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ARTERIAL CALCIFICATION
516 may well be such a one. But at present, while the new antibiotics are still under trial, there are sound reasons for supporting Professor Long’s plea that a combination of drugs should more frequently be used from the start (and not after one or two failures) in bacterial infections where resistance to drugs is known to arise readily. A. C. T. VAUGHAN. Llandaff, near Cardiff.
ARTERIAL CALCIFICATION
desirable pressure on the Minister to keep his promises. Alas ! we may not be the oldest profession, but weseem to be the most backward. The health centre must be the centre of attraction locally not only for the man in the street, but also for the doctor. Local committees of doctors and laymen should be constituted now by any responsible organisationsthe local authorities, who are responsible for building the health centres, might reasonably sponsor such a movement. Most important is the dissemination of knowledge and the firing of the doctors’ enthusiasm for this most fundamentally important weapon of medical progress. When the time comes for further excuses we might then expect an answer of a different Stamp. DAVID L. KERR. London, S.W.17.
SiR,—We have read with interest the article of March 4 by Sir Adolphe Abrahams. In the course of a study which we are making of calcification elsewhere in the body, we have taken X-ray pictures of the calves of 69 men over the age of sixty, none of whom had any symptoms of intermittent claudication. We also examined them and palpated the dorsalis pedis and posterior tibial arteries. Dividing our cases into those with and those without calcification of the tibial arteries, we found that in the calcification group (29 cases) all the foot arteries were palpable in 13, while none was felt in 4 ; in the non-calcification group (40 cases) the figures were 21 and 5, respectively. That is, the proportions are roughly the same for both groups. Thus, calcification has no relation to arterial patency, as judged by palpation of the foot arteries, and it can certainly be extensive in the absence of symptoms. C. SYMONS Royal Northern Hospital, London.
Medical Registrar.
DAVID PYKE Assistant Medical Registrar.
HEALTH CENTRES in the obscurities of the local press SiR,-Lurking The Hampstead and are occasional jewels of revelation. Highgate Observer (Jan. 26) recently reported Mr. Reginald Stamp, chairman of the L.C.C. health committee, as saying that the Minister of Health had agreed to nine health centres being built in London-" but the doctors would not come in," said Mr. Stamp. Hisremarks have now been gently and firmly corrected by the Secretary of the Local Medical Committee for London, who has pointed out (Ibid, Feb. 10) that " many doctors enter health centres when are perfectly willing to the details have been worked out. In London alone 29 groups of doctors have asked the L.C.C. to find health centre premises for them to work in." This answer, by Dr. Gray, would be less forceful but Mr. more accurate if he had said " only 29 groups." Stamp is certainly wide of the mark, and one wonders whether his lame excuses were made for want of better ones. Nevertheless as long as the profession is so uninterested in a measure so vital for the nation’s health, Mr. Stamp may succeed in throwing the blame for the failure to build health centres on to the shoulders of the medical profession, which, as every schoolboy knows, directs the financial policies of the Government and acts as bricklayers’ labourers in its spare time. Mr. Bevan has called the health centre " the pivot of the health service " ; yet no attempt has been made to encourage the profession as a whole and more particularly the general practitioners, who will have to staff and run the centres, when they are built, to voice their opinions and their difficulties on the widest scale possible. The B.M.A. has a health centre committee which has recently reported favourably on the introduction of group practice from health centres, but is now being forced by present economic difficulties to consider other Nowhere do we means of grouping in general practice. find the inspiration and the foresight among the senior members of the profession which not merely acknowledges the inevitability of health centres but organises medical opinion so that we can overcome the difficulties before they arise, and can even exert some very
THE FORGOTTEN SWAB
SIR,-The forgotten swab is
a lurking nightmare of As Sister Kent and theatre sister. (March 4) writes, sudden and unexpected haemorrhage in a deep and inaccessible cavity may cause the surgeon to pack a small swab down on to the bleeding vessel; finding this stops the haemorrhage he leaves it there, intending to remove it later when the bleeding may not recur. In the meantime he carries on with the operation, but possibly after a long and difficult procedure he forgets about the swab. Swab counts are not always correct, and sometimes a prolonged search fails to produce an alleged lost swab. This leads to an anxious feeling of uncertainty.
