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technique ; but it would be dangerous to conclude fromthis that all those who wish to qualify for the designation" nurse " must of necessity reach this high standard.There is still, and there always will be, a real need forthe " bedside " nurse who is highly trained in the practicalduties of nursing. The requirements of the communitymake it necessary, I believe, to contemplate two spheresof nursing. All who enter the profession must qualifyby undergoing a basic course of training ; those who

aspire, by reason of special interests or aptitudes, to thehighest ranks would require to undertake further training.It might be argued that this principle has already beenconceded by the recent introduction of the grade ofassistant nurse. But the term " assistant nurse," as atpresent used to describe those who have taken somethingsimilar to a basic nursing course, is an erroneous one andits implication of inferiority is unfortunate.

It should be possible, as you suggested some yearsago, to define a " basic nursing course " which wouldconstitute the warrant for the designation State-qualifiedNurse (s.Q.N.). Such persons should be able to be trainedin any hospital which comes up to a certain preordainedand strictly exercised standard. The duration of such

training should, I think, be one year, followed by a furtheryear working as a nurse in an approved hospital. Thebest material which passed through this basic coursewould be attracted to specialise in general, surgical,medical, infectious-disease, mental, and children’s

specialties, and it would be from those who have takensuch special courses that the ward sisters, theatre sisters,&c., would come. These State-qualified nurses wouldconstitute the body of the hospital nursing strength,working as nurses under the more highly trained sisters.The nurse-in-training could then be regarded more

correctly as a student and as only a part-time worker inthe ward routine.The controversy over the Fevers Register has brought

more sharply into focus the serious hazard to which ahealth service may be exposed if attention is directed

solely to the training of more highly qualified nurses.Anyone who examines the content of the student nurse’scurriculum must reach the conclusion that there is a

danger that the modern general nurse is being transformedinto a kind of unsatisfactory medical student, unbalancedby possession of a pseudoscientific mental equipment,while the real needs of the service and the public areneglected.

THOMAS ANDERSON.Department of Infectious Diseases,University of Glasgow.

1. Lancet, 1945, i, 664.2. Macintosh, R. R., Pask, E. A. Lancet, 1941, ii, 10.3. Mushin, W. W. Ibid, 1945, i, 611.

INTRA-ARTERIAL TRANSFUSIONS

A. MACKENZIE.

W. W. MUSHIN.Department of Anæsthetics,Royal Infirmary, Cardiff.

SIR,—I am prompted to write to you by ProfessorSchaeffer’s letter (May 9) describing an apparatus toprevent air-embolism in intra-arterial transfusion. Itmay be of interest to your readers to know that an

essentially similar piece of apparatus was described inyour columns in 1941, and has been available fromMedical and Industrial Equipment Ltd., 12, NewCavendish Street, London, W.l, for some nine years.Newcastle upon Tyne, 2. A. MACKENZIE.

SIR,—In the intra-arterial transfusion outfit describedby Professor Schaeffer, the essential part of the instru-ment is the glass float inside the drip chamber, whichprevents air embolus. This drip chamber and its glassfloat were first described by Macintosh and Pask 2 in theLancet in 1941, and again illustrated by myself in 1945.3It has become widely known in this country, if not theworld, since that time under the name of the OxfordSafety Dripper.

Parliament

THE N.H.S. INQUIRYDebate in the Commons

SPEAKING on a token vote on the Health Estimates onMay 18, Mr. ANEURIN BEVAN said that, though it wasreasonable for an inquiry to be held into the NationalHealth Service, he could not understand why the Ministerhad not used the Central Health Services Council, whichhad been appointed to advise him not only of any changeswhich might be necessary but of any defects which mightbe thrown up in experience of the administration of theservice. Why had the Minister then set up an indepen-dent committee ? Could it be to obtain an alibi to cutthe service ? The terms of reference suggested that thecommittee were to advise the Minister how the fundsmade available by the Exchequer were to be apportioned.In Mr. Bevan’s view priorities of expenditure inside theservice were social priorities and were a matter of politicalopinion and judgment.The expenditure in the two parts of the N.H.S. where

