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report 16 of a working party set up by the Ministry ofHealth to examine the matter in this country at the requestof the World Health Organisation and the Food andAgriculture Organisation.The whole party reported on the quantitative require-

ments for proteins in health and disease; and they alsodivided into four groups, which dealt with proteinmetabolism and its regulation, the protein values of foods,the requirements for protein in health, and the effects ofdisease on protein requirements. The report also containsvaluable appendices by various members of the workingparty on their own special areas of knowledge, and somerecommendations about further work that might confinethe problem more conveniently.

Scientists and administrators not engaged in this workprobably have little inkling of the difficulties which thisworking party had to face. No two proteins are chemicallythe same, nor have they the same value as foods.

Furthermore, all foods except pure fats and sugar containprotein in appreciable amounts, and it is well known thatproteins contribute 10-12% of the calories to all diets.

Consequently the intake of protein varies with the intakeof calories; but the requirements of protein do not varyfor the same reason as those of calories, although in certaincircumstances they depend upon the intake of calories.Added to all this, there is the certainty that no twoindividuals, even in health, will make equally good use ofthe proteins in their diet, and the differences may be large.The suggestions of the working party in terms of g. per

kg. body-weight per day are:

One of the most satisfactory aspects of the report is therefusal of the working party to commit itself to any firmfigures which might be seized upon as yardsticks by whichto make comparisons and on which to base claims. Wejust do not know how much protein Mr. A, Mrs. B, orMiss C requires, and the labour of trying to find outresembles the trials of Sisyphus. In other words, we maynever succeed.

THALIDOMIDE

THALIDOMIDE, a non-barbiturate hypnotic synthesisedin Germany in 1956, became available in the UnitedKingdom in 1958. In November, 1961, Dr. W. Lenz, ofHamburg, reported that this drug apparently had terato-genic effects when administered to women early in

pregnancy; and the drug was withdrawn from the Britishmarket on Dec. 2, 1961. The Ministry of Health has nowpublished a useful survey of affected children born inEngland and Wales between the beginning of 1960 andthe end of August, 1962.17The survey, which is limited to liveborn children,

shows that at least 349 malformed children were born tomothers who had certainly or probably taken thalidomide;and, of these, 267 survived at the time of the survey. Ofthe malformations in a further 366 children (of whom 295survived), at least some are thought to have been attribut-able to the drug. The estimate of surviving children with16. Requirements of Man for Protein. Rep. publ. Hlth med. Subj., Lond.

1964, no. 111. H.M. Stationery Office, London. Pp. 90. 5s. 6d.17. Deformities Caused by Thalidomide. Rep. publ. Hlth med. Subj., Lond.

1964, no. 112. H.M. Stationery Office. Pp. 70. 6s. 6d.

thalidomide-induced deformities varies from about 430 to150; but, says the report, the number probably liesbetween 200 and 250. Records were obtained of altogether894 deformed children. Of this total 194 (22%) had atleast one absent or vestigial limb, and 832 had some kindof limb deformity. Among babies with a defined limbdeformity, the proportion with absent or vestigial limbsdecreased from 45% in the group born to mothers whohad certainly had thalidomide to 14% in those born tomothers who had not taken thalidomide. It seems that

single limb deformities may only rarely have been causedby thalidomide. The survey suggests strongly thatthalidomide can also cause malformations of the ear, eye,heart, kidney, and gut.

In a preface Sir George Godber, chief medical officer tothe Ministry, observes that this tragic episode involvedfewer families than was feared at one time, and that therelief available to individual children has been improved." Yet each case was a personal disaster which no amountof subsequent help can wholly relieve. The small com-pensations the incident has brought within our healthservices are in improved control of drugs, a better under-standing of some factors in the xtiology of congenitaldefects and acceleration of progress in the development ofartificial limbs."

POLONIUM

THE search for carcinogens is endless, and investigationsinto the pollution of common environments by potentiallyharmful agents proceed without pause. Marsden has

lately discussed the possible significance of polonium asa carcinogenic contaminant of air, cigarette smoke, andsome foods.Polonium-210 RaF emits a particles and has a half-life

of 138 days. It has been detected in soil, air, and somewaters, notably those of artesian wells. It is present in atleast some plant tissues, which have taken it from the soilor the air. Marsden is particularly concerned with thepolonium in the exhaust gases of petrol engines and inand on tobacco leaves.

Soil polonium is derived from the parent rock, so that,if the rock is processed for lead, polonium is apt to

accompany the lead and enter compounds subsequentlyformed from it, conferring on them some radioactivity.Thus lead tetraethyl, the common " anti-knock " petroladditive, contains polonium. Combustion in the cylindersof the engine volatilises the polonium, which passes to theexhaust system of the vehicle, where some is depositedand the rest escapes into the atmosphere.The leaves of tobacco plants grown in different parts of

the world were found to contain polonium, and it isbelieved that the contamination came largely from soiland only slightly from atmospheric fallout. All the tobaccowas of Virginia type. Polonium salts volatilise easily atrelatively low temperatures: hence slowly burning tobaccoproduces smoke which, if not adequately filtered, couldwell be a source of inhaled particles. It is estimated that

inhaling the smoke of 25 cigarettes in a day could resultin the deposition on the respiratory mucosa of somethinglike 8 picocuries of polonium per day. Inhaled poloniumis taken up by soft tissues rather than bone.

Contamination of drinking-water from artesian wellsdoes not at this stage seem to be very important, and thereis usually much heavier contamination of the water byradon.

1. Marsden, E. Nature, Lond. 1964, 203, 230.

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Marsden also refers to polonium in foods. It seems thatsome wheat may be a hazard because of its radium and

polonium load. He notes that the shell-fish dietary of the’

Polynesians is a source of polonium (derived from themarine plankton) and that Maoris have a high incidenceof gastric cancer.

