243PARLIAMENT

and asked him whence he had come. It was Town Band I told him he was miles out of his way, should havegone straight on at Town C instead of turning left, andmust turn right and go straight on to town D or take aright incline through twisty lanes to town E. " Ineither case," I said, " you will arrive at the great roadbetween London and the coast in which town A is.Turn right and you will get there." And then I realisedthe enormity of my crime. I had exposed the wholeoutlay of towns in the district to a fifth-columnist.What was this pimply youth doing driving soldiers-orwere they pseudo-soldiers-on a Saturday afternoon ?As he went round the corner, my suspicions were con-firmed. He was driving with a trade-plate. I notedthe number, but having no pencil with me had to go onrepeating it to myself as I walked along the road, untilanother car slowed down and the driver asked me if itwas the road to Town F. It was an ancient Daimler andcontained a Victorian lady. The chauffeur still had ajaunty air which showed he had been her coachmanbefore she changed her carriage for this car. There’s nodeceit here, thought I ; and then a second thought," that’s just how two spies would disguise themselves " ;and my answer hissed itself out in a hoarse whisper," yes ! Straight on ! " At the cross-roads, as I returned,stood a solitary lady, middle-aged and of attractiveappearance, who asked me whether I knew of a publictelephone near-by. " None," said I, " excepting thatone "-pointing to the R.A.C. blue box. She had comeby bus, she said, expecting to be met in a car by a friendand taken on to town G. My normal behaviour wouldhave been to ask her to come in and use ours, which waswithin a stone’s throw though the house was hidden bytrees. Instead I asked her whether she had her identitycard as a preliminary. " Yes!" she said, but thankedme smiling, she would not trouble me, but would wait alittle longer for her friend. I then knew that she hadmade a mental map of the means of communication fromour cross-roads. Then an army lorry stopped and thedriver asked me if it was the way to town H. " How doI know you are not fifth-column men ?

" I asked, for bynow I was alarmed at my treacherous behaviour andfelt I must go and get my gun. But the smiles of thedriver and his mate disarmed me and I added " yes ! "I went in feeling that the only beings with whom I couldsafely commune in the country were the birds in thehigh hall garden ; and I pondered over the evennesswith which our Saxon ancestors had scattered theirsteads, their tuns and their hams over the land that theyhad conquered.

* * *

The latest diversion in our suburb is the junk shoprun in aid of the Red Cross. It was the minister of theCongregational church that did it. He borrowed a largeground-floor shop temporarily unused by a firm of motorsalesmen. He has staffed it withthe ladies and gentle-men of his congregation, and there we go and give himanything we do not want and purchase those thingswhich our neighbours no longer need. Our own acquisi-tions have been a copper kettle and two sandwich tinsand two books have been smuggled in with them. Inthe first week they took 2100, in the second 2130 and inaddition materially helped the salvage scheme by sortingout various metals and putting aside considerablequantities of paper. The third week shows no signs ofabatement, indeed, the articles exposed for sale seem togo up in value and to include a number of radio sets andgramophones. It will be interesting to note whetherthese bring in as much as the smaller articles of the firstweek ; if they do not we can return our copper kettleand sandwich tins to see if anyone else will take them.

!)! * *

The savage winter has played havoc in my garden.The macrocarpa is nearly all dead, so is the pinusinsignis of lovely green, and even laurels and laurestinusare badly hit. On the real natives, however, the willowsand oaks, it seems to have acted as a stimulus. Will warbe like that, killing off southern exotics and leavingnatives with increased fertility ? The thousand yearsor so they took becoming established now stand them ingood stead, while recent rivals perish. Commas andwhite admiral butterflies are common this year. Is thatanother result of the intense cold ? Probably, and

chaffinches and song thrushes are definitely scarcer.

Half a dozen’ winters of that sort would change thepicture of our island fauna and flora.

If another ice age came, would it come suddenly orvery gradually, a lowering on the average, say, of a tenthof a degree a year, scarcely perceptible from one genera-tion to another, allowing us and our life-brothers of furand feather and leaf time to select who is most capableof staying on and sticking it out, who is to be packed offsouth in migration, who is to be buried under the glaciertombs ? P I wonder.

