryo, during which, and

only then, it resembles the embryo of any other vertebrate in a corresponding phase in certain

general features. But while it thus agrees exactly with any other embryo of this period in

characters, which are common to all vertebrate animals it differs from the embryo of any other

class in certain special class features, and also from any other embryo 9

129

of the same class, but of a different order in other and ordinal characters. Immediately before

this period is reached it begins to put on generic and specific characters, and thus it then begins to

differ from all other embryos in these.” In other words, the embryo then first asserts its presence,

announces its own individuality. It is then first present as a complete thing. It then first begins to

use its own digestive apparatus, especially its pancreas gland, and in a higher mammal to feed

itself by means of the allantoic placenta. This critical period is common to all back-boned

animals in their development. At this period the average marsupial is born into the world, and

then it first begins its long mammary nutrition.. In so great a hurry is it to get into the world that it

forms its anus in the act of being born. The human embryo does the same at the like period, in

the seventh week of gestation, as though it were a marsupial, although it has no use for this

aperture for many months to come. Then the allantoic placenta—an organ of the embryo or

sexual generation, like the pancreas gland—first begins to function, and then normally the

trophoblast begins to function, and then normally the trophoblast begins to fade, to be suppressed,

and to degenerate.

Though ferments first made their appearance in my published writings in 1892—for I

pride myself on having been one of the very few pupils the late Professor C. F. W. Krukenberg

ever had—it was not until 1904 that their all-important bearings upon the critical period were

evident. In human gestation, if at the critical period the embryo be wanting or very abnormal (a

very abnormal human embryo can only persist as one of identical twins), the phenomena of the

critical period are lacking, and the normal trophoblast, which always begins its life by eroding the

uterine epithelium and wall, may go on with this process, exhibit indefinite powers of growth, and

eat

130

its way through uterus and other organs, finally blocking the lungs and brain of the mother. This

is chorio-epithelioma, recognized to be a form of cancer by Professor F. Marchand in 1895. This

is without doubt the most deadly form of cancer. Here the sexual generation being unable to

suppress the asexual one or trophoblast, the latter exhibits the characteristics of asexual

generations, the powers of indefinite growth and increase. Pathologists at present distinguish

wrongly between two forms of chorio-epithelioma, a malignant one and a benign one. The latter

has no real existence, for in it the trophoblast cells are all dead and undergoing the characteristic

degeneration due to the action of pancreatic ferments. A “benign” chorio-epithelioma, as

Professor Schmorl found, may happen in any gestation, for the trophoblast cells of the pre-critical

periods, which have invaded the maternal organs—even the lungs—are normally also brought to

commencing degeneration at the critical period.

In 1902 the conclusion was reached that cancer was asexual generation or irresponsible

trophoblast, and in these words for the first time in human history the nature of cancer was laid

bare.

Its origin was not at first so clear, but by the year 1904 it was recognized that the

problems of like or identical twins, upon which the writer was then and since engaged, threw light

upon its origin. Owing to their extra-embryonic origin aberrant germ-cells are quite common,

and they may be met with anywhere in the embryonic body. The ordinary aberrant germ-cells,

which usually degenerate, were much too abundant a source to furnish the origin of a cancer.

Entia non sunt multiplicanda. The etiology of double monsters and of malignant tumours was

traceable to the phenomena of

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like twins. The facts concerning these, as well as those relating to Hermann von Jhering’s finds

in the armadillo (Praopus hybridus), which my work has fully confirmed, furnished the key. This

armadillo, the “tatu,” produces all its young in one chorion or trophoblast, and therefore they are

all indentical, of the like sex, and all products of one egg. The whol doctrine of the tumours,

benign and malignant, centres in the phenomena of like twins—that is, in a former multiplicity of

embryos, all products of one egg. To-day the “tatu” (P. hybridus) produces seven to twelve such,

all derived from a single egg, all of the like sex, and some of them more or less rudimentary!

These latter tell a very significant story* to the embryo-

*Because hypothetical, the following may find a place as a foot-note. From the

consideration comparatively of a variety of embryological phenomena, well known to the

investigator, it is obvious that the procedure, where only a single embryo is going to arise from

one of the primary germ-cells, will not be quite the same when two or more embryos are destined

to unfold. The setting apart of one cell will be preceded by one or two divisions, giving one

functional cell and possibly three abortive ones. But if the development shall result in, say,

triplets, there will be, not merely two division, but at least three, if not four. Of the products,

which are all primary germ-cells, three will unfold as embryos, three may be abortive or

rudimentary, and, if there be eight all told, two will remain as “embryonic cells,” which later on,

in some or other of the individuals arising, may become the seed of tumours, benign or malignant.

But these cell division have a curious tendency to be in twos or pairs, or even in threes; so that in

the formation of triplets, instead of eight cells, there may be sixteen concerned. How many of

these will be abortive, and how many “embryonic” in potentialities, is at present impossible to

say. The armadillo, Praopus hybridus, with its seven to twelve young in one chorion or

trophoblast, affords an instance where at least sixteen cells must originally in every case have

arisen at the line of primary germ-cells and in addition to those cells destined to become the

sexual products. Of these sixteen cells, seven normally give rise to fully-developed embryos, five

to more or less rudimentary ones, and there still remain four, which—as cancer, is not known

here—may be abortive.

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ologist. They recall to him other similar phenomena in embryology. Reductions in numbers of

units (cells), formerly of importance, but which now persist, not because they are really required,

but because their existence and persistence are parts of an old scheme of the cycle of animal life.

The writer has had abundant opportunities of noting the liability of identical twins to

cancer, but to state the matter in this way is misleading. Those individuals who develop

malignant growths are as liable to such as are identical twins to cancer, but to state the matter in

this way is misleading. Those individuals who develop malignant growths are as liable to such as

are identical twins, and for the same reasons. Without doubt cancer is hereditary. This is

abundantly borne out by clinical histories in my possession. There are records where both parents

died of it, where even one or other grandparent developed cancer, and it is only too commonly

told the writer that in some particular case the father or the mother was a victim of cancer. The

most remarkable example known to me at present is in the family of a master-carpenter in

Edinburgh. His mother died of uterine cancer, and he has lost all his brothers and sisters, seven in

number, by some form or other of malignant disease. Embryologically regarded, persons suffer

from cancer because they are at the basis members of a group of identical twins or triplets. It is,

therefore, not from any and every aberrant germ-cells that a cancer takes its start, but from one or

other of some few germ-cells, embryonic in destiny, cells which should have given rise to twins,

triplets, etc., identical with the embryo, which arose in any particular gestation.

footnotes continued from page 132

But if the number of young here arising at every gestation were much reduced, while all the

preliminaries were retained, what a rich harvest of tumours might be the result! In a case of

identical triplets, cited by Professor H. H. Wilder, at least two of the sisters died of cancer.

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The line of primary germ-cells of the diagram (Fig. 5) is not made up of one only,

destined to form an embryo, and of n-1, destined for a future generation, but it is composed of a

limited number, 2 or 4 or 8, often not so many, embryonic in destiny, of which as a rule one only

becomes a normal embryo, and n-2, or n-4, etc., are set apart to provide for the cycle of

unicellular organisms or germ-cells. Such a persistent embryonic germ-cells, encapsulated within

the individual, may at any time, by illness, injury, irritation, or other cause—such as declining

years—weakening the system, be awakened into activity. The “age incidence” of cancer is

scientific nonsense, for it is only relative. Whenever this happens—the time is long past when it

should have unfolded as an embryo, it attempts to resume the cycle, and its “unconscious

memories” only enable it to try to repeat the asexual portion of the cycle. Such an encapsulated

germ-cells can only do one or other of two things in the end—and live. It may develop, and it

only does this congenitally with the developing individual, or it may attempt to go on with the

life-cycle—trophoblast.* In this way it becomes an irresponsible trophoblast, and it may imitate

or mimic anything in its environment. Whatever it mimic—something existent or non-existent—

it is always an “imitation tissue,” and behind the domino or mask an irresponsible trophoblast.

In nearly all the foregoing, morphological aspects have been under consideration. It now

behooves us to take account of the physiological and functional ones. The

* This is more fully shown in the Introduction (p.23) and in the later chapters.

134

critical period in a fish or mammal or man is that at which the embryonic organs as a whole first

begin to function. The fish begins to feed itself, digesting the yolk by intestinal digestion. The

mammal or human embryo begins to do the like (in the absence of food-yolk) by means of the

commencing functional activities of the allantoic placenta. At this epoch in the fish the pancreas

gland manifests its activities by the presence of abundant zymogen granules in the cytoplasm of

its cells, That these result in the secretion of pancreatic ferments is shown by the digestion of

yolk within the gut. Owing to this digestion, the fish, like the mammal, gets ever bigger and

bigger. None of the yolk enters its stomach, for this has then as little functional activity as the

stomach of a mammal has during foetal life. An internal yolk-sac is formed for the reception of

the yolk from the external one, and the yolk-duct opens into the duodenum. This fact alone

indicates to the embryologist that the pancreas gland is functioning. In an average marsupial at

the critical period this gland certainly begins its functional activities, for the animal is then born,

begins its mammary nutrition, and digests the milk. If a certain thing happen at the critical period

of a fish, or a marsupial, I know from experience that something corresponding to it will take

place at the like period in a higher mammal or a man. A fish forms its anus at this period, so does

a marsupial, while in the act of being born, and so does a man, although he does not need it for

some seven months more. As the pancreas gland begins its functions in a fish or an average

marsupial, so it must do in the development of a man. Otherwise there would be no essential

unity in the mode of the development. Undoubtedly, under the action of the pancreatic ferments,

the asexual structures of a fish development begin

135

to degenerate, and, as represented by the trophoblast, they do the like in a mammal or a man.

This leads to an inquiry as to modes of nutrition, regarding which the reader may find

much interesting information in Verworn’s “General Physiology,” and still more in Otto von

Fürth’s “vergleichende chemische Physiologie der niederen Tiere,” Jena, 1903. The unicellular

organisms or protozoa, all asexual generation of animals—such as invertebrate larvЊ, fish

blastoderm and mammalian trophoblast, not forgetting cancer-cells—nourish themselves

intracellularly and by means of a ferment acting in slightly acid medium. On the other hand, an

extracellular digestion, by means or ferments, pancreatic enzymes, acting in slightly acid, neutral,

or alkaline media, is restricted to the sexual generations or individuals of the higher animals

(Metazoa) and man. In the former the ferment is possibly always the like one, and it would

possible by, to my mind, identical with the cancer-ferment, discovered by Eugene Petry in 1899,

and which I have named “malignin.” The ferments of the sexual generations being much more

powerful than the intracellular one found in the forms referred to above—being, indeed, the most

powerful things in the whole range of organic nature—it would follow that just as these higher

ferments destroy in life the living cells of malignant tumours, pulling down their albumins, so

also they must destroy the organisms—usually asexual generations, of tuberculosis, sleepingsickness,

malaria, yellow fever, etc.—when injected into the blood by means of hypdermal

medication.* Regarded from the strictly scientific standpoint of the embryologist, who is “Not

* Now (1911) the writer would desire to call special attention to these words, written and

published more than fours years ago, but hitherto unheeded.

136

even a medical man,” the tubercle bacillus, like the trypanosome, or the organism of yellow fever,

or that of malaria, etc., can no more live in the presence of these higher ferments than the cancercell

can. This has been shown apparently, in one case at lease, clinically and pathologically for

the tubercle bacillus, by my friend Dr. Margaret A. Cleaves,* of New York City. The first case

of cancer which it fell to her able brain and skilled hands to treat by means of injections of

pancreatic ferments was also complicated by tuberculosis of the bowel. When, in August, 1906,

the first communications passed between us, I informed Dr. Cleaves that, in my scientific

opinion, whatever happened to the large masses of rectal cancer present, which appeared too great

to leave room for hope of their entire removal, the tubercle bacilli would be bound to go. They

disappeared, and after amylopsin had been injected for some little time the pathologists failed to

find a single tubercle bacillus in the discharge, where previously they had been abundant. In our

joint opinion, the result was due rather to amylopsin than to trypsin, for the former is the medium

of all others in which the leucocytes can act. As in the treatment of cancer, the injection used

against any of the above human inflictions should be an extract, freshly prepared from the

pancreas gland direct, and containing all the ferments, especially the one in the presence of which

the leucocytes act—amylopsin. †

* Cleaves, M. A.” “The Physiological Action of the Pancreatic Enzymes, with Special

Reference to Hematology, Urinology, and Clinical Pathology,” Medical Record, June 1, 1907.

† Now (1911) for tuberculosis, malaria, sleeping-sickness, yellow fever, etc., I would

advise the use of injections of 500 tryptic units per ampoule, plus 1,000 to 2,000 amylolytic units

per amploule (vide Appendix F). Compare also BКtzner, Wilhelm: “Trypsinbehandlung d. Chir.

Tuberculose,” in Arch. Klin, Chir., vol. xcv., Heft 1, 1911.

137

Of the ferments of the sexual generations, by far the most important is that first

discovered by the Court physician, Baron Corvisart, and to which afterwards Professor W. Kühne

gave the name of “trypsin.” It is this enormously powerful ferment, trypsin, upon which Nature

relies for the suppression of trophoblast in normal mammalian gestation. Lower down in the

scale than the mammals she associates with it its complement, amylopsin. Foetal blood of a

mammal does not contain this latter, and the foetal pancreas gland does not produce it. In the

human pancreas gland amylopsin is not formed until some few months after birth. The reason of

this is not far to seek. When in the ancestral mammals uterine development was initiated, along

with it and following its close there was evolved the mammary nutrition. In this amylopsin is not

needed, and its production by the pancreas gland was postponed until the milk nutrition was done

with. The mammary nutrition is (on the testimony of more than one embryologist: thus, on that

of my friend J. P. Hill, as well as on my own) older in time than the allantoic placenta. The latter

was introduced to defer the birth period, and by prolonging the gestation, as detailed in my “Span

of Gestation,” to bring the young into the world in a more perfect state. In prolonging the

gestation, the mammary nutrition was postponed, and in this way the appearance of amylopsin

upon the scene put off to an even later period. This has led to grave difficulties and dangers in

human gestation, for there is no such thing in nature as a ferment possessing both proteolytic and

amylolytic powers.*

The proper scientific treatment of cancer is the enzyme or pancreatic one. If trypsin

alone be used, bad symp-

*Although a ferment, possessing such powers, has been advertised in medical

newspapers.

138

toms very soon arise, all of which recall the vomiting of pregnancy and eclampsia. Trypsin alone

is a very deadly remedy for cancer, the reason being that in killing the cancer albumins this

enzyme does not split them up to harmless simple products. What the products of the action of

trypsin alone are it is impossible to say, for they may quite conceivably vary with the amount of

the injection, its strength, and with the size of the tumour. Anyway, some of them are rank

poisons to the organism, and they lead to nausea, vomiting, pain in the back, drowsiness, high

arterial tension, albuminuria, oedema, etc., and even to convulsions, lasting several hours. The

cause of such symptoms and of the eclampsia of pregnancy did not long puzzle the embryologist,

who perceived that it was the absence of the complementary ferment, amylopsin, which induced

them. Nature had committed a grave error in omitting amylopsin from foetal blood, and in relying

solely on trypsin. In normal gestation, if anything went wrong with the maternal pancreas gland,

and if the maternal supply of amylopsin became diminished or ceased, then serious symptoms

were bound to follow. To my knowledge, at the moment of writing, injection of amylopsin have

not yet been given in any case of eclampsia, but they have, whenever used in cases of cancer,

removed all the bad symptoms named.

The preparations employed in the enzyme treatment of cancer should be like those first

used in America—the Fairchild preparations; that is to say, they must be potent extracts,

scientifically prepared from the fresh gland direct. The trypsin injection must be especially rich

in trypsin. The injection of amylopsin must have great amylolytic potency, and it is also to be

used at all times to meet and remove all bad symptoms, and in the later periods of treatment,

when all the cancer albumin

139

has been destroyed It must be an extract of the pancreas gland as free as possible from trypsin.

(Compare Chapter VII.)

This treatment is not intended for use against benign tumours, which are composed of

real or somatic tissues, and which are not killed or broken up by trypsin. Owing to this, the

injections furnish a chemical test of the true nature of a tumour, whether it be benign or

malignant. Thus, some pathologists look upon adenomata as benign, or at all events as only

potentially malignant. To my mind, there are “imitation tissues,” and I should anticipate that any

and every adenoma would yield to the chemical test.

Owing to the circumstance that the cycle of life is really a continuous procession and

succession of unicellular organisms, germ-cells, from which there arise asexual generation or

trophoblast, and embryo or sexual generation, the tumours can be classified into three groups, as

follows:

1. Embryomata (benign neoplasms).—Pathological manifestations of some greater or

less portion of the sexual generation—“the embryo.” They are composed of real

tissues—that is, normal or somatic (“embryonic”) cells or tissues. At its basis each is

greater or less portion of a twin, triplet, etc., identical with the individual containing

it. They are not endowed with indefinite powers of growth, and they nourish

themselves like other normal tissues.

2. Amphimyxomata (malignant neoplasms).—Combinations of embryomata and

trophoblatomata. Pathological manifestations or attempts to reproduce the whole

life-cycle-including trophoblast and embryo. They are transitional forms. (The

mixed tumours of Wilms are not all malignant, some being merely embryomata.)

3. Trophoblastomata: Cancer and Sarcoma (malignant neoplasms).—Pathological manifestations

of the asexual portion (trophoblast) of the life-cycle. They are not known

to differentiate functional gametes, eggs or sperms. They never include or repeat any

part of an embryo. They are never composed of somatic (“embryonic”) cells, though

they may mimic such, or even resemble no other cells in the body. As Fleischmann,

Paget, and Bland-Sutton pointed out, they are “imitation tissues.” They exhibit

powers of unlimited growth and increase, and they nourish themselves by eroding

and destroying normal cells and tissues in a manner exactly like that of the

trophoblast of normal gestation, and by means of a ferment acting intracellularly—

viz., malignin.

As the two latter divisions are made up of malignant tumours, it is for them, and not for the

members of the first group, that the enzyme treatment is intended.

In the foregoing simple story I have endeavoured to the best of my ability to give in

outline some idea of the course and nature of my scientific work and conclusions since the days

of May-June, 188, when I worked on the shores of Black Lake, New York. Much has happened

since then, not only in my own little field of work, but outside of it. It is since that time—that is,

in 1889—that Hubrecht set up the name “trophoblast” to replace with a different significance the

older term “chorion.” Long after then came the period of my germ-cells researches, not yet

completed. These have, however, extended so far that they are revolutionizing embryology. In

the light they throw on phenomena, the old Wolffian idea of epigenesis, and the allied Remak-

Cohnheim hypothesis of embryonic “rests” as the sources of tumours, along with many other

things, become memories of the past in science. The night is far spent;

141

a new sun is rising. Epigenesis, somatic origin of germ-cells, and recapitulation in development,

are fading away into thin air before the mighty powers of Evolution with predestination

(Weismann), an actual tangible continuity of germ-cells from generation to generation, and an

antithetic alternation of generations as the mode—the only possible one—of animal development.

The suspicion entertained at Liverpoole in 1905, then expressed to two Professors of the

University of Liverpool, and which is somewhat reinforced by the references to the work of

Pasteur in the present chapter, that the problems of cancer had been lifted into the field of

chemistry, soon showed itself to be a reality. Not only were the questions still pending chemical

ones, but they belonged to a branch of chemistry with which the name of Pasteur will ever be

associated as its founder—stereo-chemistry. This is more clearly revealed in the following

chapter.

142

CHAPTER VI

THE ASYMMETRY OF THE CYCLE OF LIFE, BEING

“THE END OF THE THREAD.” *

In past years every new unravelling of the thread led to new problems. But no matter how many

side branches or collateral issues came up, the main course of the thread was continuous, and the

observer’s senses were concentrated upon it, to the exclusion of all else. Among other things the

thread passed through the problems of heredity and genetic variation, the determination of sex,

the continuity of germ-cells, the problems of identical twins, and by reason of these, as well as

from the nature of the cycle of life, through the embryology of neoplasms, and of cancer itself.

For a long time I had imagined the cancer studies to have been an interlude in the work, but no,

the thread of research passed directly through the problems of cancer. And now, quite

unexpectedly, the end of the thread has been reached, because portions of it had been unravelled

by some of the greatest workers in science, because Louis Pasteur, one of the greatest

investigators who ever lived, van’t Hoff, Le Bel, and Wislicenus had lived and laboured, because

their researches had founded stereo-chemistry, or chemistry, in space.

The present chapter is simply “The End of the Thread.”

*From the Medical Record.

143

Like my fellow-workers, I had been taught to regard the development of any of the higher

animals as “direct”; that is to say, from the fertilized egg a new sexual organism, a worm or a

fish, a bird or a man, arose directly. From the tissues or soma of this sexual organism new

reproductive products, eggs or sperms, sprang. In this way the simple cycle of “egg-sexual

organism, egg-sexual organism” repeated itself ad infinitum. Under this, still generally accepted,

conception of development the germ-cells were somatic in origin, and the gradual building up

(epigenesis) of a new sexual organism happened directly, when such an egg had been fertilized.

Such, briefly, was the simple embryological creed which my teachers, Milnes Marshall, Huxley,

and Carl Semper, taught. During some eight or ten of the early years of my original work this

was my embryological faith, if an investigator may have any scientific creed.

Epigenesis, direct development, and a somatic origin of germ-cells, have now long been

associated with another embryological dogma, the capitulation theory, according to which any

higher animal “climbs its own genealogical tree in the course of its development.” To what

lengths and depths of scientific error this latter doctrine can lead, see the fifth revised of

Haeckel’s “Evolution of Man.”

