a five-year plan

206

view it probably does not arise from the fullness oremptiness of the mammary gland. How far this processwhich calls out the formation of milk is linked withthe posterior-pituitary evoking one is unknown.

There is some evidence of sphincter action within thehuman nipple and sphincteric tissue has been describedthere. Now Cathcart et al. report finding a new typeof neurofibrillar network, with an outline suggestingan oak leaf, ending in it. A comprehensive account ofthe histology of the nipple, which these workers hopesoon to give, should add considerably to our knowledgeof the responses to stimulation of the nipple, but it isessential that structural work of this kind should becorrelated wherever possible with function.

THE N.H.S.

FOR inquirers at home and abroad the Ministry ofHealth and the Central Office of Information have

produced a brief and readable account of the NationalHealth Service.1 This points out that the N.H.S. andthe related social interprises require " large resourceswhich can be made available only by the determinedefforts of a people paying its way by its work " ; but itargues that, considering everything, the service has atleast been launched with remarkable smoothness.

" All big social changes start with a certain amount ofuncertainty, until people get used to the new way of doingthings ; and this Service cannot be comprehensive in thefullest sense until the country is farther along the road toprosperity and a rising standard of life. The public has stillto learn how to use the new facilities properly and eco-nomically ; and those who are actually running the Servicehave to get used to new conditions and changing needs.But if the various professions really join forces with thelaymen in the organisation described in this booklet, theycan carry out a progressive new deal in medical care whichwill redound to the benefit of all."

As might be expected, much is made of the need tochange a state of affairs in which the hospitals wereowned by " some 2000 separate, and often jealous andconflicting, local public or voluntary authorities " :

" new

forms of organisation were required to rescue the healthof the people from what Lord Horder called the maze,the unwieldiness, the overlap, the uneconomy, the lackof integration of our health services.’ " On the otherhand, it is recognised that it would be wrong for medicalneeds to be met everywhere in the same way : " medicinethrives on experiment and comparison of different waysof doing things ; uniformity of method or belief is itsenemy."’ Those who hold that too much attention is

being paid to curative medicine may get some comfortfrom reading that the present expenditure on the N.H.S.(which amounts to about 2s. 6d. per head per week)" can be justified only on the basis that the essentialaim of the Service, and all who work in it, must be toprevent illness." Similarly, proper emphasis is laid onmedical care in the home as contrasted with care in

hospital: the pamphlet says that " for nearly everybodythe family doctor is the pivot of the whole scheme apartfrom dental treatment," and describes how fuller use ofthe home (or district) nurse, of home-help services, andof sickroom equipment provided by local authorities willprevent unnecessary admissions to hospital.At a time when capital expenditure must be kept to

a minimum, and only the most urgent schemes for theextension or repair of hospitals can be permitted, thebuilding of comprehensive health centres " on anyscale " is considered impossible. We are also told once

again that " more study is also needed of the kinds ofcentres most worth trying out before any large-scaleexperiments are launched." However, it is encouragingto hear that " the building and testing of health centresin action, in different forms and circumstances, in largetowns and small, in suburbs and country areas, is a task

1. H.M Stationery Office. 1949. Pp. 36. 6d.

for the next few years." This leads up to the strikingunderstatement that " during that time a great many,perhaps most, family doctors will continue to practiseoutside health centres." Similarly irritating is theremark that in the old days " the family doctor, workingsingle-handed or in a small partnership, usually had toomuch to do because he had too many patients, insufficienthelp, and insufficient equipment, and he was unableexcept with great difficulty to keep up to date or to enjoyreasonable leisure." Little attempt is made to explainhow the coming of the N.H.S. has improved the con.ditions for general practice or arrested their deterioration,The pamphlet does not go far below the surface, and

the light in which it describes the N.H.S. is naturallyrosy. Nevertheless, like the Ministry, we hope that itwill be read by

" those who are workers in the Service,without whose understanding and whole-hearted effort itcannot succeed." Any description of the service whichbrings us back to its main objects is useful at the presenttime, reminding us that more is at stake than termsof service.

A FIVE-YEAR PLAN

Six years ago Lord Nuffield endowed .the NuffieldFoundation with £ 10 million and urged them to get onwith the job of promoting the health and well-being ofmankind. The first year was spent quietly makingplans, and by the end of their first active quinquenniumfrom their total income of -E2/ million the foundationhave given away ;E2/ million in grants. To give usefullyis a responsible and exacting task, but the foundationhave known how to be at once discriminating and bold,and their grants range from £100,000 for the Universityof London’s chair of child health to E1500 to enable theMedical Research Society to purchase Clinical Science inmemory of Sir Thomas Lewis.

In their fourth report 1 the foundation, besides givingan account of their stewardship, also deal with theirplans for the future. In continuing to further the healthand well-being of mankind they hope to help in thediscovery of new knowledge especially in biology andsocial studies-sciences which they feel have been latelysomewhat overshadowed by the more fashionable physicsand economics. They are also anxious to encourage theapplication of existing knowledge to everyday things,especially by joint effort, among groups of experts.Through the National Corporation for the Care of OldPeople the foundation look forward to continuing theirwork on behalf of the old, especially the arrangementsfor the care of the semi-sick who at present tend to beneglected because of the gap between the hospitalauthorities and the local authorities. From their ownresources and as trustees of the Oliver Bird Fund theywill also continue to support research into chronicrheumatism.

In the last twenty years research has become increas-ingly expensive. Today the man in the small semi-private laboratory is at best grievously handicapped.To achieve his utmost he may need access to facilitieswhich can only be provided by the Government, a univer-sity, or a large commercial firm. But this does notmean that the private patron should go out of business.As the foundation point out, he has the urgent task ofseeing that " creative minorities " get a first hearingand a chance of wider support. In their budget forthe next five years the foundation have therefore once’more made provisions for fellowships and training grantswhich will help the unique individual and projectto get their chance.

Prof. HILDA LLOYD has been elected president of theRoyal College of Obstetricians and Gynaecologists insuccession to Sir William Gilliatt. She will assume

office in October.

1. Obtainable from 12, Mecklenburgh Square, London, W.C.1.