Parliament

Sir Francis Fremantle presided over a meeting at theHouse of Commons on Aug. 15 when Sir Richard Cruise,F.R.C.S., and Mr. Kenneth Walker, F.R.C.S., spoke onthe prevention of war injuries by protective devices. SirRichard Cruise described the visor he had submitted to theWar Office in 1917 and which had been approved for adop-tion at the close of the last war. An improved type muchsuperior in mechanism and efficiency had now beenperfected and supplies had been ordered by the War Officefor an extended trial. A large first order for these visorshas also been placed by the Admiralty. The urgentdesirability of this protection for the eyes has beenendorsed by the Ophthalmological Society of the UnitedKingdom. Sir Richard Cruise claimed that this devicewould prevent fully 50 % of the gunshot wounds and agreat majority of the eye injuries due to small fragmentsof high-explosive shells and bombs. Mr. KennethWalker dealt specially with the prevention of chestwounds, which caused probably 60 % of war casualties.He said there was no desire to increase the heavy loadalready borne by the soldier by the addition of weightyarmour, but materials were already available whichcould be moulded for attachment to the box respiratorto form a protective shield for the chest cavity. Thegreat obstacle to be overcome was the traditional reluct-ance of the soldier to adopt safety devices, but the steelhelmet had proved so effective in preventing headinjuries that there should be less hesitation in acceptingprotection for the more vulnerable area of the body.Mr. Walker mentioned that a joint committee of theRoyal Society of Medicine and the Service departmentswas now considering suggestions which might mean agreat saving of man power by reducing the wastagecaused by war wounds. After a discussion the meetingappointed Sir Francis Fremantle, Sir Ian Fraser,Brigadier-General Sir Ernest Makins and Captain G. S.Elliston as a deputation to bring the urgency of thematter to the personal notice of the Secretary of State forWar.

FROM THE PRESS GALLERY

The Purchase Tax

IF the final debates on the Finance Bill in the Commonsdid not produce much in the way of concession on the partof the Chancellor of the Exchequer they certainly clearedup a number of points which are of importance from themedical point of view. Mr. WOOLLEY did useful serviceby raising the question of the meaning of " exceptionallycostly " as governing the exemption of medical andsurgical drugs from the purchase tax. He suggestedthat these words must be interpreted in relation to thecapacity of people to pay. It was satisfactory to knowthat insulin and the active principles of liver would beexempted, but what about the poor patient sufferingfrom a secondary anaemia ? In such cases the treatmentwas long and the burden of cost could not be measuredby the actual cost of the drug. Moreover, anaesthetics,though essential, were not included in the free list.How could people who had small means, and were facedwith increased domestic expenditure, be expected to paythis extra tax when they were ill ? This point receivedgeneral support on both sides of the House. Mr.WAKEFIELD complained that nobody knew anythingabout the list which the Financial Secretary to theTreasury had said was being drawn up defining thosedrugs or surgical instruments which were to be regardedas costly. They had been told that the list was compiledby eminent medical men who were unanimous about it.Their alleged unanimity made Mr. Wakeiield gravely

244 PARLIAMENT

suspicious. Another aspect of the problem was pre-sented by Mr. BARXES who asked that the patent andbranded medicines should receive consideration. Thisclass of article, he said. was already subject to taxationranging from 25 to 35 %. If the purchase tax wasimposed on the cheaper medicines it would lift many ofthem into the level of the higher priced medicines, therebyattracting the heavier stamp duty. He urged that eitherthe stamp duty should be repealed or the purchase taxshould not be imposed. Sir IAN FRASER said that whetherthey individually cared for proprietary medicines or notthere was a principle of equity involved which the Houseought not to allow to pass without comment. These

patent medicines were not luxuries bought by the few ;they were household commodities bought by the many.

