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The Nation's Health in 1961
931
The Nation’s Health in 1961
Public Health Congenital Abnormalities due to Thalidomide THE following information has been received from the Ministry of Health: In order to make as accurate an assessment as possible of the likely demands for special hospital facilities, the chief medical officer of the Ministry wrote to the medical officers of health of England and Wales on Aug. 1, 1962, asking them to submit details concerning children born with congenital abnormalities attributed to thalidomide. Information was asked as to each baby with a congenital deformity born to a woman who had taken thalidomide during pregnancy, in each of the years 1960 and 1961 and for 1962 up to Aug. 31 only, by which time all the babies likely to be affected by the drug would probably have been born. In addition, information was asked concerning all children with limb deformities whether or not the mother had taken thalidomide. A total of 805 returns was received of children with limb deformities born alive during the period. Of these, 153 subsequently died, including 85 where the mother took thalidomide
during pregnancy. Of the 652 remaining children, 244 mothers had definitely possibly taken thalidomide, although it was not possible to get precision as to the stage of pregnancy at which the drug was taken. 146 of the children showed gross deformities of two, three, or four limbs, including 27 with additional deformities, two-thirds of which were to the eyes or ears or both. 45 had deformities of one limb only, and a further 53 had deformities of the hands or feet or both. It is interesting to compare the distribution of the type of deformity among these cases with those where the mother did not take thalidomide. The latter group totalled 408 children of which 86 had gross deformities, 85 had only one limb affected, and 237 had minor limb deformities. (Cases of talipes have been excluded from the last figure.) Thus over half the children where the abnormality was associated with thalidomide had gross deformities, compared with about one-fifth among children regarding whose abnormality thalidomide could not be implicated. Besides the cases of limb deformities mentioned above, 61 children (including 3 who subsequently died) whose mothers had taken thalidomide had other congenital malformations. Thus there is a total of some 302 children now living who may have been affected by thalidomide. This includes 42 whose mothers took some pills during pregnancy but were uncertain as to the type. Details of the deformities in living children which may be associated with thalidomide are as follows: or
LIVING CHILDREN WHO HAVE DEFECTS ASSOCIATED WITH THALIDOMIDE Number of all cases where the mother took thalidomide (including 42mothers who took unknown pills) ............ 302 lumber of children with limb abnormalities (including 57 with additional 244 deformities) Kmnber of children with other than limb deformities only.... 58 ..................
DETAILS OF THE TYPE OF LIMB DEFORMITY
IN his reportfor 1961 Sir George Godber, chief medical officer of the Ministry of Health, remarks that an interesting feature of the expectation-of-life table is the narrow gap which now exists between the expectation of . life at birth and at age one year. In 1841 the increase in expectation of life after the first year was seven years; in 1961 this has been reduced to one year. Infant mortality continues to fall (in 1961 the rate was 21-4 per 1000 live births), though mortality during the first month of life shows no such improvement. Neonatal mortality is partly governed by events which affect the infant before it is born, and those conditions are hard to identify. Causes of Death Tuberculosis mortality continues to decline, but at a slower rate. The number of deaths from all forms of tuberculosis was 3334, only a quarter of that in 1951. The only other infective cause listed that shows a decline in deaths is syphilisfrom 944 in 1960 to 900 in 1961. Diphtheria claimed 10 victims-the highest number in any one year since 1955. Measles mortality rose from 31 deaths in 1960 to 152 in 1961, the largest number since 1955. Acute poliomyelitis mortality (59) rose above the previous year’s low record. Influenza also claimed more deaths,in 1961 (7102) than in the previous year (1098). Deaths from both pneumonia and bronchitis were nearly 5000 each more than in the preceding year. Deaths from cancer numbered 99,915 (18-1% of all deaths): the sites accounting for the largest number were the lung and bronchus (22,810), stomach (13,788), and breast (9367), while the sites with the largest increase since 1960 were the lung and bronchus (810 more) and breast (245 more). The average annual increase in deaths from cancer of the lung has been 4’7% for the past five years: they now account for 23% of all cancer deaths, compared with only 4% thirty years ago. Diseases of the heart and blood-vessels, including vascular lesions affecting the central nervous system, form the biggest group of causes of death and the number increases steadily each year, accounting for a total of 281,678 deaths in 1961. Deaths from congenital malformations are slightly more numerous (5196), but although the actual numbers have increased by 14% over the number five years ago the rate per 1000 live births has fallen slightly. Deaths of mothers due to pregnancy, abortion, and childbearing are again lower than in any previous year. Deaths from violence show little change. Motor-vehicle accidents (6634 deaths in 1961) caused 9 fewer deaths than in 1960, while the number of deaths from all other accidents (11,173), suicide (5201), and homicide and operations of war
(306)
show
a
slight
rise
over
1960.
