746 area health authorities are facing financial difficulties in running their big district hospitals and are looking for savings by closing down their smaller hospitals. The long-term aim of the Department of Health and Social Security is for a national network of fully equipped district general hospitals complemented by smaller community hospitals. But the short-term structural changes, or "sensible rationalisation" as Ministers prefer to call it, are proving painful. Small hospitals are often regarded with great affection by local communities and the Government’s elaborate consultation procedure does little to lessen the outcry. Conservatives claim that the closures are now widespread, but that the reasons for this policy and the effect it will eventually have are not being made clear. Last year there were 74 hospital closure decisions, a further 16 decisions to close part of a hospital, and 14 other decisions involving closure of buildings such as health clinics. In the first six months of this year 19 hospital closure decisions were taken, but this should not necessarily be taken to mean that the final year’s figure will be lower than 1977. Dr Gerard Vaughan, Conservative spokesman on health, commented: "What I am afraid of is that having now recognised it is a mistake to have these big hospitals we are closing down the small ones in order to sustain the big ones. So we are going to end up with a lot of big hoswe pitals which we know are uneconomic to run shall do everything we can to slow down this process".
straints,
...
Declining Standards in the N.H.S. Mounting criticism from consultants about falling standards in the National Health Service has led the
Joint Consultants Committee to set up its own SOS scheme. The plan is that a complaining consultant will be able to call in a special panel of experts to investigate his protest. If his complaint is found to be justified the consultant would then have the backing of the committee in his approaches to the local health authority or the Government. The J.C.C., representative of the B.M.A. and the Royal Colleges, devised the scheme because of its concern at the growing number of consultants approaching it unofficially for help. Their difficulty was that they found themselves unable to do anything about the inadequate resources and staff shortages they were being asked to cope with. The committee decided it was not practical to try to set down minimum standards for hospitals. So instead it came up with the idea of supplying teams of experts from among its 34 members and others to investigate complaints, on the understanding that they would be sent in only as a last after a consultant had failed to convince his health authority that there was a risk to patients. The committee envisages having to deal with a range of difficulties: surgeons responsible for the overall care of patients after operations may complain that when their patients are returned to the wards there are not enough people to look after them because of a shortage of nurses; consultants may declare that there is not much point in putting patients on life-support systems if there is no-one there to monitor them; and hospitals or units may continue to be threatened with closure. The J.C.C. could appoint a small team to carry an out on-the-spot investigation. If the experts resort
with the consultant, and the J.C.C. gave their full backing, the hope is that such pressure its report would persuade the health authority or the Government to act. Architects of the scheme believe it would be very unwise for the D.H.S.S. or a health authority to ignore a consultant supported by the J.C.C. panel. But should this happen the committee has two weapons at its disposal. The first, which it says it would use, is to reduce the rate of hospital admissions by the particular consultant. The other course, which it is. considering, would be the "blacking" of posts by the Colleges. After spending the past few weeks preparing its scheme, the J.C.C. is now ready to go into action. What response it gets from consultants and what effect such pressure will have on the authorities remains to be seen.
agreed
Obituary DERRICK GRAHAM FFARINGTON EDWARD
Dr Edward’s working life was largely devoted to the development of vaccines against a wide range of viral diseases of man and animals and to the study of mycoplasmas. He died on Sept. 4. He qualified from St. Bartholomew’s Hospital, London, in 1934, and started his long association with the Wellcome Research Laboratories when, during the war, he was a member of the research team assembled at their laboratories at Frant to develop a scrub-typhus vaccine. He joined the Wellcome Foundation in 1948 and some years later he was given the task of creating a new department of virology at the Wellcome Research Laboratories, Beckenham. His efforts soon bore fruit in the production of Sabin-type oral poliomyelitis vaccine and a living attenuated vaccine against measles. There followed the development of a rubella vaccine manufactured in a diploid-cell line. His leadership, direction, and enthusiasm were responsible for successful research and development in veterinary virology, leading to the production of vaccines against a number of diseases of farm animals and domestic pets, including many poultry diseases. He later became head of biological research at the Laboratories. His own research was mainly devoted to a study of the
mycoplasmas,
or
"pleuropneumonia-like organisms"
as
they
called when he began this work. He became widely known through his publications on taxonomy, classification, were
nomenclature, propagation, and growth characteristics, and the significance of these organisms in various infections of man and animals. When he left the Wellcome Foundation in 1969 to join the Public Health Service, firstly at County Hall and subsequently at Dulwich, he was able to concentrate his efforts on his first love, the mycoplasmas. He became a world authority and his outstanding contributions were recognised by one of the first two awards of honorary membership of the International Organisation of Mycoplasmatology. He was a man of firm principles and completely dedicated to his work. His management was firm but kindly and he always showed great interest in the welfare of his staff. He suffered a series of illnesses during the past fifteen years, twice involving brain surgery, but in between these episodes he carried on with his work with continuous enthusiasm, showing remarkable courage and determination not to give way to
adversity.
