BRITISH MEDICAL JOURNAL
8 DECEMBER 1979
NEWS AND NOTES
Viezws Michael Stern's thoughtful review of the recent decline in mortality from ischaemic heart disease in the United States (Annals of Internal Medicine, 1979, 91, 630) shows that the fall has been steepest in blacks and Mexican-Americans. Yet-as he also observes-the frenetic east coast joggers are mostly white and affluent: indeed, of the 10 000 runners in the New York Marathon 80% had college degrees. In the current state of medical knowledge the epidemic of coronary disease seems likely to have come and gone before its explanation is agreed among the experts.
A 58-year-old man who was found to have haemochromatosis, confirmed histologically (American Journal of Pathology, 1979, 96, 611), had been in the habit of taking "massive doses" of a vitamin and iron preparation for over 30 years.
A report in the "New England Journal of Medicine" (1979, 301, 1198) linking coitus late in pregnancy to amniotic-fluid infections was based on examination of the placentas from 26 886 women who had their babies between 1959 and 1966. Did it really take 13 years to analyse the data ?
Minerva was talking recently to a geneticist who is comparing in detail the genetic material of higher apes and man; he is having difficulty finding any differences. Those that do exist are due to large transpositions. One corollary of this finding seems to be that more incest might speed up the evolutionary process-and get us out of this mess.
What happens to a child known to have a skin sensitivity to nickel if he swallows a Canadian quarter? His stomach mucosa, it seems, swells (7ournal of Pediatrics, 1979, 95, 428), so trapping the coin; he develops a generalised urticarial rash; and he needs a laparotomy to remove the coin. The rash faded the day of the operation.
Ballet dancers often complain of painful feet, though true march fractures are rare. Even so (Rheumatology and Rehabilitation, 1979, 18, 235), with technetium-99m diphosphonate bone scanning stress lesions can be recognised before there is radiological evidence of a fracture.
Professor Spyros Doxiadis, drawing support from Kierkegaard, Gide, Shaw, Camus, Eliot, and Shakespeare, gave the 31st Ciba Foundation lecture in London last week. His theme was "The Right to be Different," and he was particularly concerned with young children; he thinks that only by encouraging individualism can a society be confident of survival. He showed some discouraging pictures of tiny children all dressed the same and quoted the poet Kahlil Gibran: " Your children are not your children ... You may strive to be like them, but not to make them like you."
When a child is dying let him die as an individual and not as a patient-and help the parents to build up the most important things in the child's personality to combat some of the hopelessness. This was one of the many insights offered by Jane Davies, whose 6-year-old daughter Sarah died of a Wilms's tumour, in a talk at the Royal College of Physicians. The cassette recording of the talk is available from Pitman Medical Publishing (PO Box 7, 57 High Street, Tunbridge Wells, Kent TN1 1XH) for C3A45; the proceeds will go to a charity. Everyone who deals with dying children should hear it. At first sight the fact that some serum proteins and liver antigens from the nine-banded armadillo cross-react with corresponding human proteins (Clinical and Experimental Immunology, 1979, 38, 135) might be dismissed as esoteric science. But this particular animal is used for growing leprosy bacilli, so vaccines and skin test reagents prepared from it would need to be carefully screened before being used in man.
Press and television reporters seem convinced that if corpses lie unburied after a major disaster the survivors will be exposed to all manner of dangerous infections. In fact, says the "World Health Organisation Weekly Epidemiological Record" (1979, 54, 355), epidemics of cholera, typhoid, and plague are unlikely: so long as deaths are not due to communicable diseases there is no urgency to dispose of dead bodies.
Sucking out secretions through a nasotracheal tube is a routine nursing procedure; how many physicians know (Chest, 1979, 76, 283) that it can cause a profound (if temporary) drop in the arterial oxygen saturation ? Minerva prefers her worries to be global: she is more concerned about the coming of the next ice age than her overdraft, so she was relieved to read in "Science" (1979, 206, 803) that meteorites more than 1 km in diameter hit the earth only once in 600 000 (give or take 150 000) years. A man who had his tongue removed for carcinoma developed a painful phantom which disappeared only after several stellate ganglion blocks (Anesthesia and Analgesia, 1979, 58, 436). Minerva was surprised that phantom tongue had apparently not been reported before.