Venereal Disease Each year since 1958 the number of cases of infectious syphilis has risen, and it continued to do so in 1961. Although the total is still small compared with some other countries, the proportionate increase is considerable. As in 1960, the main increase in 1961 was in the London area, but there were also increases in male cases in Manchester and Salford, on Tyneside, and in Southampton, Leeds, and Bradford. Male cases decreased on Merseyside, in Bristol, Birmingham, and Sheffield, and remained the same in Hull. The figures for women showed a small increase on Tyneside and in Birmingham, but elsewhere the numbers decreased or were not apprecially different. The number of cases of early syphilis acquired by homosexual contact reported from the East End of London is smaller than that from the West End, but this does not necessarily mean that homosexual practices are less common in the East End. Practising homosexuals tend to seek each other’s company and their meeting places are believed to be mainly in the West End. It may be that they also seek medical advice in the West End where their friends have attended on earlier occasions. 1.
Report of the Ministry of Health for the Year 1961. Part II: On the State of the Public Health, being the Annual Report of the Chief Medical Officer. H.M. Stationery Office. Cmnd 1856. Pp. 248. 13s. 6d.
932 The report adds: " The rise in the incidence of infectious syphilis has been consistent in the past three years and, in the light of the increase in other infections and of experience in other countries, it must now be regarded as significant. It is surprising that the absolute numbers are still so small, but this may be due in part to suppression of infection, or the signs of infection, as the result of the widespread use of antibiotics for other conditions." The number of new cases of gonorrhoea diagnosed at the clinics also rose. The reasons for the increase include immigration from Commonwealth countries. In spite of suggestions to the contrary, the experience at the clinics has been that the majority of infections among immigrants have been contracted in this country, and much of it is contracted from prostitutes among whom the incidence of infection is high. The chief medical officer says it is necessary, in considering the syphilis figures, to keep a sense of proportion. But these are serious infections which threaten others, and they are not and, for six years have not been, under control. He describes the increase of gonorrhoea among adolescents, between the ages of 15 to 19, as disquieting. " This has been occurring for some years and is a sign of profound social malaise in that section of the population. Its remedy involves not so much medical as social factors." Lung Cancer Apart from the increase in male lung cancer, the picture of malignant disease in general suggests containment, the striking of a balance between the factors involved. Sir George remarks that the increase in lung cancer in both sexes continues to give the greatest anxiety. " The medical profession, in full awareness of the risks, has materially changed its smoking habits. Less than half the profession now smoke cigarettes at all.... The most hopeful measure of prevention of cancer of the lung lies in preventing children and adolescents from acquiring the habit at all. But so long as adults smoke it will be difficult to convince children of the dangers inherent in the practice, especially if their parents are smokers themselves. If propaganda could only take the smartness out of smoking or could lower prestige value, children might more easily be influenced against it. Unfortunately, smoking has become for them often a symbol of emancipation and maturity which is difficult to discredit. Yet we have the clearest indication that cancer of the lung will increase still further unless as a nation we can reduce the prevalence of cigarette smoking. This the individual must do for himself; no authority can do it for him. He is entitled to compute the hazards to himself, but he cannot wholly ignore the hazard to others who may follow his ...
