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Notes and News

REORGANISATION OF THE NATIONAL HEALTHSERVICE

IN a speech at Norwich on Friday, Feb. 28, Mr. RichardCrossman, Secretary of State for Social Services, said that hewould be putting forward as soon as possible revised proposalsfor the reorganisation of the National Health Service in thelight of the criticisms of the green-paper which he was still

receiving. In studying these comments he had been struck bythe astonishing agreement in almost all of them about the mainthing which was wrong with the green-paper and also the mainthing which was right with it. To start with what was right:among the representative groups which had so far visited the

Ministry only one had queried the insistence that a modernhealth service had to be a unified Health Service, which hadbeen the central theme of the green-paper. He was glad to saythat almost everyone seemed to agree that we could not remain,like Caesar’s Gaul, divided into three parts, each administeredin a different way. That kind of separatism had probably beeninevitable when the scheme started, but almost everyone agreedthat it was the prime obstacle to an efficiently administeredHealth Service which provided the best possible service to thepatient and which was intimately in touch with the local

community.Almost everybody agreed that the fault of the green-paper

was that it seemed to concentrate authority at the centre and toexclude the possibility of a second tier of district-level executivecommittees in which both the local people who used the serviceand doctors and others who worked in it could have effectivevoices. Representatives of all the bodies administering thegeneral-practitioner and hospital services as well as two repre-sentative medical conferences had all strongly opposed the ideaof administering what had to be essentially a personal servicethrough quite a small number of appointed boards which couldso easily become terribly aloof and remote. Personally, hewelcomed the virtual unanimity with which this criticism hadbeen voiced as much as he welcomed the virtually unanimoussupport for a unified service. It was clear that not only thegeneral public outside the Health Service but also those whoworked inside it now felt strongly that the managing bodywhich ran the service in each area had to be a good deal closerto it than would be possible under the green-paper concept.And, because of this suspicion of the remote area board, aconsensus now seemed to be emerging in favour of a two-tiersolution. Of course the criticism of the single-tier system in thegreen-paper was much clearer and more precise than the ideasso far put forward of how a two-tier system could actually work.But he had heard a number of very persuasive speeches urgingthat it should take the form of district executives based ondistricts served by one or more district hospitals with, abovethem, a second tier of regional authorities-probably muchfewer than the area health boards suggested-in the green-paper.Could a practicable scheme be worked out on the basis of thisconsensus against remoteness and in favour of the districtexecutive ? He was not sure, but it was certainly well worthtrying; and that was why he had already set up a working-party 1which was preparing an alternative set of proposals based onthis concept.

CHILDREN IN CARE

The number of children in the care of local authorities inEngland and Wales has at last declined slightly. The mostrecent figures published by the Home Office 2 show that onMarch 31, 1968, 69,358 children were being cared for, 47 lessthan the previous year; whereas between 1966 and 1967 thenumbers had increased by 248. The Home Office optimisticallyclaims that this " must encourage the hope that measures toforestall or repair family breakdown are meeting with success."

1. See Lancet, Jan. 4, 1969, p. 31.2. Children in Care in England and Wales, March 1968. Cmnd 3893.

1969. H.M. Stationery Office. 2s. 6d.

Between March, 1967, and March, 1968, 26,495 of the 50,938children taken into care went because of the illness of theirparents or guardians. Could the families have been helped tofind a less drastic solution to what was generally a short-termcrisis ? Certainly there is a wide variation in the numbers ofchildren in care in different regions, but whether this is becauseone authority copes better than another or because the size ofthe problem varies is not clear. On an average 5.2 per 1000children are in care, but the figure ranges from 1-8 in Harrowto 26-1 in Tower Hamlets. In general, county councils havefewer children in their care than county boroughs and Londonboroughs (3-9, 6-5, and 7-9 respectively), and over the wholecountry the North and West have fewer than the South andEast.

Dr. Jean Packman has studied these variations.3 She startedby investigating the " need " for child care and found that aregion of " maximum need " was characterised by a rapidinflow of population, heavy pressure on housing, and a highillegitimacy rate; in addition, many inhabitants had no relativesnearby, and mental illness and marital breakdown was a majorproblem. But this pattern could be partly offset by the localauthorities’ preventive services. A vigorous home-help service,good day-nurseries, and accommodation for homeless familiesmade all the difference. The children’s departments also dif-fered in their staff and policy. Jean Packman failed to discoverany definite correlation between the numbers of children in careand the " need " of the different areas, but she successfullyhighlights the problems.

