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pursuit of his childhood, he was a beautiful fisherman; andhe accumulated a vast collection of fishing books, as well asmany on flowers and animals and birds. More important,however, he kept a countryman’s scale of values. Hisbehaviour to everyone was consistently matter-of-fact,unperturbed, and friendly ; and the confidence he inspired’as a doctor owed as much to his character as to his clinicaltalent, his carefulness, and his long experience of humanvicissitudes. He could understand weaknesses he did notshare ; the reassurance he brought was based on power tocontrol himself as well as others ; and he himself, however ill,was always very well thank you.’ ,

" As father, grandfather, uncle, and. cousin-all in a

biggish way-his home was the meeting-place of a large.

connexion,’ and his hospitality was in the best Highlandtradition. He wanted always to make his guest easy andcontent, and he had this same attitude towards his patients.But the kindness of his hospitality, conversation, or advicehad none of the exaggeration that sometimes lessens thecharm of Celtic sympathy. He was indeed often silent, andseldom spoke at length ; he might even seem rather detached :and he was never insincere. With his wide range of humour,including the sardonic, he can have had few illusions abouthis fellows ; but he probably saw more of their best side-than most of us do ; and of the living, as of the dead, hepreferred to say nothing unless it could be good.

"

Having apparently no sense of his own superiority, hewas well placed as senior partner of a large firm of prac-titioners ; and with persistent courage he continued hiswork throughout the war till it was far beyond his strength.But in his 80th year his hair was still dark and his attitudecontemporary. Neither fatigue nor age altered his per-sonality, and he went on treating his neighbour better thanhimself." "

Dr. McDougall was consulting physician to the Car-shalton War Memorial Hospital and a member of itsoriginal staff. He married, first,. Margaret Mitchell, ofRibigill, near Tongue, by whom he had three sons andtwo daughters, and secondly S. H. Mitchell, who surviveshim. One of his younger sisters was the late Dr. MaryMcDougall of Croydon. He died at Wallington onSept. 29.

JAMES MACDONALD TROUPM A ST.AND., M B CAMB.

Dr. Troup, who died on July 31 in his 78th year, was aScotsman who made South Africa his home, and cameto be regarded in Pretoria, where he practised for 43years, as the ideal family physician. He was born atHuntley, Aberdeenshire, the youngest son of the Rev.Robert Troup, and was educated at Madras College andthe University of St. Andrews, where he took his MA. In1886 he went with a Guthrie scholarship to Cambridgeand read medicine and mathematics. He was a brilliantmathematician and in the tripos of 1890 was Seventh’ .Wrangler. He did his clinical work at King’s CollegeHospital, where he was a senior scholar and becamehouse-surgeon to Watson Cheyne. In 1897 he went toSouth Africa to take up an appointment at Grahamstown,and after practising for a time at Somerset East he settledin Pretoria in 1902.Possessing an astonishing clinical acumen with a

naturally inquiring mind, Troup might well have beena consultant physician, but he preferred the wider scopeof general practice. He liked nothing better than to bethe adviser and counsellor of a multitude of families inand about Pretoria ; but he never failed to keep pacewith advances in medicine, being an assiduous readerof medical journals all his medical life. A colleague,writing in the South African Medical Journal, recalls thathis interest never flagged : " when confronted withsomething obscure or unusual his tenacity of purposewould invariably find the solution-and this with very-little help from mechanical aids. In therapeutics, asin diagnosis, he was supreme." Dr. A. Pijper, the patho-logist, writes in the same journal of his first meeting withTroup. They had been in consultation over a patientand were -standing in the street when Troup began todiscuss an article Pijper had lately published on thediffraction of light by red-blood cells. " He quietlyexplained where he thought I had gone wrong in mymathematics and physics, and-we ended by sitting onthe running-board of his car and drawing figures in thesand." Pijper also asks how many people realise that

but for Troup tick-bite fever would probably still beunrecognised. -By the early 1920’s Troup had realisedthat this was a disease sui generis, peculiar to SouthAfrica ; he had worked out its clinical features and knewit was spread by a bite ; but he left it to Pijper to eluci-date its aetiology. In 1931 they described this mildtick-typhus, with " no mortality, no sequelae, almostno complications, and practically no literature " inTHE LANCET (1931, ii, 1183). As an anaesthetist Troupkept almost entirely to chloroform and ether, and histechnical skill showed itself particularly in his adminis-trations to children and the aged.

