BRITISH MEDICAL JOURNAL
12 AUGUST 1978
509
NEWS AND NOTES EPIDEMIOLOGY Persistent excretion of salmonellas The following notes are compiled by the Communicable Disease Surveillance Centre (Public Health Laboratory Service) and the Communicable Diseases (Scotland) Unit from reports submitted by microbiologists, community physicians, and environmental health officers. A strain of salmonella was isolated from the skin of a newborn infant with sore buttocks. Within 24 hours of taking the swab three of the 31 other newborn infants in the ward, which was in a hospital obstetric unit, developed loose stools and the same salmonella (Salmonella agona) was isolated from each. On further investigation, two infants, four mothers, and one member of the staff on the ward were found to be symptomless excreters of the same organism. Although none of the children was seriously ill as a result of the infection, they were kept in hospital until free from symptoms; the other infected infants and mothers were discharged; and the ward was closed to admissions until disinfection had been completed. None of the infants was treated with an antibiotic. The member of staff found to be a carrier was excluded from work. The infected infants were followed up in the community after discharge and three further excreters, two from one family, were found among members of their families. The cause of the outbreak could not be determined accurately. The only relevant history, before the mothers' admission to hospital for confinement, came from the father of one of the infants. He had had gastroenteritis, but no intestinal pathogens were isolated from him or any other family member during the follow-up. Thus the infection was probably introduced into the unit by the mother of one of the two infants in whose families a symptomless excreter was detected. Several of the infected persons carried salmonellas for prolonged periods. Initially, specimens were obtained from each identified case or carrier at weekly intervals but, after five months' regular testing, the interval was extended to a month. When the first negative result was obtained further specimens were submitted, with at least a 48-hour interval. No one was considered to be free from infection until three consecutive negative specimens had been obtained. Two of the infants with symptoms initially were still excreting the organism 21 months after the outbreak, while the other two affected infants were not declared free of the infection until three months and nine months after onset. The two symptomless infants were free from salmonellas after seven months and ten months. Of the four mothers found to be carriers, one became free of
infection after two months, two after four months, and the fourth after 11 months. Fortunately the member of staff found to be a carrier was clear after four weeks, when she was allowed to return to her duties. Of the carriers detected among other members of the families, stool cultures from the father of one of the infants became negative after only one month but it took four months before the other two were cleared. If neonates are infected with salmonellas they commonly become persistent excreters, and not unusually this excretion persists for over a year, often until an adult diet is given.1 2 Antibacterial agents are contraindicated: indeed, they even lengthen the period of excretion of the salmonellas.' 2 There are guidelines for the management of the infant or child who becomes a persistent salmonella excreter. The Society of Medical Officers of Health and the Public Health Laboratory Service3 considered infants and children of nursery school age to belong to the special category which is most likely to transmit infection and produce serious consequences should transmission occur. The recommendation is that they should be excluded from nurseries or schools until at least three consecutive negative stool cultures are obtained, with two-day intervals between specimens. The memorandum of the Department of Health and Social Security4 is a little less demanding and allows the medical officer for environmental health some discretion, depending on the age of the child and the hygiene standards of the school. Nevertheless, children in nursery schools are considered to be especially vulnerable, and the memorandum suggests that such children may require exclusion until cultures of three consecutive stool specimens are negative. Aserkoff, S, and Bennett, J V, New England J3ournal of Medicine, 1969, 281, 636. Dixon, J M S, British Medical Journal, 1965, 2, 1343. 3 Society of Medical Officers of Health and the Public Health Laboratory Service, Public Health, 1970, 84, 197. 4 Department of Health and Social Security and the Welsh Office, Control of Communicable Disease in Schools. London, DHSS, 1977. 2
