- Email: [email protected]
CHRISTMAS QUIZ
1431
Screening costs obviously depend on the level of staff required and on the false-positive rate which determines the number of children who have to go through the full diagnostic pilocarpine sweat test. It is not possible to forecast the total costs which would arise from a screening programme, since there is, as yet, no information on how the costs of early treatment differ from those of conventional treatment at a symptomatic stage. It could be postulated that early treatment might result in savings if it led to a reduction in inpatient care, but against this would need to be set the costs of drugs and outpatient care, which would presumably be administered for
a
longer
Very Special Articles CHRISTMAS
1.-Rudyard Kipling: A.
for
reprints should be addressed
to
J. C.
REFERENCES 1. 2.
3. 4. 5. 6. 7. 8. 9. 10. 11. 12.
13. 14. 15.
16. 17. 18. 19.
20.
21. 22. 23. 24. 25.
Danes, B. S., Beam, A. G. J. exp. Med. 1969, 129, 775. Conover, J. H., Conod, E., Hirschorn, K. Lancet, 1973, i, 1122. ibid. 1973, ii, 307. Anderson, D. H. Am. J. Dis. Child. 1938, 56, 344. Shwachman, H., Diamond, L. K., Oski, F. A., Khaw, K. J. J. Pediat. 1964, 65, 645. Burke, V., Colebatch, J. H., Anderson, C. M., Simons, M. J. Archs Dis. Childh. 1967, 42, 147. Tarlow, M. J., Hadorn, B., Arthurton, M. W., Lloyd, J. K. Archs Dis. Childh. 1970, 45, 651. Registrar General. Statistical Reviews of England and Wales, 1940-71: part I, medical. H.M. Stationery Office. Peterson, E. M. J. Am. med. Ass. 1959, 171, 87. di Sant Agnese, P. A., Vidaurreta, A. M. ibid. 1960, 172, 2065. Lawson, D. in Control of Chemotherapy (edited by P. J. Watts); p. 69. Edinburgh, 1970. Matthews, L. W., Doershuk, C. F., Spector, S. Pediatrics, Springfield, 1967, 39, 176. Mearns, M. B. Archs Dis. Childh. 1972, 47, 5. Warwick, W. J. Minn. Med. 1967, 50, 1049. Warwick, W. J., Pogue, R. E. Proc. 5th int. Cystic Fibrosis Conf. 1969, p. 320. Colley, J. R. T. Br. med. Bull. 1971, 27, 9. Dobbs, R. H. Respiration, 1970, 27, suppl. p. 169. Shwachman, H., Redmond, A., Khaw, K. T. Pediatrics, Springfield, 1970, 46, 335. Bray, P. T. Proceedings of the 2nd Conference of the European Working Group on Cystic Fibrosis. Cystic Fibrosis Trust, London, 1971. Hansen, L., Muechele, M., Koroshek, J., Warwick, W. J. Am. J. clin. Path. 1968, 49, 834. Kapito, L., Shwachman, H. Pediatrics, Springfield, 1969, 43, 794. Bray, P. T. Personal communication. Hobbs, J. R. Protides biol. Fluids, 1969, 16, 517. Schutt, W. H., Isles, T. E. Archs Dis. Childh. 1968, 43, 178. Lawson, D., Westcombe, P., Saggers, B. ibid. 1969, 44, 715.
"
When I suddenly. Saye’s Horse, and fought the
physician to King-or rather the man Charles Stuart-in Oxfordshire (I had my learning at Cambridge), the plague was very hot all around us." 2. " Nearly every household in India knows that Doctors are very helpless in The battle must be fought out between Death and the Nurses minute by minute and degree by degree." 3. " One came to us (the Bhils) in the name of the Government with little ghost-knives and a magic was
-.
CONCLUSIONS
Requests
Fill the blanks in: 1. Ahem ! " Mr - said "
time.