A.J.B.
747 HENRY EDMUND SEILER M.D.
Glasg.,
F.R.C.P.E.
Notes and News
Seiler, former’medical officer of health for Edinburgh, died on Sept. 8 aged 79. Educated in Glasgow at the High School and the University, he qualified in medicine in 1921. Deciding on a career in the public-health service, he joined Glasgow Corporation Health Department where, from 1926 to 1939, he gained experience in all its branches. When working at a tuberculosis dispensary he reported a case which seemed to establish an unequivocal relationship between inhalation of asbestos dust and pulmonary fibrosis. This report precipitated Government action; and an inquiry was set up which led to the report on the effects of asbestos dust published in 1930. Later, when one of his duties Dr
to take charge of the administrative medical aspects of the Blind Persons Act, he carried out, with Dr John Marshall, an ophthalmologist, a statistical analysis of the causes of blindness in over 3000 certified blind persons in Glasgow and the south-west of Scotland. In 1939 he was appointed senior depute to Dr W. G. Clark, medical officer of health for Edinburgh, and he succeeded Clark in 1953. When the Scottish Hospitals Survey was commissioned in 1946 he was appointed one of the surveyors for the south-eastern region. In Edinburgh he prompted developments in many directions, notably in infectious-disease control, mental health, accident prevention, control of atmospheric pollution, and the coordination of voluntary and statutory agencies in health and welfare. He fostered closer and more cordial relations between the general practitioners of the city and his own department. Recognised internationally as a leader in community health, he was invited by the World Health Organisation to undertake a survey of the health services in a group of islands in the West Indies. He was appointed Queen’s honorary physician in 1959. Almost immediately after his retirement, he became honorary secretary of the newly formed Edinburgh ’committee for the coordination of services for the disabled. He is survived by two sons and a daughter., was
Sir ALEXANDER WILSON RAE, who died on Sept. 14, was chief medical officer to the Colonial Office in 1958-60. Much of his earlier career was spent in West Africa. Dr
George
Francis
Abercrombie, who died
on
Sept. 25,
was
President of the Royal College,of General Practitioners from 1959 to 1962.
Diary
of the Week
Monday,2nd ROYAL COLLEGE OF SURGEONS OF ENGLAND, 35/43 Lincoln’s Inn Fields, London WC2A3PN 6 P.M. Prof. J. P. Mitchell: Management of Trauma of the Urinary’Tract. S P.M (General Infirmary, Leeds.) Prof. I. L. Rosenberg: The Ætiology of Colomc Suture Line Recurrence. (Huntenan lecture.)
Tuesday,3rd ROYAL COLLEGE 6
P.m.
OF
SURGEONS
Mr 1. M. Hill:
Wednesday,
OF
ENGLAND
Management of the Patient with Thoracic Trauma.
4th
ROYAL COLLEGE
OF
PHYSICIANS
OF
LONDON, 11 St. Andrew’s Place, London
NW14LE
5.40
P.M.
Dr
ment.
J. P. M. Tizard: The Cerebral Palsies: Prevention and Treat(Crooman lecture.)
ROYAL COLLEGE OF SURGEONS
OF ENGLAND 5 P.M. Mr M. K. D. Benson: Hip Replacement. 6.15 P.M. Mr I. 1. Hill. Principles of Heart Surgery. INSTITUTE OF ORTHOPAEDICS, 234 Great Portland Street, London WIN 6AD 6 P.M. Mr Stephen Sedley On Giving Expert Evidence.
Thursday,
5th ROYAL COLLEGE OF SURGEONS 6
P.M.
OF ENGLAND Mr N. H. Harns: The Limping Child.
Friday,
6th ROYAL COLLEGE 6
P M.
OF SURGEONS OF ENGLAND Mr M. S. Owen-Smith: Bullet Wounds.
