1351
malignant pigmented lesions
of skin, we observed endothelial fenestrations in a cellular blue naevus (figs. 1 and 2). The fenestrations were seen in every vessel within the tumour, in contrast to their complete absence in adjacent normal skin and in various non-neoplastic dermatological conditions, including hamartomatous lesions (angiofibroma) in tuberous sclerosis. We also observed similar fenestrations in halo naevi, the other features of which have been
reported.e It has been proposed that the microscopic haemorrhage that occurs in schwannomas,3 and the gross haemorrhage commonly seen in intracranial melanomas,s result from these gaps in the endothelium. Macroscopic or microscopic haemorrhage is not seen in cellular blue naevus and halo naevus, and therefore, fenestration seems unlikely to Our current have a role in producing haemorrhage. hypothesis concerns a possible relationship between endothelial fenestration and tumour angiogenesis (? induction by tumour-angiogenesis factor). Departments of Pathology, St. Vincent Hospital, and University of Massachusetts Medical School, Worcester, Mass. 01610,
U.S.A.
JAG BHAWAN LEE EDELSTEIN J. B. JACOBS.
HEADBOX NECK SLEEVE FOR CONTINUOUS POSITIVE AIRWAY PRESSURE SiR,—The introduction of continuous positive airway pressure by Gregory and his colleagues produced dramatic improvement in the treatment of idiopathic respiratorydistress syndrome of the newborn. Several methods have been suggested to dispense with the original endotracheal
tube, including the headbox, the headbag, nasal catheters, and an iron-lung ". We initially used a headbox"with an Airshields iris-diaphragm port around the neck, but, even with an underlying foam collar, there was great difficulty in forming an adequate seal without constricting the airway and great vessels. The Vickers conical’Teflon’ neck sleeve designed by John Fehr was then used, but tension pneumothorax developed in 2 patients. With "
this device the pressure tends to push the baby out of the headbox, and when the baby is pushed back the headbox pressure may rise to danger levels. A deadweight release valve was then incorporated and no further pneumothoraces have occurred in over 40 similarly treated infants over three years; and pressures up to 15 cm. H2O have been used. The Vickers pressure monitor box has been modified to include a deadweight release valve for use with an endotracheal tube when weaning babies from prolonged intermittent positive-pressure ventilation. Further diffiwas encountered with the sharp edge of the stiff culty ’ Velcro ’ collar which 4ies outside the teflon sleeve around the base of the neck and which may damage the blood or nerve supply to the arms. A length of Hollister’ Ident-aband’ has proved a satisfactory substitute. The metal clips which fix the collar are positioned away from the brachial plexus, and, if required, the perforations allow the seal to be quickly broken. Tension pneumothorax, severe skin excoriation, hydrocephalus, and monoplegia have not been encountered in the past two years. Department of Child Health, Welsh National School of
Medicine, Heath Park, Cardiff CF4 4XN. 6.
H. V. PRICE.
Jacobs, J. B., Edelstein, L. M., Snyder, L. M., Fortier, N. Cancer Res. 1975, 35, 352.