Work on the development of tests for the early detection of cystic fibrosis suggests that a system of screening newborn infants for the condition is a real future possibility. However, evidence of the value of such a scheme is lacking in several important respects. The false-negative and false-positive rates of the various available tests need further study, as does their repeatability when applied by different observers or at different times. Knowledge of the natural history of the condition is incomplete andof greatest importance-the effect of early treatment in altering the clinical history is unknown. Until evidence on these points has been collected there is no case for routine screening of all infants for the condition. There is obviously great scope for further research, and in particular for randomised controlled trials of screening, using tests of known validity. But the difficulties inherent in such trials, arising principally from the low incidence of the condition, should not be underestimated, and it is probable that multicentre or international studies will be needed.
QUIZ
4.
» " We’ve got the
-
in
camp-it’s
worse
than
.
forty fights; We’re dying in the wilderness the Isrulites; It’s before us, an’ be’ind us, an’
same
as
we cannot
get
away,
An’ the doctor’s just reported we’ve ten more today !" 5. " Perfectly," said Rene, " I drive on the breakers. But before I strike, I shall save hundreds, thousands, millions perhaps, by my little -." 6. "He took a small tin tobacco-box from his sodden waist-belt. ‘ nay, do not be afraid ’, said Peroo to Findlayson.It is no more than -, clean Malwa ’." B. Dr Dumoise (" the Dormouse ") diagnosed a " heartrending case of hydrophobia ". What did Strickland think it was ? C. With what did the gipsy queen Sitabhai try to poison the Maharajah’s son ? D. What caused Dick Heldar’s blindness ? E. Who provided Kipling with the medical details on Laennec and Culpeper for his stories in " Marklake Witches " and " A Doctor of Medicine " ? F.Skittles ’, said all the doctors together.He’s our property.’ They severally murmured,arsenic ’, ’ strychnine ’ andopium ’, and went their way ’. Who was he and how did he actually die ? G. " And he was going to see Caesar ! And he-he had washed me clean after dysentery." Of whom was Sulinor, Captain of the Roman Guard-ship of Marseilles, speaking ? H. What made Kipling give up thoughts of a medical career when he was about sixteen ? I. Who were the two Rogers who disputed with the Abbot, John of Burgos, and the Infirmarian about Animalculae ? J. How did Muller know that Mowgli had been brought up with wolves ? K. " Holy Shmoke ! " sez the docthor, " An’ who are you, to be givin’ names to your diseases ? ’Tis To whom was Dr agin all the reg’lations." Lowndes speaking and what was the disease ? L. How did Mrs Delville,’the Dowd ’, destroy the diphtheritic membrane which was killing Dora Bent ?
2.-Miscellany: A.
B.
What doctor in fiction cleaned his teeth with a Beaujolais " as light as communion wine which he kept specially for this purpose ? With what diseases or parts of the body are the following saints popularly associated ? St. Roch;
1432
Lucy; St. Vitus; St. Giles; St. Lawrence; St. Apollonia; St. Agatha; St. Teresa of Lisieux.
ANYONE READ THE LANCET ?
St.
the medical links between these places ? (a) Winchester and Southampton; (b) Bornholm and Malta; (c) North-east Brazil and Egypt; (d) Wattisham (Suffolk) and Pont St. Esprit (Gard, France); (e) Havana, Rio de Janeiro, Veracruz, Guayaquil, Panama City. D. What prominent contemporary statesman and was described by Harvey as having philosopher " an Eie of a viper " ? E. When were questions on (a) Latin and Greek, (b) French and German discontinued in the membership examination of the Royal College of Physicians of London ? F. From what family and its connections are the names of ten streets in the Harley Street area derived ?
C. What
3.-Sayings
are
and
Writings:
Which of the following said or wrote: George Crabbe; Lord Chesterfield; Aneurin Bevan; George III; Anthony Trollope; William Hunter. A. " Most philosophers, most great men, most anatomists, and most other men of eminence lie like the devil." B.
C.
