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have yet to be worked out and we shall proceed with this also’

as quickly as we can." I am glad that we have been able to agree on these new

proposals for assistance with expenses on practice premises. Iam sure that they will be a very valuable contribution to the

- solution of the difficulties that are worrying general practitionerstoday."

Conferences

ALCOHOL AND ALCOHOLISM

THE 27th International Congress on Alcohol andAlcoholism took place from Sept. 6 to 12 in Frankfurt amMain, and was attended by some 600 delegates.

Prevalence

As in the United Kingdom, there seem to be no reliablefigures regarding the extent of alcoholism in Germany. It

is, however, estimated that the proportion of alcoholics

" requiring treatment " in the Bundesrepublik amounts to0-75% of the population-i.e., approximately 350,000-400,000people-an estimate closely resembling that usually givenfor the U.K. The use and abuse of alcohol has increasedin the past few years, not only among adult men but alsoamong the young and among women. There are about 850information and consultation bureaus which in 1962 providedhelp for 80,000 men and women; there are also 12 open and 6closed inpatient treatment centres. The cost of treatment isborne to some extent by the authorities and the social insurancesystem. Treatment is often carried out on a voluntary basis,but compulsory admission is sometimes applied in cases wherethere is lack of insight. Examples were given of cities wherethere is good cooperation between the courts and doctors, butalso of others where this was completely lacking. Thus Dr. H.NEUMANN (Kiel) complained that courts often knew next tonothing of the necessity for treatment in early cases ofalcoholism that might appear in court, or they might believethat all that was needed for a " cure " was compulsoryabstinence in prison. Dr. Neumann pleaded for much closercooperation between doctors and lawyers, and throughout theconference the need for an interdisciplinary " team " approachwas stressed by many speakers.Much was heard about the increasing danger of alcoholism

among the young. In Germany nearly 10% of alcoholicstreated over the past years were under 25 years of age. Theneed for education of the young about alcohol and alcoholismis evident, although neglected in many countries. Somecountries also seem to present an increase of alcoholism amongwomen, although Dr. BEN Z. LocKE (U.S.A.) had not foundany such increase among first admissions to Ohio publicmental hospitals.

Legislation and JurisprudenceViews on the significance of alcohol for criminality vary a

great deal (a large-scale investigation is going on in Frankfurt).It is of course necessary to distinguish between, on the onehand, the criminal behaviour of longstanding, establishedalcoholics and, on the other hand, the crimes committed underthe influence of alcohol by alcoholics as well as by occasionaldrinkers. There is rising concern about the connectionbetween alcoholism and juvenile delinquency.

Drink and DrivingThe risk to safety on the road stemming from the drinking

driver were not restricted to a special session on Road Trafficand Alcohol. Similar danger may also arise from the use orabuse of other drugs, especially when used in combinationwith alcoholic drinks. In a symposium under the chairman-ship of Dr. J. D. J. HAVARD all the members agreed that byitself clinical examination was not sensitive and reliable

enough to detect impairment of driving ability. Danger may

arise not only from alcohol but also from drugs, especiallywhen these are taken in conjunction with alcohol. In a Germaninvestigation it was found that 12% of drivers involved in anaccident had taken drugs (apparently no control study wascarried out with drivers not involved in accidents).

Treatment and ReablementProfessor ZUTT (Germany) sought to answer the question:

Why it is that, despite the many well-known risks, man has yetcarried on drinking ? He saw a possible explanation in the

anthropological significance of intoxication. At the start of hiscareer the young man has many possibilities ahead of him. In

choosing one among these manifold possibilities he blocks theroad to all the others. Thus any such choice and fulfilment alsoinvolves renunciation, and later the adult may bitterly regretthis. Temporarily intoxication offers the drinker the chance toget over the fact that he has renounced so many possibilities,and once again he may feel young again. The anthropologicalimportance of intoxication, along with the integration of

intoxicating drink in cultural customs, limits, in Zutt’s view,the efficacy of treatment. But, like all subsequent speakers, hebelieved that a great deal could and should be done. Thus he

spoke on the need for prophylaxis: the young who are threatenedsometimes by unscrupulous advertisements, need more

openings to develop their capabilities, and adults requireplaces of relaxation and recreation, possibly in an alcohol-freeatmosphere.With hardly any exceptions, speakers agreed that the

alcoholic had to accept the goal of total abstinence. Thera-

peutic programmes usually have to start with sobering-up butmust not stop there. A typical initial sobering-up and detoxica-tion programme was described by Dr. J. B. KENDIS (Washing-ton, St. Louis): a balanced diet, tranquillisers, extra vitamins,possibly anticonvulsant drugs, and, where necessary, non-

barbiturate hypnotics for a few days, barbiturates and

paraldehyde being too dangerous because of the risk ofaddiction.

