PRELIMINARY AND FINAL REPORTS O F T H E DEPARTMENT OF PUBLIC HEALTH RELATIVE TO THE CARE AND TREATMENT OF PERSONS SUFFERING FROM CANCER [C o m m it t e e o n P u b l ic H e a l t h . D e c . 15, 1926] BOSTON WRIGHT & POTTER PRINTING CO., LEGISLATIVE PRINTERS 32 DERNE STREET 1927 TABLE OF CONTENTS. PAGE R eport of C ommissioner of P ublic H ealth . 5 A uthorization . 1 0 I. Introduction . • • • . 1 1 II. R e s u l t s o f S t u d y ......... 1 3 Hospital Survey . • • .13 Number of Cases and Deaths (Table 1) . .1 4 Length of Hospital Stay (Table 2) . .1 4 Number of Hospital Beds used . .1 5 Number of Hospital Beds needed ..... 16 New Bed Resources . .17 Hospitalization by Counties (Table 3) . .1 8 Treatment given (Table 5 ) . 1 8 Disposition of Cases (Table 6) . .1 8 Comparison of Hospitalization: By Cities and Counties (Table 7) . .1 9 By Density of Population (Table 8) . .1 9 B y T ype of Cancer (Table 10) . 2 0 Cost of New Hospital Construction . .2 1 Maintenance Cost ........ 25 III. Policy o f the Department o f Public H ealth Regarding C a n c e r ......... 27 Hospitalization Program ....... 27 Clinic Program ......... 31 Educational Program ....... 35 Further Cancer Studies ....... 37 Diagnostic and Treatment Facilities ..... 38 IV. Immediate Needs o f the Departm ent ..... 3 8 Legislation for the Purchase of Radium . .3 9 V . S u m m a r y .......... 40 VI. T a b l e s a n d C h a r t 42 Cl)c Commontoealtf) of egassacfwsetts D e p a b t m e n t o f P u b l i c H e a l t h , S t a t e H o u s e , B o s t o n , O ctober 15, 1926. To the General Court of Massachusetts : In chapter 391 of the Acts of 1926, section 1, the Depart­ ment of Public Health is “ authorized and directed to formu­ late a plan for the care and treatment of persons suffering from cancer, with a view to taking any necessary initial steps toward the establishment of necessary hospital facilities for such care and treatment by the construction of new hospital buildings, by the use of existing buildings, or by additions to existing buildings. The department shall, from time to time, submit such plan to the governor and council and to the budget commissioner, and shall report its final plan to the general court not later than October fifteenth in the cur­ rent year, with drafts of such legislation as may be neces­ sary to carry the same into effect, and shall at the same time file copies thereof with the said budget commissioner.” In compliance with this the following study has been in­ stituted to determine the present hospitalization of cancer patients. A representative of the Department has visited some eighty of the leading hospitals in the State and has obtained from the hospital records the following informa­ tion for the years 1923 to 1925, inclusive: (a) number of bed days of all cancer patients in the hospital; (b) number of bed days of all cancer patients who died in the hospital; (c) number of operations; (d) number of X-ray and radium treatments; (e) type of cancer; (/) residence of patients; (g) final disposition of patient to institution, home, etc. The considerable mass of data is still in process of tabulation which will give information as to the principal hospital facili­ ties used by the various towns and cities in the State; the types of cancer now being hospitalized; the number of beds now used for cancer cases both in the early and late stages; and the available X-ray and radium facilities. House Document 1200 of 1926 shows that there is a need for additional hospital facilities for the terminal cases. This will be met in part by the utilization of the Norfolk State Hospital as authorized by chapter 391, Acts of 1926, re­ ferred to above. Renovations and repairs are now being made which will furnish bed facilities for about 85 patients. By a further outlay of some $75,000 this number could be increased to about 120. This institution will be available for patients early in 1927. A study has been made of existing hospital maintenance costs throughout the Commonwealth in order to arrive at some figure of what adequate hospitalization of cancer pa­ tients shoidd cost. Inasmuch as the General Court desired information regarding construction costs of a hospital pos­ sibly in Boston, such figures are being compiled. With our present knowledge the only hope for the cancer patient is early diagnosis and prompt treatment. At the present time, some ten months elapse between the first symptoms and rational treatment. If this interval can be decreased, the lives of an appreciable number of cancer pa­ tients will be saved. Both physicians and the general