Notes and News THE LANCET
WITH the British printing dispute unsettled, production of The Lancet remains at a rather low ebb. At present the main effect is a few days’ delay in publication; but in the weeks to come we fear that the size of the journal may suffer too. Again we ask readers and contributors to bear with us. FLUORIDE STRATEGIES
A SIGNIFICANT argument in the case against the fluoridation of public water supplies is the fact that only a minority of people obliged to drink fluoridated water can expect to benefit. Since alternative means of raising the fluoride intake of children to protect them from dental caries are available, it would be better, the argument runs, to bow to local hostility to fluoridation and adopt some other policy. Alternatives also have to be explored in countries where a proportion of the population is not on a public water supply. At first sight Professor Davies, in a report for the World Health Organisation,1 provides useful material enabling the health administrator or community physician faced with a campaign against fluoridation to compare the cost/benefit ratios of various exercises in preventive dentistry. However, Davies expressly warns his reader against using his report for this purpose, mainly because, fluoridation apart, published trials of protective agents have not been consistent in design or outcome. With fluoridation the ratio (cost of implementation—savings in cost of treatment) is about 1/4, figures of this order being attained for one U.S. trial, New Zealand, the Netherlands, and Switzerland. However, three other trials have produced very different results. In Kentucky and Pennsylvania fluoridation of school water supplies has been tried. With tablets taken by children for at least four years, ratios in the range 1/5 to 1/24 were achieved. For topical applications of fluoride by dentists or self-administered the ranges were very wide indeed. Anyone planning trials in this area would do well to read Davies’s review. COMMUNICATIONS
IN 1967, under the aegis of the Ciba Foundation in a series of evening meetings with the general theme of communication in medicine. Now reports of many of these meetings have been collated into three booklets on Communications in Medicine, the Communication Interface, and Instinct and Intellect in Human Communications.2 33 meetings are described, generally in the form of a two or three page precis. It is difficult to generalise on the value of these reports. Some of themnotably those on communications with the unborn and on communications in accident and emergency departmentsOthers seem to have little to do with the are excellent. of communication in medicine-e.g., the fact that problem " the husky dog sleeps outside in subzero temperatures " is revealed in the booklet on the Communication Interface. Much of the information is out of date, and, as the reporters admit, much of yesterday’s information is today’s trivia. Moreover, many of the reports are couched in esoteric terms: Karl Marx, had he read this series on communication, would probably have ventured an opinion about the necessity of educating the educators. On the whole, the reports do not do justice to the Ciba gatherings, which were often lively and informative.
London, there began
1. Cost and Benefit of Fluoride in the Prevention of Dental Caries. By G. N. DAVIES, University of Queensland. 1974. Pp. 91. Obtainable from W.H.O. sales agents. Sw. fr. 20. 2. Communications in Medicine. Edited by T. ANDREW QUILLIAM, University College London. The three booklets (50p each) may be obtained from the Audio-Visual Unit, University College London, Gower Street, London WC1E 6BT.
1352 NURSES IN FAMILY-PLANNING
PROJECT
THE
Department of Health and Social Security has provide funds for a research project at King’s College Hospital, London, for an experimental familyplanning clinic run by specially trained nurses. The aim of the project is to assess the feasibility of using such nurses to give family-planning advice, and to prescribe and fit all forms of contraceptive currently in use. The nurses will be responsible for the day-to-day running of the clinic, but a doctor will retain overall responsibility and The Department has will countersign prescriptions. of the project, the the nature experimental emphasised results of which will be carefully assessed with the professional and advisory bodies concerned with family planning. It should not necessarily be regarded as the pattern for the future role of the nurse in family-planning clinics elsewhere; nor will it in any way anticipate the results of the Joint Working Group on the Distribution and Supervision of Oral Contraceptives, recently set up by the Central Health Services Council, the Committee on Safety of Medicines, and the Medicines Commission. agreed
to
Sinai Hospital, New York. In 1964 he was appointed senior lecturer at the Royal Free Hospital School of Medicine, becoming reader in morbid anatomy (later histopathology) there in 1971. He is particularly interested in liver disease. of Newcastle upon Tyne Dr 0. F. W. James has been appointed to the William Leech readership in medicine (geriatrics).
University
CORRIGENDUM: Post-mortem Alcohol.-In this editorial (May p. 1229) we said that blood should be taken from three abdominal sites. They need not, in fact, be abdominal.
31,
Diary of the Week JUNE 15
HORMONAL PREGNANCY TESTS PRELIMINARY results of a case/control study,
together
OF DERMATOLOGY, St. John’s Hospital for Diseases of the Skin, Lisle Street, Leicester Square, London WC2H 7BJ 4.30 P.M. Dr Rodney Grahame: Cutaneous and Joint Disease.