MEDICOLEGAL Apology to Prison Medical Service doctors [FROM OUR LEGAL CORRESPONDENT]
In the High Court the BBC and Dr John Anthony Whitehead, a consultant psychiatrist employed by the Brighton Health District, have apologised to two doctors in the Prison Medical Service on the Isle of Wight for allegations by Dr Whitehead that there was a systematic policy of drugging prisoners for non-therapeutic reasons. The BBC and
Dr Whitehead have also agreed to pay the two doctors, Dr Brian David Cooper and Dr Andrew James Todd, substantial damages and their legal costs. The action had been brought with the help of the Medical Defence Union. Dr Cooper is the principal medical officer to the prisons on the Isle of Wight (which include Albany Prison) and the psychiatrist in charge. Together with Dr Todd, Dr Cooper is responsible for the prescription of drugs to the inmates at Albany. Counsel for the plaintiffs told Mr Justice Milmo that on 17 February 1978, in the course of an interview on the BBC television programme "South Today," Dr Whitehead had alleged that prisoners in British jails were being drugged in order to control them, and that consequently in some cases inmates had become drug addicts. Dr Whitehead specifically referred to Albany Prison and said that it had been claimed that 70% of the prisoners were taking drugs not for therapeutic reasons but as a method of control. Counsel said that, in introducing the programme, a BBC announcer had stated that it had been alleged that at Albany Prison as many as 70% of the inmates were being prescribed Largactil, a drug which (it was alleged on the programme) could cause liver damage and even death. The judge was told by the plaintiffs' counsel that the serious allegations made by the defendants contained no truth whatsoever, and that all the defendants now accepted that drugs were used by the plaintiffs only for therapeutic reasons. On the day of the broadcast, counsel said, only 11 out of the 275 prisoners at Albany were being prescribed psychotropic drugs, and of these prisoners a number were epileptics. Only two inmates were being prescribed Largactil, and in each case the doses were within normal limits. Counsel stated that, though the plaintiffs were not named in the broadcast, the allegations were naturally widely understood as referring to them. The reaction of the prisoners, he added, some of whom had seen the broadcast, had caused the plaintiffs the greatest possible distress and embarrassment and had gravely damaged the excellent relationship which had previously existed between the plaintiffs and those in their charge. Counsel concluded by saying that, since the defendants accepted the entire falsity of their allegations and had now undertaken to pay each of the plaintiffs a substantial sum in damages and their legal costs, Dr Cooper and Dr Todd, whose only concern had been to clear their names, were content to let the matter rest. Counsel for Dr Whitehead and the BBC told Mr Justice Milmo that the defendants acknowledged that there was no truth whatever in the serious allegations made on "South Today." He added: "They also accept that there is no systematic policy of using drugs for the control of prisoners, and that the prescribing of drugs by the plaintiffs is in the best interests of their patients."
510
BRITISH MEDICAL JOURNAL
MEDICAL NEWS
discomfort and sometimes worse which nonsmokers have to suffer because other people smoke." Last year the Scottish Home and Health Department issued guidelines to the Health Service in Scotland for discouraging smoking in health service premises. In his letter Mr Millan suggests on grounds of hygiene a total ban on smoking in places such as food shops and supermarkets. Where smoking causes discomfort to others in a confined space-in other shops, for example, in places of entertainment, and in public offices -he would like more areas to be reserved for non-smokers if a total ban cannot be implemented. For places where food and drink are served he recommends segregation of smokers and non-smokers, and for public transport suggests that smoking areas are needed only on long journeys.
