"Cancer as the general population knows it": Knowledge, fear, and lay education in 1950s Britain

Bulletin of the History of Medicine

Volumn 81, Issue 1, 2007, Pages 116-138

  Toon, Elizabeth ^a  

^a UNIVERSITY OF MANCHESTER   (United Kingdom)

Author keywords

"cancerphobia"; Cancer; Great Britain; Health education; Manchester committee on cancer; National health service; Palliative care; Patient experience; Ralston paterson

Indexed keywords

ATTITUDE TO HEALTH; CONFERENCE PAPER; FEAR; HEALTH EDUCATION; HISTORY; HUMAN; METHODOLOGY; NATIONAL HEALTH SERVICE; NEOPLASM; PUBLIC HEALTH; SOCIOLOGY; UNITED KINGDOM;

ATTITUDE TO HEALTH; FEAR; GREAT BRITAIN; HEALTH EDUCATION; HISTORY, 20TH CENTURY; HUMANS; NEOPLASMS; PUBLIC HEALTH; SOCIOLOGY, MEDICAL; STATE MEDICINE;

EID: 34047110145     PISSN: 00075140     EISSN: None     Source Type: Journal    
DOI: None     Document Type: Conference Paper

References (105)

1. R. Gedling to R. Brain and W. P. Kennedy, September 1949, MH 55/927, National Archives, Kew Gardens, Surrey, U.K. (hereafter NA).
2. On American cancer education, see James T. Patterson, The Dread Disease: Cancer and Modern American Culture (Cambridge: Harvard University Press, 1987);
3. Leslie J. Reagan, "Engendering the Dread Disease: Women, Men, and Cancer," Amer. J. Pub. Health, 1997, 87: 1779-87;
4. Barron H. Lerner, The Breast Cancer Wars: Hope, Fear, and the Pursuit of a Cure in Twentieth-Century America (New York: Oxford University Press, 2000);
5. Robert Aronowitz, "'Do Not Delay': Breast Cancer and Time, 1900-1970," Milbank Quart., 2001, 79: 355-86;
6. Kirsten E. Gardner, Early Detection: Women, Cancer, and Awareness Campaigns in the Twentieth-Century United States (Chapel Hill: University of North Carolina Press, 2006).
7. A brief comparison of American and British programs is James T. Patterson, "Cancer, Cancerphobia, and Culture: Reflections on Attitudes in the United States and Great Britain," Twent. Cent. Brit. His., 1991, 2: 137-49.
8. On cancer and disease education in twentieth-century Britain, see David Cantor, "Representing 'the Public': Medicine, Charity and Emotion in Twentieth-Century Britain," in Medicine, Health and the Public Sphere in Britain, 1600-2000, ed. Steve Sturdy (London: Routledge, 2002), pp. 144-68;
9. Virginia Berridge and Kelly Loughlin, "Smoking and the New Health Education in Britain, 1950s-1970s," Amer. J. Pub. Health, 2005, 95: 956-64;
10. and Ornella Moscucci's unpublished "Fast-Track to Treatment: Cancer Education in Britain, circa 1900-1948," distributed for Patients and Pathways: Cancer Therapies in Historical and Sociological Perspective, University of Manchester, October 2005.
11. Cantor, "Representing 'the Public'" (n. 2).
12. Moscucci, "Fast-Thick to Treatment" (n. 2), pp. 9-10.
13. Reagan, "Engendering" (n. 2); Gardner, Early Detection (n. 2), esp. chap. 1.
14. Aronowitz, "'Do Not Delay'" (n. 2);
15. Lerner, Breast Cancer Wars (n. 2), pp. 41-60.
16. For instance, Ronald W. Raven and Joan Cough-Thomas, "Cancer Education of the Public," Lancet, 1951, 258: 495-96, on p. 496: "the general opinion was expressed that fear of cancer was principally due to ignorance; and, if wise education was given, more patients would consult their doctors at an early stage."
17. Moscucci, "Fast-Track to Treatment" (n. 2), p. 8.
