Quite recently I read in a German Health journal what a German medical specialist had to say on the subject of smoking and cancer of the lungs, and as I consider it to be of vital importance also to our English readers I feel it incumbent upon me to pass on the information here.

Dr. F. Lickint working in the statistical department of the State Hospital of Dresden-Friedrichstandt found that the number of deaths from lung cancer in the male rose by fifteen times from 1900 to 1955, by more than thirty times in the whole of Switzerland from 1905 to 1949, and by even more than forty times in England and Wales from 1899 to 1947. A similar state of things is to be found in the Soviet Union, in the Orient, in America and in other countries.

This enormous increase has made one wise to the fact that in many countries of the globe more people now die from lung cancer than from the formerly greatly dreaded disease of tuberculosis. Indeed, in the United States of America the yearly figure of deaths from lung cancer even exceeded the total cases of deaths from inflammation of the lungs and influenza. Cancer of the lungs, has, therefore become the most frequent cause of death of all the lung diseases.

In the search for one or more of the causes working in con­junction with each other, Dr. Lickint postulated eight outstanding points which have to be taken into consideration, so as to leave no doubt as to the real cause of such a rapid increase in lung cancer since the turn of the century. What now are these points?

1. As the increase in lung cancer was not observed before the turn of the century the exciting cause must have become active among mankind at that time or just before to an appreciable degree.

2. The active principle that produced cancer affected only males at first, and females later, and world statistics on lung cancer confirm this.

3  The cancer producing cause must affect all kinds of occu­pations, as with its increase not only intellectuals are attacked but also craftsmen and labourers.

4. The evil must be just as prevalent in the country as in the town as country folk fall a prey to it just as townspeople do.

5. On the other hand the substance that is responsible for inducing cancer cannot logically be present in those countries and in their peoples in whom an increase in lung cancer has not yet been observed.

6. The activating factor does not have any effect upon the animal world, especially upon our domesticated animals: dogs, birds, horses, etc., as up to now all these animals have remained practically free from an increase in lung cancer.

7. The substance to be found as responsible must, on close analysis, contain chemicals which are known as cancer producing, of which we shall hear more later.

8. Finally the proof that this substance is the cause would be enhanced if one succeeded artificially to produce a cancer formation with it in tests on animals.

The specialist now comes to the core of the matter without further ado in that he states that there is practically only ONE substance which fulfils all the eight conditions given above, and that substance is tobacco smoke in so far as it is inhaled. This drawing into the lungs is usually indulged in cigarette smoking, which alone gives off an inhaleable mild sour smoke, whilst the smoke of a cigar or pipe has an alkaline reaction.

Before the inhaled tobacco smoke can act upon the lungs so as to produce cancer some thirty or forty years must elapse. This fact has been established by statistical data.

It comes to this then: A boy or girl, who starts smoking at about seventeen years of age will be afflicted with lung cancer (with few exceptions) at about forty-seven or fifty-seven years of age or later. In the meantime he or she feels generally quite well, and, therefore, does not pay the slightest heed to any words or writings about the danger ahead. Only in a certain percentage of cases does the so-called "smoker's cough" develop a few years before lung cancer manifests itself.

In all too many patients lung cancer is only then discovered after it has become well established when secondaries may be found in other organs, especially in the liver, in the skeletal system or brain.

Over the last few years it has been incontestably proved, within the framework of intensive analyses, that appreciable quan­tities of cancer producing tar substances are found in the smoke of cigars and cigarettes. This fact must be especially emphasised, as even to-day it is maintained, in ignorance of the results of these tests, that no cancer producing substances in tobacco smoke have been determined.

The analyses just referred to have been undertaken by num­erous researchers among whom are Prof. Lettre* and his co-worker Dr. Hahn of Heidelberg, Prof. Druckrey, of Freiburg, Dr. Seelkopf of Wurzberg, the Englishmen Cooper, Lindsay and Waller of London, and finally, Dr. Lickint in collaboration with Dr. Buchner, Apothecary Pietsch and Dr. Brehmer.

Tobacco smoking over the years then creates conditions con­ductive to lung cancer, one of the conditions, not so far mentioned, being oxygen starvation in that the inhaling of the smoke must displace that amount of air commensurate with the amount of smoke inhaled, for obviously, the lungs cannot contain both smoke and the full complement of air at the same time. The whole organism is therefore deprived of its full quota of oxygen.

The mention of oxygen-lack reminds me of a gem of a little book, which a patient of mine brought back with her from a visit to South Africa. Its title is "Oxygen: Master of Cancer" by Frank Totney. He says that smoking interferes with normal, regular breathing, in that most smokers alter their breathing in some way whilst indulging in this habit. Smoking reduces the free oxygen in the inhaled air due to the burning of the paper and tobacco. Smoking clogs up the lung surface and thereby reduces the area through which oxygen could pass to the blood. Smoke is a sus­pension of very, very tiny particles in the exhaled breath. These tiny solid and fluid (tarry) bodies unfortunately stick to the lung walls to some extent, hence smokers' cough which is an attempt to shake them off again, in order to increase the useful lung area.

Young people are certainly not devoid of common sense, I therefore earnestly hope that what is written here will not go unheeded.

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