CANCER RESEARCH 21 



If we compare the death rate from cancer in the last 40 or 50 years 

 we notice a universal increase in all civilized countries. The increase 

 has taken place rather steadily and not by leaps. According to W. J. 

 Whitney there was in Massachusetts from 1850-1910 during each 5 

 years an average but not quite uniform increase of 1.20 in the death rate 

 for 10,000 persons over 30 years of age every five years. According to 

 Dr. S. C. Dixon in an area comprising one half of the United States in 

 population the death rate increased from 4.79 (1890)-7.31 (1907). 

 In New York City there has been an increase from 5.4, which was the 

 death rate during the 4 years ending 1882 to 8.1 during 1908-1912. 

 A similar increase we notice in Germany, Norway, Amsterdam and 

 everywhere else, where statistics are available. 



While there can therefore be no doubt as to the actual increase in 

 the death rate from cancer, the interpretation of this phenomenon is not 

 quite clear. While some authors believe in a real increase, others believe 

 it to be only apparent, due to improvements in diagnosis and to better 

 registration. It is pointed out by some authors (especially by Bashford) 

 that the increase in the death rate is found mainly in internal cancers 

 which are difficult to diagnose. The increase concerns to a great extent 

 cancer in the alimentary tract. This increase is found especially in 

 persons over 60 years of age. Now in children cancer not rarely attacks 

 internal organs, and still no noteworthy increase is reported in those 

 cases. Furthermore errors in diagnosis would equally prevent physicians 

 from diagnosing as cancer cases which are not cancer as well as from attrib- 

 uting to other causes deaths really due to cancer. 



Furthermore the same increase has been noted in the well-conducted 

 autopsies in the Charite Hospital in Berlin, where the diagnostic 

 methods have not to any considerable extent changed within the last 

 thirty-five years. According to Professor Orth, in autopsies on persons 

 over 20 years of age cancer was found from 1875-1885 in 4 per cent., 

 in 1904 in 10.7, 1909 in 19, 1911 in 20.8 of all the cases. It is, there- 

 fore, probable that a certain factor which is potent in the production of 

 cancer has been gradually changed within the last fifty years causing a 

 general increase in the cancer rate, while at the same time there has 

 been a marked decrease in the death rate from tuberculosis in the corre- 

 sponding period. 



We will now consider the relative frequency of the different varieties 

 of human cancer. Here we find again a similar distribution of the vari- 

 ous kinds of cancer in all civilized countries in Europe, America and 

 as far as we can judge at the present time also in Japan. The most 

 frequent seat of cancer is the gastro-intestinal tract, especially the 

 stomach, and in the second place the female generative organs, espe- 

 cially the cervix of the uterus and the female breast. Cancer of the 

 stomach is approximately equally frequent in man and woman; in 



