1317 IDENTIFICATION OF A BODY THE Hampshire Constabulary (Incident Room, Police Station, Whitchurch, Hampshire) seeks help with the identification of a White female, aged 18-25, whose body was found at Ecchinswell, Hampshire on Sept. 29, 1975. The following
details may strike a chord in the memory of a doctor who has treated this woman. Height 62 in, weight about 120 Ib, appendicectomy scar of long standing, scar in shape of horizontal V on front of right leg, below the knee, small mole on outer aspect of left calf. There was an extensively pigmented area 2 in wide running down from above the right hip and tapering to a point towards the spine. It might have been visible after immersion in cold water, but cannot strictly be construed as a birthmark though it might have appeared as such after swimming or showering. Hard calluses at the base of the 3rd and 4th fingers of the right hand, right thumbnail shorter than normal, maybe representing new growth. Forensic examination revealed the following: blood-group A; traces of diazepam; remains of an enteric-coated bisacodyl tablet (’Dulcolax’) and mushroom, root vegetable, and uncooked, small-grained, cut wheat in stomach; small, pedunculated fibroid extruding from posterior surface of uterus.
Commentary from Westminster
under which pay-beds and facilities would be phased-out would be the availability of alternative facilities for private practice within a reasonable geographical distance. On this basis the Government calculates that there are 1000 pay-beds which could be phased-out without delay, and the Bill, when it is published, will specify these. "Without delay" in this context means within six months of the Bill’s Royal Assent, which in effect means early in 1977. Clearly the immediate phase-out would be in the big cities, and, with 1550 pay-beds in the four Thames Regional Health Authorities alone, the bulk would be in London and the south-east. The time scale for phasing-out the remaining 3000-plus pay-beds would be determined by the new board-and it is here that Labour M.p.s begin to get suspicious. For no indication is being given as to when the last pay-bed would disappear. Specific criteria would be written into the legislation to guide the board. It would state that there should be a reasonable demand for private medicine in the area of the country served by a particular hospital, that sufficient accommodation or facilities existed in the area for the reasonable operation of private medicine, and that all reasonable steps had been or were being taken to provide those alternative beds and facilities. In addition, where all reasonable steps were not being taken, that would be grounds in itself, after due warning, for withdrawing pay-beds and facilities in the hospitals con-
cerned.
Phasing-out
of
Pay-beds
FROM A CORRESPONDENT
THE Government compromise to end the dispute over pay-beds has left both sides of Parliament feeling slightly uneasy. Conservatives are unhappy because the Government refused to send the whole issue to the Royal Commission and because the commitment to phase-out pay-beds remains. Labour M.P.s are muttering angrily about a sell-out to the consultants and, seeing the familiar hand of Lord Goodman in the compromise, they are even more suspicious. But both sides privately agreed that Lord Goodman appeared to have got Mrs Barbara Castle, Secretary of State for Social Services, off an awkward hook. Twelve days after Lord Goodman’s surprise intervention in the dispute at the Prime Minister’s express invitation, Mrs Castle was able to unveil to M.p.s a detailed compromise which bore all the hallmarks of his mediation. At the heart of the proposals is the creation of an independent board which would be given the remit of phasing-out pay-beds from N.H.S. hospitals. The fiveman board, appointed by the Government, would have an independent chairman, two members from the medical profession and acceptable to it, and two members appointed after consultation with other N.H.S. staff and other interested parties. The board would have two specific commitments: one to separate private beds and facilities from the N.H.S.; the other to maintain private medical and dental practice through the renewal of the provision in the N.H.S. Amendment Act 1949 which maintains the right to private practice by entitling doctors and dentists to work both privately and in N.H.S. establishments. Initially the board’s main task would be the phasing-out of more than 4000 pay-beds. Although pay-beds last year totalled 4574, the average daily occupancy by paying patients was only 2245. As Mrs Castle explained in the Commons, the criteria
One of the factors the board would bear in mind in deciding whether private facilities for specialised operations, treatments, and investigations should be phasedout would be the willingness of the N.H.S. to make such facilities reasonably available on an occasional basis in specified circumstances and at an appropriate charge. The Bill would allow health authorities to provide and charge for such services for patients, provided that they could satisfy the Secretary of State that there would be no disadvantage to N.H.S. patients and that such patients were admitted on the same basis of medical priority as an N.H.S. patient. Charges would be made to these patients and there would be no subsidy by the N.H.S. No professional fees would be received by whole-time N.H.S. staff for their personal benefit, but an appropriate element of the total charge would be retained by the health authority. Staff on a part-time contract would be entitled to receive fees from these patients and the amount would be determined in the usual way by agreement between the parties concerned. Conservative opposition to the Government’s intentions is perhaps strongest on the proposals to regulate the private sector. Mrs Castle repeated in the Commons that her licensing scheme was still subject to further consultation with the professions, in particular on how to achieve by voluntary means a situation in which developments in the private sector did not significantly endanger the service the N.H.S. gave to its patients. She also disclosed that she is considering whether to vest in the Board reserve powers to regulate the private sector. So the Conservative opposition, already highly suspicious of Mrs Castle’s intentions towards the private sector, is now viewing the whole concept of the new board with considerable doubt. Labour t.P.s might have been less unhappy about the proposed package had Mrs Castle secured agreement on
1318 system of common waiting-lists. But continued reservations by the medical professions prevented this. So instead it is proposed that the Board be instructed to examine this issue and make recommendations within six months of the Bill’s Royal Assent. If the Goodman compromise succeeds in getting Mrs Castle out of a rough patch, it will pitch her into another one when she brings the legislation before Parliament. For Conservatives remain pledged to fight it tooth and nail; and now Labour tt.P.s are sharpening their resistance to any delay in phasing-out.
