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phia, southeastern Michigan, and Texas divisions, amongst others, report such events. In Kentucky, a Lost Cord Club of 26 members has been formed. Persons cured of cancer aided educational programs in Rhode Island. In Georgia 70 business and professional men who have had cancer are active leaders of divisional and unit service and educational programs.
During the year the New Jersey and Virginia divisions placed on the roads the mobile education units which they have received as gifts from their State Federations of Women's Clubs. In New Jersey it was the junior department of the federation which conducted the drive resulting in the donation. The Virginia cancermobile is a memorial for a cancer victim, Mrs. Claude E. Eley. Cancermobiles are bus-type vehicles, equipped with projectors, exhibits, films, literature, et cetera, which travel scheduled routes through divisional territories, visiting fairs, conventions, industrial plants, and rural areas. In charge is an educator. The units are responsible for advanced preparations, publicity, et cetera, the volunteers serving in various capacities as attendants. During the summer, the Virginia cancermobile conducted demonstrations and distributed leaflets at 24 local fairs, attended by thousands of Virginians. The New Jersey cancermobile had begun a Statewide tour at the year's end. Education and service for doctors
Statistics taken from divisional reports will reveal the scope of activities conducted by the divisions to aid the doctor in 1952:
48 divisions cosponsored with medical groups 769 statewide, district, and local conferences for the discussion of cancer.
55 divisions report 1,937 showings of films on the early diagnosis of cancer to an estimated audience of 53,886 physicians, members of hospital staffs, nurses, and medical students.
20 divisions report support for teams of doctors, emphasizing medical specialties related to cancer, who conducted meetings for doctors in local
20 divisions sponsored 153 institutes on nursing requirements of cancer, attended by an estimated audience of 4,829 regular and public health nurses. 35 divisions report other training programs for nurses.
15 divisions report special fellowships for doctors, 9 report fellowships for medical students, 8 report fellowships for nurses, 13 report fellowships for the training of cytology technicians.
24 divisions report support in some form for cytologic services to make smear tests more widely available in cancer examinations, especially cancer of the cervix.
23 divisions report activity in some stage of development for mass X-ray examinations for the early detection of lung cancer.
25 divisions are giving support to central detection centers for cancer. 41 divisions report financial or other support for 274 diagnostic and treatment clinics in general hospitals.
All divisions, through these and many other activities designed to assist the doctor, persisted in their efforts during the year to bring closer the society's goal of making "every doctor's office a cancer-detection center." Doctors' offices and detection centers
It is understandable that progress in the society's professional educational activities over the years should result in a gradual tipping of the balance as between detection centers and the doctor's own office as places for the detection examination. The Pennsylvania division, for example, reports that formal detection centers have decreased from 40 in 1949 to 25 in 1952 in that divisional area. In the past year 2,021 doctors in 44 Pennsylvania counties expressed willingness to participate in programs for standardized examinations in the doctor's office. In Connecticut, a similar doctor's office program, recently initiated, receives the support of many doctors. The New Jersey division's well-established office program is supported by over 2,000 doctors. The Illinois division reports the closing of 3 detection centers in Chicago, and 3 centers were closed in Georgia. The Milwaukee division closed its popular center during the year, saying that doctors claim every doctor's office in that city is today a detection center.
But detection centers in many areas offer a vital and much-needed service to the public. The North Carolina division reports 1952 to have been its most successful year in its cooperation with the State-conducted detection center
program. The centers have been highly successful in Delaware in stimulating both general and medical interest in cancer. Centers are effectively conducted in Philadelphia. The Brooklyn division states its 7 cancer-prevention clinics in 7 hospitals examined 3,804 persons during the year, over half of whom, though they did not have cancer, had some other disorder in need of medical attention. Two new centers were established by the Maryland and Colorado divisions in their areas during the year.
Precision attack-cervical cancer
The smear test requires much training for the pathologists who read the smears and technicians who screen them. The threefold divisional attack urges that smear examinations be made a routine feature of all examinations, particularly for cancer of the cervix. It encourages with fellowships and by other means special training for pathologists and technicians in reading and screening smear specimens. It offers financial support in many areas for laboratories in which smears, routinely forwarded from the doctor's office, can be rapidly and efficiently processed at nominal cost.