Tuesday,
Dr Scheuer is 46 and graduated M.B. from the University of London in 1954 and M.D. in 1961; he became M.R.C.PATH. in 1964. Following house-appointments and service in the R.A.M.C. he was successively resident pathologist, research registrar, and lecturer at the Royal Free Hospital. In 1962-63 he was British Postgraduate Medical Federation travelling fellow at Mount 1. 2.
Greenberg, G., Inman, W. H. W., Weatherall, J. A. C., Adelstein, A. M. Br. med. J. 1975, ii, 191. Adverse Reaction Series, no. 13. Committee on Safety of Medicines, June, 1975.
17th
INSTITUTE OF CHILD HEALTH, 30 Guilford Street, London WCI 5.30 P.M. Prof. E. H. Kass (Cambridge, Massachusetts): Hypertension as an Acquired Disease of Childhood.
Wednesday,
18th
ROYAL POSTGRADUATE MEDICAL SCHOOL, Hammersmith Hospital, London W12 2 P.M. Prof. Frederick Walker: Glomerular Basement Membrane. INSTITUTE OF ORTHOPEDICS, 234 Great Portland Street, London WIN 6AD 6 P.M. Prof. H. A. Sissons: Pathology of Nerve Tumours. ROYAL FREE HOSPITAL, Pond Street, Hampstead, London NW3 2QG 5 P.M. Dr A. G. Bearn (New York): The Investigation of Inherited Metabolic Disease in Cell Culture.
Thursday,
,
’
19th
KING’S COLLEGE HOSPITAL MEDICAL SCHOOL, Denmark Hill, London SE5 8RX 4.30 P.M. Mr. H. L.-C. Wood: The Pattern of Surgery in Nigeria. (Legg memorial lecture.) ROYAL COLLEGE OF SURGEONS OF EDINBURGH 4.30 P.M. (Royal Infirmary, Huddersfield.) Mr J. N. Longrigg: Experimental and Clinical Studies of the Renal Calyces, Pelvis, and Ureter. (Robert Liston Lecture.)
Appointments Northern
Regional Health Authority:
ANWAR, MASUD, M.B.Punjab, M.R.C.P., D.C.M.T., D.P.H.: consultant in geriatric medicine, Hartlepool district, Cleveland A.H.A. CHETTUR, B. K., M.B.Kamatak, F.F.A. R.c.s.: consultant anaesthetist, Gateshead ’
of London Prof. M. R. Alderson, professor of medical information science at the University of Southampton, has been appointed to the Cancer Research Campaign chair of epidemiology at the Institute of Cancer Research, Royal Cancer Hospital. The title of professor of clinical histopathology has been conferred on Dr P. J. Scheuer in respect of his post at the Royal Free Hospital School of Medicine.
21
INSTITUTE
with earlier work, suggest an association between hormonal pregnancy tests and congenital abnormalities. The Committee on Safety of Medicines recommends that this method should not now normally be used.2
University
To
Monday, l6th
TRAINING IN COMMUNITY MEDICINE
THE specialty of community medicine embraces a wide spectrum of skills and areas of activity, and training for those wishing to enter the specialty therefore needs to be both comprehensive and flexible enough to meet individual needs. Among the training courses offered is the Midlands and South Western inter-regional scheme of training, now in its second year, which aims not only to enable trainees to pass the first part of the membership examination of the Faculty of Community Medicine, but also to give them a sound basic knowledge and experience of the whole field of community medicine. The course is run by the West Midlands, South Western, Oxford, and Wessex Regional Health Authorities and by the Welsh Office. It gives suitable trainee registrarships of 2 years’ tenure, during which the Universities of Birmingham, Bristol, Cardiff, Exeter, Oxford, Reading, and Southampton provide 20 weeks of intensive residential training in modules of 2 Between modules trainees have experience at or 3 weeks. regional, area, and district level in accordance with their individual requirements, and under the supervision of the regional medical officer, the Faculty’s regional specialist adviser, and the trainee’s individual academic tutor.
new
A.H.A.
