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SAVING ON DRUGS
162 anaesthetic. The administration of a chloroform-ether mixture is easily taught and the technique so simple that any doctor in an emergency can give it, with success both from the patient’s and surgeon’s point of view. T.m>",7oa Htfo H w 1 H. BECKETT-OVERY. RRnKR’1’’1’-OVRR.V.
adult population. Let the scientist dietitians experiment on the adult population. May be we could " go to it " better and better on porridge, potatoes and milk. A. L. KERR. Sutton, Surrey. z
TYPHOID IN NOTTINGHAM SAVING ON DRUGS SIR,-I am pleased to hear that the therapeutic requirements committee of the Medical Research Council are to publish a revised edition of their memorandum on economy in the use of drugs. This committee has done exceptionally valuable work, but unfortunately its recommendations are read only by a comparatively few even though they are published in the medical journals, because sad to relate probably only 50% of medical men read current medical journals. This influential committee must therefore go further than mere recommendation and persuade the appropriate ministry to prevent the importation or manufacture of all drugs in category C of the committee’s classification. At present bananas and other valuable fruits’ are banned but the importation of cassia, foeniculum and tamarindus can continue unchecked. The committee has also published a list of medicinal plants which could be grown in this country. The Ministry of Health in conjunction with the Ministry of Agriculture are doing something to carry the proposals into effect. But more energetic action is required. Let the Royal Colleges disimburse some of their lucre and establish experimental farms for the growth of medicinal plants on a commercial scale. Such a long-term policy might also be the first step in the much needed rationalisation of the chaotic drug industry. MAURICE H. PAPPWORTH. Mitcham. Surrey.
SIR,-In the review in your issue of Jan. 11 (p. 57) of my annual report on the health of the City of Nottingham for 1939, you refer to an outbreak of typhoid fever. You say that all but two of the cases were infected on the same day. This is incorrect and is not to be found in my report. You also say that the outbreak I did not limit it to one was due to an infected food. food. In spite of your provocative note I am not to be tempted to disclose further details, for reasons still valid. There was proof within a few days of mode of spread, and by means of such proof the outbreak was controlled. If your note means that outbreaks of true typhoid fever are never due to specifically infected food, then I err in good company inasmuch as there are no fewer than three such outbreaks reported in the annual report of the chief medical officer to the Ministry for 1938. The Nottingham outbreak was typhoid, not ’’ paratyphoid. Your use of the term eberthella " is to die ? Bacbe should this not allowed noticed ; teriologists tell me it is obsolete. CYRIL BANKS, Medical Officer of Health, Nottingham. Dr. Banks is a little hard on an interested inquirer. We did not suggest that the outbreak was traced to any specific food ; this is one of the points we do not know and Dr. Banks still does not say. If the infection was spread by foods generally or various, then the tracing of the epidemic in the time would have been possible only if the cases were limited to persons in an institution, or who had fed at the same table. Nor did we imply that outbreaks of true typhoid are rarely spread by infected foods ; we knew of no outbreak the cause of which was suspected in 24 hours and proved within a few days-and said so. Until Dr. Banks told us that the disease in Nottingham was typhoid, not paratyphoid, we were not justified in assuming that it was. The word eberthella would at all events have made it clear.-ED. L.
**
CHILLY SWEEPER SiR,—This morning I observed a man sweeping away He was dressed in a thin blue snow in Harley Street. jacket and shabby trousers both drenched in the icy sleet which was falling at the time. It seems a grim irony that in this street which symbolises the centre of medical knowledge to many people a man should be doing such work in a garb which no-one could pretend to be healthy. I presume that he was doing casual work for Marylebone borough council. Surely there is some way of seeing that men working in the freezing cold under heavy sleet are provided with adequate protection
against it-particularly have
a
as
change of clothes
Harlev Street. vV.1. Jan. 19.
