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BLOOD-GROUPS AND DISEASE
1308 non-attenders that most of the will be discovered. -
new
cases
of tuberculosis
<
My. plea in short is for all practitioners to notify tuberculosis whether it is a pleural effusion or any form of extrapulmonary disease. If this is diligently carried out another loophole will be closed and further success obtained in the tracing of the undiagnosed and infectious case of tuberculosis. 0. D. BERESFORD. O. I
s
Bournemouth.
SYMPOSIUM ON HOSPITAL COCCAL INFECTIONS
SIR,-Under the auspices of the Association of Clinical Pathologists a symposium on the above subject is being held on Wednesday, Jan. 2,- from 10 A.M. to 6.15 P.M. at the London School of Hygiene and Tropical Medicine. As this subject affects all doctors concerned with hospitals the meeting is open to anyone interested. Programmes may be had from our xneetings secretary, Dr. J. N. Cumings, National Hospital, Queen Square, London, W.C.1, who would like
attending
so
that tea may be
to know how many
are
provided. E. H. GILLESPIE GLLLESPIE
Hon. secretary, Organising Committee.
Sheffield.
PREVENTIVE PSYCHIATRY
Sm,—I raised
by (Dec. 8).
would like to comment on one or two points Dr. Sandison in his most interesting letter
Dr. Sandison questions Dr. Watt’s contention (Nov. 24) that an increase in outpatient services would decrease the admission-rate to the mental hospital, because, he says, relatively few patients admitted directly for the first time to the mental hospital are seen by a psychiatrist beforehand." This is surely the very function which the psychiatric outpatient services of the mental hospital should fulfil ; and, if his contention is true, it is only so because these outpatient services are inadequate and perhaps also because the liaison with the services of the local health authority is insufficiently "
developed. possible for the mental-hospital staff to have knowledge of almost every patient whose admission is pending. This can be effected, quite apart from the ordinary outpatient clinics, through the hospital social workers, the duly authorised officers, the general practitioners in the telephone conversation about the patient, or by the hospital psychiatrist on a domiciliary visit. The most effective safeguard against the misuse of the mental hospital’s beds is, of course, for the patient to be seen before admission, and practically always this can be effected if the mental hospital will arrange for a daily emergency outpatient session, to which any urgent case can be brought for an opinion, to be held preferably at the mental hospital itself or, if this is not practicable, then at the nearest This session can be utilised convenient hospital or clinic. also for the instruction and advice of duly authorised officers and other local-authority workers who are in need of help with difficult cases. Every mental hospital which is reasonably close to a centre of population ought, nowadays, to have its own outpatient department backed by its own facilities for diagnosis and treatment in addition to its usual peripatetic outpatient clinics. If this sort of organisation can be achieved then I am quite certain that unnecessary admissions can largely be prevented and a great deal of psychiatrists’ time saved, particularly in domiciliary visiting. It should be
contact with
or
What we need in our hospitals is not more beds at vast capital cost but more efficient personnel of all types and better facilities for investigation and treatment. With these we can make much more efficient use of our existing accommodation. We might even be able to make effective inroads into the problems of overcrowding, but before this can be satisfactorily solved some technique will have to be worked out for dealing with the increasing numbers of geriatric and chronic-sick patients with slight mental enfeeblement, who are now threatening to overwhelm us. St. Luke’s
Hospital, Middlesbrough.
T. M. CUTHBERT.
BLOOD-GROUPS AND DISEASE SiK,—I a,m surprised to see how much space is being wasted in The I.1a,i,(!et and British Medical Journal on
articles dealing with blood-group distribution in various diseases. While many medical papers suffer from the authors’ lack of knowledge of statistical methods, more suffer from their misapplication. Knowledge is no substitute for understanding, and mathematics is a poor substitute for accurate observations, reliable laboratory work, and common sense. " The hardest things to explain are those which are untrue." In his paper of Oct. 27, Dr. Billington reports that the ABO blood-groups of patients with gastric carcinoma differ according to whether the lesion is in the prepyloric area, the body of the stomach, or the cardiac area. But it is that, when the figures for these forms of cancer are combined, the distribution of bloodgastric for the total is virtually the same as in the general gronps To me this suggests that, in assigning the population. cancer to one or other area, the investigator was subconsciously influenced, in borderline cases, by his prior knowledge of the patient’s blood-group. Can Dr. Billington exclude this possibility ? A. S. WIENER. ]3rooklyii, N.Y.
