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MINISTERIAL WHIRLIGIG
582 for the precipitation but also for the occasional dissolution of stones, COLE and HARRIDGE 24 have based Over the past seven a new therapeutic approach. years they have treated 9 patients with residual stones in their common ducts (demonstrated on cholangiograms) by protracted clamping of the T-tubes and the oral administration of bile-salts 3-4 g. daily. In 7 of the 9 patients, the stone-shadows vanished within eight to thirteen weeks. Before drawing conclusions the authors wisely make several reservations. First, they had no absolute proof that the X-ray shadows did, in fact, represent calculi. In all patients the deformity was observed in more than one film. They " fulfilled the roentgenographic requirements of stones " (CoLE and IlARRlDGE regard the irregular shape and a surface completely surrounded by the contrast medium as suggestive, and concavity at the terminal end of the There was also shadow as " fairly conclusive "). clinical evidence that all their patients had harboured stones in their common ducts at some time ; and both 24.
Cole, W. H., Harridge, W.
H.
J. Amer. med. Ass. 1957,
164, 238.
Annotations WHIRLIGIG Mr. Dennis Vosper’s resignation from the post of Minister of Health, though not unexpected, is regretted not least because of its cause, and the medical profession will join his parliamentary colleagues in good wishes for his convalescence. He is succeeded by Mr. D. C. WalkerSmith, Q.c., formerly Minister of State, Board of Trade. MINISTERIAL
Mr. Walker-Smith, who is 47, is the son of Sir Jonah Walker-Smith, who was director of housing at the of Health from 1919 to 1925. He was educated at Rossall and Christ Church, Oxford, and was secretary of the Oxford Union in 1930. He graduated with first-class honours in modern history the following year and was called to the bar in 1934. He was elected to Parliament in 1945, and since 1955 has represented the east division of Hertfordshire. In 1955 he was appointed parliamentary secretary to the Board of Trade and last year economic secretary to the Treasury. He is vice-president of the Urban District Councils’ Association of the British Waterworks Association. In 1954-55 he was chairman of the Conservative advisory committee on local government, and from 1951 to 1955 of the Conservative Members (1922) Committee.
Ministry
Mr. J. K.
Vaughan-Morgan, who as parliamentary Ministry of Health has deputised for Mr. Vosper during his illness, has been appointed to Mr. Walker-Smith’s old post at the Board of Trade, and Mr. R. H. M. Thompson becomes parliamentary secretary to the Ministry of Health. secretary
to the
Mr. Thompson, who is 44, was educated at Malvern College, and before the late war was in business in the East where he has travelled extensively. From 1940 to 1946 he served in the Royal Navy. He was elected to Parliament in 1950 and He has held appointments as now sits for Croydon South. assistant Government whip, lord commissioner of the Treasury, and vice-chamberlain of the Royal Household. In 1951 he was appointed a Cottonian family trustee of the British Museum.
Stability of tenure is political appointments,
not one of the characteristics of and the possibility of change is often one of the attractions of the system. But the shape of government, as of so many other things, is changing ; and besides the great political offices of the Secretaries of State, which have existed for centuries, there have grown up more lately the modern Ministries which carry responsibility for the administration of the services of the Welfare State-such as education, health, and pensions. In these Ministries continuity is often important. Each new Minister who is called to office has to master the often
who eventually had to be re-explored were found to have them. Secondly, it could not be proved that the stone-shadows disappeared as a result of bile. salt therapy-nor could it be settled whether they had disintegrated, dissolved, or been passed. Yet COLE and 11AItP.IDGE were sufficiently impressed to will continue to give this treatment say that they in all [similar] cases until [they have] evidence to the contrary." Lastly this regime is obviously inapplicable to patients with complete obstruction. For the bile. salt therapy to be effective, bile must flow freely around the stones, and it must be possible to clamp the T-tube for long periods. So many unknown factors-and some important
patients
B
:
B
"
reservations-may seem discouragingbut, whatever its shortcomings, this method marks a welcome physiological approach to an old and difficult problem. The time-honoured slogan that no stone will be left unturned can hardly reassure the patient who has them in his
undissolved
duct. " No stone will be left more promise. hold may
common "
which he has to implement ; to visit, the schools with which he has been entrusted; and to say, get to know the Civil Servants in Whitehall, and the (some. times less civil) professions outside. Time spent in this way is valuable if the knowledge and experience gained is put to use ; but frequent changes of Minister can turn it at best into an extravagant use of time and effort, at worst into an excuse for inaction, nescience, and administrative ineptitude. Lord Moran recently pointed out1 that, in seven years as president of the Royal College of Physicians of London, Sir Russell Brain had negotiated with no fewer than six Ministers of Health. A seventh has now been appointed and at the same time the parliamentary secretary has been changed. The record of the Ministry of Education-four Ministers in six years-is almost as variegated. But education, unlike health, has at any rate the political advantage of a seat in the Cabinet.
complex legislation
IMPORTING POLIOMYELITIS VACCINE
THE Government’s decision to buy American-made (Salk) poliomyelitis vaccine has been generally welcomed in the press. The vaccine is being imported in order to supplement the supplies of British-made vaccine, which will not suffice to meet the demand next summer. Supplies of British vaccine have been inadequate for some time, and there has been great controversy on whether American vaccine should be imported. The debate has not been conducted wholly at the scientific level, yet even when the pros and cons are considered dispassionately it has not been easy to reach a decision. The important difference between the two vaccines is the replacement in the British vaccine of the Mahoney strain of type-1 poliomyelitis virus used in the Salk vaccine by the less virulent Brunenders strain; and the significance of this step can be appreciated from a critical and revealing account by Meier 2 of the safetytesting of poliomyelitis vaccine. Meier reviews the background of the development of the vaccine in the U.S.A. in the past three years, and he points unhesitatingly to many scientific errors and errors of judgment. The introduction of any new vaccine on a mass basis involves a finite risk that the vaccine may not be entirely safe ;; but with poliomyelitis, in which the overall incidence of paralysis is very low, the use of vaccine can be justified only if the risk of acquiring the disease from the vaccine itself is extremely small. After the 1. See Lancet, 1957, i, 794. 2. Meier, P. Science, 1957,
125, 1067
Cole, W. H., Harridge, W.