18. David Cantor, "The Definition of Radiobiology: The Medical Research Council's Support for Research into the Biological Effects of Radiation in Britain, 1919-1939" (Ph.D. diss., University of Lancaster, 1987).
19. "Notes for Lord Nathan," 14 September 1954, in SA/CRC/Q.1/3, Papers of the Cancer Research Campaign, formerly the British Empire Cancer Campaign (hereafter BECC Papers), Special Collections, the Wellcome Library for the History and Understanding of Medicine, London (hereafter Wellcome Library).
20. Practical obstacles also intervened, such as wartime paper restrictions.
21. For instance, F. L. Hopwood to F. B. Tours, 24 September 1952, SA/CRC/Q.1/2, BECC Papers.
22. "Notes" (n. 10), BECC Papers.
23. Ibid.
24. F. B. Tours, January 1953, SA/CRC/R.1/4, BECC Papers.
25. Executive Committee Minute 1915, SA/CRC/Q.1/5, BECC Papers.
26. R. Brain, [August 1949]; Gedling to Brain and Kennedy (n. 1); and M. Reed, "Cancer Propaganda," 21 July 1947; all NA MH 55/927. This was part of a larger debate about the CCHE's functions relative to the Ministry of Health. In 1946-47, the Ministry and the Central Office of Information had commissioned, circulated, and revised a script for a lay cancer film, but chose to concentrate on a film for GPs: NA MH 55/910.
27. "Note for file," 13 September 1948, NA MH 55/927.
28. "Cancer Education: Memorandum by the Ministry of Health," October 1949, ibid.
29. R. Gedling, 9 May 1950, ibid.
30. See the minute by M. R. [probably M. Reed], 19 July 1950, ibid.
31. A. Bavin to R. Sutherland, 9 February 1951, ibid.
32. Standing Cancer and Radiotherapy Advisory Committee, "Minutes of Meeting held 26 June 1952," ibid.;
33. "Central Health Services Council," Lancet, 1953, 262: 295.
34. "Note of meeting," 13 March 1953, NA MH 55/927; "Note of meeting between Mr Malcolm Donaldson and officers of the Department on September 18, 1952," ibid. These memos also discussed the Marie Curie Memorial Foundation's small program of lay cancer education, conducted without much consultation with other organizations.
35. General Medical Services Committee, "Minutes of the May 12, 1953 meeting," p. 16, GMSC 1952-53, part 2, British Medical Association Archives, London (hereafter BMAA).
36. Ministry of Health to GMSC, quoted in "Agenda for the July 23, 1953 meeting," p. 33, GMSC 1953-54, part 1, BMAA.
37. Ibid., p. 39.
38. Ministry of Health, Circular 18/53.
39. Lord Horder, "The General Practitioner and Lay Education in Cancer" (letter to the editor), Lancet, 1953, 262: 137.
40. SCRAC members also pointed out that bed shortages remained acute and waiting lists long: "Minutes of Meeting held 26 June 1952," NA MH 55/927.
41. "Cancer Education: Memorandum by the Ministry of Health" (draft, October 1949), ibid. See also Gedling to Brain and Kennedy (n. 1): "From the Minister's point of view the problem resolves itself largely into whether, if some propaganda of the kind suggested by Dr. Donaldson is done, there will be diagnostic and treatment facilities available for those who hearken to it."
42. Malcolm Donaldson, "Lay Education in Cancer" (letter to the editor), Lancet, 1953, 262: 199.
43. J. Walter and E. C. Atkinson, "Early Cancer Detection and Education: A Pilot Trial," Brit. Med. J., 1955, 1: 627-30, on p. 630.
44. See also "Educating the Layman: Hunterian Society's Debate," Lancet, 1948, 252: 820.