My embryological faith was perfectly orthodox when, on June 14, 1888, I left the shores

of Black Lake, New York, with an extensive assortment of preserved material of fish

development. One of the earliest finds made after the return to the Anatomical Institute of the

University of Freiburg in Breisgau was of the existence of two distinct and separate nervous

systems in the life history of the bill-fish, Lepidosteus osseus. About a year later the like find of a

twofold nervous apparatus was

144

made in some other fishes and amphibians, and especially in the smooth skate, Raja batis.* The

transient nervous apparatus of ganglion cells and nerve fibres in the skate development

functioned for a time, for about three months from the start out the total of circa seventeen, and

then quite suddenly began to fade away, and to undergo a slow but sure degeneration.

The two nervous systems crop up again and again in my published writings since 1888,

and, as indicating the import long attached to this antithesis, I find myself writing in 1905 a paper,

“The Cancer Problem,” † opening with a recital of some of the facts in the history of the transient

ganglion cells. All my original work, from 1888 down to to-day, is impregnated with facts

concerning the two nervous systems, and the antithesis underlying them. The discovery of that

antithesis has impelled and influenced all my work since that time.

With the termination of the period of research marked by the publication of “The

Interlude of Cancer,” I recognized that my original work was approaching and tending to

converge to the work of Pasteur. The researches had led finally into problems of the chemistry of

the ferments, and especially of the extracellular enzymes, trypsin and amylopsin. It is not too

much to say that Pasteur had founded a science of the ferments. True, he laboured for many years

at the problems of intracellular enzymes, such as the yeast organism, the mould, Penicillium, etc.,

and the enzymes trypsin and

*Beard, J. : “The Early Development of Lepidosteus osseus,.” Proc. Roy. Soc. Lond.,

1889, vol. xlvi., p. 108-118. Ibid: Ichtyopsida : An Account of the Development and

Degeneration of Ganglion Cells and Nerve Fibres, Part I., Raja batis,” Zool. Jahrb. Morph.

Abteil., 1896,, vol. viii., pp. 1-106, 8 plates.

† Ibid: “The Cancer Problem,” Lancet, February 4, 1905.

145

amylopsin, for a knowledge of which the world is so greatly indebted to Corvisart* and Kühne †

never entered into the sphere of Pasteur’s researches.

The interesting thing is, according to his own testimony, ‡ that Pasteur’s work, like mine

since 1888, centred in the fundamental discovery of an antithesis. Some medical men of

Pasteur’s day denied the truth of his conclusions, either on flimsy evidences or on none at all—

just as happens to-day. Equally they sought to deny the scientific investigator the right to any

opinion on a question regarded by them as medical, but which was really scientific. “What!”

cried Pasteur, “I have been engaged for twenty years in research on a subject, and have no right to

an opinion? And the right of verifying, controlling, discussing, and questioning belongs more

especially to him who has done nothing to clear up the matter, to one who has just read more or

less attentively my works with his feet on the fender! You say, my dear colleague, that in the

actual state of science it is better to have no opinion. Ah, well! I, even I, have one, and no of

sentiment, but of reason, for I have acquired the right by twenty years of assiduous work. My

opinion, or better, my conviction is, that in the actual state of science of which you speak

spontaneous generation, is a chimЊra, for my experiences are complete, and they all prove that

spontaneous generation is a chimЊra. As to my opponents, proof in hand I have contradicted

every one of their assertions, and they have never dared

*Corvisart, Lucien: “Sur une Fonction peu connue du Pancreas,” Paris, 1857,58, pp. 1-

123.

† Kühne, Wilhelm: “Ueber das Verhalten verschiedener organisirter und sog.

Ungeformter Fermente,” and “Жber das Trypsin (Enzym des Pandreas),” Verhandl. Des. Heidelb.

Naturhist. Med. Vereins. N. s., I., No. 3, 1876, pp. 1-10.

‡ Vallery-Radot, RenО: “La Vie de Pasteur,” Paris, 1901.

146

seriously contradict one of mine.” In passing, be it remarked that every work=d of this passage

might be applied to happenings at the present time regarding the problems of cancer. Then

Pasteur explained how the whole series of his marvellous discoveries, chemical, bacteriological,

or medical, hung together and formed a complete chain—e.g., anthrax, the pure fermentation of

beer, the acetification of vinegar, the diseases of vines, the means of preventing them, and, lastly,

going back seventeen years, the first link in the chain of discoveries, that of the double tartrate

crystals, and the facts concerning their dimorphism.* “The best proof that an observer is right is

the uninterrupted fruitfulness of his work.” †

Pasteur worked for seventeen years at his chain of discoveries; it was in 1907 nineteen

years since the first link of my chain was forged. The thread each of us obtained at the start was

the discovery of the antithesis of two things: he, the two kinds of tartrate crystals; I, the two

distinct and separate nervous systems in the life-cycle of a fish.

Why should all this be? What connection was there between the two facts, which,

apparently, were as wide apart as the poles? The evident fact has already been referred to, that in

1904 the two independent lines of work were converging, but it was more than this. It was a

union. The thing which impelled Pasteur’s work incited mine also. The antithesis he discovered

was in

*Pasteur, Louis: “De la DissymmОtrie MolОculaire des Produits Organiques Naturels.”

Lecom professОe devant la SociОtО Chimique, 1860.

† This chain-like character of Pasteur’s researches has been commented upon by others—

thus by Miall (“History of Biology,” 1911)—but I doubt whether any of the commentators have

grasped the true significance of Pasteur’s meaning.

147

reality that also found by me. The asymmetry of the naturally occurring organic compounds, like

that of the tartrate crystals, was the same asymmetry as that of the two nervous systems, and the

facts of both observers were based in the fundamental verity of the asymmetrical carbon atom,

first stated by van’g Hoff and Le Bel.* Therefore, the researches and discoveries of Pasteur and

the writer, as fundamentally classified, are chapters, long or short, in the science of stereochemistry.

Behind the work, which culminated in and formed the real scientific basis for my

publication on “The Interlude of Cancer,” there are the researches in stereo-chemistry of Pasteur,

van’t Hoff, Le Bel, and Wislicenus, and the eternal truth of the asymmetrical carbon atom.

It is not fitting on this occasion to write a treatise on the science of stereo-chemistry or

chemistry in space. It has long been recognized by chemists—though this fundamental scientific

truth would appear to have had as little influence on physiology as upon medicine—that because

the carbon atom is asymmetrical, like the pentavalent nitrogen one, † isomeric compounds may

be built up in more than one direction. To take a comparatively simple instance of these isomeric

compounds, the tartrate crystals of Pasteur’s researches, the one is the looking-glass image in

crystalline form of the other. The one in solution turns the plane of polarized light to the right, is

dextro-rotatory; the other to the left, is lЊvo-rotatory. The ferment of the yeast organism acts

upon the lЊvo-tartrate; that of the mould, Penicillium, upon the dextro-tartrate. On the other

hand, the yeast

*Richardson, G. M.: “The Foundations of Stereo-Chemistry” Memoirs by Pasteur, van’t

Hoff, Le Bel, and Wislicenus. Translated and edited. New York, 1901.

† Wedekind, Edgar: “Zur Stereochemie des füunfwertigen Stickstoffes,” Leipzig, 1890.

148

organism is without action on the dextro-tartrate; the Penicillium leaves the lЊvo-tartrate

untouched. This, as Pasteur demonstrated, is one method of separating the two in a mixture.

Now, it is a remarkable fact that when any of these isomeric compounds are manufactured in the

laboratory, equal amount of the dextro- and of the lЊvo- compounds make their appearance in the

mixture. Pasteur first noted the fact that all the artificial products of the laboratories and all the

sorts of minerals encountered in nature are without action on polarized light, unlike all the

naturally occurring organic compounds. This has only altered since 1860, according to Duclaux,

in that, while chemists can manufacture certain of these compounds in mixtures of equal amounts

of the isomers, they can also be separated by the action of ferments, which are specific in this

direction. For other alterations see the works of Pope and van’t Hoff.* In the two lectures

Pasteur demonstrated that the naturally occurring organic compounds rotate the plane of polarized

light to the right or to the left, and in this way are dextro- or lЊvo- rotatory. As Duclaux writes,

“Nature alone knows how to manufacture the one isomer without producing the other.” “A living

cell is a laboratory of dissymmetrical forces, or a dissymmetrical protoplasm, acting under the

influence of the sun.”

In his “Chemical Statics and Dynamics,” Dr. J. W. Mellor † writes as follows: “It is

interesting to observe that only the dextro-sugars occur in Nature(?), and that these are the only

sugars which can be assimilated as foodstuffs by the yeast-plant. No organism capable of

*van’t Hoff, J. H.: “Stereo-Chemie nach van’t Hoff’s Dix AnnОes dans l’Histoire d’une

Theorie, neu bearbeitet von W. Meyerhoffer,” 1892.

† Mellor, J. W. : “Chemical Statics and Dynamics,” London, 1904.

149

digesting artificially synthesized lЊvo-sugars is known.” He then quotes from Professor W. J.

Pope.* “It would seem to follow, as a legitimate conclusion, that while d-glucose is a valuable

foodstuff, we should be incapable of digesting its enantiomorphously related isomeride l-glucose.

Humanity is, therefore, composed of dextro-men and dextro-women. And just as we ourselves

would probably starve if provided with food enantiomorphously related to that to which we are

accustomed, so, if our enantiomorphously related isomerides, the lЊvo-men, were to come among

us now, at a time when we have not yet succeeded in preparing synthetically the more important

foodstuffs, we should be unable to provide them with the food necessary to keep them alive.”

The term “enantiomorphism,” to describe the properties of the isomeric compounds, was coined

by Pasteur.

In Richardson’s translation of “Pasteur’s two lectures one may read (p. 27): “Perhaps this

will disclose a new world to us. Who can foresee the organization that living matter would

assume, if cellulose were lЊvo-rotatory instead of being dextro-rotatory, or if the lЊvo-rotatory

albumins of the blood were to be replaced by dextro-rotatory bodies?” With the exception of this

passage, the citation from Professor Pope is the sole chemical one I have encountered, in which

the possible existence of an antithetic generation is indicated. One may put his words differently,

that in order to exist the “lЊvo-men” would need to be able, by means of ferments, to pull down

all our food substances and to rebuild in the opposite, or enantiomorphously related, or antithetic

direction. As will appear presently, unfortunately, the hypothetical “lЊvo-men” do exist

*Pope, William J.: “Recent Advances in Stereo-Chemistry,” Nature, 1903, vol. lxviii.,

pp. 280-283.

150

among us, and they do pull down and build up again in the opposite direction, for the “lЊvomen”

are the cancers.

In the light of the antithetic alternation of generations and of the natural antithesis of the

compounds arising in the two generations, the following passage from Professor Pope’s address

(p. 283) is of interest. It is also instructive, because of the generally accepted but false views of

the question: “Again, suppose that at its origin life were carried on non-enantiomorphously, and

that it involved the consumption and the production only of non-enantiomorphous substances and

of compensated mixtures, it may well be foreseen that a stage in development might arise when

each individual, in view of the increasing complexity of his vital processes, would have to decide

to use only the one enantiomorphous component of his compensated food, and so evade an

otherwise necessary duplication of his digestive apparatus. Acting intelligently or fortuitously,

one half of the individuals would become dextro-beings, while the other halve would become

lЊvo-individuals; the succeeding generations would thus be of two enantiomorphously related

configuarations.” He then goes on to express his own opinion that in course of time one

configuration, the weaker one, would disappear permanently. But in this opinion the facts of

botanical and embryological science are not taken into account. It is, however, only necessary to

make the “succeeding generations,” spoken of, alternate in order to meet the scientific

requirements of Nature, and so to make the passage absolutely true as a statement of scientific

fact. This is done by inserting in the closing passage the word “alternating,” when it would read:

“the succeeding generations alternating would thus be of two enantiomorphously related

configurations.”

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Pasteur did, indeed, foresee that in his finds there was given the basis of a science of

comparative physiology. It is sad to reflect that in 1860 he wrote as follows, and that in all the

intervening years his weighty words have been ignored by physiologists and physicians alike: “I

have, in fact, set up a theory of molecular asymmetry, one of the most important and wholly

surprising chapters of science, which opens up a new, distant, but definite horizon, for

physiology.” Before the present writing was penned, this horizon for physiology seemed as

distant as in 1860, for as a general rule the facts concerning the asymmetrical carbon atom and the

naturally occurring organic compounds find no mention in current textbooks of modern

physiology.

“Who can foresee the organization that living matter would assume, if cellulose were

lЊvo-rotatory, instead of being dextro-rotatory?” Pasteur was a” a mere chemist,” and “not evena

a medical man.” He was not a biologist, though most of his researches were biological, and he

was not an embryologist. Had he been well versed in the biology of his own day, the suggestion

of a hypothetical lЊvo-cellulose might have opened up an immense field to his further researches.

At the time he wrote, Hofmeister’s researches* on the life-histories of various plants, with the

main facts concerning the alternation of generations therein observed, were already the

possession of science. † If there be a dextro-

*Hofmeister, Wilhelm: “Vergleichende Untersuchungen,” 1850.

† In his “History of Botany” the late Professor Julius von Sachs writes in terms of

eloquence and amiration of Hofmeister’s researches: “The result of these ‘Comparative

Investigations, 1851,’ was of such grandeur as in the realm of descriptive botany has not since

happened a second time.” He speaks of “the brilliance of the grand sum total, ‘alternation of

generations’ had proved itself to be the highest law of development in plants,

152

cellulose, or a lЊvo-albumin, or a dextro-sugar, or a dextro-glycogen, stereo-chemistry asserts the

possibility, or the necessity, of the occurrence of a lЊvo-cellulose, a dextro-albumin, a lЊvosugar,

a lЊvo-glycogen. This the reader will find laid down on p. 14 of Meyerhoffer’s German

translation of van’t Hoff’s work. Duclaux* rightly observes that to obtain the change from the on

direction of asymmetry to the other, it is necessary to back to the “germ.” Like the cellulose of a

flowering plant, a rose or an oak-tree, that of the fern-plant is dextro-cellulose. But in the lifecycle

of the fern, as in that of the flowering plant, there are two generations, the asexual one, or

fern-plant, and the sexual one, the small and insignificant prothallus. As the cellulose of the fern

is dextro-cellulose, so that of the latter must be lЊvo-cellulose, and so with the other naturally

occurring organic compounds. None such found naturally in an asexual generation of a plant, or

in a sexual generation of an animal, will be met with in the corresponding sexual generation of a

plant or asexual generation of an animal; but, it occurring at all, it will be represented by a

compound with the opposite rotation. The reason is because (like the pentavalent nitrogen one)

there is an asymmetrical carbon atom.

footnotes continued from page 152

governing the whole long series.” He dilates on “the grand picture which Hofmeister had drawn

up of the genetic connections of the members of the Plant Kingdom.” What the zoologists wee to

experience fifty years later—viz., an antithetic alternation of generations in animals as the law of

their developmental cycles, was unravelled for plants by Wilhelm Hofmeister, nine years before

Pasteur gave the two lectures “On the Asymmetry of the Naturally Occurring organic

Compounds,” and before he uttered the prophetic words, “Who can foresee the organization that

living matter would assume, if cellulose were lЊvo-rotatory instead of being dextro-rotatory?”

*Duclaux, E.: “Pasteur, Histoire d’un Espirit,” Paris, 1896, pp. I-vii and 1-393.

153

The cycle of life, animal or vegetable, is asymmetrical, because the antithetic alternation

of generations underlying it is founded on the asymmetry of these atoms. The generations, sexual

or asexual, alternate according as the compounds are built up in the one direction or the other, for

at its basis development is the building-up of naturally occurring compounds. In both animals

and plants enzymes or ferments are the chief actors in this. The new organism, whether animal or

plant, destroys that upon which it arose, and builds up in the opposite direction. The birth of the

new fern-plant implies the destruction of the prothallus. The embryo or sexual generation of a

mammal, or a man, destroys the asexual generation, the trophoblast, or chorion, upon which it

arose, and builds up its compounds in the opposite direction to that employed by the latter. So

also the cancer. This irresponsible trophoblast or asexual generation destroys the naturally

occurring organic compounds and the sexual organism upon which it arose, and builds up in the

opposite direction.

The action of a ferment is always a specific one. It fits the substance upon which it acts,

“as a key fits a lock” (Emil Fischer). Other substances it leaves untouched, even isomeric

compounds having an opposite rotation. As Dr. Margaret A. Cleaves* wrote in the Medical

Record of June 1, 2907: “It is probably that enzymes are of stereo-chemical configuration in their

construction; that is, that they are built upon a central element having a definite valence, and

hence, that all enzymes are capable of entering into chemical action

*Cleaves, M. A.: “The Physiological Action of the Pancreatic Enzymes, with Special

Reference to Hematology, Urinology, and Clinical Pathology,” Medical Record, June, 1, 1907,

New York.

154

with only those substances that attract and have an opposite isomeric form.” Confining one’s

attention to cancer, the cancer-ferment malignin acts upon and pulls down the lЊvo-albumins of

the living human body. As I have stated with von Leyden,* Blumenthal, † and Bergell, ‡ and

more recently this was confirmed by Neuberg and Ascher, the action of trypsin on the living

albumin of cancer is specific. Quoting further from Dr. Cleaves, “The only possible explanation

of the effect of trypsin on pathological conditions capable of giving a tryptic reaction must be that

certain proteid molecules—e.g.., in cancerous conditions—are capable of being attacked by

trypsin, because of their special configuration.” In other words, the conclusion (foreseen by Dr.

Cleaves also) may be drawn, that the albumin or albumins of cancer are dextro-rotatory. All this

has been denied, without evidences beyond bald assertion, by various “authorities,” official

researchers and medical journalists. As the lЊvo-albumins of the healthy living human body are

not acted upon by trypsin, whereas the albumins of a living cancer are, it follows, as day succeeds

night, that the latter must be dextro-albumins. No amount of contradiction in official reports, or

in medical newspapers, can ever alter the truth of this fact, for “all enzymes are capable of

entering into chemical action with only those substances which attract and have the opposite

isomeric form.”

Much has been written about glycogen in tumours.

*Leycen, E. von, and Bergell, P.: “Ueber die Therapeutische Anwendung von Pancreatin

in Carcinoma,” Zeitschr. F. klin. Med.., 1907, vol. lxi., pp. 360-365.

† Blumenthal, V.: “Die Chemische Abartung der Zellen beim Kreb,” Zeitschr. F.

Krebsforschung, 1907, vol. v., pp. 182-189; “Die Chemische VorgКnge bei der Krebskrankheit,”

Ergbn. D. Exper. Path. U. Therap., 1907, vol. i., pp. 65-104.

‡ Bergell, P.: “Zur Chemie der Krebsgeschwülste,” Zeitschr. F. Krebsforschung, 1907,

vol. v., pp. 204-208.

155

Brault thought that the malignancy of a tumour varied directly as its richness in glycogen.

Another medical man, impressed with this view, sought some substance which would “break up”

this glycogen of a tumour, and hit upon trypsin. But the curious thing is that not only, of course,

has trypsin no action upon the glycogen of a cancer, but the like is true of amylopsin. The latter

at once converts the dextro-glycogen of the liver, but as Dr. Cleaves has shown in her paper

already cited, amylopsin has no action upon the glycogen occurring naturally in a cancer. The

reason is because the latter glycogen is a lЊvo-one. The interpretation to be placed upon the

leucocytic phenomena of the Cleaves “trypto-glycogenic reaction” (the enormous increase of the

eosinophile leucocytes under the enzyme treatment of cancer and their attraction by the glycogen

of the tumour) is that amylopsin leaves the glycogen of a cancer untouched, but that it stimulates

the leucocytes to seize it and to invert it. Just as isomeric compounds in the form of starches

occur in both generations of plants, so also isomeric compounds of glycogen or animal starch are

found in sexual and asexual generations of animals, including cancer. But, if the dextrocompound

occur naturally in the one generation, the lЊvo-sugar in “the allantois.” According to

him, (p. 398) it disappears towards the fifth or sixth month of

*Bernard, Claude: “Lecon de Physiologie ExpОrimental,’ Paris, 1855, vol. i.

156

intra-uterine life of the calf, a fact which goes to show the lЊvo-sugar to be formed in the

trophoblast, and not in the allantois. Doubtless, its disappearance coincides with the development

of large numbers of leucocytes in the foetus. To my knowledge this lЊvo-sugar has more recently

been rediscovered “ in the placenta,” but I am not aware that the fact has been republished. Of

course, the “allantois” and the “placenta” are synonymous, but the real source of the lЊvulose in

both instances was asexual generation or trophoblast.

The asymmetrical carbon atom, like its colleague, the pentavalent nitrogen one, has

hitherto found as little place or mention in medicine or in physiology as has an antithetic

alternation of generations. Man has thus found it possible to dispense with things and phenomena

indispensable to Nature, and but for which he would have no existence! Whatever matter may be,

whatever the nature of what we term “living matter,” at the basis of life lie the fundamental facts

of the asymmetrical carbon atom and the isomeric compounds. At the base of all animal or plant

life, too, because of these facts, there rests the antithetic alternation of generations. With the start

of the asexual or the sexual phase of the cycle, the naturally occurring compounds are built up in

the one direction or in the other. With the beginning of the next phase of the cycle, the alternate

one, sexual or asexual, the swing of the pendulum about the asymmetrical carbon atom is on the

other side, and the naturally occurring organic compounds are built up in the opposite direction.

In animal life, that of the higher animals, the compounds are built up after the fertilization of the

egg, and in the life-period of the asexual generation in the direction of lЊvo-sugar, lЊvoglycogen,

and dextro albumins. This evolution of compounds is the antithesis

157

of that which obtains with the unfolding of the sexual generation, “the embryo” or individual.

