Heart disease and tuberculosis are intelligible diseases, usually painless and nearly always holding out to their victims an indefinite stretch of life if they live carefully; accordingly sufferers from either of them receive plenty of encouragement and are hopeful. The position with cancer is very different.

IT is undeniable that the cancer peril is steadily increasing in the Irish Free State and it is quite apparent that the public are being demoralized by the horror and mystery of it. The mortality from diseases of the heart and from tuberculosis still holds first and second place respectively in the death statistics, and is in every way as serious a problem but it does not arouse as much apprehension as the frequency of appearance of cancerous growths.

Heart disease and tuberculosis are intelligible diseases, usually painless and nearly always holding out to their victims an indefinite stretch of life if they live carefully; accordingly sufferers from either of them receive plenty of encouragement and are hopeful. The position with cancer is very different.

About no other disease does the ordinary person display so much fear and abysmal ignorance, and indeed not without certain reason; for never in the history of medicine has there been a disease about whose causation so much nonsense is being spoken and in whose treatment such savagery and senselessness are being displayed with such tragic results. Cancer is a very dangerous disease, especially at the time it usually comes along for treatment, but viewed realistically, it is neither very horrible nor hopeless.

It has been made far worse in the minds of the public by alarmist cancer campaigners and by the obiter dicta of people who know nothing about it, not to speak about the frightful results of its orthodox treatment by knife and ray. This morbid environment in which it is enveloped has actually raised serious and difficult problems in the domain of psychopathology.

Hordes of timid people and neurotics are tortured by the folie de cancer, vague fears that they have, or may have, the disease; some are even driven into consulting rooms to be satisfied, and, needless to say, are driven out again unsatisfied. The ordinary doctor is as ignorant as they are themselves; and, in cases where they prove incorrigible, he pushes them on to a colleagues for X-radiation or gastroscopy or sigmoidoscopy or some other meaningless and expensive form of medical prying.

The so called cancer authorities here are helpless to stem the slowly mounting tide of the disease and they throw the blame on lack of funds for research purposes. The Government of the Irish Free State makes no provision for footing the bill and the public are ungenerous despite great intimidation. Some years ago the City of Dublin Skin and Cancer Hospital, a private institution, held itself out to have taken on the responsibility of national research work.

It flourished its knives and invited the public to come forward with their lumps and moles and deluged the land with repulsive leaflets and tracts, and a great deal of touting for funds was initiated up and down the country. But it only succeeded in getting itself into disfavour with other hospitals and with the medical authorities; and its etiquette, methods and treatment were the subject of acrid criticism by leading orthodox representatives of medicine in the Free State Senate.

Not that the latter gentleman had any other different and loftier views on how cancer should be treated; but they discovered that “an attempt was being made to make a corner in cancer in Ireland”; and I am sure it was resented that well paying patients could not be shared around. This hospital is now practically under a boycott and is excluded from the benefits of the sweepstakes.

The enactment of the public Charitable Hospitals (Temporary Provisions) Act, 1930, which established sweepstakes for a period of four years turned an unexpected tide of gold into many of the leading hospitals in Dublin. It was purely a temporary measure but its success was so startling that recently the law has been changed making these sweepstakes permanent with a supervisory body known as “The Hospitals Commission” and making provision for medical research.

Any day now there is likely to be seen the birth of a full blown cancer research organization with unlimited funds to imitate the medical pyrotechnics of similar bodies elsewhere. Science will put on motley; every learned buffoon will vie with his fellows in periodically discovering the “microbe” and the “specific,” and the half witted and brutal ogre in the vivisection laboratory will be given money and encouragement to intensify his schreck-lichkeit on helpless animals.

Before proceeding to view the statistics and explanation of cancer in the Irish Free State, it is advisable to say something about that part of Ireland. It has a population of about three million people of whom a half are engaged in agriculture, which is still mainly of the stock raising and dairying type despite a great increase of tillage in recent years. Throughout great portion of the countryside the main food products consumed are bread, potatoes, cabbage, vegetables, eggs, meat and bacon.

The people themselves are peasants and live the comparatively hard life of peasants working on the land from early to late, and their standard of living is low. Along the western seaboard especially in Donegal, Connemara and Kerry the people are extremely poor and live in a primitive way; only a short time ago their diet was confined to “mixed” bread (of Indian meal and white flour) potatoes and milk, and in Connemara, the very poorest portion of the country that diet still obtains.

On the coast and on the Atlantic islands fresh fish forms a big and necessary part of the dietary of the inhabitants. In this region of the country the people generally live to a great age and preserve all their faculties as well as their teeth and are very fertile. A person who dies at seventy years of age is considered to have died young. In the cities and large towns however, although lacking any high degree of industrialization, the diet is more “civilized”.

Here white bread, sugar, meat and canned products feature strongly; and through the closer linking up of urban and rural districts their baneful influence has penetrated to many of the country people who permit their homely and natural agricultural and dairy produce to be replaced by tastier, artificial food-stuffs. These conditions of life find their expression in the cancer mortality by placing the Irish Free State as the least cancerous country of the British Isles, and inside it by placing the rural mortality from the disease relatively 20 per cent. less than the urban mortality.

The following table, whose figures are taken from the Registrar Generals Reports, shows in a small compass the evolution of cancer here. There figures for the years before 1922 relate to the geographical portion of Ireland identified with the present political unit of the Irish Free State.

From the figures it is easy to see that cancer has increased absolutely and relatively amongst the people. Even allowing for a certain amount of faulty diagnosis which is usually pleaded against figures taken from the previous century, it is impossible to dispute the rapidity with which it has sped forward in the last decades. The increase annually, however, has not been continuous but succeeding sharp rises indicate the advance made by the disease.

For example in 1924 deaths were 6 per cent. higher than in 1923, in 1925 there was a decrease of 32 per cent. on 1924, but in 1926 there was a further and more than counterbalancing increase of 8 per cent. on 1925. A similar sharp increase in likely to occur in 1934, as in 1933 there has been a slight decrease on 1932. Viewing its progress from another angle one might say that at the beginning of this century cancer mortality here was 1 in 19 of all deaths, in 1922 at the birth of the Free State 1 in 17 and to-day 1 in 13, a high ratio when it is considered that the country is an agricultural one in which a large amount of the population lives close to the soil. In England the cancer mortality is 1 in 8.

Examination of the annual mortality tables discloses only one unusual feature, namely that male deaths are more numerous than female. This can be accounted for however, by the fact that men are in a slight majority, in the population. In cancer statistics elsewhere it is usual to find that women are more prone to the ravages of the disease; and even allowing for the preponderance of the female element in most countries, there is reason to think that generally women in civilized surroundings are more liable as they suffer greater from the effects of auto- intoxication and ill-health.

No occupational incidence of cancer has so far been published. The main distribution of the lesions in the body is similar to what obtains everywhere else. Over a half of these are found in the alimentary canal; and if its adjacent and physiologically intimate structures, as the liver, gall bladder, peritoneum, etc., are included, the fraction is raised to two-thirds. It will be instructive, however, to inspect more closely the question of site and see what may be learned from it.

Cancer of the stomach regularly comprises nearly a quarter of all cancers occurring in the yearly deaths. It is the most frequent and the most deadly form of the disease. The stomach is the vestibule of the digestive tract, and under the best civilized conditions there is pitched into it daily loads of devitaminized foods, confectionery, flesh meats, hot liquids, strong and poisonous condiments; and when it rebels violently it is treated with pills, medicine and antacids. After years of frightful abuse it becomes old and foul, and the sequel is often tragic in extreme.

Peter O Connell