a
Notes and News
GETTING HLA RIGHT THE study of HLA antigens in disease is now being pursued with the same vigour that for a time accompanied investigations into unusual blood-group distributions. With one exception the study has been rather academic so far, but the first international symposium on HLA and disease, to be held in Paris in June, 1976, is to emphasise the clinical implications of a topic which in only three years has attracted more than 200 papers. Nomenclature often causes difficulty in the early days of a new science, but some sort of order is creeping into HLA. The four loci formerly known as first (LA), second (Four), third (Ajax), and fourth (LD or MLC-1) are now simply referred to as A,B,C, and D, respectively. The hyphen is dropped from HL-A, but the identification of provisional specificities by the letter W is retained. In many contexts the term HLA will be understood and may be omitted from individual specificities. The new scheme has not yet been published by the W.H.O. committee that has been looking into the matter ; all the same it is already being used in centres all over the world.
LEAD IN FOOD AND DRINK THE intake of lead from food is not thought to constitute a hazard to health in the United Kingdom. This is the main conclusion of the Government’s monitoring body, in a special report on lead in food.’ The average daily intake of lead from food and drink was calculated to be 0-17 mg; this would yield an average weekly intake of about 1.2 mg, the F.A.O./W.H.O. tolerable weekly intake being 3 mg. The lead content of baby foods in cans, which had caused concern in a previous study and resulted in a change in the regulations, is now the same as that for baby food in jars. The report deals with mean figures, normal diets, and the population as a whole. In some areas the proximity of lead works or the use of sewage sludge in the treatment of soil did result in higher amounts, but this would not be a problem provided that vegetables are washed and peeled. In others the drinking-water may contain unacceptably high, though never extreme, concentrations of lead: 11 000 water samples were tested and only 19(0.2%) contained more than 0. 1 mg/l (the W.H.O. limit).
are commonly referred to by an abbreviation or by compound noun which is both a mouthful and a hyphenators’ nightmare. A subcommittee of the IUPAC/IUB Commis-
hormones a
Biochemical Nomenclature has come out with a set of for which medical research-workers, clinicians, and editors will be grateful. The principal change is the use of three suffixes-"-tropin" for the hormones of the adenohypophysis, "-liberin" for hypothalamic releasing hormones, and "-statin" for hypothalamic release-inhibiting hormones. In this system growth hormone becomes somatotropin and human
sion
on
proposals
menopausal gonadotropin becomes urogonadotropin. Ocytocin, it is convincingly argued, is etymologically better than oxytocin, but the subcommittee accepts that the older spelling will survive. Parathyrin is suggested for parathyroid hormone. As an illustration of the nomenclature in practice the clumsy melanocyte-stimulating-hormone release-inhibiting factor becomes melanostatin. Other examples are folliberin, thyroliberin, and lutropin. Comments on the proposals should reach Dr W. E. Cohn, Oak Ridge National Laboratory, Oak Ridge, Tennessee 37830, U.S.A., by the end of May, 1976. Details may be found in ,. biol. Chem. 1975, 250, 3215 or in the IUPAC Information Bulletin appendix no. 48.
