- Email: [email protected]
FALSE ECONOMY IN THE LABORATORY
1363 leads to of diuretics does not
blood-glucose
on
use
a
similar finding-namely, that the be associated with a rise in
seem to
blood-glucose. Heart Disease Study and Biometrics Research Branch, National Heart, Lung, and Blood Institute, Bethesda, Maryland, 20014, U.S.A.
Framingham
WILLIAM B. KANNEL TAVIA GORDON DANIEL MCGEE
LOOSENING PATIENT IMMOBILITY
SIR—Despite the assertions of Professor Dudley and those (June 11, p. 1251) the size of surgical waiting-lists in most non-teaching hospitals (and even in The United Birmingham Hospitals’) has nothing to do with the length of postoperative stay. This is because almost everywhere operatingtheatres are already working to maximum capacity (this often restricted by shortages of anaesthetists and nurses). Even if Professor Dudley does send most gallbladder and ulcer surgery patients home after only 5 or 6 days the real reason that he can offer to take routine patients from elsewhere is the generous staffing of the theatres at St Mary’s in relation to he cites
local demand.
Operating-theatre staff working to the limit during the day will certainly be subjected to similar pressures from emergencies during the night. In this part of the U.K. ten or more emergency operations are done in one theatre on many nights, resulting in a worsening of the staffing problems during the day: yet nothing seems to be done to increase the staff presumably because the emergency work never appears in any of the usual statistics. The long waiting-list is the only argument for improving facilities that anyone seems to understand or heed. If Professor Dudley’s proposals were to make any impression on the provincial-hospital waiting-lists the working conditions for the operating-theatre software" (his jargon) can only stay the same or get even worse. Professor Dudley’s suggestion should be taken for what it
really is-simply a bit of special pleading to preserve the current overprovision of facilities at his teaching hospital. North
Ormesby Hospital, Middlesbrough
ROGER HOLE
have taken patients from outside our catchhave arranged for them to be accommodated for longer periods in the hospital or to use the good hotel accommodation in Stockton in rather the same way as a visitor to the Mayo Clinic would use the Kaylor Hotel-and the economics of this situation are very similar to those obtaining in Rochester, Minnesota. I think it is necessary to correct these two misconceptions in Professor Dudley’s otherwise excellent article and to agree that it is, in Professor Dudley’s words, "ideologically inescapable for everyone who feels strongly about equality as a fundamental feature of democracy" that resources must be more uniformly
indeed, when
we
ment area, we
distributed. North Tees General Hospital, Stockton-on-Tees, Teeside TS19 8PE
H. BRENDAN DEVLIN
FALSE ECONOMY IN THE LABORATORY
SIR,-The answer to your peripatetic correspondent’s ques(June 4, p.1199)-"Is it really necessary to spend £3500
tion
£4500 for a foreign microscope for a new consultant histopathologist ?"-is unequivocally yes. The output of the histopathology laboratory is finally channelled into the report of the histopathologist, and to deprive him of anything but the best optical equipment for examining the sections is a falseto
economy. A microscope of the calibre needed
by a consultant histohave to be foreign, and if it is to have a camera attachment, necessary for postgraduate and other teaching, it will be in the price range indicated. However, is this such a large sum compared with the annual cost of running the laboratory and the lifetime earnings of the histopathologist? It does not make sense to hire a man for £8000- £10 000 a year for 20-30 years and then try to save one or two thousand pounds on the one piece of equipment on which his performance depends. Unfortunately this type of stupidity is practised up and down the country, and no doubt administrators will be cheered by your correspondent’s erroneous views. pathologist
will almost
certainly
Department of Pathology, Southampton General Hospital, Southampton SO9 4XY
my friend Professor Dudley has been inin in proposing a system of "reverse iconoclasm dulging RAWP" to keep his own and similar surgical departments in London in business. However, his article must not go without
D. H. WRIGHT
SIR,-Once again
some
challenge.
