the malignant disease, was preceded by long-continued simple diseases or by some form of chronic irritation. In other words, a large proportion of cancerous people need not have had the disease at all if they had been forewarned and had their precancerous condition cured.

The second great problem lies with us as medical men. Are we as active in the treatment of precancerous diseases as we should be, or do we only too often put our patients off with some placebo and advise them not to worry? Do we always insist on a thorough examination when a patient comes to us with symptoms that may mean cancer? When an early cancer is present, do we always lay proper emphasis on the necessity for proper treatment at once? Do we not too often advise the one course which can yield to disaster and tell our patients to wait and see what develops, i. e., wait till the cancer becomes inoperable? Unfortunately at the present time these questions must be answered to our disadvantage. A recent extensive investigation has shown that on an average the family physician has had his cases of cancer under observation for about a year before they come to a real attempt to cure the disease. Our attitude to cancer needs to undergo a radical change. The average of one year's observation must be cut down to a few weeks, or, best, to a few days. Immediate attention to the precancerous condition, counsel in the doubtful cases, and immediate action in the positive cases, is the only proper service we can give our patients. To do this, we need a campaign amongst ourselves, too. A new and more efficient spirit must be created which will result in constant watchfulness to keep our patients from swelling the thousands of untimely and unnecessary deaths from cancer.

To arouse the profession fully to the necessities in the war against cancer, a movement has been started by which, during the present few months, State and County Societies all over the country are devoting special meetings to the study of cancer, and in addition, the vast combined influence of American medical journalism has been enlisted, and the

Southern Practitioner has united with a number of other medical journals to provide for its readers special cancer numbers. It would seem from the number of journals cooperating that the message must be brought directly to every medical man. We are sure that in this way the interest of the medical profession will be aroused for years to come, and we are sure that the time will be soon at hand when no blame for participation in the fatal delay can ever be laid at the door of an American physician.-Circular of the Commission on Cancer of the Medical Society of the State of Pennsylvania.

THE CANCER PROBLEM:-No discussion of vital questions of public concern at this time would be complete without some reference to the menace of cancer. In less than a generation the proportion of this disease has grown enormously in the mortality tables. Always grouped among the horrors of the ills of flesh, cancer has recently come under the searching processes of the laboratory and of public health study.

We are working with an insidious enemy of the human race. Theories have come and gone, each aiming at the solution of the cause. The contagiousness of cancer is still unproven-while its types are known and its relief largely accomplished.

Cancer may come from some unknown principle of growth, seeking its soil in an individual who has been racked by the vicissitudes of modern civilization and the struggle for existence. Some ancestral evil may have laid a heritage of undeveloped danger zones, waiting accident or occasion to fulminate in disease. There may be centers of piled up fabric left over in the embryonic growth of the individual and resting safely in some out of the way boundaries of the human frame-until the danger line of inflammation is crossed and the material breaks into activity at the cost of the mutilation or the life of the individual who has been the victim of such circumstances.

There may be some chemical product related to our food, to-day more potent in the exigencies of modern conditions, which acts as toxic material to one predisposed and finding some weak point of defense, enters the cell life of the individual and starts one or more areas of destruction, ending with the last struggle of an unresisting frame.

The story of recognized cancer is not new. The laboratory for a long time has been able to fix the types. What may be mild cancer to-day, by to-morrow may show great malignant strides. Surgical skill, medical interference, the x-ray, radium and other means have made the outcome hopeful, for probably more than seventy per cent of cancer cases, properly treated and seen early, are cured. But the great fatality in the United States to-day among cancer victims causes pause and invites more than a momentary thought for the future. The recent records indicate that over seventy-five thousand lives in the United States are lost from cancer annually. What an army of souls is sacrificed to the helplessness of medical science on the one hand and on the other to the ignorance and neglect of the afflicted.

Put this thought before you: Most cases of cancer taken in time may be cured by known measures of relief. Why more are not cured is because they come too late, often after experimenting with the advertising quack or the inexperienced attendant. The early signs of external cancer are often easily perceived and may be summed up in few words.

External growths, tumors, warts, moles, scaling spots, persistent abrasions, ulcers, and excoriations are suspicious. When these increase in size, they sound a danger signal. When they are about the eyes, ears, nose, lips, on the tongue, on the breast, or about the genitals they have reached the point where advice should be solicited from the best authority obtainable.

When moles or other smooth growths begin to roughen or scale, they need immediate attention.

With internal cancer more technical terms apply, but perhaps here, too, plain advice may be given in few words.

Women with any persistent abdominal pain, should solicit special advice. Acute, continued gastric pains, particularly after food, are serious enough to be suspicious. Accompanied by loss of weight they are serious. It is far better to find a simple condition, easily dismissed or eliminated, than, by delay, occasion a state beyond ready relief and often taxing the skill of the surgeon to meet it.

The physician is often at fault. By ignorance or minimizing growths of suspicious character, he condemns his own discernment; he often victimizes his patient by allowing him to rest upon a possible delusion, until the full growth of an early lesion is attained.

The tinkers among doctors, too, do harm. No simple wart, mole, scaling patch, or the like should be burned with irritant caustics; the cauterization should be thorough, deep, and complete the best procedure is full elimination by the knife, and where this is not practicable, by other means which leave no relic of the growth.

Every

The propaganda against cancer is multiplying. man should carry the message that prevention by early recognition and treatment is possible and this should be practiced by everybody, everywhere.-Report of U. S. Pub. Health Service.

THE EARLY DIAGNOSIS OF CANCER OF THE UTERUS* : The physician who waits for the yellow flag before diagnosing disease of the biliary passages justly merits the condemnation of his colleagues. How much worse is the man who waits for profuse hemorrhage, foul discharge, pain and other signs of well advanced cancer of the uterus, before giving the woman a fair chance for her life? While the fault lies mainly with the women in not seeking medical

*Read before the Surgical Section of the Norfolk County Medical Society, at its meeting, February, 1915. By Edward T. Hargrave, M.D., Norfolk, Va., Gynecologist Out-Patient Department, Norfolk Protestant Hospital.

aid early, are we not to blame when we fail to impress upon them the great danger of any and all irregular discharges? No physician has the right to class slight hemorrhages as a deviation of normal menstruation, or as an approach of the menopause, without excluding cancer by the employment of precise diagnostic methods. Where neurasthenia and malaria have led thousands of tubercular cases beyond the goal of hope, the menopause has led its tens of thousands beyond aid. We have often been misled in the past by age, but since the adoption and routine application of modern diagnostic methods, many early cases have been found in women under 25. No man, however great his experience, can say with certainty that a lesion on the cervix is benign, from the history, inspection, absence of hemorrhage or induration. In a very slight opportunity the writer has had to study the clinical aspects of these lesions, he has seen men of wide experience in gynecology and pathology pronounce a lesion on a cervix as benign, when the routine examination revealed beginning carcinoma. We must be constantly on our guard to detect the disease in its earliest stage, for upon an early diagnosis hangs the only hope for permanent cure.

There are no pathognomic signs in the early, and therefore most favorable cases, and it is our duty to investigate thoroughly every case presenting:

1. Any atypical bleedings, including all cases of menorrhagia and metrorrhagia; all deviations from the normal menstruation; return of bleeding after the menopause; bleeding after exercise, defecation, etc.

2. Any increase in the amount, or change in the character of the discharge in a woman who has leucorrhoea.

3. Any irregularities on the surface of the cervix, whether they bleed on touch or not.

In the consideration of the early diagnosis of cancer, it is well to remember that the primary location of the lesion is of more importance than its histology from the standpoint