OLD FAITHFUL Whitaker ’76, like its many predecessors, is an invaluable of well-arranged and carefully indexed information which otherwise might be hard to come by. In this discontented winter the reader may determine to set out to explore the 213 470 miles of roads in Britain (p. 1143) or the 11 229 miles of railway route (p. 1145). Alternatively, sailing westward, he will be glad of the intelligence (p. 175) that on April 1 the morning high tide at Dun Laoghaire will touch the 3.7 m mark (though he is not restricted to April 1: figures for 365 other days are included). If, more adventurously, our traveller should fly south and west, he will certainly wish to take account of the news (p. 780) that, on the Island of Nevis, Newcastle airstrip can take small aircraft (e.g., Islanders) but not after dark. If only he will bide his time he can be conveyed by the new, northerly trans-Siberian railway, which, completed, will enable him to gaze eastwards across the Pacific from Sovetskaya Gavan (p. 960). Should our reader after all opt for home he may well decide that the new postal rates (p. 1078) have cut him off from his friends, and settle down to read how the buying power of the pound in 1974 was about a tenth of that in 1914 (p. 1051). At home or abroad, in times good or bad, Whitaker1 is a sound companion.
source
’SECHOLEX’ AN impurity arising from the method of manufacture has been identified in this preparation (polidexide, Pharmacia). Whilst there is no intrinsic defect in the drug itself, the contaminant is thought to present a hazard and, bearing in mind its prolonged usage, the Licencing Authority has directed that the drug be recalled. Holders of stocks of ’Secholex’ are advised to return these promptly to their wholesalers for credit.
THE COMMONWEALTH FUND
The Fund wishes NAMING HORMONES DETERMINATION of the chemical structure of a hormone does make its naming any easier, and trivial names have to be retained. Hypothalamic factors and the pituitary and related
to
make it known that its grants
are
made
exclusively to institutions in the U.S.A. Its recent grant to Yale University for a centre for the study of human genetics was $2.5 million, not$250 000
as we
stated.2
not
1.
on the Monitoring of Foodstuffs for Heavy Metals. Survey of Lead in Food: first supplementary report. H.M. Stationery Office. 50p.
Working Party
1. Complete edition (1220 paper bound, £1.60; library
pp.), cloth bound, £3.50; shorter edition (692 pp.), edition, half-bound in leather with coloured maps,
£4.75. 2. Lancet,
Nov. 29, p. 1104.
details may strike a chord in the memory of a doctor who has treated this woman. Height 62 in, weight about 120 Ib, appendicectomy scar of long standing, scar in shape of horizontal V on front of right leg, below the knee, small mole on outer aspect of left calf. There was an extensively pigmented area 2 in wide running down from above the right hip and tapering to a point towards the spine. It might have been visible after immersion in cold water, but cannot strictly be construed as a birthmark though it might have appeared as such after swimming or showering. Hard calluses at the base of the 3rd and 4th fingers of the right hand, right thumbnail shorter than normal, maybe representing new growth. Forensic examination revealed the following: blood-group A; traces of diazepam; remains of an enteric-coated bisacodyl tablet (’Dulcolax’) and mushroom, root vegetable, and uncooked, small-grained, cut wheat in stomach; small, pedunculated fibroid extruding from posterior surface of uterus.
Commentary from Westminster
under which pay-beds and facilities would be phased-out would be the availability of alternative facilities for private practice within a reasonable geographical distance. On this basis the Government calculates that there are 1000 pay-beds which could be phased-out without delay, and the Bill, when it is published, will specify these. "Without delay" in this context means within six months of the Bill’s Royal Assent, which in effect means early in 1977. Clearly the immediate phase-out would be in the big cities, and, with 1550 pay-beds in the four Thames Regional Health Authorities alone, the bulk would be in London and the south-east. The time scale for phasing-out the remaining 3000-plus pay-beds would be determined by the new board-and it is here that Labour M.p.s begin to get suspicious. For no indication is being given as to when the last pay-bed would disappear. Specific criteria would be written into the legislation to guide the board. It would state that there should be a reasonable demand for private medicine in the area of the country served by a particular hospital, that sufficient accommodation or facilities existed in the area for the reasonable operation of private medicine, and that all reasonable steps had been or were being taken to provide those alternative beds and facilities. In addition, where all reasonable steps were not being taken, that would be grounds in itself, after due warning, for withdrawing pay-beds and facilities in the hospitals con-
cerned.
