766
NEWS
BRITISH MEDICAL JOURNAL
25 SEPTEMBER 1976
AND NOTES
EPIDEMIOLOGY Mycoplasma hominis infection The following notes are compiled by the Epidemiological Research Laboratory of the Public Health Laboratory Service from reports submitted by public health and hospital laboratories in the United Kingdom and Republic of Ireland. After an uneventful pregnancy a 40-year-old primigravida was delivered of a healthy infant in June this year. Labour lasted for four and a half hours, and rotation of the fetus and application of Kielland's forceps were necessary to effect delivery. The placenta and membranes were delivered intact, and the patient's general condition immediately after delivery was satisfactory. Twenty-four hours later the patient experienced pain in the left groin and medial side of the thigh, and difficulty in moving the left hip. At this point she was noted to be pyrexial but did not appear to be acutely ill. A high vaginal swab and venous blood for culture were sent to the laboratory. A Gram film prepared from the vaginal
swab showed many pus cells but no microorganisms. No growth was apparent on blood agar plates after 24 hours' incubation, but after a further 24 hours large numbers of minute colonies were observed both on the plate incubated anaerobically and on that incubated in air plus 5% CO2. Cover-slip impressions of these colonies stained by Giemsa showed the typical appearance of Mycoplasma. Meanwhile, the patient had continued to run a low-grade pyrexia and to complain of pain in the left hip. A diagnosis of septic arthritis was made and aspiration of the joint yielded purulent fluid; no micro-organisms were detected in Gram and Ziehl-Neelsen films of this material. After 48 hours' incubation cultures on blood agar yielded an organism indistinguishable from that isolated from the vagina. At this point tetracycline therapy was begun, and the patient's condition improved rapidly. The blood taken for culture at the onset of the illness had been distributed into three
bottles of 0-1% glucose broth and one bottle each of Brewer's thioglycollate medium and Robertson's cooked meat broth. All bottles were subcultured to blood agar after 48 hours. After incubation of the solid media for 48 hours Mycoplasma was isolated from one bottle of glucose broth only. The isolates from the vagina and hip were sent to the Mycoplasma Reference Laboratory, where they were identified as Mycoplasma hominis. Samples of serum taken at the onset of the illness and two weeks later were also examined but, interestingly, no evidence of antibody to M hominis was detected in either sample. Symptomatic M hominis infections are not -commonly reported by laboratories. Other reports in 1975 and 1976 include an abscess on the back of the neck related to birth trauma from forceps delivery in an infant of 11 days and conjunctivitis in a girl of 10 years. A report on two other cases of interest appeared in these columns two years ago (28 September 1974, p 816).
drugs or below the 80 mg/100 ml concentration. Arrests for impairment are also necessary where the suspect was merely in charge of the vehicle at the time that he was spotted by the police, since (to avoid random testing) arrests for excess blood-alcohol concentration can be made only where the accused was driving or attempting to drive. But a person in charge of a motor vehicle on a road or other public place can escape a conviction if he proves that at the time "the circumstances were such that there was no likelihood of his driving it so long as he remained unfit to drive."3 It was this defence which seems to have availed the Strathclyde police superintendent who was acquitted of an impairment offence in May, even though his blood-alcohol content was 224 mg/100 ml. The arresting police had seen the accused getting into his car outside his home, but the superintendent said that he was not driving and had no intention of doing so. According to the police4 the superintendent's speech was slurred, his eyes glazed, and he was unsteady on his feet. There was a smell of alcohol on his breath. On his arrival at the police station his condition dramatically improved and he satisfied the duty officer and a police surgeon who tested him that he was fit to drive. In acquitting the superintendent, the Sheriff
said that "it was probably a case of someone in a very small minority of people with a high tolerance to alcohol, who could have a very
MEDICOLEGAL Drink-driving offences FROM OUR LEGAL CORRESPONDENT
It is now nearly ten years since Parliament created the new offence of driving or attempting to drive with a blood-alcohol content above a prescribed limit of 80 mg alcohol/100 ml blood.i To permit the police to take blood or urine samples from suspected drinking drivers, the procedurally cumbersome system of breath tests was introduced. But, while the Alcotest-80 (not to be confused with the Breathalyser, which is used by trained police abroad to measure the blood-alcohol content2) was a complete innovation on British roads, Parliament did not repeal the old offence of driving or being in charge of a motor vehicle while unfit to drive through drink or drugs. The offence of unfitness to drive is now contained in section 5 of the Road Traffic Act, 1972, which lays down that the accused shall "be taken to be unfit to drive if his ability to drive properly is for the time being impaired." Before 1962 the test was whether the accused was so under the influence as to be incapable of having proper control of a motor vehicle. The vast majority of prosecutions are now brought for excess alcohol offences, but charges of impairment are used where the procedure for taking a blood or urine sample breaks down, or where the ability to drive is impaired by
high proportion of alcohol in the blood and still be fit to drive." The Sheriff's comment is more than a little surprising in view of the BMA statement in 1965 (quoted in the recent report of the Blennerhassett Committee on Drinking and Driving") that "there could be very few persons in whom impairment of the ability to drive properly and increased risk of being involved in accidents was not present to a significant extent at blood alcohol concentrations in excess of 80 mg/100 ml." Indeed, the Blennerhassett Committee recommended that drivers with a blond-alcohol concentration over 200 mg/100 ml (the approximate equivalent of 11 to 15 pints of beer or double measures of spirits6) should fall into a new category of high-risk offenders. Also falling within this category were to be those convicted twice in ten years of a drink-driving offence. It was suggested that even after they had served their appropriate period of disqualification, such offenders should still not be entitled to the return of their licence, until they had satisfied the court that they did not, because of their drinking habits, present undue danger to themselves and other road users.