noteworthy
* *This letter has been shown to Dr. Billington, whose reply follows.-ED. L. SiR,—I admit I am unable to exclude the possibility that the figures in relation to the site of gastric carcinoma might have been influenced in borderline cases by knowledge of the patient’s blood-group ; and for this reason, in the addendum to the paper, I suggested that a prospective study be undertaken with rigid criteria, to exclude this source .of error. An analysis of hospital records by a single interested observer (perforce myself) must always be regarded with suspicion. Although it appears that a similar relationship holds between ABO blood-groups and the site of chronic gastric ulcer, I will be happy to be proved wrong by better observations which elucidate more clearly the fascinating relationships between the ABO blood-groups and gastroduodenul diseases. Department of Medicine, University of Sydney.
BRIAN BILLINGTON.
SHORTAGE OF RADIOGRAPHERS
SiR,-May I, as a qualified radiographer and a member of the medical auxiliaries, bring to the notice of your readers the grave shortage of radiographers in the National Health Service which, if allowed to continue, must lead to a breakdown in the diagnostic and therapeutic fields of the service. The November issue of Radiography reports that one of the main causes of this shortage is the very poor prospects offered, together with low salary scales. On Nov. 9, after months of protracted discussions, a new salary scale was finally announced, starting at E420 for a newly qualified radiographer and finishing, after many years of experience, at E750 for a superintendent, and 850 for a superintendent in charge of a very large department. Even a teacher of student radiographers receives only 1750 at the maximum and, of course, these salaries are subject to the usual deductions such as income-tax, National Insurance, and superannuation. One might argue that it is a fair commencing salary, but what of the married male radiographer who receives only JE485 five years after qualifying ?’? Radiography is certainly an interesting and satisfying job, and the radiographer feels that he is a useful and very necessary member of the diagnostic team-but are these reasons, taken into account with the new but still totally inadequate salary scale, likely to induce modernday school-leavers, with certificates in mathematics and "
physics,
to enter
our
profession ?
new
cases
of tuberculosis
<
My. plea in short is for all practitioners to notify tuberculosis whether it is a pleural effusion or any form of extrapulmonary disease. If this is diligently carried out another loophole will be closed and further success obtained in the tracing of the undiagnosed and infectious case of tuberculosis. 0. D. BERESFORD. O. I
s
Bournemouth.
SYMPOSIUM ON HOSPITAL COCCAL INFECTIONS
SIR,-Under the auspices of the Association of Clinical Pathologists a symposium on the above subject is being held on Wednesday, Jan. 2,- from 10 A.M. to 6.15 P.M. at the London School of Hygiene and Tropical Medicine. As this subject affects all doctors concerned with hospitals the meeting is open to anyone interested. Programmes may be had from our xneetings secretary, Dr. J. N. Cumings, National Hospital, Queen Square, London, W.C.1, who would like
attending
so
that tea may be
to know how many
are
provided. E. H. GILLESPIE GLLLESPIE
Hon. secretary, Organising Committee.
Sheffield.
PREVENTIVE PSYCHIATRY
Sm,—I raised
by (Dec. 8).
