- Email: [email protected]
BOXING
384
BOXING
SiR,—Irejoice in Dr. Learoyd’s letter of Feb. 10: he is after my own heart. There is a risk in the smoking of tobacco and in the consumption of alcohol. There is a risk in most of what the Victorians called manly exercises. There is a risk in steeplechasing and an even greater risk in motor racing. The point is, Sir, what are we driving at ? This is a searching philosophical question. Should it be the aim of medicine to provide humanity with a life, as nearly as possible riskless, which goes on far too long ? adieu ne plaise ! L. N. JACKSON. Crediton, Devon. a man
CRISIS IN NUMBERS
Devon.
SiR,—The timely suggestion by Professor Wells (Feb. 3) deserves special notice. It is true that, even with the 10% more " homegrown " doctors, it will be hard to fill all the posts in the peripheral hospitals, especially when one thinks of staffing all the new and modern hospitals promised in the near future. There is no denying that " this country... is short of doctors ". In his reckoning, Professor Wells included the overseas graduates (who are obviously attracted by the good standing of higher diplomas and degrees). If this country really wants these " indispensable overseas friends " to continue to come here for higher education, it should allow them to spend some part of their training, in better-staffed and better-equipped hospitals, under experienced guidance and supervision, and I fully agree that this period should start after primary F.R.C.S., thereby assuring that the training of none of the trainees is going to be wasted. I have worked in Germany for nearly a year, and peripheral hospitals there are also short of doctors, because there are not as many foreign graduates in Germany as in Britain. In that way, this country is really supersaturated. To
the continued flow of eager and enthusiastic young foreign graduates something has got to be done to show the world that they come not only for higher qualification but also for gaining higher experience. ensure
Pontypool and District Hospital, Pontypool, Monmouthshire.
in medical schools now allotted to women, only one effective doctor emerges ; all the rest get married soon after (or even before) qualification. So, stop letting women in at all-it cannot be claimed that they are really necessary. There is a solution, which, as far as I know has been revealed to me alone. It is that the British should begin to think of foregoing to some extent the luxury of unlimited disease, of tailoring their medical requirements to the medical services that are likely to be available. Doctors are not, like teachers and police, good and useful things in themselves, the more the better. On the contrary, every one above the necessary minimum is, economically, a dead loss, except as an export, and even a menace; for, where doctors have for a living to compete in popularity, the more doctors there are the more disease there will be. GEORGE L. ALEXANDER Kingsbridge,
places
S. N.
CHATTERJEE.
SIR,-For years now the shortage in other spheres at as important as medicine has been more serious than any likely " shortage " of doctors in this country can possibly be-the Church, teaching, the regular Army, the police, for example-and nobody’s cared. Yet when the least
statisticians suggest that there may soon be rather fewer doctors than is convenient for some interested parties to have around, that the increasing demands of our increasingly affluent society for medical attention for their selfinflicted diseases may not be met absolutely in full, there is panic in Whitehall, and demands for a crash programme to start thousands more students on the assembly lines. For some consultant vacancies, already less than fifty applicants, and for some practices they are no longer numbered in dozens-Oh, Oh! We are asked to sympathise with Dr. Christine Thompson, who cannot find a neat little part-time job on her doorstepand this in a Home Counties town full of doctors. What she really means (and you too perhaps) is that in a properly planned service the duties of some male Dr. A in Aylesbury should be parcelled out among female married doctors B, C, and D; and Dr. A bundled off to the industrial North, where doctors are not so thick on the ground. If there is a shortage, Dr. Thompson herself indicates one answer. From every four or five
Colonial Medical Service, retd.
DONOR EYES SiR,—This country can well be proud of the care which is given to our blind population, but it deserves better arrangements for the collection and storage of donor eyes for corneal grafts. The aim should be to have one or more banks in each region integrated amongst themselves and reinforced by a central transplantation unit which would be responsible for research into the transplantation of eye tissues, such as corneas for grafts, vitreous for retinal detachment, sclera, conjunctiva, and skin for reconstructive surgery. The achievement of such a plan is much nearer than it was two years ago. The regional eye banks have been authorised, and the publicity and registration of eye bequests have now passed into the experienced hands of
the Royal National Institute for the Blind and away from individual hospitals; these are two major steps of progress. Dr. Carpenter (Feb. 3) points out that the shortage of eyes concerns us all and gives two reasons from his own
experience. One is the " dimculty of remembering " at the time of death and the other is the " unpleasantness of asking ". In hospital the ward sister should be aware of a bequest since all potential donors are given a " pledge card " by the R.N.I.B. which is to be carried on the person. One donor made sure by having the information tattooed on his arm! Badges have been con" sidered, but in many "ways they are undesirable. The unpleasantness of asking for consent has been an obstacle in the minds of many thinking people for a long time, but I share Dr. Carpenter’s view that it is overestimated. Indeed, it often worries the asking doctor far more than the nearest relation of the deceased. Of course, the circumstances of the death must always be carefully considered. Consent is almost always obtained where the deceased has died after a long life, but in sudden tragic deaths or where there is extreme grief no inquiry should ever be made. My article of Jan. 20 was intended as a progress report to general practitioners, for I feel that the time approaches to ask for their full cooperation. Of public response I have never had any doubt. Hitherto, without official authority
for regional banks, it was felt to be unwise to stir and release prematurely an avalanche of public goodwill-and then to run the risk of losing it because of the absence of adequate national arrangements for the collection and storage of eyes. But the situation has changed; the ophthalmic surgeon can show that corneal grafting can be a sight-saving operation in 80% of uncomplicated cases for which no other treatment is effective. The senior administrative medical officers of the regions are alive to the problem and have the organisation in hand, and the R.N.I.B. is geared to deal with further response. Now
BOXING
SiR,—Irejoice in Dr. Learoyd’s letter of Feb. 10: he is after my own heart. There is a risk in the smoking of tobacco and in the consumption of alcohol. There is a risk in most of what the Victorians called manly exercises. There is a risk in steeplechasing and an even greater risk in motor racing. The point is, Sir, what are we driving at ? This is a searching philosophical question. Should it be the aim of medicine to provide humanity with a life, as nearly as possible riskless, which goes on far too long ? adieu ne plaise ! L. N. JACKSON. Crediton, Devon. a man
CRISIS IN NUMBERS
Devon.