BRITISH MEDICAL JOURNAL
767
25 SEPTEMBER 1976
While the two offences of an excess concentration of blood-alcohol and impaired ability to drive exist quite independently, and involve quite distinct procedures for the police, the two do dovetail to some extent.' A roadside breath test is not, of course, a prerequisite for an arrest for the impairment offence, but where the police arrest a person for impairment they may still proceed against him for a bloodalcohol-concentration offence provided that at the police station he was offered a breath test and then gave a blood or urine sample for analysis. Thus in 1969 the Court of Appeal upheld a conviction for attempting to drive with excess blood-alcohol content,8 where the accused had been arrested for being in charge of a motor vehicle while unfit to drive. This interaction between the two offences is important, as the police have no power to arrest a person who is in charge of a motor vehicle (as opposed to driving or attempting to drive it) with an excessive blood-alcohol
concentration. The only way in which the police can obtain a specimen of blood or urine is by first arresting the suspect, and (unless there is an accident) the only way in which a conviction can be obtained against a man in charge of a vehicle with excess blood-alcohol concentration is if he is first arrested for being in charge while unfit to drive.
MEDICAL NEWS
and an allowance of C205 is payable in stages only for children whose certificates have been completed. Thirdly, all girls aged 13 and all women working with children were encouraged to accept rubella vaccination. Fourthly, social security payments during pregnancy were made payable only to women who attendced regularly for antenatal care. Fifthly, more money was spent on staff and equipment in obstetric units. Sixthly, facilities for resuscitation for the newborn were improved, backed by legislation prescribing minimum standards; and, lastly, 20 new units were established for intensive care of the newborn. The cumulative effect of the programme has been a steady fall in perinatal mortality, says the report, and the fall is expected to continue. It adds that the emphasis on prevention was not confined to obstetrics: it was also evident in other aspects of French health policy. Cost-benefit analysis of the perinatal programme suggested that the additional expenditure was more than balanced by the costs that would otherwise have been incurred in the care of handicapped children.
Writing and speaking in medicine There are still some vacancies for the Seminar on Writing and Speaking in Medicine, which is being held by the British Medical journal and the Birmingham Medical Institute at 36 Harborne Road, Edgbaston, Birmingham B15 3AF, on 22 October. The chairman of the morning session is Mr Barry O'Donnell, President BMA, CMA, and IMA. He is followed by Sir James Howie on "How I read"; Dr Stephen Lock on "How editors survive"; Dr Alec Paton on "How I write a paper"; Dr W F Whimster on "How I subedit"; and Dr D A Pyke on "How I referee." After lunch, there is an address by the chairman of the afternoon session, Professor A G W Whitfield; then Dr T D V Swinscow on "Presenting results"; Dr C F Hawkins on "Writing the MD thesis"; and, after workshops (on writing the MD thesis, presentation of results, speaking in medicine, and advice about articles), Dr Richard Leeper McClelland (Richard Leech) finishes with "Speak the speech, I pray you." Applications, together with registration fee of £12, and a note of which workshop you wish to join, should be sent to the Editor, BM7, BMA House, Tavistock Square, London WC1H 9JR. French lead in perinatal care
Britain should follow the example set by France in having a political commitment to prevent perinatal causes of handicap, says the Foundation for Education and Research in Child-bearing. In a report, Prevention of Handicap of Perinatal Origin (£2 00) by Margaret and Arthur Wynn, the foundation argues that the recent fall in perinatal mortality in France (from 23 4 per thousand in 1971 to 19 1 in 1974) was the result of its seven-point plan introduced in 1971, on which a total of 300 million francs was spent. The first step was the allocation of more resources to postgraduate training in obstetrics and perinatal medicine-new chairs and new departments. Secondly, more money was given to epidemiological research and the provision of detailed records for every child from birth. In France now statutory certificates of health are issued at 8 days, 9 months, and 24 months
"Untidy law" Persons arrested having given a positive breath test or having refused one can also be proceeded against for an impairment offence, and the analysis of their blood-alcohol content is admissible evidence at their trial. None the less, the Blennerhassett Committee regarded the overlap between the two offences as "untidy law." They also criticised the duplication for giving the false impression that the excess alcohol offence was a technical one
falling short of impairment. The committee suggested the merger of the two offences in such a way that there should be a single offence of driving or attempting (or being in charge) when unfit through drink or drugs. Unfitness and impairment would be proved as at present, but there would be an irrebuttable presumption of unfitness in the event of the blood-alcohol concentration being over the prescribed limit. There would then be no opportunity to argue that the accused had an exceptional tolerance to alcohol. 1 Section 1 Road Safety Act 1967 (now Section 6 Road Traffic Act 1972). 3Including in Northern Ireland, where different legislation applies to the remainder of the United
Kingdom.
3Section 5 (3) Road Traffic Act 1972. Daily Mail, 12 and 15 May 1976. Report of the Departmental Committee. London, HMSO, 1976. 6 British Medical_Journal, 1976, 1, 1103. 7 Wilkinson, Road Traffic Offences: ed by P J Holnan, p 235. London, Oyez Publishing Ltd, 1976. ' R v Jones (1969) 2 AER 1559.
