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Difficulty in access for local resection of broad-base rectal polyps in the mid rectum can present a management problem. Transanal use of the MULTIFIRE ENDO GIA provides a hemostatic excision of these rectal polyps.

State and society in modern Germany - Beamtenstaat, Klassenstaat, Wohlfahrtstaat, Eve Rosenhaft and W.R.Lee the state as employer in Germany, 1880-1918 - from paternalism to public policy, Andreas Kunz the state as an employer of women in the Weimar Republic, Helen Boak foreign labour, the state and trade unions in Imperial Germany, 1890-1918, Martin Forberg eugenics and the welfare state during the Weimar Republic, Paul Weindling industrial hygiene - a state obligation? Industrial pathology as a problem in German social policy, Dietrich Miller state and society in Germany in the aftermath of the First World War, Richard Bessel municipal finance in the Weimar Republic, Harold James the Gemeinden as agents of fiscal and social policy in the twentieth century - local government and state-form crises in Germany, Jeremy Leaman.

Cataract in mice has been found in association with experimentally induced congenital toxoplasmosis. Unilateral and bilateral cataracts were found to occur in about 5% of such mice. Parasitological...

The architecture and distribution of surface mucins were studied qualitatively and quantitatively by transmission electron microscopy in ruthenium red stained biopsies of the human conjunctiva. Six control specimens were compared with three from early keratoconjunctivitis sicca (KCS) and with three specimens from severe KCS cases. The area of the ruthenium red/OsO4/mucin reaction product on the conjunctival epithelial surface was measured by image analysis and the values were expressed in micron2 per micron length of epithelium. The total area of surface mucins was differentiated from the narrow zone of mucins in close contact with the microplicae. The value for total mucins in two cases of early KCS was higher (0.4 micron2/micron) than the control range (0.1-0.3 micron2/micron) due to the presence of large clumps of mucins on the surface. The values for microplical mucins in early and severe KCS were within the control range, but were an overestimate owing to the presence of abnormal structures, e.g. vesicles, and abnormal clumps on the surface. This morphometric technique has limitations, but with appropriate material it might be a useful tool for the identification of conjunctival surface mucins.

The plain abdominal X-rays of 277 patients suffering from five acute abdominal conditions were reviewed and specific radiological features found to occur in not less than 48 per cent of the cases. In a second series of 249 patients admitted to hospital with an acute abdomen due to all types of disease, the plain abdominal X-rays were helpful in 42 per cent of cases. A questionnaire of 50 plain abdominal X-rays was answered by surgeons and radiologists of varying clinical experience, the scores of the senior radiologists being higher. It is suggested that plain abdominal X-rays should become a routine investigation in the acute abdomen, and should be reported by senior radiologists at the time of the investigation.

In a cross sectional study of occupational exposure to inorganic lead 91 men performed a series of microcomputer based tasks assessing sensor motor reaction time, memory, attention, verbal reasoning, and spatial processing. Performance on the tasks was studied in relation to three ranges of blood lead concentration (low, less than 20 micrograms/dl; medium, 21-40 micrograms/dl; and high, 41-80 micrograms/dl) and exposure response correlations for blood lead concentration, zinc protoporphyrin (ZPP) (range 7-210 micrograms/dl), and urinary aminolaevulinic acid (ALA) (range 0.5-22.0 mg/l). The results show that the high group were impaired on most of the tasks used and, in general, the magnitude of the impairment correlated better with blood lead concentration than ZPP or urinary ALA. An examination of the patterns of task impairment indicated a general slowing of sensory motor reaction time which was relatively independent of the nature of the cognitive functions being tested. There was some evidence, however, suggesting mild impairment of attention, verbal memory, and linguistic processing. In general, workers with high blood lead concentrations showed clear impairment of sensory motor functions in the absence of correspondingly strong evidence for impaired processing and memory functions. It is argued that a general slowness in responding may underlie many previous reports of widespread cognitive impairment in lead workers.