But polonium is not yet convicted as a major day-to-daycarcinogen, for the results of investigations into its

biological effects and the true extent of contamination areas yet far from complete.

LET THERE BE LIGHT

ON the assumption that direct or reflected sunlight is agood thing of which you cannot have too much, hospitalarchitects have favoured large windows for wards. Yetthe truth is that for patients lying in bed too much daylightmay be unnecessary and unpleasant: an overlarge windowcan be uncomfortably bright in summer and a cause ofheat loss in winter. Letting the right amount of daylightinto the centre of a ward, therefore, calls for a designwhich will necessarily obscure a large area of sky from theview of the patients nearest the window. This can beachieved by means of a horizontal baffle with clerestorylighting above (as at Larchfield Hospital, Greenock) orfixed white louvres over the upper part of the window.Some years ago the division of architectural studies of

the Nuffield Foundation and the Building ResearchStation undertook a joint investigation of hospital lighting. 1In a foreword to a new book 2 on this subject, the authors(architects, engineers, lighting experts, and a solitaryophthalmologist) regret that the principles then pro-pounded, though revolutionary, have received little notice,and that the simple and not very costly criteria for goodlighting then set out have seldom been applied in thelighting of new hospitals. This earlier work and morerecent research by the joint committee on lighting of theMedical Research Council and the Building ResearchBoard form the basis of the Ministry’s recommendationsin the Artificial Lighting of Hospital Wards which arereproduced in the book.The two most important principles in hospital lighting

are the avoidance of glare from both natural and artificialsources, and the attainment of satisfactory colour render-ing in artificial light. The amount of interior daylightis much increased by light-coloured interior surfaces andlight-reflecting floors. Decorations greatly influence thelevel of daylight in a ward and should be regarded as anintegral part of the lighting design. Disaster follows whena ward, whose windows and interior reflection were plannedas a whole, is later redecorated as a part of the hospitalmaintenance without regard to the original comprehensiveplan.The simplest and most commonly used method of

general artificial illumination which eliminates glare is thecylindrical drum spreading light evenly over the ceiling,thus indirectly lighting the whole ward and at the sametime brightly illuminating the circulation area. The

patient in bed cannot see the lamp. In the so-called" race-course " ward the service rooms in the centre ofthe block need permanent artificial light. Since the wardstaff are continually passing between these rooms and thenaturally lit wards, a high level of artificial lighting is1. Studies in the Function and Design of Hospitals. Nuffield Provincial

Hospitals Trust. London, 1955.2. Hospital Lighting. Edited by R. G. HOPKINSON, PH.D., M.I.E.E., F.I.E.S.,

in charge of lighting research at the D.S.I.R. Building and ResearchStation. London: Heinemann. 1964. Pp. 128. 84s.

needed during the day to avoid accidents caused bydifficulty in adaptation.Owing to its unsatisfactory colour rendering, fluorescent

lighting should be restricted to places such as the entrancehall, corridors, and service rooms: it is not recommendedfor wards, which need a fairly low level of general lighting.Low levels of fluorescent lighting are gloomy and depress-ing, and a patient should not have to see his doctors,nurses, and fellow patients looking as if they were terriblyill. More important is the avoidance of fluorescent lightingin theatres, ansesthetic rooms, and resuscitation and re-covery rooms, where the ready detection of pallor orcyanosis is vital. In a recently built operating-theatre, litby a bank of fluorescent tubes above a glass ceiling, theanaesthetist’s trolley has had to be equipped with a

tungsten-filament torch by which to judge a patient’scolour. Although colour rendering from tungstensources of light is imperfect, training and experience inthis light develop a colour memory which enables thecolour of human skin to be judged correctly. This is notso with fluorescent lighting, especially since the spectralcontent of the tubes varies so much.

SMALLPOX REVIEWED

IN the Western world smallpox incidents, thoughtragic and costly, are now uncommon and are regardedas an indictment of our vigilance and precautions. Theseepisodes remind European and North American countriesthat smallpox is still endemic in vast areas of the worldwhere it has hitherto defied effective control. An expertcommittee appointed by the World Health Organisationhas surveyed the smallpox problem throughout theworld. 1

This report, which summarises much knowledge,includes a technical chapter on laboratory diagnosis; andit forecasts the orientation of future efforts. It acknow-

ledges the place of passive immunisation which has, inrecent incidents, been so surprisingly neglected. Thereseems to be no reason why antivaccinial y-globulin (asthe report seems to infer) should be available only inlimited quantities: every successful adult primaryvaccination-and there are very many-is a potentialsource of this agent, and only lack of forethought andorganisation prevent its accumulation in this country.Chemoprophylaxis is now available as an alternative pro-tection for the unvaccinated contact 3; and, as the reportsays, chemotherapy may soon transform the prognosis forestablished cases. There have been many disappoint-ments, however, and hopes based on therapeutic agentsshould not stifle vigorous efforts, arising from establishedknowledge, directed successively towards local preventionand the final grand assault-world eradication. One mayquestion the somewhat academic varieties of eradicationnamed in the report. " Regional eradication " may be adeceptive term: in these days of fast travel, any remainingreservoir of smallpox may rekindle the disease in formerendemic areas and undo earlier accomplishments. Thedifficulties of world eradication are enormous: whatevertechnical and financial aid is afforded, firmer attitudesand more consistent efforts will be required of the manycountries in which the disease is endemic before this canbe realised.1. Tech. Rep. Wld Hlth Org. 1964, no. 283. H.M. Stationery Office.

Pp. 37. 5s.2. Hobday, T. L. Lancet, 1962, i, 907.3. Bauer, D. J., St. Vincent, L., Kempe, C. H., Downie, A. W. ibid.

1963, ii, 494.