it or
improbable that they underclothes. CLIFFORD ALLEN. seems
FEEDING OF CHILDREN reduction of the meat ration for children is SiR,-The to my mind a dangerous act. It is not perhaps the reduction itself but the fact that the Government is capable of reducing the diet of growing children in any item. In this total war children have suffered, and will suffer, terribly, but if we are to win the war we must adhere to our war aim to preserve and advance Christian living. Such living demands the achievement of the best possible care of the growing child, and the war should be no excuse for a falling off from the highest standards in environment, in education and in the feeding of children. Things happen very quickly in childhood and the chances of doing good or ill to a growing child There may be little to show as pass and pass again. each opportunity arises, but our children of today will emerge as men and women of Britain still growing, but profoundly affected by the standard of skilled care and attention and love which has been given to their education. As a result of rationing of food associated with the 1914-18 war the incidence of fractures at a famous school rose from an average of 0-75% per annum to 1-78% (Friend, G. E. The Schoolboy, Cambridge, 1935. See Lancet, 1935, 1, 1394). A rise in the incidence of fractures is a crude and obvious sign of impaired health, and long before such manifestations appear there must be an appreciable degree of subnormal health which will alter the workings of’growth and thereby have a permanent effect on human life, as well as exposing these growing lives to greater risk of disease. The Ministry of Food should treat the feeding of children as a separate! problem, decide on the optimum diet and supply such a diet if at all possible, even at the sacrifice of ration to the! ,
EDUCATION OR COMPULSORY IMMUNISATION? After reading Dr. Killick Millard’s letter on compulsory immunisation in THE LANCET of Nov. 23 (p. 667) Dr. CHARLES F. BOLDUAN, director of the Bureau of Health Education in New York, has sent us some information about how his health department has answered this question. In 1910 the number of deaths from diphtheria in New York city was 1715, a rate of 124.8 per 100,000 children under fifteen. By 1928, when the department first set itself seriously to control diphtheria, the number of deaths from the disease had gradually fallen to 642, and the rate to 38-1. The department might have advised the Board of Health to enact a law compelling parents to have their children immunised, and under a power dating from 1866 such a law would have had all the force of one passed by the state legislature itself. Instead, however, it decided on health education in preference to police power, and organised an intensive campaign to instruct parents on the value of immunisation. Since then the deaths from diphtheria have fallen rapidly ;.by 1930 they were down to 198, by 1936 to 35, and by 1939 to 22. Up to Dec. 23 there had only been 10 deaths during 1940 and this in a city grown to a population of
7,392,000. The University of London extension and tutorial classes council in cooperation with the Central Association for Mental Welfare propose to hold a course of lectures and clinical instruction for medical practitioners on mental deficiency and allied conditions. The course will be held at Oxford and the dates suggested are from March 24 to April 4. The course cannot be held unless sufficient numbers apply and those who wish to attend are asked to send in their applications as soon as possible to the educational secretary of the association. The course will include lectures on the nature of mental deficiency ; on the administrative procedure in the ascertainment and treatment of mental defectives under the Mental Deficiency Act ; on the work of the school medical officer in relation to defectives ; and on the psychology of defectives.
adult population. Let the scientist dietitians experiment on the adult population. May be we could " go to it " better and better on porridge, potatoes and milk. A. L. KERR. Sutton, Surrey. z
TYPHOID IN NOTTINGHAM SAVING ON DRUGS SIR,-I am pleased to hear that the therapeutic requirements committee of the Medical Research Council are to publish a revised edition of their memorandum on economy in the use of drugs. This committee has done exceptionally valuable work, but unfortunately its recommendations are read only by a comparatively few even though they are published in the medical journals, because sad to relate probably only 50% of medical men read current medical journals. This influential committee must therefore go further than mere recommendation and persuade the appropriate ministry to prevent the importation or manufacture of all drugs in category C of the committee’s classification. At present bananas and other valuable fruits’ are banned but the importation of cassia, foeniculum and tamarindus can continue unchecked. The committee has also published a list of medicinal plants which could be grown in this country. The Ministry of Health in conjunction with the Ministry of Agriculture are doing something to carry the proposals into effect. But more energetic action is required. Let the Royal Colleges disimburse some of their lucre and establish experimental farms for the growth of medicinal plants on a commercial scale. Such a long-term policy might also be the first step in the much needed rationalisation of the chaotic drug industry. MAURICE H. PAPPWORTH. Mitcham. Surrey.
