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altogether more normal and far less likely to be pitied.When I walk distances of about a mile I have to be care-ful of my socks, for blisters, which soon ulcerate, startquickly and heal slowly. Of these I have had only three,all successfully treated with a sulphonamide powderand rest. Of bedsores I have had none since my hospitaldays, and the two I then had have never broken down.My right foot being useless, though only partially

" dropped," I left hospital wearing a knee-length calliper ;but this was extremely heavy so I soon rejected it. I haveworn for the last two and a half years a pair of stout-soled suede slippers, an inch-wide strap securing theright one. This method, I think, has been fairly satis-factory ; but, since my right foot wobbles and hangs alittle lower than is convenient, I would like to use a verylight calliper-but I have never seen one. I did try atoe-spring- once, but it pulled too much on my leg,which bruises easily, and might have started a sore.

I am sure that many people who use such appliances havethe same trouble, and we should be pleased if manu-facturers could make their instruments as light as possible.Finally, there is the matter of appearance, for the

psychological effect of graceless callipers and other visibleappliances can hardly be good therapy for the user, whonaturally is hoping to look as inconspicuous as possible.

ROOT PAINS

Root pains, it seems, cannot be cured; the only thingto be done is to make up one’s mind that they shall notspoil life, and then to ignore them as far as possible.

Public Health

Local-authority Areas and FunctionsTHE Local Government Boundary Commission, estab-

lished two years ago with Sir Malcolm Trustram Eve aschairman, has now issued its second annual report.lAfter two years’ energetic work, including 600 conferenceswith local authorities, the commission, whose task is tosecure " effective and convenient units of local govern-ment administration," has so far made no single orderaltering the status or boundaries of any local authority.The reasons for this apparent inertia are given in onebrief quotation from the present Minister of Health :"Everyone who knows about local government feelsthat it is nonsense to talk about functions and boundariesseparately. They have to be taken together." Thecommission’s jurisdiction -extends only to boundaries.The report therefore reviews local-government func-

tions in their bearing on areas. Weaknesses in the presentsystem arise from disparities in size and resources ; fromconurbations (particularly in the Black Country, Man-chester, Merseyside, Tyneside, the West Riding, andLondon) ; from the new system of central control,which involves submission of schemes to central govern-ment departments ; from the haphazard allocation offunctions ; and from local conflicts over boundaries.There is, however, general agreement that in the future,as in the past, both two-tier local government (as incounties) and one-tier (as in county boroughs) will con-tinue to be necessary, the appropriate type dependingon local circumstances. The general aim should be tomake administration as local as is compatible withsecuring effective services. In theory, different services- highways, education, poor-law, &c.-could be effec-tively served by different units of administration, butno-one today advocates a return to this 19th-centurypractice. Another factor is the size of the occupationalgroup-teachers, police, midwives, &c.-to be employed.Too small a group does not attract officers or adminis-trators of the right calibre.The commissioners then analyse the present position

with regard to local-government units. The increase inthe complexity, variety, and scope of functions has madethe present division of boroughs into " all-purpose "and " minor-purpose

" obsolete. A new class, embracing1. Report of the Local Government Boundary Commission for the

Year 1947. H.M. Stationery Office. Pp. 62. 1s.

the middle-size towns, of " most-purpose " authorities.

has become necessary. Rather than see county-counciladministration further whittled away, four of the fivecommissioners would regard the reduction to non-county-borough status of almost three-quarters of the existingcounty boroughs as the lesser of two evils. They thereforerecommend a redivision of all major local-governmentunits in England and Wales into new counties ; of these,the bulk would be formed by the existing counties andthe remainder by the large cities and towns, with boun-daries suitably adjusted. The counties made up of thelarge cities and towns would continue to enjoy a one-tier system of government and would have populationsof 200,000-500,000. The new counties of thepresent pattern would have populations of 200,000-1,000,000, and a two-tier system. The second tier,consisting of non-county. boroughs and urban and ruraldistricts, would be of equal status and have identicalfunctions, both by statutory right and by delegationfrom the county councils, as " county districts." Butwithin the two-tier counties would also be included a newtype of county borough-the

" most-purpose " authority-consisting of the middle-size towns and largest non-county boroughs, of 60,000-200,000 population. Thesenew county boroughs would look to the county for certainservices (including police and fire) but would be autono-mous for services such as health, education, the care of theaged, and some aspects of town-planning. For specialgeographical reasons, Liverpool and Manchester couldbest become county boroughs of this new type, and thecentres of new counties. Birmingham would be a newone-tier county. In England 67 new counties are recom-mended, of which 47 would have two-tier governmentand the remaining 20 one-tier. The new county boroughswould number 63 " most-purpose

" units.The commissioners deal briefly with the problem of

Greater London, which, with the exception of Croydonand East and West Ham as provisional new countyboroughs, is excluded from their recommendations. Inthis area live 9 million people, of whom 31/2 million arein the administrative county. They recall the statementof Mr. Bevan in dissolving the Reading Committee, that" the problem which the committee was asked to under-take cannot satisfactorily be divorced from that ofGreater London," and they ask for directions on theprinciples on which they should proceed in this area.

