399

be many cases where either the complainant or respondentis nervous, or deaf, or does not speak English fluently,when someone to assist in the presentation of his casewould be helpful to the committee. Again both partieshave the right to appeal against the findings of thecommittee and the subsequent decision of the executivecouncil. Such an appeal is in fact a rehearing, butaccurate and detailed notes of evidence given at the

original hearing may be essential in deciding whetherthere are grounds for appeal or not.

Several questions arise. Who can take notes so well asa lawyer-unless it be some other " paid advocate " Can the chairman of the committee, who is not neces-sarily a lawyer, decide whether a person assisting in thepresentation of the case is a

"

paid advocate " or not ?Does the London Medical Service Committee appreciatethat it is the doctor who is the " accused," and that thecomplainant has nothing to lose whatever the outcomeof the inquiry ? Q These and other questions should beanswered before the existing regulation, which hasapparently worked well, is amended.

FLUORIDE AND CARIES

SINCE the importance of the fluorine-caries relationshipwas first appreciated numerous studies have beenundertaken, notably in the U.S.A., to discover whetherartificial fluorination of drinking-water will recluce theamount of dental caries. It has been shown that, witha fluoride concentration in the drinking-water of 1-1-5parts per million, the incidence of caries during theformative period of the teeth may be reduced by asmuch as 65%. In 1945 three investigations into thevalue of artificially fluorinated drinking-water were

started in the U.S.A. and Canada ; and the results ofone of these studies-at Grand Rapids, Michigan-havenow been evaluated.1At Grand Rapids 1 part of fluoride per million was

added to the public water-supply, which previously hadbeen fluoride-free. Analysis of the dental examinationsin 1949 showed a considerable reduction in dental caries

compared with the rate in 1944 and 1945 ; and thisreduction was most pronounced in the younger age-groups, whose dentition was largely calcified after thefluoride was added. It will be of interest to see whetherthe improvement is maintained. In this country Weaver 2has shown that the effect of fluoride on the formingteeth, relative to caries resistance, seems to be some-vhat evanescent ; and that children with a previouslylow caries-count may in later life acquire more cariesand have an average count despite the early and markedeffect of fluoride. That fluorination affords more thantemporary benefit has still to be proved.

ULTRASONICS IN TREATMENT

SOUND-WAVES with frequencies between 16 and 30,000cycles per second are audible to the human ear ; but thefrequency can be increased far beyond this range, andthen the waves, being no longer audible, are termedultrasonic. That such ultrasonic waves can be producedby the relatively simple phenomenon of piezo-electricityhas long been known ; and with the impetus of warthis knowledge was swiftly extended.The medical application of ultrasonics has been

investigated mainly in Germany and Austria. Theenergy of ultrasonic waves can largely be converted toheat ; and many effects produced by these waves canbe attributed to the heat which is generated. They canemulsify immiscible substances ; but they can alsoreverse the process, for cumulative doses can demulsify.Clinically, they are known to cause, in certain circum-stances, oxidation and depolymerisation. Their effects

1. Dean, H. T., Arnold, F. A., Jay, P., Knutson, J. W. Publ. HlthRep., Wash. 1950, 65, 1403.

2. Weaver, R. Proc. R. Soc. Med. 1948, 41, 284.

on living cells are very varied, extending from theknown effects of heat to cavitation and vacuolation.The claims for their effect in treatment, however, seem toreflect enthusiasm for a new-fangled method rather thanany encouraging accurate scientific observation. One isreminded of the claims made for short-wave diathermywhen this was first introduced as a therapeutic agent,before it was recognised as fundamentally a form ofheat treatment. The conditions in which good resultshave been claimed for ultrasonics range from pros-tatic enlargement to otosolerosis ; and much workhas been done on the use of these waves in neoplasticconditions, without evidence of benefit. Schliephake 3claims that the field in which ultrasonics are going tobe most useful is that of the " rheumatic " diseases ;but he does not define their indications or comparethe effect of ultrasonics with that of more established

procedures.An objective article by Nelson and his colleagues 4

shows the pitfalls which beset those ardently advocatinga new physical agent such as this. There seem to befew, if any, conditions which are not still better treatedby other means. In England the Ministry of Healthhas wisely limited the provision of ultrasonic emittorsto certain hospitals, where critical physical and clinicaltrials are being carried out.

DEPARTMENT OF HEALTH OF EIRE

DURING the union Ireland, unlike Scotland, had nospecial department of health, but was subject to thesame code of laws as England and Wales, except thatIreland was specially excluded from part of it. So on itsformation the State of Eire took over a system of Statemedicine identical in theory with that of England andWales, which it administered through a department oflocal government and public health, correspondingroughly to our deceased Local Government Board.In 1947 the government set up a new department ofhealth to deal exclusively with health matters, andpassed a comprehensive Health Act which fixed forEire a form of health legislation somewhat comparableto that of England and Wales before the National HealthService Act of 1946. The Eire code of State medicinefollows in the main the English code, but it departsfrom it in many details which are of great interest tostudents of the political and social aspects of medicine.The first report of the department of health of Eire

covers the years 1945-49, but some of the statisticaltables go back to 1925, and that of tuberculosis andcancer death-rates to the beginning of the century.Progress in health has been less than in Great Britain,for the disturbed state of the country between the twowars was a great hindrance to development. Eire isdeveloping a national health service ; but this willnot be developed along the lines of our National HealthService Act. A notable achievement was the MentalTreatment Act.of 1945, which gave to Eire an improve-ment on our Act of 1930. There is much to be learnedfrom the growth of State medicine in Eire.

THE British Medical Association has decided that itwill not after all be able to take part in the joint meetingwith the Medical Association of South Africa which wasto be held at Johannesburg in July, " as an assurancecannot be given that all members of the British MedicalAssociation will be free to enter South Africa." All willregret that the policy of the South African governmenthas necessitated this decision ; but we are glad that theprofession in both countries has refused to compromisewith the exponents of racial prejudice.

3. Schliephake, E. Brit. J. phys. Med. 1950, 7, 152.4. Nelson, P. A., Herrick, J. F., Krusen, F. H. Arch. phys. Med.

1950, 1, 6.