Search

The centenary of Hopkins’s birth is also the sixtieth anniversary of the isolation of tryptophan by Hopkins & Cole (1901), and if in their paper they were in error over its constitution their work was, according to Harris (1949), one of the first to employ bacterial degradation as an aid to establishing chemical composition. The correct structure was established by Ellinger & Flamand in 1907. By 1906 Wilcock & Hopkins had shown that a particular protein zein failed as a protein source to support life and that the presence of a group in a protein molecule, viz. tryptophan, was a dietary essential and £served some purpose in the body other than forming tissue or supplying energy’. The concept and importance in nutrition of the essential amino acid thus emerges in the same year that we have Hopkins’s prophecy that ‘the factors whose deficiency were responsible for diseases such as scurvy and rickets were certainly of the kind which comprises the minimal qualitative factors which must be added to artificially refined diets to enable them to support mammalian survival and growth’: the tryptophan story was later to lead into this other realm of his activity.

A case of this unusual complication of vaccination is here reported with comments upon it; and an extended bibliography is appended. This paper was read before the American Ophthalmological Society, June, 1919.

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.

Summary The point of view has been advanced that most of the endocrine problemsof adolescence are expressions of physiologic variations which can be best handled by a sane program of physical and mental hygiene. An essential part of this program consists in the education of the parent to a proper understanding of the factors involved. Those conditions for which specific glandular therapy exists have been reviewed in the light of our current knowledge. In a field of research which is shifting so rapidly, the practitioner should adopt a cautious attitude toward the clinical application of as yet undigested experimental material. In preparing this survey, the chief emphasis has been given to methods with which the writer has had direct experience and to those employed by investigatiors upon whom he has grown to rely. To these workers, too numerous to cite, grateful appreciation is due. Their papers should be consulted for the details of the diagnostic and therapeutic procedures which could be described only briefly here. The writer has also leaned heavily on the experience and counsel of his associates in the Departments of Medicine and Pediatrics of the New York Hospital. This synthesis of experience derived from sympathetic and qualified workers in both adult medicine and in pediatrics appears to offer the most promise for the development of this important field of investigation. The point of view expressed in this survey, with its chief reliance on sound physical and mental hygiene rather than endocrine therapy, may seem unduly pessimistic in the light of much that is appearing in the current literature. This position, however, is not a negative but rather a positive one, since it stresses the existence of powerful forces inherent in the organism, which, if properly utilized, can make for a healthy transition from adolescence to adulthood. As regards the specific endocrine problems of adolescence which still remain unsolved, a consideration of the progress of the past ten years should be reassuring as to the future.

President's Address In a long and comprehensive review of the papers published by the Triological Society, the author presented the essence of the more important contributions to otolaryngology which were made by its members. He first divided the review into the following headings, under each of which were listed the men who have distinguished themselves in that particular field: Anatomy, Physiology, Pathology, Bacteriology, Diagnosis, Metagnosis, Clinical Observation, Nonsurgical Therapeutics, Surgery, Ocular Relations, Borderline Surgery, Endoscopy, Radiology, Speech and Hearing Defects, Tuberculosis, Cancer, Unusual Cases, Instruments. In a separate division of the article, the author gave an alphabetical list of the members who have been outstanding contributors to the literature, and under each name mentioned the more important and unique subjects which have occupied the member's attention during his membership in the society. The author thus took a general account of stock, and gave due recognition to the many earnest workers

This presentation will ask the question can, or how successfully can, dermatologie research be carried out in a regular office practice. Recognizing from the outset that some dermatologie investigation requires hospital and/or laboratory investigation, have not too many dermatologists overlooked or neglected the possibility of carrying out sound and fundamental investigation during their regular office practice? Our Chairman, Livingood (1), at the annual meeting last year discussed clinical investigation in dermatology and I want to explore the concept that dermatologie research can be carried out in a busy office. Katz (2) has recently given a masterful presentation on medical research and I will quote or paraphrase frequently from his paper. Pillsbury, Zimmermann and Baldridge (3) in 1950 defined necessary controls in clinical dermatologie investigation.

