806 culprits. One G .P . put it with devasting candour. The average family doctor does not understand social work in 1975 and hankers after "the good old da ys of the mental welfare officer or the almoner, rather as others complain of no servants or no longer getting the groceries delivered". The psychiatrists, after a preliminary-some might say ritualistic-complaint about the dearth of social workers with psychiatric training, readily entered into this spirit of co-operation, although not all may have grasped the implications of the radical changes being proposed. It was left to the Chief Medical Officer, Sir Henry Yellowlees, to spell them out. A shift in staffing priorities from the hospital and specialist services to the general-practice services, he hinted, may well represent a more economic and a more effective use of scarce resources. While psychiatry, in common with other medical specialties, clamours for more consultant posts, there are now clear signs that the Department is no longer convinced that an enlarged psychiatric service can deal adequately with the number, nature, and range of emotional disturbances currently presenting to general practitioners and social workers. This change in direction cannot, of course, be divorced from economic considerations. Consultant psychiatrists are more expensive than general practitioners, and social workers are cheapest of all. But , most unusually, the planners on this occasion can call on the findings of a substantial body of independent research in support of their contention. "Administrative and medical logic alike suggests that the cardinal requirement for improvement of the mental health services in this country is not a large expansion and proliferation of psychiatric agencies but rather a strengthening of the famil y doctor in his therapeutic role". This conclusion by Shepherd and his colleagues.' based on their well-known stud y and made almost a decade ago, was quoted and approved by the conference. We may be about to witness a classic example of the right thing being done for the wrong reason. Should this prove to be the case, further research will become imperative. A number of investigations, most of them done at the Institute of Psychiatry;":" have already testified to the need for and advantages of genuine multidisciplinary work between psychiatrists, social workers, and family doctors. If another bandwagon is about to roll-and there are clear omens-it should be possible for this one to travel on a relativel y well-eharted route, unlike some of its ill-fated predecessors. Nonetheless, attractive as the concept of multidisciplinary work at the pr imary health care level ma y seem, it still requires more painstaking inquiry and evaluation if it is to develop into something more substantial than a pious exhortation at the national level. Too little is known, for example, about how social workers and general practitioners identify and manage psychosocial problems, and next to nothing about the efficacy of their interventions. As for the psych iatrist, his role as a genuine consultant to group practice and social-service 4. Shepherd, M., Cooper, B., Brown, A. C., Kahon, G . W. Psychiatr ic Illness . in General Practice. London, t 966. 5. Fitzgerald, R. Update, 1970,2, 219. 6. Harw in, B. G., Cooper, B., Eastwood, M. R.• Goldberg, D. Lancet . 1970. ii, 559. 7. Cooper, B. ibid. 1970, i, 539. 8. Cooper, B., Sylph,]. Psycho!. M ed. 1973,4,421. 9. Cooper, 8., Harwin, B. G., Depla, C., Shepherd, M. Lancet. 1974, ii, 1356.
TH E LANC ET, OCTOB ER
25, 1975
department remains ill-defined and shadowy. As an editorial pointed out last year.!? "Nervous and mental diseases constitute, in Britain, a public-health problem far too great to be handled by the psychiatric specialists alone ". This conference represents an important step towards identifying the first use of the mult idisciplinary resources available for the ta sk.