The National Radiological Protection Board has produced a report, as indigestible as dry parrot seed, on the problem ofgeologic disposal of nuclear waste. More research, apparently, is needed to work out how much nuclear waste can safely be poured into the earth. Will the answer be found in time ? MINERVA
BRITISH MEDICAL JOURNAL
EPIDEMIOLOGY In most age groups and in all yearly totals The following notes are compiled by the Communicable Diseases (Scotland) Unit from reports males predominate. In the 36 weeks of 1979 studied there have been 167 reports of submitted by laboratories. infections in males, 122 in females, and five A review of laboratory reports of respiratory where the sex was not stated. In all years syncytial virus (RSV) by four-weekly periods including 1979 the main clinical pattern of since 1970 shows that a winter epidemic RSV infections was lower respiratory tract occurred every year with the exception of infection, with bronchitis the most frequently 1979 (see figure). reported condition. In all years except 1979 the outbreak of RSV infection began with a small increase in the number of reports in December followed by a rapid build up to a maximum in either February or March and thereafter a fairly quick decline in reporting, so that by the end of April the outbreak was virtually over, though sporadic cases continued to appear. Product liability In 1979, however, there was no winter epidemic but small, steadily rising numbers of cases were reported during the late winter, spring, The Lords debated the recommendations of and early summer with a maximum in mid- the Royal Commission on Civil Liability and Compensation for Personal Injury on 28 June to mid-July. RSV principally affects young children. In November. Lord Smith of Marlow drew most years the highest proportion of cases has attention to the fact that if legislation was been in children under 1 year of age, with introduced based on the recommendations those aged 1-4 years the second most affected medicinal products would be included. A group, and 1979 was no exception. In some defective product was defined in the report years, however, and notably 1978, the as one which "does not provide for persons numbers in each age group have been very or property the safety which a person is similar, and in that year more infections were entitled to expect." This, Lord Smith said, seen in adults (table). In 1971 and 1972 the was exceptionally difficult to apply to mediciage pattern was reversed, with most infections nal products. "A drug may provide for one in children aged 1-4 years and infants coming patient in every sense 'the safety which a persecond. In addition, more adults aged 25-59 son is entitled to expect' and yet may be dangerous to another patient. Or, worse still, it years were affected.
London Health Planning Consortium
The London Health Planning Consortium, set up to recommend ways of co-ordinating health services planning in London by NHS and academic authorities, has issued a profile of the present and future pattern of acute hospital services in London. Acute Hospital Services in London (HMSO, £6-50) analyses the current pattern of use of London hospitals and concludes that, even taking into account social deprivation and the wide catchment areas of the teaching hospitals, London is much better off for acute beds than the rest of the Thames regions and the rest of England. The profile also describes a method of determining future bed needs, which the consortium has used to show that the London teaching districts need to lose about 2300 acute beds over the next 10 years and the non-teaching districts about 3900, balanced by an increase of about 1100 in the rest of the Thames regions. The consortium, which
160 0 a
o 100 o n
is979 1977 1978 1975 1976 1974 1973 1971 1972 Year Laboratory Evidence of Respiratory Syncytial Virus, Scotland 1971-1979*
Respiratory syncytial virus, Scotland, 1971-1979. Percentage affected in various Age
54 51 45 49 55 34 49
12 11 10
1971 1972 1973 1974 1975 1976 1977 1978 1979*
*Up to and including
be dangerous to him at one time but not at another, dangerous to him if he is taking a particular second drug, but not if he is not." Lord Smith quoted a paper from the Royal College of Physicians of London which had stated: "It may simply not be possible when a patient perceives an adverse change in his condition, to ascribe it confidently to a drug that he has taken, to a change in the illness itself, or to one of the many possible interactions between the patient's constitution, his illness and what enters his system, whether this be food, a medicine, or a substance such as tobacco or alcohol." One thing was certain, he continued. "There will be endless scope for tribunals, court cases, and appeals occupying a great number of people for a very long time and usually resulting in the end in failure to resolve what is unresolvable. Each case of this kind in which the patient may see his doctor as in some way his adversary erodes the confidence between doctor and patient upon which all good medicine is based." Lord Smith thought that the Royal Commission had underestimated a real danger of a massive escalation in the number of medical claims. Another consequence would probably be "a pronounced reduction in the development and marketing of new drugs." In his view the most serious result would be to encourage some doctors to practise "defensive medicine." He concluded: "I hope very much that medicinal products may be excluded from any general legislation possibly by introducing later separate and more appropriate legislation to cover these products after further consideration of what is really a highly complex issue." may
Respiratory syncytial virus, 1979: Scotland
8 DECEMBER 1979
28 31 30 26 28 30
10 6 7 6 5
1 1 1 1 1 2 4
4 5 6 7 4 13 5
6 6 3 5 6 7 5 16 6
consists of representatives of the DHSS, University Grants Committee, University of London, Thames RHAs, and postgraduate institutes, has issued the profile to encourage an informed response from those responsible for planning. It has already issued separate studies on the distribution of cardiology and cardiothoracic services and radiotherapy and oncology services; further reports on neurology and neurosurgery, ophthalmology, and ENT will follow.
