820
THE LANCET, OCTOBER
shared a conviction that these payments should be refused on the grounds that they would have to be made out of district funds to the detriment of other services and that they would represent payment for work which was already being done. I have now been assured that part of the £600 million allocated to the Health Service took into account the extra cost to the N.H.S. of former F.P.A. work and that these payments were to be made for new work done in addition to that already carried out on present operating-lists. Remunerable operations will therefore be done either on new operating-lists or after normal lists have been completed. This being so the objections no longer stand but I doubt if "silencing by gold" will prove to be a very accurate description of the deal. Department of Anesthetics, Southampton General Hospital, Southampton.
P.
J. HORSEY
SIR,-I cannot see how the present free contraceptive service can be fully effective and reach all patients unless the cooperation of doctors is achieved: extending family-planning clinics, as you suggested is not enough. The Government has discovered it takes "a touch of gold" to interest doctors in this scheme: rather than consider this as a "money-spinner", it must surely be the best-ever investment for a crowded, ailing country such as Britain. My regret is that it was not introduced years ago, when thousands of unwanted children and their ensuing problems or terminations might have been prevented. What a tragedy if discontent at the Government's means prevent the end being achieved. 42, Dreghorn Loan, Edinburgh EHI3 ODE.
PENELOPE A. WATSON
SI UNITS SIR,-I read with morbid delight the article by Dr Clark and Dr Sheldon on SI units (Oct. 11, p. 700). What skill the D.H.S.S. displays in firing off diversionary volleys at a time when all our attention should be focused on the grave and very real problems that beset the N.H.S. The D. H. S. S. has carefully ordered a change which actually has some benefits and which was certain to rouse our conservative doctors. They have thus been able to sit back and enjoy watching furious clinicians battering the beleaguered biochemists. Churchill would have been proud of the physicians of Sussex standing in their last ditch on Brighton beach resisting to the end the invasion by the dread SI units. Sadly their ditch has already-to use their analogy-been flattened by the steam roller; the mole has burrowed to the very heart of the system. I would also ask our clinical colleagues to be charitable to the humble biochemist. Considered rationally the SI unit is at worst harmless, although a waste of money, and at best an advance in communication. Scientists have already invaded many of the bastions of clinical medicine and it is perhaps even sensible to talk to them in the same language. Think, too, of the joy that SI has brought to the clinical biochemist. Up and down the country committees of biochemists have sat for weeks, if not months, in total ecstasy compiling conversion tables, wall charts, booklets, new tables of normal values, and making myriads of new rules. A new spotlight has, if briefly, focused on the clinical chemist as posters round the hospitals announce the coming of SI, like a new Messiah. What joy. In hospitals where the change has already taken place there have been few problems. There are even advantages like the greater ease in calculating plasma osmolality. Think of the chaos that could ensue if we now stick halfway with half our hospitals working in the new and half in the old units. The fait has already been accompli. Perhaps it would be wise if we followed the advice of the disciple of Confucius who said: "When rape is inevitable, lie back and enjoy it". By and large the coming of the SI unit is a major non-event.
25,1975
There are many more serious problems to worry about. Laboratory services will contract and clinical care deteriorate unless more funds become available immediately. Let us avoid the smoke screens, ignore the minutiee of SI, forget private practice, and be patient over our contracts. The profession must unite to ensure that adequate finance is available for the real business of medicine--that is, providing the best possible care for our patients. University Department of Chemical Pathology, General Hospital, Southampton S094XY.
K. G. M. M. ALBERTI
SIR,-There is only one thing to be done about the directive from the Department of Health concerning SI units, and that is to ignore it. If clinicians and pathologists refuse to use this system, a deal of trouble and much paper will be saved. It would help, Sir, if you and other editors of medical journals would also refuse to use SI, and say so forthwith. 57 Egerton Crescent, London SW3 2ED.
