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INTERNATIONAL CONGRESSES
180
generally accepted. But it is not the complete to the question whether the radium beam has special advantages as a therapeutic instrument. Before forming an opinion on this question several striking findings in the report should be considered.
will be
answer
The detailed statistical tables show that at least eighteen patients with palpable lymph-glands, seven of whom were treated with the X-ray beam, were symptomfree for 3 years or longer. Cure of malignant glands by radiotherapy is rare enough to make this a considerable achievement, and the report points out that the usual view that secondary cancer in glands is more resistant and responds more slowly to radiation than the primary tumour was not borne out in this series, in which the glands often disappeared first. This suggests a special place for the radium beam, or even for an X-ray beam of this type, in the treatment of cases where cancer in a difficult site, accompanied by palpable lymph-glands, makes block-dissection of the neck almost impossible. The effect of the two types of radiation on the skin is also important. It was found that the cases treated with X rays developed skin reactions earlier and more severely ; so a further comparison was arranged between fields on the two sides of the neck of patients with suitable lesions, the fields on one side being treated with gamma rays and those on the other with X rays. This experiment showed that the average ratio of gammaray dose to X-ray dose for the same visible skin reaction was 134 :1. Thus gamma radiation has a definite advantage, even if this is due to differences in penetration and absorption and not to any specific wave-length effect. There is thus some evidence that beam therapy has special uses and that, even if the experimental X-ray beam was a practical instrument, beam therapy should be given by means of gamma rays. In the radium beam we have a source of radiation with which the block of tissue which contains the tumour can be raised to the required dosage, and which, if the tumour is superficial enough, gives a rapid fall in dosage outside this block, thus increasing the tolerance of the normal tissues. Analysis of the results of treatment by site indicates the sites in which conditions are favourable for radium-beam treatment. Unfortunately, however, in some sites, particularly the pharynx, this method, in common with all others, results in so few survivals that no conclusions can be drawn from the figures. For lesions at the back of the mouth, and for some laryngeal lesions, more particularly when the lymph-glands are involved, provisions for radiumbeam therapy should certainly be made. The report " Such apparatus" [the 10 gramme bomb] says : may continue to be used in routine treatment for some time to come " ; it might have gone further and expressed the belief that some form of beam therapy, with either radium or radioactive cobalt, will continue to be used so long as irradiation is chosen for the treatment of oral
symmetrical
"
cancer.
A most skilful and intelligent manipulator, he some. times succeeded where qualified practitioners had failed, and a number of doctors encouraged their patients to go to him-or went to him themselves. On the other hand the profession, as such, can never agree that people who have not had a basic medical training can properly be entrusted with the full care of a patient ab initio; the ultimate responsibility must rest on someone trained in comprehensive diagnosis rather than in a therapeutic technique. Professional opposition, carried rather too far, prevented any official use of Barker’s services in the treatment of injuries during the 1914-18 war, and obliged the General Medical Council to remove the name of his anaesthetist, Dr. F. W. Axham, from the Medical Register, for the offence of covering " an unregistered practitioner. The case of Dr. Axham was long and bitterly debated: the public thought it a monstrous example of professional obscurantism, and a sense of discomfort within the profession would have led to the restoration of Dr. Axham’s name had he not died first, in 1926. Meanwhile the knighthood conferred on Barker in 1922, and the demand that he should receive a Lambeth M.D., had reflected the public respect for his abilities ; and more and more doctors were prepared to believe that a man with so much practical experience, and art, might have knowledge, or at least dodges, which could usefully be embodied in orthodox practice. In 1936 the British Orthopaedic Association accepted his offer of a demonstra. tion, and a report by Mr. W. Rowley Bristow, published in our columns2 describes how Sir Herbert Barker treated 18 patients at St. Thomas’s, where films were later made of his techniques. " He taught," Mr. Bristow wrote, " the value of "
repeated manipulation; the value of traction; the personal supervision and attention to exercising the joint in all directions afterwards ; and above all, I think, the splendid optimism which is essentially a part of treatment, and a necessary part, in helping those with long-standing disabilities, whose confidence has been rudely shaken by failures of the earlier efforts at cure. It is due to Barker to say that but for his pioneer work the manipulative field of orthop2edic surgery would not occupy the position it does today, and that had his offer to demonstrate his technique been accepted twenty-five years ago the general utilisation of this branch of therapeutics would not have been so long delayed." But though Barker did not quite realise it (Mr. Bristow Orthopedic thought) the battle was already won. surgeons now practise manipulative surgery as an "
essential part of their specialty." INTERNATIONAL CONGRESSES LAST Monday the sixth International Congress of Radiology, which is being held in London under the presidency of Dr. Ralston Paterson, was rung in by six strokes on a silver bell presented by British radiologists to mark the silver jubilee of these international meetings. Afterwards the Earl of Athlone formally opened the proceedings, and Sir Henry Dale welcomed 2700 delegates from 54 countries on behalf of British science and medicine and on behalf of the Government. At the dinner held at Guildhall on Monday evening the toast of the congress was proposed by Lord Mountbatten. The exhibition of apparatus which is being held in connection with the congress shows the outstanding advances made since the last exhibition in 1937. Meanwhile at Oxford, Lord Addison, himself a former professor of anatomy, welcomed 550 delegates from 36 countries to the international anatomical congress, which is meeting there this week under the presidency of Prof. W. E. Le Gros Clark, F.R.s.
