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Notes and News

INFECTIOUS DISEASES 1979

IN 1974 the annual booklet Statistics of Infectious Diseases tookover the communicable diseases function of the Registrar General’sstatistical reviews for England and Wales. Now there has been afurther change, the 1979 summary being a joint effort by the Officeof Population Censuses and Surveys and the PHLS CommunicableDisease Surveillance Centre. Twenty-eight diseases are notifiable,but this combined report also covers non-notifiable diseases such as

campylobacter infections, rubella, influenza, and brucellosis.Notifications in 1979 and trends may be summarised as follows:Measles (77363 notifications; 17 deaths).-Biennial pattern abolished by

measles vaccination but take-up rate less than 50%. U.S. attitude-namely, toeliminate the disease by Oct. 1, 1982-"contrasts sharply with ours".

lxhoopizrg cough (30 816; 7).-Massive epidemic on decline in 1979; casefaratityratio in 1977-79 unusually low at 2. 3 per 10000 cases.Food poisoning ( 11090; 54).-Mostly Salmonella; 1979 figure unusually high.Scarler fever (9585; 9).-General decline over past decade.Tuberculosis (6808; 613) ....... continuing but slowmg decline". Health

regions with above average notification rates for respiratory tuberculosis areNorth West and North East Thames, West Midlands, North Western, andYorkshire. Late effects accounted for 323 deaths.

Infective jaundice (3216; 105).-Massive decline over decade.Amoebic and bacillary dysentery (2787).-Striking decline continuing.Malaria (1625; 6).-The Ross Institute, monitoring data from several

sources, noted 2054 cases. Spectacular increase in the 1970s. Almost allinfections acquired in Indian subcontinent or in Africa (where the prevalentorganism is Plasmodium falciparum, all 6 deaths being associated with thisform of malaria).Acute meningitis (1427 cases; 285).-No obvious trends.Typhoidandparatyphoid(294; 2).-No recent trend; 85% contracted abroad.Ophthalmia neonatorum (235).-Generally on decline.Tetanus (20; 5).-Possibly undernotified; incidence in children falhng since

immunisation became rounne twenty years ago.Leptospirosis (18; 3).-Definitely undernotified ; CDSC recorded 33

isolations of leptospires.Acute poliomyelitis (8; 2).-Cases emphasise need for non-immunised parents

to be immunised when their children are and for protection for travellersvisiting polio endemic areas. Late effects accounted for 20 deaths.Typhus (8; 0).-Possibly unusual number; only 16 cases in 1969-78, all in

last six years.Acute encephalitis (79).-Declinrng.Anthrax (3).Cholera, plague, diphtheria, smallpox, relapsing fever, yellow fever, rabies,

Lassa, Marburg, and viral haemorrhagicfevers.-No cases notified in 1979.

Among the non-notifiable diseases selected for comment are:Legionnaires’ disease (124 cases).-Four PHLS laboratones now looking for

Legronella pneumophila in water systems of hospitals, hotels, and otherbutldmgs to try and identify design features that encourage growth of theorgamsm.

Campylobacter infections (8577).-Reporting began only two years ago;source usually unknown though five outbreaks were traced to unpasteurisedmilk

Sexually transmitted diseases. -Gonorrhoea shows slight decline. &bgr;-lactamaseproducing Neisseria, gonorrhoeae isolated from 96 infections in 1979, usually inLondon and Liverpool ; 22 of these infections were acquired in England andWales rather than abroad or in people lately arrived from abroad.Brucellosis (34).-Now disappearing as proportion of herds not accredited

brucellosis free has declined. Whole of Great Britain a compulsory eradicationlrea since November, 1979.