NORMAN A. PUNT
MENTAL HEALTH ACT 1959 SIR,-For some time it has been apparent that the Mental Health Act 1959 is not working as well as it might be, and now two more cases have given rise to further doubt. The first case concerned a married woman who killed two of her children and was detained under Section 60 of the Mental Health Act 1959. As there was no restriction order, the responsible medical officer was entitled to discharge her when he saw fit. The second case concerned a patient from Broadmoor who was allowed out for the day with a social worker. The social worker and patient went to London, separated, and arranged to meet again at a specific time and place; not surprisingly, the patient failed to turn up. However, the Department of Health issued an assurance that the patient was perfectly harmless; this being so, one wonders why he was detained at Broadmoor. Where the safety of the public is involved, I feel the decision to discharge a patient from hospital should not be that of the responsible medical officer alone. Such a decision should be taken by an independent body, such as a mental health tribunal. The most simple way to deal with this problem would be to abolish Section 60 and to apply Section 65 in all cases. This would mean extra work for the mental health tribunals, but would go far towards alleviating public anxiety. Claypenny Hospital, Easingwold, Yorks. Y06 3PR.
J. NEWCOMBE
PILES: THEIR NATURE AND MANAGEMENT SIR,-The point of view of Mr Thomson concerning the modern management of piles (Sept. 13, p. 494) was already enunciated in the 12th century by Moses Maimonides in his Treatise on Hemorrhoids. I This work was written for a nobleman, as Maimonides describes in the introduction-probably a member of the Sultan's family. There are seven chapters dealing with normal digestion, foods harmful to patients with hsernorrhoids, beneficial foods, and general and local therapeutic measures such as sitz baths, oils, and fumigations. Maimonides disapproves of blood-letting or surgery for harnorrhoids except in very severe cases. His whole approach to the problem seems to bespeak a modern medical trend. Maimonides states: "Because this illness [i.e., hremorrhoids] recurred many times, the patient considered having them extirpated in order to uproot this malady from its source so that it not return again. I informed him of 1. Rosner, F., Muntoer, S. The Medical Writings of Moses Maimonidcs. Vol. Ill. Treatise on Hemorrhoids & Responsa. Philadelphia, 1969.
THE LANCET, OCTOBER
shared a conviction that these payments should be refused on the grounds that they would have to be made out of district funds to the detriment of other services and that they would represent payment for work which was already being done. I have now been assured that part of the £600 million allocated to the Health Service took into account the extra cost to the N.H.S. of former F.P.A. work and that these payments were to be made for new work done in addition to that already carried out on present operating-lists. Remunerable operations will therefore be done either on new operating-lists or after normal lists have been completed. This being so the objections no longer stand but I doubt if "silencing by gold" will prove to be a very accurate description of the deal. Department of Anesthetics, Southampton General Hospital, Southampton.
P.
J. HORSEY
SIR,-I cannot see how the present free contraceptive service can be fully effective and reach all patients unless the cooperation of doctors is achieved: extending family-planning clinics, as you suggested is not enough. The Government has discovered it takes "a touch of gold" to interest doctors in this scheme: rather than consider this as a "money-spinner", it must surely be the best-ever investment for a crowded, ailing country such as Britain. My regret is that it was not introduced years ago, when thousands of unwanted children and their ensuing problems or terminations might have been prevented. What a tragedy if discontent at the Government's means prevent the end being achieved. 42, Dreghorn Loan, Edinburgh EHI3 ODE.