The following review covers literature published from about June, 1916, to October, 1927. The bibliography to July, 1927, is relatively complete—that is, for articles which should interest the otolaryngologist. From July to October, 1927, it is not complete. In a paper of this scope it was not possible to include a review of all of the articles mentioned in the bibliography. I have had to limit myself to articles that were available and that tend to illustrate the trend of opinion concerning allergy during the past year. There have been no radical departures from knowledge reported in the previous reviews. Interesting advances have been made, however, along the lines previously initiated, especially concerning pathogenesis, diagnosis, symptoms and treatment. PATHOGENESIS In an address delivered before the Association for the Study of Allergy, Coca called attention to the individuality of what he terms atopic shock organs, which proved to be situated in

With comprehensive health care comes an increased recognition that no one profession, facility, or agency can accomplish what needs to be done alone; all the varied resources of a community must be mobilized and utilized. Dietitians and public health nutritionists have specific and valuable contributions to make, as indicated by the examples given in this paper of how the profession may cope with increased opportunities.

In this paper we have outlined a few of the most ancient of Chinese procedures in the field of physical therapy. Moxibustion, acupuncture, scraping, hydrotherapy and chromotherapy have been dealt with. An attempt has been made to present the origin of each procedure, the indications and the technic as practiced in ancient Chinese medicine.

Research must have a clear statement that is the hypothesis. This hypothesis may involve a clinical question or pathophysiologic mechanism that cannot be tested ethically or appropriately using human subjects or alternative methods. Therefore, numerous animal models have been developed that mimic to human diabetes. They provide additional knowledge about and insight into disease processes and hopefully better methods for treatment or prevention of diabetes in humans. All scientific research involving the use of animals should begin with an ethical focus by examining the risk-benefit ratio (i.e., morbidity or mortality to the animal versus the potential importance of the knowledge acquired). The aim of this paper is to discuss these ethical aspects within the context of research on diabetes and form a framework for the decision-making process. DOI: http://dx.doi.org/10.3329/bioethics.v1i2.9625 Bangladesh Journal of Bioethics 2010; 1(2): 20-23

]~]] EMBERS of any profession are interested in tools, techniques--tile ways ~I/1 and means by which they can better themselves. Statistics giving techniques for interpreting and thus using the facts and figures issuing as data from professional activities is a very powerful tool in the hands of the profession equipped to use the tool intelligently. In developing this paper I am endeavoring first to present to you facts and figures which are of interest to pediatricians and second to give you insight into the most frequently available techniques, illustrating whenever possible how each of you as professional men are entitled to use and can actually use statistics even in the everyday routines of your profession. Pediatricians can measure the growth of their profession by comparing the ten principal causes of death in 1900 with the ten leading causes of death in 1940 (Chart 1). Aided by clinical and laboratory researches which have developed drugs and methods for controlling many of the hazardous communicable and infectious diseases, members of the medical and related professions have seen diphtheria, diarrhea, and enteritis removed from the list of leading causes of death; have seen influenza-pneumonia and tuberculosis sharply losing rank positions in the list of principal causes of death, dropping from first and second positions in 1900 to ranks of 6 and 7, respectively, in 1940. The statistics in Chart 1 are rates per 100,000 population which, as you know, are derived as follows: using the number of deaths from each cause for each year obtained from the death registration certificates in the rate formula

TO those interested in the field of physical medicine and rehabilitation the major sources of publications in this country are the Archives of Physical Medicine and Rehabilitation, the American Journal of Physical Medicine and the Physical Therapy Review. In addition, of course, articles appear in the various specialty journals, all of which are now interested in rehabilitation and present papers of interest to specialists in physical medicine (physiatrists) as well as specialists in their own fields. The present review of literature in recent years is devoted to selections of certain articles found in these journals and also those . . .

The preventive measures proposed today for diabetes are individual and are aimed especially at the complications. A disease as widespread among the mass of the population as diabetes necessitates measures applicable to a great number of individuals in order to prevent the onset of the disorder itself. This involves practical difficulties and a large amount of ingenuity in the choice and mode of application of the measures. The prevention of diabetes cannot be the result of a single measure, such as a vaccine working directly upon the individual, nor can it be carried out by removing noxious environmental factors, such as destruction of mosquitoes in swamps and pools. The multiple etiology of diabetes implies multiple and widely applicable measures of prevention. Under these circumstances, during the last decades we have attempted a broader experiment, which may be considered a pilot experiment, including 14,000 diabetics. The first thousand have been followed for 25 years. The approach to this experiment and the results are reported in the present paper in order to promote the prevention of diabetes on a large scale. The authors give some considerations on the prevention by early detection, and on the general prevention of complications by daily avoidance of certain widespread factors.

