as possible was the best treatment. During the period, roughly 1920-30, Claude
Regaudof Paris argued that the differential effect of x-rays on cancer and
normaltissues could be best obtained by giving the treatment slowly. For
example, healing was very much better when skin cancer was treated over a
period of a week than in one day. Originally, they used a radium applicator,
strapped, say to the arm. Whenthe x-ray machine was introduced in about
1920, they fractionated the treatment - one brief exposure per day for seven
days. I began training in 1949, treatment schedules had gradually been
improved and become moreorless standardized, for example, treating over

the course of five weeks in the case of many types of cancers. The need for
relatively large numbers of patients in order to gauge the effectiveness of
treatment is readily appreciated when you consider the following
hypothetical example. Supposea clinic treats four hundred patients a year,
that there are five principle types of cancer, and each maybeclassified in four
stages. On the average, there would be twenty patients in each specific subgroup. If you wished to change the treatment, you could haveten in the new
group and ten in the standard one. If you expected survival to be improved
from five out of ten (fifty percent) to seven out of ten (seventy percent), it

would be difficult to establish. Obviously, much larger numbers of patients
and goodstatistical analysis would be required.
[6. Shields Warren]
BERGE:

Next question was, you said that you had been brought to

Harvard by Shields Warren, and I was wondering if you could talk a little bit
about him.

KOHN:

Shields Warren waschief Pathologist at the Deaconess and

Professor of Pathology at the Harvard Medical School. He becameinterested

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