the patient initiated expenditure-i.e., the dental andophthalmic services-had begun to fall once the initialbacklog of neglect was worked off. On the pharma.ceutical side the picture was slightly different. Herethe initiative in expenditure lay mainly with the doctor,not the patient. On that side expenditure was still risingdespite the shilling charge. It was surely a reflection onthe medical profession that last year we spent £400,000on Dexcdrine ’ ’ when the equivalent in the officialformulary would have cost about £158,000. But for thiswe should not penalise the patient but investigate theprofits of the big drug houses and stiffen more severelythe discipline over the general practitioner.Though Mr. Bevan agreed that there were questions

of priority to be settled both inside and outside theservice, he did not see that the Guillebaud Committeewas the body to do it. It might be that the CentralHealth Services Council were too deeply involved in theadministration of the N.H.S. to take an objective view.But the House of Commons was an opinion-making bodyand it was nonsense to ask an outside committee Whatdo you think our opinion should be about this ?" Thatwas why he stuck to his words that it was cowardice toset up a committee. If the Government wanted to cutthe health service, why did they not say so instead ofcalling a committee into existence and hoping to hidebehind it.

THE MINISTER’S SPEECHMr. lAIN MACLEOD, Minister of Health, said that

the appointment of the committee had been greeted withalmost universal approval in the press. Two questionsto be decided were : Was there anything to inquireinto ? and, if so, who should undertake the inquiry?On some matters within the area of dispute he wantedadvice, though he agreed that the decisions could betaken only by the House of Commons. Giving examplesof the matters on which he wanted advice, Mr. Macleodsaid it was one view that the central accounting systemof this country was never designed for the burden that ,

the health service had put upon it in the managementof several thousand hospitals. There would be greateconomies if the hospitals could plan three or five yearsahead. If the block grant was to be effective they mustbe reasonably certain of stable prices for some years ,

ahead. Ambulances were a hospital service in Scotlandand a local-authority service in England : which systemwas the better ? Had local authorities found theirright r6le in the health service ?

Mr. Macleod felt that, after five years, there was aounanswerable case for some investigation. He desired an jindependent view from independent-minded people not ’

tied either to the professions or to political parties.Expenditure in the health-service field could not becontrolled unless man-power was controlled, becausesalaries and wages accounted for two-thirds of the cost ofhospitals, and hospitals accounted for nearly two-thirdsof the cost of the scheme. They must try to relate thenumbers employed to the service obtained and he hoped

’

that as an outcome of the inquiry more staff might beavailable for the hospitals and sanatoria which were atpresent in the greatest need.

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The Government viewed the present cost of the

pharmaceutical services, as did their predecessors, withthe greatest concern. It was the only part of the healthservice which was not under financial control at present.Prescriptions were now running at the rate of 241 milliona year in Great Britain, and the average cost of a pre-scription had climbed from 38d. in 1949-50 to 405d.,47d., and 50’7d., and he had made an estimate of 52d.for each prescription for this year. The rise was due to a

general increase in ingredient costs, although that wasflattening out, to the increasing use of new, valuable, andexpensive drugs, and to the important increase in theproportion of proprietaries. The increase of 3d. lastyear in each prescription was mainly due to largequantities being supplied. Before the health service wasintroduced the proportion of proprietaries was 6 % : itwas now 25 %, which accounted for about half the drugbill, and the whole of the amount he had to payout, taking into account the hospitals, was about £60million.In a month or so, when the final arrangements were

made for the two schedules laid down by Sir HenryCohen’s committee, which referred to drugs not ofproved therapeutic value, doctors were to be asked notto prescribe them. But the biggest problem was that4000 proprietaries came in the categories which theCohen committee advised were not superior to standardpreparations but which they thought ought to be pre-scribable, subject to satisfactory price arrangementsbeing made. The problem, which was not a new one, waswhat was to be done in this matter. There was a genuinecase for many of these firms, but the trouble was that therewere firms who were merely wrapping up standardpreparations in pretty packages and forcing them onthe notice of doctors by salesmanship. The Governmenthad decided to start a number of investigations into thecost of manufacture of certain of these proprietaries,which seemed at first sight to be specially expensive.He hoped this would yield substantial savings. In duecourse he would circulate to doctors the names of thosepreparations concerning which satisfactory agreementson prices had not been reached. This action should notbe taken to be the end of the story, and he did not ruleout more drastic measures if this should fail.

Discussing the charges, Mr. Macleod related that the Is.

charge in the first month caused a drop of 14% in the numberof prescriptions, but by September the deterrent effect was¼%. The dental charges for adults had led to a slight fallin conservative treatment, while the number of children’scourses for the last quarter of 1952 was 170,000 as against350,000 in 1950, and they comprised 22% of the coursesunder the N.H.S. in 1952 as against 9% in 1950. The numberof school dentists had risen from 812 in January, 1951, to998 in January, 1953.