The authors, during four years of pharmacy schooling, participated in a nationwide prescription survey from which they derived the many benefits enumerated in this paper. Summed up, this extracurricular activity served to acquaint them better with pharmacy's many facets and facilitated choosing the niche to which each felt best suited.

In this paper manipulative suicide is defined. It is considered as a psychosomatic disease because it gives rise to a specific lesion and because it gives the opportunity to the psychiatrist to work w

THE PROFESSIONAL worker involved in any aspect of a chronic disease program-whether in the voluntary or governmental agency, at the community level, or at the state and federal level -does his job more effectively if he understands the goals and major components of a program designed to prevent chronic disease or its complications. The presentation of such a comprehensive view is the purpose of this paper. It would be inappropriate not to mention that considerable thought and planning have been given to the problem of programing for chronic disease control by a committee of experts in the American Public Health Association. The results of this committee's work have resulted in an excellent publication, "Chronic Disease and RehabilitationA Program Guide for State and Local Health Agencies." The over-all view which I wish to present is based on this guide and on the firm beliefs and activities of the Division of Chronic Diseases in the U. S. Public Health Service. The division's responsibility embraces heart disease control, cancer control, neurological and sensory disease control, diabetes and arthritis control, and nursing home program, plus other community services for the prevention and care of long-term illness. It is not necessary to dwell upon the need for control programs in chronic disease. The magnitude of the problem has been well documented in a number of publications and articles. We know only too well that cancer and heart disease together cause two out of every three deaths in this country today. There are few among us who cannot cite some tragedy of disability and dependency, either within his family or among his circle of friends, which has been caused by rheumatism, arthritis, impaired vision or hearing, stroke, diabetes, glaucoma, some neurological disease, or any of a host of other chronic disorders. The great question facing us today is not what is the problem, but rather what are we doing about it?

The first purpose of the presented paper was to provide the clinical and pathological findings of 25-years old woman suffered from SLE. The symptom was manifested during the pregnancy and the disease was exaggerated by the delivery. The second one was to discuss the relationships to the pregnancy and delivery, and the attack and exaggeration of SLE.

Although post-graduate courses of instruction, books, papers in scientific and medical journals, etc., inform the medical profession concerning the essentials of radium therapy, there is, as yet, comparatively little public information available on the economic and administrative aspects of a hospital radium service. The need for this kind of information is very apparent at the present time, when the acquisition of radium for the treatment of malignant disease is under consideration by many groups of hospital authorities. Under these circumstances we have thought it would be of interest to publish the results of an analysis of some of the records which we, as radium custodians, have kept for several years at St. Bartholomew's Hospital. As an account of the organisation and equipment of the Radium Department of the Hospital has already been given, *† we shall here confine ourselves to the task of furnishing data for the guidance of those who have to answer the following questions:— Q.I. How many patients c...

Summary The author reviews the present position of the use of methotrexate for the treatment of psoriasis in the light of his personal experience and the reports in the literature. It is concluded that this drug has a place when psoriasis which is either physically or psychologically disabling fails to respond to local therapy. With careful management, acute toxic effects should rarely occur, though since this paper was written, some cases of cirrhosis of the liver have been reported. The drug should never be given to patients whose renal function is suspect.

The examination of the records of the cases of saccharine diabetes treated in the wards of the Massachussetts General Hospital during the past seventy-four years was begun for the purpose of seeking evidence with regard to the pancreatic origin of this disease. (SeeYale Medical Journal, 1898, iv, 275.) Since several hundred volumes were to be searched it seemed desirable to obtain at the same time information upon other points which might contribute to the statistics of diabetes. Facts of interest in diagnosis and treatment were elicited as the study progressed and this paper is offered rather as a historical sketch of the progress of a disease drawn from the original records than as an attempt to advance in any way our knowledge of the subject. Since diabetes mellitus was first sharply differentiated from diabetes insipidus early in the present century, the hospital records may be considered to be nearly

