Planning medical information systems in a unified health service.
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Biomedical subjects
Publications and source records attributed to J N Morris.
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Mortality of hyperplasia of the prostate, as in many common conditions, is higher in the regional board than the teaching hospitals of England and Wales. 932 men with simple hyperplasia of the prostate consecutively admitted to two teaching and three regional-board hospitals have been studied. There were 5 deaths among 556 men admitted from the waiting-list, and negligible variation between hospitals. Among the 376 unplanned emergency admissions were 35 deaths, 26 of them in 71 men who did not have prostatectomy. Unplanned admissions, especially those not operated on, were older than the rest and mostly in acute retention, and many also had cardiovascular and other disease. 78% of the admissions to two of the regional-board hospitals were unplanned; the operation-rate on these men was generally low and case-fatality among them was 14%. In contrast, only 22% of the admissions to the two teaching hospitals were unplanned, nearly every case was operated on, and the case-fatality was 4.3%. These two regional-board hospitals with relatively small resources were carrying more than their share of the most difficult cases. A national survey to assess the treatment of hyperplasia of the prostate is now indicated, but it is time the National Health Service gathered this kind of information routinely.
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Between 1933 and 1962 42% of 223 deaths of male workers exposed to carbon disulphide in three viscose rayon factories in England and Wales were certified to coronary heart disease-compared with 24% of the deaths in the other workers of the same age, 17% of the deaths in other local men, and 14% in the Registrar General's Tables. Of men with more than 10 years in the rayon industry employed in one of the factories, those exposed to carbon disulphide had death rates from coronary heart disease between 1950 and 1964 two and a half times that of the other workers.This evidence of an occupational risk of coronary heart disease from long-term exposure to low concentrations of CS(2) was strongest in the 1940s and slight in 1958-62, and it may relate to wartime plant conditions. Current and prospective biochemical and morbidity surveys of exposed workers are now needed. These may also throw light on general issues of atherosclerosis and coronary heart disease.
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Data are presented on the incidence of ischaemic (coronary) heart disease and duodenal ulcer among the several thousand male medical practitioners aged 35-64 holding immediate sickness benefit policies with the Medical Sickness Annuity and Life Assurance Society Limited. Three periods are considered: 1947-50, 1957-60, and 1961-5.The incidence of first clinical episodes of ischaemic heart disease in the doctors altered little between 1947-50 and 1957-60 but increased in 1961-5. Comparison of the late 1940s with the early 1960s shows a 60% rise of incidence at ages 45-54 but little change at other ages. Cases first presenting as "sudden" death increased between 1947-50 and 1961-5 by 111% at 45-54, and again changed little at 55-64. In two other occupational groups that have been studied-bus conductors and insurance salesmen-the increase of incidence was greater than for the doctors at 45-54 and it occurred also over 55 years of age. The increase from 1947-50 to 1961-5 in mortality during all episodes of ischaemic heart disease was the same in the doctors as in the male population of England and Wales at 45-54, but at 55-64 it was less.The results in the doctors are not due to alterations over the period in length of sickness absence, or underwriting policy, or of the nomenclature used on the certificates.Well-documented changes in the smoking habits of doctors may be partly responsible for what appears to have been a relatively favourable experience of ischaemic heart disease from 1947-50 to 1961-5, especially at ages 55-64.Incidence of duodenal ulcer at ages 35-64 declined steadily in this population of doctors from 1947-50 to 1961-5. The decline is very likely to be real.
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