Cytology services for doctors were given direct financial support of some kind in 1952 by 24 divisions. Several divisions were assisting central cytology laboratories. As has been noted, 15 divisions report fellowships for doctors, some of whom were pathologists. Thirteen divisions offered fellowships for cytology technicians.
Precision attack-lung cancer
In 1952, 23 divisions had undertaken cooperative programs of some nature for mass chest X-ray examinations for lung cancer. For the present, the programs are as a rule confined to a few locations within divisional areas and may not yet be described as truly mass in character. But a beginning has been made. Usually the cooperating agencies are medical societies, departments of health, and local chapters of the National Tuberculosis Association and American Heart Association. Usually, expenses are shared and all agencies join in publicizing the activity. Mobile X-ray units are commonly employed, chest pictures centrally screened by doctors, and signs of disease promptly referred to individual physicians for further attention, including diagnosis and treatment in the case of lung cancer.
During the year, the Massachusetts program, cosponsored by medical societies and departments of health, was extended from Boston to the cities of Worcester and Fitchburg. Mobile X-ray units were employed in parts of North and South Carolina, South Dakota, Utah, and New Mexico. Projects in cooperation with tuberculosis sanitaria are under way in Illinois and Puerto Rico. In Oregon, an effective program has been conducted in Portland. Other divisions report programs in the planning stage.
Meetings, refresher courses, fellowships
Divisional and unit conferences for busy doctors take many forms. Some are statewide, some are for districts, some local-within the doctor's own community, where the needs of patients beginning or undergoing treatment are urgent and critical for both doctor and patient. In 1952 the divisions sponsored 62 statewide meetings, 113 regional meetings, 594 county or municipal meetings—a total of 769 meetings of all kinds.
The names of some of the larger meetings in 1952 reveal their character: Colorado-Sixth Rocky Mountain Cancer Conference (July); Illinois-Twelfth Annual Cancer Symposium (February); Florida-Southeastern States Cancer Seminar (November); Kansas-Midwest Cancer Conference (April); MaineAnnual Cancer Teaching Day (October); Massachusetts-Seventh Postgraduate Lecture Course (October); Milwaukee-Sixth Annual Cancer Symposium (April); Oregon-Sixth Annual Postgraduate Course (September); Rhode Island Cancer Teaching Day (September); Vermont-Fourth Annual Cancer Symposium (April); Virginia-State Program of Postgraduate Instruction in Cancer (year-round); Washington—Annual Dental Refresher Course (February); District of Columbia-Cancer Day, District Medical Society (February); Indiana-Fifth Annual Postgraduate Course in Malignant Diseases; UtahFifth Annual Cancer Symposium; Nassau, N. Y.-Annual Refresher Course in Cancer Recognition.
Among smaller meetings were 23 teaching clinics held in Massachusetts in cooperation with the State department of health, and meetings in 19 Boston hospitals for hospital staff members; 5 regional meetings in Wisconsin on chest
diseases cosponsored by the board of health; 2 meetings in Westchester County, N. Y., for the entire medical society and staff members of 6 hospitals; 2 meetings in West Virginia cosponsored by the Academy of General Practice; 2 meetings in Puerto Rico cosponsored by the medical society and department of health; 3 regional meetings in South Dakota cosponsored by the State board of health; 3 meetings in Nevada, cosponsored by medical societies; a symposium on cancer in New York City in cooperation with the New York Academy of General Practice; 24 meetings in 14 hospitals in the Queens, N. Y., area; 31 county meetings in California attended by 1,947 doctors, cosponsored by the cancer commission of the California Medical Association; 56 meetings in Nebraska; 20 meetings in Kentucky on request of county medical societies.
An effective activity was the sixth annual post-graduate course on cancer at the University of Oregon Medical School. Besides doctors from Oregon, the course was attended by 30 Idaho physicians sponsored by the Idaho division and 9 doctors from 7 Alaska communities sponsored by the Alaska division and the Alaska Department of Health. In Texas, post-graduate courses on cancer sponsored by the division were approved by the Academy of General Practice for credit toward requirements of members. A post-graduate course on cancer was initiated at the University of Oklahoma School of Medicine. In Virginia, a retired physician, formerly Director of the National Cancer Institute, Dr. Roscoe B. Spencer, devotes all his time to a statewide program of cancer seminars and teaching clinics, jointly sponsored by the division, the Medical Society of Virginia, the Old Dominion Medical Society, the State department of health and the extension division of the University of Virginia. In Connecticut, an especially trained physician is jointly sponsored by the division and the State board of tumor clinics as a fulltime consultant for tumor clinics of the State.