In dealing with any subject in connection with the burning question of the care and control of the feeble-minded, some reference will be expected to the second Mental Deficiency Bill recently introduced into the House of Commons by the Home Secretary. For the purposes of this paper it is unnecessary to do more than quote the Clause, which defines the classes of persons who are mentally defective and deemed to be defectives within the meaning of the Act. Taken all round, it is a much better Bill than its predecessor of last year, but it should be noted that in the present measure no allusion is made to the undesirability of procreation of children by defectives, or to any intention to penalise persons wittingly bringing about a marriage between defectives. These proposals, which were likely to arouse uncompromising disapproval, may be the less regretted, as their inclusion might doubtless have been instrumental in the blocking of the Bill as a whole. Their effacement, it is hoped, may do away with the opposition which is at present invariably evoked by any attempt to infringe upon the so-called liberty of the subject, and may also give opportunity for educating public opinon, so that in time it may be clear to all that the prevention of amentia can only be attained by life segregation on the one hand, and by the prohibition of marriage on the other. The promoters of the Bill have gone as far as they possibly could in the face of uneducated public opinion, and those of us who were present at the discussion of last year's measure in Standing Committee cannot but admire the courage and resourcefulness of Mr. McKenna in presenting the new Bill after the repeated discouragement which he had to face in connection with his first effort last year.

This paper is concerned with that section of the Army standards of physical examination having to do with diseases of the chest, particularly tuberculosis, and their application, as shown by a review of 53,400 chest x-ray films of inducted men. The standards for chest disease were prepared by the War Department with the advice and assistance of a subcommittee of the Division of Medical Sciences of the National Research Council, in conformity with a general practice of the War Department in the formulation of physical standards. Since the August 1940 edition of Mobilization Regulations, several modifications have been adopted as the need for certain changes has become evident. Inasmuch as definite standards in regard to acceptable and non-acceptable tuberculous lesions inevitably invite criticism, it might be well to examine the steps through which the present standards were evolved. Originally, in 1940, the primary concern of the committee was that x-ray examination of the chest be made an integral part o...

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.

THIS paper reviews the dangerous as opposed to the relatively benign toxic side effects of Tridione, Paradione, Mesantoin and Phenurone, and proposes a procedure for the administration of these dru...

AMONG supposedly healthy workers in the garment industry, many serious but noncritical conditions were brought to light in a health survey sponsored by the Health and Welfare Fund of the International Ladies' Garment Workers' Union, A. F. of L., in an intermediate city,1 in western Massachusetts, beginning on December 20, 1947. A total of 855 out of 1050 employees, or 81.4 per cent, were examined on a voluntary basis under ordinary working conditions. The remaining 18.6 per cent refused the examination for various reasons, as indicated later in this paper. Of the total 855 employees examined, 684, or 80 per . . .

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.

Publication trends in American psychiatry were examined by means of a large sample of the psychiatric literature from 4 general psychiatric journals over a 117-year period. This paper concerns the general categories of subjects treated in the literature and changes in etiological emphasis. In later reports, trends in treatment, research and other categories will be traced.

This paper presents a summary of occupational dermatitis occurring in government employees treated at the United States Public Health Service Outpatient Clinic from July, 1951 to July, 1952. Since many persons did not seek medical care for minor eruptions or were treated at the Health Units in the government agencies, this series of patients does not include all of those with occupational dermatitis but does represent a fair sample.

NO SUBJECT calls more insistently than social medicine for a disclaimer of omniscience. Medicine as a social institution is peculiarly complex both in structure and in function. This paper essays o...

Summary 1. The development of newer type ointment bases, particularly the emulsion bases and the soluble bases, has led to new concepts of ointment therapy. 2. On the basis of their degree of penetration, ointments can be classified as epidermic, endodermic, and diadermic. 3. For a rational understanding of the applicability of the different types of ointment bases, the pediatrician needs a sound knowledge of the histopathologic factors underlying the more common dermatoses encountered in children. 4. Accordingly, some of the newertrends in topical dermatologic therapy have been described and explanation given of the use of the newer bases to obtain optimum therapeutic effect. 5. The skin must be recognized asa functioning organ and a barometer of general health. 6. It is hoped that this paper willbe useful to pediatricians and to general practitioners in their routine care of children and that it will stimulate interest in the use of official agents.

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.