CHOUDHARY, G. P., M.B.Mangalore, M.R.C.P., M.R.C.P.I.: consultant in geriatric medicine, Sunderland A.H.A. COSBIE Ross, J. A. M.B.L’pool, M.R.C.O.G. : consultant obstetrician and gynaecologist. South Tees district, Cleveland A.H.A. consultant FRANCIS, R. C., M.B.Lond., M.R.C.O.G., D.T.M.&H.: obstetrician and gynaecologist, Gateshead A.H.A. HARKER, NOBLLB E. M., M.B., B.sc.Lond., M.R.C.PATH.: consultant haematologist, South Tees district, Cleveland A.H.A. HEAVISIDE, D. W., M.B.Durh., F.F.A. R.c.s.: consultant anaesthetist (cardiothoracic), Shotley Bridge General Hospital. IBRAHIMI, G. S., M.B.Kabul, M.R.C.PSYCH., D.P.M.: consultant in mental illness, Cherry Knowle Hospital, Ryhope. JEANS, JUNE E., M.B., B.sc.Durh., M.R.C.PSYCH., D.P.M. : consultant in mental illness (children), - Sunderland and South Tyneside A.H.A.S.
KELLY, J. F., M.B.Cantab., F.R.C.S.: consultant general surgeon, Lancaster district, Lancashire A.H.A., and Kendal Hospitals, East Cumbria district, Cumbria A.H.A. KERR, GEORGE, M.B.Brist., M.R.C.PSYCH., D.P.M.: consultant in mental handicap, Dovenby Hall Hospital, Cockermouth. NEASHAM, JOHN, M.B.Leeds, F.F.A. R.c.s.: consultant anaathetist, South Tees district, Cleveland A.H.A. NIVEN, P. A. R., M.B.Cantab., M.R.C.O.G., F.R.C.S.: consultant obstetrician and gynaecologist, Newcastle A.H.A. (teaching), and Hexham and district hospitals, Northumberland A.H.A. SARSON, DAVID, M.B.Lond., F.R.C.S. : consultant general surgeon,
Sunderland
A.H.A.
.
malignant pigmented lesions
of skin, we observed endothelial fenestrations in a cellular blue naevus (figs. 1 and 2). The fenestrations were seen in every vessel within the tumour, in contrast to their complete absence in adjacent normal skin and in various non-neoplastic dermatological conditions, including hamartomatous lesions (angiofibroma) in tuberous sclerosis. We also observed similar fenestrations in halo naevi, the other features of which have been
reported.e It has been proposed that the microscopic haemorrhage that occurs in schwannomas,3 and the gross haemorrhage commonly seen in intracranial melanomas,s result from these gaps in the endothelium. Macroscopic or microscopic haemorrhage is not seen in cellular blue naevus and halo naevus, and therefore, fenestration seems unlikely to Our current have a role in producing haemorrhage. hypothesis concerns a possible relationship between endothelial fenestration and tumour angiogenesis (? induction by tumour-angiogenesis factor). Departments of Pathology, St. Vincent Hospital, and University of Massachusetts Medical School, Worcester, Mass. 01610,
U.S.A.
JAG BHAWAN LEE EDELSTEIN J. B. JACOBS.