are the social workers who cannot accept that they represent authority and others who see themselves solely as social policemen. In*service training must prevent social workers from taking up these extreme positions. In work with the mentally ill social workers have to accept that they have to be caring and concerned with patients' rights but also have to exercise a degree of direction and control on occasion." The second report, The Mental Illness and Health Component of Basic Social Work Training (C1 00), suggests that social work students who during their general training show a special interest or aptitude for work with the mentally ill should be helped to maintain and develop it. A special elective course in mental health should be made available to such students. The report also recommends that, once qualified, social workers who want to work with the mentally ill should move straight on to a year's specialist in-service training. All social work students should be given more detailed information about mental illness and its associated handicaps, and more imaginative efforts should be made to give students experience Social workers and mental health of the practical problems likely to be encounTwo years ago a joint conference of the tered. Both reports are available from MIND, British Association of Social Workers and MIND (the National Association for Mental 22 Harley Street, London WlN 2ED. Health) agreed that there was some general disquiet about the quality of social work among Brand names in prescribing the mentally ill. MIND agreed to look at the ways social workers should be trained for this A defence of the use of brand names in medical work, and the reports of its two working parties prescriptions has been published by the Office have now been published. of Health Economics (itself founded and In-service Training for Social Work with the largely funded by the Association of the British Mentally Ill (75p) opens with a call to social Pharmaceutical Industry). In Brand Names in service agencies to re-establish their credibility Prescribing (price 50p) the OHE calls for a with psychiatrists, the psychiatric hospital reconciliation between the practical and services, primary health care teams, mentally scientific benefits of using brand names and ill people, and their families. Further specialist some clinical pharmacologists' preference training is needed, says the report, to enable 'for the use of non-proprietary names in their social workers to give the high standard of teaching. Medicines with the same active performance that psychiatrists and other ingredients made by different manufacturers doctors rightly expect of them. It recommends cannot be assumed to have an equivalent that training courses should be set up and therapeutic action, says the report. Many should be concentrated on qualified social potent drugs were known to vary in their workers. "All social workers have problems bioavailability depending on the formulation in balancing responsibility to society and used to prepare them, and this variation could clients with the statutory requirements of the have "potentially calamitous" effects. Medical agencies in which they work," the report teachers should be encouraged to use both states. "At the extreme ends of the spectrum brand names and non-proprietary names in
768
their lectures. Wider use of brand names in appropriate circumstances would, the report claims, improve the quality of NHS care at little if any monetary cost. Typhoid in Spain
At least eight British tourists are now known to have contracted typhoid while on holiday at the Spanish resort of Salou, near Tarragona. A statement from the DHSS says that the Spanish authorities are investigating the outbreak. It recommends that anyone travelling outside northern Europe, north America, Australia, or New Zealand should be advised to be vaccinated against both typhoid and
paratyphoid. Kidney transplants The number of kidney transplants undertaken in Great Britain and Eire for the month ending 31 August 1976 was 44 (number of transplants for month ending 31 July was 61). The number of potential recipients on file at 31 August, 1976 was 1080 (number of potential recipients on file at 31 July 1976 was 1054).
Mobility allowance for disabled children The Minister for the Disabled, Mr Alfred Morris, announced on 25 August that from 24 November children between 11 and 14 would qualify for the new mobility allowance of £5 per week. In the past outdoor mobility help was based on the individual's ability to drive and children were excluded. "Mobility allowance," Mr Morris said, "is the child's own benefit in a way that is unique in our social security system." The allowance will be payable whether the child is at home with his own parents, with foster parents, in hospital, or a children's home. Claims for children between 5 and 10 will be invited as soon as possible. It is estimated that there may be as many as 30 000 children between 5 and 15 who will qualify at an annual cost, at the current rate, of £8m.
BRITISH MEDICAL JOURNAL
"Clinical Biochemistry and the Medical Graduate"-Meeting, 9 October, Cambridge. Details from Dr A Grant, Department of Clinical Biochemistry, Addenbrooke's Hospital, Hills Road, Cambridge CB2 2QR. (Tel 0223 45151.) 43rd Clean Air Conference-11-15 October, Edinburgh. Details from National Society for Clean Air, 136 North Street, Brighton BNI 1RG. (Tel Brighton 26313.) Castle Priory College-Course on "The handicapped child in the learning situation," 18-21 October, Wallingford. Details from the principal, Castle Priory College, Thames Street, Wallingford, Oxfordshire OXIO OHE. (Tel 0491 37551.) King's Fund Centre-Centenary conference "Service and sanctuary," 21 October, Northampton. Details from King's Fund Centre, 126 Albert Street, London NW1 7NF. (Tel 01-267 6111.) Ashford Postgraduate Medical CentreMRCP course (Part II), 22-23 October, Ashford. Details from Medical Centre Secretary, Ashford Hospital, Ashford, Middlesex TW15 3AA. (Tel Ashford 51188 ext 370.)
SOCIETIES AND LECTURES For attending lectures marked * a fee is charged or a ticket is required. Applications should be made first to the institution concerned.
Monday, 27 September RoYAL COLLEGE OF SURGEONS OF ENGLAND-6 Mr N 0 K Gibbon: Prostatectomy.*
pm,
Tuesday, 28 September INSTITUTE OF NEUROLOGY-5.30 pm, Dr L S Wolfe (Canada): Prostaglandin endoperoxides and thromboxanes in normal and abnormal brain function. ROYAL COLLEGE OF SURGEONS OF ENGLAND-6 pm, Mr B J Harries: Intracranial space occupying lesions: some pathological and diagnostic aspects.*
"Alcoholism" advances in medical and psychiatric understanding"-Conference, 25-29 September, London. Details from the Alcohol Education Centre, Maudsley Hospital, 99 Denmark Hill, London SE5 8AZ. (Tel 01-703 8053 or 01-703 6333 ext 40.) Royal College of Physicians of LondonTeach-in on "Herpes virus infections," 5 October, London. For details see advertisement at p xiv. Homoeopathic Trust for Research and Education-Seminar for medical students, 6 October, London. Details from the Trust, Hahnemann House, 2 Powis Place, Great Ormond Street, London WC1N 3HT. (Tel 01-837 9469.)
