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THE HEART OF THE MATTER
783 convictions for robbery with violence. For the war years only a summary of the criminal statistics was published, in which the number of convictions in regard to this crime were not distinguished from other forms of violent crime for which flogging cannot be ordered. I was therefore obliged to estimate the annual number of convictions for 1939 to 1945 on the assumption that they formed annually 37-32% of the number of such crimes known to the police-the average percentage during the fifteen years 1920-34. (This percentage must not be taken to mean that the guilty party is found in only 37% of the crimes annually committed ; the apprehension and conviction of one guilty person very frequently brings to a conclusion the police investigation of several crimes.) Because this is only a best estimate " the number of floggings in relation to the estimated convictions is of doubtful accuracy for the war period. But the precise flogging rates for 1946, 1947, and 1948 (the last relating to only 9 months but expressed on an annual basis) of 11, 16, and 7% of convictions conform to the pattern for the earlier part of the century which indicates that the amount of flogging ordered was independent of the volume of crime in the country. To sum up, it is clear that the vast increase in robbery in-ith violence during and since the 1939-45 war had no counterpart during or after the 1914-18 war. The recent increase is in fact something entirely outside the experience of the last 80 years. These are the facts as- shown by the statistics. It is outside my sphere to attempt to specify to what cause or causes the increase is due. I suppose no-one can doubt that not one but many factors But those who maintain that the are contributory. upward trend can be reversed by the re-institution of corporal punishment as a deterrent must seek for justification of their beliefs elsewhere than in a study of the past relations between the extent of corporal punishment for robbery with violence and the prevalence of the crime. The recorded facts for the period 1860 to 1937 contain nothing to assist them. Department of Preventive Medicine, E. LEWIS-FANING. "
Welsh National School of Medicine, Cardiff.
PROPHYLACTIC INOCULATIONS AND POLIOMYELITIS
SIR,—The studies of Dr. McCloskey, published in your issue of April 8, and Dr. Geffen’s article in the Medical Officer of the same date, are of outstanding importance; but their significance is more psychological than
epideiniologic al. One’s first impression on reading the two articles is that evidence is given that poliomyelitis may be produced, or its risk increased, by anti-pertussis vaccination within the previous few weeks, but a careful reading of the figures shows that there is no shred of evidence for this assumption. They clearly show that persons who are inoculated with anti-pertussis vaccine and who subsequently develop poliomyelitis are very much more likely to have the paralysis show itself in the limb in which the injection has been made. They do not show that the injections produce poliomyelitis. The psychological effects of the publication of these papers are, however, arresting, and excerpts have been quoted in the national press. The impression may be gained by the public that our immunisation campaigns are likely to be followed by an increased incidence of poliomyelitis. This may or may not be so. There is no information either for or against this view except the general impression, which is not a new one, that trauma, and in particular trauma due to tonsillectomy, may be an exciting cause. Dr. Geffen was certainly wise in giving publicity to the facts which he found, since the public are likely to react very unfavourably to any suggestion that facts adverse to immunisation are being
withheld from them, and frank information on the ascertained facts is always useful. The next step, however, is to carry out a statistical inquiry into the incidence of poliomyelitis in epidemic :areas and at epidemic times in two groups of persons : (a) those who have not been inoculated within, say, the last three months against diphtheria or pertussis ; and (b) those who have. Such an inquiry may present difficulties, and one cannot disguise the very great practical obstacles in the way of obtaining two large groups which are statistically capable of being contrasted. Nevertheless the importance of the subject demands that such investigations should be carried out. This experiment might prove whether immunisation against diphtheria and pertussis was responsible for an increased incidence of poliomyelitis ; but even if it did, it -would not necessarilv follow that immunisation campaigns should be either abandoned or modified. In the light of the new information one would have to assess whether the known risks of an increased incidence of poliomyelitis were or were not counterbalanced by reduction, or even eradication, of these two diseases, which between them are responsible for a heavy yearly mortality-a mortality greatly in excess of the death-rate from poliomyelitis. The numbers of deaths from poliomyelitis and whooping-cough during the nine years 1940-48 were : Poliomyelitis.... 1307 ’
’
8508 HUGH PAUL
Whooping-cough .. ..
Medical Officer of Health.
Smethwick, Staffs.
THE HEART OF THE MATTER
SIR,—The " first Bevan lecture " in last week’s issue contains much that is timely and pertinent, but the author is mistaken when he states that no medical school gives instruction to its students in the management of a general practice. A course for final-year students has been in the curriculum of the Manchester school for more than twenty years. This lectureship in medical ethics and conditions of medical practice was founded by the faculty at my suggestion, and has been held by such well-known G.1-.s as L. Kilroe, of Rochdale, and the late T. A. Goodfellow, of West Didsbury. I know that it has been greatly valued by many men about to enter
general practice.
Prestatyn, Flintshire.