Outpatient therapy is highly developed in the Netherlands,with its network of consultative bureaus as described byDr. P. H. ESSER; and an example of the use of the day hospitalin the treatment of alcoholism was given by Dr. V. HUDOLIN(Zagreb).

In regard to long-term therapy, there was general agreementabout the need for a comprehensive programme includingindividual or group psychotherapy, drugs, and social therapy.Professor ZUTT stated that one could not cure alcoholism bychemical means; and, while the sensitising drugs were men-tioned by many speakers, hardly any mention was made ofapomorphine. Dr. D. GOLDSCHMIDT (Hungary) described acombined form of treatment using occupational therapy,group therapy, and drugs, including apomorphine-but hewas not very satisfied with the results achieved with

apomorphine.

RESEARCH IN LEUKÆMIAFROM A CORRESPONDENT

AT a symposium held by the School of Clinical Researchand Postgraduate Medical Teaching in Cambridge onAug. 18-21, speakers from Europe and one from theUnited States reviewed some aspects of leukaemiaresearch.Now that the karyotype changes in human leukxmia have

been reasonably well defined, they must be correlated withmetabolic changes in the cells-a point clearly made by Dr. J. L.STAFFORD (London). Dr. L. DMOCHOWSKI (Houston, Texas)showed pictures of virus-like particles in human leukxmic cellsand tissues; and Dr. R. J. C. HARRIS (London) made a reasonedcomparison of the ,relation between virus-induced leuka2miaand tumours in animals. Despite the carefully controlled workof Dr. Harris’s associates, showing the presence of virus-likeparticles in cultures from human leukxmic bone-marrow, westill do not know whether human leukxmia can be virus-induced.

688

Dr. L. G. LAJTHA (Manchester) illustrated his evidence forthe sequential synthesis of chromosomal D.N.A.-for example,the " inert " X chromosome associated with the Barr-bodychromatin being synthesised at the end of the D.N.A. syntheticcycle.

Dr. A. J. HALE and Dr. E. H. COOPER (London) describedexperiments on non-leukxmic proliferating leucocytes showingthe physiological variables that influence radioactive labellingof chromatin and illustrating the pyrimidine-degrading effectof granular leucocytes. Dr. E. STORTI (Modena) describedautoradiographic studies of R.N.A. and protein metabolism innormal and leukxmic leucocytes. His results were mainlyexpressed as mean counts of the number of grains overlyingeach cell which had taken up labelled precursor (a commonway of expressing such data which gives some idea of theaverage incorporation by the cell population). Dr. D. QUAGLINO(Cambridge) made qualitative comparisons of the stainingintensity of different cells after various cytochemical reactionsand of grain distributions in labelled cells. (These results mighthave been more helpful if expressed in some quantitative way.)These contributions illustrated how time-consuming is

the cytogenic and cytochemical approach to the analysisof the behaviour of leukasmic cells. They did, however,show that accurate quantitative correlations of resultsobtained by several techniques must be used if the indi-vidual cellular differences within a population of leukaemiccells are to be investigated.

Dr. F. GAVOSTO (Turin) reported an investigation of thepattern of incorporation of radioactive thymidine into theD.N.A. of replicating chromosomes. The evidence concerningthe possible sequential labelling of chromosomes in normal andleukxmic human cells is scanty: differences in the chemical or

physical make-up of individual chromosomes may account fordifferences in labelling rate, but this possibility has not yetbeen investigated.

