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799 minate all rental agreements by administrative action. But his present intention was not to withdraw a facility unless there was a reasonable alternative available. Obituary GEORGE FRANCIS ABERCROMBIE V.R.D., M.A., M.D.Camb., F.R.C.G.P. Dr Abercrombie, who was President of the Royal Col- lege of General Practitioners from 1959 to 1962, died on Sept. 25 at the age of 82. He was educated at Caius College, Cambridge, and St Bartholomew’s Hospital, London, where he held house appointments, before going on to the Hospital for Sick Children, Great Ormond Street. He entered general practice in 1924. He was lecturer in general practice at Barts from 1953 until his retirement in 1966. He had a long association with the R.N.V.R. and he was appointed honorary physician to King George VI in 1950. A.T.R. writes: "General practice has good reason to be grateful to George Abercrombie. In 1950, he was one of a group of general practi- tioners who established the Section of General Practice of the Royal Society of Medicine; he became the first president of the section, and was later elec:ed an honorary fellow of the So- ciety. From the beginning, the section flourished; its meetings were well attended and the calibre of speakers, both in opening papers and in debate, was high. Two years later a steering committee was formed to establish a college of general practi- tioners. Of the ten general-practitioner members of that com- mittee, six, including George Abercrombie, were members of the council of the section. Their experience of working together to establish the section helped greatly in the formid- able task of founding the College. In both these tasks, Aber- crombie played an outstanding part. He was the first chairman of council of the College, and served under the first two Presi- dents, William Pickes and Ian Grant. He himself became its third President in 1959. So, for ten years and more, he was in office helping to shape a course for the -infant College. His thoughtful counsel did much to ensure the weathering of the first difficult years and the laying of sound foundations for the future of the Royal College." Prof. HENRY BEDSON A member of the W.H.O. Special Study Group for Poxvirus Infections, sends this addition to our obituary of Sept. 16 (p. 641): "In my opinion the work he did with Keith Dumbell, which provided a simple method for the differentiation of smallpox and alastrim viruses (alastrim will not grow above 375°, smallpox will grow at up to 38-5°), and the discovery of a third type of ’intermediate’ smallpox in East Africa, probably repre- sents the greatest contribution made by laboratory workers to the study of smallpox since the virus was first isolated. His stud- ies on genetic hybrids of smallpox would, if finished, provide clues as to why smallpox and alastrim differ so much in viru- lence. More recently he had also been analysing the biochemi- cal basis for the differences between smallpox and alastrirr viruses and was beginning to apply these techniques to the so- called ’wild-white’ poxviruses. It is these viruses, isolated frorr African primates and rodents, which pose the greatest prob- lems as the smallpox eradication campaign reaches its climax for laboratory studies have so far failed to distinguish then from smallpox virus. It is because of circumstances such as thi’ that the W.H.O. Eradication Unit needed to obtain more dat: on smallpox and related viruses, while trying to restrict theil study to as few laboratories as possible." Notes and News HANFORD EVIDENCE REVIEWED Two years ago Dr Alice Stewart presented to the Health Physics Society meeting at Saratoga Springs, New York, an analysis of certified deaths of employees at the Hanford Works in Richland, Washington, where work involving exposure to ionising radiation had been carried out for over thirty years. No-one denies that the Hanford experience ought to be a good one for study by those interested in the effects of radiation on health, but, both before and after publication, the "Mancuso study" has been heavily criticised. The practical conclusion of the study was that generally accepted doubling doses for malig- nant disease induced by ionising radiation are wrong. The National Radiological Protection Board2 has gathered together some of the criticisms, including unpublished comments from Dr C. E. Land of the National Cancer Institute. The main criticisms are that the doses were so low that background and non-occupational exposure must confound interpretation; that dose records are incomplete (and so may be ascertainment of cause of death); that the statistical methods may not be appro- priate. The N.R.P.B. concludes: "... a wide body of experts agree that there is no evidence in the Hanford data to support the suggestion that ICRP values do seriously underestimate the risk." REPORTS ON SI]DE-EFFECTS OF DRUGS AN item in a recent issue of Scrip (Sept. 16, p. 6), a periodi- cal of pharmaceutical news which circulates largely within the pharmaceutical industry, suggested that The Lancet had un- dertaken to consult with a manufacturer before publishing any report on side-effects associated with one of his products. This is not true. BASIC HEALTH SERVICES AT a world consultation last year on the roles and educa- tion of health-care personnel the view was repeatedly heard that health services in many countries were not keeping pace with changing populations, either in quantity or quality. Dr T. Fulop, director of the W.H.O. Division of Health Manpower Development, said that in over half those countries inhabited by the majority of the world population there are less than 5 physicians per 10 000 people. In Thailand, for example, the ratio of doctors to population is 1/7600; in Zaire it is 1/27 000. Medical manpower in developing countries is often concen- trated in urban areas, because of a reluctance among trained personnel to work in the poorer rural districts. Training in pri- mary health care is also regarded by many as less important and satisfying than more specialised work. The result is an un- balanced and fragmented health service, often completely un- suited to the needs of a largely uneducated rural population. Several delegates from both developed and developing coun- tries called for a radical change in manpower planning with greater emphasis on the provision of care at primary level, a call repeated last month at the Alma-Ata conference.’ In the third world the traditional western system of medical training, 1. Mancuso, T., Stewart, A., Kneale, G. Hlth Phys. 1977, 33, 369. 2. An Assessment ofthe Mancuso Study. By J. A Reissland, M.R.P.S. 3. The Changing Roles and Education of Health Care Personnel Worldwide in view of the Increase of Basic Health Services. Papers from a consultation sponsored by the Society for Health and Human Values, 1100 Wither- spoon Building, Philadelphia, Pennsylvania 19107 4. See Lancet, Sept. 23, 1978, p. 666