New aspirin trial
Doctors who took part in Sir Richard Doll's study of the effects of smoking are again being asked to take part in a trial, this time on the prophylactic effects of aspirin on myocardial infarction. Though several studies have shown the value of aspirin in coronary thrombosis, none have examined its effects in people without heart disease. Sir Richard Doll has written to 20 000 doctors asking them to participate, and he hopes to recruit 6000: 4000 would be randomly allocated to take aspirin daily for three to six years. The entire group will then be followed up for signs of ischaemic heart disease. The study will be financed partly by contributions from manufacturers and will be co-ordinated by the Tougher controls on drug advertising Aspirin Foundation. New controls on the content and form of advertisements for medicines prescribed under the National Health Service are planned for New medical dean for University of 1 December. They are contained in draft Ibadan regulations (published last week after wideProfessor E 0 Akande has been elected spread consultations), to which the Oppodean of the faculty of medicine, University sition, however, has objected. The controls of Ibadan, in suc- would help to ensure that advertisements cession to Profes- aimed at doctors and dentists give complete E 0 Osuntoand accurate information, including contrakun. Professor indications, warnings, and precautions, with references to major side effects. Misleading Akande, who is 40, received his graphs and tables and unqualified use of the early education at word "safe" would be prohibited. Under Christ regulations, advertisements that School, separate Ado-Ekiti, and could lead to the use of an over-the-counter medicine for diseases and conditions unsuitCollege, King's Lagos. He entered able for self-diagnosis and self-treatment were the Ibadan Medibanned on 1 August. cal School in 1959 sor
and
was
a
Lever-
visiting
Campaign by London Ambulance Service
scholar at University College Hospital, London, in 1964. He obtained the MB, BS degree of the University of London in 1964 and after preregistration posts in Ibadan worked in several hospitals in the UK, including Hammersmith Hospital and the Radcliffe Infirmary. Professor Akande took the MRCOG in 1969; and after spending two years as an Oxford Trust Fund research fellow at Brasenose College, Oxford, working on thyroid dysfunction and menstrual disturbances, he obtained a DPhil in 1972. He was appointed professor of obstetrics and gynaecology at Ibadan in October 1975. His special interest is in reproductive endocrinology and he is a member of the steering committee of the WHO task force on long-acting systemic agents for the regulation of fertility.
The number of emergency journeys made by the London Ambulance Service rose from 428 942 in 1975 to 447 330 in 1977, while the number of non-urgent journeys rose from 2 319 416 to 2 531 105. This increase occurred without a corresponding improvement in manpower, and the service is now unable to meet all the (non-urgent) demands made on it. It has therefore launched a campaign to persuade patients to avoid delay and wasted journeys. Leaflets are being distributed to outpatient departments asking non-urgent users to be ready for the ambulance when it calls for them, to inform the hospital in good time if they cannot keep an appointment, and not to wander off while waiting for an ambulance to take them home.
Smoking in public places
COMING EVENTS
A plea for further restrictions on smoking in public places has been made by Mr Bruce Millan, MP, Secretary of State for Scotland. In a letter to leading organisations in public transport, entertainment, and catering and retail trades in Scotland Mr Millan points out that adult smokers are now in the minority, and that a recent survey showed 67% of smokers to favour more restrictions on smoking in public. "I want to encourage this trend," he writes, "in order to reduce the pressure on young people to start smoking, to make it easier for smokers to stop, and to reduce the
Society for the Study of Addiction-Conference on "Alcohol problems in industry," 22 September, Glasgow. Details from the Society for the Study of Addiction, 3 Grosvenor Crescent, London SWIX 7EL. Glasgow University Club-Annual dinner, 24 October, London. Details from Dr D M Mackay, Ross Institute of Tropical Hygiene, Keppel St, London WC1E 7HT. (Tel 01-636 8636.) Disabled Living Foundation-Seminar on "The elderly person with failing vision," 28 November, Portsmouth. Details from Mr P Fenton's secretary, Eye Department, Queen Alexandra Hospital, Cosham, Portsmouth. (Tel 01-602 2491.) First International Congress on Cardiovascular Diseases and 14th Annual Scientific Assembly of the American Society of Contemporary Medicine and Surgery-14-19 January, Las Vegas. Details from Dr R W Howard, CME Director, American
hulme
12
AUGUST
1978
Instructions to authors The following are the minimum requirements for manuscripts submitted for publication.