* * *

Sir KINGSLEY WooD agreed that there was a consider-able anomaly in the matter of the Medicine Stamp Duty.He promised to try to get the parties together and reachsome reasonable solution before the next Finance Bill.He could not at this stage make an exception in regard toa particular class of medicines or drugs. He assured theHouse that they would have a full opportunity of seeingthe list of medical and surgical appliances which theGovernment had in mind because it would come forwardfor approval on the section of the bill which allowed theTreasury to make the necessary definitions. It would bepossible to amend the list from time to time. He wasasking permission to impose a duty of 15!% on drugsand medicines manufactured or prepared as specified inthe third schedule. He was fortified by some remarksmade by the Chief Medical Officer of the Ministry ofHealth in his report for 1935 in which he almost invitedtaxation of medicines, even of the sort prescribed bydoctors. " A considerable proportion of the total outlayof drugs prescribed by the medical profession," said thereport, " averaging 3s. per head, could be limited withoutdetriment, indeed with advantage to the proper treat-ment of the people." A little later there was the addedcomment : " In some areas insured persons have acquireda habit of medicine drinking which the practitioners inthose areas are reluctant to control." The proper thingto do was to exact a contribution from the general classof medicines while protecting medicines, drugs and appli-ances which were essential.

* * *

Dr. MORGAN characterised Sir Kingsley Wood’sspeech as " ribald, ironical and cynical." This was anunworthy tax imposed on the sick and suffering whenother things which ought to be taxed were left un-touched. To make doctors think twice before orderingcertain medicines was a scandal to the financial systemof the country. The Chancellor had produced a state-ment by a medical bureaucrat-a man completelyisolated from patients. There were plenty of people inthis country who needed more medicine than they couldafford to buy.-Captain ELLISTON made a strong pleathat medicines dispensed by or on behalf of registeredmedical or dental practitioners should be exempted fromtax. This, he said. was recommended by the selectcommittee on the Medicine Stamp Duties which reportedin 1937.-Mrs. TATE hoped that the Chancellor wouldnot consider Captain Elliston’s suggestion. The medicalprofession was the closest trade union in the world, andshe hoped that no further unjustifiable advantage wouldbe given to it.

* * *

Mr. STOREY made another gallant attempt on thereport stage to secure exemption from the purchase taxfor the voluntary hospitals. He quoted the Chancellor’sstatement in announcing the decision to exempt news-papers that " it was not in the public interest that thereshould be a diminution in the services of newspapers tothe public." If that was a sound argument for theexemption of newspapers surely it was equally so in thecase of the hospitals.-Captain ELLISTON, Dr. EDITHSuMMERSKiLL and other members joined in the appeal,but the Chancellor refused to alter his decision of theprevious week. If any concession was to be given, hesaid, it must apply to hospitals generally, and not merelyto voluntary hospitals. He did not believe that the taxwould place an undue burden on the voluntary hospitalsor play any part in their ultimate fate.

At a later stage Sir KIXGSLEY WOOD moved an amend-ment to carry out his undertaking to exempt from taxa number of surgical and medical appliances beyond thoseoriginally contemplated-i.e., artificial limbs and spinaljackets-and to include also surgical boots, crutches,trusses, aids to the deaf and similar appliances whichmight have been held to be liable to tax. The exemptionwould include all such things made for surgical use, suchas operating tables, bandages and so forth.

Tuberculin

During the debate in the House of Lords on thesecond reading of the Agriculture (Miscellaneous WarProvisions) (No. 2) Bill on Aug. 13 Lord Moyne referredto the tuberculin now being issued. The trouble, hesaid, had been by no means limited to this country or tothe supply of tuberculin recently produced at Weybridge.The new tuberculin was undoubtedly more potent inproducing a reaction than that which used to come fromCamden Town or from the Department of Agriculture inCambridge. This trouble existed in a similar form even

- before Weybridge took over. The trouble was due to thefact that in tuberculosis, as in a great many otherdiseases due to micro-organisms, there were variousstrains. The bovine strain was not distinguished by thetest from the avian strain, which was quite harmless tocattle. Many cattle had avian tuberculosis which they hadcaught from poultry, and there were found post mortemtiny lesions of no importance from the point of view ofthe health of the cattle. Hitherto the test had not dis-tinguished between the objectionable bovine infectionand the harmless avian infection, but in future it wasproposed to have at the expense of the scheme a simul-taneous intradermal injection of bovine and avian re-agents and compare the effects. If there was a muchbigger reaction from the bovine, it would be acceptedthat the animal was a reactor to bovine tuberculosis.If the avian outstripped the bovine in the size of theintradermal reaction, then the animal would be passedas safe.

