- Email: [email protected]
CANDIDATES FOR LEISURE
1172 to be put into effect with the available re". sources Sometimes, the best plan may be much less elaborate than in the Medical Research Council vaccine trials; to reduce observations on each individual to a minimum need not prejudice a trial’s primary aim, provided the basic design is correct. Sometimes we may even have to accept imperfections in the design itself. For example, in some community studies the random allocation of individual subjects may be unacceptable, and some alternative must then be considered, such as intervention in one 5-year age-group, leaving those above and below as controls. The drawbacks of departing from random allocation are always serious; but sometimes-not always-a less-than-perfect trial is better than none at all. Preventive medicine continues to offer enormous opportunities, with commensurate risks. Let us hope that it will be guided by scientific methods in no way inferior to those of laboratory research.
practical
Annotations CANDIDATES FOR LEISURE
ONE of the curious anomalies of our country is that we shortage of labour by insisting that most of our workers retire at a fixed, comparatively early, age, irrespective of their physical health and mental resilience. People with adequate means, varied interests, and failing health many probably welcome a respite from routine. But for people, especially perhaps healthy male manual workers, retirement can be disappointing and frustrating. The inexorable mechanisation of modern industry is one of the most important reasons for automatic early retirement. On the conveyor belt the older man is unable to continue to work at his own pace; and patience, exactitude, and craftsmanship are not allowed to compensate for failing physical powers and slowing reactions. Most of the so-called light jobs which used to be reserved for the elderly are also those that are eminently suitable for mechanisation; the few that remain tend to be reserved for the young disabled worker. As a result the semi-able older man retires sooner than he needs and is apt to find himself facing too many years with too much leisure. Mr. Le Gros Clark, who has already made several inreact to a
teresting inquiries into the manual workers’ retirement problems, stresses all these points in his latest book.l He urges that
we
dismiss the idea that
a
retired
man can
always find something to do if he has a mind to. The active-minded, able-bodied, and reluctant pensioner is a product of our times. He has retired for the convenience of modern technology, and society should accept the responsibility of offering him a recognised and satisfying place in the community. In Mr. Le Gros Clark’s view research is needed into the kind and amount of financial and social help which the retired man should be given during the lengthening span of active years which medical advances promise him. We have, for instance, no scientific way of settling what the pensioner’s standard of consumption should be. Here, as a guide-line, Mr. Le Gros Clark suggests that a basic pension should be adequate to stimulate a man to take up voluntarily any mote
1. Work,
Age and Leisure. By Joseph. 1966. Pp. 151. 30s.
F. LE GROS CLARK. London: Michael
useful pursuit for which he has a taste, and Mr. Le Gros Clark believes that the retired man will usually have to occupy himself with work which will not attract payment. The problem of occupying leisure is one which will increasingly face the employed as well as the retired. Mechanisation and automation are likely both to shorten and dull the working day of many people, and Mr. Le Gros Clark believes that a renaissance of handicrafts and domestic arts and skills might be a pleasant reaction to modern industrial trends. A domestic culture of this kind, of which there are already encouraging signs, could be an effective support to the leisure of the retired as well as the employed.
RECURRING ULCERS OF THE MOUTH
RECURRING
ulceration of the mouth is an a baffling one. It is commoner in women than in men; most likely to begin in the late teens or early twenties; and tends to subside after twenty or thirty years, becoming rare after the age of 60. Attacks seem to be precipitated by minor local trauma; certain foods, such as nuts or chocolate; mental stress; or the hormonal changes associated with menstruation, the puerperium, or the menopause-but none of these factors seem to be more than a trigger for some unknown underlying disorder. Methods of treatment have been varied, empirical, and on the whole unsatisfactory. The best of a poor lot has been tetracycline taken four times daily as a suspension of 250 mg. in 5 ml. of solution, the dose being held in the mouth for two minutes and then swallowed, nothing being taken by mouth thereafter for one hour.1 That an antibiotic should have a beneficial effect suggests an infective cause, and this idea gained support when Barile and his colleagues2 isolated a pleomorphic transitional L-form of an ex-haemolytic streptococcus in pure culture from lesions in several patients with aphthous stomatitis; and with this organism they were able to produce, in animals, skin and mucosal lesions clinically and histologically similar to those of human aphthous stomatitis.3 Later4 they observed microorganisms, apparently identical in form with the cultured pleomorphic streptococcus, in histological preparations of biopsy specimens from aphthous ulcers. The same workers1 have now done skin-tests on patients with recurrent aphthous stomatitis, using a killed vaccine made from a strain of pleomorphic streptococcus isolated from aphthous ulcers. Of 30 patients tested with the vaccine, all gave a positive delayed-type hypersensitivity skin-reaction with a peak intensity within twenty-four to forty-eight hours, the severity of the reaction tending to parallel the severity of the oral ulceration; 3 of the 30 had an immediate-type reaction before the delayed one. Of 4 patients with lichen planus,1 had a moderate delayed-type skin reaction to the vaccine, and another a moderate immediate-type response. Of 6 patients with no history of aphthous stomatitis or lichen planus, only 1 (with a history of recurrent " sore throats ") had a positive delayed-type skin-reaction, while 2 others had a mild transitory immediate-type reaction. More
aphthous
unpleasant disorder; and
1. 3.
