695 anticonvulsant. In our country this drug is prohibited, and because of an incredible mountain of Government red tape erected by small negating people, it will not be released to the medical community in the foreseeable future. Can we refer patients to Dr Jeavons and his colleagues so that they may receive the best available treatment? 9615 Brighton
Way, Beverly Hills, California 90210, U.S.A.
JOHN H. MENKES
POLLUTION IN OUR OPERATING-THEATRES
SIR,-Dr Tomlin (Feb. 28, p. 478) indicates that women working in the operating-room are subject to increased risk of spontaneous abortion, congenital abnormalities in their We know of no evidence to support or about the possible effects of operating-theatre allay anxiety contamination by gaseous anaesthetics. None of the studies cited by Dr Tomlin recorded cause-effect or dose-response rela-
children, and
cancer.
tionships. The American Association of Anesthesiologists Ad Hoc Committee’ showed that the rate of spontaneous abortion among operating-room nurses and technicians was greater than that of either the nurse anaesthetists or the anaesthesiologists. If exposure to anaesthetic vapour caused an increased abortion-rate one would expect the rate to be highest among those women with greatest exposure. If there is such an occupational hazard the hazard may be something other than anxsthetic vapours.2 In the Finnish survey3 the scrub nurses had the highest frequency of miscarriages; 21.5% of the pregnancies ended in spontaneous abortion. Intensive-care-unit nurses had a miscarriage-rate of 16-7% and anaesthesia nurses 15.0%. The results did not indicate fetal lethality of anmsthetic gases but rather an increased rate of spontaneous miscarriages due to stress. In 1975 the Council of the Association of Anaesthetists of Great Britain and Ireland4stressed that there is no direct evidence that the increased spontaneous-abortion rate in women working in the operating-theatres, even if con-
firmed, is causally related to anaathetics.
Although one U.K. study5 did suggest a possible increase in congenital abnormality associated with maternal exposure, the latest survey6 did not support this. A retrospective study7 showed apparently high death-rate from malignancies of lymphoid and reticuloendothelial tissues among anaesthetists. In a prospective study no difference was found.8 It seems that any increase in spontaneous-abortion rate found in operating-theatre personnel is less likely to be due to inhalation of anaesthetic vapours than to other environmental factors. Nurses working in the operating-room often have a Smith9 pointed out that we should necessarily seek a single cause for these hazards. Contributory causes could include occupational stress, arising from irregular routine, fatigue, and emotional factors. We undertook a preliminary study (unpublished) to establish whether or not working in the operating-theatre led to increased stress. The urinary output of adrenaline and noradrenaline was estimated in theatre personnel on operating days and non-operating days. The results indicate that the noradrenaline excretion is significantly increased in theatre personnel on operating-days. The sympathetic/adrenalmedullary and the pituitary/adrenal/cortical systems show increased activity when the resting
hard, irregular workload.
not
organism is disturbed, and the adrenal gland plays a key role in regulating the response to stress. Although the causative agents of the effects outlined have not been established, exposure of theatre personnel to atmospheric pollution is undesirable and should be avoided. Toxicity studies of chronic exposure tics are limited, so it concentrations as low
Burnley Burnley,
General
Lancashire
Hospital,
BB10 2PQ
seems as
low concentrations of anaathewise to keep ambient anaesthetic
to
possible. 10 S. MEHTA P. BURTON
DEMOCRACY AND THE G.M.C. ELECTION
