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LONDON TROPICAL MEDICINE
1030 prove to be the correct one ; but in another appendix to the M.R.C. report Court Brown and Doll said that there was no evidence of a threshold below which no increase in teukmmia was produced. On the other hand, as Loutit 4 has observed, there are reasons why leukfæmia should not be taken as a rnodel for all radiation-induced malignancies, and what little quantitative evidence there is of the carcinogenic properties of radiostrontium suggests that the relationship is not linear and that there is some form Much is still of threshold or effective latent period. and the correct conclusion, as dangerously uncertain, Loutit puts it, " in the present state of scientific knowledge is that a linear relationship sets the limit and indicates the worst possible conditions, so that it would be prudent to go easy until the real facts are ascertained." It is against the Government’s apparent reluctance to do all they can to " go easy " by pressing for an early agreement on the limitation or abolition of nuclear explosions that we protest. LONDON
TROPICAL
MEDICINE
IN medicine, 1899 was a very long time ago ; and in his fascinating account of the first fifty years of the School of Tropical Medicine in London Sir Philip MansonBahr5 shows incidentally how much the world has been changed by that originally modest enterprise. At the end of the 19th century, Britain had a vast tropical empire, in many parts of which the death-rates were appallingly high. The doctors sent to the Colonies were often ill-equipped even to use what knowledge our profession then possessed of tropical diseases ; and Patrick Manson, returning to England after twenty-three years in the East, saw tliat his most important task was to promote a school for teaching and research. Appointed medical officer to the Colonial Onice in 1897, he enlisted the support of Joseph Chamberlain (his Secretary of State), as well as of the General Medical Council ; and two years later the London School of Tropical Medicine. associated with the Albert Dock Hospital, was opened with 28 students. (The Liverpool school had begun work six months before.) At first most of the students were sent by the Colonial Office, but many came from missionary societies, the Forces, and other organisations, and in 1912 the school The Dockland site had advantages was much enlarged. in that the students were secluded from the London whirl; but after the first world war a move was made to central London, where a hotel in Endsleigh Gardens became the combined school and hospital under one roof. Then in 1925 the school was merged in the London School of Hygiene and Tropical Medicine, and in 1929 the fine new buildings in Gower Street were opened. Two years later it became part of the University of London, and soon afterwards it incorporated the Ross Institute and took over the malaria laboratory at Ilorton Hospital, Epsom. The Hospital for Tropical Diseases remained at Endsleigh Gardens until it was closed at the outbreak of the second world war, after which teaching continued in the Dreadnought and other hospitals, and from 1944 in a former nursing-home in Devonshire Street. With thepassing of the National Health Service Act the decision was taken not to build the new hospital for which many of us hoped ; and instead a section of St. Pancras Hospital became in 1949 the clinical centre of the school, under the board of governors of University College Hospital. With the end of the fifty years this book closes. Sir Philip was for a decadc director of the clinical division of the school ; and his very large acquaintance will find in his history the qualities they could expect-the knowledge, the zest, the humour, and the
F. Brit. med.
4. Loutit, J. J. April 20, 1957, p. 91 4. 5. History of the School of Tropical Medicine in London :18991949. By Sir PHILIP MANSON-BAHR, F.R.C.P. Memoir no. 11of the London School of Hygiene and Tropical Medicine. London: H. K. Lewis. 1956. Pp. 329. 50s.
that bring such stories to life--not to mention, the lmiscxjlla,rroous pictures. The official facts are all there ; but so am the people who made the facts and whom they merely reflect. Perhaps nobody but this. author could (or would) have attempted to provide biographies of i, hundred of these people—doctors, scientists, and technicians—some of them long since part of medical history but others still working at the school. Even the reader who looks at nothing but these biographies will get some idea. of the achievement of London tropical medicine through its exciting expeditions and its exciting discoveries, still happily continuing. Sir Philip likens theschool to an insect which has passed through the egg, larval, and pupal stages, to blossom fort h ns a full-ucdged imago. But it performed great feats even in the earthbound or submarine stages of this analogy, and who can say where it may soar on
humanity
wings ? RADIOGRAPHERS IN THE N.H.S.
