BRITISH MEDICAL JOURNAL

2 AUGUST 1975

315

NEWS

AND NOTES

EPIDEMIOLOGY Eczema Vaccinatum and Vaccinia The following notes are compiled by the Epidemiological Research Laboratory of the Public Health Laboratory Service from reports submitted by public health and hospital laboratories in the United Kingdom and Republic of Ireland. Eczema vaccinatum may sometimes occur even when the utmost care is taken. A girl aged 9 years had had "infantile" eczema for about two years. Her parents wished to emigrate and the rest of the family had to be vaccinated. Arrangements were made for the child to stay with an aunt elsewhere, and when she had gone the other members of the family were vaccinated. The child spent three weeks with her aunt, and the parents visited her three times, at regular intervals, with freshly laundered clothes which had been washed in an automatic washing machine. During these visits there was no direct contact between the rest of the family and the girl. The mother and father took the clothes to the aunt's caravan and left them on the step, and the child conversed with her parents through a closed window. There was some doubt at one time whether the child did return to her home before the crusts had dropped off the vaccination site of one of the other children, but further inquiry showed that the girl developed eczema vaccinatum within 24

hours of her return home. So it seems that she could have acquired vaccinia from her parents only during their visits, perhaps from the laundered clothing. The diagnosis was confirmed by electron microscopy. The girl was extremely ill for 48 hours but responded well to systemic antibiotics and antivaccinial immunoglobulin, making an excellent and total recovery. In 1974, 29 cases of vaccinia were reported by laboratories, a figure similar to that reported in recent years except in 1973. In that year about twice the usual number of cases were reported because there was a small outbreak of smallpox and about twice as many persons as usual were vaccinated during the year. The diagnosis in all cases was confirmed by isolation of the virus except in one patient, in whom a 4-fold rise in antibody titre was demonstrated. In many of the cases a rapid provisional diagnosis was made by electron microscopy. Three patients were doctors, one was a nurse, and another a laboratory worker. Twenty of the 29 patients had local vaccinial lesions d,ue to accidental vaccination. The sites of these lesions included the eye, orbit, nose, lip and tongue, gum and palate, wrist, perineum, and penis. In nine instances, including the two cases of penile vaccinia, the infection was acquired from

recently vaccinated contacts. One of these was a nurse who worked in a travellers' clinic where a large number of vaccinations were performed. Another was a medical practitioner who was on long-term steroid therapy; he developed a large ulcerating lesion on his finger over a three-week period after vaccinating some patients. One woman, a cleaner in a shipping-office, was pricked in the hand by a needle protruding from a disposal bag. In seven cases the lesions were acquired by autoinoculation. In a boy aged 10 the virus was isolated from the nose, lip, and tongue five days after primary vaccination. He had pre-existing herpetic lesions around the nose when the vaccine was given, and herpes-like particles were subsequently seen by electron microscopy in swabs from the lip and tongue. In the remaining four cases no further information was given. Five patients had eczema vaccinatum. Two of these were vaccinated though they had eczema, and one acquired the infection after having a meal with a recently vaccinated person in a restaurant. In the other two no further information was given. Of the four other patients three had generalized vaccinia, and the fourth, a 19year-old man, developed a Stevens-Johnsonlike syndrome.

the wearing of seat belts. The extent of the reduction was the same whether the accident was in a built-up area or not. The judge described the defence as "extremely unattractive," and perhaps for that reason the reduction for the girl's contributory negligence was very much on the low side. In later cases awards were to be reduced by 15%,4 20%)5 6 and even as much as one-third. But there were a number of High Court judges who refused to reduce damages at all on this ground, and in the next two years an astonishing divergence of judicial opinion arose. The disparity was all the more perplexing since back in 1970 the Court of Appeal had ruled7 that a motorcyclist's failure to wear a crash helmet did amount to contributory negligence and reduced the damages for a skull fracture by

wear a belt and that of a motor-cyclist to wear a helmet. Mr. Justice Shaw, for example, emphasized8 that the motorcyclist was much more at risk: he was unenclosed and in a state of unstable equilibrium. Danger loomed large and continuously for as long as he was in the saddle. Mr. Justice O'Connor'0 expressed the general view of the judges not prepared to sanction a reduction when he said that it

