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l'Union Internationale Contre le Cancer, the Commission on Chronic Illness, the American Association for Cancer Research, the Committee on Cancer Diagnosis and Therapy (National Research Council), among others, received support. Thirty-eight requests for grants of this character were received during the year, of which 19, totalling $74,120 were acted upon favorably.
Service to the cancer patient
As service must be extended where patients live, most of it is conducted by the divisions and their community units. Nevertheless, problems of the cancer patient are foremost considerations of the national society. How can this difficult sociomedical problem, often involving whole families in later stages of the disease, best be handled? Seven hundred thousand persons are ill of the disease today. Over 500,000 new cases are diagnosed each year. Their care is a large burden for the Nation.
Certainly, the most practical tactic is to increase the number of persons cured of cancer. Public education helps, so also professional education and research. One attack with present knowledge is through cancer diagnostic and treatment clinics in general hospitals which bring to bear on the patient all the knowledge of the hospital staff and the hospital's clinical equipment. The divisions support these clinics with money and many voluntary services. Only 655 clinics had been approved by the American College of Surgeons at the end of 1952. general agreement that many more are needed.
Notable have been enabling grants, since 1947, to the American College of Surgeons to establish standards for clinic operations believed desirable by the medical profession. Assistance to nursing organizations have been helpful. Useful also have been recommendations and services of the national society in the recordkeeping of clinics-essential in patient management and for evaluation of treatment procedures.
Field relations and administration
All parts of the society must work together-the national society, the divisions, the units-doctors and lay persons-advisory committees voluntary workers and staff members. The exchange of information is vital. Many devices are employed by the national society, and encouraged within the divisions.
Mention has been made of Cancer News and the ACS Bulletin. But seminars, conferences, training meetings of all kinds, are vigorously employed. During 1952, the divisions reported 2,846 separate meetings, attended by an estimated 77,445 volunteers and staff persons. At the annual meeting of the national society, besides discharge of stated business of the board and the election of directors and officers, there is a refresher activity. Four hundred volunteers and staff people from all parts of the country attended the 1952 meeting in New York in October. Over 1,000 doctors attended the medical and scientific sessions. An innovation of the 1952 meeting was a special seminar for selected divisional and national board members.
At the 1952 annual dinner a number of individuals were honored by the society for signal contributions to the control of cancer. Upon this occasion Dr. George N. Papanicolaou and Dr. Herbert F. Traut were awarded the society's medal for their outstanding development of the cytologic method of cancer examination. Also honored with other society's citations were Senator Dennis Chavez, of New Mexico, and Representative John E. Fogarty, of Rhode Island, for their leadership in enactments by Congress of cancer control legislation. A distinguished service award was made to the Columbia Broadcasting System television feature, See It Now, produced by Edward R. Murrow and Fred W. Friendly, for a national telecast of the cancer Thanksgiving service to patients. It is used as a source book on celebration, held at Cedar Rapids, Iowa, in April.
Visits to divisions of national office field representatives are valuable aids to the interchange of information. Under direction of the department field relations, these trained members of the national staff consult with the divisions on a wide range of problems-education, service to the patient, training, management, finance, the April campaign. In 1952, several technical studies of administrative problems were completed upon divisional request. A total of 868 mandays were employed in 54 divisions in these activities.
Members of the medical and scientific department staff are also frequently in the field to address professional meetings. In 1952, the staff of the statistical research section traveled to many States for training and supervisory actions on the smoking study and other duties. So also, representatives of the public relations department and the comptroller's office made visits to the divisions for
problems in their areas. A total of 1,897 man-days in 58 divisions was employed by the national staff in this basic activity in 1952.
Relations with the National Cancer Institute
As has been noted the Director of the National Cancer Institute is a member of the national board. Correspondingly, James S. Adams, chairman of the research committee of the board, is a member of the National Advisory Council of the Institute and Dr. Frank Adair, former president of the society and board member, and Dr. Charles S. Cameron, medical and scientific director and vice president, are respectively chairman and member of the Control Grants Section Committee of the Institute. In 1952, so as to strengthen the liaison between the society and cancer control programs of the Federal Government, a Washington representative was appointed by the society.
In February, Mr. Adams, Dr. Cameron, and a group of distinguished research scientists and physicians-Dr. C. P. Rhoads, of New York; Dr. Sidney Farber, of Boston; Dr. Leon O. Jacobson, of Chicago-presented testimony before House and Senate committees in support of more adequate appropriations for the work of the Institute. Congress increased by more than $22 million the funds which will be available to the Institute in 1953-$17,887,000 as against a proposed appropriation of $15,371,000.
These funds will be expended for research and medical education, and in official control projects within the States, thus helping in the expansion of many phases of the society's attack on cancer.
Finance fiscal control
The national society leadership responsibility is exemplified by budget procedures established in recent years to control expenditures and in the financial accounting of the National Society and its 61 divisions. The society follows latest developments in accounting practices so that its affairs will be administered on a basis comparable to an efficiently conducted major business.
