210 Mr. G. King 1 and Dr. A. Newsholine. 





cast on the reality of the increase, whereas now the generally received 

 medical opinion appears to have been adopted. Thus, Dr. Ogle 

 (p. xiv, Supplement to the 45th Annual Report (1882) of the Regis- 

 trar-General) points out that the deaths ascribed to malignant disease 

 in the decennium 3851-60 amounted to 317 annually per million 

 persons living ; in the next decennium it had risen to 387 ; and in 

 the decennium 1871-80 to 473 ; but adds : " there can be very little 

 doubt that a considerable part in this apparent increase is simply due 

 to improved diagnosis and more careful statement of cause on the 

 part of the medical men." 



In the 46th Annual Report (1883) of the Registrar- General 

 (p. xviii), are the following remarks, bearing on the same point: 

 " How much, if any, of this increase (in cancer) was real cannot be 

 stated with any accuracy ; but that some part of the apparent increase 

 was only apparent, and due to improved diagnosis and more careful 

 statement of cause, can, as we stated in previous reports, scarcely be 

 doubted. Year by year the number of deaths ascribed to " abdominal 

 disease " and other imperfectly stated causes has been undergoing 

 diminution, and there has been, of course, a corresponding addition 

 to the mortality under the more definite headings. Moreover, the 

 increase of mortality from cancer has been considerably greater in the 

 male than in the female sex. Now, were the rise not only apparent 

 but real, there would seem to be no reason why males should have 

 suffered more than females ; whereas the difference is readily in- 

 telligible on the hypothesis that the rise was, at any rate in great 

 measure, really due to improved diagnosis. For the cancerous affec- 

 tions of males are in a much larger proportion internal or inaccessible 

 than are those of females, and consequently are more difficult of 

 recognition, so that any improvement in medical diagnosis would add 

 more to the male than to the female figures." 



In the 52nd Annual Report (1889) of the Registrar-General 

 (p. xiii), attention is again drawn to the increasing mortality from 

 cancer, which now amounted to 656 per million persons living, 

 " showing a further increase upon the ever-growing rates previously 

 recorded." Then follow these remarks (the italics are ours) : 



" Some of. the increase is most certainly attributable to increased 

 accuracy in statement of cause, and to the system introduced some 

 years back into this office of writing for further information in cases 

 where some vague cause, such as ' tumour,' had been given as the 

 cause of death in the original certificate ; a system which added, for 

 instance, in the year 1889 no less than 421 deaths to the heading 

 ' Cancer.' Nevertheless, in face of the constant and great growth of 

 mortality under this heading, and the expressed belief of medical 

 practitioners specially engaged in dealing with this class of diseases 

 that they are becoming more and more common, it seems scat 