MEDICOLEGAL Seat Belts and Negligence FROM OUR LEGAL CORRESPONDENT

Over two years of total uncertainty whether the failure of a driver or front-seat passenger to wear a seat belt amounted to contributory negligence has been ended by a recent appeal' sponsored by the Phoenix Assurance Company. The effect of Lord Denning's definitive judgement is that, even where the plaintiff was entirely blameless for the accident, his damages will be reduced in part-proportion to the extent that his injuries were caused or aggravated by the non-use of the seat belt. The defence that a seat belt would have reduced the extent of the plaintiff's injuries was first advanced successfully in this country in February 1973. Judge Kenneth Jones reduced23 by 5 % the damages awarded to a 20-year-old girl with severe facial injuries after hearing evidence from a Department of the Environment statistician that in cases of serious and fatal injuries the risk of injury was reduced by as much as half by

offended ordinary decency for a grossly negligent driver to be relieved of paying the proper measure of damages. The Court of Appeal ruling that has now settled the matter came from a decision of Mr. Justice Nield, one of the group of judges loath to find contributory negligence. The plaintiff had sustained a broken rib, bruises to the chest, and abrasions to the 15%. head in an accident for which the defendant A number of judges sought to differentiate was convicted of careless driving. The between the obligation of a car passenger to evidence was that, had he been wearing a

316

RIIH MEDICAL jouRNAL

seat belt, he would probably not have suffered his injuries. Lord Denning said that the material put before the court showed plainly that everyone in the front seat of a car should always wear a belt. The Highway Code urged road users "to fit seat belts in your car and make sure they are always used." He also noted that Parliament had recently discussed a Bill to make the wearing of belts compulsory. Last autumn Mr. Mulley told11 the Commons on the second reading of the Road Traffic (Seat Belts) Bill that compulsory wearing of belts could save three lives and 30 serious injuries in this country every day. His successor as Minister of Transport, Dr. John Gilbert, announced the week before the Court of Appeal decision that he intended to press through the seat belt legislation this year. The Master of the Rolls replied to those who consider they are less likely to be injured if they are thrown clear than if they are strapped in that in fact the chances of injury were four times as great. Mr. Justice Nield had been prepared to respect the minority opinion against the wearing of seat belts, but not so Lord Denning, who said that the law required everyone to exercise all such reasonable care as a man of ordinary prudence would observe. Such a man now recognized that seat belts should be worn every time a car went on the road and not just at times of high risk, such as on a motorway or in fog. The only legitimate exceptions to the rule were unduly fat or pregnant women-cases where wearing a belt might do more harm than good.

The Court of Appeal regarded the solution to the problem as being partially one of causation. A plaintiff, while not being to blme for the accident, might still be to blame for his injuries or a proportion of them. None the less, when there is an accident the negligent driver still has to bear the greater share of the responsibility. Lord Denning thought that when the evidence showed that the injuries could have been prevented altogether by wearing a seat belt the reduction in damages should be 25%. When the injuries would have been a good deal less severe with a belt worn, then the reduction ought to be 15 %. Naturally in those cases where the non-use of the belt has had no effect on the injuries no reduction will be made. It may be some little time before Dr. Gilbert's Bill comes into force, but it will be interesting to see whether in the meantime the widely publicized Court of Appeal ruling will have more effect in persuading people to wear belts than "clunk-click" advertising campaigns. However, for the insurance companies, continually making losses on motor insurance, the new ruling could save as much as £3m. a year in damages payments.

i ii | S

registrar appoint-

ments in pathology at the Lon-1don Hospital; Hospital for Sick Children, Great I 00 zt Ormond Street; and Barts. For three years he was a senior registrar in pathology at Lewisham Hospital, obtaining the M.R.C.P. in 1963. Dr. Lock joined the staff of the B.M.7. in 1964, being promoted to deputy editor in 1974, the year he was elected F.R.C.P. He is particularly interested in teaching medical writing and has lectured at medical schools and postgraduate centres in Britain and run several postgraduate

iii; _

". . . The Council has this year approved a new career structure for its own scientific staff which, while attempting to give greater security to the young scientist, inevitably results in a loss of flexibility by comparison with the previous situation. The mobility of scientists between universities and Council establishments has been greatly diminished by these developments; this is particularly worrying in the context of the training and scientific development of the young research worker and the need for cross-fertilization of research teams. The attraction of scientific research as a career at least meriting some investigation by the young graduate has diminished with the availability of career opportunities. . . ." The M.R.C. reports that it is making special attempts to expand research on cancer; deafness; drug misuse and dependence, particularly in relation to smoking and alcoholism; and population problems. It is also paying particular attention to arterial disease; environmental factors in disease; mental disease; and microbial diseases. As always, the report gives a fascinating glimpse into the catholic range of medical research: an especially interesting section is its review of M.R.C.-supported research into pain and the use of electrical stimulation for its relief.

