7
1975
567 567
JUNE 1975 JOURNAL 7 JUNE BRITISH MEDICAL JOURNAL
BRITISH MEDICAL
NEWS
AND
NOTES
EPIDEMIOLOGY Epidemic Keratoconjunctivitis in The following notes are compiled by the Epidemiological Research Laboratory 'of the Public Health Laboratory Senrice frtom treports submitted by public health and hospital laboratories tin the United Kingdom and Republic of Ireland.
a
Factory
examined grew adenovirus type 8. Tlhe interval between the onset of symptoms and the da,te,s the swabs were taken varied from one day to one monith, thougth 75 % of the swabs, including all those from vvhich virus was isolated, were taken within one week of onset. Con-valescent sera taken at least three weeks after onset were collected from 40 patients. In addiition, acute-phase sera, taken within one week of onset, were available from nine of them. Complement fixation tests were done on these specimens, but 17 (42-5 O) had no detectable adenovirus antibody three weeks after infection, even though adenovirus type 8 had been isolated -from four of these individuals. Only two of the nine paired sera showed a four-fold rise in titre; virus had been isolated from both these patients. The maximum complemenit fixation titre recorded was 40, and this was in one patient only. However, 'haemragglutination inihibiltion tests were not performed on those sera. Adenovirus type 8 has a recognized association with epidemic keratoconjunctivitis among workers in heavy industry,' parti-
cularly shipyards. Much of the work carried out in the factory in which the oiutbreak occurred is similar in type to that in shipyards, and there is also a relatiwvely high incidence of eye injuries. In the early stages of the outbreak the cases were treated at the factory. However, the sister-in-charge of the treatment room became infected early in the course of the outbreak and withdrew from duty. After this no further eye treatment was given ait the factory during the outbreak, and patients were refeTrred to the eye clinic at the local general hospital or to their family doctor. It is possible that, at the beginning of the outbreak, transmission in the treatment room at the factory may have accounted for a few cases, but this does not account for the majority of cases in the outbreak. Roller towels in the various departments of the factory may have played an important part in the spread of infection, since it was only after they were replaced by diosable paper towels that the outbreak began to subside.
However, it is not only buildings used for such purposes and belonging to local health authorities and voluntary organizations which are exempt. Sub-section 45 (d) of the Act exempts structures similar to (those referred to in the rest of the section, but not com,ing under ithose iheadings because tihey are owned or have been supplied otherwise than as mentioned. That, at any rate, is the barest precis of the section solicitor, disabled by poliomyelitis, living whose drafting is decidedly obscure. with his family in a flat in West London specially adapted to his needs. The appeal turned on section 45 of the Facts of Case General Rate Act 1967, which provides that itn fixing the rateable value of a heredita- Mr. Vandyk, ithe ratepayer, has been ment no account shall be taken of "struc- paralysed in both legs and his left arm tures" belonging to local health authorities since 1947, and is confined to a wheel-chair. or voluntary organizations foTmed for the His flat wals chosen because of its suitability purposeS3 of preventing illness or for the for the disabled (its central heating and care or after-care of sufferers from ilness wide doors), but even then numerous and supplied for the use of such persons. alterations were made. The bathroom was The section also exempts structures set up enlarged and the floor-level altered to by local health authorities or voluntary facilitate getting in and out of the bath. The organizations for the welfare4 of the blind, wash-basin in his bedroom was lowered so that he could wash from hiis wheel-chair, deaf, dumb or otherwise handicapped.
and belb-pushes were inistalled throughout the house. These changes were important, for they enabled Mr. Vandyk to counter the valuation officer's argument (which in the event appealed to one member of the court) that to grant relief in this case would involve an extension of the General Rate Act 1967 far beyond Parliament'is intention. Lord Justice Cairns tried to still the Revenlue s fears that every occupier of a house or flat will be able to claim relief, if he or a member of his family is or has been ill and needs care or after-care. He said that the physical characteristics of the structure were important: with Mr. Vandyk'ls flat it was criitical thait "it was chosen because it had speial features making it suitable to provide for the needs of a person who required after-care and was adapted and equipped to imrprove its suitability for those
An outbreak of keratoconjunctivitis occurred in a midland city in the autumn of 1974, when a total of 67 cases were recorded within a seven-week period starting in late September. Of the persons affected 61 were employees in a large boiler-making factory, and the remining six cases were close family contacts. The conjunctival infection, which wais mostly unilateral, was not associated with upper respiratory tract disease, fever, or constitutional upset. Conjunctival swabs were taken from 55 patienits. All specimens were inoculaited into rhesus monkey, HeLa, and human amnion tissue cultures and incubated at 33'C and 37°C, but all failed to yield virus. However, human embryo kidney cultures were available at the Virus Reference Laboratory alt Col,indale, in which 13 of 21 specimens