For the first time since 1946, he continued, there wasnow a genuine measure of priority for the priorityclasses. The main problem was how to meet the thrustingneeds of the hospital service. Last year the hospitalsunderspent by £14 million owing partly to the Govern-ment’s requests to them not to overspend and partly tothe fact that the Government for so many months heldthe cost of living virtually stable. In this year’s estimates£15¼ million extra had been provided for the hospitals,and, adding certain other sums to this total, he wasproviding £20 million over the out-turn for the last yearfor that purpose. No-one could say that there had notbeen cooperation with the Chancellor of the Exchequerin finding the money. With this £20 million he couldmaintain the service, bring into full use developmentswhich had been finished recently, and provide for modestfuture development. ’

Mr. Macleod admitted that if the Chancellor offeredhim more money he would not look to free dentures andfree medicines but to the mental health of the country.But he agreed that the policy of successive charges wouldin time destroy the service. He did not know if we wereat end of charges, but at least we had called a halt.What we wanted to achieve was a system by which theservice had an interest in economy which was as naturaland rewarding as was its interest in medical efficiency.That was the essence of the problem which the GuillebaudCommittee was trying to solve.

FURTHER DEBATE

Mr. ARTHUR BLENKINSOP suggested that in theMinister’s view there were two sections of the community- one which might reasonably be expected to paycharges and the other which might be expected to receivethe benefits. The richer section of the community mightuse the social services, but they paid more in rates andtaxes than the benefits they derived. Thus the socialservices were the responsibility of the rich in so far asthese were willing and able to make some extra provisionout of their resources to provide benefits for the poor.To Mr. Blenkinsop it seemed that this paternal approachwas bedevilling the service. It took no account of theinterdependence of all sections of the community. Byimposing charges we were asking that the whole provisionof our social services should be directed to one section ofthe community, who were assumed to be unable to payfor the benefits they received. Yet, in Mr. Blenkinsop’sopinion, it had been open to the Government to withdrawthe charges, instead of making extra, revenue availableto those who were already well off. Mr. Blenkinsopdeplored the maintenance of the financial ceiling for thehealth service. The Minister had said with pride that thehospital authorities had saved large sums from theirestimates last year, but many knew that these savingshad been made at the cost of the proper running of theservice.

Mr. FREDERICK MESSER accepted the need for aninvestigation into the organisation of the N.H.S., butasked that the emphasis should be on efficiency ratherthan economy. In a comprehensive service unificationwas important, and Mr. Messer pointed out that each ofthe 14 hospital regions cut through the staff of the localhealth authorities. We should, he held, investigate thepossibility- of a rearrangement of the regional-boardstructure so that the periphery was coterminous with thelocal authorities-not of course a single local authority,because obviously a regional board must be larger thanany single local health authority. He regretted that theservice was divided into three sections, and he wasanxious that more attention should be given to thepreventive side. Would the Minister consider whetherthe executive councils could not become part of the localhealth authorities ? Not only would this save administra-tive costs but it would bring the general prctitioner intoa closer relationship with the preventive service.

Dr. SANTO JEGER believed that on the whole peoplewould spend on their health what they needed. InAmerica about 4½ % of the national income was spenton health, but 90 % of it was spent privately and onlyabout 10 % publicly. In this country we spent about4 % of our national income on health ; but about 90 %of it was spent publicly, and only 10 % privately.

Colonel MALCOLM STODDART-SCOTT also felt that theorganisation of the executive councils was unsatisfactory.He believed there were too many. Some councils admin-istered their areas at a cost of 10d. per head of the popula-tion, others at 2s. 10d. He believed that by cuttingthe number of councils we could save at least £500,000a year. He also recommended that the powers of theregional hospital boards should be swept away. On thewhole they acted only as post-offices between the hospitalmanagement committees and the Minister. They alsoincreased the difference between the standards of theteaching hospitals and the other hospitals. He wouldlike to see the H.M.c.s rise in standard to that of thegovernors of teaching hospitals and to have increasedpowers and direct access to the Minister. The regionaloffices of the Ministry could, he suggested, be strengthenedto deal with over-all planning, and he thought that theteaching hospitals should be brought under the Ministry’sregional over-all planning.