example." Mental Health The results of a census of all patients in psychiatric hospitals at 30th April, 1961, while revealing the success of the Mental Health Act as measured by the very small proportion of patients under compulsory care, also show where the main therapeutic challenges for the future lie. Almost three-quarters of the resident population in hospitals for the mentally ill have been in hospital for two years or over. A proportion are middle-aged and physically healthy but have slight or moderate residual disabilities.... Improvement in the function of the psychiatric service both in the hospitals and in the community will require an increase in manpower; better training facilities for psychiatrists and a more practical grounding in psychiatry for general practitioners will be essential." "
Smallpox ON Oct. 18
who had boarded s.s. Orion at taken ashore at Suez with modified smallpox. His illness had started on Oct. 10, and he had been isolated in the ship’s hospital from Oct. 12 when the rash appeared. Medical officers of health have been notified by the Ministry of Health of passengers destined for their areas who disembarked at Marseilles on Oct. 24. Passengers who disembarked at Plymouth (on the 28th) and London (on the 29th) were placed under surveillance, and medical officers of health have been notified by the port health authorities.
Singapore
was
a
Malayan
In A
England
Now
Running Commentary by Peripatetic Correspondents
SOME questions should never be asked: one of these was heard at the preview of the Medical Art Society’s exhibition at Leighton House last week: " Is this a better show?" How better ? By what criterion are we to judge an exhibition of work that is mostly amateur ? Is it by the approximation to professional standards of technique and approach ? This was to be seen more in the watercolour section than in the oils-oddly perhaps, since watercolours need more skill and craftsmanship than oils. R. H. Rushton has essayed that most difficult of all tasks, a portrait in watercolour, and his likeness of Lord Adrian is skilful. Frank Forty is romantic with Antequera and Olive Trees, Portugal, G. H. Rose warm and free in his Pond in Osborne Estate, Isle of Wight, and Kandersteg, but too heavy with the ink in Alphubel Sas-Fee. T. Anderson is bold, sure, and vital in Bicycle Bridge (nostalgic for oarsmen of the Cam) and Distant Sea (a sea close to the hearts of Purbeck lovers). Should we look for originality, particularly in a profession hemmed in by circumstance and convention? This hardly exists in absolute terms, though the attempts are there almost as an exercise in G. Parker’s Forge and S. L. Simpson’s Pantasmagoria, but the effort to break away has caused him both to forget the quality of paint and the purpose of composition. A. M. Rackow has been more successful with Vortex and R. T. Payne’s watercolour Annunciation is likewise acceptable. And the only piece of sculpture shown (by R. A. Macdonald) has a totem quality which registers a break with amateur tradition at least. Perhaps the greatest interest lies in the observation of development in the work of those we have known over the years. There are some who have reached finality in their own maturity, such as Sir Philip Manson-Bahr (Lisbon Avernada da Liberdad), E. Peet (Weeds), J. Blewett (Spoleto), and M. Archer (Surrey Lane). Others are still searching. For years A. B. Hewlett has used a cold, competent, and meticulous style, as in The Viaduct; now he has broken away in a sensual and oddly horrorsome Green Fingers, which seems to echo the colour and feeling of the house in which it hangs. Most interesting, perhaps, is the way in which M. Little has, overnight almost, stepped from the uncertain to the sure and interesting in her landscape Cotswold Summer. B. N. Brooke, always inventive, contributes a watercolour The Pump, flat and delicately formal, Japanese-style, and two oils: one, In the Beginning, continues his essay in mysticism; while in the other, The Brett, with the aid of chiaroscuro and the ingenious use of pigment, he has given satisfying lustre to a rural scene. Your captious critic left the exhibition with a sense of sadness. Where are the younger members of our profession, some of whom
surely must paint ? *
*
*
The enuresis alarm was so successful in our child-guidance clinics that we decided to try it on our incontinent seniles. Our senior registrar constructed a suitable apparatus that not only showed a light and rang a bell, but also administered a local electric shock. Unfortunately, though working perfectly, our contraption had little immediate therapeutic effect. Sister said it was because the shock was mild and pleasurable, so our psychologist, who is a determined sort of fellow, decided to strengthen it. At what was presumably the first drop there was a blinding flash and a roar. In the ensuing hush another of our old ladies was heard complaining that it was high time the Czar gave orders to stop these nuclear tests as they were ruining the weather. When the smoke had cleared no trace of our patient was to be found. She was discovered by the police a week later a hundred miles away. The senior registrar is consoling himself for the loss of his beautiful machine by writing up " a case of Astronautism in the Female ".