Dr. Troup married twice. His first wife, EthelMacDonald, died six years after he settled in Pretoria.In 1909 he married Alberta Davif3.

Public Health

QUALIFICATIONSREVISION of the course and examination for the

diploma in public health has long been promised, and theGeneral Medical Council are now considering a report bythe Society of Medical Officers of Health which proposesa new syllabus.1 This is designed for the years in whicha National Health Service is taking shape.The new DPH course, as set out in the report, will omit

practical training in chemistry, physics, physiology,biochemistry, and bacteriology, since the time hithertospent on acquiring laboratory technique in these subjectscould be more profitably used. For similar reasonspractical tests in food inspection are to be left out.To ensure that the candidate pays attention to practical

demonstrations during his course, he will be required to keep,and produce at his examination, a day-book in which he isto discuss the implication of his practical studies. He is alsoto write a dissertation on some subject he has encounteredduring these studies.To provide a basic training in preventive and social

medicine for all doctors taking part in the public-healthservices, the report suggests a postgraduate course lastingone academic term of whole-time study or the equivalent(300 hours) in part-time study. At the end of this basiccourse a certificate will be awarded. Those seeking a fullqualification in public health will take a further courselasting two terms, or the equivalent, to fit them for the postof medical officer of health. On passing the examinationthey will receive the DPH.

,

The basic course is to cover the history of public health,functions of central and local authorities and voluntary bodies,agencies for relief, statistical information, control of infection,housing, physical education, heredity, health education andinternational health organisations. Practical work willinclude demonstrations, visits, and exercises in epidemio-logical problems and the preparation of statistics.The course for the full qualification in public health will

include the study of physiology, biochemistry, food andnutrition in relation to public health ; bacteriology, parasito-logy, and medical entomology, as applied to epidemiology;mass aspects of disease ; sanitation, water-supply, housing,town-planning ; statistics, plans, administrative methods ; thepublic-health laws ; mental health services ; occupationalhealth, and health education. Candidates will live for fourweeks in a fever hospital, or attend for 3 months part-time,and will undertake practical work in a health department.

In addition, the report deals with the position of public-health specialists, and recommends that doctors now inthe service should be placed on the specialist register ifthey have had 5 years’ postgraduate training andexperi-ence in the practice of medicine, of which not less than 2have been spent in a public-health department doingwork comparable with that of a medical officer of health,and if they hold an approved academic qualification inpublic health.

For newcomers to the service the criteria for admission to theregister should be residence for not less than 12 months inapproved hospitals or institutions, and not less than 6 months

1. Postgraduate Education of Medical Practitioners in Public Health.Report by a subcommittee of the Society of Medical Officers ofHealth, with Prof. R. M. F. Picken as chairman. Obtainablefrom the society at Tavistock House (South), Tavistock Square,London, WC1.

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in general practice ; training and service, for 2 years whole-time, 3 years part-time, in the central office of departmentof the MOH of an approved authority ; and a recognisedacademic qualification in public health.A second part of the report considers the training of

officers and specialists who give service of a special kindin the. public-health department. These include childhealth officers, school medical officers, maternity officers,chest physicians engaged in tuberculosis work, andspecialists in infectious diseases or venereal diseases.It is suggested that in addition to taking the basic course,they should have special experience in their subject, andhold a recognised qualification in it.Thus child health officers (including school medical officers)

