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WHY NOT NOW ?
614 BRITISH
EQUIVALENTS
LAST year
we
published1
OF FOREIGN DRUGS a list of official
copceial titles of foreign proprietary drugs
now
pharmaproduced
by British manufacturers. The General Medical Council has now approved names for further substances which are produced, or are likely shortly to be produced by British manufacturers, in some instances under licences granted by the Comptroller-General of Patents, Designs and
as teaching and research must be centralised in key-hospitals, and in each region it would be the task of the medical advisory committee to arrange a proper distribution of services. Other problems, to be solved by good will and understanding and cooperation, were the remuneration of medical staffs in the voluntary
well
state subsidies and the extension of insurance schemes. Mr. S. P. Richardson, hospit and jcSa.tributory chairman of the provincial hospitals’ regional committee,
Trade Marks. These substances have hitherto been known under other names. The question of including these substances in the British Pharmacopoeia is under consideration, and if any of them is included the intention is that the approved name given below will be its official title. Approved Name Proprietary Name Diodone Perabrodil Butolan Diphenan Dithranol Cignolin Triazole (Azoman) Hexazole ..
..
..
...
Mesulphen Pholedrine
..
..
Mitigal Veritol
It is
hoped that these approved names will be generally adopted. WHY
NOT
NOW ?
said there need be no interference with local tradition. The essence of the scheme was a partnership to give a better health service. In the lively to-and-fro of the general discussion which followed these speeches possible difficulties of detail emerged : would infectious diseases’ hospitals come within the scheme (they have not so far) ; would a local authority have the power to make contributions for administrative expenses to a non-statutory body like a regional council ; would the best medical staff tend to concentrate in the central hospitals to the detriment of the outside hospitals ; would voluntary hospitals still be allowed a preferential position in regard to training nurses and patients ? Sir Farquhar replied that each region must resolve its own difficulties but the idea was to distribute rather than concentrate consultants. While the principle of regionalisation was generally accepted the conference, at Prof. Henry Cohen’s suggestion, adjourned for the representatives to secure a local mandate.
IMPORTANT tasks lie to hand which we simply cannot afford to put aside till after the war.2 Regionalisation of hospital services is one of them. In his letter to a conference at Liverpool, Lord Derby pointed out that though the future may alter details the broad principles of regionalisation transcend the war. (His words have an added poignancy in view of the desperate straits in which some of the Liverpool hospitals now find themselves owing to the air peril. Pending the great scheme to replace the four branches of the United Hospital by one large hospital with medical school attached, it seems possible that on financial grounds two of the branches, removed to outlying areas, may have to close down.) The conference, which met at the suggestion of the Nuffield Provincial Hospitals’ Trust, was attended by representatives of the Liverpool Hospitals joint advisory committee, of twenty-one local authorities, and of forty-seven voluntary hospitals from the proposed region which covers North Wales, takes in Liverpool, Bootle and Preston, and extends as far north as Carlisle. Mr. W. M. Goodenough, chairman of the trust, recalled that in 1937 the Sankey Commission had urged the regionalisation of voluntary hospitals in the interests of economy and efficiency, and at Oxford Lord Nuffield had provided the money to start a joint hospitals board on the lines suggested by the commission, but with the difference that the coordination of the public-health authorities with the voluntary hospitals was stipulated. The experiment had been a success and in 1939 Lord Nuffield had endowed the trust with a million Morris Motors ordinary share units to implement the scheme throughout England, Scotland and Northern Ireland. The income of ’the trust is to be used for administration and grants in aid, and the organisation will consist of divisional councils, each covering a large area and providing most important services ; regional councils on each of which two or more divisions will be represented ; and a central hospitals regionalisation council, on which all these bodies would be represented. Despite the war rapid progress had been made in setting up divisions and regions in various parts of the country. They aimed not at a state system but at a national system working in liaison with the Ministry of Health and based on local
self-government. Sir Farquhar Buzzard, chairman of the medical advisory committee of the trust, said he had found an encouraging consensus of opinion in favour of the scheme among laymen and doctors. Any scheme of regionalisation must provide all classes with easy
access to the best that modern medicine and surgery had to offer. Today on economic grounds the more expensive and specialised methods of investigation as
Lancet, 1940, 1, 804. 2. Lord Horder in the Sunday Times of April 20.
