It would seem hardly necessary to find any excuse for the publication of a monograph on cancer of the stomach and its treatment, for when it is realised how frequent gastric cancer is and that the disease is at first local and curable in a considerable proportion of cases by early removal; the stomach being in fact invaded more frequently than any other organ accessible to direct observation, it is curious that surgical treatment of this disease has not yet received more attention.
Though cancer is distinctly amenable to treatment and is probably really curable if radically treated in its early stages, yet the fact remains that though frequently relieved it is very seldom actually cured.
The explanation of this anomaly can only be ignorance or prejudice ; for clinical observers, both medical and surgical, in various parts of the world have for some years not only been writing on the subject and trying to convince the profession and the public of the needs and the possibility of an early diagnosis with a view to successful radical treatment, but they have also clearly demonstrated the possibility of successfully practising what they have preached both with regard to diagnosis and treatment.
As regards the frequency of carcinoma of the stomach, Dr. C. N. Dowd (Medical Record, 1906) called attention to the fact that according to the census reports there were no less than 9000 deaths from cancer of the stomach in the United States in 1900, and of these very few had been submitted to surgical treatment. I find on referring to the Registrar-General's report for England and Wales that during the years 1901-1904 no less . than 19,607 deaths from cancer of the stomach were registered, equal to 4901 per annum. Professor Osier has pointed out that in the years 1901-1905, while there Avere 24,750 deaths from cancer of the stomach there were only 19,675 from cancer of the uterus, and 14,418 from cancer of the breast.
Sanitarians and statisticians, English and foreign, have called attention to the marked increase in the mortality from cancer, at the same time that there has been a gratifying decrease in the death rate from infectious disease. In England during the last thirty years the recorded death rate from cancer has nearly doubled, while in America it has almost been trebled. Doubtless this may be partly due to greater accuracy in diagnosis, for the increase has been largely recorded in the internal organs and much less in accessible parts. But, as stated by Dr. Roger Williams, there has not only been uniformity in the variations of the increments in the long accession of years, but the increase has involved all parts of the body without material alteration in the normal proportionate ratios ; moreover the increase has been recorded in most civilised countries.
The importance of the subject is arousing widespread interest both within and outside the profession; and not only at home but also abroad large sums of money are being granted both from private and public sources for the investigation of the disease.
Of the true cause of cancer we really know nothing; even if we could accept the view of those pathologists who consider malignant disease as simply due to an alteration of somatic into generative elements we should be still begging the cause ; nor can we accept unreservedly the statement of a distinguished authority that, from the histological character, method of growth, and absence of specific symptomatology, it is not permissible to seek for the causative factor of cancer outside the life processes of the cells, for our present knowledge does not warrant such a positive statement; and it would appear from the observations of several competent pathologists that facts are not incompatible with the theory that cancer may be produced by an intra-cel-lular parasite which stimulates the cell to excessive multiplication. The fact that no parasite has been hitherto discovered is no proof that the quest is hopeless, and should be no deterrent to a continuance of research work. How many years were spent in fruitless search before Koch found the tubercle bacillus-a discovery that has placed tuberculosis on quite another platform, and one which bids fair to the stamping out of the disease. Does anyone doubt the origin of measles or scarlet fever from organisms ? Yet absolute proof is still wanting. The origin of syphilis has only just been revealed by the discovery of the Spirocltceta 'pallida. Recently Councilman has apparently proved that vaccine bodies form one phase of the life-history of the protozoon said to cause smallpox, and Dr. Roswell Park and Dr. Graylord regard the cell inclusions in cancer as beino of the same nature, thousrh the presence of these organisms in cancer tissue is, of course, no proof that they are the cause of the disease. The same remarks apply to Bosc's arguments and experiments on sporozoa. That bacteria are not the only possible pathogenic parasites the history of malaria has proved. We are still in almost total ignorance of some of the lowest forms of life and of their biological peculiarities, nor are we sure that Koch's laws will be valid for them.
Even of the predisposing causes of cancer we know next to nothing though of theories there are many. My friend the late Sir William Mitchell Banks and others thought overfeedino- misrht afford an explanation; one physician asserts that it is uric acid, and would limit the intake of nitrogen ; whereas others consider it due to an excess of carbohydrates, and suggest that starches and sugar should be limited. The teetotalers, of course, find in alcohol a possible cause, and the non-smokers decry tobacco. Some advise us to eschew salads and all uncooked vegetables and others would have us abolish salt as an article of diet. In fact, there is scarcely any form of diet or luxury that has not at one time or another been condemned. Do not all these theories make one feel that until something definite is found out, the public have a just cause of complaint against those who, on insufficient evidence, not only would cut off their luxuries one by one, but would even tax the necessaries of life with suspicion ?