The Call for Radium

Dominion, Volume 22, Issue 70, 15 December 1928, Page 17

The Call for Radium

New Epoch in Cancer War

As the result of the discussions at the recent International Conference on Cancer, held in London, there has developed a strong and insistent demand for radium clinics in all the centres. “Lens,” the “New Statesman’s” medical correspondent, has an interesting article on the subject in th e November 3 issue of that journal.

THE announcement has been made, writes “Lens,” that “a committee, representative of the Ministry of Health, the Admiralty, War Office and Air Ministry, is now engaged upon inquiries into the use of radium, the sources of supply and the amounts held in this country at present.” So we may hope to have more radium; but how is it to be used when we have it?

If the supply were to be be unlimited and considerations of cost did not arise, the answer to this might not be urgent. But, in fact, there is no present prospect that the supply, at best, will be even remotely adequate for the need, and the cost of such supplies as there may be will certainly be enormous. It will speedily be seen that such radium as is available must be in continuous use. Its powers cannot be wasted for a moment. The needles must not lie in a practitioner’s drawer, after he has treated one case, until another happens to enter his consulting room. Indeed, it evidently becomes questionable whether any individual ought to be in private possession of radium at all. Unless the principles involved are recognised, we might see wealthy surgeons, deprived of their present lucrative monopoly in the surgery of cancer, compensate themselves by buying up radium, and regaining their monopoly simply in virtue of the fact that they could afford to outbid other people in the possession of the one remedy for the disease. And their fees could be readily adjusted to make their capital expenditure extremely profitable.

Costly though radium be, we must not imagine that only wealthy people can afford to have it used upon them. About two million pounds are spent annually in this country on drugs under the Insurance Act. No pharmacologist can doubt that by far the greater part of this colossal expenditure is waste or worse. Radium does its good work, and remains in effect unspent, ready to do more. Let us say that £1,500 is the cost of the radium needed for an ordinary case of cancer of the breast, and let us adopt, for an estimate, the most protracted method which leaves the needles around the breast for, say, twenty-five days. The cost of the medicine, in this instance, is only the interest on £1,500 for twenty-five days, which may roughly be called £s—£s for medicine to cure cancer of the breast without an operation. It sounds too wildly good to be true, but it is already often true. In a word, if we compare radium treatment with surgery, or with the treatment of any chronic disease, such as tuberculosis or heart disease, we discover that the new method is not expensive, even though radium costs £12,000 a gramme, but is almost incredibly cheap. Thus there is no economic reason whatever against, but excellent reason for, the remarkable and significant decision of the Ministry of Health to establish an eight-bed radium clinic in London for the treatment of cancer of the womb in pauper women under the charge of the Guardians of the several Poor Law Unions in the metropolis. It will be of great interest to observe how long well-to-do women will allow themselves to be subjected to the damnable operation of panhysterectomy, with Its enormous Immediate mortality and its deplorable final results, now that paupers are to be released from that appalling prospect and be treated, without pain or risk and with better ultimate prospects, thanks to radium.

These preliminary considerations are enough to indicate that, ere long, we shall be treating cancer with radium in some social or communal way, which supersedes in toto the hitherto accepted idea of the medical profession as a number of individualists competing against one another for a livelihood dependent on their success in attracting to themselves as much as possible of the available supply of disease. The scarcity of the new remedy, together with the economy of its use, require that it shall never be out of use and shall be available for all. We must have radium clinics.

In whose charge? In other words, who are to treat cancer henceforth—at least, until better methods than radiation are evolved by biochemistry and chemo-therapeutics? This is an all-important question, for life and death depend upon the answer.

Hitherto cancer has been the monopoly of the surgeons. Year by year they have made their operations more “complete,” and year by year the death rate has risen. The person who has not yet got cancer is of no interest to the surgeon, the person who has is of intense interest. The surgeons as a body have never concerned themselves with the prevention of,cancer, and the recent International Conference in London, which was, of course, arranged by the surgeons, did not include the prevention of cancer in its jumbled and planless programme. I pointed to that omission here before the Conference, and made the assertion now repeated concerning the time when the surgeon is interested in cancer. But the truth is nbt therein fully stated. The surgeon’s interest begins and ends with the “operability” of the case. He does not interest himself in the years of chronic irritation of the womb which was lacerated during childbirth; he is interested in the consequent cancer so long as, perchance, he can do a Wertheim’s opera-

tion, but he loses interest so soon as the possibility of operation is past. Then, but not till then, he will send the patient to the radiologist, for treatment by radium or the X-rays; but first, if possible, he must have his pound of flesh. All honour to the surgeons of the Westminster Hospital, pioneer exceptions in London to this rule.

