- Email: [email protected]
SETTLEMENT OF THE LLANELLY DISPUTE
955 What happens to aluminium ingested with food Since traces are found in most organs it is almost certain that some finds its way into the blood, though having regard to the ease with which it forms lakes and dilute solutions become sols, the amounts diffusing through the walls of the alimentary tract must be very small. It is not found, except in traces, in urine ; what reaches the blood must therefore be removed via the intestinal secretions or bile, probably in the faeces as phosphate. It would seem likely, Monier-Williams suggests, that the diffusibility of aluminium salts into the blood through the wall of the digestive tract may vary appreciably with circumstances and with the nature of the stomach contents. Colloidal aluminium hydroxide has been administered internally as an antacid in doses of about a gramme ; it is stated to be useful in peptic ulceration. Feeding experiments on animals, which received amounts very large in relation to the body-weight, showed but little action on the system, except possibly in young animals. But it should be borne in mind that the 2 mg. given to the rat as daily dose is equivalent to about 0’6 g. for a man. After discussing the clinical data Monier-Williams concludes that there is no convincing evidence that aluminium, in the amounts in which it is likely to be consumed as a result of using aluminium vessels, has a harmful effect upon the ordinary consumer. There may be individuals who are susceptible to even such small doses of aluminium as may be derived from aluminium vessels, but evidence of this is inconclusive. THE JOURNALISTIC BLASTOMA
FOR his Schorstein lecture at the London Hospital Oct. 17th Prof. William Bulloch chose the subject of Medical Periodical Literature and he asked his hearers to cooperate in stopping what he described as a malignant overgrowth. He supported the simile by an ominous picture of the shelves of the British Museum, already 60 miles in length, increasing relentlessly by a mile a year. All this fertility of expression took origin in the growth and multiplication of universities, followed by the invention of printing, and Dr. Bulloch was able to say with pride that at the end of the sixteenth century there were three universities in Aberdeenshire alone-one in Fraserburgh and two in Aberdeen-at a time when there But after were only two in the whole of England. this burst of patriotism he soon found himself once more in a mass of depressing statistics. In 1881, he said, Billings had estimated the number of doctors in the world at 180,000 ; to-day there were 57,000 in Great Britain alone and probably 400,000 or 500,000 all told. The World List of Scientific Periodicals, published in 1934, contains the names of 23,838 for the period 1900-31, of which Dr. Bulloch estimated that no less than 5000 are medical. Many of these were indispensable, many mediocre, and many valueless ; one and all they made the task of the reader daily more arduous and more hopeless. It had been said that soon libraries would become cities and those of the population not actually writing would be engaged in cataloguing. Robert Fletcher, a London Hospital man who subsequently became Billings’s chief assistant and successor at the SurgeonGeneral’s Library in Washington, had remarked that the whole world was a conspiracy against medical bibliographers. The Index Catalogue of that Library was the greatest bibliographic work ever accomplished, and with the Index Medicus and the Quarterly Cumulative Medical Index now issued jointly with the American Medical Association, it is a storehouse on
of accurate information to which we all owe an immense debt of gratitude. But the 45,600 pages of the catalogue make alarming reading. In 1893 it contained the names of 7000 books or articles on syphilis : in the period 1893-1912 14,000 more were added, and in 1913-32 another 21,000. There were no less than 116 devoted to quadruplets, and between 1913 and 1932 a total of 1280 papers on tonsillectomy made their appearance. As for tuberculosis, he had calculated that between 1893 and 1932 at least 34,000 articles and books were published on this disease-850 a year, or more than two a day for 40 years ! There are 31 periodicals in circulation
dealing with tuberculosis alone. " If all this information were good and true," said the lecturer, " it would be idle to increase it " ; but in fact there was not a single subject in medicine that could not be enriched by the humblest member of the profession. So he did not discourage the reporting of cases or observations. Medical writing however must be approached with serious purpose, and the writer should try to see how his views compare with those already on record-a purpose for which the Index Medicus is invaluable. Thus for the reform and reconstruction of medical journals which he demanded Prof. Bulloch seemed to pin his faith chiefly (but perhaps too optimistically) to the personal virtue of their contributors : they must eschew duplicate publication and verify their references and quotations from original sources. He also hopes for an extension of critical reviews which will show what is worth reading and what is not. But it must be admitted that-in the manner of pathologists-he seemed rather more intested in the morbid appearances of his blastoma than in its treatment. We are left with the hope that by the time every second medical man edits (and writes) a journal of his own the whole structure will break down through lack of nutrition. SETTLEMENT OF THE
LLANELLY DISPUTE
a satisfaction to all who care for the of medicine in South Wales to learn that good the long drawn-out dispute between the doctors serving the Llanelly area and the workmen’s medical committee has now been settled. And not settled grudgingly, but with a declaration on both sides of goodwill and cooperation which should enable the new medical service in the New Year 1936 to be amodel for similar services throughout the country. The terms of the agreement were set out in the supplement to the British Medical Journal last week. Every practitioner in the area who is entitled to be on the insurance committee’s list may join the service. There are to be no whole-time appointments, and free choice is open both to doctor and patient, remuneration to be based on the rate which existed before the dispute occurred. Besides the general practitioner service the aim is to set up a complete consultative and specialist service, the one to be paid out of the practitioners’ fund, the other out of a separate fund on a sessional, or payment for service, basis. Any local management committee is however at liberty to appoint consultants on a part-time salaried basis which bears some relation to this. Each management committee is to consist of representatives of the subscribing workmen and of the practitioners, seven of each, with an agreed independent chairman, and there is to be a similarly constituted central committee to which questions in dispute may be referred. It only remains to congratulate those whose statesmanship and forbearance have rendered such an agreement possible.
