Two years ago the present writer ventured to put forth a small book in which cancer was considered from quite a different standpoint from that commonly held by the profession and laity. The kindly reviews of the medical press indicated that, while this was antagonistic to accepted views, there was warrant for such an investigation, in view of the steadily increasing mortality from cancer all over the world, under the present mode of purely surgical treatment.

In these two years there has been very active study of cancer together with a campaign of education in regard to the desirability and necessity of operating very early in the disease, and consequently an increased surgical activity. In spite of all this, or possibly on account of it, the mortality from cancer during 1915 has been appreciably higher than the average yearly death rate during the preceding five years. It would seem, therefore, that there was increasing necessity for the study of the conditions which cause the disease, as found in the human system, rather than an increased study of pathological specimens and experimentation on animals.

During these two years the writer has sought to understand the disease better by constant clinical observation in private and public practise and by wider acquaintance with literature, and has been only strengthened and confirmed in the views which were set forth in the former small book, and which he has held and practised for over thirty years.

With some care he has prepared a second series of lectures which were given to practising physicians attending the regular Wednesday afternoon clinics at the New York Skin and Cancer Hospital in November and December, 1916, and which are now submitted to the profession at large.

The reasons for presenting the medical aspects of cancer were given in the former volume, also the hesitancy I felt lest, from an imperfect carrying out of the necessary lines of internal treatment, harm might be done or time lost in which there might possibly be some gain from surgical treatment.

But the more I have studied cancer in the living and dying subject, and the more I have tried to compass literature and analyze statistics, the more have I felt compelled to push forward a campaign of education in regard to the basic causes of the disease, ever with the thought of prophylaxis, by inculcating right living.

It has been painful to me to present the mortality statistics in such an unfavorable light as is seen in the following pages: but truth is truth and truth must prevail.

No one can study carefully the remarkable book of Hoffman on “The Mortality Statistics from Cancer Throughout the World,” and Williams’ “Natural History of Cancer,” and Wolff’s “Die Lehre von der Krebskrankheit,” and the special volume concerning “Mortality from Cancer and Other Malignant Tumors in the Registration Area of the United States,” recently issued by the Bureau of the Census, without feeling that something more should be attempted to arrest the progress of this direful disease.

This seems all the more necessary and proper in view of the gratifying decrease of mortality which has been obtained in tuberculosis, of 27.8 per cent from 1900 to 1915, by diligent and intelligent medical supervision.

The problem of cancer is indeed a great one, but surely it is not to be solved by greater activity along the lines under which its mortality has steadily risen 28.7 per cent during the same period just mentioned, in which tuberculosis has fallen so greatly. If this death rate of both diseases should continue the same for fifteen years more, cancer would outstrip tuberculosis in its actual fatality. Reason would seem to indicate the necessity of a radical change in our point of view and a complete change in our line of treatment.

In the text of these and former lectures I have endeavored to show why and how cancer should be regarded from its medical aspects, and to illustrate by a few cases some of the results which could be obtained from this line of procedure. There is absolutely no claim or suggestion that the cancer problem has been solved, but only an aim to put the real cancer problem in such a light that others might follow and develop the subject in a manner fitting to the very great importance of the end so strongly desired by all, namely, the checking of the steadily rising morbidity and mortality of cancer.

Laboratory studies are of practical value as they supplement and enlighten clinical observation. The microscope and test tube have accomplished much for medicine and with animal experimentation have undoubtedly rendered inestimable service in its scientific advancement. But divorced from the practical study of patients they may fail in the ultimate end desired. In these and the former lectures I have endeavored to indicate certain lines of scientific investigation along which much more laboratory effort is desirable, in order to determine more definitely the metabolic and blood conditions which lead up to cancer. These I have attempted to follow to a limited degree in many cases, and found them of great service in their management.

In some of the reviews of the former volume some adverse criticism was given on account of the absence of microscopic findings confirming the diagnosis of the cases reported. I explained at the time that any attempt to excise portions of tissue for such study would at once endanger the patient and imperil the success of treatment, by giving occasion to metastases, from the opening of blood vessels and lymphatics. This matter is treated of more fully in the present lectures. It is to be remembered that the vast majority of operations for cancer are undertaken upon a purely clinical diagnosis, and it may be undeniably stated that not one half of them are confirmed subsequently by competent microscopic evidence, except, of course, in properly equipped hospitals. In some of the cases now presented pathological proof has been presented, while in every one the clinical signs were so unmistakable that no one could possibly doubt the correctness of the diagnosis.

A number of reviewers of the former volume regretted that fuller and more definite statements had not been made in regard to the exact diet and mode of treatment employed in the cases reported. I had explained that it was very difficult to develop all this in the brief compass of a few lectures; indeed I may now say that it would take many times the space and time which could be given to it to develop fully all the possibilities and requirements of a dietary and medicinal treatment in every case. The object rather was to inculcate the basic idea of the true causation of cancer, leaving it to the practitioners present to carry out the measures calculated to reach the desired end. In order to make matters very clear I may occasionally have repeated some things said in the former lectures, and some repetition may be found in these successive lectures; but this will be pardoned when it is considered how necessary repetition often is in order to establish correctly a new thought. The cases were given as illustrations of what could be accomplished along the lines indicated.

In the present lectures I have endeavored to carry the thought still further and to develop the fundamental principles on which treatment and prophylaxis are to be based. I have also been much more explicit in regard to diet, and have given the exact dietary which has been used with advantage in very many cases in private and hospital practise. In regard to medical treatment I have also been more definite, although it would be quite impossible to indicate all the different remedies which those and other patients have taken over varying periods of time, to meet different requirements of the system and individual peculiarities. I think and believe, however, that sufficient data are given to enable the competent and careful physician, who is able and willing to give sufficient time and adequate attention to these cases, to accomplish the same results, provided he has thoroughly mastered and applied the matter contained in these two small books.

I fully realize the responsibility I have undertaken in gathering and revealing the evidence of the unsatisfactory results of the manner of regarding and treating cancer in years past, and certainly would not have done this were I not so strongly assured that there was something better to offer. How far I am right in my thesis I now leave to the kindly judgment of my professional brethren. My only hope is that I may, in some measure, have assisted in stemming the tide of the fearful ravages made by cancer, and that others may investigate still more deeply along the lines of its medical aspects, with increasingly satisfactory results.