This is the true reason why, until the most recent times,'the radiation of cancer has made no progress and achieved nothing worth mentioning in this country, whilst a new epoch has been created in Pa: is and Stockholm. We have a Radium Institute, to the significance of which I have been drawing attention for many years. Why has it not been curing cancer if the Radium Institutes in Paris and Stockholm have been doing so? Certainly not because the staff of our Radium Institute is incompetent or idle: it is “very otherwise.” The Institute has not been allowed to treat operable cases. The surgeons have only sent to it cases past operation, with secondary growths, quite inaccessible by our present technique. If the Radium Institute had ventured to treat operable cases it would soon have had no cases at all. I write all this on my own responsibility and without authority or knowledge on the part of the Radium Institute. During the last few months, the pressure of the facts has begun to alter this deplorable state of things, which has followed from the surgical monopoly in cancer, but we have yet far to go.

Many years ago, I here suggested the proposition, quite novel then, and far from accepted yet, that the radiologist should no longer be called in by the surgeon if he thought fit,.but that, in every case of cancer, the surgeon and the radiologist should be recognised as equal colleagues. To-day I go much further. The radiologist is the proper person to deal with cancer in the first place. If he thinks fit, and after such preliminary radiation as he thinks desirable, he will call in a surgeon to operate: the surgeon thus returning to his former status as, literally, a hand-worker, employed and directed by the physician. The radiologist, thanks to the photographic use of the X-rays, is a superior diagnostician to the surgeon; he is superior in treatment, thanks to the X-rays and radium; and thanks to those agents, he can reduce the risk of operation, make operations possible which would otherwise be impossible, and can so kill or devitalise the malignant cells that subsequent efforts by the surgeon will not implant them broadcast in previously uninvaded tissues, as frequently happens at present. Henceforth the surgeon must therefore be deprived not only of his monopoly, but also of any priority in the treatment of cancer. Clever young men who propose to specialise in surgery must consider this matter. The “glittering prizes,” enormous incomes, titles and prestige now rewarding the brilliant operator will have no counterpart a few years hence. Nor, I am happy to believe, will any such rewards attend the radiologists instead. When real science enters into medical practice and is common property, these grotesquely excessive personal successes disappear, and are best left to sleek revivalists, and the kind of man who, for cash down, can make the worse appear the better reason in the long ears of a jury.

One further, reason why the radiologists must take charge of the radium clinics to be established as soon as we have the radium is that the use of the X-rays and radium itself is essentially one and the same thing. Every radium clinic must have a complete X-ray equipment, not only for diagnosis, but also for treatment. As I pointed out in my last article, the gamma rays of radium are high pitched X-rays. The principles and practice of radiation involve the use of these rays both as produced by a Crookes tube and by radium. The radiologist alone is qualified for this work. The surgeon has not the experience, he has not the training, and only in rare eases has he the mind necessary for this work. The present state of things in this country is distressingly stupid. The Radium Institute uses radium, but not the X-rays: a ridiculous and inefficient limitation. Some years ago, whilst I was discussing here the development of X-ray therapy of cancer at Erlangen, in Bavaria, I visited the London Cancer Hospital, and there Dr. Robert Knox, the senior radiologist, showed me the new apparatus for intense X-ray treatment, which was being installed. That distinguished worker died a few weeks ago, and in the obituary notice in the Times we were informed that he was looking forward to making, during next winter, observations on the use of radium, of which the hospital had just acquired a small quantity. Can such things be?

Indeed they can, and worse than these. But the surgeons’ day, blacker than night, is nearly done; and so is the imbecile inco-ordination between our efforts to treat cancer by radiation from one source to another. We have not yet reached the stage of Stockholm, where Professor Forssell has his clinic of fifty beds for the radiation of cancer, nor does our Government provide radium for use at centres, as is the case in France; but tlie Ministry of Health has made a beginning, almost infinitesimal, indeed, but yet a beginning. Already radium is thus officially preferred to the knife in operable cancer. Wherever cancer is to be treated we must have radium clinics.