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plan of study provides for uniform criteria for the diagnosisof rheumatic fever and for the degree of rheumatic activityrequired for the admission to the study, the random alloca-tion of patients to the three treatment groups, a defineddosage schedule of the drugs for a fixed period of time, aspecified period of observation following treatment, and along-term follow-up schedule. It also lays down preciselythe frequency and type of clinical and laboratory observa-tions to be carried out on each patient.

"two date, in all three countries, 658 cases have beenadmitted to the study and the analysis of rather less thanhalf of these is the basis of the preliminary report. Thesecases were analysed for changes in those symptoms, signs,and laboratory observations usually considered importantin evaluating the course of acute rheumatic fever. In the

type of cases admitted to the trial and with the regime oftreatment laid down, it appears that individual symptoms,signs, or laboratory observations may have been affectedmore favourably by one or another of these three drugs,but no consistent pattern is evident. In short, no firmconclusions can at present be drawn concerning the drugmost effective in the control of the acute illness. The caseshave not been under observation sufficiently long to providedata on the prevention of rheumatic heart-disease.

" Admission of new cases to the study will be broughtto an end later this year. It is anticipated that a total of750 cases will be available in all three countries for completeand detailed analysis of the effects of the drugs on theacute course of the disease and later, after adequate followup, on the prevention of rheumatic heart-disease."

Parliament

Charges in the Health ServiceIN the House of Commons on July 2, a general debate

took place on the new regulations under the NationalHealth Service Acts imposing or increasing charges fordental treatment, drugs and appliances, pay-bed accom-modation in hospital, and hospital drugs and appliances.

Mr. HECTOR McNEIL thought that the practitioner, tosave his patient from being charged, would sometimesput more than one item on the prescription form andprescribe quantities larger than previously. Thus theremight be no appreciable net saving. He was told thatsome outpatient departments were already not veryzealous about the collection of the shillings. If suchdepartments were concerned solely with their legitimatetask of diagnosing, prescribing, advising, and dispensing,there would not be any time for this nonsense. Mr. ARTHURI3rrTgzrTSO said it was a tragedy that so many profes-sional men today, particularly dispensing doctors, wereobliged to spend so much more time on administrativetasks. Through these regulations they were being madeinto tax-gatherers.

Mr. H. N. LINSTEAD was surprised that this quitesubstantial administrative provision had been broughtin with so much smoothness. Speaking as one who haddaily contact with pharmacists, he believed that thenew arrangements would soon settle down into a normalpart of the health service.

Mr. JOHN BAIRD spoke of ill-feeling between the patientand the practitioner caused by the charges. According tothe Minister’s estimates the prescription charges were tobring in .813,000,000 while the dental charges might bringin only 27,000,000. But Mr. Baird forecast that less wouldbe received from the prescription charges and more fromthe dental charges. Because of the dental chargespeople were not receiving treatment, and there was agreat deterioration in the dental health of the nation.

Mr. IAIN MACLEOD, Minister of Health, said that frominformation received about the first month’s workingof the scheme five general conclusions had been reachedabout the hospital charges for drugs and appliances :(1) there had been no noticeable decline in the number ofprescriptions dispensed ; (2) there had been no variationin the quantities of drugs in prescriptions or in repeatprescriptions ; (3) there had been no falling off in thenumber of outpatients ; (4) there had been no noticeableincrease in queueing in outpatient departments ; and

(5) generally no difficulties had been caused by the

introduction of charges. There had been an extremelysubstantial fall in the estimates for dental treatment;a substantial proportion had been for people who couldclaim exemption. As there were not enough resourcesor dentists to meet all requirements, it followed thatthose most in need were getting treatment. The numberof dentists in the school dental service had increased inthe past six months from 716 to 793 and the trend wascontinuing. This meant that the priority classes wouldbe better looked after than ever. In general practiceduring the first -month-admittedly a month of fineweather with many people on holiday-there had been a15% drop in prescriptions. Replies from ten regionsshowed that there had been no substantial change in thequantities of drugs prescribed on each prescription.Mr. HILARY MARQUAND said that the Minister should

not persuade himself that all was going well. The chargeswere felt severely in working-class areas, and the numberof complaints would increase with the onset of winter.The motion to annul the regulations relating to charges

for drugs and appliances in England and Wales wasnegatived by 254 votes to 235.

QUESTION TIMELimitations of the Danckwerts Award

Replying to Mr. J. S-W. ARBUTHNOT, Mr. R. A. BUTLER,Chancellor of the Exchequer, said that he wished to make itclear that the terms of reference of Mr. Justice Danckwerts’saward were confined to the remuneration of general practi-tioners in the National Health Service and his award had nowider application. In accepting the results of the adjudica-tion, which was of an exceptional nature, the Governmenthad by no means adopted the view that similar adjustmentsin other fields should follow. In their view there was no

justification for any assumption that the appropriate standardof remuneration for the professional classes was a - rate of

100% above that in force in 1939. They considered thatremuneration should be determined in the light of all relevantcircumstances.

Industrial Reablement Units

Mr. HECTOR HUGHES asked the Minister of Labour if hewas aware that the existing provision for the- industrialrehabilitation and training of injured and handicapped personswas insufficient; that this was unjust to those persons andan economic loss to the community ; and if he would set upa committee or commission to inquire into the subject.-Sir WALTER MONCKTON replied : There are now fourteenindustrial rehabilitation units administered by my Depart-ment, including the residential centre at Egham. Over 30,000people have attended them and 1373 are at present under-going courses. As to training, the Government training centresare all open to disabled persons, and half of the courses areprovided wholly or mainly for them. More than half thosein training are disabled, and waiting-lists are now

very short.

Dispensing Doctors and Prescription ChargeReplying to Dr. A. D. D. BROUGHTON, Mr. MACLEOD

said that at the request of the British Medical Associationit had been arranged that in the case of dispensing doctors,at the option of the patient, the prescription charge mightbe paid by postage stamp. The practitioner would convertany other payments to stamps and surrender them monthlyto the executive council. The value of the stamps wouldbe transferred from Post Office funds to Ministry ofHealth vote.

Crimes of Violence

In answer to a question Sir DAVID MAXWELL FYFFE,the Home Secretary, said that the numbers of persons foundguilty in England and Wales of robbery, rape, and suchoffences of violence against the person as murder, attemptedmurder, manslaughter, wounding, and indictable assaultswere 2717 in 1947 and 4274 in 1951.

Home Help ServiceIn answer to a question Mr. MACLEOD said that during

1951 166,759 people were assisted by the Home Help Service.He did not think that local health authorities required anyspecial financial inducement to develop this service to themaximum extent practicable.