1421 as an authority on tropical medicine and as a teacher of exceptional ability. He contributed valuable papers dealing with such diseases as smallpox and typhus and relapsing and cerebrospinal fevers. He also demonstrated the great value of iron in the treatment of the severe anaemia associated with hookworm disease, and participated in an important study on endemic fluorosis in South India. In recognition of his outstanding services in Madras he was appointed C.I.E. in 1942. On the grounds of indispensibility, the Madras Government vetoed a proposal that he be appointed consultant physician to the Army in India during the 1939-45 war. In 1945 McRobert was promoted colonel on appointment as inspectorgeneral of civil hospitals in Bihar Province, a post which he held until he retired from India. He was created knight bache-
reputation
lor in 1947.
After retirement from India, Sir George filled a number of important posts in the U.K. He was a member of the medical board at the Commonwealth Relations Office from 1947 to 1958, and medical adviser to the Secretary of State from 1958 to 1962. As senior consulting physician at the Hospital for Tropical Diseases in London he had responsibility for teaching tropical medicine. In addition to these exacting duties he served on the board of governors of University College Hospital and on the governing council of Epsom College. He was an enthusiastic and greatly respected fellow of the Royal Society of Tropical Medicine and Hygiene, which he served continuously for 45 years in various capacities. He also made valuable contributions to the British Encyclopcedia of Surgical Practice (1948) and to the 6th edition of Rogers’ and Megaw’s
G. M. writes: "Jacques Monod’s life
can best be described as a succession of challenges. During the Nazi occupation of France he became an active underground fighter; later he joined the de Lattre de Tassigny army and entered Germany. In 1945, he was offered a leading job in the Government of the French zone, but instead he joined the Pasteur Institute. He preferred to work in the laboratory, since the national challenge was over. The new challenge for him was to understand the functioning of a simple living cell like Escherichia coli--a challenge which led eventually to the introduction of entirely new concepts in genetics, such as allosteric effects, regulatory genes, repressors, corepressors, inducers, messengers, and
operons. "The next
major challenge Monod described thus: ’The ambition of Science is to elucidate the relation between man and the universe’. He projected upon Man and upon the world what he had discovered in the laboratory: ’Man knows that he is alone in the indifferent immensity of the universe from where he merged by chance’. This cold, unfriendly universe is described in his best-selling book Chance and Necessity. He believed in an ideal society, a socialist society, specifically scientific as opposed to the materialistic society of marxist doctrine. Jacques Monod’s last challenge was to attempt to rescue the old Pasteur Institute from financial disaster, but in this, sadly, he failed. He lost the battle, but, as always, he had needed to fight. ’In science’, he once said, ’self satisfaction is death ... It is restlessness, anxiety, dissatisfaction, agony of mind that nourish science.’ "
Tropical Medicine (1952). Sir George was a man of absolute integrity who enjoyed the respect and admiration of all who knew him. He
was
unfail-
ingly courteous, kind, helpful, and loyal to his friends and colleagues, but never hesitated to express his firmly held convictions in forthright terms. In 1919 he married Catherine Ellen Gregory, who died in 1969; his
son,
Ronald, died in 1944 while
He is survived hv htc twn daughters
nnp
a
medical student.
nf whnm is
Q
rlnrtnr
H.W.M.