USEFUL
though
arbitration
can
be in
settling a disputed a long
issue, the arbitrator does not necessarily take view ; and in Hie National Health Service the
use of arbitration does not in any way absolve the Ministry of Health of its responsibility for seeing that the service is properly maintained. If the Ministry is inclined to think that further attention to the shortage of radiographers is unnecessary because they had an award last November from the Industrial Court, we hope it will look again at the facts of a disturbing situation. 11’e, need not recapitulate the criticisms of the award which have been made at length in our correspondence columns. Nor need we reproduce all the arguments lately set out in the Society of Radiographers’ dignified statement to the press.’ For the moment we are concerned chiefly with the evidence that despite, or because of, the award the radiographic services of the N.H.S. are deteriorating and will continue to do so. A reduction in the number of radiographers and the amount of work they do might be intelligible as part of a deliberate fully discussed with the Central Health Services Council before it was adopted ; but it is whollyunacceptable if it arises merely from the Government’s antiquated conviction that in public services people need not be paid the kind of salaries they could earn outside. The Society of Radiographers says1 that whereas the Ministry last November estimated the. general shortage at about 20% it is now nearer 25%. Some local shortages are so acute that departments have already restricted their services-the latest example being a warning that the X-ray departments in the Lewisham Hospital Group will soon be manned by askeleton sta-S.’ "2 In some places departments have been kept open only by radiographers working at a pressure which neither can nor should be continued for long periods. That in time of difficulty virtue should be its own reward is in keeping with the medical tradition; but, when one expects people to be ready to make whatever personal sacrifices are required to keep an institution running, one cannot also expect them to accept, permanently, a lower rate of pay than their skill and quality should command. The Society of Radiographers, pointing out that its own problems are closely related to similar ones in other parts of the N .H.8., puts its case fairly and with restraint:
policy,
"
"
The National Health Service is a social experiment of wide scope : those who are involved in it expected stresses and strains during its formative years and were prepared to make sacrifices to overcome them. But the society is sure that the general public, who use the service, would not wish these conditions to be regarded as other than temporary maladjustments and that they would not wish them to persist at the risk of a serious handicap on the service as a whole." 1. Present Shortage of Radiographers: its Content, Causes, and Possible Results. Memorandum from the Society of Radiographers, 32, Welbeck Street, London, W.1.
2. Erening Standard, April 29, 1957.
TROPICAL
MEDICINE
IN medicine, 1899 was a very long time ago ; and in his fascinating account of the first fifty years of the School of Tropical Medicine in London Sir Philip MansonBahr5 shows incidentally how much the world has been changed by that originally modest enterprise. At the end of the 19th century, Britain had a vast tropical empire, in many parts of which the death-rates were appallingly high. The doctors sent to the Colonies were often ill-equipped even to use what knowledge our profession then possessed of tropical diseases ; and Patrick Manson, returning to England after twenty-three years in the East, saw tliat his most important task was to promote a school for teaching and research. Appointed medical officer to the Colonial Onice in 1897, he enlisted the support of Joseph Chamberlain (his Secretary of State), as well as of the General Medical Council ; and two years later the London School of Tropical Medicine. associated with the Albert Dock Hospital, was opened with 28 students. (The Liverpool school had begun work six months before.) At first most of the students were sent by the Colonial Office, but many came from missionary societies, the Forces, and other organisations, and in 1912 the school The Dockland site had advantages was much enlarged. in that the students were secluded from the London whirl; but after the first world war a move was made to central London, where a hotel in Endsleigh Gardens became the combined school and hospital under one roof. Then in 1925 the school was merged in the London School of Hygiene and Tropical Medicine, and in 1929 the fine new buildings in Gower Street were opened. Two years later it became part of the University of London, and soon afterwards it incorporated the Ross Institute and took over the malaria laboratory at Ilorton Hospital, Epsom. The Hospital for Tropical Diseases remained at Endsleigh Gardens until it was closed at the outbreak of the second world war, after which teaching continued in the Dreadnought and other hospitals, and from 1944 in a former nursing-home in Devonshire Street. With thepassing of the National Health Service Act the decision was taken not to build the new hospital for which many of us hoped ; and instead a section of St. Pancras Hospital became in 1949 the clinical centre of the school, under the board of governors of University College Hospital. With the end of the fifty years this book closes. Sir Philip was for a decadc director of the clinical division of the school ; and his very large acquaintance will find in his history the qualities they could expect-the knowledge, the zest, the humour, and the
