While this is a pretty strong statement and many exceptions could undoubtedly be found, careful investigation will show it to be true in the main; for it must be remembered that even among the poorer classes gluttony, especially in regard to proteids, is not at all uncommon, and indolence, with impeded metabolism, is not at all unusual. Dr. Latham found that the mortality from cancer in England, from 1881–1890, was more than twice as great among well-to-do men having no specific occupation, as among occupied males in general, the respective mortality ratios being 96 for the former and only 44 for the latter. Sir William Banks confirms the steady increase in cancer very strongly, which he attributes to richer and more abundant food, of which males eat more than females, and consequently cancer is increasing proportionately more among men, as all statistics show.
Switzerland is reported to have the highest death rate from cancer of any country, it having augmented from 114 per 100,000 living in 1889, to 132 in 1898. There again the cancer mortality varies greatly in the different sections or cantons: thus, in wealthy Lucerne it is 204 per 100,000 living, and only 36 in poverty stricken Valais. In the city of Geneva it is 177 per 100,000 living.
Denmark, next to Switzerland, is reputed to have the highest cancer death rate of any country in Europe, viz.: 130 per 100,000 living in 1900. But here the statistics are only from the towns, which comprise but a quarter of the whole population: the per capita wealth is said to be higher there than any other country in Europe except France.
France shows a high cancer mortality, with a constantly increasing death rate; and, next to England, France is the richest country in Europe, and wealth is much more widely diffused: the French workers own nearly 8 times, per capita, more than those in England. In Paris the cancer death rate has increased as follows, for each 100,000 living, in 1865, 84; in 1870, 91; in 1880, 94; in 1890, 108; in 1900, 120.
Italy, a comparatively poor country, shows a low cancer mortality, but even here it is increasing from 20 per 100,000 living in 1880, to 52 in 1899, and 58 in 1905. The consumption of meat is there the smallest in any European nation, namely 23 pounds per capita in 1895. In the chief towns the rate of death from cancer is high: thus for each 100,000 living, in Florence 137, Ravenna 120, Venice 103, Milan 101, and Rome 77.
Time does not permit a wider survey of the field of distribution of cancer, as presented so remarkably from official statistics by Williams, and Wolff; but in connection with the high percentages of deaths above quoted among the richer classes it may be interesting to mention some of the lowest records. Thus, in the poor country of Kerry, Ireland, it was 27 per 100,000 living, in the province of Dalmaltia 19, in the Shetland Islands 16, in Servia 8 (from 1895 to 1904), and in Ceylon in 1903 the mortality from cancer was about 6 for each 100,000 living.
The United States, unfortunately, has not kept the vital statistics of the country in years past with anything like the fullness and accuracy which has obtained in England, nor even at the present time is it possible to learn definitely the frequency and increase of cancer in every locality. But all the statistics which have been gathered show unequivocally that the disease has steadily increased in a manner which is alarming. Analyzing the recorded deaths from cancer in thirty-one cities, and the percentage of increase in four years, one writer estimates that, if the same increase is continued, by the end of the century there will be a death rate, approximately, of 1000 in every 100,000 inhabitants, or one in every hundred.
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.