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In England NowA Running Commentary by Peripatetic CorrespondentsAT a recent trial, the learned judge rebuked a medical

witness for using the term " anxiety state." " One ofthose cliches," he said. " I suppose you mean the manwas worried." No doubt our poor colleague would havepreferred to point out that anxiety state is not merelya synonym for worry, but it takes some courage-or shallI say audacity ?-to argue with the Bench. Why, acouple of years ago the word " sibling " was derided as" one of those meaningless psychological terms," yet the

speaker refrained from exhorting His Lordship not toexpose his ignorance !Medical jargon is one of the outstanding stock Aunt

Sallies and is even in the running with kippers, mothers-in-law, seaside apartments, and the rest of the red-nosed comedian’s repertoire. There is ample scope forfacetiousness over our polysyllabic phraseology andanybody with an elementary classical knowledge canridicule the hybrid constructions and the absurd revela-tions of etymological analysis. Even in our own privatecircle we are inclined to laugh at ourselves ; witness theattempt to select or construct a word which properlyconnotes what we call venereology. And although atfirst I resented it, I am now reconciled to having patientsreferred to me, the neurotic specialist.

" A severe contusion of the infraorbital integumentswith marked extravasation of blood and ecchymosis ofthe surrounding cuticular tissue which was in a tumefiedstate. There was considerable abrasion of the cuticle."You can bet pretty confidently that whenever a newtextbook on forensic medicine appears, this allegeddescription of a black eye will be the example of howone should not talk when giving evidence. During thelast twenty-five years I have written to the Lancet andBritish Medical Journal three times when I encountereda resurrection of this imperishable monstrosity of eircum-locution to inquire for its origin. I first heard it nearlyhalf a century ago when I was a little boy. Such anelaborate construction could never have been producedon the spur of the moment; it smells too much of thelamp. I can imagine some wag pruning and polishing itand keeping it in cold storage until an opportunity arose,but so far I have had no response to my request for theidentity of the said wag. It is high time that thosewho chide us for our periphrasis found some substituteexample which is easier to remember and more plausible.

Other professions and occupations have their techni-calities, yet nobody criticises them. We don’t admonishthe mathematician because he talks of logarithms orexponential curves, and invite him to use plain English.Once I sat in company with a couple of engineers and oftheir conversation I could not understand two words inten ; yet I attributed my inability to my ignorance, notto their eclectic affectation.

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Doctor’s letter to Hospital Physician : " Night sweats.Please investigate."

Hospital Physician to Patient : " Do you sweat atnight ? "

Patient: " Dreadful "Hospital Physician : "What is your job P"Patient: " Night stoker:"

At the back of the bookcase I have found a bacterio-logical scrap-book whose first entries are of 1896 and thelast of 1902. Before the war the compiler used’to visitthe laboratory regularly, an old man very curious afterthe new knowledge of others and far too prone to belittlinghis own. In spite of his long connexion there are fewrecords of him in this laboratory which he founded andfinanced in the spring days of bacteriology ; the part-authorship of an " Atlas of Bacteriology to which no-one now refers (to the loss of everyone ) ; a minute andarchaic autoclave ; and the book of lecture notes whichhe brought back from Paris when he had attended a

course at the Institut Pasteur. Alas, by that time theeponymous director no longer lectured and it was youngRoux who taught, but our visitor had seen and spokento the man who had so inadvertently founded "a newscience. -

I am afraid, Mr. Editor, that it is your contemporary

that furnished most of the cuttings. They concern

bacteriology only ; they are not indexed ; one missesthe comments in the correspondence next week. Butin manner and matter they do not differ much from thepublished articles of today. The subjects ? I quoteat random : " The sterilisation of milk and its effecton the nutritive values " ; " The bacteriology of infantilediarrhoea " ; " The antitoxin treatment of diphtheria " ;" Serum diagnosis " ; " The epidemiology of malaria " ;" The parasites of smallpox and chickenpox " (arte-facts I fear in this case).

I have not consulted the index for 1945 but I suspectthat all these subjects would appear there. But-with one honoured exception-the names would bedifferent. And what names ! The scrap-book readslike the Court Circular of Valhalla : Koch, Manson,Ross, Wright, Haffkine, Martin, Houston, Celli, Cantlie,Delepine, &c., &c., &c. (for once I see point in the tri-petition). Unlike those heroes of the older Valhallawho needed bards to tell their stories, these have writtentheir own, in plain English and without using the word" evaluate." But, like the old old tales, their storiesare powerful in dispelling any &bgr;&rgr;&tgr;&sfgr; that may overcomea bacteriologist of today after digesting the banquet ofreading matter that showers through his letter-box.We have not yet convinced our legislators that a sterilemilk compensates for some small loss in nutritive value.Infantile diarrhoea is one of the commonest hardy peren-nials of Adam Street, and no praise is ever given to thewoman who, with a bit of muslin and a dozen beads,made a milk-jug fly-proof. " Serum diagnosis " is ahandier phrase than agglutination reaction, and I wishI had had Celli’s article on malaria to read in the Arakan.