45. Charles Webster, The National Health Service: A Political History (Oxford: Oxford University Press, 1998);
46. David Morrell, "Introduction and Overview," pp. 1-19,
47. and Charles Webster, "The Politics of General Practice," pp. 20-44, in General Practice under the National Health Service, 1948-1997, ed. Irvine Loudon, John Horder, and Charles Webster (London: Clarendon Press, 1998);
48. Elston Grey-Turner and F. M. Sutherland, History of the British Medical Association, vol. 2: 1932-1981 (London: British Medical Association, 1982), chap. 5.
49. Stanford Cade, in "Report of a Visit to Canada and the United States by a Delegation from the British Empire Cancer Campaign, July 1948," [issued 25 March 1949], p. 13, PP/FGS/E.30, F. G. Spears Papers, Wellcome Library.
50. F. B. Tours, ibid., pp. 102-3.
51. Ibid., pp. 13 (Cade), 41 (Windeyer), and 102-3 (Tours).
52. Lerner, Breast Cancer Wars (n. 2), pp. 64-67.
53. "Report on the Special Meeting of the Chelsea Cancer Committee," 12 January 1950, p. 8, NAMH 55/927.
54. Aronowitz, "'Do Not Delay'" (n. 2), p. 358.
55. Guy F. Robbins et al., "The Significance of Early Treatment of Breast Cancer: Changes Correlated with the Cancer Education Programs of 1940-1955," Cancer, 1959, 12: 688-92;
56. Aronowitz, "'Do Not Delay'" (n. 2), p. 380.
57. "Cancer Education and Earlier Diagnosis," [probably 1953], NA MH 55/927. See also Richard Doll to Neville Goodman, 13 August 1953, ibid.;
58. R. W. Scarff to F. L. Hopwood, 16 March 1954, SA/CRC/Q.1/3, and correspondence regarding H. H. Bentall, "Cancer Education," January 1956, SA/CRC/Q.1/4, BECC Papers.
59. Eileen Magnello, A Centenary History of the Christie Hospital Manchester (Manchester: Christie Hospital, 2001), pp. 46-47.
60. Ralston Paterson, C. Metcalfe Brown, and John Wakeneld, "An Experiment in Cancer Education," Brit. Med. J., 1954, 1: 1219-21, on p. 1219;
61. John Wakefield, "Cancer Education in Practice," in Education of the Public Regarding Cancer: Report of Conference Held at B.M.A. House, 24 January 1957 (Central Council on Health Education, 1957), pp. 29-35, on p. 30, NA ED [Ministry of Education] 50/693.
62. Paterson, Brown, and Wakefield, "Experiment" (n. 44), p. 1219.
63. This was actually two surveys: one of 1,200 women, specifically about cancer, and another of 1,200 women questioned at the end of a mass radiography survey conducted by commercial canvassers and health visitors. See Ralston Paterson and Jean Aitken-Swan, "Public Opinion on Cancer: A Survey among Women in the Manchester Area," Lancet, 1954, 267: 857-61, on p. 857.
64. By the mid-1950s the Manchester group and the Canadian Cancer Society used the same questionnaire to facilitate international comparisons: Ralston Paterson, "Why Do Cancer Patients Delay?" Can. Med. Assoc. J., 1955, 73: 931-40.
65. Paterson and Aitken-Swan, "Public Opinion" (n. 46), p. 857.
66. Fifty percent of the women responding to the cancer survey said they believed cancer could never be cured, while women responding to the same question at the end of the tuberculosis survey were more pessimistic: 55% of those asked by health visitors said cancer could never be cured, while 74% of those asked by commercial canvassers said so. The obvious conclusion, though the Manchester team did not draw it, was that women felt more comfortable admitting this pessimism to commercial canvassers than to potentially judgmental health visitors.