_
DRUG TESTING IN ANIMALS MORE and more tests are being done on drugs before they are marketed yet some nasty side-effects slip through the safety net. At a Royal Society of Medicine symposium held in April, 1977,’ Dr Ralph Heywood cited practolol, diethylstilbrestrol, and clioquinol as examples. Dr A. P. Fletcher gave an analysis of experience with forty-five drugs coming under the scrutiny of the Committee on Safety of Medicines, the animal data being supplied in applications for clinical trial certificates and the human experience being obtained in trials done in connection with product licences. Since data obtained after marketing do not seem to have been included-and this is the time when drug side-effects are often first recorded-it is difficult to be confident about the predictive power of the animal experiments. An animal given a drug dose designed to kill it may well convulse; and, at the other extreme, animals cannot report effects such as nausea, headache, or dizziness. All the same there were more correlations than discrepancies, and Fletcher reckons that "... for any individual drug up to 25% of the toxic effects observed in animal studies might be expected to occur as adverse reactions in man". One alarming discrepancy was hypotension with three drugs not thought to have that property. Fletcher suggests extending the study to two hundred compounds; it would also be interesting to see how drugs from the first forty-five have got on in the early years of marketing.
ALCOHOLISM A REPORT from the Advisory Committee on Alcoholism2 says that between 1955 and 1975 deaths from cirrhosis of the liver, per 100 000 of the British
population aged 15 and
over,
rose
4.8, admissions for treatment of alcoholism from 18-7to 35.5, and convictions for drunkenness offences
from 3.4
to
(excluding those related to motor vehicles) from 157 to 276. Half a million people in Britain have a "drinking problem" (a term which includes the pre-alcoholic stages of excessive drinking) and many are not getting the help they need. The Committee proposes the establishment of a well coordinated, flexible system of medical, social, and voluntary services. Treatment and care would be provided mainly by the primary health-care team, by social workers, and by voluntary agencies such as the Samaritans and local councils on alcoholism, with back-up from hospitals, alcoholism treatment units, and probation and aftercare services. In addition, a place or centre of activity should be available in each health-authority area to act as a focal point for information and treatment. Many of these proposals could be implemented within existing financial allocations, but the report warns that unless an effective preventive strategy can be found, drinking problems will take up more and more public money. Another body interested in prevention is ACCEPT, the Alcoholism Community Centre for Education Prevention and Treatment, whose annual report3 maintains that last year alcohol abuse cost Britain about ;350 million in "lost production"; this figure, says the centre, could be much reduced by early recognition, referral for treatment, and support upon return to work of employees troubled by 1. Jl R.
Soc. Med.
1978, 71, 675-696.
2. The Pattern and Range of Services for Problem Drinkers. Report by the Advisory Committee on Alcoholism. 3. ACCEPT. 2nd Annual Report 1977 Western Hospital, Seagrove Road, Lon-
don SW6
straints,
...
Declining Standards in the N.H.S. Mounting criticism from consultants about falling standards in the National Health Service has led the
Joint Consultants Committee to set up its own SOS scheme. The plan is that a complaining consultant will be able to call in a special panel of experts to investigate his protest. If his complaint is found to be justified the consultant would then have the backing of the committee in his approaches to the local health authority or the Government. The J.C.C., representative of the B.M.A. and the Royal Colleges, devised the scheme because of its concern at the growing number of consultants approaching it unofficially for help. Their difficulty was that they found themselves unable to do anything about the inadequate resources and staff shortages they were being asked to cope with. The committee decided it was not practical to try to set down minimum standards for hospitals. So instead it came up with the idea of supplying teams of experts from among its 34 members and others to investigate complaints, on the understanding that they would be sent in only as a last after a consultant had failed to convince his health authority that there was a risk to patients. The committee envisages having to deal with a range of difficulties: surgeons responsible for the overall care of patients after operations may complain that when their patients are returned to the wards there are not enough people to look after them because of a shortage of nurses; consultants may declare that there is not much point in putting patients on life-support systems if there is no-one there to monitor them; and hospitals or units may continue to be threatened with closure. The J.C.C. could appoint a small team to carry an out on-the-spot investigation. If the experts resort
with the consultant, and the J.C.C. gave their full backing, the hope is that such pressure its report would persuade the health authority or the Government to act. Architects of the scheme believe it would be very unwise for the D.H.S.S. or a health authority to ignore a consultant supported by the J.C.C. panel. But should this happen the committee has two weapons at its disposal. The first, which it says it would use, is to reduce the rate of hospital admissions by the particular consultant. The other course, which it is. considering, would be the "blacking" of posts by the Colleges. After spending the past few weeks preparing its scheme, the J.C.C. is now ready to go into action. What response it gets from consultants and what effect such pressure will have on the authorities remains to be seen.