(1) Typing should be on one side of the paper, with double or triple spacing between the lines and 5-cm margins at the top and left-hand side of the sheet. (2) Two copies (or preferably three) should be submitted. (3) Spelling should conform to that of Chambers Twentieth Century Dictionary. (4) References must be set out in the style used in the BM7, and their accuracy verified before the manuscript is submitted. (5) SI units are used for scientific measurements. In the text they should be followed by traditional units in parentheses. In tables and illustrations values are given only in SI units, but a conversion factor must be supplied. For general guidance on the International System of Units, and some useful conversion factors, see The SI for the Health Professions (WHO, 1977). (6) Authors should give their names and initials, their current appointments, and not more than two degrees or diplomas. Each author must sign the covering letter as evidence of consent to publication. (7) Acknowledgments will not be sent unless a stamped addressed envelope or an international reply coupon is enclosed. (8) Detailed instructions are given in the BMJ dated 7 January (p 6). Society of Contemporary Medicine and Surgery, 6 North Michigan Avenue, Chicago, Illinois 60602, USA. Thermal characteristics of tumours: applications in detection and treatment-Conference 14-16 -March 1979, New York. Details from the Conference Department, New York State Academy of Sciences, 2 East 63 Street, New York, New York 10021. (Tel 212
838-0230.) Symposium on Infarct Size-9-10 April 1979, Utrecht. Details from Prof Dr F L Meyler, Department of Cardiology, University Hospital, Catharijnesingel 101, 3500 CG Utrecht, Netherlands. British Council-Course 925, "Information sources on pollution," 13-25 May 1979, Loughborough; Course 931, "Perinatal paediatrics," 10-22 June, London; Course 938, "Neonatal surgery," 24 June-6 July, London. Details from the British Council, Courses Department, 65 Davies Street, London W1Y 2AA. (Tel 01-499 8011.) Ultrasonics International 79-Conference, 15-18 May 1979, Graz, Austria. Details from Dr Z Novak, Conference Organiser, Ultrasonics International 79, IPC House, 32 High Street, Guildford, Surrey GUl 3EW, England. Italian Group for Mass Spectrometry in Biochemistry and Medicine-10th International Symposium on Chromatography and Electrophoresis, 21-23 May 1979, Rimini, and 6th International Symposium on Mass Spectrometry in Biochemistry and Medicine, 20-22 June 1979, Venice. Details from the Italian Group for Mass Spectrometry in Biochemistry and Medicine, Istituto di Ricerche Farmacologiche "Mario Negri," Via Eritrea 62, 20157 Milano, Italy. (Tel 35 54 546.) Czechoslovak Medical Society-Details of medical congresses and symposia with international participation in 1979 are now available from the Czechoslovak Medical Society, 120 26 Praha 2, Sokolska 31, Czechoslovakia.
(D British Medical Journal 1978 All Rights Reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior permission of the British Medical Journal.
12 AUGUST 1978
509
NEWS AND NOTES EPIDEMIOLOGY Persistent excretion of salmonellas The following notes are compiled by the Communicable Disease Surveillance Centre (Public Health Laboratory Service) and the Communicable Diseases (Scotland) Unit from reports submitted by microbiologists, community physicians, and environmental health officers. A strain of salmonella was isolated from the skin of a newborn infant with sore buttocks. Within 24 hours of taking the swab three of the 31 other newborn infants in the ward, which was in a hospital obstetric unit, developed loose stools and the same salmonella (Salmonella agona) was isolated from each. On further investigation, two infants, four mothers, and one member of the staff on the ward were found to be symptomless excreters of the same organism. Although none of the children was seriously ill as a result of the infection, they were kept in hospital until free from symptoms; the other infected infants and mothers were discharged; and the ward was closed to admissions until disinfection had been completed. None of the infants was treated with an antibiotic. The member of staff found to be a carrier was excluded from work. The infected infants were followed up in the community after discharge and three further excreters, two from one family, were found among members of their families. The cause of the outbreak could not be determined accurately. The only relevant history, before the mothers' admission to hospital for confinement, came from the father of one of the infants. He had had gastroenteritis, but no intestinal pathogens were isolated from him or any other family member during the follow-up. Thus the infection was probably introduced into the unit by the mother of one of the two infants in whose families a symptomless excreter was detected. Several of the infected persons carried salmonellas for prolonged periods. Initially, specimens were obtained from each identified case or carrier at weekly intervals but, after five months' regular testing, the interval was extended to a month. When the first negative result was obtained further specimens were submitted, with at least a 48-hour interval. No one was considered to be free from infection until three consecutive negative specimens had been obtained. Two of the infants with symptoms initially were still excreting the organism 21 months after the outbreak, while the other two affected infants were not declared free of the infection until three months and nine months after onset. The two symptomless infants were free from salmonellas after seven months and ten months. Of the four mothers found to be carriers, one became free of