History merges into mythology and I would like tohave known more personalia of the heroic age. Didthey wash with alcohol and soap and water before theyshook hands with a visitor ? Or did they light theirpipes at the bunsen, or hum Dolly Gray as they workedat night alone ? No hint appears in all these papers of thecramped quarters, the improvised apparatus, and meagrerecognition enjoyed by these men among whom thecompiler was not the least. Before the haze of timecovers the view, someone should write the story of theanni decem mirabiles of bacteriology, 1896-1905.

* * * .

My young friend Cash in the village stores, who figuredin these columns about -a year ago, is even thinner andis more often away ill. She was taking down my ordera few days ago and concurrently lamenting our diet.I tried to comfort her by saying that things wouldprobably be better later this year. " If we’re not allinvalids first," she sighed. In her mind it is a race withtime. * * *

If plain living and high thinking go together, thenI must be well above the mental average, for so far Ihave seen no improvement in the amount or qualityeither of rations or luxuries. Even the belt that I amadvised to tighten is getting a bit frayed. Usually I donot notice such mundane things, but there are occasionswhen my proud citadel gets painfully assaulted, par-ticularly when I see a borrowed magazine from theUnited States. On the advertisement pages, whichseem to make up eighty per cent. of the publication, areall kinds of goodies, friendly to tongue and innards,beautifully tempting in all their natural and tinnedcolorations, and lacking only in availability. There,from the glossy pages, they stare back at me-lobster,lettuce, and salad cream ; fruits of extreme’delicacy andbloom ; bronze-tinted hams and streaky bacon slices ;port and sherry to tempt even a teetotaller ; orange andlemon drinks to satiate the most dehydrated abstainer.

" What’s the matter, Jack ? " says my wife, hearingme smack my lips, " Are you hungry ? " And beforeI have time to answer this disastrous reminder of mynewly acquired condition she continues, " It’s sausagestoday ; very badly needing using up, I think, but allI could get."

I have no real grudge against those fine folk of theUnited States, their President, or their constitution ;but I do wish they would not upset my morale like this.During the war I occasionally got an American medicaljournal with an article or two painted black by the censor(it took me quite a time to work the black off) ; isn’t

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there now as great a need for that black paint on adver-tisements likely to cause despondency in ex-occupiedor ex-lease-lent countries ?

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At the hospital the other day I was examining thethroat of a little girl of five who was having persistentheamorrhage after tonsillectomy, when she exclaimed :" You should put me on M. & B.; that’s what Mummydoes." And this is exactly what an increasing numberof mummies are doing-wheedling a box of sulpha-pyridine tablets (the most modern prefer sulphathiazole)out of their doctor and thereafter distributing them tothe family for any ailment from measles to asthma, viacoryza, much as their grandmothers handed out brim-stone and treacle and their mothers castor oil. Theremarkable thing is that so few children come to anyharm from the practice.

ParliamentON THE FLOOR OF THE HOUSE

.

MEDICUS, M.P.LARGE measures are jostling each other for precedence

in the parliamentary programme. On Jan. 30 thesecond reading of the Coal Nationalisation Bill wascarried by 359 to 182 and an opposition proposal torefer it to the House of Commons as a whole, sitting asa committee, was lost by 356 to 181. It was then9.30 P.M. : the debate had already lasted the whole ofTuesday and the financial resolution was debated until2.57 A.M. on Thursday morning. On Thursday afternoonthe Minister of Health moved the second reading of theAcquisition of Land Bill which speeds up compulsoryacquisition for factories, houses, or whatever may berequired, and the Government obtained the secondreading at 9.12 P.M. by 241 votes to 98.

Legislation for the current week includes the NationalInsurance Bill, which gives us all security for 4s. Ild. aweek, and a measure to control and direct investment.,The National Insurance Bill was in the main an agreedcoalition measure but it is a massive document, andMr. Eden, as acting leader of the Opposition, asked ifmore time could not be given for members to consider theBill, and Mr. Clement Davies, leader of the Liberal Ten,backed him up. Mr. Davies urged that the Houseshould not be saddled with so heavy a burden so soonafter the coal debate. At first Mr. Morrison dug in histoes, but finally he agreed to give an extension of timeto discussion of the financial resolution. One memberreferred to Mr. Morrison as " the right honourable andtotalitarian member " and was- duly rebuked by theSpeaker. Another M.P. complained that we have hada lot to absorb in two weeks, and Mr. Morrison felt" bound to warn the hon. and gallant member that hewill have a lot more to absorb before we are done."Perhaps in this atomic age the temperature of political

controversy is rising. The Bevin-Vyshinsky bouts atUNO have been high-spirited and perhaps alarming, andin Parliament the fights of Government and Oppositionare bound to become more and more intense. But it isdoubtful whether this will much affect the proposals fora National Health Service. This also belongs to a largeextent in the class of measures about which agreementexists. The plans of the Medical Planning Commission ofthe B.M.A. and other representative medical bodies wenta long way towards a National Health Service, and anidea which seemed revolutionary before 1939 now findsitself in tune with the spirit of the time. A NationalHealth Service will enable Great Britain to take aneffective share in the structure of the new internationalhealth organisation which will be part of UNO.