CLASSIFYING GASTROENTERITIS VIRUSES D URING the past few years three morphologically different viruses have been isolated from the fseces of man and animals with gastroenteritis. The first of these isolates, the Norwalk agent, is a small virus, 27nm in diameter and resembling the parvoviruses and picornaviruses electron microscopically. This virus was found in association with gastroenteritis in human adults, and it produces the illness in volunteers. Although Norwalk agent is regarded as a parvovirus, on evidence presented at the International Congress for Virology in Madrid this conclusion is not very well founded . This year, another virus of the same size as the Norwalk agent but of different morphology has been found in association with gastroenteritis in infants. On the basis of its starshaped configuration in the electron microscope, C. R. Madeley and B. P. Cosgrove have proposed the name astrovirus. As with the Norwalk agent, there is not enough information to allow it to be classified. There is, however, considerably more information about the third group of gastrointestinal viruses . These are the reo-like viruses associated with diarrhoea in young children, calves, and piglets. There is good evidence that the viruses isolated from the calf and pig will cause the disease in those species and, although there is no direct evidence that the virus isolated from human pat ients will infect man, G. N. Woode and his colleagues have shown that the human virus will infect pigs. This close relationship between the viruses is underlined by their antigenic relatedness. Several names have been proposed for these viruses, largely on the basis of appearance. It now seems that the human and calf viruses contain a segmented, double-stranded R.N.A. genome similar to that possessed by the reovirus and orbivirus groups but differing enough from them to be designated as members of a related subgroup. Even so, the Madrid Congress thought it premature to assign a name to them until more information had been obtained on their ph ysico-ehemical characteristics. Our knowledge of the gastrointestinal viruses is clearl y insufficient to allow more than a tentative classification . The Norwalk agent is probably a parvovirus or a picornavirus, but the morphology of the astrovirus differs from that of other small viruses. The situation with the reovirus-like agents is less obscure, but even with these viruses more information is required before the y can be classified with certainty. The interesting antigenic relationship between the reo virus-like particles isolated from different species, and the general importance of these viruses and of the Norwalk and astroviruses in gastrointestinal disorders, is likely to lead to further efforts at classification. The culture and immunofluorescence work reported on p. 821 should be helpful. 10. ibid. 1974, ii, 1362.
TH E LANC ET, OCTOB ER
25, 1975
department remains ill-defined and shadowy. As an editorial pointed out last year.!? "Nervous and mental diseases constitute, in Britain, a public-health problem far too great to be handled by the psychiatric specialists alone ". This conference represents an important step towards identifying the first use of the mult idisciplinary resources available for the ta sk.
CLASSIFYING GASTROENTERITIS VIRUSES D URING the past few years three morphologically different viruses have been isolated from the fseces of man and animals with gastroenteritis. The first of these isolates, the Norwalk agent, is a small virus, 27nm in diameter and resembling the parvoviruses and picornaviruses electron microscopically. This virus was found in association with gastroenteritis in human adults, and it produces the illness in volunteers. Although Norwalk agent is regarded as a parvovirus, on evidence presented at the International Congress for Virology in Madrid this conclusion is not very well founded . This year, another virus of the same size as the Norwalk agent but of different morphology has been found in association with gastroenteritis in infants. On the basis of its starshaped configuration in the electron microscope, C. R. Madeley and B. P. Cosgrove have proposed the name astrovirus. As with the Norwalk agent, there is not enough information to allow it to be classified. There is, however, considerably more information about the third group of gastrointestinal viruses . These are the reo-like viruses associated with diarrhoea in young children, calves, and piglets. There is good evidence that the viruses isolated from the calf and pig will cause the disease in those species and, although there is no direct evidence that the virus isolated from human pat ients will infect man, G. N. Woode and his colleagues have shown that the human virus will infect pigs. This close relationship between the viruses is underlined by their antigenic relatedness. Several names have been proposed for these viruses, largely on the basis of appearance. It now seems that the human and calf viruses contain a segmented, double-stranded R.N.A. genome similar to that possessed by the reovirus and orbivirus groups but differing enough from them to be designated as members of a related subgroup. Even so, the Madrid Congress thought it premature to assign a name to them until more information had been obtained on their ph ysico-ehemical characteristics. Our knowledge of the gastrointestinal viruses is clearl y insufficient to allow more than a tentative classification . The Norwalk agent is probably a parvovirus or a picornavirus, but the morphology of the astrovirus differs from that of other small viruses. The situation with the reovirus-like agents is less obscure, but even with these viruses more information is required before the y can be classified with certainty. The interesting antigenic relationship between the reo virus-like particles isolated from different species, and the general importance of these viruses and of the Norwalk and astroviruses in gastrointestinal disorders, is likely to lead to further efforts at classification. The culture and immunofluorescence work reported on p. 821 should be helpful. 10. ibid. 1974, ii, 1362.
