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THE CAMPAIGN IN BURMA
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treated children under the age of 10 years, 4 developed nodular thyroids seven to thirteen years later.2 The other group is derived from the well-known survey in Rochester, U.S.A., of 2809 infants given thymic X radiation. The latest follow-up has revealed 14 thyroid carcinomas and 27 adenomatous thyroids; there were no carcinomas and 2 adenomas in 4329 unirradiated sibs.3 In this Rochester group all the carcinomas and most of the adenomas were solitary. The average dose of thyroid X radiation was 600 rads in the children who developed thyroid cancer, 370 rads in those who developed thyroid adenomas, and 220 rads in the group as a whole-less than the 1000 rads received by the thyroids of the Rongelap children. The multinodular glands of the Rongelap group are similar pathologically to those found in the Californian group. This suggests that the post-irradiation development of a solitary thyroid nodule or of a multinodular gland may be correlated with radiation dose. It is generally accepted that children’s thyroids are more susceptible to the carcinogenic action of radiation than are those of adults. This may be due not to any greater intrinsic susceptibility, but to a carcinogenic summation of normal mitotic growth in childhood with malignant cell changes, otherwise latent, induced by radiation.4 The multinodular glands resemble the thyroids of adult rats given 1000 rads X rays to the thyroid or 30µC 1311 and subsequently maintained on goitrogens .4 The possibility that in adult man irradiated thyroids may respond similarly to children’s thyroids if subsequently stimulated to hyperplasia is borne out by a recent report. Doniach et al.5 found multinodular thyroids resembling the Californian and Rongelap ones in 3 adults whose thyroids had received a few hundred or more rads during the treatment of breast carcinoma and who by chance subsequently
developed primary hyperthyroidism.
THE CAMPAIGN IN BURMA
THOSE doctors who were in Imphal, the Kaladan valley, and across the Irrawaddy, will read the new volume 6 in the Medical History of the Second World War with mixed feelings. It was all so long ago but the pictures sometimes stir the memory too vividly for comfort. The Medical History has two purposes: to record work done; and to guide those who in the future may be faced with similar problems. Scholarly care has been lavished on this book, but many who would have liked to read it are no longer alive. As for its future usefulness, many of the lessons of this campaign are likely to have been forgotten, judging by the fate of similar work produced after the 1914-18 war. Much of such a history is bound to be a dry summary of comings and goings, of moderate triumphs and shabby disasters; but here and there are essays of permanent interest. The treatment and disposal of men with malaria and other transient fevers was a heavy drain on manpower until the formation of the advanced centres for medical treatment, where men could be held for a week before returning to their units. Evacuation of the wounded remained a problem to the end. It was said that those from 2
Sheline, G. T., Lindsay, S., McCormack, K. R. J. clin. Endocr. Metab. 1962, 22, 8. 3 Pifer, J.W., Hempelmann, L. H. Ann. NY. Acad. Sci. 1964, 114, 838. 4. Doniach, I. Brit. med. Bull. 1958, 14, 181. 5 Doniach, I., Eadie, G. A., Hope-Stone, H. F. Br.J. Surg.1966, 53, 681. 6 Medical
History of the Second World War. The Army Medical Services. Campaigns, Vol. V:Burma. Edited by F. A. E. CREW, F.R.S. London: H.M. Stationery Office. Pp. 754. 150s.
the first campaign in the Arakan suffered 28 changes of transport, litter to ambulance to sampan to lorry to raft and so on, before they reached Chittagong. The introduction of the light aeroplane which operated within range of Japanese fire was a great life-saver. In minutes the patient could exchange the noise and mud of the battle for the peace and order of a casualty clearing station. Closely connected with this problem were the changes in surgical methods. The sulphonamide powder and occlusive dressing brought to Burma by the surgeons from the 8th Army were no good for the man who might have to travel for four weeks before he reached skilled surgical help. " Delayed primary suture " became the watchword, and the burden was largely carried by the advanced surgical units. Soldiers will argue until the cows come home about the value of the two Chindit operations. The medical history of these activities was not a happy one and shows once more that the wise commander should listen very carefully to his medical advisers. Certainly the medical advisers in the Burma campaign did their best to see that such knowledge as they had penetrated to the humblest regimental officer. It may have been the " forgotten army " but there were no forgotten doctors.
