1141
vincing : the number of heroin addicts has risen by 37% (1426 to 1954) over the six years 1970 to 1975, inclusive, but the rate of climb seems to be slowing." These figures refer to addicts known to be receiving drugs as at Dec. 31, and this figure, at the end of 1975, was 1954. The Home Office news release of Oct. 7, 1976, on 1975 Statistics of the Misuse of Drugs in the United Kingdom, gives the following figures for narcotic drug addicts known to the Home Office in 1975, by new notifications and numbers no longer recorded as drug addicts.
Definition
No.
Addicts known to be receiving drugs at Jan. 1, 1975 1972 Notifications by medical practitioners of: New addicts during 1975 926 Former addicts renotified 532 Addicts no longer recorded as at Dec. 31, 1975: Died 69 Admitted to a penal institution 483 Admitted to other institution 1 No longer seeking treatment 923 Addicts known to be receiving drugs as at Dec. 31, 1975 1954
Cytogenetics Laboratory, Department of Pathology, Letterman Army Medical Center, Presidio of San Francisco, California 94129, U.S.A.
If you add the numbers of new addicts in 1975 (926) and the number of former addicts renotified (532) to the number known to be receiving narcotic drugs on Jan. 1 (1972) you will see that the total numbers of addicts seen throughout 1975 was 3430. Also, if you add the number who died (69), those admitted to a special institution (483), and those no longer seeking treatment (926), you will see that 1475 were no longer recorded as at Dec. 31,1975. I bring these figures to your notice as your excellent journal is widely read in the United States and it could be that the report is correct in its opinion that there is evidence of a slowly
worsening problem. Division of Resource Development, National Institute on Drug Abuse, Rockville, Maryland 20857, U.S.A.
RICHARD V. PHILLIPSON
TWO-MINUTE METHOD FOR BANDING HUMAN CHROMOSOMES
StR,-For the past 2 years I have been trying to achieve a Giemsa chromosome banding method that is reliable, simple, fast, and cheap. Such a method has been devised with the addition of acetone to the stain which reduces the staining-time
Part of metaphase
spread showing banding achieved
acetone/Giemsa method.
with
and produces more distinct bands. Starting with air-dried slides the whole procedure can be done at room temperature in under 2 min. Human leucocytes are cultured to obtain metaphases using 75 mmol/1 potassium chloride as the hypotonic solution for 4 min at 37°C and fixation with a freshly prepared mixture of glacial acetic acid and methanol (1/3) at least three times before transfer to clean, dry slides by blowing. The slide is then submerged horizontally in 0.25% trypsin (Difco) in physiological saline solution for 10-15 s and then passed through two rinses of saline. At this point the slide is stained horizontally for 1 min with Giemsa stain (Reagent Chemicals, Saugerties, N.Y.) diluted 1/4 with pH 6.8 buffer salts (Reagent Chemicals) plus the addition of 0.75% acetone. The slide is rinsed well in pH 6.8buffer salts, blotted dry on filterpaper, rinsed in xylol, and mounted in a neutral mounting medium. This method has resulted in consistent Giemsa bands for the past 8 months.
