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CENSUS, 1966
533
works to rehabilitate their own salaries."
patients, the
more
they undermine
Ministry and Whitley Council must reach an acceptable solution to this problem of the points system, which is damaging many hospitals, not only those for the
nursing staff, who will have to make up ward lists, select the sample, and maybe complete the forms for patients too ill to do so themselves; and he has thanked them in advance for their cooperation.
subnormal. The few concessions that have been allowed for individual cases have altered the overall situation very little. The state of our hospitals for the subnormal can and must be improved, both in their structure and in the quantity and quality of their staffing.
Annotations CENSUS,
1966
BUT for interruption by other engagements in 1941, Britain would have had a census regularly every ten years since 1801. The pattern of 20th-century life has been shifting so rapidly, however, that this decennial review is no longer sufficient to measure her changing structure with precision. At midnight, therefore, on Sunday, April 24, 1966, there will be a half-time census of one household in ten and of a 10% sample of the residents of other institutions (including hospitals). A census measures change as well as present state, so the questions it asks cannot differ notably from one census to another; but in April some of the uncertainty left by the 1961 census 1concerning tenure and what the Registrar General calls " household amenities "-will be removed by more detailed questions. Place of birth may be relevant to diseases of later life; so, to help with future inquiries, information about birthplace is asked for in the 1966 Census. The answers will also help to define focuses of
immigrant populations. A census is not an academic exercise: it is the main instrument for all sorts of plans; and, in conjunction with mortality and morbidity statistics, it is the starting-point for many epidemiological surveys. Planners and epidemiologists need details and in the past, though the preliminary picture of the census has emerged with commendable swiftness, the full analyses have taken much longer. The three reports of housing from the 1961 Census were published four years later2 and the full population-migration tables are still " in the press ". Fortunately, such a long delay is not envisaged for the 1966 census: with greater help from the War Office computer, the statisticians at Somerset House hope to complete their formidable task and publish the results in about two years. The responsibility for administering the census of patients and resident staff in 3753 hospitals and 135 out of 1332 " smaller medical establishments " (such as nursing-homes) will be delegated to a chief resident officer (commonly, the hospital secretary). In 1961, it seems, the admonition " warts and everything " was not rigidly observed in the preparation of the 10% samples in hospitals-the very sick or potentially uncooperative patient may have been passed over, thus introducing a bias. Some guidance on how to prepare an unbiased sample will be given to each resident officer. The Registrar General realises that by delegating the running of the census he is adding to the work of administrative and 1. Lancet, 1965, 2. ibid. pp. 211,
i, 365. 380, 611
CANCER OF THE UTERINE BODY
MANY gynaecologists believe that cancer of the body of is more common today than it was fifteen or twenty years ago, but it is hard to be certain about this. Little reliance can be placed on the experience of individual clinics, because local factors may influence year by year the number of patients referred to any one centre. At national level the Registrar General’s annual figures1 show that the death-rate due to cancer of the uterine body has not changed significantly since 1950, nor has the ratio of death from cancer of the cervix to cancer of the body (2:1) changed over the same period. In women who have few rather than many children the disease appears most often between the ages of 55 and 60; but it is not uncommon in younger women. In a series of 983 patients in Birmingham2 a third were under 55, and 6% were under 45. Other reports 34 note that between 20% and 30% of women were still menstruating when the tumour was discovered (these women tend to menstruate to a later age than normal.6) Unfortunately, cytological examination of cells in the vagina is less reliable in endometrial than in cervical cancer, though there have been reports 7-9 that examination of cells aspirated from the uterine cavity gives an accurate diagnosis in 90% of cases of endometrial cancer. Early diagnosis still depends on the prompt investigation of all instances of postmenopausal vaginal discharge or bleeding. In younger women some minor deviation from the usual menstrual pattern may be the earliest feature of the disease; and failure to appreciate this point is an important cause of error or delay in diagnosis.10 11 uterus
In
Birmingham2 during the period under review there policy of " operation whenever reasonably possible ", and 84% of all patients underwent hysterectomy with or without radiotherapy. Almost half the patients had vaginal radium therapy after hysterectomy, but the 5-year
was a
survival-rate
the same as for women who underwent alone. Here, as in other series,12-16the hysterectomy results suggest that preoperative or postoperative irradiation may reduce slightly the incidence of vaginal metastases, but the effect is not decisive. The secondary deposit which appears so constantly 1 or 2 cm. above the urinary meatus is of particular interest. Way 17 found a high was
3. 4. 5. 6. 7. 8. 9.