Here the naturally occurring organic compounds are evolved in the direction of dextro-sugars,

dextro-glycogen, and lЊvo-albumins. It is of great interest to compare together animals and

plants in this connection. As I wrote some years ago; “the plan carried out in animals has been

such as to favour the ever greater and greater amplification of the sexual generation. In plants, as

elsewhere already insisted, the reverse is the case. Here the asexual generation has undergone

increased amplification without ever being able to attain to any very high degree of histological

differentiation. The sexual generation of plants is at the best a miserable failure from the

morphological point of view, and this must be set down to the factors indicated, and still more to

others yet to be described. The higher one ascends, the smaller it becomes, until, in the highest

flowering plants, it has almost reached the vanishing point, without, however, being able to

disappear entirely. In animals it is the phorozoon or asexual generation which makes the bravest

show in the lower metazoa; but even here it is usually overshadowed in degree of morphological

differentiation by the embryo or sexual generation. In the higher forms it becomes reduced; but,

like the rudimentary sexual generation of the higher plants, it cannot vanish, for it also has its

assigned task in the reproductive round.” The scientific investigator does not, of course, deal in a

priori agruments. Were he to do so, he would expect to find the condition exactly the same in

plants as in animals. For is it not “generally held,” and for this reason scientifically correct, that

animals and plants have a common ancestry? Do not zoologists and botanists agree that at the

bottom of the scale animals

158

and plants merge together, and that some of the lower organisms may be described equally well

as animals or as plants? The scientific truth of the matter is that there is no merging together of

the two kingdoms. Such a blending is impossible, because of the asymmetrical carbon atom.

None the less, the asymmetrical carbon atom vouches the unity of organic nature.

It is clear that, if in any group of organisms, animals, plants, bacteria, fungi, etc., there be

two phases of the life-cycle, asexual and sexual, there are for any given case two directions in

which the naturally occurring organic compounds can be built up. But it should not be forgotten

that the number of possible isomeric compounds increases with their complexity. The sexual

generation of animals is characterized by dextro-sugars, dextro-glycogen, and lЊvo-albumins. In

the corresponding sexual generation of plants, such as the fern prothallus, these are absent, being

replaced by enantiomorphous compounds with the opposite rotations. It is the asexual generation

of plants, the flowering plant, and not the sexual generation, which possess dextro-sugar, destrostarch,

and lЊvo-albumins. The harmony of this is twofold. It realizes the apparent possibilities,

and from the point of view of animal life it is of overwhelming important that it should be so.

Ultimately, of course, all animals are dependent on plants for their foodstuffs. Were the sexual

generations of plants the producers of the foodstuffs of animals, the latter, owing to the

insignificance of the former, would find existence a very serious problem. The sexual

generations of plants form substances resembling those fabricated by the asexual generations of

animals, trophoblast, or cancer. Even if obtainable in sufficiently large quantities, the substances

found naturally in a cancer would not be suitable as the

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foodstuffs of an animal—a man, for example. But, as the asexual mode of reproduction, whether

of a plant or of a cancer, is the more prolific one, there has been, hitherto at all events, no failure

of the part of the asexual generation of plants to furnish ultimately the foodstuffs of animals. The

conditions met with in animals are reversed in plants. Here a lЊvo-cellulose, a lЊvo-sugar, a

lЊvo-starch, and one or more dextro-albumins must be sought for, not in the asexual generation

as in animals, but in the sexual one, as represented by, for example, the fern prothallus. “Science

is prevision,” said Pasteur. Because of the truth of this one is able to set up the following table of

comparisons:

Animal.

Sexual generation or individual. Asexual generation, trophoblast or cancer

LЊvo-albumins, not acted upon when Dextro-albumins, not acted upon when

living by trypsin and amylopsin, but living by their own intracellular ferment,

attacked in life and pulled down by the malignin, but attacked in life by trypsin

cancer-ferment, malignin. and amylopsin.

Dextro-sugars. LЊvo- sugar.

Dextro-glycogen. LЊvo-glycogen.

Pigment melanin. Pigment not melanin (in

melanosarcoma),

Blumenthal.

Plant.

Asexual generation (flowering plant Sexual generation (fern prothallus).

or fern). Dextro-albumin.

LЊvo-albumins. LЊvo-starch.

Dextro-starch. LЊvo-sugars.

Dextro-sugars.

It would be interesting, were sufficient information available, to inquire into the

conditions met with in bacteria and fungi. These are fundamentally neither animals nor plants.

So far as the facts are known regarding their compounds and their ferments, some of them

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seem to resemble the asexual generation of animals, rather than that of plants. In given

circumstances many of them can attack the living compounds of the sexual generations of

animals, or of the asexual generations of plants, pulling them down and building up in an opposite

direction. As the plants and the animals are not genetically connected, so also, in all probability,

the bacteria and the fungi have no genetic relationships with each other, or with the animals or the

plants. Like the two latter, they are separate evolutions.

In 1889, in his study of the placentation of the hedgehog, Erinaceus europoeus, Professor

A. A. W. Hubrecht* set up the term “trophoblast” (p. 298), at the same time assigning to it, as the

name implies, a nutritive significance. The nutritive import of the trophoblast of normal

mammalian gestation has since that time been confirmed by many other embryologists, notably

by Professor E. van Beneden and M. Duval, and it has been “generally accepted.” In the light of

our present knowledge, a significance different from that seen in it by Professor Hubrecht must be

recognized in “trophoblast.” Trophoblast has, and can have, no nutritive import for the

developing embryo. This is quite obvious, once it is noted that the natural compounds formed in

it are built up in the wrong direction to be useful as food for the developing sexual organism. The

term, therefore, cannot be employed in future in a physiological sense. As Duclaux said: “Nature

alone knows how to manufacture the one isomer without producing the other.” The chemist in

the laboratory manufactures equal amounts of both isomers. May one deny Nature the power to

do the like

*Hubrecht, A. A. W.: “The Placentation of Erinaceus europoeus,” Quart. Journ. Micros.

Sci., 1889, vol. xxx., pp. 283-404, 13 plates.

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on occasion? Certainly not. It must be concluded, that in the fertilized egg she can build up in

both directions. By the first few cleavages of the egg—usually the first three to five—she can

separate off portions as cells, endowed solely with the powers of producing the isomeric

compounds of trophoblast, while retaining for the cell in the line of heredity the property of

forming both. With the start of the evolution of an embryonic body, again by cell-division, she

can separate off one or more original embryonic cells with powers the opposites of those

possessed by trophoblast, all this taking place before any extra-cellular enzymes, such as trypsin

and amylopsin, are formed. Full agreement, therefore (in a sense), may be expressed with the

conclusion of Duclaux, that “to introduce in a cell principles immediately different, and the

inverse of those which existed there, it is necessary to act upon it at the moment when it is most

plastic, to take the cell of the germ and try to modify it” (p. 66). But, as Duclaux also observes,

this cell has an heredity, and this determines not only its being, but what it shall become.

As may be gathered from the foregoing, the enzyme treatment of cancer professes to be,

as is, a scientific one. Mankind in general, and surgeons in particular, have long looked for a cure

for cancer. Presumably, this was to replace the knife. Now, at last, science and scientific

research have offered not a cure, but the scientific treatment of and the cure of cancer. At once

the surgical demand was altered into the request for a cure after the fact of operation on the living

cancer. Scientifically, this demand cannot be met. Cancer is a natural phenomenon, not a

disease. To “operate” upon living asexual generation is unnatural. As a scientific remedy, the

enzyme treatment of cancer makes no claim to be the cure for cancer after it has been interfered

with opera-

162

tively once or oftener. As a natural treatment, it is not intended for post-operative “inoperable”

recurrent cases. Did surgeons know that cancer was in its nature asexual generation, they would

never touch a living cancer with the knife. For it is the property of asexual generation, animal or

vegetable, that it can be subdivided indefinitely. In evidence of this fact one need only refer to all

the inoculations of cancer which, starting from one original mouse-tumour, have been made into

other mice. But on may also cite the very numerous observations made in recent years in what

has been termed “experimental embryology,” but which would be designated more correctly

“experimental pathology.” Very numerous observations in this unnatural subject will be found in

the many volumes of the Archiv für Entwicklungsmechanik, in the Journal of Experimental

Zoology, and elsewhere. Many of the observations were made upon fertilized eggs in cleavage,

and the experiments were almost as successful in subdividing the asexual generation represented

by an egg in cleavage as are the gardener’s proceedings in making and rooting cuttings from a

chrysanthemum plant. The student of all these published experiments will notice, that the

organisms experimented upon never reverted to the normal. These experiments proclaim the

truth of the statement, that by operation a living cancer may be, and usually is, subdivided

indefinitely. Moreover, let the words of the late Professor of Medicine in the University of

Berlin, E. von Leyden, be recalled: A cancer reacts by increased growth to any injury,

mechanical, chemical, or thermal.” As a rule, not free from exceptions, in my experience, while

absolutely unoperated cases, if not too advanced, invariably do well under the treatment, cases

where there was previously operative interference cannot be guaranteed, and by me are not

endorsed as likely to

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be successful. Nature does not “operate” upon living asexual generation, and perhaps for this

reason she has not evolved an infallible mode of treating scientifically the failures of surgical

operation. Dr. Rice’s case* of laryngeal cancer may be cited as an instance of the successful

treatment of an unoperated tumour, as also the Naples case of inoperable cancer of the tongue. †

Within the past few days (1907) another case of the like kind has been reported privately as

cured. Here, in October, 1906, on operation a leading London surgeon found an inoperable

cancer of the cЊcum. ‡ He made no attempt to remove it. In December the enzyme treatment

was commenced, and continued until April, when on examination this surgeon pronounced it

“almost a cure.” Now, in August, the cancer has quite disappeared. This unreported case is

paralleled by one in the British Medical Journal of August 31, 1907, p. 541. The like history is

true of many other cases. But with post-operative recurrent cases, while there may be success, as

in Dr. Wiggin’s case, § since certified as cured, the cancer is more likely to “run its parabola”

than to yield to a scientific treatment.

When official researchers are heard proclaiming to mankind that the enzymes, trypsin

and amylopsin, have no action upon living cancer-cells, this is not merely a denial of the truth and

validity of all my embryological work of the past nineteen years. (That is nothing new.

*Rice, Clarence C.: “Treatment of Cancer of the Larynx by Subcutaneous Injection of

pancreatic Extract (Trypsin),” Medical Record, November 24, 1906, pp. 812-816, New York.

† Beard, J.: “The Scientific Criterion of a Malignant Tumour,” Medical Record, January

5, 1907, New York. See also Appendix D.

‡ See Appendix G, No. 3.

§ Wiggin, F. H.: “Case of Multiple Fibro-Sarcoma of the Tongue,” Journ. Amer. Med.

Assoc., December 15, 1906. Pp. 2003-2008.

164

Were it to-day a new scientific discovery that “two and two make four,” its truth would be

challenged!) But by such negations the fundamental truths of the science of stereo-chemistry are

also impugned, as well as the asymmetrical carbon atom. In short, when the efficacy of the

enzyme treatment of cancer is question or denied, the constitution of the visible universe is

condemned.

“Sooner or later a conviction may dawn upon investigators that the laws governing

animal development lie deep, and that to discover them we must also take wider and more

comprehensive views of our problems. Moreover, it should not be forgotten that little things, like

a few stray ganglion cells, may hide an all-important story, and that here, as elsewhere, in the

apparent exception itself the key to the mystery often lies concealed.”

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PART 11

THE PANCREATIC OR ENZYME TREATMENT

OF CANCER

RETROSPECT

About three years ago a medical correspondent in New York suggested to the writer that in a year

or two he would perhaps review the history of the enzyme or pancreatic treatment of cancer

during the years from 1906, pointing out the mistakes he and others had made, and withdrawing

those things in his scientific conclusion which had not stood the test of time and experiment. The

reply then made was: “When that time comes, I shall have nothing to retract.” This is true to-day,

and nothing in the first “Scientific Report”* issued by the New York Skin and Cancer Hospital

alters its truth in the least. When, in 1903, the writer laid aside other scientific work on the germcells,

heredity and variation, he was well aware that the impending campaign would be a deadly

one, and that if victory did—as scientifically it must—result, the field of conflict would be as

thickly strew with the victims of cancer as any of the bloodiest battle-grounds of human history.

Six years ago, when,

*Bainbridge, William Seaman, A.M., Sc.D., M.D.: “The Enzyme Treatment for Cancer”

(Scientific Report on Investigations with Reference to the Treatment of Cancer, No. 1, 1909, New

York, pp. 1-34.

166

on January 20, 1905, in a public lecture in Liverpool, “the secretion of that important digestive

gland, the pancreas,” was clearly indicated as the scientific means of routing cancer, nothing at all

was known as to doses and strengths of pancreatic injections, or even as to the proper modes of

making up potent and keeping solutions of trypsin and amylopsin. Failures galore must have

resulted, even if medical men had given the treatment to their best, instead of to their very worst,

cases—as a rule, to advanced inoperable, or to post-operative recurrent inoperable, cases. There

have, indeed, been many failures, even without the list published by Dr. Bainbridge, but—there

have also been some successes. In the face of any successes, of Dr. Bainbridge’s own words (p.

32), “That injecto trypsini, in some cases, seems to cause more rapid disintegration of” (to

‘liquefy’ according to Beard) “cancerous tissue,” and “that injectio amylopsini seems to diminish

cachexia in some cases, in accordance with the claims of Beard and other,” of what value are the

failure—what do they prove in science? There are few—indeed, there are no—scientific

discoveries of import to man which escape the like fate, if others attempt to confirm them, or if,

and more usually (such is human nature), others seek to refute them. To take an instance

suggested by a medical friend with reference to this report, how many of those, who in one way

or another, with weak or with inert injections, or with minimal doses, or single injections, or with

none at all, have sought to test my conclusions, could confirm the scientific researches of Starling

on secretin? Not one! From some knowledge of the history of science, and of the receptions

accorded by mankind to many scientific discoveries of import to the human race, and from a

close knowledge and experience of the medical profession

167

–for have not several thousand medical men now in practice passed through my hands as pupils?-

-what else could be expected, than that witha very little knowledge, or with none at all, adverse

verdicts should be pronounced upon the thing without any delay to examine the scientific

evidences?

So little scientific care is, as a rule, bestowed upon the publication of the results of the

enzyme treatment that, notwithstanding the publication of semi-polar accounts of my work in the

Lancet and the Medical Record, I never yet read an accurate description* of the scientific basis of

the matter from a medical pen in the pages of any medical newspaper. Most of the medical

writers appeared not even to know what trophoblast was. It would be an easy, not to add an

instructive, task to show that my work on the germinal origin and trophoblastic nature of cancer,

with all its consequences (trypsin and amylopsin), differed in no way in the reception it

encountered at the hands of the medical profession from previous discoveries recorded in the

history of medicine. Have the names and labours of Pasteur, Lister, Morton, and Corvisart—to

name but a few—been forgotten?

Scientific objections, which might have been raised, but which were never produced until

it was too late, have been noted by others. Here I will add anew one. According to my finds, in

any normal human gestation, Nature only allows the equivalent of cancer—trophoblast—to grow

for a little less than seven weeks before she introduces the suppressing and destroying ferment or

ferments. This is a point which should be borne in mine,

*There is one surgical exception to this. In the Appendix of his book, “The Control of a

Scourge” (pp. 293 et seq.), Mr. C. P. Childe, B.A., F.R.C.S., gives a correct scientific account of

the “pre-embryonic or trophoblastic theory” of cancer.

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but which hitherto has usually been ignored, in attempting to remove by ferments an

“inoperable,” usually recurrent cancer of two years’ or more standing, or in a laboratory vainly

trying, aided by weak, or even inert, ferments, to cure a moust of a tumour “about as big as

itself.” The processes employed by Nature in destroying asexual generation (trophoblast) are

probably, like so many of her methods, self-regulating, and in view of this one might not be so

sanguine of imitating her successfully, had not undoubted success been obtained.

More than once official cancer researchers have publicly described the pancreatic

ferments, usually through other spokesmen, as devoid of action upon living cancer-cells, but in

not one of the three “Scientific Reports” of the Imperial Cancer Research Fund are any evidences

at all for this untrue assertion to be found. The photographs contained in this book, as well as the

evidences concerning the liquefaction of cancer, amply refute this false and erroneous conclusion.

Of course, the probability—nay, certainty—is that inert ferment-jpreparations had been employed

in the unpublished experiments relied upon. Such official researchers may be asked to note that I

have never urged the use of inert ferments in cancer, and have never supposed that such would

have any action upon cancer-cells—or upon any proteid or other substance whatever, for that

matter.

Four years ago a medical correspondent, Captain in the Indian Medical Service, wrote

from Bushire, making the pertinent remark: “It is a pity that your opponents do not try to meet

your ‘facts,’ instead of taking their stand upon their ‘opinions,’” The reply to this was not

difficult to find. As Dr. Bainbridge sagely remarks on p. 4 of his “Scientific Report”: “The

irresponsible trophoblast does not concern us here.” The reasons

169

and evidences for my conclusions as to the nature of cancer and its treatment on natural or

scientific lines were beyond them. “Was der Bauer nit kennt, das frisst er nit.” What the leaderwriter

or ex-cancer researcher never learnt, that he is not likely to try and refute. Even “mecial

science” would tilt in vain against the organization of the visible universe, though it has often

made the essay, as witness Pasteur’s experiences.

In his essay “on Liberty,” which as a weighty, scientific document may be recommended

to the attion of those who write on and of “medical science,” John Stuart Mill says: “The dictum

that truth always triumphs over persecution is one of those pleasant falsehoods which men repeat

after one another till they pass into commonplaces, but which all experience refutes.”

The passage cited was laid down by Mill in 1878, and possibly human nature has

changed since then. The reader will note that all experience refutes the dictum. Medicine, which

includes, or should include, the applications of certain sciences to human needs, has its own

history in this respect. It is much simpler, and requires infinitely less knowledge, a modicum of

crass ignorance often sufficing, to stifle a truth in its birth than to refute it on scientific grounds.

To attempt to do the latter, moreover, entails the observance of certain canons of science, one of

these being that no assertion shall be made without the production of the evidences. This is,

perhaps, the real reason why the evidences for the asexual (trophoblastic) nature of cancer, etc.,

have never been attacked on scientific grounds.

The numerous “negative results” obtained by Dr. Bainbridge and by many other medical

men are not scientific evidences against the truth of my conclusions.

170

They only prove that in certain cases, where as a rule the pancreatic ferments were administered

as an alternative to the Last Sacrament, these ferments, as there exhibited, did not cure cancer, in

the New York Skin and Cancer Hospital; though on the testimony of others they did cure it in

Naples, in York and in other places.

On reading the thirty theses, advanced as conclusions, mostly without the evidences, by

Dr. Bainbridge, I am reminded of another phase of this cancer problem. Some years ago two

graduates of Edinburgh decided to test the asexual (trophoblastic) nature and the germinal origin

of cancer in a crucial fashion, by transplanting living ovaries and living trophoblast into other

individials (rabbits) of the same species. At that time I was wont to discuss these cancer

problems with a scientific man, a human anatomist, since deceased. Occasion was taken to

describe the results of these “crucial experiments.” “They published no details of the

experiments,” I said, “so that it was not possible to inquire into the reasons for the failures; but

they concluded that, because trophoblast and ovary were not transplanted successfully and

brought to grow in a new individual of the species, therefore, cancer was not germinal in origin or

trophoblastic in nature.” The words were hardly uttered when my departed friend, the professor

anatomy, sprang up. “No, no!” he cried, “that will not do. A negative result of that sort never

proves anything in science.”* It remains to add that a few years later living ovaries were

transplanted successfully in the rabbit by Dr. F. H. A. Marshall and W. A. Jolly †, and others, and

*Vide Appendix H.

† Marshall, Francis H. A., and Jolly, William A.: “Results of Removal and

Transplantation of Ovaries,” in Trans. Roy. Soc. Edinburgh, 1907, vol. xv., with two plates; also

“The Nature of the Ovarian Influence upon the Uterus as illustrated

171

to-day the sole impediment in the way of the successful transplantation of living trophoblast is the

Act of Parliament relating to vivisection.

When Mr. Walter Ball and Mr. E. F. Thomas saw fit to publish an account of how they

tried “the trypsin treatment,” to their credit be it said, they did give particulars, as will appear

anon, such that a good insight could be obtained into, and an estimate made of what they had

really done. The like cannot be said of Dr. Bainbridge’s report. It winds up with thirty theses or

conclusions, but the evidences establishing the truth of these are not to be found in the text. This

is as true of the favourable points as of the unfavourable ones. The references to the liquefying

action of trypsin on cancer-cells, and to the beneficial effects of amylopsin, might seem to refute

this, but no evidences of these are adduced anywhere in this “scientific report,” and certainly the

writer would feel inclined to doubt them, had he not witnessed them elsewhere again and again.

The liquefaction of cancer, by adequate injections of trypsin, which was first seen by me

in actual liquid cancer, taken from living patients by a prominent consulting physician in London,

and which I first brought to Dr. Bainbridge’s notice in microscopical preparations of such liquid

cancer, is a matter of supreme importance, worth of much more length reference than the two

lines accorded to it in Bainbridge’s report. The facts were first seen on February 26, 1907, and

afterwards confirmed in the same case and in another. Since it is quite four years ago that the

discovery was made, in the interests

footnotes continued from page 171

by the Effects of Excision and Grafting of Ovaries,” in Coll. Rep. Univ. Edin., Physiol. Dept.,

1907-08, No. ii; and “Results of Ovarian Transplantation,” in Seventeenth Internate. Congress

Physiol., Heidelberg, 1907.

172

of science and of scientific truth I feel it my duty to record them. The first intimation was in

these words under the above date: “A pensioned fireman had a cancer of the tongue and jaw

removed at King’s College Hospital. It recurred as a mass the size of my two fists. The case was

desperate, and I treated him at once with my strongest stuff. Five days ago a soft place appeared,

which I thought was an abscess, but I could get out no pus. The softness* is increasing, and

yesterday I put in a needle and drew out some fluid, which I am sending you in a bottle. You

shall see what you shall see. To my eyes it is already dead broken-down cancer tissue, and that in

less than a fortnight.” The fluid could not be filtered down, and resort was made to a centrifuge.