Only a few of the detailed changes suggested by thecommissioners can be indicated here.

Lancashire, which at present has 1 administrative countycouncil and 17 county-borough councils, is, with Westmorlandand parts of Cheshire, to form 5 new counties, all the existingcounty boroughs (except perhaps Bury) becoming new " most-purpose " county boroughs. Yorkshire, with 3 administrativecounties and 13 county boroughs, together with the northbank of the Tees, would make 8 counties, 4 of them (Bradford,Leeds, Hull, and Sheffield) of the one-tier type. Staffordshire,with its 7 county boroughs, would form 3 new counties (theseareas, with Cheshire, contain 41 out of the present 80 countyboroughs in England, and have a population of 11 million).Certain counties on the other hand require union to formsuitable units ; Hereford and Worcester, and Leicester andRutland may be instanced.

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So far as Wales, with a population like that of Lancashireand a rateable value like that of Essex, is concerned, no definiteproposals are yet made, but certain alternatives are outlinedand examined briefly.No major adjustment of local-government boundaries

has taken place for sixty years. Since 1944 the functionsof local government have been completely recast.Education, health, town and country planning, police,fire, transport, electricity, gas, water-supply, and thecare of children have all been or are the subject of majorlegislation, with the effects of which local authorities arenow coping. These developments have produced dis-turbance ; the setting up of the commission has itselfadded to the unrest; and early acceptance or otherwiseof the principles discussed is of importance. Immediatelegislation is not essential, but a decision on it is, andwould enable the commissioners to continue with theimmense volume of preliminary work. Above all, ifregrouping is ever to take place it should be attemptednow.. I

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This report is of great importance and will receivewide- discussion. The case for functions and units ofadministration being considered together seems inescap-able. It has been too long shelved by legislators of allparties.

PoliomyelitisThe number of notifications (uncorrected) in England

and Wales during the week ended April 3 was polio-myelitis 15 (17) and polioencephalitis 4 (1) ; figures forthe previous week are given in parentheses.

It is of some interest to compare experience of thebeginning of this year with that of the beginning of 1939,for 1938 was the year of highest incidence before 1947.

The total number of notifications in the 13 weeks endedApril 1, 1939, was poliomyelitis 116 and polioencephalitis21. The total number in the 13 weeks ended March 27,1948, was poliomyelitis 425 and polioencephalitis 21.The figures for 1939 were higher than is usual in thefirst quarter, and the chief medical officer of the Ministryof Health pointed out 1 that a similar phenomenon wasobserved in 1927 fallowing the high prevalence in 1926.In 1926-27 it was ascribed to the abnormally mild weatherin the last two months of 1926, but in the winter of1938-39- there was a very cold spell about Christmasfollowed by a very wet and cold January.The incidence of poliomyelitis in the early part of a

year seems to be an inconsistent guide to the probableincidence during the year. The following are someexamples:

Notifications (polimyelitis only)Year First quarter Whole year1925.. 72- .... 3711926.. 55 .... 11591938.. 71 .... 14891939.. 116 .... 7441944* .... 58 .... 4641945* .... 52 .... 7841946* .. ,. 83 .... 6061947 .. 102* .... 73501

* Corrected figures.t Estimated corrected figure.

MeaslesThe recent rise in notifications in England and Wales

has been disproportionate and somewhat out of rhythm.Although not explaining this trend, the pattern ofmeasles in the country makes the rise more easilyunderstood.