Mr. H. A. MARQUAND pointed out that the proportionof our national income which was being spent on theN.H.S. was dropping, because the Government had stuckto the £400 million ceiling even though circumstanceshad changed and the Chancellor had twice been able toreduce taxation. Yet, Mr. Marquand held, there werecogent reasons for raising the ceiling. If we had the steel,for instance, it was false economy to deprive hospitalsof fuel-saving appliances. The increase in our population,

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with its higher proportion of aged and young people,was another reason for spending more on the N.1f.S.Again, much of our hospital equipment was obsolescent,and finally the needs of the new towns and housing estatesmust be considered. Tfe hoped that the Minister wouldask the Guillebaud Committee to consider how the servicecould be run more economically by providing bettercapital equipment, and whether it might not be sensibleto present the capital account of the health serviceseparately from the current account. Mr. Marquandsaid that the Trades Union Congress, before appointinga representative to the Guillebaud Committee, hadquestioned the terms of reference, as they had thoughtthe words " to avoid a rising charge " implied that thecommittee must keep within a ceiling. The T.U.C. hadbeen given a

" clarification," and the Chancellor of theExchequer had given an assurance that the committeehad been given no ceiling. Mr. Marquand asked for adefinite assurance that the committee would be free torecommend changes which would involve increasedexpenditure.

GOVERNMENT REPLY AND DIVISION

Commander T. D. GALBRAITH, Under-Secretary ofState, Scottish Office, replying to the debate, said theGuilleband Committee would be able to study the meritsof whole-time and part-time service, but it would notdeal with rates of pay. He was sure that the committeewould arrange sittings in Scotland and hear Scottishevidence.

Mr. BEVAN moved to reduce the token vote for theNational Health Service for the current year by ;E5.The motion was negatived by 293 votes to 268 : Govern-ment majority 25.

Hospital Nursing ServicesIn the House of Lords on May 12, Lord CROOK said

that he noted with concern that today there were

employed in the hospitals 47,000 fully trained nursesand some 8000 part-time nurses as against 52.000 trainednurses and another 48,000 in training in 1948. Presentemployment could not meet the needs of the presentsituation, much less the potential growth of the healthservice. He had chosen this moment to raise the subject,he explained, because the report of the Nuffield Pro-vincial Trust made it plain that the most skilled nurseswere not being used in the most skilful jobs. The reportmade it clear that proper use was not being made ofward orderlies, though 25,000 members of that gradewere now employed. Almost three-quarters of the timespent on nursing duties in the wards was contributedby student nurses, and only 16 % of the time spent onnursing duties was given by trained nurses. The staffnurse had only a small amount of time to devote toactual nursing. The time spent in training the studentnurses was negligible, ranging from eleven hours a weekto seven minutes. One of the deterrents to the recruit-ment of nurses had been domestic work, and Lord Crookwas glad that the amount of domestic work performedby student nurses was today much lower. Instead, theworrying thing was the nature of the nursing dutiesallocated to them. Everyone was accustomed to studentnurses taking pulses and temperatures, but the reportshowed that, apart from doing dressings, student nursesnow gave injections, were responsible for checking drugs,and carried out urine tests. Indeed, 72 % of the total timespent on the dressings of patients was contributed bystudent nurses. Yet the theory of wound dressing was,in the main, shown to be picked up rather than taught.Much of the waste of man-power, Lord Crook continued,was due to the poor design of buildings and the shortageof good equipment. There should be some system ofpriorities to make certain that money was spent onequipment that would ease the man-power problem.The report revealed shortages of elementary hospitalequipment which ought not to exist in a State healthservice, and the Central Health Services Council hadsaid that they saw no reason why financial stringencyshould prevent the provision of, for instance, adequatefacilities for the sterilisation of bedpans.The number of under-staffed hospital beds in April

this year was 28,502, and the present shortage of nurseswas estimated to be 10,420. In the last four and a half

years the improvement had been very slow, and LordCrook hoped that, tic House would be given an assuranceabout the 5% reduction in staffs which he understoodthe Ministry had told hospital management committeesto make. If the cut was applied to domestic staff,domestic work would again fall on the student nurseswho would flow out of the hospitals even faster thanthey were doing so now.Lord MORAN said that since three-quarters of the

