378
BRITISH MEDICAL JOURNAL
9 AUGUST 1975
NEWS AND NOTES EPIDEMIOLOGY This Year's Salmonella Infections The following notes are compiled by the Epidemiological Research Laboratory of the Public Health Laboratory Service from reports submitted by public health and hospital laboratories in the United Kingdom and Republic of Ireland.
Salmonellas continue to be one of the most common organisms reported to the Public Health Laboratory Service. During the first 24 weeks of this year there were 3053 reports. Though about 100 different serotypes were reported, seven serotypes made up 2141 (70%) of this total. As usual by far the most common was S. typhimurium (951 reports). S. enteritidis, S. heidelberg, S. indiana, and S. newport were each reported between two and three hund-red times. S. agono and S. branderup both featured in more than 100 reports. Reports of salmonellas reach a peak during warm weather in summer and are least common in winter and spring, but individual serotypes often show considerable variation from this general rule. For example, 164 of the 275 infections of S. indiana were received in January and 119 of the 225 reports of S. newport during February. Only 22 infections of S. enteritidis were received in
MEDICOLEGAL Legal Actions against Nurses FROM OUR LEGAL CORRESPONDENT
With very little hesitation the House of Lords has dismissed an appeal' by the Broadmoor patient whose successful prosecution of a male nurse for assault was quashed by the divisional court.2 The nurse was convicted before the Bracknell Justices without anyone referring to section 141(2) of the Mental Health Act 1959, which prohibits the institution, without the leave of the High Court, of either criminal or civil proceedings in respect of any act done or purporting to be done in pursuance of the 1959 Act. Such leave will only be given where the High Court is satisfied that there is substantial ground for the contention that the potential defendant acted in bad faith or without reasonable care, for only if that can be proved will civil or criminal proceedings
succeed. In the divisional court Lord Widgery stated that the section was wide enough to protect any nurse (or doctor) involved in an incident with a patient when on duty and purportedly exercising his functions as a nurse. The patient (who had been transferred to Broadmoor from prison under section 71 of the Act) claimed that the nurse
January, whereas 180 of the total of 262almost 7000-were reported during April and May. The sources, other than man, from which these serotypes are most often identified are poultry and animal feeding stuffs. A sudden large increase in the reports of a single serotype usually indicates the occurrence of a big single outbreak from a common foodstuff. Thus the sudden increase in the reports of S. indiana early in. January was due to several large outbreaks whose origin was infected turkeys from a single source of supply (12 July, p. 107). Much of the increase in S. newport infections was associated with a large outbreak in a mental hospital after a turkey dinner. This year the increase in S. enteritidis was largely due to two outbreaks-one in an infant school and one in a hotel. More troublesome from an epidemiological point of view is a consistent increase in numbers of a single serotype which persists for weeks or months. S. heidelberg, for example, is not usually one of the commonest serotypes reported. The average number of reports during the first half of the last five years was only 35, but this year there have already been 243. This excess was already
evident in the first few weeks of the year and has consistently increased every month. Reports come from many areas. The food usually implicated has been chicken,' though pork sausage and hen's eggs were mentiond in two reports. So far there have been eight outbreaks, though none of them have been large. Three occurred in February, two in April, two in May, and one in early June. No outbreaks occurred' during the corresponding period last year. One outbreak was associated with a special-care baby unit. One baby failed to thrive and was found to be infected with S. heidelberg. On investigation two more babies, a nurse, and a house physician were found to be excreting the organism. The physician had resuscitated all three infected babies; he had just returned from Bangladesh. Other cases were reported in twin babies in the unit, and in a mother and two siblings of infected infants. In another outbreak three out of 15 members of a school party had diarrhoea on their return from Romania; all three were excreting S. heidelberg. Five outbreaks concerned individual households; in the remaining one the community was not stated. No common source of infection has yet been identified.
had punched him on the shoulder as he said goodbye to visiting relatives. His counsel argued that section 141 provided protection only from proceedings based on acts done expressly in pursuance of the Act's functions: for example, the signature of certificates or detention orders and the disposition of patients' property. The section, he contended, did not apply to staff discharging their ordinary routine duties. Lord Edmund-Davies was not prepared to accept this contention any more than had been Lord Widgery in the court below. He said that the 1959 Act provided an entirely new code for the- mentally disordered and that consequently it did not help when interpreting it to look at pre-1959 legislation which merely dealt with reception and certification. The new Act contained innovations, particularly as regards compulsory procedures. For the House to have reached any other conclusion would have been surprising, but it will be of reassurance to the medical profession that the five Law Lords were unanimously agreed that the protection of section 141 extends to acts both done and purportedly done by staff in the course of controlling those patients in mental hospitals established under the National Health Service Reorganization Act 1973.
PARLIAMENT
1 The Times, 25 June 1975. 2 British Medical Yournal, 1975, 1, 283.
Agency Nurses Opening a debate on agency nurses on 28 July, Mr. Kenneth Lewis (Lab., Rutland and Stamford) said that he objected to the decision in a recent D.H.S.S. circular (H.S.C.(I.S.)164) to discontinue the employment of agency nurses in the N.H.S. The circular said that agency nurses should not be involved in management, that they had an effect on training, and that their employment "masked" manpower problems in the Health Service. But, Mr. Lewis maintained, they had nothing to do with management or training and if they were not employed more permanent staff would have to be taken on to cover, for example, holiday periods and the latter might be underemployed at other times. Taking into account such things as holiday pay and pensions, he continued, the cost of employing agency nurses was 6% less than employing permanent staff. Moreover, agency nurses accounted for only 2% of the total number of nurses in the Health Service in the U.K. (278 000 in 1973). Mr. Lewis said that the Secretary of State had been forced to issue the circular because of union pressure but he feared that if implemented hospital beds would close and service to patients would suffer.
BRITISH MEDICAL JOURNAL
9 AUGUST 1975
The Government had taken the present action, Mr. Michael Meacher, Under Secretary for Health and Social Security, replied, because the dependence on agency nurses had increased in recent years, especially in London. There were 1450 in 1965 and 4850 in 1974 and they accounted for 3-6%, not 20/,,, of all qualified nurses. There were, he maintained, problems associated with the employment of agency nurses. He said, "The most important is that where agency nurses are employed, especially if there is frequent change, continuity and stability in the working environment for all nurses are affected, and the patients suffer in consequence of the continued change in the nurses who are attending them. Agency nurses tend to be less willing or able to play a full part in administrative work, and the training and supervision of student and pupil nurses may also suffer." Following the issue of the circular, he explained, the D.H.S.S. had asked health authorities to report the progress made by the end of October. Mr. Meacher told the House that the Secretary of State had accepted that "to achieve the long-term objective of a more stable nursing force of directly employed nurses, with its consequential benefit for patients . . . there could be some risk of a temporary reduction of services in some areas." He hoped that by adopting a restrictive approach on the use of agency nurses a number of nurses would be given the necessary stimulus to give up the agency way of life and return to the N.H.S.
