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58
It has been the custom, since this centre was started, to treat patients even when
there seems no chance of cure, and the medical officers of the Council's hospitals
are asked to leave the decision to us, no matter how bad the patient seems. At any
rate, treatment by radium does relieve advanced cases by arresting haemorrhage and
relieving some of the distress, and now and again a cure results in apparently the most
hopeless case, or a life is markedly prolonged. Whether the latter is an advantage
may be a matter for debate, but there must be many cases in which a prolongation
of life is of vital importance to the patient or to his or her dependants. The reasons
why treatment has been refused at this centre have always been stated in these
reports. This centre is peculiar, as has been pointed out in former reports, in that it
receives patients only from the Council's hospitals, the majority of whom have
undergone a process of selection before they reach the centre, having been refused
treatment, either surgical or radiological, at other hospitals, and have found their
way into the Council's hospitals to die. Now that the Council's hospitals have been
reorganized, it may be that in future years the average case treated at this centre
will not be so far advanced ; but, since most patients seeking advice and suffering
from carcinoma of the uterus are seen first in the out-patient departments at the
voluntary hospitals, it may be a long time before this centre ceases to be loaded with
such advanced cases, since the early cases are kept for treatment by the voluntary
hospitals.
Since this centre was started, it has received 753 patients. Of these, 523 were
cases of carcinoma of the cervix, and, of these, 379 were treated. During the year
one patient died as the direct result of the application of radium, the cause of death
in this case being general peritonitis. During the whole period 16 patients have died
as the result of treatment.
When this centre was situated at the North-Western hospital there were no
facilities for X-ray treatment following the application of radium. At the time the
centre was set up it was not the custom, in most centres, to give X-ray treatment
in addition, the published results from the well-known centre of Stockholm, for
example, where X-rays were not used, being as good as those from centres where
X-rays were employed ; and for the first 5 years at this centre X-rays were not used.
However, in view of improved methods of treatment, it has gradually become
recognised by the medical profession that the addition of X-ray treatment certainly
leads to an improvement in the survival rate. When this centre was, therefore,
transferred to Lambeth, it had available this additional method of treatment, the
centre being situated adjacent to one of the best X-ray departments in the country,
under the care of Mr. Stebbing, and, with the two departments working most amicably
together, the patients at this centre suffering from carcinoma of the uterus have,
during the last 9 months, had the benefit of being treated with X-rays after the
radium treatment was completed, and only a few patients have refused. It must
be remembered that the combined treatment takes some time, and the marked
improvement in the condition of most of the patients after treatment with radium
makes some of them hesitate or unwilling to proceed with further treatment. However,
the resident staff, both medical and nursing, are so tactful that in most cases
this difficulty has been overcome.
Lastly, the result of the " follow up " is very satisfactory and amounts to nearly
99 per cent., only 6 patients having been lost sight of since the centre was established.
This result is due to two factors. One, that the Council allows its ambulances to
fetch the patients and return them home if they wish, and the other the great trouble
the secretary of the centre takes in tracing the patients. I have described in former
reports the steps which are taken to trace a patient who has " disappeared," including
letters to everyone who it is thought might give some information—the Council's
hospitals, private doctors, relatives, local agencies such as the post office and clergyman
of the parish, and so on. There must always, however, be a certain number of
patients who disappear, no matter what method is devised to ascertain their present
address, since, unlike the law in some foreign countries, people in this country do not
have to report to the police a change of address.