MILK OR SACRED?
1
289 phetamine. The need for insistence on orthodxy would then disappear. It is long past time to call urgently a national inter- disciplinary conference to clear up some of the vast confusion and to hammer out policy. DOMESTIC SILICOSIS PRIMITIVE methods of grinding corn, though laborious and time-consuming, seem unlikely to endanger health, but an epidemiological study 1 in the Transkei region of South Africa has shown this apparently innocent practice to be an unexpected source of silicosis in women. Corn grind- ing first came under suspicion when young nurses in the local hospitals were found to show radiological evidence of early silicosis. Studies of older women revealed every degree of change up to massive fibrosis with cor pulmonale. Since silicosis predisposes to tuberculosis, and since the tuberculosis-rates in the Transkei are among the highest in South Africa, it is evident that a major public-health problem has been uncovered. The grinding stones used in the Transkei, unlike those used in other areas, are made of quartzite, which has a high silica content; moreover, the grinding is done indoors, so that the food itself, the clothing, and the dust in the huts contain an abundance of silica. The women and girls (who start grinding at the age of 9 or so and continue thereafter for about an hour a day) are bound to inhale large quantities of silica dust, and the effects of this are quite evident by the age of 20-25 years. The risk of sili- cosis could be removed by a change in the method of grinding, and " Transkei dust disease " will no doubt be tackled energetically now that it has been identified as domestic silicosis. FLUORESCENT ANTIBODIES IN DIAGNOSIS OF INFECTIONS ANTIBODIES labelled with fluorescent dyes are being widely used for the identification of infectious diseases. They have already been successfully applied to the identi- fication in infected tissues of almost every known agent from viruses to fungi. A slight modification of technique enables the investigator to demonstrate the presence of specific antibodies in the serum of infected persons. The successful application, however, of both these immuno- fluorescent methods depends on an adequate supply of reliable reagents. To demonstrate specific antibodies to a given infective agent, the so-called sandwich technique is usually applied. The test serum is added to a smear of the suspected organisms so that specific antibodies, if present, become firmly bound to the organismal antigens. The bound immunoglobulin is then displayed by treatment with a fluorescent antiserum to this immunoglobulin, which has been prepared in an animal of another species. In a positive test the infective agent fluoresces when examined in light of the appropriate wavelength, usually in the blue or ultraviolet parts of the spectrum. Of the many diseases whose diagnosis is now being simplified by these methods, syphilis is one of the 1. Palmer, P. E. S., Daynes, G. S. Afr. med. J. 1967, 41, 1182. 2. Wagner, M. Fluoreszierende Antikörper und ihre Anwendung in der Mikrobiologie. Jena, 1967. most important. Success depends on the availability of a reliable fluorescent anti-human immunoglobulin G. As commercial preparations of suitable reliability are expensive and only just becoming available, the provisional specification for fluorescein-labelled antibody against human globulin (IgG), recently published,3 is valuable and timely. Adequate details for the preparation and standardi- sation of the reagent are provided, and this text should prove of great value in improving the diagnostic reliability of this type of immunofluorescent procedure. MILK OR SACRED? IT is unfortunate that the status of a symbol has been thrust upon prescription charges. As a result their mani- pulation over the past sixteen years has been dictated by political expediency rather than sincere belief that their imposition (or removal) was in the best interests of citizens as patients, potential patients, or taxpayers. Symbols are almost impervious to rational thought, and the imposition, removal, and reimposition of the charges have been con- ducted in a furore which has often obscured the real issues. This is all the more unfortunate because they are important. It would be possible to defend the charges on the grounds that too many people take too much medicine which they would be better (or at least equally well) with- out, or that the money spent on footing the drug bill could be more usefully spent on other parts of the service. The last part of the argument is the one that is being used at present. The prescription charges are to do their valiant best to protect the hospital-building programme. But hard facts about the hard cash they will actually pro- duce are hard to come by. Estimates range haphazardly from E25 million to E12 million. Everyone is agreed that such vulnerable groups as old people, children, mothers, and the chronic sick must be protected. The method of protection is disappointingly vague. It is agreed it would be better to exempt these groups from payment rather than merely offer them a refund (and on the face of it this would seem to be a less cumbersome procedure). But in practice this method seems to be beset with difficulty, and the Minister of Social Security has admitted that it may not be achieved. Certainly it is unlikely that a working scheme will be ready to start with the charges which are due to begin in the spring. Estimates of those who will be eligible for repayment, or exemption, also vary. Their numbers might, of course, be reduced by the Chancellor’s enthusiasm for selectivity, but, if their existence and difficulties are generously recognised, the money which the charges are expected to produce will be drastically and rightly reduced. Expenses of administration and/or collection cannot be negligible and can only further reduce the contribution which the charges will make to the upkeep of the N.H.S. A further point was raised by Lord Brockway 4 among others, who asked how cuts in the social services would help the balance of payments. Admittedly, if the charges reduce the number of prescriptions, they will also reduce the Government’s expenditure, but expectations on this score are apparently not optimistic. All in all, the man- in-the-surgery is left with an uneasy feeling that an inept scheme is being overhastily applied and that its results may well be disappointing. 3. Brighton, W. D., Taylor, C. E. D., Tomlinson, A. H., Wilkinson, A. E. Mon. Bull. Min. Hlth, 1967, 26, 179. 4. See Lancet, Feb. 3, 1968, p. 253.
Transcript of MILK OR SACRED?
289
phetamine. The need for insistence on orthodxy wouldthen disappear.
