At the present time I will only remind you of what I have so often said before: that it is the complex of modern civilization, with all its temptations and errors in regard to eating and drinking, and living, including the nervous strain felt everywhere, that in some way produces alterations in nutrition which account for many of our diseases. This operates through the blood current, which ministers in such a way to the tissues that under some slight provocation a heterologous growth of certain tissue cells occurs, with malignant tendencies, instead of the normal homogeneous and stabile structures which compose healthy tissues; and this departure from normal cell action we call cancer.
LECTURE III
THE MORTALITY FROM CANCER; ANALYSIS OF SURGICAL STATISTICS
As has been already shown in these and previous lectures, the death rate from cancer has been steadily and alarmingly increasing in almost every locality, ever since statistics have been collected. The attempt has been made from time to time to show that this increase is not real, but is apparent, and that the error arises from three main causes. These are: 1. The increased longevity in general, leading to the existence of more people of the cancerous age; 2. Improved diagnosis; and 3. More careful death certification.
Time does not allow us to go into this matter very fully, but this erroneous impression is so widespread, and one so constantly meets it in conversation, that it is desirable to present briefly the grounds and proof for an absolute denial of the assertion that there has been very little or no real increase in the mortality from cancer.
First, it may be stated that most of the arguments quoted against the correctness of statements regarding the steadily rising death rate of cancer date back to King and Newsholme, who, in 1893, some twenty-three years ago, attempted a study of early statistics and drew certain conclusions from them. This was long before the era of careful research and reliable diagnosis and statistics, and can have little, if any, weight. Bashford and Murray in the Second Scientific Report of the Imperial Cancer Research Fund, in 1905, attempted to show the same thing. But even this was eleven or twelve years ago, and the utter fallacy of the sophistical arguments appears in the absolute, steady increase in the death rate of cancer as shown by official tables from many countries, and as especially collected and seen in the remarkable book by Hoffman on “The Mortality from Cancer Throughout the World.”
It is impossible in a brief lecture to give even a faint idea of the immense and valuable amount of research represented, and consequently the most useful information furnished in this monumental work; the material is taken from original documents with new information, freshly obtained from original sources. All is given with an impartiality and clearness which are refreshing when compared with some recent writings on the subject. With the immense accumulated data on record, some of which will be referred to, all showing a steady rise of mortality up to the present time, and that during a period of especial study of cancer such as the world has never known before, it is quite unreasonable and impossible to believe that this advance is only apparent, and that it is influenced by the three suppositions mentioned. While accuracy of diagnosis may be important in early cancer, it is certain that in late stages and at death, from which the various mortality tables are taken, there is rarely any question as to the diagnosis. There is evidence, however, to show that cancer is increasing even more rapidly than appears from mortality statistics.
In 1900 the recorded mortality from cancer in the registration area of the United States was 63 per 100,000 living, and in 1914 it had risen to 79.4, or an increase of 16.4 per 100,000 living, or over 26 per cent. While in 1915 there were 54,584 deaths from cancer against 52,420 in 1914 in the registration area of the United States, or 2,164 more deaths. The total number of deaths in the entire United States is estimated at about 80,000 last year. The death rate in 1915 was 81.1 per 100,000, or a rise of over 28.7 per cent since 1910. The increase during this past year has been 1.7 per 100,000 living, while the gross increase for the preceding five years was but 5.6 per 100,000, or less than an average of 1.2 per 100,000 each year. So that the great activity in cancer education and in operative surgery during that year has succeeded in raising the death rate from cancer by .5 per 100,000 over the average of the preceding five years!
It is to be noted that this increasing mortality from cancer has been steady and constant, though with slight diminution occasionally, some years ago, before the great activity in cancer research, cancer control, and cancer surgery. All this would certainly indicate some deep-seated cause of the malady which had not been recognized; indeed the mortality during the last five years was as follows: 1911, 74.3; 1912, 77; 1913, 78.9; 1914, 79.4; and in 1915, 81.1 per 100,000.
It may be of interest to know that the mortality from cancer varies very greatly in different portions of the United States, and it would be instructive to investigate the cause; but the data for this do not exist. The highest death rate for 1914 was in Vermont, 109.9; Maine had 107.6; Massachusetts, 101.8; New Hampshire, 100.8; California, 97.9; all against the general average of 79.4 per 100,000 inhabitants in the registered area of the United States. The lowest among the registration States was Utah, with 45.8 per 100,000 living. In New York State the deaths from cancer in 1914 were 88 per 100,000 population in the cities and 96.1 in rural districts.
Many cities, of course, show a higher death rate from cancer than the average, owing in part to the number of patients coming for treatment, and also to the more complex life of the cities, with the greater temptations leading to the disturbances of metabolism causing cancer. Thus, the average of twenty large cities gives a rise in death rate of cancer from 48.6 from 1881 to 1885, to 89.3 per 100,000 living in 1913.