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FAILURE OF CERVICAL CYTOLOGY?
1218 Crawford in the fatty-acid composition of the tissue lipids of the ruminants can probably be ascribed to differences in the extent to which P.F.A. from various dietary sources have undergone hydrogenation by bacteria in the animals’ forestomachs.When seeds and nuts rather than herbage form the principal diet of the ruminant, some of the constituent P.F.A. may escape hydrogenation owing to a greater rate of passage of the digesta through the forestomachs, or because structural elements of the feed render their associated lipids inaccessible to bacterial action. Rowett Research Institute, Bucksburn, Aberdeen AB2 9SB.
G. A. GARTON.
FAILURE OF CERVICAL CYTOLOGY?
SiR,ŇIt is difficult to understand why Dr. Lees (May 17, p. 1020) regards the rise in the mortality-rate of women between the ages of 40 and 50 as proof that cervical cytology has failed. Does he assume that all these women underwent a cervical-cytology test ? Should not the value of cervical cytology be assessed by comparing the incidence of carcinoma of the cervix among those who have been tested, and those who have not. This has been done in British Columbia: Fidler and Boyes ’7 reported that the incidence of cervical cancer among tested women is about half that among untested women, and that there was an overall decrease in the incidence from 28-4 per 100,000 in 1955, to 13-6 per 100,000 in 1966; there was a drop in mortality from the disease from 11-4 per 100,000 in 1958 to 7-8 in 1966. Cancer Information Association, 6 Queen Street, MALCOLM DONALDSON. Oxford OX1 1BR
WITHDRAWAL OF ANTICOAGULANT THERAPY SIR,-In their interesting paper (May 24, p. 1025), Dr. Kamath and Dr. Thorne cite our laboratory studiesas evidence for " rebound " hypercoagulability. Whether rebound hypercoagulability results in rebound thrombosis can of course be determined only by clinical studies. Since the great majority of thromboembolic episodes and deaths in their series occurred long after the withdrawal period, their study does not provide the answer to the problem of whether we should " tail off " anticoagulant treatment or stop it abruptly. In fact the regimen of tailing off " anticoagulants by halving the dose cannot be regarded as gradual withdrawal; we showedthat halving the dose in this way did not completely prevent rebound hypercoagulability. Since that time we have adopted the procedure of reducing the maintenance dose by a quarter at intervals of a fortnight. The significance of Dr. Kamath and Dr. Thorne’s paper is therefore in supporting Wright’s view9 that the increased thrombotic risk after stopping anticoagulants results from the " catching up " process after protection is removed. The fact that the " good risk " patients fared worse than the bad risk " patients in whom anticoagulants were continued further supports this view. L. POLLER Withington Hospital, Manchester 20. JEAN M. THOMSON. "
"
SELF-HELP BED-HANDLES
SIR,-During a recent spell in the surgical ward of a hospital I found that, when being rolled over in bed for washing purposes, I had the greatest difficulty in being helpful. Hospital beds have no side-handles on which to pull. If the sidemembers of the bed-frame had on either side a
handle-grip,
Garton, G. A. Wld Rev. Nutr. Diet. 1967, 7, 225. Fidler, D. A., Boyes, L. J. Obstet Gynœc. Br. Commonw. April, 1960, p. 399. 8. Poller, L., Thomson, J. M. Br. med. J. 1965, i, 1475. 9. Wright, I. S. J. Am. med. Ass. 1960, 174, 89. 6. 7.
which when which when
not in use would be in the down position, but required could be swung up and held with, say, two pins (as on the adjustable back-rests), then the patient would have secure grips to help to turn himself on his side. I am sure that the design staff of hospital-bed manufacturers would have no difficulty in incorporating this feature, which should prove both beneficial to patients and helpful to the staff.