JACQUES LUCIEN MONOD D.Sc. Paris
Prof. Jacques Monod, director of the Pasteur Institute prizewinner for his work on bacterial genetics, died on May 31 at the age of 66. After graduating from the University of Paris in 1931, he taught in the university’s zoology department until, in 1936, in Paris and Nobel
Rockefeller fellowship took him to the California Institute of for a year. He then returned to Paris, where he received his doctorate in natural sciences in 1941. In 1945 he joined the Pasteur Institute and soon became head of the department of microbial physiology. In 1957 he was appointed professor of metabolic chemistry at the University of Paris, and in 1971 he became director of the Pasteur Institute. During his early work on lactose utilisation in Escherichia coli, Monod became interested in the mechanisms which control the rate of synthesis of the enzymes involved in the lactose pathway. To study this further he joined forces with a colleague at the Institute, François Jacob, who was working on bacteriophage genetics; and together they successfully applied theories of genetic regulation of virus replication in lysogenic bacteria to the coordinated control of enzyme synthesis in bacteria. From this work they developed the concept of the "operon"-a genetic unit containing not only structural genes but also genes whose sole function was to regulate the activity of the structural genes. In 1965 this important work won for Monod and Jacob the Nobel prize for medicine, which they shared with another phage geneticist from the Pasteur Institute, André Lwoff. Professor Monod was a commander of the French Order of Merit and an officer of the Legion of Honour. a
Technology
Notes and News THE WHEN AND WHERE OF HEART-ATTACKS SEVEN months ago Tunstall Pedoe and his colleagues reported on a community study of acute myocardial infarction, based on a defined population in East London.’ This was part of a large collaborative project in nineteen communities, coordinated by W.H.O.’s Regional Office for Europe; the full report has just been published.2 The total population at risk was over 3t million, and countries from Eastern Europe joined
with those from the West and with Israel and Australia in supplying material. The design of the report follows the one from Tower Hamlets,’ but there is a lot more detail. The object of the exercise was to record the "natural history" of the coronary heart-attack from the moment of onset (and before where possible) to death or one-year follow-up. This goal has been achieved: we have a clear picture of myocardial infarction as it presents and evolves in Europe. The picture is not a particularly cheerful one-the proportion of early deaths, often before medical intervention has a chance to be effective, and the sometimes low percentage of patients able to return to full activity within a year being all too familiar. The community register is an epidemiological tool-the clinician may well say that there is nothing here that he did not know already-and the sometimes staggering differences in figures between the participating centres are certainly pointers for further epidemiological effort. The age-standardised attack-rate for males aged 20-64 varied five-fold between Helsinki (7-3 per 1000) and Erfurt in East Germany (1’4); one-year-survival rates ranged from 52.0% (Helsinki again) to 75.8% in Erfurt; in Lublin, Poland, only 19% of patients were back to full activity at one year while in Kaunas, U.S.S.R., this figure was 68%. Most patients had a history of, for example, previous myocardial infarction, angina, or hypertension; unfortunately prodro1. Tunstall
Pedoe, H., Clayton, D., Morris, J. N., Brigden, W., McDonald, L. Lancet, 1975, ii, 833.
2. Myocardial Infarction Community Registers. Distributed by Regional Office for Europe, Copenhagen, Denmark. 1976.
W.H.O.
1422 mal symptoms such as chest pain or tiredness in the four weeks before the attack were just as common in patients in whom the diagnosis of acute myocardial infarction was not confirmed. A formal programme of rehabilitation does not seem to have affected return to activity.
VALUE CONFLICTS IN SOCIAL WORK SOCIAL workers every day face situations where the need to take action compels them to decide between conflicting values and differing courses of intervention. The decisions affect not only the welfare of their clients, but such things as the allocation of restricted resources, relationships with other agencies, the direction of future policy, and the standing of their profession, and they are required, in some ways uniquely, to be aware of the larger implications of their actions and of the value bases on which they are made. The difficulties of training social workers for this kind of responsibility have been explored by a working-party set up by the Central Council for Education and Training in Social Work. In their report’ they point to a number of developments which have made their study particularly pertinent-the fact that social-work methods now include not only casework, but also such things as advocacy, behaviour modification, and group and community work; that many workers are questioning traditional casework principles as founded on a consensus view of society which no longer seems applicable; that workers increasingly wish their help to be offered on a basis of equality and unity of purpose with their clients; and that pressure on limited resources means that workers are compelled to make some very hard decisions. As a starting-point the working-party briefly discuss different views of human nature-Christian, Zen
Buddhist, Marxist, Kantian/liberal, mechanistic, psychoanalytic, and existentialist-and conclude that, while the value to which the social-work profession most often lays claim is that of respect for the person as an end, this by no means represents the ultimate value for all workers. Many of them find it impossible to ignore the social and political dimensions of their clients’ problems, and may turn to political or even revolutionary forms of intervention. A key question that social workers must put to themselves, therefore, is whether they are or should be agents of social change or agents of social control (or both). And they should go on to ask what is the source and nature of their authority; how far they can go in supporting alternative patterns of behaviour, particularly if they accept that their authority may derive from the wish of society as a whole to preserve norms of behaviour; how far they can be involved in social protest, and whether by protesting they are using clients to further their own political or religious beliefs; and at what point the claims of the individual supersede the claims of the community, and vice versa. Social-work teachers will find much useful guidance on how to help students work out their responses to questions such as these, and others will find in it much to provoke thought on the nature of contemporary society and its institutions.