1 Froom v. Butcher: The Times, 22 July 1975. 2 Pasternack v. Poulton: (1973) 1 W.L.R. 476.

3 British Medical Yournal, 1973, 1. 497. 4 Drage v. Smith: (1975) 1 LI. L.R. 438. 5 Parnell v. Shields: (1973) R.T.R. 409.

6 British Medical Yournal, .1973, 1, 686. 7 O'Connell v. Yackson: (1970) 3 W.L.R. 463. 8 Challoner v. Williams: (1974) R.T.R. 221. 9 British Medical Yournd, 1974, 2, 455. 10 Smith v. Blackburn: (1974) 2 U. L.R. 229. 11 British Medical Yournal, 1974, 4, 542.

MEDICAL NEWS Editor, B.MJ. Dr. Stephen Lock has succeeded Dr. Martin Ware as Editor of the British Medical 7ournal. Dr. Lock, who is 46, was educated at the City of London School; Queens' College, Cambridge; and St. Bartholomew's Hospital, where he edited St. Bartholomew's Hospital 7ournal. After quaLifying in 1953 he held house jobs at Barts, the Brompton Hospital, and the _ CentralMiddlesex _ Hospital and did two years' national service in the Royal Air Force. He t h en held

2 AUGusT 1975

courses in the principal medical schools in Finland and Iraq. Of his four books, one (written jointly with Dr. A. J. Smith under the pseudonym of Charles Thorne) is Better Medical Writing.

M.R.C.'s Report for 1974-5 "Static or declining budgets" with "much decreased career opportunities for scientists" are two gloomy comments on the year 1974-5 as seen by the Medical Research Council. In its annual report for that year just published (H.M.S.O., price £2-75) the M.R.C. refers to the reorganization of its advisory and decision-taking machinery. The previous Clinical and Biological Research Boards have been replaced by the new Environmental Medicine Committee and three new research boards-the Neurobiology and Mental Health Board, the Cell Biology and Disorders Board, and the Physiological Systems and Disorders Board. This has resulted in the appointment of "over 50 additional eminent scientists from all parts of the United Kingdom" to membership of these new bodies. The report also comments on progress in the second of the three "transitional" years during which the Rothschild customer/ contractor principle outlined in the 1972 White Paper on Government research has been introduced. The halt in university expansion has had its effect on the M.R.C. The report states:

Substitutes for Tobacco In its first report, published last week, the Independent Scientific Committee on Smoking and Health sets out procedures for testing substances that may be added to tobacco or smoked as a substitute for it. The procedures are those to be used before marketing a product. A subsequent report will consider longer-term studies in man. The responsibility for marketing a product and for the health consequences rests with the manufacturers, says the committee. And it adds: "It will only be when a tobacco substitute has been smoked over a long period by heavy smokers that a full assessment can be made of the relative dangers of a product containing a tobacco substitute and one composed wholly of tobacco." Dr. R. B. Hunter, vice-chancellor of Birmingham University, is chairman of the committee.-Tobacco Substitutes and Additives in Tobacco Products. H.M.S.O. (50p net).

Digoxin Tablets B.P. The Department of Health has written to doctors (16 July) about a new and stricter specification for digoxin tablets B.P. to be introduced on 1 October 1975. The letter reads: "In taking this decision the British Pharmacopoeia Commission has received advice from the Committee on Safety of Medicines in consultation with the British Medical Association, the British Cardiac Society, the Royal College of General Practioners, and other experts. "The effect of this change is that digoxin tablets B.P. complying with the new specification may be more potent than unbranded tablets currenty available. "Adequate supplies of the new tablets will be available by the end of September but pharmacists have been asked not to dispense these tablets before 1 October 1975. To facilitate identification, pharmacists and dispensing doctors are asked to ensure that the

