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Medical uses of radium
1l~
PUBLIC HEALTH.
Amongst the defects found by far the largest number were in connection with the skin, 205,668 cases of skin disease being detected. Defects of vision, generally high amongst the totals, numbered in 193~J, 173,793, other large contributors being affections of the ear, nose and throat, and deformities of various kinds. The total number of cases of malnutrition was ~'9,979. Not unnaturally the figures with regard to this and any statements in the report upon it or any matter affecting nutrition are of great importance at the moment. For that reason it is interesting, and heartening also, to have the opinion of Sir George Newman that malnutrition, though it has not been abolished, has been successfully reduced: that the nutrition of the English people is better to-day than at any past period of which we have record, and that undernourishment is not generally more prevale~t than in recent years in spite of the econom.lc depression and the mental distress ~nd. hardship following in its train. Largely this IS due to increased care and devotion of the mothers and teachers. To a great extent, too, it is agreed, it resulted from and through medical supervision. As an effect of this also there is early and more complete detection of cases of defect of all kinds and the securing of treatment for these. For it must be remembered that not all the defects numbered in the totals are serious; very many are very minor, and because they are detected and put in the way of treatment those suffering are quickly brought back into the group of normal healthy children on whose behalf the school medical service should be just as active and anxious as they are for the unfortunate sufferers from disease or ill-health. Evidence of the success that has followed on the work done is to be found in many places throughout the report but in none possibly is it more conclusive than in the section showing the reduction in the number of operations performed on account of tonsils and adenoids, and that in which infection and mortality in school children is discussed. In this last the marked decline in mortality amongst children, which, beginning in the decennium 1871-1880, has continued practically without interruption till now, is stressed. Amongst other remarkable figures quoted none is more striking than those that show the fall of the death-rate in the agegroup 1 to 5 from 16·2 in the quinquennium 1911-1915 to 6·6 in 1933. Encouragement to greater activity on behalf
JANUAtw J
of the healthy children, the augmentation of health and the performance of any works likely to advantage the children, improve their future and make them good and happy and contented citizens, is to be found everywhere in the report. In the chapters on physical education and hygiene, and the relation of the school medical service to employment, Sir George Newman reveals, and seeks to instil, an intense enthusiasm on behalf of the school child. In the latter section he forecasts a new and brighter era with the coming into operation of the Unemployment Act of 19~'4. The proper use of the facilities for the teaching of hygiene and physical culture he shows also to be fraught with wonderful possibilities for good. With that, all Who know schools, school children and the school medical service will agree. As they will agree also with the adoption of an optimistic tone in the sections dealing with orthopsedics, and the education of defective children, and that a tone a little less optimistic is appropriate in the chapter on school dental work. Sir George Newman in his reports can always be relied upon to provide not merely a report but rather a contribution to the literature on the subject dealt with. His" Health of the School Child" in 1933 is more conspicuously than ever such a contribution.
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Medical Uses of Radium. a report under this title", in continuance I ofN accounts given in the eleven similar reports that have preceded it, the Medical Research Council summarise the results of research work in the treatment of cancer-and also of some non-malignant conditions-which has been done during 1933 by means of radium lent to selected centres throughout the country. In addition to describing work done during the past year, the report gives statistical data relating to the after_ histories of patients treated in earlier years. It contains, further, a section dealing with some purely experimental inquiries into the action of radium. In an interesting introduction to the report it is claimed, with justification, for the research initiated by the Council that it has done two things: it has helped towards the stabilisation of methods of treatment, and it has shown all too convincingly that the reaction of the tissues of the body to this form of radiation is of the mOst complex and bewildering variety. ·Special Report Series, No. 197. Office, 1934. Price 9d. net.
II.M. Stati;;;;Y
1035.
PUBLIC HEALTH.
