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From the point of view of the British Medical Associa-tion such a course has much to commend it. The temp-tation to allow the present dispute to assume a politicalcomplexion would be diminished. The greater thedrift in this direction, the stronger is Mr. Bevan’scontention that Parliament has spoken and settled thematter. The necessity for the professional representativesto state their case so as to carry the Central HealthServices Council would help to eliminate what seems tothe outsider to be an overstatement of the case. Fromthe Minister’s angle the procedure offers a legitimateopportunity to sidestep slightly the present impasseand-to use new machinery. It offers him besides anopportunity to set the coping-stone squarely in placeupon the legislation he put through Parliament.

It is all wrong that there should be, or even seem tobe, a divergence of interest between the Minister and theprofession. In the long run the profession should be Eable to look to its Minister to help it to fight its battles,to press the claims of health services upon the Exchequerand other Government departments. The Central HealthServices Council is a necessary part of the machineryenabling-him to do so.London. A. MURRAY.

Parliament

QUESTION TIMEArbitration

Mr. R. DE LA BERE asked the Prime Minister if, in-view ofthe necessity of obtaining the cooperation of the maximumnumber of the medical profession before July 5 he wouldconsider appointing an independent arbitrator for the purposeof finding a solution to the present impasse.-Mr. C. R. ATTLEEreplied : No sir. Matters which have already been decidedby Parliament would not be a proper subject for arbitration.- Mr. DE LA BERE : Is the Prime Minister fully aware of thevery grave position which must arise in July because he hasrefused to meet the views of the vast majority of the doctors ?Is he further aware that the people of this country want toknow why the Government have allowed this position to cometo pass ?-Mr. ATTLEE : That does not give any justificationfor the hon. member’s proposal.-Mr. DE. LA BERE : It givesevery justification.,

Air Commodore A. V. HARVEY : Do the Government intendto charge the public for a service if they are not in a positionto supply it ? (Cries of

"

Answer. ")-Mr. WILS011T HARRIS :Would the Prime Minister be prepared to lend a hand himselfin future negotiations, if he should think that that would belikely to help matters ?-Mr. ATTLEE : I am prepared toconsider any suggestion put to me.Squadron-Leader E. L. FLEMING : Are we to understand

that no approach has been made up to date by either theB.M.A. or the Minister of Health on this matter ? Mr.ATTLEE : To whom ?-Squadron-Leader FLEMING : Eachother. No further reply was given.

Treasury Grants to HospitalsMr. SoMERVILLE HASTINGS asked the Minister of Health

whether he was aware that certain voluntary hospitals nowreceiving Treasury grants made the receipt of an honorariumby members of their honorary staffs dependent on resignationfrom their medical advisory committees ; and if, in these cases,he would consider withdrawing the grant.-Mr. ANEinMNBEVAN replied : Although I deprecate any such action,Exchequer help is given before the appointed day to keepthe hospitals going and would not in my view justifyinterference with their domestic affairs.

International Children’s Emergency FundIn answer to a question Mr. ERNEST BEVIN announced

that the Government had decided to make a contribution of100,000 to this fund, but that the exact fashion in which itwill be allocated was not yet determined.

Exchange Control Medical Advisory FeesMajor E. A. H. LEGGE-BouRKE asked the Secretary to the

Treasury how much had been collected in fees from applicantsby the Exchange Control Medical Advisory Committee sinceits establishment ; what proportion represented fees taken

from those subsequently refused foreign exchange for medicaltreatment abroad ; and what was the composition of thecommittee.-Mr. GLENVIL HALL replied : £1659, including;&bgr;378 from applicants who were subsequently refused foreignexchange for medical treatment abroad. The members of thecommittee are all distinguished medical specialists who havereceived no payment beyond the fees mentioned above. Iwould add that it has been decided that no fees will be payableby applicants as from March 1, 1948. In future all applicationsto the committee should be made through a doctor and notby the patient ,himself.