1 Jawetz, E., British Medical Yournal, 1959, 1, 873.
MEDICOLEGAL Rates and Disablement FROM OUR LEGAL CORRESPONDENT
In a judgement of the greatest importance for disabled ratepayers the Court of Appeal has heldl 2 that where premises are used for ,the care or after-care of persons suffering from illness (or for looking after the blind, deaf, dumb or otherwise disabled), and are supplied accordingly, the occupier is entitled to rating reLief on the same basis as relief is given to special institutions for the disabled. The successful ratepayer was a
pusposes." The Lord Justice dismissed the argument that for rating relief to be granted the ratepayer must show that the provision of the flat was for the primary purpose of after-
BRITISH MEDICAL JOURNAL 7 JUNE 1975
568 care rather than for a residence for his family. No adjective in the lelation, he pointed out, qualified the word "purpose." Nor did it nusser if the structure was not similar to structures acualUy provided by the locl healh authority. it wuas sufficient if there was a simiAarity to structes which
tihe local
health authority couild provide under its powers. To Lord Justice Inwton a simpler argument appealed: had Mr. Vandyk not nade an effort to overcome his disabilities, be would have been in a insitution. Such a place would unquestionably not have been
PARLIAMENT Medical Schools The Secretary of State for Education and Science, Mr. R. PRENTICE, was asked in the Commons on 20 May whe'ther in view of the current shortage of British-4bomn doctors he would make steps to encourage medical schools to relax the entrnce qualifications for Britisih-born students in line wiith the requirements expected from non-ntiona medical students. In a written reply, Mr. Prentice said tat no wedical school laid down entrance requirements whidh were more Academic Year of Admission 1972-3 19734 1974-5
Overseas Candidates
Applicants
Applicaants Refuseed
1903 2156 2257
2048 2169
Total
I-l -I-
1812
severe for British-born students than for others. He gave the nunmer of candidates applying through the Universties Central Council on Admissions (U.C.C.A.) for entry to medical schools in the United Kingdom, and the number refused, together wi,th information from the University Grants Committee about the percentage of overseas students attending medical schools in the United Kingdom:
United Kingdom Candidates Applicants Total Refused Applicants 9274 10 759 10 746
6442
7809 7875
-
Percentage of Overseas Students in all Medical Schools in the United Kingdom
-1
3-7 3-6 Not yet available
rated. Why then should he be rated if he provided himself with the same facilities and acconnodation which a local authority was bound to provide, but at no cost to it? The ratepayers flat ought to be assessed on the same basis for relaef as the institution. The thrd member of the court, Mr. Justice MacKenna, disagreed, finding in the obscurity of the section some support for his belief that Parliament cannot have intended so extravagant a result as every house and flat in the country where people receive care or after-care for illness being, as to its structure, exempt from rates. The matter of Mr. Vandyk's flat is now to go to the Lords, though on terms that the Revenue pay all his legal costs. What interpetation the House wvll give to ithe section and whether they wil be unanimous must be extremely uncertain. They may even decide to take the middle course and give relief to the roons specially adapted to Mr. Vandyk's needs but not to the whole of the flat. Before the conclusion of the appeal and as soon as possible, doctors ought to prompt disabled rtepayers to apply to their local valuation officer to alter their rateable value, since ithe new value will only be backdated ,to the date of the application and not beyond. 1 The Times, 11 February 1975. 2 (1975) 2 W.L.R. 797. 3 As defined by section 28(1) National Health Service Act 1946 as amended by section 12 Health Services and Public Health Act 1968. 4 As defined by section 29(1) National Assistance Act 1948.
MEDICAL NEWS Temporary Registration: Tests for Overseas Doctors
From 1 June 1975 onwards the General Medical Council states that it will not normally be prepared to grant temporarY registration for the first time to any doctor from overseas unless, in addition to holding a qualifiction whidh is recognzed for tem, porary registration, he has passed the test of proficiency in the English langage and of professional knowledge and competence. These tests will be conducted, on behalf of the Conil, by the Temporary Registration Assessment Board established for the purpose by the non-university lcening bodies in the United Kingdonm The Council has reaffrmed that the standard of professional competence required to pass these tests will be equivalent to that attested by the grant of full registration to a British qualified doctor; that is to say to the standard reached by a doctor wbo has passed a qualifying examination for a British primry medical qualification and thereafter satisfactorily comleted a year as a resident house offioer in an approved hospital.
Pay Beds Cut by 10%
about 430 fewer pay beds from 1 July, affecting just over 100 hospitals. In hospitals wilh six or more pay beds the number alloowed in future will depend on how nany were actualiy used during 1972 and 1973. If less thn three-fiths were used there will be an overall cut of 20%. If only twoAifths or less were used the reduction will be substantially greater. No 'hospi-tal willi be affected in which the numnber of pay beds actually in use during those two years exceeded 60% of the hospitals available pay
affecting the socal health services. In 1974 there was a severe decline in world food reserves. Food prices rocketed and several large countries introduced rationing. Mass hunger precipitated political unrest in some oountries, and in several of the developing countries malnutrition caused a severe setback to their economic and social
public spending
progress. planning, constitute gra s,
Human
reproduction,
family
and population dynamics now one of W.H.O.'6s lagest proaccording to its Director-General.
beds. Conservative Medical Society A society of medical and other professional people in the heal-th -services has been formd under the aegis of the Conservative Party to provide a forum for the exchange of views between Conservatives in the health field and to inform the public of current attitudes of health workers; 'to collect evidence for committees examining the N.H.S.; and to set up discussion and research groups on policy. Further details may M.P., comnmissioned. The survey gave enthusiastic be obtained from Dr. G. F. Vaughan, support for the preparation of a full sub- at the House of Commons, London S.W.1. nu,ssion.
Medical School at Keele Keele University believes it should again submit to the University Grants Conxnittee its case for the establishment of a medical school. The univerity recently invited Sir Melvile Arnott, of Birmingham University, assisted by other professorial colleagues from Birmingham Medical School, to conduct a preliminary survey to establish whether a full study of the project should be
Royal College of Radiologists
Barbara Castle has announced a cut of Work of World Health Organization The Royal College of Radiologists held an about 10% in the number of pay beds in N.H.S. ospijtals. The cuts, which are Acording to th,e 1974 annual report of the Inaugural Day on Friday, 6 June. A service separate from the Government's prposals Director-General of the World Health of dedication was held at S,. Clement Danes to phase out private practioe from N.H.S. OrganiaDn sooeconomic malaise in the Church, followed by an inaugural lecture hospitals (10 May, p. 347) have been liited industrial countres has had repercussions by Dr. Robert Moseley, prsident of the to hospitls in wihdch there has been con- on develDp'ing countries. In some countries Amenrican College of Radiology, on "Whither sidemble under-occupation. There will be iflation had led to a severe cutback in Radiology." The celebrations ended with Mrs.
