34

ment, whom at that time no other country but Switzer-land would accept. The facts about their progresscertainly do not indicate that they would have beeneither a grave financial burden or a noticeable public-health risk if they had been admitted to the countriesthat barred their frontiers against them.World Refugee Year brought some relaxation of the

regulations, and Great Britain and other countries agreedto accept refugees with active tuberculosis. GreatBritain was prepared to accept 200 handicapped refugees,and 20 with tuberculosis were accepted; but only 5 ofthese had disease so severe as to require hospital treat-ment. In March, 1960, it was stated that persons withcurable tuberculosis would be admitted. But the criteriaof curability were not stated, nor is it known what

authority on tuberculosis decided who was curable orwho incurable.

Canada, one of the countries with the most strict

regulations for excluding the tuberculous, has, in fact,accepted over 700 persons with active disease. As partof its contribution to World Refugee Year, a specialfund was set up to take tuberculous patients and their

families to Canada. In December, 1959, and January,1960, a hundred families were admitted, and these wereintegrated into the community so rapidly that a secondgroup of 39 families was admitted in June. TheCanadian Secretary of State for Foreign Affairs declaredlast December, that the period of treatment and integra-tion of these tuberculous families had proved to beshorter than was originally estimated and that a thirdgroup was to be admitted. Of the first 100 tuber-culous refugees only 38 had moderately or far advanceddisease. Three months after arrival in Canada 58

patients had been discharged from hospital, 3 were

awaiting discharge, and only 7 still had tubercle bacilliin the sputum.The picture that emerges from these few investiga-

tions of the after-history of tuberculous refugeesadmitted as immigrants supports the view that there"

appear to be no medical grounds for excluding anyrefugee with tuberculosis, curable or incurable, fromentering Great Britain 11.2 In World Refugee Year theantiquated regulations were relaxed. What was begunby compassion might now be extended through reason.

1. See Lancet, 1961, i, 1269.

Annotations

GROUPING LONDON’S POSTGRADUATETEACHING HOSPITALS

THIS week the Minister of Health made his expected 1statement on postgraduate teaching hospitals in London(see p. 57). The main feature of his plan is the transferto a site near the Royal Marsden and Brompton Hospitals,in Fulham Road, of three urological hospitals (St. Peter’s,St. Paul’s, and St. Philip’s), of St. John’s Hospital forDiseases of the Skin, and of St. Mark’s Hospital.Secondly, the group of hospitals in the Holborn area isto be increased by the addition, on the present site of theRoyal Free Hospital, of a unified Moorfields Eye Hospital.Hammersmith Hospital, the Maudsley and Bethlem Hos-pitals, and Queen Charlotte’s Hospital (with the ChelseaHospital for Women to be rebuilt nearby) are unaffected.

This plan, by which the main localities of postgraduateteaching will be reduced to five or six, has much to com-mend it. But important questions remain to be answered-including the timing of the whole operation, the extentto which the grouped hospitals are to share services, andhow these specialised hospitals are to be assured of theiressential links with general hospitals. One clause in theMinister’s statement must be rated as disappointing.This is that " Provision will be made for the eventualinclusion [on a site in Fulham Road] of the NationalHeart Ilospital and the Institute of Cardiology ". So faras it goes, this suggests that the Ministry is willing forthe transfer to take place. But the Ministry is not theonly body concerned; and elsewhere there may bereluctance to see the National Heart Hospital moved-cramped, inadequate, and isolated though it is-on the

ground that much thought and work have gone into itsdevelopment. Yet surely the chance should be seized tocorrelate the study and treatment of cardiovascularand of respiratory diseases. Such integration could beone of the largest gains from development of the FulhamRoad group of hospitals.

1. Siegal, S. Ann. intern. Med. 1945, 23, 1.2. Mamou, H., Cattan, R. Sem. Hôp. Paris, 1952, 28, 1062.3. Benhamou, E., Albou, A., Sayag, P. Algérie méd. 1955, 59, 809.4. Reimann, H. A., Moadie, J., Semerdjian, S., Sahyoun, P. F. J. Amer.

med. Ass. 1954, 154, 1254.5. Artunbal, S., Seyahi, V. Bull. Soc. turq. Méd. 1955, 21, 282.6. Sohar, E., Prass, M., Heller, J., Heller, H. Arch. intern. Med. 1961,

107, 529.7. Bickel, C., Lasserne, R. Schweiz. med. Wschr. 1957, 87, 5.

FAMILIAL MEDITERRANEAN FEVER

THE earliest reports of familial Mediterranean feverrelated to Jewish patients in the United States 1; butthe full range of the clinical features of this remarkablecondition were perhaps first appreciated in France

through observations on immigrants from North Africa.2The illness is almost confined to peoples originating fromthe southern and eastern shores of the Mediterranean;and those who write on it tend to have such pleasinglyunfamiliar names as Mamou and Benhamou 3 (NorthAfrica), Semerdjian and Sahyoun 4 (Lebanon), andArtunbal and Seyahi (Turkey).The disorder is characterised by recurrent attacks of pain

in the abdomen, chest, or joints, with fever, sometimes anerysipelas-like rash, and quite often progressive renaldisease. The condition was early recognised as running infamilies. Four physicians in Tel-Aviv 6 have completeda genetic analysis based on 262 index patients, drawnfrom all the public hospitals in Israel, of whom 232 wereavailable for the family study. This large series showsclearly that the great majority of cases are due to thehomozygous state of a recessive gene. There was a raisedprevalence (over 20%) of parental consanguinity; andabout 1 in 4 of the sibs (but few relatives of other degree)were affected. In a few families a dominant gene was

apparently responsible. One such is the Armenian familyreported by Reimann et a1.4 from the Lebanon. Anotheris the family reported from Switzerland by Bickel andLesserne 7; this, too, was an Armenian family from theLebanon, and may have been a related kindred.

Israel, where most of the inhabitants are immigrants, iswell suited to the study of variations of gene frequency indifferent human populations. The largest group ofimmigrants-over half the whole-are Ashkenazi Jews,but only 6 of the patients belonged to this group. In