BRITISH MEDICAL JOURNAL
8 DECEMBER 1979
New professor of anatomy, Queen's University of Belfast Professor T J Harrison has been appointed to the chair of anatomy and headship of the department of anatomy in the Queen's University of Belfast. Professor Harrison, who is 60, graduated in medicine from Belfast in 1942, and after house appointments at the Royal Victoria Hospital he joined the Royal Air Force. In 1947 he was appointed demonstrator and later acting lecturer in anatomy at the Queen's University, becoming lecturer in 1951, senior lecturer in 1963, and consultant in 1964. Professor Harrison was appointed to a readership in anatomy in 1969 and to the second chair in 1978. His main research interest is in growth problems, particularly as they relate to the bony skeleton.
Biochemical Society-Details of the 585th and 586th meetings, 19-21 December, Guildford, and 3-4 January 1980, Bristol, are now available from the meetings officer of the society, 7 Warwick Court, High Holborn, London WC1R 5DP. (Tel 01-242 1076-8.) Manchester Medical Society-Details and copies of the programme for December are now available from the society, Coupland Building, The University, Manchester M13 9PL. (Tel 061-273 6048.)
SOCIETIES AND LECTURES For attending lectures marked * a fee is charged or a ticket is required. Applications should be made first to the institutions concerned. Monday, 10 December INSTITUTE OF LARYNGOLOGY AND OTOLOGY-5.30 pm, Dr B Doshi: A case of otosclerosis. KING'S COLLEGE HOSPITAL MEDICAL SCHOOL-4.30 pm, Wiltshire memorial lecture by Professor Dame Sheila Sherlock: Cholestasis, diagnosis and management. Wednesday, 12 December ROYAL COLLEGE OF SURGEONS OF ENGLAND-5 pm, Bradshaw lecture by Mr Howard Hanley: Urinary diversion. ROYAL FREE HOSPITAL SCHOOL OF MEDIcINE-5 pm, Dr P V L Curry: Cardiac arrhythmias.
The Health Education Council keeps a Thursday, 13 December ROYAL INFIRMARY-5 pm, Honyman bibliography of journal articles of interest to EDINBURGH Gillespie lecture by Dr A G Leitch: The hypoxic drive health educators; unbound journals may be to breathing-fact and fancy. borrowed. Details from the council at 78 New NUFFIELD PROVINCIAL HOSPITALS TRUST-At Royal College of Obstetricians and Gynaecologists, Rock Oxford Street, London WC1A 1AH. Carling lecture by Professor Michael Rutter to Summary reports of WHO meetings A collection of summary reports of all the meetings organised by the World Health Organisation's Regional Office for Europe during 1978 is available from the Regional Office, Scherfigsvej 8, DK-2100 Copenhagen 0, Denmark. The office will also supply further information on any of the activities described in the reports.
introduce his monograph: Changing youth in a changing society. QUEEN CHARLOTTE'S MATERNITY HOsPITAL-12.15 pm, Dr Michael Reinhardt: Longitudinal studies of lactation in West Africa. RoYAL COLLEGE OF SURGEONS OF ENGLAND-5 pm, Arris and Gale lecture by Mr N I Ramus: Cholecystokinin 'netabolism in normal man and patients with duodenal ulcer.
BMA NOTICES Central Meetings DECEMBER
Concerts for hospital staff
BMA Council Executive Committee, 10 am. 12 Wed 13 Thurs General Purposes Subcommittee (CCHMS), 10 am. 19 Wed Negotiating Subcommittee (CCHMS), 10 am. 19 Wed Membership and Communications Subcommittee (CCHMS), 2 pm. 20 Thurs General Medical Services Committee, 10 am.
Taped concerts with ambiophonic sound (four speakers) can be arranged for hospital staff free of charge in any part of the country. Details from Mr Bernard Lesser, 69 Dove Division Meetings Park, Hatch End, Pinner, Middlesex.
AMA scientific meeting The American Medical Association has invited BMA members and their families to attend a winter scientific meeting in the San Antonio Convention Centre, San Antonio, Texas, from 12 to 15 January 1980. BMA members will not be charged a registration fee. For those wishing to attend an inclusive travel itinerary has been arranged by Turnbull Gibson Travel (10 to 18 January) with accommodation at the Hilton Palacio Del Rio Hotel, San Antonio. Further details of the package, costing £378 per person, and of the scientific programme can be obtained from Miss B E Middlemiss, assistant secretary, BMA, BMA House, Tavistock Square, London WC1H 9JP (01-387 4499).
