1073 N.H.S.C. scholarship recipients. Currently, 46 institutions have more than 50 N.H.S.C. students enrolled. Schools need to develop primary-care tracks in their curricula which focus on the specific issues of health care for the poor, the isolated, the institutionalised, and the disenfranchised. The quality of the N.H.S.C. programme and the attitude of all concerned, practitioners and patients alike, will suffer considerably if the N.H.S.C. attempts to place a cadre of frustrated ophthalmologists and neurosurgeons in small Appalachian practices, in state hospitals, and in inner-city clinics. The N.H.S.C. needs medical schools to take the problem of training practitioners for underserved areas seriously and creatively. Finally, both the executive and legislative branches of the Federal Government must firmly support the programme. Retooling the medical assembly line as well as restructuring parts of medical practice in the nation will not come without a price tag." A principal goal of the Public Health Service is the establishment of equity
has
some
Point of View "HAVE YOU EATEN LABURNUM?" R. M. FORRESTER
Mary Sheridan Centre, Leigh Infirmary, Leigh
Summary
In
WN7 1HS
three thousand children are admitted to hospital in England and Wales because of laburnum poisoning. It is suggested that laburnum is not as dangerous as has been thought and that many of these admissions are unnecesan
average
summer over
sary.
THE laburnum flowers in late spring and early sumIts seeds are attractive and hang on the tree in their pods for months. They look like peas and they do not taste bad. The tree grows well in towns and appears to be more in evidence in heavily populated areas than in the country. In other words, you find laburnum where you find children. Throughout the summer months casualty departments receive a steady flow of children who have eaten the seeds or the pods-or, very occasionally, the flowers. Some are sent home with a caution, some after an emetic or gastric lavage; but many are admitted to hospital for overnight observation. In the summer of 1976 seventeen children were admitted to Wigan Infirmary for this reason. Each child stayed overnight, and each went home the next day, none the worse for his adventure. Admissions recorded for the same reason in the whole of the north-west region of England totalled 309 in 1976. Assuming that laburnums grow equally well throughout the country, and that children behave alike, we can guess that in England and Wales in 1976 about 3800 children were admitted to hospital overnight for this reason. Were all these admissions really necessary? Laburnum has a bad reputation. Its alkaloid, cystisine, is present in the seeds and the pods of all the various varieties that are grown. It is known, in very special circumstances, to have killed people’ and animals.2 Mitmer.
in health care. With consistent governmental support the N.H.S.C. can achieve that goal. REFERENCES 1. President’s Commission on the Health Needs of the Nation. Building America’s Health, Vol 2, p 117. U.S Government Printing Office, Washington, 1952 2. National Commission on Community Health Services. Health is a Com-
munity Affair, p. 91 Cambridge, 1966. Commission on Higher Education. Higher Education and the Nation’s Health Policies for Medical and Dental Education; p. 18. New York, 1970. 4 Mollan, Fitzhugh. White Coat, Clenched Fist: The Political Education of an American Physician, p 41 New York, 1976. 5 U.S Senate, Committee on Labor and Public Welfare. Report, Health Professions, Educational Assistance Act of 1974, p. 69. U.S. Government
3. Carnegie
Printing Office, Washington. 6 Eric Redman. I he Dance of Legislation. New York, 1973. 7 U. S Congress, Public Law 91-623, Emergency Health Personnel Act of 1970. 8 U.S Congress, Public Law 92-585, Emergency Health Personnel Act Amendments of 1972. 9. U.S Congress, Public Law 94-484, Health Professions Educational Assistance
Act of 1976.
10 U. S Government Federal
Register, Vol. 43, no. 189. Shortage Areas, Sept. 28, 1978. Richmond, Julius B. The Blue Sheet. 1977, 20, p. S-4.
List of Health Man-
power
11.
chelP discussed human laburnum poisoning in detail in 1951and found no mention of it in the Index Medicus during the previous twenty-five years. Another twentyfive years have passed and still nothing of significance has been published on the subject. None of Mitchell’s cases came to any serious harm, but the two that he described in detail seem to have been quite ill for a brief
period. The Hospital Activity Analysis national computer for the period 1963/ 74 showed only five deaths coded under the International Classification of 998. As this code includes all food poisoning (including fungi, shellfish, and fifty-seven varieties of plants), it seems likely that the "laburnum" element over this period was very low. The common symptoms of laburnum poisoning are vomiting and restlessness. The more rare and violent symptoms are reported to be abdominal pain, dizziness, and convulsions. All these symptoms appear within a short time of ingestion and they are reported to subside completely within twelve hours. One of the commonest causes of attendance of children at casualty departments is head injury. Most of these children are allowed to go home with "head injury instructions" which are intended to alert parents to important symptoms and to ask them to bring the child back if they are worried. In this way, many admissions avoided. It would seem easy to adopt a similar course in laburnum poisoning and to give simple instructions to parents, including the promise to review the child and admit him if necessary. It might be wise always to suggest an emetic in the casualty department but some might think this even more traumatic than laburnum are
itself. If this approach is tried, its effect on the admissionrate for code 998 should be easy to monitor at hospital level.
