Conferences

336 The

bacteriological findings

in

25

follows :

were as

patients’ sputa

Staphylococcus albus 3. Staph. pyogenes 2. hæmolytic streptococcus 0. noii-hipmolytic streptococcus 14. pneumococcus 9. Neisseria catarrhulis 19. proteus 5. Friedlinder’s bacillus 4. aerop

ra

.

Hœmophilus influenzœ 1. diphtheroids 1. Bact.

1.

of infections with the hæmolytic streptoand pyogenes is remarkable, as these were considered to play the major part in the deaths after influenza in 1918 in Europe. It may well be that it renects dinerence in the soil rather than the seed, as in The

paucity

coccus

Staph.

general ha’molytic streptococci

are

rarely responsible

for sickness and infection in this part of the world. EPIDEMIOLOGY

attendances were of little help in assessing the incidence in the general population as the vast majority were content to suffer at home : judging by the of government departments, about 50% of the inhabitants must have had the disease in the month June 20 to July 20. The colony’spopulation is about 140.000. The average number of deaths per week in the colony during June and July, 1956, was 42 : in 1957 the deaths per week in June and the first three weeks of July numbered 49, 46, 41.77, 128, 103, and 5M. Thus it seems likely that about 200 deaths were attributable directly or indirectly to the epidemic-a case mortality of 1 in 350. In general the incidence of the disease followed the usual pattern, reached its peak very rapidly and almost simultaneously in all blanches of the civilian community in the last few days of June, and died away at the same rate. My thanks are due to the Director of Medical Services, Aden, fur permission to publish this paper.

Uutpatient

experience

Poliomyelitis Concern is still felt at the high incidence of poliomyelitis this year at Coventry ; up to Aug. 9, 83 cases had been confirmed, including 54 paralytic cases. About half of the 13,629 children registered for vaccination have been immunised, and there have been no confirmed cases The doctors and nurses at Whitley Hosamong them. pital, where most of the patients are being treated, have been vaccinated. Mr. M. Edelman, M.P., asked the Ministry of Health to send additional supplies of poliomyelitis vaccine to the city, particularly for the use of

and their families.B The Ministry replied that had its proper share, and that, since immunity took some time to develop, vaccination would not be of much use in righting the outbreak. A businessman offered to arrange for a gift of American vaccine to the citB- 2; but the Ministry of Health would not allow the corporation to use the vaccine for its programme under the National Health Service, because Salk vaccine has not been licensed. There are ten large areas with notification-rates this year exceeding 45 per 100,000 ; these include Colchester and Stevenage, with rates of over 90, but not Coventry, where the rate is about :,1. Last Friday the Ministry issued a series of questions The British and answers on polionyelitis vaccine. vaccine, it said. was more effective and safer than Salk vaccine ;if the latter were imported, safety testing would take three months. A team was going to North America to investigate the possibility of overseas manufacture of the British vaccine, and the present safety and efficacy The import of small gifts of vaccine of Salk vaccine. was being allowed because the Ministry did not wish to control individuals rigidly, as long as a doctor had taken responsibility for injection, knowing that the safety standards did not come up to British requirements. 33 such packages had been dealt with in May, 48 in June, and 58 in July. The Ministry statement makes no mention of the distinction between gifts of vaccine sent from the United States, which are permitted. and the purchase of vaccine by private persons in Britain. which is not.3

doctors

Coventry had

1. Times. Aug. 8, 1957. 2. Ibid, Aug. 9. 3. See Lancet, Aug. 10,

Another point raised by Mr. Edelman was the connection between poliomyelitis and river-pollution. The Coventry health committee advises against bathing in streams and canals. though they say there is no proof of any connection between the disease and pollution of watercourses. At Gosport notices warned the public that bathing at certain states of tide might endanger health :-. but because no illness could be definitely traced to sewage-polluted water, these notices were withdrawn.* Mr. E. V. Balsom, secretary of the Institution of Public Health Engineers, said that many coast towns pumped untreated sewage into the sea, and that the cost of sewage-purification works would be huge.5 Xew notifications of poliomyelitis in England and Wales in the week ended Aug. 3 numbered 260 (2HO). of which 119 (123) were non-paralytic (previous week’s figures in parentheses). The year’s total to Aug. 3 is 2364, compared with 1485 last year and 2593 in 1950.

