1174 measured volume is required, it is important to monitor the weight delivered. The commercial container delivering the nearest to the nominal volume was the vented bottle-pak, delivering 500-510 ml against the nominal 500 ml. No work has yet been done on the effect of a peristaltic pump on the volume delivered from a non-vented container. Area Pharmaceutical Service, Saint Mary’s Hospital,
T. H. FURBER
S. D. SCOBIE
Manchester M130JH
Health Services Research Unit,
Department of Pharmacy, University of Manchester
R. HAMBLETON
CHILD-RESISTANT PACKAGING
is
-
bv experience?
J. PREECE
378 Pinhoe Road, and 38 Polsloe Road, Exeter
R. FAIRHEAD
SIR,-It was heartening to read the study by Dr Sibert and his colleagues (Aug. 6, p. 289) of the effects on under-5s admitted to hospital in Newcastle and South Glamorgan of the introduction of safety packaging for children’s aspirin and paracetamol on Jan. 1, 1976. I have some confirmatory data from groups of hospitals in areas which are geographically separate and socially different. Data were collected from hospital records on the numbers of children aged under 5 years admitted in the Bristol Health District (Teaching) or to four hospitals in the East Kent area between 1973 and 1977 and who were suspected of having in-
gested salicylate.
uautmacu.
w 64 111
12
cases
nm
up
to
M. CALNAN
SIR,-In so far as Dr Mole (Nov. 5, p. 981) has H.M. Factory Inspectorate in mind he misunderstands the nature of an inspector’s dealings with industry, and I cannot accept Dr Mole’s claim that employee-management relations will be worsened by inspectors’ actions. At an inspection of a workplace an inspector will discuss with management matters affecting safety and health, and he or she will expect the management to take note immediately of those which require attention. In the course of such a discussion the inspector is likely both to commend and condemn, and certainly there is no instruction to inspectors that they should not praise where praise is due. Inspectors are no more inhibited now in this respect than they have been for the past 140 years. If a discussion is confirmed in writing-and this is not always done-the letter will probably be confined to important matters needing attention before the inspector visits again or in some agreed period. The letter will be unlikely to raise issues not already been discussed. Pressure of work on inspectors encourages them to keep their letters brief. Inspectors are instructed to seek out representatives of workpeople at their visits, usually a convenor or shop steward. From October, 1978, they will be dealing with appointed safety representatives. In such dealings inspectors are equally free to draw attention to what is good as to what is bad, and they regularly do so. Section 28(8) of the Health and Safety at Work Act 1974 requires them to provide information to workers’ representatives about any action which they have taken or propose to take in connection with the premises, and in the nature of things this is likely to refer to matters which need to be put right. Although inspectors are encouraged to cooperate fully with employers and employees and spend much of their time advising industry, at the end of the day they are appointed to enforce the law. Health and Safety Executive, 259 Old Marylebone Road, London NW1 5RR
HJ .
in Bristol, September in September
University of Kent at Canterbury, Canterbury, Kent CT2 7NF
HEALTH AND SAFETY INSPECTIONS
be reduced by child-resistant SIR,-Child poisoning such as the bottle caps which were the principal packaging cause for improvement in the results of studies by Dr Sibert and colleagues (Aug. 6, p. 289) and others. We are, however, not satisfied that bubble, foil, and cellophane strip packaging is child resistant, having seen a girl of 3 years who extracted and swallowed 13 ’Eugynon 30’ tablets, and another of 4 years who took 17 ’Gynovlar 21’ tablets. Both appeared to have used fingernails to open the foil behind the bubble pack, and the second child probably did this quite quickly. Even opaque plastic does not prevent incidents of this type. Bubble, foil, and cellophane strip packaging is an effective means of regulating drug dosage but is the theory that it child resistant borne out can
&† dag er; Estimated: Estimated:
hospital admits all suspected cases of salicylate poisoning then my propositions are redundant. Child-resistant containers do create problems in some circumstances, as Dr Sibert and his colleagues suggest, and it is not clear if the benefits outweigh the costs. Perhaps, as Henry has pointed out, "rather than designing ’safety’ containers we should be developing safer medicine and making greater use of non-pharmaceutical therapeutics".’1 ever, if the
5
cases
up to
V. C.
August
JORDAN
in East Kent.
Since the beginning of 1976 there has been a significant dein the numbers of children admitted to hospital because of suspected salicylate poisoning in the Bristol and East Kent areas. These findings support the conclusion "that the effectiveness of child-resistant containers, first demonstrated in field trials has now been confirmed in practice". However, I have no evidence that sales policy or admission policy in the two areas have not changed; for instance, the numbers of children taken to accident-and-emergency departments may not have dropped but the proportion subsequently admitted may have substantially decreased. This evidence is particularly relevant in the areas where aspirin has been packaged in unitary form rather than child-resistant containers since this might not prevent the child taking the substance or the mother rushing to casualty but it may provide firmer evidence upon which the doctor can make his diagnosis and his decision to admit. How-
crease
1.
Henry, S. Hlth soc. Serv. J. Sept. 30, 1977.
MEDICAL EDUCATION FOR AFRICANS IN SOUTHERN AFRICA
SiR,-It is a matter of serious concern to the Medical Association of South Africa when, in the same issue, two articles appear in your journal which do not conform to the high standard which we have come to expect of it. Your editorial on a W.H.O. report on psychiatric services for Blacks in South Africa (Sept. 3, p. 491) reeked of bias and lack of objectivity, and has been adequately commented upon by the president of the South African Psychiatric Association (Oct. 29, p. 920). You were again guilty of lack of objectivity and respect for truthful reporting by publishing Dr Gude’s article (Sept. 3, p. 498), and I believe it is time that your readers were made aware of the changing standards which you appear to accept as being within the norms of scientific accuracy. The establishment of the Medical
University
of Southern
T. H. FURBER
S. D. SCOBIE
Manchester M130JH
Health Services Research Unit,
Department of Pharmacy, University of Manchester
R. HAMBLETON
CHILD-RESISTANT PACKAGING
is
-
bv experience?