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minate all rental agreements by administrative action.But his present intention was not to withdraw a facilityunless there was a reasonable alternative available.

Obituary

GEORGE FRANCIS ABERCROMBIE

V.R.D., M.A., M.D.Camb., F.R.C.G.P.

Dr Abercrombie, who was President of the Royal Col-lege of General Practitioners from 1959 to 1962, died onSept. 25 at the age of 82.He was educated at Caius College, Cambridge, and St

Bartholomew’s Hospital, London, where he held house

appointments, before going on to the Hospital for Sick

Children, Great Ormond Street. He entered general practice in1924. He was lecturer in general practice at Barts from 1953until his retirement in 1966. He had a long association withthe R.N.V.R. and he was appointed honorary physician toKing George VI in 1950.

A.T.R. writes:"General practice has good reason to be grateful to George

Abercrombie. In 1950, he was one of a group of general practi-tioners who established the Section of General Practice of the

Royal Society of Medicine; he became the first president of thesection, and was later elec:ed an honorary fellow of the So-ciety. From the beginning, the section flourished; its meetingswere well attended and the calibre of speakers, both in openingpapers and in debate, was high. Two years later a steeringcommittee was formed to establish a college of general practi-tioners. Of the ten general-practitioner members of that com-mittee, six, including George Abercrombie, were members ofthe council of the section. Their experience of workingtogether to establish the section helped greatly in the formid-able task of founding the College. In both these tasks, Aber-crombie played an outstanding part. He was the first chairmanof council of the College, and served under the first two Presi-dents, William Pickes and Ian Grant. He himself became itsthird President in 1959. So, for ten years and more, he was inoffice helping to shape a course for the -infant College. Histhoughtful counsel did much to ensure the weathering of thefirst difficult years and the laying of sound foundations for thefuture of the Royal College."