Special Rations for InvalidsMr. H. W. BUTCHER asked the Minister of Food why he

had refused to grant additional rations to a boy resident inSpalding, whose own medical adviser had given a certificatethat the boy had been intermittently suffering from asthmafor 7 years ; had been in and out of hospital several times ;had stated that he would benefit from extra rations as hewas under weight ; and whether, before refusing such rations,he arranged to have the boy medically examined by theMinistry’s medical advisers.-Dr. EDITH SUMMERSKILL replied :Our medical advisers never undertake to examine applicantsfor special rations, but always accept the diagnosis of thepatient’s own medical adviser. Their unwelcome task is toadvise on the relative needs of different groups of invalids

bearing in mind the limited amounts of rationed food available.The need of uncomplicated cases of asthma for extra rations isnot such as to justify a claim on this limited supply. If thecase mentioned is in some way complicated, I will gladly askour medical advisers to consider any fresh information.Mr. BUTCHER : Is the hon. lady aware that in the doctor’s

certificate dated Nov. 9 the local doctor categorically statedthat the lad would benefit from extra rations ? Is it the

practice of her department to disregard the advice of thelocal medical practitioner who has seen the patient in favourof the advice of people in London, who, however distinguished,have not even been near the boy ?-Dr. SuMMERSKiLL : Asthmais a fairly common complaint and if we gave extra rations inthis case we would open the door to a large number of peoplewho would feel that they should be treated in the same way.I have examined all the documents relating to this case andI have invited the hon. member to give me a further certificateelaborating what the doctor had already said, in order thatI should know of any special circumstances which would,enable me to permit these rations to be given. The only letterwhich I have had is one telling me that the child had a dryskin.

Mr. J. S. C. REID : Is the hon. lady’s reason for refusingthese allowances that she thinks that the doctors do not knowtheir job, or that she does not trust them ? There seems tobe no other reason.-Dr. SUMMERSKILL: I think that thatis a reflection on the distinguished men who advise us in thesematters, all of whom are physicians or surgeons. I must repeatthat we give extra rations in order to alleviate certain symp-toms. I do not think that any doctor in this country wouldsay that these extra rations which are being called for wouldnecessarily alleviate the symptoms of asthma.

Priority Milk Permits for Dyspeptic PatientsMr. EDWARD DAViES asked the Minister of Food if he would

make arrangements for doctors to issue priority milk permits,valid for more than one month, to old-age pensioners withfeeble digestions and whose need was likely to be prolonged.- Dr. EDITH SUMMERSKILL replied : The medical advisers ofmy department consider it essential to restrict the validity of £medical certificates for dyspepsia to one month, as this is notnecessarily a chronic complaint, and a short period of validity,therefore, conserves supplies.

Disability Pensions for Diabetes MellitusMr. GRANVILLE SHARP asked the Minister of Pensions

what was the approximate number of claims for disability’pensions made by Servicemen of the 1939-45 war on accountof diabetes mellitus ; what proportion of these he had

rejected ; what proof there was that men, classified as Al, whohad fought through the hardest campaigns but were later dis-charged-as medically unfit with diabetes mellitus, must tracetheir condition to an inborn weakness of the pancreas ; andwhether he would review the position and reconsider theclaims he had rejected in the past.-Mr. GEORGE BUCHANANreplied : The answer to the first part of the question is 3600,

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of which about 3000 have been rejected. As regards thesecond part, ex-Servicemen are not required to trace thecause of their disablement. On the contrary, the onus ofproving that their condition is not due to war service rests onme. The recent dismissal by the High Court of some appealsin cases of diabetes shows that in those cases the learned

judge’s view was that this onus had been discharged. In thecircumstances it is difficult for me, in face of the High Courtdecisions, to review all past cases, but I am of course alwayswilling to examine any particular case in which fresh evidencebecomes available and would also be prepared to look at thegeneral question in the light of any modification of the existingmedical view in this type of case.

Mr. SHARP : In view of the fact that many of these menwere considered to be fit to fight through the hardest cam-paigns, will the right hon. gentleman agree that, having losttheir health in war service, they should be considered to befit for pensions ?-Mr. BUCHANAN: The hon. gentlemanraises the general issue that, if a man was Al, he should get apension. I do not mind that becoming the view of the Govern-ment, but the.House of Commons must make a decision ofthat kind. Under the Royal Warrant I have to deal withmedical evidence, and the medical evidence ih this case, evenwith the best will in the world, is against taking them in, andthe High Court has upheld that decision. In the meantime,I have to administer the Act, and if my hon. friend or anyother person can bring evidence to show that the doctors arenot right in this matter, nobody will be better pleased thanI am.