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economies would have to be made by the reorganized Service without affecting patient care and he suggested that there was a case for reducing or abolishing regional health authorities. Lord Pannell asked if the Government would look into the question of how far the salaries of administrative staff were fixed by bodies over which the Secretary of State had no control. Lord Wells-Pestell said that some senior and middle management grades were subject to control by the D.H.S.S. and an allocation of a quota of posts had been imposed on each region. He told Baroness Summerskill that the ratio of administrative and clerical staff to consultants, doctors, nurses, and ancillary staff in the N.H.S. had fallen from 1:7-6 in 1970 to 1:6-9 in 1973.
-
Questions in the Commons
MEDICAL NEWS
Social Services Expenditure In a written answer on 18 July, Dr. David Owen, Minister of State at the Department of Health and Social Security, gave the following figures for expenditure on health and personal social services and social security as a percentage of gross domestic produce and per head of population:
Registrar, Royal College of Physicians
Year
Percentage Per capita of at 1974 G.D.P. prices £
Questions in the Lords Abortion Lord Somers asked several questions about therapeutic abortions on 22 July and, for the Government, Lord Wells-Pestell replied that the number of therapeutic abortions performed in Great Britain on residents and non-residents in 1973 was 1769 (20 weeks or more gestation) and 648 (two weeks or more gestation). The figures for abortions in N.H.S. hospitals in England, Wales, and Scotland in 1973 were 13 699 (13 weeks or more gestation) and 3947 (16 weeks or more gestation). Lord Wells-Pestell told the House that the means of disposal of fetal material in N.H.S. hospitals was the responsibility of individual area health authorities and incineration was most frequently used.
N.H.S. Administration Lord Wallace of Coslany asked the Government on 22 July what steps were being taken to avoid an excessive growth of administrative staff in the reorganized N.H.S. operating against the primary objective of patient care. Lord Wells-Pestell, for the Government, told him that the Secretary of State was dissatisfied with the management arrangements introduced by the Conservative Government and a planning system was being introduced "to ensure that health authorities bring commitments, including staff employed in administration, into balance with resources according to established priorities." Lord Wallace pointed out that drastic
proposal, which is subject to the North-east Thames Regional Health Authority's agreement and her approval. They propose, given assurance of resources, to discuss with community health councils, appropriate local authorities and other interested bodies, retention of the hospital on its present site in a rationalized form but without a separate matemity home, until it can be incorporated within a future district general hospital development. "The implications of this proposal to commence discussions are now being carefully considered. No final decision will be taken by my right hon. Friend until the views of the regional health authority have been received."
1950 1955 1960 1965 1966 1967 1968 1969 1970 1971
i972 1973 1974
1975-76
69.8 76-7 98.1 127-0 131-4 142-6 152.8 13-5 154.7 13-8 162-0 14.0 163-8 13.8 14.5 178-9 181-3 14.0 195.5* 15-3* Not Not available available 10.1 9.4 10-4 11.9 12.1 12.9
* Provisional
Vaccine-dam aged Children Mr. Alfred Morris, Minister for the Distold the House of Commons on 30 abledy July that parents withfor vaccine-damaged help from the children we re eligible to help severely Family Funsd, which exists handicapped children. Until October 1974 the fund was pi)ermitted to help only children with congenital handicaps, but it has been extended to include all severely handicapped children. "T'his means," he said, "that contrary to a recent report, families with vaccine-dam: aged children are eligible to apply for healp. I understand that a number of families in this category have in fact already been helped by the fund.... I also announced 1l ast October the grant of a further £3m. to the fund."
Dr. D. A. Pyke has been elected registrar of the Royal College of Physicians of London. Dr. David Pyke, who was born in 1921, was educated at Leighton Park School, Reading; Clare College, Cambridge; and University College Hospital Medical School, where he qualified in 1945. After holding junior hospital appointments and serving in the R.A.M.C., he was medical registrar at the Postgradu.'4 k |nate Medical School, then ^! ! | 11 senior registrar and later medical tutor at the Rad*. cliffe Infirmary, Oxford. He obtained the M.R.C.P. in 1949 and proceeded M.D. in 1956. In 1959 he was appointed to the staff of King's College Hospital; in 1964 he was elected F.R.C.P.; and in 1971 succeeded Dr. Wilfrid Oakley as physician in charge of the diabetic department at that hospital. Since 1968 he has also been physician to the Queen Victoria Hospital, East Grinstead. He has written various scientific papers and has been author or editor of five books, including (with W. G. Oakley and K. W. Taylor) Clinical Diabetes and its Biochemical Basis (1968) and Diabetes and its Management (1973 and 1975). His main research interest at present is a study of diabetes in identical twins. From 1968 to 1973 Dr. Pyke was hon. secretary of the Association of Physicians and from 1972 to 1974 an hon. secretary of the Royal Society of Medicine. Since 1951 he has been joint editor of Family Planning, the quarterly journal of the F.P.A., whose secretary or chairman from 1930 until her death in 1966 was Dr. Pyke's mother,
Margaret Pyke.
Elizabeth G;arrett Anderson Hospital Answering aa question on the E.G.A. Hos- Annual Report of the Department of Health pital on 299 July the Minister of State, D.H.S.S., Dor. David Owen, said in a written A total of £3032m. was spent on the health answer: "T he Camden and Islington Area and personal social services in England in Health Authiority (T) has informed my right the financial year to 31 March 1914-a 16% hon. FriendI [Mrs. Barbara Castle] of its increase over the previous year. This was
BRITISH MEDICAL JOURNAL
announced by the D.H.S.S. in its annual report for 1974 which was published on 31 July (Cmnd. 6150, H.M.S.O., price £1l55). £644m. was spent on local health and personal social services. Central Government provided 81 % of the total cost of the services, N.H.S. contributions via National Insurance payments 61% or £195m. Revenue from direct payments by people using the services amounted to £145m. compared with £129m. the preceding year. Of this figure £86m. came from charges for prescriptions, dental treatment, dentures, and spectacles, and private treatment in hospital.
HOSPITAL ACTIVITY
In 1974 there was another reduction in the total number of available beds, the fall since 1964 amounting to over 9%. Mental illness beds accounted for over 94% of this decrease. There has been a reduction of almost 51 % in the number of infectious diseases and diseases of the chest beds over the last 10 years. The number of new outpatients attending consultant clinics decreased in 1974 but total attendances rose slightly with day cases going up by 10 %. These latter are patients attending as non-resident patients for investigation, therapeutic test, operative procedure, or other treatment.
