Popular Science Monthly/Volume 26/March 1885/English Experience with Cancer
By H. PERCY DUNN, F. R. C. S.
THERE is reason for the frequent inquiry which meets the ears of medical men in the present day, Is it not true that cancer is increasing? For, however much we may attempt to throw into the shade our convictions upon this matter, the records of the Registrar-General remain to show, in all the obtrusiveness of an unvarnished statement, the annual increasing mortality from this terrible disease. A reference to the forty-third annual report of the Registrar-General discloses a somewhat alarming state of things, in connection with which it must be conceded that reflection affords but little assistance in the attempt to solve the cause. According to the report, 80,049 deaths from cancer occurred during the ten years from 1860-'69 inclusive, and the annual average increase was 248. During the years 1870-'79 the total number of deaths from cancer was 111,301, and the annual average increase was 320. As far, therefore, as numbers are capable of showing, we have here conclusive evidence of the increment in the mortality from cancer. It is observable also that the rate of increase is much higher in the latter than in the first ten years. It is, moreover, the case that the annual rate of increase is higher in the years 1860-'69 than in the preceding decennium—namely, in the years 1850-'59. In short, in the years 1850-'59 the increment was about 2,000; in 1860-'69, 2,400; in 1870-'79, 3,200. We have then confessedly to face the fact that cancer is increasing in our midst at a rate which bids fair to become more and more serious with the advance of time. In an article entitled "An Inquiry into the Causes of the Increase of Cancer," published in the "British Medical Journal" a year ago, I drew attention to the observations which had been made upon the subject by the late Charles Moore, whose investigations into the pathology of cancer had brought under his notice the incontrovertible evidence of the increase of the disease. In the year 1865 he published a small book called the "Antecedents of Cancer," the contents of which chiefly consist in an attempt to explain in what manner the augmentation of cancer is influenced by the circumstances of life prevailing in this country. For instance, he held that the introduction of corn laws, the discoveries of gold and sanitary improvements, whereby the well-being of the nation was conspicuously established, affected cancer indirectly by bringing into prominence the predisposing causes of its occurrence; and good living, it is thought, which follows as a corollary of commercial prosperity, is intimately associated with the manifestation of cancer. Again, inasmuch as cancer is characteristic of the healthy, it maybe expected to abound amid the conditions of health. The greater prevalence of the disease among the rich than among the poor can probably be explained in this manner. According to a French observer, the proportion of cancer in the wealthy classes is about 106 in 1,000, in the poor classes it is 72 in 1,000; or at a rate in the former case of ten per cent, and in the latter of seven per cent. Now, curious as it may seem, cancer is met with in the lower animals; and it has been said to prevail more frequently among those which are flesh-eaters than those which are herb-eaters. It has been stated by the late Dr. Crisp, who had good opportunities of judging, that cancer is by no means an uncommon disease among the domesticated animals, while in wild animals and uncivilized man it is rare. In 230 also of the •quadrumana which he had examined there were no traces of cancer. Thus the inference to be drawn from these statements appears to be plain. It is almost conclusive that the habits of life, either in man or the lower animals, are concerned in the production, or at least in the predisposition, to cancer. The surroundings, it is conceivable, of an autochthonic existence do not include influences which favor the production of the disease; consequently, in uncivilized man the disease is rare. It is, however, different when man becomes civilized, for then the predisposing, if not exciting, causes come into play, and man has entered an area of life in which the disease has acquired not only a pronounced but an augmenting fatality. And the same is true of animals. Now, as far as we know at present, cancer has not a zymotic origin; in other words, it does not arise from any microorganism or "germ." It is consequently neither infectious nor contagious. Cancer, in short, can neither be "caught" nor "given." It commences de novo in each individual whom it attacks. There is, moreover, no such thing as anything cancerous being transmitted from parent to child in the cases in which the disease occurs in one and the other. It is possible to inherit a predisposition to cancer—that is, if cancer appears in a family, the members may be said to possess a liability to the disease, but practically this statement does not convey with it much significance, because, until the disease becomes manifest, no person can be said to be cancerous, inasmuch as he does not inherit the disease, but simply the liability to it. We are confronted with the problem of how to limit the frequency of the disease, and the difficulty of this is apparent in view of the fact that we know almost nothing of its origin. Cancer, as I have said, is not contagious; it stands almost alone as a disease which increases with our prosperity, and, while our health laws are raising the standard of public health, the mortality from cancer stands forth as a blot upon the results, detracting in part at least from the measure of the success that has thus far been obtained. Observation has shown that cancer has a certain geographical distribution. It prevails extensively in some parts of the globe, and is scarcely known in others. For instance, it is met with most largely in the central parts of Europe, but in the extreme north of this continent the inhabitants enjoy an almost complete immunity from cancer. It is stated to be unknown in the Faroe Islands, while in Iceland in one year it proved mortal in only thirty-seven cases out of 50,000 habitants, or in a proportion of 0·07 to 1,000. With reference to England in this connection, Englishmen may be regarded as unfortunate; for within the geographical area of these islands cancer asserts largely malignant and fatal influence. It afflicts mankind chiefly at an age at which, by universal consent, life is best enjoyed. Many and various have been the attempts devised to combat the inevitable fatality of its accession. A few years ago, a drug, Chian turpentine, was somewhat extensively employed, its introducer, Dr. Clay, claiming that under its influence cancerous tumors would gradually diminish in size, and ultimately dwindle away. But, unfortunately for humanity, various scientific trials, prosecuted with uncomplaining forbearance on the part of the sufferers, yielded in the end negative results, and Chian turpentine was again relegated to the obscurity from which it had emerged for a brief space of time. The gleam of light, however, which Las shed some radiancy over the gloominess of cancer, comes from surgery. It may be said of the surgery of the present day that better results are obtained from the surgical treatment of cancer than was probably the case in any former age. Some operations are now being practiced which hitherto were not considered justifiable, owing to the want of success which followed their performance. Others have lately been introduced, the practicability of which has proved the wisdom of their conception. Sufferers from cancer who formerly would not have been relieved are, in the present day, benefiting from the application of the principles of scientific surgery. Years of life—some years at least—and the mitigation of much physical and mental suffering, fall to the lot of surgeons to confer. Even the stomach, which in the male after a certain age commonly becomes the seat of cancer, has been dealt with, and a portion of it removed which was diseased, the result being favorable in so far as suffering was relieved and life prolonged. It must be, however, remembered that the successful treatment of cancer depends as much upon its early recognition as upon the means adopted for its relief. There should be no hesitation in ascertaining the nature of a tumor or swelling which is suspicious or uncertain. The improvements in the methods of diagnosis enable surgeons to recognize cancer in its earliest stages; and as soon as the presence of the disease becomes unequivocally demonstrated the probability of a successful result is largely enhanced by its early removal. The reason for this is obvious. Cancer commences in each person presumably as a local disease. But it spreads and infects by means of the blood-vessels and lymphatics, first the nearest lymphatic glands and then the more distant organs of the body. When this has occurred, the disease is no longer a local one, it has become what is called constitutional. It is therefore manifest that the most favorable time at which to obtain the best results from surgical interference is when the disease persists simply as a local growth, and when the blood and tissues of the body have not received the impress of a cancerous taint.—Pall Mall Budget.