BRITISH MEDICAL JOURNAL

2 AUGUST 1975

date of dispensing is shown on all containers for digoxin tablets. "It is important to be aware that from 1 October 1975 prescriptions for digoxin tablets will be dispensed with tablets complying with the new specification. To ensure a trouble-free introduction of the new specification it is suggested that reassessment of maintenance dosages is undertaken for patients who may develop digoxin intoxication following the substitution of a better absorbed preparation. The Department has been advised that the following patients should be considered for reassessment: "(1) The elderly and the young; (2) patients with impaired renal function; (3) patients with low blood potassium; (4) patients receiving concomitant diuretic therapy; (5) Patients with low absorption rates as evidenced by treatment with daily doses of 500 micrograms of digoxin or more. "Prescribers are reminded that patients who have been given prescriptions dated before 1 October 1975 which are presented for dispensing after this date will be issued with the new standard of tablet. In such instances pharmacists will be advised to consult the prescriber prior to dispensing the prescription if the daily dose is 500 micrograms of digoxin or more, or the patient is a child." New Vice-chancellor for Queen's University, Belfast Professor Peter Froggatt, professor of epidemiology and dean of the Faculty of Medicine since 1971, has been appointed president and vice-chancellor of Queen's University, Belfast, from 1 October 1976. Professor Froggatt, who is 47, graduated from Trinity College, Dublin, and has experience of general practice in both Dublin and Northern Ireland, and of industrial medicine; since 1959 he has been successively lecturer, reader, and professor in the Department of Social and Preventive Medicine.

Amenity Bed Charges Up From 1 August 1975 amenity accommodation in a single room will cost £3 a day and in a small ward with two or more beds £1-50 a day. When Mrs. Barbara Castle announced that the Government would be

introducing legislation

to

phase

out

private

beds from N.H.S. she also stated that it was the Government's policy "to maintain the system of amenity beds and to build on it"

(10 May, p. 346). People in the News Professor H. E. de Wardener has been ap-

pointed honorary consultant physician to the Army in succession to Sir John Richardson, Bt.

COMING EVENTS Vth International Conference of the International Association for Accident and Traffic Medicine and 3rd International Conference on Drug Abuse.-1-5 September, London. Details from Conference Services Ltd., the Conference Centre, 43 Charles Street, London, W1X 7PB. (Tel. 01-499 1101.)

ROYAL COLLEGE OF PHYSICIANS OF

10th British Congress on the History of EDINBURGH Medicine.-"Social Support and Rehabilitation At the quarterly meeting held on 17 July with Professor J. W. Crofton, president, in the chair, the in Britain, 1725-1975," 2-6 September, York. following were to Fellowship: H. H. Stott, Details from Dr. John Cule, the Library, St. M. Medalie, R.admitted A. Bustamante, G. I. Robertson, A. C. A. Coombes, W. Cooper, S. Sachdev, A. R. David's Hospital, Carmarthen, West Wales. 20th Congress of the World Union of Medical Writers.-1-5 October, Amsterdam. Details from Dr. E. Pereira-d'Oliveira, Jacob Obrechtlaan 13, Bussum- 1351, Netherlands.

Winchester and Central Hampshire Medical and Dental Federation.-Copies and details of the programme for September to December, 1975, are now available from the Postgraduate Medical Centre, Royal Hampshire County Hospital, Winchester, Hants. (Tel. 0962 63535, ext. 422.)

UNIVERSITIES AND COLLEGES Mental Handicap Inquiry Mrs. Barbara Castle in a parliamentary answer on 17 July announced the members and the terms of reference of the Committee of Inquiry into the Nursing and Care of the Mentally Handicapped, under the chairmanship of Mrs. Peggy Jay. The committee will "inquire into the nursing and care of the

examine the roles mentally handicapped and aims of nurses and residential care staff required by the health and personal social services for the care of mentally handicapped adults and children [consider] the implications for recruitment and training"; and make recommendations. Among the members of the committee, which contains nurses and social workers, are two consultant psychiatrists, Dr. G. Kerr .

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.

.

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.

and Dr. D. Rick. New Chairman of U.C.C.A. Dr. H. University

R. of

Pitt, vice-chancellor of the Reading,

has

been

appointed

chairman of the Universities Central Council on Admission from 1 October 1975. He succeeds Dr. G. Templeman, vice-chancellor of the University of Kent, who has been chairman since August 1964.