rapid
Commentary
from Westminster
From Our Parliamentary
The Next
RICHARD J. DERR
Correspondent
Stage on the Consultants’ Contract
AFTER negotiations which have lasted for most of the year, details of a proposed new contract for consultants have now been agreed with the Government and are expected to be finalised this week. The proposed contract, to cover all but exceptional cases, is for a mini-
of ten notional half-days of 3 Zhours a week, comprising eight sessions of scheduled work, one for administrative and committee work, and one for on-call commitment in recognition of the fact that a consultant continues to accept responsibility for his patients and his own department even when he is not officially at work. Extra sessions would then be offered by health authorities, who would take into account a consultant’s outside commitments to private practice. At the moment, full-. time consultants in the National Health Service work eleven sessions of 3t hours each a week and undertake not to do private practice. Part-time consultants work nine sessions and lose two-elevenths of their pay, but are allowed to do private work. The aim of the Department of Health and Social Security has been to increase the commitment of consultants to the National Health Service, although whether the proposed contract achieves this will be one of the main areas of dispute. The consultants’ negotiating team has been anxious to see that consultants get more money in order to make the job more attractive for juniors. Indeed, it has been largely with the younger generation of consultants and juniors in mind that the new contract has been drawn up. The aim of the consultants has been to negotiate a contract which identifies what they are being paid for and flexible enough to allow payment for additional work. But in doing this they did not want to be tied down to a tightly timed agreement. In working out the details of the new contract the two sides have faced a number of difficulties. mum
1142
One has been the definition of the "on call" commitment, since interpretations vary. To avoid an arrange. ment which gave unfair financial advantage to thos( with considerable on-call responsibilities, such as sur. geons, at the expense of others, such as pathologists anc radiologists, a banding system has been agreed for extr: payments. In the top band would be those who had responsibility for emergency work but were on their own In the bottom band would be those whose commitment was only nominal. There would also be a recall fee foi emergencies and this would operate between 7 P.M. and 8.30 the following morning from Monday to Friday and all day Saturday and Sunday. The principle of a ceiling on the number of notional half-days which can be collected has been agreed by the consultants and this looks like being fixed at fifteen. Agreement has been reached on better telephone allowances. But the issue of motor-car allowances has been set aside for the time being. There has also been some discussion, mainly from the Government side, about changing the present family-planning scheme to one of sessional payments, although whether this ends up as part of the new contract remains to be seen. Distinction awards have also entered into the discussions. The Government has been pressing for changes in the system to relax some of the confidentiality which now exists. Agreement on this seems to be tentative. The consultants’ negotiating committee has been able to accept most of what the Government has asked for, which it sees as merely formalising the changes the distinction-awards committee has already been carrying out in an unofficial way. But the operation of the scheme is likely to be an issue for continuing discussions. Agreement between the two sides on the new contract is just the beginning of events. The proposals have yet to be considered by Ministers, who may find a few political obstacles in their way. The hope is that a document setting out the detailed proposals will be ready to go before the Central Committee for Hospital Medical Services, representing 12 500 consultants, next week. There will then be a period of six to eight weeks of public debate. Meetings will be held up and down the country to explain to consultants what is being proposed. It is then envisaged that a ballot of consultants will be held sometime in January and, if approved, the contract will be priced by the Review Body on Doctors’ and Dentists’ Remuneration. What the consultants would like is for the contract to be priced freely and introduced in sucha way that it is not part of the Government’s pay policy. Existing contracts will be safeguarded and consultants given the choice to remain as they are or change to the new contract.
The proposed new contract is bound to be controversial. Already there has been criticism that it will encour- . age more consultants to do private practice and that the gap between the public and private health sectors will widen. The suspicions of Labour M.p.s have been aroused and a meeting of the Party’s backbench health committee is expected to reinforce the hostility. Mr Laurie Pavitt, the committee chairman, has urged that in renegotiating the contract the Government should make it a condition of employment that common waiting-lists are accepted. Supporters of the new contract argue that it will make for a more contented profession, although such a change is bound to take time. Morale
among consultants is seriously low, a point emphasised in the last Review Body report and accepted by the Government. The hope is that the new proposals will change this and that some of the present problems of career structure will be eased, particularly among those specialties where there are serious shortages. The Government may also have in mind-although there has been no hint of a bargain during the negotiations-that when consultants’ morale has been raised by the new contract, they may become more cooperative in helping to tackle the matter of waiting-lists.
