410

The pancreas showed the typical histological changes of fibro-cystic disease with atrophy of acinar cells, dilatation of ductsand acini with inspissated secretion, and an increase in fibrousstroma.

CASE 2.-A male Kikuyu child, aged 2 years, came fromup-country on Feb. 11, 1960. X-ray examination there hadrevealed cystic changes in the right lung. The parents did notaccompany the child and the family history was not known.He weighed 7-55 kg. and appeared thin and stunted, withdepigmentation of hair, rough dry skin, and no oedema. Theabdomen was distended, he had a large umbilical hernia, andthe stools were pale and bulky.A chest X-ray revealed extensive cystic bronchiectasis in the

right middle and lower left lobes, with surrounding inflamma-tory reaction. The Mantoux test was negative, and no organ-isms were cultured from the sputum, although it was thick andpurulent. Specimens of duodenal juice on three occasionsduring the first month in hospital contained no trypsin, and theShwachmann sweat-plate test was strongly positive.The child ran an intermittent fever for 3 weeks and was

treated with penicillin and a high-protein diet. He improvednutritionally, but there was little change in the chest X-ray.Throughout he was always ravenously hungry.One month after admission sulphafurazole, 0-25 g. daily, was

started and he was maintained on this until the time of dis-

charge on April 8. By this time he had gained 1 ’27 kg. in weight,but continued to have pale bulky stools. A further specimen ofduodenal juice before discharge still contained no trypsin.He was followed up in his own home district, and his

subsequent progress is not known.

Although pancreatic enzymes are known to bediminished or absent in kwashiorkor and marasmus,6 7

dietary treatment usually produces a progressive increasein enzyme activity during recovery. 7

The persistent absence of trypsin in these children,together with the pulmonary lesions, positive sweat-

plate test (case 2), and necropsy findings (case 1) seem toprove that they did in fact have cystic fibrosis.

LORNA G. MACDOUGALL.Hospital for Sick Children,Toronto, Canada.

A CATHETER CONTAINER

SIR,-Urethral catheters put up in plastic envelopes ofone sort or another and sterilised by gamma rays havecome into use lately. They are helpful in urinaryinfections which, as your annotation 8 started, are attribut-able in about 45% of cases to catheterisation. But in

gynaecological and obstetric wards, where catheter

specimens are mainly required for bacteriological examina-tion or to determine the extent of residual urine after a

prolapse operation, a simpler and more economical methodmight achieve the same standard of asepsis.Robert Whitelaw, of Newcastle upon Tyne, makers of

Klintex’ paper bags for the autoclaving of surgical gloves,have kindly made for me a klintex catheter container consistingof a paper envelope measuring 181/2 x 21/2 in., with an innerwrapper folded at the corners which will contain a Jaques(Nelaton) rubber catheter, such as is commonly used by nursesor midwives.

The envelope has a label on which the size and type ofcatheter is written, and the date of autoclaving (which can bedone with a date stamp). The envelope is sealed with autoclavetape, and autoclaved like rubber gloves. In this way rubbercatheters can be used repeatedly. They are easily distributedand can be taken out on " flying-squad " calls without theirsterility being in doubt. When needed, the outer envelope iscut with sterile scissors, and the catheter in its inner folded6. Badr E1-Din, M. K., Aboul Wafa, M. H. J. trop. Pediat. 1957, 3, 17.7. Trowell, H. C., Davies, J. N. P., Dean, R. F. A. Kwashiorkor; pp. 169,

217. London, 1954.8. Lancet, 1962, i, 789.

wrapper slid out of the envelope on to a kidney dish. Thecatheter can be passed by a " no-touch " technique usingsterile forceps and an autoclaved catheter lubricant. It rests onits autoclaved wrapper right up to the moment of use.We have used these envelopes for several months at the Royal

Devon and Exeter and other hospitals, and they have proved simple,satisfactory, and economical.

P. M. G. RUSSELL.Royal Devon and Exeter Hospital,Exeter.

Obituary

FREDERICK HALL

C.B.E., M.D. Manc., D.P.H.

Dr. Frederick Hall, formerly county medical officer ofhealth for Lancashire, died at Bournemouth on Aug. 16,at the age of 77.

He qualified M.B. at Manchester in 1907, and took the D.P.H.three years later. After holding junior appointments at

Manchester Royal Infirmary, Crumpsall Union Infirmary, andSt. Mary’s Hospitals, Manchester, he was appointed assistantmedical officer successively to Lincoln and Derby. In the1914-18 war he served in the R.A.M.C., afterwards returningto Derby. After the war he was called to the bar; and in 1925he graduated M.D. He had by then moved to Lancashire, wherehe spent most of the remainder of his professional life, succes-sively as assistant and chief assistant medical officer, and asmedical officer of health.

