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MARIE CURIE HOSPITALNEW X RAY DEPARTMENT

l SOME two years ago the board of management ofthe Marie Curie Hospital were told by their cancerresearch committee that even better clinical resultsmight be secured if a modern deep X ray therapyplant were acquired and used in suitable cases to

supplement radium treatment. At that time thehouse in Fitzjohn’s-avenue adjoining the hospitalwas in private occupation and could only have beenprocured at a prohibitive price. Various plans foraccommodating the plant in a large ward or in a newbuilding in the garden were being reviewed whenthe death of the owner brought No. 4, Fitzjohn’s-avenue into the market, and was acquired throughthe generosity of Dr. Elizabeth Courtauld and otherdonors and was adapted to its new purpose by MissElizabeth Scott, A.R.I.B.A., of Messrs. Scott,Chesterton, and Shepherd.The new building, which provides nine additional

beds and extra accommodation for nurses and maids,as well as rooms for consultation and radiologicalapparatus, was opened on Feb. 16th by the Duchessof York, in the presence of the French and PolishAmbassadors, the Mayor and Mayoress of Hampstead,and a representative gathering of the friends of thehospital. Lord Reading, chairman of the councilof the British Empire Cancer Campaign, which hassupported the hospital from its inception, presided.

Miss M. M. CHADBURN, M.D., chairman of the

hospital, which is staffed by medical women, spokeof the encouraging results achieved during the lastseven to eight years at this centre with radium.

Nearly every patient had been greatly relieved, andsome had been free from any sign or symptom of thedisease for years and were, it was hoped, cured. , Careful records were kept and every patient wasfollowed up after she left the hospital. This hospitalwas poor and was struggling for its life. The new

apparatus had cost between :E2000 and E3000, andas an example of the other expenses involved in itsestablishment Miss Chadburn mentioned that in

FIG. 2.-Adjustable treatment couch. Tube stand with200 kilovolt shockproof metalix tube, fitted with light-focusing and direction-indicating apparatus (A).

order to protect the workers from injury duringirradiation of patients the cubicles had to be linedwith lead and the observation windows to be madeof lead-glass, costing 5 a foot.The X ray plant had been made in England by an

English firm, and she dared now say that it was verygood, because it had been praised and admired, afterinvestigation and examination, by Dr. Coutard andother experts. The provision of the X ray plant hadmade the hospital a very complete unit ; but it also’

- East-

FIG. 1.—Plan of part of ground floor containingtwo patients’ cubicles, operator’s bay, and high-tension switch enclosure.Each cubicle has four windows, besides artificial ventilation and two radiators.

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meant that its maintenancewould cost about Y2000 ayear more than it haddone in the past. Each

patient who had to havefull treatment would pro-bably cost at least E30.Lord READING said that

those who had workedat the hospital had reasonto be proud of what theyhad done. The problemthey had tackled was a

most complicated and diffi-cult one, but cancer wouldsurely yield in the endto human interest, humanintellect, and human skillexpended in such a gene-rous manner as it was inthis hospital. Dr. Coutard

expressed the good wishesof the Fondation Curie,referring to the valuableresearch work being doneby Dr. E. Hurdon, thedirector, and Dr. H.Chambers, the pathologist

FIG. 3.-Lead-lined control cubicle showing switchboard, ampere and milliampere meters,and lead-glass observation windows.

to the hospital; and Mrs. Walter Runciman thankedthe Duchess of York for her visit in graceful terms.

THE NEW DEPARTMENT

The X ray apparatus for deep therapy manufacturedby Newton and Wright Ltd. comprises a high-tension unitdesigned for voltages up to 300,000, feeding two X raytubes mounted on " Gantry " type stands. The depart-ment, which is on the ground floor, is very convenientlylaid out. The operator’s bay is shaped like a truncated" V," with a treatment room on either side and a deskpattern control table in front. High-tension measuringinstruments are mounted at eye level in an enclosure

immediately beyond the control table. Two patients, theinstruments, and the control panel are therefore underobservation from a central position. The treatmentrooms are light and airy, having good natural ventilation,supplemented by extractor fans. The X ray tubes areshockproof and self-protective, and there is no exposedhigh-tension circuit in either of the rooms; consequentlythere is no contamination of the atmosphere from thissource and no collection of dust.An optical system has been developed from the system

of light focusing in use at the Fondation Curie to assistin defining the beam of radiation. A beam of light is usedwhich is coincident with the X ray beam. This light beamis cut down to the desired shape and size by a series ofdiaphragms and located in the right position and at thecorrect angle. The beam is sufficiently intense for this tobe done without darkening the room. The treatmentcouches have been specially designed to carry diaphragms.The high-tension generating unit itself is housed on the

lower ground floor, and conductors are brought up throughthe floor into the high-tension enclosure. High-tensionswitches are provided so that either or both X ray tubescan be used. If two patients are being treated for differentperiods of time, the radiation can be cut off from one tubeby means of an electromagnetically controlled shutteroperated from the control panel without disturbing theother. Integrating ionisation instruments are providedfor indicating the radiation received by each patient, andinterlocking devices prevent the apparatus from beingrun unless the water-cooling system is in operation andswitch it off automatically should this system fail.The control of kilovoltage is effected by a new form of

stepless regulator which is free from moving contacts andavoids any tendency for the production of surges whenbringing up the voltage to its full value.

The hospital now contains 31 beds, including 8 for

private patients at fees ranging from 5 to 15 guineasa week, excluding surgeon and ansesthetist.

MEDICINE AND THE LAW

The Medical Practitioner at the Police StationJUDICIAL comments last week at the Liverpool

Assizes showed how easily the doctor summoned tothe police station may find himself entangled individed loyalties. A Warrington lorry-driver namedWhiteley was standing his trial for the usual trio ofserious motoring offences-manslaughter, being in

charge of a motor vehicle while under the influenceof drink, and dangerous driving. He pleaded "notguilty " to all three. The prosecution alleged that hehad collided with another lorry after drinking twobottles of beer at a hotel. Police officers consideredthat Whiteley was under the influence of drink ; theysent for the police surgeon who confirmed their view,and added that he was unfit to drive. Whiteley wasthen given the opportunity at the police station ofobtaining the opinion of a local doctor. From a listof six names he chose Dr. A who was fetched toexamine him. Dr. A said that he too considered thatWhiteley was under the influence of drink and unfitto drive. At the assizes Dr. A was called to give thisevidence for the prosecution. He explained that hehad been asked by the police to examine Whiteleyat the latter’s own request in the police station. Mr.Justice Swift at once put questions, which raised theissue of the confidential relationship of doctor andpatient. " Who paid you

" The witness replied thathe was paid by the police who, he understood, hadreceived the money from Whiteley. "Was Whiteleyyour patient " " Yes," replied Dr. A. " Is it not alittle unfair," asked the judge, "for the police toinvite a man to send for his own doctor, who thencomes and gives evidence against him after being paidby the patient ? " Counsel for the prosecution inter-vened to suggest that this was a matter for the doctor ;the court, however, thought it might be even more amatter for the patient. Dr. A, it appeared, had beenpaid 10s. 6d. " He gave you that money," repeatedthe judge, " to examine him and you give evidence