would be required to have had 18 months’ general clinicalexperience in resident medical and surgical appointments andgeneral practice ; a year of special experience as a resident in ahospital with children’s wards ; and not less than a year in thechild-welfare section of a health department. They would beexpected to take a postgraduate qualification in child health,the examination for which should give prominence to preven-tive and social factors.Maternity officers, who, in the subcommittee’s view, should

be responsible for the antenatal, intranatal, and postnatalcare of the mother, would be required to have the same generalclinical experience as child health officers, followed by twoyears’ experience in maternity hospitals or hospitals -withmaternity wards, and in clinics. Some part of this time shouldpreferably be spent in a hospital taking gynaecological casesand children. - They should also attend antenatal, postnatal,and child-welfare clinics, and should take a postgraduatequalification in obstetrics and gynaecology.Similar standards are proposed for the other specialists

in this group, except that these-specialising in tuber-culosis, infectious diseases, and venereal diseases-wouldbe required to take a higher qualification in medicineinstead of a special diploma.

Infectious Disease in England and Wales.

WEEK ENDED OCT. 6 -

ocaoMS.—The following cases of infectious diseasewere notified during the week : smallpox, 0 ; scarletfever, 1683 ; whooping-cough, 909 ; diphtheria, 479 ; ;paratyphoid, 11 ; typhoid, 15 ; measles (excludingrubella), 367 ; pneumonia (primary or influenzal), 377 ;puerperal pyrexia, 155 ; cerebrospinal fever, 38 ; polio-myelitis, 29 ; polio-encephalitis, 0 ; encephalitis leth-argica, 0 ; dysentery, 207 ; ophthalmia neonatorum, 79.No case of cholera or typhus was notified during the week.The number of service and civilian sick in the Infectious Hospitals

of the London County Council on Sept. 26 was 1021. -During theprevious week the following cases were admitted : scarlet fever, 69;diphtheria, 41 ; measles, 4 ; whooping-cough, 17. ’

Deaths.-In 126 great towns there were no deaths fromenteric fever, measles, or scarlet fever, 4 (1) from whoop-ing-cough, 12 (1) from diphtheria, 47 (7) from diarrhoea,and enteritis under two years, and 8 (0) from influenza.The figures in parentheses, are those for London itself.Liverpool reported 10 deaths from diarrhoea and enteritis.

The number of stillbirths notified during the week was200 (corresponding to a rate of 29 per thousand totalbirths), including 11 in London.

On Active Service

AWARDS

CBEColonel F. A. BEARN, DSO, MC, MD MANC., RAMCBrigadier ERNEST BULMER, OBE, MD EDIN., FRCP, RAMCBrigadier J. T. MCCONKEY, LRCPI, RAMC ’

OBE

Surgeon Lieut.-Commander J. S. GUEST, RANRFor great skill and devotion to duty as PMO of HMAS Westralia

during the landing on Tarakan Island on May 1, 1945.

, DSO

Lieut..Colonel M. W. GONIN, MRCS, RAMC

MENTIONED IN DESPATCHES.

Surgeon Lieut.-Commander W. H. MILROY, RANR

Notes and NewsNURSES FOR THE TUBERCULOUS

IN view of the acute shortage of nurses in sanatoriums, theMinister of Health asks all hospital authorities to considerwhether they can release some of their trained or assistantnurses-who, of course, must be willing to make the transfer-for training at such institutions. If most hospitals canspare one or two nurses for this purpose, the situation in thesanatoriums will be greatly eased. On May 1 of this year thenumber of tuberculosis nurses needed was estimated at 1909(24-2% of the full establishment) ; in February the deficithad been only 1771 (23-2%), and in November, 1944, 1471(20-2%). Patients awaiting admission to hospital have risenfrom 4628 in March of this year to 4972 in June ; so thesituation is deteriorating. The Minister asks that matronsor other responsible officers will explain to their nurseshow urgent the need has become. He also asks as manyhospitals as possible to make arrangements for nurses takinggeneral or fever training- to be seconded to sanatoriumsfor part of their training.