G. D. BAILEY.
Parliament Young Offenders Children’s and Young Persons Bill
THE was considered on report in the House of Commons on June 9. Mr. ELYSTAN MORGAN, under-secretary of State for the Home Department, moved a new clause that would leave the prosecution of young persons to the police, after consultation with the local authority. In the original Bill a young person could not be prosecuted without the consent of a juvenile court magistrate. The new clause also provided the police with criteria they were to use in taking their decisions. The Home Secretary would be empowered to make regulations specifying the kinds of case in which an informant might prosecute. Mr. MARK CARLISLE welcomed the Government’s second thoughts, because he thought that the original idea of consulting magistrates would be cumbersome and cause unnecessary delay. But he did not agree that the police should be limited by regulations which laid down what type of offences should be prosecuted. They should use their own discretion. Mr. MORGAN insisted that the police needed to be guided in reasonably specific terms because the aim of the regulations was to rectify the gross discrepancies of police practice in dealing with young offenders. Mr. PETER ARCHER was more worried that too heavy a burden was being placed on the police. He believed that there should be a body, even after discussions with the local authority, intervening between the police and a juvenile court or a higher court. Mr. CARLISLE was also concerned about the clause which stated that an informant should not prosecute unless he was satisfied that a parent or teacher could not deal with the child. Might pressure be brought on a child which would force him to admit guilt when, if tried by a court, he might be found to be innocent ? The new clause was agreed to. Mr. CARLISLE later moved an amendment to the Bill to do away with the necessity for the prosecution to prove a child was in need of care and control which he was unlikely to receive unless the court made an order. As it stood, he believed that the Bill distinguished between a child from a good home and one from a bad. Mr. MORGAN pointed out that anyone who persisted in disagreeing with pre-court decisions was saying that they did not agree with the aim of the Bill to keep children away from the courts when possible and that all children without exception should be dealt with by the courts. The amendment was rejected. Mr. JAMES CALLAGHAN, Secretary of State for the Home Department, moved two amendments which were accepted. One enabled care proceedings to be brought in the case of a child under 5 without the child going to court; the other enabled magistrates courts to make compensation orders, not exceeding E100, in care proceedings for an indictable offence. Later Mr. CARLISLE moved an amendment to widen the power to bring criminal prosecutions against people under 14 when the offence, if committed by an adult, would be punished by fourteen years or more imprisonment. Mr. MORGAN admitted that young children could commit very serious offences, but in these circumstances the serious act would be the clearest indication that something was fundamentally wrong with the life of the child. The child had shown his particular need and the Court should be concerned that he should get the care and control which he was crying out for, without an order being made. The amendment was negatived.
G. A. GARTON.
FAILURE OF CERVICAL CYTOLOGY?
SiR,ŇIt is difficult to understand why Dr. Lees (May 17, p. 1020) regards the rise in the mortality-rate of women between the ages of 40 and 50 as proof that cervical cytology has failed. Does he assume that all these women underwent a cervical-cytology test ? Should not the value of cervical cytology be assessed by comparing the incidence of carcinoma of the cervix among those who have been tested, and those who have not. This has been done in British Columbia: Fidler and Boyes ’7 reported that the incidence of cervical cancer among tested women is about half that among untested women, and that there was an overall decrease in the incidence from 28-4 per 100,000 in 1955, to 13-6 per 100,000 in 1966; there was a drop in mortality from the disease from 11-4 per 100,000 in 1958 to 7-8 in 1966. Cancer Information Association, 6 Queen Street, MALCOLM DONALDSON. Oxford OX1 1BR
WITHDRAWAL OF ANTICOAGULANT THERAPY SIR,-In their interesting paper (May 24, p. 1025), Dr. Kamath and Dr. Thorne cite our laboratory studiesas evidence for " rebound " hypercoagulability. Whether rebound hypercoagulability results in rebound thrombosis can of course be determined only by clinical studies. Since the great majority of thromboembolic episodes and deaths in their series occurred long after the withdrawal period, their study does not provide the answer to the problem of whether we should " tail off " anticoagulant treatment or stop it abruptly. In fact the regimen of tailing off " anticoagulants by halving the dose cannot be regarded as gradual withdrawal; we showedthat halving the dose in this way did not completely prevent rebound hypercoagulability. Since that time we have adopted the procedure of reducing the maintenance dose by a quarter at intervals of a fortnight. The significance of Dr. Kamath and Dr. Thorne’s paper is therefore in supporting Wright’s view9 that the increased thrombotic risk after stopping anticoagulants results from the " catching up " process after protection is removed. The fact that the " good risk " patients fared worse than the bad risk " patients in whom anticoagulants were continued further supports this view. L. POLLER Withington Hospital, Manchester 20. JEAN M. THOMSON. "
"
SELF-HELP BED-HANDLES
SIR,-During a recent spell in the surgical ward of a hospital I found that, when being rolled over in bed for washing purposes, I had the greatest difficulty in being helpful. Hospital beds have no side-handles on which to pull. If the sidemembers of the bed-frame had on either side a
handle-grip,
Garton, G. A. Wld Rev. Nutr. Diet. 1967, 7, 225. Fidler, D. A., Boyes, L. J. Obstet Gynœc. Br. Commonw. April, 1960, p. 399. 8. Poller, L., Thomson, J. M. Br. med. J. 1965, i, 1475. 9. Wright, I. S. J. Am. med. Ass. 1960, 174, 89. 6. 7.
