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By R. M. Shaw, R. A. Bowen, G. E. Paget

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The usual practice in the case of Wilms' tumours is to operate at once, almost as an emergency measure, and then refer the child for post-operative radiotherapy. That this common practice of immediate and urgent surgery is not effective is evidenced by the small number of children so treated who reach adult life or even adolescence. Yet Wilms' tumour is supremely radiosensitive and the response to radiation is enhanced by suitable concomitant chemotherapy, such as actinomycin D. Massive tumours, often filling a large part of the abdomen, regress rapidly and within a few weeks of such combined therapy nephrectomy becomes simple, easy and far less traumatizing ; whereas attempts at the removal of large, tense, vascular tumours 38 SIR STANFORD CADE spread the disease by the blood stream and do so rapidly.

1 Impressed no doubt by his juvenile experience, Jackson drew attention to the frequency with which a fragment of jargon forms a stereotypy. Here again, reduplication is common, if not the rule ('Tan Tan', 'zu zu', 'watty watty', 'taratata'). Modification of the Recurrent Utterance Whether the recurrent utterance be a 'word', phrase or piece of gibberish, certain modifications may develop over the course of time. The stereotyped formula-speech is at first produced on every possible occasion, however unlikely.

The few exogenous human cancers are man-produced, the well-known industrial cancers, the cancers following exposure to radioactivity. Numerically these are insignificant, mostly preventable and in fact only pointers to the possible carcinogenic agencies in our environment, resulting in some aberration in the normal chemical and hormonal processes which determine the occurrence of endogenous growths. The Patient's Viewpoint Let us for a moment consider the average patient, be he a hospital patient in the out-patient department, or consulting his family doctor, or facing the specialist.

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