REFERENCES 1 Richards, H G H, Stephens, A Med. Sci Law. 1970, 10,260 2 Forsyth, A A , British Poisonous Plants, p. 34 H.M Stationery Office. 3. Mitchell, R. G Lancet, 1951, ii, 57
has
some
Point of View "HAVE YOU EATEN LABURNUM?" R. M. FORRESTER
Mary Sheridan Centre, Leigh Infirmary, Leigh
Summary
In
WN7 1HS
three thousand children are admitted to hospital in England and Wales because of laburnum poisoning. It is suggested that laburnum is not as dangerous as has been thought and that many of these admissions are unnecesan
average
summer over
sary.
THE laburnum flowers in late spring and early sumIts seeds are attractive and hang on the tree in their pods for months. They look like peas and they do not taste bad. The tree grows well in towns and appears to be more in evidence in heavily populated areas than in the country. In other words, you find laburnum where you find children. Throughout the summer months casualty departments receive a steady flow of children who have eaten the seeds or the pods-or, very occasionally, the flowers. Some are sent home with a caution, some after an emetic or gastric lavage; but many are admitted to hospital for overnight observation. In the summer of 1976 seventeen children were admitted to Wigan Infirmary for this reason. Each child stayed overnight, and each went home the next day, none the worse for his adventure. Admissions recorded for the same reason in the whole of the north-west region of England totalled 309 in 1976. Assuming that laburnums grow equally well throughout the country, and that children behave alike, we can guess that in England and Wales in 1976 about 3800 children were admitted to hospital overnight for this reason. Were all these admissions really necessary? Laburnum has a bad reputation. Its alkaloid, cystisine, is present in the seeds and the pods of all the various varieties that are grown. It is known, in very special circumstances, to have killed people’ and animals.2 Mitmer.
in health care. With consistent governmental support the N.H.S.C. can achieve that goal. REFERENCES 1. President’s Commission on the Health Needs of the Nation. Building America’s Health, Vol 2, p 117. U.S Government Printing Office, Washington, 1952 2. National Commission on Community Health Services. Health is a Com-
munity Affair, p. 91 Cambridge, 1966. Commission on Higher Education. Higher Education and the Nation’s Health Policies for Medical and Dental Education; p. 18. New York, 1970. 4 Mollan, Fitzhugh. White Coat, Clenched Fist: The Political Education of an American Physician, p 41 New York, 1976. 5 U.S Senate, Committee on Labor and Public Welfare. Report, Health Professions, Educational Assistance Act of 1974, p. 69. U.S. Government
3. Carnegie
Printing Office, Washington. 6 Eric Redman. I he Dance of Legislation. New York, 1973. 7 U. S Congress, Public Law 91-623, Emergency Health Personnel Act of 1970. 8 U.S Congress, Public Law 92-585, Emergency Health Personnel Act Amendments of 1972. 9. U.S Congress, Public Law 94-484, Health Professions Educational Assistance
Act of 1976.
10 U. S Government Federal
Register, Vol. 43, no. 189. Shortage Areas, Sept. 28, 1978. Richmond, Julius B. The Blue Sheet. 1977, 20, p. S-4.
List of Health Man-
power
11.
chelP discussed human laburnum poisoning in detail in 1951and found no mention of it in the Index Medicus during the previous twenty-five years. Another twentyfive years have passed and still nothing of significance has been published on the subject. None of Mitchell’s cases came to any serious harm, but the two that he described in detail seem to have been quite ill for a brief
period. The Hospital Activity Analysis national computer for the period 1963/ 74 showed only five deaths coded under the International Classification of 998. As this code includes all food poisoning (including fungi, shellfish, and fifty-seven varieties of plants), it seems likely that the "laburnum" element over this period was very low. The common symptoms of laburnum poisoning are vomiting and restlessness. The more rare and violent symptoms are reported to be abdominal pain, dizziness, and convulsions. All these symptoms appear within a short time of ingestion and they are reported to subside completely within twelve hours. One of the commonest causes of attendance of children at casualty departments is head injury. Most of these children are allowed to go home with "head injury instructions" which are intended to alert parents to important symptoms and to ask them to bring the child back if they are worried. In this way, many admissions avoided. It would seem easy to adopt a similar course in laburnum poisoning and to give simple instructions to parents, including the promise to review the child and admit him if necessary. It might be wise always to suggest an emetic in the casualty department but some might think this even more traumatic than laburnum are
itself. If this approach is tried, its effect on the admissionrate for code 998 should be easy to monitor at hospital level.
REFERENCES 1 Richards, H G H, Stephens, A Med. Sci Law. 1970, 10,260 2 Forsyth, A A , British Poisonous Plants, p. 34 H.M Stationery Office. 3. Mitchell, R. G Lancet, 1951, ii, 57