which when which when
not in use would be in the down position, but required could be swung up and held with, say, two pins (as on the adjustable back-rests), then the patient would have secure grips to help to turn himself on his side. I am sure that the design staff of hospital-bed manufacturers would have no difficulty in incorporating this feature, which should prove both beneficial to patients and helpful to the staff.
G. D. BAILEY.
Parliament Young Offenders Children’s and Young Persons Bill
THE was considered on report in the House of Commons on June 9. Mr. ELYSTAN MORGAN, under-secretary of State for the Home Department, moved a new clause that would leave the prosecution of young persons to the police, after consultation with the local authority. In the original Bill a young person could not be prosecuted without the consent of a juvenile court magistrate. The new clause also provided the police with criteria they were to use in taking their decisions. The Home Secretary would be empowered to make regulations specifying the kinds of case in which an informant might prosecute. Mr. MARK CARLISLE welcomed the Government’s second thoughts, because he thought that the original idea of consulting magistrates would be cumbersome and cause unnecessary delay. But he did not agree that the police should be limited by regulations which laid down what type of offences should be prosecuted. They should use their own discretion. Mr. MORGAN insisted that the police needed to be guided in reasonably specific terms because the aim of the regulations was to rectify the gross discrepancies of police practice in dealing with young offenders. Mr. PETER ARCHER was more worried that too heavy a burden was being placed on the police. He believed that there should be a body, even after discussions with the local authority, intervening between the police and a juvenile court or a higher court. Mr. CARLISLE was also concerned about the clause which stated that an informant should not prosecute unless he was satisfied that a parent or teacher could not deal with the child. Might pressure be brought on a child which would force him to admit guilt when, if tried by a court, he might be found to be innocent ? The new clause was agreed to. Mr. CARLISLE later moved an amendment to the Bill to do away with the necessity for the prosecution to prove a child was in need of care and control which he was unlikely to receive unless the court made an order. As it stood, he believed that the Bill distinguished between a child from a good home and one from a bad. Mr. MORGAN pointed out that anyone who persisted in disagreeing with pre-court decisions was saying that they did not agree with the aim of the Bill to keep children away from the courts when possible and that all children without exception should be dealt with by the courts. The amendment was rejected. Mr. JAMES CALLAGHAN, Secretary of State for the Home Department, moved two amendments which were accepted. One enabled care proceedings to be brought in the case of a child under 5 without the child going to court; the other enabled magistrates courts to make compensation orders, not exceeding E100, in care proceedings for an indictable offence. Later Mr. CARLISLE moved an amendment to widen the power to bring criminal prosecutions against people under 14 when the offence, if committed by an adult, would be punished by fourteen years or more imprisonment. Mr. MORGAN admitted that young children could commit very serious offences, but in these circumstances the serious act would be the clearest indication that something was fundamentally wrong with the life of the child. The child had shown his particular need and the Court should be concerned that he should get the care and control which he was crying out for, without an order being made. The amendment was negatived.