Conferences CHEMICAL ADDITIVES IN FOODS A CONFERENCE arranged jointly by the Food Law Institute of the United States, the Food Group of the Society of Chemical Industry, and the Association of Public Analysts of Great Britain was held in London on July 26. Mr. C. W. DUNN summarised the current position of food additives in the United States, where Congress had lately begun considering amendment of the Federal Food Drug Cosmetic Act regulating the addition of chemicals to food ; the Food and Drug Administration proposed that all food additives should be pre-tested for safety, and the pre-testing data properly filed before regulation sanctioned their use, which would then be subject to a threefold review : scientific, administrative, and judicial. Mr. G. P. LARRICK and Dr. A. J. LEHMAN were both in the United States to attest before the Congress committee : their paper was presented by Mr. J. L. Harvey. The main purposes in using additives were to reduce starvation, to increase the variety of active foods, and to release women from the drudgery of the kitchen. The permitted food colours had been and were still being revised : there was no evidence that any past or present permitted colours were carcinogenic. Cancer could be produced in animals by the repeated injection of sugar, arachis oil, cottonseed oil, lard, or tannic acid : a substance could not therefore be banned from food simply because it produced any cancer in any test animal by any route of administration. Dr. C. A. MORRELL, whose paper was presented by Dr. B. L. Oser, said that identity, or at least of control methods in various countries would be of advantage to international trade. The government had to protect public health and to maintain the consumer’s confidence that his food was safe. It needed a clear and practical code of enforcement when acting as referee in instances where the interests of the public and industry seemed to vary, and this should involve a minimum of delay since it was important not to withhold from use In the first place, it was new and desirable processes. necessary to establish tolerances. A main difficulty was to define the minimum conditions which must be satisfied for the acceptance of a new substance ; whatever these conditions were it was fair to acknowledge evidence for other closely related substances, and where experts disagreed on such points they and not the administrators should seek a resolution. Mr. X. C. WRIGHT, D.SC., described the position of preservatives, colouring agents, and other chemical additives to food under the Food and Drugs Act and the procedure by which regulations made under the Act were brought into being and varied. The Food Standards

government

similarity,

4. 1957,

p. 280.

5.

Times, Aug. 12. Ibid, Aug. 13.

337

Committee, responsible jointly to the Minister of Health and the Minister of Agriculture, Fisheries, and Food, received evidence from representatives of the trade and other parties interested, and reports were published and proposals circulated to allow further representations before regulations were finally made and brought into

In

England Now

A Running Commentary by Peripatetic Correspondents SwEET are the uses of advertisement, and doubtless after the Egyptian Polydamna had prescribed for operation. Helen of Troy a herb which banished all care, sorrow, and Mr. E. J. MILLER, outlined the control of risks to ill-humour, contemporary medical men wearied of operators and consumers of treated crops arising from hurling into their urns the vast loads of the use of agricultural pesticides in the field and in food .shards, papyri, &c.,waste-papyrus the Original Trojan advertising stores. The present desire was that control should be Tranquiliser (Polydamna & Co.) ten drachma per disvoluntary ; apart from the general provisions of the pensing-pack (including tax) and a drachma back Food and Drugs Act, legislation existed only for protecon the amphora. Modern drug-houses’ circulars are even more exasperatA tion of workers using the more toxic chemicals. from simple statements of more-or-less voluntary scheme existed whereby manufacturers notified ing and range " She fact-e.g., thought her nappies were white until their intention to market new products. Baby drank the Detergent "-to meretricious envelopes Antibiotics in Food bearing 2d. stamps. I received one signed " Freddie," telling me how much he was enjoying life now that his Dr. HENRY WELCH, whose paper was presented by haemoglobin was 100 %, thanks to somebody’s pills. L. in Mr. J. Harvey, said that antibiotics animal feeding- There was also a snapshot of him in a deck-chair : except stuffs at a level of 5-20 parts per million, or on crops, did that he didn’t ask me for a loan, he resembled Ananias’s not appear as residues in foods under normal marketing cousin Fred, whose ideas of meum et tuum so far differed conditions ; but their presence could be shown in from those of the judge that he was given five years in which to revise them. If it is indeed Fred, any hemocarcases of poultry treated with higher doses. Conclusive globin he may possess he has certainly stolen and not evidence of safety and usefulness had been required in dug out of an imaginary haemoglobin mine in which he the use of on eviscerated permitting tetracyclines poultry, may try to interest you. and would again be required if they or other antibiotics of course, the deck-chair man may be Alternatively were permitted in meat or fish. To control the amount of a playwright at work, for many firms now employ them antibiotic reaching the public through milk from cows treated for mastitis, it was at present required that milk should be discarded for at least seventy-two hours from the final treatment. Recently three further steps had been taken : an intensive programme to educate farmers as to the importance of the problem, the publication of a notice that a warning statement would be required on the containers of antibiotic drugs for intramammary use, and the proposal of a rule to limit the