This furnished a small amount of solid matter, and sufficient to make up about ten microscopical

slides. The examination of these enabled the certain diagnosis of epthelioma or skin cancer to be

made. In this first bottle there were some remains of epithelial cells, as well as the characteristic

“pearls” of epithelioma. In another bottle, obtained two days later, the “pearls” were the sole

*The mention of this softness is very interesting in connection with the happenings of the

York case, described in a subsequent chapter. The photographic figures (6and 7) were taken on

July 15. In the charts one may read: “July 15, photographs taken, slough removed, a ragged hole

left, but no bleeding; granulations hard and firm.” Prior to this time the charts contain the

following: “June 14, the growth is beginning to separate in the cheek, a little depression is visible,

and on palpation only the thickness of the skin intervenes between the finger and the mouth. July

6, face very swollen, red margin or demarcation round tumour. July 9, a small vesicle has formed

on the cheek. July 10, vesicle grows rapidly. July 11, vesicle has burst, and a profuse seropurulent

discharge pours from the cheek; a pultaceous slough is disclosed. July 13, the slough

increases in size.” Probably the phenomena noted in the two cases were identical up to a point.

The profuse “sero-purulent discharge” mentioned by Captain Lambelle, may be identified as

liquid cancer.

173

evidences, and they were not at all numerous. The opinion then formed was, that, in the course of

two or three days more, even these evidences of epithelioma would have vanished. Very shortly

afterwards the same hospital physician had a similar result in an American patient suffering from

cancer of the tongue.

This liquefaction of cancer, which, it may be added, can only be carried out safely in the

presence of large quantities of amylopsin, is, of course, a stereo-chemical reaction. Now, Dr.

Bainbridge admits (p. 32) that it occurs “in some case” and not in others; why there was an

apparent exception to this chemical reaction. The reason, of course, was, that in many of the very

advanced cases experimented upon the strengths and doses of the injections were inadequate to

perform this chemical reaction. But this obvious explanation seems never to have occurred to the

author.

Regarded from the point of view of science, this liquefaction of a living malignant

tumour by means of adequate injections of trypsin and amylopsin is seen to be of momentous

importance. It stamps the treatment, when scientifically given, as one continuous and sustained

stereo-chemical reaction. Obviously, the liquefaction of the tumour and of any metastases is the

aim of the treatment. To the writer it does not seem that great difficulties will usually be

encountered with glandular metastases or again and again he has known these to disappear, even

when the main tumour continued its career of growth and destruction. But in two ways at least

the matter has great practical import. Since the liquefaction is the goal to be aimed at, and since

all toxic

174

effects produced by the action of trypsin upon the tumour-cells can be averted by sufficiently

powerful injections of genuine amylopsin of great strength, made along with those of trypsin, in

all probability in the long run a considerable shortening of the vital and crucial period of the

treatment can be, and will be, obtained. Again, the resulting liquefaction may be looked upon as

being in essence a separation of the tumour into two main portions,–a liquid one, which either

must be got rid of as a “sero-purulent” discharge, or, getting into the blood, must be excreted by

the skin and kidneys; and a more solid portion, the skeleton or framework of the tumour-cells,

which, it near the surface, may be sloughed out; if deeper, then encapsulated. In many cases it

may be desirable once the phenomena of liquefaction have been induced, to remove the dead

tumour by operation, and, so it appears to me, it is at such a time, when every tumour-cell has ben

killed and its albumins liquefied, that surgical intervention is called for, if at all.

The eighth thesis (p. 32) must be specially noted and challenged. It reads: “That because

of the tendency of injectio trypsini to disintegrate the tissues, it may to a direct menace to life—

(a) by eroding large blood-vessels(when the disease is contiguous to these structures, as when

deep in the neck or in the ;elvis), thus causing death by hЊmorrhage; (b) when given in large

doses, over considerable periods of time, by overwhelming the system with toxic products

(tumour toxins), thus, in some cases, hastening death.” Regarding (a), I deny flatly that trypsin

has any such action on normal somatic tissues as that attributed to it by Bainbridge. His

conclusion is not in accord with the tenets of stereo-chemistry. The statement is a new answer to

the old riddle: “Why do the stomach and intestines not digest

175

themselves in life?” The reply here given is tantamount to saying, “Because they do.” The

scientific answer to the conundrum is, that those ferments, such as trypsin and amylopsin, which

build up the somatic albumins in life, do not pull them down in the living state, but that the

antitheses of these ferments, their stereo-isomers, the ferments of cancer, do attack and pull down

such albumins in life. In the cases mentioned by Bainbridge it is the fault of the tumour—that is,

of its ferments, not that of the “trypsin” injection, and in such cases as much danger at least

attaches to any possible treatment, even to surgery. The erosion of a “large vessel” is caused by

the tumour, and not be the “trypsin.” The flimsy inaccuracy of the statement (a) is shown by the

following considerations: Wherever the cancer may be, the injections are never made into it, but

hypodermically, or deep into the muscles, at some distance from it. Owing to Harvey’s discovery

of the circulation of the blood, it is clear that in this treatment the ferments circulate in the blood

to reach the tumour. Therefore, in all cases they course through all the “large vessels,” but in

Bainbridge’s report there is no suggestion that these ferments ever “erode” the “large bloodvessels,

unless these be contiguous to the tumour. In the case of the York ex-pensioner the

tumour was not many millimetres away from the carotid artery, but even the injection of 60,000

units of trypsin (in four months) caused no damage to this vital structure. As to (b), this was a

discovery of mine in 1906, and not of Dr. Bainbridge’s. it is quite true, if nothing but trypsin be

administered, provided that the trypsin injection be strong. Not only did I discover this fact, but

my scientific knowledge also furnished, in amylopsin, the remedy. I well recollect that this latter

find had to be

176

made against time, in order to save the life of a very distinguished man, a brilliant artist and artcritic.

The New York surgeon forgets the great feature of the enzyme treatment of cancer,

amylopsin. Since June, 1906 (Medical Record, June 23, 1906, p. 1020), the writer has never

recommended the use of trypsin without amylopsin, sufficient to counteract the formation of the

toxic products, of which Dr. Bainbridge writes. When he put down this paragraph, he must surely

have forgotten that he ever heard from me of certain uses of amylopsin. Finally, both of his

objections are proved to be absurd from Captain Lambelle’s procedure and results. In the case,

cited anon, in the period from march 8 to July 15 (four months), Captain Lambells injected

somewhere about 60,000 tryptic units, an amount possibly much greater than Dr. Bainbridge ever

injected in a single case. But Captain Lambelle did not experience either (a) or (b), and his

observations are opposed diametrically to both of those conclusions, which can only be described

as “errors of experiment.” Taken alon with thesis 9, “that the injections are often painful,” the

two things together read like an attempt to create a prejudice against the treatment. Scientifically,

it is not easy to decide which of the two paragraphs is the more trivial.

In certain cases, and in these only, there are two dangers inherent in the enzyme

treatment. These are (a) perforation, due to shrinkage of the tumour under the action of the

ferments, as in oesophageal and gastric cancer; and (b) hЊmorrhage, really due to the like cause,

as in uterine and some pelvic cases. The physician should, however, note that these dangers are

present in such cases, whatever treatment be adopted, or even if the cancer be allowed to pursue

its course merrily; and that

12

177

they do not arise always, though threatening to do so, as in the Uppingham case of cancer of the

stomach and liver.

In his report Dr. Bainbridge does not conceal a tendency to belittle the experiences of

other physicians. Some of “the earlier claims of cures” were not so “absurd” as he imagines, and

the “strange symptoms” and “terrific” results from small doses were, in my opinion, correct. The

author overlooks the circumstance that he was not using the same injections as these observers,

that he had profited by the increased experiences of the makers. Looked at scientifically, the

writer would anticipate “terrific” results, even serious ones, from the use of small doses of trypsin

in certain cases of cancer, where the tumour was large and the antitryptic power of the blood

small. His remarks upon this and other matters only reveal to the scientific observer a lack of

scientific imagination and of the capacity to adapt means to ends, which is so important in

scientific experiment. If an injection be deficient in amylopsin, as also if it be not properly freed

from poisonous peptones, even the use of no more than 1 c.c. daily may, as I have known to

happen, be attended by serious consequences. Like the literature in general, the experimental

results of Dr. S. Pinkus* receive no notice in this “scientific report.” This investigator found the

following things after injecting certain unnamed sterile solutions of “pancreatin preparations” in

dogs and guinea-pigs: “Here one or two injections sufficed to raise the temperature from 1° to 18°

permanently; in all cases there was a strong local reaction, invariably leading to further necroses.

Five cavies and the dog No. 4 died in eight to ten days.” It is also added that

Pinkuss, A., and Pinkus, S.: “Die Krebskrankheit und ihre therapeutische Beeinflussung

durch Fermente,” Sonderabdruck aus der Medizinische Klinik, 1907, Nos. 28 and 29; 15 pages.

178

all the disturbances subsided when an injection of genuine amylopsin was substituted.

The thirtieth and final thesis of Bainbridge’s report reads that the enzyme treatment “does

not cure cancer.” At the time this verdict was published, Captain Lambelle had reported his latest

case of success to the War Office of Great Britain, and this report is given verbatim on a

succeeding page. Even though there had been no others, even though Rice, Golley, Wiggin,

Campbell, Goeth, Cutfield, Guarracino, and others, had had no successful cases, even if the

remains of the cancer of the tongue in the Naples case had not been seen by two of the leading

physicians of Naples (vide Appendix D) to shell out, “like the kernel of a nut,” I am prepared to

take my stand, and now do so, upon the result of the published case of the recurrent sarcoma in

York alone, to maintain that it has established the truth of my theses, and to declare that with this

result all the essential portions of the problem, regarded scientifically, are solved once and for all.

Bainbridge’s thirtieth thesis is false. He, who would set up the frivolous objection that the York

case was one of malignant sarcoma, not of cancer, and that sarcoma does “not come within the

definition of cancer,” may be invited to study the eleventh chapter of the present writing, and

before urging this multiplication of causes scientifically to make for himself the crucial tests with

the polarimeter to prove that cancer and sarcoma are not identical. In the cycle of animal life, as

also in the visible universe, there is not room for two fundamentally different malignant tumours,

cancer and sarcoma. The embryological evidences upon which this distinction has been founded,

like those of this science underlying all current pathological classifications of malignant tumours,

are absurd and unscientific.

179

When Captain Lambelle first sent me the three original photographs of his case, he

remarked that the outcome was “just as in the Naples case.” The Naples case was described

briefly by me in the Medical Record for January 5, 1907 (see Appendix D). Here, in a case of

inoperable epithelioma (skin cancer) of the tongue, the remains of the tumour finally shelled out

“like the kernel of a nut.” Referring, finally, to my abortive experiments,* which from

circumstances beyond my control were never completed, in the preliminary report it was written

that “it appeared probably to us that at the time we killed it, its ‘cure’ (i.e., that of the “trypsin”

mouse) from cancer was not far distant, and the microscopical examination confirmed this

opinion. Even without further treatment the tumour would in all probability have been absorbed

shortly, or its remains cast out.” What was here foretold happened in fact in an epithelioma in

Naples and in a sarcoma in York. It is on positive results such as these that the edifice of science

is built up; not upon negative finds, such as those recorded without the scientific evidences by Dr.

Bainbridge.

As to the “thorough scientific test” of which the author writes on p. 3, I demur to this,

just as I question the accuracy of the statement on p. 5, that “at all times during the trial of the

enzyme treatment I (Dr. Bainbridge) have been in close touch with Dr. Beard.” † Since I first met

Dr. Bainbridge, in September, 1906, with the single exception of Case 7, I have been entirely

*Beard, J. : “The Action of Trypsin unpon the Living Cells of Jensen’s Mouse-Tumour,”

in British Medical Journal, January 20, 1906.

† Compare also the Lancet (October 9, 1909, p. 1079): “We would point out, as a proof

of the straightforward character of the inquiry, that throughout touch seems to have been kept

with Dr. Beard.” In the sense understood by the Lancet this is incorrect.

180

ignorant of his doing. No information was at any time vouchsafed to me. Of the 100 cases, one

(No. 49) was not cancer, sixty-six were post-operative failures, and eighteen were “inoperable,”

making eighty-nine out of the 100. Of the remaining eleven, four are described as “lost sight of”

and three as “alive.” Of the class of case which a scientific test demands—viz., an absolutely

unoperated one-the100 cases include seven, as against sixty-six recurrent cases after one or

several operations. Of these seven cases, three were “lost sight of,” three were “alive,” and one

was dead. Five of the cases at least were syphilitic, and my experience hitherto has been that no

good results can be hoped for in cases suffering from such a complication as syphilis. Ten of

them had been treated with the X rays, which, looked at scientifically, must be regarded as one of

the best stimulants of cancer ever discovered. How far the eighteen inoperable cases wee suitable

ones for the treatment it is impossible to say. Here, as in all other respects, Dr. Bainbridge was

his own judge, jury, prosecuting advocate, etc., and all the scientific man need say to sum up

shortly what the report is, apart from all other considerations, there are in it no evidences at all to

show that Dr. Bainbfidge ever considered, much less sought to eliminate, all or any possible

sources of error in his experiments.

On the fifth line of his “scientific report” the author refers to the determination he had

expressed in 1907 to give the enzyme treatment “a thorough, scientific test.” A study of his

report reveals that (1) five strengths of trypsin injections were used, of which the strongest is

stated to have had six times the potency of the weakest; but no attempt is made in the report to

discriminated between these five injections, or the cases in which each

181

was employed, and there are no records of the doses or their number in a given time. (2) One

case (No. 49) was “goitre,” not cancer; of the remaining ninety-nine, sixty-six were postoperative

failures; that is, in a test assumed by the author to have been “a thorough, scientific

test,” two out of every three cases contained the pernicious source of error of previous operation.

(3) Lambelle’s results show—and this I have always maintained—that a treatment of less than

three months cannot be considered adequate; I would even add an additional month, and regard

120 days as a general minimum, not maximum. Therefore (4) the hundred cases treated by

Bainbridge may be summed up as follows:

Per Cent.

(a) Exclude from the result, because no injections were given, Nos. 35,49,52,&92 = 4

(b) Exclude, because no real treatment was given, or because “lost sight of,” or ceased

treatment. Nos. 11,31,37,38,39,40,41,43,44,45,47,48,57,58,63,70,75,86,88,89,94

97, and 99 =23

( c) Exclude No. 7 (Miss K.H.), for obvious reasons = 1

(d) According to the report, there was “improvement,” or prolongation of life, in Nos.

5,6,8,14,16,17,18,19,20,22,26,28,34,42,46,50,60,72,78,80,and 100 =21

(e) Treated for more than ninety days, Nos. 3,12,23,32,51,66,76,79,81,82,84,98 =12

(f) Exclude, because treated for less than ninety days, with an average treatment of

forty-six days, or six weeks four days, Nos. 1,2,4,9,10,13,15,21,24,25,27,29,30,

33,36,53,54,55,56,59,61,62,64,65,67,68,69m71,73,74,77,83,85,87,90,91,93,95&96=39

____

100

But of those under (e) we are bound to exclude from a “scientific test”—

(1) The post-operative failures, Nos. 23, 76,79,82,and 84 = 5

(2) Owing to previous X-ray treatment, Nos. 3, 51 and 66

= 3

___

8

leaving under the heading (e) 4 per cent.

182

The sum of these numbers, 4, 23, 1, 21, 12, and 39 makes up the total of 100. Of the four

cases remaining under (e), No. 12 was a surgical failure after the enzyme treatment, and the

remaining three were evidently very advanced and malignant cases. The lack of anything more

than “improvement” and “prolongation of life” in the twenty-one cases under (d), and the failure

of the four cases under (e) might conceivably be due to injections too weak or doses too small, or

to both, for those particular cases. I am, however, reminded of Blumenthal’s opinion (2), and the

possibility or probability must not be overlooked that they may have been so advanced and

hopeless that no possible treatment could have saved them. The like probably held the nine “test”

cases treated by Messrs. Ball and Thomas.

The impression made upon the mind of another, who more than once has had success*

withthe enzyme treatment, and who understands and fully appreciates its scientific foundations—

I mean Captain F. W. Lambelle, M.D., R.A.M.C., lately operating surgeon of the Military

Hospital, York—may be cited.

*In all four cases, treated as described in the present writing. They were (1) chondrosarcoma

of ribs; (2) encephaloid carcinoma of breast; (3) lympho-sarcoma, induced by X-ray

treatment for carotid aneurysm by another medical man; and (4) round-celled sarcoma of jaw.

The fate of the third is described in the present writing. The other three are, I believe, alive and

well. Concerning (2) see Appendix L.

Regarding the case of lympho-sarcoma, it may be mentioned, as showing the true

inwardness orf th pathological distinction of sarcoma and carcinoma, that in the microscopical

examination of sections of the treated tumour after death the keratinous remains of tumour-cells

were “mistaken” for epithelial cells by an official pathologist, and the diagnosis of “epithelioma”

was given. I do not term this a mistake, for it was clear evidence of as little, “epithelial cells” as

those of epithelioma or of trophoblast.

183

He writes: “In reading Dr. W. Seaman Bainbridge’s report one is struck by two repeated

phrases, which seem to dominate his whole theme—(1) the patient ‘died’ within a few months of

treatment by ferments have been undertaken; (2) the treatment was ‘negative in all respects.’

Though Dr. Bainbridge’s report is lacking in many details, which would have greatly helped in

establishing its value as a scientific report, it is evident from (1) that the great majority of the

cases which came under treatment were in an advanced stage of the disease. What does failure in

such cases mean? Does Dr. Bainbridge as a surgeon condemn the operation for strangulated

hernia simply because in a strangulated hernia case of five days’ duration the patient’s chances of

recovery are one in ten or less? With regard to (2), the treatment was “negative”; it is also stated

that ‘the control cases did as well with injections of glycerin and sterile water, or sterile water

alone plus the rОgime, as did the others with the full enzyme treatment.’ These statements may be

capable of some other interpretation than that which Dr. Bainbridge gives. Dr. Bainbridge has

only shown that in his hands the treatment of cancer by ferments has been a failure, and it has yet

to be shown wherein lay the cause of the want of success, remembering that failure is always

easier of attainment than success in anything, and that on the frontiers of science still more so is

this the case. Nor is that failure surprising to me, when I read how little Dr. Bainbridge has

understood of the enzyme treatment, for in his summary he says, ‘that aiding digestion, increasing

elimination, and decreasing local absorption are the most important features of the treatment’ Dr.

Bainbridge’s report may be ‘negative in all respects,’ for paragraph 7 of his summary is proof that

Dr. Bainbridge has never seen the effects of trypsin upon a malignant growth. He says ‘that,

while it may accelerate the breaking down in the centre of the tumour mass, the periphery is

found to be actively growing.’

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Herein he describes the normal life-history of an unchecked cancerous growth—the growth goes

on its own course merrily, without restraint from the enzyme treatment exhibited.*

“In the four years a fair amount of pathological evidence has been acquired, which is not

in accordance with Dr. Bainbridge’s experience; and, without going minutely into details, let me

cite two cases which seem to me to indicate (1) that trypsin does attack cancerous growths; (2)

that trypsin can destroy cancerous growths:

“Case 1.—Male, 51. Lympho-sarcoma. Superficial cervical glands. Died from

hЊmmorhage from separating sloughing tumour. Naked-eye inspection of the tumour showed no

gland-tissue whatever-it was a dense fibrous stroma pent up with purulent fluid. Microscopically,

all that remained of the malignant cells were keratinous masses, in which the individual cells

were unrecognizable. The treatment had exerted a selective action on the malignant cells, had

destroyed them almost entirely, and their necrotic remains were in process of removal by

leucocytes.

“Case 2.—Male, 25. Round-celled sarcoma of upper jaw. Primary growth removed by

operation…recurrence in all the glands of the left side of the face. Treatment begun March 8,

1909. Tumour removed entire as one large slough on July 15, 1909, patient making an excellent

recovery.

“What happened in both these cases was that under the action of trypsin the tumour

became gangreous.

*If the account be taken of the “heterolytic” cancer-ferment termed by me “malignin,”

and of the antitryptic properties of the blood in most, if not all, cancer cases, it must be clear that

Dr. Bainbridge produces no evidence at all that he has ever had free pancreatic ferments in the

blood of any of his unsuccessful cases. Nay, in view of Captain Lambelle’s apt criticism

concerning the natural course of cancer, described by Dr. Bainbridge in his report, it is quite

palpable that Dr. Bainbridge, in any of these unsuccessful cases, had never exhibited sufficient

trypsin and amylopsin to neutralize the cancer ferment or ferments present.

185

The periphery of the growth in each case was marked out be a red line—an ‘area of demarcation’

as plain as in a gangrenous limb. In Case 1—a failure just short of success—we can see the

process set forth, the influence of the trypsin upon the peripheral portions of the growth being to

stem the invasion of the malignant cells, and to rouse the adjacent somatic tissues to that process

of repair pathology calls inflammation. In Case 2 the gangrene of the tumour became complete,

and the sloughing tumour was lifted from its bed without leaving one bleeding-point, nor so much

as an oozing granulation.”

It will be demonstrated presently that from a knowledge of ferment powers (in the tryptic

and amylotytic units set up by the late Sir William Roberts, M.D. F.R.S., Professor of Medicine

in the Owens College, Manchester), and from the details furnished by the authors themselves, a

fairly accurate estimate may be made for each individual case of the actual amount of trypsin and

of amylopsin exhibited in the cases reported by Messrs. Ball and Thomas. In leaving the report

under notice it may be remarked, with some emphasis upon its scientific value, that a similar

estimate can be made in not a single on the cases described by Dr. Bainbridge. In view of more

recent clinical work of others, it may be stated that the amylopsin injections employed by Dr.

Bainbridge were very much too weak; that his four weaker trypsin injections. All of which I have

more than once tested, were in strength quite inadequate for their work; and that regarding the

fifth and strongest trypsin injection, the “special quadruple X,” which to my knowledge has never

been sent to Great Britain, and possibly never furnished to anyone except Dr. Bainbridge, I can

say nothing, beyond that I doubt whether it possesses more than 750 Roberts

186

tryptic units, whereas it should have 1,000 such at least.

