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W.H.O. IN 1951
1101
Annotations W.H.O. IN 1951 THAT the World Health Organisation is now a sturdy child is demonstrated by the need for 200 double-column Dr. Brock pages in the directors’ report for 1951.1 a further the records Chisholm, development of " world health consciousness." There is a widespread opinion that it is " the duty of those countries more richly endowed with resources and more skilled in their use and conservation to help those less developed to provide the scientific and medical means of improving the health of their peoples." This is no longer an ideal limited to a hopelessly small number of missionaries and humanitarians ; it has the practical support of 69 countries who subscribed nearly six million dollars to the funds of W.H.O. last year. The United Kingdom’s share was the sterling equivalent of$815,452. Basic work on epidemiology, environmental sanitation (which " remains the bedrock of the preservation of health)," and drugs and therapeutic substances is being continued. The scope of W.H.O.’s work is now so large that detailed direction from Geneva is no longer practicable. Six regional headquarters have been set up-in Africa, the Americas, South-East Asia, Europe, the Eastern Mediterranean, and the Western Pacific. Autonomy and opportunity for initiative exist within these regions, and this administrative decentralisation will undoubtedly contribute to a more stable and efficient
director-general,
organisation.
the Soviet Union, and other eastern European countries. Despite this unfortunate gap, the United Nations has proved itself capable of promoting international coöperation for the good of the world’s health. None but the unduly pessimistic can fail to be heartened by reading on fundaof these attacks by international teams -.
"
"
mental human problems. EXPERIMENTAL PULMONARY HÆMOSIDEROSIS
THE interesting experimental work1 done by Dr. F. R. Magarey in the department of pathology of the Welsh National School of Medicine justifies a postscript to our leading article of May 17. Lendrum and his colleagues2 believe that the focal deposits of siderophores are the result of bleeding into the lungs from the mucosa of the terminal bronchioles at the site of the anastomoses between the bronchial and pulmonary circulations. Magarey has shown that blood injected endotracheally into the lungs of rats is at first widely distributed, but later it collects in groups of alveoli as aggregates of intracellular hæmosiderin like those seen in human pulmonary haemosiderosis. Some animals received a single injection of blood, while others had repeated injections over a period of months. In those rats killed immediately after injection, the blood was distributed diffusely large areas of the lungs. Some rats were killed two days after injection ; many phagocytes were found in the alveoli, a lot of them containing red cells, but a few red cells were still free in the alveoli. At this stage large extracellular crystals of haemoglobin were present. Four days after injection the phagocytes, which tended to congregate in clumps, contained a few minute haemosiderin crystals. After a week the phagocytes were full of hæmosiderin, and the haemoglobin crystals had disappeared. By ten days most of the siderophores had collected in small groups, and at fourteen days the aggregation was even more noticeable, but there were still a few phagocytes irregularly scattered through the
through
Of the many plans being put into action, two involve methods of special interest. There is the bold attempt to eradicate yaws from heavily infected populations by examining every person and systematically treating these infected. This work has started in SouthEast Asia, and in the first half of 1951 alone over half a million people were examined in Thailand and Indonesia by local teams under international guidance, and 140,000 cases of yaws were discovered and treated with penicillin. The aim is that every inhabitant of these countries should be examined. This immense task is in the hands of a team; the expert consultative staff is supplied by W.H.O., the local staff by the national governments, and most of the penicillin, the necessary jeeps (the camels of the jungle), and the administrative help by UNICEF. There is also the first serious attempt to deal with the problem of excessive population on an international scale. The W.H.O. regional committee for South-East Asia, with the help of the government of India, has set upa pilot experiment in the-use of the rhythm method " of population control. Such an experiment is fraught with difficulties, both educational and physiological. Both W.H.O. and the government of India have shown courage and vision in undertaking an experiment which must be regarded by many experienced critics as attempting the impossible. The venture is well worth while, even if the pilot experiment has only a limited success, for it will point the way to other means of studying the growth and control of large populations-a problem fundamental to world health-and it should advance our knowledge of maternal and child health. W.H.O. also teaches by collecting, sorting, and Seventeen interdistributing technical knowledge. national training courses were organised last year : these included one in London on the reablement of physically handicapped children, another in Calcutta- on nutrition, and a medical teaching mission to Iran. During the year 655 fellowships were granted to nationals of 73 countries. The report is a record of solid achievement. The one black spot is the list of " inactive members " : China,
for instance, is there widespread, diffuse distribution of haemosiderin in some cases, and in others focal accumulations ? This fact alone shows that red cells, widely scattered in the lungs, are not always collected into aggregates. Magarey’s
1. The Work of W.H.O. Annual report of the director-general W.H.O. Geneva. 1952. Pp. 200. 9s. Obtainable from H.M. Stationery Office.