PRIMARY HEALTH CARE
The D.H.S.S. reports that the number of G.P.s working in groups has increased, and the numbers of ancillary staff employed by practitioners has gone up by about 85 %. Financial support continued to encourage practitioners to improve their own premises. Family practitioner committees made improvement grants to a total of £270 000 in 1974 and in 1973-4 the General Practice Finance Corporation made 217 loans totalling £2 508 000. Of the 274m. prescriptions dispensed during 1974 in England, 165m. were dispensed without charge to the patient. Of the remaining 109m., the charges amounted to £22m. and £888 000 was received from dispensing doctors. About £149 000 was refunded to patients, including charges refunded on grounds of low income. About 11 5m. children under 16 and about 7-8m. men aged 65 and over and women aged 60 -and over were exempted from prescription charges on grounds of age. At the end of the year there were 566 -health centres in use and 3000 general medical practitioners were working in centres; a further 99 centres were under construction.
9 AUGUST 1975
graduation ceremony will take place on 25 June. An organizing committee has been set up and rooms provisionally reserved in the university halls of residence. The committee hopes that many Edinburgh graduates, including, of course, families and friends, will attend one or more of the functions. Further information will be sent by the medical school as it becomes available on completion of a form (obtainable from the Secretariat, 250th Anniversary Celebrations, University of Edinburgh Medical School, Teviot Place, Edinburgh EH8 9AG) and payment of a preliminary registration fee of £1 to cover printing and postage.
DRUG DEPENDENCE AND ALCOHOLISM
Leon Szur Memorial Fund Dr. Leon Szur died on 21 February 1975. To commemorate his memory, it is proposed to establish a special book collection in the Wellcome Library at the Royal Postgraduate Medical School. The collection will relate to oncology and it will, in general, be built around the fields of radiotherapy, haematology, and nuclear medicine, as these were Dr. Szur's life work in which he made so many important contributions to scientific research and to teaching, as well as in the clinical care of his patients. A fund has been opened and anyone wishing to contribute should send a donation to the Accountant, Royal Postgraduate Medical Faculty of Medicine, University of School, Du Cane Road, London W12 OHS. Edinburgh Cheques should be made payable to: "Royal Medical School, Leon Szur 1976 will be the 250th anniversary of Postgraduate Fund." Memorial the foundation of the faculty of medicine and the University of Edinburgh plans to commemorate the occasion officially Medicines Commission and Committee on in June. There will be historical demonstra- Safety of Medicines tions, special lectures, and entertainment by junior staff as well as functions organized by In 1974 the Committee on Safety of Medibodies outside the university. A medical cines considered 549 applications (131 for clinical trial certificates and 418 for product licences) as well as 123 brought forward from the previous year, according to its annual report for 1974. This report and those of the Medicines Commission, the Phased Opening for Hong Kong's New Hospital Veterinary Products Committee, and the The phased opening of the 27-acre Princess wing, a psychiatric wing, and combined staff British Pharmacopaeia Commission, were Margaret Hospital complex at Lai Chi Kok, quarters. Capital costs of the complex amount published in one volume on 29 July on the south-west of Hong Kong's New to over £12m. and the Hong Kong Govern- (H.M.S.O., price 95p). The Medicines Commission in its report Territories, is planned to start in October ment expects that nearly 1000 beds will be comments that when licensing of medicines with the opening of infectious diseases operational at the end of the first stage. began product licences of right were granted wards. The complex comprises a general automatically on application for medicinal products on the market on 1 September 1971. The understanding was that these would all be reviewed. In 1974 the Commission was consulted by the health departments about a review of "some 36000 licensed products." It has recommended that a product licence review committee should be set up to carry out a pilot exercise on two groups of products; this review committee would then advise on the feasibility of extending the examination. The commission heard appeals on four products turned down by the Committee on Safety of Medicines; one was successful and three were rejected. In 1973 3619 suspected adverse reactions to drugs were reported and in 1974 this figure rose to 4818. The Committee on Safety of Medicines sees these as only "a small proportion of those which actually occur." It is holding discussions with the Association of the British Pharmaceutical Industry about the introduction of a scheme
The number of narcotic addicts receiving hospital treatment, the Department reports, was 1534 outpatients and 62 inpatients at the end of 1974. There are about 2000 active addicts. This year there have again been fewer notifications of addicts in their teens. General and psychiatric hospitals have continued to provide medical and psychiatric services for alcoholics. At the end of 1973 there were 20 specialized hospital treatment units in England providing 412 beds, including some beds in units which treat drug addiction or alcoholism. Recently a day hospital for alcoholics has been commissioned.
BRITISH MEDICAL JOURNAL
9 AUGUST 1975
to indicate specially in the Monthly Index of Medical Specialities and on data sheets products designated as recently introduced. The committee admits that towards the end of 1974 there was a backlog of applications for clinical trial certificates and product licences for new drugs. There was an even larger backlog affecting products containing known ingredients and for variations of existing licences.
London University M.B., B.S. in 1962, and has held various appointments in the department of anatomy and embryology at Univerity College since then. He was appointed reader in 1974.
Lunch at B.M.A. House in Edinburgh B.M.A. members visiting Edinburgh on holiday or for the Edinburgh Festival are reminded that luncheon facilities for members and their families are available at the Petition to Save E.G.A. Hospital Scottish House, 7 Drumsheugh Gardens, A petition signed by over 23 000 patients from Mondays to Fridays, 12.30-2 p.m. and supporters of the Elizabeth Garrett Anderson Hospital was presented at 10 Downing Street on 29 July. The petition Society of Apothecaries asked the Prime Minister to ensure that the At a soiree on 23 July the society's gold all-women hospital in Euston remains open, medal in therapeutics was bestowed on Dr. states the E.G.A. action committee. The Leonard Goodwin "in recognition of his outhospital's future is soon to be determined by standing contributions in the fields of the health ministers, after a submission from pharmacology and chemotherapy." the Camden and Islington Area Health Authority last week. The action committee of patients and staff was established in Novem- COMING EVENTS ber to fight the threatened closure. Since then, the hospital's survival has been sup- Institute of Medical Laboratory Technology. ported by the new local Community Health -Symposium "Clinical Enzymology 1975," 5-7 Council, and its future has been debated in September, Liverpool. Details from Mr. D. C. both chambers of the Houses of Parliament, Cowell, Liverpool Area Health Authority (T), Ashton with about 100 M.P.s declaring their sup- Department of Chemical Pathology, 2085.) Street, Liverpool L3 5RT. (Tel. 051-709 port for the hospital. Writing and Speaking in Medicine The B.M.Y. will be holding a one-day seminar on writing and speaking in medicine on Friday, 14 November at the School of Pharmacy, Brunswick Square, London W.C.1. The speakers, including Professor J. S. Calnan, Dr. Clifford Hawkins, and Dr. D. A. Pyke, will discuss various aspects of writing, refereeing, and editing medical articles (see advertisement, p. vi).
