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SMOKING AND PAPILLOMA OF THE URINARY BLADDER
1320
while the hospital admissions of these old people for physical illness have fallen by half, their admission for senile psychosis has actually ceased. This, said Dr. Rusk, is real preventive medicine-the preventive medicine of the future. Though he admitted that it was unscientific to say so, he believes that a purpose in life, and being happy, does something to prevent the progression of arteriosclerosis. Having just returned from an international conference called by the International Labour Office to discuss rehabilitation of the disabled workers, Dr. Rusk ended his lecture by endorsing the plea of a Russian representative that against disability we should all work together. He has never, he said, been anywhere in the world where doctors-regardless of race, creed, colour, politics, and curtains-do not have a common language and a common purpose. In the healing arts we have a tremendous responsibility and also a tremendous opportunity. In this world that is so technologically precocious and spiritually adolescent we can, if we try, build at least one block of international understanding. SMOKING AND PAPILLOMA OF THE URINARY BLADDER
IN Denmark Clemmesen et al.l investigated the smoking habits of patients with papilloma of the urinary bladder, and they conclude that among men with this disease there is a lower proportion of non-smokers than there is among the healthy, and that, where patients smoke only one type of tobacco preparation, cigarettes, cigars, and cigarillos are implicated, but not pipe-smoking. They noted that admission to hospitals in Copenhagen of patients with papilloma of the bladder had increased steadily from the three-year period 1944-46 up till the period 1953-55. The numbers were respectively 22 and 110 in men and 4 and 40 in women. From information previously gained from the Danish Cancer Register it is stated that the increase in incidence of bladder tumours, both benign and malignant, has occurred in men but not in women and follows closely that of bronchial cancer-though this is not borne out by the hospital figures cited in their report. Clemmesen et al. questioned patients still alive between March, 1956, and November, 1957, about their smoking habits and compared the information .thus gained with similar information from healthy persons obtained for another purpose in 1952-53. But 153 patients (more than a third) were not interviewed on account of lack of response (31) or death or inability to trace their whereabouts (122). Lilienfeld et al.2 suggested provisionally, from a retrospectivesurvey of clinical records of patients admitted to hospital with urinary-bladder cancer, that a significantly larger proportion of the men had smoked cigarettes for longer than had other classes of patients chosen for comparison; no such association was found in women. Holsti and Ermala3 swabbed the lips and oral cavities of mice with tobacco tar for 140 days and reported that they had observed both benign and malignant papillomatosis of the bladder at the end of a year of observation. But no confirmation of this finding has been described. An association between papilloma and cancer of the bladder on the one hand and the manufacture, purification, and usage of certain aromatic amines on the other is well established in every country where such an industry exists. 1. Clemmesen, J., Lockwood, K., Nielsen, A. Danish med. Bull. 1958, 5, 121. 2. Lilienfeld, A., Levin, M., Moore, G. Arch. intern. med. 1956, 98, 129. 3. Holsti, L., Ermala, P. Cancer, 1955, 8, 679.