Patients with oral or pharyngeal cancer in the two main textile regions of England were matched for age and sex with patients having cancers not known to be associated with textile work. Data were recorded on age, sex, cancer site, and smoking, chewing and drinking habits together with dental and occupational history. There were 102 and 61 matched pairs of males and 52 and 60 matched pairs of females in the North-west and West Yorkshire regions respectively. There were significantly (P less than 0.05) more textile workers in the cases compared with their matched controls for only the females in the North-west. No particular type of textile work occurred more frequently for the cases than the controls in all four matched comparisons. Only for the males in the North-west were there significant differences (P less than 0.05) in the proportions of textile workers in the three cancer sites of the tongue, mouth and pharynx. These results do not confirm the association between textile work and oral or pharyngeal cancer found by the mortality study of Moss and Lee (1974). The results for the association between oral or pharyngeal cancer and smoking, drinking, chewing and wearing of dentures are discussed.

An electron microscopic investigation was conducted to study the extracellular materials of the endothelial meshwork in the human outflow apparatus. A quantitative analysis was made to determine the changes which occur with age. Tissue from 20 cases, ages 4 months to 80 years, was examined. A morphometric technique which utilised a grid of 100 random points was used to estimate the percentage area of extracellular components in the endothelial meshwork. It was found that while the percentage area occupied by amorphous ground substance and fibrillar material decreased with age, the percentage area occupied by the electron-dense component increased. Variation in distribution of these components was noted both between cases of similar age and also within one section. A qualitative description of other changes in the trabecular meshwork is given, and the limitations of the technique are discussed.

Twenty-two anaesthetists participated in a study to assess the influence of occupational exposure to anaesthetic agents on mood (arousal and stress) and cognitive functions. In a cross-over design, each anaesthetist worked one day in a reference facility (for example, intensive care) and another day in a scavenged operating theatre where time-weighted exposure averaged nitrous oxide 58 p.p.m. and halothane 1.4 p.p.m. The results showed that arousal scores reached a peak in the middle of the theatre day, but this appeared to reflect the nature of operating theatre work rather than exposure. Reports of stress were also unaffected by exposure, although higher scores were associated with longer and more demanding work. Similarly, there was no evidence that exposure impaired performance of tasks assessing syntactic and semantic reasoning, verbal and spatial memory, sensory-motor reaction time and attention. Performance in these tasks was, however, sensitive to the cognitive demands of the tasks and to naturally varying non-exposure factors. It is concluded that, compared with the reference condition, the concentrations of anaesthetic agents found in actively scavenged operating theatres have no detrimental effect on either the mood or the cognitive functions of anaesthetists.

Postgraduate medical education in the United Kingdom has changed. Now, five years of undergraduate training merely prepare a doctor for postgraduate training, whatever his specialty will be. After undergraduate training (and a year in hospital) all doctors do three years General Professional Training followed by some four years Higher Specialist Training. Occupational physicians do the same General Professional Training as physicians or primary care general practitioners. Their Higher Specialist Training lasts four years and is based on supervised practical experience in the factory or other place of work. After the first two years of this they take an examination covering the broad field of occupational medicine (AFOM). After the next two years of supervised practical experience the doctor has to present evidence of special study and can then become specialist (MFOM). In the U.K. about 70% of occupational physicians work part time. Their supervised practical experience is therefore spread over a long period. Many stop at the AFOM. If, later in their career, they change to full time in occupational medicine, they can proceed to the specialist qualification (MFOM). Most part-timers do other work and therefore cannot go away to one of the few universities that provide courses for the AFOM. Those who live near one of the few universities can go on day release. A "distance teaching" project has been started to take teaching material on occupational medicine such as audio tapes, tape slides, and video tapes to these doctor. It will be supplemented by local seminars and short courses at universities.

The training of occupational physicians has recently undergone profound changes, is still changing, and in the future we may see some of the developments envisaged here. All four of the phases of training are changing: undergraduate, general professional training (basic specialist training), higher specialist training and, finally, continuing education which is maintained throughout professional life. That these separate phases should not be viewed in isolation is not always recognized, particularly by those concerned with the detailed planning of one particular phase.