infection after two months, two after four months, and the fourth after 11 months. Fortunately the member of staff found to be a carrier was clear after four weeks, when she was allowed to return to her duties. Of the carriers detected among other members of the families, stool cultures from the father of one of the infants became negative after only one month but it took four months before the other two were cleared. If neonates are infected with salmonellas they commonly become persistent excreters, and not unusually this excretion persists for over a year, often until an adult diet is given.1 2 Antibacterial agents are contraindicated: indeed, they even lengthen the period of excretion of the salmonellas.' 2 There are guidelines for the management of the infant or child who becomes a persistent salmonella excreter. The Society of Medical Officers of Health and the Public Health Laboratory Service3 considered infants and children of nursery school age to belong to the special category which is most likely to transmit infection and produce serious consequences should transmission occur. The recommendation is that they should be excluded from nurseries or schools until at least three consecutive negative stool cultures are obtained, with two-day intervals between specimens. The memorandum of the Department of Health and Social Security4 is a little less demanding and allows the medical officer for environmental health some discretion, depending on the age of the child and the hygiene standards of the school. Nevertheless, children in nursery schools are considered to be especially vulnerable, and the memorandum suggests that such children may require exclusion until cultures of three consecutive stool specimens are negative. Aserkoff, S, and Bennett, J V, New England J3ournal of Medicine, 1969, 281, 636. Dixon, J M S, British Medical Journal, 1965, 2, 1343. 3 Society of Medical Officers of Health and the Public Health Laboratory Service, Public Health, 1970, 84, 197. 4 Department of Health and Social Security and the Welsh Office, Control of Communicable Disease in Schools. London, DHSS, 1977. 2
MEDICOLEGAL Apology to Prison Medical Service doctors [FROM OUR LEGAL CORRESPONDENT]
In the High Court the BBC and Dr John Anthony Whitehead, a consultant psychiatrist employed by the Brighton Health District, have apologised to two doctors in the Prison Medical Service on the Isle of Wight for allegations by Dr Whitehead that there was a systematic policy of drugging prisoners for non-therapeutic reasons. The BBC and
Dr Whitehead have also agreed to pay the two doctors, Dr Brian David Cooper and Dr Andrew James Todd, substantial damages and their legal costs. The action had been brought with the help of the Medical Defence Union. Dr Cooper is the principal medical officer to the prisons on the Isle of Wight (which include Albany Prison) and the psychiatrist in charge. Together with Dr Todd, Dr Cooper is responsible for the prescription of drugs to the inmates at Albany. Counsel for the plaintiffs told Mr Justice Milmo that on 17 February 1978, in the course of an interview on the BBC television programme "South Today," Dr Whitehead had alleged that prisoners in British jails were being drugged in order to control them, and that consequently in some cases inmates had become drug addicts. Dr Whitehead specifically referred to Albany Prison and said that it had been claimed that 70% of the prisoners were taking drugs not for therapeutic reasons but as a method of control. Counsel said that, in introducing the programme, a BBC announcer had stated that it had been alleged that at Albany Prison as many as 70% of the inmates were being prescribed Largactil, a drug which (it was alleged on the programme) could cause liver damage and even death. The judge was told by the plaintiffs' counsel that the serious allegations made by the defendants contained no truth whatsoever, and that all the defendants now accepted that drugs were used by the plaintiffs only for therapeutic reasons. On the day of the broadcast, counsel said, only 11 out of the 275 prisoners at Albany were being prescribed psychotropic drugs, and of these prisoners a number were epileptics. Only two inmates were being prescribed Largactil, and in each case the doses were within normal limits. Counsel stated that, though the plaintiffs were not named in the broadcast, the allegations were naturally widely understood as referring to them. The reaction of the prisoners, he added, some of whom had seen the broadcast, had caused the plaintiffs the greatest possible distress and embarrassment and had gravely damaged the excellent relationship which had previously existed between the plaintiffs and those in their charge. Counsel concluded by saying that, since the defendants accepted the entire falsity of their allegations and had now undertaken to pay each of the plaintiffs a substantial sum in damages and their legal costs, Dr Cooper and Dr Todd, whose only concern had been to clear their names, were content to let the matter rest. Counsel for Dr Whitehead and the BBC told Mr Justice Milmo that the defendants acknowledged that there was no truth whatever in the serious allegations made on "South Today." He added: "They also accept that there is no systematic policy of using drugs for the control of prisoners, and that the prescribing of drugs by the plaintiffs is in the best interests of their patients."