A. D. writes:" Lancashire is renowned for the quality of its public-health

department and for the distinction of its county medical officersof health. None was more distinguished than Frederick Hall,who guided the county’s medical affairs during the difficultyears of the war and the bringing into operation of the NationalHealth Service. Many of his assistants are now eminent, andthey learnt the principles of good administration under hisurbane guidance.

"-He was always a strong supporter of the Society of MedicalOfficers of Health, of which he became president. After hisretirement from Lancashire he was invited to take the office of

part-time medical secretary. Towards the close of this period ofoffice he put forward a scheme for the reorganisation of thesociety, which was adopted and has proved most successful.The award of the c.B.E. as a recognition of his professionaleminence was much appreciated by his colleagues.

" He was no mean after-dinner speaker, but he enjoyed mosta small and intimate gathering of old friends where his witwould sparkle and he would recount amusing anecdotes aboutformer colleagues. He was a keen golfer and spent much of hisleisure on the links."

DAVID LAURENCE NAIRACB.M. Oxon.

Dr. David Nairac, who died on Aug. 10, was a housephysician at St. Bartholomew’s Hospital. He was a youngman of exceptional promise, and had previously held apost as house-surgeon at Whipps Cross Hospital withunusual distinction. Those who worked with him had nodoubt that his ability would lead him to wherever he chosein the medical profession, and as his inclination wastowards surgery one must believe that the country has losta potential fine surgeon. Both as student and as housemanhe was a most enthusiastic worker, combining this with anatural insight into people, and beautiful easy manners.His sudden death has saddened us all. H. w. B.

DR. LEILA HAWKSLEYR. A. W. writes :" Dr. Leila Hawksley was one of those modest retiring scien-

tists whose true worth is known to only a few intimate fellow

411

workers. It was my great good fortune to be one of these, andto benefit from her wide experience and from her generosity ingiving me many unusual histopathological specimens and notesembodying her thoughts about them. It is to be regretted thatshe herself published very little, for her knowledge of tumourpathology in particular was second to none."

Public Health

SmallpoxA 3-year-old Indian boy with suspected smallpox was

removed from the liner Oronsay when this arrived at Tilburyon Aug. 15 from Japan, Bombay, and the Middle East. Heand his mother were taken to Long Reach Isolation Hospital,Dartford, where modified smallpox was confirmed in the child.At the beginning of this week he was still seriously ill. Therewas evidence that he had been successfully vaccinated about ayear ago. Another five of the liner’s passengers were taken tohospital with chickenpox. Efforts were being made by localmedical officers of health to trace and vaccinate both passengersand crew.

Vaccination against Foot-and-mouth DiseaseThe first commercial consignment of attenuated live vaccine

to combat African foot-and-mouth disease was flown to

Johannesburg on Aug. 16.1The vaccine, developed by the Animal Virus Research Institute at

Pirbright, and supplied by Burroughs Wellcome, is for use on thecattle ranches of South-West Africa. It costs less than 2s. 6d. a dose,and each dose gives twelve months’ protection; by contrast, the moreexpensive killed vaccine gives only three months’ immunity.The outbreak of African foot-and-mouth disease in the Middle

East has prompted the producers of the vaccine to step up its output.But a start on the large-scale vaccination programme to attempt tocontain the disease cannot be made until the Food and AgricultureOrganisation of the United Nations has found the necessary funds.

Appointments

ANDERSON, J. P., M.D. Durh., M.R.C.P.E., D.C.H.: consultant physician inchest and infectious diseases, South Somerset clinical area.

BYRNE, J. A., M.B. Belf., D.P.H., D.T.M. & H.: deputy M.o.H., Dover.CAPEL, L. H., M.D. Lond., M.R.C.P. : assistant physician, London Chest

Hospital.EDGAR, W. M., M.A., M.D. Cantab.: consultant in pathology, Bradford.EvANS, J. H., M.D. Lond., M.R.C.P.: consultant physician, Hope Hospital,

Salford.GRIFFITH, T. P., M.B. Lond., D.o.; consultant ophthalmologist, West Cum-

berland hospital group.JAMES, Brenda, M.B. Birm.: assistant M.o., maternity and child welfare

services, Stoke-on-Trent.JONATHAN, 0. M., M.B. Lond., F.R.C.S.: second consultant in general surgery,

Clwyd and Deeside hospital group, based at the Royal AlexandraHospital, Rhyl.

JoNES, J. T., M.B., B.SC. Wales, D.P.H.: senior M.O., Newcastle upon Tyne.RICHARDS, Frances M.,M.B., B.SC. Wales, D.OBST., D.c.H.: senior M.o., Cardiff.TRAIN, T. S. R., M.D. Glasg., M.R.C.O.G. : consultant obstetrician and

gynaecologist. East Fife group of hospitals.WILLS, V. A., M.B. Lond., L.R.c.P., D.P.H.: assistant M.o. for mental health,

Monmouthshire.

