In a recent Bulletin of the Board of Health of New York City the following statements are made in regard to the mortality from cancer in 1913: “The statistics of our seven largest cities recently tabulated, show that the cancer death rate was the highest on record. For New York City the rate was 82 per 100,000 of the population, against an average of 79, for the last five years: for Boston 118 against an average of 110: for Pittsburgh 79, against an average of 70: for Baltimore 105, against an average of 94: for Chicago 86, against an average of 81: for Philadelphia 95, against an average of 88: for St. Louis 95, against an average of 85.” This average increase of almost 8 per cent. of deaths from cancer in the combined population of these seven cities, during the last five years is certainly an alarming fact, and cannot be explained on the ground of greater accuracy of diagnosis: for it is not to be presumed that there has been such great improvement along diagnostic lines during the single year 1913. It is difficult to state the exact prevalence of cancer in the entire United States, as the “registration areas” include only about two-thirds of the total population: much can be learned, however, from the annual volumes published since 1900. According to these Mortality Statistics of the United States, the deaths from cancer and other malignant tumors per 100,000 population were as follows: in 1900, 63, in 1904, 70.2, in 1909, 73.8; and in 1912 there were 46,531 deaths from cancer, or 77 per 100,000 population, an increase in the death rate from this disease of almost 25 per cent. since 1900; while, as before stated the tuberculosis mortality had fallen a little over 25 per cent. in the same period. As in other countries, which might also be expected from the statements already made, the disease varies in frequency in different localities and communities. Thus, cancer is stated to be much more prevalent in the northern than in the southern states, and as already stated, the negroes are much less subject to the disease than whites, especially when they are living their own natural home life; but when they come to the cities, as waiters, etc., in hotels, their cancer death rate increases. But even in New York City in 1912 the deaths from cancer in negroes was 1 in 32.2 total deaths, against 1 in 17.7 in whites; the mass of negroes here, of course, live plainly and work hard. The North American Indians also are believed to be almost exempt from cancer in their primitive savage condition, but as they have come under the influence of civilization they are more affected. It has also been noted by several observers that immigrants and their descendants present a very much higher mortality from malignant diseases than prevails in their native countries; from these and other considerations Williams suggests that abrupt change of environment may also be a factor in the causation of this disease.