SiR,—The timely suggestion by Professor Wells (Feb. 3) deserves special notice. It is true that, even with the 10% more " homegrown " doctors, it will be hard to fill all the posts in the peripheral hospitals, especially when one thinks of staffing all the new and modern hospitals promised in the near future. There is no denying that " this country... is short of doctors ". In his reckoning, Professor Wells included the overseas graduates (who are obviously attracted by the good standing of higher diplomas and degrees). If this country really wants these " indispensable overseas friends " to continue to come here for higher education, it should allow them to spend some part of their training, in better-staffed and better-equipped hospitals, under experienced guidance and supervision, and I fully agree that this period should start after primary F.R.C.S., thereby assuring that the training of none of the trainees is going to be wasted. I have worked in Germany for nearly a year, and peripheral hospitals there are also short of doctors, because there are not as many foreign graduates in Germany as in Britain. In that way, this country is really supersaturated. To
the continued flow of eager and enthusiastic young foreign graduates something has got to be done to show the world that they come not only for higher qualification but also for gaining higher experience. ensure
Pontypool and District Hospital, Pontypool, Monmouthshire.
in medical schools now allotted to women, only one effective doctor emerges ; all the rest get married soon after (or even before) qualification. So, stop letting women in at all-it cannot be claimed that they are really necessary. There is a solution, which, as far as I know has been revealed to me alone. It is that the British should begin to think of foregoing to some extent the luxury of unlimited disease, of tailoring their medical requirements to the medical services that are likely to be available. Doctors are not, like teachers and police, good and useful things in themselves, the more the better. On the contrary, every one above the necessary minimum is, economically, a dead loss, except as an export, and even a menace; for, where doctors have for a living to compete in popularity, the more doctors there are the more disease there will be. GEORGE L. ALEXANDER Kingsbridge,
places
S. N.
CHATTERJEE.
SIR,-For years now the shortage in other spheres at as important as medicine has been more serious than any likely " shortage " of doctors in this country can possibly be-the Church, teaching, the regular Army, the police, for example-and nobody’s cared. Yet when the least
statisticians suggest that there may soon be rather fewer doctors than is convenient for some interested parties to have around, that the increasing demands of our increasingly affluent society for medical attention for their selfinflicted diseases may not be met absolutely in full, there is panic in Whitehall, and demands for a crash programme to start thousands more students on the assembly lines. For some consultant vacancies, already less than fifty applicants, and for some practices they are no longer numbered in dozens-Oh, Oh! We are asked to sympathise with Dr. Christine Thompson, who cannot find a neat little part-time job on her doorstepand this in a Home Counties town full of doctors. What she really means (and you too perhaps) is that in a properly planned service the duties of some male Dr. A in Aylesbury should be parcelled out among female married doctors B, C, and D; and Dr. A bundled off to the industrial North, where doctors are not so thick on the ground. If there is a shortage, Dr. Thompson herself indicates one answer. From every four or five
Colonial Medical Service, retd.
DONOR EYES SiR,—This country can well be proud of the care which is given to our blind population, but it deserves better arrangements for the collection and storage of donor eyes for corneal grafts. The aim should be to have one or more banks in each region integrated amongst themselves and reinforced by a central transplantation unit which would be responsible for research into the transplantation of eye tissues, such as corneas for grafts, vitreous for retinal detachment, sclera, conjunctiva, and skin for reconstructive surgery. The achievement of such a plan is much nearer than it was two years ago. The regional eye banks have been authorised, and the publicity and registration of eye bequests have now passed into the experienced hands of
the Royal National Institute for the Blind and away from individual hospitals; these are two major steps of progress. Dr. Carpenter (Feb. 3) points out that the shortage of eyes concerns us all and gives two reasons from his own
experience. One is the " dimculty of remembering " at the time of death and the other is the " unpleasantness of asking ". In hospital the ward sister should be aware of a bequest since all potential donors are given a " pledge card " by the R.N.I.B. which is to be carried on the person. One donor made sure by having the information tattooed on his arm! Badges have been con" sidered, but in many "ways they are undesirable. The unpleasantness of asking for consent has been an obstacle in the minds of many thinking people for a long time, but I share Dr. Carpenter’s view that it is overestimated. Indeed, it often worries the asking doctor far more than the nearest relation of the deceased. Of course, the circumstances of the death must always be carefully considered. Consent is almost always obtained where the deceased has died after a long life, but in sudden tragic deaths or where there is extreme grief no inquiry should ever be made. My article of Jan. 20 was intended as a progress report to general practitioners, for I feel that the time approaches to ask for their full cooperation. Of public response I have never had any doubt. Hitherto, without official authority
for regional banks, it was felt to be unwise to stir and release prematurely an avalanche of public goodwill-and then to run the risk of losing it because of the absence of adequate national arrangements for the collection and storage of eyes. But the situation has changed; the ophthalmic surgeon can show that corneal grafting can be a sight-saving operation in 80% of uncomplicated cases for which no other treatment is effective. The senior administrative medical officers of the regions are alive to the problem and have the organisation in hand, and the R.N.I.B. is geared to deal with further response. Now