agreed
Obituary DERRICK GRAHAM FFARINGTON EDWARD
Dr Edward’s working life was largely devoted to the development of vaccines against a wide range of viral diseases of man and animals and to the study of mycoplasmas. He died on Sept. 4. He qualified from St. Bartholomew’s Hospital, London, in 1934, and started his long association with the Wellcome Research Laboratories when, during the war, he was a member of the research team assembled at their laboratories at Frant to develop a scrub-typhus vaccine. He joined the Wellcome Foundation in 1948 and some years later he was given the task of creating a new department of virology at the Wellcome Research Laboratories, Beckenham. His efforts soon bore fruit in the production of Sabin-type oral poliomyelitis vaccine and a living attenuated vaccine against measles. There followed the development of a rubella vaccine manufactured in a diploid-cell line. His leadership, direction, and enthusiasm were responsible for successful research and development in veterinary virology, leading to the production of vaccines against a number of diseases of farm animals and domestic pets, including many poultry diseases. He later became head of biological research at the Laboratories. His own research was mainly devoted to a study of the
mycoplasmas,
or
"pleuropneumonia-like organisms"
as
they
called when he began this work. He became widely known through his publications on taxonomy, classification, were
nomenclature, propagation, and growth characteristics, and the significance of these organisms in various infections of man and animals. When he left the Wellcome Foundation in 1969 to join the Public Health Service, firstly at County Hall and subsequently at Dulwich, he was able to concentrate his efforts on his first love, the mycoplasmas. He became a world authority and his outstanding contributions were recognised by one of the first two awards of honorary membership of the International Organisation of Mycoplasmatology. He was a man of firm principles and completely dedicated to his work. His management was firm but kindly and he always showed great interest in the welfare of his staff. He suffered a series of illnesses during the past fifteen years, twice involving brain surgery, but in between these episodes he carried on with his work with continuous enthusiasm, showing remarkable courage and determination not to give way to
adversity.
A.J.B.
747 HENRY EDMUND SEILER M.D.
Glasg.,
F.R.C.P.E.
Notes and News
Seiler, former’medical officer of health for Edinburgh, died on Sept. 8 aged 79. Educated in Glasgow at the High School and the University, he qualified in medicine in 1921. Deciding on a career in the public-health service, he joined Glasgow Corporation Health Department where, from 1926 to 1939, he gained experience in all its branches. When working at a tuberculosis dispensary he reported a case which seemed to establish an unequivocal relationship between inhalation of asbestos dust and pulmonary fibrosis. This report precipitated Government action; and an inquiry was set up which led to the report on the effects of asbestos dust published in 1930. Later, when one of his duties Dr
to take charge of the administrative medical aspects of the Blind Persons Act, he carried out, with Dr John Marshall, an ophthalmologist, a statistical analysis of the causes of blindness in over 3000 certified blind persons in Glasgow and the south-west of Scotland. In 1939 he was appointed senior depute to Dr W. G. Clark, medical officer of health for Edinburgh, and he succeeded Clark in 1953. When the Scottish Hospitals Survey was commissioned in 1946 he was appointed one of the surveyors for the south-eastern region. In Edinburgh he prompted developments in many directions, notably in infectious-disease control, mental health, accident prevention, control of atmospheric pollution, and the coordination of voluntary and statutory agencies in health and welfare. He fostered closer and more cordial relations between the general practitioners of the city and his own department. Recognised internationally as a leader in community health, he was invited by the World Health Organisation to undertake a survey of the health services in a group of islands in the West Indies. He was appointed Queen’s honorary physician in 1959. Almost immediately after his retirement, he became honorary secretary of the newly formed Edinburgh ’committee for the coordination of services for the disabled. He is survived by two sons and a daughter., was
Sir ALEXANDER WILSON RAE, who died on Sept. 14, was chief medical officer to the Colonial Office in 1958-60. Much of his earlier career was spent in West Africa. Dr
George
Francis
Abercrombie, who died
on
Sept. 25,
was
President of the Royal College,of General Practitioners from 1959 to 1962.