How well have you read The Lancet in the past year ? 1. Who minted the bougie ? 2. Who or what, in 1973, were 21,25,75, 150 ... or about 2100 (any three will do) ? 3. What locked up the bowels of men for 14° of latitude ? 4. The birds and the bees were triply honoured in 1973. How ? 5. What upset the jazz at Hazlerigg ? 6. What have Candau, Godber, and Howie in common ? 7. Connect, if you can, cricket with the prepuce. 8. v.D. on the farm ! What is it ? 9. Where is Dr Collis Browne remembered ? 10. What city experienced a planetary visit ? 11. Who saw an elephant in the Atlantic ? 12. The vibrios came from the sea-but where did they strike ? 13. What connects Pontefract with Addison’s disease ? 14. The patient was left with I.P.P. after an A.D.C. Translate. 15. What bird-fancier had better luck in Chapel Market than in Brick Lane ? A
A physician should not be admitted to the College, till he could bring proof of his having cured, in his own person, at least four incurable dis-
tempers." college of physicians, some sanitary board, some great hospital should surely erect a statue
" Some
to Moliere." D. " All pride and business, bustle and conceit... A potent quack, long versed in human ills, Who first insults the victim whom he kills; Whose murd’rous hand a drowsy Bench protect, And whose most tender mercy is neglect." E. " The issue for the medical profession today is not therefore, whether they will join a service the final shape of which cannot yet be known, but whether they will accept or forgo the opportunity to influence its shaping." F. " I am sorry to hear, Doctor, that you have exchanged a profession for which I have the highest regard (the Church) for one which I dislike (medicine)."
prize,
a
copy of
J.
B. Bronowski’s The Ascent of
Man, will be awarded for the three
most
nearly
correct
solutions. Incomplete entries are eligible. Entries, which should be marked Christmas Competition and sent to the London office of The Lancet, will be held unopened until Monday, Feb. 4, to allow overseas readers to enter.
Views of General Practice THE WAITING GAME
STEPHEN MCGRAIL
Department of Sociology and Social Administration, University of Durham " But the laddie’s bad. That’s why I brought him. I’ve come from Hylton Road. It cost me 4p ", she adds
hopefully. "
4.-Here and There: Two eminent doctors were born in the village of Somerby in Leicestershire, in the 17th and 19th century, respectively. Who ? B. Where are now the three statues of (1) Linacre, (2) Harvey, (3) Sydenham, which were on the front of the Royal College of Physicians in Pall Mall East ? C. What port on the coast of Brittany describes itself as Berceau de la Thalassotherapie " ? D. In what church in Ireland will this epitaph on a boy of 11 be found ? " His death was occasioned by his top having fallen from him and in stooping to regain it a Car rolled on him in the street
A.
"
(1837). E. F.
For what medical reason is the Suffolk village of Bures famous ? In what Welsh town is there a memorial 80 feet high to a doctor for his local services including " intrepid and devoted attendance on the sufferers " from the cholera epidemic of 1832 ? N. M. G.
Answers
on
page 1458
I’m sorry. I’ve told you doctor is busy. You know you must have an appointment. You can’t expect doctor to see you just when you want. You’ll have to wait till there’s a space, and I’ll put you with one of the other
doctors." The receptionist bends back to her filing, congratulating herself on another successful engagement in her long battle to protect doctor from the intrusion of people who thoughtlessly get ill at the wrong time. But on the other side of the room the patients are restless. She affects not to hear that the practice isn’t like it was when old Dr James was alive, he’d come and see you if you wanted, and she wasn’t there then. Impudent, she is. Wouldn’t care if you was dying. A gloomy silence falls as the patients retire into their private worlds of pain or sorrow or anxiety, heeding the large notice that tells them that silence is requested because it helps the doctor. I sit there too. This is the thirtieth waiting-room I’ve sat in while doing my research into G.P.s’ referrals, and that means that there are only twenty more to go. After seeing that number, you become a bit of a connoisseur, you speculate on the ethology of the waitingroom. Take the notices, for instance. In this room, as in all the others, a large proportion of the notices seem to be telling you of ways in which you can help the doctor,
Screening costs obviously depend on the level of staff required and on the false-positive rate which determines the number of children who have to go through the full diagnostic pilocarpine sweat test. It is not possible to forecast the total costs which would arise from a screening programme, since there is, as yet, no information on how the costs of early treatment differ from those of conventional treatment at a symptomatic stage. It could be postulated that early treatment might result in savings if it led to a reduction in inpatient care, but against this would need to be set the costs of drugs and outpatient care, which would presumably be administered for
a
longer
Very Special Articles CHRISTMAS
1.-Rudyard Kipling: A.
