1285 antimicrobials will prevent bacterial contamination of as Galland et al. claim; this depends on surgical technique, without doubt the single most important factor in the prevention of wound infection.
topical a
wound,
Professorial Surgical Unit, St Bartholomew’s Hospital, London EC1A 7BE
O. J. A. GILMORE
BLOOD-GROUP A AND GIARDIASIS
SIR,—Barnes and Kayl found
association between Giardia lamblia infestation and blood-group A. In Recife, Brazil, I studied 201 children between the ages of 4 months and 14 years, with different gastrointestinal complaints, attending outpatient clinics. Each child was examined clinically, the stool was examined microscopically, the blood-group (ABO) was determined. The ABO blood-groups of these patients were compared with those of 7938 newborn babies from the same city. Both patients and controls belonged to the lower social class of the population and had the same racial background. 186 of 201 patients had parasites in their stools and of these, 55 (27%) had G. lamblia infestation: an
Put beside the letter from the D.H.S.S. to Mr Choyce, it pretty clear that a situation could arise where patients from other member States of the E.E.C. receive free N.H.S. treatment in the U.K. whereas patients from the U.K. have to be paid for if they receive treatment elsewhere in the E.E.C. Although it seems unlikely that there will be a rush to N.H.S. hospitals from the Continent, the possibility that there is an inequity here is one which the European Conservative Group will now explore by questioning the E.E.C. Commission and the Council in the European Parliament. seems
European Conservative Group, European Parliament, 1000 Brussels, Belgium Secretariat member
CAROLINE JACKSON, responsible for Social Affairs
COMMUNITY HEALTH CARE
SIR,—You suggest (Nov. 26, p. 1114) that "demystification of medical
technology and its attendant jargon, thus allowing ordinary people into the inner shrines ..." would enable community representatives to take part rationally in local decisions to allocate resources for health care. This is a laudable objective which many would welcome. A less gratifying tendency expressed unconsciously by the writer of your editorial is the substitution of management or social-science jargon for medical jargon. I cannot understand the term "allowable amounts of discretionary space", and I cannot readily overcome my ignorance because the reference given is inaccessible.
blood-group distribution in these 55 children was significantly different from that of the control population, giardiasis being associated with an increased frequency of blood-group A and a decreased frequency of group 0 (see table). The
Department of Clinical Chemistry, Northwick Park Hospital and Clinical Research Centre, Harrow, Middlesex HA1 3UJ
These results thus confirm the conclusion that G. lamblia infestation is associated with particular ABO blood-groups. Disciplina de Puericultura & Neonatologia, Universidade Federal de Pernambuco, Recife, Brazil *Present address: OX13 9DU.
Department
of
MERALDO ZISMAN*
Pædiatrics, John
Radcliffe
Hospital, Oxford
NON-EMERGENCY N.H.S. TREATMENT FOR OTHER E.E.C. CITIZENS
SIR,-The Times (Oct. 22) draws attention to the point raised by Mr Choyce (Oct. 22, p. 870)-namely, the possibility that doctors in any country in the European Economic Community may refer a patient for free N.H.S. treatment in the U.K. Since this question might come up during any campaign preceding direct elections to the European Parliament I suggested that Mr Ralph Howell, M.P., a member of the European Conservative Group in the European Parliament, should ask the Secretary of State for Social Services the following question : "In view of the fact that doctors in any Member State of the EEC may refer a patient for free National Health Service treatment in the United Kingdom, in which Member States can United Kingdom nationals expect reciprocal facilities?"
In reply, Mr said that:
Moyle,
the Minister of State
at
the D.H.S.S.,
L., Kay, R. Lancet, 1977, i,
TESTING OF INDUSTRIAL CHEMICALS
SIR,—Dr McLean’s article (Nov. 19, p. 1070) was timely and interesting, but misleading in certain respects. The part of his message which deserves attention from all in a position to influence events is that concerned with the shortage of "thoughtful" toxicologists who are needed to evaluate the data derived from tests on biological systems. There is a shortage worldwide at a time when most industrial nations are striving to establish controls over the potential impact of chemicals on man and the natural environment. McLean’s statement that the notification scheme proposed by the Health and Safety Commission takes no account of consumer or environment is not true. The consumers of a great number of new chemicals are the firms who utilise them in their own processes. Surely also the greater knowledge of the toxic properties of new substances which will flow from notifications under the scheme will be of immense benefit in judging potential impact on anyone or indeed on the environment. His low regard for the H.S.C. scheme as value for money seems to be based on a misunderstanding of the proposals. The package of tests described in the discussion document is the initial screen, to be followed, as determined by the advice of a working group of experts, by such further testing as may be necessary to identify and evaluate hazards, in much the same way that the Pesticides Safety Precautions Scheme operates. The ultimate costs in individual cases may well be comparable. Nowhere do the
advocate secrecy, but certain must surely be respected, under the pesticides, drugs, and food additives
proposals
aspects of commercial confidentiality
"The EEC Social Security Regulations provide that a designated health authority of a Member State can refer its nationals for appropriate treatment by the health authorities in any other Member State. The authority in the sending country must bear the cost. In the United Kingdom this authority is the appropriate health department". (Hansard, Nov. 22, 1977, written answers, col. 672). 1. Barnes, G.