BRITISH MEDICAL JouRNAL
7 JUNE 1975
dinner at Quaglino's with Professor Howard Middeniiss, president, in the chair. Guests included The Rr. Hon. Lord and Iady Robens of Woldingham, Lord and Lady Hunit of Fawley, and thfe presidents of the other royal colleges.
Precarious Balance The "mouniting global concern over the precarious balance between population growth and the world's sace and resourcee" prompted the World Medical Associaition and other bodies to join in a conference at Stockbolm last autum on "The Physician and Population Change." A report of the proceedigs of the conference has now been pblished as Population Change: A Strategy for Physicians. Contributors to it discuss the role and attitudes of physicians, the role of medicl associations, and family pianning services. Copies ($3 post free) from: World Federation for Medical Education, One Dupont Circle, Suite 201, Washington, D.C. 20036, U.S.A. Professor of Psychological Medicine, London Dr. R. H. Cawley has been appointed to the chair of psychologcal medicine at King's College Hospital Medial Scwol and the Institute of Psychiatry. Dr. Oawley, who is 50, graduated fromn Birmingham University, gning his B.Sc. in 1947, P&hD. in 1949, and M.B., Ch.B. in 1955. He went on to DiP.M. in 1959, M.R.CJP. in 1966, and F.R.CPsOych. in 1971. After house appointments in Birmingbam and London, Dr. Cawley was appointed clinical lectuer at the Institute of Psychiatry in 1960, senior lecturer and first assistant in e University of Birmingham in 1962, consultat psychiatrist to the BEklem Royal and Maudsley bospitals in 1967, and first assistant in die Deprtment of Psychiatry in 1969. From 1971 to 1972 Dr. Cawiley was sub-dean and senlior dlinical tuitor in the Institute of Aydhiatry.
569 H. V. R. Jones, Young People's Unit, Whitchurch Hospital, Cardiff, CF4 7JG. (Tel. 0222 62191 ext. 118.) Oxford Ophthalmological Congress.-7-9 July, Oxford. Details from the honorary secretary, Mr. W. Martin Walker, 609 Warwick Road, Solihull, West Midlands B91 lAP. Association of Psychiatrists in Training.Debate "Tomorrow's Psychiatrists," 8 July, London. Details from Dr. Julian Bird, Maudsley Hospital, Psychological Treatment Unit, 99 Denmark Hill, London SE5 8AZ. (Tel. 01-703 5411 ext. 139.) Institute of Religion and Medicine.-Annual Assembly and conference "Education for Wholeness," 8-10 July, Exeter University. Details from the organizing secretary, Institute of Religion and Medicine, St. Mary Abchurch Vestry, Abchurch Lane, London EC4N 7BA. (Tel. 01-626 0306.) National Association of Maternal and Child Welfare.-Annual conference, on the theme "Food and the Family," with address by Dr. David Owen, Minister of State for Health, 8-10 July, York University. Details and application forms from the general secretary, N.A.M.C.W., Tavistock House North, Tavistock Square, London WC1H 9JG. (Tel. 01-387 1874.) 18th Annual Scientific Assembly of the College of Family Physicians of Canada.10-14 August, Vancouver, Canada. Details from Mr. G. A. Ackehurst, Director of Communications, College of Family Physicians, 4000 Leslie Street, Willowdale, Ontario M2K 2R9, Canada.
Branch and Division Meetings to be Held Members proposing to attend meetings marked* are asked to notify in advance the honorary secretary concerned.
Greenwich Division.-At Woodlands, Vanbrugh Hill, Saturday, 14 June, 7.30 p.m., barn dance.* Shropshire and Mid-Wales Division.-At Copthorne Hospital, Thursday, 12 Tune, 8.15 p.m., open meeting followed by film: "Vascular and Tubercular Organization of the Kidney." Rotherham Division.-At Slacks Farm, Bramley, Saturday, 14 June. 8.30 p.m., summer barbecue.
UNIVERSITIES AND COLLEGES
SOCIETIES AND LECTURES
ROYAL COLLEGE OF RADIOLOGISTS At a ceremony hlxd on 16 May the president, Professor Howard Middlemiss, admitted Dr. C. Alexander of New Zealand as an Honrary Fellow. The following were admitted as Fellows without examination.-W. H. Bond, F. 0. Brown, W. Campbell, J. H. E. Carmichael, L. S. Carstairs, P. T. Chtopping, W. P. Cockshott, J. 0. Y. Cole, D. H. Cummack, Vera M. Daly, D. K. L. Davies, R. J. Dickson, A. A. Donaldson, Patricia P. Franblyn, A. W. G. Goilden, I. R. S. Gordon, R. I. Green, G. L. Gryspeerdt, S. Haase, H. Herlinger, R. D. Hoare, F. H. Howarth, A. R. Lyons, V. R. McCready, D. J. Mitchell, W. M. Mum, G. A. Newsholme, R. D. S. Rhys-Lewis, D. K. Sambrok, J. L. Steven, A. M. Stewart, W. C. Swanson, J. L. G. Thomson, R. J. Walton. The following were admitted as Fellows after examination.- T. T. Aye, A. P. Baytias, J. P. Bottomley, C. H. Brown, J. D. K. Brown, K. A. Brownlie, M. Dalziel, E. Dillon, A. Dinath, S. A. EI-Badawy, R. A. Fawcitt, J. R. Fulerton, P. W. Gill, R. Gopal, C. A. Grafton, Catherine A. Heller, G. Hussain, Pamela A. Jones, P. F. Joyce, R. U. Khan, P. T. King, D. P. E. Kingsley, 0. M. E. Koriech, Rita M. Linggood, R. G. Lovett, G. T. MaCreath, Elisabeth A. Macdonald, L. G. Maddock, L. J. Peters, C. S. B. Roch-Berry, A. Smith, H. M. Warenius.
