Cancer in the Mentally Ill

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Abstract
An analysis is given of cancer among mental patients of the St. Elizabeth Hospital, Washington, D. C. during a 10-yr. period. Altogether 227 cases occurred, 189 were fatal. The distribution of the fatal primary malignancies according to site does not deviate from the expectancy, while the % of skin and lip cancers is much smaller than expected in a southern area. The ratio of cancer deaths is 7.1% for the whole 10 yr. period, the ratio is increasing toward the end of the period of observation. The cancer mortality of the white patients from the area in which the hospital is located is significantly lower than that of the corresponding white population of New York City. 2/3 of the white patients were born north of the 40[degree], but lived in the South before they were admitted to the hospital. For the patients born in the South, and residing there before admission, the cancer mortality was 38.3% less than the expectancy calculated on the basis of the mortality statistics for New York City (1935). For the white patients born north of the 40[degree] and who migrated to the South the cancer mortality was 27.0% less than the expectancy. The cancer mortality of the white ex-soldiers and of the colored mental patients does not deviate from the data calculated on the statistics of the white inhabitants of New York City. Of the white ex-service men, 2/3 were born in the North, and only a small part of them was exposed to the climatic conditions of the South either in childhood or later; they served in the armed forces for a short period only. The probability of metastizing to the brain was studied for primary tumors of various organs. Out of 189 fatal cancer cases 155 were examined post mortem. Cancer of lungs and adrenals has a higher probability of metastasizing to the cerebrum, exclusive of hypophysis, and cerebellum than cancer of other organs. Cancer of the prostate has a much higher chance of metastizing to the hypophysis, the lepto-meninges, and the dura than any other cancer, the relation being as 1:21, 1:7 and 1:10.

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