CANCER.

Lyttelton Times, Volume XCIX, Issue 11541, 30 March 1898, Page 2

CANCER.

STATISTICS FOR 1500 TEARS, SPREAD OF THE DISEASE IN NEW ZEALAND. The Medical Conference opened in Wellington last week. The President (Dr Fell) took “Malignant New Growths” as the subject of his opening address. He dealt mainly with cancer. The following digest of the address is taken from the Post. There was (said Dr Fell) a wide-spread belief among the people of New Zealand that cancer was increasing. .Was this, false ? One might suppose that the Registrar-General’s statistics.would furnish an easy answer, but they did not, for many possible fallacies had to be considered. In the first place they covered a very short space of time, thus being very misleading. What they wanted to study was not the statistics of fifteen years, but of one thousand five hundred years, or better still, of the last three thousand, when they would see that cancer as a common cause of death was of comparatively recent development. What the President had read of the seventy-two books written by the seven doctors of the family of Hippocrates had proved to him that cancer, if it existed at all in ancient Greece, was a rare and unimportant disease. In the Bible they had leprosy, epilepsy, insanity, blindness all singled out for special mention, but cancer, a disease just as terrible, and appealling as strongly to the imagination, was nowhere alluded to. It was impossible to believe that cancer was two thousand years ago the common and formidable complaint which now had to be dealt with. Even in the middle ages he believed cancer was A RARE AND UNIMPORTANT DISEASE. Cancer now in New Zealand alone claimed a death rate of about 380 per annum, or more than one for every day of the year. New Zealand statistics, short as the period they covered, showed a decided increase in the deaths from cancer. From 1880 to 1884 the deaths were 781; from 1890 to 1894 they were 1637, or considerably more than double; while the population in the meantime had increased by less than onethird. In 1881 the deaths from cancer per 10,000 living were 2 - 69. In 1895 they were 5‘53. But it should be remembered that the population had during this period increased not in numbers only, but in age, and cancer being a disease of mature life an increase in the number of deaths from this cause was to be expected. To obtain more correct results they should compare the deaths at groups of ages with the number living at corresponding ages, A return kindly prepared by the RegistrarGeneral for the President clearly set out THE ANNUAL DEATH RATE from cancer in New Zealand per 10,000 living at each age period:— DEATHS FROM CANCER.

According to this table the male rates show a continuous and astonishing increase; the proportion of male deaths to every 10.000 living between the ages of fifty and sixty having actually doubled within the last fifteen years. It was irlO in 1881 and 22 - 00 in 1896. The proportion of females' deaths show a considerable but rather erratic increase. This difference, the president thought, admitted of an explanation which had escaped the notice of the statisticians. From the ages forty to fifty females were most prone to malignant disease of the breast and of uteri, and during that period the mortality returns for females showed only a slight increase, which was proof, not that there was only a slight increase in cancer cases at that age period, but of the success which now attended operations on the breast and uteri, which had largely reduced the mortality in these cases. On the other hand; the cancerous affections of males were in much larger proportion

INTERNAL AND INOPERABLE, and consequently fewer cases were cured by operations —hence more deaths. Unlike English statisticians. Dr Fell believed the increase of cancer deaths was real, and that it would be much greater but for the