number as at present on display in Euston Road. The rest will be housed at the Science Museum’s store at Hayes, Middlesex, where they will be accessible for study. A separate department for the history of medicine will be set up in the museum. The department will maintain close links with the Wellcome Institute, especially for advice on updating the collection. New staff will be recruited, one of whom will fill an academic post financed by the Wellcome Trustees. The Wellcome Trustees have also offered jC150 000 over five years for cataloguing and conservation of the collection. The Wellcome Institute library will remain at Euston Road, to be developed as an international centre for postgraduate academic research. Researchers requiring both objects from the museum and material from the library will be permitted to study both at either the museum or the library. The collection itself will also remain open to the public at Euston Road while the new department is being set up at the museum.
University of Cambridge Dr M. J. Hare has been appointed gynaecology.
lecturer in obstetrics and
University of Southampton Mr
J. R. Shearer has been appointed
to
the chair of orth-
opaedic surgery. Mr Shearer, who is 34, graduated M.B. from the University of Aberdeen in 1966 and PH.D. in 1975; he became F.R.C.S.E. in 1971. He was Anderson and Thompson research fellow in surgery at Aberdeen University before taking up an M.R.C. junior research fellowship in 1969. In 1970 he was appointed surgical registrar to the Aberdeen General Hospitals, and since 1972 he has been senior orthopaedic registrar to the Grampian Area Health Board and clinical lecturer in orthopaedic surgery at the University of Aberdeen. For the past year he has been seconded as lecturer in onhopaedic surgery to the Nuffield Orthopaedic Centre at Oxford.
Association of Psychiatrists in Training An open forum on communication skills is being held by the Association at 4.30 P.M. on Tuesday, July 6, at the Royal Society of Medicine, 1 Wimpole Street, London Wl. Details may be had from Dr John Cobb, Maudsley Hospital, Denmark Hill, London SE5 8AZ.
Diary of the Week JUNE 27
TO
JULY 3
Monday, 28th WELLCOME HOME THE Wellcome collection for the history of medicine is to be presented on long-term loan to the Science Museum. It will form the basis of a new national collection for the history of to be shown in the top floor of an extension to the which will be completed in June, 1977. However, the exhibits will not be on show to the public for 3 or 4 years, and then no more than five thousand of the quarter-of-a-million items in the collection will be on display, about the same
CARDIOTHORACIC INSTITUTE, Brompton Hospital, Fulham Road, London SW3 6HP. 5.15 P.M. Dr John Scadding: Drowning. Dr John Moxon: Sarcoidosis or
Tuberculosis? DERMATOLOGY, St. John’s Hospital for Diseases of the Skm, Lisle Street, Leicester Square, London WC2H 7BJ Dr D. M. S. Dane: Virus Diseases of the Skin.
INSTITUTE 5
P.M.
OF
medicine
Wednesday, 30th
museum
NORTHWICK PARK HOSPITAL, Watford Road, Harrow, Middlesex HA1 3UJ 1 P.M. Mr Peter Rudge: Parkinsonism. ROYAL FREE HOSPITAL, Pond Street, Hampstead, London NW3 2QG 5 P.M. Dr R. A. Smallwood (Melbourne): The Physiological Properties of Bile Acids-Detergency is not Enough
Thursday, 1. Values in Social Work. A discussion paper produced by the Working Party on the Teaching of the Value Bases of Social Work. Central Council for Education and Training in Social Work, Clifton House, Euston Road,
London NW1
2RS. £1·50.
