406 On the alleged Increase of Cancer. [May 4, 



higher than the female Scotch curve ; and it must be assumed there- 

 fore that there is some condition more favourable to the causation of 

 cancer in English than in Scotch female life. 



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

 probably pointing to more accurate diagnosis and certification than 

 for the whole country, especially at the earlier periods. 



That the apparent increase of cancer is at any rate chiefly due to 

 improved diagnosis is shown by a comparison of the male and female 

 curves respectively. They run practically parallel throughout. If 

 cancer had really increased, its increase would probably have been 

 an approximately equal percentage in the two sexes, and consequently 

 the curves would have widened their distance apart. Even if — 

 assuming that a real increase of cancer had occurred — the increase 

 were unequal in amount in the two sexes, it is highly improbable 

 that the increase would have been of such a distribution as to main- 

 tain the parallelism of the male and female curves. 



The statistics for Frankfort-on-the-Main enable us to classify 

 cancer in accordance with the part of the body primarily affected. 

 We have, therefore, classified the returns into two groups, according 

 as the cancer is " accessible " or easy of diagnosis, and " inaccessible " 

 or difficult of diagnosis. The results of this classification show that 

 in those parts of the body in which cancer is easily accessible and 

 detected there has been no increase in cancer mortality between 1860 

 and 1889. It is true that the majority of the deaths from "acces- 

 sible" cancer are among women — the deaths from "accessible" 

 cancer among men at Frankfort-on-the-Main being too few to be, 

 when considered alone, trustworthy — but we know of no reason for 

 supposing that, while female cancer of " accessible " parts has re- 

 mained stationary, male and female cancer of the other parts of the 

 body has really increased. 



The general conclusions arrived at are that — ■ 



1. Males and females suffer equally from cancer in those parts of 

 the body common to man and woman, the greater prevalence of 

 cancer among females being due entirely to cancer of the sexual 

 organs. 



2. The apparent increase in cancer is confined to what we have 

 called inaccessible cancer. This is shown (a) by the Frankfort 

 figures; (h) by the fact that the difference between the rates for 

 males and females respectively is approximately constant, and does 

 not progressively increase with the apparent increase in cancer in 

 each of the sexes ; and (c) because the apparent increase in cancer 

 among the well-to-do assured lives, who are presumably attended by 

 medical men of more than average skill, is not so great as among the 

 general population. 



3. The supposed increase in cancer is only apparent, and is due to 



