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SOCIAL MEDICINE GETS A CHAIRANEW spirit is stirring in medicine, as the focus of

attention swings from the negative to the positive aspectsof health. The cure of disease has fascinated us for cen-turies, partly because success when it comes is so immedi-ately rewarding and partly because one sick man makesa more dramatic appeal than ninety-nine not obviouslyin danger. Moreover, in the excitement of research it ispossible to lose sight of the whole in enthusiasm for thepart. That an impulse to share knowledge is abroad ismanifest in proposals for health centres, for regionalcancer control, and in the foundation of such units as theLondon Hospital department of psychiatry and neurology.Alongside this desire to pool knowledge a wider concep-tion of the functions of medicine is growing up. Thisis no sudden awakening to the latent possibilities of

preventive medicine, for we have been aware of thoselong enough : advances in public health such as vaccina-tion, purifi-cation of water and rising standards in publicand personal cleanliness have all helped to reduce disease.It is rather a growing sense of social responsibility amongdoctors-a realisation that since many diseases dependon social conditions it is the business of the profession tostudy those conditions and propose remedies. This is whythe foundation, by the Nuffield Provincial Hospitals Trust,of a professorship and institute of social medicine at OxfordUniversity is such a landmark. The trust proposes todevote 10,000 a year, for ten years in the first instance,to this purpose. The task of the institute will be to inves-tigate the influence of social, genetic, environmental anddomestic factors on the incidence of disease ; and to seekand promote the protection of the individual and thecommunity against forces hindering the development andmaintenance of full mental and physical capacity. Ifthe university wishes, the institute will also provideinstruction in social medicine for medical students anddoctors approved by the board of the university facultyof medicine. It is to be hoped that the opportunitywill be taken to establish a nursing section in the newinstitute; for the progress of social medicine dependson public as well as medical education, and in this thepublic health nurse of the future, by whatever nameshe is known, must play an increasing part both as aninvestigator and a teacher. The institute will beadministered by a committee on which the trust willbe represented by six members who will help to linkup the institute with research institutions elsewhere.

OIL AND PETROL IN THE LUNG

FLUIDS which intensely irritate the bronchial mucousmembrane may be partly removed by coughing ; but theparoxysms may aggravate the risk of suffocation, and inthe case of volatile poisons the rate of absorption is sogreat that coughing does not appreciably reduce the riskof remote toxic effects. This is illustrated in the casereported recently by Cope 1 of aspiration of petrol intothe lungs. Attempts to cough it up seem to have beenhampered by acute dyspncea, and unconsciousnesssupervened in a few seconds. The lung and even thepleura is liable to sustain considerable damage in suchcases. Machle 2 in a review of gasoline intoxicationmentions hypersemia, petechial haemorrhages, subpleuralextravasations and gross pulmonary haemorrhages inwhich the alveoli may be filled and the epithelium becomenecrotic in entire lobules. Bronchitis is common andseveral instances of pleural effusion have been recorded.Poppyseed oil, the base of iodised oil (BP), is ofteninjected into the lung as a diagnostic agent and occasion-ally as a remedy. Cases of iodism are reported from timeto time after the use of this preparation, but the oil itselfappears to give no trouble, even though years may elapsebefore the last traces of it are removed by coughing.Yet neurologists are showing increasing reluctance to

1. Cope, C. L. Lancet, 1942, i, 469.2. Machle, W. J. Amer. med. Ass. 1941, 117, 1965.

inject it into the spinal theca because signs of irritationof nerve trunks are occasionally seen ; so that it may bepremature to conclude that iodised oil is harmless in thelungs. The reputation of liquid paraffin as a blandmechanical laxative has been questioned by Americaninvestigators,3 and it has been shown to cause pneumonia,and even the formation of paraffinoma when aspirated intothe lungs. Kaplan 4 states that since 1925 a total of 411cases of oil pneumonia have been reported, and that in68% of the cases liquid paraffin was wholly or partlyresponsible. By applying a simple histochemical tech.nique, he was able to prove, in a case of oil pneu-monia under his care, that liquid paraffin and cod-liver oil were present in the lung, which showed the" typical structure of an acute and chronic interstitialtype of oil pneumonia." The clinical picture and patho-logical findings in cases of petroleum aspiration on theone hand and liquid-paraffin aspiration on the other areevidently closely related not only to the intrinsic toxicityof the material but also to the physical and chemicalproperties of the different types of oils, and these in turndetermine the rate of absorption through the lung.In recent, years there has been a considerable increase inthe number of cases of unresolved pneumonia, associated,it seems, with the use of the sulphonamides ; but thewidespread habit of taking liquid paraffin as a laxative,and the administration of cod-liver and other vitam-inised oils to children should be borne in mind whenconsidering the differential diagnosis. Moreover theseoils are often inflicted on debilitated and prostratepatients by force majeure, and for these aspiration intothe lungs is a real danger.

EVEN THE GIARDIA MAY TURN

INFESTATION with Giardia lamblia is almost universalamong the natives of India, Egypt and Iraq, and thereit seems as a rule a harmless guest. Elsewhere it isalso common-in Norway, for instance, where Boe5 5

has lately demonstrated that at least half of a fair

sample of the healthy population carry some intestinalprotozoon, in 5% the parasite was the giardia. A

variety of symptoms have been ascribed to giardiasisin Latin America and the United States but it has beendifficult to decide whether this is not merely a secondaryinvader which gains a footing when other causes of illhealth have rendered the intestinal or biliary tractsuitable for its multiplication. In Norway patientswith diseased gall-bladders were found to be more ofteninfested than healthy people, but otherwise the clinicalfindings were inconclusive. The introduction of a specificparasiticide against giardia-mepacrine hydrochloride(’ Atebrin ’)-seemed likely to settle the question of itspathogenicity. At the Mayo Clinic Kyser 6 analysed thesymptoms encountered in 100 people with giardia inthe stools and the effect of treatment with mepacrinein some of them. In 11 cases the giardiasis was asympto-matic. The main symptoms found in the rest were

diarrhoea, with 2-20 loose stools daily, pain or discomfortin the upper or less commonly lower abdomen, nervoussymptoms such as tiredness and irritability, intermittentfever and vomiting attacks. Of these, diarrhoea andabdominal discomfort occurred in nearly two-thirds ofthe patients ; the other symptoms were rarer and theirconnexion with the parasite less definite. In 35 patientsa five-day course of 1 gramme of mepacrine three timesa day was given, followed by re-examination of thestools. In all but one the parasites disappeared fromthe stools, and in 13 the symptoms were completelyrelieved for a significant period. O’Donovan, McGrathand Boland 7 of Dublin have raised the question whether

3. See Lancet, 1941, i, 219.4. Kaplan, L. Amer. J. Dis. Child. 1941, 62, 1217.5. Bøe, J. Nord. Med. 1942, 14, 1495.6. Kyser, F. A. Proc. Mayo Clin. 1941, 16, 493.7. O’Donovan, D. K., McGrath, J. and Boland, S. J. Lancet, July 4,

1942, p. 4.