On changes in the recorded mortality from cancer and their possible interpretation / by Major Greenwood, jun., and Frances Wood.

  • Greenwood, Major, 1880-1949.
Date:
1914
Catalogue details

Licence: In copyright

Credit: On changes in the recorded mortality from cancer and their possible interpretation / by Major Greenwood, jun., and Frances Wood. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

    8/54 (page 6)
    be subject, but we shall only deal with one which is, we think, of special importance. A possible interpretation of their results would be that, while the true incidence of cancer was constant, the relative hospital mortality had increased owing to (1) a greater proportion of admissions from cancer, (2) a lower mortality from causes other than cancer, or (3) a different selection of hospital cases. The first objection they hold to be met by the fact that the ratio of cancer cases to all admissions has not increased sensibly during the period 1870-99 (the figures do, however, as the authors pointed out, show some tendency to increase) ; they also argue that the mortality from causes other than cancer in persons aged over 35 has not diminished greatly, so that the increasing ratio could not be explained in this way. Neither of these contentions meets the difficulty italicized. It is certain that a hospital population is not a random sample of the general population, but both pathologically and economically select. If we first suppose that the basis of this selection has not been changed, that all who present themselves for admission are, so far as space permits, admitted and are of the same economic class, the increased relative death-rate from cancer would only be evidence that cancer is more fatal among persons of the class furnishing hospital patients, and only then if the death-rate from other causes in that class has been constant. We think, as a matter of fact, that neither the economic class nor the general fatality rate observed among hospital patients can be assumed to have remained constant, although in the case of certain occupations and diseases Greenwood and Candy failed to demonstrate any very striking change during the last fifty years (they found that the pneumonia fatality rate had not markedly diminished since 1854, and that the proportion of labourers among the hospital patients diminished between 1783 and 1907, but that there were difficulties in accepting the comparison as valid owing to possible differences of classification). Another difficulty is this : if the policy of the hospital has not changed and the same class of patients presents itself as formerly, we should expect to find a larger proportion of admissions for cancer if the incidence of that disease upon the class furnishing hospital patients has increased; but the percentage admissions for cancer to the Middlesex Hospital has remained (very approximately) constant, and therefore, as it seems to us, if cancer has increased among the population the policy of the hospital or, what comes to the same thing, the policy of those who resort to the hospital cannot have remained