Dr. I. F. SEITZ (Leningrad) and Dr. E. SALVIDIO (Genoa)presented much information on the biochemical analysis ofmetabolic pathways in leukasmic cells. Again, the difficulty ofassigning the detected differences to changes in cell type, cellnumber, or cell activity in the samples analysed illustrated thelimitations of such an approach.A beautifully argued paper by Dr. W. JACOBSON (Cambridge)

illustrated the ability of leukxmic cells to overcome the effecton their proliferative activity of folic-acid antagonists. Thecombination of biochemical, cytological, and cytochemicalapproaches demonstrated what detailed information can beobtained about celltilar activity.The main impression from the meeting was that,

although we have lately acquired much information aboutthe metabolic and cytogenic differences between normaland leuksemic leucocytes, we still are nowhere near theessential biochemical defect that makes leukaemic cells

persist in proliferating. The defect may be inherited, or itmay be induced by radiation, virus, hormone, or drug, orby a combination of effects: there can be little hope ofeffective therapy until the defect is identified.

Medicine and the Law

Court Allows Blood-transfusion

AT an emergency sitting of Norwich juvenile court the

magistrates made an order for a girl, whose parents wereJehovah’s Witnesses, to be placed in the care of Norfolk CountyCouncil.’ The girl needed a blood-transfusion if, in the viewof her doctors, she was to survive the effects of an internalhxmorrhage. Consent for the transfusion had been refused bythe girl’s parents on religious grounds.

1. Times, Sept. 19, 1964.

In England Now

A Running Commemary by Peripatetic Correspondents

SHOULD doctors give up clinical time to sit on committees ? Ashort while ago I read a comment by one of our elders that as hegrew older he found less and less time in which he could do anywork, because of the staggering increase in the number of com-mittees on which he was expected to sit. Prominent members ofour profession sit hour by hour at the committee table, and thechairmen of the various central committees have to spend vastamounts of time each year, often for days on end, in negotiationand argument (which is always non-clinical and often non-medical). And what is a committee but a collection of peoplesitting round a table talking about what they ought to be doing ?

In the surgeon the waste is most obvious. Here is a man inhis professional prime, with the clinical and operative experi-ence of a life-time at his disposal for the benefit of his patients,and, through his juniors, of posterity. He may sit at the tableday by day, month after month, arguing with representativesand officials of the Ministry who are briefed not on the meritsof the case, but on what the Treasury is prepared to allow. Ona more local level, each hospital management committee,responsible for supervision of the day-to-day running of itshospitals, has 20-25 members. Leaving out Scotland and theteaching hospitals, there are 398 H.M.C.S (by the 1962 figures).That means that some 8000 people are telling 398 groupsecretaries and other full-time administrative officers how theirbusiness is to be ordered. Of this 8000 perhaps 1 in 5 (say 5 oneach committee) may have some idea of what goes on inside ahospital, but all 8000 are losing working time, of their own andthe country, while they talk, and talk, and talk. It is not thefault of the 6400-odd that they are not by training or byexperience qualified to express useful opinions on things ofwhich they know so little. All praise be to them for trying sohard on the well-nigh impossible task set them, but it is a littlehard on the 1600-odd who have to try to make them under-

stand, while so many of the 1600-odd would more profitablybe occupied in practising the medicine for which they are

trained.* * *

One morning during our holiday it was raining, and as theycould not play on the beach the children suggested a train ride.We travelled to the end of the line by diesel train, sitting justbehind the driver and looking out forwards. For the return

journey we wished to do the same again, but the front of thetrain now was the first-class section, so I went to the bookingoffice and asked to pay the excess fare.

Now if we had been travelling at ordinary fares the calcula-tion of the amount to pay would have been easy, but does any-one ever travel at ordinary fares ? Again, if we had beentravelling on cheap-day return tickets and wished to pay theexcess to travel both ways first-class, it would have been easy.But to travel cheap-day return and do only one way first-classcaused difficulties. The booking clerk consulted a number ofpamphlets, which did not seem to help. Then he made a

telephone call; that did not help either. " Look," he said," if I were you I should just do it on second-class tickets-andif anyone likes to ask you for any extra, let them work out howmuch."

* :II< ’*’

The other evening I attended, knowingly, my first witch.A plump, rosy-faced, little man, with a beard and high myopia,he had left his sweet-and-tobacco shop to travel many mileswith his coven to a Lammas Sabbath, where he had sprainedhis ankle dancing round a ritual fire.

They were all, male and female, styled witches, he told me,and his coven was a white coven, practising only white magic.The black variety was kinky, and as far as they were concernedwas out. This had nothing to do with any colour-bar, I

gathered, simply goodies and baddies. There were the usualthirteen witches in his coven, twelve members and a leader,