1.
Public Health in Glasgow unusual the recent epidemic about nothing of whooping-cough in Glasgow, nor anything exceptional about its fatality for young children. If the former is inevitable the latter should be a continual spur to medical endeavour. In Glasgow the disease is more or less prevalent every second winter. During the past winter the rise began in mid-October, 1940, gradually increasing until the new year. Like measles it travels through the city from one district to another, but now it is general with a weekly average of 600 + new cases. The total number of cases registered in the first six months of recent years is as follows :—
Whooping-cough
THERE is
1933-34 193!-35 1935-36 1936-37
....
3117
.... 10,691 ....
....
2106 6645 *
1937-38 1938-39 1939-40 1940-41 estimated.
....
....
....
....
1388 9453 305 8800*
Sex- and age-distribution for the first sixteen weeks of this year may be compared with the corresponding figures for 1939 :—
from which it may be observed that whooping-cough is very common in younger school-children. In so far as it can be reasonably computed for the current epidemic the case-mortality is 3-6%, being highest at the youngest ages: under one year 22%, under five years 4-6%. What Lord Horder calls a troglodyte existence cannot be said to have anything to do with the incidence or fatality, as shelter life plays little Dart in Glasgow. From the Annual
Reports
HORNSEY AND EAST HAM
The reports of two boroughs of the outer ring of the metropolis, Hornsey (R. P. Garrow, M.O.H.) and East Ham (Malcolm E. Barker, M.O.H.) make an interesting comparison, for the units are widely different in character. Their death-rates were nearly the same,
EQUIVALENTS
LAST year
we
published1
OF FOREIGN DRUGS a list of official
copceial titles of foreign proprietary drugs
now
pharmaproduced
by British manufacturers. The General Medical Council has now approved names for further substances which are produced, or are likely shortly to be produced by British manufacturers, in some instances under licences granted by the Comptroller-General of Patents, Designs and
as teaching and research must be centralised in key-hospitals, and in each region it would be the task of the medical advisory committee to arrange a proper distribution of services. Other problems, to be solved by good will and understanding and cooperation, were the remuneration of medical staffs in the voluntary
well
state subsidies and the extension of insurance schemes. Mr. S. P. Richardson, hospit and jcSa.tributory chairman of the provincial hospitals’ regional committee,
Trade Marks. These substances have hitherto been known under other names. The question of including these substances in the British Pharmacopoeia is under consideration, and if any of them is included the intention is that the approved name given below will be its official title. Approved Name Proprietary Name Diodone Perabrodil Butolan Diphenan Dithranol Cignolin Triazole (Azoman) Hexazole ..
..
..
...
Mesulphen Pholedrine
..
..
Mitigal Veritol
It is
hoped that these approved names will be generally adopted. WHY
NOT
NOW ?
said there need be no interference with local tradition. The essence of the scheme was a partnership to give a better health service. In the lively to-and-fro of the general discussion which followed these speeches possible difficulties of detail emerged : would infectious diseases’ hospitals come within the scheme (they have not so far) ; would a local authority have the power to make contributions for administrative expenses to a non-statutory body like a regional council ; would the best medical staff tend to concentrate in the central hospitals to the detriment of the outside hospitals ; would voluntary hospitals still be allowed a preferential position in regard to training nurses and patients ? Sir Farquhar replied that each region must resolve its own difficulties but the idea was to distribute rather than concentrate consultants. While the principle of regionalisation was generally accepted the conference, at Prof. Henry Cohen’s suggestion, adjourned for the representatives to secure a local mandate.