Summer Recess

The parliamentary week has been shortened since thewar began, but members have been subject to a good dealof extra strain and have earned a holiday, even if it issmall compared with the customary summer recess. Ithas been arranged that Parliament will rise on Thursday,Aug. 22, and reassemble on Thursday, Sept. 5, but theauthorities of both Houses will have power to summonmembers earlier in an emergency. In the autumn itwill be necessary to pass legislation prolonging the lifeof the present Parliament for another twelve months.

QUESTION TIME

War-time Bread

REPLYING to a question whether the Minister was awarethat there are many medical men in this House sceptical aboutthe addition of vitamin Bl to flour, Mr. R. BOOTHBY saidhe was also aware that there are many medical men andscientists in this House and outside it who are warmly infavour of it. Asked whether the process was all done underthe patent of Roche Ltd., he said : No, the process has beenundertaken by various firms in different countries, but Iunderstand that Roche Ltd. are the only firm at presentproducing in this country.

Sir FRANCIS FREMANTLE : Is the Parliamentary Secretaryaware that there is not one medical man who does notconsider it infinitely better to have wholemeal bread ?-Mr.BOOTHBY: The view of the Government is that a largenumber of people in this country do not care to eat brownbread, and this is really the primary reason for the decisionwhich has been come to.

Milk

Mr. DAVID ADAMS asked what steps were being taken torender fit for human consumption undesignated milk nowbeing supplied for food by the Milk Marketing Board ; andwhether, pending such remedial action, he would prohibit thesale of this product in the interests of public health.-Mr.BOOTHBY replied : During the past 6 years the proportion ofundesignated milk has fallen from 95% to 52% of the totalquantity of milk produced. Every effort is being made bythe milk marketing boards with the financial assistance of the

245PARLIAMENT

Government to increase the production of designated milk.In addition, a proportion of undesignated milk is pasteurisedbefore sale for liquid consumption. The proportion varies indifferent parts of the country. It would not be practicable toprohibit the sale of undesignated milk, since the supply ofdesignated milk is not yet sufficient to meet the requirementsof the liquid consumer.Mr. ROBERT MORGAN asked for information about the

eircularisation of the staff of Lewis’s with the object of obtain-ing guidance upon the distribution of milk.-Mr. BooTHBYreplied : The inquiry was made at the request of the com-mittee recently appointed to advise the Minister on milkdistribution costs. I understand that the committee desiredto obtain some indication of the manner in which the consump-tion of milk would be likely to be affected by changes in priceand methods of distribution. For this purpose informalarrangements were made for the issue of a simple questionnaireto the staffs of :-

, The Ford Motor Company, Ltd.,Lewis’s (Manchester, Liverpool, &c.),The Gramophone Company Ltd., Hayes, Middlesex,’The Raleigh Cycle Co. Ltd., Nottingham,

and certain other commercial and industrial firms.

Rear-Admiral BEAMISH asked how it was proposed to

operate the extended distribution of the national milk powder.- me. BOOTHBY replied : No extended distribution of thepowder is contemplated. Its issue is being restricted to thecase of infants of under 12 months of age for whom a medicalcertificate is received that milk powder, instead of liquid milk,should be provided under the National Milk Scheme. Thedistribution of the powder will be in the hands of the Ministry’smilk officer, who will be assisted, wherever practicable, bylocal welfare centres and district nurses.