For attending lectures marked * a fee is charged or a ticket is required. Applicatitm should be made first to the institution concerned.
APPOINTMENTS
Monday, 9 June CIBA FOUNDATION.-At Royal College of Physicians of London, 5 p.m., Professor G. Mathe: Ten Years of Immunotherapy in Leukaemia and Cancer: Pharmacology, Indications, Results, and Perspectives.
NoRTH-EAsT THAs R.H.A.-The following consultants have been apointed: Mr. M. Sinh (urology); Dr. J. M. Aitken (medicine); Dr. E. M. Blshamma (radiology); Dr. K. S. Perinpansyagam (adolesoent psychiatry). NORTH-WEST THAMES R.H.A.-Mr. J. S. Kenefick (consulant in general surgery and vascular surgery).
Wednesday, 11 June INSTITUTE OF PSYCHIATRY.-5.30 p.m., Dr. M. Selignan (U.S.A.): Depression + Learned Helplessness. ROYAL COLLEGE OF PSYCmATRISTS.-At Royal Corrections Society of Medicine, 8.15 p.m., Dr. Isaac Marks: New Developments in the Treatment of Obsessive Hormone Patterns in Anorexia Nervosa Compulsives. ROYAL POSTGRADUATE MEDICAL ScHOOL.-2 p.m., In the leading artide on this subject (12 April, Dr. I. Whimster: Pigmented Skin Tumours. WESTMINSTER MEDICAL ScHooL.-At Queen Mary's p. 52) reference 10 should read "Palmer, R. L., Hospital, 4 p.m., teach-in: Limb Loss-Diffi- et al., oumrnal of Endocrinology, 1974, 63, 32p." cusities and Their Amelioration. In the subsequent letter from Mr. B. Alderman and Mr. M. F. Burke (17 May, p. 392) the fourth
Cost of Prescnptions The average cost of NHS. presciptions was 101 3p in 1974, said Dr. David Owen Thursday, 12 June in a written reply to a recent parliatnentary ROYAL COLLEGE OF SURGEONS OF ENGLAND.-At Insti,tute of Ophthamology, 3 p.m., Edridgequestion. Tis conpared with 67-2p in Green lecture by Professor Harris Ripps: Night Blindness and Retinal Mechanisms of Visual 1970 and 88-2p in 1973.
COMING EVENTS Royal Free Hospital.-Meeting "Clinical Genetics of Liver Disease," 13 June, London. Details from Professor Sheila Sherlock, Royal Free Hospital, Pond Street, Hampstead, London NW3 2QG. (Tel. 01-794 0500.) Royal Society of Medicine.-Anglo-American conference on "Sexually Transmitted Diseases," 23-25 June, London. For details see advertisement at p. xvi. University of Liverpool Medical Students' Society Centenary Year.-Symposium "Disease and the Environment," 3-4 July. Details from Mr. Laurence Wood, President, Medical Students' Society, University of Liverpool, New Medical School, Ashton Street, P.O. Box 147, Liverpool L69 3BX. (Tel. 051-709 6022 ext. 201.) Association for the Psychiatric Study of Adolescents.-Weekend residential course/conference "The Adolescent and his Family," 4-6 July, University College, Cardiff. Details from Dr.
sentence of the third paragraph should read "In the paper referred to by Besser et al.2 the response obtained by administering various doses of L.H./ F.S.H.(R.H. to normal patients was reported...." Adaptation. We regret any misunderstanding which may ROYAL POSTGRADUATE MEDICAL SCHOOL.-11 a.m., have arisen from these errors. Mr. Peter Lord: Treatment of PiHes.
ROYAL POSTGRADUATE MEDICAL ScHOoL.-5.30 p.m., Dr. M. J. T. Peaston: Parenteral Nutrition. ST. MARY'S HOSFITAL MEDICAL SCHOOL.-5.15 p.m., Professor R. Taylor: Hornone Dependent Cancer in the Female.
Notice to Authors When original articles and letters for publication are not submitted exclusively to the British Medical Journal this must be stated. B.M.A NOTICES Correspondence on editorial business should be addressed to the Editor, British Medical Journal, B.M.A. House, Tavistock Square, London Diary of Central Meetings WCIH 9JR. Telephone: 01-387 4499. Telegrams: Aitiology, London, W.C.1. JUNE Authors wanting reprints ot their articles 7 Sat. Welsh Council (at Hotel Metropole, should notify the Publishing Manager, B.M.A. Llandrindod Wells), 2.30 p.m. 11 Wed. and Annual Conference of Representatives House, Tavistock Square, WC1H 9JR, on re12 Thurs. of Local Medical Committees, 10 a.m. ceipt of proofs. 13 Fri.
18 Wed. 19 Thurs.
23 Mon.
26 Thurs.
26 Thurs.
28 Sat.
Ophthalmic Group Committee, 2.15 p.m. Journal Committee, 2.15 p.m. General Medical Services Coxnmittee, 10 a.m. Panel on Gaps in Medical Research, 10 a.m. Board of Science and Education, 2 p.m. C.C.HIM.S. Executive Subcomnittee, 10 a.m. Annual Conference of Community Medicine, 10 a.m.
© British Medical Journal 1975 All Rights Reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior permission of the British Medical 7ournal.