HEADBOX NECK SLEEVE FOR CONTINUOUS POSITIVE AIRWAY PRESSURE SiR,—The introduction of continuous positive airway pressure by Gregory and his colleagues produced dramatic improvement in the treatment of idiopathic respiratorydistress syndrome of the newborn. Several methods have been suggested to dispense with the original endotracheal
tube, including the headbox, the headbag, nasal catheters, and an iron-lung ". We initially used a headbox"with an Airshields iris-diaphragm port around the neck, but, even with an underlying foam collar, there was great difficulty in forming an adequate seal without constricting the airway and great vessels. The Vickers conical’Teflon’ neck sleeve designed by John Fehr was then used, but tension pneumothorax developed in 2 patients. With "
this device the pressure tends to push the baby out of the headbox, and when the baby is pushed back the headbox pressure may rise to danger levels. A deadweight release valve was then incorporated and no further pneumothoraces have occurred in over 40 similarly treated infants over three years; and pressures up to 15 cm. H2O have been used. The Vickers pressure monitor box has been modified to include a deadweight release valve for use with an endotracheal tube when weaning babies from prolonged intermittent positive-pressure ventilation. Further diffiwas encountered with the sharp edge of the stiff culty ’ Velcro ’ collar which 4ies outside the teflon sleeve around the base of the neck and which may damage the blood or nerve supply to the arms. A length of Hollister’ Ident-aband’ has proved a satisfactory substitute. The metal clips which fix the collar are positioned away from the brachial plexus, and, if required, the perforations allow the seal to be quickly broken. Tension pneumothorax, severe skin excoriation, hydrocephalus, and monoplegia have not been encountered in the past two years. Department of Child Health, Welsh National School of
Medicine, Heath Park, Cardiff CF4 4XN. 6.
H. V. PRICE.
Jacobs, J. B., Edelstein, L. M., Snyder, L. M., Fortier, N. Cancer Res. 1975, 35, 352.
Notes and News THE LANCET
WITH the British printing dispute unsettled, production of The Lancet remains at a rather low ebb. At present the main effect is a few days’ delay in publication; but in the weeks to come we fear that the size of the journal may suffer too. Again we ask readers and contributors to bear with us. FLUORIDE STRATEGIES
A SIGNIFICANT argument in the case against the fluoridation of public water supplies is the fact that only a minority of people obliged to drink fluoridated water can expect to benefit. Since alternative means of raising the fluoride intake of children to protect them from dental caries are available, it would be better, the argument runs, to bow to local hostility to fluoridation and adopt some other policy. Alternatives also have to be explored in countries where a proportion of the population is not on a public water supply. At first sight Professor Davies, in a report for the World Health Organisation,1 provides useful material enabling the health administrator or community physician faced with a campaign against fluoridation to compare the cost/benefit ratios of various exercises in preventive dentistry. However, Davies expressly warns his reader against using his report for this purpose, mainly because, fluoridation apart, published trials of protective agents have not been consistent in design or outcome. With fluoridation the ratio (cost of implementation—savings in cost of treatment) is about 1/4, figures of this order being attained for one U.S. trial, New Zealand, the Netherlands, and Switzerland. However, three other trials have produced very different results. In Kentucky and Pennsylvania fluoridation of school water supplies has been tried. With tablets taken by children for at least four years, ratios in the range 1/5 to 1/24 were achieved. For topical applications of fluoride by dentists or self-administered the ranges were very wide indeed. Anyone planning trials in this area would do well to read Davies’s review. COMMUNICATIONS
IN 1967, under the aegis of the Ciba Foundation in a series of evening meetings with the general theme of communication in medicine. Now reports of many of these meetings have been collated into three booklets on Communications in Medicine, the Communication Interface, and Instinct and Intellect in Human Communications.2 33 meetings are described, generally in the form of a two or three page precis. It is difficult to generalise on the value of these reports. Some of themnotably those on communications with the unborn and on communications in accident and emergency departmentsOthers seem to have little to do with the are excellent. of communication in medicine-e.g., the fact that problem " the husky dog sleeps outside in subzero temperatures " is revealed in the booklet on the Communication Interface. Much of the information is out of date, and, as the reporters admit, much of yesterday’s information is today’s trivia. Moreover, many of the reports are couched in esoteric terms: Karl Marx, had he read this series on communication, would probably have ventured an opinion about the necessity of educating the educators. On the whole, the reports do not do justice to the Ciba gatherings, which were often lively and informative.
London, there began
1. Cost and Benefit of Fluoride in the Prevention of Dental Caries. By G. N. DAVIES, University of Queensland. 1974. Pp. 91. Obtainable from W.H.O. sales agents. Sw. fr. 20. 2. Communications in Medicine. Edited by T. ANDREW QUILLIAM, University College London. The three booklets (50p each) may be obtained from the Audio-Visual Unit, University College London, Gower Street, London WC1E 6BT.