Communal FeedingReplying to Mr. ADAMS, Mr. BOOTHBY said that extensive

facilities for communal feeding were already provided bycommercial enterprise and by voluntary agencies. These werebeing continually augmented to meet current requirements,particularly in industrial centres. Steps had been taken toencourage an extension of existing school-feeding facilities,and the Ministry of Food had undertaken to investigate anycases in which, as a result of inquiries made by the welfareofficers of the Ministry of Labour, it appeared that existingor prospective provision for the feeding of factory workers isinadequate. While the need for further provision was beingkept under review, it seemed unlikely that any measure ofcompulsion in regard to communal feeding would be necessary.

Surgical Mobile UnitsSir F. FREMANTLE asked the Minister of Health how

many surgical mobile units were now equipped and ready foraction in the Emergency Medical Service ; what was theirdistribution and personnel ; and under whose orders theywould move.-Mr. M. MAcDoNALD replied : The number of

surgical mobile units equipped and ready for action is 456,including 7 special units. Of this total 115 are in the Londonsectors and the remainder distributed over the principal townsin each region. A team consists of a surgeon, an anaesthetist,a sister and a male assistant who may be either an orderlyor a medical student. The teams will move under the ordersof the hospital officer or the group officer in the respectiveareas.

Mr. MACDoNALD added that at the time of the evacuationfrom Dunkirk a great many of these mobile surgical teamsdid exceedingly valuable work.

Pay of R.A.M.C. OfficersSir ERNEST GRAHAM-LITTLE asked the Secretary of State

for War whether he was aware of the anomaly of pay whichexisted between retired officers of the same rank in the RoyalArmy Medical Corps, who were employed before the outbreakof war, under the Royal Warrant of Pay, 1931, Article 520 A(or 1940, Article 498 A), and those taken into employmentafter mobilisation, September, 1939 ; and as the former, whoelected to serve in peace, were being held to their engagementswithout any pay revision or allowance for the increase in workand responsibilities out of all proportion to their original con-tracts, whether he would allow these officers to accept serviceunder Article 518 of 1931 (Article 496 of 1940).-Sir EDWARDGRIGG, under-secretary for war, replied : Retired R.A.M.C.

officers employed during peace on a contract under which theyreceive a rate of pay in addition to their retired pay are one ofseveral categories of re-employed retired officers employedduring peace. It has been the practice since the war began tohold such officers to their peace conditions where the dutieshave remained unchanged. Where such officers havetransferred to other duties involving a liability to move andserve at any station according to military requirements, orwhere the peace-time duties have changed in character

involving automatic liability to serve anywhere according tomilitary requirements, the officers have been transferred tofull pay and allowances, their retired pay ceasing. In general,the peace-time R.A.M.C. retired officers have continued toserve in their peace-time stations, but a number who havechanged their stations and accepted general liability for servicehave been restored in full pay, and this would be applied inany future cases where general liability for service, with for-feiture of any peace-time contract rights, is accepted.

ByssinosisDr. H. B. MORGAN asked the Home Secretary the position

with regard to byssinosis, or card-room workers’ bronchitis ;whether a scheme for workmen’s compensation for thosedisabled by this disease had been agreed, ’or negotiationscompleted ; whether the necessary legislation was beingprepared ; whether this legislation, or Parliamentary approvalto the scheme, could be expedited ; and when it was likely tobe laid before the House.-Sir JOHN ANDERSON replied:Proposals based on the departmental committee’s recommenda-tions have been substantially accepted by the employers’and workers’ associations concerned, and a bill to enableeffect to be given to them is being prepared. I hope that itmay be possible to introduce the bill soon after Parliamentreassembles.

Shell Shock

Mr. RHYS DAVZs asked the Minister of Pensions the numberof shell-shock cases still being treated from the war of 1914-18 ;what was the annual cost of such treatment ; and whetherany new remedies had recently been tried to cure shell shock.-Sir W. VomxsLEy replied : I am advised that no cases whichcould, as such, properly be described as " shell shock " arenow, or have indeed for many years been, under treatment bythe Ministry. Shock and other war neuroses are fully dealtwith in the report of a conference of neurological specialistsconvened by me last year.

