33

least once, and so everyone is aware of it. There is also an

uneasy feeling that what is an irritating pinprick to manycan be a real hardship to old people, to the parents oflarge families, and especially to the chronic sick, despitethe arrangements for reclaiming the money through theNational Assistance Board.

Some of this public uneasiness is reflected in the

uncertainty shown by successive Governments in handlingthis payment by patients. First introduced in 1952 as a

charge on each prescription form, it was recast at the endof 1956 into a charge on each item. At the time of this

change we expressed our doubt whether enough wasknown about the use of the pharmaceutical service foranyone to do more than guess about the wider socialeffect of the new arrangements. In their review, based onthe variation in the charges (p. 36), Dr. Martin and Mrs.Williams suggest that these have in fact produced someunexpected results. The original introduction of the

shilling-a-form charge, they say, decreased only slightlythe frequency of prescriptions (making allowance for theinfluenza epidemic which distorted the figures for 1951).On the other hand, doctors, as some observers had pro-phesied, began to write more prescriptions on each form,and by this means probably saved their patients aboutE21/2 million between 1952 and 1956. Even so, the chargebrought in revenue at a rate of nearly E6 million a year,and, allowing for money refunded through the NationalAssistance, contributed 25 million towards a drug billofE198 million during those years.The effects of the change to the shilling-an-item charge

were still more obvious. The number of prescriptionsper patient dropped from 5-51 in 1956 to 4-93 in 1957-the lowest figure recorded since the N.H.S. began. Notunexpectedly the number of prescriptions per form alsodropped. At the same time the average cost of each

prescription rose sharply from 4s. 9d. to 5s. 10d. Part ofthis rise was due to an increase in dispensing fees, whichcoincided with the modification of the charges, and partto the addition of some new and expensive preparationsto the general practitioner’s repertoire. Even so, Dr.Martin and Mrs. Williams calculate that nearly half theincrease was due to doctors prescribing larger quantitiesof drugs. For chronic patients at least, such as diabetics,this practice had the support of the Minister of Health.But, despite it, the actual cost of charges to patients rosesharply from an average of 3s. 4d. in 1956 to 4s. l ld. in

1957, and the proportion of the drug bill borne bypatients from 12-26% to 1707°,0. Though after theintroduction of the charge-per-item the number of

prescriptions fell by nearly 20 million, the total drug billrose by nearly E6 million. About a third of this was dueto the increased dispensing fees. Towards the remainingB4 million the new charge (after deduction of the increasedrefunds through National Assistance) brought theGovernment E2 million in revenue. But the end resultappears to be a deficit of f:11 /2 million instead of the

saving of about E4 million which the Chancellor

apparently expected in his statement announcing thenew charge.This discrepancy Dr. Martin and Mrs. Williams

attribute largely to doctors changing their prescribingpractice so as to protect their patients from the full rigourof the new charge, and they believe that the complexrelationship of doctor and patient makes unjustifiable thesimple economic prediction of the ultimate financial

1. Lancet, 1956, ii, 929.

effects of charges of this kind. It is also doubtful howsuccessful the charges have been in reducing the volume ofthe national consumption of drugs. The value of a

" bottleof medicine " may easily be overestimated by patients,and the drug bill may have risen at the expense of moredeserving parts of the service. The remedy here, as SirHugh Linstead has pointed out,2 is not a fresh charge" but education of both practitioners and public ".

2. See ibid. 1956, ii, 1219.3. Accident at Windscale No. 1 Pile on 10th October, 1957. Cmnd. 302. H.M.

Stationery Office.4. Stewart, N. G., Crooks, R. N. Nature, Lond. 1958, 182, 627.5. Chamberlain, A. C., Dunster, H. J. ibid. p. 629.6. Maycock, G., Vennart, J. ibid. p. 1545.

