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cerned; and, to many, the edentulous and denture-fitted state is still the most blessed. In such a climate of

opinion, the continued decline of the school dentalservice is not surprising. The parlous condition of theservice can be news to nobody, since it has time andagain attracted comment.31-33 Nevertheless, the report 34of the House of Commons’ committee of inquiry into thedental services contains startling evidence of administra-tive confusion and consistent neglect.The Education Act of 1918 made local authorities

responsible for inspecting the teeth of all children

attending their schools and for arranging any treatmentrequired; in England and Wales, the task of seeing thatthese obligations are fulfilled falls to the Ministry ofEducation. The school dental service was intended to

provide for the examination of the teeth of every school-child annually, to offer treatment to those in need of it,and to treat any who accepted the offer. But, in 1961,less than 54% of schoolchildren in England and Waleshad their teeth examined under the service; and onlyabout 17% were treated by school dental officers,although as many as two-thirds of those examined werefound to need treatment. The number of children

passed as dentally fit in the course of the year is notknown, since there is at present no means of discoveringwhether a child examined at school attends a dentist ofthe regional service, or a private dentist, for the necessarytreatment. But the figures cited are enough to show thatthe school dental service is not fumlline its function.

Its inadequacy is due primarily to shortage of staff.The Ministry of Education has estimated that onedentist is needed for every 3000 children. By this

standard, there should be 2300 school dental officers inEngland and Wales and 300 in Scotland, whereas thenumbers are 1069 and 160 respectively. But the com-mittee find that this is only one of many troubles. Theycomment on the decline of "productivity

" in theservice: in 1952, each dentist in England and Walestreated an average of 1900 schoolchildren; by 1961 thefigure had fallen to 1200. This trend is perhaps attribut-able to the greater amount of conservative dentistry nowbeing done: to fill a tooth takes longer than to extract it.But the committee conclude that many of the lowerfigures reflect poor local organisation, with the dentistspending time on clerical work. A possible contributoryfactor is the lack of effective control of the clinics’

functioning by either local authorities or Ministry. Evenin professions, a salaried service may require somesupervision if it is to maintain the amount and standardof the work done; and a declining service does notattract the enthusiast. In England and Wales, a singledental officer of the Ministry of Education has to lookafter the school services provided by the 146 localauthorities, but in Scotland the regional dental officersinspect and advise on the operation of the school clinics.The committee recommend that this Scottish practicebe adopted in the South. They suggest besides that the31. ibid. 1960, i, 832.32. ibid. 1960, ii, 358, 861.33. ibid. 1962, i, 524, 697.34. First Report from the Estimates Committee: Dental Services. H.M.

Stationery Office, 1962. Pp. 384. £1 4s.

Ministry of Health should assume responsibility for theservice and should do all it can to encourage localauthorities in dental education and in the recruitmentof dentists. Present rates of pay within the service donot compare with the average earnings of dentists

working in the National Health Service. Moreover, thelocal authority’s principal dental officer is virtuallysubordinate to the school medical officer, and fewcouncils consider him of sufficient consequence to beinvited to meetings at which dental matters are to bediscussed. The ambitious are unlikely to enter a serviceto whose highest echelons so little prestige attaches.

Unless the status of the school dentist is radicallyimproved, the school dental service seems bound forextinction: patients will not opt for treatment under aservice held to be second best. And not until an efficientschool service is operating beside the dental services ofthe National Health Service will it be possible to judgewhether the dichotomy is wise. What should not beallowed to continue is the present casual attitude of

parents, and administrators, to the dental health ofchildren. N.H.S. dentistry-already stretched to capa-city-seems likely to be overwhelmed by future demandfor treatment as today’s children reap the painful, time-consuming, and expensive reward of years of untreatedcaries.

Annotations

DISCLOSURE OF CONFIDENCES

Desmond Clough, a journalist, was directed by theRadcliffe Tribunal, inquiring into the Vassall spy case tosay who had given him certain information. Cloughrefused to answer the question on the grounds both ofthe honour of his profession and of his self-interest as ajournalist which required him to preserve the confi-

dentiality of information received and not to disclose thesource of information. The Tribunal reported the matterto the High Court, and the case came before the LordChief Justice.The Lord Chief Justice had to consider two points.

The first was whether the question put to Clough waslawful-that is, whether it was relevant to the Tribunal’sinquiries-and on this point his Lordship agreed with theTribunal that the question was lawful in this sense. Thesecond point was whether a journalist is entitled to theprivilege claimed by Clough. On this point, the LordChief Justice pointed out that there were certain com-munications which ought not to be disclosed, such ascommunications between solicitor and client, matrimonialconfidences, and matters which tend to incriminate. Inevery such case the privilege of non-disclosure was basedon a principle dependent on public policy. Althoughcounsel for Clough had argued that the Press had certainfunctions as the watchdog of liberty and that the Law didin fact give certain privileges to the Press, his Lordshipdid not agree that there was a sufficient principle of publicpolicy to justify extending the privilege of non-disclosureto journalists. Since Clough had indicated that he wouldstill not be prepared to answer the question, he wassentenced to six months’ imprisonment, but the orderfor committal was suspended for ten days; meanwhile

313

Clough’s informant came forward and the order forcommittal was not proceeded with.Medical practitioners who have been asked in a court

of law to reveal confidential matters concerning a patientwill have some fellow-feeling for the journalist. But thecase of the journalist is in some respects different fromthat of the doctor. Where the Law does recognise aprivilege of non-disclosure, the privilege is normally thatof the communicant who does not want certain informa-tion disclosed, and the communicant can if he wisheswaive the privilege. Clough’s case was different in thathis informant intended the information to be passed onbut not in his own name. The difference is important, andit may well be that the doctor has an even better claimthan the journalist to a privilege which at the moment theLaw does not give to either.The courts ought not lightly to be hampered in their

work. As the Attorney-General argued in the Cloughcase, every extension of privilege is a shackle on the

discovery of truth and an impediment to the due adminis-tration of the Law which is the foundation of the libertiesof this country, and there must be a very sound reason in

public policy to require such a shackle. And, of course,the courts are not merely concerned with the libertiesreferred to by the Attorney-General: their work, especiallynowadays, extends to fields involving the welfare of

individuals-e.g., in such matters as matrimonial disputesand the custody of children. On the other hand, might notpublic policy require the welfare of the patient (and thusfull and free discussion between doctor and patient to takeplace without fear of disclosure) to be put first ? The

Clough case does not alter the position of doctors in anyway, but it does reopen an old debate.