- QUESTION TIMENational Health Service

Sir H. MORRIS-JONES asked the Minister of Health why,in his recent interview with some representatives of localauthorities concerning his proposals for hospital administra-tion in his forthcoming National Health Bill, they wereforbidden by him to consult their associations or to divulge hisproposals.-Mr. A. BEVAN replied : The Government’s

proposals for a National Health Service will be published inthe proper manner, by the submission of a Bill to Parliament.Before settling final details of that Bill, I am seeking advice

on various points from expert representatives from localgovernment and other fields. I am not asking them tocommit the local authorities or other bodies to any particularproposal, and my discussions with them must obviously be,confidential.

Approved SocietiesMr. H. E. GOODRICH asked the Minister of National

Insurance if he would give an assurance that it is his intentionto seek the assistance of the voluntary friendly societies in theadministration of his scheme during the transitional period,even though he did not intend to use them as an integral partof his scheme ; and for how long he anticipated seeking theadvice of friendly societies for this purpose.-Mr. JAME&GRIFFITHS replied : I contemplate that there will be a

transitional period during which the change to the new systemof health insurance will take place by stages. This is inevitableowing to the magnitude and complexity of the operationand has the advantage that it will enable any arrangementsthat may be decided upon for transfer of staffs of approvedsocieties to be made without the risk of a breakdown ofadministration at the date of transfer. During the tran-sitional period some use will have to be made of the machineryof the approved societies generally. The extent and mannerin which this can best be done is one of the matters at presentbeing discussed with a committee representative of all classesof approved societies, and until these discussions have madefurther progress I cannot say what form these arrangementswill take or how long they will last.

Invalidings from the ServicesMr. W. N. W ARBEY asked the Minister of Pensions how

many men and women discharged from the Services as unfitsince September, 1939, had been refused a pension; andhow many of these were placed in medical category grade Iwhen they entered the Service.-Mr. WILFRED PALING replied :In all some 680,000 men and women have been invalided fromthe Forces since 1939, but no statistics are available as to theirmedical category on enlistment. An award of pension hasbeen made in about 285,000 cases. All invalidings are auto-matically notified to my department irrespective of whetherthe individual desires that his entitlement to pension shouldbe considered. In fact in well over half the cases where noaward of pension was warranted the person concerned has atno time made or inferred anything in the nature of a claim.

Silicosis ’and Pneumoconiosis

Replying to a question Mr. E. SHINWELL, Minister of Fueland Power, stated that from 1940 to 1944 there were 514certificates of death and 5054 certificates of suspension inrespect of silicosis and pneumoconiosis to coalminers.

Deaf-aids .

Mr. R. ASSHETON asked the President of the Board of Tradawhether, in view of the high quality of certain deaf-aids madein the U.S.A., he would consider remitting the customs dutyon these instruments in order to bring their selling price in thiscountry within the reach of those with moderate means ; andwhether he would also consider if some arrangement could bemade between this country and the U.S.A. for the mutualexchange of such articles as deaf-aids, artificial limbs, eyes,&c., without the payment of any duties on either side.-SirSTAFFORD Cztirps replied : Deaf-aids produced in this countryare available at prices which in general compare favourablywith those charged by overseas manufacturers. The type,which the right hon. gentleman has in mind is required for avery small proportion of cases of deafness. I have consideredthe information as to the price at which it is available to

purchasers in this country and I do not feel that I can advisethe Chancellor of the Exchequer that a remission of importduty would be justified.

Grants for Medical StudentsSir E. GRAHAM-LITTLE asked the Minister of Labour how

many medical students had received grants from the FurtherEducation and Training Scheme since its inception; whatwas their total amount ; and whether, as the need for qualifiedmedical practitioners would become greatly increased underthe proposals for future health services, he would make grants-in proportion to that need.-Miss E. WILKINSON replied :Up to Jan. 24 130 awards have been made for courses oftraining in medicine. The grants provide for maintenanceand the cost of fees, but it is not possible, without unduelabour, to give the total cost for this type of award in par-ticular. All applications from men and women who appearbo be eligible for awards under the scheme will be verysympathetically considered.