In the future it should be
possible
to
predict with are likely
degree of certainty that certain chemicals
some
to
be
carcinogenic, but it will be far more difficult to tell which will be non-carcinogenic. The risk is not confined to the aromatic intermediates from which dyes are made: the finished dyes may also be carcinogenic, especially the azo compounds; and some of these, or their close chemical relatives, are in use as food dyes in some countries. The exogenous causes of bladder papilloma and cancer is receiving concentrated investigation; and in this chemical age it is to be expected that the incidence will rise for reasons unconnected with tobacco smoking. THE CURE OF SOULS AND BODIES
FROM earliest times the Churches have shared with doctors the responsibility for the care of the sick, and the origins of many of our oldest hospitals show the value and strength of this ancient alliance. But with the growth of scientific medicine, the partnership became uneasy. The doctor was less ready to share with the priest the responsibility for his patients. Today he is becoming increasingly aware of the effect of the patient on the disease and of the need to treat the person rather than the case. This shift of emphasis has led many doctors to reconsider their attitude. The Church of Englandand the Church of Scotland2 have also been considering their duties and responsibilities towards the sick in the modern world, and in the reports which Commissions of both churches have lately presented the thoughtful doctor will perhaps find a form of contract for a new and firmer
partnership. Both Commissions are reserved in their attitude towards medically inexplicable healings. Though they do not deny that these may occur they recognise that so-called miracles may be acclaimed in good faith by the layman who, unlike the doctor, is unaware of the normal course of a disease and possible natural remissions. The Anglican Commission, which acknowledge the help they received from a committee of the British Medical Association,3 wisely point out that many people are too ready to admire the unusual, and too slow to recognise the wonder of the familiar. They regret " the popular idea that what can be scientifically explained has little or nothing to do with God ". The Scottish Commission insist that " problems affecting physical and mental health require consideration first by a physician " and that spiritual healing should only be used with great discretion and always in consultation with the patient’s doctor. The Anglican Commission suggest that the rigid separation of the spiritual and physical " which has, without doubt, enabled medicine (as much as other sciences) to make progress " has now outlived its usefulness, and both Commissions believe that the patient would now gain by closer cooperation between the churches and the doctors. Doctor and priest, the Anglican Commission hold, need to respect each other’s skill and understand the purpose of each other’s work, and this will not be achieved by 1. The Church’s Ministry of Healing. 1958. Pp. 84. 2s. 6d. Obtainable from the Church Information Board, Church House, Westminster, S.W.1. The medical members of the Archbishops’ Commission were: Mr. E. S. Brentnall, Dr. Denis Brinton, Dr. Ronald Cove-Smith, Dr. J. A. Hadfield, Dr. R. A. Henson, Lady Jefferson, Prof. Alan Moncrieff, Sir James Paterson Ross, Dr. Joy Patrick, and Dr. David Stafford-Clark. 2. Report of the Commission on Spiritual Healing. 1958. Obtainable from the Publications Department, Church of Scotland, 121, George Street, Edinburgh, 2. The medical members of the Church of Scotland’s Commission were: Dr. W. A. Alexander, Prof. Stanley Alstead, Sir David Henderson, Dr. G. W. Ireland, Dr. Marjorie Keith, and Mr. G. H. Stevenson. 3. Divine Healing and Cooperation between Doctors and Clergy. London, 1956.
while the hospital admissions of these old people for physical illness have fallen by half, their admission for senile psychosis has actually ceased. This, said Dr. Rusk, is real preventive medicine-the preventive medicine of the future. Though he admitted that it was unscientific to say so, he believes that a purpose in life, and being happy, does something to prevent the progression of arteriosclerosis. Having just returned from an international conference called by the International Labour Office to discuss rehabilitation of the disabled workers, Dr. Rusk ended his lecture by endorsing the plea of a Russian representative that against disability we should all work together. He has never, he said, been anywhere in the world where doctors-regardless of race, creed, colour, politics, and curtains-do not have a common language and a common purpose. In the healing arts we have a tremendous responsibility and also a tremendous opportunity. In this world that is so technologically precocious and spiritually adolescent we can, if we try, build at least one block of international understanding. SMOKING AND PAPILLOMA OF THE URINARY BLADDER
IN Denmark Clemmesen et al.l investigated the smoking habits of patients with papilloma of the urinary bladder, and they conclude that among men with this disease there is a lower proportion of non-smokers than there is among the healthy, and that, where patients smoke only one type of tobacco preparation, cigarettes, cigars, and cigarillos are implicated, but not pipe-smoking. They noted that admission to hospitals in Copenhagen of patients with papilloma of the bladder had increased steadily from the three-year period 1944-46 up till the period 1953-55. The numbers were respectively 22 and 110 in men and 4 and 40 in women. From information previously gained from the Danish Cancer Register it is stated that the increase in incidence of bladder tumours, both benign and malignant, has occurred in men but not in women and follows closely that of bronchial cancer-though this is not borne out by the hospital figures cited in their report. Clemmesen et al. questioned patients still alive between March, 1956, and November, 1957, about their smoking habits and compared the information .thus gained with similar information from healthy persons obtained for another purpose in 1952-53. But 153 patients (more than a third) were not interviewed on account of lack of response (31) or death or inability to trace their whereabouts (122). Lilienfeld et al.2 suggested provisionally, from a retrospectivesurvey of clinical records of patients admitted to hospital with urinary-bladder cancer, that a significantly larger proportion of the men had smoked cigarettes for longer than had other classes of patients chosen for comparison; no such association was found in women. Holsti and Ermala3 swabbed the lips and oral cavities of mice with tobacco tar for 140 days and reported that they had observed both benign and malignant papillomatosis of the bladder at the end of a year of observation. But no confirmation of this finding has been described. An association between papilloma and cancer of the bladder on the one hand and the manufacture, purification, and usage of certain aromatic amines on the other is well established in every country where such an industry exists. 1. Clemmesen, J., Lockwood, K., Nielsen, A. Danish med. Bull. 1958, 5, 121. 2. Lilienfeld, A., Levin, M., Moore, G. Arch. intern. med. 1956, 98, 129. 3. Holsti, L., Ermala, P. Cancer, 1955, 8, 679.