COMMERCE AND THE PUBLIC HEALTHON PORTON DOWN

ONE year after the PHLS Centre for Applied Microbiology andResearch began work under its new name it lost its vaccine pro-action unit at Allington Farm behind the Ministry of Defencebarriers on Porton Down. Stocks were built up, however, and theseIncluded two important, though commercially non-viable products,Kreim test antigen and human anthrax vaccine. What is nowneeded is a production unit on the Centre’s own site, and, as the

1. Communicable Disease Statistics 1979: England and Wales London: HM StationeryOffice. £5.60

annual report of the Public Health Laboratory Service points out,’"any significant delay in building this new facility will be veryserious indeed". Outside the period covered by this reportnegotiations with the Department of Health have continued, andthe project has passed the obvious first stage (agreement on the needfor such a unit); there are grounds for optimism that agreement onthe next stage may not be far off. The capital sum, The Lancet under-stands, is of the order of f2-3 million; the unit will need to be in aseparate building, since there is concern in some quarters at theproduction of medicines in proximity to work on dangerouspathogens.The Centre is committed to "income generating activities" to off-

set costs. Nearly £ 11/2 million was raised in this way in 1979-80,though almost half this came by way of support funds, such as£ 276 000 from the DHSS for anti-cancer enzymes, from publicbodies. The true money spinners, outside the public sector, were thesale of microbial products (to various purchasers), and D 98 000from Immuno Ltd of Austria for tick borne encephalitis vaccine,one of the products of the now inaccessible Allington Farm.The restrictions on full-blooded commercial activity at CAMR

are twofold: the report, rightly, stresses that "a primary con-sideration is the need to maintain the scientific and technologicalexcellence of the Centre"; and, besides the current lack of vaccineproduction, there are the elderly and inadequate pilot plant and therestraints of genetic manipulation work that the regulatoryauthorities impose.

DRUG ADDICTION

THE number of drug addicts in the United Kingdom known to bereceiving narcotic drugs from medical practitioners at Dec. 31,1980, was 2849—7% higher than that at the end of 1979. This rate ofincrease corresponds to the average annual rate since 1970, but it is4% less than the increase between 1978 and 1979.2 The number ofnew notifications for 1980 was 1606, which is a levelling off at thefigure for 1979, in contrast to the steady increase of the previousthree years. The 8% increase in renotifications, however, continuedthe upward trend since 1977. 2267 persons ceased to be recorded asaddicts, a 7% increase over the figure for 1979, but about theaverage (6%) for 1970-80. The system of notification (by whichdoctors inform the Home Office of addicts they treat) means thatthose who cease to be recorded (by the doctor) as addicts because ofadmission to penal or other institutions may be classified (by theinstitution) as new notifications or re-notifications. Details such asages of addicts, drugs prescribed, information about drug seizures,and drug offenders will be published later in the annual statisticalbulletin on the misuse of drugs.The Home Secretary, Mr William Whitelaw, said on April 9 at a

meeting of the Advisory Council on the Missuse of Drugs that thesestatistics suggest a continued rise in drug misuse. He reminded thecouncil that the policies of prevention, treatment, and rehabilitationwhich were being studied should also cope with problems caused bythe diversion of drugs from illicit supplies by irresponsibleprescribing, forgery of prescriptions, and theft from pharmacies.

OLD AGE

PROFESSIONALS and the public tend to see a certain inevitabilityin the difficulties faced by the rapidly increasing numbers of theelderly. Prof. Peter Townsend wrote 3 : "Some old people are poorby virtue of their life-long low class position. Others are poor byvirtue of society’s creation of an ’under-class’ by the imposition ofretirement status with lower income." The elderly are still a

neglected group and it is left to charities such as Help the Aged andAge Concern to represent their interests in Britain and abroad.At the annual meeting of Help the Aged, in London on April 10, Sir

1. Public Health Laboratory Service. Annual report 1979-80. London: PHLS, 1981.2. Home Office Statistical Bulletin, issue 6/81. 1981. £1. Availabe from the Home Office,

Statistical Department, Room 1617, Tolworth Tower, Surbiton, Surrey, or fromthe Senior Librarian, Home Office, 50 Queen Anne’s Gate, London SW1 9AT.

3 The Failure to House Britain’s Aged By PETER TOWNSEND. Available, price 30p,from Help the Aged, 32 Dover Street, London W1A 2AP.

958

Ferguson Anderson, emeritus professor of geriatric medicine,University of Glasgow, looked forward to the 1982 United NationsWorld Assembly on ageing, and remarked that only 14 chairs ofgeriatric medicine existed in Britain. Ambitious doctors seekingkudos simply did not enter the specialty. For the old people whomanage to live independently of the social services, it is the extremeisolation2 which is perhaps the most horrifying aspect of old age. Inthe Third World, meanwhile, it is total lack of the necessities of lifewhich makes people old at 45.