F. W. Martin, J. A. Rennie, N. Rushton, A. R. Mundy, Deirdre C. T. Watson, I. G. Kidson, R. E. Mansel, G. D. Rooker, N. S. Bamrah, D. J. Mukherjee, M. Z. U. Khan, N. A. Gibson, K. Nagasayana Rao, 0. F. Hanna, M. A. Edalat, S. Mohan, M. R. Weedon, M. S. Abdul Hameed, M. A. J. Al-Ani, J. L. Cooke, S. R. Khan, A. F. C. Pinto, J. P. Dhasmana, B. Balakrishnan, E. F. D'Costa, B. A. R. Falahi, M. R. Fansa, Q. du P. Fehrsen, M. R. M. Foda, G. el-D. H. Kazem, M. Masieh-ud-Din, L. S. Monga, K. A-D. Abulata, N. A. Attar, M. A. T. Cook, A. El T. El Tahir, R. I. Hill, B. Hopkisson, D. B. Innes, S. N. Kassis, N. S. Parulekar, K. S. Toor, Meena R. Agrawal, Z. Ahmad, G. W. Arthur, F. J. Bonar, R. K. Chopra, A. K. Chowdhury, Y. E. M. El-Arabi, H. R. Glennie, F. P. Houlihan, R. Nadaraja, S. Sagar, M. K. Souri, D. Vella, C. R. Baldock, R. A. Cartmill, F. M. Charnock, R. F. Dale, J. P. Fleetcroft, P. D. Fogarty, I. W. Forster, D. M. Grosser, W. S. L. Gunasekera, J. S. Harvey, J. R. Hindmarsh, B. K. Kalapesi, A. J. Khan, E. M. Kiely, Maeve A. McDermott, Hymavathy Raman, R. D. Rawlins, K. K. Ray, B. 0. 0. Songonuga, R. N. Telang, A. Bianchi, P. J. Bore, R. A. Buxton, J. S. Davies, C. P. Forrester-Wood, P. M. G. B. Grimaldi, D. P. Josa, M. S. Kokri, E. R. Lippey, H. W. B. Litchfield, P. Malycha, A. R. Scott, I. H. K. Scott, J. L. Talbot, K. A. Attara, E. T. Bainbridge, R. Baker, A. F. Bedford, H. N. Blackford, R. J. Blunt, W. J. Brawn, R. L. Cable, K. K. Chan, R. G. M. Duffield, A. N. Edwards, J. R. Farndon, D. C. Fermont, S. W. Fountain, P. M. Foy, M. M. S. Glasgow, R. J. R. Goodall, H. P. Henderson, R. J. D'A. Honey, A. J. Howcroft, D. M. Ingram, J. L. Jay, D. J. Leaper, J. R. C. Logie, D. M. Matheson, K. F. Parsons, D. A. Price, L. Rangecroft, V. A. C. Reece, C. Roberts, W. A. M. Saikali, S. D. Singh, P. Staniforth, M. H. Thorneloe R. R. Ullal, D. Valerio, T. H. Walsh, G. S. E. Dowd, A. R. Hearn, P. J. Milewski, C. Swain, D. M. Thomas, P. Whelan, J. H. N. Wolfe. J. R. Pepper.

ROYAL COLLEGE OF SURGEONS OF ENGLAND At the quarterly meeting of the council held on 10 July, Sir Rodney Smith was re-elected president, and Mr. R. H. Franklin and Mr. R. S. Handley were re-elected vice-presidents for the ensuing year. Mr. A. W. Badenoch and Mr. A. S. Frere were admitted to the Court of Patrons. Mr. G. Qvist was re-admitted and Mr. Ian T-odd and Professor G. Slaney were admitted as members of the council of the college. Dr. B. Sellick was admitted to council as an invited representative of the Faculty of Anaesthetists. Sir Stanley Clayton was admitted as the newly co-opted member of council representing obstetrics and gynaecology. Professor G. R. Seward was admitted to the Board of Examiners in Dental Surgery. Dr. A. J. Whitaker was elected to the Fellowship. Professor N. L. Browse and Mr. C. V. Mann were elected to the Court of Examiners in general surgery, and Mr. V. T. Hammond in otolaryngology. The Nuffield prize was awarded to Dr. David J. Gwilt. At the extraordinary meeting of the council held on 9 July, with Sir Rodney Smith, president, in the chair, Professor E. Polak of Prague was admitted to the honorary Fellowship. Dr. D. Dooley, Dr. F. Kohn, Dr. R. G. W. Olierenshaw, Mr. Giles Romanes and Mr. N. Rowe were elected to the Fellowship. The following were admitted to