M. G. RINSLER
808.
as
they
are
schemes. Assessment of risk and control of hazards are matters which are routinely dealt with by inspectorates under the Health and Safety at Work Act 1974 and related legislation, and the data from the proposed scheme will enable this to be done much more reliably and effectively. Of course, human epidemiology is the ultimate means of verification and necessary. This, how-
topical a
wound,
Professorial Surgical Unit, St Bartholomew’s Hospital, London EC1A 7BE
O. J. A. GILMORE
BLOOD-GROUP A AND GIARDIASIS
SIR,—Barnes and Kayl found
association between Giardia lamblia infestation and blood-group A. In Recife, Brazil, I studied 201 children between the ages of 4 months and 14 years, with different gastrointestinal complaints, attending outpatient clinics. Each child was examined clinically, the stool was examined microscopically, the blood-group (ABO) was determined. The ABO blood-groups of these patients were compared with those of 7938 newborn babies from the same city. Both patients and controls belonged to the lower social class of the population and had the same racial background. 186 of 201 patients had parasites in their stools and of these, 55 (27%) had G. lamblia infestation: an
Put beside the letter from the D.H.S.S. to Mr Choyce, it pretty clear that a situation could arise where patients from other member States of the E.E.C. receive free N.H.S. treatment in the U.K. whereas patients from the U.K. have to be paid for if they receive treatment elsewhere in the E.E.C. Although it seems unlikely that there will be a rush to N.H.S. hospitals from the Continent, the possibility that there is an inequity here is one which the European Conservative Group will now explore by questioning the E.E.C. Commission and the Council in the European Parliament. seems
European Conservative Group, European Parliament, 1000 Brussels, Belgium Secretariat member
CAROLINE JACKSON, responsible for Social Affairs
COMMUNITY HEALTH CARE
SIR,—You suggest (Nov. 26, p. 1114) that "demystification of medical
technology and its attendant jargon, thus allowing ordinary people into the inner shrines ..." would enable community representatives to take part rationally in local decisions to allocate resources for health care. This is a laudable objective which many would welcome. A less gratifying tendency expressed unconsciously by the writer of your editorial is the substitution of management or social-science jargon for medical jargon. I cannot understand the term "allowable amounts of discretionary space", and I cannot readily overcome my ignorance because the reference given is inaccessible.
blood-group distribution in these 55 children was significantly different from that of the control population, giardiasis being associated with an increased frequency of blood-group A and a decreased frequency of group 0 (see table). The
Department of Clinical Chemistry, Northwick Park Hospital and Clinical Research Centre, Harrow, Middlesex HA1 3UJ
These results thus confirm the conclusion that G. lamblia infestation is associated with particular ABO blood-groups. Disciplina de Puericultura & Neonatologia, Universidade Federal de Pernambuco, Recife, Brazil *Present address: OX13 9DU.
Department
of
MERALDO ZISMAN*
Pædiatrics, John
Radcliffe
Hospital, Oxford
NON-EMERGENCY N.H.S. TREATMENT FOR OTHER E.E.C. CITIZENS
SIR,-The Times (Oct. 22) draws attention to the point raised by Mr Choyce (Oct. 22, p. 870)-namely, the possibility that doctors in any country in the European Economic Community may refer a patient for free N.H.S. treatment in the U.K. Since this question might come up during any campaign preceding direct elections to the European Parliament I suggested that Mr Ralph Howell, M.P., a member of the European Conservative Group in the European Parliament, should ask the Secretary of State for Social Services the following question : "In view of the fact that doctors in any Member State of the EEC may refer a patient for free National Health Service treatment in the United Kingdom, in which Member States can United Kingdom nationals expect reciprocal facilities?"
In reply, Mr said that:
Moyle,
the Minister of State
at
the D.H.S.S.,
L., Kay, R. Lancet, 1977, i,
TESTING OF INDUSTRIAL CHEMICALS
SIR,—Dr McLean’s article (Nov. 19, p. 1070) was timely and interesting, but misleading in certain respects. The part of his message which deserves attention from all in a position to influence events is that concerned with the shortage of "thoughtful" toxicologists who are needed to evaluate the data derived from tests on biological systems. There is a shortage worldwide at a time when most industrial nations are striving to establish controls over the potential impact of chemicals on man and the natural environment. McLean’s statement that the notification scheme proposed by the Health and Safety Commission takes no account of consumer or environment is not true. The consumers of a great number of new chemicals are the firms who utilise them in their own processes. Surely also the greater knowledge of the toxic properties of new substances which will flow from notifications under the scheme will be of immense benefit in judging potential impact on anyone or indeed on the environment. His low regard for the H.S.C. scheme as value for money seems to be based on a misunderstanding of the proposals. The package of tests described in the discussion document is the initial screen, to be followed, as determined by the advice of a working group of experts, by such further testing as may be necessary to identify and evaluate hazards, in much the same way that the Pesticides Safety Precautions Scheme operates. The ultimate costs in individual cases may well be comparable. Nowhere do the
advocate secrecy, but certain must surely be respected, under the pesticides, drugs, and food additives
proposals
aspects of commercial confidentiality
"The EEC Social Security Regulations provide that a designated health authority of a Member State can refer its nationals for appropriate treatment by the health authorities in any other Member State. The authority in the sending country must bear the cost. In the United Kingdom this authority is the appropriate health department". (Hansard, Nov. 22, 1977, written answers, col. 672). 1. Barnes, G.
M. G. RINSLER
808.
as
they
are
schemes. Assessment of risk and control of hazards are matters which are routinely dealt with by inspectorates under the Health and Safety at Work Act 1974 and related legislation, and the data from the proposed scheme will enable this to be done much more reliably and effectively. Of course, human epidemiology is the ultimate means of verification and necessary. This, how-
