cancer.

the rates for women under 55 being lower than South Australian women as compared with they were thirty years ago ; that the apparent those of the old country. As to cancer on the increase of cancer is most marked in old people, whole, in that State there was a decrease in the and particularly in women of 75 and upwards ; number of deaths registered. Their statistics and I am sirongly of opinion that most of this showed a rapidly increasing liability to cancer apparent increase is fictitious, being due partly with advancing age. Many cases of cancer to changes in the age distribution of the popula- declared themselves to the laymen, but others tion, and partly to more regular medical ex- could not be diagnosed by the most skilled of amination, better diagnosis, and more explicit scientists. The more scattered a population the registration.

fewer were the cases of cancer registered. Comparison of Australasian with English There was nothing to explain in connection with Rates.-If we finally compare the cancer male mortality, unless the slightly increased statistics of Australasia with those of England rate was attributed to a greater accuracy in and Wales, it is found that the Australasian diagnosis ; but what did require elucidation was rates are decidedly lower for male and for the apparently marked freedom of women from females, and this both for all ages, and at

A peculiar feature of statistics was almost every period of life except for persons the smallness of the death-rate from cancer of 75 and upwards. The rates for England among women in South Australia. At Frankand Wales were higher in 1899 than ever fort-on-Maine, where the statistics were before, the general rate being 8 29 per 10,000 probably kept with accuracy, the death-rate living, the male rate 6.72 and the female rate among women was 50 per cent. higher than 9.77. When the generative and mammary among men, and in Great Britain and Ireland systems are excluded, the female rate in Eng- 45 per cent. bigher. What, then, did this low land and Wales is only slightly less than the female mortality among women in South male. These proportions between the sexes Australia mean? Whatever might be the contrast strongly with those which obtain in solution of the low death-rate among women, Australasia, where the total female rate is less the conclusion was forced upon them that than the male, instead of being nearly half as South Australian women-and he was glad to large again ; and where exclusion of the find that it meant Australian women generallygenerative and mammary systems brings the enjoyed a decided immunity from cancer ratio of the female rate to the male rate down compared with their sisters on the other side of to, approximately, as 10:17. In England and the world. Wales, as in Australasia, the cancer rates in- Dr. W. Camac Wilkinson (Sydney) read a crease from middle life into old age. While the paper on the “ Etiology of Cancer.” The subtotal rates in England and Wales have increased ject of cancer had a very melancholy interest from 4:46 in the period 1874-75 to 8.29 in 1899, for the physician as well as the layman. the Australasian rates have increased from 2.75 Whatever success might have been achieved in in 1870-72, to 5.72 in 1900.

other fields of science, cancer was the one dis

ease which baffled and set at defiance the efforts Cancer DiscusSION

of the medical profession. In other diseases Dr. Verco (Adelaide) read a paper on the the greatest advances had been made by a South Australian statistics as to the disease; closer study of the etiology of those diseases but explaining that when he prepared his paper The best prospects of success in dealing with he did not know that Professor Allen would the important question of cancer, especially deal with the statistics of all Australasia. As with regard to its treatment and prevention, to the prevalence of the disease in South was to obtain a better understanding of its Australia, between 1874 and 1900 there had origin and nature. Whether the increase in been 3,282 cases ; average per million, 382 of

was real or apparent, no one had the all ages; the death rate was 60 per cent, during hardihood to .assert that it was diminishing. that period, of that of the old country. He The extent of cancer could be measured by the concluded that cancer rapidly increased with various deaths that took place. In Tasmania advancing age. New methods of comparison there had been very little increase since 1870. raised the percentage from 60 per cent to 82 Females suffered more than men from cancer, per cent. as compared with the old country. between the ages of 55 and 60, but after the Among men the mortality in South Australia age of 60, males suffered more than females. from cancer was slightly higher than in England Occupation appeared to have some effect on canand lower as to females. Up to date statistics cer, and clergymen occupied the best position, showed a marked freedom from caneer among and chimneysweeps the warst. As he had

as

cer.

are so

were

proviously remarked, statistics showed that there treatment of cancer would not be regarded as was an increase in the number of cases of can- a last resort, but as a means for actual cure.