VagrantsMr. AssHETON, parliamentary secretary to the Ministry of

Labour, informed Captain STRICKLAND that the total numberof vagrants accommodated in casual wards in England andWales on June 28, 1940, the latest date for which figures wereavailable, was 3739 (including a small number of women andchildren) which compares with 5098 on May 24, 1940, and7255 on June 30, 1939. There was no information to showhow many of these were able-bodied men.

Spectacles Exempt from Purchase Tax

Captain H. F. C. CROOESHANE, Financial Secretary to theTreasury, informed Mr. Rhys Davies that it was not pro-posed that the purchase tax should apply to spectacles orto lenses used in spectacles. Spectacle frames would not betaxed unless made from luxury materials such as tortoiseshelland gold.

A.B. BRAND DELAY INSULIN, 40 units per c.cm., ismanufactured jointly by British Drug Houses andAllen and Hanburys. It should not be confused withA.B. Protamine Insulin with Zinc Suspension. It isavailable in boxes of 5 x 5 c.cm. vials, with a vial ofsodium phosphate solution. A.B. Brand DelayInsulin will shortly be put on the market at doublestrength.CORRIGENDuM.-In the paper by Dr. Kark and Dr.

Souter in our issue of June 29, a sentence under " Failureof response to therapy" on p. 1152 should read : "... asecond group of patients with less severe and morechronic hepatic disease seem able to produce prothrombinconstantly but in quantities insufficient to maintain anormal level in the blood." .

246 BRITISH CHILDREN IX AbIERIC 1

Letters to the Editor

WHOLE-TIME FACTORY DOCTORS

SiR,—A recent order by the Minister of Labour makescompulsory the employment of whole-time medicalofficers in certain large factories in this country. Thisexpansion of industrial medicine-even if it is only of atemporary nature-will be welcomed by all who recog-nise the importance to the nation of the fullest medicalcare of the industrial worker. It will be readily appre-ciated that this young branch of medicine is highlyspecialised, and it follows that if the maximum benefit isto be derived from the Minister’s order considerable careshould be taken both in the selection and training ofcandidates.For these appointments the services are required of

well-qualified men and women, with good experience andwide knowledge and sympathies, and following theirselection it is important that they should receive sometraining in their new work. Not only will it be necessaryfor them to possess some knowledge of the prevention andtreatment of occupational diseases ; they will have tolearn something of general factory hygiene and of thenumerous factors which influence the well-being and out-put of the industrial worker. A great deal of researchhas been carried out in this field in the last twenty-fiveyears, and it is important that medical men enteringindustry should know how to tap this fund of knowledge.In addition, they must know something of the structureof industry and of factory organisation if they are toavoid elementary mistakes early in their industrialcareer-mistakes which may prejudice their chancesof successful cooperation with management at a laterstage.

I venture to make two suggestions :-(1) That assistance should be offered to employers in mak-

ing appointments of industrial medical officers, and that allsuch appointments should be finally approved by the CentralMedical War Committee.

(2) That a short course of about two weeks be made avail-able for those appointed. There is little doubt that the

cooperation of the factory medical department of the HomeOffice and the London School of Hygiene would be forth-coming for this work.These matters, I submit, require urgent attention if agreat waste of opportunity and of effort is to be avoided.

Finally, I would like to offer the whole-heartedcooperation of this association in the practical training ofthose who are selected to undertake this work in industry.

RONALD E. LANE,Chairman, Association of Industrial Medical Officers.

NEGATOL

SIR,—In a letter in THE LANCET of Dec. 30, 1939(p. 1386), I set out some preliminary results in thetreatment of various forms of vaginal discharge withNegatol, and I intimated my intention of following up thecases with a view to publishing a more detailed acountof the end results. The follow-up has been rendereddifficult by existing circumstances but here is a resumeof the final results.

