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by virtue of their specific amino-acids or the vitamin B12which all of them probably contain. Some experimentaland theoretical evidence which supported this conceptwas advanced by Dr. R. F. A. Dean. He has fed childrenwith mixtures of soya and various cereals, and is con-vinced that diets could be constructed exclusively fromplant sources, on which young children could growrapidly and remain healthy. His mixtures lacked vitamin

B12 ; he has found that the addition of this improvestheir nutritive value for rats, and it would probablyimprove their value for children. The mixtures were

given their original scientific trials by Miss HarrietteChick, who suggested that many similar mixtures hadgreat possibilities, especially in child nutrition. Even

protein-free extracts of some plants have, it seems,remarkable powers of supplementation when added toplant proteins.The meeting demonstrated the broad range of the

modern science of nutrition. Scientific knowledge isoften many years in advance of its application to humanpurposes. Do our administrators and their financialadvisers realise that in nutrition the need to apply ourknowledge is urgent ?

TOO FEW BEDS

THE London Local Medical Committee has publisheda resolution urging " that in view of the amount ofillness at the present time, unprecedented since thestart of the National Health Service, and the con-

sequent increased need for hospital accommodationin London for acute cases, every step should be takento provide beds by all possible means." Among themeans suggested are exclusion from hospital of normalmaternity cases, postponement of non-urgent operations,and temporary crowding of wards.

Certainly the incidence of sickness is now unusuallyheavy. Dr. Frank Gray, secretary of the committee,points out that one in three of the cases offered to the’ Emergency ’ Bed Service is not admitted to hospital.This is a serious matter, though fortunately the chancesof getting a patient admitted are better than this ratiosuggests, since the doctor commonly makes arrange-ments directly with the hospital; indeed the service is

only provided as a means of helping doctors when directapproach has failed. Inquiry of the service shows thatin the first week of January applications for admissionof acute cases were 32% higher than at the startof last year. There were 1792 applications, with 1058admissions ; the number admitted is actually greaterthan in the same week of 1950, owing, no doubt, to thegradual increase in the number of staffed beds. Duringthe same week the service received 571 applications foradmission to infectious-disease hospitals, and about thesame proportion were admitted. This is the first timesince the start of the N.H.S. that there has been anyserious difficulty in gaining admission for patients withinfectious diseases. This difficulty is due primarily tothe unusually high prevalence of infectious diseases, andnotably of measles ; but probably it is due also inpartto the recent appropriation of infectious-disease hospitalsfor general use.Except for the closing of maternity wards to normal

confinements, the remedies suggested by the LondonLocal Medical Committee are already being put intooperation. The regional boards have called for a

reduction in the intake of cases from waiting-lists, andmany hospitals have spontaneously started crowdingtheir wards. Whether in the long run this is a wisestep remains doubtful. In some large hospitals it hasan evil reputation, and the gain in the numbers of nursingstaff achieved through determination not to overworknurses should not lightly be endangered. Perhaps bynext winter criteria for definite stages -of emergencycould be worked out ; at each stage a definite degree of

overcrowding would be called for, and this would equallydefinitely be cancelled as soon as the emergency passed.Such a system would ensure that the willingness ofnurses was not exploited unnecessarily.

RELIEF OF POSTOPERATIVE PAIN

THE anaesthetic used to be the worst part of havingan operation, but now the focus of dislike has changedto the postoperative period. Pain, particularly afterabdominal and thoracic operations, is the worst featureof this period, and its relief must be a first concern.The favourite remedies are morphine and its syntheticsubstitutes (which were discussed in our leading articlelast week) ; but their value is sometimes offset by suchundesirable side-effects as respiratory depression andvomiting. Many alternatives have been suggested;two very promising ones are intravenous procaine andintravenous alcohol. With each of these two methods,however, careful supervision is necessary if overdosageis to be avoided. Now Blades and Ford 1 suggest anotherrather novel method of relieving postoperative pain,which they have used successfully after thoracotomy-an operation commonly followed by severe pain.Fine plastic tubes made of Aeroflex’ are placed alongthe edge of each of four ribs bordering the incision.The tubes are held in place with a few fine sutures, andthe end of each tube is brought out at the anterior angleof the wound. Through these tubes, 2 ml. of procainesolution is injected every two to three hours. At thesame time morphine is given, if necessary, for its euphoriceffect. These workers are convinced that the procaineinjections produce very great and hitherto unobtainablerelief. Pain disappears immediately after the injection,and the patients are able to move about in bed ; andearlier ambulation is possible. The tubes are left in situfor nine days, and the wounds heal well and withoutinfection.

MR. BEVAN AND MR. MARQUANDTHE new Minister of Health, unlike Mr. Aneurin

Bevan, will not be a member of the Cabinet. Some maywelcome this as evidence that the health services arebeing taken out of politics ; but in the next few years,when Defence will demand an increasing share of thenational resources, we may have cause to regret the lossof influence that Mr. Bevan’s departure entails. Mr. H. A.Marquand, however, may prove an able advocate ofefficient medical care, and he comes to the Ministry ata time when a fresh mind and a conciliatory dispositioncan do much good. His chief task is to improve thebalance of the service by giving more weight to theneeds of public health and general practice-if onlybecause failure to meet these needs is partly responsiblefor the strain on the hospitals. As will be seen from thebrief biography we print on p. 243, he brings to theseproblems a valuable experience not only of economicsbut of human relations and of social services ; and hehas won approval at the Ministry of Pensions. It remainsto be seen whether the N.H.S. will gain or lose by theremoval of housing from the control of the Minister ofHealth : when a change of this kind has been debatedand resisted for years it is somewhat irritating to haveit made overnight, to facilitate a Cabinet reshuffle,and without detailed consideration of the consequences.As has been sensibly suggested, a logical sequel tothe present changes might be the union of the Ministryof Health with the Ministry of National Insurance ina Ministry of Social Services-over which Mr. Marquand(elections permitting) would be well qualified to preside.Meanwhile, he has more than enough on his handswithout asking for more. The medical profession willearnestly wish him success in what he has to do.

1. Blades, B., Ford, W. B. Surg. Gynec.Obstet. 1950, 91, 524.