PENELOPE A. WATSON
SI UNITS SIR,-I read with morbid delight the article by Dr Clark and Dr Sheldon on SI units (Oct. 11, p. 700). What skill the D.H.S.S. displays in firing off diversionary volleys at a time when all our attention should be focused on the grave and very real problems that beset the N.H.S. The D. H. S. S. has carefully ordered a change which actually has some benefits and which was certain to rouse our conservative doctors. They have thus been able to sit back and enjoy watching furious clinicians battering the beleaguered biochemists. Churchill would have been proud of the physicians of Sussex standing in their last ditch on Brighton beach resisting to the end the invasion by the dread SI units. Sadly their ditch has already-to use their analogy-been flattened by the steam roller; the mole has burrowed to the very heart of the system. I would also ask our clinical colleagues to be charitable to the humble biochemist. Considered rationally the SI unit is at worst harmless, although a waste of money, and at best an advance in communication. Scientists have already invaded many of the bastions of clinical medicine and it is perhaps even sensible to talk to them in the same language. Think, too, of the joy that SI has brought to the clinical biochemist. Up and down the country committees of biochemists have sat for weeks, if not months, in total ecstasy compiling conversion tables, wall charts, booklets, new tables of normal values, and making myriads of new rules. A new spotlight has, if briefly, focused on the clinical chemist as posters round the hospitals announce the coming of SI, like a new Messiah. What joy. In hospitals where the change has already taken place there have been few problems. There are even advantages like the greater ease in calculating plasma osmolality. Think of the chaos that could ensue if we now stick halfway with half our hospitals working in the new and half in the old units. The fait has already been accompli. Perhaps it would be wise if we followed the advice of the disciple of Confucius who said: "When rape is inevitable, lie back and enjoy it". By and large the coming of the SI unit is a major non-event.
25,1975
There are many more serious problems to worry about. Laboratory services will contract and clinical care deteriorate unless more funds become available immediately. Let us avoid the smoke screens, ignore the minutiee of SI, forget private practice, and be patient over our contracts. The profession must unite to ensure that adequate finance is available for the real business of medicine--that is, providing the best possible care for our patients. University Department of Chemical Pathology, General Hospital, Southampton S094XY.
K. G. M. M. ALBERTI
SIR,-There is only one thing to be done about the directive from the Department of Health concerning SI units, and that is to ignore it. If clinicians and pathologists refuse to use this system, a deal of trouble and much paper will be saved. It would help, Sir, if you and other editors of medical journals would also refuse to use SI, and say so forthwith. 57 Egerton Crescent, London SW3 2ED.
NORMAN A. PUNT
MENTAL HEALTH ACT 1959 SIR,-For some time it has been apparent that the Mental Health Act 1959 is not working as well as it might be, and now two more cases have given rise to further doubt. The first case concerned a married woman who killed two of her children and was detained under Section 60 of the Mental Health Act 1959. As there was no restriction order, the responsible medical officer was entitled to discharge her when he saw fit. The second case concerned a patient from Broadmoor who was allowed out for the day with a social worker. The social worker and patient went to London, separated, and arranged to meet again at a specific time and place; not surprisingly, the patient failed to turn up. However, the Department of Health issued an assurance that the patient was perfectly harmless; this being so, one wonders why he was detained at Broadmoor. Where the safety of the public is involved, I feel the decision to discharge a patient from hospital should not be that of the responsible medical officer alone. Such a decision should be taken by an independent body, such as a mental health tribunal. The most simple way to deal with this problem would be to abolish Section 60 and to apply Section 65 in all cases. This would mean extra work for the mental health tribunals, but would go far towards alleviating public anxiety. Claypenny Hospital, Easingwold, Yorks. Y06 3PR.
J. NEWCOMBE
PILES: THEIR NATURE AND MANAGEMENT SIR,-The point of view of Mr Thomson concerning the modern management of piles (Sept. 13, p. 494) was already enunciated in the 12th century by Moses Maimonides in his Treatise on Hemorrhoids. I This work was written for a nobleman, as Maimonides describes in the introduction-probably a member of the Sultan's family. There are seven chapters dealing with normal digestion, foods harmful to patients with hsernorrhoids, beneficial foods, and general and local therapeutic measures such as sitz baths, oils, and fumigations. Maimonides disapproves of blood-letting or surgery for harnorrhoids except in very severe cases. His whole approach to the problem seems to bespeak a modern medical trend. Maimonides states: "Because this illness [i.e., hremorrhoids] recurred many times, the patient considered having them extirpated in order to uproot this malady from its source so that it not return again. I informed him of 1. Rosner, F., Muntoer, S. The Medical Writings of Moses Maimonidcs. Vol. Ill. Treatise on Hemorrhoids & Responsa. Philadelphia, 1969.