PROHIBITION OF OPIUMTHE Times of Oct. 10 announces that the British military

administration has totally prohibited opium in Malaya andall British-protected territories in the Far East. Before thewar, government revenue from the opium monopoly wasbeing gradually reduced, with total prohibition as the ultimateaim. It is emphasised that the success of the new policywill depend on effective control of opium production in othercountries, and the British Government are consulting othergovernments to secure their cooperation.University of Cambridge

.

The title of the degree of Ms, B CHIR has been conferred. onthe following: I. M. S. Chappel, P. J. Coope, M. E. P. Hele,J. E. Keilin, L. A. Norris, H. M. Russell, C. N. Smith, J.Whitham, and G. B. Wrong.Royal College of Surgeons of EnglandOn Oct. 11 Sir Howard Florey, FRS, professor of pathology

in the University of Oxford, delivered the Lister lecture onthe use of micro-organisms for therapeutic purposes (see p.503). Afterwards Sir Alfred Webb-Johnson, president ofthe college, presented him with the Lister medal and prizeof ;E500. Sir Howard, in returning thanks, reiterated thatthe successful use of penicillin was the outcome of the worknot of himself alone, but of a host of collaborators.At a meeting of the council held on Oct. 11, with Sir Alfred

Webb-Johnson, the president, in the chair, a Leverhulmeresearch scholarship was awarded to Mr. P. B. Ascroft, forresearch on the pathology of head injuries.A diploma of fellowship was granted to David Barrett

Feather (Leeds), and diplomas of membership were grantedto the following :

C. H. de Boer, Lucy M. Dunkerley, R. L. Greenwood, E. C.Hutchinson, P. M. Jeavons, H. A.1,Lane, W. H. Lonsdale, andHarold Wainstead.

The following diplomas were granted jointly with the RoyalCollege of Physicians of London :D. Phys. Med.-J. F. Bach and E. J. Crisp.DCH.-H. I. C. Balfour, Henry Blair, AgnesA. Brash, E. H. Brown,

E. F. B. Cadman, Alexander Comfort, Nancy D. Cox, J. G. Dathan,R. L. J. S. Derham, Glenys M. M. Donaldson, F. R. M. Elgood,Elizabeth de C. Falle, I. W. Gallant, Susanna Gordon, Mona Griffin,G. R. Griffith, Ursula Jerram, Alexander Kahan, Margaret Kemsley,Vivien U. Lutwyche, Helen M. C. Morley, Joan L. Noak, G. E.Paget, Margaret Pardoe, H. E. Parry, P. E. Polani, Phyllis Poyner-Wall, L. S. Prasad, R. J. P. Pugh, Mary M. E. Rutter, Vivian M. N.Usborne, D. E. Yarrow, S. S. Yudkin, Charles Zahra Neumann,Hedwig L. Zondek.

Major (Non-Teaching) Voluntary Hospitals StaffThe annual general meeting of the Association of the

Honorary Staffs of the Major’ (Non-teaching) VoluntaryHospitals of England and Wales will be held at the RoyalCollege of Surgeons, Lincoln’s Inn Fields, London, WC2, onFriday, Nov. 9, at 2.15 PM. Mr. H. J. McCurrich is presidentof the association, Mr. Kenneth Heritage treasurer, and Mr.M. P. Reddington hon. secretary.Return to PracticeThe Central Medical War Committee announces that the

following have resumed civilian practice :Mr. F. d’Abreu, FRCS, 82, Harley Street, Wl.Mr. Geoffrey H. Bateman, FRCS, 55, Harley Street, Wl.Dr. F. W. Jacobson, 75, Wimpole Street, Wl.Dr. G. L. S. Konstam, pucF, 40, Harley Street, Wl.Dr. V. R. O’Connor, 8, Leam Terrace, Leamington Spa.Dr. W. R. Reynell, FRCP, 87, Harley Street, London, VVl.