-
E. D. TELFORD.
A CODE OF ETHICS
SIR,—As you mentioned
on March 18 (p. 524), the Association has recentlv circulated a pamphlet on Ethics and Members of the Medical Profession. Primarily it is prepared for the information of practitioners who have qualified within the last ten years ; but, although the pamphlet is dated 1949, the compilers seem to be unaware of the passage of the National Health Service Act, 1946. The initial paragraphs are excellent, pointing out the position of privilege which
British
Medical
and stating that " the for the freedom of medicine lies in the hands of those who practise it." But instead of applying these principles to the problems of today,.the pamphlet then passes to the Hippocratic Oath, which may possibly have been written by Hippocrates 400 years before the birth of Christ. It is in its.way admirable, but it is limited in its scope as a guide to conduct in 1950. The need for a revised code of ethics is obvious, but perhaps the British Medical Association is no longer the most suitable body to sponsor it. I venture to suggest as one item an expansion of the Eighth Commandment of the Decalogue : " Thou shalt not acquire purchasing power without making an equivalent return in service to the community." HENRY H. MACWILLIAM. Liverpool.
the doctor
justification
occupies in society
Welsh National School of Medicine, Cardiff.
PROPHYLACTIC INOCULATIONS AND POLIOMYELITIS
SIR,—The studies of Dr. McCloskey, published in your issue of April 8, and Dr. Geffen’s article in the Medical Officer of the same date, are of outstanding importance; but their significance is more psychological than
epideiniologic al. One’s first impression on reading the two articles is that evidence is given that poliomyelitis may be produced, or its risk increased, by anti-pertussis vaccination within the previous few weeks, but a careful reading of the figures shows that there is no shred of evidence for this assumption. They clearly show that persons who are inoculated with anti-pertussis vaccine and who subsequently develop poliomyelitis are very much more likely to have the paralysis show itself in the limb in which the injection has been made. They do not show that the injections produce poliomyelitis. The psychological effects of the publication of these papers are, however, arresting, and excerpts have been quoted in the national press. The impression may be gained by the public that our immunisation campaigns are likely to be followed by an increased incidence of poliomyelitis. This may or may not be so. There is no information either for or against this view except the general impression, which is not a new one, that trauma, and in particular trauma due to tonsillectomy, may be an exciting cause. Dr. Geffen was certainly wise in giving publicity to the facts which he found, since the public are likely to react very unfavourably to any suggestion that facts adverse to immunisation are being
withheld from them, and frank information on the ascertained facts is always useful. The next step, however, is to carry out a statistical inquiry into the incidence of poliomyelitis in epidemic :areas and at epidemic times in two groups of persons : (a) those who have not been inoculated within, say, the last three months against diphtheria or pertussis ; and (b) those who have. Such an inquiry may present difficulties, and one cannot disguise the very great practical obstacles in the way of obtaining two large groups which are statistically capable of being contrasted. Nevertheless the importance of the subject demands that such investigations should be carried out. This experiment might prove whether immunisation against diphtheria and pertussis was responsible for an increased incidence of poliomyelitis ; but even if it did, it -would not necessarilv follow that immunisation campaigns should be either abandoned or modified. In the light of the new information one would have to assess whether the known risks of an increased incidence of poliomyelitis were or were not counterbalanced by reduction, or even eradication, of these two diseases, which between them are responsible for a heavy yearly mortality-a mortality greatly in excess of the death-rate from poliomyelitis. The numbers of deaths from poliomyelitis and whooping-cough during the nine years 1940-48 were : Poliomyelitis.... 1307 ’
’
8508 HUGH PAUL
Whooping-cough .. ..
Medical Officer of Health.
Smethwick, Staffs.
THE HEART OF THE MATTER
SIR,—The " first Bevan lecture " in last week’s issue contains much that is timely and pertinent, but the author is mistaken when he states that no medical school gives instruction to its students in the management of a general practice. A course for final-year students has been in the curriculum of the Manchester school for more than twenty years. This lectureship in medical ethics and conditions of medical practice was founded by the faculty at my suggestion, and has been held by such well-known G.1-.s as L. Kilroe, of Rochdale, and the late T. A. Goodfellow, of West Didsbury. I know that it has been greatly valued by many men about to enter
general practice.
Prestatyn, Flintshire.
-
E. D. TELFORD.
A CODE OF ETHICS
SIR,—As you mentioned
on March 18 (p. 524), the Association has recentlv circulated a pamphlet on Ethics and Members of the Medical Profession. Primarily it is prepared for the information of practitioners who have qualified within the last ten years ; but, although the pamphlet is dated 1949, the compilers seem to be unaware of the passage of the National Health Service Act, 1946. The initial paragraphs are excellent, pointing out the position of privilege which
British
Medical
and stating that " the for the freedom of medicine lies in the hands of those who practise it." But instead of applying these principles to the problems of today,.the pamphlet then passes to the Hippocratic Oath, which may possibly have been written by Hippocrates 400 years before the birth of Christ. It is in its.way admirable, but it is limited in its scope as a guide to conduct in 1950. The need for a revised code of ethics is obvious, but perhaps the British Medical Association is no longer the most suitable body to sponsor it. I venture to suggest as one item an expansion of the Eighth Commandment of the Decalogue : " Thou shalt not acquire purchasing power without making an equivalent return in service to the community." HENRY H. MACWILLIAM. Liverpool.
the doctor
justification
occupies in society