1975
567 567
JUNE 1975 JOURNAL 7 JUNE BRITISH MEDICAL JOURNAL
BRITISH MEDICAL
NEWS
AND
NOTES
EPIDEMIOLOGY Epidemic Keratoconjunctivitis in The following notes are compiled by the Epidemiological Research Laboratory 'of the Public Health Laboratory Senrice frtom treports submitted by public health and hospital laboratories tin the United Kingdom and Republic of Ireland.
a
Factory
examined grew adenovirus type 8. Tlhe interval between the onset of symptoms and the da,te,s the swabs were taken varied from one day to one monith, thougth 75 % of the swabs, including all those from vvhich virus was isolated, were taken within one week of onset. Con-valescent sera taken at least three weeks after onset were collected from 40 patients. In addiition, acute-phase sera, taken within one week of onset, were available from nine of them. Complement fixation tests were done on these specimens, but 17 (42-5 O) had no detectable adenovirus antibody three weeks after infection, even though adenovirus type 8 had been isolated -from four of these individuals. Only two of the nine paired sera showed a four-fold rise in titre; virus had been isolated from both these patients. The maximum complemenit fixation titre recorded was 40, and this was in one patient only. However, 'haemragglutination inihibiltion tests were not performed on those sera. Adenovirus type 8 has a recognized association with epidemic keratoconjunctivitis among workers in heavy industry,' parti-
cularly shipyards. Much of the work carried out in the factory in which the oiutbreak occurred is similar in type to that in shipyards, and there is also a relatiwvely high incidence of eye injuries. In the early stages of the outbreak the cases were treated at the factory. However, the sister-in-charge of the treatment room became infected early in the course of the outbreak and withdrew from duty. After this no further eye treatment was given ait the factory during the outbreak, and patients were refeTrred to the eye clinic at the local general hospital or to their family doctor. It is possible that, at the beginning of the outbreak, transmission in the treatment room at the factory may have accounted for a few cases, but this does not account for the majority of cases in the outbreak. Roller towels in the various departments of the factory may have played an important part in the spread of infection, since it was only after they were replaced by diosable paper towels that the outbreak began to subside.
However, it is not only buildings used for such purposes and belonging to local health authorities and voluntary organizations which are exempt. Sub-section 45 (d) of the Act exempts structures similar to (those referred to in the rest of the section, but not com,ing under ithose iheadings because tihey are owned or have been supplied otherwise than as mentioned. That, at any rate, is the barest precis of the section solicitor, disabled by poliomyelitis, living whose drafting is decidedly obscure. with his family in a flat in West London specially adapted to his needs. The appeal turned on section 45 of the Facts of Case General Rate Act 1967, which provides that itn fixing the rateable value of a heredita- Mr. Vandyk, ithe ratepayer, has been ment no account shall be taken of "struc- paralysed in both legs and his left arm tures" belonging to local health authorities since 1947, and is confined to a wheel-chair. or voluntary organizations foTmed for the His flat wals chosen because of its suitability purposeS3 of preventing illness or for the for the disabled (its central heating and care or after-care of sufferers from ilness wide doors), but even then numerous and supplied for the use of such persons. alterations were made. The bathroom was The section also exempts structures set up enlarged and the floor-level altered to by local health authorities or voluntary facilitate getting in and out of the bath. The organizations for the welfare4 of the blind, wash-basin in his bedroom was lowered so that he could wash from hiis wheel-chair, deaf, dumb or otherwise handicapped.
and belb-pushes were inistalled throughout the house. These changes were important, for they enabled Mr. Vandyk to counter the valuation officer's argument (which in the event appealed to one member of the court) that to grant relief in this case would involve an extension of the General Rate Act 1967 far beyond Parliament'is intention. Lord Justice Cairns tried to still the Revenlue s fears that every occupier of a house or flat will be able to claim relief, if he or a member of his family is or has been ill and needs care or after-care. He said that the physical characteristics of the structure were important: with Mr. Vandyk'ls flat it was criitical thait "it was chosen because it had speial features making it suitable to provide for the needs of a person who required after-care and was adapted and equipped to imrprove its suitability for those
An outbreak of keratoconjunctivitis occurred in a midland city in the autumn of 1974, when a total of 67 cases were recorded within a seven-week period starting in late September. Of the persons affected 61 were employees in a large boiler-making factory, and the remining six cases were close family contacts. The conjunctival infection, which wais mostly unilateral, was not associated with upper respiratory tract disease, fever, or constitutional upset. Conjunctival swabs were taken from 55 patienits. All specimens were inoculaited into rhesus monkey, HeLa, and human amnion tissue cultures and incubated at 33'C and 37°C, but all failed to yield virus. However, human embryo kidney cultures were available at the Virus Reference Laboratory alt Col,indale, in which 13 of 21 specimens