would like to comment on one or two points Dr. Sandison in his most interesting letter
Dr. Sandison questions Dr. Watt’s contention (Nov. 24) that an increase in outpatient services would decrease the admission-rate to the mental hospital, because, he says, relatively few patients admitted directly for the first time to the mental hospital are seen by a psychiatrist beforehand." This is surely the very function which the psychiatric outpatient services of the mental hospital should fulfil ; and, if his contention is true, it is only so because these outpatient services are inadequate and perhaps also because the liaison with the services of the local health authority is insufficiently "
developed. possible for the mental-hospital staff to have knowledge of almost every patient whose admission is pending. This can be effected, quite apart from the ordinary outpatient clinics, through the hospital social workers, the duly authorised officers, the general practitioners in the telephone conversation about the patient, or by the hospital psychiatrist on a domiciliary visit. The most effective safeguard against the misuse of the mental hospital’s beds is, of course, for the patient to be seen before admission, and practically always this can be effected if the mental hospital will arrange for a daily emergency outpatient session, to which any urgent case can be brought for an opinion, to be held preferably at the mental hospital itself or, if this is not practicable, then at the nearest This session can be utilised convenient hospital or clinic. also for the instruction and advice of duly authorised officers and other local-authority workers who are in need of help with difficult cases. Every mental hospital which is reasonably close to a centre of population ought, nowadays, to have its own outpatient department backed by its own facilities for diagnosis and treatment in addition to its usual peripatetic outpatient clinics. If this sort of organisation can be achieved then I am quite certain that unnecessary admissions can largely be prevented and a great deal of psychiatrists’ time saved, particularly in domiciliary visiting. It should be
contact with
or
What we need in our hospitals is not more beds at vast capital cost but more efficient personnel of all types and better facilities for investigation and treatment. With these we can make much more efficient use of our existing accommodation. We might even be able to make effective inroads into the problems of overcrowding, but before this can be satisfactorily solved some technique will have to be worked out for dealing with the increasing numbers of geriatric and chronic-sick patients with slight mental enfeeblement, who are now threatening to overwhelm us. St. Luke’s
Hospital, Middlesbrough.
T. M. CUTHBERT.
BLOOD-GROUPS AND DISEASE SiK,—I a,m surprised to see how much space is being wasted in The I.1a,i,(!et and British Medical Journal on
articles dealing with blood-group distribution in various diseases. While many medical papers suffer from the authors’ lack of knowledge of statistical methods, more suffer from their misapplication. Knowledge is no substitute for understanding, and mathematics is a poor substitute for accurate observations, reliable laboratory work, and common sense. " The hardest things to explain are those which are untrue." In his paper of Oct. 27, Dr. Billington reports that the ABO blood-groups of patients with gastric carcinoma differ according to whether the lesion is in the prepyloric area, the body of the stomach, or the cardiac area. But it is that, when the figures for these forms of cancer are combined, the distribution of bloodgastric for the total is virtually the same as in the general gronps To me this suggests that, in assigning the population. cancer to one or other area, the investigator was subconsciously influenced, in borderline cases, by his prior knowledge of the patient’s blood-group. Can Dr. Billington exclude this possibility ? A. S. WIENER. ]3rooklyii, N.Y.
noteworthy
* *This letter has been shown to Dr. Billington, whose reply follows.-ED. L. SiR,—I admit I am unable to exclude the possibility that the figures in relation to the site of gastric carcinoma might have been influenced in borderline cases by knowledge of the patient’s blood-group ; and for this reason, in the addendum to the paper, I suggested that a prospective study be undertaken with rigid criteria, to exclude this source .of error. An analysis of hospital records by a single interested observer (perforce myself) must always be regarded with suspicion. Although it appears that a similar relationship holds between ABO blood-groups and the site of chronic gastric ulcer, I will be happy to be proved wrong by better observations which elucidate more clearly the fascinating relationships between the ABO blood-groups and gastroduodenul diseases. Department of Medicine, University of Sydney.
BRIAN BILLINGTON.
SHORTAGE OF RADIOGRAPHERS
SiR,-May I, as a qualified radiographer and a member of the medical auxiliaries, bring to the notice of your readers the grave shortage of radiographers in the National Health Service which, if allowed to continue, must lead to a breakdown in the diagnostic and therapeutic fields of the service. The November issue of Radiography reports that one of the main causes of this shortage is the very poor prospects offered, together with low salary scales. On Nov. 9, after months of protracted discussions, a new salary scale was finally announced, starting at E420 for a newly qualified radiographer and finishing, after many years of experience, at E750 for a superintendent, and 850 for a superintendent in charge of a very large department. Even a teacher of student radiographers receives only 1750 at the maximum and, of course, these salaries are subject to the usual deductions such as income-tax, National Insurance, and superannuation. One might argue that it is a fair commencing salary, but what of the married male radiographer who receives only JE485 five years after qualifying ?’? Radiography is certainly an interesting and satisfying job, and the radiographer feels that he is a useful and very necessary member of the diagnostic team-but are these reasons, taken into account with the new but still totally inadequate salary scale, likely to induce modernday school-leavers, with certificates in mathematics and "
physics,
to enter
our
profession ?