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DANZIG SCHEME FOR EARLY DETECTION OF CANCER
147
sides, but sometimes in the back or lower abdomen, and accompanied by rise of temperature to between 100° and 102° F. ; recovery from the initial attack takes place after about 24 hours, but there is usually a relapse on the third day, again lasting about 24 hours ; and pathological examination is negative. The prognosis is wholly favourable, and the chief importance of the disease lies in the readiness with which it may be mistaken for more serious conditions -for example, acute appendicitis, perforated peptic ulcer, pneumonia or pleurisy. Of Weterings’s three patients one was admitted to hospital as a case of acute appendicitis, one as perforated peptic ulcer and one as diaphragmatic pleurisy. All three seemed seriously ill on admission, and the first two showed pronounced muscular rigidity. The first patient, a youth of fifteen, was operated on for supposed perforation of a peptic ulcer, and only the fact that the symptoms were very similar saved the second patient from an unnecessary operation. Bornholm disease is uncommon, but it should be thought of in the differential diagnosis of an acute abdomen. NATIONAL CAMPS
THE Minister of Health has told the House of Commons of the progress so far made in implementing the Camps Act. The National Camps Corporation Ltd. has inspected 155 sites of which 30 have been approved for use as school-camps in time of peace and as evacuation camps in time of war ; of these sites two have been given to the corporation and the others have been purchased or are shortly to be
purchased. The camps are being built to the design of the consulting architects, Sir John Burnet, Tait and Lorne; the buildings will be of Canadian cedar with cedar shingle roofs. Each camp will be laid out by an architect selected from a panel approved by the Royal Institute of British Architects. Work has begun on two camps in the county of Oxford, one in Hants and one in Bucks, and seven others will be started within a few days. The first camp will be completed by the end of August. CHEMOTHERAPY AND THE WHITE CELLS
Dr. Leonard Colebrook’s letter on p. 158 should be read by all who use sulphanilamide; and they are many. It is more than three years since we his first report, with Dr. Meave Kenny, published on the effects of Prontosil in puerperal sepsis, and as a pioneer of the new chemotherapy his plea for caution demands respect from more recent adherents. He is concerned, as will be seen, with the risk of inducing with sulphanilamide and its congeners a or even fatal diminution of polymorpholeucocytes. At a time when tons of these drugs are being consumed in Europe and America every month, if not every week, it may seem that
dangerous
nuclear
this risk is remote, since very few fatal cases have been reported. But the question arises, Are they recognised Are not the toxic symptoms usually put down to the illness for which the remedy is prescribed ? Elsewhere in this issue Dr. French records a study of the blood of children given large doses of sulphanilamide over longish periods ; and like Britton and Howkins, who gave smaller quantities to ambulant patients, she notes a slight but constant depression of polymorphs, which might well become serious where the bone-marrow was already depressed by infection. The bright side of chemotherapy is represented by the paper on p. 148 by Prof. Baird and his colleagues at Aberdeen, where prontosil was introduced in 1936, Their few fatal
cases,
however, include one, hitherto unrecorded, in dosage (in 1937) produced agranulocytosis ;
which high
and we fear that in private practice this disaster is still not uncommon though often misinterpreted. Dr. Colebrook makes practical suggestions for its avoidance ; while on another page Prof. Campbell and Dr. Morgan write encouragingly of the prevention of another and less serious complication—methaemoglobinaemia—by means of methylene-blue. DANZIG
SCHEME FOR EARLY DETECTION
OF
CANCER
ON June 1 a law came into force in the Free City Danzig which enables women over 30 and men over 45 to undergo an annual examination for malignant disease free of cost to themselves. It also provides for the creation of an administrative body to combat cancer by educational activities and otherwise. The new law requires that treatment of the disease shall be in the hands of doctors only, treatment by correspondence and other irregular and unethical methods being forbidden. Early notification is imposed on the practitioner who diagnoses cancer, and the cost of diagnosis is to be borne by the administrative body in question. In a review of the considerations behind this new legislation Redenzquotes instructive figures from Mecklenburg where a system of voluntary notification of all new cases of malignant disease has been started. From April, 1937, to April, 1938, in this community of some 800,000 souls, 1040 women and 823 men in other were notified as suffering from cancer ; words, the annual incidence was 0-23 per cent. These cases were classified in two main groups according as the lesion was or was not accessible to palpation and inspection. In the first group there were only 226 men but 611 women, whereas in the second group there were 597 men and only 331 women. (The reason why these figures do not tot up to the score of those already mentioned is that in a few cases the exact seat of the disease was unknown.) The classification shows the relatively unfavourable situation of men as regards the frequency with which they suffer from deep-seated cancers. Redenz, who is in charge of the State Maternity Hospital in Danzig-Langfuhr, writes as an enthusiastic supporter of the new law and hopes it will prove a model for similar legislation elsewhere. of
1. Redenz,
E., Dtsch. med. Wschr. May 26, 1939, p. 854.
V.D. TREATMENT DURING MILITARY TRAINING.The men who are being called up as liable for service under the Military Training Act, 1939, may well include patients receiving treatment for venereal disease by private practitioners. As it is desirable that the treatment should not be interrupted information regarding each case should be available to the medical board undertaking the examination and details of previous treatment should be made known to the medical officer at the depot where the patient is called up. The Ministry of Health does not think it practicable to circularise all practitioners, but considers it would be helpful if medical officers of health instructed those distributing arsenobenzene compounds to practitioners, and pathologists doing tests of specimens for private practitioners, to send with the supply of the compound or with the report that a specimen is positive a request that, in the event of a patient being called up under the act, the practitioner should furnish him with particulars of the case on form V.15. Copies of the form can be had from the nearest V.D. treatment centre.