The management prescribed by physicians for patients complaining of snoring as a severe physical and mental nuisance has always been more or less unsatisfactory, and there is a marked paucity of literature to which one may turn to enlist aid in their behalf. Modern textbooks are curiously barren on this subject, and a search of recent periodic literature discloses but two references to scientific papers published in the last fifteen years. The fact is that this seriocomic symptom is often treated far more lightly than it deserves, as will be attested by many whose domestic tranquility may be strained to the breaking point by it. From certain developments in other fields of medicine which can be applied to the present problem, I feel that it is possible to attack this symptom with a fair measure of confidence by therapeutic methods entirely and constantly under the control of the physician and

SummaryNoticing the great deficiencies in the care of rheumatics the author suggested the establishment of rheumatism dispensaries as early as 1928 but owing chiefly to opposition from the authorities concerned the realisation of the project along the lines indicated in pages 118—120 was delayed until 1951. The present paper discusses the results of the activities at the Vastmanland dispensary in the period 1951—1955.The result of the activities has come up to expectations and an important contributary factor was the appointment of physiotherapists in 1954. The good result stimulated similar activity in other places.On the basis of his experiences the author suggests some further improvements and concludes by stressing the importance of the dispensary doctor's keen and unflagging interest in his work even in the face of unavoidable difficulties.

SummaryThis paper has indicated that modern scientific medicine is quite different from “allopathy” which was originally defined as suppression of disease symptoms by an agent producing the opposite symptoms.The term Homœopathy does not express cure and it is suggested that a new term such as Symptom Stimulation Cure or the initials S.S.C. might be more acceptable.Hahnemann's four original examples of allopathic treatment, i.e., laxatives, blood letting, alkalis and opiates are discussed in the light of modern medicine which confirms his criticisms of this method, which is not the best in acute illness and is harmful in chronic disease.Drug addiction and the abuse of mood altering drugs are given as examples of the dangers of allopathic practice today.Modern scientific medicine has accepted most of what Hahnemann taught, but still refuses to consider the minimal dose.

Child guidance clinics are part of a large class of organizations concerned with the treatment of maladjusted individuals. Research findings indicate that such clinics are not adequately serving the needs of the community. The assumptive base of clinic organization is challenged in the paper, and alternate recommendations are presented.

Summary Branded prescription medicines account for 95% of the total cost of the NHS pharmaceutical service, and 74% of all prescriptions written by general practitioners employ the brand name. This predominance of branded preparations reflects the fact that 96% of the leading medicines prescribed in 1969 had been first introduced since 1949. These are the products of modern pharmaceutical research, typically introduced under their brand name. Potential savings, if generic names were used instead of brand names in prescribing, are very small because it is only in exceptional cases that cheaper alternatives exist with the same active ingredients as the original branded preparation. The paper suggests that since general practitioners appear so overwhelmingly to favour the use of brand names it would be logical to introduce their use into medical teaching.

The question of deciding what is the best dose to use in X-ray therapy is as unsettled as some of the international problems with which we are faced to-day, but, by reasonable consideration, accurate observation and recording of reactions and results, and the free co-operation without resort to violence which should be possible amongst radiotherapists, it should not be difficult to settle the radiological problems, even if words like insuperable are used of the international ones. As an introduction to the question, I propose to give some idea of the working hypothesis which has been guiding my footsteps in radiotherapy for the past six years, built up on information from so many sources that I cannot acknowledge them in detail in this short note. Any fundamental research, published or unpublished, chance observations in clinical papers, and my own clinical experience based on personal knowledge of all the patients treated in a clinic which has dealt with about 9000 patients since 1931, have all contribut...

IT was appropriate that Sir Derrick Dunlop should have chosen to speak on the drug problem when giving the Croonian Lecture at the Royal College of Physicians. Since retiring from the chair of therapeutics and clinical medicine at Edinburgh, he has been chairman of the Safety of Drugs Committee appointed by the Ministry of Health, and he acknowledged that the problem is both complex and perplexing and full of conflicting interests. He said that a pharmacologist had defined a drug as a substance that, when injected into a rat, would produce a scientific paper. From the clinical point of view . . .

Economic appraisal of health care projects is not new. Indeed the instigator of this approach, Sir William Petty, the so-called father of political economy, was an Oxford medical don in the late 17th century. To an economist the aim of studies evaluating expenditure on health care is to throw light on the use of resources and to provide information which will enable us to improve our decision taking. The studies can provide guidance about (a) the allocation of resources to the health sector, and (b) the allocation of resources within the health sector. In this paper the various studies which have been made are considered and the problems and limitations of the techniques used and the usefulness of the studies to planners of services are discussed.

