As has been already shown in these and previous lectures, the death rate from cancer has been steadily and alarmingly increasing in almost every locality, ever since statistics have been collected. The attempt has been made from time to time to show that this increase is not real, but is apparent, and that the error arises from three main causes. These are: 1. The increased longevity in general, leading to the existence of more people of the cancerous age; 2. Improved diagnosis; and 3. More careful death certification.

Time does not allow us to go into this matter very fully, but this erroneous impression is so widespread, and one so constantly meets it in conversation, that it is desirable to present briefly the grounds and proof for an absolute denial of the assertion that there has been very little or no real increase in the mortality from cancer.

First, it may be stated that most of the arguments quoted against the correctness of statements regarding the steadily rising death rate of cancer date back to King and Newsholme, who, in 1893, some twenty-three years ago, attempted a study of early statistics and drew certain conclusions from them. This was long before the era of careful research and reliable diagnosis and statistics, and can have little, if any, weight. Bashford and Murray in the Second Scientific Report of the Imperial Cancer Research Fund, in 1905, attempted to show the same thing. But even this was eleven or twelve years ago, and the utter fallacy of the sophistical arguments appears in the absolute, steady increase in the death rate of cancer as shown by official tables from many countries, and as especially collected and seen in the remarkable book by Hoffman on “The Mortality from Cancer Throughout the World.”

It is impossible in a brief lecture to give even a faint idea of the immense and valuable amount of research represented, and consequently the most useful information furnished in this monumental work; the material is taken from original documents with new information, freshly obtained from original sources. All is given with an impartiality and clearness which are refreshing when compared with some recent writings on the subject. With the immense accumulated data on record, some of which will be referred to, all showing a steady rise of mortality up to the present time, and that during a period of especial study of cancer such as the world has never known before, it is quite unreasonable and impossible to believe that this advance is only apparent, and that it is influenced by the three suppositions mentioned. While accuracy of diagnosis may be important in early cancer, it is certain that in late stages and at death, from which the various mortality tables are taken, there is rarely any question as to the diagnosis. There is evidence, however, to show that cancer is increasing even more rapidly than appears from mortality statistics.

In 1900 the recorded mortality from cancer in the registration area of the United States was 63 per 100,000 living, and in 1914 it had risen to 79.4, or an increase of 16.4 per 100,000 living, or over 26 per cent. While in 1915 there were 54,584 deaths from cancer against 52,420 in 1914 in the registration area of the United States, or 2,164 more deaths. The total number of deaths in the entire United States is estimated at about 80,000 last year. The death rate in 1915 was 81.1 per 100,000, or a rise of over 28.7 per cent since 1910. The increase during this past year has been 1.7 per 100,000 living, while the gross increase for the preceding five years was but 5.6 per 100,000, or less than an average of 1.2 per 100,000 each year. So that the great activity in cancer education and in operative surgery during that year has succeeded in raising the death rate from cancer by .5 per 100,000 over the average of the preceding five years!

It is to be noted that this increasing mortality from cancer has been steady and constant, though with slight diminution occasionally, some years ago, before the great activity in cancer research, cancer control, and cancer surgery. All this would certainly indicate some deep-seated cause of the malady which had not been recognized; indeed the mortality during the last five years was as follows: 1911, 74.3; 1912, 77; 1913, 78.9; 1914, 79.4; and in 1915, 81.1 per 100,000.

It may be of interest to know that the mortality from cancer varies very greatly in different portions of the United States, and it would be instructive to investigate the cause; but the data for this do not exist. The highest death rate for 1914 was in Vermont, 109.9; Maine had 107.6; Massachusetts, 101.8; New Hampshire, 100.8; California, 97.9; all against the general average of 79.4 per 100,000 inhabitants in the registered area of the United States. The lowest among the registration States was Utah, with 45.8 per 100,000 living. In New York State the deaths from cancer in 1914 were 88 per 100,000 population in the cities and 96.1 in rural districts.

Many cities, of course, show a higher death rate from cancer than the average, owing in part to the number of patients coming for treatment, and also to the more complex life of the cities, with the greater temptations leading to the disturbances of metabolism causing cancer. Thus, the average of twenty large cities gives a rise in death rate of cancer from 48.6 from 1881 to 1885, to 89.3 per 100,000 living in 1913.