Division Meetings to be Held Members proposing to attend meetings marked * are asked to notify in advance the honorary secretary concerned. Burton upon Trent and District-At Stanhope Arms Hotel, Tuesday, 28 September, 7 for 7.30 pm, dinner meeting, speaker Mr G Newton.* Doncaster-At Doncaster Royal Infirmary, Wednesday, 29 September, 7.30 for 8 pm, Doncaster Medical Society dinner lecture, speaker Mr R Brearley: "Tomorrow to fresh woods and pastures new." (Wives are invited.) * Greenwich-At 93 Kidbrooke Gove, Saturday, 2 October, 8 pm, buffet supper with chairman. (Partners are invited.)* Ipswich-At Orchard Street Health Centre, Thursday, 30 September, 7.45 pm, agm.* Islington-At 31 St Mary's Grove, Canonbury, Thursday, 30 September, 8.30 pm, get together at Dr Core's house. Lewisham-At Yeomanry House, Bromlev Road, Friday, 1 October, 8 pm, chairman's annual reception.* Redbridge and Stratford-At King George Hospital, Tuesday, 28 September, 8.30 pm, agm. Sheffield-At Nether Edge Hospital, Friday, 1 October, 8.30 pm, agm. South Middlesex-At Jolly Gardeners, Wednesday, 29 September, 8.30 pm, joint symposium with Hounslow Veterinary Club on rabies.* (Preceded by dinner, 7 pm.*) South Tees-At Marton Country Club, Thursday, 30 September, 8.45 pm, BMA lecture by Professor Sam Shuster: "Melanocyte stimulating hormone-my part in its cutaneous downfall."5 (Preceded by dinner, 7.15 for 7.45 pm.* Guests are invited.) Woking and Chertsey-At St Peter's Hospital, Wednesday, 29 September, 8.30 pm, general meeting.
UNIVERSITIES AND COLLEGES LONDON The title of professor of surgical studies has been conferred on Mr J H Wyllie in respect of his post at University College Hospital Medical School. The title of reader in clinical pharmacology has been conferred on Dr A Richens in respect of his post at St Bartholomew's Hospital Medical College. MD-P M Carter, M Davis, P 0 Fasan, G L D Gibbens, A B 0 0 Oyediran, R L Powles, Diana M Samson. MS-S J S Kent.
Wednesday, 29 September ROYAL COLLEGE OF SURGEONS OF ENGLAND-5 pm, Tudor Edwards Memorial lecture by Mr W P Cleland: Chest injuries during and after World War II.* 6.15 pm, Mr N V Addison: Chronic inflammatory disease of the large bowel.* UNIVERSITY OF CAMBRIDGE-At Addenbrooke's Hospital, 5.15 pm, Professor I H Scheinberg (New York): The life and death of plasma proteins.
APPOINTMENTS BIRMINGHAM AREA HEALTH AUTHORITY (TEACHING)Dr Linda M Winkley (consultant child psychiatrist). CITY AND EAST LONDON AREA HEALTH AUTHORITY (TEACHING)-Mr 0 J A Gilmore (consultant surgeon and senior lecturer).
Thursday, 30 September ROYAL COLLEGE OF SURGEONS OF ENGLAND-6 pm, Mr G L Bunton: Some aspects of the acute abdomen in childhood.*
Friday, 1 October ROYAL COLLEGE OF SURGEONS OF ENGLAND-5.15 pm, Mr J W Jackson: Oesophageal obstruction: diagnosis and management.* 6.30 pm, Mr J Chapman: Hydronephrosis.* ROYAL COLLEGE OF PHYSICIANS OF LONDON-5 pm, Ernestine Henry lecture by Professor E P G H du Boulay: Radiation hazards. ROYAL COLLEGE OF SURGEONS OF ENGLAND-At Dental Hospital, Birmingham, 5.30 pm, Pocklington memorial lecture by Professor A E Maumenee: Advances in corneal transplantation.
Smoking in the USA The Weekly Epidemiological Record of the WHO reports that smoking is continuing to decline in popularity in the USA. Defining a current regular smoker as "anyone who has smoked at least 100 cigarettes in his lifetime Saturday, 2 October and who now smokes cigarettes," the latest SOCIETY FOR THE STUDY OF HUMAN SEXUAL BEHAVIOUR -At Royal Edinburgh Hospital Department of data show that in 1975 39O' of men and 290' Psychiatry, Edinburgh, 10.30 am, agm. of women were smokers: in 1970 the figures were 42 %' and 30 0,and in 1965 52% and 32%.
COMING EVENTS
25 SEPTEMBER 1976
Corrections Change at DHSS The photographs of Mr Stanley Orme and Mr Roland Moyle (18 September, p 709) were incorrectly captioned by Universal Pictorial Press. The names appearing under these pictures should read from left to right Mr Roland Moyle and Mr Stanley Orme and not as printed.
Notice to authors When original articles and letters for publication are not submitted exclusively to the British Medical Journal this must be stated. For detailed instructions to authors see page 6 of the issue dated 3 January 1976. Correspondence on editorial business should be addressed to the Editor, British Medical Journal, BMA NOTICES BMA House, Tavistock Square, London WC1H 9JR. Telephone: 01-387 4499. Telegrams: Diary of Central Meetings Aitiology, London WC1. Communications will not be acknowledged unless a stamped addressed SEPTEMBER postcard or an international reply coupon is Private Practice Committee, 10.30 am. 29 Wed enclosed. OCTOBER Authors wanting reprints of their articles should Full-time Medical Teachers and Research notify the Publishing Manager, BMA House, 1 Fri Workers Committee, 10 am. Tavistock Square, WC1H 9JR, on receipt of proofs. 6 Wed Council, 10 am. Scottish Council (7 Drumsheugh Gardens, Edinburgh), 10.45 am. Joint Consultants Committee (Royal College of Physicians, Edinburgh), 9.30 am. Central Ethical Committee, 10 am. Wed Wed Occupational Health Committee, 10.30 am. Scottish Committee for Hospital Medical Wed Services (7 Drumsheugh Gardens, Edinburgh), 10.45 am. Committee on the EEC, 2.30 pm. Wed Thurs General Medical Services Committee, 10 am.
12 Tues
19 Tues 20 20 20
20 21 21 Thurs
Organisation Committee, 10 am.
(© British Medical Journal 1976 All Rights Reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior permission of the British Medical Journal.