Graykowski, E. A., Barile, M. F., Lee, W. B., Stanley, H. R. J. Am. med. Ass. 1966, 196, 637. Barile, M. F., Graykowski, E. A., Driscoll, E. J., et al. Oral Surg. 1963, 16, 1395. Graykowski, E. A., Barile, M. F., Stanley, H. R. J. Am. dent. Ass. 1964,
4.
69, 118. Stanley, H. R., Graykowski, E. A., Barile, M. F. Oral Surg. 1964, 18
2.
335.
practical
Annotations CANDIDATES FOR LEISURE
ONE of the curious anomalies of our country is that we shortage of labour by insisting that most of our workers retire at a fixed, comparatively early, age, irrespective of their physical health and mental resilience. People with adequate means, varied interests, and failing health many probably welcome a respite from routine. But for people, especially perhaps healthy male manual workers, retirement can be disappointing and frustrating. The inexorable mechanisation of modern industry is one of the most important reasons for automatic early retirement. On the conveyor belt the older man is unable to continue to work at his own pace; and patience, exactitude, and craftsmanship are not allowed to compensate for failing physical powers and slowing reactions. Most of the so-called light jobs which used to be reserved for the elderly are also those that are eminently suitable for mechanisation; the few that remain tend to be reserved for the young disabled worker. As a result the semi-able older man retires sooner than he needs and is apt to find himself facing too many years with too much leisure. Mr. Le Gros Clark, who has already made several inreact to a
teresting inquiries into the manual workers’ retirement problems, stresses all these points in his latest book.l He urges that
we
dismiss the idea that
a
retired
man can
always find something to do if he has a mind to. The active-minded, able-bodied, and reluctant pensioner is a product of our times. He has retired for the convenience of modern technology, and society should accept the responsibility of offering him a recognised and satisfying place in the community. In Mr. Le Gros Clark’s view research is needed into the kind and amount of financial and social help which the retired man should be given during the lengthening span of active years which medical advances promise him. We have, for instance, no scientific way of settling what the pensioner’s standard of consumption should be. Here, as a guide-line, Mr. Le Gros Clark suggests that a basic pension should be adequate to stimulate a man to take up voluntarily any mote
1. Work,
Age and Leisure. By Joseph. 1966. Pp. 151. 30s.
F. LE GROS CLARK. London: Michael
useful pursuit for which he has a taste, and Mr. Le Gros Clark believes that the retired man will usually have to occupy himself with work which will not attract payment. The problem of occupying leisure is one which will increasingly face the employed as well as the retired. Mechanisation and automation are likely both to shorten and dull the working day of many people, and Mr. Le Gros Clark believes that a renaissance of handicrafts and domestic arts and skills might be a pleasant reaction to modern industrial trends. A domestic culture of this kind, of which there are already encouraging signs, could be an effective support to the leisure of the retired as well as the employed.
RECURRING ULCERS OF THE MOUTH
RECURRING
ulceration of the mouth is an a baffling one. It is commoner in women than in men; most likely to begin in the late teens or early twenties; and tends to subside after twenty or thirty years, becoming rare after the age of 60. Attacks seem to be precipitated by minor local trauma; certain foods, such as nuts or chocolate; mental stress; or the hormonal changes associated with menstruation, the puerperium, or the menopause-but none of these factors seem to be more than a trigger for some unknown underlying disorder. Methods of treatment have been varied, empirical, and on the whole unsatisfactory. The best of a poor lot has been tetracycline taken four times daily as a suspension of 250 mg. in 5 ml. of solution, the dose being held in the mouth for two minutes and then swallowed, nothing being taken by mouth thereafter for one hour.1 That an antibiotic should have a beneficial effect suggests an infective cause, and this idea gained support when Barile and his colleagues2 isolated a pleomorphic transitional L-form of an ex-haemolytic streptococcus in pure culture from lesions in several patients with aphthous stomatitis; and with this organism they were able to produce, in animals, skin and mucosal lesions clinically and histologically similar to those of human aphthous stomatitis.3 Later4 they observed microorganisms, apparently identical in form with the cultured pleomorphic streptococcus, in histological preparations of biopsy specimens from aphthous ulcers. The same workers1 have now done skin-tests on patients with recurrent aphthous stomatitis, using a killed vaccine made from a strain of pleomorphic streptococcus isolated from aphthous ulcers. Of 30 patients tested with the vaccine, all gave a positive delayed-type hypersensitivity skin-reaction with a peak intensity within twenty-four to forty-eight hours, the severity of the reaction tending to parallel the severity of the oral ulceration; 3 of the 30 had an immediate-type reaction before the delayed one. Of 4 patients with lichen planus,1 had a moderate delayed-type skin reaction to the vaccine, and another a moderate immediate-type response. Of 6 patients with no history of aphthous stomatitis or lichen planus, only 1 (with a history of recurrent " sore throats ") had a positive delayed-type skin-reaction, while 2 others had a mild transitory immediate-type reaction. More
aphthous
unpleasant disorder; and
1. 3.
Graykowski, E. A., Barile, M. F., Lee, W. B., Stanley, H. R. J. Am. med. Ass. 1966, 196, 637. Barile, M. F., Graykowski, E. A., Driscoll, E. J., et al. Oral Surg. 1963, 16, 1395. Graykowski, E. A., Barile, M. F., Stanley, H. R. J. Am. dent. Ass. 1964,
4.
69, 118. Stanley, H. R., Graykowski, E. A., Barile, M. F. Oral Surg. 1964, 18
2.
335.