BLEEDING MONKS

158 Because tryptophan is actively transported into the human lenssv such as aspirin, which relapse tryptophan bound to serum albumin, would increase the levels of this aminoacid in the aqueous humor and then in the lens. On the other hand, the increase of free tryptophan leads to increased hepatic tryptophan degradation. We found a significant decrease in non-proteic lens tryptophan content, following the cataract pigmentation. Our findings suggest that non-proteic tryptophan, once inside the lens, is transformed to other compounds, contributing to the pathogenesis of senile

drugs,

cataract. Institute of Pharmaceutical

Chemistry.

University of Padua, 35100 Padua, Italy

GRAZIELLA ALLEGRI

Institute of Clinical Ophthalmology, University of Padua

MARIO R. ANGI

BLEEDING MONKS

SIR,—In his summary Dr Sullivan (June 13, p. 1293) writes: "The depletion of iron stores by regular phlebotomy could be the experimental system for testing this hypothesis, and a preventive therapy Cotlier E, Beaty C The role of Na+ ions in the transport of &agr;-aminoisobutyric acid and other amino acids into the lens Invest Ophthalmol 1967; 6: 64-75 9 Sharma YR, Cotlier E Increased plasma tryptophan levels in senile cataracts and aphakic patients Association for Research in Vision and Ophthalmology (1980 meeting), abstr p 89. 10. Allegri G, Angi MR, Costa C, Vanzan S. Tryptophan lens levels in senile cataract Boll Soc Ital Biol Sper (in press). 8.

Commentary from Westminster The Debate

on

the Black

Report

THE Government clearly does not think it has yet won the ideological debate which has raged around its health policy. The self-confidence of the early days of the reign of the Social Services Secretary, Mr Patrick Jenkin, and the Health Minister, Dr Gerard Vaughan, seems now to have evaporated. Certainly Ministers are pressing ahead with plans and exhortations aimed at involvement of the private sector in many of the ancillary services of the N.H.S., at encouragement of private medicine, and at dissuading people from expecting from the N.H.S. (in Mr Jenkin’s memorable phrase) "a pill for every ill". Certainly Ministers are still insisting that funds for the Health Service will remain scarce for the forseeable future and that individuals must learn to rely less on the service which has grown in the past thirty years to become Britain’s biggest employer. But there is some unease, to put it no higher, remaining in Ministers’ minds about their ability to carry with them enough N.H.S. staff, health politicians, and members of the public for the Government’s plans to be put effectively into action. This is demonstrated in the extensive research now taking place, under D.H.S.S. aegis, into the theses of the Black report on Inequalities in Health and into the relationship between unemployment and ill-health. When the report (commissioned by the previous Labour Government, but completed in Mr Jenkin’s tenure) was published the Conservatives’ tactic was to ignore it, save for a dismissive preface written by Mr Jenkin. This was unsurprising, since the report made much of the relationship between chronic poverty and chronic ill-health: "Presen1 social inequalities in health in a country with substantial resources like Britain are unacceptable and deserve to be sc declared by every section of public opinion." The Opposition in Parliament were not prepared to accep! Mr Jenkin’s dismissal of the report, and they have long beer demanding a debate on its implications. Mr Jenkin dealt with

if the hypothesis is confirmed." This could have beenfaitaccomplilftf proper records were kept at the Barnwell or Ely monasteries around 1306. Flemming,1writing on monks "undergoing their periodical bleeding" asks: "Did this practice represent a definite monastic rule or did it merely reflect contemporary medical practice? The latter is rendered more likely when it is remembered that monastic libraries contained standard medical works in which the need for venisection would be set forth. Once a practice was con. sidered necessary, it would be made the subject of definite rules. in At Barnwell the monks were bled seven times a year. At Ely they were bled weekly batches, each batch being about one-sixth of the convent, the rule being for each brother to be bled six times a year."

The exact purpose for the bleeding of healthy men is never mentioned. Was it "common knowledge among common people in the country" that bleeding prevented heart disease? If so, this observation ranks with that of the market-women of Corsica in regard to scabies, an old woman in Shopshire and foxglove, and the cowpox tradition in Gloucestershire. If this hypothesis proves to be valid all due credit should be given to Dr Sullivan for demonstrating that certain antique procedures may be based on practical considerations and should not be scoffed at merely because scientific proofhas not as yet been discovered. There may be confirmation that a little anaemia is healthy for you. 341 Linwood Avenue, Buffalo, N Y 14209, U.S.A.

1.

VICTOR L. COHEN

Flemming P The medical aspects of the mediaeval monastery in England. In: Cope Z, ed Sidelights on the history of medicine. London: Butterworth, 1957.

agitation for a while almost by pretending it was not happening. Then at the beginning of this year he went on the offensive. In a speech, he claimed that Black offered no worthwhile analysis of how social class affected health. Since Black’s recommendations were so unrealistically expensive this

the report had little to offer. More research was needed, he said, and the D.H.S.S. had that in hand. Mr Jenkin made much of work done at Bath University by Rudolph Klein and Elizabeth Collins, who opined that "Britain’s primary health care system does not speak with an upper-class accent." Meanwhile the Opposition has continued to press for a debate on Black, and that demand has been conceded. The debate will probably take place in the autumn. The Opposition has also been pressing for more details of research completed for the D.H.S.S. and research which is still going on. There have been accusations from the Labour benches that the Government has deliberately suppressed work which does not support its ideology, followed by indignant denials from D.H.S.S. Ministers. A case in point is a study (commissioned by the D.H.S.S.) of unemployment and health in families by Dr Leonard Fagin. This series of case studies suggested that unemployment can indeed have powerful effects on the health of the unemployed person anc his family. Why had no effort been made to publicise the report, asked Labour spokesman, Mr Gwyneth Dunwoody in the Commons? Retorted the Under-Secretary Sir Georgt Young: "That is untrue." The D.H.S.S. had made the repor available to the press, who took little interest in it, he said (Health correspondents will confirm, nevertheless, that th’ Fagin study was scarcely publicised by the Department,in striking contrast to its attitude to the work of Klein an’

Collins.) There is much further research being done for the D.H.S.S. at the moment. It seems Ministers no longer feel they can dismiss the Black report’s implications as confidently as Mr Jenkin first chose to do. To start with there is now a detailed extension of the Klein and Collins work being carried out by D.H.S.S. statisticians, who say their conclusions so far contradict many of Black’s claims. With