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Since general notification began in 1940 there havebeen four biennial periods, in each of which the mainepidemic peak came, in the early months of the secondyear, following a gradual rise during the whole of thefirst year. During each of the first three biennia thelast three months of the second year were periods ofsubepidemic level.At the present moment (the early part of the first

year of the fifth biennial period) figures are exceptionallyhigh, and the rate of increase is more rapid than at thecorresponding period in previous " even " years. Themain difference from previous periods seems to - bethe absence of the expected quiescent period in the lastmonths of 1947. A rise in incidence followed immediatelyupon the subsidence of the main 1947 epidemic, and acomparatively high level had already been attained bythe beginning of 1948. Present levels of incidence aregreatly in excess of those at the corresponding time in1946 in all parts of the country, the proportionate increasebeing greater in some districts than in others.There are two possibilities :1. That the present incidence is the beginning of a two-year

<’yole similar to the previous four and leading to an unprecedentedmaximum at the beginning of 1949. Against this are the factsthat (a) the rate of increase is more rapid than at the same stagein previous epidemics, (b) the rise began well before the beginningof the year, and (c) some counties have already passed their peakand begun to decline,

2. That present behaviour is unique since notification began,and that we are now approaching a maximum for the whole countryin the " even " year.

Forecasting what may now happen is largely guess-work. In 1946-47 certain towns (e.g., London, Sunder-land, and Liverpool) began early in 1946 and came to amaximum in the summer of that year, each havinga- further epidemic in the summer of 1947. Englandand Wales may possibly follow the lead of these towns,1. Annual Report of the Chief Medical Officer of the Ministry of

Health. 1938; p. 32.

in which case we can expect two maxima in 1948-49,one in the summer of each year. On the other hand,if a sufficiently large part of the country remains on therhythm of the winter-spring epidemic we may expectthe figures for the whole country to show two peaks,one in the summer of 1948 and the other early in 1949.

It seems inevitable that there will be a high incidencethis summer, and this may be welcomed as being likelyto reduce fatality even further.

In England NowA Running Commentary by Peripatetic CorrespondentsMy favourite patient dropped in this morning. Six

months ago she came to me because she was getting electricshocks all over the body whenever she touched water.For a good while she did pretty well on homoeopathicdoses of the irritating medium, tinged with gentianviolet and flavoured with menthol. She now feels betterthan she has done for years and is putting on weight, butshe still gets little shocks in the fingers when she washesclothes. I advised her to put a lighted candle by the sideof the tub, on the principle that the presence of fire shouldneutralise the evil elements in the water. She went offwell satisfied with the idea. We shall see.

* * *

Talking of burns, one very hot morning in July,1944, when we were in Normandy, a R.E.M.E. privatewas brought in to see us. He was clearly in much pain,and the cause was not difficult to find, for after removinghis trousers we observed that a large circular patch oferythema covered his buttocks. His trousers were noteven singed, which at first seemed odd, but when thepatient had overcome his modesty he explained how itall happened. In the early hours of the morning hehad been forced to make a rapid excursion to the latrines.While comfortably seated, he decided to spend thebrief period of solitude in meditation, so he lit a cigaretteand discarded the lighted match into the bowels of theearth. Great must have been his consternation whensheets of flame issued forth out of the darkness andplayed with such extraordinary fury upon the exposedpart of his anatomy that he was fairly severely burntbefore he could spring up. ,

.

We decided to investigate this sad affair, so after lunchwe sallied forth in the ambulance to the scene of the.crime. The officer commanding the unit sent withoutdelay for the orderly corporal, who told us, that thecamp was infested with a serious plague of flies, so beinga conscientious corporal he had decided that morning, tostart a blitzkrieg on their hide-outs. Having pouredpetrol down the latrines with the intention of settingfire to it immediately, he found that he had left hismatches behind in his pack. While he was searchingfor them our unfortunate patient unwittingly, butnevertheless efficiently, produced the required result.

* * *

The monstrous regiment of women has arrived in ourmedical college, and we have absorbed it with pleasureand without any troubles, other than structural diffi-culties arising from sep. tab. and baths h. & c.; in fact,they add a splash of colour, both to the laboratories andto the edges of the teacups. Our worst fears are unrealised.As we are well past the third month, without evidence ofdisaster, all is probably going to be well.

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But how will Cambridge take it ? Not that they areunused to women-I am thinking of the problem oftransferring the New Look to academic dress. They’llsneak out on the textile shortage, you mark my words.

* if *

Recently I was marking a case-history taken by astudent and found the following account of the patient’sprevious illnesses : " Chicken-pox aged 10, measlesaged 12, married aged 18, diphtheria aged 21." Soat last matrimony has been recognised as pathological.

* **

I was sorting out my kit after years of campaigningin the Tropics when a clinical photograph of a case ofyaws in an African babe dropped from a book. My wifepicked it up. - " What’s this ? " she inquired. " It’syaws," I replied. " It certainly is not," she saidindignantly.

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