The following table gives the average cancer mortality from 1906 to 1910 per 100,000 in certain American cities:

In the city of New York, as given by the Board of Health Bulletin, there were from July 1, 1915, to June 30, 1916, 4,672 deaths from cancer, or an average of just 12.8 persons per day; in the last six months, July 1 to December 31, there were 2,264 deaths from cancer, 990 males and 1,274 females, with a daily average of a little higher than last year.

It is readily understood that many factors enter into the study and proper understanding of the statistics of cancer, such as age, sex, location of the lesion, etc., and the limits of a lecture do not permit any adequate presentation of the subject, but a few points may be mentioned.

Thus, in regard to age, the States which represented the greatest number of deaths from cancer, Vermont with 109.9 and Maine with 107.6, show that the proportion of individuals over 45 years of age was over 27 per cent, compared with 17.7 per cent for Kentucky and 16.2 per cent for Montana, which latter gave almost the lowest mortality from cancer.

The same is true somewhat in regard to sex, although sufficient data are not at hand to show the relative number of living males and females in the different States. We know, of course, that the great preponderance of cancer in females is due to that affecting the breast and uterus, and where females preponderate in the population the total cancer mortality would be the highest.

The location of the lesion has also a bearing upon the understanding of statistics. Thus in Norway, for some unexplained reason, cancer of the stomach caused the great mortality of 60 per cent (66.9 males, 52.9 females) of all cancer mortality, while cancer of the breast caused but 7.6 and of the uterus 16.2 per cent of the whole, the general rate being 93.9 per 100,000 inhabitants. In the United States, in 1914, cancer of the stomach and liver caused the deaths of 37.9, cancer of the breast 10, and cancer of the female genital organs 14.2 per cent of all deaths from cancer.

There are other points also to be taken under consideration in connection with cancer statistics which we cannot even touch on and can only mention one, namely, the physical condition; for the disease is known to be more frequent proportionately among the better nourished and well-to-do classes, etc.

Turning to other countries, we find abundant confirmation of the persistent and considerable increase in the mortality from cancer, in many cases much greater than has occurred in the United States; and in nearly all of them the increase can be recognized as commensurate with the progress or advance of so-called civilization, especially as emphasized in city life.

England and Wales afford us about the most satisfactory statistics in this regard. W. R. Williams has given a valuable table, already referred to in connection with food, showing the prevalence of cancer and its relative increase in England and Wales from 1840 to 1905. In 1840 the cancer death rate was 17.7 per 100,000 living, with a proportion of 1 to 129 of total deaths. The deaths from cancer increased with almost a perfect regularity until in 1905 there was a mortality of 88.5 per 100,000 living, and 1 in 17 of the total deaths was due to cancer, as against 1 to 129 in 1840. The total proportion of deaths from all causes is given for each year, and while the population has only a little more than doubled in these 65 years, the deaths from cancer have increased from 2,786 to 30,221, or over ten times the number; the rate of cancer deaths per 100,000 living had increased five times, while the ratio of deaths from cancer to total deaths had multiplied more than seven times. Since 1905 the cancer death rate in England and Wales has advanced to 99.3 per 100,000 in 1911, and to 105.5 in 1913, and in London the cancer mortality is 114.9 per 100,000 population.

Statistics from other countries, collected by Hoffman, show the same steady increase. I will not weary you with much more of statistical detail, but it is interesting to record a few of the more striking facts, illustrating the universal increase in the cancer death rate during these later years of cancer research and active surgery. The data are from 1896 to 1910, and the countries will be arranged according to proportionate increase in the death rate per 100,000 population. Thus, Ireland comes first, with an increase of 20.7, which is explained in part by the emigration of younger persons, leaving more of the cancer age; next comes Denmark, increased from 118.9 to 137.3, or 18.4 per 100,000 population; then the German Empire with an increase of 13.4; Hungary, 12.9; Italy, 12.7; Holland, 11.6; Norway, 10.9; Austria, 9.4; and France from 97.3 to 102.7, or only 5.4 per 100,000 population. During this same period the deaths from cancer in the United States have increased about 18 per 100,000, or almost as much as the highest of the countries mentioned.

In regard to the bearing of all these figures upon the alleged apparent and not real increase of cancer, I may quote from Hoffman: “The evidence is so convincing” as to the reality of the increase of cancer “that it may be safely maintained that no other statistical conclusion in medicine is so concisely and incontrovertibly established as this: in any event, no satisfactory evidence is available to successfully contradict this conclusion at the present time. If all this evidence, however, is inconclusive and worthless, then no alternative remains but to discredit the statistical returns of every country in the world with regard to any single disease or group of diseases, although the returns are accepted as approximately accurate in regard to every other important cause of death.”