SiR,—The last day for the receipt of voting papers for the General Medical Council is April 20, so there is still time to point out some of the anomalies of this election. The object of having elected as well as nominated members is presumably meant to be in the interest of democracy. But, as I pointed out to the Merrison Committee (in written evidence), you cannot really have free choice when you know nothing about the candidates. Very few doctors in Hull, for instance, will know candidates in general practice in Tiverton. I suggested other methods, but I suppose they were deemed impracticable. What I predicted has happened. The British Medical Association has pre-empted the bidding by circulating a list of 8 candidates sponsored by the B.M.A., and has published brief election addresses by them in the R.M.]. of March 20. The other 26 candidates are ignored, although their names include at least 4 people personally known to me of outstanding merit (not merely academic merit). It includes 4 women, and 2 doctors whose work for the community has already been recognised by the award of an o.B.E. If we are to approach even the semblance of a democratic election I suggest the following: (1.) The B.M.A. should publish brief particulars of the service which the other 26 candidates have made to medicine and the community. (2.) Before accepting the B.M.A. list en masse voters should try to get some personal information of candidates unknown to them, from local or other sources, and should consider the merits of the 26 candidates not sponsored by the B.M.A. (3.) If a voter wishes to vote for one or more non-B.M.A. candidate he or she should not vote for anyone else. There is no need to vote for more than 1 candidate. To explain this, let us suppose that 40% of the profession will vote for the 8 B.M.A. candidates a, b, c, d, e, f, g, and h and 60% wish to see x and y elected. Ten voting papers would then show two votes for each of the B.M.A. candidates and three each for x and y. But suppose the voters think they should make up 8 votes in all and in addition to voting for x and y they also vote B.M.A. candidates a, b, c, d, e, and f, then all these will get three votes each, and a majority for x and y will not be achieved. (4.) Voters should only vote "blind" (if at all) for the whole of the B.M.A. 8 if they deem that the policy of the B.M.A. in years has been wise and meritorious and could not be improved by the presence on the G.M.C. of some elected members who were not B.M.A. sponsored. recent
I have
1. American
Society of Anesthesiologists Ad Hoc Committee Anesthesiology, 1974, 41, 321. 2. Walts, L. F., Forsythe, A. B., Moore, G. ibid. 1975, 42, 608. 3 Rosenberg, P., Kirves, A. Acta anœsth. scand. 1973, 53, 37. 4 Vickers, M.D. Anœsthesia, 1975, 30, 697. 5. Knill-Jones, R. P., Moir, D. D., Rodrigues, I. V., Spence, A. A. Lancet, 1972, i, 1326. 6. Knill-Jones, R. P., Newman, B. J., Spence, A. A. ibid. 1975, ii, 807. 7.Bruce, D. L., Eide, K. A., Linde, H. W., Eckenhoff, J. E. Anesthesiology,
1968, 29, 565. Eide, 1974, 41, 71.
8. Bruce, D. L.,
K.
A., Smith,
N.
nothing personal against any one of the 8 sponsored I think they are getting an unfair and wholly undemocratic advantage; some of us must see to it that some of the outstanding persons ignored by the B.M.A. get a fair candidates, but
chance of election. House of Lords, London SW1
’
PLATT
J., Seltzer, F., Dykes, M. H. M. ibid.
9. Smith, W. D. A. Proc. R. Soc. Med. 1974, 67, 987.
10. Mehta, S., 265.
Cole,
W.
J., Chari, J., Lewin, K. Can. Anœsth. Soc. J. 1975, 22,
Way, Beverly Hills, California 90210, U.S.A.
JOHN H. MENKES
POLLUTION IN OUR OPERATING-THEATRES
SIR,-Dr Tomlin (Feb. 28, p. 478) indicates that women working in the operating-room are subject to increased risk of spontaneous abortion, congenital abnormalities in their We know of no evidence to support or about the possible effects of operating-theatre allay anxiety contamination by gaseous anaesthetics. None of the studies cited by Dr Tomlin recorded cause-effect or dose-response rela-
children, and
cancer.
tionships. The American Association of Anesthesiologists Ad Hoc Committee’ showed that the rate of spontaneous abortion among operating-room nurses and technicians was greater than that of either the nurse anaesthetists or the anaesthesiologists. If exposure to anaesthetic vapour caused an increased abortion-rate one would expect the rate to be highest among those women with greatest exposure. If there is such an occupational hazard the hazard may be something other than anxsthetic vapours.2 In the Finnish survey3 the scrub nurses had the highest frequency of miscarriages; 21.5% of the pregnancies ended in spontaneous abortion. Intensive-care-unit nurses had a miscarriage-rate of 16-7% and anaesthesia nurses 15.0%. The results did not indicate fetal lethality of anmsthetic gases but rather an increased rate of spontaneous miscarriages due to stress. In 1975 the Council of the Association of Anaesthetists of Great Britain and Ireland4stressed that there is no direct evidence that the increased spontaneous-abortion rate in women working in the operating-theatres, even if con-
firmed, is causally related to anaathetics.