being

content of mastitis preparations to 100,000 units per dose. Mr. C. A. Adams presented the paper by Dr. F. S. THATCHER, who said that antibiotics should be permitted only in those foods which would normally be prepared by cooking in such a way as to destroy any residual antibiotic content. Evidence to date supported the view that in Canada the permitted levels of aureomycin (chlortetracycline) and oxytetracycline in fish and poultry (5 p.p.m. and 7 p.p.m. respectively) satisfied this criterion. Treated foods had to be clearly labelled to that effect. Any abuse of antibiotics or any attempt to extend the shelf-life of treated foods needed to be subject to strict control action by the authorities, and the use of these substances should be coupled with an increased effort to improve general standards of hygiene and sanitation. The use of antibiotics in food should be regarded as a tentative venture, final conclusions on specific aspects of sustained value and safety being possible only after experience. Each antibiotic proposed for use in this way should be considered on its own merits. Mr. A. L. BACHARACH summarised the present legal position in Great Britain relating to the use of antibiotics. The Therapeutic Substances Act, 1956, controlled thirteen specified antibiotics in a manner designed to prevent their use by any but medical or veterinary practitioners ; but three were specifically exempted from the Act if used in animal feeding-stuffs. The Preservative Regulations did not include antibiotics in the permitted list of preservatives for foods. The occurrence of small quantities of penicillin in milk from cows under veterinary treatment set a legal problem, though the amount likely to be found was considered far below the minimum sensitising or evoking doses associated with allergic responses. Such direct ill effects as had been found with antibiotics were all from relatively large and repeated doses, given almost always by injection and with therapeutic intent.

penicillin

to write short scenarios around their medicaments. As yet I have received no script which earns my vote as the Best One-Act Play of 1957, though I enjoyed a pamphlet in which the dialogue was written all round a patient who had a large red arrow sticking in him exactly where, reasonably enough, he felt a pain. Ambroise Pare would have removed the arrow forthwith, but in these days of specialisation the G.P. had called in a consultant, presumably in toxophily. The consultant appeared on the opposite page, with a bow-tie and a hyphen, lecturing to the awestruck G.P., whose part was made up of stooge-like lines such as " By Jove, Henry, I never thought of that ! In one of the snappier medical magazines this playwright technique is now used for a three-act quiza sort of Three Characters in Search of a Diagnosis. At the top of the bill is again our hyphenated consultant, The his " feed " being usually his medical registrar. patient is merely the excuse for the whole thing. The prologue announces that if the reader can make a diagnosis from Act I alone, he has unusual clinical acumen, luck, (all of which I usually swap for a perspicacity, &c. quick look at the answer on the back page) ; from Act n, common sense ; and from Act III—well, you should be ashamed. But the authors don’t play fair. French, H., assisted by me (I turned over the pages), once whittled down the possible causes of a patient’s drowsiness to 19 differential diagnoses. Yet only at the end of Act ill was I told that the patient was a product-sampler in a "

phenobarbitone factory. *

*

*

The way a doctor takes leave of a patient is important. Who has confidence in the chap who leaves his hat on the washstand, trips over the carpet, and drives his car into the rose-bed ? But it is the last sentence to the patient, the punch-line, which is the most important of all. The acute case is easy. " Have you in the office next week " : " Bit of a rest, do us all good " : or more facetiously : " Go easy on the grapes." The patient is left cheerful and resigned to his brief indisposition. After my 97th visit to old Harry with his chronic chest, however, such brisk remarks fall a bit flat, and here’s where the weather, skilfully used, comes in handy. Such are the vagaries of our climate that almost any change must be for the better. When the fogs of January turn the old boy blue, he is encouraged to look forward to the spring. The misty, moisty April gives him pneumonia, but during the district nurse’s daily calls with penicillin he can look forward to summer. In July it gets so hot he can hardly breathe, so we tell him it’ll be easier when it’s cooler; and so we get round to where we came

in.