In order that the real increase in the mortality from cancer may be readily understood, the accompanying chart (now hanging before you) has been copied from that given in the volume of the United States Mortality Statistics for 1914, and it will help to visualize what has just been stated. The data for 1915 have been added through the courtesy of Mr. Rogers, Director of the Census, in a personal communication.

The striking fact brought out in this chart is the comparison between the steadily diminishing death rate of tuberculosis, through careful medical supervision, and the steadily increasing death rate of cancer, under surgical care. While the mortality of tuberculosis has fallen from 201.9 persons in 1900 to 145.8 in 1915, or 56.1 less deaths in each 100,000 population, or over 27.7 per cent, the cancer death rate has risen in the same time from 63 to 81.1 per 100,000, or over 28.7 per cent. They have therefore approached each other by 56.4 per cent, and unless this rate of progression is changed in some way, the lines will have crossed one another in less than fifteen years more, even as that for organic heart disease has already crossed that of tuberculosis, it having risen almost 27 per cent.

Another interesting lesson to be drawn from this chart is that the death rate from organic heart disease, nephritis, and apoplexy have all risen coincidently with that of cancer, only that the rate of the latter has outstripped them all. If we accept the fact that the increasing death rate of these three diseases is largely the result of modern civilization, especially from erroneous eating and drinking, it would appear that cancer is due to the same cause.

Realizing, then, that the mortality of cancer is materially and steadily rising, in spite of most diligent research by innumerable honest and capable scientists, with the expenditure of vast sums of money and countless animal lives, and in spite of the work of ardent, earnest, and capable surgeons, who have failed to stay the terrible progress of the disease, let us briefly study some of the reported statistics in regard to the results of operative interference in cancer.

It may be first stated that this is a most difficult task, so different are the reports from different surgeons. There are many elements which affect the statistics relating to the surgery of cancer. First of these is, perhaps, the stage of the disease at which the operation is performed. Second, the results vary, of course, immensely with the knowledge and skill of the operator and the excellence of the technique. Third, the class of cases operated on has much to do with favorable or unfavorable results reported. Fourth, the length of observation after operation is always to be considered in connection with surgical statistics. Finally, the optimism of the reporter must be regarded in weighing the true value of reports as to ultimate results. We will briefly consider these points.

First, as to the stage of the disease at which the operation was performed. We have seen in this and previous lectures that the lesion which we call cancer is but a result of a deranged blood state, and is not a purely local process, a something simply to be removed surgically in order to have the patient get well and remain well. For one sees plenty of cases where there were recurrences even after the very earliest operations possible. But the claims put forth that favorable results are conditioned on very early operations are so strenuous and persistent that we must believe that a measure of the favorable results can be thus accounted for. We know, of course, that very late in the disease operations are out of the question. It is a little curious, however, that most of the pictures shown, statistics presented, and arguments adduced by these ardent advocates of early operation relate to cancer of the skin, especially about the face, which cause hardly 2 per cent of all the deaths from cancer in various countries; whereas those who see much of cutaneous epithelioma know that if properly handled it is generally a comparatively mild affair and relatively easily cured without surgical operation, as you have so constantly seen in this clinic in past years. But mortality statistics are greatly influenced by the class of cases which the operator takes, and so if epithelioma of the skin is included, the ratio of cures will be high. Selected cases also always give more favorable statistics.

Second, the knowledge and skill of the operator and the perfection of technique undoubtedly influence surgical statistics. The ordinary practitioner or surgeon cannot hope for as favorable results in many operations on cancer as can those who are past masters in this line, and these latter are the ones who furnish the favorable statistics.

Third, the class of cases operated on affects surgical statistics very greatly. While epithelioma of the face, and even of the lip, when well removed, may yield most favorable statistics, cancer of the breast, uterus, stomach, intestines, gall bladder, etc., yield increasingly unfavorable statistics, as will be presently seen.

Fourth, the duration of observation after operation affects very seriously the validity of statistics. Not long ago three years’ freedom from disease was considered the time to regard a cancer as permanently cured; but this time has been lengthened more and more, by the observation of any number of cases where the disease has recurred even long afterwards, and reliable observers are now very chary in expressing an opinion as to the final cure of a cancer. This will be more fully considered in another lecture.