Phasing-out
of
Pay-beds
FROM A CORRESPONDENT
THE Government compromise to end the dispute over pay-beds has left both sides of Parliament feeling slightly uneasy. Conservatives are unhappy because the Government refused to send the whole issue to the Royal Commission and because the commitment to phase-out pay-beds remains. Labour M.P.s are muttering angrily about a sell-out to the consultants and, seeing the familiar hand of Lord Goodman in the compromise, they are even more suspicious. But both sides privately agreed that Lord Goodman appeared to have got Mrs Barbara Castle, Secretary of State for Social Services, off an awkward hook. Twelve days after Lord Goodman’s surprise intervention in the dispute at the Prime Minister’s express invitation, Mrs Castle was able to unveil to M.p.s a detailed compromise which bore all the hallmarks of his mediation. At the heart of the proposals is the creation of an independent board which would be given the remit of phasing-out pay-beds from N.H.S. hospitals. The fiveman board, appointed by the Government, would have an independent chairman, two members from the medical profession and acceptable to it, and two members appointed after consultation with other N.H.S. staff and other interested parties. The board would have two specific commitments: one to separate private beds and facilities from the N.H.S.; the other to maintain private medical and dental practice through the renewal of the provision in the N.H.S. Amendment Act 1949 which maintains the right to private practice by entitling doctors and dentists to work both privately and in N.H.S. establishments. Initially the board’s main task would be the phasing-out of more than 4000 pay-beds. Although pay-beds last year totalled 4574, the average daily occupancy by paying patients was only 2245. As Mrs Castle explained in the Commons, the criteria
One of the factors the board would bear in mind in deciding whether private facilities for specialised operations, treatments, and investigations should be phasedout would be the willingness of the N.H.S. to make such facilities reasonably available on an occasional basis in specified circumstances and at an appropriate charge. The Bill would allow health authorities to provide and charge for such services for patients, provided that they could satisfy the Secretary of State that there would be no disadvantage to N.H.S. patients and that such patients were admitted on the same basis of medical priority as an N.H.S. patient. Charges would be made to these patients and there would be no subsidy by the N.H.S. No professional fees would be received by whole-time N.H.S. staff for their personal benefit, but an appropriate element of the total charge would be retained by the health authority. Staff on a part-time contract would be entitled to receive fees from these patients and the amount would be determined in the usual way by agreement between the parties concerned. Conservative opposition to the Government’s intentions is perhaps strongest on the proposals to regulate the private sector. Mrs Castle repeated in the Commons that her licensing scheme was still subject to further consultation with the professions, in particular on how to achieve by voluntary means a situation in which developments in the private sector did not significantly endanger the service the N.H.S. gave to its patients. She also disclosed that she is considering whether to vest in the Board reserve powers to regulate the private sector. So the Conservative opposition, already highly suspicious of Mrs Castle’s intentions towards the private sector, is now viewing the whole concept of the new board with considerable doubt. Labour t.P.s might have been less unhappy about the proposed package had Mrs Castle secured agreement on
1318 system of common waiting-lists. But continued reservations by the medical professions prevented this. So instead it is proposed that the Board be instructed to examine this issue and make recommendations within six months of the Bill’s Royal Assent. If the Goodman compromise succeeds in getting Mrs Castle out of a rough patch, it will pitch her into another one when she brings the legislation before Parliament. For Conservatives remain pledged to fight it tooth and nail; and now Labour tt.P.s are sharpening their resistance to any delay in phasing-out.
a
Notes and News
GETTING HLA RIGHT THE study of HLA antigens in disease is now being pursued with the same vigour that for a time accompanied investigations into unusual blood-group distributions. With one exception the study has been rather academic so far, but the first international symposium on HLA and disease, to be held in Paris in June, 1976, is to emphasise the clinical implications of a topic which in only three years has attracted more than 200 papers. Nomenclature often causes difficulty in the early days of a new science, but some sort of order is creeping into HLA. The four loci formerly known as first (LA), second (Four), third (Ajax), and fourth (LD or MLC-1) are now simply referred to as A,B,C, and D, respectively. The hyphen is dropped from HL-A, but the identification of provisional specificities by the letter W is retained. In many contexts the term HLA will be understood and may be omitted from individual specificities. The new scheme has not yet been published by the W.H.O. committee that has been looking into the matter ; all the same it is already being used in centres all over the world.
