24 J. B. S. Jackson, Extracts from the Records of the Boston Society for Medical Improvement, vol. v., Appendix, p. 109, Boston, 1867.
25 Mathien (Du Cancer précoce de l'Estomac, Paris, 1884) has recently analyzed, chiefly from a clinical point of view, 27 cases of gastric cancer occurring under thirty-four years of age. Of these, 3 were under twenty and 14 were between twenty and thirty years. He also emphasizes the error of considering cancer of the stomach as exclusively a disease of advanced life.
Such statistics as we possess would make it appear that gastric cancer, as well as cancer in general, is somewhat less common in the United States than in the greater part of Europe.26 These statistics, however, are too inaccurate, and the problems involved in their interpretation are too complex, to justify us in drawing any positive conclusions as to this point. It is certain that cancer is not a rare disease in the United States.
26 Of 1000 deaths in New York in 1882, 19.3 were from cancer. The statistics on this point from some of the large European cities are—Geneva, 53 deaths from cancer per mille; Frankfort, 47.6; Copenhagen, 33.2; Christiania, 29; London, 28.7; Paris, 27; Edinburgh, 25.4; Berlin, 22.4; St. Petersburg, 15; Amsterdam, 12. These statistics are obtained from the Forty-fourth Annual Report of the Registrar-General (for 1881), London, 1883; from Preussische Statistik, Heft lxiii., Berlin, 1882; and from Traité de la Climatologie médicale, Paris, 1877-80, by Lombard, in whose excellent work will be found much information on this subject.
To judge from statistics in this country and in England, the death-rate from cancer is undergoing a rapid annual increase. Whereas in New York in 1868 this death-rate was only 12.6 per mille, in 1882 it was 19.3. In England and Wales in 1858 the deaths from cancer per 1,000,000 persons living were 329, and in 1881 they were 520. It seems probable, as suggested in the above report of the Registrar-General, that this apparently increasing large death-rate is due to increased accuracy in diagnosis. It may be also that decrease in infant mortality and prolongation of life by improved sanitary regulations may account in part for this increase. From this point of view Dunn makes the paradoxical statement that the cancer-rate of a country may be accepted as an index of its healthfulness (Brit. Med. Journ., 1883, i.).
It is said on good authority that in Egypt and Turkey gastric cancer and other forms of cancer are infrequent.27 A similar infrequency has been claimed for South America, the Indies, and in general for tropical and subtropical countries; but all of these statements as to the geographical distribution of cancer are to be accepted with great reserve, as they do not rest upon sufficient statistical information.
27 Hirsch, Handb. d. Historisch-geographische Pathologie, Bd. ii. p. 379, Erlangen, 1862-64.
I have analyzed the frequency of gastric cancer among negroes upon a basis of 7518 deaths among this race in New York, and I find the proportion of deaths from this cause about one-third less than among white persons.28 It has been stated that cancer is an extremely rare disease among negroes in Africa.29 The admixture with white blood makes it difficult to determine to what degree pure negroes in this country are subject to cancer.
28 According to the Ninth Census Report of the United States, in the census year 1870 the deaths from cancer among white persons were 13.7 per mille, and among colored persons only 5.7 per mille; but it is well known that the registration returns upon which the vital statistics in these reports are based are very incomplete and unsatisfactory.
29 Bordier, La Geographie médicale, Paris, 1884, p. 464. Livingstone speaks of the infrequency of cancer among the negroes in Africa.