Registrar General’s Statistical Review of England and Wales. Part in: Commentary. H.M. Stationery Office, 1950-62. Dobbie, B. M. W., Taylor, C. W., Waterhouse, J. A. H. J. Obstet. Gynœc. Br. Cwlth, 1965, 72, 659. Dearnley, G. ibid. 1949, 56, 819. Kimbell, C. W. A. Proc. R. Soc. Med. 1954, 47, 895. Burch, P. R. J., Rowell, N. R. Lancet, 1963, ii, 784. Way, S. J. Obstet. Gynœc. Br. Emp. 1954, 61, 46. Reagan, G. W., Sommerville, R. L. Am. J. Obstet. Gynec. 1954, 68, 78. Hecht, E. L. ibid. 1956, 71, 819. Morton, D. G. J., Moore, J. G., Chang, N. J. int. Coll. Surg. 1959, 31,
10. 11.
Finn, W. F. NW. Med. Seattle, 1952, 52, 235. Bourne, A. W., Williams, L. H. Recent Advances in Obstetrics and
12. 13. 14. 15. 16. 17.
Gynæcology. London, 1962. Rickford, B. J. Obstet. Gynœc. Brit. Emp. 1949, 56, 41. Dobbie, B. M. W. ibid. 1953, 60, 702. Stander, R. W. Am. J. Obstet. Gynec. 1956, 71, 776. Lingren, L. Acta obstet. gynec. scand. 1957, 36, 426. Graham, J. B. Acta cytol. 1958, 2, 579. Way, S. J. Obstet. Gynœc. Brit. Emp. 1951, 58, 558.
1. 2.
570.
works to rehabilitate their own salaries."
patients, the
more
they undermine
Ministry and Whitley Council must reach an acceptable solution to this problem of the points system, which is damaging many hospitals, not only those for the
nursing staff, who will have to make up ward lists, select the sample, and maybe complete the forms for patients too ill to do so themselves; and he has thanked them in advance for their cooperation.
subnormal. The few concessions that have been allowed for individual cases have altered the overall situation very little. The state of our hospitals for the subnormal can and must be improved, both in their structure and in the quantity and quality of their staffing.
Annotations CENSUS,
1966
BUT for interruption by other engagements in 1941, Britain would have had a census regularly every ten years since 1801. The pattern of 20th-century life has been shifting so rapidly, however, that this decennial review is no longer sufficient to measure her changing structure with precision. At midnight, therefore, on Sunday, April 24, 1966, there will be a half-time census of one household in ten and of a 10% sample of the residents of other institutions (including hospitals). A census measures change as well as present state, so the questions it asks cannot differ notably from one census to another; but in April some of the uncertainty left by the 1961 census 1concerning tenure and what the Registrar General calls " household amenities "-will be removed by more detailed questions. Place of birth may be relevant to diseases of later life; so, to help with future inquiries, information about birthplace is asked for in the 1966 Census. The answers will also help to define focuses of
immigrant populations. A census is not an academic exercise: it is the main instrument for all sorts of plans; and, in conjunction with mortality and morbidity statistics, it is the starting-point for many epidemiological surveys. Planners and epidemiologists need details and in the past, though the preliminary picture of the census has emerged with commendable swiftness, the full analyses have taken much longer. The three reports of housing from the 1961 Census were published four years later2 and the full population-migration tables are still " in the press ". Fortunately, such a long delay is not envisaged for the 1966 census: with greater help from the War Office computer, the statisticians at Somerset House hope to complete their formidable task and publish the results in about two years. The responsibility for administering the census of patients and resident staff in 3753 hospitals and 135 out of 1332 " smaller medical establishments " (such as nursing-homes) will be delegated to a chief resident officer (commonly, the hospital secretary). In 1961, it seems, the admonition " warts and everything " was not rigidly observed in the preparation of the 10% samples in hospitals-the very sick or potentially uncooperative patient may have been passed over, thus introducing a bias. Some guidance on how to prepare an unbiased sample will be given to each resident officer. The Registrar General realises that by delegating the running of the census he is adding to the work of administrative and 1. Lancet, 1965, 2. ibid. pp. 211,