It was for them to consider if that in- Professor ALLEN (Melbourne), read a paper crease was real or apparent. It was no use prepared by Dr. F. D. Bird, of Melbourne, on saying actuaries and statisticians were wrong ; “The general results of radical operation." He they were right according to their own methods. dealt with the disease from the point of view of If they were wrong it was due to the fact that the practical operating surgeon. He pointed out incorrect data were supplied to them. If medi- that the many varying forms of disease wbich cal men could not settle the question no body are grouped under the term "cancer of men could settle it.

Medical men

numerous, and so different in their structure blamed for not knowing more, but false, mor- and effects that it would be well-nigh impossible bid sentiment often stood in the way of re- to describe them all within the limits of a search. The view was now held that the single paper. The almost utter hopelessness of growth of cancer was altogether independent of the surgeon of 50, or even 20 years ago, in the tissue invaded. A proper system of research the presence of this disease contrasts required not only post-mortem examination, strongly with the confidence of the more but also histological investigation. He quoted sanguine surgeon of

the

present day. the opinions of eminent authorities with regard With regard to the prospect of the cure of to the cause of cancer. Benign tumours, al cancer by operation, it lies, nowadays, somethough large, did not have a bad effect on the where between these two extremes. The older blood, but malignant tumours, no matter how surgeon, with his crude, imperfect operations, small, did affect the blood. There were great undoubtedly cured some cases, whereas the gaps to be yet filled in before it would be pos- modern surgeon, with all his latest improvesible to declare that cancer was due to a para- ments, fails to bring about a cure in a great site. If it was found that cancer was due to a many instances. Nevertheless, in few branches parasite, something might then be done to of the doctor's art have the chances of complete arrest its

progress, and he hoped that the cure been advanced so much. Mr. Bird quoted efforts of the scientists at present engaged in Sir William Banks, who asks the question as to the work would be successful.

what would be the result if every cancer were Dr. SYDNEY JAMIESON (Sydney) read a paper operated upon when it was of very small size? on “The part played by injury, chronic To bring this happy result about, the public irritation, and inflammation, in the production must be gradually educated up to the fact that of new growth.” After dealing with the a larger number of cancers are perfectly and occupation of those attacked, Dr. Jamieson permanently curable, if only surgical relief is instanced cases in which cancerous growths sought at an early stage. It was pointed out attacked injured tissues ; examples of new that in some cancers, easily accessible to the growth following upon chronic irritation and surgeon's knife, the percentage of actual cures inflammation then instanced, many had lately been gradually rising from two or examples being seen of tumours arising at points three to 20 and 30 and lately even to 55 per which were the seats of chronic inflammation ; cent., and this, too, in spite of the fact that epitheliomata not infrequently were found many cases are now operated upon which growing in the edges of chronic ulcers In- would formerly have been left to their fate. numerable cases could be instanced where long How many cases of cure can every operating continued irritation and inflammation had been surgeon call to mind, which, to all appearances, associated ultimately with cancer formation. hardly justified an operation, owing to the In conclusion, he said by taking means to advanced stage of the disease. On the other prevent inflammatory attacks from becoming hand, the surgeon to-day is often persuaded chronic; by adopting skin grafting to a greater to operate, when his surgical instinct tells him extent in the healing of burns and ulcers, and that surgery can scarcely avail anything. by as far as possible relieving the tissues from Sometimes, to his delight and that of his the baneful effects of prolonged irritation, they patient, even here he scores a genuine and unwould, he felt sure greatly reduce the incidence expected success. To surgeons in the past, all of new growth.

