An Element of Hope: Radium and the Response to Cancer in Canada, 1900–1940 (review)

An Element of Hope documents the transformation of cancer from a hidden illness to an object of public policy. Cancer initially fitted uncomfortably within the rubric of Canadian public health. It did not appear to be infectious, and it was not concentrated in urban areas. Its diagnosis often came late, and any understanding of its mortality or morbidity rates was crippled by a lack of mandatory reporting and impoverished record-keeping. Yet cancer, like other chronic diseases, was on the rise, and its visibility demanded an entirely new kind of health care that distributed the miserable business of therapy evenly across the county, while at the same time respecting the diversity and autonomy of the medical profession and its offerings.

The discovery of radium's biologic effects, argues Hayter, slowly precipitated an institutional and administrative response that continues to dominate the structure of Canadian cancer care. Radium was scarce and its therapy was capital-intensive. It was also a medical novelty in an era that welcomed such things with a set of critical tools very different from those we currently employ. So a limited number of groups (enterprising physicians) and institutions (prominent urban hospitals) were the first to apply radium to cancer and assorted dermatological conditions starting in 1908. By the early 1930s, radium's high cost, coupled with an impoverished population that seemed to be suffering from an increased incidence of cancer, brought provincial governments into the game. Some, like Saskatchewan, proved more eager than others. The BC Cancer Foundation, for example, shamed its government into action by spending $105,000 on 3.5 grams of radium in 1936, only to have it locked in a bank vault until suitable facilities for its deployment were created.

By the end of the decade, cancer care had come under the control of most provinces through an uneven patchwork of local concessions, in which a conflict between the advocates of centralization and its critics played out a shopworn drama of self-interest and bureaucratic expansion. Patients hardly figure in this story, but this is, after all, part of Hayter's criticism of the system, the origins of which are here carefully reconstructed through institutional and provincial archives. Hayter attempts to explain why, when confronted with cancer, the nature of our treatment and its accessibility differs from region to region. This lack of coherence is not, as some historians of science might have it, presented as evidence of the power of local knowledge. It is presented as an affront to rational treatment – an integral part of the ongoing 'cancer crisis' that, one hopes, might be helpfully addressed by historical scholarship.

Hayter's story artfully puts radium at the centre of classic disputes in the history of medicine regarding the conflicting roles of technologies, expertise, and governmental control. The book is at its best when the author tackles these issues in close detail, as when he reconstructs aspects of the bureaucratic decision-making by analyzing some 2,400 radon requisition forms (and their responses) discovered in the Archives of Ontario. The bigger picture, however, sometimes gets lost. There is no hint, for example, of any parallel between the rise of cancer care and that of 'big science,' though economic, bureaucratic, intellectual, and even material analogies surely exist. Some issues internal to medicine also get short shrift. The dynamics of the profession, such as radiology's recognition in 1937 as a medical specialty, appear as afterthoughts, even though many of the most outspoken critics of centralization appear to have been surgeons who, as a group, had the most to lose with the advent of radiotherapy. Nor is the question of the role of X-rays as a competing form of radiotherapy with a radically different structure and flexibility clearly laid out. But these criticisms do not take away from the particular genius of how An Element of Hope responds to contemporary frustrations with...