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THE PREVENTION OF TETANUS
489 "
worth while; through his uncalloused skin the whole child" and the influence of the environment are more easily comprehended. A sense of disquiet is produced, as is clearly intended, by this survey of the functions of general practitioners, paediatricians, hospitals, local-authority services, and administration, which demonstrates so many weaknesses, inconsistencies, and irrelevancies. Happily the authors do not stop there. On evidence already available, but largely ignored, they put forward well-argued proposals on current problems (including medical education), and they suggest studies from which we may learn to do better in the future. Much of what they say is not new. A few suggestions are personal and petillant, if not deliberately provocative-and are all the better for that. The whole is impressive and deeply disturbing. Dr. Joseph and Dr. Mac Keith have floodlit the makeshift, shored-up structure of child care in this country for those who care enough to look.
JOHN APLEY.
Public Health THE PREVENTION OF TETANUS The following statement was approved by the International Conference on Tetanus held in Berne on ,fuly 15-19 under the sponsorship of the Swiss Academy of Medical Sciences with the support of W.H.O.
Antibiotics such as penicillin and tetracycline have been shown to be effective against vegetative tetanus bacilli both in vitro and in experimental animals. They have no effect against toxin. The effectiveness of antibiotics for prophylaxis remains unproved, and, if used, they should be given over a period of at least five days. It is the
responsibility of organised medical groups, as well public-health authorities, to bring about universal active immunisation against tetanus at the earliest practicable date, by whatever method is compatible with the concepts of each community, and to ensure that the prophylactics used are of acceptable standard. as
Occupational
Cancers and Social
Pleural and peritoneal mesotheliomas in asbestos workers have been added to the list of prescribed industrial diseases, and victims of this disease, or their dependants, may be entitled to benefit after Aug. 22, 1966. The schedule is as follows (and it is qualified by certain conditions set out as a " transitional provision ") : Nature of occupation Description of disease or injury 44. Primary malignant neoplasm of Any occupation involving: the mesothelium (diffuse mesothe- (a) The working or handling of lioma) of the pleura or of the asbestos or any admixture of asbestos; peritoneum.
Description
(b) the manufacture
or repair of other articles containing or composed of asbestos; (c) the cleaning of any machinery or plant used in any of the foregoing operations and of any chambers, fixtures and appliances for the collection of asbestos dust; (d) substantial exposure to the dust arising from any of the foregoing
asbestos textiles
BASIC PROPHYLACTIC MEASURES
The risk of tetanus is universal. It is particularly high in the developing countries and is a major cause of neonatal death in many of these areas. The most effective and durable protection against tetanus is by active immunisation with adsorbed toxoid. Prophylactic measures given at the time of injury to non-immunised patients cannot be guaranteed to offer protection. Readily detectable and easily preservable information about the vaccination status of individuals is essential (e.g., identity
documents, driving-licences). Neonatal tetanus is preventable by active immunisation of the mother before or during the first 6 months of pregnancy. This can be achieved by two intramuscular injections of adsorbed toxoid given 6 weeks apart. The method of choice for active immunisation is as follows: For children, three intramuscular injections of toxoid in combination with other antigens after the third month of life, and for adults three intramuscular injections of adsorbed toxoid. The first and second injections 4-6 weeks apart, and the third 6-12 months later. PROPHYLACTIC MEASURES IN THE INJURED All wounds should receive effective surgical debridement as soon as possible after injury. Completely vaccinated patients should receive a toxoid booster unless they had one within the last year. Unvaccinated or incompletely vaccinated patients should receive a dose of toxoid followed by completion of active
immunisation (adsorbed toxoid). Additional prophylaxis may be provided for patients subject to special geographical or individual risks. Examples of special risks are : perforating wounds in the lower limbs, tissue damage, injuries on agricultural ground, retained foreign bodies. Additional prophylaxis may consist of antitoxin (human, heterologous) and antibiotics. Tetanus immune globulin of human origin has practically none of the disadvantages of heterologous antitoxin. Its use is to be encouraged. The recommended dose is 250 units. It should not be given intravenously, and not be injected at the same site as toxoid. The use of heterologous serum carries certain risks and its efficacy is limited. It must lie within the free competence of the physician to refuse the use of horse serum or other heterologous serums. If they are used, the recommended dose is 1500-3000 units. In special areas or circumstances, higher doses may be given.