SONNE DYSENTERY

IT may be premature to say that the epidemiologicalpattern of Sonne dysentery in Great Britain is now fixed,but there have been no great changes in the past ten years.When the disease was first recognised it was, like otherintestinal infections, an illness of the late summer andautumn. Its prevalence is now greatest in winter andspring.l Infection is not limited to any age-group but iscommoner in children than in adults. It is more preva-lent in large cities than in the country, and apparently inthe North than in the South. In general it seems to bespread by personal contact or fomites, but if food or waterbecome polluted with infected excreta the spread of thedisease is accelerated. No convincing evidence has beenproduced that any deliberate measures help to terminatean epidemic.Published reports suggest that Sonne dysentery is com-

moner in Great Britain than in other temperate countries,or that we make more of it or are perhaps more conscien-tious in notification. There are, for instance, not manyaccounts of the disease in epidemic form from urban areasof the U.S.A., and for this reason a report by Mosley eta1.2 from Omaha, Nebraska, is of some interest. The out-break is described as " large ", but since the number ofcases confirmed bacteriologically was no more than 97 itwas of small account compared with the epidemicsreported in Ipswich, Northampton, and Leicester.3-5 The1. Bradley, W. H., Richmond, A. E. Mon. Bull. Minist. Hlth Lab. Serv.

1956, 15, 2.2. Mosley, W. H., Adams, B., Lyman, E. D.J. Amer. med. Ass. 1963, 182,

1307.3. Shaw, C. H. Mon. Bull. Minist. Hlth Lab. Serv. 1953, 12, 44.4. Hagan, J. G. ibid. 1956, 15, 56.5. Ross, A. I., Gillespie, E. H. ibid. 1952, 11, 36.

background may be rather different from these. Mosleyet al. state that the disease is not endemic in Omaha,but few English towns of comparable size could make thatclaim nowadays. Despite the small numbers, the associa-tion of the disease with non-white race, overcrowding, anddilapidated property was clear. These three factors arenot easily separated; but Mosley et al. are inclined to agreewith the suggestion of Stewart et al. (whose work wasdone in rural Georgia) that the most important singlefactor may be shortage of clean water for washing.

In this country influence of social conditions on theprevalence of Sonne dysentery has been little studied. In

Liverpool Macleod 7 showed that it was almost confinedto social grades m-v, but comparison of the notificationsin the London boroughs gave no very conclusive results.Indeed this is a disease where notification is likely to beexceptionally fallacious. Notification is a two-stage pro-cess : not only must the family doctor tell the medicalofficer of health, but the patient must bring his disease tothe notice of the family doctor. Infection in Sonne

dysentery may be symptomless or cause no more thantransient diarrhoea: for many of those infected a bottle ofmedicine is not worth the loss of a day’s pay.

Efforts should be concentrated on the unanswered

questions. What are the factors which favour dissemina-tion in the winter ? What touches off the explosive waveof infection which sweeps across England every few years ?On the analogy of measles, is this periodicity due to short-term immunity ? Spread in the home and in the school isunderstandable. What mechanisms are responsible-notmight be responsible-for spread between adults ?

Speculative answers to all these are only too easy, but it istime that our knowledge was on a firmer foundation.Sonne dysentery may soon be the commonest of theunpreventable diseases.

QUANTITATIVE ANALYSES OF BACTERIAIN SPUTUM

IN most cases of acute respiratory infection, examina-tion of cultures and stained smears of sputum gives theclinician sufficient bacteriological guidance. Louria 8 nowsuggests, however, that occasionally quantitative bacterio-logical analyses of sputum specimens can give valuableadditional information. For such studies sputum speci-mens are collected for an hour in sterile jars, homogenised,and serially diluted, and agar-pour plates are made ofa sample of each dilution; in addition streak plates are madeof each dilution on several media, including blood-agar,MacConkey, and Leventhal (for Haemophilus infiuenzae).9 9From this the number of microorganisms of each speciesin the aerobic flora of sputum can be estimated.

Louria suggests that this technique may usefully beemployed when two or more pathogens are found ininitial samples of sputum; when doubt arises about theefficacy of the drug therapy employed; when there isneed to decide whether a potential pathogen is a com-batant or an innocent bystander; and when the significanceof the appearance of a new organism during the courseof therapy requires evaluation.

Louria describes several cases which illustrate some ofthe circumstances in which the method may give helpfulinformation. In two cases of staphylococcal pneumoniathe patients remained critically ill and routine bacterio-

6. Stewart, W. H., McCabe, L. J., Jr., Hemphill, E. C., de Capito, T.Amer. J. trop. Med. 1955, 4, 718.

7. Macleod, R. C. Mon. Bull. Minist. Hlth Lab. Serv. 1958, 17, 2.8. Louria, D. B. J. Amer. med. Ass. 1962, 182, 1082.9. Louria, D. B., Kaminski, T. Amer. Rev. resp. Dis. 1962, 85, 649.