cancer cases seemed almost hopeless ; to-day Dr. TodD (Adelaide), read a paper on “ The there are cases—unpromising, truly—but far desirability of removing the chain of glands near fewer cases can be labelled absolutely hopeless. its growth.” He believed the limits of curing This is a great and encouraging advance. No cancer by the knife had been reached ; yet at surgeon can say decidedly whether a case is present the principal hope was that the surgical favourable or not. The only fear is that of

were

The paper

recurrence after removal. Sometimes, even when for the increase of cancer cases. a cancer returns several times after removal, it gave an interesting analysis of the sex, type of can be ultimately cured by repeated operation. new growth, organ involved, and occupation of These are strange and rare instances of the dis- the victims of cancer. ease, but every surgeon

has seen many

of them. A paper was taken as read, prepared by Mr. The disease seems, in fact, after a time, to wear T. A. Coghlan, New South Wales Government itself out. Now-a-days, the presence of what Statistician, on “ The causes of the increase or is known as the “Cancerous Cachexia” is not alleged increase in cancer, examined in the necessarily a bar to operation. On the con- light of the statistics of New South Wales, trary, it very often is an indication for it, and since 1856." He discussed the question of the it is surprising how quickly a cancerous patient increase of cancer entirely from a statistical will regain health and strength after the focus, point of view, limiting observations to the or poison centre, of his disease has been re- statistics of New South Wales. As regards the moved. Thus they had a number of rational alleged increase of cancer there has been much inducements to operate, a number of subsidiary controversy. It is alleged that the increase in reasons for using the knife, but the grand in the cancer figures is due to an alteration in the ducement--the overpowering reason for operat- age constitution of the people, and to the ing—is that, in a number of cases, they could fallacious mode of referring cancer deaths to the cure the patient outright. The prominent note whole population rather than to the age groups, of the paper was one of hope for further suc- cancer being mainly a disease of adult ages. cesses from surgery in the near future, as the This contention is disposed of by a comparison public becomes alive to the importance of ap- of the deaths in age groups with the number of plying for relief early in the disease. There persons exposed to risk in those same groups. was also hope for the surgeon, who must bear By this the statistics unmistakably show that, in mind the fact that, however unpromising the taking a term of years for comparison, there ,

a case may appear, he has a reasonable chance of has been an increase in the rate in each group. curing his patient by a thorough and complete In the past ten years, a period during which it removal.

is not claimed that any great improvement in A paper, taken as read, on “Some Aspects diagnosis has taken place, the increase of of Cancer,” was submitted by Dr. W. M. Sten- cancer has been very considerable for both sexes house (Dunedin), contending that cancer was and for all ages, the only exception being for mainly a disease of old age, and was due to the females in the age group, 25 to 34. In this loss of some power or property which, in earlier group there has been a slight decline in the years, constituted a protection ; instancing number of deaths compared with the population. however, a case of sarcoma of the kidney in & Improved diagnosis does not, therefore, account young, healthy woman, with excellent family for the increase of the cancer figures. history, and no obvious cause. Dr. Stenhouse Professor Allen replied. He said it might was not disposed to attach great importance to seem strange that no free discussion should folheredity, but laid great stress on nervous or low. But he thought that was one sign of the moral shock, and quoted cases illustrating the great truth that the work of a medical congress rapid development of cancer in such circum- lay more in the private communications be

tween members than in the public transactions Dr. A. W. Finch Noyes (Melbourne) sub of the Congress. They learned more by coming mitted a paper, with statistics on cancer records together, man to man, and comparing their for the principal hospitals of Victoria. His thoughts and experiences than by getting upon analysis comprehended 3,936 cases of carcinoma the platform and making set speeches. He beand sarcoma, extended over 20 years, and lieved that the bringing up of the subject of collected from the principal hospitals of Victoria cancer would not be a fruitless thing. It would He showed that there was an increase in cancer, bring forth fruit. If it stimulated investigawhich exceeded the increase of population. tion and led to the avoidance of difficulties and The greater accuracy of diagnosis, helped by errors met and committed in the past they the more thorough microscopical examination of might arrive at some substantial results. He doubtful growths, and the greater frequency of thanked the Congress for the attention given to post-mortem examinations, tend to swell the his very long paper. And yet it was only in numbers. Many cases, too, are now admitted the nature of a sketch. He had much more for surgical treatment, which in the past, material available than he had submitted to would have been turned away as inoperable, the Congress, but he had given his own main but these factors alone cannot wholly account impressions. He had not seen any reason to

change his conclusions as to the origin of cancer,

A PRELIMINARY NOTE ON THE SERUMand he did not put them in any dogmatic way.

