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NOBEL PRIZEMAN
728 the authorities administering all the other mental-health services. It is proposed that the mental-deficiency authority shall be given compulsory powers to deal with all ascertained defectives. " It is wrong to wait until the defective gets into trouble or runs
foul of the law before
affording
him the care, super-
vision, and training which his mental condition requires
and which it is in his own interests to receive. Mental deficiency is often hereditary, and we consider it wrong to leave any power in the hands of mentally defective parents. It is not suggested that all defectives would be sent to " institutions." The committee favours a single colony with, eventually, 1000 beds, to be established within 20-30 miles of Belfast. A school should be included, where the opportunity of education might be extended not only to those unsuitable for ordinary or day special schools but also to the so-called ineducable defectives. Suspected defectives should be admitted for a short time to an observation unit which should not be in, but should be near, the colony. Defectives in the colony could be sent out on licence to a hostel, a private house, or their own homes. The provision of sheltered employment, the committee concludes, should be considered when mental...
deficiency legislation
is being drafted.
NOBEL PRIZEMAN THE award of the Nobel prize for 1946 in physiology and medicine to H. J. Muller, of Indiana University, will be welcomed by scientists all over the world. Muller’s genetical work is widely known mainly on account of his spectacular demonstration in 1927 of the effects of X rays in producing mutations. His imaginative power at once enabled him to develop the discovery in collaboration with others, to plan further experiments, and to appreciate the evolutionary significance of the new knowledge. He focused attention on the essential property of the genic substance-namely, its ability not only to copy itself but, after being changed by mutation, to copy the alteration as well. Apart from the impressive contributions of Muller in the experimental field, his capacity to integrate many aspects of the subject has made him an outstanding figure in genetics. At the present time the medical importance of the knowledge of radiation effects on germ cells is becoming increasingly obvious,, and Muller’s work is now of more practical value than even he himself could have foreseen twenty years ago.
Public Health Tuberculosis under the National Health Service THOSE who have worked among the tuberculous hold that this disease presents a special medical problem
and must be considered apart from other social diseases. Dr. Norman Tattersall, principal medical officer of the King Edward VII Welsh National Memorial Association,! fears that under the National Health Service Bill the need for unity of tuberculosi:control is being lost sight of ; chest cases are to be referred to the care of a chest physician, bones and joints to the orthopaedist, and other forms to the appropriate special department. Though he agrees that each special department must direct the treatment of particular phases of infection, yet tuberculosis is always an infectious disease combined with a social problem, and all forms must be subject to broad control of the disease, with the family and not the " individual as the unit. " If this is lost," he writes, we has shall witness a reversal of the principle which guided the development of the service ever since Sir Robert Philip opened the first dispensary in 1887." Sir Edmund Spriggs, in a discussion of the same subject at the annual meeting of the association’s board of governors, said that the Bill as at present drafted seems to hand over tuberculosis to general physicians, surgeons, and health visitors, though pulmonary cases would be protected to some extent by the fact that some of the chest physicians would be former tuberculosis new For some fifty years he has watched the doctors. development of the medical and surgical management of tuberculosis, and has concluded that it does call for special experience. " A doctor without that experience is no more able to do the best possible for a random 1.
Thirty-fourth Annual Report
of the Association.
Pp. 35.
series of cases of tuberculosis than he is to perform a succession of varied operations before he has had surgical training." Among his reasons for regarding tuberculosis as a problem of its own he gave the following: 1. It is a general disease with local manifestations. The division into pulmonary cases and surgical cases, to be treated by physicians and surgeons respectively, is not wholly sound. At the North Wales Sanatorium, Dr. F. S. Hawkins and Dr. G. 0. Thomas recently found pulmonary disease present in The no less than a quarter of 143 so-called surgical cases. complication might easily have been overlooked if the patients had been transferred to general surgical wards, beyond the supervision of a tuberculosis specialist. 2. Many tuberculous patients must be segregated, for their sakes and that of the community. 3. They need treatment over a long period. These last two considerations mean that tuberculous cases must be managed on a different.plan from other diseases amenable to arrest and cure. 4. Pulmonary tuberculosis is the commonest chronic disease of young people. Other common chronic diseases, such as heart disease, arthritis, and arteriosclerosis, occur mostly in later life, and many of those affected are already of pensionable age ; others by care and treatment may gain five or ten years of useful life. But every case of tuberculosis in a young person which is arrested, or better prevented, brings to the community 30-40 years of possible usefulness. The treatment of this disease, especially of early cases, thus has a high economic value. " It pays handsomely."