PRISONS 1965
THE train robbers have understandably made the Prison Department a little nervous, and security is given special notice in its latest report.! For a short time in 1965 an Army picket was stationed within the walls of Durham
prison to guard against possible armed rescue of these prisoners, who were regarded as special escape risks "; but by the end of the year new special-security accommodation at Durham, Leicester, and Parkhurst was ready to receive these and other high-risk prisoners. Spectacular escapes-such as the removal, with outside help, of four men from an exercise yard at Wandsworthinevitably attract a good deal of public attention; but in 1965 there were only 71 escapes from " secure " prisons, compared with 85 in 1964. Every escape during the year was thoroughly’investigated as part of a wider survey of security precautions. Electronic and visual security aids were tested, and members of the Prison Department visited the United States, West Germany, and Sweden to study the latest methods of prison security. During 1965 the number of boys serving borstal sentences rose from 4782 to 5069, and an increasing proportion were being found suitable for closed conditions only-either because of the nature of their offences or because they were too inadequate or too unstable to cope with life in an open institution. The governors’ reports reveal a pervading air of gloom. One wrote of a vast deterioration in the type of lad received "; another described the year’s intake as " a crop of feckless and inadequate youths " who had long since abandoned traditional standards of morality. Drug addiction-at one time mainly a London problem-has now spread to borstals in other large cities. The success-rate of discharged offenders is not encouraging: between half and two-thirds are likely "
"
be reconvicted within three years. There has been a notable increase in resistance to training over the past two years, the boys seeming less ready to respond to a friendly to
1.
Report H.M.
the Work of the Prison Department, Stationery Office, 1966. Pp. 78. 6s. 6d.
on
1965. Cmnd. 3088.
treated children under the age of 10 years, 4 developed nodular thyroids seven to thirteen years later.2 The other group is derived from the well-known survey in Rochester, U.S.A., of 2809 infants given thymic X radiation. The latest follow-up has revealed 14 thyroid carcinomas and 27 adenomatous thyroids; there were no carcinomas and 2 adenomas in 4329 unirradiated sibs.3 In this Rochester group all the carcinomas and most of the adenomas were solitary. The average dose of thyroid X radiation was 600 rads in the children who developed thyroid cancer, 370 rads in those who developed thyroid adenomas, and 220 rads in the group as a whole-less than the 1000 rads received by the thyroids of the Rongelap children. The multinodular glands of the Rongelap group are similar pathologically to those found in the Californian group. This suggests that the post-irradiation development of a solitary thyroid nodule or of a multinodular gland may be correlated with radiation dose. It is generally accepted that children’s thyroids are more susceptible to the carcinogenic action of radiation than are those of adults. This may be due not to any greater intrinsic susceptibility, but to a carcinogenic summation of normal mitotic growth in childhood with malignant cell changes, otherwise latent, induced by radiation.4 The multinodular glands resemble the thyroids of adult rats given 1000 rads X rays to the thyroid or 30µC 1311 and subsequently maintained on goitrogens .4 The possibility that in adult man irradiated thyroids may respond similarly to children’s thyroids if subsequently stimulated to hyperplasia is borne out by a recent report. Doniach et al.5 found multinodular thyroids resembling the Californian and Rongelap ones in 3 adults whose thyroids had received a few hundred or more rads during the treatment of breast carcinoma and who by chance subsequently
developed primary hyperthyroidism.
