419

still carries a high mortality. COLEBROOK has alsodrawn attention to cases infected by a sulphonamide-resistant strain of a streptococcus, and in this issueFRANCIS illustrates how troublesome such streptococcican be in the preparation of wounds for skin-grafting.D. N. MATTHEWS, in his Hunterian lecture in February,stated that if daily viable counts are done during localchemotherapy of a wound the count falls profoundlyduring the first four days, but after that there is oftena slight but maintained rise. This holds good for alltypes of organisms examined, including streptococci,and he suggested that the survivors had developed atolerance to the sulphonamide. The strategy ofattack on bacteria is, like that of human war, toattack the environment and the food. Zinc peroxideacts by creating an environment unfavourable togrowth and toxin formation ; sulphonamides are

believed to act by interfering with an essentialbacterial metabolite. The two may work together,for it has been shown that when a wound is previouslytreated with hydrogen peroxide local sulphonamideaction is enhanced. In zinc peroxide we have a

therapeutic weapon which is especially -powerfulagainst all anaerobic bacteria and the haemolyticstreptococcus. Its objection is its insolubility, whichmakes it difficult to ensure that it reaches the " fjords "of the wound and prevents its use in closed wounds.Its main indication is infection with anaerobes, andmany more such cases would probably be revealedif anaerobic culture were done as a routine when awound resisted treatment without obvious cause.

MUM’S THE WORDLOCAL authorities have been exhibiting an occa-

sional tendency to deny the press a chance to recordthe proceedings of their councils and committees.Not long ago -the Stepney borough council was one ofthe defendants in litigation- which revealed unsus-pected liabilities to libel actions lurking even in thepublication of agenda.. Other councils took fright.War-time operations increase the opportunity and theexcuse for secrecy. The hurried recourse to emer-

gency committees, to which local authorities can dele-gate their functions (other than those of borrowingmoney) without restrictions or conditions, is a furtherdiscouragment to public inquisitiveness. Rate-

payers, and indeed not a few councillors who findthemselves outside the inner circle, are less successfulthan formerly in discovering what is going on. Whenall allowance is made for war-time necessities, thisrestriction of publicity is unfortunate. Last year amember of a seaside town council (who was also amedical practitioner) proposed that the press be

prohibited from mentioning cases of infectious diseasesoccurring within the district. A case of typhoidhad lately been reported, and he was anxious that thepublic should not be scared. The council, unwillingto imitate the Riviera hoteliers who would suppressthe news of local snowstorms, rejected his motion.Scares are far worse when rumour runs unchecked

by public announcement. And now that MOH’s

reports are reduced to a shadow of their former selvesthe cit is far less aware of local health problems thanhe was. Recently the Minister of Health has issued acircular to local authorities which urges that facilitieshitherto afforded to the press be not withdrawn orrestricted except for reasons of national security.

Where those reasons are absent, the Minister suggests,matters of public interest in the sphere of ordinarylocal government should continue to be debated inopen session, and, where administrative conveniencerequires that such matters be finally dealt with by anemergency committee, the question of admitting thepress to the committee’s proceedings demands carefulconsideration. The 1908 act, passed after the Tenbycorporation case had established that nobody had aright to attend a borough council’s meetings withoutits consent, begins with the declaration that repre-sentatives of the press shall be admitted to the meet-ings of every local authority. Then follows a provisothat the authority may temporarily exclude the pressas often as may be desirable at any meeting where amajority of the councillors resolve that " in view ofthe special nature of the business then being dealt with,or about to be dealt with, such exclusion is advisablein the public interest." A subsequent section some-what obscurely excepts meetings of committees, butthere is nothing in the act to interfere with a commit-tee’s-power to admit the public to its discussions as itmay think fit. What is wanted-and what theMinister of Health evidently -wants-is that localbodies should not surround themselves with a veil ofmystery which is the negation of democracy.

Annotations

A CHANCE FOR THE TUBERCULOUS

THE state has played an increasingly active part in thecontrol of tuberculosis in’ the present century, but fromany list of its accomplishments there is one glaringomission : no sincere attempt has so far been made toenable the tuberculous patient to earn a satisfactorylivelihood within the limits of his impaired strength.He must, it seems, obey the " all or none " law ; forthere is no middle course he can follow between a returnto the competitive industry that was his undoing andliving a life of idleness. Economic necessity determineswhich direction he goes, and the figure, all too familiarto the tuberculosis officer, of the young breadwinner whohas relapsed within a short time after leaving sanatoriumis the result. The gap .between the sheltered existencein a sanatorium and the normal life in shop or factorymust be bridged if the tuberculous ex-patient is everto regain his place in the world on an equal footing withhis fellows. For this reason the decision of the Ministryof Labour to include the tuberculous in its interim schemefor the training and resettlement of disabled persons islikely to be a landmark in the history of social medicine,and the Tuberculosis Association at its meeting on

Feb. 22 discussed the implications, near and remote, of thedecision. Two points were considered of such cardinalimportance as to justify immediate reference to the

Ministry of Labour : (1) the case suitable for rehabilita-tion under the scheme and the type of employment forwhich the patient is best fitted should be decided-jointlyby the tuberculosis officer and the representative of theministry, with the help of the medical superintendent ofthe institution in which the patient last received treat-ment ; (2) the principle of part-time employment withsubsidised wages on a sliding scale must be accepted ifthe ex-patient is to be nursed back to normal industry.Application of the scheme to those men and women onlywho are capable of whole-time employment under worka-day conditions would limit its advantages to a smallfraction of the tuberculous community. But we may hopethat well begun is half done and look forward to a moreambitious scheme which will relieve the consumptive ofhis sense of frustration and help him to rediscover his soul.