National Association for Mental Health.Workshop "Some Sexual Minorities," 6-7 September, Polytechnic of Central London. Details from Maxine Budd, Education Department, MIND, 22 Harley Street, London WlN 2ED. (Tel. 01-637 0741.) College of Speech Therapists.-National Conference, 8-12 September, Cardiff. Details from the publicity secretarv, Mrs. S. I. Brenchley, 17 Woodland Road, Llanmartin, Gwent, NP6 2ES. World Conference on Gifted Children."Looking to their Future," 8-12 September, at Royal College of Surgeons of England, organized by the National Association for Gifted Children (U.K.). The president of the Royal College of Surgeons and the Permanent Secretary at the Department of Education and Science will address the conference. Details from Mr. I. S. Macphail, World Conference on Gifted Children, Conference Services Ltd., 43 Charles Street, London WlX 7PB. (Tel. 01-624 3535.) 4th European Congress on Sterility.-5-8 October, Madrid, Spain. Details from Prof. Dr. med. K. Semm, Department of Obstetrics and Gynaecology, University of Kiel, Hegewischstr. 4, D-23 Kiel 1, West Germany. 5th International Congress of the European Society of Pathology.-5-10 October, Vienna. Details from the secretary of the society, Instituto di Anatomia Patologica, Via F. Sforza 38, Milan, Italy. "Laboratory Hazards."-Day symposium, 10 October, West Centre Hotel, London S.W.6, organized by Royal College of Pathologists and Institute of Medical Laboratory Technology. Details and application forms from I.M.L.T., 12 Queen Anne Street, London WlM OAU.
Chair of Experimental Haematology, Sheffield Dr. George Hudson, Administrative Dean of the Faculty of Medicine and honorary clinical lecturer in haematology, Sheffield University, has been appointed to a personal chair of experimental haematology at Sheffield. Dr. Hudson, who is 51, was educated at Bury Grammar School and at the University of Manchester, where he graduated M.B., Ch.B. in 1949, proceeding at Bristol to M.D. in 1959 and D.Sc in 1966. After posts at the Manchester Royal Infirmary and the University of Bristol he did his national service in the R.A.M.C., returning to Bristol as lecturer and then reader in anatomy and preclinical dean. In 1959-60 Dr. Hudson gained a Fulbright travel award and was appointed assistant professor in the University of Minnesota. In 1968 he became administrative dean of the Faculty of Medicine and honorary clinical tutor in haematology at Sheffield. He was elected B.M.A. NOTICES F.R.C.Path. in 1975. Dr. Hudson's main research interests are in the quantitative and Armed Forces Committee: Nomination of Members for Co-option cellular aspects of haematology. The constitution of the Armed Forces Committee allows for the co-option of two Chair of Anatomy, King's College representatives of the rank of major or Dr. K. E. Webster, reader in anatomy at equivalent (lieutenant-commander or squadUniversity College, has been appointed from ron leader) or below (one of whom should' 1 October 1975 to the chair of anatomy at preferably be of specialist status) from the King's College. Dr. Webster graduated from medical branch of each of the three Services.
Last session the following members were co-opted: Royal Navy: Surgeon LieutenantCommander P. Clarke (Birmingham) and Surgeon Lieutenant-Commander D. P. Pryce (Gosport). Army: Major R. M. L. Anderson (Catterick) and Major D. Murray (Woolwich). Royal Air Force: Squadron Leader W. R. Fitzgerald (Ely) and- Squadron Leader C. J. Sharples (Cottishall). Serving medical officers are now invited to nominate members of the Association in the armed Forces in the above-mentioned ranks for co-option to the committee for the 1975-6 session. The members listed above are eligible for reappointment provided their rank is not now above that of major or equivalent. Nominations should be sent to the Secretary of the Association by Monday, 1 September 1975, and nominees will be informed of the co-options made by the Armed Forces Committee following its first meeting after the closing date. DEREK STEVENSON,
Secretary
UNIVERSITIES AND COLLEGES ABERDEEN The honorary degree of LL.D. has been conferred on Mr. S. G. Davidson. M.D.-A. Akinkugbe, R. G. Condie, C. S.
McIntosh, G. R. D. Catto, G. P. M. Crawford, M. J. Metcalf, Janet Sorbie. M.S.-A. K-N. Ah See. D.PH.-J. R. Shearer.
APPOINTMENTS HAMPSliIRE
AREA HEALTH AUTHORITY (TEACHING).Dr. S. W. Hettiaratchy (consultant in child psychiatry). MANCHESTER AREA HEALTH AUTHORITY (TEACHING).The following consultan,ts have been appointed: Dr. A. Razak (anaesthetics); Dr. E. G. Daw (obstetrics and gynaecology). NORTH-WEST THAMES R.H.A.-The following consultants have been appointed: Dr. R. F. Pinerua (respiratory medicine); Dr. R. K. Gupta (anaesthetics); Dr. G. P. L. M. de Silva (microbiology, interest in virology). SALFORD AREA HEALTH AUTHORITY (TEACHING).The following consultants have been appointed: Dr. P. J. August (dermatology); Mr. R. W. Marcuson (general surgery); Dr. (Mrs.) S. Thurairajasingam (radiology). YORKSHIRE R.H.A.-The following consultants have been appointed: Dr. H. M. Klar (psychiatry); Mr. C. M. S. Royston (general surgery); Dr. P. E. McGill (general medicine); Mr. M. R. Gooding (neurosurgery); Dr. I. Blacker, Dr. P. M. Norton (anaesthetics); Mr. G. H. Randle (obstetrics and gynaecology); Dr. N. K. Jain (radiology).
Notice to Authors When original articles and letters for publication are not submitted exclusively to the British Medical Journal this must be stated. Correspondence on editorial business should be addressed to the Editor, British Midical Journal, B.M.A. House, Tavistock Square, London WC1H 9JR. Telephone: 01-387 4499. Telegrams: Aitiology, London, W.C.1. Authors wanting reprints of their articles should notify the Publishing Manager, B.M.A. House, Tavistock Square, WC1H 9JR, on receipt of proofs.