Expenditures from the 15 percent of contributions accruing to the national society are controlled by a budget processed well in advance of the start of the fiscal year. Departmental budgets are prepared, coordinated into an overall budget, further reviewed by the finance committee of the board before board approval. When approved, the budget becomes a guide and control for expenditures. In practice, in the 1952 fiscal year, the cost of the national society's program was $2,309,000-95.8 percent of the announced budget of $2,410,000.
Expenditures from the 25 percent of gross annual contributions allocated to the national research program are controlled with similar care. Applications for research assistance are studied by the research committee of the board or the committee on growth before grants are made by the board. Grantees are required to submit detailed budgets outlining proposed expenditures. They must furnish periodic reports of expenditures and adhere to the society's regulations on grants. Further controls provide for visits by national office auditors to check reports of expenditures with the institutions' records.
The national society works with the divisions in the establishment of similar practices with respect ot the 60 percent of total contributions employed in their programs. Charters of the divisions include standards providing for the submission of budgets aproved by divisional boards and adequate narrative explanation. Divisions also furnish the national society with audited annual financial reports prepared by independent public accountants. From these reports, a combined budget and combined financial statement are prepared and published each year by the national society. The society takes pride in having been the first national voluntary health agency with geographical divisions throughout the country to present such a report to the public. For the 1952 fiscal year, the society's total combined program budget was announced as $15,891,000, whereas the actual cost was $15,325,000-96.4 percent of the forecast. Below is a graph of the society's 1952-53 combined budget-for details.
The divisions are separately incorporated under the laws of the different States but bound to each other and the national society by charter of the national organization. Usually, they are named "American Cancer Society, Division." Some of the older divisions are organized by metropolitan areas, but the usual area of operation is a State. Sixty-one divisions of the society, operating through 3,301 local organizations or community units, carried forward the fight against cancer in 1952, in the 48 States, Alaska, Puerto Rico, the District of Columbia, and 10 other areas.
Responsibilities of the divisions
Much of the divisional attack is carried by the community units which make up the total divisional structure. But as divisional offices usually have direct responsibility for certain programs as well as for overall direction and general policies of the units, comment is in order to make clear the relationship between divisional and unit organizations.
As a rule, medical programs can best be handled at the divisional level where total needs of the area are visible and contact with central medical organizations on policies can be continuous. Thus, decisions concerning the relative emphasis to be given detection examinations in the doctor's office or in detection centers are reached at the divisional level and programs placed in operation. Similarly, educational programs for doctors and nurses, support for diagnostic and treatment clinics in hospitals, and programs for the various technical services needed by doctors in the detection and treatment of cancer are usually formulated and directed by the divisions. Generally, the decision concerning the kind and extent of support for services for patients, such as nursing services, is made by the division. The divisions have major responsibilities in public education and training of volunteers. Finally, a primary and climatic responsibility of the division is the conduct within the divisional area of the society's anual drive for funds. The cancer crusade is conducted as a major educational program as well as an appeal for the funds to maintain and strengthen the society's work. These duties involve constant planning of where and in what form divisional resources may be used to best advantage. Budgets for divisional and unit activities and the control of expenditures are constant preoccupations of divisional offices. Divisional direction
Divisional boards of directors are composed, as is the national board, of both lay and professional members-a formula vitally important to a society whose purposes are both medical and social. For greatest effectiveness, units are represented on the boards and the major medical, scientific, and lay interests on the area. In 1952, 2,452 persons were serving on divisional boards of directors: 1,162 were doctors and scientists, 1,290 lay persons.
At divisional headquarters is a small staff, consisting usually of an executive director, assisted as required by an educational director, a service director and a publicity director, with the necessary field representatives to maintain contact with the local units. Always, the medical and medical service program is carefully planned by the medical committee of the board to make sure it corresponds with policies approved by the medical profession of the area. Where they exist, cancer committees of State medical societies and the cancer control sections of State departments of health are often represented on the board.
Sixty percent of the contributions made by the public is retained by the divisions from annual collections for divisional programs. The programs are closely linked in plan and execution with activities in research, public and professional education, and other fields of the national society. Thus, the full program of the society is constantly expressed, and all funds, divisional or national, devoted to the defeat of cancer at all times within each divisional
Some idea of the broad sweep of divisional public educational activities may be gained from statistics taken from divisional reports for 1952:
35,647,910 copies of cancer's Seven Danger Signals were distributed in divisional and unit public educational activities.
18,453,504 separate pamphlets describing the disease were distributed. 44,695 showings of the society's educational films were arranged.
446,903 posters were displayed.
15,029 store windows and other displays were exhibited.
2,689 radio and television stations made use of the society's transcriptions, special scripts, spot announcements and other features, in 7,543 individual broadcasts and telecasts and 46,812 spot announcements.
A vast number of articles, editorials, news stories, and photographs were published in State and regional newspapers, magazines, and organizational periodicals for which divisional and unit activities supplied factual content on
Programs with organized groups
Educational programs with organized groups have been a notable feature of the divisional educational attack over many years. In 1952, an estimated 18,478 separate educational programs of this nature, usually involving the showing of films and a talk by a medical or lay volunteer speaker, were conducted by the divisions and their units.