Papers on reciprocal licensure, published between 1883 and 1972, are reviewed with the purpose of identifying common themes. The issue of reciprocal licensure is examined from a historical viewpoint. Common themes are identified by focusing on selected writings of the periods from 1883 to 1972. The review concludes that there has been a demonstrated interest in the issue of reciprocal licensure; that the dental profession has made progress toward facing the issue; that the 1972 Survey of Attitudes on Dental Licensing Procedures indicated widespread support for regional boards and national reciprocity; and that the dental profession is seeking final resolution of the issue of reciprocal licensure in the near future.

The views expressed in this paper are the views of the author and should not be taken to represent the views of the Department of Health and Social Security.

The 'fifties and 'sixties were decades in which developing countries became involved in the construction of large teach ing hospitals. These institutions have tragically misdirected medical effort, and in tackling national nutrition problems have been particularly ineffective. In this and the next de cade the villager must himself become involved if the nutrition problems of the developing world are to be over come. This paper suggests why the large teaching hospital is unsuited to tackle the nutritional problems of developing countries, and offers an alternative approach.

In this paper we describe the use of punched feature cards in a general practice for 18 months. Its advantages are the low cost, speed of information retrieval, visible statistics, computer compatibility, accuracy, confidentiality, flexibility, and simplicity of setting up and collection of information. The system encourages the doctor to ask questions about his practice, and could readily be adopted in other practices.

The dental expert at present may have difficulty in answering a question about how unusual is a particular combination of tooth characteristics. This paper describes a survey designed to answer, at least in part, such a question and discusses how the results might be presented in Court.

TO THOSE of us living in that uneasy middle generation, forbidden to be modern and reluctant to be mellow, there is a growing feeling of guilt that we are in part responsible for what appears to be the inadequate training of the undergraduate student in the specialties of medicine. There is then, understandably, a great desire among us to reevaluate our concepts and our goals in the light of that some have been pleased to call "the changing order." Nowhere among the medical specialties is this desire greater than among the dermatologists, as witnessed by the discussions of Wile, 1 Cole, 2 Stokes, 3 Lane, 4 Cipollaro, 5 and those engaged in the organization and operation of the American Board of Dermatology and Syphilology. Within the many papers on medical education there is abundant evidence of a growing dissatisfaction with existing methods of instruction. * On the other hand, there

Delivered at the Thirty-Seventh Annual Session of the American Medical Association, in St. Louis, on May 6, 1886. Article II, Section 4 of the By-Laws of the Association prescribes that the "chairmen of the several Sections shall prepare and read, in the general sessions of the Association, papers on the advances and discoveries of the past year in the branches of science included in their several sections." In attempting to discharge this duty it will be well, first, to define State Medicine and the branches of science which it includes. I have been unable to find a definition sufficiently comprehensive to cover what is conceived to be properly embraced within the scope of State Medicine. Dunglison defines it to be "the medical knowledge brought to bear on State objects, as on public hygiene and matters pertaining to medical jurisprudence." In the introduction to his Manual of Practical Hygiene, Parkes, in

THE diagnosis of lead poisoning is, at times, a vexatious and controversial subject, and today the problem frequently is not purely a clinical one, but one with medicolegal and employee Compensation Commission aspects, and it is also a matter of increasing interest to industrial hygienists on the federal, state, and local levels, to labor organizations, and to manufacturers and trade associations.' The present paper is confined to the activities of the St. Louis Division of Health in its efforts to assist the medical profession in arriving at accurate and -tenable diagnoses in cases of suspected lead poisoning and to assist the health commissioner in determining the preva-lence of lead poisoning in St. Louis. The development of chemical micro-analytical methods, in relation to the determination of lead in biological materials (body fluids or tissues), is perhaps the most important single factor in establishing evidence of the extent of lead absorption.2 Since February, 1946, the Laboratory Section of the St. Louis Division 'of Health has provided a routine service for the quantitative determination of lead in blood. This service was made available to all hospitals, clinico-pathological laboratories, and all physicians located in the City of St. Louis, Mo. On August 1, 1948, this service was extended so as to furnish an