In the future it should be
possible
to
predict with are likely
degree of certainty that certain chemicals
some
to
be
carcinogenic, but it will be far more difficult to tell which will be non-carcinogenic. The risk is not confined to the aromatic intermediates from which dyes are made: the finished dyes may also be carcinogenic, especially the azo compounds; and some of these, or their close chemical relatives, are in use as food dyes in some countries. The exogenous causes of bladder papilloma and cancer is receiving concentrated investigation; and in this chemical age it is to be expected that the incidence will rise for reasons unconnected with tobacco smoking. THE CURE OF SOULS AND BODIES
FROM earliest times the Churches have shared with doctors the responsibility for the care of the sick, and the origins of many of our oldest hospitals show the value and strength of this ancient alliance. But with the growth of scientific medicine, the partnership became uneasy. The doctor was less ready to share with the priest the responsibility for his patients. Today he is becoming increasingly aware of the effect of the patient on the disease and of the need to treat the person rather than the case. This shift of emphasis has led many doctors to reconsider their attitude. The Church of Englandand the Church of Scotland2 have also been considering their duties and responsibilities towards the sick in the modern world, and in the reports which Commissions of both churches have lately presented the thoughtful doctor will perhaps find a form of contract for a new and firmer
partnership. Both Commissions are reserved in their attitude towards medically inexplicable healings. Though they do not deny that these may occur they recognise that so-called miracles may be acclaimed in good faith by the layman who, unlike the doctor, is unaware of the normal course of a disease and possible natural remissions. The Anglican Commission, which acknowledge the help they received from a committee of the British Medical Association,3 wisely point out that many people are too ready to admire the unusual, and too slow to recognise the wonder of the familiar. They regret " the popular idea that what can be scientifically explained has little or nothing to do with God ". The Scottish Commission insist that " problems affecting physical and mental health require consideration first by a physician " and that spiritual healing should only be used with great discretion and always in consultation with the patient’s doctor. The Anglican Commission suggest that the rigid separation of the spiritual and physical " which has, without doubt, enabled medicine (as much as other sciences) to make progress " has now outlived its usefulness, and both Commissions believe that the patient would now gain by closer cooperation between the churches and the doctors. Doctor and priest, the Anglican Commission hold, need to respect each other’s skill and understand the purpose of each other’s work, and this will not be achieved by 1. The Church’s Ministry of Healing. 1958. Pp. 84. 2s. 6d. Obtainable from the Church Information Board, Church House, Westminster, S.W.1. The medical members of the Archbishops’ Commission were: Mr. E. S. Brentnall, Dr. Denis Brinton, Dr. Ronald Cove-Smith, Dr. J. A. Hadfield, Dr. R. A. Henson, Lady Jefferson, Prof. Alan Moncrieff, Sir James Paterson Ross, Dr. Joy Patrick, and Dr. David Stafford-Clark. 2. Report of the Commission on Spiritual Healing. 1958. Obtainable from the Publications Department, Church of Scotland, 121, George Street, Edinburgh, 2. The medical members of the Church of Scotland’s Commission were: Dr. W. A. Alexander, Prof. Stanley Alstead, Sir David Henderson, Dr. G. W. Ireland, Dr. Marjorie Keith, and Mr. G. H. Stevenson. 3. Divine Healing and Cooperation between Doctors and Clergy. London, 1956.