STENGEL PRIZE

THIS prize (El 20) was set up from contributions by Prof.Erwin Stengel’s colleagues to mark his retirement from thechair of psychiatry at the University of Sheffield. It is to beawarded every three years, to any doctor or group of doctors

working in the Sheffield region, for research on a subject relatedto clinical psychiatry. The first award will be made in July,1970. Inquiries should be addressed to the Board of Assessorsfor the prize, at the University Department of Psychiatry,Whiteley Wood Clinic, Woofindin Road, Sheffield 10.

VENTURE INTO AFRICA

Michael Gelfand, professor of medicine with special referenceto Africa, at the University College of Rhodesia, has writtenseveral books on the history, customs, and peoples of CentralAfrica. The Society of Jesus had worked on the lower Zambesiuntil the beginning of the 17th century, but Livingstone’s callto bring Christianity into Africa prompted a group of mis-sionaries to travel further into the interior. In Gubulawayo andBeyond 4 Professor Gelfand, by drawing on letters and journalsin the Jesuit archives, reveals a stirring passage in the history ofthe Society of Jesus and of South-Central Africa. The lettersbring the reader very close to the difficulties, disappointments,ordeals, and tragedies endured by the missionaries-but thereare many human touches too. The Zambesi mission was afailure because of fever, that " more bitter, far more terribleenemy ", but it did pave the way for later more successful

missionary efforts. The book is an account of human endeavourand of great courage, and will be enjoyed by all whohave an interest in the history of this part of Africa. AfricanCrucible 5 is an ethico-religious inquiry with special emphasison the Shona-speaking people of Rhodesia.

University of OxfordDr. J. A. Baldwin, who is at present directing the North East

Scottish Psychiatric Case Register, has been appointed medicaldirector of the Oxford record-linkage study and unit of clinicalepidemiology.3. Child Care: Needs and Numbers. By Dr. JEAN PACKMAN. London:

George Allen and Unwin. 1969. Pp. 247. 42s.4. Gubulawayo and Beyond: Letters and Journals of the Early Jesuit

Missionaries to Zambesia (1879-1887). Edited by MICHAEL GELFAND.London: Geoffrey Chapman. 1968. Pp. 496. 63s.

5. African Crucible. By MICHAEL GELFAND. Cape Town, Wynberg, andJohannesburg: Juta & Co. 1968. Pp. 163. R4.50, 45s. throughoutSouthern Africa.

538

University of LiverpoolWith a grant of E60,000 from the Ford Foundation, New

York, this university is to set up a unit, headed by Dr. TimothyGlover, for research into male reproduction and fertility.The following have been successful in examinations:M.D.-G. H. Fletcher, B. V. Lewis, C. Matthews, J. V. Occleshaw.Ch.M.-T. I. Barakat.M.Ch.Orth.-M. R. Al-Tikriti, M. Aung, A. K. Basu, W. J. Boyle,

C. Cheyne, D. M. Dall, A. G. Hayes, W. Krom, M. Lenghi, P. N. Mehta,T. A. Minhas, U. S. Mishra, A. A. Qazi, R. C. Sheth, G. W. Simonds.M.B., Ch.B.-J. I. Edwards, J. R. Eldridge, F. J. Griffiths, K. D. E. Hope,

C. G. Male, A. A. Nasher, B. E. Ryan, R. J. Shepherd, D. A. Thomas,D. G. Thomas, M. J. Wellstood-Eason.D.T.M. & H.-N. K. Agarwala, I. H. Ansari, M. Y. Ashraf, G. K.