1 Jawetz, E., British Medical Yournal, 1959, 1, 873.
MEDICOLEGAL Rates and Disablement FROM OUR LEGAL CORRESPONDENT
In a judgement of the greatest importance for disabled ratepayers the Court of Appeal has heldl 2 that where premises are used for ,the care or after-care of persons suffering from illness (or for looking after the blind, deaf, dumb or otherwise disabled), and are supplied accordingly, the occupier is entitled to rating reLief on the same basis as relief is given to special institutions for the disabled. The successful ratepayer was a
pusposes." The Lord Justice dismissed the argument that for rating relief to be granted the ratepayer must show that the provision of the flat was for the primary purpose of after-
BRITISH MEDICAL JOURNAL 7 JUNE 1975
568 care rather than for a residence for his family. No adjective in the lelation, he pointed out, qualified the word "purpose." Nor did it nusser if the structure was not similar to structures acualUy provided by the locl healh authority. it wuas sufficient if there was a simiAarity to structes which
tihe local
health authority couild provide under its powers. To Lord Justice Inwton a simpler argument appealed: had Mr. Vandyk not nade an effort to overcome his disabilities, be would have been in a insitution. Such a place would unquestionably not have been
PARLIAMENT Medical Schools The Secretary of State for Education and Science, Mr. R. PRENTICE, was asked in the Commons on 20 May whe'ther in view of the current shortage of British-4bomn doctors he would make steps to encourage medical schools to relax the entrnce qualifications for Britisih-born students in line wiith the requirements expected from non-ntiona medical students. In a written reply, Mr. Prentice said tat no wedical school laid down entrance requirements whidh were more Academic Year of Admission 1972-3 19734 1974-5
Overseas Candidates
Applicants
Applicaants Refuseed
1903 2156 2257
2048 2169
Total
I-l -I-
1812
severe for British-born students than for others. He gave the nunmer of candidates applying through the Universties Central Council on Admissions (U.C.C.A.) for entry to medical schools in the United Kingdom, and the number refused, together wi,th information from the University Grants Committee about the percentage of overseas students attending medical schools in the United Kingdom:
United Kingdom Candidates Applicants Total Refused Applicants 9274 10 759 10 746
6442
7809 7875
-
Percentage of Overseas Students in all Medical Schools in the United Kingdom
-1
3-7 3-6 Not yet available
rated. Why then should he be rated if he provided himself with the same facilities and acconnodation which a local authority was bound to provide, but at no cost to it? The ratepayers flat ought to be assessed on the same basis for relaef as the institution. The thrd member of the court, Mr. Justice MacKenna, disagreed, finding in the obscurity of the section some support for his belief that Parliament cannot have intended so extravagant a result as every house and flat in the country where people receive care or after-care for illness being, as to its structure, exempt from rates. The matter of Mr. Vandyk's flat is now to go to the Lords, though on terms that the Revenue pay all his legal costs. What interpetation the House wvll give to ithe section and whether they wil be unanimous must be extremely uncertain. They may even decide to take the middle course and give relief to the roons specially adapted to Mr. Vandyk's needs but not to the whole of the flat. Before the conclusion of the appeal and as soon as possible, doctors ought to prompt disabled rtepayers to apply to their local valuation officer to alter their rateable value, since ithe new value will only be backdated ,to the date of the application and not beyond. 1 The Times, 11 February 1975. 2 (1975) 2 W.L.R. 797. 3 As defined by section 28(1) National Health Service Act 1946 as amended by section 12 Health Services and Public Health Act 1968. 4 As defined by section 29(1) National Assistance Act 1948.
MEDICAL NEWS Temporary Registration: Tests for Overseas Doctors
From 1 June 1975 onwards the General Medical Council states that it will not normally be prepared to grant temporarY registration for the first time to any doctor from overseas unless, in addition to holding a qualifiction whidh is recognzed for tem, porary registration, he has passed the test of proficiency in the English langage and of professional knowledge and competence. These tests will be conducted, on behalf of the Conil, by the Temporary Registration Assessment Board established for the purpose by the non-university lcening bodies in the United Kingdonm The Council has reaffrmed that the standard of professional competence required to pass these tests will be equivalent to that attested by the grant of full registration to a British qualified doctor; that is to say to the standard reached by a doctor wbo has passed a qualifying examination for a British primry medical qualification and thereafter satisfactorily comleted a year as a resident house offioer in an approved hospital.
Pay Beds Cut by 10%
about 430 fewer pay beds from 1 July, affecting just over 100 hospitals. In hospitals wilh six or more pay beds the number alloowed in future will depend on how nany were actualiy used during 1972 and 1973. If less thn three-fiths were used there will be an overall cut of 20%. If only twoAifths or less were used the reduction will be substantially greater. No 'hospi-tal willi be affected in which the numnber of pay beds actually in use during those two years exceeded 60% of the hospitals available pay
affecting the socal health services. In 1974 there was a severe decline in world food reserves. Food prices rocketed and several large countries introduced rationing. Mass hunger precipitated political unrest in some oountries, and in several of the developing countries malnutrition caused a severe setback to their economic and social
public spending
progress. planning, constitute gra s,
Human
reproduction,
family
and population dynamics now one of W.H.O.'6s lagest proaccording to its Director-General.
beds. Conservative Medical Society A society of medical and other professional people in the heal-th -services has been formd under the aegis of the Conservative Party to provide a forum for the exchange of views between Conservatives in the health field and to inform the public of current attitudes of health workers; 'to collect evidence for committees examining the N.H.S.; and to set up discussion and research groups on policy. Further details may M.P., comnmissioned. The survey gave enthusiastic be obtained from Dr. G. F. Vaughan, support for the preparation of a full sub- at the House of Commons, London S.W.1. nu,ssion.
Medical School at Keele Keele University believes it should again submit to the University Grants Conxnittee its case for the establishment of a medical school. The univerity recently invited Sir Melvile Arnott, of Birmingham University, assisted by other professorial colleagues from Birmingham Medical School, to conduct a preliminary survey to establish whether a full study of the project should be
Royal College of Radiologists
Barbara Castle has announced a cut of Work of World Health Organization The Royal College of Radiologists held an about 10% in the number of pay beds in N.H.S. ospijtals. The cuts, which are Acording to th,e 1974 annual report of the Inaugural Day on Friday, 6 June. A service separate from the Government's prposals Director-General of the World Health of dedication was held at S,. Clement Danes to phase out private practioe from N.H.S. OrganiaDn sooeconomic malaise in the Church, followed by an inaugural lecture hospitals (10 May, p. 347) have been liited industrial countres has had repercussions by Dr. Robert Moseley, prsident of the to hospitls in wihdch there has been con- on develDp'ing countries. In some countries Amenrican College of Radiology, on "Whither sidemble under-occupation. There will be iflation had led to a severe cutback in Radiology." The celebrations ended with Mrs.