67. Paterson and Aitken-Swan, "Public Opinion" (n. 46), p. 858.
68. Ibid., p. 859.
69. Ibid., p. 860.
70. These interviews seem not to have survived.
71. Jean Aitken-Swan and Ralston Paterson, "The Cancer Patient: Delay in Seeking Advice," Brit. Med. J., 1955, 2: 625-27, on pp. 623-24.
72. Ibid., pp. 624-25.
73. Ibid., p. 625. This resembles the attitude found by Lucinda McCray Beier's studies of health in working-class Lancashire communities: Beier, "Expertise and Control: Childbearing in Three Twentieth-Century Working-Class Lancashire Communities," Bull. Hist. Med., 2004, 78: 379-409;
74. Beier, "'We Were Green as Grass': Learning about Sex and Reproduction in Three Working-Class Lancashire Communities," Soc. Hist. Med., 2003, 16: 461-80.
75. Paterson, "Why Delay?" (n. 47), pp. 933-34.
76. See, e.g., J. G. Henderson, E. D. Wittkower, and M. N. Lougheed, "A Psychiatric Investigation of the Delay Factor in Patient to Doctor Presentation in Cancer," J. Psychosom. Med., 1958, 3: 27-41,
77. cited by John Wakefield, "A Co-operative Scheme of Public Education about Cancer," Brit. J. Clin. Pract., 1961, 15: 165-67.
78. Wakefield, "Cancer Education in Practice" (n. 44), p. 32.
79. John Wakefield, Cancer and Public Education (London: Pitman Medical Publishing, 1962), p. 26.
80. Paterson, "Why Delay?" (n. 47), p. 934 (emphasis in original).
81. Ibid., p. 935.
82. Jean Aitken-Swan, "Nursing the Late Cancer Patient at Home: The Family's Impressions," Practitioner, 1959, 183: 64-69.
83. Aitken-Swan and Paterson, "Cancer Patient" (n. 54), p. 627. This reiterated what a 1952 survey found: a substantial proportion of dying cancer patients were dependent on family, friends, and neighbors for care, and many were aware that they had been "sent home from hospital to die"
84. (Joint National Cancer Survey Committee of the Marie Curie Memorial and the Queen's Institute of District Nursing, A Report on a National Survey Concerning Patients with Cancer Nursed at Home [Marie Curie Memorial, April 1952], p. 25, SA/QNI/P.1/5, The Queen's Nursing Institute Collection, Wellcome Library).
85. See also Noémi Tousignant, "Exposing Relief: Place, Cancer Pain and Appropriate Care for the Dying in Britain, 1950-1980" (M.Sc. thesis, University of Manchester, 2001).
86. Aitken-Swan and Paterson, "Cancer Patient" (n. 54), p. 627.
87. Wakefield, "Co-operative Scheme" (n. 58), p. 166.
88. Paterson, Brown, and Wakefield, "Experiment" (n. 44), pp. 1219-21, on p. 1220;
89. Paterson, "Why Delay?" (n. 47), p. 936.
90. Wakefield, Cancer and Public Education (n. 60), pp. 23, 24.
91. Richard Hoggart, The Uses of Literacy: Aspects of Working-Class Life (London: Chatto and Windus, 1957).
92. Wakefield, Cancer and Public Education (n. 60), p. 27.
93. Ralston Paterson and Jean Aitken-Swan, "Public Opinion on Cancer: Changes Following Five Years of Cancer Education," Lancet, 1958, 272: 791-98, on p. 791.
94. Ibid., p. 792.
95. Ibid.
96. Ibid., pp. 792-93
97. Ibid.
98. Ibid., p. 793.
99. Jean Aitken-Swan and Ralston Paterson, "Assessment of the Results of Five Years of Cancer Education," Brit. Med. J., 1959, 1: 708-12, on p. 709.
100. Ibid., p. 709.
101. Ibid., p. 711.
102. Ibid.
103. Ibid., p. 712.
104. Ibid.
105. Berridge and Loughlin, "Smoking" (n. 2).