BARKER FEW unqualified practitioners in medicine reach the eminence attained by Sir Herbert Barker. His death at the age of 81 ends a career that roused strong feeling in the medical profession and brought controversy to a focus. The son of a solicitor, he became, at 19, assistant to his cousin, John Atkinson, who derived his knowledge of bonesetting, by a sort of apostolic succession, from the Hutton family, yeoman farmers of the North. Starting for himself in practice in Manchester, lie found many patients among footballers and athletes, and won the confidence of Walter Whitehead, professor of clinical surgery in Manchester rniversity.1 A first attempt to start a practice in London was abortive, but after a ON July 22 Prof. HiLDA LLOYD was re-elected president period in Glasgow he returned and had great success. of the Royal College of Obstetricians and Gynaecologists. SIR
HERBERT
.
1. Manchester Guardian, July 24, p. 8.
2. Lancet, 1937. i, 546.
generally accepted. But it is not the complete to the question whether the radium beam has special advantages as a therapeutic instrument. Before forming an opinion on this question several striking findings in the report should be considered.
will be
answer
The detailed statistical tables show that at least eighteen patients with palpable lymph-glands, seven of whom were treated with the X-ray beam, were symptomfree for 3 years or longer. Cure of malignant glands by radiotherapy is rare enough to make this a considerable achievement, and the report points out that the usual view that secondary cancer in glands is more resistant and responds more slowly to radiation than the primary tumour was not borne out in this series, in which the glands often disappeared first. This suggests a special place for the radium beam, or even for an X-ray beam of this type, in the treatment of cases where cancer in a difficult site, accompanied by palpable lymph-glands, makes block-dissection of the neck almost impossible. The effect of the two types of radiation on the skin is also important. It was found that the cases treated with X rays developed skin reactions earlier and more severely ; so a further comparison was arranged between fields on the two sides of the neck of patients with suitable lesions, the fields on one side being treated with gamma rays and those on the other with X rays. This experiment showed that the average ratio of gammaray dose to X-ray dose for the same visible skin reaction was 134 :1. Thus gamma radiation has a definite advantage, even if this is due to differences in penetration and absorption and not to any specific wave-length effect. There is thus some evidence that beam therapy has special uses and that, even if the experimental X-ray beam was a practical instrument, beam therapy should be given by means of gamma rays. In the radium beam we have a source of radiation with which the block of tissue which contains the tumour can be raised to the required dosage, and which, if the tumour is superficial enough, gives a rapid fall in dosage outside this block, thus increasing the tolerance of the normal tissues. Analysis of the results of treatment by site indicates the sites in which conditions are favourable for radium-beam treatment. Unfortunately, however, in some sites, particularly the pharynx, this method, in common with all others, results in so few survivals that no conclusions can be drawn from the figures. For lesions at the back of the mouth, and for some laryngeal lesions, more particularly when the lymph-glands are involved, provisions for radiumbeam therapy should certainly be made. The report " Such apparatus" [the 10 gramme bomb] says : may continue to be used in routine treatment for some time to come " ; it might have gone further and expressed the belief that some form of beam therapy, with either radium or radioactive cobalt, will continue to be used so long as irradiation is chosen for the treatment of oral
symmetrical
"
cancer.
