CANCER [To (he Editor of the SPECTATOR.]
Sin,--For a considerable time the daily Press has shown much interest in the cancer problem, but has confined its attention almost entirely to new means and methods of treating the disease. The cancer research campaign turned all eyes to a not too distant horizon, just beyond which was to be found come specific cure of this disease, still believed by most people to be incurable in spite of the evidence to the contrary pro- duced by surgeons even prior to the discovery of X-rays and radium.
We may, however, have to wait a long time for the hoped- for diseovery,and meanwhile there is one aspect of the cancer problem which has been too long neglected, namely, the early diagnosis, or recognition, of the complaint. It is true that the public has been told that on early diagnosis depends the prospect of cure of the disease, but little attempt is made to provide on a sufficient scale for the diagnosis of the numerous cases of internal cancer, the most difficult cases of all to diagnose and the cases which consequently have benefited least from the recent advances in treatment.
The best-known method of diagnosing of early internal
cancer is undoubtedly X-ray examination. This is recognized in hospital, where the aid of X-rays is constantly sought, with the consequence that the installations are being used to full capacity already. Outside the hospital, owing to the high cost of provision and upkeep of powerful X-ray plant, the fees are of necessity high, and for the patient of small means almost prohibitive. If such a patient having scraped together the necessary money finds nothing serious is revealed by the examination, he should rejoice, but more probably he will blame the conscientious family doctor for involving hint in unnecessary expense. Hence it comes about that both inside and outside the hospital X-rays are frequently used too late in the disease.
In 1921, by publishing an article I had written on " Treat-
ment Centres," the Spectator greatly helped to forward the scheme I had suggested to the Kensington Division of the British Red Cross Society, for converting its orthopaedic clinic for ex-Service men, then fast approaching the end of its period of usefulness, into a physical treatment centre for the civilian population, a scheme ardently supported by H.R.H. Princess Louise, Duchess of Argyll, and so developed since by the division's honorary secretary and her co-workers as to have, admittedly, served as a model for the many other centres subsequently founded. Remembering this help, I venture to ask you to give publicity to a further suggestion, which, if carried out, would bring many further benefits to suffering humanity.
In the course of time it is probable that, as is already the case in the Kensington Division physical treatment centre, need will arise for such clinics to provide X-ray apparatus for the diagnosis of such cases as now come to them for treatment. Such apparatus is expensive and its installation has only been rendered possible by the generosity of certain supporters of the institution and the untiring efforts of the administrative officers. I would like to suggest that whenever it is planned to instal X-ray plant in one of these clinics the apparatus should be capable of being used for the diagnosis of internal diseases, more especially cancer. To the cost of the apparatus would have to be added the salary of an expert radiologist, without whom the necessary investigations are impossible. I am convinced that in the course of a few years the X-ray department could be made self-supporting, but in the immedi- ate future the administrative staff, already exhausted by its efforts to obtain funds for its important work, would be faced with the necessity of redoubled efforts. I cannot, therefore, be surprised if the prospect of further burdens should fill none of them with enthusiasm. If, however, some generous benefactor or benefactors would be prepared to give the necessary financial support, I believe one of the treatment centres might be persuaded to give my scheme a trial, the results of which would quickly convince any doubters of the pressing need of extended facilities for the early diagnosis of internal cancer.'
The late Mr. St. Loe Strachey, in an editorial note to the article on " Treatment Centres," heartily commended the scheme, and I hope, Sir, you will view with equal favour my later scheme and consent to publish this letter.—I am, Sir, &c., HAROLD H. SANGUINETTI, D.M. (Oxon). 19 Ilornton Street, Kensington, TV. 8.
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