Diary
of the Week
Monday,2nd ROYAL COLLEGE OF SURGEONS OF ENGLAND, 35/43 Lincoln’s Inn Fields, London WC2A3PN 6 P.M. Prof. J. P. Mitchell: Management of Trauma of the Urinary’Tract. S P.M (General Infirmary, Leeds.) Prof. I. L. Rosenberg: The Ætiology of Colomc Suture Line Recurrence. (Huntenan lecture.)
Tuesday,3rd ROYAL COLLEGE 6
P.m.
OF
SURGEONS
Mr 1. M. Hill:
Wednesday,
OF
ENGLAND
Management of the Patient with Thoracic Trauma.
4th
ROYAL COLLEGE
OF
PHYSICIANS
OF
LONDON, 11 St. Andrew’s Place, London
NW14LE
5.40
P.M.
Dr
ment.
J. P. M. Tizard: The Cerebral Palsies: Prevention and Treat(Crooman lecture.)
ROYAL COLLEGE OF SURGEONS
OF ENGLAND 5 P.M. Mr M. K. D. Benson: Hip Replacement. 6.15 P.M. Mr I. 1. Hill. Principles of Heart Surgery. INSTITUTE OF ORTHOPAEDICS, 234 Great Portland Street, London WIN 6AD 6 P.M. Mr Stephen Sedley On Giving Expert Evidence.
Thursday,
5th ROYAL COLLEGE OF SURGEONS 6
P.M.
OF ENGLAND Mr N. H. Harns: The Limping Child.
Friday,
6th ROYAL COLLEGE 6
P M.
OF SURGEONS OF ENGLAND Mr M. S. Owen-Smith: Bullet Wounds.
_
DRUG TESTING IN ANIMALS MORE and more tests are being done on drugs before they are marketed yet some nasty side-effects slip through the safety net. At a Royal Society of Medicine symposium held in April, 1977,’ Dr Ralph Heywood cited practolol, diethylstilbrestrol, and clioquinol as examples. Dr A. P. Fletcher gave an analysis of experience with forty-five drugs coming under the scrutiny of the Committee on Safety of Medicines, the animal data being supplied in applications for clinical trial certificates and the human experience being obtained in trials done in connection with product licences. Since data obtained after marketing do not seem to have been included-and this is the time when drug side-effects are often first recorded-it is difficult to be confident about the predictive power of the animal experiments. An animal given a drug dose designed to kill it may well convulse; and, at the other extreme, animals cannot report effects such as nausea, headache, or dizziness. All the same there were more correlations than discrepancies, and Fletcher reckons that "... for any individual drug up to 25% of the toxic effects observed in animal studies might be expected to occur as adverse reactions in man". One alarming discrepancy was hypotension with three drugs not thought to have that property. Fletcher suggests extending the study to two hundred compounds; it would also be interesting to see how drugs from the first forty-five have got on in the early years of marketing.
ALCOHOLISM A REPORT from the Advisory Committee on Alcoholism2 says that between 1955 and 1975 deaths from cirrhosis of the liver, per 100 000 of the British
population aged 15 and
over,
rose
4.8, admissions for treatment of alcoholism from 18-7to 35.5, and convictions for drunkenness offences
from 3.4
to
(excluding those related to motor vehicles) from 157 to 276. Half a million people in Britain have a "drinking problem" (a term which includes the pre-alcoholic stages of excessive drinking) and many are not getting the help they need. The Committee proposes the establishment of a well coordinated, flexible system of medical, social, and voluntary services. Treatment and care would be provided mainly by the primary health-care team, by social workers, and by voluntary agencies such as the Samaritans and local councils on alcoholism, with back-up from hospitals, alcoholism treatment units, and probation and aftercare services. In addition, a place or centre of activity should be available in each health-authority area to act as a focal point for information and treatment. Many of these proposals could be implemented within existing financial allocations, but the report warns that unless an effective preventive strategy can be found, drinking problems will take up more and more public money. Another body interested in prevention is ACCEPT, the Alcoholism Community Centre for Education Prevention and Treatment, whose annual report3 maintains that last year alcohol abuse cost Britain about ;350 million in "lost production"; this figure, says the centre, could be much reduced by early recognition, referral for treatment, and support upon return to work of employees troubled by 1. Jl R.
Soc. Med.
1978, 71, 675-696.
2. The Pattern and Range of Services for Problem Drinkers. Report by the Advisory Committee on Alcoholism. 3. ACCEPT. 2nd Annual Report 1977 Western Hospital, Seagrove Road, Lon-
don SW6
