631 clear in

papers and prospectuses and I am at a loss to unerror arose. Most of the year is devoted to in depth of a special subject. Project work is included our

derstand how the a


and taken into account in the award of the B.MED.sci. degree. Some of this work has been judged worthy of publication. We believe this year to be of exceptional educational value. But for the error, Nottingham would have inevitably qualified for Sir George’s and Dr Ellis’s approbation for having had "the wisdom and courage to devote one of the five years of the University course to study in depth". We do exactly that, and we were the first to do it. We are delighted that Southampton was able to include a similar, but not identical, opportunity within their

five-year course. Medical School, Queen’s Medical Centre, Nottingham NG7 2UH


MEDICAL EDUCATION IN MALTA am a Maltese doctor who as a student had to come Britain to sit for the final M.R.C.S., L.R.C.P. exam to obtain my medical qualifications. Together with my colleagues I had to come over to Britain because our final M.D. exams were suspended indefinitely following an industrial dispute between the Maltese Government and the Medical Association of Malta. All this started because of a situation similar to the one described by Mr Lee from Singapore (Aug. 12, p. 382). The Maltese Government had a shortage of housemen and the Health Minister first proposed that newly qualified doctors should sign a contract to work for two years as housemen. A breach of such a contract or failure to sign the contract would lead to a fine of £10 000. After internal opposition to this proposal, the Minister passed a law through Parliament to the effect that newly qualified doctors had to work as housemen for two years immediately after qualifying, otherwise they would never be granted a warrant to practice in Malta. In the same law, the Government transferred the powers for the registration of foreign doctors from the Maltese Medical Council to the Minister of Health. ’To show its disapproval the Medical Association of Malta directed Government employed doctors to refrain from attending outpatient clinics and from performing non-emergency operations. As a reprisal to this partial industrial action, the Government locked out and later dismissed these doctors from their employment, suspended the final M.D. exams, and imported foreign doctors to run the medical services. Now, everybody has a moral obligation to give his services to his country when these are needed. On the other hand the Government has the obligation to provide adequate education facilities to its citizens. The great majority of us freely offered to make a gentleman’s agreement with the Government that we would work for two years, with the Medical Association acting as our guarantor. However, the Government said that this was not good enough. We maintain that since we were to be forced to work for the Government, "moral obligation" was not the issue any more. It had become "forced labour" without freedom to fight for our rights because, once dismissed or suspended, we would forfeit our warrant. The outcome is that most of the Maltese doctors and medical students are in Britain and elsewhere while the medical services in Malta are being run by foreign doctors---one big mess.



Whittington Hospital, London N19

recommendations of the Second Progress Report of 1971. The ultimate responsibility for lowered standards and consequent risks to patients’ lives must rest with the Department of Health and Social Security, but we should not ignore the part played by the Central Manpower Committee and its advisors from the Colleges and the profession who seem oblivious to the consequences of their advice for patient care. It is a curious anomaly that such central dictates usually find it necessary to recommend that staffing inequalities be corrected by reductions rather than by differential increases for those less well endowed. It is also astonishing that the representatives of the Colleges and Universities on the Central Manpower Committee are prepared to endorse policies which contradict some of the recommendations of their own parent bodies regarding the maintenance of safety standards. The reason for this apparent paradox ’lies in a clever bureaucratic manoeuvre which limits the C.M.C.’s direct terms of reference to balancing the training and career grades and not to the service needs. The regional manpower committees, on the other hand, are directly responsible for carrying out the advice of the C.M.C. and D.H.S.S., though they are given some leeway in the way they perform this task. The only safe short-term solution left for individual consultants who may be faced with such imposed staff reductions is to reduce the service to levels which are considered safe, while stating the reasons for this action. In the long term, we can only hope for a complete revision of our current and contradictory staffing policies which are directly responsible for the present situation. Shotley Bridge General Hospital, Shotley Bridge, Consett DH8 0NB

G. I. B.



SECRETORY IgA ANTIBODY TO ROTAVIRUS IN HUMAN MILK 6-9 MONTHS POSTPARTUM et al. found antibody rotavirus in human colostrum by the enzyme-linked immunosorbent assay (ELISA) and by immunofluorescence, respectively. We have confirmed this observation by solid-phase radioimmunoassay and extended it by showing that there is secretory IgA antibody to rotavirus in human milk for 6-9 months post partum. This last observation is in contrast to previous reports34 in which antibody to rotavirus was not found (by immunofluorescence or neutralisation tests) in milk more than a week after parturition.

SIR Simhon and Mata’ and Inglis



was a modification of our prosimian rotavirtis, SA-11, as a convenient substitute antigen for human rotavirus. The detection antibody was 125I-labelled anti-human-secretory-component rabbit globulin (Behring). Specificity was shown by absorption of antibody with purified rotavirus. Milk was collected from healthy mothers who gave informed consent as approved by the Memorial Hospital human experimentation committee.

solid-phase radioimmunoassay

cedures which


We found secretory IgA antibody to rotavirus in the colosof 12 of 15 women. 38 of 105 milk specimens collected for up to 9 months p,st partum were antibody-positive. 5 of 9 mothers secreted milk antibody as late as 6 or 9 months post partum. Milk antibody titres were 1 :20-1 :320. IgA antibody levels are normally highest in colostrum and decline fairly rapidly with time.67 However, we found that in 9 of 18 women studied sequentially, there were four-fold or greater rises in secretory IgA antibody titres to rotavirus during the post-partum period. This might be explained by infection of the mother with rotavirus, although we have no direct virus-detection data to confirm this hypothesis. It is trum



SIR The letter signed by 55 consultants in the Northern region (Sept. 2, p. 531) is a serious indictment of chaotic staffing policies which are based on the illogical and contradictory


Simhon A., Mata, L Lancet, 1978, i, 39.

2. 3.

Inglis, G. C., and others. ibid. p. 559. Schoub, B. D., Prozesky, O. W., Lecatsas, G., Oosthuizen, R. J. med. Micro-

biol. 1977, 11, 25. 4. Thouless, M. E., Bryden, A. S., Flewett, T. H. Br, med. J. 1977, ii, 1390. 5. Cukor, G., Berry, M. K., Blacklow, N. R.J. infect. Dis. (in the press). 6. Reddy, V., Bhaskaram, C., Raghuramulu, N., Jagadeesan, V. Acta paediat. scand. 1977, 66, 229. 7. Ogra, S. S., Ogra, P. L. J. Ped, 1978, 92, 546.

Medical staffing.

631 clear in papers and prospectuses and I am at a loss to unerror arose. Most of the year is devoted to in depth of a special subject. Project work...
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