Most of these programs were for physicians now in practice. In addition, in 1952, 18 divisions offered 56 fellowships for special training in cancer diagnosis and therapy for medical students and younger physicians of promise. The New York City cancer committee gives substantial support to a large program in several New York hospitals for the advanced training of doctors. These training activities of the divisions are in addition to the extensive medical fellowships program of the national society.
Nurses' training programs
A most effective technique in training nurses in the special problems of cancer patients is the nursing institute. Usually, they are sizeable meetings, held in some central place and lasting for several days, jointly cosponsored by the division, medical societies, medical schools, and departments of health. Besides financial support for the meeting itself, the divisions often provide for the nurse's expense while attending the meeting. Nursing problems in the different kinds and stages of cancer are described and demonstrated, helping the nurse and providing better care for patients within her community. Twenty divisions report 153 nursing institutes attended by 4,829 nurses as having been held in their areas in 1952.
Among other activities of the divisions for nurses are programs and teaching materials for nurses in training--such as the society's film for nurses, What Is Cancer? and its booklet, Cancer, A Source Book for Nurses. The Minnesota division supports one full-time staff member on the faculty of the university school of nursing to help with nursing training. The Montana division employs a nurse for training purposes, and the South Carolina division employs eight full-time nurses for calls on patients and to help train public-health nurses.
Eight divisions offered seventy-five scholarships for nurses in 1952; of these, the Indiana division provided 17 scholarships and the Iowa division 49 full 3-year scholarships, bringing to 182 the number of nurses who are in training or have been trained by the division for service in Iowa.
Aid for cancer clinics
Grants from the divisions make it possible for hospitals to establish and operate cancer clinics which meet standards for approval by the College of Surgeons. The grants are used for the purchase of equipment needed by the hospital in diagnosis and treatment and to help pay salaries of clinic aides, such as a nurse or the medically trained secretary who is usually in charge of the recordsalways a vital part of the clinic apparatus. As will be noted, the divisions provide many other services to clinics through volunteers of the units. For
1952, 41 divisions report support of some kind for 274 diagnostic and treatment clinics in hospitals of their areas.
Basic grants, supplemented by other assistance, are made to 31 clinics by the New Jersey division which has developed a remarkably broad medical service program. In Indiana 22 clinics are assisted with clerical help and by the provision of radioactive materials for indigent patients. In the past 10 years, the Georgia division has supplied by agreement with the State board of health, one quarter of the X-ray equipment for 17 State-aided clinics. In Kentucky clinics are supported with equipment, secretarial, and nursing assistance; a mobile diagnostic clinic has been supported with great success in the same State. In Florida grants were made in 1952 to 12 clinics for secretarial help and general operating purposes. In Illinois the division made possible the employment of secretaries and medical social workers in 17 clinics. Twenty-nine clinics have been or are now being aided in Connecticut and 59 clinics have been or are now being helped to become self-supporting by the Pennsylvania division. In 1952 27 clinics received assistance from the New York division. Traveling clinics are supported in Oklahoma and Wyoming.
The smoking study
What is the cause of the fivefold increase in the past few decades in deaths from lung cancer? No other cancer has shown a rise anywhere near so great. This form of the disease has become especially prevalent in men of the 50-69year age group. Many authorities relate some of the increase to smoking, a habit much increased in the same period.
Under authority of the national board, the society set out a year ago to see if smoking was in fact the answer. About 27,000 volunteers in units of the California, Illinois, Iowa, Michigan, southeastern Michigan, Minnesota, New Jersey, New York, Pennsylvania, and Wisconsin divisions are participating in the study. These divisions were selected because of their geographic location and the numbers of men in the proper age group in their populations. In 1952, the volunteers conducted interviews with over 200,000 men above 50 years of age, carefully recorded their lifetime smoking habits. These basic records are now on file at the national office. So large a sample should tell the true story when lung cancer cases, smokers versus nonsmokers, are studied a few years hence.