Bergter, T. R. L. Black, D. Brownlie, I. A. Chaudry, W. I. Choudhury,A. B. Cross, K. Doo, J. N. Eccott, B. B. Edoo, P. G. Effersoe, V. E. Egwuatu,P. L. Giacometti, Janet M. Gordon, S. A. Greenhalgh, Tahera Hameed,M. E. Haque, P. B. Hodson, M. Hossain, M. H. Jafary, S. Kumar, C. M.Lockwood, M. W. McDonnell, T. R. Malhotra, R. L. Mehta, K. Merchant,F. A. J. Monteiro, M. Moshtaky, M. Mustaqueem, H. M. A. Nazhat,A. A. Osman, T. J. Paton, J. E. Pedley, Varapun Pichaipat, Margaret S.Povey, A. U. W. Quraman, S. M. Qureshi, M. M. U. Rahim, K. Rama-chandran, S. K. Sachdeva, S. N. Sahai, H. A. Shaikh, M. R. Shetty,D. Singh, M. A. Sooltan, R. F. Tajouri, S. I. Terry, Photjanee Than-varachorn, W. Turner, Kanchana Udhaikanchana, Barbara H. M. Warsing,M. Yasin, Salima A. Yousafzai.

University of EdinburghProf. E. W. Horton, who at present holds the Wellcome chair

of pharmacology at the School of Pharmacy of the University ofLondon, has been appointed to the chair of pharmacology atEdinburgh.

Professor Horton, who is 39, was educated at Sedbergh School andthe University of Edinburgh, from which he graduated B.sc. withfirst-class honours in pharmacology in 1953 and M.B. two years later.After a year of hospital appointments in England, he returned toEdinburgh as a research scholar under Prof. J. H. Gaddum, and forhis research on pharmacologically active polypeptides he was awardedthe Lauder Brunton medal and a Gunning Victoria Jubilee prize.After graduating PH.D. in 1958 he joined the Medical ResearchCouncil’s scientific staff at Mill Hill, where he worked on the isolationand elucidation of the chemical structure of the peptide, bradykinin.In 1960 he was appointed head of the department of pharmacology(later director of therapeutic research) of the Miles-Ames ResearchLaboratories, Stoke Poges, and there he studied the pharmacology ofthe prostaglandins, reporting their actions on the central nervoussystem, their absorption from the vagina into the circulation, and thefirst thin-layer chromatographic method for their separation. From1963 to 1966 he was senior lecturer in physiology at St. Bartholomew’sHospital Medical School, London. His work at that time was on theidentification of prostaglandins as natural constituents of brain andspinal cord, and he reported the occurrence of prostaglandin E2 inblood under physiological conditions. He was appointed to the chairof pharmacology in London in 1965, and his recent research has beenconcerned with gastrointestinal function in man, the adenyl-cyclase/cyclic-adenosine-monophosphate system, and the estimation of pro-staglandin concentrations in blood. He took the D.sc. last year.

University of AberdeenDr. Linda J. Brown has been appointed lecturer in pathology.

University of DundeeMr. M. H. Lyall has been appointed lecturer in surgery.

Royal College of Surgeons in IrelandThe following have been elected F.R.C.S.I.:Ameena Bootwalla, R. M. Cazabon, Susilkumar Das Chowdhury, D. P.

Dunne, George Patrikios, L. K. Pretorius, B. T. Poole.

Gavin Livingstone LectureIt is proposed that an annual lecture about handicapped

children shall be held at Oxford to commemorate the lateGavin Livingstone’s work. Contributions should be sent toMr. W. S. Lund at the department of otolaryngology of theRadcliffe Infirmary, Oxford, OX2 6HE.Edward Mapother LectureThe Bethlem Royal Hospital and the Maudsley Hospital are

sponsoring a new series of annual lectures named in memory ofEdward Mapother, first professor of psychiatry in the Univer-sity of London. Sir Aubrey Lewis will give the first lecture onWednesday, March 26, at 5.30 P.M., at the Institute of Psychia-try, De Crespigny Park, Denmark Hill, London S.E.5. He willspeak on Edward Mapother and the Making of the Maudsley.

Control Mechanisms in Biochemistry and EndocrinologyThe Association of Clinical Biochemists (southern region)

and the Society of Endocrinology are to hold a joint meetingon this subject on Saturday, March 29, at St. Thomas’sHospital, London S.E.1. Details may be had from Dr. A. M.Bold, southern-region secretary, at the department of metabolicdiseases of the hospital.Grants for Medical Research

The National Fund for Research into Crippling Diseases hasannounced research grants, including E250.000 to the Institutesof Child Health and of Obstetrics and Gynaecology at theHammersmith Hospital, London, and E250,000 to the Bland-Sutton Institute of Pathology at the Middlesex Hospital, bothof which are for new buildings; E1170,000 to the Royal Collegeof Surgeons for the establishment of a chair of teratology; andE50,000 to the Institute of Orthopaedics, Royal NationalOrthopaedic Hospital, Stanmore, Middlesex, for research.