One criticism, if it can be called such, has been made to the effect that the theoretical

basis on which “the trypsin treatment of cancer” is built contains too many unknown factors to be

accepted as sound. There is a learned ring about this empty statement, but it lacks all evidences.

I suppose that, as the factors are unknown, they cannot be named. One might as well say, “The

theoretical basis upon which Newton’s conception of universal gravitation is built contains too

many unknown factors to be accepted as sound.” Certainly, one could not name these! I seem to

read once more the remark made by a pathologist, who was one of the first to whom I told by

letter my conclusions as to the import of the pancreatic enzymes in cancer in 1904. It was that

there were “difficulties.” He never named them, then or later. It was a strange and weird remark

to make to a man who had spent his life overcoming and trying to overcome and trying to

overcome scientific “difficulties.” There is also the fallacy of speaking of “the trypsin treatment,”

which I agree is thoroughly unsound.

As to the researches of Achalme, von Bergmann, Guleke, and Bamberg, cited sometimes

as proving “that injections of trypsin are immediately followed by the production anytitrypsin, so

that an effect opposite to that aimed at is produced,” the marvel is that this statement should be

made seriously. The reason is passed over in silence that this result was due to organic impurities

in the preparations used.

187

CHAPTER VII

GENERAL DIRECTIONS FOR THE PANCREATIC OR ENZYME

TREATMENT OF CANCER IN ITS VARIOUS FORMS

When, in January, 1906, trypsin began to be employed in the treatment of cancer in many places,

Fairchild’s “trypsin in powder,” and Merck’s trypsin, were the best-known preparations of this

enzyme upon the market. Fairchild’s “trypsin in powder” was a very potent substance, prepared

by this firm for “dissolving diphtheritic membrane,” and, so I understand, long used successfully

for this purpose. In recent years it had been superseded by Behring’s “antidiptheritic serum,” a

substance the nature of which is still unknown. Regarded scientifically, the innovation cannot be

described as an advance. The sole mistake made by Messrs. Fairchild Brothers was in advocating

its use as a powder, and not in the form of a hypodermic injection of trypsin (and amylopsin).

There is no doubt in my mind to-day that certain of the injections of trypsin and of amylopsin, in

combination, would with certainty and without any of the dangerous complications (serumanaphylaxis)

attaching to the usage of a “serum” dissolve this membrane, and cure diphtheria.

But, of course, at present the medical profession is wedded to “sera,” which may be described

briefly as unknown substances of uncertain action. So much for the preparations of “trypsin”

188

obtainable some years ago. When injections for use in cancer were first on sale, none of the

makers did, or could, furnish any general direction as to how they should be employed. Many

were the letters received by the writer, especially from French and Italian physicians and

surgeons, asking for some directions as to the procedure to be adopted. These requests led to the

first “general directions” from my pen. These latter were constantly being altered in accordance

with the reports received and the knowledge gained. Even in their final formed, as printed for my

convenience in 1907, they professed to lay down no strict course applicable to all cases. It was

written: “The question of proper dosage is not yet decided finally, and it will probably be found to

vary with different cancer.” Many of his friends and correspondents will, if need be, confirm the

statement that all along the writer’s chief concern has been to impress upon physicians and

chemists the urgent necessity of seeing that every dose of trypsin was accompanied by an

adequate amount of amylopsin. The one injection was termed, unfortunately, injectio trypsini by

the makers, but those with which I was in any way concerned always contained some amylopsin,

a quantity which I could never get made large enough for the requirements. As will be seen, this

has now been brought about in another way.

Even now it is not for me to lay down any fixed limit of size of tumour, or of time for the

previous growth of the tumour, beyond which success cannot be hoped for; but it must be

insisted, and emphasis laid upon the point, that no treatment can be considered adequate, unless it

be such as will more than overcome, more than negative, the antitryptic (toxic) properties of the

cancer ferment, malignin. To find in very bad cases, as some

189

have done, trypsin in the urine* is not enough; it must be shown that this is not antitrypsin (vide

Bainbridge’s Report, p. 14: “The above experiments showed the presence in the urine in cases on

the trypsin treatment, in non-cancerous patients, and in patients with cancer who had not been

treated by trypsin, of an enzyme possessing properties of digestion similar to trypsin”).

This is cited as one instance where the actual ferment present was not determine. In the

same way, if sugar be noted in the urine, it must be determined that it is not lЊvulose.

Dr. Bainbridge and others have, of their own initiative, set up what they term “test cases.”

In a scientific sense no case can be regarded as a test one, where any other treatment had been

employed previously, or where the conditions of the “test,” like the Ball and Thomas ones, and

those of Dr. Bainbridge, had been laid own by the authors themselves without the agreement of

the investigator, and without the scientific observance of the rules relating to “errors of

experiment.” As will later on be done with one series of these “test,” so any other “scientific

tests” shall be placed in their proper scientific aspects, including all the cases published by Dr.

Bainbridge, when the authors see fit to reveal in scientific fashion what they have really done in

the process of carrying out their “scientific experiments.”

Then there are the preparations and the dosage. Scores,

*Similarly, in the first of the cases recorded by Dr. A. Pinkuss, in the paper already cited

(p.12), it is stated that trypsin was first detect in the urine after forty-eight injections, and from

thence onwards it remained mostly positive. Considering the strengths of injections used, it

appears more likely that antitrypsin from the cancer was mistaken for trypsin, and this surmise is

rather confirmed by the statement that a rigor was only observable on the forty-third day or

treatment.

190

if not hundreds, of those in this country who, if asked, would give an adverse opinion of the

pancreatic enzymes in cancer have never even employed them.. This may be illustrated.

A former pupil, a physician in this city, has urged that the medical man is bound to trust

to chemists for his drugs, etc., and as an instance he cited digitalis. To which the reply was

obvious. If a physician, using digitalis, did not get the reaction he anticipated, he would naturally

suspect the preparation, and would inquire as to its true chemical character, but he would not, in

the absence of the expected reaction, condemn the use of digitalis. This, however, has been done

again and again with preparations of trypsin (and amylopsin), in the absence of any proof or

knowledge that the preparations used contained any enzymes whatever. It is illogical and absurd

to condemn a scientific treatment, as some eminent surgeons in London have done, when it was

the preparations employed by them which needed their censure.

Early in July, 1909, I spent several hours in the society of a well-known Glasgow

operation surgeon, who volunteered the information that he had used “trypsin” in cancer, but had

gathered a poor opinion of it. “It all depends upon what you used,” I said. He named certain

preparations at one time much advertised. “Well,” I answered, “as to those preparations, in 1906-

07, when quite fresh, if they contained any active ferments at all it was only pure trypsin, and

they were so made up that a box of them would be inert in fourteen days or less; indeed, they had

no keeping properties at all. At times, as I had to know, they were exported to the Cape, but it is

inconceivable that they could have been in the least active by the time they crossed the Equator.”

191

In certain independent laboratory estimations of these preparations, made by a fully competent

chemist and physician in February, 1907, the tryptic power per ampoule of these preparations was

found to be 9б6 Roberts tryptic units. That is to say, if preparations of such a strength of trypsin

(9б6 units), and of the very slight amylolytic power of 0б37 amylolytic units, were now used for

what Captain Lambelle and I regard as full normal doses, given daily or every other day, the

following would be the procedure: The full daily dose of 1,000 tryptic units would require the use

of quite 100 ampoules of 9б6 units, and the full dose of amylopsin could be obtained from more

than 5,000 ampoules of the strength of 0б37 unit, ore more than five litres. I commend these

figures to certain transparently anonymous scribes, cancer researchers and ex-researchers, in the

English medical press.

It has been pointed out that little or no evidences of the value of pancreatic ferments in

malignant disease have been published in France or Germany. With out present knowledge of the

requirements of the treatment, it would be surprising to find any positive evidence in the medical

publications of either country. This lack of evidences is easily explicable. From Germany the

total number of applications for general directions or for preparations to date (June, 1911) is two,

all told, and doubtless most of the cases there treated received the German preparations

mentioned by Dr. P.T.Hald (LancetI, November 16, 1907, pp. 1371-1375)k, and to his article the

reader may be referred for information as to their strength (vide Appendix M).

The writer has not a single record of a request for injections as strong as 250 or 500

tryptic units from any French physician. Some French and Italian cases were

192

treated with the first Fairchild injections, which have long been recognized as far too weak, and

which are not now on sale anywhere. In France and Italy, whence came the first rush of request in

1906, a very large number of cases in 1906 received injections, which at that time were found to

possess a tryptic power of 9б6 tryptic units.

Before me lies a “list of doctors and hospitals” in Great Britain which were supplied with

certain active preparations of trypsin and amylopsin. The list was compiled for the information of

Dr. Bainbridge. The trypsin injections include the “regular,” or 125 units, and the “extra special,”

or 500 units. The amylopsin injection had presumably 100 units of strength. The total number of

physicians is 126, of hospitals 43. Of the former, 96 used trypsin of 125 units, and 30 of 500

units. Amylopsin, as a separate injection (100 units of activity), was order by 74 of the 126

physicians, and by 16 of the 42 hospitals. That is to say, 77 per cent. of the physicians and 79 per

cent. of the hospitals never had a stronger injection of trypsin than 125 units, and amylopsin was

employed by about 59 per cent. of the physicians, and by 37 per cent. of the hospitals. Some of

the latter were large London hospitals, others special hospitals for the treatment of cancer. These

are some of the “fair trials” given to this scientific treatment. As the strengths of the preparations

employed wee entirely in the hands of the physicians and surgeons concerned, for the makers

resolved to be guided by them, it is clear that the trial of the enzymes in Great Britain was little, if

anything, better than the von Leyden experiments with very weak trypsin in Germany. None the

less, Professor von Leyden wrote (German Journal of Clinical Medicine, vol. lxi., pp. 360-365):

“In the therapy of the experiment there lies a new experience established.

13

193

For we have never seen that a tumour which was circumscriptly brought to a dissolution of its

cells by a tryptic ferment, reacted by increased growth to this procedure, either locally or

generally.” According to my calculations, based upon Table V. of Dr. Hald’s paper, to be cited

presently, the “trypsin” employed in the Berlin experiments varied in strength downwards from a

maximum of about 125 units (see Appendix M). There is no mention of the employment of

amylopsin in any of the Berlin work. It is easy to recognize that had von Leyden and his

colleagues made use of injections of 1,000 units of tryptic strength, plus similar ones of 2,000

units of amylolytic activity, and in the doses given in more than one case by Captain Lambelle, he

would, in all probability, have expressed the opinion, later on give by Professor F. Blumenthal,

and quoted in the British Medical Journal of January 11, 1908, that “the treatment by a ferment

which destroys the cancer cell has a great future before it.” It is not a new opinion of the writer’s

that, with the exceptions of those of Captain Lambelle and a very few others, the injections given,

especially in the years 1906-1909, were in the inverse proportion to the results vainly expected.

Hitherto in his publications the writer has not committed himself to definite statements as

to the actual and relative strengths of the injections of enzymes, or their amount. The actual

treatment of every single case, the writer being “not even a medical practitioner,” exactly as

Pasteur was “not even a medical man,” was absolutely in the hands of the physician concerned.

But I doubt whether any physician or surgeon can say truthfully that I ever told him that he was

giving too large or too strong injections of trypsin and amylopsin. Again, the manufacturers

placed on sale just such preparations as

194

they deemed suitable, and with one exception none of them ever asked a scientific opinion from

me as to their procedure. More than once the one firm with whom, through their European

manager, I was long in constant communication, declined to put out still stronger injections, until

some physician should ask for them. That is to say, like the writer, they preferred to place the

responsibility upon the shoulders of the physicians in charge. When, therefore, for example, Dr.

P. Tetens Hald,* referring to one of the Fairchild preparations, says, “This solution is of the same

strength as the ‘special injection’ recommended by Beard,” this “recommendation” must be

understood as given because the high reputation of the firm of Fairchild Brothers and Foster was

a guarantee that all their preparations were reliable and scientifically prepared, and not because,

in my scientific opinion, they wee at that time the best possible preparations ideally for use in

either absolute or relative strengths. I knew of no better ones on the market—indeed, for a very

long time, of none as good; and, in addition to other advantages, they had for my purposes the

very great recommendation that through agents they could be obtained in almost every part of the

world, at the Cape, in Australia, India, Italy, Spain, etc. Thus, no single correspondent had to be

told that reliable injections of trypsin and of amylopsin were out of his reach. Moreover, these

injections had active ferment powers in whatever part of the world they happened to be

purchased, a thing which cannot be said of certain other injections.

The time has now arrived when it is the writer’s duty

*Hale, P. Teten: “Comparative Researches on the Tryptic Strengths of Different Trypsin

Preparations, and on their Action on the Human Body,” in the Lancet (November 16, 1907, pp.

1371-1375).

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as a scientific investigator bound to publish the truth for its own sake, no matter what the cost

may be, to state in brief terms the conclusions which he has formed from his studies, from results

obtained by others, and from various information. Many physicians and surgeons have “tried the

treatment” with either (1) injections so weak or inert as to be no better than glycerine and water,

or (2) weak injections of almost pure trypsin, fortunately as a rule in very small doses.* For, as I

have more than once warned the medical profession, trypsin alone is about the most deadly

remedy for cancer which could possibly be devised. Again, in Germany especially, preparations

of “trypsin” have been used which were not free from poisonous peptones, and such may still be

in use there, for aught I know. Again, trypsin with no amylopsin has been used (London), and

amylopsin alone (Geneva and Paris), and pepsin alone (Glasgow), and lastly, anything with the

label “trypsin,” the medical men concerned not knowing or troubling to find out whether they

were using trypsin, or amylopsin, or both, or something else, or neither the one nor the other. At

times, as I found, the general directions for the use of genuine preparations of trypsin and

amylopsin were being employed with preparations which would have been quite useless even as a

cure for corns.

In venturing to lay down a course of treatment for average cases of cancer (carcinoma

and sarcoma) certain conditions must be mentioned and insisted upon. More-

*There was once case reported to me out in the far West of the United States, in which, as

no other preparations could be obtained, an apparently strong injection of pure trypsin, made up

on the spot, was employed. The patient developed quickly those symptoms of eclampsia which at

one time were the rule from the sixth to the eighth weeks of treatment, and in addition he was

seized with convulsions lasting several hours, with complete unconsciousness (coma).

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over, it must be understood distinctly, that if “test cases” are to be treated, after the lines of

Messrs. Ball and Thomas and Dr. W. S. Bainbridge, certain other scientific stipulations must be

made, and in scientific fashion “the test” must be carried out under rules of procedure agreed

upon between the testing surgeon and the scientific investigator. In other words, all apertures for

the creeping in of “errors of experiment” must be closed up. Above all, cases such as postoperative

recurrent ones, in which any other treatment had been employed previously, cannot be

used and cited as failures in any test claiming to be scientific.

1. From Captain Lambelle’s results, published and unpublished, and from the outcome

of the Uppingham case, the treatment appears to be applicable to inoperable,

recurrent, and primary cases; but in taking up treatment the physician is urged to bear

in mind all along the size and extent of the tumour and the previous history in fixing

upon strengths and doses. On occasion much larger doses might probably be injected

with safety, provided that for every increased of trypsin an adequate amount of

amylopsin be injected at the same time; or under the system of Roberts units

advocated, for every tryptic unit let there be at least two amyloytic ones.

2. The injections should be freshly made, and when ever possible not many days old.

All boxes should bear the date of manufacture.

3. On no account may the injections be made up from commercial “trypsin in powder”

or

similar things.

Great stress must be laid upon both of these points. Obviously injections containing

peptones are unfit for use, though in some instances the treatment has been condemned after the

employment of such. A special reason for the use of freshly-made-up injections lies in

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the facts concerning the conversion of amylopsin into trypsin in solutions of the pancreas gland,

which have stood for some time.

4. Nothing less strong than the injections and doses to be mentioned presently can be

relied upon, judging by past experiences, as adequate. The remark about “toxins and

antitoxins” in the “General Directions,” drawn up by me in 1907, may be recalled.

“While the tumour is alive, and for some little time after, it may be taken that the

cancer ferment, malignin, and the pancreatic ferments, especially trypsin, act towards

each other, somewhat like toxin and antitoxin.” There is in my mind no doubt that the

strengths hitherto used have, except in a few cases, been quite inadequate to over the

antitryptic properties of the blood in cancer patients, and unless this be done it is

useless to expect the usual results of ferment action—i.e., that a ferment present itself

in a very small amount produces a great output of work.

5. The actual position of affairs in the past few years can be best described by quoting

the impartial opinion of a competent author. On p. 340 of “E. Merck’s Annual Report

of Recent Advances in Pharmaceutical Chemistry and Therapeutics” (Darmstadt, vol.

xxii., August, 1909) on may read regarding trypsin: “The mode of action and the

value of pancreas preparations in cancer has not yet received a wholly reliable

explanation. Great difficulties are encountered because the preparations used by the

various investigators differ greatly in respect to their chemical properties, their purity,

and in the amount of active substances they contain, and often these factors are not

fully known to the student of the literature, or to the physician who has used them

and describes their action. Further difficulties arise

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5. (cont’d) when pancreatin and trypsin are described as substances of equal value,

and how shall we gauge the action of pancreatin and trypsin ampullЊ whose mode

of preparation and whose composition is not mentioned in the original paper,

neither is there any mention made of their sterility of the method by which they

have been sterilized? We need not wonder, then, to find that one author has never

seen local inflammation follow the injection, while another reports severe local

irritant effects. So long as the solutions of pancreatin and trypsin are treated as

secret remedies no one will be able to form a clear picture of the value of trypsin

treatment from the many publications which have appeared.”

6. If the foregoing citation be read carefully, and its meaning appreciated, the reader

will be prepared for what follows. The writer has never made up, or offered for

sale, injections of either trypsin and amylopsin. In laying down, as I am about to

do, certain strengths and doses of trypsin and of amylopsin as normal ones, which

in the discretion of the physician may be exceed on occasion, if used in the same

invariable proportions, I also state how, in my scientific opinion, these should be

assayed—that is, “standardized.” The physician must satisfy himself that all this

has been done, and he must not ask any guarantee from the scientific investigator

for any preparation to which he has not placed his name as a pledge of its true

character. If the physician should

*The following passage occurs in a recent letter from one who knows thoroughly what

he is writing about: “Even at this day, by the way, there is a ‘trypsin’ (so labelled) on

the market which is practically identical with the products sold as pancreatin from the

same source; the only way they differ is in the name—the label. Equally, there are

products sold as amylopsin which differ from the preparations sold as pancreatin only

in name.”

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publish “test cases,” apart form other conditions of a scientific test, he must be

prepared to produce scientific evidences that the preparations he employed were

what they pretended to be. As I have no preparations upon the martket, the onus

is upon him, and it will not suffice as a scientific test of any value at all if he

produce, as Messrs. Ball and Thomas did, mere elementary qualitative evidences

that “in each stance the solutions were found to be potent” (Reports of the

Middlesex Hospital, 1907, No. 6, p. 19).

7. Again, a South American physician once informed the writer that in South

America all sorts of things had been offered for sale and used under the name of

“trypsin,” some of them possibly with the writer’s name attached to them, as did

indeed happen, without his consent or knowledge, in Italy. I do not suppose that

matters wee on the whole much better in the Old World Among other happenings

a preparation was advertised as “a proteolytic and amylolytic ferment”—that is to

say, as a ferment possessing both proteolytic and amylolytic powers.

8. It has been pointed out recently to the writer by a medical friend, that in every

disease there is a period beyond which success in treatment cannot be hoped for

or expected, and the like is true of cancer. It is, therefore, in the highest interests

of the patient that, for example, there should be no delay for futile operations.

During such times the mischief is progressing, possibly slowly but surely, and

the above period is getting nearer and nearer. When the pancreatic enzymes,

trypsin and amylopsin, will act upon so-called “normal tissues” (Bainbridge and

Blumenthal), this period has been reached or passed. Though for the sake of

humanity the treatment may be give in such cases, it is not, scientifically

regarded, intended for these cases. As

200

Dr. Cleaves first insisted, and Captain Lambelle has urged it too, during the

treatment scientific blood-examinations are of very great importance. This again

points to the treatment of cases in sanatoria.

The system of units of tryptic and amylolytic activity adopted by Sir W. Roberts, M.D.,

F.R.S., is an empirical one, but it possesses certain advantages over some of the methods

employed in scientific laboratories for estimating, for example, tryptic activity. Unlike, for

instance, the accurate scientific methods advocated by Dr. Emil Westergasard and Dr. Tetens

Hald (Lancet, November 16, 1907, p. 1371 et seq.), it does not require a fully, equipped

laboratory for its accomplishment, and often I have used it in my own house. With a little practice

and after the careful study of Sir W. Roberts’ papers, any physician ought to be able to use these

excellent methods for himself with very simple apparatus, which can be put together almost

anywhere. The apparatus should include a racing stop-watch. It may be that in course of time

some more severly scientific methods of estimating the activity of trypsin, and amylopsin too,

may, with great advantage, be employed, such as, for example, the tryptic assay, advocated and

discovered by Emil Abderhalden (Zeitschrift physiol. Chemie, 1907, vol. li.). In the meantime the

writer is content to suggest, as at present sufficiently accurate and scientific for all practical

purposes, the tryptic and amylolytic methods discovered by Sir William Roberts, and published

by him in the Proceeding of the Royal Society, London, as well as in a special book.*

*Roberts, William: “On the Estimation of the Amylolytic and Proteolytic Activity of

Pancreatic Extracts,” in Proc. Roy. Soc. London, 1881, vol. xxxii., pp. 145-161; and “Digestion

and Diet,” London, 1891, Smith, Elder and Co.