The Nation’s Health in 1961
Public Health Congenital Abnormalities due to Thalidomide THE following information has been received from the Ministry of Health: In order to make as accurate an assessment as possible of the likely demands for special hospital facilities, the chief medical officer of the Ministry wrote to the medical officers of health of England and Wales on Aug. 1, 1962, asking them to submit details concerning children born with congenital abnormalities attributed to thalidomide. Information was asked as to each baby with a congenital deformity born to a woman who had taken thalidomide during pregnancy, in each of the years 1960 and 1961 and for 1962 up to Aug. 31 only, by which time all the babies likely to be affected by the drug would probably have been born. In addition, information was asked concerning all children with limb deformities whether or not the mother had taken thalidomide. A total of 805 returns was received of children with limb deformities born alive during the period. Of these, 153 subsequently died, including 85 where the mother took thalidomide
during pregnancy. Of the 652 remaining children, 244 mothers had definitely possibly taken thalidomide, although it was not possible to get precision as to the stage of pregnancy at which the drug was taken. 146 of the children showed gross deformities of two, three, or four limbs, including 27 with additional deformities, two-thirds of which were to the eyes or ears or both. 45 had deformities of one limb only, and a further 53 had deformities of the hands or feet or both. It is interesting to compare the distribution of the type of deformity among these cases with those where the mother did not take thalidomide. The latter group totalled 408 children of which 86 had gross deformities, 85 had only one limb affected, and 237 had minor limb deformities. (Cases of talipes have been excluded from the last figure.) Thus over half the children where the abnormality was associated with thalidomide had gross deformities, compared with about one-fifth among children regarding whose abnormality thalidomide could not be implicated. Besides the cases of limb deformities mentioned above, 61 children (including 3 who subsequently died) whose mothers had taken thalidomide had other congenital malformations. Thus there is a total of some 302 children now living who may have been affected by thalidomide. This includes 42 whose mothers took some pills during pregnancy but were uncertain as to the type. Details of the deformities in living children which may be associated with thalidomide are as follows: or
LIVING CHILDREN WHO HAVE DEFECTS ASSOCIATED WITH THALIDOMIDE Number of all cases where the mother took thalidomide (including 42mothers who took unknown pills) ............ 302 lumber of children with limb abnormalities (including 57 with additional 244 deformities) Kmnber of children with other than limb deformities only.... 58 ..................
DETAILS OF THE TYPE OF LIMB DEFORMITY
IN his reportfor 1961 Sir George Godber, chief medical officer of the Ministry of Health, remarks that an interesting feature of the expectation-of-life table is the narrow gap which now exists between the expectation of . life at birth and at age one year. In 1841 the increase in expectation of life after the first year was seven years; in 1961 this has been reduced to one year. Infant mortality continues to fall (in 1961 the rate was 21-4 per 1000 live births), though mortality during the first month of life shows no such improvement. Neonatal mortality is partly governed by events which affect the infant before it is born, and those conditions are hard to identify. Causes of Death Tuberculosis mortality continues to decline, but at a slower rate. The number of deaths from all forms of tuberculosis was 3334, only a quarter of that in 1951. The only other infective cause listed that shows a decline in deaths is syphilisfrom 944 in 1960 to 900 in 1961. Diphtheria claimed 10 victims-the highest number in any one year since 1955. Measles mortality rose from 31 deaths in 1960 to 152 in 1961, the largest number since 1955. Acute poliomyelitis mortality (59) rose above the previous year’s low record. Influenza also claimed more deaths,in 1961 (7102) than in the previous year (1098). Deaths from both pneumonia and bronchitis were nearly 5000 each more than in the preceding year. Deaths from cancer numbered 99,915 (18-1% of all deaths): the sites accounting for the largest number were the lung and bronchus (22,810), stomach (13,788), and breast (9367), while the sites with the largest increase since 1960 were the lung and bronchus (810 more) and breast (245 more). The average annual increase in deaths from cancer of the lung has been 4’7% for the past five years: they now account for 23% of all cancer deaths, compared with only 4% thirty years ago. Diseases of the heart and blood-vessels, including vascular lesions affecting the central nervous system, form the biggest group of causes of death and the number increases steadily each year, accounting for a total of 281,678 deaths in 1961. Deaths from congenital malformations are slightly more numerous (5196), but although the actual numbers have increased by 14% over the number five years ago the rate per 1000 live births has fallen slightly. Deaths of mothers due to pregnancy, abortion, and childbearing are again lower than in any previous year. Deaths from violence show little change. Motor-vehicle accidents (6634 deaths in 1961) caused 9 fewer deaths than in 1960, while the number of deaths from all other accidents (11,173), suicide (5201), and homicide and operations of war
(306)
show
a
slight
rise
over
1960.
