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SOCIETY FOR SOCIAL MEDICINE
853
Medical Societies SOCIETY FOR SOCIAL MEDICINE THE fourth annual meeting of the society was held in Oxford from Sept. 29 to Oct. 1. Leukaemia Dr. ALICE STEWART (Oxford) propounded the view that many cases of stem-cell leukaemia in childhood have their origin in an inherited defect. Children in the preleukaemic state (like mongols, who have an exceptionally high risk of
developing leukxmia) are especially liable to die of pyogenic infections. Hence both the number of deaths attributed to leukaemia and their age-distribution have been altered by the advent of antibiotics and
by the declining incidence
of these
infections. A. H. LEE
"
"
in the age curve of mortality from leukaemia between the ages of 13 and 19. This is due to a temporary rise in acute myeloid cases, most notable in males, which is evident on both sides of the Atlantic, and can be traced back at least as far as the 1920s. Dr. F. W. GuNz (Christchurch, New Zealand) reported on a study now in progress which covers over 80% of leukxmia cases diagnosed throughout New Zealand. Although reporting is relatively incomplete in Maoris, chronic lymphocytic leukaemia is clearly less common in this group than in the population of European origin. Compared with their controls the leukxmia cases showed a clear excess of exposures to radiotherapy and of personal histories of cancer, but at most 7% of all cases could be accounted for in terms of any recognised aaiological factors. In the discussion questions were raised about recent evidence conflicting with previous reports of an association between childhood malignant neoplasms and antenatal radiography. Dr. RICHARD DOLL (London) said that his own study, relating to leukxmia in children, had not confirmed this association, but that it could not be regarded as disproved. Dr.
J.
(London) described
General
a
bulge
Epidemiology
A large body of data collected by the Veterans Administration in the U.S.A. was used by Dr. E. D. AcHESON (Oxford) to demonstrate a rising incidence of multiple sclerosis from south to north, both between and within States, and applying to both white and coloured men as well as to veterans of both world wars. Reasons were given for believing that this gradient did not merely reflect differences in diagnostic standards, and certain climatic variables (severity of winter, rainfall) could also be ruled out. Preliminary analysis of mortality data from the southern hemisphere appeared to confirm the positive correlation between incidence of multiple sclerosis and latitude. Dr. D. CAMERON and Dr. G. D. FORWELL (Edinburgh) had attempted a complete ascertainment of cases of diagnosed diabetes among the patients in 77 Scottish practices. The overall prevalence was between 4 and 5 per 1000 population. The prevalence estimates paralleled mortality figures in showing an excess of cases among manual workers in the younger adult age-groups, and an excess among non-manual workers at
higher
ages. A paper by Dr. DOLL and Dr. R. E. W. FISHER
(London) showed how detailed epidemiological analysis, supplemented by chemical study of air samples, had led to the inculpation of an old-fashioned type of retort as responsible for the excess of deaths from lung cancer among gas-retort workers. In studies of this type one should not trust mortality expectations computed from national data to yield a standard appropriate to a selected industrial group, but occupational mortality-rates within the industry could be compared with some confidence. Pregnancy Hazards do a small Why only proportion of the second and later rhesus-positive children born to rhesus-negative women develop hsemolytic disease of the newborn ? This question was discussed by Dr. E. G. KNOX (Newcastle upon Tyne), whose
previous work had shown that matemal-foelal ABO
incompatibility tends to prevent sensitisation of rhesusnegative mothers. Comparison of the obstetric details in a group of sensitising pregnancies with a control group indicated that toxaemia, surgical interference, and placental anomalies were among the factors which might pave the way for rhesus isoimmunisation in
a later pregnancy. Dr. R. G. RECORD (Birmingham) discussed variations in the incidence of anencephalus, which has shown a rising trend in recent years. Though the variables implicated are to some extent confounded with one another, at least four (parity, maternal age, low social class, season of conception) can be shown to have an independent effect.