Public Health

Smells

IN both Britain and the United States the perceptionof human odours has recently been taken as the principalcriterion of the efficiency of ventilation. One by onethe more objective standards, such as oxygen andcarbon dioxide, have been discarded ; and now thenose is arbiter even in the Egerton report 1 :

" Several English research workers used body odourconcentration as the index of the purity of the air. Recently,American research workers have studied this aspect inmore detail and formed the opinion that body odour is asuitable criterion for ventilation, and that when ’it is

perceptible headaches may result, and people subjected tothe odours may lose their appetites. The amount offresh air was, therefore, estimated on the basis of that

necessary to keep the space occupied free from noticeableodours, and this work has been used in the present reportto determine the requirements for ventilation " (p. 20). ).We ought not to condemn the sense of smell without

a fair trial. A similar test is used in certain industries,apparently-- with good results. Even a great firm ofchocolate-makers relies on the olfactory sense of a

handful of young women in deciding whether the eggsthat go (or used to go) into its products are good or bad.May not three sniffs of the trained nostril be as effective eas the palate of the wine-taster, who after all dependslargely on bouquet for his assessment ?The rancid vapours of human bodies (as the Rev.

Stephen Hales called them) have been recognised sincethe beginning of history, and B.o., as it is now called,is as villainous a stage joke today as in the time ofAristophanes. Our satire, it is true, omits explicitreference to the goat under the armpits and otherunpleasant emanations, but we still take delight inDr. Johnson’s famous rejoinder, and his learneddistinction between smell and stink. We are no doubtmore sensitive to body odours than we used to be inthe good old days, when we enjoyed everything wellseasoned, but this does not in itself establish a criterion.In other words, there is need for research into the causesof the phenomenon,’ the means to be adopted for itsabatement, and the value of the test as a criterion of theatmospheric purity of a room.

1. Ministry of Works Post-war Building Studies, no. 19, 1945.2. Catullus, lxix.

CAUSES

Certain points may be regarded as established. Theaccumulation of odours in a room occupied by humanbeings is in part caused by the discharge of organicmaterial from the bodies of the occupants. It occurswhen no clothing is worn and when the bodies are

thoroughly clean. Further study is required to deter-mine the nature of this material. The concentration ofsmell is substantially increased when the bodies have notbeen washed for some time and when the clothinghas not been changed. There is no evidence to indicatewhether the heavy type of clothing commonly worn inBritain gives rise to a stronger smell than light summerclothes. Yaglou 3 found no difference between thesexes, but recorded that children had a more pronounced

,.body odour than adults. ’

There is a significant association between social classand body smell, and many of the stinks which we connectwith overcrowding and slum conditions generally comefrom human sources, including excreta, and fromodoriferous occupations.A second point to observe is that some persons tend to

stink more than others. In the overwhelming majorityof instances this can be remedied by meticulous cleansingof person and clothing, or by medical or dental treat-ment-and in refractory cases by some of the widelyadvertised deodorants. It may be true in a spiritualsense that " the dirty sweaters are nearer the angels forcleanliness than my Lord and Lady Sybarite out of abath, in chemical scents 11 4 ; but this is poor comfortwhen one has to occupy the same room.The Egerton report, after reviewing the minimum

standard of ventilation required for health, adopts afigure of 600 c. ft. per hour per person which ’’ shouldbe sufficient to prevent an undue concentration of

objectionable odours, and is suitable for persons of

average cleanliness." " Average cleanliness " is not

defined, nor is the type of clothing worn in a ventilationtest. In the American studies Yaglou is more precisein his reference to light summer clothing ; but he is rathervague in his account of the bathing habits of his subjectsand of the time when they last changed their clothes.Moreover, no distinction is made in any of the recordsbetween outer clothing and underclothing. Howeverthat may be, it is of melancholy interest to record thatAmerican workers, using the same criterion as British,find that 400 c. ft. per- hour per person is sufficient to

prevent the accumulation of body odours. One mightbe tempted to draw an inference.

ABATEMENT

The means to be adopted for the abatement of bodyodours obviously depends on the accurate analysis oftheir nature. It has been reported, for example, thatbody smells tend to disappear in a comparatively shorttime, even in the absence of ventilation, while the stinkof tobacco increases with time and becomes more

unpleasant. We have no very clear knowledge of therelation between body odour and temperature or

humidity ; or of the relative contribution of person andclothing. It may be that a simple remedy can be found,perhaps applicable to clothing or to the air of a room.At any rate here is a subject for research. We have no

right to assume that ventilation is the only, or even

the most desirable remedy. The fact that recirculatedair is as effective as fresh air in removing body odours isof interest, but before giving official approval to anynew form of air-heating we must be sure that the systemwill not intensify the problem of smells. Air-ducts

may possibly become the habitat of certain lowlycreatures notorious for their unpleasant stink, and the

3. Yaglou, C. P., Riley, E. C., Coggins, D. I. Heating, Piping, andAir-conditioning, 1936, 8, 65.

4. Meredith, G. The Amazing Marriage.