Group (a) : 17 cases of which 11 were seemingly cured.One had had a relapse which is, however, not uncommon afterany of the known treatments for trichomonas vaginitis. Nofurther cases of this type of infection have been treated withnegatol for another method has in my experience a muchhigher cure-rate.Group (b) : 47 cases of non-specific cervicitis with erosion,

of which 45 were symptom-free with healed erosions. Of thesecases 4 have developed discharge with recurrence of erosion,but after three weeks treatment apparent cure has again beenobtained. A few cases are untraced, but since I had previ-ously asked all these patients to let me know if symptomsrecurred it seems reasonable to presume that they are free fromsymptoms.Group (c) : 25 cases of residual cervicitis with erosion follow-

ing a proved gonococcal infection, with apparent cure in 20cases. No case has relapsed in this group as far as can beascertained.

Over 100 new cases have begun treatment since theprevious results were published. These included a few

cases of monilia infection in addition to groups (b) and(c). The treatment has also been extended to cases ofpostnatal cervical erosion with satisfactory results. Oneother case deserves mention.

A patient was admitted at the 24th week of gestation withpersistent slight haemorrhage per vaginam. She was regardedas a threatened abortion until inspection revealed a largevascular erosion of the cervix which was oozing continuously.The entire area was swabbed with 100% negatol on threeoccasions with complete cessation of bleeding. The preg-nancy was in no way disturbed.

The new cases have all been subjected to the samedetailed clinical and bacteriological control but thetreatment has been slightly modified in individual casesby omission of the vaginal pack with 5 % negatol. Theresults so far appear to bear out the efficiency of thetreatment.

I would appreciate comments from anyone who hasused this substance in the treatment of vaginal discharge.

Middlesex Hospital, W.1. O. LLOYD.

BRITISH CHILDREN IN AMERICA

SIR,-In connexion with the overseas evacuationof children from Britain which has been discussed somuch in this country as well as in Britain, it is possiblethat a. personal word might be of some interest. Adefinite effort is being made on this side to match asmany features as possible of the home here with the homefrom which a child comes. I believe this work is incapable hands. I have had my own application for aboy between 5 and 7 from a professional family in thehands of the English-speaking Union for some time andmy own children are anxiously ready to welcome another.Although a decision such as must be made by parentsin Britain must be most difficult it may be reassuringto them to know that people here are trying to considerin advance all features of family adjustment and theparticular factors of age and background which wouldwork out best for all concerned.

I believe that those British parents who send theirchildren here can feel confident that everything will bedone for them which could be done at home. Someexternals may be different but people are much alike.

EDWIN P. JORDAN.American Medical Association, North Dearborn Street,

Chicago, Ill.

INDUSTRIAL TUBERCULOSIS

SiR,-In a recent annotation (July 20, p. 78) youexpressed a fear that the inevitable strain in factory andworkshop will lead to breakdown in workers with earlyor latent phthisis, and you advocated the elimination ofthese undesirable recruits with the help of miniatureradiography on a large scale. I can see no chance ofapproval for the universality of such a scheme in indus-trial establishments under present conditions. Here arethe reasons which lead me to take this view :

(1) In any sane state of society, where vested interestswere subject to national good, the scheme would be anexcellent one. It would work out cheaper thanordinary-size radiographs. Recording would be easier,as well as storage and transport. The early sifting of theclear from’the potentially infected or doubtful would bea boon in any antitubarculous campaign. The stampingout of tuberculosis can only be secured by very earlydiagnosis. Here is a practical method to secure earlydiagnosis even on recruitment into industry. Everyintelligent worker would agree to the scheme if he sawhis economic interests and future safeguarded. Youmay argue that he should sacrifice his economic interestsfor the sake of the future health and well-being of thenation. That would be ideal. He would answer byinsisting on a similar sacrifice from other interests. Hewould never agree to a unilateral sacrifice.

(2) It is seldom recognised, even in the medical pro-fession, how frequently in balancing life’s chances theworker has to run the risk of sacrificing his health for thesake of employment--of securing or of being retainedin work. Sometimes the workman keenly recogniseshe is risking his future health by sticking to work orsticking to a potentially risky job. The spectre ofunemployment haunts the homes of workers, organised