NEWS
BRITISH MEDICAL JOURNAL
25 SEPTEMBER 1976
AND NOTES
EPIDEMIOLOGY Mycoplasma hominis infection The following notes are compiled by the Epidemiological Research Laboratory of the Public Health Laboratory Service from reports submitted by public health and hospital laboratories in the United Kingdom and Republic of Ireland. After an uneventful pregnancy a 40-year-old primigravida was delivered of a healthy infant in June this year. Labour lasted for four and a half hours, and rotation of the fetus and application of Kielland's forceps were necessary to effect delivery. The placenta and membranes were delivered intact, and the patient's general condition immediately after delivery was satisfactory. Twenty-four hours later the patient experienced pain in the left groin and medial side of the thigh, and difficulty in moving the left hip. At this point she was noted to be pyrexial but did not appear to be acutely ill. A high vaginal swab and venous blood for culture were sent to the laboratory. A Gram film prepared from the vaginal
swab showed many pus cells but no microorganisms. No growth was apparent on blood agar plates after 24 hours' incubation, but after a further 24 hours large numbers of minute colonies were observed both on the plate incubated anaerobically and on that incubated in air plus 5% CO2. Cover-slip impressions of these colonies stained by Giemsa showed the typical appearance of Mycoplasma. Meanwhile, the patient had continued to run a low-grade pyrexia and to complain of pain in the left hip. A diagnosis of septic arthritis was made and aspiration of the joint yielded purulent fluid; no micro-organisms were detected in Gram and Ziehl-Neelsen films of this material. After 48 hours' incubation cultures on blood agar yielded an organism indistinguishable from that isolated from the vagina. At this point tetracycline therapy was begun, and the patient's condition improved rapidly. The blood taken for culture at the onset of the illness had been distributed into three
bottles of 0-1% glucose broth and one bottle each of Brewer's thioglycollate medium and Robertson's cooked meat broth. All bottles were subcultured to blood agar after 48 hours. After incubation of the solid media for 48 hours Mycoplasma was isolated from one bottle of glucose broth only. The isolates from the vagina and hip were sent to the Mycoplasma Reference Laboratory, where they were identified as Mycoplasma hominis. Samples of serum taken at the onset of the illness and two weeks later were also examined but, interestingly, no evidence of antibody to M hominis was detected in either sample. Symptomatic M hominis infections are not -commonly reported by laboratories. Other reports in 1975 and 1976 include an abscess on the back of the neck related to birth trauma from forceps delivery in an infant of 11 days and conjunctivitis in a girl of 10 years. A report on two other cases of interest appeared in these columns two years ago (28 September 1974, p 816).
drugs or below the 80 mg/100 ml concentration. Arrests for impairment are also necessary where the suspect was merely in charge of the vehicle at the time that he was spotted by the police, since (to avoid random testing) arrests for excess blood-alcohol concentration can be made only where the accused was driving or attempting to drive. But a person in charge of a motor vehicle on a road or other public place can escape a conviction if he proves that at the time "the circumstances were such that there was no likelihood of his driving it so long as he remained unfit to drive."3 It was this defence which seems to have availed the Strathclyde police superintendent who was acquitted of an impairment offence in May, even though his blood-alcohol content was 224 mg/100 ml. The arresting police had seen the accused getting into his car outside his home, but the superintendent said that he was not driving and had no intention of doing so. According to the police4 the superintendent's speech was slurred, his eyes glazed, and he was unsteady on his feet. There was a smell of alcohol on his breath. On his arrival at the police station his condition dramatically improved and he satisfied the duty officer and a police surgeon who tested him that he was fit to drive. In acquitting the superintendent, the Sheriff
said that "it was probably a case of someone in a very small minority of people with a high tolerance to alcohol, who could have a very
MEDICOLEGAL Drink-driving offences FROM OUR LEGAL CORRESPONDENT
It is now nearly ten years since Parliament created the new offence of driving or attempting to drive with a blood-alcohol content above a prescribed limit of 80 mg alcohol/100 ml blood.i To permit the police to take blood or urine samples from suspected drinking drivers, the procedurally cumbersome system of breath tests was introduced. But, while the Alcotest-80 (not to be confused with the Breathalyser, which is used by trained police abroad to measure the blood-alcohol content2) was a complete innovation on British roads, Parliament did not repeal the old offence of driving or being in charge of a motor vehicle while unfit to drive through drink or drugs. The offence of unfitness to drive is now contained in section 5 of the Road Traffic Act, 1972, which lays down that the accused shall "be taken to be unfit to drive if his ability to drive properly is for the time being impaired." Before 1962 the test was whether the accused was so under the influence as to be incapable of having proper control of a motor vehicle. The vast majority of prosecutions are now brought for excess alcohol offences, but charges of impairment are used where the procedure for taking a blood or urine sample breaks down, or where the ability to drive is impaired by
high proportion of alcohol in the blood and still be fit to drive." The Sheriff's comment is more than a little surprising in view of the BMA statement in 1965 (quoted in the recent report of the Blennerhassett Committee on Drinking and Driving") that "there could be very few persons in whom impairment of the ability to drive properly and increased risk of being involved in accidents was not present to a significant extent at blood alcohol concentrations in excess of 80 mg/100 ml." Indeed, the Blennerhassett Committee recommended that drivers with a blond-alcohol concentration over 200 mg/100 ml (the approximate equivalent of 11 to 15 pints of beer or double measures of spirits6) should fall into a new category of high-risk offenders. Also falling within this category were to be those convicted twice in ten years of a drink-driving offence. It was suggested that even after they had served their appropriate period of disqualification, such offenders should still not be entitled to the return of their licence, until they had satisfied the court that they did not, because of their drinking habits, present undue danger to themselves and other road users.