IT will be name
FOR his Schorstein lecture at the London Hospital Oct. 17th Prof. William Bulloch chose the subject of Medical Periodical Literature and he asked his hearers to cooperate in stopping what he described as a malignant overgrowth. He supported the simile by an ominous picture of the shelves of the British Museum, already 60 miles in length, increasing relentlessly by a mile a year. All this fertility of expression took origin in the growth and multiplication of universities, followed by the invention of printing, and Dr. Bulloch was able to say with pride that at the end of the sixteenth century there were three universities in Aberdeenshire alone-one in Fraserburgh and two in Aberdeen-at a time when there But after were only two in the whole of England. this burst of patriotism he soon found himself once more in a mass of depressing statistics. In 1881, he said, Billings had estimated the number of doctors in the world at 180,000 ; to-day there were 57,000 in Great Britain alone and probably 400,000 or 500,000 all told. The World List of Scientific Periodicals, published in 1934, contains the names of 23,838 for the period 1900-31, of which Dr. Bulloch estimated that no less than 5000 are medical. Many of these were indispensable, many mediocre, and many valueless ; one and all they made the task of the reader daily more arduous and more hopeless. It had been said that soon libraries would become cities and those of the population not actually writing would be engaged in cataloguing. Robert Fletcher, a London Hospital man who subsequently became Billings’s chief assistant and successor at the SurgeonGeneral’s Library in Washington, had remarked that the whole world was a conspiracy against medical bibliographers. The Index Catalogue of that Library was the greatest bibliographic work ever accomplished, and with the Index Medicus and the Quarterly Cumulative Medical Index now issued jointly with the American Medical Association, it is a storehouse on
of accurate information to which we all owe an immense debt of gratitude. But the 45,600 pages of the catalogue make alarming reading. In 1893 it contained the names of 7000 books or articles on syphilis : in the period 1893-1912 14,000 more were added, and in 1913-32 another 21,000. There were no less than 116 devoted to quadruplets, and between 1913 and 1932 a total of 1280 papers on tonsillectomy made their appearance. As for tuberculosis, he had calculated that between 1893 and 1932 at least 34,000 articles and books were published on this disease-850 a year, or more than two a day for 40 years ! There are 31 periodicals in circulation
dealing with tuberculosis alone. " If all this information were good and true," said the lecturer, " it would be idle to increase it " ; but in fact there was not a single subject in medicine that could not be enriched by the humblest member of the profession. So he did not discourage the reporting of cases or observations. Medical writing however must be approached with serious purpose, and the writer should try to see how his views compare with those already on record-a purpose for which the Index Medicus is invaluable. Thus for the reform and reconstruction of medical journals which he demanded Prof. Bulloch seemed to pin his faith chiefly (but perhaps too optimistically) to the personal virtue of their contributors : they must eschew duplicate publication and verify their references and quotations from original sources. He also hopes for an extension of critical reviews which will show what is worth reading and what is not. But it must be admitted that-in the manner of pathologists-he seemed rather more intested in the morbid appearances of his blastoma than in its treatment. We are left with the hope that by the time every second medical man edits (and writes) a journal of his own the whole structure will break down through lack of nutrition. SETTLEMENT OF THE
LLANELLY DISPUTE
a satisfaction to all who care for the of medicine in South Wales to learn that good the long drawn-out dispute between the doctors serving the Llanelly area and the workmen’s medical committee has now been settled. And not settled grudgingly, but with a declaration on both sides of goodwill and cooperation which should enable the new medical service in the New Year 1936 to be amodel for similar services throughout the country. The terms of the agreement were set out in the supplement to the British Medical Journal last week. Every practitioner in the area who is entitled to be on the insurance committee’s list may join the service. There are to be no whole-time appointments, and free choice is open both to doctor and patient, remuneration to be based on the rate which existed before the dispute occurred. Besides the general practitioner service the aim is to set up a complete consultative and specialist service, the one to be paid out of the practitioners’ fund, the other out of a separate fund on a sessional, or payment for service, basis. Any local management committee is however at liberty to appoint consultants on a part-time salaried basis which bears some relation to this. Each management committee is to consist of representatives of the subscribing workmen and of the practitioners, seven of each, with an agreed independent chairman, and there is to be a similarly constituted central committee to which questions in dispute may be referred. It only remains to congratulate those whose statesmanship and forbearance have rendered such an agreement possible.
IT will be name