It has been asserted that carcinoma is rare in malarious districts, and that those who have suffered from ague are seldom afflicted with malignant disease. For such statements, however, we can find no justification. In England, one of the principal cancer districts is situated in those regions where malaria is chiefly encountered, and we have been assured by competent observers that in Africa men who have had many attacks of fever are in no way exempt from cancer. Owing to its situation near the docks, cases of malaria are frequently admitted into the London Hospital, and our series of deaths from carcinoma of the stomach includes no fewer than eight men who had previously suffered from malaria. It is noteworthy that in two of these the malignant disease ran its course in less than five months. Several writers have remarked upon the comparative rarity of syphilis among the subjects of carcinoma, and our own experience is confirmatory of this. Of our hospital cases, only 6 per cent, of the men had apparently suffered from the disease, which is a very small proportion for the district from which they were drawn.
(g) Apoplexy and Insanity. -No particular stress can be laid upon the somewhat excessive frequency of cerebral haemorrhage among the progenitors of those who die from gastric cancer, since many of them lived to an extreme old age. On the other hand, there seems to be a distinct connection between insanity and malignant disease, possibly through their mutual association with tuberculosis. Both melancholia and mania occasionally develop during the course of the gastric complaint, and in such cases there is usually a history of tuberculosis or insanity in the family.