Fellowship: I. R. Fraser M. C. Bishop, J. H. Cook, P. G. Wragg, D. L. Boase, F. Fisher, M. G. Hoffman, G. J. Benke, W. N. Bodey, P. M. H. Cherry, Helena J. Frank, J. E. Lovegrove, I. S. Fyfe, D. A. Berstock, M. A. Cifton, N. J. R. George, R. H. C. Markham, S. Sircar, R. Bourne, M. M. Henry, A. C. John, R. W. Motson, K. Pearman, D. J. Spalton, C. R. J. Woodhouse, P. R. Allen, P. M. Thompson, R. B. Smith, I. W. Bintcliffe, D. McK. Craig, D. M. Davies, B. R. Kenning,

Elmubarak, G. M. Lurie, H. M. P. Perera, R. C. Parikh, J. H. Learmonth, L. H. Field, W. D. Elliott, A. M. I. Wasfi, N. J. W. Royston, P. K. Roy, R. G. Mitchell, D. Pittaway, F. P. Retief, L. L. Wilson, W. G. Wenley, T. D. P. G. Pillai, S. Kumar, J. D. W. Fisher, K. P. Sinha, S. M. 0. Hilal H. Ranasinghe, B. Simpson, I. M. Breckenridge, Alice Shun-Haan Chau, A. C. Ikeme, Oon Swee Yeoh, J. A. Aitken, R. S. Mellick, J. Schneeweis, M. S. Grewal, K. B. Harveyson, N. R. M. Buist, N. T. A. Byam, C. G. Uragoda, F. C. 0. Adi, H. H. Youssef, R. G. Luke, C. C. Kar, A. L. Bass, G. M. Cochrane, J.McI. Williamson, S. Gopalakrishnan, G. M. McAndrew, K. S. Shubair, A-H. Al-Abbasi, A. N. Patel, P. W. Kershaw, M. K. Strelling, J. Le Gassicke, B. H. R. Stack, P. J. L. Holt, A. V. Shetty, H. N. Khattri, N. R. Pal, S. E. Siddiqui, J. J. Huston, I. B. Sardharwalla, J. B. Morley, E. D. Silove, P. D. Bewsher, N. Mackay, J. J. B. Petrie, B. E. Marshall, E. T. Young, M. C. Gupta, T. B. Stephens, M. F. El-Islam, T. I. McBride, J. K. Campbell, P. C. Ganguli, W. P. U. Kennedy, E. M. R. Critchley, J. D. Briggs, T. R. W. Hampton, T. C. Hindson, T. F. P. Mackintosh, G. P. Duffy, N. M. Baker, A. S. T. Wee, A. W. Blair, A. J. Akhtar, D. M. Roberts, A. J. Radford, S. Nagaswami, H. Ikram, Mvo Min (Tan, Cyril), M. A. Salmon, El-S. K. Assem, A. M. Patel, J. K. Brown, Anne E. Walker, T-K. Chan, D. H. Lawson, V. Mlikian, A. M. Martin, R. L. G. Sutcliffe, D. N. S. Malone, A. L. Muir, S. K. Kajubi, A. G. Mowat, M. W. C. Yeung, C. Y. Yeung, W. G. M. Ritchie, F. Harris, A. R. Milne, A. R. Cini, R. Astley, E. Housley, A. B. Kay.

Notice to Authors When original articles and letters for publication are not submitted exclusively to the British Medical Journal this must be stated. Correspondence on editorial business should be addressed to the Editor, British Medical Journal, B.M.A. House, Tavistock Square, London WC1H 9JR. Telephone: 01-387 4499. Telegrams: Aitiology, London, W.C.1. Authors wanting reprints of their articles should notify the Publishing Manager, B.M.A. House, Tavistock Square, WC1H 9JR, on receipt of proofs. r British Medical Journal 1975 All Rights Reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means,

electronic, mechanical, photocopying, recording or otherwise, without the prior permission of the British Medical _ournal.

Seat belts and negligence.

BRITISH MEDICAL JOURNAL 2 AUGUST 1975 315 NEWS AND NOTES EPIDEMIOLOGY Eczema Vaccinatum and Vaccinia The following notes are compiled by the Epid...
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