LEAD IN FOOD AND DRINK THE intake of lead from food is not thought to constitute a hazard to health in the United Kingdom. This is the main conclusion of the Government’s monitoring body, in a special report on lead in food.’ The average daily intake of lead from food and drink was calculated to be 0-17 mg; this would yield an average weekly intake of about 1.2 mg, the F.A.O./W.H.O. tolerable weekly intake being 3 mg. The lead content of baby foods in cans, which had caused concern in a previous study and resulted in a change in the regulations, is now the same as that for baby food in jars. The report deals with mean figures, normal diets, and the population as a whole. In some areas the proximity of lead works or the use of sewage sludge in the treatment of soil did result in higher amounts, but this would not be a problem provided that vegetables are washed and peeled. In others the drinking-water may contain unacceptably high, though never extreme, concentrations of lead: 11 000 water samples were tested and only 19(0.2%) contained more than 0. 1 mg/l (the W.H.O. limit).
are commonly referred to by an abbreviation or by compound noun which is both a mouthful and a hyphenators’ nightmare. A subcommittee of the IUPAC/IUB Commis-
hormones a
Biochemical Nomenclature has come out with a set of for which medical research-workers, clinicians, and editors will be grateful. The principal change is the use of three suffixes-"-tropin" for the hormones of the adenohypophysis, "-liberin" for hypothalamic releasing hormones, and "-statin" for hypothalamic release-inhibiting hormones. In this system growth hormone becomes somatotropin and human
sion
on
proposals
menopausal gonadotropin becomes urogonadotropin. Ocytocin, it is convincingly argued, is etymologically better than oxytocin, but the subcommittee accepts that the older spelling will survive. Parathyrin is suggested for parathyroid hormone. As an illustration of the nomenclature in practice the clumsy melanocyte-stimulating-hormone release-inhibiting factor becomes melanostatin. Other examples are folliberin, thyroliberin, and lutropin. Comments on the proposals should reach Dr W. E. Cohn, Oak Ridge National Laboratory, Oak Ridge, Tennessee 37830, U.S.A., by the end of May, 1976. Details may be found in ,. biol. Chem. 1975, 250, 3215 or in the IUPAC Information Bulletin appendix no. 48.
OLD FAITHFUL Whitaker ’76, like its many predecessors, is an invaluable of well-arranged and carefully indexed information which otherwise might be hard to come by. In this discontented winter the reader may determine to set out to explore the 213 470 miles of roads in Britain (p. 1143) or the 11 229 miles of railway route (p. 1145). Alternatively, sailing westward, he will be glad of the intelligence (p. 175) that on April 1 the morning high tide at Dun Laoghaire will touch the 3.7 m mark (though he is not restricted to April 1: figures for 365 other days are included). If, more adventurously, our traveller should fly south and west, he will certainly wish to take account of the news (p. 780) that, on the Island of Nevis, Newcastle airstrip can take small aircraft (e.g., Islanders) but not after dark. If only he will bide his time he can be conveyed by the new, northerly trans-Siberian railway, which, completed, will enable him to gaze eastwards across the Pacific from Sovetskaya Gavan (p. 960). Should our reader after all opt for home he may well decide that the new postal rates (p. 1078) have cut him off from his friends, and settle down to read how the buying power of the pound in 1974 was about a tenth of that in 1914 (p. 1051). At home or abroad, in times good or bad, Whitaker1 is a sound companion.
source
’SECHOLEX’ AN impurity arising from the method of manufacture has been identified in this preparation (polidexide, Pharmacia). Whilst there is no intrinsic defect in the drug itself, the contaminant is thought to present a hazard and, bearing in mind its prolonged usage, the Licencing Authority has directed that the drug be recalled. Holders of stocks of ’Secholex’ are advised to return these promptly to their wholesalers for credit.
THE COMMONWEALTH FUND
The Fund wishes NAMING HORMONES DETERMINATION of the chemical structure of a hormone does make its naming any easier, and trivial names have to be retained. Hypothalamic factors and the pituitary and related
to
make it known that its grants
are
made
exclusively to institutions in the U.S.A. Its recent grant to Yale University for a centre for the study of human genetics was $2.5 million, not$250 000
as we
stated.2
not
1.
on the Monitoring of Foodstuffs for Heavy Metals. Survey of Lead in Food: first supplementary report. H.M. Stationery Office. 50p.
Working Party
1. Complete edition (1220 paper bound, £1.60; library
pp.), cloth bound, £3.50; shorter edition (692 pp.), edition, half-bound in leather with coloured maps,
£4.75. 2. Lancet,
Nov. 29, p. 1104.
