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AND ONE WAY TO FIND THEM
716 would curb both " ministerial
intransigence and sectional
exaggeration." As Lord Brain recalled, before the 1939-45 war the great voluntary hospitals were breaking down for lack of money, while the standard of the local-authority hospitals and services was uneven in quality and distribution. Thus the new venture in medical care might reasonably have seemed to deserve generous financial support. Admittedly the needs created by such things as the backlog of decrepit buildings and neglected teeth and the upsurge of new and expensive techniques meant that more and more money was needed, but it would have been well spent. Instead, in Lord Brain’s words, " government after government has behaved like a man who has unwittingly married an extravagant wife and repeatedly repudiates her debts." Every branch of the service he thought had been treated with impartial parsimony, and in 1961 the percentage of our national income spent on social-security and health services was lower than the lowest in the European Community and not quite three-fifths of the highest. He took issue with Mr. Enoch Powell’s defence of this level of expenditure on grounds of lack of public dissatisfaction and the imprisonment of politicians by priorities. Lord Brain doubted whether any substantial percentage of the public knows or cares what proportion of the national income is devoted to any particular branch of national expenditure, and he wondered how politicians took such supposed ideas into account. He thought that we could safely divert some of what we now spend on armaments to education, research, and medical schools and hospitals. He added: " I am sure that we should maintain our power in the world, but there is a power which does not seek to impose its will on others."
...
AND ONE WAY TO FIND THEM
THE news that the British Medical Association has set a Forward Planning Unit is welcome, and it is doubly welcome because the procedure and deliberations of this research and intelligence group are to be " entirely free from pressure or interference ". Some of the problems to be considered will come from the Association’s council; but others are expected to arise from its own discussions. It will delegate each study to a working party which will report back to the unit. The first working party, already at work under the direction of Dr. Ivor Jones, is collecting material for a definitive history of the National Health Service together with an account of its economic problems; and other issues that may be studied include the systems of medical organisation and finance in other countries, the intensive-care unit, computer science in medicine, the future of preventive medicine, and the future of general up
practice. The unit, however industrious, cannot command the Ministry of Health’s resources in collecting facts as a prerequisite to planning; but it may prompt the Ministry to display in this sphere the zeal for which Lord Brain called. Nor, by its constitution, can the unit approach Mr. McLachlan’s idealof a broad-based, multidisciplined national agency, distinct and removed from the actual machinery of Government " which would have its own powerful research and intelligence arm, and be able to plan exercises and experiments. What the unit can hope to do is to display convincingly where action is needednotably the injection of capital into hospital construction: "
1.
McLachlan,
G.
Lancet, March 25, 1967,
p. 629.
hitherto the Ministry’s complacency and evasiveness have concealed from the public the harsh fact that in the pace of hospital construction this country is running just fast enough to find itself on the same unhappy spot at the end of the century. The unit may also emerge as a rallyingpoint for the many with useful ideas about the development of the N.H.S. But it cannot succeed unless its studies— and some of the projected ones are daunting enough—are conducted in depth. Nor can it succeed unless it retains its independence and initiative. (Auspiciously the initial members form a striking group of non-yes men under the chairmanship of Prof. Henry Miller, who can hardly count submissiveness as his outstanding characteristic.2) If these conditions are met, the nation will have cause to be grateful to the B.M.A., and the public’s esteem for the Association is likely to rise sharply-an incidental benefit which should not be scorned when for so long it has presented such a dismal image of myopic self-interest.8 Developments will be awaited eagerly.
INTERNATIONAL CLASSIFICATION OF TUMOURS
they classify tumours, pathologists and clinicians guided by their own experience and by retrospective reports of large series of cases. One man’s experience, however, can seldom encompass the whole subject; and retrospective inquiries from special centres may still be subject to various forms of bias. The terminology of morbid anatomy, in particular, is confused, and a multiplicity of classifications and nomenclature have interfered with progress. Statistically, reliable prospective investigations are urgently needed to establish universally applicable classifications. The principles that should govern the statistical WHEN
are
classification of tumours were outlined in a report 4 from expert committee of the World Health Organisation in 1952. Since 1958, W.H.O. has established 11 international reference centres for the study of tumours at various sites. Each centre exchanges histological preparations and clinical histories with a number of collaborating laboratories and produces final classifications. At present, 115 pathologists in thirty-seven countries are collaborating, and a further eleven centres are planned. The international centre for the histological definition and classification of lung tumours was established in Oslo under the direction of Prof. Leiv Kreyberg. Histological Typing of Lung Tumours,5 the first volume in a series on International Histological Classification of Tumours, sets out unequivocally the appearances seen in varying types of lung tumours. Detailed descriptions and morphology are given and there are a number of excellent photomicrographs in colour, with a full account of a combined staining method for keratin and mucinlike substances. Professor Kreyberg and his associates define many subdivisions of the main histological groups, though they are fully aware of the difficulties that sometimes arise in placing individual tumours, particularly with the group of large-cell carcinomas. No classification an
2. 3. 4. 5.