1352 NURSES IN FAMILY-PLANNING
PROJECT
THE
Department of Health and Social Security has provide funds for a research project at King’s College Hospital, London, for an experimental familyplanning clinic run by specially trained nurses. The aim of the project is to assess the feasibility of using such nurses to give family-planning advice, and to prescribe and fit all forms of contraceptive currently in use. The nurses will be responsible for the day-to-day running of the clinic, but a doctor will retain overall responsibility and The Department has will countersign prescriptions. of the project, the the nature experimental emphasised results of which will be carefully assessed with the professional and advisory bodies concerned with family planning. It should not necessarily be regarded as the pattern for the future role of the nurse in family-planning clinics elsewhere; nor will it in any way anticipate the results of the Joint Working Group on the Distribution and Supervision of Oral Contraceptives, recently set up by the Central Health Services Council, the Committee on Safety of Medicines, and the Medicines Commission. agreed
to
Sinai Hospital, New York. In 1964 he was appointed senior lecturer at the Royal Free Hospital School of Medicine, becoming reader in morbid anatomy (later histopathology) there in 1971. He is particularly interested in liver disease. of Newcastle upon Tyne Dr 0. F. W. James has been appointed to the William Leech readership in medicine (geriatrics).
University
CORRIGENDUM: Post-mortem Alcohol.-In this editorial (May p. 1229) we said that blood should be taken from three abdominal sites. They need not, in fact, be abdominal.
31,
Diary of the Week JUNE 15
HORMONAL PREGNANCY TESTS PRELIMINARY results of a case/control study,
together
OF DERMATOLOGY, St. John’s Hospital for Diseases of the Skin, Lisle Street, Leicester Square, London WC2H 7BJ 4.30 P.M. Dr Rodney Grahame: Cutaneous and Joint Disease.
Tuesday,
Dr Scheuer is 46 and graduated M.B. from the University of London in 1954 and M.D. in 1961; he became M.R.C.PATH. in 1964. Following house-appointments and service in the R.A.M.C. he was successively resident pathologist, research registrar, and lecturer at the Royal Free Hospital. In 1962-63 he was British Postgraduate Medical Federation travelling fellow at Mount 1. 2.
Greenberg, G., Inman, W. H. W., Weatherall, J. A. C., Adelstein, A. M. Br. med. J. 1975, ii, 191. Adverse Reaction Series, no. 13. Committee on Safety of Medicines, June, 1975.
17th
INSTITUTE OF CHILD HEALTH, 30 Guilford Street, London WCI 5.30 P.M. Prof. E. H. Kass (Cambridge, Massachusetts): Hypertension as an Acquired Disease of Childhood.
Wednesday,
18th
ROYAL POSTGRADUATE MEDICAL SCHOOL, Hammersmith Hospital, London W12 2 P.M. Prof. Frederick Walker: Glomerular Basement Membrane. INSTITUTE OF ORTHOPEDICS, 234 Great Portland Street, London WIN 6AD 6 P.M. Prof. H. A. Sissons: Pathology of Nerve Tumours. ROYAL FREE HOSPITAL, Pond Street, Hampstead, London NW3 2QG 5 P.M. Dr A. G. Bearn (New York): The Investigation of Inherited Metabolic Disease in Cell Culture.
Thursday,
,
’
19th
KING’S COLLEGE HOSPITAL MEDICAL SCHOOL, Denmark Hill, London SE5 8RX 4.30 P.M. Mr. H. L.-C. Wood: The Pattern of Surgery in Nigeria. (Legg memorial lecture.) ROYAL COLLEGE OF SURGEONS OF EDINBURGH 4.30 P.M. (Royal Infirmary, Huddersfield.) Mr J. N. Longrigg: Experimental and Clinical Studies of the Renal Calyces, Pelvis, and Ureter. (Robert Liston Lecture.)