THE CAMPAIGN IN BURMA
THOSE doctors who were in Imphal, the Kaladan valley, and across the Irrawaddy, will read the new volume 6 in the Medical History of the Second World War with mixed feelings. It was all so long ago but the pictures sometimes stir the memory too vividly for comfort. The Medical History has two purposes: to record work done; and to guide those who in the future may be faced with similar problems. Scholarly care has been lavished on this book, but many who would have liked to read it are no longer alive. As for its future usefulness, many of the lessons of this campaign are likely to have been forgotten, judging by the fate of similar work produced after the 1914-18 war. Much of such a history is bound to be a dry summary of comings and goings, of moderate triumphs and shabby disasters; but here and there are essays of permanent interest. The treatment and disposal of men with malaria and other transient fevers was a heavy drain on manpower until the formation of the advanced centres for medical treatment, where men could be held for a week before returning to their units. Evacuation of the wounded remained a problem to the end. It was said that those from 2
Sheline, G. T., Lindsay, S., McCormack, K. R. J. clin. Endocr. Metab. 1962, 22, 8. 3 Pifer, J.W., Hempelmann, L. H. Ann. NY. Acad. Sci. 1964, 114, 838. 4. Doniach, I. Brit. med. Bull. 1958, 14, 181. 5 Doniach, I., Eadie, G. A., Hope-Stone, H. F. Br.J. Surg.1966, 53, 681. 6 Medical
History of the Second World War. The Army Medical Services. Campaigns, Vol. V:Burma. Edited by F. A. E. CREW, F.R.S. London: H.M. Stationery Office. Pp. 754. 150s.
the first campaign in the Arakan suffered 28 changes of transport, litter to ambulance to sampan to lorry to raft and so on, before they reached Chittagong. The introduction of the light aeroplane which operated within range of Japanese fire was a great life-saver. In minutes the patient could exchange the noise and mud of the battle for the peace and order of a casualty clearing station. Closely connected with this problem were the changes in surgical methods. The sulphonamide powder and occlusive dressing brought to Burma by the surgeons from the 8th Army were no good for the man who might have to travel for four weeks before he reached skilled surgical help. " Delayed primary suture " became the watchword, and the burden was largely carried by the advanced surgical units. Soldiers will argue until the cows come home about the value of the two Chindit operations. The medical history of these activities was not a happy one and shows once more that the wise commander should listen very carefully to his medical advisers. Certainly the medical advisers in the Burma campaign did their best to see that such knowledge as they had penetrated to the humblest regimental officer. It may have been the " forgotten army " but there were no forgotten doctors.
PRISONS 1965
THE train robbers have understandably made the Prison Department a little nervous, and security is given special notice in its latest report.! For a short time in 1965 an Army picket was stationed within the walls of Durham
prison to guard against possible armed rescue of these prisoners, who were regarded as special escape risks "; but by the end of the year new special-security accommodation at Durham, Leicester, and Parkhurst was ready to receive these and other high-risk prisoners. Spectacular escapes-such as the removal, with outside help, of four men from an exercise yard at Wandsworthinevitably attract a good deal of public attention; but in 1965 there were only 71 escapes from " secure " prisons, compared with 85 in 1964. Every escape during the year was thoroughly’investigated as part of a wider survey of security precautions. Electronic and visual security aids were tested, and members of the Prison Department visited the United States, West Germany, and Sweden to study the latest methods of prison security. During 1965 the number of boys serving borstal sentences rose from 4782 to 5069, and an increasing proportion were being found suitable for closed conditions only-either because of the nature of their offences or because they were too inadequate or too unstable to cope with life in an open institution. The governors’ reports reveal a pervading air of gloom. One wrote of a vast deterioration in the type of lad received "; another described the year’s intake as " a crop of feckless and inadequate youths " who had long since abandoned traditional standards of morality. Drug addiction-at one time mainly a London problem-has now spread to borstals in other large cities. The success-rate of discharged offenders is not encouraging: between half and two-thirds are likely "
"
be reconvicted within three years. There has been a notable increase in resistance to training over the past two years, the boys seeming less ready to respond to a friendly to
1.
Report H.M.
the Work of the Prison Department, Stationery Office, 1966. Pp. 78. 6s. 6d.
on
1965. Cmnd. 3088.