for
reprints should be addressed
to
J. C.
REFERENCES 1. 2.
3. 4. 5. 6. 7. 8. 9. 10. 11. 12.
13. 14. 15.
16. 17. 18. 19.
20.
21. 22. 23. 24. 25.
Danes, B. S., Beam, A. G. J. exp. Med. 1969, 129, 775. Conover, J. H., Conod, E., Hirschorn, K. Lancet, 1973, i, 1122. ibid. 1973, ii, 307. Anderson, D. H. Am. J. Dis. Child. 1938, 56, 344. Shwachman, H., Diamond, L. K., Oski, F. A., Khaw, K. J. J. Pediat. 1964, 65, 645. Burke, V., Colebatch, J. H., Anderson, C. M., Simons, M. J. Archs Dis. Childh. 1967, 42, 147. Tarlow, M. J., Hadorn, B., Arthurton, M. W., Lloyd, J. K. Archs Dis. Childh. 1970, 45, 651. Registrar General. Statistical Reviews of England and Wales, 1940-71: part I, medical. H.M. Stationery Office. Peterson, E. M. J. Am. med. Ass. 1959, 171, 87. di Sant Agnese, P. A., Vidaurreta, A. M. ibid. 1960, 172, 2065. Lawson, D. in Control of Chemotherapy (edited by P. J. Watts); p. 69. Edinburgh, 1970. Matthews, L. W., Doershuk, C. F., Spector, S. Pediatrics, Springfield, 1967, 39, 176. Mearns, M. B. Archs Dis. Childh. 1972, 47, 5. Warwick, W. J. Minn. Med. 1967, 50, 1049. Warwick, W. J., Pogue, R. E. Proc. 5th int. Cystic Fibrosis Conf. 1969, p. 320. Colley, J. R. T. Br. med. Bull. 1971, 27, 9. Dobbs, R. H. Respiration, 1970, 27, suppl. p. 169. Shwachman, H., Redmond, A., Khaw, K. T. Pediatrics, Springfield, 1970, 46, 335. Bray, P. T. Proceedings of the 2nd Conference of the European Working Group on Cystic Fibrosis. Cystic Fibrosis Trust, London, 1971. Hansen, L., Muechele, M., Koroshek, J., Warwick, W. J. Am. J. clin. Path. 1968, 49, 834. Kapito, L., Shwachman, H. Pediatrics, Springfield, 1969, 43, 794. Bray, P. T. Personal communication. Hobbs, J. R. Protides biol. Fluids, 1969, 16, 517. Schutt, W. H., Isles, T. E. Archs Dis. Childh. 1968, 43, 178. Lawson, D., Westcombe, P., Saggers, B. ibid. 1969, 44, 715.
"
When I suddenly. Saye’s Horse, and fought the
physician to King-or rather the man Charles Stuart-in Oxfordshire (I had my learning at Cambridge), the plague was very hot all around us." 2. " Nearly every household in India knows that Doctors are very helpless in The battle must be fought out between Death and the Nurses minute by minute and degree by degree." 3. " One came to us (the Bhils) in the name of the Government with little ghost-knives and a magic was
-.
CONCLUSIONS
Requests
Fill the blanks in: 1. Ahem ! " Mr - said "
time.
