Government Funding of Research

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Commentary from Westminster Civil Defence: the NHS after

a

Nuclear Attack

THE risk of war in Europe is now judged to be very low, the Government states. But there can be "no absolute and permanent guarantee" that the UK will not be involved, directly or indirectly, in war, possibly nuclear. That is the assessment underlying the issue of a new set of guidelines on preparations for civil defence from several Government departments, including the DHSS. The issue of the guidelines seems to herald a new seriousness in official attitudes to preparedness for nuclear war. There is as yet no sign of Government willingness to spend money on nuclear blast or fallout shelters for the civilian population. (Apart from a huge elaborate shelter for selected politicians and top civil servants only 400 yards from Parliament, into which political journalists will not be invited when the apocalypse

arrives.) Nevertheless the Government clearly hopes to improve the probable rates of survival in a nuclear attack by taking various steps in planning and management beforehand. They include advising the public on how to make their homes slightly more protective (which only the most optimistic seem to find reassuring); suggesting to farmers how their livestock’s chances of unpolluted survival might be increased; and planning for the maximum possible survival of health services during and after nuclear destruction. All health authorities, family practitioner committees, and the blood transfusion services have been sent a draft document on this

subject for consultation. In their present form the plans require that doctors, nurses, and other health-service personnel should be designated for specific roles in the management of health services before, during, and after nuclear war. These people would help to plan and operate the response to the unthinkable, since the present NHS, according to a piquant phrase in the DHSS circular, "would need adaptation". Contingency planning is a fundamental part of general management responsibilities and key personnel should be clearly identified in advance, the DHSS declares. But some doctors believe that to join in these civil defence preparations is irresponsible, because the preparations help only to maintain a delusion that a nuclear attack of any size greater than a couple of "demonstration" missiles on Britain is "survivable" in any worthwhile sense. It would be more useful, some doctors believe, to underline the full extent of the horror and destruction which nuclear war would bring. The Government clearly thinks otherwise, and it proposes contingency plans in which the essential elements could be implemented in 48 hours, and the rest within 7 days. Such might be the maximum period available between drastic deterioration of international relations and a nuclear attack. Many lives could be saved which would otherwise be lost, and much suffering avoided, the DHSS asserts, if plans were made for the NHS to cope along the following lines. As international tension grew, the Secretary of State would give orders, under his emergency powers, for the discharge from hospitals of all patients whose retention there was not medically or socially essential. Outpatient clinics would be closed. The selection of patients for discharge should take account of the facilities available to care for them in the community. Accident and emergency services would continue to operate. Medical supplies and equipment would

be rapidly dispersed by health authorities, since concentrated stocks are vulnerable to attack. Peacetime planning should include efforts by health authorities to stockpile drugs, dressings, and anaesthetic agents, against the eventuality of war. Most ambulances and their staff should also be dispersed. As soon as patients had been sent home, the DHSS adds, all medical staff not required to operate an emergency service should be sent home themselves, or dispersed within the region. Stocks of blood collecting and giving equipment, grouping reagents, and plasma volume expanders should also be dispersed. Provision should be made for an emergency independent refrigeration service. Designated medical and local government personnel would by this stage have taken over their emergency duties. The period of tension might well end with a conventional attack on Britain, which would probably cause localised, if heavy, casualties, the DHSS continues. Then the nuclear attack would come. It might be the delivery of one or two demonstration nuclear warheads, which need not disrupt the NHS too widely. But it might equally well come in the shape of an attack aimed at completely destroying the civil and military functioning of the country. In these circumstances, the DHSS concedes, "almost inevitably there would be casualties on a scale which would overwhelm surviving hospital resources, though over how great an area would depend on the scale of the attack". Then, emergency medical centres would have to concentrate on triage, supportive care, and basic medical treatment. They might have to accept severe limitations in the availability of anaesthetics. Fluid replacement therapy would be required by many patients and would be a "constant problem". Strict priorities would have . to govern the admission of patients to such hospital facilities as were available. There was no specific treatment for radiation sickness, and these patients should be cared for in the community, where spontaneous recovery might be assisted by hydration and careful nursing. Treatment of burns and blast injuries, also, might have to be selective, depending on the stores available and the prospects for recovery of individual patients under the prevailing conditions. There is plenty of impressive understatement in the DHSS’s suggestions. Mass casualties and widespread destruction would inevitably "present serious problems". Destruction of water and electricity supplies, fuel, and sewerage could seriously affect the ability of hospitals and health services to function and planners should take these factors into consideration. Communications networks could become overloaded or, later, disrupted. Epidemics would be an ever-present risk. Health regions would be liable to "requests" for sharing of their resources. Fallout would impose severe restraints on movement. The basic contention of the DHSS, however, is that whatever the damage inflicted by an attack, "the responsibility to do as much as human and other resources permit would nevertheless remain." Furthermore, if plans had been adequately laid, it would be reasonable to expect that in any area peripheral to the target where there were survivors, there would be some kind of health care, even if limited. Afterwards, it is suggested, at least a primitive network of health care could be built up around the shattered remains of the NHS.