own
Sir Edmund believes that, to get the best care and reablement of the discharged tuberculous patient and of his whole family should be in the hands of specially trained health visitors who are in direct personal relation with the expert tuberculosis doctor. A liaison between the staffs of general hospitals and tuberculosis hospitals is desirable and will benefit both, but if the welfare of the patient is to be the first consideration there should not, in his view, be fusion. Paratyphoid in Sheffield cases New of paratyphoid in Sheffield have now fallen to 1 or 2 a day, and it seems likely that the source of infection present in September and October has been eliminated, though it is still untraced and likely to remain so The total number of cases to Nov. 12 was 141. The younger age-groups have been most affected throughout, and the illnesses have been of moderate severity, but with a remarkably profuse rash. The authorities of Sheffield University felt that members of the staff and students should not be denied the protection by inoculation which has been so successful in the Armed Forces. Arrangements were made for T.A.B. inoculations to be carried out in the bacteriology department on four days of one week and four days of the succeeding week ; 340 completed the course of two inoculations of0’5 and 1 c.cm., and an additional 26had There were no serious reactions. one inoculation only. This is not a new departure in Sheffield, for immunisation against typhoid and against diphtheria was made available to students and staff who desired it during the war years 1940-43, and large numbers took advantage of the offer. In view of the changed situation it was not provided in 1944 or 1945. In all cases the immunisation was entirely voluntary and the diphtheria immunisation was naturally only given to Schick-positive subjects. Infectious Disease in England and Wales
Lastly,
results, the
WEEK ENDED NOV.
2
2VoM/tce[MoMS.—Smallpox, 0 ;; scarlet fever, 1187; whooping-cough, 1549 ; diphtheria, 274 ; paratyphoid, 66 (38 at Sheffield) ; typhoid 6 ; measles (excluding rubella), 3374 ; pneumonia (primary or influenzal), 485 ; cerebrospinal fever, 40 ; poliomyelitis, 25 ; polioencephalitis, 2; encephalitis lethargica, 0 ; dysenterv,69; puerperal pyrexia, 117 ; ophthalmia neonatorum 63. No case of cholera, plague, or typhus was notified during the week. Deaths.-In 126 great towns there were no deaths from enteric fever, 3 (0) from scarlet fever, 2 (0) from
measles, 8 (1) from whooping-cough, 3 (1) from diphtheria, 31 (2) from diarrhoea and enteritis under two years, and 12 (1) from influenza. The figures in parentheses those for London itself. The number of stillbirths notified during the week was 273 (corresponding to a rate of 30 per thousand total births), including 38 in London.
are
foul of the law before
affording
him the care, super-
vision, and training which his mental condition requires
and which it is in his own interests to receive. Mental deficiency is often hereditary, and we consider it wrong to leave any power in the hands of mentally defective parents. It is not suggested that all defectives would be sent to " institutions." The committee favours a single colony with, eventually, 1000 beds, to be established within 20-30 miles of Belfast. A school should be included, where the opportunity of education might be extended not only to those unsuitable for ordinary or day special schools but also to the so-called ineducable defectives. Suspected defectives should be admitted for a short time to an observation unit which should not be in, but should be near, the colony. Defectives in the colony could be sent out on licence to a hostel, a private house, or their own homes. The provision of sheltered employment, the committee concludes, should be considered when mental...
deficiency legislation
is being drafted.
NOBEL PRIZEMAN THE award of the Nobel prize for 1946 in physiology and medicine to H. J. Muller, of Indiana University, will be welcomed by scientists all over the world. Muller’s genetical work is widely known mainly on account of his spectacular demonstration in 1927 of the effects of X rays in producing mutations. His imaginative power at once enabled him to develop the discovery in collaboration with others, to plan further experiments, and to appreciate the evolutionary significance of the new knowledge. He focused attention on the essential property of the genic substance-namely, its ability not only to copy itself but, after being changed by mutation, to copy the alteration as well. Apart from the impressive contributions of Muller in the experimental field, his capacity to integrate many aspects of the subject has made him an outstanding figure in genetics. At the present time the medical importance of the knowledge of radiation effects on germ cells is becoming increasingly obvious,, and Muller’s work is now of more practical value than even he himself could have foreseen twenty years ago.