Though no conclusions concerning lung cancer are yet possible, some preliminary findings on smoking habits are of interest. About 18 percent of the men whose histories are now available for study have never smoked. About 6 percent have never smoked more than occasionally. About 76 percent have been regular smokers. Older men have smoked less than younger men. Older men show a greater tendency to quit smoking than younger men. One-fourth of all polled have dropped from the list of regular cigarette smokers at some time in their lives; one-half of the onetime regular cigar and pipe smokers have stopped that habit.
It is estimated that this study would have cost up to now, at a minimum of $10 per interview, at least $2 million if privately undertaken-about $10 million 5 years hence, when conclusions may be drawn. It was begun in 1952 with no extra cost to the public as a part of the regular duties of national, divisional, and unit staff members and the society's hard-working volunteers.
Many of the men volunteering information on their smoking habits asked for information and cancer symptoms and reported to their doctors for physical examinations. In New York 10 cases of cancer were diagnosed in this manner, most of them in early stages and probably curable.
Divisional research projects
The Divisions occasionally supplement the national research program by support for research undertakings in medical and scientific institutions of the divisional area. In some cases, as in Illinois and California, projects are aided by legacies and memorial trusts, founded by various individuals for cancer research, which are administered by the division. Though serving a valuable purpose, the projects are usually limited in their nature and reviewed by the national society for conformance and consistency with the national research program. In 1952, research projects were being supported by 19 divisions.
The divisions have primary responsibility for training activities of volunteers. A great range of topics are involved and many methods employed. State meet
ings may be in order, sometimes district or local meetings. In general, training materials and techniques developed by the national staff are being more widely used. Noteworthy has been the acceptance of modern participation techniques for adult groups, such as workshops, roundtables, panel and forum discussions. A total of 2,521 meetings of all kinds attended by 77,443 volunteers are noted in divisional reports for 1952. Of these, 59 were statewide meetings, 362 regional or district meetings, and 2,100 local meetings. There were 1,012 meetings on service programs for patients, 610 on public education, and 899 in preparation for the April campaign.
Bulletins and publications
So as to keep volunteers and unit leaders constantly informed of divisional and national activities, 42 divisions publish monthly or bimonthly bulletins. Formats vary from tipped-together mimeographed sheets to letterpress offerings, illustrated with photographs. All are colorful and informative of the society's work.
Occasionally, divisions issue special publications to advance various aspects of programs. Notable in 1952 was production by the Connecticut division of an expertly presented, clearly written Handbook for Workers of the Connecticut Cancer Society, outlining for volunteers all aspects of the divisional program. The Massachusetts division prepared an excellent Teachers Guide for Cancer Education. The California division produced a Lay Service Manual to guide local service programs for patients. The Illinois and Indiana divisions issued special pamphlets to interest employers in business and industry educational programs. An effective undertaking was a film strip prepared by the Pennsylvania division, Pennsylvania Crusade, with related narrative on objectives of all elements of program in that area.
Iowa's quarterly-New Horizons
During the year the Iowa division was awarded a 1952 Cancer Crusade Citation by the national society for its magazine, New Horizons. This competent, illustrated quarterly is a program journal for the public which 4 times a year takes information on cancer to 200,000 readers in Iowa. A survey of readers by the University of Iowa indicates that 86 percent can name one or more symptoms of cancer.
Citation for the Alaska division
In 1952, the Alaska division, one of the newer divisions of the society, was awarded a crusade citation for its effective programs in public and professional education. In a remarkably short space of time the division was established, volunteers organized, and a control program initiated which has won the support of Alaska people as attested by regular oversubscription of the annual appeal quota. In 1952, the division raised 345.8 percent of its announced goal. Loss of two great leaders
The society lost two of its great medical leaders in 1952 in the deaths of Dr. Louis C. Kress of New York and Dr. Thurman B. Rice of Indiana. Dr. Kress' death occurred a few days after he had been cited by his division and honored by Governor Thomas E. Dewey as "the man who had done most for the cause of cancer prevention and cure in the society's New York State division." Dr. Kress was a member of the national board of directors. Dr. Rice was regarded as the father of the Indiana division. He was head of the department of public health, Indiana University School of Medicine and author of many articles and books on health and medicine. At the time of his death, Dr. Rice was president of the Indiana division.
The April appeal
The 1952 crusade was one of the most successful yet conducted by the society. Outstanding details are discussed in a concluding section of this report. In a very high degree the success was due to the hard work of the divisions in organizing the crusade and the unflagging spirit, resourcefulness and drive of volunteers of the community units in its execution.