Security Benefits
or
. operations.
Transitional provision Where a person, who has been employed on or at any time after 5th July 1948 in insurable employment in any of the occupations specified in the second column of the Schedule hereto, is, as the result of mesothelioma, either incapable of work or suffering from a loss of faculty on the date on which these regulations come into operation, and the disease is due to the nature of the employment, the provisions of regulation 6 of the principal regulations (which relates to the date of development) shall be applied subject to the modification that the said date on which these regulations come into operation shall be treated as the first day on which he was incapable of work or, as the case may be, as the day on which he first suffered from the relevant loss of faculty, and the date of development shall be determined accordingly.
Flavouring Agents In a joint announcement the Ministry of Agriculture, Fisheries and Food, Ministry of Health, Scottish Home and Health Department, and Home Office say that, after consideration of the Food Standards Committee’s report on flavouring agentsand comments on this report, it has been concluded that the most effective way of controlling the use of flavouring agents is by means of a permitted list. There are serious difficulties in proceeding, as the Food Standards Committee suggested, by means of a short prohibited list as a first step. Ministers therefore propose, after consulting the Food Additives and Contaminants Committee and in the light of their advice, to give the interests concerned an opportunity to provide evidence to establish the freedom from health hazard of those substances they wish to see included in a permitted list.
Food
Labelling
In its second and final report on food labelling2 (the first was issued in 1964 3) the Food Standards Committee recommends that the present controls on the various types of claims made for food should be extended, that the use of certain words should be restricted, and that regulations should be made on the use of pictures in labels and advertisements relating to food. Before deciding on action, Ministers will consider any representations by interests concerned. 1. See Lancet, 1965, ii, 395. 2. H.M. Stationery Office. 4s. 3. See Lancet, 1964, ii, 641.
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worth while; through his uncalloused skin the whole child" and the influence of the environment are more easily comprehended. A sense of disquiet is produced, as is clearly intended, by this survey of the functions of general practitioners, paediatricians, hospitals, local-authority services, and administration, which demonstrates so many weaknesses, inconsistencies, and irrelevancies. Happily the authors do not stop there. On evidence already available, but largely ignored, they put forward well-argued proposals on current problems (including medical education), and they suggest studies from which we may learn to do better in the future. Much of what they say is not new. A few suggestions are personal and petillant, if not deliberately provocative-and are all the better for that. The whole is impressive and deeply disturbing. Dr. Joseph and Dr. Mac Keith have floodlit the makeshift, shored-up structure of child care in this country for those who care enough to look.
JOHN APLEY.
Public Health THE PREVENTION OF TETANUS The following statement was approved by the International Conference on Tetanus held in Berne on ,fuly 15-19 under the sponsorship of the Swiss Academy of Medical Sciences with the support of W.H.O.
Antibiotics such as penicillin and tetracycline have been shown to be effective against vegetative tetanus bacilli both in vitro and in experimental animals. They have no effect against toxin. The effectiveness of antibiotics for prophylaxis remains unproved, and, if used, they should be given over a period of at least five days. It is the
responsibility of organised medical groups, as well public-health authorities, to bring about universal active immunisation against tetanus at the earliest practicable date, by whatever method is compatible with the concepts of each community, and to ensure that the prophylactics used are of acceptable standard. as
Occupational
Cancers and Social
Pleural and peritoneal mesotheliomas in asbestos workers have been added to the list of prescribed industrial diseases, and victims of this disease, or their dependants, may be entitled to benefit after Aug. 22, 1966. The schedule is as follows (and it is qualified by certain conditions set out as a " transitional provision ") : Nature of occupation Description of disease or injury 44. Primary malignant neoplasm of Any occupation involving: the mesothelium (diffuse mesothe- (a) The working or handling of lioma) of the pleura or of the asbestos or any admixture of asbestos; peritoneum.