It is generally agreed that the three varieties of malignant disease (other than skin cancer) which offer the most promising field for the use of radium are uterine, buccal and breast cancer, and in the body of the report returns relating to success in these and other areas are summarised and, in addition, notes are given with regard to various types of malignant growth. From data contributed by the various centres for 1930, 1931, 1932 and 1933, it is gathered that a total of 7,955 patients suffering from malignant disease have been treated. Of these, 2,275 have been treated by means of surgery alone, making 29 per cent., and 3,415 have been treated by means of radium alone, making 43 per cent. Contrasting the two procedures, particularly in relation to the three varieties of malignant disease already referred to, the report states that in the case of uterine cancer there are two outstanding points: frankly operable cases are treated just as successfully by radium as by surgery, but with a much smaller operation mortality, while surgically inoperable cases treated by radiation yield a by no means negligible percentage of clinical cures (i.e., apparent freedom from disease) of five years' standing. In regard to buccal cancer, at most responsible radium clinics in the country there is felt to be comparatively little difficulty in dealing with primary growths of the tongue by radium treatment. Where dissatisfaction remains, however, is in the treatment of the glands associated with buccal cancer, and at present there seems to be about an even balance of opinion and practice between surgical removal and irradiation, either interstitially or externally, by radium or X-rays. With breast cancer, owing to the success which has followed surgery in early cases of mammary cancer, surgery will continue to be used for many years yet. At the same time, however, from the reports of the Council's centres it would seem that both surgery and radiology are employed almost to an equal extent in the treatment of breast cancer. The details given of the procedure adopted at centres in St. Bartholomew's Hospital and Aberdeen are most interesting. Here the primary growth, with the probable extensions of the disease in the axilla and neighbouring glands, has been treated with interstitial radium, and after the lapse of six to eight weeks the primary growth has been removed and subjected to the scrutiny of pathologists to see the extent to which the
119
malignant portions have been affected by the gamma radiation to which they have been subjected. The details which have been so far published, especially those of Aberdeen, show that under certain definite conditions of irradiation there are comparatively few actively growing malignant portions of the growth left. In the purely experimental section of the report there is given a summary of researches designed to elicit more about the response of living organisms to radiation, both when changes are made in the type of radiation and the time intervals at which the dose of irradiation is given, and when changes in the physiological condition of the cell are manifest. Here, as elsewhere in the report, the information given is largely of value to the researcher and investigator but, as showing the extent of the work in hand and already done, it has an interest, if not general, at least to the medical profession as a whole, and in particular to those in the public health and preventive medical s~rvice.
... ... ... ... Public Health (Shell-Fish) Regulations,
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1934.
T
H E Public Health (Shell-fish) Regulations, 1934·, which come into operation on January 1st, 1935, revoke the Public Health (Shell-fish) Regulations, 1915, and replace them by provisions which are generally similar but are modified in certain respects, more particularly as regards the procedure for making orders. In the earlier regulations a local authority which has received representations with regard to suspected shell-fish is required to give notice to persons interested to appear before them to show cause why an order should not be made prohibiting the distribution of the shell-fish for sale for human consumption unless they have been suitably relaid, and if sufficient cause is not shown the local authority are required to make an order forthwith. Under the new regulations it is the duty of the medical officer of health to make an investigation with regard to any laying from which suspected shell-fish have been derived and to make a report to the local authority. Upon consideration of the report, and after giving all persons interested a reasonable opportunity of making representations, the local authority - ----- - - -- - - ·Statutory Rules and Orders, 1934, No. 1342. H.M. Stationery Office. Price 2d. net. Accompanying Circular (H46), price Id. net.
PUBLIC HEALTH.
Amongst the defects found by far the largest number were in connection with the skin, 205,668 cases of skin disease being detected. Defects of vision, generally high amongst the totals, numbered in 193~J, 173,793, other large contributors being affections of the ear, nose and throat, and deformities of various kinds. The total number of cases of malnutrition was ~'9,979. Not unnaturally the figures with regard to this and any statements in the report upon it or any matter affecting nutrition are of great importance at the moment. For that reason it is interesting, and heartening also, to have the opinion of Sir George Newman that malnutrition, though it has not been abolished, has been successfully reduced: that the nutrition of the English people is better to-day than at any past period of which we have record, and that undernourishment is not generally more prevale~t than in recent years in spite of the econom.lc depression and the mental distress ~nd. hardship following in its train. Largely this IS due to increased care and devotion of the mothers and teachers. To a great extent, too, it is agreed, it resulted from and through medical supervision. As an effect of this also there is early and more complete detection of cases of defect of all kinds and the securing of treatment for these. For it must be remembered that not all the defects numbered in the totals are serious; very many are very minor, and because they are detected and put in the way of treatment those suffering are quickly brought back into the group of normal healthy children on whose behalf the school medical service should be just as active and anxious as they are for the unfortunate sufferers from disease or ill-health. Evidence of the success that has followed on the work done is to be found in many places throughout the report but in none possibly is it more conclusive than in the section showing the reduction in the number of operations performed on account of tonsils and adenoids, and that in which infection and mortality in school children is discussed. In this last the marked decline in mortality amongst children, which, beginning in the decennium 1871-1880, has continued practically without interruption till now, is stressed. Amongst other remarkable figures quoted none is more striking than those that show the fall of the death-rate in the agegroup 1 to 5 from 16·2 in the quinquennium 1911-1915 to 6·6 in 1933. Encouragement to greater activity on behalf
JANUAtw J
of the healthy children, the augmentation of health and the performance of any works likely to advantage the children, improve their future and make them good and happy and contented citizens, is to be found everywhere in the report. In the chapters on physical education and hygiene, and the relation of the school medical service to employment, Sir George Newman reveals, and seeks to instil, an intense enthusiasm on behalf of the school child. In the latter section he forecasts a new and brighter era with the coming into operation of the Unemployment Act of 19~'4. The proper use of the facilities for the teaching of hygiene and physical culture he shows also to be fraught with wonderful possibilities for good. With that, all Who know schools, school children and the school medical service will agree. As they will agree also with the adoption of an optimistic tone in the sections dealing with orthopsedics, and the education of defective children, and that a tone a little less optimistic is appropriate in the chapter on school dental work. Sir George Newman in his reports can always be relied upon to provide not merely a report but rather a contribution to the literature on the subject dealt with. His" Health of the School Child" in 1933 is more conspicuously than ever such a contribution.