BRITISH MEDICAL JOURNAL
767
25 SEPTEMBER 1976
While the two offences of an excess concentration of blood-alcohol and impaired ability to drive exist quite independently, and involve quite distinct procedures for the police, the two do dovetail to some extent.' A roadside breath test is not, of course, a prerequisite for an arrest for the impairment offence, but where the police arrest a person for impairment they may still proceed against him for a bloodalcohol-concentration offence provided that at the police station he was offered a breath test and then gave a blood or urine sample for analysis. Thus in 1969 the Court of Appeal upheld a conviction for attempting to drive with excess blood-alcohol content,8 where the accused had been arrested for being in charge of a motor vehicle while unfit to drive. This interaction between the two offences is important, as the police have no power to arrest a person who is in charge of a motor vehicle (as opposed to driving or attempting to drive it) with an excessive blood-alcohol
concentration. The only way in which the police can obtain a specimen of blood or urine is by first arresting the suspect, and (unless there is an accident) the only way in which a conviction can be obtained against a man in charge of a vehicle with excess blood-alcohol concentration is if he is first arrested for being in charge while unfit to drive.
MEDICAL NEWS
and an allowance of C205 is payable in stages only for children whose certificates have been completed. Thirdly, all girls aged 13 and all women working with children were encouraged to accept rubella vaccination. Fourthly, social security payments during pregnancy were made payable only to women who attendced regularly for antenatal care. Fifthly, more money was spent on staff and equipment in obstetric units. Sixthly, facilities for resuscitation for the newborn were improved, backed by legislation prescribing minimum standards; and, lastly, 20 new units were established for intensive care of the newborn. The cumulative effect of the programme has been a steady fall in perinatal mortality, says the report, and the fall is expected to continue. It adds that the emphasis on prevention was not confined to obstetrics: it was also evident in other aspects of French health policy. Cost-benefit analysis of the perinatal programme suggested that the additional expenditure was more than balanced by the costs that would otherwise have been incurred in the care of handicapped children.
Writing and speaking in medicine There are still some vacancies for the Seminar on Writing and Speaking in Medicine, which is being held by the British Medical journal and the Birmingham Medical Institute at 36 Harborne Road, Edgbaston, Birmingham B15 3AF, on 22 October. The chairman of the morning session is Mr Barry O'Donnell, President BMA, CMA, and IMA. He is followed by Sir James Howie on "How I read"; Dr Stephen Lock on "How editors survive"; Dr Alec Paton on "How I write a paper"; Dr W F Whimster on "How I subedit"; and Dr D A Pyke on "How I referee." After lunch, there is an address by the chairman of the afternoon session, Professor A G W Whitfield; then Dr T D V Swinscow on "Presenting results"; Dr C F Hawkins on "Writing the MD thesis"; and, after workshops (on writing the MD thesis, presentation of results, speaking in medicine, and advice about articles), Dr Richard Leeper McClelland (Richard Leech) finishes with "Speak the speech, I pray you." Applications, together with registration fee of £12, and a note of which workshop you wish to join, should be sent to the Editor, BM7, BMA House, Tavistock Square, London WC1H 9JR. French lead in perinatal care
Britain should follow the example set by France in having a political commitment to prevent perinatal causes of handicap, says the Foundation for Education and Research in Child-bearing. In a report, Prevention of Handicap of Perinatal Origin (£2 00) by Margaret and Arthur Wynn, the foundation argues that the recent fall in perinatal mortality in France (from 23 4 per thousand in 1971 to 19 1 in 1974) was the result of its seven-point plan introduced in 1971, on which a total of 300 million francs was spent. The first step was the allocation of more resources to postgraduate training in obstetrics and perinatal medicine-new chairs and new departments. Secondly, more money was given to epidemiological research and the provision of detailed records for every child from birth. In France now statutory certificates of health are issued at 8 days, 9 months, and 24 months
"Untidy law" Persons arrested having given a positive breath test or having refused one can also be proceeded against for an impairment offence, and the analysis of their blood-alcohol content is admissible evidence at their trial. None the less, the Blennerhassett Committee regarded the overlap between the two offences as "untidy law." They also criticised the duplication for giving the false impression that the excess alcohol offence was a technical one
falling short of impairment. The committee suggested the merger of the two offences in such a way that there should be a single offence of driving or attempting (or being in charge) when unfit through drink or drugs. Unfitness and impairment would be proved as at present, but there would be an irrebuttable presumption of unfitness in the event of the blood-alcohol concentration being over the prescribed limit. There would then be no opportunity to argue that the accused had an exceptional tolerance to alcohol. 1 Section 1 Road Safety Act 1967 (now Section 6 Road Traffic Act 1972). 3Including in Northern Ireland, where different legislation applies to the remainder of the United
Kingdom.
3Section 5 (3) Road Traffic Act 1972. Daily Mail, 12 and 15 May 1976. Report of the Departmental Committee. London, HMSO, 1976. 6 British Medical_Journal, 1976, 1, 1103. 7 Wilkinson, Road Traffic Offences: ed by P J Holnan, p 235. London, Oyez Publishing Ltd, 1976. ' R v Jones (1969) 2 AER 1559.
