Study of the heredity of cancer based on 23 families, in which several members I•ere affected. In these 23 families there were G9 cases of cancer, distributed as follows: 57 in the stomach, 4 in the uterus, 3 in the breast, 3 in the rectum, 1 in the bladder, 1 in the liver. Of the 57 cases occurring in the stomach, 41 were in males, 16 in females. In 11 fami lies the heredity was exclusively in the male line, in 5 in the female; in 6 fami lies both sexes were equally affected. Moreover, 14 out of 22 families showed cancer in the stomach, and of these the males were affected in 8. It appears, therefore, that heredity in cancer should be no longer doubtful. The special form of cancer is itself hereditary. Manichon (Jour. de MM., Sept. 10, '96).
Robert Behla (Centralb. f. Bakt., Nov. 25, '99) has made some interesting studies in regard to the geographical distribution of cancer. (See Plate 1.) In San Francisco the ratio of cancer mortality has crept up from 16.5 cases in 100,000 population, in 1866, to 103.6 cases to 100,000 population. in 1898. In Boston the rate has trebled in the twenty-four years between 1S63 and 1887. The combined cancer-mortality of the seven largest American cities, exclusive of Chicago, has doubled in 28 years. There are at least 100,000 persons suffer ing from cancer in the United States at the present time. During 1898 it caused 49,800 deaths. G. B. Massey (Amer. Jour. Med. Sciences, Feb, 1900).
The increase of cancer has been marked in the past fifty years. In England and Wales during the last twenty years deaths from cancer more than doubled. In New York State cancer is the only disease tabulated which shows a progress ive and steady increment. The greatest increase in this country is in San Fran cisco. J. C. Warren (Boston Med. and Surg..Tour., July 12, 1900).
In a series of 7790 autopsies, performed during a period of six years at a Berlin hospital, 711 cases presented a patho logical diagnosis of carcinoma. In 156 cases—almost 22 per cent.—the diagnosis could not be or was not made before death. Considering the susceptibility of the sexes, it seems that in general both are about equally affected. If, however, the varieties of tumor peculiar to each sex are eliminated, the proportions change, the male being the more often afflicted. The male sex is more :,u-,cep tible to carcinoma of the (esophagus, stomach, larynx, lungs, and face. the fe male to carcinoma of the genitals, gall bladder, and =mince. A large number
of cases found in which the bronchi. the hangs, or the pancreas were involved. The increase in the number of cancer cases may be accounted for by the fact that a greater number of persons reach the susceptible age by the improved methods of diagnosis. NV. Rieehelmann (Berliner klin. Wochen.. Aug. 4. 1902).
In seeking to learn the causes of cancer, attention must be directed to the influence of climate, soil, race, age, sex, occupation, heredity, alimentation, other diseases, etc. It is distributed by stagnant water or by floods. by the use of such water for domestic purposes, by eating of uncooked vegetables, such as salads and celery, by contact with infected animals, by the fungoid growths upon trees standing on the banks of streams due to taphrinoid and nectrioid chytridiacece, or by blood-suck ing insects, etc.
In all cases of malignant disease there is a precancerous stage. Cancer is of local origin. Heredity as a factor in eti ology is unimportant. In over 500 cases of cancer where careful investigations were made and the question of heredity was given the benefit of every possible doubt, less than 5 per cent. was found where it was claimed that there had been a history of cancer in the family. Daniel Lewis (Med. Rev. of Rev., June 25, '98).
That cancer is not a disease of the poor and poorly nourished is shown as fol lows: 1. The improvement of the condi tion of the people in England has doubled in the last 150 years, poverty is one-half less; but, despite this, cancer has in creased fourfold. 2. The mortality from cancer is least among the poor and great est among the rich. 3. In Ireland, where people are as poor now as 50 years ago, cancer has not inereasea. Williams gives overnourishing and an easy life as pre disposing causes. In rich West London the cancer mortality is twice that in the poor district of East London, while among savages it does not exist. Of 325 cases of cancer in females, none were in prostitutes; and of 160 cases only one patient had had syphilis. (Williams); 25,000 women out of 25,000,000 in Ger many die of cancer uteri; of these only 10 to 30 per cent. are operable, and only one-third or one-fourth of the operable ones remain free from a return; hence only one-tenth of all eases of uterine can cer are saved from death by operation. Duhrrsen (Dent. med. Woch., Jan. 26, '99).