Obituary BERTRAM LESLIE ARDILL
T.D., M.D., B.Sc. Belf, F.R.C.S. Dr Leslie Ardill, consultant in community medicine tc the North and West Belfast district, died on Sept. 21 a
the age of 9. He was born in Ballywalter, Co. Down and educated a1 Methodist College, Belfast, and the Queen’s University of Belfast, where he graduated B.SC. in 1959 and M.B. in 1962.A year as assistant lecturer in physiology was followed by thre years as a Beit memorial research fellow in the physiology department of St. Mary’s Hospital Medical School, London.A long-held interest in surgery took him back to Northern Ireland, but a promising career in peripheral vascular surgery was cut short by illness in 1973. After a period of reappraisal he turned toward medical administration, and became first a consultant in community medicine and then district administrative medical officer to the North and West Belfast district, a position he held until his death. The change from a clinical surgical career to one of medical administration was considerable but Leslie brought to his new role the same application, retentive memory, and clear-cut thinking which had always characterised his work; he also showed much patience in listening to every side of a problem before taking decisive action. Outside work, he got great satisfaction in his last few years from time spent with his own young family. Nevertheless, he continued an amazing number of additional interests. His collection of ’MG’ cars attested to his engineering skill. He became an officer of the Order of St. John of Jerusalem shortly before his death, and was secretary of his local Presbyterian church. He is survived by his wife, Claire, a son, and a daughter.
A.D.M.G. adds: "In Leslie Ardill an unusual range of qualities were combined. He had wisdom, intelligence, courage, generosity, and remarkable technical and manual skills and ingenuity. During the tenure of his Beit fellowship at St. Mary’s he did excellent work, made many friends, and characteristically helped all those with whom he came into contact. He was always a doer and giver. It is tragic that so versatile and valuable a man should have been taken at so young an age, but his contribution and example have enduring value." Dr ERNEST GRAHAME JONES, senior physician to the Gwent Hospital, Newport, died on Aug. 4.
Royal
Dr JOHN HENRY MARSHALL, who was a general practitioner in Sandy, Bedfordshire, died on Sept. 20 at the age of 75. Dr
HILARY
Scarborough the age of 6 3.
FRANCIS MARCH, consultant radiologist in the and Beverley health districts, died on Nov. 16 at
vincing : the number of heroin addicts has risen by 37% (1426 to 1954) over the six years 1970 to 1975, inclusive, but the rate of climb seems to be slowing." These figures refer to addicts known to be receiving drugs as at Dec. 31, and this figure, at the end of 1975, was 1954. The Home Office news release of Oct. 7, 1976, on 1975 Statistics of the Misuse of Drugs in the United Kingdom, gives the following figures for narcotic drug addicts known to the Home Office in 1975, by new notifications and numbers no longer recorded as drug addicts.
Definition
No.
Addicts known to be receiving drugs at Jan. 1, 1975 1972 Notifications by medical practitioners of: New addicts during 1975 926 Former addicts renotified 532 Addicts no longer recorded as at Dec. 31, 1975: Died 69 Admitted to a penal institution 483 Admitted to other institution 1 No longer seeking treatment 923 Addicts known to be receiving drugs as at Dec. 31, 1975 1954
Cytogenetics Laboratory, Department of Pathology, Letterman Army Medical Center, Presidio of San Francisco, California 94129, U.S.A.
If you add the numbers of new addicts in 1975 (926) and the number of former addicts renotified (532) to the number known to be receiving narcotic drugs on Jan. 1 (1972) you will see that the total numbers of addicts seen throughout 1975 was 3430. Also, if you add the number who died (69), those admitted to a special institution (483), and those no longer seeking treatment (926), you will see that 1475 were no longer recorded as at Dec. 31,1975. I bring these figures to your notice as your excellent journal is widely read in the United States and it could be that the report is correct in its opinion that there is evidence of a slowly
worsening problem. Division of Resource Development, National Institute on Drug Abuse, Rockville, Maryland 20857, U.S.A.