’
sides, but sometimes in the back or lower abdomen, and accompanied by rise of temperature to between 100° and 102° F. ; recovery from the initial attack takes place after about 24 hours, but there is usually a relapse on the third day, again lasting about 24 hours ; and pathological examination is negative. The prognosis is wholly favourable, and the chief importance of the disease lies in the readiness with which it may be mistaken for more serious conditions -for example, acute appendicitis, perforated peptic ulcer, pneumonia or pleurisy. Of Weterings’s three patients one was admitted to hospital as a case of acute appendicitis, one as perforated peptic ulcer and one as diaphragmatic pleurisy. All three seemed seriously ill on admission, and the first two showed pronounced muscular rigidity. The first patient, a youth of fifteen, was operated on for supposed perforation of a peptic ulcer, and only the fact that the symptoms were very similar saved the second patient from an unnecessary operation. Bornholm disease is uncommon, but it should be thought of in the differential diagnosis of an acute abdomen. NATIONAL CAMPS
THE Minister of Health has told the House of Commons of the progress so far made in implementing the Camps Act. The National Camps Corporation Ltd. has inspected 155 sites of which 30 have been approved for use as school-camps in time of peace and as evacuation camps in time of war ; of these sites two have been given to the corporation and the others have been purchased or are shortly to be
purchased. The camps are being built to the design of the consulting architects, Sir John Burnet, Tait and Lorne; the buildings will be of Canadian cedar with cedar shingle roofs. Each camp will be laid out by an architect selected from a panel approved by the Royal Institute of British Architects. Work has begun on two camps in the county of Oxford, one in Hants and one in Bucks, and seven others will be started within a few days. The first camp will be completed by the end of August. CHEMOTHERAPY AND THE WHITE CELLS
Dr. Leonard Colebrook’s letter on p. 158 should be read by all who use sulphanilamide; and they are many. It is more than three years since we his first report, with Dr. Meave Kenny, published on the effects of Prontosil in puerperal sepsis, and as a pioneer of the new chemotherapy his plea for caution demands respect from more recent adherents. He is concerned, as will be seen, with the risk of inducing with sulphanilamide and its congeners a or even fatal diminution of polymorpholeucocytes. At a time when tons of these drugs are being consumed in Europe and America every month, if not every week, it may seem that
dangerous
nuclear
this risk is remote, since very few fatal cases have been reported. But the question arises, Are they recognised Are not the toxic symptoms usually put down to the illness for which the remedy is prescribed ? Elsewhere in this issue Dr. French records a study of the blood of children given large doses of sulphanilamide over longish periods ; and like Britton and Howkins, who gave smaller quantities to ambulant patients, she notes a slight but constant depression of polymorphs, which might well become serious where the bone-marrow was already depressed by infection. The bright side of chemotherapy is represented by the paper on p. 148 by Prof. Baird and his colleagues at Aberdeen, where prontosil was introduced in 1936, Their few fatal
cases,
however, include one, hitherto unrecorded, in dosage (in 1937) produced agranulocytosis ;
which high
and we fear that in private practice this disaster is still not uncommon though often misinterpreted. Dr. Colebrook makes practical suggestions for its avoidance ; while on another page Prof. Campbell and Dr. Morgan write encouragingly of the prevention of another and less serious complication—methaemoglobinaemia—by means of methylene-blue. DANZIG
SCHEME FOR EARLY DETECTION
OF
CANCER
ON June 1 a law came into force in the Free City Danzig which enables women over 30 and men over 45 to undergo an annual examination for malignant disease free of cost to themselves. It also provides for the creation of an administrative body to combat cancer by educational activities and otherwise. The new law requires that treatment of the disease shall be in the hands of doctors only, treatment by correspondence and other irregular and unethical methods being forbidden. Early notification is imposed on the practitioner who diagnoses cancer, and the cost of diagnosis is to be borne by the administrative body in question. In a review of the considerations behind this new legislation Redenzquotes instructive figures from Mecklenburg where a system of voluntary notification of all new cases of malignant disease has been started. From April, 1937, to April, 1938, in this community of some 800,000 souls, 1040 women and 823 men in other were notified as suffering from cancer ; words, the annual incidence was 0-23 per cent. These cases were classified in two main groups according as the lesion was or was not accessible to palpation and inspection. In the first group there were only 226 men but 611 women, whereas in the second group there were 597 men and only 331 women. (The reason why these figures do not tot up to the score of those already mentioned is that in a few cases the exact seat of the disease was unknown.) The classification shows the relatively unfavourable situation of men as regards the frequency with which they suffer from deep-seated cancers. Redenz, who is in charge of the State Maternity Hospital in Danzig-Langfuhr, writes as an enthusiastic supporter of the new law and hopes it will prove a model for similar legislation elsewhere. of
1. Redenz,
E., Dtsch. med. Wschr. May 26, 1939, p. 854.
V.D. TREATMENT DURING MILITARY TRAINING.The men who are being called up as liable for service under the Military Training Act, 1939, may well include patients receiving treatment for venereal disease by private practitioners. As it is desirable that the treatment should not be interrupted information regarding each case should be available to the medical board undertaking the examination and details of previous treatment should be made known to the medical officer at the depot where the patient is called up. The Ministry of Health does not think it practicable to circularise all practitioners, but considers it would be helpful if medical officers of health instructed those distributing arsenobenzene compounds to practitioners, and pathologists doing tests of specimens for private practitioners, to send with the supply of the compound or with the report that a specimen is positive a request that, in the event of a patient being called up under the act, the practitioner should furnish him with particulars of the case on form V.15. Copies of the form can be had from the nearest V.D. treatment centre.
’