IMPORTANT tasks lie to hand which we simply cannot afford to put aside till after the war.2 Regionalisation of hospital services is one of them. In his letter to a conference at Liverpool, Lord Derby pointed out that though the future may alter details the broad principles of regionalisation transcend the war. (His words have an added poignancy in view of the desperate straits in which some of the Liverpool hospitals now find themselves owing to the air peril. Pending the great scheme to replace the four branches of the United Hospital by one large hospital with medical school attached, it seems possible that on financial grounds two of the branches, removed to outlying areas, may have to close down.) The conference, which met at the suggestion of the Nuffield Provincial Hospitals’ Trust, was attended by representatives of the Liverpool Hospitals joint advisory committee, of twenty-one local authorities, and of forty-seven voluntary hospitals from the proposed region which covers North Wales, takes in Liverpool, Bootle and Preston, and extends as far north as Carlisle. Mr. W. M. Goodenough, chairman of the trust, recalled that in 1937 the Sankey Commission had urged the regionalisation of voluntary hospitals in the interests of economy and efficiency, and at Oxford Lord Nuffield had provided the money to start a joint hospitals board on the lines suggested by the commission, but with the difference that the coordination of the public-health authorities with the voluntary hospitals was stipulated. The experiment had been a success and in 1939 Lord Nuffield had endowed the trust with a million Morris Motors ordinary share units to implement the scheme throughout England, Scotland and Northern Ireland. The income of ’the trust is to be used for administration and grants in aid, and the organisation will consist of divisional councils, each covering a large area and providing most important services ; regional councils on each of which two or more divisions will be represented ; and a central hospitals regionalisation council, on which all these bodies would be represented. Despite the war rapid progress had been made in setting up divisions and regions in various parts of the country. They aimed not at a state system but at a national system working in liaison with the Ministry of Health and based on local
self-government. Sir Farquhar Buzzard, chairman of the medical advisory committee of the trust, said he had found an encouraging consensus of opinion in favour of the scheme among laymen and doctors. Any scheme of regionalisation must provide all classes with easy
access to the best that modern medicine and surgery had to offer. Today on economic grounds the more expensive and specialised methods of investigation as
Lancet, 1940, 1, 804. 2. Lord Horder in the Sunday Times of April 20.
1.
Public Health in Glasgow unusual the recent epidemic about nothing of whooping-cough in Glasgow, nor anything exceptional about its fatality for young children. If the former is inevitable the latter should be a continual spur to medical endeavour. In Glasgow the disease is more or less prevalent every second winter. During the past winter the rise began in mid-October, 1940, gradually increasing until the new year. Like measles it travels through the city from one district to another, but now it is general with a weekly average of 600 + new cases. The total number of cases registered in the first six months of recent years is as follows :—
Whooping-cough
THERE is
1933-34 193!-35 1935-36 1936-37
....
3117
.... 10,691 ....
....
2106 6645 *
1937-38 1938-39 1939-40 1940-41 estimated.
....
....
....
....
1388 9453 305 8800*
Sex- and age-distribution for the first sixteen weeks of this year may be compared with the corresponding figures for 1939 :—
from which it may be observed that whooping-cough is very common in younger school-children. In so far as it can be reasonably computed for the current epidemic the case-mortality is 3-6%, being highest at the youngest ages: under one year 22%, under five years 4-6%. What Lord Horder calls a troglodyte existence cannot be said to have anything to do with the incidence or fatality, as shelter life plays little Dart in Glasgow. From the Annual
Reports
HORNSEY AND EAST HAM
The reports of two boroughs of the outer ring of the metropolis, Hornsey (R. P. Garrow, M.O.H.) and East Ham (Malcolm E. Barker, M.O.H.) make an interesting comparison, for the units are widely different in character. Their death-rates were nearly the same,