Prof. HENRY BEDSON

A member of the W.H.O. Special Study Group forPoxvirus Infections, sends this addition to our obituaryof Sept. 16 (p. 641):

"In my opinion the work he did with Keith Dumbell, whichprovided a simple method for the differentiation of smallpoxand alastrim viruses (alastrim will not grow above 375°,smallpox will grow at up to 38-5°), and the discovery of a thirdtype of ’intermediate’ smallpox in East Africa, probably repre-sents the greatest contribution made by laboratory workers tothe study of smallpox since the virus was first isolated. His stud-ies on genetic hybrids of smallpox would, if finished, provideclues as to why smallpox and alastrim differ so much in viru-lence. More recently he had also been analysing the biochemi-cal basis for the differences between smallpox and alastrirrviruses and was beginning to apply these techniques to the so-called ’wild-white’ poxviruses. It is these viruses, isolated frorrAfrican primates and rodents, which pose the greatest prob-lems as the smallpox eradication campaign reaches its climaxfor laboratory studies have so far failed to distinguish thenfrom smallpox virus. It is because of circumstances such as thi’that the W.H.O. Eradication Unit needed to obtain more dat:on smallpox and related viruses, while trying to restrict theilstudy to as few laboratories as possible."

Notes and News

HANFORD EVIDENCE REVIEWED

Two years ago Dr Alice Stewart presented to the HealthPhysics Society meeting at Saratoga Springs, New York, ananalysis of certified deaths of employees at the Hanford Worksin Richland, Washington, where work involving exposure toionising radiation had been carried out for over thirty years.No-one denies that the Hanford experience ought to be a goodone for study by those interested in the effects of radiation onhealth, but, both before and after publication, the "Mancusostudy" has been heavily criticised. The practical conclusion ofthe study was that generally accepted doubling doses for malig-nant disease induced by ionising radiation are wrong. TheNational Radiological Protection Board2 has gathered togethersome of the criticisms, including unpublished comments fromDr C. E. Land of the National Cancer Institute. The maincriticisms are that the doses were so low that background andnon-occupational exposure must confound interpretation; thatdose records are incomplete (and so may be ascertainment ofcause of death); that the statistical methods may not be appro-priate. The N.R.P.B. concludes: "... a wide body of expertsagree that there is no evidence in the Hanford data to supportthe suggestion that ICRP values do seriously underestimatethe risk."

REPORTS ON SI]DE-EFFECTS OF DRUGS

AN item in a recent issue of Scrip (Sept. 16, p. 6), a periodi-cal of pharmaceutical news which circulates largely within thepharmaceutical industry, suggested that The Lancet had un-dertaken to consult with a manufacturer before publishing anyreport on side-effects associated with one of his products. Thisis not true.

BASIC HEALTH SERVICES

AT a world consultation last year on the roles and educa-tion of health-care personnel the view was repeatedly heardthat health services in many countries were not keeping pacewith changing populations, either in quantity or quality. Dr T.Fulop, director of the W.H.O. Division of Health ManpowerDevelopment, said that in over half those countries inhabitedby the majority of the world population there are less than 5physicians per 10 000 people. In Thailand, for example, theratio of doctors to population is 1/7600; in Zaire it is 1/27 000.Medical manpower in developing countries is often concen-trated in urban areas, because of a reluctance among trained

personnel to work in the poorer rural districts. Training in pri-mary health care is also regarded by many as less importantand satisfying than more specialised work. The result is an un-balanced and fragmented health service, often completely un-suited to the needs of a largely uneducated rural population.Several delegates from both developed and developing coun-tries called for a radical change in manpower planning withgreater emphasis on the provision of care at primary level, acall repeated last month at the Alma-Ata conference.’ In thethird world the traditional western system of medical training,

1. Mancuso, T., Stewart, A., Kneale, G. Hlth Phys. 1977, 33, 369.2. An Assessment ofthe Mancuso Study. By J. A Reissland, M.R.P.S.3. The Changing Roles and Education of Health Care Personnel Worldwide in

view of the Increase of Basic Health Services. Papers from a consultationsponsored by the Society for Health and Human Values, 1100 Wither-spoon Building, Philadelphia, Pennsylvania 19107