It

number of cases cured by operation. This was perhaps a bold statement, and standing alone js a mere expression of opinion was perfectly valueless, but be offered figures in support. Dr Ewart had Idndly analysed' for him the cancer operations in the Wellington Hospital during the last five years, and from this it appeared that fifty-four cases had been operated upon, and of these twenty-two left the Hospital- cured for the time being, and had not since been heard of. Thus they might fairly assume the majority of these were so far well and free from recurrence. Now, those if not operated on would have helped to swell the death rate ere now.. Dr Bryant, at a recent discussion on cancer, said he had operated in private on seventytwo cases of cancer; of these forty-four lived for more than three years from date of operation, and of these latter one-half lived for five years and upwards. Of the cases of carcinoma of the breast operated on by the President during the last ten years he gave particulars of seven. Three were too recent to reckon with, all having been operated on within the year, but all were well so far. Of the other four two were dead and two were alive and-well; and, it being now seven and eight years since operation, may fairly be considered cured. Dr Pell could quote figures from many . ... ;; * SUKGEONS’ STATISTICS - . to show that a similar average of cures was being obtained by thousands of stir-; geons all over the world, and it seemed evident that the cancer mortality was very largely diminished thereby. It might seem rash, said the President, for him to try and point out a fatal error in the conclusions drawn by such well-known" statisticians as Dr Newsholme and Mr George King (honorary secretary to the Institute of Actuaries), hut when they state distinctly that the supposed increase in cancer was only apparent and due to improvement of diagnosis and more careful certification, giving as their reason that the apparent increase in cancer was mainly due to what were called inaccessible cases, he (Dr Fell) must point out that they had ignored the surgeon's triumph altogether, having only considered cancer as a necessarily; fatal disease. He, for one, was very unwilling to consider it such. Admitting a great increase in the recorded deaths from cancer and mainly in so-called inaccessible cases, did not that tend to show that the reason I the increase was not general was because of operable cases—a great many being cured by operation ? Comparing the mortality now with that of 100, 200 or 300 years ago, and, if possible go back 1000 or more years, and they‘would arrive at the startling conclusion that CAHCEB WAS A NEW DISEASE.

What, then, in modern life led to the increase of cancer ? Was it because they lived faster? Was it because modem life was full of worry and anxiety ? Was it because they ate meat of infected animals ? They were not competent at present to answer all these questions, becansein cancer there was an unknown something to which they could give no name—the nature of which they could not even guess at. Some day the riddle would be solved, and preventive measures would check the ravages of cancer as surely as they will check the spread! of tubercular infection. The progress of medicine had been impeded for countless ages by the false notion that the doctor's only mission was to heal and cure disease. They were at last awakening to the knowledge that their power of curing disease was very limited, while the power of preventing disease was almost unlimited, and as one infecting fever after another was traced to its real source they felt their horizon expanding and a new hope da,wiling that doctors would some day be all health officers paid by the State to [prevent THE ORIGIN AND SPREAD OP DISEASE. Dr Fell thought there was nothing in our modern life which could be fairly said to cause cancer. It was found among the quiet and bucolic quite as much as among the members of the’Stock Exchange or the medical profession, and some causa much more tangible and specific, than worry or alteration of habit would have to be found to account for the increase—and that cause would not be found until the nature of cancer was thoroughly understood. Dr Fell believed tbat, just as in the lower animal and vegetable kingdoms new species were constantly being produced and old ones altering and dying out, so diseases were constantly altering iu type, and in this connection syphilis was referred to as an example, and the doctor related some of his own experiences and observations of the appearance and growth of cancer. He did not much favour the theory that locality (such as low-tying, unhealthy, confined districts, especially on the hanks of a sluggish stream) had more than an accidental connection with the prevalence of cancer. In conclusion. Dr Fell analysed various treatments which, cancer had received.

30 to 40 40 to 50 50 to 60 60 to 70 years* years. years. years. jyi. F. Si', P. SI, P. SI. P. 1881 4 11 19 18 16 18 13 17 1886 7 7 22 27 41 31 27 17 1887 8 9 26 21 40 46 31 19 1888 3 18 25 26 45 40 43 24 1889 2 17 21 21 43 31 45 29 1890 7 13 25 33 49 44 48 31 1891 7 12 18 31 49 45 . 46 35 1892 11 11 22 24 61 44 51 34 1893 5 10 21 33 52 S3 63 30 1894 12 14 24 44 85 52 78 31 1895 7 10 34 38 67 58 58 43 1896 3 17 25 32 67 66 71 45 Proportion per 10,000 living at each age period: — 30 to 40 40 to 50 60 to 60 60 to 70 years. years, years, years. SI. P. M. P. m. P. SI. p. 1881 0-98 3-98 5-58 9-80 11-10 22-57 22-86 4378 1886 1-66 2-30 5-90 11-50 19-14 26-23 33-63 32-08 1891 1-65 3*64 5-17 12-27 17-68 28-00 39-63 49-77 1896 0 65 4-30 6-09 11-60 22-00 32' ■80 41-86 44-74