F. Brit. med.
4. Loutit, J. J. April 20, 1957, p. 91 4. 5. History of the School of Tropical Medicine in London :18991949. By Sir PHILIP MANSON-BAHR, F.R.C.P. Memoir no. 11of the London School of Hygiene and Tropical Medicine. London: H. K. Lewis. 1956. Pp. 329. 50s.
that bring such stories to life--not to mention, the lmiscxjlla,rroous pictures. The official facts are all there ; but so am the people who made the facts and whom they merely reflect. Perhaps nobody but this. author could (or would) have attempted to provide biographies of i, hundred of these people—doctors, scientists, and technicians—some of them long since part of medical history but others still working at the school. Even the reader who looks at nothing but these biographies will get some idea. of the achievement of London tropical medicine through its exciting expeditions and its exciting discoveries, still happily continuing. Sir Philip likens theschool to an insect which has passed through the egg, larval, and pupal stages, to blossom fort h ns a full-ucdged imago. But it performed great feats even in the earthbound or submarine stages of this analogy, and who can say where it may soar on
humanity
wings ? RADIOGRAPHERS IN THE N.H.S.
USEFUL
though
arbitration
can
be in
settling a disputed a long
issue, the arbitrator does not necessarily take view ; and in Hie National Health Service the
use of arbitration does not in any way absolve the Ministry of Health of its responsibility for seeing that the service is properly maintained. If the Ministry is inclined to think that further attention to the shortage of radiographers is unnecessary because they had an award last November from the Industrial Court, we hope it will look again at the facts of a disturbing situation. 11’e, need not recapitulate the criticisms of the award which have been made at length in our correspondence columns. Nor need we reproduce all the arguments lately set out in the Society of Radiographers’ dignified statement to the press.’ For the moment we are concerned chiefly with the evidence that despite, or because of, the award the radiographic services of the N.H.S. are deteriorating and will continue to do so. A reduction in the number of radiographers and the amount of work they do might be intelligible as part of a deliberate fully discussed with the Central Health Services Council before it was adopted ; but it is whollyunacceptable if it arises merely from the Government’s antiquated conviction that in public services people need not be paid the kind of salaries they could earn outside. The Society of Radiographers says1 that whereas the Ministry last November estimated the. general shortage at about 20% it is now nearer 25%. Some local shortages are so acute that departments have already restricted their services-the latest example being a warning that the X-ray departments in the Lewisham Hospital Group will soon be manned by askeleton sta-S.’ "2 In some places departments have been kept open only by radiographers working at a pressure which neither can nor should be continued for long periods. That in time of difficulty virtue should be its own reward is in keeping with the medical tradition; but, when one expects people to be ready to make whatever personal sacrifices are required to keep an institution running, one cannot also expect them to accept, permanently, a lower rate of pay than their skill and quality should command. The Society of Radiographers, pointing out that its own problems are closely related to similar ones in other parts of the N .H.8., puts its case fairly and with restraint:
policy,
"
"
The National Health Service is a social experiment of wide scope : those who are involved in it expected stresses and strains during its formative years and were prepared to make sacrifices to overcome them. But the society is sure that the general public, who use the service, would not wish these conditions to be regarded as other than temporary maladjustments and that they would not wish them to persist at the risk of a serious handicap on the service as a whole." 1. Present Shortage of Radiographers: its Content, Causes, and Possible Results. Memorandum from the Society of Radiographers, 32, Welbeck Street, London, W.1.
2. Erening Standard, April 29, 1957.