View report page

114
I come now to what has been done in England and Wales. The Ministry of Health issued in
July, 1923, a Memorandum on Cancer prepared by its Departmental Committee on Cancer, in which
it was suggested that Local Public Health Authorities might periodically consider such questions
as the following :—
(1) Improving the local facilities for clinical consultations and for pathological examinations.
(2) Improving the local facilities for Cancer treatment (operative or provision of X-ray and
radium apparatus) and of considering the adequacy of arrangements for this purpose
at hospitals, local institutions, etc., which serve the area.
(3) Improving the facilities for transport of patients.
(4) Arranging locally for post-graduate demonstrations, lectures or courses on Cancer for
medical men practising in the area.
(5) Arranging locally for the education of the public.
Moreover, in the Memorandum and in three others issued subsequently by the Ministry a
concise and non-technical summary was given of our present knowledge as to the nature and incidence
of Cancer, the effects of radium and X-rays, the results of surgical operation in cases of Cancer of the
Breast and lastly a survey was given of the ground broken by experimental Cancer research at that
date (July, 1924). It has been my object in the first part of this memorandum to amplify this summary
and bring it up to date, without detracting from its value by the introduction of any contentious
matter.
The Departmental Committee has since its formation initiated an interesting and valuable
investigation into the statistics of Cancer of the Breast. This investigation has been confined to certain
large towns where, in the opinion of the Committee, special facilities existed for conducting such an
investigation, and valuable information has already been obtained which is now serving as a guide
to further researches.
On reviewing now the measures taken for the control of Cancer by Local Health Authorities, it
will at once be seen that though much work of great value has been accomplished, only a small part
of the field outlined in the Ministry's first memorandum on Cancer has been covered, and that an
enterprising Local Authority still has an unique opportunity of breaking new and valuable ground.
(1) Cancer Committees and Research.—Such Committees have been formed in response to the
suggestion of the Ministry in the following towns: Manchester, Leeds, Bradford, Leicester, Sheffield,
Birmingham, Nottingham, Bristol and Cardiff.
In most cases these bodies appear to be of the nature of Advisory Sub-Committees convened
by the Health Committee of the Local Authority and consisting almost entirely of local medical men
representing the hospitals and other medical institutions of the city.
The special investigation into the statistics of Cancer of the Breast being now carried out by
some of these Committees has been referred to above. Liverpool and Newcastle-upon-Tyne, though
having no Cancer Committee, are also co-operating in this investigation. At Leeds, moreover, an
additional investigation into Cancer of the Female Generative Organs is also being carried out, and a
special Medical Officer, whose salary is being paid by the Health Committee of the Town Council,
has been put in charge of these two investigations.
At Manchester, an After-Care, Follow-up and Treatment Sub-Committee has been appointed
to undertake (i.) the continuous supervision of each case of Cancer in the city, (ii.) the provision of
suitable treatment without delay for any recurrence of growth, (iii.) the establishment of a regular
and complete system of record-keeping of Cancer cases in all the city hospitals and in private practice,
(iv.) microscopic examination of specimens from each case, etc. A special Medical Officer is being
appointed to carry on this work.
At Cardiff a system of voluntary notification of cases of Cancer with the usual fee attached is
in operation with the object of obtaining more complete data.
(2) Facilities for Treatment.—As far as I can ascertain, the only real effort in this direction
made by Local Authorities has been at Bradford, where an apparatus for Deep X-ray treatment for
Cancer has lately been installed in the Municipal General Hospital.
(3) Direct Cancer Propaganda.—The pioneer effort in this direction (so far as this country is
concerned) was made at Portsmouth as long ago as January, 1914, when a leaflet drawn up by the
Medical Officer, Dr. Mearns Fraser, setting forth the chief known facts about the disease and urging
the public to consult a doctor for certain conditions was distributed. The contents of this leaflet
were also inserted once a fortnight in the local press, but this practice was eventually discontinued,
on the grounds of economy, though definite evidence was obtained that the reading of this leaflet
had resulted in a number of patients applying to their doctors at an early stage of the disease. The
leaflet is, however, still issued to Nursing Bodies, Midwives and other workers among the poor. Similar
leaflets have also been issued at Bristol, Leeds, Leicester and Cardiff (Cancer of the Breast). I may
also mention here that leaflets on Cancer of the Womb and of the Breast, drawn up by the
Chairman, have been issued by the Central Midwives Board ever since 1908.
The Manchester Cancer Committee has appointed a Propaganda Sub-Committee to which the
Public Health Committee has delegated its powers with regard to propaganda under Section 67 of the
Public Health Act, 1925.
As regards Lectures on Cancer, so far as I can ascertain, nothing of the kind has yet been organised
by public authorities in this country.