During the three years 1967-69, 781 cases of squamous cell carcinoma of the skin were reported to the Manchester Regional Cancer Registry. The proportions of males to females were significantly different (p

The present interest in medical services for small factories is matched by the limited objective information which is available on the demand for and needs of such services. As a teaching project, a survey was made of factories with between 30 and 200 employees on an estate in the North West where there was no organized medical service. Unfortunately, time allowed only 22 factories to be visited. The findings, therefore, are regarded as indicative rather than conclusive, but this does not detract from their interest. Factories were visited by two or three postgraduate students who completed a questionnaire designed to standardize their findings. The questionnaire is included as an appendix to this paper. Regarding the demand for medical services, four of the 22 factories were subsidiaries of larger organizations and had part-time medical advice, 14 expressed no interest even if this would have involved no financial commitment, and the remaining four were interested for differing reasons. The needs of the factories in this context were found to be, first, advice and perhaps better supervision of non-mechanical hazards and, secondly, supervision of the first aid arrangements. From the ambulance journey records of the local authority there appeared to be no great demand for local casualty facilities. To meet these needs it is suggested that the functions of the appointed factory doctor might be modified to include wider supervision of non-mechanical hazards and supervision of first aid arrangements. It is also suggested that the National Health Service should form the basis for dealing with those cases requiring more than first aid.

Three malignant melanomas of the iris, classified as spindle-B type by paraffin histology, have been studied by electron-microscopy. The cells from each tumour were similar at the level of fine structure, but there was some variation in appearances between the tumours and the pattern suggested stages of dedifferentiation. The fine structural features of the tumours differed in no significant way from the previously published descriptions of posterior uveal melanomata and indicated an origin from stromal melanocytes.

`Notification is only useful as the prelude to inquiry and recommendations, and without such development, is nothing more than a cog in the wheel of statistics which resolves annually but gets nowhere.' Sir Frank Tillyard (1948)

Low-frequency electric currents of a few milliamperes flowing through the body cause muscular contractions. In the arm such an effect may make a subject unable to let go of a live conductor. The highest currents which 99.5 per cent of men and 99.5 percent of women are able to let go have been shown to be 9 and 6 mA, respectively. Currents somewhat larger than this, in the range of 20 to 40 mA, passing across the chest may arrest respiration leading to asphyxia, unconsciousness, and even death.

The effects on the respiratory and circulatory systems of rabbits of pulsed currents from two sources have been studied. The sources were an industrial high voltage test-set (source A) and an automobile ignition system (source B). When the fore-limb to fore-limb pathway was used, source A produced complete arrest of respiration at the highest output voltage, 5kV (corresponding to a current of 392 mA), and at a pulse repetition rate of 30 per second. Progressive reduction of either of these factors resulted in progressively less interference with respiration. With the fore-limb to hind-limb pathway complete arrest of respiration occurred at an output voltage of 2 kV (corresponding to a current of 140 mA) and at a pulse repetition rate of 30 per second. Again progressive reduction of either current or pulse repetition rate resulted in progressively less interference with respiration, although at 30 per second even with the lowest voltage setting (1 kV; 64 mA) only diaphragmatic respiration occurred. Source B used on either pathway up to a pulse repetition rate of 16 per second did not cause complete arrest of respiration whether the current was taken straight from the ignition coil or off the distributor. Neither source caused ventricular fibrillation either when delivering pulses at a preset rate or when the pulses were timed to coincide with successive T waves of the E.C.G. In these experiments the trains of pulses falling on the T waves lasted about 10 seconds. With both sources the current and voltage waveforms were similar and in phase. With source A increase in current was directly related to increase in applied voltage. These findings suggest that under these experimental conditions, with minimum contact resistance, the animal impedance is resistive with no significant reactance.

Scott, Janet R., Lee, W. R., and Zoledziowski, S. (1973).British Journal of Industrial Medicine,30, 155-161. Ventricular fibrillation threshold for AC shocks of long duration, in dogs with normal acid-base state. Earlier experimental studies of threshold ventricular fibrillating currents passing along the common accident pathway of forelimb to leg have shown a wide range of results for any one shock duration. In the present investigation the acid-base state of the experimental animals (dogs) was held within normal limits. It was found that whereas the mean minimum fibrillating current, 82·2μA for 3-second shocks, was within the values found by other workers, the range of results was reduced considerably to 67-101μA. Further, when the shock duration was increased, in stages, up to 60 seconds, again keeping the acid-base state within normal limits, the mean minimum fibrillating current did not alter markedly (being 80μA at 60 seconds) but the range of results progressively fell and was 73-88μA at 60 seconds. In the light of these findings the mechanism of ventricular fibrillation is discussed.

