Public health and public medical care

This paper deals briefly with the historical development of the major movements and organizations dedicated to the preservation of the health and security of the American people. Statements of various national organizations on the need for integration of these various services for the protection of the indigent are presented, and the experience of one county department in San Mateo which operates a completely integrated department of public health and welfare is reviewed, giving the pros and cons of the operation of a number of disciplines through a single administration. The major advantage of an integrated department of this kind is that all the services having to do with human needs-the needs arising from emotional distress, economic reverses or illness-are combined under the direction of a physician. It is probable that failure of the health discipline to provide such services was a factor in the presentation of the Wagner Act in 1938 and the Wagner-Murray-Dingell Bill in 1943. Continued close cooperation between the various disciplines devoted to the protection of the health and welfare of American citizens can help in solving some of the current problems.     

Survey of safety and health care in British medical laboratories.

A retrospective postal survey of 24 000 medical laboratory workers in England, Wales, and Scotland showed highly variable standards of safety and health care. Pre-employment health screening was offered to two-thirds of employees, the physicians being the least likely to be examined (15%). Scottish laboratories provided better safety control than English and Welsh laboratories, while Public Health Service Laboratories had a better record than National Health Service establishments. Mouth pipetting is still practised in 65% of English and Welsh laboratories, and the use of protective clothing is rarely compulsory. The servicing of safety cabinets is often inadequate. Known and suspected carcinogens are still apparently used in a few laboratories (2-10%). In view of the wide variation in standards among laboratories, urgent consideration should be given to establishing regulations for codes of safe practice rather than relying merely on recommendations as at present.     

Hepatitis B virus infection in medical and health care personnel.

Analysis of 51 cases of hepatitis B virus infection in health care workers admitted as patients to the liver unit over seven years showed three healthy carriers of hepatitis B virus, seven cases of fulminant hepatic persistent hepatitis, 17 cases of chronic active hepatitis (of whom 11 had cirrhosis), and five cases of hepatocellular carcinoma. To date 11 of these patients have died. Only 15 of the 51 patients had a history of direct occupational exposure and only three patients could recall specific inoculation injuries. In contrast, the source of infection was apparent in 32 of 50 consecutive cases of fulminant hepatic failure or acute hepatitis B in nonmedical staff. Since specific inoculation injuries are not the usual mode of infection ion medical staff and since only a few of the patients who are hepatitis B virus carriers will be detected by selective screening of "high-risk" patients, the overall risk of infection can be reduced only by stricter precautions in the handling of any patient''s blood and by the use of hepatitis B virus vaccines for medical staff at high risk.     

Canadian medical schools before ACMC.

The earliest medical schools were established to supplement apprenticeship, the only route to practice available in colonial Canada. By 1885, eight medical schools were trying to accommodate the volume of new scientific information flowing from Europe. In 1910, when Flexner evaluated the schools against the Johns Hopkins model, some were woefully deficient, but by 1928 all had achieved Class A rating. The 1921 discovery of insulin in Toronto gave impetus to scientific research and, possibly, influenced the formation and funding of the National Research Council in 1934. Clinical specialization expanded, leading in 1929 to the establishment of the Royal College of Physicians and Surgeons of Canada to accredit training and certify graduates. The Association of Canadian Medical Colleges was formed at a meeting of deans to discuss a federal offer of funding and to accelerate the graduation of physicians for the war effort.     

Canada's medical schools

A 20-year-old man with a 10-year history of glomerulonephritis presented with a purpuric rash on his legs. A renal biopsy specimen obtained when he was 11 years old had shown mesangial glomerulonephritis; staining 9 years later for IgA had negative results. A second renal biopsy, performed when the rash was present, revealed mesangial glomerulonephritis and mesangial deposits of IgA; biopsies of the involved skin showed leukocytoclastic vasculitis. In this case isolated glomerulonephritis appeared to change to a multisystem illness, with a different immunologic character, through one of several possible pathogenetic mechanisms.