Appointments Northern
Regional Health Authority:
ANWAR, MASUD, M.B.Punjab, M.R.C.P., D.C.M.T., D.P.H.: consultant in geriatric medicine, Hartlepool district, Cleveland A.H.A. CHETTUR, B. K., M.B.Kamatak, F.F.A. R.c.s.: consultant anaesthetist, Gateshead ’
of London Prof. M. R. Alderson, professor of medical information science at the University of Southampton, has been appointed to the Cancer Research Campaign chair of epidemiology at the Institute of Cancer Research, Royal Cancer Hospital. The title of professor of clinical histopathology has been conferred on Dr P. J. Scheuer in respect of his post at the Royal Free Hospital School of Medicine.
21
INSTITUTE
with earlier work, suggest an association between hormonal pregnancy tests and congenital abnormalities. The Committee on Safety of Medicines recommends that this method should not now normally be used.2
University
To
Monday, l6th
TRAINING IN COMMUNITY MEDICINE
THE specialty of community medicine embraces a wide spectrum of skills and areas of activity, and training for those wishing to enter the specialty therefore needs to be both comprehensive and flexible enough to meet individual needs. Among the training courses offered is the Midlands and South Western inter-regional scheme of training, now in its second year, which aims not only to enable trainees to pass the first part of the membership examination of the Faculty of Community Medicine, but also to give them a sound basic knowledge and experience of the whole field of community medicine. The course is run by the West Midlands, South Western, Oxford, and Wessex Regional Health Authorities and by the Welsh Office. It gives suitable trainee registrarships of 2 years’ tenure, during which the Universities of Birmingham, Bristol, Cardiff, Exeter, Oxford, Reading, and Southampton provide 20 weeks of intensive residential training in modules of 2 Between modules trainees have experience at or 3 weeks. regional, area, and district level in accordance with their individual requirements, and under the supervision of the regional medical officer, the Faculty’s regional specialist adviser, and the trainee’s individual academic tutor.
new
A.H.A.
CHOUDHARY, G. P., M.B.Mangalore, M.R.C.P., M.R.C.P.I.: consultant in geriatric medicine, Sunderland A.H.A. COSBIE Ross, J. A. M.B.L’pool, M.R.C.O.G. : consultant obstetrician and gynaecologist. South Tees district, Cleveland A.H.A. consultant FRANCIS, R. C., M.B.Lond., M.R.C.O.G., D.T.M.&H.: obstetrician and gynaecologist, Gateshead A.H.A. HARKER, NOBLLB E. M., M.B., B.sc.Lond., M.R.C.PATH.: consultant haematologist, South Tees district, Cleveland A.H.A. HEAVISIDE, D. W., M.B.Durh., F.F.A. R.c.s.: consultant anaesthetist (cardiothoracic), Shotley Bridge General Hospital. IBRAHIMI, G. S., M.B.Kabul, M.R.C.PSYCH., D.P.M.: consultant in mental illness, Cherry Knowle Hospital, Ryhope. JEANS, JUNE E., M.B., B.sc.Durh., M.R.C.PSYCH., D.P.M. : consultant in mental illness (children), - Sunderland and South Tyneside A.H.A.S.
KELLY, J. F., M.B.Cantab., F.R.C.S.: consultant general surgeon, Lancaster district, Lancashire A.H.A., and Kendal Hospitals, East Cumbria district, Cumbria A.H.A. KERR, GEORGE, M.B.Brist., M.R.C.PSYCH., D.P.M.: consultant in mental handicap, Dovenby Hall Hospital, Cockermouth. NEASHAM, JOHN, M.B.Leeds, F.F.A. R.c.s.: consultant anaathetist, South Tees district, Cleveland A.H.A. NIVEN, P. A. R., M.B.Cantab., M.R.C.O.G., F.R.C.S.: consultant obstetrician and gynaecologist, Newcastle A.H.A. (teaching), and Hexham and district hospitals, Northumberland A.H.A. SARSON, DAVID, M.B.Lond., F.R.C.S. : consultant general surgeon,
Sunderland
A.H.A.
.
