1343

more than three months or who are thought to havebronchiectasis. Children with recurrent respiratorydisease, such as asthma or sinobronchitis, are liable toboth recurrent and persistent collapse, which representsa real threat to their lungs and calls for adequatetreatment of the primary condition.The experience of James and her colleagues strengthens

the view that sinobronchitis is a clinical entity ; but abetter name should be devised before " sinobronchitis "

passes into acceptance through ’continued misuse.

1. Gear, H. S., Deutschman, Z. Chron. World Hlth Org. 1956,10, 275.

ON GUARD AGAINST PLAGUES

WHEN the Fourth World Health Assembly adoptedthe International Sanitary Regulations in 1951 it was a

legal rather than a hygienic innovation. From thatdate all nations who were members of the Assemblybecame bound by the regulations, and such membernations that wished to deviate from them in part or inwhole had to submit their reservations to the Assembly.It may be a sign of the times that so little fuss was madeover this victory for common sense over national

prejudices. Since then the regulations have beenmodified in detail and will, no doubt, be modified againto meet new dangers or to remove useless impedimentsto commerce and travel. They are concerned with the"

quarantinable diseases " only—plague, cholera, yellowfever, smallpox, typhus, and relapsing fever. In generalthey do no more than codify the many existing agree-ments, but in the process many obsolete procedures havebeen abandoned and the recommendations limited towhat now appears sound and efficacious.Even fifty years ago the medical officer of every port

in the world knew that he was sitting on an epidemio-logical volcano. His first news of plague in Surabaya orsmallpox in Bahia Blanca might be a ship in the roadswith the yellow jack in her rigging or a dying man in hisisolation hospital. Today patient clerks in Geneva sortand distribute a weekly return of infectious diseasesfrom almost every country. The- advances in the pre-vention and treatment of the pestilent diseases are asgreat as those in any branch of medicine. Activeimmunisation is effective not only against smallpox butagainst yellow fever and typhus, and (perhaps) againstcholera and plague. Thanks to the newer insecticides thelocal extermination of mosquitoes is now a reality andthe louse a very rare animal indeed. The rat survives,but new ships and more subtle poisons have drawn histeeth. That travel by air might bring with it the riskof spreading disease was readily appreciated, and notraveller can doubt that every care is now taken to avoid

introducing undesirable aliens-with 2, 4, or 6 legs.All these technical improvements have been accom-

panied by a remarkable and world-wide decline in thequarantinable diseases which goes a long way to justifythe optimism of a recent review of the subject from theWorld Health 0 rganisation. 1 Nevertheless a carefreefaith in the certainty of continual and inevitable progresshas led mankind into trouble before now and it wouldbe foolish to forget that these diseases remain a dangerso long as they are endemic in any part of this contractingworld. Cholera today is almost confined to India, China,and the intervening countries. (It is hard to knowwhether India’s place at the top of -the table is a meriteddisgrace or the penalty of conscientious diagnosis andnotification.) Cholera is a " simple " disease of whichthe cause and method of spread are well known ; and yet,in spite of much thought and toil, the stimulus whichconverts endemic to epidemic infection is still a matterfor surmise. In the future we may be able to confine theinfection more closely than in the past, but the threatremains. No-one knows the origin of the outbreak inEgypt in 1947 and very few are certain why it ended

when it did. Much the same is true of plague. The majorepidemics have been more widely spaced than those ofcholera, but they lasted far longer. It is still a sporadicdisease in many parts of the world and endemic foci inwild animals are known in three continents. If we knewthe chain of infection from a marmot in Turkestan to amillion rats in the slums of Bombay we would be betterplaced to forecast our immunity from the pestilence.Vaccination against yellow fever gives a lifelongimmunity. This by itself should be enough, but vaccina-tion is a costly business and it is hard to justify theexpense in a poor country where antibodies in the inhabi-tants’ blood are the only evidence of the disease. In

populous places it seems almost as effective to eradicateAëdes cegypti (as has been done in parts of Brazil), but" jungle yellow fever " in monkeys and marmosetsremains a threat of unknown potency. It is not entirelyclear if the " wild " disease can give rise to the urbanepidemic form : some slight evidence from Trinidad

suggests that it might. At any rate, during the last fewyears jungle yellow fever has been advancing rapidlynorthward along the Central American isthmus : it mayinvade Mexico at any time and the U.S.A. is not outsidethe zone of danger if the disease is transmitted to Aëdes

œgypti in the coastal belt.2 Typhus and relapsing feverare diseases of war and at the moment we enjoy peace ofa sort : in any case, the experience in Naples in 1943suggests that louse-borne infection can be checked evenin the middle of a war. Smallpox is everywhere lesscommon than it was, and yet where doctors are few andmoney is scarce it is seldom absent. No doctor anywherein the world can be quite certain that the next patientmay not show a pustular rash which will cause him somehard thinking. This seems the disease most likely to bespread by air travel, but accurate diagnosis and sufficientvaccine should ward off a major epidemic.

It is equally a cause for thanksgiving that the combinedwisdom of experts of all nations could be used in draftingthese regulations and that the nations of the world

accepted them with so little demur. At the moment

they are sufficient, but the problems of disease are

dynamic. Old diseases may assume new forms or newdiseases appear to threaten us. The laws of the Medesand Persians are a poor model for medical legislation.

2. Elton, N. W. Amer. J. publ. Hlth, 1956, 46, 1259.

MEDICAL REFUGEES

SOME of the Hungarian doctors in this country needpersonal hospitality, as we said last week ; but some nowneed-perhaps more than anything else-a little money.In supplying the physical wants of the thousands of

refugees in their care, the British Council for Aid to

Refugees provides pocket-money for all ; but it cannotdiscriminate and give larger amounts to any particulargroup. To the professional people among them the smallallowance they receive must seem almost negligible ; andsupplementary help is required to enable them at least tomake small purchases of clothes, or to make necessaryjourneys. For such help towards restoring their sense ofindependence they should look particularly to their pro-fessional colleagues, and we are therefore opening a smallfund to supply it. We ask other contributors to leave usdiscretion in the disbursement of what they send, merelyassuring them that it will all be given to Hungariandoctors and their families as and when we ascertain theirneed for this kind of temporary support. Contributionsmay be sent to the Editor of THE LANCET at 7, AdamStreet, London, W.C.2 (cheques being crossed " Hun-garian Doctors Account ").

Dr. W. G. BARNARD, professor of pathology in theUniversity of London, dean of St. Thomas’s HospitalMedical School, and treasurer of the Royal College ofPhysicians of London, died on Dec. 20.