Finally, the optimism of the reporter seems often to have something to do with the reliability of surgical statistics. This need hardly be discussed. The older and more experienced the surgeon the less confident he is of having actually cured cancer with the knife. At a discussion in the New York Academy of Medicine, some years ago, Dr. Robert F. Weir said that the late Dr. Agnew, a celebrated surgeon of Philadelphia, had remarked, just before his death, that he doubted if he had ever been justified in an operation upon cancer, and he, Dr. Weir, stated that he could almost say the same.

Turning now to the actual statistics of operative surgery on cancer, we will find that the percentage of reported cures varies very greatly, in accordance with the points just stated. It is understood, of course, that no accurate statements can be made from statistics in reference to the actual mortality of cancer in any location, partly owing to the paucity of figures, and partly because the stages and extent of the disease differ so greatly, and the results vary with the previous duration of the lesion and the period of observation after the operation.

Cancer of the skin presents the best operative statistics of any region, and the claim is made that all cases are curable if operated on early enough and rightly. While this is not wholly true, it is certain that if all lesions which one chooses to call “pre-cancerous” are thoroughly extirpated very early, and included in the statistics, the percentage of cures can be reported as very high. So that it may be said that, taking all statistics together, including very small as well as large lesions, the favorable results, that is permanent cures of lesions which can be truly called cutaneous epithelioma, may run as high as 75 per cent. But against this is to be set the fact that a very large share of these cases, taken early and by competent persons, are equally amenable to cure by lighter measures, without the horrible disfigurement which one sometimes sees after purely surgical procedures.

Cancer of the lip, when taken early and treated radically, including gland extirpation, also yields a fairly satisfactory result, depending, of course, on the stage of the disease, or amount of involvement of tissue and glands, and the completeness of the operation. But while some operators have claimed 75 per cent of cures, Hertzler makes the percentage of permanent cures not much over 25 per cent. And here again, if taken very early and treated correctly, many of these cases yield without the knife, whereas very late cases may be practically inoperable.

When, however, we come to cancer within the mouth, the tongue, etc., it is quite a different story, and the end results of surgery are commonly unsatisfactory. Certain European surgeons have reported an operative mortality in cancer of the tongue as high as 36 per cent, while recurrences are the rule, and really permanent cures the very great exception.

As before stated, it is extremely difficult to give any true and accurate estimate of the real end results from operative surgery as ordinarily performed in cancer affecting various regions. The obvious reason of this is that most of our statistics are from those who are especially occupied with the disease under most favorable hospital facilities, and also certain statistics may be from selected cases; moreover, operators are naturally inclined to report mainly satisfactory results, while the other aspect of the case is seldom presented. Aside, then, from superficial epitheliomata, about the only locations in which there is even a fair chance for the patient under the knife are the breast, uterus, and rectum, and for these large statistics are available; but again these are unsatisfactory, as they vary so greatly.

The reported statistics of cancer of the breast are very provoking. Individual operators have claimed as high as 50 and even 70 per cent of cures (Rodman). Murphy, on the other hand, on a basis of end results states that the plump woman invariably succumbs, and that Paget’s disease ends fatally in 90 per cent of cases. Hildebrand mentions 606 operations in which the percentage of permanent cures varied from 15 to 23 per cent; late recurrence is not uncommon in cancer of the breast. He thinks that 35 per cent is the maximum possibility for permanent cures. He would be very suspicious of any higher figure. Judd reports that of 266 cases of carcinoma of the breast in the Mayo Clinic, which could be traced, 39.8 per cent were reported as alive at the end of five years, although there was recurrence in 6 cases.

Lubhardy, in an article on recurrence, in 1902, states that 1,321 recurrences were known to have occurred after 2,107 operations, or nearly 63 per cent, 4 per cent of which were late recurrences; he does not mention the number “cured” nor the number of patients untraced. Unfavorable results in breast cancer are seldom published. Dr. H. C. Coe in a discussion quotes the experience of a friend who had operated on between 200 and 300 cases of cancer of the breast with exactly 13 recoveries.