510
BRITISH MEDICAL JOURNAL
MEDICAL NEWS
discomfort and sometimes worse which nonsmokers have to suffer because other people smoke." Last year the Scottish Home and Health Department issued guidelines to the Health Service in Scotland for discouraging smoking in health service premises. In his letter Mr Millan suggests on grounds of hygiene a total ban on smoking in places such as food shops and supermarkets. Where smoking causes discomfort to others in a confined space-in other shops, for example, in places of entertainment, and in public offices -he would like more areas to be reserved for non-smokers if a total ban cannot be implemented. For places where food and drink are served he recommends segregation of smokers and non-smokers, and for public transport suggests that smoking areas are needed only on long journeys.
New aspirin trial
Doctors who took part in Sir Richard Doll's study of the effects of smoking are again being asked to take part in a trial, this time on the prophylactic effects of aspirin on myocardial infarction. Though several studies have shown the value of aspirin in coronary thrombosis, none have examined its effects in people without heart disease. Sir Richard Doll has written to 20 000 doctors asking them to participate, and he hopes to recruit 6000: 4000 would be randomly allocated to take aspirin daily for three to six years. The entire group will then be followed up for signs of ischaemic heart disease. The study will be financed partly by contributions from manufacturers and will be co-ordinated by the Tougher controls on drug advertising Aspirin Foundation. New controls on the content and form of advertisements for medicines prescribed under the National Health Service are planned for New medical dean for University of 1 December. They are contained in draft Ibadan regulations (published last week after wideProfessor E 0 Akande has been elected spread consultations), to which the Oppodean of the faculty of medicine, University sition, however, has objected. The controls of Ibadan, in suc- would help to ensure that advertisements cession to Profes- aimed at doctors and dentists give complete E 0 Osuntoand accurate information, including contrakun. Professor indications, warnings, and precautions, with references to major side effects. Misleading Akande, who is 40, received his graphs and tables and unqualified use of the early education at word "safe" would be prohibited. Under Christ regulations, advertisements that School, separate Ado-Ekiti, and could lead to the use of an over-the-counter medicine for diseases and conditions unsuitCollege, King's Lagos. He entered able for self-diagnosis and self-treatment were the Ibadan Medibanned on 1 August. cal School in 1959 sor
and
was
a
Lever-
visiting
Campaign by London Ambulance Service
scholar at University College Hospital, London, in 1964. He obtained the MB, BS degree of the University of London in 1964 and after preregistration posts in Ibadan worked in several hospitals in the UK, including Hammersmith Hospital and the Radcliffe Infirmary. Professor Akande took the MRCOG in 1969; and after spending two years as an Oxford Trust Fund research fellow at Brasenose College, Oxford, working on thyroid dysfunction and menstrual disturbances, he obtained a DPhil in 1972. He was appointed professor of obstetrics and gynaecology at Ibadan in October 1975. His special interest is in reproductive endocrinology and he is a member of the steering committee of the WHO task force on long-acting systemic agents for the regulation of fertility.
The number of emergency journeys made by the London Ambulance Service rose from 428 942 in 1975 to 447 330 in 1977, while the number of non-urgent journeys rose from 2 319 416 to 2 531 105. This increase occurred without a corresponding improvement in manpower, and the service is now unable to meet all the (non-urgent) demands made on it. It has therefore launched a campaign to persuade patients to avoid delay and wasted journeys. Leaflets are being distributed to outpatient departments asking non-urgent users to be ready for the ambulance when it calls for them, to inform the hospital in good time if they cannot keep an appointment, and not to wander off while waiting for an ambulance to take them home.