The test for trypsin was named by Roberts “the meta-casein

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Because to do so would take up much space, I refrain from giving an account of the

Roberts methods and their results. Possibly in the interest of science—not “medical science”—

some of the medical journals may see fit to republish his Royal Society paper. If not, one

prominent consulting physician, who has made still further investigations into these matters, may

deem it expedient to publish the memoir, which, I believe, he wrote down a few years ago.

Briefly, it may be stated that Roberts set up certain tryptic and amylolytic units, in terms of which

preparations or injections might be designated. Thus, of the injections used in 1907, practically all

those sold by two firms, the one in London, the other in New York, had no greater tryptic strength

than 500 Roberts units, while as a rule their amylolytic activities were considerably under 500

units. Some of the injections had not more than 100 units of strength, and the German injections

were excessively weak in such units of tryptic strength and possessed no amylolytic powers worth

mentioning. Under the newer procedure it has been found best to put up the two ferments, trypsin

and amylopsin, in separate ampoules, which I would suggest should be differently coloured. The

trypsin injection thus prepared should be as free as possible of amylopsin, and the amylopsin

injection should be to all intents free from trypsin. The ampoule of 1 c.c. should contain in this

bulk 1,000 units of tryptic activity, and the ampoule of amylopsin should have per ampoule at

least 2,000 units of amylolytic activity. Personally, I do not believe that reliance can be placed

upon injections containing respec-

(footnotes from page 201)

test,” and it depends upon the time required by milk to reach the coagulation point. It is, in my

experience, an extremely delicate test, and free from the objections attaching to the “bitter taste”

test employed in America.

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tively per c.c. less than 1,000 units of tryptic strength and 2,000 units of amylolytic power. It

must be specially noted that on no account whatever should the trypsin injection be used without

the amylopsin one. The rule is for every ampoule of 1 c.c. of trypsin (1,000 units) on injection a

corresponding amount, 1 ampoule of 1 c.c. of amylopsin (2,000 to 2,400 units), must be

employed. The two injections should be mixed together in the syringe. What, for want of a better

term, may be described as the normal daily dose is 1 ampoule, or 1 c.c. of trypsin (1,000) plus 1

ampoule, or 1 c.c. of amylopsin (2,000 to 2,400 units). If a less dose be deemed necessary, the

contents of the ampoule can be diluted or less used. But the one injection should never be used

without the other, and in the proportion named. On occasion I see no objections to the use of still

stronger injections, but I understand that 1,300 tryptic units per 1 c.c. represents about the

maximum strength at present obtainable. As a scientific man, I do not believe than an injection of

, say, 124 tryptic units or less is of any real value.

It may be stated here than even with the large amount of amylopsin injected by Captain

Lambelle in the york case the patient exhibited unfavourable symptoms of drowsiness, nausea,

and vomiting in June, 1909. These may be explained in one of two ways: Either the amylopsin

injection was breaking up into trypsin, or sufficient amylopsin was not being used, in spite of the

large or strong doses being given. After much consideration of the matter, the writer urges

strongly the two following things. All amylopsin injections employed should have the maximum

strength possible of amylopsin—which, I believe, about 2,400 units per cubic centimetre or

ampoule. As shown in Chapter IX., to all appear-

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ances it is impossible with present methods to avoid the presence of some trypsin in every

amylopsin injection. A careful watch should be kept on this, that it is as little as possible—from

10 to 20 units. But even this is not sufficient. The injections used should be as freshly made up as

possible, for, as will be seen, amylopsin may be some means be broken up into trypsin, and at

present the conditions under which this happens are not known. It may, of course, be a change

due to temperature.

In the past few years the injections have been given hypodermically, but the great

advantages of the procedure adopted by Captain Lambelle, and give in his own words on a

succeeding page, may be insisted upon; that is, the injections should be given “intramuscularly

deeply into the muscles of the buttock, or about the iliac crest, or in the flank.” To my mind it is

as unnecessarily painful procedure to give them hypodermically into the abdominal wall.

It is of the utmost importance to avoid any suspension of treatment, especially during the

first four months, or until the tumour has liquefied, and its remains have shelled out or become

encapsulated. There are two reasons for this. In the first place, if there be still any living portions

of the tumour, even a few single cells, these may thereby have time to adapt themselves to their

ferment environment, and by increased secretion of antitryptic bodies (? intracellular ferments)

sicceed in neutralizing the pancreatic enzymes injected. This is in complete accordance with the

finding of stereo-chemistry, for when present in equal amounts, the dextro- and lЊvo- stereoisomers

neutralize each other, and the mixture has no action upon polarized light (Pasteur).

Secondly, under such circumstances there is great danger of toxЊmia, from the formation of

poisonous substances

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from the degenerating tumour, or from the portion in degeneration. In my experiences cases have

occurred where the physician, being convinced that the tumour was dead, and that the remains

might best be left “to come away of themselves,” has permitted the patient to remove himself far

from all medical supervision, with the inevitable result that a fatal toxЊmia has ended the case.

Assuming the treatment to be continued for at least four full months, or 120 days, in this

rigorous fashion—a thing which experience in York and elsewhere has proved possible—then it

can be stated that the patient received in this time at least 1,000 x 60 to 1,000 x 120 tryptic units,

and 2,000 x 60 to 2,000 x 120 amylolytic units, or in all 60,000 to 12,000 tryptic units and

120,000 to 240,000 amylolytic units—in words, from sixty to one hundred and twenty thousand

tryptic units, and from one hundred and twenty thousand to two hundred and forty thousand

amylolytic units. As one instance, the case described by Captain Lambelle received in 120 days

about 60,000 tryptic units, according to calculations made from the charts.

In the Uppingham case of cancer of the stomach and liver, the physician did not allow me

to make the requisite calculations from the charts taken; but from other sources the amount of

trypsin injected would appear to have been 63,00 units, and of amylopsin 94,000 units. As will be

seen, this amount much exceeds the total injected by Messrs. Ball and Thomas, not in one, but in

nine “test” cases: trypsin, 63,000 units against 30,000 units; and amylopsin, 94,000 units against

the miserable total of 16,00 units in these experiments. It may be added that certain hospitals

which “tested” the treatment, with weak trypsin injections in small doses, never obtained

205

any amylopsin at all, and therefore never used amylopsin injections.

All injections which are not standardized after the above fashion, or at all events not

guaranteed at least equal in tryptic or amylolytic potency to any injections so standardized, and all

which contain less tryptic and amylolytic strengths than those indicated, are not, in my scientific

opinion, suitable for use in the treatment of cancer, and not in conformity with the enzyme

treatment of cancer.

All weaker injections, say, 500, 250, 125, or even 10 tryptic units, should be refused, and

none of those with less than 2,000 amylolytic units are to be employed. If smaller or weaker

doses be deemed desirable, less of the injections should be used. The amylopsin injection may be

given without the trypsin one, not to “cure” the cancer, or to “digest” it, but to remove any of the

bad symptoms. The trypsin injection, on the contrary, may never be employed without at the

same time at least as much of the amylopsin injection; in other words, for every trypsin unit at

least 2 amylopsin units must be injected. The ideal place for the treatment is in a sanatorium

under constant medical and nursing supervision, and in good hygienic surroundings. The patient

should be kept as quiet as possible, a diet as laid down by Captain Lambelle in this book be

given, and the patient should refrain from any exertions of a bodily kind which could be avoided,

even though he or she might feel fit to carry such out.

A special warning must be made against the all too common practice of sending cancer

patients to the seaside. Again and again I have known it to happen that in the course of this

enzyme treatment the physician has, on his own responsibility, stopped the treatment for a time in

206

order to allow the patient to enjoy the benefits of a stay by the sea. There is, however, nothing,

except possibly the X or RЪntgen rays, which is so favourable to the rapid growth and increase of

cancer-cells as sea air. As asexual generation—the equivalent of cancer—first arose in the sea,

the possible reason of this may be ovbious.

Finally, the writer begs to intimate to possible correspondents that he does not undertake

to guarantee any particular preparations of pancreatic ferments. It has indeed been suggested that

the writer should “hold himself responsible for the ferments being rightly furnished” to

physicians who wish to “try” the enzyme treatment. The guarantees must be sought from the

manufacturers, and not from one whose object in publishing these facts is merely to demonstrate

beyond contradiction, that the words he said, regarding the uses Nature made of the secretion of

the pancreas gland, at Liverpool on January 20, 1905, were true. Moreover, the writer holds

strongly, that it is the duty of the State to provide and guarantee suitable injections of trypsin and

of amylopsin, properly standardized, and in this way not allow these to be exploited at times by

persons incompetent to make up scientifically standardized injections of the kinds demanded by

the treatment. Any work with the pancreatic enzymes, even the making-up of ampoules of

injections, calls for great scientific knowledge, skill, and accuracy. As is well known to some, the

enzymes are extremely delicate bodies, and often, when the inexperienced experimenter thinks he

has got trypsin or amylopsin safely bottled and hermetically sealed up, all traces of it as an active

agent have vanished.

On any point of difficulty arising out of the contents of this book, or in the scientific

treatment of cancer cases, he is prepared to reply, as in the past, to all letters of a

207

genuine character (“ plants” have not been lacking), provided that sufficient stamps, or, if from

abroad, an international reply-coupon be enclosed. Cables and telegrams, if replies be desired,

must have such replies prepaid. The writer does no treat any cancer cases himself, and in past

years also he has not done so.

208

CHAPTER VIII

TWO RECENT CASES

The York case of recurrent sarcoma was published in a scientific and medical journal, which is

not readily accessible. To the editor of the Journal of the Royal Army Medical Corps, Major W.

H. Horrocks, R. A. M.C., I am indebted for permission to republish Captain F. W. Lambelle’s

report to the War Office, and my acknowledgments and thanks to him and to my friend Captain

F. W. Lambelle, R. A. M. C., may be expressed here for their consent to the republication with

the original photographs. The report, which speaks for itself, was published, with three

photographs, by the War Office of Great Britain in the Journal of the Royal Army Medical Corps,

No. 3, vol. xiv., March, 1910, pp. 316-318. It is as follows:

A.—A FURTHER REPORT OF THE CASE OF PENSIONER W. DU T., LATE

DRUMMER, NO. 5669, PERMANENT STAFF, 4TH BATTALION WEST

YORKSHIRE REGIMENT, BY CAPTAIN F. W. LAMBELLE, ROYAL ARMY

MEDICAL CORPS, WITH THREE PHOTOGRAPHS.

Admitted to Military Hospital, York, on January 11, 1909, suffering from sarcoma of left upper

jaw

Operations for the removal of the growth were performed on January 12, 1909, and on March 2,

1909.

Section l* of the growth submitted to the Royal Army

*Scientific accuracy demands a correction here. In the copies of the official documents

relating to the case, on March 2, 1909, Captain Lambelle writes of sending “ a pathological

specimen”—

14

209

Medical College on March 2, 1909, was found to be round-celled sarcoma.

Recurrence occurred soon after the second operation, infiltrating the lymphatic glands of

the face, and extending by continuity of periosteum to opposite alveolar process and along orbital

plate and nasal process of same side, when further operative treatment became impracticable.

After special request Squire’s trypsin and amylopsin were supplied for the treatment of the case.

On July 15, 1909, all the recurrent growths were necrotic, and were in process of being cast off,

firm, healthy granulations being left behind. The treatment has been continued until September

15, 1909, on which date the patient showed no sign whatever of malignant growth. All the

necrotic tumour has been cast off; the mouth is clean and healed. The patient’s general condition

has also greatly improved, though he is still debilitated from his long illness, and requires hospital

treatment. A small plastic operation may be necessary to close the sinus in the cheek; this, with

nutritious dieting and massage, will, I believe, complete the cure.

F. W. Lambelle, Captain, R. A. M.C.

York,

September 27, 1909.

The writer feels called upon to say that the permission to republish this report is dated

July 30, 1910, and that at this date, more than a year after the slough of the dead tumour was

lifted out of its bed, the patient was still free from any trace of malignant disease.

A later letter from Captain Lambelle, dated October 17, 1910, with two further

photographs, describes the patient as quite well, free from malignant disease, and “cured.”

(footnotes from page 209)

“ a portion of a tumour of the superior maxillary bone.” Under date March 6, 1909, the diagnosis

of round-celled sarcoma is given by the official pathologist of the Royal Army Medical College,

and the words are added: “A stained specimen is sent by this post.”

210

The last photographs were taken on October 15, 1910.

From the copies of the ten charts of this case kindly given me by Captain Lambelle, I take

the following notes: “Treatment began, March 8, 1909; stopped, September 17, 1909;

recommenced, January 14, 1910; finally stopped, March 24, 1910; 120 injections in all given.

August 9, 1909, small slough removed from floor of orbit. August 12, 1909, a large slough

removed from the mouth from situation of tuberosity of maxilla. August 24, 1909, mouth now

clear of sloughs, is quite clean, and healing rapidly. On October 28, 1909, plastic operation to

close small aperture in face.” Captain Lambelle last wrote to the writer regarding this case under

date November 23, 1910: “I saw du T. on Saturday morning last [November 19], alive and well—

‘Never better in his life,’ he said—for he had come to bid me good-bye on my leaving the

hospital at York.” In view of the publication of this book, the writer wrote to the patient referred

to above, under date September 11, 1911. The reply came with the date September 14, 1911, from

the patient himself, and on this date he was alive, well, and not suffering from sarcoma of the jaw.

The six photographic illustrations (Figs. 6 to 11) relate to this case.

Captain Lambelle’s success in three out of his four cases to date was due, in my opinion,

not at all to any help of mine, for as a fact I knew nothing of his cases until the treatment in each

had done its work, but to the circumstance that he had studied the matter theoretically and

practically. He knew from his own observations on my material, as well as from the study of my

scientific memoirs, all about “the irresponsible trophoblast. “Unlike Bainbridge, it never occurred

to him to say: “The irresponsible trophoblast does not concern us here.”

211

Were he asked, he would undoubtedly say: “On the contrary, since cancer is asexual generation

or trophoblast, in its treatment, all question concerning the irresponsible trophoblast do concern

us.” To this I would add, to a far greater degree than the use of the knife upon a living

“irresponsible trophoblast” or cancer. The critics have, by common consent, been silent all along

concerning the scientific grounds of the enzyme treatment of cancer. But to the scientific man

first and foremost comes the question: “What is your attitude towards scientific general

principles?”

It is really remarkable with what persistence the identity of sarcoma and carcinoma is

denied by the medical profession—almost without exception. Since the writing of this book was

finished this supposed “fact” of the absence of identity has been affirmed from the medical side.

Doubtless the writer will hear again and again the old, old fable, that sarcoma and carcinoma are

very different things, and that the York case was only one of sarcoma—of a very malignant type.*

In anticipation, it may be pointed out that, apart from other considerations, † the course and

outcome of the York case were exactly in parallel with those of the Naples case of inoperable

carcinoma (epithelioma) of the tongue, for among other things, here as there, the remains of the

tumour finally shelled out “like the kernel of a nut.” The like is true of Lambelle’s unreported

case

*The charts demonstrate this abundantly. Professor Friedrich Henke describes the “smallcelled

round-celled” sarcoma as one of the most malignant of the sarcomata (Mikroscopisch

Geschwulstdiagnostik, Jena, 1907, p. 107).

† As long ago as 1904, I detected under the microscope the “epithelial cell” among the

tumour-cells of several slides of sarcomata, purchased from two Leipzic dealers. This find was

one of the things which led me to the conclusions of the mimicry of the malignant tumours, and

of the fundamental identity of carcinoma and sarcoma.

212

of “encephaloid” cancer of the breast, except that here the remains of the tumour, being more

deeply seated, did not shell out, but presumably became encapsulate (see Appendix L). The only

real differences between these two successful cases and the recurrent “round-celled” sarcoma in

York were that in them there was no microscopical diagnosis; but in fact something of infinitely

greater scientific moment was present—a stereo-chemical diagnosis. The art—not science—of

modern medicine would be no more rational than the “medicine” of Macbeth or Romeo and

Juliet, unless it were based in such sciences as chemistry, embryology, etc.

B.—THE UPPINGHAM CASE OF CANCER OF THE STOMACH,

WITH EXTENSIONS TO THE LIVER.

This Case is a present unpublished, and, therefore, I do not propose to do more than give

the briefest account of it, and only in order to use the figures concerning the injections employed.

The physician informed me some time ago that he intended to publish it in due course. At the

same time he did not allow me to examine the charts again, though I had often seen these. They

were asked for in order to compute from them the number of units of trypsin and amylopsin

injected, but the figures of these were obtained actually from other and reliable sources. This case

of cancer in a man of middle age was diagnosed surgically as inoperable, presumably because of

the involvement of the liver after an exploratory laparotomy by one of the chief surgeons at St.

Thomas’s Hospital, London about the end of July, 1908. The man was sent home to die.

Apparently in November, 1908, the treatment was commenced. The charts taken regularly were

sent to me from time to time, and I may mention that for a long time they showed a temperature

reaction after the

213

injections. From time to time information as to the procedure employed by Captain Lambelle was

furnished for use in this case. Beginning November 11, 1908, the injections of trypsin and

amylopsin were continued until August 18, 1909, and they were then stopped, not having been

resumed since. In this period there were injected at least 63,000 tryptic units and 94,000

amylolytic ones. This amount is similar to that used in the case of the York pensioned soldier, and

it much exceeds the total employed at the Middlesex Hospital, not in one, but in nine cases.

Under the date August 5, 1910, there came the intimation, from a friend who had just visited him,

that the patient was still alive, and that on the above date it was “now exactly two years and one

week since the abdominal incision was made, and the case pronounced by Mr. Battle as one of

inperable carcinoma of the stomach.” Looking back over the history of this case, I feel bound to

say, that while the numbers of unites of trypsin and of amylopsin were such as might be

considered adequate, the administration of the amount was spread over far too great an interval of

time (nine month).

The above opinion was written in August, 1910. Soon afterwards the patient developed a

more extensive albuminuria, which had troubled him for some little time. He died about the end

of September, 1910. Another physician called in diagnosed “Bright’s disesase,” which was the

scientific opinion I had formed independently, but on his return home his own physician declared

the mischief to be cancer. There was, so I understand, no post-mortem, the symptoms in the latter

months were not those usually associated with cancer of the stomach and liver, but of Bright’s

disease. It is now an old opinion of the writer’s, frequently stated to

214

medical correspondents, that many cancer patients, even if cured of cancer, would sooner or later

fall victims to diabetes or Bright’s disease. In my scientific opinion these are both diseases of the

liver, and for diabetes the illustrious physiologist, Claude Bernard, published this conclusion

more than fifth years ago.*

It has been written: “We do not underestimate the value of temporary relief; but even

accepting all the statements of its advocates as absolutely trust worthy, it is still conspicuously

inferior in this respect to surgery.” This is, presumably, a reference to the enzyme treatment of

cancer, which in years now past, on the testimony, published and unpublished, of numerous

physicians in all parts of the world, has given great and continued relief from pain and suffering

to the victims of cancer in cases where every device of surgery had failed. If any man living know

the equal of adequate injections of trypsin and amylopsin in this respect, let him produce it. These

ferments, trypsin and amylopsin, have not—at least in the visible universe—their superiors, or

even their equals, as means of relief in cancer. Regarding the above citation, the matter can be

carried a little further. Surgery has never once succeeded where trypsin and amylopsin had failed.

On the other hand, as witness the published York case, trypsin and amylopsin have succeeded

where surgery failed—as it die twice in this case.

CAPTAIN LAMBELL’S COURSE OF TREATMENT.

1. Diet.—Avoid acid-forming foods. No beef, no wine, no common salt, no vinegar.

Stimulants, when necessary, brandy or whisky. Reduce nitrogenous food

*For some of the other reported successful case vide Appendix G, 273.

215

to a minimum consistent with keeping up the bodily strength. Diet recommended: milk, fresh

vegetables, bread, butter, cheese, with eggs, chicken, and the lighter sot of fish in moderate

amount. The idea being to keep an excess of alkalies in the blood—the internal administration of

calcium lactate aids the above diet in this respect.

2. Oral Administration.—I give no ferment preparation by the mouth at all. Calcium

lactate is the only drug necessary.

3. General Management.—As usual in hospital.

4. Local Treatment.—None, unless there be an inflamed or ulcerating skin area or opening.

Hot boric fomentation, changed four hourly. Irrigation with potassium permanganate

lotion or weak iodine lotion, where there is foul discharge. Strong antiseptics—e.

g., mercuric salts and carbolic acid, etc.—are to be avoided, as interfering with the –

action of the ferments. On no account may the case be subjected to treatment with radium

or RЪntgen rays.

5. Hypodermic Treatment.—This is the essential part. Injections used are trypsin of

1,000 units of tryptic activity per cubic centimetre, and amylopsin of 2,000 units of

amylolytic activity per cubic centimetre.. The injections should be given daily, if

possible. The injection must not be made into the cancer itself. The injections are

given intramuscularly, deeply into the muscles of the buttock, or about the iliac crest

or in the flank. Abscess frequently follows injections into the subcutaneous tissues.

In

some hundreds of injections I have never once had an abscess. I always give equal

quantities of the above two preparations. I never give the trypsin without adding

more

amylopsin. The full dose has been 1 ampoule of trypsin, or 1 c.c. + 1 ampoule of

amylopsin,

or 1 c.c. In units of activity, 1,000 units of tryptic activity + 2,000 units of

amylolytic power. After an injection I always massage the part for one minute, so

that

the injection does not lie in a pool, or abscess may follow. A local analgesic is unnecessary.

Cleanse the part before injection with spirit solution of biniodide of mercury,

1 in 1,000, and seal the puncture with rubber plaster.

