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stances. It is not so simple to suggest an explanationfor the greater common incidences of heart disease andcancer. Marital contagion might be an element in heartdisease if the causative factor in rheumatic heart diseaseis infectious ; otherwise we can but fall back on consciousor unconscious marital selection of like by like in con-stitution. There is no evidence of a physical type forcancer, most workers deny an infective agent, and thereremains, it seems, only the common environment includ-ing diet. This suggests a line of approach which meritsfurther attention.

BLOOD SEDIMENTATION

Two short articles by N. K. Basu in the IndianJournal of Pediatrics for January (p. 27) deal withblood sedimentation in relation to tuberculosis andvitamin-C deficiency. The experimental evidence quotedis too meagre to allow of any definite conclusions beingdrawn, but the papers are none the less interesting.Basu uses an unusual technique for measuring theB.S.R., inasmuch as the blood is diluted with saline tothe extent of 1 in 50. This startling departure fromcommon practice may serve as a reminder that theprincipal requirement of any technique is that it shallgive results which show an accurate relation to clinicalfindings. It has been suggested that B.S.R. measure-ments are of value in the diagnosis of tuberculosis, andalthough this view is not generally held in this country,it may be that Basu’s modification of the sedimentation-test gives the greater sensitiveness he claims for it. Healso finds that the administration of ascorbic acid totuberculous patients tends to improve the B.S.R. buthe leaves it to others to decide whether this is accom-panied by improvement of the patient. The sedimenta-tion-test has had a long run, and it is time that theassessment of its clinical value was agreed upon. Theease with which the test can be performed has perhapsstifled clinical as distinct from laboratory research ; orpossibly the organisation of the collective researchrequired has been dismissed as impracticable. Thematter should not remain here.

STAMPING OUT HEAD LICE

WHEN medical inspection was introduced 34 years agothe formidable problem of the head louse was for thefirst time tackled systematically. Like so many drivesin medicine and public health, the attack failed toachieve complete victory because of the success of itsearly battles. Within a few years the rate of infesta-tions of the heads of school-children fell from nearly90 to about 10% and the foulest disappeared. In .somedistricts even better results have been obtained and ofa few it may be said that the head louse is no longerresident and does not breed regularly ; but these arefew indeed. Lately the attack has been one of passiveroutine rather than active warfare and though it has

kept the lousiness of the heads of school-children withinreasonable limits in normal circumstances nothing hasbeen done towards extermination. The Ministry ofHealth and the Board of Education have now issued amemorandum on the subject which is timely, for

though it might neither surprise, enlighten or help thefirst generation of school inspectors the present generationhas largely forgotten the experiences of the past. Thememorandum states that powers are available to localauthorities which " should be adequate to secure thedesired result." The experience of the past is that thesepowers are not adequate. The most important in theoryis the power to cleanse verminous persons, but as thisrequires consent it is of no real value. For there neverwas any great difficulty in cleansing those who wishedto be cleansed. As the head louse is a strict parasite

1. Accompanying Circulars 2306 (Ministry of Health) and 1544(Board of Education) to local authorities.

and its habitat the hair of human scalps, success can beachieved only by action on this nidus, but to effectelimination all heads must receive attention. The chiefreservoir of the louse has shifted from school-children toinfants and young women, so the main attack should beshifted also to these fields where our powers are muchrestricted. Continuous instruction and education ofsenior girls is our chief hope, for if these are well trainedthey will keep their own heads clean when they leaveschool and look to the heads of their children in after

years. But for complete success we must have

compulsory powers to cleanse those who will not cleansethemselves. Now that the Board of Education and

Ministry of Health have reawakened to the menace ofthe head louse, they may realise that the intermittentissue of circulars does not solve national problems.

MINIMAL HEALTH REPORTS

CIRCULAR 2314 of the Ministry of Health is no morethan a reminder that the reports for 1940 should beframed as laid down by circular 2067 which was the finalinstruction for the reports of 1939. Some of the reportsfor that year were nearly completed and many morehad been commenced before circular 2067 was receivedin July, so they are a mixed lot, some being but slightlyshortened and others stripped to the bone. It is to benoted that reports for 1940 are required, but they areto be as short as possible and to deal only with mattersrelevant to that year which were of public-healthinterest. Owing to the suppression of conferences,difficulties of communication and curtailment of journals,we have not the general knowledge of the public-healthhistory of 1940 that we have usually at the end of ayear, and are largely unaware of any points of specialconsequence or interest which may have occurred in thevarious localities. It is important that any suchhappenings as would be reported in ordinary circum-stances should be recorded in the reports for 1940,especially in view of the exceptional difficulties in

forecasting what is likely to happen in the epidemiologicalfield in the years ahead of us. We are not prophetsand cannot foretell the future, but we can deduceprobabilities from evidence which we look to find in theannual reports for the past year. In present circum-stances the most interesting information is that concern-ing outbreaks, or alleged outbreaks, of food-poisoningor food-spread diseases and unusual prevalence ofdiseases which are, or might be, connected with nutri-tional deterioration.

Prof. W. W. C. TOPLEY, F.R.S., has been appointedsecretary to the Agricultural Research Council in succes-sion to Sir Edwin Butler who is retiring through illhealth. Professor Topley, who was appointed a memberof the council last year, is director of the division of

immunology at the London School of Hygiene, and sincethe outbreak of war has been guiding a nationallaboratory service. In this appointment we see an

important development in the union of health andagriculture.UNDER the new schedule all medical and dental

students will be reserved from the date of acceptance bya recognised medical school, subject to satisfactoryreports on their progress in study from time to time.The medical schools will, however, not have unlimitedright of admission, but will be requested to adopt somequota in terms of recent entries. ,

WE regret to learn of the death, in London on April 10,of Dr. DAVID FORSYTH, consulting physician to CharingCross Hospital and to the Evelina Hospital for Children.Dr. Forsyth was one of the early students of psycho-analysis and modern psychological methods. He was64 years of age.