APPROVED NAMES

Continued from April 18 issueApproved name Other names

Iotroxic acid 3,3’-(3,6,9-trioxaundecanedioyldi-imino-bis)2,4,6-tri-iodobenzoic acid). Radio-opaque substance (Schering);’Billiscopin’ is the meglumine salt.

Levonantradol (6S,6aR,9R,10aR)-5,6,6a,7,8,9,10,10a-Octahydro-9-hydroxy-6-methyl-3-[(1R)-1-methyl-4-phenylbutoxy]phenanthridin-1-yl acetate. Antzemetic;analgesic (Pfizer); CP-50,556-1 is the hydrochloride.

Menadiol 2-Methylnaphthalene-l,4-diol. Treatment ofhypoprothrombinaemia (Roche); ’Synkavit’ is thediphosphate tetrasodium salt.

Mesna Sodium 2-mercaptoethanesulphonate (BoehringerIngelheim).

Milenperone 5-chloro-1-[3-(4-p-fluorobenzoylipiperidino)=propyl]-1,3-dihydrobenzimidazol-2-one. Neuroleptic (Janssen);R 34009.

Nafazatrom 3-methyl-1-[2-(2-naphthyloxy)ethyl]-5-pyrazolone.Antithrombotic and thrombolytic (Bayer); BAY g 6575.

Naftifine (E)-cinnamyl(methyl)1-naphthylmethyl)amine.Antifungal (Sandoz); SN 105-843.

Oxmetidine 2-[2-(5-methylimidazol-4-ylmethylthio)-ethylamino]-5-piperonylpyrimidine-4(1H)-one. Histamine H,-receptor antagonist (Smith Kline & French); SK&F92994.

Pirenzepine 5,1 1-dihydro-11-(4-methylpiperazin-1-ylacetyl)-6Hpyrido[ 2,3-bl [ 1,4] =benzodiazepm-6-one. Treatment ofgastric ulcer (Boehringer Ingelheim) ; L-S 519 CL-2 isthe dihydrochlonde.

To be concluded ,

Junior Hospital Doctors and the Review BodyThe Hospital Junior Staff Committee of the British Medical Asso-

ciation is to seek prompt reactions from regional committees ofjunior doctors when the recommendations of the Review Body ondoctors’ and dentists’ pay, presented to the Prime Minister lastweek, are published. The regional meetings will be asked to considerwhat steps to take following the probable decision of the Govern-ment to hold doctors to within the 6% overall cash limits. Thecommittee has passed the following resolution: "The HJSC isdisturbed by reports m the press suggesting that the Governmentwill interfere with this year’s Review Body award. The juniors, whohave only this year returned to the Review Body system, can see noclear and compelling reasons for the Government to interfere withthe Review Body award and insist that it should be implemented infull". Dr Michael Rees, chairman of the HJSC said: "We are nottalking about industrial action, simply sounding out the views ofjunior staff to assist us in making policy at our annual conference inJune".

Trent Regional Health AuthorityDr Leonard Arthur, a consultant paediatrician, who has been

charged with the murder of a 3-day-old baby with Down syndrome,has been authorised to resume work at Derbyshire Children’s Hos-pital, provided that he does not treat newborn children, and that, ifso requested by a parent or guardian, he will refer the case to acolleague. A statement issued by the Medical Protection Societyincludes this passage: "We know that this decision will be welcomedby the many thousands of people and patients who have written towish him well and who regard him with affection and clearly holdhim in undiminished esteem".

2 Cry, and You Cry Alone Published by Help the Aged, price 50p.

The Royal College of Surgeons of Edinburgh will hold a symposium or.Emergencies in Surgery at Dumfries and Galloway Royal Infirmary or.May 1. Details may be obtained from Mr William Seright, Dumfries andGalloway Royal Infirmary, Bankend Road, Dumfries DG1 4AP.