Levin (Med. Record, Jan. 27, 1917, p. 175) has recently made some startling statements in regard to the recurrence of carcinoma after breast operations. While granting that early cases without lymphatic involvement yielded good results, he states that these represented at the utmost only 25 per cent of the cases operated on: 75 per cent were advanced cases with involvement of the skin and lymph glands. Of these barely 25 per cent could be cured by radical operation, and in 52 per cent of the advanced cases operated on metastases appeared in distant organs without local recurrences. The longer the period after the operation the greater was the number of recurrences.

He quoted Heurtaux, a French surgeon, who had followed up 284 cases which he himself had operated on during the previous 20 years. H. stated that four years after operation 43 per cent remained free of the disease, eight years after only 16 per cent, and 20 years after only 2.5 remained free from the disease. There were a great many cases of carcinoma of the breast reported in which the patient died from metastasis in different organs without local recurrence 10, 15, and 20 years after the operation. The late metastases most frequently took place in the skeleton, which was due to the fact that skeletal lesions might continue a long time without causing clinical symptoms.

Dr. Levin confirmed the skeletal involvement by roentgenograms of ten cases of carcinoma of the breast observed during the last two years, in which it was found that the metastases must have been present at the time of operation.

Dr. Willy Meyer in the discussion said that physicians had long been too prone to consider carcinoma a local disease, and when he found signs of metastatic infection he never felt that he could expect anything from an operation.

We can only state with Hartwell and others that every especially favorable series of cancer cases, and this applies particularly to the breast, should be subject to close scrutiny. Why did this or that operator get marvelous results and an equally efficient man get very poor ones?

There are also many factors to be considered. How many cases were of the senile or scirrhous type? How many of the tumors removed were proved microscopically to be cancer? If one operates radically on every tumor or swelling in the breast, however small, the end results will, of course, be more favorable; for undoubtedly many innocent lesions, chronic mastitis, adenoma, cystic tumors, etc., are often removed unnecessarily. The question also arises as to what was the after care, and what steps were taken to prevent recurrence? In view of the statement of Hildebrand, just quoted, that 35 per cent is the maximum possibility for permanent cure, and considering the terrible pain and miserable death one so constantly sees in recurrences, it really becomes a question as to the advisability of surgical interference.

The opinion has been expressed more than once by those who have watched the disease, that if left alone, with ordinary medical care, the entire average of 100 cases would be better, as to length of life and suffering, than if submitted to operation. I shall hope to show you in a later lecture that a greater proportion of breast tumors, diagnosed as cancer by competent surgeons, have recovered completely for years, under proper dietary and medical care than the percentage yielded by operative procedure.

There is a wealth of statistics regarding operations for cancer of the cervix uteri. Despite the figures obtained by radical operators like Wertheim, the vast majority of those surgeons who practise either vaginal or abdominal hysterectomy have obtained far inferior results to those of Byrne, with his cautery, which is still in use. Wertheim once reported the astonishing figure of 61 per cent of 5–year recoveries. In a later report, however, Wertheim stated that only about one half of the cases that come to him are operable, and of these about one half are cured by operation, that is, about 25 per cent of all cases. But experience shows that if these cases could be followed up there would be very many late recurrences. The claims of Wertheim and others must be offset, however, by the high operative mortality reported by many; as the cases must have been incipient in order to be operable, it is possible that Byrne with his cautery could have done nearly as well, and Byrne never lost a patient. But Klein of Munich, by circular letters compiled many statistics, and concluded that the percentage of cure was but 4.5 per cent, and Klein himself obtained only 3.6 per cent. Reinecke asserted that only 10 per cent of cases of cancer of the cervix can be cured.

Fredrick (Trans. Gynæcol. Soc., 1905, p. 136) collected the records of 500 hysterectomies for cancer of the cervix performed by prominent colleagues and himself. Of this entire material there had been but 13 five-year cures. In discussion Henrotin stated that he had practically given up abdominal hysterectomy. Currier stated that surgery was a failure as a cure for cancer.

At an earlier session of the Society, 1900, in a discussion of Pryor’s paper, Van de Warker asserted that surgery had done nothing for cancer; Lapthorne Smith said that many women did better if left alone. J. Byrne stated that hysterectomy for cancer was a crime. Engleman thought that cancers left alone may insure a longer survival than those treated surgically.

In a discussion before the same Society in 1896 (on Byrne’s paper) vaginal hysterectomy was discussed. While Boldt, Dudley, and Baldy claimed excellent results, Segond is known to have had but 5 relative cures (2–5 years) in 80 cases. Mundé saw a rapid return in all his 25 cases. Polk had recurrence in every one of 50 cases. Byrne collected notes of 283 operations by ten men, and the results were as follows: died, 7 per cent; life prolonged, 11 per cent; and became worse, 82 per cent.