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BRITISH MEDICAL JOURNAL
9 AUGUST 1975
NEWS AND NOTES EPIDEMIOLOGY This Year's Salmonella Infections The following notes are compiled by the Epidemiological Research Laboratory of the Public Health Laboratory Service from reports submitted by public health and hospital laboratories in the United Kingdom and Republic of Ireland.
Salmonellas continue to be one of the most common organisms reported to the Public Health Laboratory Service. During the first 24 weeks of this year there were 3053 reports. Though about 100 different serotypes were reported, seven serotypes made up 2141 (70%) of this total. As usual by far the most common was S. typhimurium (951 reports). S. enteritidis, S. heidelberg, S. indiana, and S. newport were each reported between two and three hund-red times. S. agono and S. branderup both featured in more than 100 reports. Reports of salmonellas reach a peak during warm weather in summer and are least common in winter and spring, but individual serotypes often show considerable variation from this general rule. For example, 164 of the 275 infections of S. indiana were received in January and 119 of the 225 reports of S. newport during February. Only 22 infections of S. enteritidis were received in
MEDICOLEGAL Legal Actions against Nurses FROM OUR LEGAL CORRESPONDENT
With very little hesitation the House of Lords has dismissed an appeal' by the Broadmoor patient whose successful prosecution of a male nurse for assault was quashed by the divisional court.2 The nurse was convicted before the Bracknell Justices without anyone referring to section 141(2) of the Mental Health Act 1959, which prohibits the institution, without the leave of the High Court, of either criminal or civil proceedings in respect of any act done or purporting to be done in pursuance of the 1959 Act. Such leave will only be given where the High Court is satisfied that there is substantial ground for the contention that the potential defendant acted in bad faith or without reasonable care, for only if that can be proved will civil or criminal proceedings
succeed. In the divisional court Lord Widgery stated that the section was wide enough to protect any nurse (or doctor) involved in an incident with a patient when on duty and purportedly exercising his functions as a nurse. The patient (who had been transferred to Broadmoor from prison under section 71 of the Act) claimed that the nurse
January, whereas 180 of the total of 262almost 7000-were reported during April and May. The sources, other than man, from which these serotypes are most often identified are poultry and animal feeding stuffs. A sudden large increase in the reports of a single serotype usually indicates the occurrence of a big single outbreak from a common foodstuff. Thus the sudden increase in the reports of S. indiana early in. January was due to several large outbreaks whose origin was infected turkeys from a single source of supply (12 July, p. 107). Much of the increase in S. newport infections was associated with a large outbreak in a mental hospital after a turkey dinner. This year the increase in S. enteritidis was largely due to two outbreaks-one in an infant school and one in a hotel. More troublesome from an epidemiological point of view is a consistent increase in numbers of a single serotype which persists for weeks or months. S. heidelberg, for example, is not usually one of the commonest serotypes reported. The average number of reports during the first half of the last five years was only 35, but this year there have already been 243. This excess was already
evident in the first few weeks of the year and has consistently increased every month. Reports come from many areas. The food usually implicated has been chicken,' though pork sausage and hen's eggs were mentiond in two reports. So far there have been eight outbreaks, though none of them have been large. Three occurred in February, two in April, two in May, and one in early June. No outbreaks occurred' during the corresponding period last year. One outbreak was associated with a special-care baby unit. One baby failed to thrive and was found to be infected with S. heidelberg. On investigation two more babies, a nurse, and a house physician were found to be excreting the organism. The physician had resuscitated all three infected babies; he had just returned from Bangladesh. Other cases were reported in twin babies in the unit, and in a mother and two siblings of infected infants. In another outbreak three out of 15 members of a school party had diarrhoea on their return from Romania; all three were excreting S. heidelberg. Five outbreaks concerned individual households; in the remaining one the community was not stated. No common source of infection has yet been identified.
had punched him on the shoulder as he said goodbye to visiting relatives. His counsel argued that section 141 provided protection only from proceedings based on acts done expressly in pursuance of the Act's functions: for example, the signature of certificates or detention orders and the disposition of patients' property. The section, he contended, did not apply to staff discharging their ordinary routine duties. Lord Edmund-Davies was not prepared to accept this contention any more than had been Lord Widgery in the court below. He said that the 1959 Act provided an entirely new code for the- mentally disordered and that consequently it did not help when interpreting it to look at pre-1959 legislation which merely dealt with reception and certification. The new Act contained innovations, particularly as regards compulsory procedures. For the House to have reached any other conclusion would have been surprising, but it will be of reassurance to the medical profession that the five Law Lords were unanimously agreed that the protection of section 141 extends to acts both done and purportedly done by staff in the course of controlling those patients in mental hospitals established under the National Health Service Reorganization Act 1973.
PARLIAMENT
1 The Times, 25 June 1975. 2 British Medical Yournal, 1975, 1, 283.
Agency Nurses Opening a debate on agency nurses on 28 July, Mr. Kenneth Lewis (Lab., Rutland and Stamford) said that he objected to the decision in a recent D.H.S.S. circular (H.S.C.(I.S.)164) to discontinue the employment of agency nurses in the N.H.S. The circular said that agency nurses should not be involved in management, that they had an effect on training, and that their employment "masked" manpower problems in the Health Service. But, Mr. Lewis maintained, they had nothing to do with management or training and if they were not employed more permanent staff would have to be taken on to cover, for example, holiday periods and the latter might be underemployed at other times. Taking into account such things as holiday pay and pensions, he continued, the cost of employing agency nurses was 6% less than employing permanent staff. Moreover, agency nurses accounted for only 2% of the total number of nurses in the Health Service in the U.K. (278 000 in 1973). Mr. Lewis said that the Secretary of State had been forced to issue the circular because of union pressure but he feared that if implemented hospital beds would close and service to patients would suffer.
BRITISH MEDICAL JOURNAL
9 AUGUST 1975
The Government had taken the present action, Mr. Michael Meacher, Under Secretary for Health and Social Security, replied, because the dependence on agency nurses had increased in recent years, especially in London. There were 1450 in 1965 and 4850 in 1974 and they accounted for 3-6%, not 20/,,, of all qualified nurses. There were, he maintained, problems associated with the employment of agency nurses. He said, "The most important is that where agency nurses are employed, especially if there is frequent change, continuity and stability in the working environment for all nurses are affected, and the patients suffer in consequence of the continued change in the nurses who are attending them. Agency nurses tend to be less willing or able to play a full part in administrative work, and the training and supervision of student and pupil nurses may also suffer." Following the issue of the circular, he explained, the D.H.S.S. had asked health authorities to report the progress made by the end of October. Mr. Meacher told the House that the Secretary of State had accepted that "to achieve the long-term objective of a more stable nursing force of directly employed nurses, with its consequential benefit for patients . . . there could be some risk of a temporary reduction of services in some areas." He hoped that by adopting a restrictive approach on the use of agency nurses a number of nurses would be given the necessary stimulus to give up the agency way of life and return to the N.H.S.
