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an important cause of industrial disability (Troup, 1965), little discussion of it is given in the standard textbooks of orthopaedics. As the aetiology, pathology, and prognosis are all obscure, this lack of attention is understandable. To many minds acute lower back pain, with or without sciatica, suggests as a first possibility prolapsed lumbar intervertebral disc; to others the "osteopathic lesion" is the common explanation (Stoddard, 1959). This paper represents an attempt to measure the incidence of " acute backs " in one general practice and to note if a cause such as back strain is often present. An effort has also been made to discover if any aspects of the clinical condition have a significant influence on the duration of the initial attack or the liability to recurrence.

Pain may be attacked in the rheumatic diseases (1) centrally, with drugs ranging in efficiency from those which are potentially addictive and under the Dangerous Drugs Act (e.g., pethidine) and are therefore rarely used, down to simple analgesics such as paracetamol; (2) peripherally, by local action, whether it be by applications of heat or cold, by injections of local anaesthetics or anti-inflammatory agents, or by surgery; (3) peripherally, by anti-inflammatory non-analgesic agents taken systemically, such as the corticosteroids; and (4) peripherally, by anti-inflammatory-analgesic-antipyretic agents taken systemically, such as aspirin.The exact sites of action of the pyrazoles, indomethacin, the anthranilic compounds, and other anti-inflammatory-analgesic-antipyretic drugs are as yet uncertain, but along with these methods of attacking the pain-producing areas help must also be given to the distressed mind behind the joints. Faith in the future, cheerfulness, freedom from depression, and the development of a philosophy to deal with the uncertainties of the disease are essential. It has been said that you don't have to be a doctor to treat uncomplicated lobar pneumonia: anybody with a bottle of penicillin in his hands holds the cure. It is the incurable diseases that are really worth treating, and that make demands on the physician. To quote Tuker: "My last word is this. Whoever has the care of a sorely stricken arthritic must encourage him to fulfil himself intellectually and spiritually, and to achieve-no matter what, but to achieve, so that he may nightly lay himself down on his bed of pain looking forward happily to the morrow's task, mind centred upon it, no matter what it is; sticking in stamps, research into anything you like, dabbling with pastel or water colours, writing chatty letters to friends. Anything at all, but let it be for him the most pressing thing of the day, and let him believe that you think it is. Help him and let him live, live fully."This is perhaps the best analgesic of all.

Certificates of inability or fitness to work were issued on 6,161 occasions in one year in one group practice. Half the episodes of illness lasted for seven days or less, and two thirds of the episodes ended on a Sunday. Clearly in most cases the doctor does no more than countersign the patient's declaration of his fitness or not to work. Abolition of short-term medical certification would probably have little effect on absenteeism or the sums paid out as sick benefit.

The transfer of responsibility for the care of the chronic sick in hospital from Local Authorities to Regional Hospital Boards has raised two important questions. First, Regional Hospital Boards have to decide on the location and number of beds to be provided for this class of patient. Their waiting lists indicate that more accommodation is needed, but more accommodation of the existing type would aggravate staffing difficulties which are already serious. The alternative possibility of catering for these patients in general hospitals has much to recommend it, but raises the objection that the apparent number of patients would prohibit the general application of such a policy. Second, Local Authorities have to agree on the interpretation of those sections of Part III of the National Health Services Act* (1946) and of Part III of the National Assistance Actf (1948), which refer to their responsibility for complementary facilities. The intention of the acts is evidently to leave to Local Authorities domiciliary and institutional care of persons who need not be admitted to hospitals, but the wording of the acts reflects the lack of informa tion about the numbers and types of patients for whom Local Authorities will be expected to cater. The fact that social as well as medical needs have in the past determined the admission and retention of patients in hospitals for the chronic sick suggested that the number of patients now in hospital is unreliable as a guide to future develop ments. Consideration of the medical, nursing, and social requirements of 1,005 patients in one hospital indicated that about three-fifths were not in need of hospital services and could have been cared for in their own homes or in institutions other than hospitals (Lowe and McKeown, 1949). One-fifth of the patients required institutional supervision because of their abnormal mental state, and only the remaining one-fifth were in need of services which could properly be considered the concern of general hospital authorities. Reduced to these dimensions, the problem of the chronic sick in hospital can be reconsidered in relation to the general hospitals. In this paper we examine other data which have a bearing on the commitments of Regional Hospital Boards and Local Authorities.

The patients in the ear, nose, and throat wards were under the care of Mr. C. P. Wilson, Mr. J. P. Monkhouse, and Mr. D. Ranger, and I thank them for permission to carry out the trial. I also thank Dr. J. D. N. Nabarro for his criticisms and en couragement in the preparation of the paper; Mr. M. P. Curwen, of St. Bartholomew's Hospital, for his invaluable help with the statistics; Dr. Margaret Briggs, of Roche Products, for the pre paration and dispensing of the tablets; and the night sisters and their nursing staff, whose enthusiastic co-operation made this trial nnssiileh REFERENCES Brandman, O., Coniaris. J., and Keller, H. B. (1955). J. med. Soc. N.J., 52, 246. Cass, L. J., Frederik, W. S., and Andosca, J. B. (1955). New Engl. J. Med., 253. 586. Hare, E. H. (1955). Brit. J. prev. soc. Med., 9, 140. Kemper, H. (1955). Dtsch. med. Wschr., 80, 1034. Schmitt, W. (1955). Med. KlUn., 50, 1223.

It was with some misgiving that I read in my morning paper that as from 1 April 1974 all contraceptives are to be made available on National Health Service prescription. Some 7 months ago my partner and I found that the number of women in our practice on the pill was assuming such proportions that we were unable to be as thorough in our 6-monthly check-ups as we wished. We therefore decided to employ on a sessional basis a woman doctor who devoted all her available time to family planning work. The result has been most encouraging and the 75p for prescribing the pill has been a great help in her renumeration. Can I take it that as from 1 April 1974 family planning will be yet another item the general practitioner must carry out with no extra renumeration? If so I am sure a great many G.P.s will discontinue any form of regular examination for these women. Even at the present time numerous women arriving in this area have been astonished to learn that they are unable to obtain a repeat prescription without an examination. So far as condoms are concerned I did not study medicine with the ideas of supplying these articles. If the general public are to have condoms on the N.H.S. I suggest that family planning clinics supply them or possibly the local health or welfare departments. As a medical examination is not necessary before a condom is worn I do not propose to issue prescriptions for these articles and feel that many G.P.s will follow suit.(FULL TEXT)