patients in hospitals were nursed by student nurses, itwas important that these students should have thebenefit of instruction and supervision by trained nurses.The scarcity of nurses was not a passing factor. Asthe wastage of student nurses in training was 50%,no great increase in the number of trained nurses couldbe looked for in the future. ’ We must concentrate onmaking the best use of those we had. For instance, heasked, were there any activities of the nurse which couldbe done by somebody who was not a nurse ? He wonderedwhether some nursing procedures were not apt todegenerate into rituals. Was it necessary to take thepulse, respiration, and temperature of a patient up tothe moment lie walked out as a convalescent ? Onehour of the sister’s nine-hour day was devoted to clericalwork and nearly all of it could be done by a secretary.Yet when an enterprising provincial hospital institutedthe secretarial system they were told to desist on thegrounds of economy. Another hour was given up togoing round with doctors. In the male ward surelymuch of that was unnecessary. At the risk of offendingmany of his own profession, Lord Moran suggested thatno doctor should go round a ward before 10 A.M. or

between noon and 2 P.M., or after 5 P.M. There must bemore cooperation with nurses if they were to economisetheir time.The question whether any of the nurse’s activities

could be done by a nurse who was not necessarily a trainednurse was, lie admitted, more controversial. The themeof the job analysis described in the Nuffield report wasthat the trained nurse had been taken away from thebedside and that she ought to be brought back to thepatient. He agreed that the nurse must learn the artof accurate and discriminating observation at the bed-side. Only the repetition of apparently menial dutiesallowed the nurse to get to know her patient. On theother hand it was said that all, or most, of these bedsideduties could be done by a person not as skilled as atrained nurse, and at a time of great scarcity of trainednurses it logically followed that less skilled personsshould be provided for the work. Nobody had ever

introduced dilution into a trade or profession withoutprofound controversy, but, he pointed out, dilution hadtaken place among almoners ; among dentists it wasbeing considered ; and the doctor had already beendiluted. After all, the nurse was dilution. She was nowdoing jobs which the doctor did years ago. It wasinevitable that there should be dilution in the nursingprofession. Those who spoke for the nursing and medicalprofessions were generally attached to teaching hospitals,yet half the hospital beds in this country were in mentalhospitals. Surely the case for dilution of the nursingprofession was overwhelming. If the diluting agentcould be the assistant nurse everyone would be happy,but there did not appear to be any prospect of gettinganything like enough of them. There remained the orderly.He felt that orderlies trained for a year would be mostuseful, at any rate in hospitals where acute cases werenot treated.We could not leave aside redistribution when con-

sidering the best use of the trained nurse. In sanatoria,in mental hospitals, and in institutions for the chronicsick and elderly, there was probably a gross shortage oftrained nurses. But if a nurse was to be sent to theseinstitutions, Lord Moran believed that she must govoluntarily-there could be no direction of labour. Healso felt that, at a time when nurses were so scarce, itwas surely wise to be very prudent before furtherdepleting the hospitals where acute illness was nursed.Lord AMULREE agreed that some form of dilution

was the only way round our difficulties. One of the waysin which dilution could be introduced without seriousharm was by making different arrangements, so thatnurses could care for more people than they did now.

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One or two schemes had been set going whereby patientscould be discharged from hospital properly and rathermore quickly than before. At Cambridge, with thecooperation of general practitioners and the districtnursing service, some surgical patients with clean

operations were discharged from hospital within four orfive days. He agreed with Lord Moran that the teachingof nurses should be done at the bedside. We seemedat present in danger of getting too many nurses trainedto too high a standard. They were in fact going to benot very good doctors rather than very good nurses.The nurse so trained looked for an administrative job ;no other would give an increased salary.Lord HADEN-GuBST regarded dilution of the nursing

profession as a defeatist policy. We must do somethingwhich was more productive of efficiency. It was truethat there was a great deal of difference between ordinarynursing and nursing in a mental hospital, but the useof the word " dilution " was unfortunate, because therewas already too much dilution in the nursing profession.It was better to have carefully trained people ratherthan those who had just picked up knowledge as theywent along. He saw no immediate solution in prospect,and the Nuffield report did not in fact offer one. Whatit offered was a survey of the facts, - and he would liketo know what action the Government were prepared totake to remedy the situation revealed in the report.Lord WOOLTON, Chancellor of the Duchy of Lancaster,