A meeting organised by Prof. R. A. Gregory, Prof. 0. H. Peterson, and SirArnold Burgen on the Control of Secretion wil be held at the Royal Societyon May 28-29. Further information may be obtained from the Royal Society,6 Carlton House Terrace, London SWIY 5AG.

The 163rd meeting and 36th annual meeting of the Society for

Endocrinology will take place at the Institute of Education, 20 Bedford Way,London WC1, on May 28-29. Further details may be obtained from Prof.L. H. Rees, Society for Endocrinology, 23 Richmond Hill, Bristol BS8 IEX

TheBritish Psycho-Analytical Society will hold a one-day course of lecturesand discussion on Self-destructive Acts: a Psycho-Analytic Approach atthe Institute of Psycho-Analysis, 63 New Cavendish Street, London WI, onJune 6. Application should be made to the Hon. Secretary at the Institute

A bicentenary symposium to mark the founding of the Montrose Asylumin 1781 will be held at Sunnyside Royal Hospital, Montrose, on June 23.Details are available from Dr K. M. G. Keddie, Sunnyside Royal Hospital,Montrose DD10 9JP, Angus, Scotland.

The British Leprosy Relief Association (LEPRA) is offering a prize ofup to L100 for an essay on either the in-vitro cultivation of the leprosy bacillusor leprosy and primary health care. Details may be obtained from Dr ColinMcDougall, Slade Hospital, Headington, Oxford OX3 7JH

Mr H. K. Basu has been elected president of the Indian Medical Associa-tion (Great Britain).

Diary of the Week

APRIL 26 TO MAY 2

Monday, 27thINSTITUTE OF DERMATOLOGY, St John’s Hospital for Diseases of the Skin, Lisle

Street, Leicester Square, London WC2H 7BJ4.45 P.M. Mr R. C. G. Russell: Some Surgical Aspects of Skin Disease

MANCHESTER MEDICAL SOCIETY, Coupland Building, University, ManchesterMI39PL

5.30 P.M. (Architecture Building) Mr P. D. Bird: Development of PanommcRadiography.

8.30 P.M. Dr D. H. Bunting: I am a Free Man on Sundays!

Tuesday, 28thLONDON MEDICAL GROUP

5.45 P.M. (St Mary’s Hospital, Praed Street, London W2) Symposium. -AlcoholismMANCHESTER MEDICAL SOCIETY

5.30 P M. Dr J. Erulkar: Growing Pains.

Wednesday, 29thINSTITUTE OF DERMATOLOGY4.45 P.M. Dr C. L. H. L. Cameron: Virus Diseases of the Skin

ROYAL FREE HOSPITAL, Pond Street, London NW3 2QG5 P M. Prof. A. Masen: A New Look at Coronary Artery Disease

MANCHESTER MEDICAL SOCIETY5 P.M. Dr 1. Chanann: Some Aspects of Megaloblastic Anaemia.

UNIVERSITY OF DUNDEE MEDICAL SCHOOL, Nmewells Hospital, DundeeDD I 9SY

12 P.M. Dr A. K. Tulloch’ Ophthalmology in My Time1 P.M. Dr A. S. Todd: Hepann.

Thursday, 30thST MARY’S HOSPITAL MEDICAL SCHOOL, Norfolk Place, London W2 1PG

5.15 P.M. Dr Tom Lind’ Reproductive Efficiency of the Diabenc MotherLONDON MEDICAL GROUP

5.45 P.M. (St Thomas’ Hospital, Lambeth Palace Road, London SEI) Sympostum-Alternatives to the GP: Phone-in, Confessional or Agony Column

CHRISTIAN MEDICAL FELLOWSHIP, Royal Commonwealth Society Hall, CravenStreet, London WC2

7.30 P.M. Mr Richard C. M. Cook: The Deformed Child-Who Cares?MANCHESTER MEDICAL SOCIETY

5 P.M. Prof. Ian Leck: Applications of Teratology.WEST OF SCOTLAND COMMITTEE FOR POSTGRADUATE MEDICAL

EDUCATION, Alison Hunter House, 6 Lancaster Crescent, GlasgowG)2 nRP

9.30 A.M Dr J. K. Davidson: Modern Radiology and Imaging Methods