4. See Lancet, Sept. 23, 1978, p. 666

Page 2: Notes and News

800

which emphasises prevention of disease rather than main-tenance of health is often unsatisfactory because it minimisespeople’s responsibility for their own health. Several countrieshave revised their medical training programmes: in parts ofSouth America students are required to work in rural hospitalsduring their sixth year and much of the teaching is done bynurses rather than doctors; in China the peasant barefoot doc-tor receives basic training which is supplemented by mobilehealth-care teams from the city hospitals, and roughly a thirdof China’s medical students come from barefoot origins. Thedevelopment of primary health services is also receiving moreattention in developed countries. In Sweden, for instance, post-graduate students must complete a period of 21 months’

general service, which includes 6 months’ training in primaryhealth care. There was, however, a general feeling among thedelegates that the undergraduate medical course should in-clude training not only in primary health care but also in thesocial services and the humanities.

SARCOIDOSIS AND OTHER GRANULOMATOUSDISEASES

THOSE who met at a recent international conference in Car-diff agreed that sarcoidosis is distributed worldwide and mustbe distinguished from other granulomatous disorders. Diag-nosis requires proof of multisystem involvement-e.g., central-nervous-system and cardiac lesions-and can be aided by elec-tronmicroscopy (to assist in excluding known granulogenicagents) and new techniques such as computerised tomographywhich join the still useful transbronchial biopsy and Kveim-Siltzbach skin test. The serum-angiotensin-converting enzymeconcentration is also of diagnostic value and is both course andsteroid dependent. Like the less specific serum-lysozyme, thisenzyme is probably derived from granuloma cells. Family stu-dies on an association between HLA-B8, erythema nodosum,and arthritis have been inconclusive. Pulmonary-lavage fluidhas a raised Ig level and-unlike the blood-an adequatenumber of activated T lymphocytes. Why they are there is un-clear. Lung function tests may show diffusion defects and alsosome degree of chronic airways obstruction. The steroid re-sponse depends upon the degree of fibrosis, and increasingawareness of myocardial involvement suggests a further indi-cation for treatment.The conference discussed the pathology of granulomas in

detail. The constituent cells of sarcoid granulomas have a com-plex relationship and granulomas of other diseases consist ofsimilar, sometimes identical, cells.

Proceedings of the VIIIth International Conference on Sarcoidosis.and Other Granulomatous Diseases will be obtainable from AlphaOmega Publishing Ltd, P.O. Box 88, College Buildings, UniversityPlace, Cardiff CF1 ISA.

University of London

Dr A Garner, reader in experimental pathology at the Insti-tute of Ophthalmology has been appointed to the chair ofpathology at the Institute.Dr J. C. Gunn, senior lecturer in forensic psychiatry at the

Institute of Psychiatry has been appointed to the chair of for-ensic psychiatry at the Institute.Dr P. H. Millard, senior lecturer in geriatric medicine at St

George’s Hospital Medical School and director of the GeriatricTeaching and Research Unit, has been appointed to theEleanor Peel chair of geriatric medicine at the school.

Prof. Alison McDonald of McGill University has been

appointed to the chair of epidemiology and preventive medi-cine at St. Mary’s Medical School.

Dr Ruthven Mitchell has been appointed director of the Glasgowand West of Scotland Blood Transfusion Service which covers a popu-lation of approximately 3,000,000 in the West of Scotland.

The Tuberous Sclerosis Association of Great Britain will hold its Iannual meeting on Nov. 11, 1978 at the Conference Hall, NationalChildren’s Bureau, 8 Wakley Street, London EC IV 7QE. Details maybe had from Mrs Ann Hunt, Church Farm House, Church Road,North Leigh, Oxford OX8 6TX.