UNIVERSITY 4.30 P.M.
1st
OF
LONDON
(King’s College Hospital Medical School, Denmark Hill, SE5.) Prof. R. E. Herron (Houston): Shapes and Images in Medicine and Dentistry
reputation
lor in 1947.
After retirement from India, Sir George filled a number of important posts in the U.K. He was a member of the medical board at the Commonwealth Relations Office from 1947 to 1958, and medical adviser to the Secretary of State from 1958 to 1962. As senior consulting physician at the Hospital for Tropical Diseases in London he had responsibility for teaching tropical medicine. In addition to these exacting duties he served on the board of governors of University College Hospital and on the governing council of Epsom College. He was an enthusiastic and greatly respected fellow of the Royal Society of Tropical Medicine and Hygiene, which he served continuously for 45 years in various capacities. He also made valuable contributions to the British Encyclopcedia of Surgical Practice (1948) and to the 6th edition of Rogers’ and Megaw’s
G. M. writes: "Jacques Monod’s life
can best be described as a succession of challenges. During the Nazi occupation of France he became an active underground fighter; later he joined the de Lattre de Tassigny army and entered Germany. In 1945, he was offered a leading job in the Government of the French zone, but instead he joined the Pasteur Institute. He preferred to work in the laboratory, since the national challenge was over. The new challenge for him was to understand the functioning of a simple living cell like Escherichia coli--a challenge which led eventually to the introduction of entirely new concepts in genetics, such as allosteric effects, regulatory genes, repressors, corepressors, inducers, messengers, and
operons. "The next
major challenge Monod described thus: ’The ambition of Science is to elucidate the relation between man and the universe’. He projected upon Man and upon the world what he had discovered in the laboratory: ’Man knows that he is alone in the indifferent immensity of the universe from where he merged by chance’. This cold, unfriendly universe is described in his best-selling book Chance and Necessity. He believed in an ideal society, a socialist society, specifically scientific as opposed to the materialistic society of marxist doctrine. Jacques Monod’s last challenge was to attempt to rescue the old Pasteur Institute from financial disaster, but in this, sadly, he failed. He lost the battle, but, as always, he had needed to fight. ’In science’, he once said, ’self satisfaction is death ... It is restlessness, anxiety, dissatisfaction, agony of mind that nourish science.’ "
Tropical Medicine (1952). Sir George was a man of absolute integrity who enjoyed the respect and admiration of all who knew him. He
was
unfail-
ingly courteous, kind, helpful, and loyal to his friends and colleagues, but never hesitated to express his firmly held convictions in forthright terms. In 1919 he married Catherine Ellen Gregory, who died in 1969; his
son,
Ronald, died in 1944 while
He is survived hv htc twn daughters
nnp
a
medical student.
nf whnm is
Q
rlnrtnr
H.W.M.