Members proposing to attend meetings marked * are asked to notify in advance the honorary secretary concerned. Barnet and Finchley-At Barnet General Hospital, Wednesday, 12 December, 7.30 for 8 pm, joint meeting with North Middlesex Law Society, speaker Mr Joseph Jackson: "Divorce." East Yorkshire-At Hull Royal Infirmary, Wednesday, 12 December, 8 pm, Dr R R Gordon: "Adolescent medicine." Edgware and Hendon-At Hendon Hall Hotel, Tuesday, 11 December, 8 for 8.30 pm, film followed by dinner. * Glasgow and West of Scotland Divisions-At Normandy Hotel, Renfrew, Saturday, 15 December, 7 for 7.30 pm, dinner party and dance.* Lothian-At BMA Scottish House, Friday, 14 December, 10 am, symposium "International Year of the Child."* North and Mid Staffordshire-At North Staffordshire Medical Institute, Thursday, 13 December, 6.30 pm, joint cocktail party with North Staffordshire Medical Society. * Rotherham-At Rotherisam District General Hospital, Friday, 14 December, 8 pm, annual Christmas party.* (Families invited.) St Helens and Knowsley-At 22 Cowley Hill Lane, St Helens, Monday, 10 December, 8 pm, agm. Stockport-At Stepping Hill Hospital, Wednesday, 12 December, 8 pm, BMA "recruitment" party.
UNIVERSITIES AND COLLEGES COMING EVENTS
CAMBRIDGE M D-K M Shaw.
Royal Society of Health-Conference "The elderly in the community," 18 December, Exeter. Details from the conference department of the society, 13 Grosvenor Place, London SWlX 7EN. (Tel 01-235 9961.)
ABERDEEN Appointment-Dr C M Childs (senior lecturer in environmental and offshore medicine).
Instructions to authors The following are the minimum requirements for manuscripts submitted for publication. A stamped addressed envelope or an international reply coupon must accompany the manuscript if acknowledgment of its receipt is desired.
(1) Typing should be on one side of the paper, with double or triple spacing between the lines and 5-cm margins at the top and left-hand side of the sheet. (2) Two copies (or preferably three) should be submitted. (3) Spelling should conform to that of Chambers Twentieth Century Dictionary. (4) References must be in the Vancouver style (BMJ, 24 February, p 532) and their accuracy checked before submission. (5) SI units are used for scientific measurements. In the text they should be followed by- traditional units in parentheses. In tables and illustrations values are given only in SI units, but a conversion factor must be supplied. For general guidance on the International System of Units, and some useful conversion factors, see The SI for the Health Professions (WHO, 1977). (6) Authors should give their names and initials, their current appointments, and not more than two degrees or diplomas. Each author must sign the covering letter as evidence of consent to publication. (7) Letters to the Editor submitted for publication must be signed personally by all the authors. (8) Acknowledgments will not be sent unless a stamped addressed envelope or an intemational reply coupon is enclosed. (9) Detailed instructions are given in the BMJ' dated 6 January 1979 (p 6).
ROYAL COLLEGE OF RADIOLOGISTS On 23 November the following candidates were admitted fellows-A N Abu-Saif, Dorothy E Anderson, Ann H Ap-Thomas, K S Bansi, I Beggs, C G Blakeney, J F Bray, N F Butler, P J Drury, B M Epstein, I Glaves, A Grundy, S Hamilton, A J Harris, R Y Jones, A S A Karim, D E Kats, K J H K Kelly, E Y T Ma, C M S Mac A'Bhaird, H Mamtora, S T K Miller, Janet B Murfitt, H B Murtagh, S P Namjoshi, G Papasiopoulos, J F Ratcliffe, N J Ring, M A A Shaltot, D F C Shepherd, B A Sullivan, A K M Tsui, M G Vaidya, G K Warusavitharana, F Williams, Fatimah B M Yakin, J W R Young, A A Zammit, Y C A Cheung, M G Glaser, Helen H Lucraft, Annabella M Marks, W R Pratt, A Rodger, D Spooner, J S Tobias.
CONSULTANT APPOINTMENTS HAMPSHIRE AHA-Dr N G Cockman (child and adolescent psychiatry); Mr R H S Lane (general and vascular surgery). NORTH-WESTERN RHA-Dr P J Hayes (general medicine); Dr A G Pocklington, Dr J 0 Griffiths (anaesthetists); Mr M A Morris (traumatic and orthopaedic surgery); Dr K C Lapsia (radiology); Mr R J Shepherd (obstetrics and gynaecology); Dr H H Gunson (haematologist and director of blood transfusion service); Dr E F Fenton (psychiatry); Dr E E Smith (rheumatology and rehabilitation).
C) British Medical Journal 1979 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 yournal.