500

4. Zondek, H. Die Krankheiten der endokrinen Druesen; p. 305. Basle,1953.

5. Harnett, R. W. F., Paterson, J. R. S., Lowe, K. G., Stewart, I. M.,Vytman, J. D. Lancet, 1959, ii, 762.

6. Sonderen, A. G. J. van. Ned. T. Geneesk. 1957, 101, 538.7. Rappert, E. Dtsch. Z. Chir. 1938, 250, 276; Wien. klin. Wschr. 1953,

65, 603.8. Schmitter, H. Munch. med. Wschr. 1958, 43, 1658.

genic factor and the gonadotrophic factor. The questionis still open whether this case is a singular one and reactedto reserpine because it was a hypophyseal-diencephalicexophthalmos, as described by Zondek,4 or whether everyexophthalmos is liable to recede after high doses ofreserpine.

M. ASSAELF. GABAIH. Z. WINNIK.N. KHAZANF. G. SULMAN.

Talbieh Psychiatric Hospital.Hebrew University-Hadassah Medical School.

Department of Applied Pharmacology,Hebrew University-Hadassah

School of Pharmacy, Jerusalem.

TREATMENT OF CEREBRAL FAT-EMBOLISM

A. G. J. VAN SONDEREN.

SIR,-Reading the article 5 by Dr. Harnett and hiscolleagues, I was surprised at the remark, " Attempts atspecific treatment have not been very successful." I donot agree and I wish to draw attention to two articles

published during recent years.(1) The first 6 was concerned with the excellent results of

decholin therapy, as described by Rappert,7 obtained in the0. L. Vrouwe Gasthuis, Amsterdam.

(2) The second paper 8 was also concerned with the decholintherapy of fat-embolism. Results showed that only 8 out of100 patients with severe fat-embolism died. A very successfultreatment indeed.

Amsterdam.

Public Health

Influenza

ACUTE respiratory infections have been increasing in pastweeks in the Northern Hemisphere. As in every year since

1957-58, the World Health Organisation reports, the outbreaksseem to be mainly due to the A2 (A/Asian) virus, although insome places, notably Finland, virus B seems to be responsible.The disease is nowhere as widespread as in 1957-58, and isgenerally benign and of short duration, although as in everyinfluenza epidemic there are some deaths from pneumonia,usually in elderly people or those suffering from other diseases.The situation as reported to W.H.O. is as follows:

United States.-In the week ending Jan. 23 there were localisedoutbreaks of influenza, but absence from schools and in industriesmost affected by the disease did not exceed 15-20%. Influenza dueto virus A2 was confirmed in 12 States and the District of Columbia,and there were reports of epidemics of acute respiratory infectionsof which only a few were confirmed to be influenza in 11 others.France.-The epidemic is more important in the country than in

Paris, the principal centres of infection being the east, centre,south-west, and south-east. Virus strains have not yet beenidentified.

Netherlands.-Virus A2 was isolated from a fatal case of viruspneumonia in The Hague.

Sweden.-Localised outbreaks of a mild influenza-like disease,which has not yet been identified, have been reported from severalgarrisons in the north and south of the country, but so far there hasbeen no spread to the civil population.

Switzerland.- The number of influenza cases reported grew from385 in the week ending Jan. 16 to 2837 in the week ending Jan. 23.The cantons of Zurich, Basle-Town, Geneva, and Grisons were theworst affected.

In this country the Ministry of Health’s weekly influenzastatement for the week ended Feb. 13 said there had beenno laboratory evidence of influenza virus A or B, nor otherevidence of the prevalence of influenza.

1. Lancet, 1959, i, 974

Medicine and the Law

A Partner’s Notes

D. R. ELLISONBarrister-at-Law.

AT the hearing of a wife’s petition for divorce on theground of cruelty, a doctor who had seen the wife fromtime to time over the past few years was called to giveevidence relating to her health. This doctor, who was inpartnership with another doctor, used, for the purpose ofrefreshing his memory while giving evidence, the wife’smedical history card. This card recorded dates uponwhich the wife was seen, complaints made by her of herhusband’s behaviour to her, of her own health, and thetreatment prescribed. The card contained notes made notonly by the doctor giving evidence, but also by his partnerrelating to an occasion when the partner saw the wife.The question arose whether the witness could give inevidence notes recorded by his partner, the latter not

being called as a witness.Mr. Justice PHILLIMORE ruled that by the Evidence

Act 1938 notes made by the partner could be given inevidence, in so far as the notes recorded facts, such as thedate on which the wife was seen and the treatment

prescribed, but that the notes concerning the complaintsmade by her were not admissible.Robinson v. Robinson-Probate, Divorce, & Admiralty Division: Philli-

more, V. Feb. 18, 1960. Counsel and solicitors: John Alliott (Rootes &Alliott, of Folkestone).

Parliament

Social Workers and Their TrainingON Feb. 17 the EARL OF FEVERSHAM drew attention to the

Younghusband report 1 and sought the Government’s reactionsto its recommendations. His own were favourable, for hebelieved that lack of training and status had lost the socialservices many potential recruits in the last fourteen years. Thelocal authorities’ growing responsibilities under the welfareand health Acts made the recruitment of more social workersa matter of urgency. He was particularly impressed by theneed for trained mental-welfare officers; 40% of the presentofficers were due to retire within the next ten years.Lord AMULREE felt that the training proposed in the report

was a trifle on the theoretical side. He was also uneasy aboutthe report’s tendency to regard the health and welfare depart-ments as separate entities. In his view there was some sort ofmedical aspect to most welfare and social work and he wouldlike to see the welfare and health departments, if not combined,which would be ideal, at least working closely together, withthe medical officer of health a member of the two committeesor having both working under his care.

Baroness WOOTTON OF ABINGER thought that some of thereport’s recommendations were not entirely realistic. The

grading of the workers and the classification of the cases

seemed to her too tidy. In practice people might be handedfrom one worker to another. One of the besetting diseases ofour community was a delight in professionalism for its ownsake. Another was a tendency to confuse the economic andpsychological. She would be the last to dispute that wherethere was a problem of mental health, psychological trainingwas essential, and it was deplorable that so few of our mental-welfare workers had had that kind of training. But she thoughtthat interest in psychological problems sometimes led to

failure to discriminate between a plain practical need-oftenlack of money-and a true mental or psychological difficulty.In her view many of the problems with which the socialworker had to deal were basically economic. People who hadfallen into difficulties from lack of money should not be treatedas though they were failures in personal or social functions,and she hoped that the Government would be cautious in the