General Medical Council

At a meeting of the Disciplinary Committee of the GeneralMedical Council from Feb. 25 to 28 the names of Maung Seinand Mary Valvis were ordered to be erased from the Register.These erasures are subject to appeal within 28 days.

CORRIGENDUM: Intramuscular Pentagastrin.-In the report of aMulticentre Study (Feb. 15, p. 341) the third entry in column 5 oftable i should read: " 7 x 15 min.".

Diary of the WeekMARCH 9 TO 15

Monday, 10thROYAL POSTGRADUATE MEDICAL SCHOOL, Ducane Road, London W.12

4 P.M. Prof. John Yudkin: Changing Pattern of Malnutrition.

Tuesday, llthINSTITUTE OF DERMATOLOGY, St. John’s Hospital for Diseases of the Skin,

Lisle Street, London W.C.24.30 P.M. Mr. B. Jay: Oculo-cutaneous Disease.

ROYAL ARMY MEDICAL COLLEGE, Millbank, London S.W.15 P.M. Lieut.-General Sir Neil Cantlie: Looking Back into the Past.

LONDON MEDICAL GROUP5.45 P.M. (University College Hospital Medical School Union, Huntley

Street, W.C.1.) Dr. Jacobus Dominian: Marital Breakdown.MANCHESTER MEDICAL SOCIETY

8 P.M. (Medical School.) Surgery. Mr. S. A. Zaheer: Lumbar Sympa-thectomy for Intermittent Claudication. Mr. lain MacLennan:

Surgical Treatment of Cushing’s Syndrome.

Wednesday, 12thUNIVERSITY OF LONDON

5.30 P.M. (University College, Gower Street, W.C.I.) Prof. WilliamHayes: Evolution of Transmissible Genetic Elements in Bacteria.

ROYAL POSTGRADUATE MEDICAL SCHOOL2 P.M. Dr. J. C. Wagner: Asbestos and Cancer.

INSTITUTE OF DERMATOLOGY4.30 P.M. Dr. G. M. Levene: In-vitro Studies with Lymphocytes.

INSTITUTE OF DISEASES OF THE CHEST, Brompton Hospital, London S.W.35 P.M. Dr. I. H. Kerr: Some Unusual Shadows.

ROYAL FREE HOSPITAL, Gray’s Inn Road, London W.C.15.15 P.M. Dr. R. B. McConnell: Genetic Aspects of Gastroenterology.

BEDFORD COLLEGE, Regent’s Park, London N.W.15.15 P.M. Lord Platt: Limitations of Academic Education in Training for

Medicine. (Last of three lectures.)MANCHESTER MEDICAL SOCIETY

5 P.M. (Medical school.) Pathology. Dr. V. Schwarz: Cystic Fibrosis-Defect in Sodium Transport?

Thursday, 13thROYAL COLLEGE OF SURGEONS OF ENGLAND, Lincoln’s Inn Fields, London

W.C.25 P.M. Sir Michael Woodruff: The Challenge of Osteosarcoma. (Watson-

Jones lecture.)ST. MARY’S HOSPITAL MEDICAL SCHOOL, Paddington, London W.2

5 P.M. (Wright-Fleming Institute.) Dr. C. 0. Carter: Genetic Counsel-ling.

LONDON MEDICAL GROUP8 P.M. (London Hospital Medical College, Turner Street, E.I.) Dr.

M. H. B. Joyce: Concept of Guilt in Religion and Psychiatry.

Friday, 14thROYAL POSTGRADUATE MEDICAL SCHOOL

4 P.M. Dr. B. Lewis: Disorders of Lipoprotein Metabolism.INSTITUTE OF LARYNGOLOGY AND OTOLOGY, 330-332 Gray’S Inn Road,

London W.C.1 15.30 P.M. Mr. Anthony Radcliffe: Management of Chronic Maxillary

Sinusitis.