H.
J. Amer. med. Ass. 1957,
164, 238.
Annotations WHIRLIGIG Mr. Dennis Vosper’s resignation from the post of Minister of Health, though not unexpected, is regretted not least because of its cause, and the medical profession will join his parliamentary colleagues in good wishes for his convalescence. He is succeeded by Mr. D. C. WalkerSmith, Q.c., formerly Minister of State, Board of Trade. MINISTERIAL
Mr. Walker-Smith, who is 47, is the son of Sir Jonah Walker-Smith, who was director of housing at the of Health from 1919 to 1925. He was educated at Rossall and Christ Church, Oxford, and was secretary of the Oxford Union in 1930. He graduated with first-class honours in modern history the following year and was called to the bar in 1934. He was elected to Parliament in 1945, and since 1955 has represented the east division of Hertfordshire. In 1955 he was appointed parliamentary secretary to the Board of Trade and last year economic secretary to the Treasury. He is vice-president of the Urban District Councils’ Association of the British Waterworks Association. In 1954-55 he was chairman of the Conservative advisory committee on local government, and from 1951 to 1955 of the Conservative Members (1922) Committee.
Ministry
Mr. J. K.
Vaughan-Morgan, who as parliamentary Ministry of Health has deputised for Mr. Vosper during his illness, has been appointed to Mr. Walker-Smith’s old post at the Board of Trade, and Mr. R. H. M. Thompson becomes parliamentary secretary to the Ministry of Health. secretary
to the
Mr. Thompson, who is 44, was educated at Malvern College, and before the late war was in business in the East where he has travelled extensively. From 1940 to 1946 he served in the Royal Navy. He was elected to Parliament in 1950 and He has held appointments as now sits for Croydon South. assistant Government whip, lord commissioner of the Treasury, and vice-chamberlain of the Royal Household. In 1951 he was appointed a Cottonian family trustee of the British Museum.
Stability of tenure is political appointments,
not one of the characteristics of and the possibility of change is often one of the attractions of the system. But the shape of government, as of so many other things, is changing ; and besides the great political offices of the Secretaries of State, which have existed for centuries, there have grown up more lately the modern Ministries which carry responsibility for the administration of the services of the Welfare State-such as education, health, and pensions. In these Ministries continuity is often important. Each new Minister who is called to office has to master the often
who eventually had to be re-explored were found to have them. Secondly, it could not be proved that the stone-shadows disappeared as a result of bile. salt therapy-nor could it be settled whether they had disintegrated, dissolved, or been passed. Yet COLE and 11AItP.IDGE were sufficiently impressed to will continue to give this treatment say that they in all [similar] cases until [they have] evidence to the contrary." Lastly this regime is obviously inapplicable to patients with complete obstruction. For the bile. salt therapy to be effective, bile must flow freely around the stones, and it must be possible to clamp the T-tube for long periods. So many unknown factors-and some important
patients
B
:
B
"
reservations-may seem discouragingbut, whatever its shortcomings, this method marks a welcome physiological approach to an old and difficult problem. The time-honoured slogan that no stone will be left unturned can hardly reassure the patient who has them in his
undissolved
duct. " No stone will be left more promise. hold may
common "
which he has to implement ; to visit, the schools with which he has been entrusted; and to say, get to know the Civil Servants in Whitehall, and the (some. times less civil) professions outside. Time spent in this way is valuable if the knowledge and experience gained is put to use ; but frequent changes of Minister can turn it at best into an extravagant use of time and effort, at worst into an excuse for inaction, nescience, and administrative ineptitude. Lord Moran recently pointed out1 that, in seven years as president of the Royal College of Physicians of London, Sir Russell Brain had negotiated with no fewer than six Ministers of Health. A seventh has now been appointed and at the same time the parliamentary secretary has been changed. The record of the Ministry of Education-four Ministers in six years-is almost as variegated. But education, unlike health, has at any rate the political advantage of a seat in the Cabinet.
complex legislation
IMPORTING POLIOMYELITIS VACCINE
THE Government’s decision to buy American-made (Salk) poliomyelitis vaccine has been generally welcomed in the press. The vaccine is being imported in order to supplement the supplies of British-made vaccine, which will not suffice to meet the demand next summer. Supplies of British vaccine have been inadequate for some time, and there has been great controversy on whether American vaccine should be imported. The debate has not been conducted wholly at the scientific level, yet even when the pros and cons are considered dispassionately it has not been easy to reach a decision. The important difference between the two vaccines is the replacement in the British vaccine of the Mahoney strain of type-1 poliomyelitis virus used in the Salk vaccine by the less virulent Brunenders strain; and the significance of this step can be appreciated from a critical and revealing account by Meier 2 of the safetytesting of poliomyelitis vaccine. Meier reviews the background of the development of the vaccine in the U.S.A. in the past three years, and he points unhesitatingly to many scientific errors and errors of judgment. The introduction of any new vaccine on a mass basis involves a finite risk that the vaccine may not be entirely safe ;; but with poliomyelitis, in which the overall incidence of paralysis is very low, the use of vaccine can be justified only if the risk of acquiring the disease from the vaccine itself is extremely small. After the 1. See Lancet, 1957, i, 794. 2. Meier, P. Science, 1957,
125, 1067