*
•
*
•
•
Medical Uses of Radium. a report under this title", in continuance I ofN accounts given in the eleven similar reports that have preceded it, the Medical Research Council summarise the results of research work in the treatment of cancer-and also of some non-malignant conditions-which has been done during 1933 by means of radium lent to selected centres throughout the country. In addition to describing work done during the past year, the report gives statistical data relating to the after_ histories of patients treated in earlier years. It contains, further, a section dealing with some purely experimental inquiries into the action of radium. In an interesting introduction to the report it is claimed, with justification, for the research initiated by the Council that it has done two things: it has helped towards the stabilisation of methods of treatment, and it has shown all too convincingly that the reaction of the tissues of the body to this form of radiation is of the mOst complex and bewildering variety. ·Special Report Series, No. 197. Office, 1934. Price 9d. net.
II.M. Stati;;;;Y
1035.
PUBLIC HEALTH.
It is generally agreed that the three varieties of malignant disease (other than skin cancer) which offer the most promising field for the use of radium are uterine, buccal and breast cancer, and in the body of the report returns relating to success in these and other areas are summarised and, in addition, notes are given with regard to various types of malignant growth. From data contributed by the various centres for 1930, 1931, 1932 and 1933, it is gathered that a total of 7,955 patients suffering from malignant disease have been treated. Of these, 2,275 have been treated by means of surgery alone, making 29 per cent., and 3,415 have been treated by means of radium alone, making 43 per cent. Contrasting the two procedures, particularly in relation to the three varieties of malignant disease already referred to, the report states that in the case of uterine cancer there are two outstanding points: frankly operable cases are treated just as successfully by radium as by surgery, but with a much smaller operation mortality, while surgically inoperable cases treated by radiation yield a by no means negligible percentage of clinical cures (i.e., apparent freedom from disease) of five years' standing. In regard to buccal cancer, at most responsible radium clinics in the country there is felt to be comparatively little difficulty in dealing with primary growths of the tongue by radium treatment. Where dissatisfaction remains, however, is in the treatment of the glands associated with buccal cancer, and at present there seems to be about an even balance of opinion and practice between surgical removal and irradiation, either interstitially or externally, by radium or X-rays. With breast cancer, owing to the success which has followed surgery in early cases of mammary cancer, surgery will continue to be used for many years yet. At the same time, however, from the reports of the Council's centres it would seem that both surgery and radiology are employed almost to an equal extent in the treatment of breast cancer. The details given of the procedure adopted at centres in St. Bartholomew's Hospital and Aberdeen are most interesting. Here the primary growth, with the probable extensions of the disease in the axilla and neighbouring glands, has been treated with interstitial radium, and after the lapse of six to eight weeks the primary growth has been removed and subjected to the scrutiny of pathologists to see the extent to which the
119
malignant portions have been affected by the gamma radiation to which they have been subjected. The details which have been so far published, especially those of Aberdeen, show that under certain definite conditions of irradiation there are comparatively few actively growing malignant portions of the growth left. In the purely experimental section of the report there is given a summary of researches designed to elicit more about the response of living organisms to radiation, both when changes are made in the type of radiation and the time intervals at which the dose of irradiation is given, and when changes in the physiological condition of the cell are manifest. Here, as elsewhere in the report, the information given is largely of value to the researcher and investigator but, as showing the extent of the work in hand and already done, it has an interest, if not general, at least to the medical profession as a whole, and in particular to those in the public health and preventive medical s~rvice.
... ... ... ... Public Health (Shell-Fish) Regulations,
•
1934.
T
H E Public Health (Shell-fish) Regulations, 1934·, which come into operation on January 1st, 1935, revoke the Public Health (Shell-fish) Regulations, 1915, and replace them by provisions which are generally similar but are modified in certain respects, more particularly as regards the procedure for making orders. In the earlier regulations a local authority which has received representations with regard to suspected shell-fish is required to give notice to persons interested to appear before them to show cause why an order should not be made prohibiting the distribution of the shell-fish for sale for human consumption unless they have been suitably relaid, and if sufficient cause is not shown the local authority are required to make an order forthwith. Under the new regulations it is the duty of the medical officer of health to make an investigation with regard to any laying from which suspected shell-fish have been derived and to make a report to the local authority. Upon consideration of the report, and after giving all persons interested a reasonable opportunity of making representations, the local authority - ----- - - -- - - ·Statutory Rules and Orders, 1934, No. 1342. H.M. Stationery Office. Price 2d. net. Accompanying Circular (H46), price Id. net.