Disease and Its Causes, William Thomas Councilman [best historical fiction books of all time .txt] 📗

structure resembles structures found in the body at some period of life. The tumor cells, like all other cells of the body, grow by means of the nutriment which the body supplies; they have no intrinsic sources of energy. The great problem is what starts the cells to grow and why the growth differs from that of normal tissue, why it is not regulated and coördinated as are other forms of growth. When a small piece of the skin, for instance, is cut out growth as rapid as that in tumors takes place in the adjoining cells, but it ceases when the loss is restored. The same is true when a piece of the liver is removed.

Various hypotheses have been formed to explain the tumor, all of them of interest, and they have had great importance in that the attempt to prove or disprove the hypothesis by continued observation and experiment along definite lines has produced new knowledge. The various theories as to cause may be divided into three heads.

The parasitic theory. This supposes that a living parasite invades the body, and by its presence excites the cells of certain tissues to grow in tumor form. It is known that active growth of the cells of the body can be excited in a number of ways, by chemical substances such as certain of the coal tar products, and that it often takes place under the influence of bacteria. It is further known that parasites can produce tumor-like growths in plants. The large, rough excrescences on the oaks are produced by a fly which lays its eggs in or beneath the bark, and the larva which develops from the egg secretes a substance which causes the cells about it to multiply, and a huge mass is formed which serves the developing insect for both food and protection. Large tumor-like masses are formed on the roots and stalk of cabbages as the result of the invasion of the cells by a minute organism: the tumors of olive trees are due to a bacterium; the peculiar growths on cedar trees, the so-called "witches' brooms," are produced by a fungus, and there are many other such examples. These have many analogies with tumors in animals. Under the stimulus of the parasite the cells seem to have unlimited growth capacity and a greater nutritive avidity than have the normal plant cells; the character of the mass produced differs as does the tumor, to a greater or less extent, from the normal growth; on the cedar, for instance, the "witches' broom" consists of a thick mass of foliage with small stems less green than the usual foliage, the leaves wider and not so closely applied to the stems. The entire plant suffers in its nutrition and a condition resembling tumor cachexia3 is produced, and there are no fundamental differences between the plant and animal tumors. Support has also been given to the parasitic theory by the discovery within tumor cells of bodies which were supposed to be a peculiar sort of parasite. If the truth of the parasitic theory could be proved, there would be justifiable expectation that the tumor disease might be controlled as are many of the parasitic diseases, but the hypothesis awaits the demonstration of its correctness. Despite the study of tumors which is being actively pursued in many places and by the most skilled investigators, no parasites have been found in animal tumors; the objects previously described as parasites have been found not to be such. It is difficult to bring in accord with the parasitic theory the great variation in tumor structure, the relation of certain tumors, as the malignant tumors of the breast and uterus, with the age of the bearer, the congenital tumors which develop in intra-uterine life, and there are many other conditions which oppose the theory.

The traumatic4 theory. There is much in favor of this. In a certain number of cases tumors do develop at the site of injuries. The coincidence of injury and tumor is apt to be overestimated because of the strong tendency to connect succeeding events. Tumors are not most common on those parts of the body which are most exposed to injury. They are rare, for instance, on the hands and feet, and very rarely do they appear at the site of wounds caused by surgical operations. For those tumors which develop in intra-uterine life it is difficult to assign injury as a cause. There does, however, seem to be a relation between tumors and injuries of a certain character. The natives of Cashmere use in winter for purposes of heat a small charcoal stove which they bind on the front of the body; burns often result and tumors not infrequently develop at the site of such burns. Injuries of tissue which are produced by the X-ray not infrequently result in tumor formation and years may elapse between the receipt of the injury and the development of the tumor. These X-ray injuries are of a peculiar character, their nature but imperfectly understood, and the injured tissues seem to have lost the capacity for perfect repair.

In regard to the possible action of both injuries and parasites in causing tumors, the possibility that their effects on different individuals may not be the same must be considered. In addition to the trauma or the parasite which may be considered as extrinsic factors, there may be conditions of the body, intrinsic factors, which favor their action in tumor development. The peculiar tissue growth within the uterus called decidua, which occurs normally in pregnancy and serves to fasten the developing ovum to the inner lining of the uterus, may be produced experimentally. This growth depends upon two factors, an internal secretion derived from the ovary and the introduction into the uterus of a foreign body of some sort; in the case of pregnancy the developing embryo acts as the foreign body. It is not impossible that some variation in the complex relations which determine normal growth may be one factor, possibly the most important, in tumor formation.

