MINISTRY OF HEALTH STATEMENT ON STREPTOMYCIN

360 cases such as cardiac and gastric conditions and patients with tuberculosis. Most homes refuse cases needing The bed-treatment or nursing attention at night. almoners note that this leads to wastage of nurses, for some homes with several nurses on the staff make this condition. Some homes have a bare institutional look; others provide long minatory lists of rules which take no account of the real welfare of the patient. The almoners note that there is a need for more convalescent homes, particularly in north-east England. The classes most poorly catered for are mothers with babies, children, adolescent boys, patients with severe heart trouble, asthma, pulmonary tuberculosis and other chest complaints, fits, or skin diseases, and those needing more complicated treatment, dressings, or special diet. Holiday and rest-break homes are also needed. Many homes could be brought up to modern standards if altered and adapted, and furnished more cheerfully. A friendly reception, the almoners say, is highly important ; and patients should be encouraged to breakfast and rest in bed, especially during the first week. Hours of rising should be later, and there should be plenty of restingplaces, in and out of doors. The length of stay should be determined only by the patient’s needs ; expert advice should be sought on diet ; and occupation and recreation, as well as other methods of reablement, should be extended. Finally they suggest that there should be a central advice service to coordinate the work of all convalescent homes, to set up standards, and to give information about organisation and staffing. Since the moment is not too propitious for extending services, it might be useful to consider how our existing convalescent homes could be used to the best advantage ; and since " convalescence " three months after the illness is .rather unsatisfactory, it might be well to decide what types of patient should have first claim on available beds. Children who would otherwise return directly to slum areas should surely be among the first considered, and so should mothers of families who would otherwise go straight back to domestic chores. Young people in the growing years, old people living alone, and patients with pulmonary tuberculosis all seem to deserve some preference. If these needy cases were served first it is possible that they could also be served at once.

MINISTRY OF HEALTH STATEMENT ON STREPTOMYCIN

THE Ministry of Health announce that the preliminary results of the streptomycin trials organised by the Medical Research Council have proved sufficiently encouraging to justify the view that, as supplies of the drug permit, patients suffering from tuberculous meningitis or miliary tuberculosis should be given the opportunity of receiving treatment with the drug. Streptomycin is the best drug at present available for the treatment of these conditions, but it prolongs life and relieves symptoms in only a proportion of cases, and it is too early to say whether it ever produces a permanent ’

cure.

The production of streptomycin in this country is still very limited ; but additional supplies obtained from the United States have made it possible to allocate some each month to certain medical schools for use in teaching or associated hospitals. Supplies are available at the moment in the United Kingdom for about 150 beds. The cost of the streptomycin is still very high, and for the time being the drug will be distributed by the Government to the medical schools free of charge. In view of the limited experience of treatment with streptomycin in other conditions, the medical schools have been asked for the present to restrict treatment with the drug to cases of tuberculous meningitis and miliary tuberculosis. It is not recommended for chronic

pulmonary tuberculosis.

Tuberculous meningitis and miliary tuberculosis will be treated with streptomycin at the following hospitals : ENGLAND

Liverpool.-Alder Hey Children’s Hospital (6 children’s beds) and Royal Southern Hospital, Fazakerley (3 adult beds).
Hospital,

Bristol,

1.

Manchester.-Royal Infirmary. Birmingham.-Children’s Hospital, Ladywood Road, Birmingham, 16. Leeds.-General Infirmary and St. James’s Hospital. London.-The Middlesex Hospital, W.1, St. Bartholomew’s Hospital, E.C.1, The London Hospital, E.l, St. Mary’s Hospital, W.2, St. Thomas’s Hospital, S.E.1, and Guy’s Hospital, S.E.1. ’

WALES

Cardiff.-Isolation Hospital. NORTHERN IRELAND

Belfast.-Whiteabbey

Sanatorium, Whiteabbey, Hospital, Purdysburn. Siinilar arrangements are being made in Scotland details will be announced shortly.

Purdysburn

and

Fever

and

Practitioners who have a case of suspected tuberculous meningitis or miliary tuberculosis should get in touch direct with the nearest convenient hospital on this list, or (in the case of hospitals in the London area) with the Emergency Bed Service (telephone Monarch 8515). This scheme does not in any way affect the arrangements already made by the Medical Research Council for the treatment in certain hospitals of cases of meningitis due to Haemophilus influenzcs. NATIONAL HEALTH SERVICE FOR NORTHERN IRELAND

Northern Ireland, in its turn, is now to create a national health service, and the Bill has just been published. In the main, the provisions follow the pattern already familiar in the English and Scottish Acts. But the size and population of the six counties is no greater than that of some of the separate regions into which England has been divided for hospital planning and administration, and this has permitted simplification Thus instead of a of the administrative structure. number of regional hospital boards there will be a single Hospitals Authority, placed in charge of all existing hospitals, and entrusted with providing (by fresh building or by reorganisation) a full service., Much like the regional boards in England, this authority will be constituted by the minister after consultation with the university, the medical profession, the local authorities, and the hospitals both voluntary and rate-aided. Again, instead of separate local executive councils in most health-. authority areas; Northern,Ireland is to have a single General Health Services Board, half professional (medical, dental, and pharmaceutical) and half lay. As in England and Scotland, there will also be local medical, dental, and pharmaceutical committees in each health-authority area. So far the scheme follows the earlier models closely. But the official document circulated in explanation of the Bill contains indications that some of the amendments vainly sought in London have been conceded in Belfast. For instance, there is no mention of a basic salary for the general practitioner ; " every doctor will be paid according to the number of persons-men, women, and children -who have chosen him as their family doctor." Also in so far as inquiries are concerned into " allegations that any person providing professional services is inefficient or unsuitable "-a final appeal lies -to the High Court. The General Health Services Board will be the employing authority for general practitioners and will also be responsible for planning and building health centres (a responsibility which in England is placed upon the - local health authority). The pathological, bacteriological, and blood-transfusion services are made the