J. PREECE
378 Pinhoe Road, and 38 Polsloe Road, Exeter
R. FAIRHEAD
SIR,-It was heartening to read the study by Dr Sibert and his colleagues (Aug. 6, p. 289) of the effects on under-5s admitted to hospital in Newcastle and South Glamorgan of the introduction of safety packaging for children’s aspirin and paracetamol on Jan. 1, 1976. I have some confirmatory data from groups of hospitals in areas which are geographically separate and socially different. Data were collected from hospital records on the numbers of children aged under 5 years admitted in the Bristol Health District (Teaching) or to four hospitals in the East Kent area between 1973 and 1977 and who were suspected of having in-
gested salicylate.
uautmacu.
w 64 111
12
cases
nm
up
to
M. CALNAN
SIR,-In so far as Dr Mole (Nov. 5, p. 981) has H.M. Factory Inspectorate in mind he misunderstands the nature of an inspector’s dealings with industry, and I cannot accept Dr Mole’s claim that employee-management relations will be worsened by inspectors’ actions. At an inspection of a workplace an inspector will discuss with management matters affecting safety and health, and he or she will expect the management to take note immediately of those which require attention. In the course of such a discussion the inspector is likely both to commend and condemn, and certainly there is no instruction to inspectors that they should not praise where praise is due. Inspectors are no more inhibited now in this respect than they have been for the past 140 years. If a discussion is confirmed in writing-and this is not always done-the letter will probably be confined to important matters needing attention before the inspector visits again or in some agreed period. The letter will be unlikely to raise issues not already been discussed. Pressure of work on inspectors encourages them to keep their letters brief. Inspectors are instructed to seek out representatives of workpeople at their visits, usually a convenor or shop steward. From October, 1978, they will be dealing with appointed safety representatives. In such dealings inspectors are equally free to draw attention to what is good as to what is bad, and they regularly do so. Section 28(8) of the Health and Safety at Work Act 1974 requires them to provide information to workers’ representatives about any action which they have taken or propose to take in connection with the premises, and in the nature of things this is likely to refer to matters which need to be put right. Although inspectors are encouraged to cooperate fully with employers and employees and spend much of their time advising industry, at the end of the day they are appointed to enforce the law. Health and Safety Executive, 259 Old Marylebone Road, London NW1 5RR
HJ .
in Bristol, September in September
University of Kent at Canterbury, Canterbury, Kent CT2 7NF
HEALTH AND SAFETY INSPECTIONS
be reduced by child-resistant SIR,-Child poisoning such as the bottle caps which were the principal packaging cause for improvement in the results of studies by Dr Sibert and colleagues (Aug. 6, p. 289) and others. We are, however, not satisfied that bubble, foil, and cellophane strip packaging is child resistant, having seen a girl of 3 years who extracted and swallowed 13 ’Eugynon 30’ tablets, and another of 4 years who took 17 ’Gynovlar 21’ tablets. Both appeared to have used fingernails to open the foil behind the bubble pack, and the second child probably did this quite quickly. Even opaque plastic does not prevent incidents of this type. Bubble, foil, and cellophane strip packaging is an effective means of regulating drug dosage but is the theory that it child resistant borne out can
&† dag er; Estimated: Estimated:
hospital admits all suspected cases of salicylate poisoning then my propositions are redundant. Child-resistant containers do create problems in some circumstances, as Dr Sibert and his colleagues suggest, and it is not clear if the benefits outweigh the costs. Perhaps, as Henry has pointed out, "rather than designing ’safety’ containers we should be developing safer medicine and making greater use of non-pharmaceutical therapeutics".’1 ever, if the
5
cases
up to
V. C.
August
JORDAN
in East Kent.
Since the beginning of 1976 there has been a significant dein the numbers of children admitted to hospital because of suspected salicylate poisoning in the Bristol and East Kent areas. These findings support the conclusion "that the effectiveness of child-resistant containers, first demonstrated in field trials has now been confirmed in practice". However, I have no evidence that sales policy or admission policy in the two areas have not changed; for instance, the numbers of children taken to accident-and-emergency departments may not have dropped but the proportion subsequently admitted may have substantially decreased. This evidence is particularly relevant in the areas where aspirin has been packaged in unitary form rather than child-resistant containers since this might not prevent the child taking the substance or the mother rushing to casualty but it may provide firmer evidence upon which the doctor can make his diagnosis and his decision to admit. How-
crease
1.
Henry, S. Hlth soc. Serv. J. Sept. 30, 1977.
MEDICAL EDUCATION FOR AFRICANS IN SOUTHERN AFRICA
SiR,-It is a matter of serious concern to the Medical Association of South Africa when, in the same issue, two articles appear in your journal which do not conform to the high standard which we have come to expect of it. Your editorial on a W.H.O. report on psychiatric services for Blacks in South Africa (Sept. 3, p. 491) reeked of bias and lack of objectivity, and has been adequately commented upon by the president of the South African Psychiatric Association (Oct. 29, p. 920). You were again guilty of lack of objectivity and respect for truthful reporting by publishing Dr Gude’s article (Sept. 3, p. 498), and I believe it is time that your readers were made aware of the changing standards which you appear to accept as being within the norms of scientific accuracy. The establishment of the Medical
University
of Southern