RICHARD V. PHILLIPSON
TWO-MINUTE METHOD FOR BANDING HUMAN CHROMOSOMES
StR,-For the past 2 years I have been trying to achieve a Giemsa chromosome banding method that is reliable, simple, fast, and cheap. Such a method has been devised with the addition of acetone to the stain which reduces the staining-time
Part of metaphase
spread showing banding achieved
acetone/Giemsa method.
with
and produces more distinct bands. Starting with air-dried slides the whole procedure can be done at room temperature in under 2 min. Human leucocytes are cultured to obtain metaphases using 75 mmol/1 potassium chloride as the hypotonic solution for 4 min at 37°C and fixation with a freshly prepared mixture of glacial acetic acid and methanol (1/3) at least three times before transfer to clean, dry slides by blowing. The slide is then submerged horizontally in 0.25% trypsin (Difco) in physiological saline solution for 10-15 s and then passed through two rinses of saline. At this point the slide is stained horizontally for 1 min with Giemsa stain (Reagent Chemicals, Saugerties, N.Y.) diluted 1/4 with pH 6.8 buffer salts (Reagent Chemicals) plus the addition of 0.75% acetone. The slide is rinsed well in pH 6.8buffer salts, blotted dry on filterpaper, rinsed in xylol, and mounted in a neutral mounting medium. This method has resulted in consistent Giemsa bands for the past 8 months.
rapid
Commentary
from Westminster
From Our Parliamentary
The Next
RICHARD J. DERR
Correspondent
Stage on the Consultants’ Contract
AFTER negotiations which have lasted for most of the year, details of a proposed new contract for consultants have now been agreed with the Government and are expected to be finalised this week. The proposed contract, to cover all but exceptional cases, is for a mini-
of ten notional half-days of 3 Zhours a week, comprising eight sessions of scheduled work, one for administrative and committee work, and one for on-call commitment in recognition of the fact that a consultant continues to accept responsibility for his patients and his own department even when he is not officially at work. Extra sessions would then be offered by health authorities, who would take into account a consultant’s outside commitments to private practice. At the moment, full-. time consultants in the National Health Service work eleven sessions of 3t hours each a week and undertake not to do private practice. Part-time consultants work nine sessions and lose two-elevenths of their pay, but are allowed to do private work. The aim of the Department of Health and Social Security has been to increase the commitment of consultants to the National Health Service, although whether the proposed contract achieves this will be one of the main areas of dispute. The consultants’ negotiating team has been anxious to see that consultants get more money in order to make the job more attractive for juniors. Indeed, it has been largely with the younger generation of consultants and juniors in mind that the new contract has been drawn up. The aim of the consultants has been to negotiate a contract which identifies what they are being paid for and flexible enough to allow payment for additional work. But in doing this they did not want to be tied down to a tightly timed agreement. In working out the details of the new contract the two sides have faced a number of difficulties. mum
1142
One has been the definition of the "on call" commitment, since interpretations vary. To avoid an arrange. ment which gave unfair financial advantage to thos( with considerable on-call responsibilities, such as sur. geons, at the expense of others, such as pathologists anc radiologists, a banding system has been agreed for extr: payments. In the top band would be those who had responsibility for emergency work but were on their own In the bottom band would be those whose commitment was only nominal. There would also be a recall fee foi emergencies and this would operate between 7 P.M. and 8.30 the following morning from Monday to Friday and all day Saturday and Sunday. The principle of a ceiling on the number of notional half-days which can be collected has been agreed by the consultants and this looks like being fixed at fifteen. Agreement has been reached on better telephone allowances. But the issue of motor-car allowances has been set aside for the time being. There has also been some discussion, mainly from the Government side, about changing the present family-planning scheme to one of sessional payments, although whether this ends up as part of the new contract remains to be seen. Distinction awards have also entered into the discussions. The Government has been pressing for changes in the system to relax some of the confidentiality which now exists. Agreement on this seems to be tentative. The consultants’ negotiating committee has been able to accept most of what the Government has asked for, which it sees as merely formalising the changes the distinction-awards committee has already been carrying out in an unofficial way. But the operation of the scheme is likely to be an issue for continuing discussions. Agreement between the two sides on the new contract is just the beginning of events. The proposals have yet to be considered by Ministers, who may find a few political obstacles in their way. The hope is that a document setting out the detailed proposals will be ready to go before the Central Committee for Hospital Medical Services, representing 12 500 consultants, next week. There will then be a period of six to eight weeks of public debate. Meetings will be held up and down the country to explain to consultants what is being proposed. It is then envisaged that a ballot of consultants will be held sometime in January and, if approved, the contract will be priced by the Review Body on Doctors’ and Dentists’ Remuneration. What the consultants would like is for the contract to be priced freely and introduced in sucha way that it is not part of the Government’s pay policy. Existing contracts will be safeguarded and consultants given the choice to remain as they are or change to the new contract.
