Cancer in Ireland
Agnes Arnold-Forster (King’s College London) shows how the 19th century conceptualisation of cancer as a disease of civilisation impacted on understandings of its place in Ireland.
The 1840s and 1850s saw the British populace increasingly measured and counted. This practice derived in part from the development of statistical methods, and grew alongside a quantitative study of people and their activities more generally. The main source of disease statistics was the Annual Report of the Registrar-General on Births, Deaths and Marriages in England, first presented to Parliament in 1838. In 1839 the statistician William Farr joined the General Registry Office [GRO], and proceeded to tabulate regional and national vital statistics – births, marriages and deaths – for each of the country’s divisions.
The fourth Annual Report onwards recorded causes of death, alongside the person’s sex, age and profession. The GRO also calculated the annual mortality by each cause. Parallel reports were later produced for Scotland, Wales and Ireland. Narrative prefaces to each annual report situated individual investigations within a broad chronology, and enabled doctors and public health professionals to comment on yearly shifts in the disease profile of the British Isles.
As the quantity of data on cancer and its incidence accumulated, observers began drawing conclusions about the disease’s relative rates in different years. Cancer appeared to be increasing. The Forty-Second Annual Report, published in 1879, recorded that among men of all ages cancer was the cause of 4121 deaths, on par with diseases like diarrhoea (5712), whooping cough (5804), scarlet fever (9148), and measles (4678). It also caused many more deaths than cholera, the quintessential Victorian malady (122). Among women the figures were even more dramatic, with cancer causing 8508 deaths, more than any other disease. The preface elaborated on these high numbers, and expressed concern over the increased mortality from cancer, which had “maintained the increase to which it has been gradually mounting for many years.” Responses to this supposed increase became increasingly melancholic. In 1883 The British Medical Journal published an article in which the author lamented, “A cursory examination only is sufficient to divulge that the fell disease claims year by year a higher ratio of victims.” This bleak prognosis filtered through multiple layers of nineteenth-century society. Concern over the new “cancer epidemic” was not confined to professional discourse – rather evidence for, and debates about, the increase in cancer appeared in a variety of publications. “The rapid increase of cases of death by that dread disease cancer”, wrote the New York Times in 1902, “is exciting attention in Europe as it has here.”
The epidemic, however, was not understood to be expanding at equal rates in each of the Four Nations. This perceived asymmetry was deployed as a way of thinking through the challenges of civilisation, as well as to reconfirm a hierarchy in the lifestyles and public health practices between different locales, in particular, England and Ireland.
The cancer epidemic was read by all – in one way or another – as an unintended consequence of social, political, and economic progress. Some saw it as manifesting the inherent bodily degeneration that all advanced populations were undergoing at the turn of the twentieth century. In 1911 E. Ray Lankester wrote, “Degeneration is a necessary accompaniment of progress.” These “new discourses of degeneration” have been much studied by historians, but the role of cancer within these conversations has not been recognised. A mid-nineteenth-century commentator was explicit: “Civilisation appears to be the cause of this disease.”
The conceptualisation of cancer as a disease of civilisation was dependent on nineteenth-century theories of racial hierarchy. Commenters from Linnaeus to Lapouge suggested European populations could be separated along biological lines. An article published in 1888 claimed, “The Celtic, including the Gaelic, Welsh, Irish and North French races…were never able to reach a full development…They have never organised stable government or contributed largely to human progress.” The author also claimed that Ireland had the greatest proportion of “persons of unsound mind” in the world. Connections were also drawn between Irish and ‘other’ non-white races. They were caricatured in the British press, with simian noses, long upper lips, huge projecting mouths, and sloping foreheads. An early twentieth-century commentator claimed that the “loose sex relations” of “the negro” were shared by the Irish, so that both were “multiplying so fast.”
In light of this, Ireland’s comparatively small “cancer epidemic” made sense. The British Medical Journal published data comparing cancer rates in Ireland favourably with rates in England: “In the eleven years 1877-87 the annual death-rate from cancer in England and Wales among persons aged upwards of 25 years was 1,188 per million; and the rate increased steadily year by year from 1,079 in 1877 to 1,331 in 1887. In Ireland, on the other hand, the mean annual rate in the same eleven years, at the same ages, was only 828 per million.” If cancer was a product of progress, and Ireland was on a lower rung of the global civilisation ladder, then it made sense for the latter to have a lower cancer mortality than its more advanced neighbour: “Certain races seemed to have a greater susceptibility than others to cancer, a tendency especially marked among peoples of Teutonic or Scandinavian origin, while an exceptionally low mortality was most often noted among Celtic or Slavonic [sic] peoples.”
Victorian medical literature also drew comparison between wild animals and ‘wild’ or ‘uncivilised’ peoples. And, parallels were drawn between ‘civilised’ man and domesticated creatures: “Cancer is by no means an uncommon disease among the domesticated animals, while in wild animals and uncivilised man it is rare.” “The negro” was also, therefore, understood to be almost immune to cancer. A doctor wrote in the British Medical Journal about the “apparent rarity” of the disease among the “aborigines” of Sierra Leone. Cancer – or the lack thereof – was used to reinscribe the essential relationship between Celts and that nineteenth-century archetype of savagery: the black African.
Cancer played its own role in the construction of the Irish as inferior in both body and mind. However, this literature on the ‘epidemic’ (or lack thereof) in Ireland also worked to configure cancer as a disease of civilisation, a pathology of progress, and an unintended consequence of modernity: a trio of understandings that are familiar to us today.