Psychiatry: Mental Abilities Dr. J. (London) had conducted a study of male schizophrenic patients under the age of 60 who had been resident at two London mental hospitals for upwards of two K. WING
years. Though mental symptoms and most types of ward behaviour showed no significant trend with length of stay in this group, unfavourable attitudes to discharge were commoner in the longer-stay patients. This was interpreted as reflecting a syndrome of institutionalism ", possibly similar to a syndrome which has been described in other segregated "
communities. Six years after their discharge from mental hospital twothirds of a group of patients were found to be " not ill from a psychiatric point of view ". This favourable outcome was reported by Dr. LILLI STEIN and Dr. W. WARREN (London) in their follow-up study of patients treated in the adolescent unit of the Bethlem Royal Hospital. Relatively young patients (under 14 on admission) did well, as did those with neurotic rather than psychotic or organic disorders, but on an individual basis there was little association between prognosis at discharge and condition at follow-up. The influence of birth rank and family size on educational selection was discussed by Dr. J. W. B. DOUGLAS (Edinburgh), who produced evidence that the handicapping of later children and children from large families derived from environmental rather than genetic factors. A measure of parental interest in the child, generally higher for children of small families, was found to correlate not only with performance at the ages of 8 and 11 but also with the progress achieved between these ages. Dr. MERVYN SussER and Dr. ZENA STEIN (Manchester) reported on a study of the social distribution of children classed as educationally subnormal. Except when associated with brain damage this condition appeared to occur only in
families belonging to what was characterised as a " demotic " -in contradistinction to an " aspirant "-subculture. Data from other studies were adduced in support of the thesis that this type of mental retardation is due to environmental factors.
Reviews of Books Doctors and Disease in Tudor Times W. S. C. COPEMAN, O.B.E., Pp. 186. 42s.
F.R.C.P.
London: Dawsons.
1960.
THEON, the mathematician of Alexandria and the last notable philospher of the Graeco-Roman era, died about A.D. 400. A kind of twilight descended on men’s minds thereafter, and did not lighten for more than a thousand years. Then, in 1543, two great works appeared, distinguished because they did not merely repeat old dogmas but contained new observations and were based on experimental methods. One was Vesalius’s treatise on human anatomy, and the other the De reuolutionibus orbium caelestium of Copernicus. The Dark Ages were over, and the Renaissance had begun. In this country, about the same time, the Tudor period began, and within that era Linacre founded the Royal College of Physicians, and Vicary united the Guild of Surgeons with the Barber’s Company. John Caius created one of our first medical schools and William Harvey went to study there. The significance of such times for the medical historian needs no
Medical Societies SOCIETY FOR SOCIAL MEDICINE THE fourth annual meeting of the society was held in Oxford from Sept. 29 to Oct. 1. Leukaemia Dr. ALICE STEWART (Oxford) propounded the view that many cases of stem-cell leukaemia in childhood have their origin in an inherited defect. Children in the preleukaemic state (like mongols, who have an exceptionally high risk of
developing leukxmia) are especially liable to die of pyogenic infections. Hence both the number of deaths attributed to leukaemia and their age-distribution have been altered by the advent of antibiotics and
by the declining incidence
of these
infections. A. H. LEE
"
"
in the age curve of mortality from leukaemia between the ages of 13 and 19. This is due to a temporary rise in acute myeloid cases, most notable in males, which is evident on both sides of the Atlantic, and can be traced back at least as far as the 1920s. Dr. F. W. GuNz (Christchurch, New Zealand) reported on a study now in progress which covers over 80% of leukxmia cases diagnosed throughout New Zealand. Although reporting is relatively incomplete in Maoris, chronic lymphocytic leukaemia is clearly less common in this group than in the population of European origin. Compared with their controls the leukxmia cases showed a clear excess of exposures to radiotherapy and of personal histories of cancer, but at most 7% of all cases could be accounted for in terms of any recognised aaiological factors. In the discussion questions were raised about recent evidence conflicting with previous reports of an association between childhood malignant neoplasms and antenatal radiography. Dr. RICHARD DOLL (London) said that his own study, relating to leukxmia in children, had not confirmed this association, but that it could not be regarded as disproved. Dr.
J.