Work on the development of tests for the early detection of cystic fibrosis suggests that a system of screening newborn infants for the condition is a real future possibility. However, evidence of the value of such a scheme is lacking in several important respects. The false-negative and false-positive rates of the various available tests need further study, as does their repeatability when applied by different observers or at different times. Knowledge of the natural history of the condition is incomplete andof greatest importance-the effect of early treatment in altering the clinical history is unknown. Until evidence on these points has been collected there is no case for routine screening of all infants for the condition. There is obviously great scope for further research, and in particular for randomised controlled trials of screening, using tests of known validity. But the difficulties inherent in such trials, arising principally from the low incidence of the condition, should not be underestimated, and it is probable that multicentre or international studies will be needed.
QUIZ
4.
» " We’ve got the
-
in
camp-it’s
worse
than
.
forty fights; We’re dying in the wilderness the Isrulites; It’s before us, an’ be’ind us, an’
same
as
we cannot
get
away,
An’ the doctor’s just reported we’ve ten more today !" 5. " Perfectly," said Rene, " I drive on the breakers. But before I strike, I shall save hundreds, thousands, millions perhaps, by my little -." 6. "He took a small tin tobacco-box from his sodden waist-belt. ‘ nay, do not be afraid ’, said Peroo to Findlayson.It is no more than -, clean Malwa ’." B. Dr Dumoise (" the Dormouse ") diagnosed a " heartrending case of hydrophobia ". What did Strickland think it was ? C. With what did the gipsy queen Sitabhai try to poison the Maharajah’s son ? D. What caused Dick Heldar’s blindness ? E. Who provided Kipling with the medical details on Laennec and Culpeper for his stories in " Marklake Witches " and " A Doctor of Medicine " ? F.Skittles ’, said all the doctors together.He’s our property.’ They severally murmured,arsenic ’, ’ strychnine ’ andopium ’, and went their way ’. Who was he and how did he actually die ? G. " And he was going to see Caesar ! And he-he had washed me clean after dysentery." Of whom was Sulinor, Captain of the Roman Guard-ship of Marseilles, speaking ? H. What made Kipling give up thoughts of a medical career when he was about sixteen ? I. Who were the two Rogers who disputed with the Abbot, John of Burgos, and the Infirmarian about Animalculae ? J. How did Muller know that Mowgli had been brought up with wolves ? K. " Holy Shmoke ! " sez the docthor, " An’ who are you, to be givin’ names to your diseases ? ’Tis To whom was Dr agin all the reg’lations." Lowndes speaking and what was the disease ? L. How did Mrs Delville,’the Dowd ’, destroy the diphtheritic membrane which was killing Dora Bent ?
2.-Miscellany: A.
B.
What doctor in fiction cleaned his teeth with a Beaujolais " as light as communion wine which he kept specially for this purpose ? With what diseases or parts of the body are the following saints popularly associated ? St. Roch;
1432
Lucy; St. Vitus; St. Giles; St. Lawrence; St. Apollonia; St. Agatha; St. Teresa of Lisieux.
ANYONE READ THE LANCET ?
St.
the medical links between these places ? (a) Winchester and Southampton; (b) Bornholm and Malta; (c) North-east Brazil and Egypt; (d) Wattisham (Suffolk) and Pont St. Esprit (Gard, France); (e) Havana, Rio de Janeiro, Veracruz, Guayaquil, Panama City. D. What prominent contemporary statesman and was described by Harvey as having philosopher " an Eie of a viper " ? E. When were questions on (a) Latin and Greek, (b) French and German discontinued in the membership examination of the Royal College of Physicians of London ? F. From what family and its connections are the names of ten streets in the Harley Street area derived ?
C. What
3.-Sayings
are
and
Writings:
Which of the following said or wrote: George Crabbe; Lord Chesterfield; Aneurin Bevan; George III; Anthony Trollope; William Hunter. A. " Most philosophers, most great men, most anatomists, and most other men of eminence lie like the devil." B.
C.