It is long past time to call urgently a national inter-disciplinary conference to clear up some of the vast
confusion and to hammer out policy.
DOMESTIC SILICOSIS
PRIMITIVE methods of grinding corn, though laboriousand time-consuming, seem unlikely to endanger health, butan epidemiological study 1 in the Transkei region of SouthAfrica has shown this apparently innocent practice to bean unexpected source of silicosis in women. Corn grind-ing first came under suspicion when young nurses in thelocal hospitals were found to show radiological evidence ofearly silicosis. Studies of older women revealed everydegree of change up to massive fibrosis with cor pulmonale.Since silicosis predisposes to tuberculosis, and since thetuberculosis-rates in the Transkei are among the highestin South Africa, it is evident that a major public-healthproblem has been uncovered.The grinding stones used in the Transkei, unlike those
used in other areas, are made of quartzite, which has ahigh silica content; moreover, the grinding is done indoors,so that the food itself, the clothing, and the dust in thehuts contain an abundance of silica. The women and girls(who start grinding at the age of 9 or so and continuethereafter for about an hour a day) are bound to inhalelarge quantities of silica dust, and the effects of this arequite evident by the age of 20-25 years. The risk of sili-cosis could be removed by a change in the method ofgrinding, and " Transkei dust disease " will no doubt betackled energetically now that it has been identified asdomestic silicosis.
FLUORESCENT ANTIBODIES IN DIAGNOSIS OF
INFECTIONS
ANTIBODIES labelled with fluorescent dyes are beingwidely used for the identification of infectious diseases.They have already been successfully applied to the identi-fication in infected tissues of almost every known agentfrom viruses to fungi. A slight modification of techniqueenables the investigator to demonstrate the presence ofspecific antibodies in the serum of infected persons. Thesuccessful application, however, of both these immuno-fluorescent methods depends on an adequate supply ofreliable reagents.To demonstrate specific antibodies to a given infective
agent, the so-called sandwich technique is usually applied.The test serum is added to a smear of the suspectedorganisms so that specific antibodies, if present, becomefirmly bound to the organismal antigens. The bound
immunoglobulin is then displayed by treatment with afluorescent antiserum to this immunoglobulin, which hasbeen prepared in an animal of another species. In a
positive test the infective agent fluoresces when examinedin light of the appropriate wavelength, usually in the blueor ultraviolet parts of the spectrum.Of the many diseases whose diagnosis is now being
simplified by these methods, syphilis is one of the1. Palmer, P. E. S., Daynes, G. S. Afr. med. J. 1967, 41, 1182.2. Wagner, M. Fluoreszierende Antikörper und ihre Anwendung in der
Mikrobiologie. Jena, 1967.
most important. Success depends on the availabilityof a reliable fluorescent anti-human immunoglobulin G.As commercial preparations of suitable reliability are
expensive and only just becoming available, the provisionalspecification for fluorescein-labelled antibody againsthuman globulin (IgG), recently published,3 is valuable andtimely. Adequate details for the preparation and standardi-sation of the reagent are provided, and this text shouldprove of great value in improving the diagnostic reliabilityof this type of immunofluorescent procedure.
MILK OR SACRED?
IT is unfortunate that the status of a symbol has beenthrust upon prescription charges. As a result their mani-pulation over the past sixteen years has been dictated bypolitical expediency rather than sincere belief that theirimposition (or removal) was in the best interests of citizensas patients, potential patients, or taxpayers. Symbols arealmost impervious to rational thought, and the imposition,removal, and reimposition of the charges have been con-ducted in a furore which has often obscured the realissues. This is all the more unfortunate because they areimportant. It would be possible to defend the charges onthe grounds that too many people take too much medicinewhich they would be better (or at least equally well) with-out, or that the money spent on footing the drug bill couldbe more usefully spent on other parts of the service.The last part of the argument is the one that is being
used at present. The prescription charges are to do theirvaliant best to protect the hospital-building programme.But hard facts about the hard cash they will actually pro-duce are hard to come by. Estimates range haphazardlyfrom E25 million to E12 million. Everyone is agreed thatsuch vulnerable groups as old people, children, mothers,and the chronic sick must be protected. The method of
protection is disappointingly vague. It is agreed it wouldbe better to exempt these groups from payment ratherthan merely offer them a refund (and on the face of it thiswould seem to be a less cumbersome procedure). But in
practice this method seems to be beset with difficulty, andthe Minister of Social Security has admitted that it maynot be achieved. Certainly it is unlikely that a workingscheme will be ready to start with the charges which aredue to begin in the spring.
Estimates of those who will be eligible for repayment, orexemption, also vary. Their numbers might, of course, bereduced by the Chancellor’s enthusiasm for selectivity,but, if their existence and difficulties are generouslyrecognised, the money which the charges are expected toproduce will be drastically and rightly reduced. Expensesof administration and/or collection cannot be negligibleand can only further reduce the contribution which thecharges will make to the upkeep of the N.H.S.A further point was raised by Lord Brockway 4 among
others, who asked how cuts in the social services wouldhelp the balance of payments. Admittedly, if the chargesreduce the number of prescriptions, they will also reducethe Government’s expenditure, but expectations on thisscore are apparently not optimistic. All in all, the man-in-the-surgery is left with an uneasy feeling that an ineptscheme is being overhastily applied and that its results maywell be disappointing.3. Brighton, W. D., Taylor, C. E. D., Tomlinson, A. H., Wilkinson, A. E.
Mon. Bull. Min. Hlth, 1967, 26, 179.4. See Lancet, Feb. 3, 1968, p. 253.
