222 Mr. G. King and Dr. A. Newsholme. 



than in the male, and improvement in diagnosis would raise the 

 curve for males in greater proportion than that for females. 



This argument is, however, scarcely consistent with the fact that 

 the curve for English females is the highest of the seven. It appears 

 therefore probable that, apart from diagnosis, there is some cause in 

 English female life more favourable to cancer than among Scottish 

 women. 



The Scottish Widows 1 Fund curve has the easiest gradient of all, 

 and this seems strongly to point in the direction so frequently indi- 

 cated by the Registrar- General, that the apparent increase of cancer 

 in the community is due to increased accuracy in diagnosis and certi- 

 fication. The policy holders in the Scottish Widows' Office are 

 insured on the average for substantial sums, and are, therefore, pre- 

 sumably well-to-do, and able to secure, on the whole, better medical 

 attendance than the mass of the people. The diagnosis throughout 

 has, therefore, probably been good, as suggested by the fact that the 

 curve begins comparatively high. But even among the most highly 

 skilled members of the medical profession diagnosis has been im- 

 proving, and therefore the Scottish Widows' Fund curve rises like 

 the others. Among the class of practitioners attending assured lives 

 there is not, however, the same scope for improvement in diagnosis 

 and certification of death as in the profession as a whole, and the 

 gradient of the Scottish Widows' Fund curve is consequently easy. 

 This curve might have been expected to be below those for English 

 and Scottish males, because, although there is a small admixture of 

 females who suffer more severely from cancer than males, yet the 

 lives are select. Persons with marked cancerous family his- 

 tories are excluded. Cancer, moreover, is a disease whose de- 

 velopment is usually gradual and slow, and may be preceded 

 for several years by non-malignant disease of the part subse- 

 quently affected with cancer; hence, for two, or even three or 

 four, years after an initial medical examination, cancer among 

 insured lives should be comparatively rare. Notwithstanding these 

 considerations, the Scottish Widows' Fund curve is above all the 

 other curves for males at the commencement, though it falls below 

 those for England and Scotland at the finish. This, as we have 

 already remarked, points to good diagnosis on the part of the 

 medical attendants of the assured lives, and to an improvement in 

 diagnosis on the part of the medical profession generally during the 

 last thirty years. 



Another reason for thinking that the apparent increase in cancer is 

 at any rate mostly due to improved diagnosis is derived from a com- 

 parison of the curves for males and females respectively. It will be 

 noticed that the curves for females are always the higher, and that 

 in each pair of curves the difference is practically constant through- 