Description
(b) the manufacture
or repair of other articles containing or composed of asbestos; (c) the cleaning of any machinery or plant used in any of the foregoing operations and of any chambers, fixtures and appliances for the collection of asbestos dust; (d) substantial exposure to the dust arising from any of the foregoing
asbestos textiles
BASIC PROPHYLACTIC MEASURES
The risk of tetanus is universal. It is particularly high in the developing countries and is a major cause of neonatal death in many of these areas. The most effective and durable protection against tetanus is by active immunisation with adsorbed toxoid. Prophylactic measures given at the time of injury to non-immunised patients cannot be guaranteed to offer protection. Readily detectable and easily preservable information about the vaccination status of individuals is essential (e.g., identity
documents, driving-licences). Neonatal tetanus is preventable by active immunisation of the mother before or during the first 6 months of pregnancy. This can be achieved by two intramuscular injections of adsorbed toxoid given 6 weeks apart. The method of choice for active immunisation is as follows: For children, three intramuscular injections of toxoid in combination with other antigens after the third month of life, and for adults three intramuscular injections of adsorbed toxoid. The first and second injections 4-6 weeks apart, and the third 6-12 months later. PROPHYLACTIC MEASURES IN THE INJURED All wounds should receive effective surgical debridement as soon as possible after injury. Completely vaccinated patients should receive a toxoid booster unless they had one within the last year. Unvaccinated or incompletely vaccinated patients should receive a dose of toxoid followed by completion of active
immunisation (adsorbed toxoid). Additional prophylaxis may be provided for patients subject to special geographical or individual risks. Examples of special risks are : perforating wounds in the lower limbs, tissue damage, injuries on agricultural ground, retained foreign bodies. Additional prophylaxis may consist of antitoxin (human, heterologous) and antibiotics. Tetanus immune globulin of human origin has practically none of the disadvantages of heterologous antitoxin. Its use is to be encouraged. The recommended dose is 250 units. It should not be given intravenously, and not be injected at the same site as toxoid. The use of heterologous serum carries certain risks and its efficacy is limited. It must lie within the free competence of the physician to refuse the use of horse serum or other heterologous serums. If they are used, the recommended dose is 1500-3000 units. In special areas or circumstances, higher doses may be given.
Security Benefits
or
. operations.
Transitional provision Where a person, who has been employed on or at any time after 5th July 1948 in insurable employment in any of the occupations specified in the second column of the Schedule hereto, is, as the result of mesothelioma, either incapable of work or suffering from a loss of faculty on the date on which these regulations come into operation, and the disease is due to the nature of the employment, the provisions of regulation 6 of the principal regulations (which relates to the date of development) shall be applied subject to the modification that the said date on which these regulations come into operation shall be treated as the first day on which he was incapable of work or, as the case may be, as the day on which he first suffered from the relevant loss of faculty, and the date of development shall be determined accordingly.
Flavouring Agents In a joint announcement the Ministry of Agriculture, Fisheries and Food, Ministry of Health, Scottish Home and Health Department, and Home Office say that, after consideration of the Food Standards Committee’s report on flavouring agentsand comments on this report, it has been concluded that the most effective way of controlling the use of flavouring agents is by means of a permitted list. There are serious difficulties in proceeding, as the Food Standards Committee suggested, by means of a short prohibited list as a first step. Ministers therefore propose, after consulting the Food Additives and Contaminants Committee and in the light of their advice, to give the interests concerned an opportunity to provide evidence to establish the freedom from health hazard of those substances they wish to see included in a permitted list.
Food
Labelling
In its second and final report on food labelling2 (the first was issued in 1964 3) the Food Standards Committee recommends that the present controls on the various types of claims made for food should be extended, that the use of certain words should be restricted, and that regulations should be made on the use of pictures in labels and advertisements relating to food. Before deciding on action, Ministers will consider any representations by interests concerned. 1. See Lancet, 1965, ii, 395. 2. H.M. Stationery Office. 4s. 3. See Lancet, 1964, ii, 641.
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