450 but there was no evidence of increased enterovirus during this time. Cipto Mangunkusumo, Sumber Waras, Husada Hospitals; NAMRU-2, Jakarta Detachment, Cipto Mangunkusumo Hospital;
and
and National Institute of Health Research and Development,
Jakarta, Indonesia
activity
VACCINATION AND IMMUNISATION ACCEPTANCE-RATES DEC.
31, 1976,
FOR CHILDREN BORN IN
(%) AT
1974
SUMARMO H. WULUR
E. JAHJA D. J. GUBLER T. S. SUTOMENGGOLO J. SULIANTI SAROSO
IF I WERE A DEAN
SIR,-Dr Brooks (Jan. 21,
140) implies that a student intelligent enough to get good "A-levels" is only likely to be interested in research. This has not been my experience. Few students
p.
leave clinical medicine, and most surgical registrars-to take one example-have to be pushed hard to leave the wards for a research year. The intelligent student is more able to stand back and take the larger view, and is likely, therefore, to be more aware of and responsive to the patient as a person with problems, than is the less intelligent student who finds the basic mechanics of history-taking and examination more difficult. The more intelligent also tends to work faster and more accurately, and therefore has more time to talk about personal problems and to get to know the patient as a person. I am not suggesting that all take the trouble to do so, and this certainly has to be encouraged. However, the opposite generalisation is certainly false. Dr Brooks’ student, like most, is interested in caring for the sick, but is not quite so enthusiastic about "the complex interrelationship between pathophysiological disorders, psychological and behaviour processes, and social environment". Thank goodness that, despite the insidious invasion of this jargon, medicine now attracts students of higher calibre than ever before. Hopefully, their combined intelligence will improve medical thinking, and thus medical education. or
young doctors wish
to
Lewisham Hospital, London SE13 6LH
DAVID NEGUS
EQUAL OPPORTUNITY AND THE SALMON STRUCTURE
SIR,-By law men and women now have equal opportunities in all occupations. Nursing has always been a career which has attracted the most intelligent, able, and willing of our womenfolk. The Salmon structure was supposed to bring a career structure for nursing. Why is it, therefore, that an increasing and disproportionate number of senior posts in the nursing establishment are being filled by male nurses? General
Hospital, Birmingham B4 6NH
GEORGE T. WATTS
IMMUNISATION LEVELS AND THE COMPUTER
SIR,--We have read with interest the letters about
our
We accept the point made by all your correspondents-that computer systems are only one element in a com-
paper.’
plex problem. Nevertheless, our suggestion that computers make a recognisable contribution receives support from the data and conclusions of Dr Williams2 and Dr Sutherland and Mr Young.3 Further evidence has now come to hand in the shape of "league tables" prepared by the Department of Health and 1. Bussey, A. L., Holmes, B. S. Lancet, 1977, ii, 970. 2. Williams, B. T. ibid p. 1366 3. Sutherland, A , Young, E.J. ibid. Jan. 7, 1978, p. 45.
* Rates for tetanus were as for diphtheria± 0-1%.
Social Security.4 The tables relate to primary courses of vaccination and immunisation against measles, diphtheria, whooping-cough, tetanus, and poliomyelitis completed by Dec. 31, 1976, for children born in 1974 (equivalent to our index year plus two). These data are presented in a similar form to that used in our paper, relating the number of completed courses for each disease to 1974 live births and expressing the result as a percentage acceptance-rate for each of the 14 regions and 90 areas in England. From a questionnaire returned in 1977 by all 90 area medical officers in England (in connection with a separate study of the efficacy of the measles-vaccination programme) we have been able to identify 33 A.H.A.S which used computers from 1974 to 1976 throughout their area and 24 which did not. The remaining 33 A.H.A.S used computers in only part of their territory or for part of the time. Discarding these 33, we have used the D.H.S.S. data to compare the acceptance-rates for the population served by computers with the rates for the population where computers were not used (see table). For all five immunisation programmes the mean acceptance-rate for the computer-serviced populations was greater than the average for England, the reverse being true for the non-computer population. Moreover, in the computer population acceptance-rates for measles are 21 -6% higher than in the non-computer population, for diphtheria 10-1% higher, for tetanus 9.9% higher, for poliomyelitis 12.6% higher, and even for whooping-cough 8-8% higher. While accepting the statistical reservations relating to migration, area populations, and reporting deficiencies attached to their figures by the D.H.S.S., we believe that these national data support our suggestion that computers do make a difference. A. L. BUSSEY West Sussex Area Health Authority, B. S. HOLMES Goring, Sussex BN12 4NQ
MEDICINE ON THE WEST BANK OF THE JORDAN
SIR,—Politics in the Middle East
are difficult and delicate without the boat rocked enough being by the medical profession, which traditionally crosses frontiers and knows no discrimination. All people like to be governed by their ownwhether they are Scots, Israelis, or Palestinians-but this desire for self-government should not be used as a cloak for obscuring the truth. Your Round the World piece entitled "Palestinian Doctors Wait for a Settlement" (Feb. 4, p. 261) is misleading and unbalanced, and its concluding paragraph is frankly inaccurate. Between 1967 and 1975 the population of the West Bank increased from 600 000 to 675 000. In this period the infantmortality rate fell to 36 per 1000, which is by far the lowest in any Arab country. Lebanon is next in line with 59 deaths per 1000, and the highest is Saudi Arabia with 157 per 1000.