1. Magarey, F. R. J. Path. Bact. 1951, 63, 729. 2. Lendrum, A. C., Scott, L. D. W., Park, S. D. S. 1950, 19, 249.
new
"
lung. In the rats which had had repeated injections for about thirteen weeks, small clusters of alveoli packed with pigment-bearing phagocytes were seen in the region of the alveolar ducts, while the neighbouring alveoli were almost free of cells. Some animals were killed immediately after the last injection, and in these the discrete aggregations of siderophores were surrounded by red cells diffusely distributed in many alveoli. But nine months after the last injection, focal collections of siderophores were fairly evenly scattered through the lungs ; there were rather more in the dorsal parts, suggesting that gravity had little or no effect on their distribution. A few deposits of haemosiderin were found in the perivascular and peribronchial interstitial tissue, but most of the pigment was in alveoli well away from these sites. Magarey points out that his experiments suggest that collections of haemosiderin-containing phagocytes, such as those seen in the lungs in mitral stenosis, may be the result of diffuse haemorrhage within the lungs. He rightly says that there are small differences in the minute anatomy of the lung in man and rat, but that the similarity of the appearances is close enough to conclude that the fundamental process is the same in both. His experiments, however, do not mean that Lendrum and his colleagues are necessarily wrong about the source of the bleeding in human hæmosiderosis. They were dealing with abnormal human lungs, and Magarey with those of healthy rats. Much remains
unexplained ; why,
experiments,
Quart. J. Med.
Annotations W.H.O. IN 1951 THAT the World Health Organisation is now a sturdy child is demonstrated by the need for 200 double-column Dr. Brock pages in the directors’ report for 1951.1 a further the records Chisholm, development of " world health consciousness." There is a widespread opinion that it is " the duty of those countries more richly endowed with resources and more skilled in their use and conservation to help those less developed to provide the scientific and medical means of improving the health of their peoples." This is no longer an ideal limited to a hopelessly small number of missionaries and humanitarians ; it has the practical support of 69 countries who subscribed nearly six million dollars to the funds of W.H.O. last year. The United Kingdom’s share was the sterling equivalent of$815,452. Basic work on epidemiology, environmental sanitation (which " remains the bedrock of the preservation of health)," and drugs and therapeutic substances is being continued. The scope of W.H.O.’s work is now so large that detailed direction from Geneva is no longer practicable. Six regional headquarters have been set up-in Africa, the Americas, South-East Asia, Europe, the Eastern Mediterranean, and the Western Pacific. Autonomy and opportunity for initiative exist within these regions, and this administrative decentralisation will undoubtedly contribute to a more stable and efficient
director-general,
organisation.
the Soviet Union, and other eastern European countries. Despite this unfortunate gap, the United Nations has proved itself capable of promoting international coöperation for the good of the world’s health. None but the unduly pessimistic can fail to be heartened by reading on fundaof these attacks by international teams -.