In the Transactions for 1912 (Discussion of Neal’s paper, Wertheim’s operation) Bovee stated that only 10 per cent of cancers of the cervix were operable. Polak had no survivors from operations, although four were living from Byrne’s cautery method. Chalfant had 3 cures (6 years) in 30 cases. In general the saving of life was offset by the high operative mortality. Later I shall report two remarkable cases of very extensive cancer of the cervix which have entirely recovered, with normal cervix, without operation.

In regard to operative results in cancer of the stomach there are relatively few satisfactory statistics. W. J. Mayo reported recently (Levin, Hoffman “Statistics of Mortality,” etc., 1915, p. 210) on 996 cases of carcinoma of the stomach. Of these 344 cases only were operable and of the latter 25 per cent remained cured five years and over, after operation. In other words, about 9 per cent of cases of carcinoma of the stomach can be cured by surgery at the hands of Mayo, how much less in the hands of most other surgeons? Against such success must be opposed the analysis of 1,000 cases of cancer of the stomach by Friedenwald (Amer. Jour. Med. Sci., November, 1914). He states “of the entire number, operations were performed in 266 instances; of these there is not one patient living.” But few lived more than a year after operation; the majority died within the first six months.

In cancer of the gall bladder several good operators have reported that there have been absolutely no good results.

In cancer of the rectum there is a high operative mortality and very questionable ultimate curative results; indeed, there are very few reliable statistics in regard to this. In 27 perineal and sacral operations Mayo reports 7 per cent primary mortality, and in 44 abdominal and combined abdominal and perineal operations 20 per cent operative mortality. Tuttle reports a higher operative mortality. While there are no available data in regard to the duration of life after operation, it is well known that the disease usually recurs, and in many a colostomy is performed, with all its distressing features and very intangible results.

Time does not admit, nor is it necessary for me to go further into the brave but futile attempts which have been made by surgeons to cure such cases of cancer as can be reached by the knife, which, as we have seen by the testimony of many foremost in their ranks, has been found ineffective to a very great degree. In addition to the locations just mentioned there are many others where the attempt has been made to eradicate the disease surgically, but either with results quite as unsatisfactory as those mentioned, or much worse. Thus cancer of the tongue, palate, esophagus, cardiac orifice of stomach, liver, gall bladder, pancreas, small intestine, bladder prostate, etc., also of the brain and spinal cord, are most unfavorable, and both the operative mortality and end results are disheartening. All surgeons agree that at least 50 per cent of all cancers are inoperable, so that in all the reports concerning the results of operations this must be taken into consideration, and the real percentage of cures of cancer by surgery must be divided into at least one half. Thus, if operative surgery yields an average of 25 per cent of apparent cures in all cases operated on, this would mean only 12.5 per cent of all cases of cancer. This, considering the late recurrences often not traced, bears out the commonly received opinion that about 90 per cent of all patients once attacked by cancer die of the disease.

Surely the outlook for surgery, borne out by the steadily rising general mortality from cancer, is most unpromising, and one naturally turns to medicine, to know if there is not some means of modifying the system so that there shall not be this tendency to malignant tissue change, so destructive to life. In my former lectures I attempted to show that all experience and biochemical laboratory studies looked this way, and in a later lecture I shall hope to show that by dietary, hygienic, and medicinal measures the disease can be and has been checked repeatedly, and cancer cured without surgical operation. The permanence of the cure depends, of course, upon the continued faithful adherence of the patient to the means and measures which caused the dissipation of the tumor. For no one can doubt but that, if the real cause is met and kept in check by prolonged proper measures, the disease will not and cannot redevelop.

Do not misunderstand me and think that I claim that each and every case of cancer, in any stage, can be cured. Alas, my sad experience with the many deaths from recurrent and inoperable cancer, especially in the New York Skin and Cancer Hospital, has taught me the contrary, and I have often been appalled at the impotence of human endeavor; although even these patients have often been grateful for the amount of benefit and relief afforded by proper measures, and in my former lectures I reported to you several such cases. But I do assert that the total percentage of cures in reasonable cases is far, far greater under the line of treatment I am presenting to you than under that most commonly employed.