The foregoing directions for treatment have my full approval. One or two things may be

added to them. With slight alterations, the “General Directions,” drawn up by the writer, and

amended from time to time in 1906-07, in most respects still hold good. While never regarding

the oral treatment as more than an adjunct to the patient’s digestion—but a valuable one without

the slightest influence upon the cancer—I see no objections at all—but advantages—in the use of

calcium lactate, suggested by Captain Lambelle. It has been my opinion now for more than four

years that it was of the utmost importance that each and every trypsin injection should contain

much amylopsin. It seems best to follow the procedure adopted by Captain Lambelle, and to use

two separate injections of trypsin and amylopsin. These should never be of less potency than

1,000 units of tryptic activity, and 2,000 units of amylolytic power. The trypsin injection should

never be given without at the same time a corresponding amount of amylopsin; and, if this be

done, the necessity of using amylopsin alone will, I imagine, disappear. On occasion the full dose

of 1,000 tryptic and 2,000 to 2,400 amylolytic units may, in the judgment of the physician, be

increased, provided that the rule of two amylolytic units for each tryptic unit be followed strictly.

The injection of amylopsin (2,000 to 2,400 units per cubic centimetre) may, in the

judgment of the physician, be given without the injection of trypsin, for it is only the use of

trypsin alone which causes bad symptoms. It must be stated distinctly that the dose of 1,000 units

of

217

trypsin + 2,000 to 2,400 units of amylopsin is not to be understood as one which will suffice for

all cases. In very malignant cancers and sarcomata, more especially in recurrent cases, it may be

necessary to exceed, even to doubt it. This may be expressed briefly in the words, “Give the most

you can give, and as often as you can give it, with due regard to the constitutional effects

produced. Do not, however, rely upon preparations, which are not guaranteed to possess a tryptic

strength of 1,000 units per cubic centimetre, or an amylolytic power of at least 2,000 units per

cubic centimetre. In the eyes of its discoverer, the enzyme treatment of cancer does not consist in

the use of preparations of less guaranteed strengths than these.” Judging by the charts of Captain

Lambelle’s latest case, it is not necessary in all cases to give daily injections for long period, for

in the first four months of treatment the total number of injections did not exceed sixty, within

sixteen more from the middle of July to September 17.

There are certain points in the treatment which call for special notice. The injections,

hypodermic or intramuscular, are the essential items. The chief—possibly the only—uses of oral

preparations in the treatment are the improvement of the patient’s digestion and metabolism. It

must be recalled that Dr. S. Pinkus, in his experiments of introducing large doses of pancreatic

ferments into the blood of a healthy dog, could note, as the sole visible effect, increase in weight

on the part of the animal. In treating cases of cancer the physician should not forget this fact. As I

and others have noted again and again—and the like observation has been made by Captain

Lambelle—it is one thing to introduce pancreatic ferments into the blood of a healthy man, and

quite another to do the like in such a person, afflicted with

218

malignant disease. In the first instance, always provided that scientifically prepared and pure

ferment preparations were used, there would be no obvious reactions, no rigors, and no rises of

temperature. At most there would increase in weight, due to increased and improved metabolism,

and a sense of well-being on the part of the “patient.” But, again, what enormous differences

occur when the patient is suffering from cancer! Reactions, obvious ones, may then be looked for

with certainty, and these alone would, in my opinion, be a sufficient diagnosis of cancer, if such

complications as tuberculosis could be excluded. Let it be repeated, and with emphasis, that small

and weak doses of injections are useless. Even as I write these line there comes a report of violent

reactions from even the injection of five drops of strong trypsin* in a case where large masses of

cancer were present. The small, almost insignificant, amount of trypsin in use here was

attempting a task beyond its powers-to wit, the complete breaking up of the cancer-substance it

had attacked. With a much large dose, given along with an equal amount of strong genuine

amylopsin, there would be present sufficient of each of the ferments—trypsin and amylopsin—to

break up the portions of cancer attacked completely into simple harmless products, and such

violent effects would not, in my opinion, be encountered.

I have always maintained that, were I treating cases, my own treatment would commence

with the injection of, say, 1,000 units of trypsin and 2,000 units of amylopsin,

*An interesting commentary upon Bainbridge’s statement in his report (p.7): “From this

it will be seen how absurd were some of the earlier claims of “cures,” as well as the strange

symptoms and “terrific” results from the small doses employed.” In this case, in Chicago, one of

the strong Fairchild injections employed by Bainbridge was in use on August 12,1911.

219

mixed on injection; that is, I should employ Captain Lambelle’s usual procedure from the start. I

should not willingly reduce the dose of trypsin, but rather, if bad effects were noted, increased the

amount of amylopsin, even double it. With such doses as these not many injections—not half a

dozen—would be exhibited before the injection would be followed shortly by a rigor, which soon

passes off, if the patient be in bed. Later in the day—in my experience from 6 p.m. to 9 p.m.—

there would be a marked temperature reaction up to 103ЉF., or even sometimes higher. The

patient will demand, and should have at all times, abundant water, or barley-water, to drink. The

curious feature of this rise in temperature, as I have seen it, is that the skin is dry, and not bathed

in perspiration. Of course, the pulse along with it is very much quickened. In fact, this treatment

would appear to place great demands upon the heart, and it is my own opinion that wherever

possible the patient should receive the injections in bed, should be kept there during such

temperature-reaction, and as before stated at all times be kept as quiet as possible, refraining from

all avoidable physical exertions. In Captain Lambelle’s cases it was noted by him that the effects

of the injections—i.e., the constitutional symptoms—lasted from eighteen to twenty-four hours.

On the average he gave injections every other day. At times the amount of injection, the number

of units, was decreased to one-half or one-quarter of the usual amount of 1,000 tryptic and 2,000

amylolytic units. Also, as I conceive it, the injections should, if the patient can stand such a

course, be exhibited oftener than every other day—as often as four,

220

five, or six times a week—if such “heroic” treatment be demanded by the case under treatment.

Probably the case—a very desperate one—of the pensioned fireman, described in connection with

the “liquefaction of cancer,” failed, not on account of the large amount of tryptic units given daily

(to wit, 2,000), but because along with these at least 4,00 amylolytic units were called for, but not

exhibited. From the phenomena noted in this case and in two of those treated by Captain

Lambelle, it would appear that the objective to be aimed at in the enzyme treatment of cancer is

the liquefaction of the main tumour or tumours. With this in view, it should be the purpose of the

physician to give as large and as strong injections of the two ferments in the proper proportions as

the patient can endure. As Captain Lambelle remarks in one of his letter: “Give the most you can,

and as often as you can, with regard to the constitutional effects produced.” The self-evident fact

that very strong injections should be used has been stated already by Dr. P. Tetens Hald in the

Lancet as long ago as 1907.

There remains another serious problem which, I confess, it is beyond my feeble powers to

solve. It is this: “How shall the physician be provided with only the preparations upon which on

all occasions he can rely?” I have known my own printed “General Directions” to be used along

with preparations, which in my own experiences, as well as in those of others, had no action

worth speaking of upon milk, and which did not at that time contain an appreciable amount of

amylopsin. There was no excuse for this, as these directions not only gave full particulars

concerning genuine preparations of trypsin, amylopsin, etc., but also a list of places and addresses

throughout the world where these could be obtained. These—the Fairchild Preparations—were

absolutely genuine; but—

221

as now recognized by me, as a rule not free from exception—they were not in former years strong

enough for their work. In various quarters of the world worthless preparations of trypsin and

amylopsin have been offered for sale, at times extensively advertised, and employed in cases of

cancer, to the serious detriment of the scientific enzyme treatment of cancer. The problem is—

and it is not one for the scientific investigator as such—How shall this sort of happening be

prevented in the future? It is an extremely grave matter, for human lives are at stake in this

treatment. One of the chief medical newspapers in Great Britain, the Lancet, has as one of its

features—and a most excellent one it is—a laboratory for the making of scientific examinations

and the drawing up and publication of reports upon pharmaceutical products offered for sale and

for use in medicine. To my knowledge, none of the injections employed hitherto in the treatment

of cancer have been reported upon by this laboratory, and in default of State control and State

monopoly the sooner and the oftener such examination and report upon various pancreatic

preparations be made the better for mankind and for science.

222

CHAPTER IX

ON THE RELATIONS OF TRYPSIN AND AMYLOPSIN

When one reads some of the things which have been written concerning trypsin in some medical

journals, as well as in American daily newspapers, one might think that our present knowledge of

this and other ferments dated back to the time of Moses, or that was embraced among the laws of

the Medes and Persians. Actually, of course, a knowledge of any real functions of the pancreas

gland is not yet sixty years old, and the name “trypsin” goes no further back than 1876, when it

was bestowed finally on one of the pancreatic ferments by the investigator, Wilhelm Kühne, of

Heidelberg. The name “amylopsin” is of still more recent origin (Wingrave, “Amylolytic

Ferments,” Lancet, 1898, i., p. 1251). The latest phase of our knowledge will be found in the third

edition of Oppenheimer’s book, “Die Fermente,” in which there is a table classifying ferments

into tryptases, amylases, etc. Reference should also be made to the circumstances that some

investigators have been of opinion that trypsin was not a single ferment, and that a “vegetable

trypsin” had also been recognized. Now, it has long been the writer’s experience that no useful

end was served in scientific research by diving and subdividing things, so as to increase their

number; on the contrary, that the unity or organic nature was always

223

to be aimed at, and that, as William of Occcam long ago laid down, Entia non sunt multiplicanda.

In the following lines something must be said of two aspects of the writer’s studies of

pancreatic ferments and their uses. There are not many things in my research career which fill me

with greater satisfaction than the line of reasoning and the conclusions as to the place of

amylopsin in the enzyme treatment of cancer. Amylopsin itself, no matter what the doses be, will

not cure cancer; but it cannot be dispensed with when pancreatic ferments, such as trypsin, are

employed against malignant disease. If trypsin had been as successful hitherto in its mission in

the treatment of cancer as amylopsin, there would be many living who are now departed, and the

literature of medicine would contain fewer “scientific” leaders upon “cancer booms” Amylopsin

was introduced into the enzyme treatment, not because of the discovery of any action upon cancer

cells, and no because it was “thought ‘to digest’ the dead cancer cells” (Bainbridge’s Report, p.

6),but because the conclusion was reached, upon purely embryological grounds, that sufficiently

potent injections of amylopsin would remove all the bad symptoms leading up to something

identical with “the vomiting of pregnancy” and with eclampsia itself, which had arisen in very

many cases in England, Italy, France, and elsewhere. In the very first case in which it was “tried,”

as also in countless cases since that time, amylopsin always removed these symptoms. But it is a

curious commentary upon what has been termed the “conservatism” of the medical profession,

that although injections of this enzyme were recommended for the treatment of eclampsia, not a

single case is known at present to the writer where this was employed. So much for the place of

science in “medical science.”

224

When, in the early days of December, 1904, the writer first came to recognize the import of “the

secretion of that important digestive gland, the pancreas,” in the medical treatment of cancer, at

once he became alive to the necessity of keeping a scientific eye upon all the four supposed

ferments described in its secretion. The import of trypsin was quite clear from the first moment.

Not many months elapsed before the place of amylopsin could be assigned to it, and on scientific

grounds, which have never been impugned. Rightly or wrongly, but in accordance with the

scientific plan of avoiding all unnecessary multiplication of causes, the separate existence of a

milk-curdling ferment in the pancreas gland was rejected. Finally, no function in the treatment

could be found for a fat-emulsifying enzyme. It may have its uses, but certain discoveries known

to me on this point were the work of another, and not of myself, and they are still unpublished.

Now, from the start it appeared very unlikely that a gland, like the pancreas gland, should

secret four fundamentally different ferments. It was known, moreover, that the relative amounts

of these depended largely upon the kind of food upon which the animal was fed. Nitrogenous

foods led to the production of much trypsin; a starchy diet increased the relative amount of

amylopsin. These considerations, along with the chemical facts concerning the action of

amylopsin upon starches, led the writer, in the closing months of 1906, to certain conclusions as

to the relations of trypsin and amylopsin. They were not published, because during that and the

preceding year the writer had furnished the transparently anonymous scribes of certain arguments

and criticisms—there never were any such—but for their “opinions” and powers 15

225

of ridicule. However, on January 18, 1907, the writer, in a letter to an old fellow-student, a

consulting and hospital physician in London, wrote as follows: “As to trypsin and amylopsin, this

is private, lest….The real original ferment of the pancreas gland, in my opinion, is trypsin.

Amylopsin is a modification of trypsin. The latter probably acts by adding 2 molecules of

hydorxyl, the other 6. Assuming T (trypsin) to be the substratum, to which these molecules are

attached, the two things would be like this (here there was a rough diagram in the letter). How the

tryspin molecules get slung together to form amylopsin is more than I can say; but it does not

seem to me a priori probable that a gland should form four fundamentally different ferments.” At

the time, although, since “science is prevision,” so much could be foreseen, the steps needed to

establish this in fact were not obvious. Later on, from the avidity with which the leucocytes

appeared to seize upon amylopsin, some further slight evidence seemed to be presenting itself,

but the mystery did not clear up. Then came the paper by Dr. P. Teten Hald,* and this contained

some surprising things concerning the two amylopsin injections on sale. It may be stated here,

that the reason why the writer had insisted that the amylopsin injection should be free from

trypsin was, because it had been found impossible to persuade the manufacturers to increase the

amylolytic strength of their trypsin injections without diminishing the strength of trypsin. Owing

to this, it appeared that after some weeks of treatment any injection of trypsin was not as well

borne as previous.y Dr. Hald tested two of

*Hald, P. Tetens: “Comparative Researches on the Tryptic Strength of Different Trypsin

Preparations, and on their Action on the Human Body,” in the Lancet, November 16, 1907,.pp.

1371-1372.

226

the amylopsin injections as to their supposed freedom from trypsin, and found that in fact they

both, from different makers, showed pronounced tryptic activities. On p. 1375 he writes:

“The two amylopsin preparations which I examined were stated to be free from trypsin.

They behaved, however, with respect to the second phase, just as if they were genuine strong

trypsin preparations, as they brought about a very pronounced decomposition of the glutin into

lower nitrogenous compounds. The doubt that was aroused by the surprising result of the gelatin

experiments was therefore solved. Unquestionably, the amylopsin preparations contained

abundant quantities of trypsin, and their importance for the treatment could not, if they really

have any such importance, be due to their freedom from trypsin.”

While accepting Dr. Hald’s facts, at that time the writer could not account for them, any more

than he could then explain certain happenings in New York with some of the first-made injections

of amylopsin. Here the physician had found that the injection amylopsin intensified the very

symptoms which it was supposed to counteract. The only supposition then possible was that he

had by mistake injected trypsin instead of amylopsin, the tubes and boxes then in use being

alike.*

For the sake of accuracy, it should be added that long before the publication of Dr. Hald’s

paper the writer had from time to time tested the injection of amylopsin sent out from New York

as to the existence of tryptic powers in it, but invariably with negative results. The number of

tests carried out by Dr. Hald, and the period of time over which these extended, were not

sufficient

*To avoid such mistakes, it is most important that the two injections should be put up in

differently coloured ampoules.

227

to warrant the conclusion that all the ampoules of amylopsin at that time sent out as “free from

trypsin” did, in fact, contain much trypsin. As a fact—so I am informed—the amylopsin

injections now on sale cannot be free with certainty of all traces of trypsin.

In March, 1910, in the course of a correspondence with Mr. P. W. Squire, of Messrs.

Squire and Sons, chemists on the establishment of the King, certain facts transpired which, by the

kindness of Mr. Squire, Iam permitted to publish in his own words. He wrote: “With regard to

mentioning my name in your paper, I have no objection to this, providing you confine yourself to

a question of fact, and you must not commit me to any theoretical view of the subject. The facts

as I have them are as follows: Sterilettes amylopsin (Squire) were being prepared, and a batch of

the liquid was examined for its tryptic and amylolytic values, which were respectively found to

be—trypsin=500; amylopsin-2,400. This was on July 28, 1909. On January 30, 1910, the liquid

was again examined; the tryptic value then equalled 1,250, and the amylolytic value 1,200.” It

may be added that Mr. Squire’s figures relate to the units of tryptic and amyloytic activity set up

by the late Sir William Roberts.

I regard these facts as a scientific proof of the truth of my conclusion of January, 1907,

that “amylopsin is a modification of trypsin.” The facts recorded seem to indicate a

decomposition of some portion of the amylopsin of July, 1909,. into trypsin by by January 30,

1910. Any mistake in the assays does not appear possible. The find also throws the needed light

upon the discovery by Dr. Hald of trypsin in two different amylopsin prepara-

228

tions, sent out as pure amylopsin. Of course, it has still other bearings; upon the specificity of

ferments, for instance, and upon the relations between the leucocytes and amylopsin in the

enzyme treatment of cancer and tuberculosis. Amylopsin might be regarded as the ferment-food

of the leucocytes, in extension of the view previously expressed by the writer in the Medical

Record that amylopsin was the medium in which the leucocytes acted. By the use of the scientific

imagination possessed by the writer, and of which professor Leo Loeb recently wrote in the

Medical Record (June 25, 1910, p. 1086; see Appendix E, p. 267), he considers that it is highly

probably, not only that the leucocytes can convert amylopsin into an intracellular tryptic ferment,

but that they can transform it into an inverting enzyme. The interesting subject may be left with

the remark that once again it is a confirmation of the scientific truth of the words of Pasteur, that

“Science is Prevision.”

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CHAPTER X

A PUBLISHED TEST OF “THE TRYPSIN TREATMENT OF CANCER”

Like the publication by Dr. Bainbridge, the contribution* of Messrs.. Ball and Thomas professes

to be a “scientific report.” As already stated, unlike the former document, the publication of the

latter does give information—such that a searching scientific investigation can be made into the

details of the procedure adopted. It must be recalled that, in the words of this report, “Two cases

of carcinoma were placed on trypsin treatment in My, 1906, in the Cancer Wards of the

Middlesex Hospital, but with negative result, there being no improvement in the patients, nor was

the progress of the growth influenced by the trypsin injections.” Here the authors omitted to

notice two significant facts: of these cases, one had a single injection, and the preparation used

had at that time been found to be inert in ferment powers by others as well as by myself. These

cases are Nos. 1 and 2 of the report. It is possible—though I should not care to guarantee it

scientifically—that in Case 1 as much as 100 Roberts tryptic units were in all exhibited, and in

Case 2 certainly not more than ten such. There is no mention of any employment of

*Ball, Walter, and Thomas, E. Fairfield: “The Trypsin Treatment of Cancer,” in Archives

of the Middlesex Hospital, Sixth Report from the cancer Research Laboratories, London, May,

1907, pp. 18-34.

230

amylopsin, active or inert. The other nine cases were treated with the Fairchild injections, and

every ampoule of trypsin and of amylopsin was tested qualitatively, not quantitatively, before use.

It was found that each and every ampoule had some strength—how much, apparently, being

regarded as a detail of minor importance. Quinine is said to cure malaria, but to-day no physician

or surgeon would anticipate any “improvement” from the use of preparations containing a small

amount of active quinine, irrespective of the amount per cubic centimetre and of the dosage. I

pass over the previous histories of the cases, for the good reason that the report is practically

silent upon these points. One remark on p. 33 may be noted, viz., that—

“The length of time during which the patient were under observation previous to the

commencement of treatment is of importance. For in large measure a prolonged period before

commencement of treatment signifies an acclimatization of the patient to hospital surroundings,

and a greater equanimity towards the possible value of any particular treatment in view of the

many failures with which the ‘patient’s lengthened stay in hospital has made him acquainted.”

The enzyme treatment is a stereo-chemical—not a hypnotic one! This argument, if of any

scientific value at all, would apply to the surgical dictum of “early operation” in cancer also,

Moreover, it ignores the fact that the cancer also “acclimatizes” itself, not to add that it grows.

The injections used had per ampoule, without any loss for qualitative tests, the following

values: Trypsin “regular,” 125 units; trypsin “special,” 250 units; and amylopsin, 100 units. The

maximum dose given in most cases was 15 minims, or . ampoule; never 40 minims, as

mentioned as the general dose then in use in the “Direc-

231

tions,” which (?) ”were rigorously carried out” (p. 18). The strongest dose of trypsin given, and

but for a part of the time, was 188 units—of amylopsin, 75 units. Had the “General Directions”

been followed, the average dose would have been : trypsin, 500 units; amylopsin, 200 units. That

is to say, the dose was never even half enough of either injection, according what was them

known. In the light of Captain Lambelle’s results, the dose of 15 minims of trypsin was less than

one-fifth of what it should have been, and the amylopsin, which should have been given along

with the trypsin, was one-twenty-sixth of the normal. In other words, if the “special trypsin” had

been in use all the time, the present daily dose of trypsin would have been reached in the

injections of more than five days together, and the amylopsin daily dose in some twenty-six days.

In the following an estimate is made of the number of units of trypsin and of amylopsin injected

in each case, the figures of the report being used for the calculations.

TABLE 1

Case. Days treated. Units Trypsin. Units Amylopsin.

III.* 24 938 625

IV. 40 2,500 20

V. 68 3,750 1,200

VI. 26 1,000 600

VII. 71 3,575 1,700

VIII. 71 2,250 1,600

IX. 122 7,625 4,500

X. 77 4,000 2,050

IX. 118 9,250 2,150

*Case III. Is stated to have been a “carcinoma of the Kidney,” and after death the tumour

was found to weigh 70 ounces—that is 4 pounds 6 ounces—the size of a respectable joint of beef.

Could it be regarded as a scientific experiment, seriously

232

In Table 2 the number of doses given in each of the nine cases during the whole period of

treatment is given. These doses are, of course, those which at the present time have been given in

York Uppingham, London, and possible elsewhere.

TABLE 2.—SUMMARY OF DOSES OF 1,000 UNITS TRYPSIN AND 2,000 UNITS

AMYLOPSIN GIVEN IN THE NINE CASES.

Case. Trypsin. Amylopsin.