Public Health Tuberculosis under the National Health Service THOSE who have worked among the tuberculous hold that this disease presents a special medical problem
and must be considered apart from other social diseases. Dr. Norman Tattersall, principal medical officer of the King Edward VII Welsh National Memorial Association,! fears that under the National Health Service Bill the need for unity of tuberculosi:control is being lost sight of ; chest cases are to be referred to the care of a chest physician, bones and joints to the orthopaedist, and other forms to the appropriate special department. Though he agrees that each special department must direct the treatment of particular phases of infection, yet tuberculosis is always an infectious disease combined with a social problem, and all forms must be subject to broad control of the disease, with the family and not the " individual as the unit. " If this is lost," he writes, we has shall witness a reversal of the principle which guided the development of the service ever since Sir Robert Philip opened the first dispensary in 1887." Sir Edmund Spriggs, in a discussion of the same subject at the annual meeting of the association’s board of governors, said that the Bill as at present drafted seems to hand over tuberculosis to general physicians, surgeons, and health visitors, though pulmonary cases would be protected to some extent by the fact that some of the chest physicians would be former tuberculosis new For some fifty years he has watched the doctors. development of the medical and surgical management of tuberculosis, and has concluded that it does call for special experience. " A doctor without that experience is no more able to do the best possible for a random 1.
Thirty-fourth Annual Report
of the Association.
Pp. 35.
series of cases of tuberculosis than he is to perform a succession of varied operations before he has had surgical training." Among his reasons for regarding tuberculosis as a problem of its own he gave the following: 1. It is a general disease with local manifestations. The division into pulmonary cases and surgical cases, to be treated by physicians and surgeons respectively, is not wholly sound. At the North Wales Sanatorium, Dr. F. S. Hawkins and Dr. G. 0. Thomas recently found pulmonary disease present in The no less than a quarter of 143 so-called surgical cases. complication might easily have been overlooked if the patients had been transferred to general surgical wards, beyond the supervision of a tuberculosis specialist. 2. Many tuberculous patients must be segregated, for their sakes and that of the community. 3. They need treatment over a long period. These last two considerations mean that tuberculous cases must be managed on a different.plan from other diseases amenable to arrest and cure. 4. Pulmonary tuberculosis is the commonest chronic disease of young people. Other common chronic diseases, such as heart disease, arthritis, and arteriosclerosis, occur mostly in later life, and many of those affected are already of pensionable age ; others by care and treatment may gain five or ten years of useful life. But every case of tuberculosis in a young person which is arrested, or better prevented, brings to the community 30-40 years of possible usefulness. The treatment of this disease, especially of early cases, thus has a high economic value. " It pays handsomely."
own
Sir Edmund believes that, to get the best care and reablement of the discharged tuberculous patient and of his whole family should be in the hands of specially trained health visitors who are in direct personal relation with the expert tuberculosis doctor. A liaison between the staffs of general hospitals and tuberculosis hospitals is desirable and will benefit both, but if the welfare of the patient is to be the first consideration there should not, in his view, be fusion. Paratyphoid in Sheffield cases New of paratyphoid in Sheffield have now fallen to 1 or 2 a day, and it seems likely that the source of infection present in September and October has been eliminated, though it is still untraced and likely to remain so The total number of cases to Nov. 12 was 141. The younger age-groups have been most affected throughout, and the illnesses have been of moderate severity, but with a remarkably profuse rash. The authorities of Sheffield University felt that members of the staff and students should not be denied the protection by inoculation which has been so successful in the Armed Forces. Arrangements were made for T.A.B. inoculations to be carried out in the bacteriology department on four days of one week and four days of the succeeding week ; 340 completed the course of two inoculations of0’5 and 1 c.cm., and an additional 26had There were no serious reactions. one inoculation only. This is not a new departure in Sheffield, for immunisation against typhoid and against diphtheria was made available to students and staff who desired it during the war years 1940-43, and large numbers took advantage of the offer. In view of the changed situation it was not provided in 1944 or 1945. In all cases the immunisation was entirely voluntary and the diphtheria immunisation was naturally only given to Schick-positive subjects. Infectious Disease in England and Wales
Lastly,
results, the
WEEK ENDED NOV.
2
2VoM/tce[MoMS.—Smallpox, 0 ;; scarlet fever, 1187; whooping-cough, 1549 ; diphtheria, 274 ; paratyphoid, 66 (38 at Sheffield) ; typhoid 6 ; measles (excluding rubella), 3374 ; pneumonia (primary or influenzal), 485 ; cerebrospinal fever, 40 ; poliomyelitis, 25 ; polioencephalitis, 2; encephalitis lethargica, 0 ; dysenterv,69; puerperal pyrexia, 117 ; ophthalmia neonatorum 63. No case of cholera, plague, or typhus was notified during the week. Deaths.-In 126 great towns there were no deaths from enteric fever, 3 (0) from scarlet fever, 2 (0) from
measles, 8 (1) from whooping-cough, 3 (1) from diphtheria, 31 (2) from diarrhoea and enteritis under two years, and 12 (1) from influenza. The figures in parentheses those for London itself. The number of stillbirths notified during the week was 273 (corresponding to a rate of 30 per thousand total births), including 38 in London.
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