The proposed new contract is bound to be controversial. Already there has been criticism that it will encour- . age more consultants to do private practice and that the gap between the public and private health sectors will widen. The suspicions of Labour M.p.s have been aroused and a meeting of the Party’s backbench health committee is expected to reinforce the hostility. Mr Laurie Pavitt, the committee chairman, has urged that in renegotiating the contract the Government should make it a condition of employment that common waiting-lists are accepted. Supporters of the new contract argue that it will make for a more contented profession, although such a change is bound to take time. Morale
among consultants is seriously low, a point emphasised in the last Review Body report and accepted by the Government. The hope is that the new proposals will change this and that some of the present problems of career structure will be eased, particularly among those specialties where there are serious shortages. The Government may also have in mind-although there has been no hint of a bargain during the negotiations-that when consultants’ morale has been raised by the new contract, they may become more cooperative in helping to tackle the matter of waiting-lists.
Obituary BERTRAM LESLIE ARDILL
T.D., M.D., B.Sc. Belf, F.R.C.S. Dr Leslie Ardill, consultant in community medicine tc the North and West Belfast district, died on Sept. 21 a
the age of 9. He was born in Ballywalter, Co. Down and educated a1 Methodist College, Belfast, and the Queen’s University of Belfast, where he graduated B.SC. in 1959 and M.B. in 1962.A year as assistant lecturer in physiology was followed by thre years as a Beit memorial research fellow in the physiology department of St. Mary’s Hospital Medical School, London.A long-held interest in surgery took him back to Northern Ireland, but a promising career in peripheral vascular surgery was cut short by illness in 1973. After a period of reappraisal he turned toward medical administration, and became first a consultant in community medicine and then district administrative medical officer to the North and West Belfast district, a position he held until his death. The change from a clinical surgical career to one of medical administration was considerable but Leslie brought to his new role the same application, retentive memory, and clear-cut thinking which had always characterised his work; he also showed much patience in listening to every side of a problem before taking decisive action. Outside work, he got great satisfaction in his last few years from time spent with his own young family. Nevertheless, he continued an amazing number of additional interests. His collection of ’MG’ cars attested to his engineering skill. He became an officer of the Order of St. John of Jerusalem shortly before his death, and was secretary of his local Presbyterian church. He is survived by his wife, Claire, a son, and a daughter.
A.D.M.G. adds: "In Leslie Ardill an unusual range of qualities were combined. He had wisdom, intelligence, courage, generosity, and remarkable technical and manual skills and ingenuity. During the tenure of his Beit fellowship at St. Mary’s he did excellent work, made many friends, and characteristically helped all those with whom he came into contact. He was always a doer and giver. It is tragic that so versatile and valuable a man should have been taken at so young an age, but his contribution and example have enduring value." Dr ERNEST GRAHAME JONES, senior physician to the Gwent Hospital, Newport, died on Aug. 4.
Royal
Dr JOHN HENRY MARSHALL, who was a general practitioner in Sandy, Bedfordshire, died on Sept. 20 at the age of 75. Dr
HILARY
Scarborough the age of 6 3.
FRANCIS MARCH, consultant radiologist in the and Beverley health districts, died on Nov. 16 at