IODINE AND WINDSCALE

ON Oct. 10, 1957, radioactive materials escaped fromthe chimney of no. 1 pile of the Atomic Energy Authority’splutonium factory at Windscale in Cumberland. Duringa release of Wigner energy from the graphite in the pile,one or more fuel cartridges failed and the contents

oxidised slowly, finally causing afire. 3 The radioactivecloud emitted then travelled south-east, passing overLondon on Oct. 11 and 12.4 Measurements made nearWindscale and further afield 4 showed that the increasein radioactivity was largely due to 1311, a short-lived

isotope of iodine with a half-life of 8 days. (Other radio-active isotopes were detected in smaller quantities, but notall of them necessarily came from Windscale.) Someevidence of the radiation delivered to human thyroids bythe 131J in this cloud is now available.

Towards the end of October, 1957, Maycock andVennart observed that the gamma-ray activity of certainmembers of the staff of the Radiobiological ProtectionService at Belmont, Surrey, was higher than expectedfrom previous estimates. The source of the additional

activity was identified as 1311, which had not appearedbefore in the gamma-ray spectrum of these persons; andthere was also evidence of a slight increase in 13 7cos.In view of these findings and since iodine is concentratedin the thyroid gland, measurements were made at Belmontof 1311 in human thyroids. The measurements weremade in a low-background laboratory by a sodiumiodide (thallium) crystal optically coupled to a photo-multiplier tube. 18 people were examined, most of themliving in or on the edge of the Greater London area(2 lived farther out in Surrey and 1 was a visitor from

Leeds). In a few persons it was possible to take a seriesof readings and one such series showed an elimination-rate from the thyroid which was slower than the radio-active decay-rate of 1311, indicating clearly that the

uptake of 131 was continuing throughout the period ofmeasurement. This individual, who had more 1311 inthe thyroid (6-3 m[LC on Nov. 1) than anyone else in theLondon group, was also the greatest consumer of milk,which supports the view that milk was the main sourceof 1311. By Nov. 15 this thyroid contained 2-6 muC of131 I, and by Jan. 2, 1958, the figure had fallen to 0-09 mThe visitor from Leeds gave a reading of 8-5 m[LC onNov. 1. It was estimated that the total mean radiationdose to the thyroid of the person with the initial readingof 6-3 m[LC was 0-13 rad, and that the average memberof the Surrey and London groups received about0-04 rad. The results in the 2 children studied suggestthat there is little difference in the uptake of 1311 into thethyroid at different ages: because of the smaller thyroidweights, therefore, the dose to the children’s thyroidswas twice that to the adults’. The radiation dose to adult

34

human thyroids in the London and Surrey people wasthus comparable with that expected each year fromnatural background radiation, which contributes, for

example, about 0-08 rad per annum in Sutton, Surrey.

1. East Anglian Daily Times, Oct. 9, 1958.

BACTERIA AND BEDSCREENS

As long as patients are herded together in large wards,arrangements must be made to give them privacy. For

years nurses have carried mobile screens and arrangedthem round the beds before medical examinations oruse of the bedpan and at other times when a patient wishesto be unseen. Throughout the country, many nurse-miles are covered each day in moving these screens-though patients, from consideration for the nurses, oftenmanage without screens when they would really like tohave them. Patients and nurses therefore welcome theinstallation of pull-round screens for every bed. But

these, like motor-cars and television, bring dangers withtheir undoubted advantages.

Cross-infection in hospital wards is often attributed toairborne and dustborne bacteria; these, in turn, have beenattributed to fabrics and furnishings that harbour dust.Much attention has been given to blankets, which, it

seems, make a substantial contribution to aerial con-tamination. Curtains may well do the same, but this hasnot been seriously investigated. Pull-round screens foreach bed involve much more curtain-material than half-a-dozen sets of mobile screens and thus form a largerreservoir for dust and bacteria. Moreover, the act ofpulling them round a bed probably sends out more dustthan does arranging mobile screens fitted with tightlystretched fabric. Another disadvantage of the pull-round screen is that it needs a rail suspended from theceiling. This is a dust-trap that cannot be cleaned everyday; so movement of the runners may send down showersof contaminated dust.Some of these dangers can be reduced, though often

by methods that create other difficulties. Cotton curtains

may be changed, perhaps fortnightly, and sent to thelaundry, where they will be boiled. But the removal and

replacement of twenty sets of screens, each of two orthree curtains, involves more strenuous work for thenurses than changing the curtains on a few mobileframes. This difficulty, as well as that of cleaning therails, is accentuated when the screens are higher than isnecessary. These jobs are much easier if the curtainsare not more than 6 ft. 9 in. high and are suspended bysplit plastic rings from simple rods instead of by rollerson grooved metal rails.