379
economies would have to be made by the reorganized Service without affecting patient care and he suggested that there was a case for reducing or abolishing regional health authorities. Lord Pannell asked if the Government would look into the question of how far the salaries of administrative staff were fixed by bodies over which the Secretary of State had no control. Lord Wells-Pestell said that some senior and middle management grades were subject to control by the D.H.S.S. and an allocation of a quota of posts had been imposed on each region. He told Baroness Summerskill that the ratio of administrative and clerical staff to consultants, doctors, nurses, and ancillary staff in the N.H.S. had fallen from 1:7-6 in 1970 to 1:6-9 in 1973.
-
Questions in the Commons
MEDICAL NEWS
Social Services Expenditure In a written answer on 18 July, Dr. David Owen, Minister of State at the Department of Health and Social Security, gave the following figures for expenditure on health and personal social services and social security as a percentage of gross domestic produce and per head of population:
Registrar, Royal College of Physicians
Year
Percentage Per capita of at 1974 G.D.P. prices £
Questions in the Lords Abortion Lord Somers asked several questions about therapeutic abortions on 22 July and, for the Government, Lord Wells-Pestell replied that the number of therapeutic abortions performed in Great Britain on residents and non-residents in 1973 was 1769 (20 weeks or more gestation) and 648 (two weeks or more gestation). The figures for abortions in N.H.S. hospitals in England, Wales, and Scotland in 1973 were 13 699 (13 weeks or more gestation) and 3947 (16 weeks or more gestation). Lord Wells-Pestell told the House that the means of disposal of fetal material in N.H.S. hospitals was the responsibility of individual area health authorities and incineration was most frequently used.
N.H.S. Administration Lord Wallace of Coslany asked the Government on 22 July what steps were being taken to avoid an excessive growth of administrative staff in the reorganized N.H.S. operating against the primary objective of patient care. Lord Wells-Pestell, for the Government, told him that the Secretary of State was dissatisfied with the management arrangements introduced by the Conservative Government and a planning system was being introduced "to ensure that health authorities bring commitments, including staff employed in administration, into balance with resources according to established priorities." Lord Wallace pointed out that drastic
proposal, which is subject to the North-east Thames Regional Health Authority's agreement and her approval. They propose, given assurance of resources, to discuss with community health councils, appropriate local authorities and other interested bodies, retention of the hospital on its present site in a rationalized form but without a separate matemity home, until it can be incorporated within a future district general hospital development. "The implications of this proposal to commence discussions are now being carefully considered. No final decision will be taken by my right hon. Friend until the views of the regional health authority have been received."
1950 1955 1960 1965 1966 1967 1968 1969 1970 1971
i972 1973 1974
1975-76
69.8 76-7 98.1 127-0 131-4 142-6 152.8 13-5 154.7 13-8 162-0 14.0 163-8 13.8 14.5 178-9 181-3 14.0 195.5* 15-3* Not Not available available 10.1 9.4 10-4 11.9 12.1 12.9
* Provisional
Vaccine-dam aged Children Mr. Alfred Morris, Minister for the Distold the House of Commons on 30 abledy July that parents withfor vaccine-damaged help from the children we re eligible to help severely Family Funsd, which exists handicapped children. Until October 1974 the fund was pi)ermitted to help only children with congenital handicaps, but it has been extended to include all severely handicapped children. "T'his means," he said, "that contrary to a recent report, families with vaccine-dam: aged children are eligible to apply for healp. I understand that a number of families in this category have in fact already been helped by the fund.... I also announced 1l ast October the grant of a further £3m. to the fund."
Dr. D. A. Pyke has been elected registrar of the Royal College of Physicians of London. Dr. David Pyke, who was born in 1921, was educated at Leighton Park School, Reading; Clare College, Cambridge; and University College Hospital Medical School, where he qualified in 1945. After holding junior hospital appointments and serving in the R.A.M.C., he was medical registrar at the Postgradu.'4 k |nate Medical School, then ^! ! | 11 senior registrar and later medical tutor at the Rad*. cliffe Infirmary, Oxford. He obtained the M.R.C.P. in 1949 and proceeded M.D. in 1956. In 1959 he was appointed to the staff of King's College Hospital; in 1964 he was elected F.R.C.P.; and in 1971 succeeded Dr. Wilfrid Oakley as physician in charge of the diabetic department at that hospital. Since 1968 he has also been physician to the Queen Victoria Hospital, East Grinstead. He has written various scientific papers and has been author or editor of five books, including (with W. G. Oakley and K. W. Taylor) Clinical Diabetes and its Biochemical Basis (1968) and Diabetes and its Management (1973 and 1975). His main research interest at present is a study of diabetes in identical twins. From 1968 to 1973 Dr. Pyke was hon. secretary of the Association of Physicians and from 1972 to 1974 an hon. secretary of the Royal Society of Medicine. Since 1951 he has been joint editor of Family Planning, the quarterly journal of the F.P.A., whose secretary or chairman from 1930 until her death in 1966 was Dr. Pyke's mother,
Margaret Pyke.
Elizabeth G;arrett Anderson Hospital Answering aa question on the E.G.A. Hos- Annual Report of the Department of Health pital on 299 July the Minister of State, D.H.S.S., Dor. David Owen, said in a written A total of £3032m. was spent on the health answer: "T he Camden and Islington Area and personal social services in England in Health Authiority (T) has informed my right the financial year to 31 March 1914-a 16% hon. FriendI [Mrs. Barbara Castle] of its increase over the previous year. This was
BRITISH MEDICAL JOURNAL
announced by the D.H.S.S. in its annual report for 1974 which was published on 31 July (Cmnd. 6150, H.M.S.O., price £1l55). £644m. was spent on local health and personal social services. Central Government provided 81 % of the total cost of the services, N.H.S. contributions via National Insurance payments 61% or £195m. Revenue from direct payments by people using the services amounted to £145m. compared with £129m. the preceding year. Of this figure £86m. came from charges for prescriptions, dental treatment, dentures, and spectacles, and private treatment in hospital.
HOSPITAL ACTIVITY
In 1974 there was another reduction in the total number of available beds, the fall since 1964 amounting to over 9%. Mental illness beds accounted for over 94% of this decrease. There has been a reduction of almost 51 % in the number of infectious diseases and diseases of the chest beds over the last 10 years. The number of new outpatients attending consultant clinics decreased in 1974 but total attendances rose slightly with day cases going up by 10 %. These latter are patients attending as non-resident patients for investigation, therapeutic test, operative procedure, or other treatment.
