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nicotine. When the drugs themselves lead to further suffering, we find ourselves in a new paradox which we are unable or unwilling to solve.

NOMENCLATURE OF CONGENITAL LIMB DEFICIENCIES AFTER the thalidomide tragedy, closer attention to congenital malformations of the limbs revealed considerable confusion in terminology. Words such as meromelia or ectromelia do not always have the same meaning to those who use them and are incomprehensible to many others. Attempts to improve methods of classification, such as those by Frantz and O’Rahilly1 and Swanson2 in the United States and by Henkel and Willert3 in Germany, have helped to increase understanding of the congenital limb deficiencies, but the multiplicity of modifications and revisions in use throughout the world creates difficulties in discussing and comparing scientific work from different centres. A multinational working-group, sponsored by the International Society for Prosthetics and Orthotics, has now agreed on a new terminology,4 which makes it possible to classify these malformations simply and precisely. Every skeletal limb deficiency is considered as either transverse or longitudinal and further described in terms of the bones involved and the extent of their deficiency. The proposed system has been subjected to exhaustive field trials in many centres in the United States, the United Kingdom, and elsewhere in Europe. Among 400 cases none was encountered which could not be classified under the new system, which is now recommended for general use. Terms such as amelia and phocomelia are so well established in ordinary clinical practice in the U.K. that they are unlikely to be dropped immediately. Nevertheless, universal adoption of the new system of classification in case records and reports would go a long way to promote international understanding of skeletal limb deficiencies and of all that can be done to help those who suffer from them.

INFLATION AND THE N.H.S.

ON

11 the Government published the whiteThe Attack on Inflation, and, on the same day, paper, Mrs Barbara Castle, Secretary of State for Social Services, described the financial prospects for the National Health Service as bleak. We would be very lucky, she told the first annual meeting of the National Association of Health Authorities, if in the next three or four years we saw any real growth whatever in the N.H.S. The steady annual growth of the Service, which had enabled it to cope not only with the extra demands arising from demographic factors (notably the increase in the elderly population), and with the extra costs of new drugs and new kinds of treatment, but also to make real progress in development, could not now be maintained. It was not possible to say 1. 2. 3. 4.

July

Frantz, C. H., O’Rahilly, R. J. Bone Jt Surg. 1961, 43A, 1202. Swanson, A. B. Interclin. Inf. Bull. 1966, 6, 1. Henkel, H., Willert, H. J. Bone Jt Surg. 1969, 51B, 399. Proposed International Terminology for the Classification of Congenital Limb Deficiencies. Dev. Med. Child Neurol. 1975, 17, suppl. 34.

yet what the exact limit to growth would be, and Mrs Castle denied rumours that the N.H.S. would be inflation-proofed only up to a ceiling of 10%. Whatever the figure turned out to be, the money available should be spent as effectively as possible. In achieving savings, Mrs Castle would, she said, be utterly dependent on the professions and the health authorities to show what could be done, but she thought that administrative costs should be reduced (if possible to pre-reorganisation levels), that duplication of function between the Department, the regions, and the areas should be avoided, and that there should be some sharing of planning and financing of services between the health and local authorities. Mrs Castle is also planning to publish before the end of the year a document for discussion on priorities in the health and personal social services, but she has turned down the request from representatives of the British Medical Association, the Royal College of Nursing, the British Dental Association, the Royal College of Midwives, and the Joint Consultants Committee for an independent inquiry into the financing of the N.H.S. In a letter to Mr Walpole Lewin, chairman of the five groups, Mrs Castle declared that, with no extra money in the kitty for the N.H.S., such an inquiry would be irresponsible, and would fail to exert any influence on the Government’s decisions concerning the allocation of resources. She maintained that, in its first year of office, the present Government had raised the percentage of the gross national product devoted to the N.H.S. from 4-9%, which was the level of the previous two years, to, as provisionally assessed, 5-4% of the G.N.P. from April, 1974, to April, 1975-the largest single increase in expenditure devoted to the N.H.S. in any year since 1948. Nonetheless, Mrs Castle was quite willing to admit, in her speech of July 11, that the Health Service did not benefit as much as it should do (and as the Education Service certainly did) from effective pressure groups capable of influencing the Government’s decisions on spending priorities. In order to promote the growth of pressure groups and responsible local opinion in the N.H.S., Mrs Castle is going ahead with plans for the further democratisation of the Health Service as outlined in the consultation paper, Democracy in the N.H.S. The numbers of local-authority members on area and regional health authorities is to be increased to one-third of the total, and provision is to be made for the inclusion on health authorities of two members representing workers in the N.H.S. apart from doctors and nurses. Community health councils will be entitled to send one of their members to attend meetings of their area health authority with speaking, but not voting, rights. Meanwhile, the doctors, who are usually capable of making their views known and exerting pressure when required, are to seek a very early meeting with Mrs Castle to discuss the implications for the Health Service of the measures announced in the white-paper on inflation. They will be wanting to point out that large numbers of general practitioners, consultants, and senior registrars will be affected by the E8500 cut-off limit for pay increases, and that junior and Armed Forces doctors and medical teachers all have pay increases outstanding.

Editorial: Nomenclature of congenital limb deficiencies.

117 nicotine. When the drugs themselves lead to further suffering, we find ourselves in a new paradox which we are unable or unwilling to solve. NOM...
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