replying for the Government, said that the discussionmight lead one to think that the situation was worsethan it actually was. The nursing force in this countryhad increased by two and a half times in the last 50 years.The demand had increased even more, but that alsowas a sign of progress ; more care was being taken ofthe sick. Nursing staff was recruited not so much bystereotyped regulations as by showing people who mightenter the nursing profession that it was held in highesteem. The Nuffield report offered a wealth of newinformation, and the Minister of Health had at oncesummoned his advisory committee to consider whataction should be taken. Lord Woolton was not so

depressed as some of the speakers by the fact that74% of the basic work in hospitals was done by studentnurses. A great deal of that work did not require highprofessional skill, but it did require a great deal ofpersonal kindness. In talks with nurses he had beenhorrified to find that promotion went in the line ofadministration. It was a great pity if highly trainednurses were being called upon to do clerical work whichinvolved an entirely different sort of capacity anddifferent attitude of mind. It seemed to him from thisreport that they ought to see what reorganisationcould be obtained both in the direction of the person-nel employed in administration and also in the fulleruse of orderlies.In the last four years the number of full-time trained

nurses in England and Wales had gone up from 40,000to 47,600 and student nurses had gone up from 42,000to 50,500 ; there had been a drop from 12,000 to 11,500in assistant nurses, and other nursing staff had risenfrom 16,000 to 25,500, making a total of 135,000 full-time nurses compared with 110,000 in 1948. In 1948the shortage of beds due to the shortage of nurses was57,000. Last year the figure was 28,500. ’ When theMinister of Health urged the hospital authorities to cutstaff he stipulated that this must not be done by throwingdomestic work on to the nurses. The reason. for therestriction of the engagement of nurses was that theMinister felt that the problem was becoming to a con-siderable extent one of distribution of nurses. Someplaces were considerably better off than others, thoughstill short ; and in order that the nurses might beemployed to the best advantage the Minister broughtin the restriction order.

Therapeutic Substances (Prevention of

Misuse) Bill

Mr. IAIN MACLEOD, the Minister of Health, in movingthe second reading of this two-clause Bill 1 in the Houseof Commons on May 13, explained that the PenicillinAct, 1947, had been found to be too narrow because it

1. See Lancet, Feb. 7, 1953, p. 280.

applied only to antibiotics. Clause 1 of the Bill was, headmitted, extremely wide, and on principle he did notlike to ask for such wide powers. But he thought it rightto do so because. we were in an age of immense advancesin chemotherapy, and we did not know what sort ofsubstances would be discovered. He was, therefore,asking for powers to make regulations similar to thosemade under the 1947 Act in respect of any substancewhich appeared to the Minister of Health capable ofcausing danger to the health of the community.

Isoniazid, the drug which had given rise to this clause,was a simple chemical substance ; it was cheap to makeand it could be bought over a chemist’s counter. At themoment the Pharmaceutical Society had suggested totheir members that it should only be supplied on a doctor’sprescription. But Mr. Macleod felt that this arrangementdid not discharge his duty to the public, and that it wasmore satisfactory that he should be enabled to makeregulations for isoniazid, similar to those that could bemade for antibiotics.

According to the Bill, before making a regulation hewould have to consult the Medical Research Council, andhe was prepared to give an assurance that he would alsoconsult the manufacturers concerned. This was thegeneral practice under the Penicillin’ Act, and he wouldbe prepared to continue these consultations providedit was clearly understood that the final decision must betaken only on medical grounds. ,

The second clause, popularly known as the penicillinfor pigs clause, was, Mr. Macleod admitted, to use thePrime Minister’s accidental coinage, a pigmeal solutionto a new problem. It had been found that the additionof a minute quantity of antibiotics to feeding stuffshad a remarkable effect in encouraging the growth andfattening of pigs. The Medical Research Council hadassured him that this addition would have no adverseeffect upon human beings who ate the meat thus pro-duced. He would guard against the possibility of creatingby this wider use of antibiotics a sort of black market in--penicillin by ensuring that the antibiotics were used in’such a way that they could not be extracted and usedfor medication. At the moment he would only makeregulations applying -to penicillin, because this was theonly substance of this kind of which we had sufficientsupplies. But it was possible that later aureomycin andterramycin would also be used for this purpose.

Mr. Macleod admitted that he had several timesboasted that he had not introduced any legislation ; inextenuation he pleaded that this was only a little Bill,which wisely extended an Act which had been found tobe too narrow and which brought forward a new and mostinteresting use for antibiotics which might have a mostimportant effect on our food-supplies.

