In England Now

369 a sheeted figure, the glimpse that does but suggests endlessly. " If you want to be bold and bad, go and do it in the boxing ring or on the football field or on a horse. Only 23 people were killed in these ways last year, whereas on motor-bikes there were ..."

through

a

door at

not disclose

In

finally

At the end of the courses for drivers and riders, when they were handed their licences, they would be given a little slip telling them-quite cheerfully-that the most dangerous time for them would be not when they first went on the road but shortly afterwards, when the caution of the novice had worn off. The whole course would take about ten days, and a driver’s licence would be on a par with a pilot’s certificate, and as worth guarding as a minor professional

qualification. Any motoring offence, especially exceeding

the limit restricted roads, where two-thirds of the deaths occurred last year, should automatically involve a testing or re-testing. This would make the old driver who was uncertain of passing the test extraordinarily careful. It would also threaten the livelihood of the careless goods-vehicle driver, who is the biggest killer of children. This should be made mandatory on our amateur justices, the bulk of whom are drivers themselves and can be lenient to the point of flabbiness. on

CONCLUSION

The whole question is this : Having regard to the facts that 4500-5000 people are killed and some 150,000 wounded on the roads each year and that 90% of these accidents are preventable, is driving a sufficiently lethal occupation to demand skilled drivers who are adequately tested ?‘ Whether the Minister of Transport and a Parliament of drivers are brave and selfless enough to do anything about it is another matter. Meanwhile twelve people going about their tasks today are destined to be killed on the roads tomorrow.

Public Health Supplies

of B.C.G. Vaccine

ACCORDING to an announcement by the Department of Health for Scotland, " reports and letters appearing in the press indicate that there is a belief that the temporary stoppage of supplies of B.c.G. vaccine is due to

financial reasons. " This belief," says the announcement, " has no foundation. As has been previously stated, the stoppage is entirely due to production difficulties of a technical nature. Everything possible is being done to overcome these difficulties, and the Department of Health hope that as a result further supplies of B.c.G. will be available in the near future." Scottish Report on Poliomyelitis In a report on the 1947 epidemic of poliomyelitis, the Department of Health for Scotland notes that the disease seemed to attack small, rather than large, family groups : and " it was obvious that poliomyelitis was a disease especially of persons living in four apartment houses, particularly those with less than six occupants." Compared with previous years, there was a significant increase in the percentage of cases among people over 15 years of age. In the 1947 epidemic, 6-5% of cases were among children under 1 year of age, 35-8% among .

those aged 1-4 years, 34-6 % among those aged 5-14 years, and 23-1% among people aged 15 years or more. Paralytic poliomyelitis was a disease principally of the cities. The focal attack of the outbreak in cities was in children under 5 years of age, whereas in rural areas it was in older patients. Estimate of Births The Registrar-General’s return for the week ended Feb. 4 gives the following estimates for live births in England and Wales : final estimate for the quarter ending March 31, 186,000 ; provisional estimate for the quarter ending June 30, 183,000.

A

England

Now

Running Commentary by Peripatetic Correspondents

I HAVE been following the activities of my colleagues, and others who are offering themselves at the hustings, with purely academic interest, because, like everyone else, I made up my mind which way to vote before -the campaign had even started and quite irrespective of the candidates’ oratorical powers. I have been sadly disappointed at the low standard of repartee in dealing with hecklers, which is perhaps attributable to the modern habit of politicians of haranguing defenceless audiences " over the wireless. Such retorts as Shut up ! ", " Oh do shut up ! ", and " You silly woman " represent a stage in the development of repartee that most of us left behind at our prep-school and are asking for the radio " rejoinder : " You clot! to be a There seems lack of subtlety and originality in the posters, too. When Lord Addison was standing in the 1910 election his opponent put up a poster saying : " Dr. Addison asks for support on the ground that he is used to cutting up bodies. Will you let him cut up the Empire ? Don’t vote for Addison who Cuts Up the Stomach, but vote for Hay who will See it is FILLED." People (including the Editor of The Lancet) wrote to the Daily Chron’icle about it. You can read the angry headlines in the faded cuttings in that fascinating store of medical miscellanea, the scrap-books in the Royal College of Surgeons library in London. I fancy that one of the attractions of electioneering is that sticking up posters for passers-by to see gives vent to a primitive There is surely the same underlying motive in urge. sticking slogans on outdoor walls at election times and in scribbling other things on other walls at other times. *