Amongst cooperating organizations frequently mentioned in divisional reports are the women's clubs, men's service clubs, farm and home demonstration clubs, the junior league, parent-teacher associations, American Legion and Veterans of Foreign Wars Auxiliaries, junior chambers of commerce, business and professional women's clubs, the Farmers' Union, State organizations and locals of the American Federation of Labor, the Congress of Industrial Organizations, and the International Ladies' Garment Workers Union, the Rebekahs, the Order of the Eastern Star, the League of Catholic Women, the United Order of True Sisters, the League of Jewish Women, and many other church organizations of faiths of all kinds.
Doctors and others especially equipped to discuss cancer are in constant demand as speakers in these group educational programs. For this reason most divisions maintain standing speakers' bureaus. In 1952, 42 divisions reported speakers' bureaus in their areas staffed by 2,699 medical and lay persons, all of them volunteers. In Pennsylvania, 1,252 talks were given to audiences of 65,561 persons. In New York 981 doctors spoke at various meetings during the year.
Precision attack-breast cancer
The film Breast Self-Examination, jointly produced 2 years ago by the society and the National Cancer Institute, leads the precision attack against breast It is a weapon ideally suited to close-up fighting through community action. The divisions report 15,625 showings of the film in 1952 to an estimated audience of 1,057,252 women. The figure brings the total of those who have seen the picture since its release to above 2 million women-still only 6 percent of the target audience.
Among interesting breast self-examination programs undertaken during the year was a 2-year project in Utah for showing the film to the women of the 39087-53--pt. 1- -16
Church of the Latter Day Saints. Many industries employing large numbers of women made use of the picture in health programs during the year. For the past 2 years the Bell Telephone System has been especially cooperative in this respect.
Business and industry programs
Another weapon is education at places of work in businesses and industries of the home community. Often these are continuing programs conducted in steps, ranging from the distribution of warning leaflets to the showing of the society's films and talks on cancer by volunteer speakers. In 1952, the divisions report that 5,513 programs were conducted for an estimated total audience of 865,627 people.
It is apparent from the year's reports that more and more employers are recognizing that cancer can be a major economic problem as well as a personal problem for the individual employee. Many lives are lost which can ill be spared; many hours of work are disturbed by anxiety for a cancer patient at home. The Iowa division quotes one personnel director as saying, "In all my years of personnel experience, this program is the best thing I ever got tangled up with." But most employers still fail to realize that an educational program is among the services to be expected from the society. The Alabama division reports that a number of employers in its area were astonished to learn the society's educational services "are free."
The Georgia division has been responsible for a highly successful program amongst 1,786 Georgia industries, employing 285,000 people. The southeastern Michigan division is conducting effective programs for General Motors and Chrysler Corp. employees at Detroit. New Hampshire reports 38 percent of the larger industries of the State are cooperating in education. Notable support was received during the year from the Industrial Medical Association, the American Association of Industrial Nurses, and labor unions. But there are today over
60 million persons employed in industries in the United States-the work has only been started.
School and college programs
The divisions report that 10,095 school programs in 1952 reached an estimated total of 1,328,574 students of high-school grade, and that 444 programs were conducted for 88,561 students at the college and university level. These substantial figures promise well for a stronger control of cancer in the future.
In Connecticut, students of the Yale University School of Drama at New Haven prepared television presentations on cancer which were widely broadcast in the area. In Idaho, students of speech at Ricks College, Rexburg, assumed responsibility for the second year for radio talks and public meetings sponsored by the division. In Iowa 16 students in sociology of Westmar College, Le Mars, undertook the technical direction of the smoking study which was conducted in Plymouth County of that State.
Especially significant in school programs in 1952 was the number of seminars on cancer for secondary school teachers sponsored by the divisions. In South Carolina, summer schools on cancer at 7 colleges reached 1,000 teachers or potential teachers. College credit is given teachers in Virginia in a cancer workshop conducted at Madison College. A noteworthy program for teachers was sponsored by the Puerto Rico division. Six summer workshops were conducted in Louisiana. Twenty-one divisions held special programs for secondary school teachers in 1952.
Students of biology are the doctors and research scientists of tomorrow. The society's film From One Cell seeks to rouse their interest in cancer as a still unsolved biological and medical problem, as well as to teach facts about the disease. It was again in wide demand in school programs in 1952: 570 prints were in use by boards of education and individual secondary schools during the year. Biology teachers, school superintendents, and State and county departments of secondary education made use of 5,455 copies of the teaching guide which accompanies the film.
Aid from persons cured of cancer
Many persons who have survived cancer volunteer their services in the society's educational programs because they know their experiences will help others to defeat the disease. Persons who have learned a new method of speech following operations for cancer of the larynx appeared most effectively on radio and television programs in many areas during the crusade. The Milwaukee, Philadel