PRIMARY HEALTH CARE
The D.H.S.S. reports that the number of G.P.s working in groups has increased, and the numbers of ancillary staff employed by practitioners has gone up by about 85 %. Financial support continued to encourage practitioners to improve their own premises. Family practitioner committees made improvement grants to a total of £270 000 in 1974 and in 1973-4 the General Practice Finance Corporation made 217 loans totalling £2 508 000. Of the 274m. prescriptions dispensed during 1974 in England, 165m. were dispensed without charge to the patient. Of the remaining 109m., the charges amounted to £22m. and £888 000 was received from dispensing doctors. About £149 000 was refunded to patients, including charges refunded on grounds of low income. About 11 5m. children under 16 and about 7-8m. men aged 65 and over and women aged 60 -and over were exempted from prescription charges on grounds of age. At the end of the year there were 566 -health centres in use and 3000 general medical practitioners were working in centres; a further 99 centres were under construction.
9 AUGUST 1975
graduation ceremony will take place on 25 June. An organizing committee has been set up and rooms provisionally reserved in the university halls of residence. The committee hopes that many Edinburgh graduates, including, of course, families and friends, will attend one or more of the functions. Further information will be sent by the medical school as it becomes available on completion of a form (obtainable from the Secretariat, 250th Anniversary Celebrations, University of Edinburgh Medical School, Teviot Place, Edinburgh EH8 9AG) and payment of a preliminary registration fee of £1 to cover printing and postage.
DRUG DEPENDENCE AND ALCOHOLISM
Leon Szur Memorial Fund Dr. Leon Szur died on 21 February 1975. To commemorate his memory, it is proposed to establish a special book collection in the Wellcome Library at the Royal Postgraduate Medical School. The collection will relate to oncology and it will, in general, be built around the fields of radiotherapy, haematology, and nuclear medicine, as these were Dr. Szur's life work in which he made so many important contributions to scientific research and to teaching, as well as in the clinical care of his patients. A fund has been opened and anyone wishing to contribute should send a donation to the Accountant, Royal Postgraduate Medical Faculty of Medicine, University of School, Du Cane Road, London W12 OHS. Edinburgh Cheques should be made payable to: "Royal Medical School, Leon Szur 1976 will be the 250th anniversary of Postgraduate Fund." Memorial the foundation of the faculty of medicine and the University of Edinburgh plans to commemorate the occasion officially Medicines Commission and Committee on in June. There will be historical demonstra- Safety of Medicines tions, special lectures, and entertainment by junior staff as well as functions organized by In 1974 the Committee on Safety of Medibodies outside the university. A medical cines considered 549 applications (131 for clinical trial certificates and 418 for product licences) as well as 123 brought forward from the previous year, according to its annual report for 1974. This report and those of the Medicines Commission, the Phased Opening for Hong Kong's New Hospital Veterinary Products Committee, and the The phased opening of the 27-acre Princess wing, a psychiatric wing, and combined staff British Pharmacopaeia Commission, were Margaret Hospital complex at Lai Chi Kok, quarters. Capital costs of the complex amount published in one volume on 29 July on the south-west of Hong Kong's New to over £12m. and the Hong Kong Govern- (H.M.S.O., price 95p). The Medicines Commission in its report Territories, is planned to start in October ment expects that nearly 1000 beds will be comments that when licensing of medicines with the opening of infectious diseases operational at the end of the first stage. began product licences of right were granted wards. The complex comprises a general automatically on application for medicinal products on the market on 1 September 1971. The understanding was that these would all be reviewed. In 1974 the Commission was consulted by the health departments about a review of "some 36000 licensed products." It has recommended that a product licence review committee should be set up to carry out a pilot exercise on two groups of products; this review committee would then advise on the feasibility of extending the examination. The commission heard appeals on four products turned down by the Committee on Safety of Medicines; one was successful and three were rejected. In 1973 3619 suspected adverse reactions to drugs were reported and in 1974 this figure rose to 4818. The Committee on Safety of Medicines sees these as only "a small proportion of those which actually occur." It is holding discussions with the Association of the British Pharmaceutical Industry about the introduction of a scheme
The number of narcotic addicts receiving hospital treatment, the Department reports, was 1534 outpatients and 62 inpatients at the end of 1974. There are about 2000 active addicts. This year there have again been fewer notifications of addicts in their teens. General and psychiatric hospitals have continued to provide medical and psychiatric services for alcoholics. At the end of 1973 there were 20 specialized hospital treatment units in England providing 412 beds, including some beds in units which treat drug addiction or alcoholism. Recently a day hospital for alcoholics has been commissioned.
BRITISH MEDICAL JOURNAL
9 AUGUST 1975
to indicate specially in the Monthly Index of Medical Specialities and on data sheets products designated as recently introduced. The committee admits that towards the end of 1974 there was a backlog of applications for clinical trial certificates and product licences for new drugs. There was an even larger backlog affecting products containing known ingredients and for variations of existing licences.
London University M.B., B.S. in 1962, and has held various appointments in the department of anatomy and embryology at Univerity College since then. He was appointed reader in 1974.
Lunch at B.M.A. House in Edinburgh B.M.A. members visiting Edinburgh on holiday or for the Edinburgh Festival are reminded that luncheon facilities for members and their families are available at the Petition to Save E.G.A. Hospital Scottish House, 7 Drumsheugh Gardens, A petition signed by over 23 000 patients from Mondays to Fridays, 12.30-2 p.m. and supporters of the Elizabeth Garrett Anderson Hospital was presented at 10 Downing Street on 29 July. The petition Society of Apothecaries asked the Prime Minister to ensure that the At a soiree on 23 July the society's gold all-women hospital in Euston remains open, medal in therapeutics was bestowed on Dr. states the E.G.A. action committee. The Leonard Goodwin "in recognition of his outhospital's future is soon to be determined by standing contributions in the fields of the health ministers, after a submission from pharmacology and chemotherapy." the Camden and Islington Area Health Authority last week. The action committee of patients and staff was established in Novem- COMING EVENTS ber to fight the threatened closure. Since then, the hospital's survival has been sup- Institute of Medical Laboratory Technology. ported by the new local Community Health -Symposium "Clinical Enzymology 1975," 5-7 Council, and its future has been debated in September, Liverpool. Details from Mr. D. C. both chambers of the Houses of Parliament, Cowell, Liverpool Area Health Authority (T), Ashton with about 100 M.P.s declaring their sup- Department of Chemical Pathology, 2085.) Street, Liverpool L3 5RT. (Tel. 051-709 port for the hospital. Writing and Speaking in Medicine The B.M.Y. will be holding a one-day seminar on writing and speaking in medicine on Friday, 14 November at the School of Pharmacy, Brunswick Square, London W.C.1. The speakers, including Professor J. S. Calnan, Dr. Clifford Hawkins, and Dr. D. A. Pyke, will discuss various aspects of writing, refereeing, and editing medical articles (see advertisement, p. vi).