(London) described
General
a
bulge
Epidemiology
A large body of data collected by the Veterans Administration in the U.S.A. was used by Dr. E. D. AcHESON (Oxford) to demonstrate a rising incidence of multiple sclerosis from south to north, both between and within States, and applying to both white and coloured men as well as to veterans of both world wars. Reasons were given for believing that this gradient did not merely reflect differences in diagnostic standards, and certain climatic variables (severity of winter, rainfall) could also be ruled out. Preliminary analysis of mortality data from the southern hemisphere appeared to confirm the positive correlation between incidence of multiple sclerosis and latitude. Dr. D. CAMERON and Dr. G. D. FORWELL (Edinburgh) had attempted a complete ascertainment of cases of diagnosed diabetes among the patients in 77 Scottish practices. The overall prevalence was between 4 and 5 per 1000 population. The prevalence estimates paralleled mortality figures in showing an excess of cases among manual workers in the younger adult age-groups, and an excess among non-manual workers at
higher
ages. A paper by Dr. DOLL and Dr. R. E. W. FISHER
(London) showed how detailed epidemiological analysis, supplemented by chemical study of air samples, had led to the inculpation of an old-fashioned type of retort as responsible for the excess of deaths from lung cancer among gas-retort workers. In studies of this type one should not trust mortality expectations computed from national data to yield a standard appropriate to a selected industrial group, but occupational mortality-rates within the industry could be compared with some confidence. Pregnancy Hazards do a small Why only proportion of the second and later rhesus-positive children born to rhesus-negative women develop hsemolytic disease of the newborn ? This question was discussed by Dr. E. G. KNOX (Newcastle upon Tyne), whose
previous work had shown that matemal-foelal ABO
incompatibility tends to prevent sensitisation of rhesusnegative mothers. Comparison of the obstetric details in a group of sensitising pregnancies with a control group indicated that toxaemia, surgical interference, and placental anomalies were among the factors which might pave the way for rhesus isoimmunisation in
a later pregnancy. Dr. R. G. RECORD (Birmingham) discussed variations in the incidence of anencephalus, which has shown a rising trend in recent years. Though the variables implicated are to some extent confounded with one another, at least four (parity, maternal age, low social class, season of conception) can be shown to have an independent effect.
Psychiatry: Mental Abilities Dr. J. (London) had conducted a study of male schizophrenic patients under the age of 60 who had been resident at two London mental hospitals for upwards of two K. WING
years. Though mental symptoms and most types of ward behaviour showed no significant trend with length of stay in this group, unfavourable attitudes to discharge were commoner in the longer-stay patients. This was interpreted as reflecting a syndrome of institutionalism ", possibly similar to a syndrome which has been described in other segregated "
communities. Six years after their discharge from mental hospital twothirds of a group of patients were found to be " not ill from a psychiatric point of view ". This favourable outcome was reported by Dr. LILLI STEIN and Dr. W. WARREN (London) in their follow-up study of patients treated in the adolescent unit of the Bethlem Royal Hospital. Relatively young patients (under 14 on admission) did well, as did those with neurotic rather than psychotic or organic disorders, but on an individual basis there was little association between prognosis at discharge and condition at follow-up. The influence of birth rank and family size on educational selection was discussed by Dr. J. W. B. DOUGLAS (Edinburgh), who produced evidence that the handicapping of later children and children from large families derived from environmental rather than genetic factors. A measure of parental interest in the child, generally higher for children of small families, was found to correlate not only with performance at the ages of 8 and 11 but also with the progress achieved between these ages. Dr. MERVYN SussER and Dr. ZENA STEIN (Manchester) reported on a study of the social distribution of children classed as educationally subnormal. Except when associated with brain damage this condition appeared to occur only in
families belonging to what was characterised as a " demotic " -in contradistinction to an " aspirant "-subculture. Data from other studies were adduced in support of the thesis that this type of mental retardation is due to environmental factors.
Reviews of Books Doctors and Disease in Tudor Times W. S. C. COPEMAN, O.B.E., Pp. 186. 42s.
F.R.C.P.
London: Dawsons.
1960.
THEON, the mathematician of Alexandria and the last notable philospher of the Graeco-Roman era, died about A.D. 400. A kind of twilight descended on men’s minds thereafter, and did not lighten for more than a thousand years. Then, in 1543, two great works appeared, distinguished because they did not merely repeat old dogmas but contained new observations and were based on experimental methods. One was Vesalius’s treatise on human anatomy, and the other the De reuolutionibus orbium caelestium of Copernicus. The Dark Ages were over, and the Renaissance had begun. In this country, about the same time, the Tudor period began, and within that era Linacre founded the Royal College of Physicians, and Vicary united the Guild of Surgeons with the Barber’s Company. John Caius created one of our first medical schools and William Harvey went to study there. The significance of such times for the medical historian needs no