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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.

In Northern Ireland all prescriptions* written by family doctors are sent to the Northern Ireland General Health Services Board so that pharmacists may be paid. The opportunity has been taken to analyse the prescribing of drugs or groups of drugs and changes in prescribing between 1966 and 1970. In this paper the prescribing of an hypnotic preparation, Mandrax,* is described. Differences of prescribing in different practices and geographical differences are reported and a study of the high prescribers of the preparation has been carried out. The paper is the first of a number which examine critically the prescribing of drugs by family doctors in the community. The work described in this paper began after the thalidomide disaster in 1961. Everyone who in vestigated the cause of the increase in the birthrate of phocomelic infants at that time found great difficulty in ascertaining whether the mothers had been prescribed thalidomide during their pregnancy. Doctors had seldom kept any records of the drugs prescribed and the memory of both patients and doctors of what had taken place several months previously was so imperfect as to be valueless. It was Speirs (1962), working in Stirlingshire, who con ceived the idea of examining National Health Service prescription scripts. He was able to obtain documentary proof that thalidomide had been prescribed during the pregnancy of 8 out of 10 women who had given birth to deformed children but who had denied, as did their family doctors, that the drug had ever been prescribed for them. To achieve these results, however, Speirs had to make a long and tedious search through thousands of prescription scripts written in central Scotland during the relevant period of time. Wade (1966) found that a similar search could be made much more rapidly in Northern Ireland where details of all prescriptions were more readily accessible, This was because in 1952 the Northern Ireland General Health Services Board pricing bureau had introduced a system of mechanized data

If we are not now aware that old age and chronic sickness are among the most urgent of contemporary medical problems, it is not the fault of the numerous writers who have tried to persuade us. Their case is supported by national statistics, and stated briefly amounts to this: the fact that preventive medicine (to use the term in its most inclusive sense) has reduced the incidence of disease in younger age groups means that a higher proportion of the general population suffers from the diseases of old age; the relative contribution of these diseases to the total Incidence of disease is already high and is increasing; we are comparatively ignorant about the diseases of late life and have the best of reasons for learning more about them (in this matter we have the double interest of the actuary and of the insured). In this paper, the first of a series based on an Investigation of the chronic sick in hospital, we deal mainly with administrative difficulties created by these diseases. It will be useful first to consider the reasons which have led to the coupling of the problem of chronic sickness with that of old age, for If we use the term chronic sickness in reference to diseases which continue or recur over a considerable period, it is quite evident that it is not limited to late life. Bronchitis, rheumatic heart disease, and disseminated sclerosis are examples, in the respira tory, circulatory, and nervous systems respectively, of chronic diseases which commonly appear for the first time in young people. The fact that we associate chronic sickness with old age reflects a natural preoccupation with the administrative problem. As scientists we should like to know the proportion of the chronic diseases which first appear in each age group, but as medical administrators we are more concerned with the proportion of individ uals in each age group who require attention.

The third conference of the British Occupational Hygiene Society was held at the London School of Hygiene and Tropical Medicine on November 1, 1954. The President of the Society, Professor E. J. King, was in the Chair. The following papers were read at the conference, and the discussion after each is also presented.

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.

During the year ended March 31,1957, all absences from duty, whether for sickness or non-sickness reasons, were recorded systematically for student, trained, and other nursing staff employed in the hospitals of the United Oxford Hospitals and the Oxford Regional Hospital Board. Altogether 6,232 persons (732 males and 5,500 females) were observed in 103 hospitals having almost 15,000 beds. The detailed analysis of the results is available elsewhere*; the purpose of the present paper is to give a brief summary of the more important and interesting findings relating to sickness.

The quantity and identity of drugs prescribed under the National Health Service vary widely between different towns (Martin, 1957; Benjamin and Ash, 1964). The reasons are not well understood, but differences of morbidity and mortality in the towns are not solely responsible (Lee, 1964). The differences in prescribing between towns remain relatively stable over months and years, so that the rank order of towns with different rates or different costs of prescribing is fairly stable (Ministry of Health Reports, 1963). In any town, there is considerable variation between individual doctors, and there is some evidence that the behaviour of particular doctors is also fairly stable over periods of time. Doctors differ not only in how much and how often they prescribe but also in what they prescribe (Weatherall, 1964), and it is desirable to understand the origin of such differences. A study of all the prescriptions issued in one month in each of three industrial towns has already been reported (Lee, 1964; Lee, Draper, and Weatherall, 1965). Most of the practitioners concerned in that study who had over 1,000 patients on their N.H.S. lists were interviewed about various aspects of their practice. The present paper describes these inter views and their analysis in relation to the prescribing of the doctors interviewed.

The way in which data on the prescribing of drugs by doctors in Northern Ireland has been collected and analysed with the aid of electronic data proces sing equipment which was first installed in 1966 has been described by Wade and Hood (1972). The present paper describes changes in Northern Ireland in the prescribing of chloramphenicol, amphetamines, and bronchodilator aerosols, all of which are preparations which in recent years have been found to have serious adverse reactions.

The health of an ever-ageing population is one of the major problems facing our society. In particular, the chance of developing a psychiatric illness requiring hospital admission increases so rapidly with advancing age (Registrar General, 1955) that knowledge of the prevalence of serious psychiatric illness in the elderly living in the community is essential if there is to be effective planning of the country's psychiatric services. It is also important to know what social and other health factors are associated with such illness. This study is a contri bution to such knowledge. A survey aiming to examine the physical and mental health of a random sample of elderly people living in their own homes was carried out in Swansea during the summer of 1961. The survey was part of a larger social research programme carried out between April, 1960, and September, 1962, and was financed by the Joseph Rowntree Memorial Trust. This paper deals only with the mental health of the sample. The general results of the health survey will be published separately.

Though women have always been able to exercise some control over the risk of an unwanted preg nancy, the availability of effective and acceptable contraceptive methods and of abortion have made voluntary control of fertility by the individual simpler and more certain than ever. The object of this paper is to examine the degree and features of self-selection for pregnancy in one community (Aberdeen) in the 'pre-pill' era and to assess the implications of an increase in fertility control for the interpretation of national and hospital statistics.

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)