*

*

My wife has undertaken to distribute milk to the needy coloured infants at what may be called a welfare clinic in the grounds of our excellent maternity

more

unit. The maximum age is about three years. Since she started this I have often been surprised to hear smatterings of pidgin-Arabic floating round the house, to the amusement of the servants, because with commendable enterprise my wife took on the job not knowing much more than imshi and the more useful fissa. In my own ignorance I had carefully explained to her that a certain amount of organisation was needed if she was to make up, distribute, and annotate the issue of milk to upwards of fifty screaming infants whose escorts had never learnt the art of queueing. The maths involved in mixing dried milk with water, being psychic as to the number who would turn up, and opening sufficient tins in advance occupied more than one whole evening. We need not have worried. All our planning went by the board. The children appeared with escortusually some relative about a year older than the eldest child taking part in this new whim of the mad British. Sometimes the escorts would appear without infants but with filthy bottles in lieu, so the order went out : " 1Btwo chicos, no milk." On the next few mornings the provision of " chicos " was accomplished with such speed that the only honest explanation could have been that all the " patients " lived just outside the hospital

compound. The proceedings

are enlivened by the occasional appearance of the clinic doctor-a very hard-worked lady-whose method of communication can at least be said to quell the riot for a few seconds. She resorts to a flow of language, pitched in a voice even higher than that of the indigenous population, which leaves all mute and gaping with awe. The method adopted by one of the interpreters, who gave a helping hand the first few mornings, is equally effective ; this consists in beating a rapid tattoo with both hands on the heads of all children in reach. The milk is distributed in emptied butter tins, and woe betide the doler-out-ofmilk if, in a fit of temporary aberration, she hands out an Australian butter tin when a South African one was handed in. The very small infants are given bottleswith careful instructions as to which is the teat and which the valve. The finest sight of all is the row of babies

370 on their backs on their half pints like old

lying

narrow

*

benches

swigging

down

topers. *

*

society

deliver his fervent address while giving fearful his shoulder at the serpents and cockatrices on the walls which seemed likely to attack a tergo. To secretaries of similar bodies I recommend the Pavilion. There is space for man and motor-car, catering above the average-and Brighton. Of all towns in this country it has most of that gaiety which is sometimes called " Contii-iental." (Have you ever been in Rennes on a wet Monday evening ?) But these conventions of learned and less learned societies are becoming a major problem. Few medical schools can deal with an attendance of several hundred, and hotel accommodation in many towns is insufficient. Our colleagues in the U.S.A. take one or more hotels entire, and that method, or some cooperation with Mr. Butlin, might be explored here. Wouldn’t the provision of accommodation offer an escape from penury to one or more noble dukes ? Bed and board for a few hundred, with lectures in the ballroom and dinner in the banqueting-hall, should not be too difficult, and at the rate at -which we doctors form congregations of common interest the palace might be let for ten months out of twelve. The row of Lelys or Gainsboroughs would look better on the wall than those dusty anatomical charts. over

*

*

*

I’m not much of a one for Old So-and-So’s gatherings, and I have only been to one Old Boys’ dinner since I left school in 1921 (great scot! It’s nearly thirty years). I went to last night’s one to see Norman, a life-long though intermittent friend, and the secretary knew this,. but of course he put us in opposite’corners of the room, blast him. My neighbours were (a) a rugger enthusiast, real or simulated, :who somehow recalled that I was in the xv (as 15th man)and therefore assumed that I knew and cared how the school was doing this season ; and (b) a man who mistook me for my elder brother and regaled me with reminiscences of friends whom I had never known. But these were at least decent looking old boys (as distinct from Old Boys). What shocked me were the glimpses I kept getting of my real school friends hidden behind the battered ruins of a human face. Sometimes a trick of expression or typical gesture would someone would ask : " Isn’t that give them away.. Or " Then I would realise that this fat old X over there ? bald puffy-cheeked debauchee was indeed all that remained of my study-mate, lively and lovely Bill X, and I would remember that Sunday off when we got up at 6 A.M., rode to my home on our bikes, and there played tennis and browsed in the strawberry bed alternately till it was- time to -ride back. Was it 15 or 20 sets we played ? And (no, it can’t be : yes it is) that scraggy old bird next to him, with a collar four sizes too big, was I remembered hearing he’d been ill. He once Peter Y. was the one who ate so many cream horns that the Head said he was getting like one. He looked as if he could do with a few now-and a wash. I managed to catch Norman in the cloakroom on the way out and fix up to meet him at Lyons Corner House, so I needn’t go next year. *

