533

works to rehabilitate patients, the more they underminetheir own salaries."

Ministry and Whitley Council must reach an accept-able solution to this problem of the points system, whichis damaging many hospitals, not only those for thesubnormal. The few concessions that have been allowedfor individual cases have altered the overall situation verylittle. The state of our hospitals for the subnormal canand must be improved, both in their structure and inthe quantity and quality of their staffing.

Annotations

CENSUS, 1966

BUT for interruption by other engagements in 1941,Britain would have had a census regularly every ten yearssince 1801. The pattern of 20th-century life has been

shifting so rapidly, however, that this decennial review isno longer sufficient to measure her changing structurewith precision. At midnight, therefore, on Sunday,April 24, 1966, there will be a half-time census of onehousehold in ten and of a 10% sample of the residents ofother institutions (including hospitals). A census measureschange as well as present state, so the questions it askscannot differ notably from one census to another; but inApril some of the uncertainty left by the 1961 census 1-

concerning tenure and what the Registrar General calls" household amenities "-will be removed by more

detailed questions. Place of birth may be relevant to

diseases of later life; so, to help with future inquiries,information about birthplace is asked for in the 1966Census. The answers will also help to define focuses ofimmigrant populations.A census is not an academic exercise: it is the main

instrument for all sorts of plans; and, in conjunction withmortality and morbidity statistics, it is the starting-pointfor many epidemiological surveys. Planners and epidemi-ologists need details and in the past, though the prelimin-ary picture of the census has emerged with commendableswiftness, the full analyses have taken much longer. Thethree reports of housing from the 1961 Census were pub-lished four years later 2 and the full population-migrationtables are still " in the press ". Fortunately, such a longdelay is not envisaged for the 1966 census: with greaterhelp from the War Office computer, the statisticians atSomerset House hope to complete their formidable taskand publish the results in about two years.The responsibility for administering the census of

patients and resident staff in 3753 hospitals and 135 outof 1332 " smaller medical establishments " (such as nurs-ing-homes) will be delegated to a chief resident officer(commonly, the hospital secretary). In 1961, it seems,the admonition " warts and everything " was not rigidlyobserved in the preparation of the 10% samples in hos-pitals-the very sick or potentially uncooperative patientmay have been passed over, thus introducing a bias.Some guidance on how to prepare an unbiased samplewill be given to each resident officer. The RegistrarGeneral realises that by delegating the running of thecensus he is adding to the work of administrative and

1. Lancet, 1965, i, 365.2. ibid. pp. 211, 380, 611

nursing staff, who will have to make up ward lists, selectthe sample, and maybe complete the forms for patientstoo ill to do so themselves; and he has thanked them inadvance for their cooperation.

CANCER OF THE UTERINE BODY

MANY gynaecologists believe that cancer of the body ofuterus is more common today than it was fifteen or

twenty years ago, but it is hard to be certain about this.Little reliance can be placed on the experience of indi-vidual clinics, because local factors may influence year byyear the number of patients referred to any one centre.At national level the Registrar General’s annual figures 1show that the death-rate due to cancer of the uterine

body has not changed significantly since 1950, nor has theratio of death from cancer of the cervix to cancer of the

body (2:1) changed over the same period. In womenwho have few rather than many children the disease

appears most often between the ages of 55 and 60;but it is not uncommon in younger women. In a series of983 patients in Birmingham 2 a third were under 55, and6% were under 45. Other reports 3 4 note that between20% and 30% of women were still menstruating whenthe tumour was discovered (these women tend to men-struate to a later age than normal. 6) Unfortunately,cytological examination of cells in the vagina is less reliablein endometrial than in cervical cancer, though there havebeen reports

7-9 that examination of cells aspirated fromthe uterine cavity gives an accurate diagnosis in 90% ofcases of endometrial cancer. Early diagnosis still dependson the prompt investigation of all instances of post-menopausal vaginal discharge or bleeding. In youngerwomen some minor deviation from the usual menstrualpattern may be the earliest feature of the disease; andfailure to appreciate this point is an important cause oferror or delay in diagnosis.10 11

In Birmingham 2 during the period under review therewas a policy of " operation whenever reasonably possible ",and 84% of all patients underwent hysterectomy with orwithout radiotherapy. Almost half the patients had vaginalradium therapy after hysterectomy, but the 5-yearsurvival-rate was the same as for women who underwent

hysterectomy alone. Here, as in other series,12-16 theresults suggest that preoperative or postoperative irradia-tion may reduce slightly the incidence of vaginal meta-stases, but the effect is not decisive. The secondary depositwhich appears so constantly 1 or 2 cm. above the urinarymeatus is of particular interest. Way 17 found a high1. Registrar General’s Statistical Review of England and Wales. Part in:

Commentary. H.M. Stationery Office, 1950-62.2. Dobbie, B. M. W., Taylor, C. W., Waterhouse, J. A. H. J. Obstet.

Gynœc. Br. Cwlth, 1965, 72, 659.3. Dearnley, G. ibid. 1949, 56, 819.4. Kimbell, C. W. A. Proc. R. Soc. Med. 1954, 47, 895.5. Burch, P. R. J., Rowell, N. R. Lancet, 1963, ii, 784.6. Way, S. J. Obstet. Gynœc. Br. Emp. 1954, 61, 46.7. Reagan, G. W., Sommerville, R. L. Am. J. Obstet. Gynec. 1954, 68, 78.8. Hecht, E. L. ibid. 1956, 71, 819.9. Morton, D. G. J., Moore, J. G., Chang, N. J. int. Coll. Surg. 1959, 31,

570.10. Finn, W. F. NW. Med. Seattle, 1952, 52, 235.11. Bourne, A. W., Williams, L. H. Recent Advances in Obstetrics and

Gynæcology. London, 1962.12. Rickford, B. J. Obstet. Gynœc. Brit. Emp. 1949, 56, 41.13. Dobbie, B. M. W. ibid. 1953, 60, 702.14. Stander, R. W. Am. J. Obstet. Gynec. 1956, 71, 776.15. Lingren, L. Acta obstet. gynec. scand. 1957, 36, 426.16. Graham, J. B. Acta cytol. 1958, 2, 579.17. Way, S. J. Obstet. Gynœc. Brit. Emp. 1951, 58, 558.