done with operations on Cancer. I hope that none of you will ever ask me to operate again. I do not know if I have done good enough by operation to warrant its performance." Some years ago, during the great war, when the summer issues of journals were devoted to cancer surgically, a wellknown editor of a leading medical paper to whom I had sent a strong article, entitled, "A plea for the rational treatment of cancer,” when I wrote to him, saying that it was probably opposed to what would be written by others, wrote to me felicitly and strongly in regard to it, as I had written to him to blue pencil it as he wished, or throw it into the waste paper basket, and he replied, "The whole article shall go in, exactly as you wrote it, for it is hard to overthrow entrenched prejudices with gentle words." And it went in with no known results; so hard it is to "overthrow intrenched prejudices." The general belief of the laity, which has been so instilled into them is, that surgical operation offers the only prospect of a cure. So they yield reluctantly, only to discover their mistake later, when a recurrence appears; then, to be often told by the surgeon, "There is nothing more that can be done;" for few surgeons seem to have any idea of what can be done-accomplished by medical treatment. This latter happens because they will not, or do not, study the literature which has been published by observers all over the world. Some surgeons are peculiarly obstinate, for when I read before the American Cancer Research Association, with a wall map, showing the various proofs of the constitutional nature of Cancer, while no pathologist or scientific member raised any objection, but some surgeons said, in discussion that cancer was a local disease, and they cured it by surgical operation. The London Journal, "Truth," had a striking editorial, entitled "Lies about Cancer" in its issue of March 3, 1926, which was reprinted in CANCER, Vol. No. 3, and which is worth briefly referring to. It said, "The distinguished surgeon, Sir Berkeley Moynihan is like the shoemaker who proclaimed his belief that "there is nothing like leather." He is reported to have de livered his opinion or sentiment, at York last week, in the following words, "There is no way of curing cancer, except by surgery. No man can deny it. If he does, he is a liar." The editorial then goes on to narrate and speak of many cases, even of recurrent and inoperable cancer cured, even for a long time by non-operatic measures. He then goes on to say, "Will anybody who considers the number of witnesses to all the cases referred to above-dozens of cases-accept in preference to their testimony Sir Berkeley Moynihan's opinion that they are liars, or will they not prefer to believe with me that the lying is on the other side. I do not mean deliberate, intentional lying, but the lying which springs from ignorance, accompanied by refusal to investigate the truth... there is a crime anywhere it seems to be on the side of those who, without attempting to explore its possibilities, denounce non-operative treatment as a dangerous imposture, at the same time condemning to death every man and woman afflicted with inoperable cancer, and condemning the rest to mutilation for life, often at a ruinous expense, and too often without the elimination of the disease. This is the attitude of the high priest of medicine, when 50,000 people (in England) are dying every year in spite of Sir Berkeley Moynihan and his brethren of the knife-Should not one rather say, in consequence of them." If But the ingrained or "intrenched prejudice" sometimes rests upon the patient with cancer and others than the surgeon. My abundant notes of cancer patients show that dozens, almost hundreds of them, are seen only once, or a few times, and ceased to keep appointments long before any true judgment could be formed by them or by any one, of the true efficacy of medical treatment, although dozens persisted faithfully, until every trace of disease had disappeared, and many were watched 5, 10, 20 and even 29 years, found to be perfectly well. Many are discouraged at the prospect of prolonged dieting, hygienic and medical treatment, when they are wrongly imbued with the idea that a brief surgical operation will end it all. But this erroneous course of action is also encouraged by nurses, who know only of surgical treatment, with no knowl edge or experience in non-operative measures. Also family physicians, have been accustomed to refer all cancer patients to surgeons, who often confess that they know nothing of the cause of cancer, and by foolish friends, or relatives, who are also ignorant of anything but surgery for cancer, and too often dissuade the patient from trying medical treatment, of which perhaps they have never heard. Thus it is that many poor sufferers from cancer do not know of or appreciate that there is a life-boat waiting to take them from the threatened wreck. Nevertheless there are many, nurses and others, who have known of fearful recurrences