Smoking in public places
COMING EVENTS
A plea for further restrictions on smoking in public places has been made by Mr Bruce Millan, MP, Secretary of State for Scotland. In a letter to leading organisations in public transport, entertainment, and catering and retail trades in Scotland Mr Millan points out that adult smokers are now in the minority, and that a recent survey showed 67% of smokers to favour more restrictions on smoking in public. "I want to encourage this trend," he writes, "in order to reduce the pressure on young people to start smoking, to make it easier for smokers to stop, and to reduce the
Society for the Study of Addiction-Conference on "Alcohol problems in industry," 22 September, Glasgow. Details from the Society for the Study of Addiction, 3 Grosvenor Crescent, London SWIX 7EL. Glasgow University Club-Annual dinner, 24 October, London. Details from Dr D M Mackay, Ross Institute of Tropical Hygiene, Keppel St, London WC1E 7HT. (Tel 01-636 8636.) Disabled Living Foundation-Seminar on "The elderly person with failing vision," 28 November, Portsmouth. Details from Mr P Fenton's secretary, Eye Department, Queen Alexandra Hospital, Cosham, Portsmouth. (Tel 01-602 2491.) First International Congress on Cardiovascular Diseases and 14th Annual Scientific Assembly of the American Society of Contemporary Medicine and Surgery-14-19 January, Las Vegas. Details from Dr R W Howard, CME Director, American
hulme
12
AUGUST
1978
Instructions to authors The following are the minimum requirements for manuscripts submitted for publication.
(1) Typing should be on one side of the paper, with double or triple spacing between the lines and 5-cm margins at the top and left-hand side of the sheet. (2) Two copies (or preferably three) should be submitted. (3) Spelling should conform to that of Chambers Twentieth Century Dictionary. (4) References must be set out in the style used in the BM7, and their accuracy verified before the manuscript is submitted. (5) SI units are used for scientific measurements. In the text they should be followed by traditional units in parentheses. In tables and illustrations values are given only in SI units, but a conversion factor must be supplied. For general guidance on the International System of Units, and some useful conversion factors, see The SI for the Health Professions (WHO, 1977). (6) Authors should give their names and initials, their current appointments, and not more than two degrees or diplomas. Each author must sign the covering letter as evidence of consent to publication. (7) Acknowledgments will not be sent unless a stamped addressed envelope or an international reply coupon is enclosed. (8) Detailed instructions are given in the BMJ dated 7 January (p 6). Society of Contemporary Medicine and Surgery, 6 North Michigan Avenue, Chicago, Illinois 60602, USA. Thermal characteristics of tumours: applications in detection and treatment-Conference 14-16 -March 1979, New York. Details from the Conference Department, New York State Academy of Sciences, 2 East 63 Street, New York, New York 10021. (Tel 212
838-0230.) Symposium on Infarct Size-9-10 April 1979, Utrecht. Details from Prof Dr F L Meyler, Department of Cardiology, University Hospital, Catharijnesingel 101, 3500 CG Utrecht, Netherlands. British Council-Course 925, "Information sources on pollution," 13-25 May 1979, Loughborough; Course 931, "Perinatal paediatrics," 10-22 June, London; Course 938, "Neonatal surgery," 24 June-6 July, London. Details from the British Council, Courses Department, 65 Davies Street, London W1Y 2AA. (Tel 01-499 8011.) Ultrasonics International 79-Conference, 15-18 May 1979, Graz, Austria. Details from Dr Z Novak, Conference Organiser, Ultrasonics International 79, IPC House, 32 High Street, Guildford, Surrey GUl 3EW, England. Italian Group for Mass Spectrometry in Biochemistry and Medicine-10th International Symposium on Chromatography and Electrophoresis, 21-23 May 1979, Rimini, and 6th International Symposium on Mass Spectrometry in Biochemistry and Medicine, 20-22 June 1979, Venice. Details from the Italian Group for Mass Spectrometry in Biochemistry and Medicine, Istituto di Ricerche Farmacologiche "Mario Negri," Via Eritrea 62, 20157 Milano, Italy. (Tel 35 54 546.) Czechoslovak Medical Society-Details of medical congresses and symposia with international participation in 1979 are now available from the Czechoslovak Medical Society, 120 26 Praha 2, Sokolska 31, Czechoslovakia.
(D British Medical Journal 1978 All Rights Reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior permission of the British Medical Journal.