are the social workers who cannot accept that they represent authority and others who see themselves solely as social policemen. In*service training must prevent social workers from taking up these extreme positions. In work with the mentally ill social workers have to accept that they have to be caring and concerned with patients' rights but also have to exercise a degree of direction and control on occasion." The second report, The Mental Illness and Health Component of Basic Social Work Training (C1 00), suggests that social work students who during their general training show a special interest or aptitude for work with the mentally ill should be helped to maintain and develop it. A special elective course in mental health should be made available to such students. The report also recommends that, once qualified, social workers who want to work with the mentally ill should move straight on to a year's specialist in-service training. All social work students should be given more detailed information about mental illness and its associated handicaps, and more imaginative efforts should be made to give students experience Social workers and mental health of the practical problems likely to be encounTwo years ago a joint conference of the tered. Both reports are available from MIND, British Association of Social Workers and MIND (the National Association for Mental 22 Harley Street, London WlN 2ED. Health) agreed that there was some general disquiet about the quality of social work among Brand names in prescribing the mentally ill. MIND agreed to look at the ways social workers should be trained for this A defence of the use of brand names in medical work, and the reports of its two working parties prescriptions has been published by the Office have now been published. of Health Economics (itself founded and In-service Training for Social Work with the largely funded by the Association of the British Mentally Ill (75p) opens with a call to social Pharmaceutical Industry). In Brand Names in service agencies to re-establish their credibility Prescribing (price 50p) the OHE calls for a with psychiatrists, the psychiatric hospital reconciliation between the practical and services, primary health care teams, mentally scientific benefits of using brand names and ill people, and their families. Further specialist some clinical pharmacologists' preference training is needed, says the report, to enable 'for the use of non-proprietary names in their social workers to give the high standard of teaching. Medicines with the same active performance that psychiatrists and other ingredients made by different manufacturers doctors rightly expect of them. It recommends cannot be assumed to have an equivalent that training courses should be set up and therapeutic action, says the report. Many should be concentrated on qualified social potent drugs were known to vary in their workers. "All social workers have problems bioavailability depending on the formulation in balancing responsibility to society and used to prepare them, and this variation could clients with the statutory requirements of the have "potentially calamitous" effects. Medical agencies in which they work," the report teachers should be encouraged to use both states. "At the extreme ends of the spectrum brand names and non-proprietary names in
768
their lectures. Wider use of brand names in appropriate circumstances would, the report claims, improve the quality of NHS care at little if any monetary cost. Typhoid in Spain
At least eight British tourists are now known to have contracted typhoid while on holiday at the Spanish resort of Salou, near Tarragona. A statement from the DHSS says that the Spanish authorities are investigating the outbreak. It recommends that anyone travelling outside northern Europe, north America, Australia, or New Zealand should be advised to be vaccinated against both typhoid and
paratyphoid. Kidney transplants The number of kidney transplants undertaken in Great Britain and Eire for the month ending 31 August 1976 was 44 (number of transplants for month ending 31 July was 61). The number of potential recipients on file at 31 August, 1976 was 1080 (number of potential recipients on file at 31 July 1976 was 1054).
Mobility allowance for disabled children The Minister for the Disabled, Mr Alfred Morris, announced on 25 August that from 24 November children between 11 and 14 would qualify for the new mobility allowance of £5 per week. In the past outdoor mobility help was based on the individual's ability to drive and children were excluded. "Mobility allowance," Mr Morris said, "is the child's own benefit in a way that is unique in our social security system." The allowance will be payable whether the child is at home with his own parents, with foster parents, in hospital, or a children's home. Claims for children between 5 and 10 will be invited as soon as possible. It is estimated that there may be as many as 30 000 children between 5 and 15 who will qualify at an annual cost, at the current rate, of £8m.
BRITISH MEDICAL JOURNAL
"Clinical Biochemistry and the Medical Graduate"-Meeting, 9 October, Cambridge. Details from Dr A Grant, Department of Clinical Biochemistry, Addenbrooke's Hospital, Hills Road, Cambridge CB2 2QR. (Tel 0223 45151.) 43rd Clean Air Conference-11-15 October, Edinburgh. Details from National Society for Clean Air, 136 North Street, Brighton BNI 1RG. (Tel Brighton 26313.) Castle Priory College-Course on "The handicapped child in the learning situation," 18-21 October, Wallingford. Details from the principal, Castle Priory College, Thames Street, Wallingford, Oxfordshire OXIO OHE. (Tel 0491 37551.) King's Fund Centre-Centenary conference "Service and sanctuary," 21 October, Northampton. Details from King's Fund Centre, 126 Albert Street, London NW1 7NF. (Tel 01-267 6111.) Ashford Postgraduate Medical CentreMRCP course (Part II), 22-23 October, Ashford. Details from Medical Centre Secretary, Ashford Hospital, Ashford, Middlesex TW15 3AA. (Tel Ashford 51188 ext 370.)
SOCIETIES AND LECTURES For attending lectures marked * a fee is charged or a ticket is required. Applications should be made first to the institution concerned.
Monday, 27 September RoYAL COLLEGE OF SURGEONS OF ENGLAND-6 Mr N 0 K Gibbon: Prostatectomy.*
pm,
Tuesday, 28 September INSTITUTE OF NEUROLOGY-5.30 pm, Dr L S Wolfe (Canada): Prostaglandin endoperoxides and thromboxanes in normal and abnormal brain function. ROYAL COLLEGE OF SURGEONS OF ENGLAND-6 pm, Mr B J Harries: Intracranial space occupying lesions: some pathological and diagnostic aspects.*
"Alcoholism" advances in medical and psychiatric understanding"-Conference, 25-29 September, London. Details from the Alcohol Education Centre, Maudsley Hospital, 99 Denmark Hill, London SE5 8AZ. (Tel 01-703 8053 or 01-703 6333 ext 40.) Royal College of Physicians of LondonTeach-in on "Herpes virus infections," 5 October, London. For details see advertisement at p xiv. Homoeopathic Trust for Research and Education-Seminar for medical students, 6 October, London. Details from the Trust, Hahnemann House, 2 Powis Place, Great Ormond Street, London WC1N 3HT. (Tel 01-837 9469.)