after operation, and the frightful sufferings that many have undergone thereafter, and also perchance of certain patients who have recovered under medical treatment, or have had greatly prolonged lives, without an opiate, and some who have died peacefully and without pain, also without morphine. These latter good friends often give encouragement to those who dread the seemingly tedious regime of dietary, hygienic, and medicinal measures, which, if continued long and faithfully do accomplish the happy end results so often seen in the medical treatment of cancer. We see, therefore, that it is ignorance, unintentional perhaps, on the part of the laity and the medical profession, which is at the bottom of the cause why the systemic or constitutional nature of cancer has not been duly accepted and acted upon. But in the mean time over 100,000 poor victims of cancer die yearly in the United States every year, and in New York City almost one a day. As these 100,000 are replaced each year by fresh victims, it is computed that there are all the time about. 300,000 persons so afflicted, and when one appreciates the horrors they undergo, one is almost stunned, and cries out, how long, O Lord, will this ignorance last? Tuberculosis was once more feared than cancer, now it is well under control by medical and sanitary measures; when will the world see light and know truth? CANCER A PRACTICAL QUARTERLY JOURNAL Under the Auspices of the American Association for the Prevention and Cure of Cancer EDITOR L. DUNCAN BULKLEY, A.M., M.D. ASSOCIATE EDITOR J. LYMAN BULKLEY, M.D. COLLABORATORS RUSSELL C. KELSEY, M.D. EDWARD PREBLE, M.D. A. H. ROFFO, M.D., Argentina All original matter must be addressed to the Editor and contributed exclusively to this Journal Address subscriptions and matter relating to advertising, reprints, etc., to 121 East 60th Street, New York City Copyright, 1926, by L. D. Bulkley Price, prepaid, $5.00 per volume, United States, Canada and Mexico; THE STUDY OF CANCER Cancer has never, as far as we know, been really studied. We recognize fully that hundreds of able and honest men have spent an infinite number of hours of patient and laborious work at the microscope, studying and deliniating the appearance of the body cells of human beings and animals. We realize that countless hours have been expended on experiments on animals with inoculations, and the possible parasitic influence in them. We agree that thousands of pages have been written on them, and many obstruse and learned discussions have been held in regard to the histological appearances of the cancerous tissues excised before and after death in human beings, and perhaps on other subjects related to cancer, which might be mentioned; and yet we assert again that, as far as we know, cancer as a disease has never been really studied. In an early number of CANCER, Vol. 1, No. 3 we gave an editorial on "The study of Carcinosis as a Disease," and as this has not apparently been noticed, much less disputed, it seems wise to again call attention to the subject, hoping that more of the thoughtful ones in the profession may give to it due consideration and action. So it may not be unwise to repeat, with elaboration some of the thoughts there expressed, as also some of those in a somewhat similar editorial in the first issue of CANCER. In the earlier history of medicine much more attention was given to the clinical study of disease, as will be appreciated by those familiar with older writers. But in these later days of laboratories the art of medicine seems to be largely lost, and judgment rests far more largely on laboratory findings and X-ray demonstrations: so that definite reliance is placed on them far more than on experience, and thought, and the personal senses of sight, touch, and sound, by percussion. From the time of Esculapius, in whose temple those who had recovered from various illnesses, wrote out and hung on its walls tablets recording the name, the disease and the manner of cure, down to that of the wonderful clinical studies of Trousseau, Watson, Ziemmsen, Osler, and hosts of others the knowledge of medicine has depended largely on clinical observation. It is to be remembered that the laboratory is a very recent addition to our method of studying cancer, compared to the hundreds of years during which the science and practice of medicine has been built up. The laboratory cannot solve every problem, and has not seemed to cover that of cancer, much more than when it started: and many have expressed in writing the view that the modern tendency of relying so much on laboratory work has really done harm, and lessened the proper dependence upon acute and accurate observation and record. Everything and every disease has its cause, and cancer is no exception. It is, therefore, up to the medical portion of the profession, by patient and intelligent work, to seek and find the bottom cause of the disease carcinosis, and to devise and execute proper measures to overcome it. Nature seems to know |