BRITISH MEDICAL JouRNAL
7 JUNE 1975
dinner at Quaglino's with Professor Howard Middeniiss, president, in the chair. Guests included The Rr. Hon. Lord and Iady Robens of Woldingham, Lord and Lady Hunit of Fawley, and thfe presidents of the other royal colleges.
Precarious Balance The "mouniting global concern over the precarious balance between population growth and the world's sace and resourcee" prompted the World Medical Associaition and other bodies to join in a conference at Stockbolm last autum on "The Physician and Population Change." A report of the proceedigs of the conference has now been pblished as Population Change: A Strategy for Physicians. Contributors to it discuss the role and attitudes of physicians, the role of medicl associations, and family pianning services. Copies ($3 post free) from: World Federation for Medical Education, One Dupont Circle, Suite 201, Washington, D.C. 20036, U.S.A. Professor of Psychological Medicine, London Dr. R. H. Cawley has been appointed to the chair of psychologcal medicine at King's College Hospital Medial Scwol and the Institute of Psychiatry. Dr. Oawley, who is 50, graduated fromn Birmingham University, gning his B.Sc. in 1947, P&hD. in 1949, and M.B., Ch.B. in 1955. He went on to DiP.M. in 1959, M.R.CJP. in 1966, and F.R.CPsOych. in 1971. After house appointments in Birmingbam and London, Dr. Cawley was appointed clinical lectuer at the Institute of Psychiatry in 1960, senior lecturer and first assistant in e University of Birmingham in 1962, consultat psychiatrist to the BEklem Royal and Maudsley bospitals in 1967, and first assistant in die Deprtment of Psychiatry in 1969. From 1971 to 1972 Dr. Cawiley was sub-dean and senlior dlinical tuitor in the Institute of Aydhiatry.
569 H. V. R. Jones, Young People's Unit, Whitchurch Hospital, Cardiff, CF4 7JG. (Tel. 0222 62191 ext. 118.) Oxford Ophthalmological Congress.-7-9 July, Oxford. Details from the honorary secretary, Mr. W. Martin Walker, 609 Warwick Road, Solihull, West Midlands B91 lAP. Association of Psychiatrists in Training.Debate "Tomorrow's Psychiatrists," 8 July, London. Details from Dr. Julian Bird, Maudsley Hospital, Psychological Treatment Unit, 99 Denmark Hill, London SE5 8AZ. (Tel. 01-703 5411 ext. 139.) Institute of Religion and Medicine.-Annual Assembly and conference "Education for Wholeness," 8-10 July, Exeter University. Details from the organizing secretary, Institute of Religion and Medicine, St. Mary Abchurch Vestry, Abchurch Lane, London EC4N 7BA. (Tel. 01-626 0306.) National Association of Maternal and Child Welfare.-Annual conference, on the theme "Food and the Family," with address by Dr. David Owen, Minister of State for Health, 8-10 July, York University. Details and application forms from the general secretary, N.A.M.C.W., Tavistock House North, Tavistock Square, London WC1H 9JG. (Tel. 01-387 1874.) 18th Annual Scientific Assembly of the College of Family Physicians of Canada.10-14 August, Vancouver, Canada. Details from Mr. G. A. Ackehurst, Director of Communications, College of Family Physicians, 4000 Leslie Street, Willowdale, Ontario M2K 2R9, Canada.
Branch and Division Meetings to be Held Members proposing to attend meetings marked* are asked to notify in advance the honorary secretary concerned.
Greenwich Division.-At Woodlands, Vanbrugh Hill, Saturday, 14 June, 7.30 p.m., barn dance.* Shropshire and Mid-Wales Division.-At Copthorne Hospital, Thursday, 12 Tune, 8.15 p.m., open meeting followed by film: "Vascular and Tubercular Organization of the Kidney." Rotherham Division.-At Slacks Farm, Bramley, Saturday, 14 June. 8.30 p.m., summer barbecue.
UNIVERSITIES AND COLLEGES
SOCIETIES AND LECTURES
ROYAL COLLEGE OF RADIOLOGISTS At a ceremony hlxd on 16 May the president, Professor Howard Middlemiss, admitted Dr. C. Alexander of New Zealand as an Honrary Fellow. The following were admitted as Fellows without examination.-W. H. Bond, F. 0. Brown, W. Campbell, J. H. E. Carmichael, L. S. Carstairs, P. T. Chtopping, W. P. Cockshott, J. 0. Y. Cole, D. H. Cummack, Vera M. Daly, D. K. L. Davies, R. J. Dickson, A. A. Donaldson, Patricia P. Franblyn, A. W. G. Goilden, I. R. S. Gordon, R. I. Green, G. L. Gryspeerdt, S. Haase, H. Herlinger, R. D. Hoare, F. H. Howarth, A. R. Lyons, V. R. McCready, D. J. Mitchell, W. M. Mum, G. A. Newsholme, R. D. S. Rhys-Lewis, D. K. Sambrok, J. L. Steven, A. M. Stewart, W. C. Swanson, J. L. G. Thomson, R. J. Walton. The following were admitted as Fellows after examination.- T. T. Aye, A. P. Baytias, J. P. Bottomley, C. H. Brown, J. D. K. Brown, K. A. Brownlie, M. Dalziel, E. Dillon, A. Dinath, S. A. EI-Badawy, R. A. Fawcitt, J. R. Fulerton, P. W. Gill, R. Gopal, C. A. Grafton, Catherine A. Heller, G. Hussain, Pamela A. Jones, P. F. Joyce, R. U. Khan, P. T. King, D. P. E. Kingsley, 0. M. E. Koriech, Rita M. Linggood, R. G. Lovett, G. T. MaCreath, Elisabeth A. Macdonald, L. G. Maddock, L. J. Peters, C. S. B. Roch-Berry, A. Smith, H. M. Warenius.