Venereal Disease Each year since 1958 the number of cases of infectious syphilis has risen, and it continued to do so in 1961. Although the total is still small compared with some other countries, the proportionate increase is considerable. As in 1960, the main increase in 1961 was in the London area, but there were also increases in male cases in Manchester and Salford, on Tyneside, and in Southampton, Leeds, and Bradford. Male cases decreased on Merseyside, in Bristol, Birmingham, and Sheffield, and remained the same in Hull. The figures for women showed a small increase on Tyneside and in Birmingham, but elsewhere the numbers decreased or were not apprecially different. The number of cases of early syphilis acquired by homosexual contact reported from the East End of London is smaller than that from the West End, but this does not necessarily mean that homosexual practices are less common in the East End. Practising homosexuals tend to seek each other’s company and their meeting places are believed to be mainly in the West End. It may be that they also seek medical advice in the West End where their friends have attended on earlier occasions. 1.
Report of the Ministry of Health for the Year 1961. Part II: On the State of the Public Health, being the Annual Report of the Chief Medical Officer. H.M. Stationery Office. Cmnd 1856. Pp. 248. 13s. 6d.
932 The report adds: " The rise in the incidence of infectious syphilis has been consistent in the past three years and, in the light of the increase in other infections and of experience in other countries, it must now be regarded as significant. It is surprising that the absolute numbers are still so small, but this may be due in part to suppression of infection, or the signs of infection, as the result of the widespread use of antibiotics for other conditions." The number of new cases of gonorrhoea diagnosed at the clinics also rose. The reasons for the increase include immigration from Commonwealth countries. In spite of suggestions to the contrary, the experience at the clinics has been that the majority of infections among immigrants have been contracted in this country, and much of it is contracted from prostitutes among whom the incidence of infection is high. The chief medical officer says it is necessary, in considering the syphilis figures, to keep a sense of proportion. But these are serious infections which threaten others, and they are not and, for six years have not been, under control. He describes the increase of gonorrhoea among adolescents, between the ages of 15 to 19, as disquieting. " This has been occurring for some years and is a sign of profound social malaise in that section of the population. Its remedy involves not so much medical as social factors." Lung Cancer Apart from the increase in male lung cancer, the picture of malignant disease in general suggests containment, the striking of a balance between the factors involved. Sir George remarks that the increase in lung cancer in both sexes continues to give the greatest anxiety. " The medical profession, in full awareness of the risks, has materially changed its smoking habits. Less than half the profession now smoke cigarettes at all.... The most hopeful measure of prevention of cancer of the lung lies in preventing children and adolescents from acquiring the habit at all. But so long as adults smoke it will be difficult to convince children of the dangers inherent in the practice, especially if their parents are smokers themselves. If propaganda could only take the smartness out of smoking or could lower prestige value, children might more easily be influenced against it. Unfortunately, smoking has become for them often a symbol of emancipation and maturity which is difficult to discredit. Yet we have the clearest indication that cancer of the lung will increase still further unless as a nation we can reduce the prevalence of cigarette smoking. This the individual must do for himself; no authority can do it for him. He is entitled to compute the hazards to himself, but he cannot wholly ignore the hazard to others who may follow his ...