The University of London Institute of Obstetrics and Gynaccologywill hold a symposium on Respiratory Distress Syndrome at QueenCharlotte’s Maternity Hospital, London, on Dec. 8, 1978. Details maymay be had from the Symposium Secretary, Institute of Obstetrics andGynxcology, Queen Charlotte’s Maternity Hospital, Goldhawk Road,London W6 OXG.

The Indian Society of Human Genetics will hold its 5th annual con-ference in Bombay on Dec. 20-24, 1978. The conference will includean international symposium on population structure and human varia-tion. Details may be had from Dr Lalit M. Ambani, Institute forResearch in Reproduction, Bombay-400012, India.

The W.H.O./Menarini symposium, entitled Renal Pathophysiol-ogy-Recent Advances, will be held in Florence on Jan. 26-29, 1979.Details may be had from Prof. A. Leaf, Harvard Medical School,Massachusetts General Hospital, Boston MA 02114, U.S.A.

The British Heart Foundation will hold a symposium on non-inva-sive techniques in cardiology at the Imperial College of Science andTechnology, London, on June 26-28, 1979. Details may be had fromConference Services Ltd., 43 Charles Street, London Wl.

Correction

Lead and Renal Disease.-We apologise to Dr R. P. Wedeen for themis-spelling of his name in his letter (p. 477) and on the title page ofour issue of Aug. 26.

Diary of the Week

OCT. 8 TO 14

Tuesday, 10thINSTITUTE OF CHILD HEALTH, 30 Guilford Street, London WC1N 1EH

5.30 P.M. Mr Stanley 0. Aylett: Total colectomy and Ileorectal anastomosisin the surgical treatment of ulcerative colitis m the young. (Alex

Simpson Smith lecture.)

Wednesday, llthINSTITUTE OF NEUROLOGY, Queen Square, London WC1

6 P.M. 1’rot. N. A. Mnchison, F.R.S. Cellular interactions in immunology.7 P.M. Prof. W. Bryan Matthews: Neurological comphcanons of sarcoidosis.

(Sandoz Foundation lectures.)INSTITUTE OF ORTHOPAEDICS, 234 Great Portland Street, London WIN 6AD

6 P.M. Mr R. Saunders: Recent Advances in Skin Cover.7 P.M. Mr J. C. Angel: Functional Cast Bracing.

WEST LONDON HOSPITAL, Hammersmith Road, London W65.30 P.M. Mr Alan G. Johnson: The pylorus and peptic ulcer. (Alex Simpson

Smith lecture.)ROYAL COLLEGE OF SURGEONS OF EDINBURGH, Nicholson Street, Edinburgh

EH89DW4.30 P.M. Mr A. G. D. Marran: Malignant disease of the oral cavity.

Thursday, 12thROYAL COLLEGE OF PHYSICIANS OF LONDON, 11 St. Andrew’s Place, London

NW1 4LE5 P.M. Dr James Spencer Malpas: Cancer in children. (Lockyer lecture.)

ROYAL COLLEGE OF SURGEONS OF ENGLAND, Lincoln’s Inn Fields, London WC2A3PN

5 P.m. Prof. J. Leigh Collis: The organisation of the specialty of cardiothoracicsurgery. (Tudor Edwards lecture.)

ST. MARY’S HOSPITAL MEDICAL SCHOOL, London W2 1PG5.15 P.M. Prof. Stuart Campbell: The application of ultrasound in clinical ob-

stetrics and gynxcology. (Aleck Bourne lecture.)ONCOLOGY CLUB, Royal Marsden Hospital, London SW3 6JJ

6.30 P.M. Dr Eve Wiltshaw: Carcinoma of the Ovary.

Friday, 13thSOCIETY FOR THE SOCIAL HISTORY OF MEDICINE

6.30 P.m. (London School of Hygiene and Tropical Medicine.) Dr RobertHeller: The education of the blind in the 18th century.