JACQUES LUCIEN MONOD D.Sc. Paris
Prof. Jacques Monod, director of the Pasteur Institute prizewinner for his work on bacterial genetics, died on May 31 at the age of 66. After graduating from the University of Paris in 1931, he taught in the university’s zoology department until, in 1936, in Paris and Nobel
Rockefeller fellowship took him to the California Institute of for a year. He then returned to Paris, where he received his doctorate in natural sciences in 1941. In 1945 he joined the Pasteur Institute and soon became head of the department of microbial physiology. In 1957 he was appointed professor of metabolic chemistry at the University of Paris, and in 1971 he became director of the Pasteur Institute. During his early work on lactose utilisation in Escherichia coli, Monod became interested in the mechanisms which control the rate of synthesis of the enzymes involved in the lactose pathway. To study this further he joined forces with a colleague at the Institute, François Jacob, who was working on bacteriophage genetics; and together they successfully applied theories of genetic regulation of virus replication in lysogenic bacteria to the coordinated control of enzyme synthesis in bacteria. From this work they developed the concept of the "operon"-a genetic unit containing not only structural genes but also genes whose sole function was to regulate the activity of the structural genes. In 1965 this important work won for Monod and Jacob the Nobel prize for medicine, which they shared with another phage geneticist from the Pasteur Institute, André Lwoff. Professor Monod was a commander of the French Order of Merit and an officer of the Legion of Honour. a
Technology
Notes and News THE WHEN AND WHERE OF HEART-ATTACKS SEVEN months ago Tunstall Pedoe and his colleagues reported on a community study of acute myocardial infarction, based on a defined population in East London.’ This was part of a large collaborative project in nineteen communities, coordinated by W.H.O.’s Regional Office for Europe; the full report has just been published.2 The total population at risk was over 3t million, and countries from Eastern Europe joined
with those from the West and with Israel and Australia in supplying material. The design of the report follows the one from Tower Hamlets,’ but there is a lot more detail. The object of the exercise was to record the "natural history" of the coronary heart-attack from the moment of onset (and before where possible) to death or one-year follow-up. This goal has been achieved: we have a clear picture of myocardial infarction as it presents and evolves in Europe. The picture is not a particularly cheerful one-the proportion of early deaths, often before medical intervention has a chance to be effective, and the sometimes low percentage of patients able to return to full activity within a year being all too familiar. The community register is an epidemiological tool-the clinician may well say that there is nothing here that he did not know already-and the sometimes staggering differences in figures between the participating centres are certainly pointers for further epidemiological effort. The age-standardised attack-rate for males aged 20-64 varied five-fold between Helsinki (7-3 per 1000) and Erfurt in East Germany (1’4); one-year-survival rates ranged from 52.0% (Helsinki again) to 75.8% in Erfurt; in Lublin, Poland, only 19% of patients were back to full activity at one year while in Kaunas, U.S.S.R., this figure was 68%. Most patients had a history of, for example, previous myocardial infarction, angina, or hypertension; unfortunately prodro1. Tunstall
Pedoe, H., Clayton, D., Morris, J. N., Brigden, W., McDonald, L. Lancet, 1975, ii, 833.
2. Myocardial Infarction Community Registers. Distributed by Regional Office for Europe, Copenhagen, Denmark. 1976.
W.H.O.
1422 mal symptoms such as chest pain or tiredness in the four weeks before the attack were just as common in patients in whom the diagnosis of acute myocardial infarction was not confirmed. A formal programme of rehabilitation does not seem to have affected return to activity.
VALUE CONFLICTS IN SOCIAL WORK SOCIAL workers every day face situations where the need to take action compels them to decide between conflicting values and differing courses of intervention. The decisions affect not only the welfare of their clients, but such things as the allocation of restricted resources, relationships with other agencies, the direction of future policy, and the standing of their profession, and they are required, in some ways uniquely, to be aware of the larger implications of their actions and of the value bases on which they are made. The difficulties of training social workers for this kind of responsibility have been explored by a working-party set up by the Central Council for Education and Training in Social Work. In their report’ they point to a number of developments which have made their study particularly pertinent-the fact that social-work methods now include not only casework, but also such things as advocacy, behaviour modification, and group and community work; that many workers are questioning traditional casework principles as founded on a consensus view of society which no longer seems applicable; that workers increasingly wish their help to be offered on a basis of equality and unity of purpose with their clients; and that pressure on limited resources means that workers are compelled to make some very hard decisions. As a starting-point the working-party briefly discuss different views of human nature-Christian, Zen
Buddhist, Marxist, Kantian/liberal, mechanistic, psychoanalytic, and existentialist-and conclude that, while the value to which the social-work profession most often lays claim is that of respect for the person as an end, this by no means represents the ultimate value for all workers. Many of them find it impossible to ignore the social and political dimensions of their clients’ problems, and may turn to political or even revolutionary forms of intervention. A key question that social workers must put to themselves, therefore, is whether they are or should be agents of social change or agents of social control (or both). And they should go on to ask what is the source and nature of their authority; how far they can go in supporting alternative patterns of behaviour, particularly if they accept that their authority may derive from the wish of society as a whole to preserve norms of behaviour; how far they can be involved in social protest, and whether by protesting they are using clients to further their own political or religious beliefs; and at what point the claims of the individual supersede the claims of the community, and vice versa. Social-work teachers will find much useful guidance on how to help students work out their responses to questions such as these, and others will find in it much to provoke thought on the nature of contemporary society and its institutions.