It is unfair to compare the situation in the N.H.S. with that
of the great private clinics such as the Mayo, Lahey, and Shouldice in North America. These clinics do not provide health care to the generality of the population in the same way as the N.H.S. has to provide it in Britain-indeed the businessman travelling to the Shouldice Clinic to have his hernia repaired will take his wife with him and put up at one of the best hotels in Toronto. One can hardly expect a miner from Wigan to put his wife up at the Hilton while he has his rupture mended, albeit very successfully, by Professor Dudley at St. Mary’s Hospital round the corner. Professor Dudley also says that in our department at Stockton we have shown "beyond peradventure that the methods of day and short-stay surgery are safe".2,3 We have indeed, but we have had the advantage of operating on local patients and using a fully integrated hospital and community nursing service-perhaps the only benefit of the N.H.S. reorganisation of 1974. We have not encouraged patients from outside the district to come in and have day-case surgery in this system1. Dawson Edwards, P. Barrow, M. Br. 2. Russell, I. T., Devlin, H. B., Fell,
DETECTION OF INFANTILE GASTROENTERITIS VIRUS (ROTAVIRUS) BY ELISA
’
med. J. 1977, i, 1532. M., Glass, N. J., Newell,
D. J. Lancet, 1977, i, 844. 3. Devlin, H. B., Russell, I. T., Muller, D., Sahay, A. K., Tiwari, P. N. ibid. p. 847.
SIR,-Infantile gastroenteritis virus has been implicated as important cause of diarrhoea in infants.’ The infection can be diagnosed by detection of the virus in stools by electron mican
roscopy,z but this method is time consuming and not everyone has access to electron microscopy. We have used an enzyme-linked immunosorbent assay (ELISA)3’4 for the detection of newborn calf diarrhoea virus (N.c.D.v.),’ which is serologically related to the infantile gastroenteritis virus.6 In this test, a faecal extract is incubated in polystyrene tubes coated with antibodies against N.C.D.V. Bound viral antigens are then reacted with specific antibody, linked to peroxidase. Complexed enzyme-labelled antibody was detected by adding a suitable enzyme substrate. As a result of the serological relationship between N.C.D.v. and infantile gastroenteritis virus,6 the test can also be used for the detection of the human virus. Bryden, A. S., Davies, H. A., Hadley, R. E., Flewett, T. H., Morris, C. A., Oliver, P. Lancet, 1975, ii, 241. 2. Bishop, R. F., Davidson, G. P., Holmes, J. H., Ruck, B. J. ibid. 1974, i, 149. 3. Engvall, E., Perlmann, P. J. Immun. 1972, 109, 129. 4. Voller, A., Bartlett, A., Bidwell, D. E., Clark, M. F., Adams, A. N. J. gen. Virol. 1976, 33, 165. 5. Ellens, D. J., de Leeuw, P. W. Unpublished. 6. Thouless, M. E., Bryden, A. S., Flewett, T. H., Wood, G. N., Bridger, J. C., Snodgrass, D. R., Herring, J. A. Archs Virol. 1977, 53, 287. 1.
blood-glucose
on
use
a
similar finding-namely, that the be associated with a rise in
seem to
blood-glucose. Heart Disease Study and Biometrics Research Branch, National Heart, Lung, and Blood Institute, Bethesda, Maryland, 20014, U.S.A.
Framingham
WILLIAM B. KANNEL TAVIA GORDON DANIEL MCGEE
LOOSENING PATIENT IMMOBILITY
SIR—Despite the assertions of Professor Dudley and those (June 11, p. 1251) the size of surgical waiting-lists in most non-teaching hospitals (and even in The United Birmingham Hospitals’) has nothing to do with the length of postoperative stay. This is because almost everywhere operatingtheatres are already working to maximum capacity (this often restricted by shortages of anaesthetists and nurses). Even if Professor Dudley does send most gallbladder and ulcer surgery patients home after only 5 or 6 days the real reason that he can offer to take routine patients from elsewhere is the generous staffing of the theatres at St Mary’s in relation to he cites
local demand.