THERAPY OF SNAKE-BITE. There was room, both for those who held the parasitic theory and those who did not. He By Frank Tidswell. M.B., Ch M., D.P.H., Prinhimself would gladly welcome a proof of that

cipal Assistant Medical Officer of the

Government, and Microbiologist to the theory, which would bring hope in the future.

Board of Health, N.S.W., Sydney. One of the chief authorities cited in favour of the parasitic theory did not contend that he (From the Microbiological Laboratory of the Board of had proved the parasitic nature of the disease

Health, Sydney). of cancer.

Another authority mentioned dealt with yeasts ; but all their experience would lead them to say that such vegetable organisms By the courteous permission of the President did not produce the phenomena of cancer either of the Board of Health, I am enabled to publish locally or in dissemination. Having referred the present preliminary note in anticipation of to other parasites, Professor Allen went on to an official report dealing with the general subsay that with regard to statistics Dr. Verco ject of snake bite in this State. had pointed out sources of error. Statistics In February, 1894, Phisalix and Bertrand, were very apt to lead one astray. But when, and A. Calmette announced almost simulfor example, one found in these colonies the taneously that animals could be rendered striking fact that women suffered so much less immune to snake venom, and that the blood than men they could not ignore the figures. serum of such animals was possessed of curative The figures for 1900 were not so satisfactory properties. These statements were confirmed as they might be, owing to the noncompletion by the investigations of T. Frazer, an account of the census. In two or three years' time of which was published in the following year. more definite information would be available. Some observations on the same subject were It was to be hoped, however, that steps would made by Sewell and A. A. Kanthack, but its be taken to obtain some united forms of record more recent development is mainly due to the and establish some nomenclature of cancer. researches of Calmette. This able observer has Mr. Coghlan spoke of external cancer, but he carried his labours to the point of elaborating meant accessible cancer, including cancer of and placing upon the market the produc; no v the throat. Cancer in the face and lips of well-known as Serum Antivenimeux” anglicé males had not increased ; cancer of the breast "antivenine.” in women stood lower than it did 30 years Although this serum is prepared by treating ago. He himself had brought up his figures in a horses chiefly with cobra venom, smaller quansimple way. He hoped the Government Statists tities of other venoms are additionally used, would keep this matter going, and not allow it and Calmette claims that the serum obtained is to drop, and analyse it to the utmost. Then active against the vënoms of all species of they might find the totality of result most snakes. It is specifically stated to have been valuable. With regard to treatment, all must tested against the poisons of the cobra and tribe agreed that immense progress had been meresurus of Asia, the naja haie and cerastes of made ; but they hail also to fear whether Africa, the crotalus of America, the bothrops of there had not also been unwisdom, as well as the West Indies, the viper of Europe, and the wisdom in some of the advanced methods that pseudechis (black snake) and hoplocephalus had been used.

(tiger snake) of Australia. Dr. WOLFHAGEN, on behalf of the executive, Partly from a knowledge of differences in moved a hearty vote of thanks to Professor chemical composition and physiological action Allen for the trouble he had taken in preparing between the venoms of different species of such an able paper to open the discussion, and snakes, and partly as the result of practical

, also to the other gentlemen who had taken experience, this sweeping assertion of the allgreat pains in preparing most interesting and round efficacy of the serum has not received instructive papers. To the Government Statis

acceptance.

As regards Indian serpents, ticians they were also deeply indebted.

