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sympathising to some extent with this objection, thecommittee points out that " the National Insurance

(Medical Certincation) Regulations, 1948 (S.I. 1948,no. 1175), provide, in paragraph 3 of the Schedule, thatif, in the practitioner’s opinion; a disclosure to theclaimant of the precise cause of incapacity would beprejudicial to his well-being, the certificate may containa less precise statement."

PARA-AMINOSALICYLIC ACID AND

STREPTOMYCIN IN PULMONARY

TUBERCULOSIS

A CLINICAL trial of p-aminosalicylic acid (P.A.s.) andstreptomycin in pulmonary tuberculosis was undertakenin 1948 by the Medical Research Council, with the

cooperation of the British Tuberculosis Association. Thetrial is not yet completed but some of the results alreadyobtained are so important that the joint committee

responsible for guiding the trial has decided to issue thefollowing preliminary statement. .

A major disadvantage of streptomycin is that theperiod of effective therapy is limited in many patientsby the emergence of streptomycin-resistant strains oftubercle bacilli after five or more weeks of treatment.Many workers have suggested that the addition ofanother tuberculostatic agent might suppress the resis-tant strains, which in the initial phases are present invery small numbers ; published reports on a few casestreated with P.A.S. and streptomycin have been encourag-ing. The present investigation was planned to examine,by the method of controlled trial, the possibility thatP.A.S. has this property, and at the same time to assessthe clinical effect of this drug alone and in combinationwith streptomycin.

PLAN OF TRIAL

Three treatment groups of over 50 cases each wereobserved : (a) P.A.S. alone (20 g. of the sodium salt

daily) ; (b) streptomycin alone (I g. daily) ; and (c) bothdrugs together (20 g. of the sodium salt of P.A.S. and1 g. of streptomycin daily). The methods were similarto those employed in the first M.R.C. clinical trial of

streptomycin in pulmonary tuberculosis,’- and the typeof case was again defined as follows : acute rapidlyprogressive bilateral pulmonary tuberculosis, of recent

development, unsuitable for collapse therapy, in youngadults aged 15-30. After acceptance for the trial by apanel, patients were allocated to one or other of thethree treatment groups by a method of random selection.The prescribed treatment was given for three monthsin each group. Clinicians and pathologists at elevenhospital centres have cooperated in this investigation,keeping uniform records, using standard clinical andbacteriological procedures, and reporting results at regularintervals to the council’s Tuberculosis Research Unit,where the grouped results have been analysed.

PRELIMINARY RESULTS

For this well-defined type of case of pulmonarytuberculosis, the trial has demonstrated unequivocallythat the combination of P.A.S. with streptomycin con-siderably reduces the risk of development of strepto-mycin-resistant strains of tubercle bacilli during thesix months following the start of treatment. This con-clusion is applicable so far- only to the acute form ofdisease treated, and it remains to be seen whether thesame results are obtainable in. other forms of tubercu-losis amenable to streptomycin, therapy. Furthermore,the conclusion is applicable only to the large dose ofP.A.s. used; ; this dosage causes discomfort in some

1. Brit. med. J. 1948, ii, 769.

patients and it has been agreed to find out, by furthertrials, whether smaller doses would achieve a same

result. It must be stressed also that streptomycin iseffective only in certain forms of tuberculosis, and thefinding reported here must not be interpreted as indicatingthat a combination with another drug will be effectivein those forms for which little result would be expectedfrom streptomycin alone.

THE NEW ZEALAND ELECTION

FROM OUR NEW ZEALAND CORRESPONDENT

AT this general election on Nov. 30, the NationalParty was returned with the substantial majority of46 seats to Labour’s 34, the latter figure including allthe 4 Maori seats. The Labour government’s fourteenyears of office thus came to an end, and Mr. S. G. Holland vhas assumed office as prime minister. The new ministerof social security and health is Mr. J. T. Watts, ofChristchurch, a barrister and solicitor about 40 yearsof age with a distinguished academic record, who enteredparliament six years ago.The National Party’s election policy emphasised

prevention and research, and promised a completereorganisation of the hospital system on a basis ofregional control and decentralisation. It supportedrecent Acts for the more economical management ofmedical and pharmaceutical benefits, and promised helpfor the elderly, for the Post Graduate Women’s TeachingHospital in Auckland, and for a number of other projects.With recent and forthcoming appointments inside thehealth department-notably that of the new ’ director-general, Dr. J. Cairney—the field is open for much-needed progressive development.The Labour Party’s fourteen years saw the intro-

duction, in spite of war-time difficulties, of an almostcomplete series of medical and allied benefits under socialsecurity, specialist services being the only major gap.The fee-for-service principle in maternity and medicalbenefits was dominant. Little change in hospital organisa-tion and planning was undertaken, though,during this..era the government came to be much more responsible-’for finance than formerly. , . -

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Public Health

Typhoid on a Li-nerWHEN the liner s.s Mooltan arrived in the ’Port of

London on Dec. 16, three sick members of the crew wereremoved to hospital for observation. - On -subsequentdays further members of the crew were admitted tohospital, and a diagnosis of typhoid fever has now beenconfirmed in some of them. , On Dec. 22 a total of elevenconfirmed cases were under treatment, and five furthermembers of the crew were under observation in hospital.The organism is Vi-phage type A. Retrospectiveinquiries suggest that the dates of onset of illness wereduring the last ten days of the voyage. One passengerhas been admitted to hospital as a suspected case ofenteric fever. The names and addresses of- passengersand members of the crew who left the vessel have beennotified to medical officers ’of health of the destinationsto which they were proceeding.

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PoliomyelitisIn the week ended Dec. 10 notifications in England

and Wales numbered: poliomyelitis 124,(141), polio-encephalitis 10 (15). Figures for the previous week areshown in parentheses. The total of 134 notificationsof poliomyelitis and polioencephalitis together-may’becompared with figures of 76 in the corresponding weekof 1947 and, 36 in 1948. In 1926 the corresponding