public need further education regarding the disease. This can be furnished to a large extent by means of community cancer clinics as directed in section 2 of said chapter. The phy­ sicians will improve their knowledge through consultations and observing the results obtained by the close cooperation of various specialists in cancer therapy. The general public will be educated to the value of early diagnosis and treat­ ment by seeing a considerable number of actual cures. The Department is endeavoring to establish cancer clinics in a number of centers. Inasmuch as the success of the clinic depends to a large measure on the amount of local interest, the efforts of the Department are being first di­ rected to those communities where well organized welfare work is already under way. One member of the staff is de­ voting full time to coordinating the community organiza­ tions and arousing them to what can be accomplished in cancer control. Hospitalization will care for the terminal cases needing institutionalization; well-functioning clinics should lower the cancer mortality so that fewer cases will come to the terminal stage, but these steps will not lower the incidence of the disease. Further research is needed. It would be unsound for the State to attempt clinical or laboratory research on any large scale, nor is such endeavor indicated as many laboratories and hospitals throughout the world are working on these problems. The Commonwealth can, however, furnish a form of research not available elsewhere. This consists of compiling data regarding cancer morbidity. Morbidity reports are not now available and all statistical research has to be done with mortality records. Plans are under way for establishing a morbidity reporting area in the Commonwealth. The records obtained from the area as well as from the clinics and the mortality records will furnish important contributions which will be of material help in accurately judging of the size of the problem medically, socially and economically, and in intelligently directing further steps towards its solution. All of the above measures are under way but none of them are sufficiently advanced at the present time to war­ rant submitting the completed report called for in chapter 391 of the Acts of 1926. It is respectfully requested that this statement be accepted as a preliminary report and that an elaborated report be accepted on January first next. GEORGE H. BIGELOW, M.I)., Commissioner of Public Health. €bc Commontuealtf) of SgassaciHigetts D e p a r t m e n t o f P u b l i c H e a l t h , S t a t e H o u s e , B o s t o n , M a s s , December 15, 1926. To the General Court of Massachusetts. In compliance with section 1, chapter 391, Acts of 1926, directing the Department of Public Health to formulate a plan for the care and treatment of persons suffering from cancer, we have the honor to submit herewith the results of certain investigations conducted by the Department together with a plan which, in the opinion of the Depart­ ment offers most in the way of benefit both to the individual afflicted with cancer and to the Commonwealth. Respectfully, GEORGE H. BIGELOW, M.D., Commissioner of Public Health. AUTHORIZATION. [C h a p t e r 3 9 1 o p t h e A c t s o p 1 9 2 6 .) A n Act to Promote the Prevention and Cure of Cancer and t h e E x t e n s io n o f R e s o u r c e s f o r it s C a r e a n d T r e a t m e n t . Whereas, it is important for the protection of the public health that immediate steps be taken for the further prevention of cancer and the cure and treatment of persons afflicted with cancer, therefore this act is hereby declared to be an emergency law, necessary for the immediate preservation of the public health. Be it enacted, etc., as follows: Section 1. The department of public health, hereinafter called the department, is hereby authorized and directed to formulate a plan for the care and treatment of persons suffering from cancer, with a view to taking any necessary initial steps toward the establish­ ment of necessary hospital facilities for such care and treatment by the construction of new hospital buildings, by the use of existing build­ ings, or by additions to existing buildings. The department shall, from time to time, submit such plan to the governor and council and to the budget commissioner, and shall report its final plan to the general court not later than October fifteenth in the current year, with drafts of such legislation as may be necessary to carry the same into effect, and shall at the same time file copies thereof with the said budget commissioner.