Commercial-frequency currents of a few milliamperes flowing through the body will cause muscular contractions, resulting in the inability of the victim to release his grasp on a live conductor. Values of ``let-go'' current are very important criteria in the establishment of safe-current requirements. Since ventricular fibrillation, a condition in which circulation is arrested, is probably the most common cause of death from electric shock, studies of minimum fibrillating currents under various conditions are also significant. This article discusses investigations of both let-go and fibrillating current and presents some of the experimental data that have been obtained to date.

1 . Normal and diseased bone was obtained by biopsy from five patients suffering from Paget's disease. The tissue was studied by histology, microradiography and quantitative fluorescence microscopy using tetracycline markers. Study of the morphological changes showed that two of the biopsies could be regarded as normal, while one was osteoporotic; two biopsy specimens were in the porotic phase of Paget's disease and the remaining five were in the sclerotic phase. 2. The tetracycline markers were used to measure the linear rate at which bone was deposited on individual surfaces (appositional growth rate) in µ per day and the percentage volume of new bone added to the total volume of bone per day (bone formation rate). The values obtained for appositional growth rate in all the biopsies were of the order of 1 µ per day, but slightly higher values were obtained in the diseased tissue of each individual. The bone formation rate in normal bone from the proximal femur was about 0·04 per cent per day, about 0·13 per cent per day in the porotic phase, and about 0·4 per cent per day in the sclerotic phase of Paget's disease. 3. Although these values must be accepted with some reservation, there seems to be no doubt that there is an upper limit of about 1 µ per day to the rate of deposition of bone on an individual bone surface; this suggests that in Paget's disease the osteoblast behaves as a normal cell.

Basic information on the relationship between processing variables and the physical chemical changes occurring during the “precure” of latex blends is required for optimum process control. To obtain this type of information, the particle size and particle size distribution of a latex blend undergoing a maturation or precure treatment were monitored by low angle light scattering techniques. The absence of any measurable particle size change during precure indicates that the process is simply an initiation of crosslinking within the individual latex particles which is caused by penetration of molecular sulfur and other activators and accelerators. Volume swelling measurements were performed at intervals to determine the degree of precure attained by the blend.

SUMMARYBy shielding abdominal segments III–V, queen honeybees were enabled to survive otherwise lethal doses of radiation; in contrast, irradiating only segments III–V with 10 000 r. killed all queens within three weeks, as did whole-body irradiations. Lead shields are described that protect part of the abdomen and permit irradiation of either the spermatozoa in the spermatheca or the oogonia of the ovary, with higher doses that could otherwise be administered without killing the queen.

1. In two dogs, approximately one to two years and three to four months of age, an experimental comparison was made between the calcium accretion rate as defined by the Bauer-Carlsson-Lindquist equation, and the bone formation rate determined by double tetracycline labelling. 2. The overall calcium accretion rate was determined from the specific activity of the blood plasma, and the urinary and faecal excretion of isotope, following an intravenous tracer dose of Ca45. A time of five days after injection was used for the calculation of accretion rates, but data for shorter times of calculation are included. 3. Local accretion rates were obtained for different parts of the skeleton by determining the specific activities of bone samples at the end of the experiment. 4. The amount of isotope the uptake of which was not related to new bone formation (the diffuse component) was determined autoradiographically. 5. Local values for appositional growth rate and bone formation rate were obtained, using sections of undecalcified bone specimens, by measuring the linear separation between two tetracycline bone markers and the area of new bone enclosed by them. 6. In the older dog, the measurements for cortical bone showed that the accretion rate was two to three times as great as the bone formation rate: the observed diffuse component was sufficient to account for the greater part of this difference. Measurement of the bone formation rate for cancellous bone presented difficulties, but the approximate values obtained suggested that the accretion rate and the bone formation rate were of about the same order for this tissue. 7. In the younger dog, the bone formation rate could be determined only in cortical bone: at the sites studied, the values for the accretion rate and the bone formation rate did not differ by more than 20 per cent. It is suggested that this is due partly to the low specific activity of the diffuse component in this young animal, and partly to the relatively large amounts of new bone formed during the period of the experiment. 8. Despite the important differences between the rates of calcium accretion and bone formation that were found to exist in regions where there was only a small amount of new bone formation, there was a strong correlation between the two rates. The value of the accretion rate as a parameter of bone metabolism is clear.