SIR,-In the review in your issue of Jan. 11 (p. 57) of my annual report on the health of the City of Nottingham for 1939, you refer to an outbreak of typhoid fever. You say that all but two of the cases were infected on the same day. This is incorrect and is not to be found in my report. You also say that the outbreak I did not limit it to one was due to an infected food. food. In spite of your provocative note I am not to be tempted to disclose further details, for reasons still valid. There was proof within a few days of mode of spread, and by means of such proof the outbreak was controlled. If your note means that outbreaks of true typhoid fever are never due to specifically infected food, then I err in good company inasmuch as there are no fewer than three such outbreaks reported in the annual report of the chief medical officer to the Ministry for 1938. The Nottingham outbreak was typhoid, not ’’ paratyphoid. Your use of the term eberthella " is to die ? Bacbe should this not allowed noticed ; teriologists tell me it is obsolete. CYRIL BANKS, Medical Officer of Health, Nottingham. Dr. Banks is a little hard on an interested inquirer. We did not suggest that the outbreak was traced to any specific food ; this is one of the points we do not know and Dr. Banks still does not say. If the infection was spread by foods generally or various, then the tracing of the epidemic in the time would have been possible only if the cases were limited to persons in an institution, or who had fed at the same table. Nor did we imply that outbreaks of true typhoid are rarely spread by infected foods ; we knew of no outbreak the cause of which was suspected in 24 hours and proved within a few days-and said so. Until Dr. Banks told us that the disease in Nottingham was typhoid, not paratyphoid, we were not justified in assuming that it was. The word eberthella would at all events have made it clear.-ED. L.
**
CHILLY SWEEPER SiR,—This morning I observed a man sweeping away He was dressed in a thin blue snow in Harley Street. jacket and shabby trousers both drenched in the icy sleet which was falling at the time. It seems a grim irony that in this street which symbolises the centre of medical knowledge to many people a man should be doing such work in a garb which no-one could pretend to be healthy. I presume that he was doing casual work for Marylebone borough council. Surely there is some way of seeing that men working in the freezing cold under heavy sleet are provided with adequate protection
against it-particularly have
a
as
change of clothes
Harlev Street. vV.1. Jan. 19.
it or
improbable that they underclothes. CLIFFORD ALLEN. seems
FEEDING OF CHILDREN reduction of the meat ration for children is SiR,-The to my mind a dangerous act. It is not perhaps the reduction itself but the fact that the Government is capable of reducing the diet of growing children in any item. In this total war children have suffered, and will suffer, terribly, but if we are to win the war we must adhere to our war aim to preserve and advance Christian living. Such living demands the achievement of the best possible care of the growing child, and the war should be no excuse for a falling off from the highest standards in environment, in education and in the feeding of children. Things happen very quickly in childhood and the chances of doing good or ill to a growing child There may be little to show as pass and pass again. each opportunity arises, but our children of today will emerge as men and women of Britain still growing, but profoundly affected by the standard of skilled care and attention and love which has been given to their education. As a result of rationing of food associated with the 1914-18 war the incidence of fractures at a famous school rose from an average of 0-75% per annum to 1-78% (Friend, G. E. The Schoolboy, Cambridge, 1935. See Lancet, 1935, 1, 1394). A rise in the incidence of fractures is a crude and obvious sign of impaired health, and long before such manifestations appear there must be an appreciable degree of subnormal health which will alter the workings of’growth and thereby have a permanent effect on human life, as well as exposing these growing lives to greater risk of disease. The Ministry of Food should treat the feeding of children as a separate! problem, decide on the optimum diet and supply such a diet if at all possible, even at the sacrifice of ration to the! ,
EDUCATION OR COMPULSORY IMMUNISATION? After reading Dr. Killick Millard’s letter on compulsory immunisation in THE LANCET of Nov. 23 (p. 667) Dr. CHARLES F. BOLDUAN, director of the Bureau of Health Education in New York, has sent us some information about how his health department has answered this question. In 1910 the number of deaths from diphtheria in New York city was 1715, a rate of 124.8 per 100,000 children under fifteen. By 1928, when the department first set itself seriously to control diphtheria, the number of deaths from the disease had gradually fallen to 642, and the rate to 38-1. The department might have advised the Board of Health to enact a law compelling parents to have their children immunised, and under a power dating from 1866 such a law would have had all the force of one passed by the state legislature itself. Instead, however, it decided on health education in preference to police power, and organised an intensive campaign to instruct parents on the value of immunisation. Since then the deaths from diphtheria have fallen rapidly ;.by 1930 they were down to 198, by 1936 to 35, and by 1939 to 22. Up to Dec. 23 there had only been 10 deaths during 1940 and this in a city grown to a population of
7,392,000. The University of London extension and tutorial classes council in cooperation with the Central Association for Mental Welfare propose to hold a course of lectures and clinical instruction for medical practitioners on mental deficiency and allied conditions. The course will be held at Oxford and the dates suggested are from March 24 to April 4. The course cannot be held unless sufficient numbers apply and those who wish to attend are asked to send in their applications as soon as possible to the educational secretary of the association. The course will include lectures on the nature of mental deficiency ; on the administrative procedure in the ascertainment and treatment of mental defectives under the Mental Deficiency Act ; on the work of the school medical officer in relation to defectives ; and on the psychology of defectives.