Department of Technical Cooperation:FRIEDMAN, L., M.D. Strasbourg, F.R.C.S. : orthopaedic specialist, Hong Kong.HODGES, W. A. Ashford, M.B. Cantab., F.R.C.S. : surgical specialist, Tan-

ganyika.JOHNSTONE, GEORGE, F.R.F.P.S., L.D.S. : senior surgical specialist, Tan-

ganyika.OLD, E. G., M.B. Lond., L.R.C.P., D.OBST.: medical and health officer, Hong

Kong.

Royal Air Force Medical Service:Wing-Commander S. E. CUPPLES, M.B. Belf., D.P.H.: senior M.o., Little

Rissington.Wing-Commander H. L. JENKINS, M.D. Durh. : senior M.o., Head Quarters,

Malta.Wing-Commander I. H. MERCER, L.M.S.S.A. : senior M.o., Bahrein, Persian

Gulf.Wing-Commander I. M. O’CoNNOR, M.CH. N.U.I., D.P.H., D.O.M.S.:

ophthalmic duties, R.A.F. Hospital, Cosford.Wing-Commander F. L. A. VERNON, M.R.C.O.G., D.OBST.: gynaecological

duties, R.A.F. Hospital, Wroughton.1. Times, Aug. 16, 1962.2. Lancet, Aug. 4, 1962, p. 237.

Notes and News

NEW SOMERSET HOSPITAL CENTENARY

THE first hospital at the Cape of Good Hope was foundedby Jan van Riebeck in 1656. Nursing duties were carried outby slaves who nursed the patients on straw beds. In 1699 a

hospital accommodating no less than 1000 patients was builtby Governor Simon van der Stel for employees of the DutchEast Indies Company.

After the British occupation of the Cape a Naval surgeon,Dr. Samuel Bailey, provided the funds for a hospital wherementally disordered patients as well as medical and surgicalcases could be treated. This hospital, erected in 1818, was theOld Somerset Hospital. A general hospital of 100 beds wasbuilt in 1862, mainly through the efforts of Dr. HenryBickersteth, who had gone out as a young medical studentfrom St. Thomas’s Hospital to be apprenticed to Dr. Bailey.He later came back to London to qualify fully, and to becomea fellow of the Royal College of Surgeons. He returned to theCape-the first fellow to practise as a surgeon in southernAfrica.

I

The new hospital became the New Somerset Hospital ahundred years ago this month. For eighteen years-from1920-it served as the first teaching hospital in southern

Africa, until the rapid growth of the medical school of theUniversity of Cape Town necessitated further expansion. In1938 the New Somerset Hospital was replaced by the GrooteSchuur Hospital, a 1000-bed hospital well known to medicalteachers in other countries who have visited it as lecturers orexaminers, or who have on their own hospital staffs graduatesand postgraduates who were trained there.The New Somerset Hospital, now greatly modernised, was

turned into a purely non-European hospital with all its nurses,staff nurses, and patients non-European. For the first time

young non-European women were given the opportunity totrain as nurses. Today it is a training centre for interns,nurses, and medical students.

The South African Medical Journal has brought out a

special issue 1 to commemorate the centenary of the NewSomerset Hospital. Besides a handsomely illustrated accountof its early history, the journal has a clinical section, contributedby members of the hospital staff, which provides ampleevidence of the high standards evolved during the hundredyears of the hospital’s existence.

REHABILITATION OF SCHIZOPHRENICS IN VERMONT

THE role of activity programmes, total push, factory workwith financial incentive, and so forth in the rehabilitation ofchronic mental patients is smaller in the United States thanhere. Indeed, the average American State mental hospital-especially for long-stay patients-is a gloomy place, and remainsseveral decades behind its British counterpart in therapeuticphilosophy. An account of a programme in Vermont 2 istherefore particularly interesting as it shows the way in whichAmerican psychiatrists cope with the chronically psychoticpatient.The use of physical treatments approximates to current practice

here, and the programme has many points in common with socio-therapy in this country, although couched in more psychoanalyticjargon. In the course of a year, 298 patients were referred to the

/

scheme and 247 of these were discharged; the number of long-staypatients in the hospital is steadily diminishing. The account

emphasises that great expansion of staff and resources is not needed,and that useful work can be done with the personnel and equipmentalready to hand. The patients’ careers before and after rehabilitation,and the criteria on which patients were selected are not given indetail; and the bibliography is almost exclusively American. But

many psychiatrists will be able to pick up hints from this smallpublication. Particularly useful is the pamphlet reprinted in it, forrelatives, friends, and employers of the newly discharged patient.

1. South African Medical Journal, Aug. 18, 1962.2. Chittick, R. A., Brooks, G. W., Irons, F. S., Deane, W. N. The Vermont

Story. 1961. Pp. 105. Obtainable, free of charge, from: The Super-intendent, Vermont State Hospital, Waterbury, Vermont, U.S.A.