III. minus 1 1/3

IV. 2. 1/100

V. nearly 4 3/5

VI. 1 1/3

VII. 3 . minus 1

VIII. 2 . minus 1

IX. 8 2 .

X. 4 1

XI. 9 . 1 1/8

Taken together, the nine cases received about thirty-six doses of trypsin and about eight

of amylopsin. On an average adequate treatment extending over 120 days, the total trypsin

injected would be at least 1,000 x 60 units, or 60,000 units; of amylopsin, 2,000 x 60 units, or

120,000 units. In the nine cases the total number of tryptic units injected, as far as can be

determined, was 36,000 units; of amylopsin, 16,000 units. To have made success more certain

there should have been injected—of trypsin, 720,000 units; of amylopsin, 1,440,000 units. The

(footnotes continued from page 232)

undertaken, to attempt to digest and liquefy a joint of beef of these dimensions, in twenty-four

days or in a blue month, with the minute quantity of 938 tryptic units, which could easily be

compressed into a bulk of 1 c.c., or less than twenty drops of water?

233

points are summarized in the statement that on the average each patient received about one-tenth

of the trypsin, and one twenty-second of the amylopsin, which under the directions (which “were

rigorously carried out”) he should have received. In the newer light of to-day, on an average, the

trypsin for each case was on-seventeenth, and the amylopsin one seventy-seventy (1/77), of the

amount it should have been. The only scientific facts proved in these experiments on “the trypsin

treatment of cancer” were that, examined qualitatively by their actions* on white of egg and on

starch, the Fairchild preparations then on sale “were found to be potent.”

*Regarding this “test” for trypsin, one who has devoted very many years of his life to the

study of the ferments, writes me recently: “Dr. X., for instance, has given wide publicity to a test

by which trypsin is condemned or approved by its action upon coagulated egg-albumin, when it is

a fact, known to everyone familiar with the chemistry of the enzymes, that trypsin is of feeble

action upon boiled egg-albumin, and, indeed, it may be said naturally characteristically so. The

enzymes act upon the substances, upon which they are naturally engaged, and native coagulated

albumin, which has never received any preliminary or initial conversion by gastric juice, is a

proteid which trypsin has never learned to act upon.”

234

CHAPTER XI

THE CRUCIAL TEST OF THE NATURE OF CANCER

In AN ARTICLE UPON CANCER (Medical Record, December 4, 1909, p. 940), Dr. Jabez N.

Jackson writes of the spending of millions of dollars on laboratories for cancer research, and

opines “that the entire lives of many of the ablest and most scientific investigators in our [that is,

the medical] profession have been devoted exclusively to this problem.” It should have been

added, not in such laboratories, or as paid researchers. It so happens that most of my own private

cancer studies cover approximately the period of this official investigation of cancer—i.e., from

1903 to the present time. Voluminous official reports and statistics have been published in this

period, but for all the funds expended upon large salaries and petty researches, amounting to

thousands of pounds sterling yearly, no strikingly important fact or suggestion bearing in the least

upon the origin, the nature, or the scientific treatment of cancer has come to light.* It was, indeed,

recognition of this happening, and of its probable continued occurrence in the near future, owing

to entire lack of scientific general principles † in official

*Even the conclusion, based in research, that “carcinoma is common to all vertebrates”

forms no exception, for it was enunciated by another investigator in 1895, years before official

research commenced.

† According to Sir Robert Finlay, MP., K.C., the celebrated Edinburgh surgeon, Sime,

said, in answer to one of his assistants, Annandale, who had asked for a particular direction,

instead of

235

research, which led the writer to throw aside absorbing work on the problems of Heredity and

Germinal Continuity, and take up on branch of his studies—cancer, or asexual generation, or

trophoblast.

Whether the sum be millions of dollars or not, unquestionably very large amounts—

thousand of pounds sterling yearly—have been expended in recent years on cancer research in

England alone.* And the result of eight years’ of work and “research”? Chi lo sa! True, the

official researchers and others often speak or write about the “cause” of cancer, as if the “cause”

were a legitimate object of their quest, and—in ignorance of the teachings of Carl Ernst von Baer,

Emil du Bois-Reymond, and other great investigators—that “causes” are beyond the range of

scientific research. †

(footnotes from page 235)

a general principle, “ You are wrong. If you get a general principle you can keep right on the

whole, and supplement your information as you go along. If you get a particular direction, and

take a single turning you are done for ever.”

*It should not be forgotten that the cancer researches recorded in this book cost the

Carnegie Trust (Universities of Scotland) Research Fund the sum of seventy pounds sterling

(БТ70). Ofthis sum, fifty shillings, the price paid for a certain dog, was lost, owing to the then

ignorance of myself and of an Edinburgh surgeon that chloroform is fatal to dogs. Fifty pounds

was expended in the wages of a youth being trained to do microscopical work (preparation and

staing of section) for me. When trained, he had to accept another situation! So that the actual

balance-sheet of these researches upon cancer works out to the magnificent sum of seventeen

pounds ten shillings.

† The latest pronouncement of official cancer research is contained in “”The Ingleby

Lectures on Advances in Knowledge of Cancer” (the LancetI, June 10, 1911, pp. 1596-1597). It

concludes as follows: “What had to be found was, how to imitate the process of natural healing,

and how not to hunt on false tracks after curative sera on the analogies of diphtheria antitoxin or

cytotoxic sera; till then the surgical treatment must remain a rational and the only treatment; but

in the end it ought not to be beyond human ingenuity to find out and imitate the mechanism of the

natural healing of cancer.” This latter

236

The true author of the theory of “embryonic rests” as the source of tumours, malignant

and benign, was the embryologist Remak.* Later on his views were adopted by the pathologist

Cohnheim, and t0-day the theory is invariably, but erroneously, attributed to the latter, under the

name of “Cohnheim’s theory.” Following in his footsteps, some researches at times regard

cancer-cells of this, that, or the other organ, skin, mammary gland, liver, etc., therby implying, if

not stating, their somatic nature. Well and good. If cancer-cells be “embryonic” or somatic in

nature—if they be skin-cells, or liver-cells, or breast-cells, † etc.—then it follows that their

albumins must be of the same nature as those of the normal somatic or embryonic cells from

which presumably they arose. This I deny point-blank, and, as the scientific man is bound to do, I

will shortly give some of the reasons. In passing, be it remarked, nothing

(footnotes from page 236)

is exactly what the enzyme treatment of cancer or malignant disease professes to do, neither more

nor less. If words have meaning, “natural healing” signifies nature’s method, which is all the

scientific investigator is concerned with. The mere denial of this, or the use of inert trypsin to test

its truth, is not scientific evidence.

*Remak, Robert: “Ein Beitrag zur Entwickelungsgeschichte der krebshaften

Geschwülste,” in Deutsche Klinik, 1854, vol. vi., p. 170.

† My old opponent, Mr. W. Roger Williams, F.R.C.S., is one of these. In the Medical

Record of February 9, 1907, (p. 237), he implied that the cells of a malignant tumour of the

pancreas gland could secrete, not merely trypsin, but also amylopsin and lipase. On which I

suggested that in a universe in which this could happen it would not be surprising to learn “that

some cancer-cells produce bile or excrete urea, or that in cancer of the breast the tumour-cells,

true to their (supposed) origin from mammary-cells—the mythical ‘tumour germs’ of my

opponent—actually go the length of secreting—milk!”

237

could reveal more distinctly the fundamental divergence between “Cohnheim’s theory” of

neoplasms and embryonic rest—mythical structures which the practical embryologist never

sees—and my theories of the origin and nature of cancer.

“If a doctrine be challenged,” said Pasteur, “it happens seldom that its truth or falsehood

cannot be established by some crucial test. Even a single experiment will often suffice either to

refute or to consolidate the doctrine.” By “ a single experiment” Pasteur meant a single scientific

experiment. A hundred experiments—or even a hundred thousand—of the sorts given by Dr.

Bainbridge (First Scientific Report) would not be crucial in any sense to a Pasteur.

Now, the doctrine of the asexual (trophoblastic) nature of cancer has been challenged,

although no scientific evidences of any kind have ever been adduced against its truth by official

cancer researcher, ex-researchers, anonymous leader-writers, newspaper scribes, or medical men.

Of course, the non-existent evidences against its truth cannot be produced, no matter how often or

how urgently they be demanded. This doctrine of the asexual (trophoblastic) nature of cancer,

however, as a scientific one, falls into line with those referred to by Pasteur; for it happens that its

truth or falsehood can be established by “some crucial test”—by a crucial test of the severest

scientific character. This natural test has not as yet been applied to this doctrine of the nature of

cancer, even by the writer, who with Pasteur believes that “science is prevision.” He has never yet

seen with his own eyes that which he now challenges the whole array or researchers and

writers—the pathologist, the official researchers, and the Executive of the Imperial cancer

Research, London—to refute. If, after due

238

scientific investigation, published, unlike many other things, with the scientific experiments and

evidences—if after this any many deny the truth of what is about to be affirmed on the word of a

scientific investigator of nearly twenty-nine years’ standing, then it will be the time for the writer

to make for himself the crucial test; and this shall be done, and the results published, as soon as

the necessary material has been obtained.

In Pasteur’s lectures* one may read:

“How can one avoid, for example the assumption that corresponding to a dextro-rotatory

body there must be a lЊvo-rotatory body, now that we know the cause of the dextro- and lЊvorotatory

character? That would be to doubt that an irregular tetrahedron had an enantiomorphous

image, or that for a right-handed screw there could be a corresponding left-handed screw, or that

a right hand was matched by a left hand. Therefore the elementary constituents of all living

matter will assume one or the other of the opposite asymmetries, according as the mysterious lifeforce

which causes asymmetry in natural bodies acts in one direction or the other. Perhaps this

will disclose a new world to us. Who can foresee the organization that living matter would

assume, if cellulose were lЊvo-rotatory instead of being dextro-rotatory, or if the lЊvo-rotatory

albumins of the blood were to be replaced by dextro-rotatory bodies? These are mysteries which

call for an immense amount of work in the future, and to-day (1860) bespeak consideration in

science.”

(1) It is, of course, a truism to state that the normal or somatic albumins are lЊvorotatory.

(2) In the pancreas gland they form for themselves the wonderful

*Pasteur, Louis: “On the Asymmetry of Naturally Occurring Organic Compounds,: in G.

M. Richardson’s “The Foundations of Stereo-Chemistry,” loc. Cit., p. 27. New York, American

Book Company (no date).

239

enzymes or ferments, trypsin and amylopsin, which help the intracellular enzymes to build them

up. (3)Cancer-cells attack and pull down the living lЊvo-rotatory albumins. (4) As racemic acid is

a mixture of dextro- and lЊvo-tartrates, which are attacked respectively by the mould

(Penicillium) and by yeast (Torula), and are separable by them—or, more strictly, by the ferments

they produce—so also a living human being, suffering from the natural phenomenon, not disease,

known as cancer, is in a sense a mixture of two sorts of albumins—the lЊvo-rotatory albumins of

the body, and the dextro-rotatory ones of cancer. (5) As Torula (yeast) attacks the lЊvo-tartrate,

so cancer-cells attack and pull down the lЊvo-rotatory albumins of the body; and as the mould

(Pencicillium) acts upon dextro-tartrates, so, when administered in adequate doses, and such as

are more than sufficient to neutralize the antitryptic ferments of cancer, trypsin and amylopsin,

the powerful pancreatic enzymes, attack in life and pull down the dextro-rotatory albumins of

cancer. (6) The albumins of cancer are stereo-isomers of those of the body, and the antithesis of

these; and as the latter are lЊvo-rotatory, the albumins of cancer are dextro-rotatary. (7) The

crucial test of the true nature of the albumins of cancer may be made by submitting a solution of

them to an examination in the polarimeter, when this solution will be found to rotate the plane of

polarized light to—the right!

The reader may not cherish the fond delusion that as yet there are no evidences of an

observational kind supporting the thesis that the albumins of cancer are dextro-bodies. There are,

and these are of a decisive nature, although not to be found in the published researches of any

official cancer research body. As the chemist Emil Fischer remarked, a ferment fits the sub-

240

stance upon which it acts “as a key fits a lock.” Now, on a previous page, reference has been

made to the “liquefaction of cancer” by means of potent hypodermic injections of trypsin. This

has been seen more than once by a London consulting physician, who sent me several tubes of

such liquid cancer from two patients suffering from epithelioma (skin-cancer). As already stated,

the accuracy of this observation has been confirmed by Professor F. Blumenthal, of Berlin, and

by the observation made by Captain Lambelle in the treatment of the two cases of lymphosasrcoma

and sarcoma.* Since no observation refuting this has ever been published, it stands as a

discovery doubly confirmed by observation. As hundred of medical men have found, trypsin does

not “liquefy” the normal somatic lЊvo-rotatory albumins of the body and blood, although in some

very advanced cancer cases, where they have been much injured by the action of the cancer, it

may not be without some action upon them. ‡ It follows from all this that, even without the use of

the polarimeter, the scientific

*Bainbridge’s sixth thesis on p. 32 of his “Scientific Report” reads: “That injectio

trypsini, in some cases, seems to cause more rapid disintegration of (to ‘liquefy,’ according to

Beard) cancerous tissue.” Since to this author it only “seems to do this, and since his report does

not contain a particle of evidence of the fact, I do not here cite—because there are none to

quote—any observations of his as confirming this undoubted fact. It suffices that Professor

Blumenthal and Captain Lambelle have witnessed it, the latter in two case. Possible, Dr.

Bainbridge never saw it at all, except in the microsocpical preparation, or preparations, which I

sent him in 1907.

‡ Such cases are probably much too advanced for success to be possible. A medical

friend has recently written to me that in every disease there is a point beyond which the case is

hopeless, and that blood-examinations in cancer cases under treatment were very desirable. In my

opinion, this again indicates the folly of operation on living cancer, for this does but stimulate its

growth and increase, until anon this point is reached. Then it is too late for any treatment to be

successful.

241

conclusion is warranted that the albumins of cancer, because liquefied in the living state by

adequate injections of trypsin, are dextro-bodies. This conclusion was, indeed, clearly enunciated

in the pages of the Medical Record of October 19, 1907, by the writer (compare Chapter VI.). It

has not been “generally accepted,” nor has it been refuted, but it has been ignored. Facts,

however, are awkward things, which in the long run cannot be set aside systematically, especially

by those who are supposed to be searchers after the truths of Nature.

242

CHAPTER XII

“SCIENCE IS PREVISION”

The science of stereo-chemistry, or chemistry in space was founded by Pasteur in 1860, He it was

who then set up what he termed “enantiomorphism” to describe the peculiarities of the isomeric

naturally occurring organic compounds. As every teacher in any medical school is well aware, the

science of chemistry plays too unimportant a part in the education of the medical student.

Therefore it is not strange that the stereo-chemistry of naturally occurring organic compounds

should have been so neglected in the practice of medicine, in what is wrongly designated

“medical science.” If the neglect be excusable in medicine, the like may not be siad for natural

science. Leaving physiology aside, for all the use hitherto made of its findings in zoology and

embryology, in animal biology in a wide sense, stereo-chemistry might never have had any

existence. For instance, practically all the beliefs—superstitions one might truly term them—of

embryologists, such as the germ-layer theory, the recapitulation theory, epigenesis or direct

development, etc., date back to a time when there was no known science of stereo-chemistry.

Except by the writer, no attempt has ever been made by any other embryology—least of all by

Hackel or Weismann—to bring the doctrines of embryology into line with the

243

canons of stereo-chemistry. But it may be taken as an axiom not open to ridicule that what Nature

cannot dispense with, that the scientific investigator may not ignore.

Now, in the course of my research career it has never been a maxim of mine to leave unto

others what I could do myself, and the like is true of the present situation also. Much more than

the asexual (trophoblastic) theory of cancer depends upon this crucial test. It is the ultimate basis

of the law and mode of animal development. By the canons of stereo-chemistry, no less than by

those of embryology, trophoblast and cancer must be made up of dextro-rotatory albumins—that

is, in simple words, these albumins in solution must in the polarimeter rotate the plane of

polarized light to the right, not to the left.

The foregoing theses are set up to define the position now, and the prophecy is made that,

when submitted to the polarimeter under strictly scientific conditions, it will be seen that the

albumins of cancer and of trophoblast rotate the plane of polarized light to the right, and not to

the left. The natural—that is, the scientific—means of destroying these dextro-rotatory albumins

in the living condition are sufficiently potent injections of trypsin and amylopsin.

A great investigator and thinker, August Weismann, once said that the investigator should

never forget that he stood upon his predecessors’ shoulders. Possibly the scoffers and the

anonymous writers stand upon nothing less substantial than a soap-bubble! They have kept

concealed carefully the foundations upon which their feet might be supposed to rest. Let them not

forget that my feet rest upon the mighty shoulders of Pasteur, and that, in their turn, his were

fixed firmly upon foundation-stones of the visible universe.

244

“I have, in fact,” said this genius, “set up a theory of molecular asymmetry—one of the

most important and wholly surprising chapters of science—which opens up a new, distant, but

definite, horizon for physiology.”

Again, Pasteur wrote:

“The characteristic of erroneous theories is that they are never able to present new facts;

and every time a fact of this nature is discovered, in order to take it into account, they are obliged

to graft a new hypothesis upon the old ones. The characteristic of true theories, on the contrary, is

of being the expression of the facts themselves, of being commanded and dominated by them, of

being able to foresee new facts certainly, because these by their nature are linked up with the

former—in a word, the characteristic of these theories is focundity.”*

As a “crucial test” of the true nature of a supposed malignant tumour it is inconceivable

that anything should be named beside the stereo-chemical one. To carry it out in some of the

many wealthy official cancer research laboratories would be a matter of ease for any stereochemist.

It would not be a serious drain on the vast funds of many of them to engage the services

of a trained stereo-chemist to do the work. The cost could hardly equal—certainly not exceed—

that of the publication of a single “scientific report.” The results obtained by a properly qualified

man—a scientific investigator in the true spirit as well as in the letter—would at all events tend to

close for ever one pathway leading to error (Huxley); and I venture to think—whether it be a

hanging matter or not—that it might open the eyes of the medical profession to the roadway

leading to scientific

*Vallery-Radot, RenО: “La Vie de Pasteur,” Paris, 1901, p. 352. What Pasteur termed “a

true theory” I identify as “a general principle.”

245

truth. After all, the naturally occurring organic compounds, as is now well known, except in

orthodox embryology, zoology, and pathology, are either lЊvo- or dextro-rotatory. If the

albumins of cancer be lЊvo-rotatory, and not, as I affirm, dextro-rotatory, then embryology as a

science, as the absorbing passion of a life of investigation, is in vain. Then trypsin and amylopsin

open left-handed locks. Then—but then only—there is some contradiction in the constitution of

the visible universe, as it has been determined by scientific men, who have worked for the love of

the labour. But if the albumins of cancer be dextro-rotatory, and its glycogen lЊvo-rotatory, then

let the scoffers hide their diminished heads.

Let trypsin and amylopsin be recognized to be what they are—the most powerful things

in the whole range of organic nature.

It can add nothing of import to what the writer has endured during a research life of

nearly twenty-nine years for daring to proclaim new truths of science without fear or favour, to

take this further decisive step, which must either damn his labours of the past twenty-three years,

or crown them with unfading glory; for it is my scientific conviction that that septuagenarian

army surgeon of the American Civil War, who had had the enzyme treatment for cancer himself

some four or five years ago (1906-07)spoke truly, when (December, 1908) he wrote words to the

effect that the treatment of cancer by the ferments trypsin and amylopsin would in the end replace

the knife—that this scientific treatment would go on, and be ever more developed, after he and I

had done our labours and were at rest.

246

APPENDIX A

THE LIVERPOOL LECTURE:* GERM CELLS AND THE CANCER PROBLEM

Last evening Dr. John Beard, University Lecturer on Comparative Embryology, Edinburgh,

delivered an address at the Liverpool University Anatomical Society upon “Germ-Cells in

Relation to Malignant Disease.” In the opening statement reference was made to the supposed

cancer parasite, and the curative serum recently brought forward by Doyen, of Paris; to the secret

treatment now being used by Professor Opitz, of Marburg; and to the recently issued pessimistic

report of the American Cancer Commission. There was, of course, remarked the speaker, no

cancer parasite; but did such a thing exist, the Parisian one could not be the real article, for a wellknown

pathologist was about to publish an account of what he (the pathologist) held to be the

only true cancer parasite. Thus one advocate of the parasitic theory refuted another, and the

American Cancer Commission denied, with the great majority of pathologists, the existence of

any cancer parasite. In the telegraphic summary of the American report there were only three

statements not open to challenge. These were that the best remedy was early operation, that

cancer was not due to any parasite, but that it was probably connected with errors of

development. Notwithstanding all that

*From the Liverpool Daily Post and Mercury, January 21, 1905.

247

The American Commission might say, the nature of cancer as an irresponsible asexual generation

or trophoblast had been known for two and a half years. The speaker proceeded to give an

account of his own work upon the history and origin of the germ-cells, from which it had been

established beyond question that these were pre-embryonic in origin, arising upon an asexual

foundation or trophoblast, and that by the self-sacrifice of one an embryo was unfolded to contain

and to nourish the other germ-cells for a certain brief span of time. In every case examined it had

been found that a varying percentage of the germ-cells failed to reach the right place in the body,

and these might be found in almost any organ or position. At first sight it had seemed that any of

these might later on give rise to a tumour, benign or malignant, for they represented, in fact, the

“lost germs” of the pathologists. The speaker’s earlier work upon the life-cycle, published

between 1894 and 1898, was next briefly described. These researches had established that, prior

to the appearance of an embryo or sexual form, there arose an asexual foundation—the

trophoblast—upon which the germ-cells and embryo came into being. In any normal case, at a

certain definite period, the embryo was able to suppress the asexual foundation, and the latter

slowly degenerated. If however, the embryo were absent or very abnormal, the trophoblast might,

and often did, become a very deadly form of cancer—chorio-epithelioma. The two generations

had different nutritions—a fact of extreme importance—and the “digestion” of a cancer

resembled that of the trophoblast of normal development. An account was then given of the

speaker’s conclusions as to the origin of tumours, and their relation to identical twins, triplet, etc.

It was shown that each such identical twin, triplet, etc., was due to the independent development

of a single germ-cell, and not, as was commonly held,

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