example." Mental Health The results of a census of all patients in psychiatric hospitals at 30th April, 1961, while revealing the success of the Mental Health Act as measured by the very small proportion of patients under compulsory care, also show where the main therapeutic challenges for the future lie. Almost three-quarters of the resident population in hospitals for the mentally ill have been in hospital for two years or over. A proportion are middle-aged and physically healthy but have slight or moderate residual disabilities.... Improvement in the function of the psychiatric service both in the hospitals and in the community will require an increase in manpower; better training facilities for psychiatrists and a more practical grounding in psychiatry for general practitioners will be essential." "
Smallpox ON Oct. 18
who had boarded s.s. Orion at taken ashore at Suez with modified smallpox. His illness had started on Oct. 10, and he had been isolated in the ship’s hospital from Oct. 12 when the rash appeared. Medical officers of health have been notified by the Ministry of Health of passengers destined for their areas who disembarked at Marseilles on Oct. 24. Passengers who disembarked at Plymouth (on the 28th) and London (on the 29th) were placed under surveillance, and medical officers of health have been notified by the port health authorities.
Singapore
was
a
Malayan
In A
England
Now
Running Commentary by Peripatetic Correspondents
SOME questions should never be asked: one of these was heard at the preview of the Medical Art Society’s exhibition at Leighton House last week: " Is this a better show?" How better ? By what criterion are we to judge an exhibition of work that is mostly amateur ? Is it by the approximation to professional standards of technique and approach ? This was to be seen more in the watercolour section than in the oils-oddly perhaps, since watercolours need more skill and craftsmanship than oils. R. H. Rushton has essayed that most difficult of all tasks, a portrait in watercolour, and his likeness of Lord Adrian is skilful. Frank Forty is romantic with Antequera and Olive Trees, Portugal, G. H. Rose warm and free in his Pond in Osborne Estate, Isle of Wight, and Kandersteg, but too heavy with the ink in Alphubel Sas-Fee. T. Anderson is bold, sure, and vital in Bicycle Bridge (nostalgic for oarsmen of the Cam) and Distant Sea (a sea close to the hearts of Purbeck lovers). Should we look for originality, particularly in a profession hemmed in by circumstance and convention? This hardly exists in absolute terms, though the attempts are there almost as an exercise in G. Parker’s Forge and S. L. Simpson’s Pantasmagoria, but the effort to break away has caused him both to forget the quality of paint and the purpose of composition. A. M. Rackow has been more successful with Vortex and R. T. Payne’s watercolour Annunciation is likewise acceptable. And the only piece of sculpture shown (by R. A. Macdonald) has a totem quality which registers a break with amateur tradition at least. Perhaps the greatest interest lies in the observation of development in the work of those we have known over the years. There are some who have reached finality in their own maturity, such as Sir Philip Manson-Bahr (Lisbon Avernada da Liberdad), E. Peet (Weeds), J. Blewett (Spoleto), and M. Archer (Surrey Lane). Others are still searching. For years A. B. Hewlett has used a cold, competent, and meticulous style, as in The Viaduct; now he has broken away in a sensual and oddly horrorsome Green Fingers, which seems to echo the colour and feeling of the house in which it hangs. Most interesting, perhaps, is the way in which M. Little has, overnight almost, stepped from the uncertain to the sure and interesting in her landscape Cotswold Summer. B. N. Brooke, always inventive, contributes a watercolour The Pump, flat and delicately formal, Japanese-style, and two oils: one, In the Beginning, continues his essay in mysticism; while in the other, The Brett, with the aid of chiaroscuro and the ingenious use of pigment, he has given satisfying lustre to a rural scene. Your captious critic left the exhibition with a sense of sadness. Where are the younger members of our profession, some of whom
surely must paint ? *
*
*
The enuresis alarm was so successful in our child-guidance clinics that we decided to try it on our incontinent seniles. Our senior registrar constructed a suitable apparatus that not only showed a light and rang a bell, but also administered a local electric shock. Unfortunately, though working perfectly, our contraption had little immediate therapeutic effect. Sister said it was because the shock was mild and pleasurable, so our psychologist, who is a determined sort of fellow, decided to strengthen it. At what was presumably the first drop there was a blinding flash and a roar. In the ensuing hush another of our old ladies was heard complaining that it was high time the Czar gave orders to stop these nuclear tests as they were ruining the weather. When the smoke had cleared no trace of our patient was to be found. She was discovered by the police a week later a hundred miles away. The senior registrar is consoling himself for the loss of his beautiful machine by writing up " a case of Astronautism in the Female ".