*

*

Last week’s disclosure that medical discussions are to be broadcast in the United States, has given me a further idea. Instead of medical journals let us have medical recordings. Then the medical library of the future will have. rows of those comfortable cubicles where you can try your choice, like the gramophone shops, It is so much with perhaps a few studios for films. easier to listen than to read. Except, of course, that you cannot skip the dull bits. ’

it

*

*

Topical Terminology Paediatrician to mother : Is there any tuberculosis in the family ? Mother : Oh, that’s all right, doctor. He was patched

last month.

to

the Editor

SOCIAL SIGNIFICANCE OF SYMPTOMS

The Society of Applied Omphaloscopists held its winter meeting at the Pavilion at Brighton. The programme, intellectual, social, and nutritional, could not have been bettered, and it was worth a lot to see the doyen of the

glances

Letters

SiR,-Dr. Gooddy’s article in your issue of Feb. 11 is more than disturbing. It starts with some paragraphs of crypto-political exposition containing a number of assumptions which could hardly be argued out in your journal. The views put forward appear to lead to a somewhat derogatory attitude towards social security, the psychiatrists, and the individual about whom this article is most concerned. Is this’latter, for example, the only person who smokes under the " no-smoking " notice ? Is he any worse than the patient who walks into my consulting-room smoking without permission, equally idle, equally improvident of other people’s resources, but who does think that I can help himT It would appear that there are three classes of patients in Dr. Gooddy’s mind-those with organic disease, those with some psychopathology, and; in between, a definable group whose troubles arise from social circumstances, and whose difficulties are therefore not in the province of medicine. What is this groupPerhaps Dr. Gooddy’s experience in Queen Square with its highly selected sick population is not common experience ; and I certainly cannot identify this impatient, ill-behaved, certificate-seeking individual, who is supposed to blackmail me with his blackouts and gastritis and fibrositis, the sequel of conscription, change of job, or amatory setback (often precipitated by seeing a romantic cinema programme). If I could identify this patient who is unadjusted because of his social background from amongst all those whose symptoms are expressed with a lavish use of superlatives and exaggeration, I would have to include many people with organic disease and perhaps all my Irish patients, whose language is naturally a rich one. In the definition of this group the causes of the disability include constitutional defects, defective education and social opportunities, and particularly inadequate housing, susceptibility to medical advertisements, ignorance, and the desire to get something for nothing. Apart from the suggestion that the " something for nothing" may be a certificate to the housing authorities, I fail to see what this patient is after. Can it really be, perhaps, that he prefers to live on sick-pay instead of his normal wage, which is probably at least three times as large ? Finally, having stated that it is impossible for the medical profession to help such patients in these matters, a solution of the problem is suggested. This consists in the doctor’s scientific by an attempt approach replacing to achieve a dogmatic statement in every case-to be able to tell the patient, after a thorough examination, that it is certain that there is nothing wrong with him and to offer him sympathy and the exit door of the outpatients’ department. I cannot help remembering that most of my medical mistakes in missing grave organic disease have occurred in two groups of cases : firstly, those whose description of their symptoms has sounded exaggerated ; and secondly, and most importantly, those who have had the most complete and repeated examinations. When one remembers the attitude of the medical profession in the Victorian era towards the work of social reformers and public-health authorities, when one recalls the attitude of the Royal Colleges to the report on the fitness of Boer War recruits, one should be a little humble before defining the scope of the work of the doctor. If these patients come to see me seeking my help, I will think it within my province on that account alone. Medicine is a social function and the job of the doctor relates to the maintenance of health and care of sickness of the individual living in society. If illness arises from any maladjustment of the individual’s relationships, then it is a province of medical study. ‘