CARS FOR DOCTORS

122 of his medical attendant. In diagnosis it is imperative to retain the confidence of the patient-

mind

not confuse him. Trick methods are a poor substitute for clinical science, and history-taking should be sufficiently discerning to render them unnecessary.

S. BARTON HALL.

Liverpool.

CARS FOR DOCTORS SIR,—In their letter of June 19 Mr. Cooke and Mr. Grafton say : "At no time has the industry undertaken to give absolute priority to doctors. The term used is’preferential delivery,’ which is intended to apply only where a doctor has no serviceable car or no car at all." Can they explain why the doctor in genuine need should I write as one who, not be given absolute priority ? since the end of January, 1947, has driven over 22,000 miles in the work of my practice in country much of which is rough, hilly, and water-splashed. This work simply cannot be done without a serviceable car. On reading their letter I can only conclude that Mr. Cooke and Mr. Grafton think that either a motorcar is an unnecessary luxury for a doctor or that a doctor is an unnecessary luxury for a sick person. P. R. BOUCHER. Winfrith, Dorset.

OPERATIONS FOR HERNIA

SiR,,-In their article last week Moloney, Gill, and Barclay make assumptions which will surely not be accepted by any physiologist or pathologist. They

say : " The effective constituent of the buttress is the suture material ; and, though fibrous tissue is laid down and is helpful, it is neither essential nor dependable for

permanent repair." This statement

completely overlooks

the facts that

living tissues are being dealt with and that they react. Any suture, when tied sufficiently tightly to be effective, causes pressure necrosis of some of the tissue within its grasp. This dead material is removed by the reaction of neighbouring living tissues and is removed. The grasp of the suture then becomes loose and, as far as holding the sutured parts together is, concerned, useless. Eventually and inevitably the strength of the repair must depend upon the new fibrous tissue formed in the meshes of the " darn." The nylon network acts solely and simply as a splint to hold the parts together until this new tissue has been formed. This is one of the simple fundamental facts of surgical repair. To base an operation on the assumption that a non-absorbable suture will act as a permanent bond can only lead to error in every stage of its conception and development. Non-absorbable sutures are used in hernia repair, not because they remain unabsorbed, but because they interfere less than catgut with processes of repair. St. Mary’s Hospital, London, W.2. CHARLES A. PANNETT.

INCOMES FOR SPECIALISTS AND GOVERNMENT MEDICAL OFFICERS

SIR,—I was most interested to read in your issue of July 10 that the Institution of Professional Civil Servants

bringing forward the question of the salaries of Government medical officers. I hope that many besides their general secretary have read the letter in your issue of June 19 signed " A Stepchild of the Profession." May I suggest that the attention of your readers be drawn to the question asked by Sir Ernest Graham-Little with regard to the salaries of deputy medical officers of health, together with the Minister’s reply-namely, "it is not for me arbitrarily to determine these officers’ salaries, but rather to encourage the appropriate negotiating machinery for dealing with any proposals for revision." It has never been suggested that the Minister should determine arbitrarily either the salaries of local Government medical officers or the salaries of those employed by the Ministries. It is, however, clearly the duty of the Minister to determine the general principles which govern the remuneration of the different branches of the profession, and to ensure that all men and women holding specialist qualifications be remunerated at approximately equivalent rates whether they are employed by

are

,

Government departments, teaching hospitals and medical or in clinical medicine. In view of the Minister’s reply it would be interesting to know specifically three things : (1) exactly what negotiating machinery has been set up and whether it has commenced its deliberations ; (2) whether it is sitting entirely in private session or whether it is prepared to hear evidence from members of the profession ; and (3) the approximate date when it is thought likely that the negotiating machinery will have reached its conclusions with regard to the salaries of local and central Government medical officers and the salaries of medical teachers. V. O. B. GARTSIDE

schools,

,

Oxford.

Deputy County

M.O.H.

INTRAVENOUS ANÆSTHETICS

SIR,—Mr. Vartan’s letter last week was generous and timely. The intravenous needle is recording a sad tale of misadventures. A few months ago, a young woman of 21 was given an intravenous anxsthetic for an operation that could quite properly have been performed under some other form of anæsthesia. She lost her arm as the result of the drug being injected into an abnormal artery. It would be much in the public interest if the present " flight from ether " were to be abandoned. JOHN E. ELAM. New Barnet.

SCHOOL DOCTORS AND THE ACT Smith (July 10) quotes the Ministry of Education and the secretary to the Ministry of Health in support of additional payments for services which most people will consider should be " covered by the provision of general medical services." The Act is intended to introduce not only free treatment of the sick but a positive health service ; Dr. Smith implies that " routine or. special examinations and the giving of advice on general health " are outside the scope of the service, which seems to limit the preventive side to the syringe and needle., Thus, in a family of several children, one suffering from an infectious disease would receive free treatment, but the mother would be denied advice on measures intended to limit its spread unless she was prepared to pay for it. Surely this is absurd ? A doctor who has accepted boys as patients under the Act has a duty to give advice to the school authorities and, when necessary, to carry out routine examinations. The honorarium can only be the beginning of a black market in school medicine. FATHER OF EIGHT.

SIR,—Dr.

.

Obituary THOMAS HENRY SYMONS K.B.E., C.S.I., O.B.E., M.R.C.S. Major-General Sir Henry Symons, director-general of the Indian Medical Service from 1926 to 1930, died at his home in Hampshire on July 3, at the age of 76. A Cornishman, Symons was educated privately and at Charing Cross Hospital, where he held several houseappointments after qualifying in 1894. He entered the Indian Medical Service in 1896, and five years later was transferred to the civil side. After a short period in the Central Provinces he went to Madras ; and at the medical college there he rose to be professor of surgery and held the post of senior surgeon at the General Hospital. For several years he was also professor of anatomy ; this appointment was combined in those days with a surgical post at the hospital-an arrangement which provided valuable training for surgeons. Symons himself was a capable surgeon and a good teacher with a forthright manner which appealed to students. In 1915 he was appointed to command the hospital ship Madras, with which he remained until the end of the war. For his services he was mentioned in despatches and was appointed O.B.E. In 1923 he became surgeongeneral to the government of Madras, and three years later, the first officer on the general list to hold this appointment, he became director-general of the I.M.S. in succession to Sir Charles McWhatt. He took over at a difficult time, for retrenchment was then the chief