QUESTION TIME

Hospital Nursing StaffsMr. R. W. SoREjsrsEjsr asked the Minister if the distribution

of nursing staff among hospitals had improved as a result ofthe reviews of hospital staffs made at his request by hospitalauthorities.-Mr. IAIN MACLEOD replied : It is too early to assessthe results of the reviews of hospital staffs, but I hope thatthey will make a useful contribution to the improvement inthe distribution of nursing staff which I am seeking to achieveby this and other means.

Mr. SORENSEN In -the meantime is anything being doneto secure a more equitable distribution of the nurses available,since some of the hospitals are virtually understaffed and othersgrossly overstaffed ?-Mr. MACLEOD : That was one of the

thoughts in my mind when I issued the circular which hasreceived so much criticism, but other progress is going on allthe time. The line that seems most promising at the momentis the seconding of nurses, which is being done increasingly.over the country, particularly to sanatoria.

Mr. A. BLENKiNSor : Will the Minister at the same time makesure that there is no suggestion of compulsory secondment,in view of the attitude which I am sure the nursing associationswould take on the matter ?

Hospital Circulars and RegulationsMr. S. HASTINGS asked the Minister if he would issue a booklet

with index giving a summary of the regulations issued by hisdepartment to hospitals since the appointed day which werestill in operation.--Mr. MACLEOD replied : I assume the hon.

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Member has in mind circulars issued to hospital authorities.Some consolidation on particular subjects has already beeneffected, and this will be extended as circumstances permit.A useful index to all circulars is prepared annually by theBirmingham Regional Hospital Board and is widely circulated.

Tuberculosis Among Immigrants ,

Mr. SAMUEL STOREY asked the Minister what" proportionof the notifications of tuberculosis referred to persons who hadrecently entered the country from Eire.-Mr. MACLEODreplied : The present returns from medical officers of healthmake no distinction as to nationality.

, Mr. STOREY : In view of the fact that the incidence oftuberculosis is 50% higher in Eire than it is in this country,and also that in some parts of the country a large proportionof infections are amongst persons who have recently comefrom Eire, does the Minister not think it a good thing to insistupon radiographical screening and a certificate of fitnessbefore allowing people to come from Eire to seek employmentin this country ?-Mr. MACLEOD : There are a number ofother people and Ministries involved in this. The hon. memberis quite right that a certain amount of difficulty has beencaused by people coming from Eire, and I will see whetherwe ought to get more information on this subject and whethersteps should be taken at the ports and airports.

Mass RadiographyDr. BARNETT STBOSS asked the Minister how many mass-

radiography units were in use in England and Wales ; whatwas the approximate number of cases X-rayed per week ormonth ; and how far the number of units in use was to beincreased in the near future.—Mr. MACLEOD replied : 63 unitsare now in use. Last December the 62 units then in use made190,386 examinations. 5 additional units have recently beenallocated and arrangements are in hand to bring them intooperation.

Bone-conduction Hearing-aidsReplying to a question, Mr. MACLEOD stated that up to

April 18, 958 patients in England and Wales had been suppliedwith bone-conduction hearing-aids.

Fibre-glass and Industrial InjuryIn answer to a question Sir WALTER MoCKTOj-r, the Minister

of Labour, stated that the Factory Department had main-tained a close watch on the manufacture and handling offibre-glass in factories, but there was no evidence to showthat it was injurious to the lungs, although it might give riseto a mild skin irritation which soon disappeared. Samplesof materials consisting of fibre-glass and resins which werenow being used in the aeroplane industry were being investi-gated microscopically by the chemical branch of the FactoryDepartment to determine the size and nature of the dustgiven off when components made from these materials weremachined.

Vivisection LicencesMr. PETER FREEMAK asked the Home Secretary how many

certificates were issued last year to perform experiments onliving animals under the Cruelty to Animals Act, 1876 ; inhow many cases no experiments were performed ; andwhether he would consider curtailing the issue of such unneces-sary certificates.-Sir DAVID MAXWELL FYFE replied : In1952 I granted 678 licences, valid for five years. During thatyear 1335 licensees performed no experiments under the Act.Every year the revocation of licences which have not beenused during their currency is reviewed.