Operating-theatre staff working to the limit during the day will certainly be subjected to similar pressures from emergencies during the night. In this part of the U.K. ten or more emergency operations are done in one theatre on many nights, resulting in a worsening of the staffing problems during the day: yet nothing seems to be done to increase the staff presumably because the emergency work never appears in any of the usual statistics. The long waiting-list is the only argument for improving facilities that anyone seems to understand or heed. If Professor Dudley’s proposals were to make any impression on the provincial-hospital waiting-lists the working conditions for the operating-theatre software" (his jargon) can only stay the same or get even worse. Professor Dudley’s suggestion should be taken for what it
really is-simply a bit of special pleading to preserve the current overprovision of facilities at his teaching hospital. North
Ormesby Hospital, Middlesbrough
ROGER HOLE
have taken patients from outside our catchhave arranged for them to be accommodated for longer periods in the hospital or to use the good hotel accommodation in Stockton in rather the same way as a visitor to the Mayo Clinic would use the Kaylor Hotel-and the economics of this situation are very similar to those obtaining in Rochester, Minnesota. I think it is necessary to correct these two misconceptions in Professor Dudley’s otherwise excellent article and to agree that it is, in Professor Dudley’s words, "ideologically inescapable for everyone who feels strongly about equality as a fundamental feature of democracy" that resources must be more uniformly
indeed, when
we
ment area, we
distributed. North Tees General Hospital, Stockton-on-Tees, Teeside TS19 8PE
H. BRENDAN DEVLIN
FALSE ECONOMY IN THE LABORATORY
SIR,-The answer to your peripatetic correspondent’s ques(June 4, p.1199)-"Is it really necessary to spend £3500
tion
£4500 for a foreign microscope for a new consultant histopathologist ?"-is unequivocally yes. The output of the histopathology laboratory is finally channelled into the report of the histopathologist, and to deprive him of anything but the best optical equipment for examining the sections is a falseto
economy. A microscope of the calibre needed
by a consultant histohave to be foreign, and if it is to have a camera attachment, necessary for postgraduate and other teaching, it will be in the price range indicated. However, is this such a large sum compared with the annual cost of running the laboratory and the lifetime earnings of the histopathologist? It does not make sense to hire a man for £8000- £10 000 a year for 20-30 years and then try to save one or two thousand pounds on the one piece of equipment on which his performance depends. Unfortunately this type of stupidity is practised up and down the country, and no doubt administrators will be cheered by your correspondent’s erroneous views. pathologist
will almost
certainly
Department of Pathology, Southampton General Hospital, Southampton SO9 4XY
my friend Professor Dudley has been inin in proposing a system of "reverse iconoclasm dulging RAWP" to keep his own and similar surgical departments in London in business. However, his article must not go without
D. H. WRIGHT
SIR,-Once again
some
challenge.
It is unfair to compare the situation in the N.H.S. with that
of the great private clinics such as the Mayo, Lahey, and Shouldice in North America. These clinics do not provide health care to the generality of the population in the same way as the N.H.S. has to provide it in Britain-indeed the businessman travelling to the Shouldice Clinic to have his hernia repaired will take his wife with him and put up at one of the best hotels in Toronto. One can hardly expect a miner from Wigan to put his wife up at the Hilton while he has his rupture mended, albeit very successfully, by Professor Dudley at St. Mary’s Hospital round the corner. Professor Dudley also says that in our department at Stockton we have shown "beyond peradventure that the methods of day and short-stay surgery are safe".2,3 We have indeed, but we have had the advantage of operating on local patients and using a fully integrated hospital and community nursing service-perhaps the only benefit of the N.H.S. reorganisation of 1974. We have not encouraged patients from outside the district to come in and have day-case surgery in this system1. Dawson Edwards, P. Barrow, M. Br. 2. Russell, I. T., Devlin, H. B., Fell,
DETECTION OF INFANTILE GASTROENTERITIS VIRUS (ROTAVIRUS) BY ELISA
’
med. J. 1977, i, 1532. M., Glass, N. J., Newell,
D. J. Lancet, 1977, i, 844. 3. Devlin, H. B., Russell, I. T., Muller, D., Sahay, A. K., Tiwari, P. N. ibid. p. 847.
SIR,-Infantile gastroenteritis virus has been implicated as important cause of diarrhoea in infants.’ The infection can be diagnosed by detection of the virus in stools by electron mican
roscopy,z but this method is time consuming and not everyone has access to electron microscopy. We have used an enzyme-linked immunosorbent assay (ELISA)3’4 for the detection of newborn calf diarrhoea virus (N.c.D.v.),’ which is serologically related to the infantile gastroenteritis virus.6 In this test, a faecal extract is incubated in polystyrene tubes coated with antibodies against N.C.D.V. Bound viral antigens are then reacted with specific antibody, linked to peroxidase. Complexed enzyme-labelled antibody was detected by adding a suitable enzyme substrate. As a result of the serological relationship between N.C.D.v. and infantile gastroenteritis virus,6 the test can also be used for the detection of the human virus. Bryden, A. S., Davies, H. A., Hadley, R. E., Flewett, T. H., Morris, C. A., Oliver, P. Lancet, 1975, ii, 241. 2. Bishop, R. F., Davidson, G. P., Holmes, J. H., Ruck, B. J. ibid. 1974, i, 149. 3. Engvall, E., Perlmann, P. J. Immun. 1972, 109, 129. 4. Voller, A., Bartlett, A., Bidwell, D. E., Clark, M. F., Adams, A. N. J. gen. Virol. 1976, 33, 165. 5. Ellens, D. J., de Leeuw, P. W. Unpublished. 6. Thouless, M. E., Bryden, A. S., Flewett, T. H., Wood, G. N., Bridger, J. C., Snodgrass, D. R., Herring, J. A. Archs Virol. 1977, 53, 287. 1.