every
surgeon
Various methods have been devised to render swabs traceable by X rays, such as the metal thread referred to by Miss Alexander (Feb. 25). Being unable to get special gadgets I devised a simple method. The theatre sister, Sister Shaw, of the Royal Sussex County Hospital, inserts into each gauze swab a small metal staple with a. little press for clipping letters which we got from the
ARTERIAL CALCIFICATION
desirable pressure on the Minister to keep his promises. Alas ! we may not be the oldest profession, but weseem to be the most backward. The health centre must be the centre of attraction locally not only for the man in the street, but also for the doctor. Local committees of doctors and laymen should be constituted now by any responsible organisationsthe local authorities, who are responsible for building the health centres, might reasonably sponsor such a movement. Most important is the dissemination of knowledge and the firing of the doctors’ enthusiasm for this most fundamentally important weapon of medical progress. When the time comes for further excuses we might then expect an answer of a different Stamp. DAVID L. KERR. London, S.W.17.
SiR,—We have read with interest the article of March 4 by Sir Adolphe Abrahams. In the course of a study which we are making of calcification elsewhere in the body, we have taken X-ray pictures of the calves of 69 men over the age of sixty, none of whom had any symptoms of intermittent claudication. We also examined them and palpated the dorsalis pedis and posterior tibial arteries. Dividing our cases into those with and those without calcification of the tibial arteries, we found that in the calcification group (29 cases) all the foot arteries were palpable in 13, while none was felt in 4 ; in the non-calcification group (40 cases) the figures were 21 and 5, respectively. That is, the proportions are roughly the same for both groups. Thus, calcification has no relation to arterial patency, as judged by palpation of the foot arteries, and it can certainly be extensive in the absence of symptoms. C. SYMONS Royal Northern Hospital, London.
Medical Registrar.
DAVID PYKE Assistant Medical Registrar.
HEALTH CENTRES in the obscurities of the local press SiR,-Lurking The Hampstead and are occasional jewels of revelation. Highgate Observer (Jan. 26) recently reported Mr. Reginald Stamp, chairman of the L.C.C. health committee, as saying that the Minister of Health had agreed to nine health centres being built in London-" but the doctors would not come in," said Mr. Stamp. Hisremarks have now been gently and firmly corrected by the Secretary of the Local Medical Committee for London, who has pointed out (Ibid, Feb. 10) that " many doctors enter health centres when are perfectly willing to the details have been worked out. In London alone 29 groups of doctors have asked the L.C.C. to find health centre premises for them to work in." This answer, by Dr. Gray, would be less forceful but Mr. more accurate if he had said " only 29 groups." Stamp is certainly wide of the mark, and one wonders whether his lame excuses were made for want of better ones. Nevertheless as long as the profession is so uninterested in a measure so vital for the nation’s health, Mr. Stamp may succeed in throwing the blame for the failure to build health centres on to the shoulders of the medical profession, which, as every schoolboy knows, directs the financial policies of the Government and acts as bricklayers’ labourers in its spare time. Mr. Bevan has called the health centre " the pivot of the health service " ; yet no attempt has been made to encourage the profession as a whole and more particularly the general practitioners, who will have to staff and run the centres, when they are built, to voice their opinions and their difficulties on the widest scale possible. The B.M.A. has a health centre committee which has recently reported favourably on the introduction of group practice from health centres, but is now being forced by present economic difficulties to consider other Nowhere do we means of grouping in general practice. find the inspiration and the foresight among the senior members of the profession which not merely acknowledges the inevitability of health centres but organises medical opinion so that we can overcome the difficulties before they arise, and can even exert some very
THE FORGOTTEN SWAB
SIR,-The forgotten swab is
a lurking nightmare of As Sister Kent and theatre sister. (March 4) writes, sudden and unexpected haemorrhage in a deep and inaccessible cavity may cause the surgeon to pack a small swab down on to the bleeding vessel; finding this stops the haemorrhage he leaves it there, intending to remove it later when the bleeding may not recur. In the meantime he carries on with the operation, but possibly after a long and difficult procedure he forgets about the swab. Swab counts are not always correct, and sometimes a prolonged search fails to produce an alleged lost swab. This leads to an anxious feeling of uncertainty.
every
surgeon
Various methods have been devised to render swabs traceable by X rays, such as the metal thread referred to by Miss Alexander (Feb. 25). Being unable to get special gadgets I devised a simple method. The theatre sister, Sister Shaw, of the Royal Sussex County Hospital, inserts into each gauze swab a small metal staple with a. little press for clipping letters which we got from the