Another theory is that the tumor is the result of imperfect embryonic development. The development of the child from the ovum is the result of a continued formation and differentiation of cells. A cell mass is first produced, and the cells in this differentiate into three layers called ectoderm, entoderm and mesoderm, from which the external and internal surfaces and the enclosed tissues respectively develop, and the different organs are produced by growth of the cells of certain areas of these layers. The embryonic theory assumes that in the course of embryonic development not all the cell material destined for the formation of individual organs is used up for this purpose, that certain of the embryonic cells become enclosed in the developing organs, they retain the embryonic capacity for growth and tumors arise from them. There is no doubt that something like this does take place. There is a relation between malformations due to imperfect development of the embryo and tumors, the two conditions occurring together too frequently to be regarded as mere coincidence. Also tumors may occur in parts of the body in which there is no tissue capable of forming structures which may be present in the tumors. The theory, however, is not adequate, but it may be among the factors.

The problems concerned in the nature and cause of tumors are the most important in medicine at the present time. No other form of disease causes a similar amount of suffering and anxiety, which often extends over years and makes a terrible drain on the sympathy and resources of the family. The only efficient treatment for tumors at the present time is removal by surgical operation, and the success of the operation is in direct ratio to the age of the tumor, the time which elapses from its beginning development. It is of the utmost importance that this should be generally recognized, and the facts relating to tumors become general knowledge. Tumors form one of the most common causes of death (after the age of thirty-five one in every ten individuals dies of tumor); medical and surgical resources are, in many cases, powerless to afford relief and the tumor stands as a bar to the attainment of the utopia represented by a happy and comfortable old age, and a quiet passing. Every possible resource should be placed at the disposal of the scientific investigation of the subject, for with knowledge will come power to relieve.

Chapter IV

The Reactions Of The Tissues Of The Body To Injuries.—Inflammation.— The Changes In The Blood In This.—The Emigration Of The Corpuscles Of The Blood.—The Evident Changes In The Injured Part And The Manner In Which These Are Produced.—Heat, Redness, Swelling And Pain.—The Production Of Blisters By Sunburn.—The Changes In The Cells Of An Injured Part.—The Cells Which Migrate From The Blood-Vessels Act As Phagocytes.—The Macrophages.—The Microphages.—Chemotropism.—The Healing Of Inflammation.—The Removal Of The Cause.—Cell Repair And New Formation.—New Formation Of Blood-Vessels.—Acute And Chronic Inflammation.—The Apparently Purposeful Character Of The Changes In Inflammation.

Injury and repair have already been briefly considered in their relation to the normal body and to old age; there are, however, certain phenomena included under the term inflammation which follow the more extensive injuries and demand a closer consideration than was given in Chapter II. These phenomena differ in degree and character; they are affected by the nature of the injurious agent and the intensity of its action, by the character of the tissue which is affected and by variations in individual resistance to injury. A blow which would have no effect upon the general surface of the body may produce serious results if it fall upon the eye, and less serious results for a robust than for a weak individual.

Most of the changes which take place after an injury and their sequence can be followed under the microscope. If the thin membrane between the toes of a living frog be placed under the microscope the blood vessels and the circulating blood can be distinctly seen in the thin tissue between the transparent surfaces. The arteries, the capillaries and veins can be distinguished, the arteries by the changing rapidity of the blood stream within them, there being a quickening of the flow corresponding with each contraction of the heart; the veins appear as large vessels in which the blood flows regularly (Fig. 11). Between the veins and arteries is a large number of capillaries with thin transparent walls and a diameter no greater than that of the single blood corpuscles; they receive the blood from the arteries and the flow in them is continuous. The white and red blood corpuscles can be distinguished, the red appearing as oval discs and the white as colorless spheres. In the arteries and veins the red corpuscles remain in the centre of the vessels appearing as a rapidly moving red core, and between this core and the wall of the vessels is a layer of clear fluid in which the white corpuscles move more slowly, often turning over and over as a ball rolls along the table.

If, now, the web be injured by pricking it or placing some irritating substance upon it, a change takes place in the circulation. The arteries and the veins become dilated and the flow of blood more rapid, so rapid, indeed, that it is difficult to distinguish the single corpuscles. In a short while the rapidity of flow in the dilated vessels diminishes, becoming slower than the normal, and the separation between the red and white corpuscles is not so evident. In the slowly moving stream the white corpuscles move much more slowly than do the red, and hence accumulate in the vessels lining the inner surface and later become attached to this and cease to move forward. The attached corpuscles then begin to move as does an amoeba, sending out projections, some one of which penetrates the wall,