ding obscure cases of
internal tumours. But if the better diagnosis of to-day accounts for
some part of this increase since 1860, it does not seem probable that
it can explain the rising death-rate of the last ten or fifteen
years. The medical practitioner of 1900 was certainly as well
qualified to pronounce upon the character of the disease as the
surgeon or physician of to-day. Nevertheless, the cancer death-rate
of England in 1910 had increased 16 per cent. above that of ten years
before, and during the fifteen years 1895-1900 it had increased fully
28 per cent. Certainly in these last few years there has been no such
increased ability to detect the disease as would account for all
this. Yet another fact suggests doubt of this optimistic hypothesis.
If the increased cancer death-rate were due merely to the increased
ability of the physician or surgeon to recognize the ailment, we
should certainly find that the increase of cancer would be seen only
in those parts of the system, such as internal organs, where some
degree of doubt might perhaps be entertained; while, on the other
hand, there would be little or no increase discernible in the
mortality of cancers affecting parts of the body where its nature
could not be mistaken by any intelligent physician or surgeon. Now,
for a number of years, perhaps with this hypothesis in view, the
Registrar-General in England has tabulated all deaths from cancer of
either sex, not only by different age-periods, but also by the part of
the body affected by the fatal disease. A study of the facts thus
made known is extremely suggestive. It is true that a marked increase
in the death-rate has occurred in cancer affecting internal organs, as
we should naturally suppose; but it is also true that malignant
disease affecting parts of the body where little or no doubt of the
character of the ailment could be entertained by the physician,
exhibit in some instances as marked an increase in the death-rate as
in some other cases, where doubt of malignancy might be justifiable.
For example, cancer of the tongue among men showed a death-rate of 32
per million population in 1897; it went up to 47 per million in 1910--
an increase of nearly 50 per cent. Cancer of the female breast showed
a death-rate of about 142 per million population in 1897; it had
arisen to a rate of 190 per million only thirteen years later; and
here, assuredly, the nature of the disease in fatal cases cannot be
mist