Health Statistics: vaccination and immunisation acceptance 31 December 1976 for children born in 1974. D.H.S.S. Statistics and Research Division, Blackpool, October, 1977.
4. Community rates at
and
and National Institute of Health Research and Development,
Jakarta, Indonesia
activity
VACCINATION AND IMMUNISATION ACCEPTANCE-RATES DEC.
31, 1976,
FOR CHILDREN BORN IN
(%) AT
1974
SUMARMO H. WULUR
E. JAHJA D. J. GUBLER T. S. SUTOMENGGOLO J. SULIANTI SAROSO
IF I WERE A DEAN
SIR,-Dr Brooks (Jan. 21,
140) implies that a student intelligent enough to get good "A-levels" is only likely to be interested in research. This has not been my experience. Few students
p.
leave clinical medicine, and most surgical registrars-to take one example-have to be pushed hard to leave the wards for a research year. The intelligent student is more able to stand back and take the larger view, and is likely, therefore, to be more aware of and responsive to the patient as a person with problems, than is the less intelligent student who finds the basic mechanics of history-taking and examination more difficult. The more intelligent also tends to work faster and more accurately, and therefore has more time to talk about personal problems and to get to know the patient as a person. I am not suggesting that all take the trouble to do so, and this certainly has to be encouraged. However, the opposite generalisation is certainly false. Dr Brooks’ student, like most, is interested in caring for the sick, but is not quite so enthusiastic about "the complex interrelationship between pathophysiological disorders, psychological and behaviour processes, and social environment". Thank goodness that, despite the insidious invasion of this jargon, medicine now attracts students of higher calibre than ever before. Hopefully, their combined intelligence will improve medical thinking, and thus medical education. or
young doctors wish
to
Lewisham Hospital, London SE13 6LH
DAVID NEGUS
EQUAL OPPORTUNITY AND THE SALMON STRUCTURE
SIR,-By law men and women now have equal opportunities in all occupations. Nursing has always been a career which has attracted the most intelligent, able, and willing of our womenfolk. The Salmon structure was supposed to bring a career structure for nursing. Why is it, therefore, that an increasing and disproportionate number of senior posts in the nursing establishment are being filled by male nurses? General
Hospital, Birmingham B4 6NH
GEORGE T. WATTS
IMMUNISATION LEVELS AND THE COMPUTER
SIR,--We have read with interest the letters about
our
We accept the point made by all your correspondents-that computer systems are only one element in a com-
paper.’
plex problem. Nevertheless, our suggestion that computers make a recognisable contribution receives support from the data and conclusions of Dr Williams2 and Dr Sutherland and Mr Young.3 Further evidence has now come to hand in the shape of "league tables" prepared by the Department of Health and 1. Bussey, A. L., Holmes, B. S. Lancet, 1977, ii, 970. 2. Williams, B. T. ibid p. 1366 3. Sutherland, A , Young, E.J. ibid. Jan. 7, 1978, p. 45.
* Rates for tetanus were as for diphtheria± 0-1%.
Social Security.4 The tables relate to primary courses of vaccination and immunisation against measles, diphtheria, whooping-cough, tetanus, and poliomyelitis completed by Dec. 31, 1976, for children born in 1974 (equivalent to our index year plus two). These data are presented in a similar form to that used in our paper, relating the number of completed courses for each disease to 1974 live births and expressing the result as a percentage acceptance-rate for each of the 14 regions and 90 areas in England. From a questionnaire returned in 1977 by all 90 area medical officers in England (in connection with a separate study of the efficacy of the measles-vaccination programme) we have been able to identify 33 A.H.A.S which used computers from 1974 to 1976 throughout their area and 24 which did not. The remaining 33 A.H.A.S used computers in only part of their territory or for part of the time. Discarding these 33, we have used the D.H.S.S. data to compare the acceptance-rates for the population served by computers with the rates for the population where computers were not used (see table). For all five immunisation programmes the mean acceptance-rate for the computer-serviced populations was greater than the average for England, the reverse being true for the non-computer population. Moreover, in the computer population acceptance-rates for measles are 21 -6% higher than in the non-computer population, for diphtheria 10-1% higher, for tetanus 9.9% higher, for poliomyelitis 12.6% higher, and even for whooping-cough 8-8% higher. While accepting the statistical reservations relating to migration, area populations, and reporting deficiencies attached to their figures by the D.H.S.S., we believe that these national data support our suggestion that computers do make a difference. A. L. BUSSEY West Sussex Area Health Authority, B. S. HOLMES Goring, Sussex BN12 4NQ
MEDICINE ON THE WEST BANK OF THE JORDAN
SIR,—Politics in the Middle East
are difficult and delicate without the boat rocked enough being by the medical profession, which traditionally crosses frontiers and knows no discrimination. All people like to be governed by their ownwhether they are Scots, Israelis, or Palestinians-but this desire for self-government should not be used as a cloak for obscuring the truth. Your Round the World piece entitled "Palestinian Doctors Wait for a Settlement" (Feb. 4, p. 261) is misleading and unbalanced, and its concluding paragraph is frankly inaccurate. Between 1967 and 1975 the population of the West Bank increased from 600 000 to 675 000. In this period the infantmortality rate fell to 36 per 1000, which is by far the lowest in any Arab country. Lebanon is next in line with 59 deaths per 1000, and the highest is Saudi Arabia with 157 per 1000.
Health Statistics: vaccination and immunisation acceptance 31 December 1976 for children born in 1974. D.H.S.S. Statistics and Research Division, Blackpool, October, 1977.
4. Community rates at