How well have you read The Lancet in the past year ? 1. Who minted the bougie ? 2. Who or what, in 1973, were 21,25,75, 150 ... or about 2100 (any three will do) ? 3. What locked up the bowels of men for 14° of latitude ? 4. The birds and the bees were triply honoured in 1973. How ? 5. What upset the jazz at Hazlerigg ? 6. What have Candau, Godber, and Howie in common ? 7. Connect, if you can, cricket with the prepuce. 8. v.D. on the farm ! What is it ? 9. Where is Dr Collis Browne remembered ? 10. What city experienced a planetary visit ? 11. Who saw an elephant in the Atlantic ? 12. The vibrios came from the sea-but where did they strike ? 13. What connects Pontefract with Addison’s disease ? 14. The patient was left with I.P.P. after an A.D.C. Translate. 15. What bird-fancier had better luck in Chapel Market than in Brick Lane ? A
A physician should not be admitted to the College, till he could bring proof of his having cured, in his own person, at least four incurable dis-
tempers." college of physicians, some sanitary board, some great hospital should surely erect a statue
" Some
to Moliere." D. " All pride and business, bustle and conceit... A potent quack, long versed in human ills, Who first insults the victim whom he kills; Whose murd’rous hand a drowsy Bench protect, And whose most tender mercy is neglect." E. " The issue for the medical profession today is not therefore, whether they will join a service the final shape of which cannot yet be known, but whether they will accept or forgo the opportunity to influence its shaping." F. " I am sorry to hear, Doctor, that you have exchanged a profession for which I have the highest regard (the Church) for one which I dislike (medicine)."
prize,
a
copy of
J.
B. Bronowski’s The Ascent of
Man, will be awarded for the three
most
nearly
correct
solutions. Incomplete entries are eligible. Entries, which should be marked Christmas Competition and sent to the London office of The Lancet, will be held unopened until Monday, Feb. 4, to allow overseas readers to enter.
Views of General Practice THE WAITING GAME
STEPHEN MCGRAIL
Department of Sociology and Social Administration, University of Durham " But the laddie’s bad. That’s why I brought him. I’ve come from Hylton Road. It cost me 4p ", she adds
hopefully. "
4.-Here and There: Two eminent doctors were born in the village of Somerby in Leicestershire, in the 17th and 19th century, respectively. Who ? B. Where are now the three statues of (1) Linacre, (2) Harvey, (3) Sydenham, which were on the front of the Royal College of Physicians in Pall Mall East ? C. What port on the coast of Brittany describes itself as Berceau de la Thalassotherapie " ? D. In what church in Ireland will this epitaph on a boy of 11 be found ? " His death was occasioned by his top having fallen from him and in stooping to regain it a Car rolled on him in the street
A.
"
(1837). E. F.
For what medical reason is the Suffolk village of Bures famous ? In what Welsh town is there a memorial 80 feet high to a doctor for his local services including " intrepid and devoted attendance on the sufferers " from the cholera epidemic of 1832 ? N. M. G.
Answers
on
page 1458
I’m sorry. I’ve told you doctor is busy. You know you must have an appointment. You can’t expect doctor to see you just when you want. You’ll have to wait till there’s a space, and I’ll put you with one of the other
doctors." The receptionist bends back to her filing, congratulating herself on another successful engagement in her long battle to protect doctor from the intrusion of people who thoughtlessly get ill at the wrong time. But on the other side of the room the patients are restless. She affects not to hear that the practice isn’t like it was when old Dr James was alive, he’d come and see you if you wanted, and she wasn’t there then. Impudent, she is. Wouldn’t care if you was dying. A gloomy silence falls as the patients retire into their private worlds of pain or sorrow or anxiety, heeding the large notice that tells them that silence is requested because it helps the doctor. I sit there too. This is the thirtieth waiting-room I’ve sat in while doing my research into G.P.s’ referrals, and that means that there are only twenty more to go. After seeing that number, you become a bit of a connoisseur, you speculate on the ethology of the waitingroom. Take the notices, for instance. In this room, as in all the others, a large proportion of the notices seem to be telling you of ways in which you can help the doctor,