On the alleged Increase of Cancer. 223 



out the entire period. Now, if there were a real increase of cancer, 

 there is no sufficient ground for thinking that this would be confined 

 to any one set of organs of the body, or would affect one sex more than 

 another ; and in such case the difference between the cancer in males 

 find females would be a percentage of the total, and would increase 

 at the same rate as the curves themselves rise, and consequently the 

 curves for males and females would tend to widen their distance 

 apart. This, however, is not so. In each of the three pairs the 

 curves for males and females do not diverge, but, if anything, tend to 

 approximate. 



It may be urged that, notwithstanding what has been said above, 

 cancer may have increased more in certain parts of the body than in 

 others, and that, although it has really increased in both sexes, it has 

 increased in such greater proportion among males, that the curves for 

 the two sexes remain parallel. This view, however, is contradicted 

 by the Frankfort statistics, to be discussed presently, which confirm 

 in a remarkable manner the conclusion we have drawn that it is only 

 the cancer of organs common to both males and females which has 

 apparently increased, while cancer of the special female organs, 

 which is most easy of all to diagnose, has practically remained 

 constant. 



The chief weakness of the figures already given for cancer consists 

 in (1) the absence of distinction between carcinoma and sarcoma, the 

 two chief varieties of malignant disease, which are, however, patho- 

 logically distinct; and (2) the absence of statement of the part of the 

 body primarily affected by the cancer. 



An accurate statement of the site of the primary cancer in each 

 case would enable us to ascertain whether the increase of cancer had 

 been general, or chiefly in the cancer of inaccessible parts the 

 diagnosis of which is comparatively difficult. Unfortunately medical 

 certificates of death commonly omit any statement of the organ 

 affected by cancer, and comparisons founded on those cases in which 

 the position is stated in successive years are open to the fallacy that 

 the non-localised cancers may have been transferred in increasing 

 numbers to the more definite headings as time goes on. 



There are no statistics available in which an accurate distinction is 

 made between carcinoma and sarcoma, and the general terms 

 *' cancer" or "malignant disease" must therefore be regarded as 

 including these two forms of malignant new growths in unknown 

 proportions. It may be added, moreover, that no such statistics 

 would be trustworthy unless each death were followed by an autopsy 

 and by a microscopical examination of the diseased parts. 



The town of Frankfort-on-the-Main is the only one known to us 

 which has for a long series of years kept an accurate record of deaths 

 from all causes, in which deaths from cancer are classified according 