Mr. FREEMAN : Many of these 1335 have never performed asingle experiment since they first received a certificate ; andwill the Minister not consider curtailing the number ofcertificates issued in this way ?

Sir DAVID MAXWELL FYFE : We keep a check on currentyears to find the licensees who have not performed an experi-ment. When we have discovered this we work back to seewhether they have up to that time not performed an experi-ment for, say, four or five years. If they have not we prunethe list.

Use of Agene in FlourLord HANKEY asked Her Majesty’s Government for lists

of countries in Europe and North America in which theuse of agene in flour for human consumption was permitted,and of those countries in which agene was prohibited.Lord CARR-flTGTO14, the joint parliamentary secretary to the

Ministry of Agriculture and Fisheries, replied : The treatmentof flour for human consumption with nitrogen trichloride

(agene) is permitted in the United Kingdom, Eire, Holland,

Germany, Norway, Donmark, Italy, Sweden, and Finland.’It is prohibited in Canada, the United States, France, Belgium,Spain, Portugal, Switzerland, Turkey, and Greece.

Medical Posts in the Civil Service

Dr. A. D. D. BuouctiTTON asked the Secretary to the

Treasury in which medical journals he now advertised thevacancies for appointment of registered medical practitionersin the Civil Sorvico.-Mr. J. A. BOYD-CARPENTER replied:None, Sir. Since no recruitment is taking place, vacanciesare not a,t present being advertised at all.

Dr. BuouctHTON : Can the Financial Secretary state in termswhich are more easy to understand why there have been noadvertisements of civil servant medical-officer posts in themedical journals recently ? Is it possible that the FinancialSecretary is in disgrace with the medical profession, and thatthe British Medical Association has imposed a ban upon thepublication of advertisements of this sort ? If that is so,would he inform the House what the trouble is about ?

Mr. BoYD-CARPENTER : Those issues, particularly the onerelating to myself, are of an intriguing character, but theyare wholly different from the point raised in the question.The hon. gentleman asked in which medical journals vacanciesare advertised, and the answer that I have already given himis "None."

Synthetic Detergents InquiryMr. HAROLD MACMILLAN, Minister of Housing and Local

Government, in a written reply said that after consulting theSecretary of State for Scotland and the Minister of Healthhe had appointed a committee with the following terms ofreference :

" to examine and report on the effects of the increasing use ofsynthetic detergents and to make any recommendations that seemdesirable with particular reference to the functioning of the publichealth services."

The chairman of the committee is Sir Harry Jepheott,F.R.I.c., and the 14 members include the following doctors:

Dr: N. R. Beattie, principal medical officer, Ministry of Health(attached to Ministry of Housing and Local Government); Dr.J. C. Cruickshank, professor of bacteriology as applied to hygiene,London School of Hygiene and Tropical Medicine ; Lieut.-ColonelE. F. W. Mackenzie, director of water examination, MetropolitanWater Board.

Public Health

SmallpoxX 0 new cases were reported from Yorkshire in the

week ended at noon on May 19, but the Baildon minerwho was admitted to hospital with smallpox on May 5.died on May 13. The total number of confirmed casesin the outbreak is 30, including 8 deaths. The lastpatient who might have spread the disease was taken tohospital on May 5. Although the period of surveillanceof known contacts has almost expired, special vigilancemust be lnaintained for a longer period because thesource of infection of 4 patients who fell ill several weeksago has not been traced.

Diphtheria Immunisation in AntriinIn his report for 1951, Dr. P. V. Pritchard, medical

officer of health for county Antrim, says that not enoughchildren are being immunised against diphtheria tomaintain a safe level of protection in the county. Figuresfor 1951 indicate that less than 30 % of the children arebeing immunised. Dr. Pritchard points out that thefacilities for immunisation in the county are not as

extensive as elsewhere, for the county health committee’sinstructions are that immunisation should be carried outsolely by general practitioners, except in a small minorityof cases dealt with by medical officers of the public-health department at long-established clinics. The com-rnittee lately reconsidered the matter, but decided tocontinue the present system and not to extend immunisa-tion in clinics.. Some Antrim doctors claim that a satis-factory number of children are being immunised and thatthe figures are unreliable because returns are incomplete.But Dr. Pritchard says that an inquiry into the quantityof diphtheria prophylactic supplied to doctors in thecounty has failed to support this claim. In his view.the only solution is to offer the public the alternatives ofimmunisation by the family doctor or at a health-committee clinic.