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REMUNERATION OF MEDICAL ADMINISTRATORS

ON a later page we print the Industrial Court’s awardon the claim of administrative medical officers inthe hospital service. This award acknowledges the

responsibility that these doctors carry, by placing theirremuneration more or less on a par with that of con-sultants. Other medical administrators-and notablyfull-time public-health workers, who even after the recentincreases 1 still count themselves at a financial dis-

advantage-may be tempted to envy their colleagues inthe hospital service ; but this latest amendment will

provide a strong point in favour of public-health workerswhen next their remuneration comes under review.

TUBERCULOSIS IN NEIGHBOURING HOUSEHOLDS

SOMETIMES the essential findings of work involving agreat amount of detailed study can be stated in onesentence. This is true of an investigation 2 which hasshown unequivocally that in the period 1921-48 notifica-tions of tuberculosis from adjacent houses in a typicalcounty borough (Northampton) were more common

than would be expected on a random basis ; and, further,that these second notifications tended to occur more oftenwithin twelve years than would be expected. Thisresult has been obtained only by close study of allnotifications in the period and by new statistical tech-niques. House-to-house infection is the most likelyexplanation of the result ; but it is perhaps unfortunatethat Dr. Josefine Webb and Dr. Alice Stewart, theauthors of this study, do not consider other possiblecauses more fully. True, they exclude the possibilityof bias from relations living next door to each other,but there are surely other possibilities. For example,could the result not have been produced by a tendencyfor neighbours to present themselves for examinationwhen a case of consumption has been found next door ?There is a large, though diminishing, pool of undiagnosedcases, and any one group that is examined more oftenthan others may be expected to have a relatively highnotification-rate.

It seems, however, that spread of infection accountsfor at least some of the excess. The increasing numberof workers who attach little importance to superinfectionwould attribute the preponderance to primary infectionof neighbours and their children. There is, indeed,some evidence for this view ; for the inclusion of thesmall number of meningeal and miliary cases with thepulmonary cases increases the percentage excess ofnotifications in. next-door houses from 16 to 20. Since

pulmonary notifications are about 15 times as numerousas miliary plus meningeal, it appears that a large partof the excess may be due to the tragic sequelae of primaryinfection. Because of this, and the fact that the excessof notifications for other types of tuberculosis wasapparently small, it would have been interesting toknow something of the state of the milk-supply to thetown : if for a large part of the time much tuberculousmilk was being consumed " other tuberculosis " and,to some extent, meningeal tuberculosis could not beexpected to occur especially often as a result of proximityto human sources of infection. Since so much informa-tion is given to show that the notifications and deathsfor the town follow the usual pattern with regard tohousing, economic circumstances, and occupation, thisomission is surprising.

This investigation does not seem to indicate a needto alter current practice in the examination of contacts ;for, while second notifications from the same housewere more than three times as common as would beexpected, notifications from adjacent houses were only1. See Lancet, 1950, ii, 918 ; Ibid, Jan. 6, 1951, p. 58 ; Ibid, May 26,

1951, p. 1176.2. Webb, J., Stewart, A. Brit. J. soc. Med. 1951, 5, 13.

one-third more common ; and thus the number of casesfound would scarcely justify the effort. It would seemreasonable, however, to examine neighbours when theyhave been in close contact, or when the source of a pri-mary lesion in a child cannot be found. Obviouslyspecial care is necessary in some of the new housingestates where a high proportion of families have beenre-housed because of a case of infectious tuberculosisin the household.

BAGS UNDER THE EYES" Discuss bags under the eyes " would be an interest-

ing, if unpopular, question for the final examination.This common and unsightly condition is often secondaryto renal or cardiac disease or hypothyroidism, andtreatment of these disorders may cause the bags todiminish or disappear. But there remain the bags which" just growed." What of these ? Some light-albeitdim-has been thrown on this question by four anonymousauthorites.1 It seems that various types of food or

inhalant allergy are occasionally responsible for bagsunder the eyes. Drug allergies and allergy to cosmeticsmay also be involved. Then again, local stasis or cedemain the loose vascular tissue of the lower eyelid may reflecteven slight changes in muscle tone, elasticity of the skin,or other factors relating to the patient’s general condition.Anaemia, malnutrition, and late pregnancy are otherconditions which may give rise to bags under the eyes.It is gratifying to learn that bags are " not necessarilyan indication of debauchery and dissipation." Thesize of the bags may vary at different periods of theyear or times of day ; relative cardiac insufficiency,not enough to be diagnosed clinically, may produce" evening bags." Bags under the eyes may be,familial. One of these American authorities states

frankly that " no one knows the exact cause of thiscondition."

BIRTHDAY HONOURS

THE promotions and appointments to the orders ofchivalry announced this year on the King’s Birthdayinclude five new medical knights and-a greater rarity-a medical dame. Dr. G. S. Todd, who is promoted fromC.V.O. to a knighthood in the Royal Victorian Order,has been, since 1934, superintendent of the King EdwardVII Sanatorium, at Midhurst, in which the Royal Familyhave always taken much more than nominal interest.Prof. Hilda Lloyd, P.R.C.O.G., who becomes a dame of theBritish Empire, is the first woman to have presided overone of the Royal Colleges, and she has created a valuableprecedent with dignity and tact.The new knights bachelor include Mr. P. S. Messent,

director of surgical studies at the University of Adelaide.The remaining accolades will fall on professorial shoulders.nearer home. Prof. C. A. Lovatt Evans, F.R.s., has notonly held three chairs of physiology and served UniversityCollege as an outstanding medical dean, but has presidedover Government committees and taken part in the.counsels of the Royal Society and of the Medical ResearchCouncil. He spent the late war on Salisbury Plain ar,

principal scientific officer at the Experimental Station,.Porton. Mr. E. F. Finch, a vice-president of the RoyalCollege of Surgeons and lately professor of surgery in theUniversity of Sheffield, has long shown special concernfor the organisation of a cancer service to provide timelydiagnosis and treatment. Dr. J. W. McNee is physicianto the King in Scotland and holds the regius chair ofmedicine in Glasgow ; but beyond the borders of Scot-land many will remember him as a surgeon rear-admiralin the late war. The profession may be rightly proud ofthe long list of other medical honours, reproduced on,another page, for it testifies to work well done in allparts of the world.

1. J. Amer. Med. Ass. 1951, 145, 858.