Although one U.K. study5 did suggest a possible increase in congenital abnormality associated with maternal exposure, the latest survey6 did not support this. A retrospective study7 showed apparently high death-rate from malignancies of lymphoid and reticuloendothelial tissues among anaesthetists. In a prospective study no difference was found.8 It seems that any increase in spontaneous-abortion rate found in operating-theatre personnel is less likely to be due to inhalation of anaesthetic vapours than to other environmental factors. Nurses working in the operating-room often have a Smith9 pointed out that we should necessarily seek a single cause for these hazards. Contributory causes could include occupational stress, arising from irregular routine, fatigue, and emotional factors. We undertook a preliminary study (unpublished) to establish whether or not working in the operating-theatre led to increased stress. The urinary output of adrenaline and noradrenaline was estimated in theatre personnel on operating days and non-operating days. The results indicate that the noradrenaline excretion is significantly increased in theatre personnel on operating-days. The sympathetic/adrenalmedullary and the pituitary/adrenal/cortical systems show increased activity when the resting
hard, irregular workload.
not
organism is disturbed, and the adrenal gland plays a key role in regulating the response to stress. Although the causative agents of the effects outlined have not been established, exposure of theatre personnel to atmospheric pollution is undesirable and should be avoided. Toxicity studies of chronic exposure tics are limited, so it concentrations as low
Burnley Burnley,
General
Lancashire
Hospital,
BB10 2PQ
seems as
low concentrations of anaathewise to keep ambient anaesthetic
to
possible. 10 S. MEHTA P. BURTON
DEMOCRACY AND THE G.M.C. ELECTION
SiR,—The last day for the receipt of voting papers for the General Medical Council is April 20, so there is still time to point out some of the anomalies of this election. The object of having elected as well as nominated members is presumably meant to be in the interest of democracy. But, as I pointed out to the Merrison Committee (in written evidence), you cannot really have free choice when you know nothing about the candidates. Very few doctors in Hull, for instance, will know candidates in general practice in Tiverton. I suggested other methods, but I suppose they were deemed impracticable. What I predicted has happened. The British Medical Association has pre-empted the bidding by circulating a list of 8 candidates sponsored by the B.M.A., and has published brief election addresses by them in the R.M.]. of March 20. The other 26 candidates are ignored, although their names include at least 4 people personally known to me of outstanding merit (not merely academic merit). It includes 4 women, and 2 doctors whose work for the community has already been recognised by the award of an o.B.E. If we are to approach even the semblance of a democratic election I suggest the following: (1.) The B.M.A. should publish brief particulars of the service which the other 26 candidates have made to medicine and the community. (2.) Before accepting the B.M.A. list en masse voters should try to get some personal information of candidates unknown to them, from local or other sources, and should consider the merits of the 26 candidates not sponsored by the B.M.A. (3.) If a voter wishes to vote for one or more non-B.M.A. candidate he or she should not vote for anyone else. There is no need to vote for more than 1 candidate. To explain this, let us suppose that 40% of the profession will vote for the 8 B.M.A. candidates a, b, c, d, e, f, g, and h and 60% wish to see x and y elected. Ten voting papers would then show two votes for each of the B.M.A. candidates and three each for x and y. But suppose the voters think they should make up 8 votes in all and in addition to voting for x and y they also vote B.M.A. candidates a, b, c, d, e, and f, then all these will get three votes each, and a majority for x and y will not be achieved. (4.) Voters should only vote "blind" (if at all) for the whole of the B.M.A. 8 if they deem that the policy of the B.M.A. in years has been wise and meritorious and could not be improved by the presence on the G.M.C. of some elected members who were not B.M.A. sponsored. recent
I have
1. American
Society of Anesthesiologists Ad Hoc Committee Anesthesiology, 1974, 41, 321. 2. Walts, L. F., Forsythe, A. B., Moore, G. ibid. 1975, 42, 608. 3 Rosenberg, P., Kirves, A. Acta anœsth. scand. 1973, 53, 37. 4 Vickers, M.D. Anœsthesia, 1975, 30, 697. 5. Knill-Jones, R. P., Moir, D. D., Rodrigues, I. V., Spence, A. A. Lancet, 1972, i, 1326. 6. Knill-Jones, R. P., Newman, B. J., Spence, A. A. ibid. 1975, ii, 807. 7.Bruce, D. L., Eide, K. A., Linde, H. W., Eckenhoff, J. E. Anesthesiology,
1968, 29, 565. Eide, 1974, 41, 71.
8. Bruce, D. L.,
K.
A., Smith,
N.
nothing personal against any one of the 8 sponsored I think they are getting an unfair and wholly undemocratic advantage; some of us must see to it that some of the outstanding persons ignored by the B.M.A. get a fair candidates, but
chance of election. House of Lords, London SW1
’
PLATT
J., Seltzer, F., Dykes, M. H. M. ibid.
9. Smith, W. D. A. Proc. R. Soc. Med. 1974, 67, 987.
10. Mehta, S., 265.
Cole,
W.
J., Chari, J., Lewin, K. Can. Anœsth. Soc. J. 1975, 22,