A most skilful and intelligent manipulator, he some. times succeeded where qualified practitioners had failed, and a number of doctors encouraged their patients to go to him-or went to him themselves. On the other hand the profession, as such, can never agree that people who have not had a basic medical training can properly be entrusted with the full care of a patient ab initio; the ultimate responsibility must rest on someone trained in comprehensive diagnosis rather than in a therapeutic technique. Professional opposition, carried rather too far, prevented any official use of Barker’s services in the treatment of injuries during the 1914-18 war, and obliged the General Medical Council to remove the name of his anaesthetist, Dr. F. W. Axham, from the Medical Register, for the offence of covering " an unregistered practitioner. The case of Dr. Axham was long and bitterly debated: the public thought it a monstrous example of professional obscurantism, and a sense of discomfort within the profession would have led to the restoration of Dr. Axham’s name had he not died first, in 1926. Meanwhile the knighthood conferred on Barker in 1922, and the demand that he should receive a Lambeth M.D., had reflected the public respect for his abilities ; and more and more doctors were prepared to believe that a man with so much practical experience, and art, might have knowledge, or at least dodges, which could usefully be embodied in orthodox practice. In 1936 the British Orthopaedic Association accepted his offer of a demonstra. tion, and a report by Mr. W. Rowley Bristow, published in our columns2 describes how Sir Herbert Barker treated 18 patients at St. Thomas’s, where films were later made of his techniques. " He taught," Mr. Bristow wrote, " the value of "
repeated manipulation; the value of traction; the personal supervision and attention to exercising the joint in all directions afterwards ; and above all, I think, the splendid optimism which is essentially a part of treatment, and a necessary part, in helping those with long-standing disabilities, whose confidence has been rudely shaken by failures of the earlier efforts at cure. It is due to Barker to say that but for his pioneer work the manipulative field of orthop2edic surgery would not occupy the position it does today, and that had his offer to demonstrate his technique been accepted twenty-five years ago the general utilisation of this branch of therapeutics would not have been so long delayed." But though Barker did not quite realise it (Mr. Bristow Orthopedic thought) the battle was already won. surgeons now practise manipulative surgery as an "
essential part of their specialty." INTERNATIONAL CONGRESSES LAST Monday the sixth International Congress of Radiology, which is being held in London under the presidency of Dr. Ralston Paterson, was rung in by six strokes on a silver bell presented by British radiologists to mark the silver jubilee of these international meetings. Afterwards the Earl of Athlone formally opened the proceedings, and Sir Henry Dale welcomed 2700 delegates from 54 countries on behalf of British science and medicine and on behalf of the Government. At the dinner held at Guildhall on Monday evening the toast of the congress was proposed by Lord Mountbatten. The exhibition of apparatus which is being held in connection with the congress shows the outstanding advances made since the last exhibition in 1937. Meanwhile at Oxford, Lord Addison, himself a former professor of anatomy, welcomed 550 delegates from 36 countries to the international anatomical congress, which is meeting there this week under the presidency of Prof. W. E. Le Gros Clark, F.R.s.
BARKER FEW unqualified practitioners in medicine reach the eminence attained by Sir Herbert Barker. His death at the age of 81 ends a career that roused strong feeling in the medical profession and brought controversy to a focus. The son of a solicitor, he became, at 19, assistant to his cousin, John Atkinson, who derived his knowledge of bonesetting, by a sort of apostolic succession, from the Hutton family, yeoman farmers of the North. Starting for himself in practice in Manchester, lie found many patients among footballers and athletes, and won the confidence of Walter Whitehead, professor of clinical surgery in Manchester rniversity.1 A first attempt to start a practice in London was abortive, but after a ON July 22 Prof. HiLDA LLOYD was re-elected president period in Glasgow he returned and had great success. of the Royal College of Obstetricians and Gynaecologists. SIR
HERBERT
.
1. Manchester Guardian, July 24, p. 8.
2. Lancet, 1937. i, 546.