number as at present on display in Euston Road. The rest will be housed at the Science Museum’s store at Hayes, Middlesex, where they will be accessible for study. A separate department for the history of medicine will be set up in the museum. The department will maintain close links with the Wellcome Institute, especially for advice on updating the collection. New staff will be recruited, one of whom will fill an academic post financed by the Wellcome Trustees. The Wellcome Trustees have also offered jC150 000 over five years for cataloguing and conservation of the collection. The Wellcome Institute library will remain at Euston Road, to be developed as an international centre for postgraduate academic research. Researchers requiring both objects from the museum and material from the library will be permitted to study both at either the museum or the library. The collection itself will also remain open to the public at Euston Road while the new department is being set up at the museum.
University of Cambridge Dr M. J. Hare has been appointed gynaecology.
lecturer in obstetrics and
University of Southampton Mr
J. R. Shearer has been appointed
to
the chair of orth-
opaedic surgery. Mr Shearer, who is 34, graduated M.B. from the University of Aberdeen in 1966 and PH.D. in 1975; he became F.R.C.S.E. in 1971. He was Anderson and Thompson research fellow in surgery at Aberdeen University before taking up an M.R.C. junior research fellowship in 1969. In 1970 he was appointed surgical registrar to the Aberdeen General Hospitals, and since 1972 he has been senior orthopaedic registrar to the Grampian Area Health Board and clinical lecturer in orthopaedic surgery at the University of Aberdeen. For the past year he has been seconded as lecturer in onhopaedic surgery to the Nuffield Orthopaedic Centre at Oxford.
Association of Psychiatrists in Training An open forum on communication skills is being held by the Association at 4.30 P.M. on Tuesday, July 6, at the Royal Society of Medicine, 1 Wimpole Street, London Wl. Details may be had from Dr John Cobb, Maudsley Hospital, Denmark Hill, London SE5 8AZ.
Diary of the Week JUNE 27
TO
JULY 3
Monday, 28th WELLCOME HOME THE Wellcome collection for the history of medicine is to be presented on long-term loan to the Science Museum. It will form the basis of a new national collection for the history of to be shown in the top floor of an extension to the which will be completed in June, 1977. However, the exhibits will not be on show to the public for 3 or 4 years, and then no more than five thousand of the quarter-of-a-million items in the collection will be on display, about the same
CARDIOTHORACIC INSTITUTE, Brompton Hospital, Fulham Road, London SW3 6HP. 5.15 P.M. Dr John Scadding: Drowning. Dr John Moxon: Sarcoidosis or
Tuberculosis? DERMATOLOGY, St. John’s Hospital for Diseases of the Skm, Lisle Street, Leicester Square, London WC2H 7BJ Dr D. M. S. Dane: Virus Diseases of the Skin.
INSTITUTE 5
P.M.
OF
medicine
Wednesday, 30th
museum
NORTHWICK PARK HOSPITAL, Watford Road, Harrow, Middlesex HA1 3UJ 1 P.M. Mr Peter Rudge: Parkinsonism. ROYAL FREE HOSPITAL, Pond Street, Hampstead, London NW3 2QG 5 P.M. Dr R. A. Smallwood (Melbourne): The Physiological Properties of Bile Acids-Detergency is not Enough
Thursday, 1. Values in Social Work. A discussion paper produced by the Working Party on the Teaching of the Value Bases of Social Work. Central Council for Education and Training in Social Work, Clifton House, Euston Road,
London NW1
2RS. £1·50.
UNIVERSITY 4.30 P.M.
1st
OF
LONDON
(King’s College Hospital Medical School, Denmark Hill, SE5.) Prof. R. E. Herron (Houston): Shapes and Images in Medicine and Dentistry