See Miller, H. ibid. 1966, ii, 647. ibid. Jan. 7, 1967, p. 31. Tech. Rep. Ser. Wld Hlth Org. 1952, 53, 45. International Histological Classification of Tumours. No. 1: Histological Typing of Lung Tumours. By LIEV KREYBERG, head, W.H.O. International Reference Centre for the Histological Definition and Classification of Lung Tumours; in collaboration with A. A. Liebow, E. A. Uhlinger, and seventeen pathology departments in fifteen countries. Geneva: World Health Organisation. 1967. Pp. 28. £4; $16.00; Sw. fr. 48.
intransigence and sectional
exaggeration." As Lord Brain recalled, before the 1939-45 war the great voluntary hospitals were breaking down for lack of money, while the standard of the local-authority hospitals and services was uneven in quality and distribution. Thus the new venture in medical care might reasonably have seemed to deserve generous financial support. Admittedly the needs created by such things as the backlog of decrepit buildings and neglected teeth and the upsurge of new and expensive techniques meant that more and more money was needed, but it would have been well spent. Instead, in Lord Brain’s words, " government after government has behaved like a man who has unwittingly married an extravagant wife and repeatedly repudiates her debts." Every branch of the service he thought had been treated with impartial parsimony, and in 1961 the percentage of our national income spent on social-security and health services was lower than the lowest in the European Community and not quite three-fifths of the highest. He took issue with Mr. Enoch Powell’s defence of this level of expenditure on grounds of lack of public dissatisfaction and the imprisonment of politicians by priorities. Lord Brain doubted whether any substantial percentage of the public knows or cares what proportion of the national income is devoted to any particular branch of national expenditure, and he wondered how politicians took such supposed ideas into account. He thought that we could safely divert some of what we now spend on armaments to education, research, and medical schools and hospitals. He added: " I am sure that we should maintain our power in the world, but there is a power which does not seek to impose its will on others."
...
AND ONE WAY TO FIND THEM
THE news that the British Medical Association has set a Forward Planning Unit is welcome, and it is doubly welcome because the procedure and deliberations of this research and intelligence group are to be " entirely free from pressure or interference ". Some of the problems to be considered will come from the Association’s council; but others are expected to arise from its own discussions. It will delegate each study to a working party which will report back to the unit. The first working party, already at work under the direction of Dr. Ivor Jones, is collecting material for a definitive history of the National Health Service together with an account of its economic problems; and other issues that may be studied include the systems of medical organisation and finance in other countries, the intensive-care unit, computer science in medicine, the future of preventive medicine, and the future of general up
practice. The unit, however industrious, cannot command the Ministry of Health’s resources in collecting facts as a prerequisite to planning; but it may prompt the Ministry to display in this sphere the zeal for which Lord Brain called. Nor, by its constitution, can the unit approach Mr. McLachlan’s idealof a broad-based, multidisciplined national agency, distinct and removed from the actual machinery of Government " which would have its own powerful research and intelligence arm, and be able to plan exercises and experiments. What the unit can hope to do is to display convincingly where action is needednotably the injection of capital into hospital construction: "
1.
McLachlan,
G.
Lancet, March 25, 1967,
p. 629.
hitherto the Ministry’s complacency and evasiveness have concealed from the public the harsh fact that in the pace of hospital construction this country is running just fast enough to find itself on the same unhappy spot at the end of the century. The unit may also emerge as a rallyingpoint for the many with useful ideas about the development of the N.H.S. But it cannot succeed unless its studies— and some of the projected ones are daunting enough—are conducted in depth. Nor can it succeed unless it retains its independence and initiative. (Auspiciously the initial members form a striking group of non-yes men under the chairmanship of Prof. Henry Miller, who can hardly count submissiveness as his outstanding characteristic.2) If these conditions are met, the nation will have cause to be grateful to the B.M.A., and the public’s esteem for the Association is likely to rise sharply-an incidental benefit which should not be scorned when for so long it has presented such a dismal image of myopic self-interest.8 Developments will be awaited eagerly.
INTERNATIONAL CLASSIFICATION OF TUMOURS
they classify tumours, pathologists and clinicians guided by their own experience and by retrospective reports of large series of cases. One man’s experience, however, can seldom encompass the whole subject; and retrospective inquiries from special centres may still be subject to various forms of bias. The terminology of morbid anatomy, in particular, is confused, and a multiplicity of classifications and nomenclature have interfered with progress. Statistically, reliable prospective investigations are urgently needed to establish universally applicable classifications. The principles that should govern the statistical WHEN
are
classification of tumours were outlined in a report 4 from expert committee of the World Health Organisation in 1952. Since 1958, W.H.O. has established 11 international reference centres for the study of tumours at various sites. Each centre exchanges histological preparations and clinical histories with a number of collaborating laboratories and produces final classifications. At present, 115 pathologists in thirty-seven countries are collaborating, and a further eleven centres are planned. The international centre for the histological definition and classification of lung tumours was established in Oslo under the direction of Prof. Leiv Kreyberg. Histological Typing of Lung Tumours,5 the first volume in a series on International Histological Classification of Tumours, sets out unequivocally the appearances seen in varying types of lung tumours. Detailed descriptions and morphology are given and there are a number of excellent photomicrographs in colour, with a full account of a combined staining method for keratin and mucinlike substances. Professor Kreyberg and his associates define many subdivisions of the main histological groups, though they are fully aware of the difficulties that sometimes arise in placing individual tumours, particularly with the group of large-cell carcinomas. No classification an
2. 3. 4. 5.
See Miller, H. ibid. 1966, ii, 647. ibid. Jan. 7, 1967, p. 31. Tech. Rep. Ser. Wld Hlth Org. 1952, 53, 45. International Histological Classification of Tumours. No. 1: Histological Typing of Lung Tumours. By LIEV KREYBERG, head, W.H.O. International Reference Centre for the Histological Definition and Classification of Lung Tumours; in collaboration with A. A. Liebow, E. A. Uhlinger, and seventeen pathology departments in fifteen countries. Geneva: World Health Organisation. 1967. Pp. 28. £4; $16.00; Sw. fr. 48.