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ECONOMICS OF PUBLIC HEALTH

A PLEA for priority for public-health services-especiallythose that maintain and raise physical and mentalfitness-was made by Dr. F. Hall, M.o.n. for Lancashire,in his presidential address on Oct. 23 to the Society ofMedical Officers of Health. He quoted with approvalthe remark of the Working Party on Nursing that wemust " ascertain the optimal effort that needs to bedevoted to preventive and curative services respectively."The passing of the National Health Service Act, he said,is a recognition of the advances made in all branchesof medical science, " and in one sense may be regardedas a compliment to the profession " ; but its emphasis,he feels, is on medical treatment rather than on public-health measures. However, he foresees that when theexpense of treating sickness in hospitals and otherinstitutions is no longer masked by gifts, either of

money or service, but appears publicly in the nation’saccounts, the administrator will pay more attention topreventive methods, and there will be more likelihoodof these being intensively applied both in the medicalfield and in home and factory.

Today, said Dr. Hall, there are special reasons why weshould develop means of improving the health of thepeople, and their productive capacity. But even whenour immediate economic difficulties have been overcomethere will still be problems, arising from the effects oftwo wars and the ageing of the population, which it willbe hard to solve unless the public health is raised to afar higher level than now obtains. While not wishing tounderestimate the importance of providing for membersof th& community who become unfit by reason of ageor infirmity, he urged that their care and welfare " dependin the long run upon the soundness of , the national

economy, to which a high standard of public healthmakes the most valuable contribution." Of the measuresproved useful for preventing ill health some can becarried out by central authorities, but the majoritydemand local investigation and personal contacts.The appointment of the first medical officer of health

a hundred years ago was, in Dr. Hall’s view, a businessproposition ; and he clearly believes that it is throughDuncan’s successors that medicine could make its greatestcontribution to the nation’s economic well-being.

THE NOBEL PRIZEMEN

THE Nobel prize for-medicine for 1947 is shared betweenProf. Bernardo A. Houssay, of Buenos Aires, and Prof.Carl F. Cori and Dr. Gerty T. Cori, of the departmentof biochemistry, Washington University, St. Louis.The value of Professor Homsay’s work is recognised

by all interested in the problems of the endocrine controlof metabolism in general and of carbohydrate metabolismin particular. It is now over twenty years since he firstdemonstrated the importance of the pituitary gland incarbohydrate metabolism, and his observation thatremoval of the anterior portion of that gland reducesthe severity of experimental diabetes mellitus was

responsible for a rapid advance in our knowledge ofthe metabolic defect in diabetes. Before Houssay’sexperiments it was widely accepted that the fullydepancreatised dog could combust no carbohydrate atall, since it was believed that insulin was essential for

any oxidation of carbohydrate. Houssay’s experimentsdemonstrated in a straightforward manner that carbo-hydrate oxidation can take place in the animal body,in the apparently complete absence of insulin. Further-more, his demonstration that the hypophysectomised-depancreatised dog (the " Houssay

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animal) can survivemuch longer than the dog from which the pancreasalone has been removed, revealed an antagonism betweenthe effects of anterior-pituitary extract and of insulin.Subsequently he and his school, and also other investi-gators, were able to induce a temporarily diabetic

condition in animals treated with anterior-pituitaryextract, and this has again led to fundamental advances.

Dr. and Mrs. Cori have worked for many years in afield which has now merged to some extent with thatstudied from a different angle by Houssay and his school.Since the early 1920’s the Coris have pursued the glucosemolecule in its peregrinations round the animal body,into glycogen, into lactic acid, into hexose phosphates,and into many other intermediary compounds. Theirdemonstration of the in-vitro synthesis of glycogen andof starch from glucose-1-phosphate by appropriateenzyme systems was a most useful contribution in thisfield, and m )re recently they have shown the antago-nistic influences of anterior-pituitary extract and insulinin the formation of the glucose-6-phosphate from glucosein vitro under the action of the enzyme hexokinase.This demonstration has gone a long way towards pro-viding the explanation in terms of enzyme systems ofthe observations of Houssay and others on the antago-nistic action of anterior-pituitary extracts and of insulin,and has opened a new approach to the action of hormoneson enzyme systems in general.

WORLD CONGRESS ON MENTAL HEALTH

THERE have already been two world congresses onmental health : one at Washington in 1930, and theother in Paris in 1937. The third congress, to be held inLondon next year from Aug. 11 to 21, has been designedon ambitious lines, and will, it is hoped, attract some3000 people from over fifty countries. The difficultiesof reaching this country may be eased by the activesupport promised by UNESCO and the World HealthOrganisation.The congress will embody international conferences

on child psychiatry and medical psychotherapy (Aug. 12-15) and on mental hygiene (Aug. 16-21). The themeswill be, in the first conference, foundations of mentalhealth in childhood ; in the second, guilt ; and inthe third, mental health and world citizenship. The

congress committee, headed by Dr. J. R. Rees, is exertingitself to ensure that the communications on this last

topic shall represent all shades of opinion in each country.Sociologists, psychologists, educationists, and othersare being invited to participate ; and already discussiongroups, or preparatory commissions, have been set upin this country and in North America to synthesisedifferent individual views. The work of these com-missions is coordinated from London by means of amonthly digest of activity in all countries. The organisers’hope is that international comparisons will lead to aclearer understanding of the social relationships bearing onthe well-being of the individual and of society. Informa-tion may be had from the congress office at 39, QueenAnne Street, London, W.l.

NEGOTIATIONS WITH THE MINISTER

ANSWERING a question in Parliament last week theMinister of Health explained that he has not yet metthe Negotiating Committee but intends to do so soon.Arrangements for the National Health Service havebeen discussed with officers of the Ministry; but thecommittee will now present a statement to the Ministerhimself. A meeting with Mr. Bevan has been arrangedfor the week after next, and it is expected that thecommittee’s statement and the Minister’s reply will bepublished shortly afterwards.

THE death is announced on Oct. 24 of Lieutenant-General’Sir HAROLD FAwCUS, director-general of Army MedicalServices from 1929 to 1934, and director-general of theBritish Red Cross Society from 1934 to 1938. He was71 .years of age.THE next session of the General Medical Council

will be held on Tuesday, Nov. 25, at 2 when SirHerbert Eason, the president, will take the chair.