Division Meetings to be Held Members proposing to attend meetings marked * are asked to notify in advance the honorary secretary concerned. Burton upon Trent and District-At Stanhope Arms Hotel, Tuesday, 28 September, 7 for 7.30 pm, dinner meeting, speaker Mr G Newton.* Doncaster-At Doncaster Royal Infirmary, Wednesday, 29 September, 7.30 for 8 pm, Doncaster Medical Society dinner lecture, speaker Mr R Brearley: "Tomorrow to fresh woods and pastures new." (Wives are invited.) * Greenwich-At 93 Kidbrooke Gove, Saturday, 2 October, 8 pm, buffet supper with chairman. (Partners are invited.)* Ipswich-At Orchard Street Health Centre, Thursday, 30 September, 7.45 pm, agm.* Islington-At 31 St Mary's Grove, Canonbury, Thursday, 30 September, 8.30 pm, get together at Dr Core's house. Lewisham-At Yeomanry House, Bromlev Road, Friday, 1 October, 8 pm, chairman's annual reception.* Redbridge and Stratford-At King George Hospital, Tuesday, 28 September, 8.30 pm, agm. Sheffield-At Nether Edge Hospital, Friday, 1 October, 8.30 pm, agm. South Middlesex-At Jolly Gardeners, Wednesday, 29 September, 8.30 pm, joint symposium with Hounslow Veterinary Club on rabies.* (Preceded by dinner, 7 pm.*) South Tees-At Marton Country Club, Thursday, 30 September, 8.45 pm, BMA lecture by Professor Sam Shuster: "Melanocyte stimulating hormone-my part in its cutaneous downfall."5 (Preceded by dinner, 7.15 for 7.45 pm.* Guests are invited.) Woking and Chertsey-At St Peter's Hospital, Wednesday, 29 September, 8.30 pm, general meeting.
UNIVERSITIES AND COLLEGES LONDON The title of professor of surgical studies has been conferred on Mr J H Wyllie in respect of his post at University College Hospital Medical School. The title of reader in clinical pharmacology has been conferred on Dr A Richens in respect of his post at St Bartholomew's Hospital Medical College. MD-P M Carter, M Davis, P 0 Fasan, G L D Gibbens, A B 0 0 Oyediran, R L Powles, Diana M Samson. MS-S J S Kent.
Wednesday, 29 September ROYAL COLLEGE OF SURGEONS OF ENGLAND-5 pm, Tudor Edwards Memorial lecture by Mr W P Cleland: Chest injuries during and after World War II.* 6.15 pm, Mr N V Addison: Chronic inflammatory disease of the large bowel.* UNIVERSITY OF CAMBRIDGE-At Addenbrooke's Hospital, 5.15 pm, Professor I H Scheinberg (New York): The life and death of plasma proteins.
APPOINTMENTS BIRMINGHAM AREA HEALTH AUTHORITY (TEACHING)Dr Linda M Winkley (consultant child psychiatrist). CITY AND EAST LONDON AREA HEALTH AUTHORITY (TEACHING)-Mr 0 J A Gilmore (consultant surgeon and senior lecturer).
Thursday, 30 September ROYAL COLLEGE OF SURGEONS OF ENGLAND-6 pm, Mr G L Bunton: Some aspects of the acute abdomen in childhood.*
Friday, 1 October ROYAL COLLEGE OF SURGEONS OF ENGLAND-5.15 pm, Mr J W Jackson: Oesophageal obstruction: diagnosis and management.* 6.30 pm, Mr J Chapman: Hydronephrosis.* ROYAL COLLEGE OF PHYSICIANS OF LONDON-5 pm, Ernestine Henry lecture by Professor E P G H du Boulay: Radiation hazards. ROYAL COLLEGE OF SURGEONS OF ENGLAND-At Dental Hospital, Birmingham, 5.30 pm, Pocklington memorial lecture by Professor A E Maumenee: Advances in corneal transplantation.
Smoking in the USA The Weekly Epidemiological Record of the WHO reports that smoking is continuing to decline in popularity in the USA. Defining a current regular smoker as "anyone who has smoked at least 100 cigarettes in his lifetime Saturday, 2 October and who now smokes cigarettes," the latest SOCIETY FOR THE STUDY OF HUMAN SEXUAL BEHAVIOUR -At Royal Edinburgh Hospital Department of data show that in 1975 39O' of men and 290' Psychiatry, Edinburgh, 10.30 am, agm. of women were smokers: in 1970 the figures were 42 %' and 30 0,and in 1965 52% and 32%.
COMING EVENTS
25 SEPTEMBER 1976
Corrections Change at DHSS The photographs of Mr Stanley Orme and Mr Roland Moyle (18 September, p 709) were incorrectly captioned by Universal Pictorial Press. The names appearing under these pictures should read from left to right Mr Roland Moyle and Mr Stanley Orme and not as printed.
Notice to authors When original articles and letters for publication are not submitted exclusively to the British Medical Journal this must be stated. For detailed instructions to authors see page 6 of the issue dated 3 January 1976. Correspondence on editorial business should be addressed to the Editor, British Medical Journal, BMA NOTICES BMA House, Tavistock Square, London WC1H 9JR. Telephone: 01-387 4499. Telegrams: Diary of Central Meetings Aitiology, London WC1. Communications will not be acknowledged unless a stamped addressed SEPTEMBER postcard or an international reply coupon is Private Practice Committee, 10.30 am. 29 Wed enclosed. OCTOBER Authors wanting reprints of their articles should Full-time Medical Teachers and Research notify the Publishing Manager, BMA House, 1 Fri Workers Committee, 10 am. Tavistock Square, WC1H 9JR, on receipt of proofs. 6 Wed Council, 10 am. Scottish Council (7 Drumsheugh Gardens, Edinburgh), 10.45 am. Joint Consultants Committee (Royal College of Physicians, Edinburgh), 9.30 am. Central Ethical Committee, 10 am. Wed Wed Occupational Health Committee, 10.30 am. Scottish Committee for Hospital Medical Wed Services (7 Drumsheugh Gardens, Edinburgh), 10.45 am. Committee on the EEC, 2.30 pm. Wed Thurs General Medical Services Committee, 10 am.
12 Tues
19 Tues 20 20 20
20 21 21 Thurs
Organisation Committee, 10 am.
(© British Medical Journal 1976 All Rights Reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior permission of the British Medical Journal.