i, 365. 380, 611
CANCER OF THE UTERINE BODY
MANY gynaecologists believe that cancer of the body of is more common today than it was fifteen or twenty years ago, but it is hard to be certain about this. Little reliance can be placed on the experience of individual clinics, because local factors may influence year by year the number of patients referred to any one centre. At national level the Registrar General’s annual figures1 show that the death-rate due to cancer of the uterine body has not changed significantly since 1950, nor has the ratio of death from cancer of the cervix to cancer of the body (2:1) changed over the same period. In women who have few rather than many children the disease appears most often between the ages of 55 and 60; but it is not uncommon in younger women. In a series of 983 patients in Birmingham2 a third were under 55, and 6% were under 45. Other reports 34 note that between 20% and 30% of women were still menstruating when the tumour was discovered (these women tend to menstruate to a later age than normal.6) Unfortunately, cytological examination of cells in the vagina is less reliable in endometrial than in cervical cancer, though there have been reports 7-9 that examination of cells aspirated from the uterine cavity gives an accurate diagnosis in 90% of cases of endometrial cancer. Early diagnosis still depends on the prompt investigation of all instances of postmenopausal vaginal discharge or bleeding. In younger women some minor deviation from the usual menstrual pattern may be the earliest feature of the disease; and failure to appreciate this point is an important cause of error or delay in diagnosis.10 11 uterus
In
Birmingham2 during the period under review there policy of " operation whenever reasonably possible ", and 84% of all patients underwent hysterectomy with or without radiotherapy. Almost half the patients had vaginal radium therapy after hysterectomy, but the 5-year
was a
survival-rate
the same as for women who underwent alone. Here, as in other series,12-16the hysterectomy results suggest that preoperative or postoperative irradiation may reduce slightly the incidence of vaginal metastases, but the effect is not decisive. The secondary deposit which appears so constantly 1 or 2 cm. above the urinary meatus is of particular interest. Way 17 found a high was
3. 4. 5. 6. 7. 8. 9.
Registrar General’s Statistical Review of England and Wales. Part in: Commentary. H.M. Stationery Office, 1950-62. Dobbie, B. M. W., Taylor, C. W., Waterhouse, J. A. H. J. Obstet. Gynœc. Br. Cwlth, 1965, 72, 659. Dearnley, G. ibid. 1949, 56, 819. Kimbell, C. W. A. Proc. R. Soc. Med. 1954, 47, 895. Burch, P. R. J., Rowell, N. R. Lancet, 1963, ii, 784. Way, S. J. Obstet. Gynœc. Br. Emp. 1954, 61, 46. Reagan, G. W., Sommerville, R. L. Am. J. Obstet. Gynec. 1954, 68, 78. Hecht, E. L. ibid. 1956, 71, 819. Morton, D. G. J., Moore, J. G., Chang, N. J. int. Coll. Surg. 1959, 31,
10. 11.
Finn, W. F. NW. Med. Seattle, 1952, 52, 235. Bourne, A. W., Williams, L. H. Recent Advances in Obstetrics and
12. 13. 14. 15. 16. 17.
Gynæcology. London, 1962. Rickford, B. J. Obstet. Gynœc. Brit. Emp. 1949, 56, 41. Dobbie, B. M. W. ibid. 1953, 60, 702. Stander, R. W. Am. J. Obstet. Gynec. 1956, 71, 776. Lingren, L. Acta obstet. gynec. scand. 1957, 36, 426. Graham, J. B. Acta cytol. 1958, 2, 579. Way, S. J. Obstet. Gynœc. Brit. Emp. 1951, 58, 558.
1. 2.
570.