Investigations of late years, however, might seem to indicate that cancer is more prevalent in India than previously supposed, but its incidence still bears no real relation to that in many other countries, and an analysis of some recent reports explains in an interesting and curious manner the reasons for the diversity of opinion as to the actual frequency of the disease.
Thus, Benratt collected a total of 1700 cases only from 5 years’ statistics of 15 Mission Hospitals and 34 Government Hospitals, representing, of course, many million inhabitants, whereas in New York City, according to the weekly Bulletin of the Board of Health, there were 2193 deaths from cancer in the last six months, a striking illustration of the rarity of cancer in India. Moreover of these 1700 cases, over 1200 were about the mouth, a very large share of these arising from the very common habit of chewing betel, which contains also much calcium, which latter is one of the salts incriminated in the causation of cancer. Sandwith attempts to show that cancer is prevalent in India, but refers to only 2000 cases reported in the hospitals there, in three years, also among many millions of people, and he refers likewise to the betel chewing cancer, and the “kangri burn” on the abdomen of men, from the charcoal furnace worn for warmth: these peculiar local disorders vitiate any deductions which could be drawn from such statistics.
In China, according to a recent writer, “cancer is comparatively uncommon in those parts where the bulk of the people live on an almost exclusively vegetarian diet, being too poor to purchase any of the various flesh foods, which are there used for culinary purposes.” But in places where cancer is said to be more prevalent, the reporter adds, “All Chinamen there eat fish and pork at morning and evening meals: fowls and ducks are always on the table of all but the most humble of the coolie class.”
In regard to the occurrence of cancer in the Far East, however, some of the modern investigators, such as Bashford, have endeavored to overturn the generally accepted view as to its infrequency, but I do not feel that the evidence presented can at all weigh against the unprejudiced opinion of most capable medical men who have long lived and practiced in those regions, some of whom as medical missionaries have had most intimate contact and acquaintance with the natives. Only very recently a medical missionary, who has long been connected with the medical college and hospital in Beirut, Syria, told me that cancer was practically unknown among the thousands of patients who flock there from all over the Near East, he adding that they were all largely vegetarians.
During a rather extensive trip through the Far East I was unable to see or even hear of any cancer, although I met a large number of medical men, and made diligent inquiry regarding the same. As I wished to verify my views in regard to the rarity of the occurrence of cancer among those who lived on rice or other vegetarian diet, I visited very many civil, military, and mission hospitals, with a total of many thousands of patients, and ministering to many millions of population; in Japan, Korea, China, the Philippines, India, Siam, and Egypt, I met the same response, that cancer was rarely seen among those vegetarian natives.
Brazil is credited with having the lowest cancer record of any portion of the western hemisphere, especially among the natives in the Equatorial regions, while in the Argentine Republic, where meat is known to be largely consumed, cancer is fairly common. From many parts of the world there come reports of the relative infrequency or even absence of cancer among simple living natives, one writer in regard to the West Indies stating “Even those cases which I have witnessed in this class of people have been among the better orders of them, whose habits of living assimilated to those of Europeans.”
England and Wales present the most satisfactory field for the study of the progress of cancer, as the national vital statistics have been well kept since 1840; even at that time under the able direction of William Farr they had already acquired a well-deserved reputation for reliability, as Williams remarks, from whom I shall freely quote.
In that year, 1840, there died of malignant disease in England and Wales 1 in 5,646 of the total population, 1 in 129 of the total mortality, or 117 per million living. In 1905, the deaths, due to this cause were 1 in 1,131 of the total population, 1 in 17 of the total mortality, or 885 per million living: thus, while the population had only a little more than doubled, the cancer death rate per million living had increased five fold. Dr. Williams answers by figures and tables the several objections which have been raised in regard to the actual increased mortality from cancer, as it has been repeatedly claimed that the increase is only apparent and not real; thus it has been asserted that it is due—1. To mere increase of population: 2. To the average age of the population having advanced: and 3. To improved diagnosis and more careful death certification. Time does not admit a full presentation of his statistical refutation of these claims, to which he devotes some pages very convincingly, but it can be safely accepted that for some as yet unknown reason, cancer has made strides in England which are truly alarming.
Williams has also made some most interesting studies in regard to the increase of cancer in connection with changed conditions of life, and from his analysis of statistics, he very clearly shows that the spread of the disease has closely followed urbanization, and the rapid increase in material prosperity of recent years: in England where 80 per cent. of the population are now town dwellers, this tendency to collect in cities and towns has gone farther than in any other community. He recognizes that any far-reaching, environmental change of some duration is probably potent in disturbing the stability of the constituents of living bodies, and the sudden change from poverty to riches and plenty is conducive to the development of cancer: allusion has already been made to the inverse relation of deaths from cancer and tuberculosis, the latter diminishing with improved material conditions, while the former increases as wealth and indolence increase.
He shows this by statistics from various localities, and by data from towns in different countries he makes it pretty clear that “Cancer mortality is lowest where the conditions of life are hardest, the surroundings the most squalid, the density of population greatest, where the tubercle mortality is highest, the general and infantile mortality greatest, and where sanitation is least perfect—in short, among the poor of the industrial class in our great towns: whereas among the wealthy and well-to-do, where the standard of health is at its best and life is easiest, and where all the conditions of life are just the reverse of the foregoing, there the cancer mortality is highest.”