National Association for Mental Health.Workshop "Some Sexual Minorities," 6-7 September, Polytechnic of Central London. Details from Maxine Budd, Education Department, MIND, 22 Harley Street, London WlN 2ED. (Tel. 01-637 0741.) College of Speech Therapists.-National Conference, 8-12 September, Cardiff. Details from the publicity secretarv, Mrs. S. I. Brenchley, 17 Woodland Road, Llanmartin, Gwent, NP6 2ES. World Conference on Gifted Children."Looking to their Future," 8-12 September, at Royal College of Surgeons of England, organized by the National Association for Gifted Children (U.K.). The president of the Royal College of Surgeons and the Permanent Secretary at the Department of Education and Science will address the conference. Details from Mr. I. S. Macphail, World Conference on Gifted Children, Conference Services Ltd., 43 Charles Street, London WlX 7PB. (Tel. 01-624 3535.) 4th European Congress on Sterility.-5-8 October, Madrid, Spain. Details from Prof. Dr. med. K. Semm, Department of Obstetrics and Gynaecology, University of Kiel, Hegewischstr. 4, D-23 Kiel 1, West Germany. 5th International Congress of the European Society of Pathology.-5-10 October, Vienna. Details from the secretary of the society, Instituto di Anatomia Patologica, Via F. Sforza 38, Milan, Italy. "Laboratory Hazards."-Day symposium, 10 October, West Centre Hotel, London S.W.6, organized by Royal College of Pathologists and Institute of Medical Laboratory Technology. Details and application forms from I.M.L.T., 12 Queen Anne Street, London WlM OAU.
Chair of Experimental Haematology, Sheffield Dr. George Hudson, Administrative Dean of the Faculty of Medicine and honorary clinical lecturer in haematology, Sheffield University, has been appointed to a personal chair of experimental haematology at Sheffield. Dr. Hudson, who is 51, was educated at Bury Grammar School and at the University of Manchester, where he graduated M.B., Ch.B. in 1949, proceeding at Bristol to M.D. in 1959 and D.Sc in 1966. After posts at the Manchester Royal Infirmary and the University of Bristol he did his national service in the R.A.M.C., returning to Bristol as lecturer and then reader in anatomy and preclinical dean. In 1959-60 Dr. Hudson gained a Fulbright travel award and was appointed assistant professor in the University of Minnesota. In 1968 he became administrative dean of the Faculty of Medicine and honorary clinical tutor in haematology at Sheffield. He was elected B.M.A. NOTICES F.R.C.Path. in 1975. Dr. Hudson's main research interests are in the quantitative and Armed Forces Committee: Nomination of Members for Co-option cellular aspects of haematology. The constitution of the Armed Forces Committee allows for the co-option of two Chair of Anatomy, King's College representatives of the rank of major or Dr. K. E. Webster, reader in anatomy at equivalent (lieutenant-commander or squadUniversity College, has been appointed from ron leader) or below (one of whom should' 1 October 1975 to the chair of anatomy at preferably be of specialist status) from the King's College. Dr. Webster graduated from medical branch of each of the three Services.
Last session the following members were co-opted: Royal Navy: Surgeon LieutenantCommander P. Clarke (Birmingham) and Surgeon Lieutenant-Commander D. P. Pryce (Gosport). Army: Major R. M. L. Anderson (Catterick) and Major D. Murray (Woolwich). Royal Air Force: Squadron Leader W. R. Fitzgerald (Ely) and- Squadron Leader C. J. Sharples (Cottishall). Serving medical officers are now invited to nominate members of the Association in the armed Forces in the above-mentioned ranks for co-option to the committee for the 1975-6 session. The members listed above are eligible for reappointment provided their rank is not now above that of major or equivalent. Nominations should be sent to the Secretary of the Association by Monday, 1 September 1975, and nominees will be informed of the co-options made by the Armed Forces Committee following its first meeting after the closing date. DEREK STEVENSON,
Secretary
UNIVERSITIES AND COLLEGES ABERDEEN The honorary degree of LL.D. has been conferred on Mr. S. G. Davidson. M.D.-A. Akinkugbe, R. G. Condie, C. S.
McIntosh, G. R. D. Catto, G. P. M. Crawford, M. J. Metcalf, Janet Sorbie. M.S.-A. K-N. Ah See. D.PH.-J. R. Shearer.
APPOINTMENTS HAMPSliIRE
AREA HEALTH AUTHORITY (TEACHING).Dr. S. W. Hettiaratchy (consultant in child psychiatry). MANCHESTER AREA HEALTH AUTHORITY (TEACHING).The following consultan,ts have been appointed: Dr. A. Razak (anaesthetics); Dr. E. G. Daw (obstetrics and gynaecology). NORTH-WEST THAMES R.H.A.-The following consultants have been appointed: Dr. R. F. Pinerua (respiratory medicine); Dr. R. K. Gupta (anaesthetics); Dr. G. P. L. M. de Silva (microbiology, interest in virology). SALFORD AREA HEALTH AUTHORITY (TEACHING).The following consultants have been appointed: Dr. P. J. August (dermatology); Mr. R. W. Marcuson (general surgery); Dr. (Mrs.) S. Thurairajasingam (radiology). YORKSHIRE R.H.A.-The following consultants have been appointed: Dr. H. M. Klar (psychiatry); Mr. C. M. S. Royston (general surgery); Dr. P. E. McGill (general medicine); Mr. M. R. Gooding (neurosurgery); Dr. I. Blacker, Dr. P. M. Norton (anaesthetics); Mr. G. H. Randle (obstetrics and gynaecology); Dr. N. K. Jain (radiology).
Notice to Authors When original articles and letters for publication are not submitted exclusively to the British Medical Journal this must be stated. Correspondence on editorial business should be addressed to the Editor, British Midical Journal, B.M.A. House, Tavistock Square, London WC1H 9JR. Telephone: 01-387 4499. Telegrams: Aitiology, London, W.C.1. Authors wanting reprints of their articles should notify the Publishing Manager, B.M.A. House, Tavistock Square, WC1H 9JR, on receipt of proofs.
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