For attending lectures marked * a fee is charged or a ticket is required. Applicatitm should be made first to the institution concerned.
APPOINTMENTS
Monday, 9 June CIBA FOUNDATION.-At Royal College of Physicians of London, 5 p.m., Professor G. Mathe: Ten Years of Immunotherapy in Leukaemia and Cancer: Pharmacology, Indications, Results, and Perspectives.
NoRTH-EAsT THAs R.H.A.-The following consultants have been apointed: Mr. M. Sinh (urology); Dr. J. M. Aitken (medicine); Dr. E. M. Blshamma (radiology); Dr. K. S. Perinpansyagam (adolesoent psychiatry). NORTH-WEST THAMES R.H.A.-Mr. J. S. Kenefick (consulant in general surgery and vascular surgery).
Wednesday, 11 June INSTITUTE OF PSYCHIATRY.-5.30 p.m., Dr. M. Selignan (U.S.A.): Depression + Learned Helplessness. ROYAL COLLEGE OF PSYCmATRISTS.-At Royal Corrections Society of Medicine, 8.15 p.m., Dr. Isaac Marks: New Developments in the Treatment of Obsessive Hormone Patterns in Anorexia Nervosa Compulsives. ROYAL POSTGRADUATE MEDICAL ScHOOL.-2 p.m., In the leading artide on this subject (12 April, Dr. I. Whimster: Pigmented Skin Tumours. WESTMINSTER MEDICAL ScHooL.-At Queen Mary's p. 52) reference 10 should read "Palmer, R. L., Hospital, 4 p.m., teach-in: Limb Loss-Diffi- et al., oumrnal of Endocrinology, 1974, 63, 32p." cusities and Their Amelioration. In the subsequent letter from Mr. B. Alderman and Mr. M. F. Burke (17 May, p. 392) the fourth
Cost of Prescnptions The average cost of NHS. presciptions was 101 3p in 1974, said Dr. David Owen Thursday, 12 June in a written reply to a recent parliatnentary ROYAL COLLEGE OF SURGEONS OF ENGLAND.-At Insti,tute of Ophthamology, 3 p.m., Edridgequestion. Tis conpared with 67-2p in Green lecture by Professor Harris Ripps: Night Blindness and Retinal Mechanisms of Visual 1970 and 88-2p in 1973.
COMING EVENTS Royal Free Hospital.-Meeting "Clinical Genetics of Liver Disease," 13 June, London. Details from Professor Sheila Sherlock, Royal Free Hospital, Pond Street, Hampstead, London NW3 2QG. (Tel. 01-794 0500.) Royal Society of Medicine.-Anglo-American conference on "Sexually Transmitted Diseases," 23-25 June, London. For details see advertisement at p. xvi. University of Liverpool Medical Students' Society Centenary Year.-Symposium "Disease and the Environment," 3-4 July. Details from Mr. Laurence Wood, President, Medical Students' Society, University of Liverpool, New Medical School, Ashton Street, P.O. Box 147, Liverpool L69 3BX. (Tel. 051-709 6022 ext. 201.) Association for the Psychiatric Study of Adolescents.-Weekend residential course/conference "The Adolescent and his Family," 4-6 July, University College, Cardiff. Details from Dr.
sentence of the third paragraph should read "In the paper referred to by Besser et al.2 the response obtained by administering various doses of L.H./ F.S.H.(R.H. to normal patients was reported...." Adaptation. We regret any misunderstanding which may ROYAL POSTGRADUATE MEDICAL SCHOOL.-11 a.m., have arisen from these errors. Mr. Peter Lord: Treatment of PiHes.
ROYAL POSTGRADUATE MEDICAL ScHOoL.-5.30 p.m., Dr. M. J. T. Peaston: Parenteral Nutrition. ST. MARY'S HOSFITAL MEDICAL SCHOOL.-5.15 p.m., Professor R. Taylor: Hornone Dependent Cancer in the Female.
Notice to Authors When original articles and letters for publication are not submitted exclusively to the British Medical Journal this must be stated. B.M.A NOTICES Correspondence on editorial business should be addressed to the Editor, British Medical Journal, B.M.A. House, Tavistock Square, London Diary of Central Meetings WCIH 9JR. Telephone: 01-387 4499. Telegrams: Aitiology, London, W.C.1. JUNE Authors wanting reprints ot their articles 7 Sat. Welsh Council (at Hotel Metropole, should notify the Publishing Manager, B.M.A. Llandrindod Wells), 2.30 p.m. 11 Wed. and Annual Conference of Representatives House, Tavistock Square, WC1H 9JR, on re12 Thurs. of Local Medical Committees, 10 a.m. ceipt of proofs. 13 Fri.
18 Wed. 19 Thurs.
23 Mon.
26 Thurs.
26 Thurs.
28 Sat.
Ophthalmic Group Committee, 2.15 p.m. Journal Committee, 2.15 p.m. General Medical Services Coxnmittee, 10 a.m. Panel on Gaps in Medical Research, 10 a.m. Board of Science and Education, 2 p.m. C.C.HIM.S. Executive Subcomnittee, 10 a.m. Annual Conference of Community Medicine, 10 a.m.
© British Medical Journal 1975 All Rights Reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior permission of the British Medical 7ournal.
