In a long experience I have seldom, if ever, come across a patient with cancer who had had any intelligent and prolonged attempt to check its development by dietary, hygienic, and medicinal means; invariably the knife, X-ray, and radium have been the only measures under consideration. Also, after an operation the patient is dismissed, or watched for a recurrence and again operated on, with no prolonged effort to so modify the constitution that the same causes shall not reproduce the malady in the same or other localities. And yet I have narrated to you cases of undoubted cancer, verified by competent surgeons, who urged instant removal, which had entirely disappeared without operation under the line of treatment detailed, and who remained in perfect health for many years, sixteen in two instances. I also reported cases illustrating the beneficial result of dietary and medicinal measures in cases recurrent after operation. This matter will be more fully considered in a later lecture, with further illustrations. We may now consider some general matters bearing on the question of a medical rather than an exclusively surgical aspect of cancer. The founders of the Index Medicus placed cancer among the diseases of metabolism, along with gout, obesity, chronic rheumatism, diabetes, and a few conditions of minor importance. This grouping of cancer in no wise interferes with the idea that a chronic local irritant may be the _exciting_ cause of the _local_ development of the tumor, which becomes malignant, in any particular situation; any more than what is observed in the case of late syphilis, where a gummy tumor or a bone lesion may appear at a point of injury, or where gout will develop in a joint which has been bruised. But it does show that broad medical thought has long recognized that cancer is not a purely local disease, but that it arises from some disturbance of nutrition, tending to localize in some particular spot, even as a neuralgia will occur in some special nerve and be reached, not by local measures, but by those of a general nature. Repeated casual observations have often been made by clinicians, and even by surgeons of prominence, of the apparent relations between cancer and gout or rheumatism, and also diabetes, and all recognize the rebelliousness of cancer when it occurs in connection with obesity. The late Dr. John B. Murphy was very strong in regard to this latter point. The constant occurrence of cancer in rheumatic individuals is a very striking feature, which I observe almost daily.