Plastic curtains probably harbour and scatter fewerbacteria than cotton ones, and they can be wiped with adamp cloth to remove dust. For mobile screens this is

easily done, but railed curtains must usually be takendown, and the work for the ward staff in removing andcleaning twenty sets is much greater than sending cottoncurtains to the laundry. Thick plastic materials are

heavy to handle; thin ones are often semitransparent andgive insufficient privacy, though some, with printeddesigns on them, are satisfactory.

Thus, no type of screen is clearly better than others.When hospital management committees consider theirown needs, as the Colchester Group Hospital Manage-ment Committee has lately done,l they will make theirdecision after balancing the sometimes conflictingdemands of privacy and bacteriological safety. They willbe influenced bv local factors, such as the number of

beds in the ward, the type of patients occupying them, andthe number of nurses and ward orderlies. Different

hospitals, and even different wards in the same hospital,may best be served by different methods of screening.

Perhaps we may suggest that in large wards pull-roundscreens for each bed seem justified, but that in smallerwards their advantages are fewer. In some surgical wardswhere patients are especially susceptible to hospitalinfection, such as those dealing with burns and thosethat must house both clean and septic cases, the surgeonmay be justified in preferring the old-fashioned mobilescreens. Plastic materials are certainly best for mobilescreens, and probably also for the pull-round type if theward staff can clean them fairly often. If they cannotdo this, cotton curtains must be used and should be sentto the laundry regularly.

1. Camb. Univ. Rep. Dec. 10, 1958, p. 481.2. See Times, Dec. 8, p. 12.

RESEARCH IN CRIMINOLOGY" Life for life, eye for eye, tooth for tooth, hand for hand,

foot for foot, burning for burning, wound for wound, strifefor strife."

CRIMINAL law has been with us since the time of Mosesand before. Though its form, severity, and purpose haschanged with changing civilisations, ignorance of itsefficacy has remained constant, and today we still do notknow how well our different systems of punishment andreablement work. Probation, corrective detention, im-prisonment, approved schools-which is most effective?Would the people they handle perhaps turn out less anti-social in the long run if left quite alone ? Probation is

usually regarded as a successful service, and this may wellbe because it is the one which interferes least with normallife. Again, the real effectiveness of the open prison is hardto assess because the men selected for the few availableplaces are often those who would have gone straight,whatever prison they were sent to. But besides these

important questions about the management of wrong-doers there are a thousand others, equally fundamental,about the cause and prevention of crime which also stillawait an answer.

It is therefore excellent news that Mr. R. A. Butler,the Home Secretary, has agreed with the general board ofthe university to set up an institute of criminology atCambridge, which is to open on Oct. 1 under the

directorship of Dr. L. Radzinowicz. The chief objects ofthe new institute are to set up (for the first time in thiscountry) a university qualification in criminology, to

develop the teaching of this subject to undergraduate andpostgraduate students, and to promote research. TheHome Office and the university have wisely agreed that itshould begin modestly as a small unit based on the existingdepartment of criminal science. It will no doubt expandas trained men and women become available. Competentand experienced experts in the forensic aspects ofpsychology, psychiatry, and the other social sciences arehard to come by; but, as the number of appointmentsincreases, more people may well be attracted to this newand valuable specialty.At Oxford the outlook for criminology is less bright,

for it is proposed that the readership there should beallowed to lapse when its present holder, Dr. MaxGrunhut, retires in 1960. A group of senior members ofthe university have expressed regret at this decision 2

and pointed out that, far from being a "

fringe " subject,criminologv has affinities with medicine, law, and