Lamb has found that whilst the serum is The motion was passed amid applause. capable of neutralising the effects of cobra

venom,

it The Estate of the late Sir William Mac

possesses no potency against daboid

Observations made in this country Cormac. —The value of the estate of the late Sir

have also failed to support Calmette's co enWilliam MacCormac, Bart, F.R.C.S, formerly Pres. dent of the Royal College of Surgeons of England, has

tion. In some unpublished experiments made been proved at £22,812 58. 6d.

in this laboratory in October, 1896, the serum

"

venom

venom.

proved unable to preserve the animals against The horse subjected to the immunisation was tiger snake venom, and similar negative results a sturdy, well-nourished creature, incapacitated were reported by C. J. Martin in August, from ambulance service only by reason of a 1897, this observer then expressing the opinion sprained shoulder, which induced lameness on “That Calmette's conclusions regarding the continued work. Throughout the treatment value of the serum of an animal immunised this animal has remained fat and sleck, his against cobra venom as a protection against general excellent health being only temporarily other venoms are, as they stand, untrue, and disturbed for brief periods after the injections require considerable modification.” Subsequent of venom. experiments performed in this laboratory have, The treatment was commenced on June 7th, unfortunately, only confirmed the view that 1898, by the subcutaneous injection of .0005 Calmette's claim cannot be admitted as regards gramme of the venom. This was repeated in a Australian snake venoms.

week, and a week later the dose was increased There is no need in this place to enter more

to .00075 gramme.

Increments of .00025 at deeply into the explanation of this lack of success each dose were maintained during the first six than to point out that curative serums are months of the treatment, but after that they essentially specific, acting, as a rule, only or only were raised more rapidly: e.g., by.0005(January, effectively against the toxines with which they 1899), .01 (March, 1899), 05 (May, 1889), and have been prepared ; and that, amongst othör .1 (January, 1901,) gramme. The increments things, there are differences between the effects were pretty regularly given, the same dose of cobra venom and tiger snake venom, such as being repeated only on rare occasions when the might serve to explain why a remedy, applicable reaction was more than usually pronounced. to one, proves ineffective against the other. As Between October, 1899, and May, 1900, the already stated, the venom used by Calmette for pressure of other work interfered with regular the preparation of the serum is chiefly cobra treatment, but otherwise the horse was injected

But other venoms are mixed with it, once a week (June, 1898, to April, 1899); and, by consequence, the serum is not strictly once a fortnight (May, 1899, to May, 1900); adapted for the settlenient of this question of and once a month (July, 1900, to January, specificity. It is necessary for this purpose to 1902.) The lengthening of the intervals was possess a serum prepared with one single kind due to the difficulty of collecting the larger of venom, and to test its efficacy against the amounts of venom required as the dose insame and other kinds of venom. Researches creased. This same difficulty has limited the with this object have been carried on in this maximum dosage to :6 gramme, which laboratory during the past three or four years, reached in April, 1901, and which it has not been and have now resulted in the immunisation of possible to more than approximately maintain a horse, and the acquisition of a serum fulfill to date. During the period of 3 years covered ing the conditions just mentioned.

by the treatment the horse has received a total The venom selected for the immunisation of quantity of about 10 grammes of pure tigerthe horse was that of the tiger snake (notechis snake venom. It may, perhaps, be pointed out scutata vel hoplocephalus curtus), this choice that the dose which the horse now bears withbeing determined by the consideration that out effect ( 6 gramme) is about equal to the should an effective serum be obtained it would aggregate yield of 21 or 22 average snakes, and be serviceable in the treatment of the bites of that the total amount received by the horse the most dangerous of our snakes. The venom during the treatment (10 grammes) is about was taken directly from living snakes kept in equal to the amount which would be yielded by the laboratory, the reptiles being made to bite | 333 average snakes. and eject their venom into a watch-glass covered The serum used in the experiments about to with thin rubber sheeting, which the poison be described was obtained at two bleedings perfangs alone penetrate. By this means the formed on May 5th, 1901, and October 9th, 1901. venom is obtained free from saliva and from any The horse was bled in the usual way from the adventitious products which might be squeezed jugular vein by means of a trochar and canor dissolved out of excised glands. The pure nula. The subsequent manipulations up to the venom was thoroughly dried over calcium in distribution of the serum into small sealed dessicators, and preserved in phials for use as tubes are fully described in the general report, required. Venom so prepared has been obtained but need not detain us here. Sutlice it to say, from the ck, brown and tiger snakes, and therefore, that from first to last the serum is from the death adder. For injection the venom entirely preserved from any risk of contamiwas dissolved in 9 per cent. saline solution. nation, and is finally obtained perfectly pure

was