BRITISH MEDICAL JOURNAL

289

29 JANUARY 1977

not to realise that the "philosophy" of SI is not only to facilitate the transmission of knowledge internationally within a single discipline but also to prevent related disciplines from using differing-sometimes widely differingunits. Thus biology, chemistry, and other medically related (to whatever degree) pure sciences should be written and reported in the same units as medicine. Since Western medicine differs from tribal witch-doctoring by claiming to be "scientific" it is only logical for it to use the same units as science. The change of course is unpopular. Any change which demands that established professionals shall change their modus operandi is bound to be resisted. However, if medicine clings to traditional units it will be to its ultimate detriment. Not only will scientists and technologists eventually have problems in understanding the basic measurements on which we base our conclusions, but we will find it a great trouble to try and comprehend their results; thus a slower adoption of new ideas into medicine will ensue, with a concomitant reduction in our rate of attainment of ultimate medical care-surely the aim of medical research even if it is debatable whether it will ever be reached. The philosophy of SI may be too idealised for hardened and committed medical laboratory workers and clinicians, but there is one problem which I have yet to see mentioned in the literature: medical studies are begun at the age of 18. Until this age schoolchildren are taught basic science by pure science graduates who have turned to teaching. Needless to say, this means that a significant proportion of today's and the vast majority of tomorrow's first-year medical students arrive speaking fluent "SI" but usually only with a "traditional units" phrase book at best. This leads to problems and conflict. The already heavy medical courses are yet further overburdened and tempers become frayed. I know from private communications that this is precisely what is occurring now in at least a dozen of our medical schools. Dr Lester and other writers on SI appear to be unaware of this rising tide of "juvenile" dissatisfaction. Medicine is a traditional subject; traditions of medical ethics, medical dedication, and the standards of medical care are worth fighting to maintain. Traditional units are not. They may withstand the combined onslaught of science and technology, but they will eventually and inevitably fall to what an anti-SI writer might call "the rot from within." Finally, it is interesting to note that Dr Lester's numerical analysis is in the same issue as an article on the medical misuse of statistics by Miss Sheila M Gore and others (p 85). I find it positively encouraging to see that over 34",, (228 of 661) laboratories world-wide use SI. As the other laboratories acquire younger, more far-sighted directors I foresee the num-

bers increasing. CHARLES CLAOUIE Churchill Col'ege,

Cambridge

SIR,-A badly phrased sentence in my previous letter (15 January, p 167) may have given the impression that I did not credit clinical biochemists with interpreting their own results. That was not my intention. I mentioned a few who were enthusiastic for SI in implied contrast to the many who act as clinicians themselves or interpret results for their colleagues and who (if they are over 40) are probably

finding the same difficulty as myself. Indeed, some of the verbal and written comments I have received suggest that a majority of clinical biochemists were against the introduction of SI, but it was not their voice which prevailed. DAVID KERR University Department of Medicine, Royal Victoria Infirmary, Newcastle upon Tyne

SI units and the millimetre of mercury

SIR,-We read with interest your melancholy but, in our view, fair leading article on the adverse effects caused by the introduction of SI units (1 January, p 5). On the very next page of your journal you emphasise that authors should not use SI units for expressing blood pressure measurements but should continue to employ the millimetre of mercury. The millimetre of mercury is, however, at least in the European Economic Community, also due to disappear by 31 December 1979. We are extremely anxious that the millimetre of mercury should not be replaced as the unit for expressing blood pressure measurements, and repeated representations have been made to the World Health Organisation and to other bodies emphasising the baneful effects which the abandonment of the millimetre of mercury would have. During 1976 both the International Society of Hypertension and the Scientific Board of the International Society of Cardiology agreed resolutions in the following terms: "The millimetre of mercury should be retained for blood pressure measurement in both clinical and clinical laboratory use and in related scientific publications. It is our opinion that the use of SI units in such circumstances is totally inappro-

priate. "

The millimetre of mercury can still be reprieved, but massive and sustained exertions are needed. F GROSS Chairman of Scientific Board, International Society of

Cardiology

Institute of Pharmacology, University of Heidelberg, Heidelberg, Germany

J I S ROBERTSON President,

International Societv of Hypertension

MRC Blood Pressure Unit, Western Infirmary,

Glasgow

General practitioners and coronary care SIR,-Dr T J Orchard has suggested (25 December, p 1559) that my interpretation (27 November, p 1325) of the views expressed by Drs J D Hill and J R Hampton in their article on the mode of referral to hospital of patients with heart attacks is idiosyncratic. Reference to the article in question (30 October, p 1035) indicates that the Nottingham "cardiac ambulance" no longer accepts calls from general practitioners. I feel certain that other readers will share my difficulty in understanding how the family doctor can play a realistic role in the provision of prehospital care for patients with myocardial infarction without having access to a mobile unit. Dr Orchard believes that the general practitioner improves the prognosis of the patients

to such an extent that a mobile unit is rarely required. Drs Hill and Hampton did not disclose what treatment the practitioners gave, but their figure suggests that the practitioners' salutary role is achieved mainly by arriving late. Dr Orchard is incorrect in stating that the Belfast mobile unit does not generally accept calls from the public. For several years 999 calls have been referred to the duty registrar when the caller mentions chest pain, and many of these calls are accepted. If the red tape were removed in Nottingham and calls for a mobile unit were accepted from doctors or the lay public when the symptoms reported are of recent onset and suggestive of infarction; if the family doctors were encouraged to deal quickly with "coronary" calls from patients, referring them direct to the mobile unit if a delay in reaching the patient were inevitable; if the public were informed of the need to seek immediate medical assistance in the event that they or their relatives developed severe constricting precordial pain; and if selected lay individuals were taught the rudiments of cardiopulmonary resuscitation, then the people of that city would have greater reason to be satisfied with the arrangements for emergency care. Doubtless the statistical evaluation of the effects of such logical innovations would be of interest to Dr Hampton and his colleagues. J S GEDDES Cardiac Department, Royal Victoria Hospital, Belfast

SIR,-For over a year it has been the policy in my practice of 2000 patients to regard all cases of chest pain as extreme emergencies justifying the cessation of whatever else one is doing and going to their aid. The aim has been to reach a case within half an hour of the initial call even in this widely scattered rural area. In 1976 I saw 20 cases of myocardial infarction and much to my surprise I was present during cardiac arrest on five occasions. My surprise was due to the fact that in the previous 24 years of general practice I had been present when arrest occurred on only three occasions, the event being so rare as to merit mentioning it to one's colleagues when next one met together. During 1976 there was also one case of cardiorespiratory arrest during a severe asthmatic attack; which means that there have been six occasions when resuscitation has been necessary. External cardiac massage and forced ventilation were given on two occasions successfully and on one unsuccessfully. Defibrillation with a portable machine was carried out successfully in one case and unsuccessfully in two others in which cardiac arrest had probably been present for five minutes. Of the cases of sudden death to which I was called, in three the patient had died overnight and in one the .patient had developed chest pain on starting work in the morning, had returned home, and retired to bed. I was sent for only when arrest occurred, but had a message been sent earlier there is no doubt that I would have been present when the heart stopped. I hope that the figures quoted will persuade general practitioners who may question their own usefulness in treating cardiac arrest that their presence during the first two or three hours after a myocardial infarction can be lifesaving. In my experience very little abuse

General practitioners and coronary care.

BRITISH MEDICAL JOURNAL 289 29 JANUARY 1977 not to realise that the "philosophy" of SI is not only to facilitate the transmission of knowledge inte...
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