The Changing Faces of Childhood Cancer: Clinical and Cultural Visions since 1940 by Emm Barnes Johnstone and Joanna Baines (review)

This is an interesting and informative book on the development of child cancer services in Great Britain from 1940. As the authors point out, “the childhood cancer patient is a familiar cultural icon in twenty-first century Great Britain, a symbol of innocent victimhood” (p. 1). They go on to say that they will look “at the relation between changing institutions and the meanings of a disease” (p. 3). They also bring to their study a personal perspective: “one of us has had cancer, the other is mother to a survivor of childhood cancer” (p. 3).

Although the book is informative and useful, it is a pity that it does not go onto explore what it promises about the “meanings of a disease” and does not attempt to look at the idea of “innocent victimhood,” which is a universal trope in contemporary society.

The book details many facts, details, and narratives that will be of use to researchers in the area. In the 1940s cancer in childhood was considered rare and fatal. Now it is well known and very survivable. The book tracks that trajectory in Great Britain with reference to the United States. The chapters look at childhood cancer in the 1930s, the significance of leukemia, the development of cancer registries, the development of cooperative groups, chemotherapy trials, and the work of Burkitt in Uganda and his identification of an infectious agent causing lymphoma. A particularly interesting chapter looks at media and public interest, the search by some parents for unorthodox treatment in the 1960s, and the reaction of authorities and the profession even as orthodox medicine did not have particularly good results. Other chapters look at the emergence of pediatric oncology as a subspecialty and the onset of specialized, centralized centers. The book is noteworthy in adding a human face to the statistics with a number of child case studies and a discussion of the problems of survivors and the development of the area of psycho-oncology.

The authors attempt to make a case for a special study of the British approach to pediatric cancer: “The history of paediatric oncology in Great Britain is thus particularly worthy of study, for it has emerged from research interests and networks that are rather different from those well documented in histories of the growth of oncology in the USA” (p. 29). But it is difficult to discern whether this case is made in the book. It is true that radiotherapists, pathologists, and pediatricians pioneered the treatment of child cancer in the United Kingdom, whereas in the United States hematologists and pharmaceutical companies shaped the approach. But in general it appears more that the British lagged behind the Americans and only gradually caught up. There are hints at interesting differences, for example in the area of clinical trials, where the British argued in 1965 that it was not ethically justifiable to expose young children to severe side effects when there was little hope of survival. Whether the individual patient should be sacrificed to the future good of all patients is possibly a significant difference in approach to clinical medical research and would benefit from a more in-depth analysis.

Unfortunately the authors do not really look in detail at the differing medical contexts between the United Kingdom and the United States. The politics of specialization and subspecialization are very different in the two countries. The book neglects the contexts of power, influence, and economics in the creation of the specialty of pediatrics and its demarcation from general practice and then the subsequent subspecialization of pediatric oncology. There is a wider discussion to be had here on why the United Kingdom has over the years resisted specialization and subspecialization.

In summary, the book is a valuable narrative addition to the important subject of the changing nature and perception of childhood cancer. [End Page...