"
"
mental human problems. EXPERIMENTAL PULMONARY HÆMOSIDEROSIS
THE interesting experimental work1 done by Dr. F. R. Magarey in the department of pathology of the Welsh National School of Medicine justifies a postscript to our leading article of May 17. Lendrum and his colleagues2 believe that the focal deposits of siderophores are the result of bleeding into the lungs from the mucosa of the terminal bronchioles at the site of the anastomoses between the bronchial and pulmonary circulations. Magarey has shown that blood injected endotracheally into the lungs of rats is at first widely distributed, but later it collects in groups of alveoli as aggregates of intracellular hæmosiderin like those seen in human pulmonary haemosiderosis. Some animals received a single injection of blood, while others had repeated injections over a period of months. In those rats killed immediately after injection, the blood was distributed diffusely large areas of the lungs. Some rats were killed two days after injection ; many phagocytes were found in the alveoli, a lot of them containing red cells, but a few red cells were still free in the alveoli. At this stage large extracellular crystals of haemoglobin were present. Four days after injection the phagocytes, which tended to congregate in clumps, contained a few minute haemosiderin crystals. After a week the phagocytes were full of hæmosiderin, and the haemoglobin crystals had disappeared. By ten days most of the siderophores had collected in small groups, and at fourteen days the aggregation was even more noticeable, but there were still a few phagocytes irregularly scattered through the
through
Of the many plans being put into action, two involve methods of special interest. There is the bold attempt to eradicate yaws from heavily infected populations by examining every person and systematically treating these infected. This work has started in SouthEast Asia, and in the first half of 1951 alone over half a million people were examined in Thailand and Indonesia by local teams under international guidance, and 140,000 cases of yaws were discovered and treated with penicillin. The aim is that every inhabitant of these countries should be examined. This immense task is in the hands of a team; the expert consultative staff is supplied by W.H.O., the local staff by the national governments, and most of the penicillin, the necessary jeeps (the camels of the jungle), and the administrative help by UNICEF. There is also the first serious attempt to deal with the problem of excessive population on an international scale. The W.H.O. regional committee for South-East Asia, with the help of the government of India, has set upa pilot experiment in the-use of the rhythm method " of population control. Such an experiment is fraught with difficulties, both educational and physiological. Both W.H.O. and the government of India have shown courage and vision in undertaking an experiment which must be regarded by many experienced critics as attempting the impossible. The venture is well worth while, even if the pilot experiment has only a limited success, for it will point the way to other means of studying the growth and control of large populations-a problem fundamental to world health-and it should advance our knowledge of maternal and child health. W.H.O. also teaches by collecting, sorting, and Seventeen interdistributing technical knowledge. national training courses were organised last year : these included one in London on the reablement of physically handicapped children, another in Calcutta- on nutrition, and a medical teaching mission to Iran. During the year 655 fellowships were granted to nationals of 73 countries. The report is a record of solid achievement. The one black spot is the list of " inactive members " : China,
for instance, is there widespread, diffuse distribution of haemosiderin in some cases, and in others focal accumulations ? This fact alone shows that red cells, widely scattered in the lungs, are not always collected into aggregates. Magarey’s
1. The Work of W.H.O. Annual report of the director-general W.H.O. Geneva. 1952. Pp. 200. 9s. Obtainable from H.M. Stationery Office.
1. Magarey, F. R. J. Path. Bact. 1951, 63, 729. 2. Lendrum, A. C., Scott, L. D. W., Park, S. D. S. 1950, 19, 249.
new
"
lung. In the rats which had had repeated injections for about thirteen weeks, small clusters of alveoli packed with pigment-bearing phagocytes were seen in the region of the alveolar ducts, while the neighbouring alveoli were almost free of cells. Some animals were killed immediately after the last injection, and in these the discrete aggregations of siderophores were surrounded by red cells diffusely distributed in many alveoli. But nine months after the last injection, focal collections of siderophores were fairly evenly scattered through the lungs ; there were rather more in the dorsal parts, suggesting that gravity had little or no effect on their distribution. A few deposits of haemosiderin were found in the perivascular and peribronchial interstitial tissue, but most of the pigment was in alveoli well away from these sites. Magarey points out that his experiments suggest that collections of haemosiderin-containing phagocytes, such as those seen in the lungs in mitral stenosis, may be the result of diffuse haemorrhage within the lungs. He rightly says that there are small differences in the minute anatomy of the lung in man and rat, but that the similarity of the appearances is close enough to conclude that the fundamental process is the same in both. His experiments, however, do not mean that Lendrum and his colleagues are necessarily wrong about the source of the bleeding in human hæmosiderosis. They were dealing with abnormal human lungs, and Magarey with those of healthy rats. Much remains
unexplained ; why,
experiments,
Quart. J. Med.