Funding of Research The Education Secretary, Sir Keith Joseph, admitted in a Commons debate on Government funding of scientific Government

research that he is

now

very concerned about reports that

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increasing

numbers of Britain’s cleverest scientists

are

leaving the country to work overseas. The Advisory Board for the Research Councils has been asked by him to collect information about this drain; but, apart from that, Sir Keith had little of substance to say in the debate which might alleviate worries about the future of research in Britain. He made it clear the Government had no plans to fund research

generously. Labour’s spokesman,

more

Dr Jeremy Bray, pointed out that in 1948 the best electron microscope could be bought for £3000—the price of a Rolls Royce car. Now the best cost £250 000, the price of ten Rolls Royces. These instruments were the necessary tools of research. Without them it was not possible to work at the frontiers of science. Britain’s failure to fund its research adequately had important economic

REGINALD LIGHTWOOD

Lond, FRCP, DPH

Dr Lightwood was one of the group of paediatricians whose efforts advanced British paediatrics greatly in the two decades

following the

1939-45

war.

He died

on

American drug company. In Britsh laboratories there were six high-voltage electron microscopes, bought in 1971. In Japanese laboratories there were 40 microscopes of more recent

vintage.

Labour’s health spokesman, Mr Frank Dobson, pointed out that in 1981-82 the MRC could give approval to all the top-grade applications it got for long-term research funding. But in 1983-84 the MRC had to deny long-term funding to 22 applications recognised as meritorious, and it refused short-term funding to another 199 applications.

RODNEY DEITCH

Cambridge. The

Obituary MD

implications. The former head of the MRC neurochemical pharmacology unit at Cambridge, Dr Leslie Iversen, was now working in a £25 million laboratory set up for him by an

May 26, aged 87.

After leaving Monckton Coombe School, Bath, he joined the Royal Artillery in 1917, only to be invalided home after being gassed in the third Battle of Ypres. Fortunately no permanent lung damage resulted, and while a medical student at King’s College Hospital,

London, he won the half mile in the Amateur Athletic Association

championships on three consecutive occasions. He also defeated the great Paarvo Nurmi in a 5000 m race in Paris, but with his habitual modesty he always insisted that Nurmi had run that race against the stop watch rather than against the other competitors. Reginald Lightwood was a keen rider, and he continued to enjoy ski-ing well into his seventies. He qualified in 1921, and after a year as a ship’s doctor and three

general practice he turned to paediatrics. An appointment honorary assistant paediatrician to the Westminster Hospital in 1933 brought him into contact with Donald Paterson, and when Paterson returned to his native Canada, he took over the authorship of one of the best-known textbooks of paediatrics of this century,

years in as

Paterson’s Sick Children. He was later to edit with Wilfrid Gaisford the three-volume encyclopedia, Paediatrics for the Practitioner, published in 1953. He was elected honorary consultant to the Hospital for Sick Children, Great Ormond Street, in 1935, and in 1939 he was chosen as the first honorary consultant paediatrician to St Mary’s Hospital, London. During the 1939-45 war he worked untiringly for many of London’s children who were referred to the Emergency Medical Service hospitals scattered around the outskirts of the city. After the war he set about the task of creating the academic unit of paediatrics at St Mary’s. His views were not parochial the establishment of the exchange registrarship in paediatrics between St Mary’s and the Boston Children’s Hospital, USA, was a notable forerunner of many similar arrangements subsequently made elsewhere. In the early days of the National Health Service he recognised the need to train enough paediatricians to staff all the major medical centres in the country. The clarity of his arguments, his enthusiasm, vigour, and persistence were major contributions to the success of that programme. As a teacher he was neither a great orator nor a dogmatic teacher, but he brought out the best in his juniors. Once an initiative had passed his critical testing he would use all his powers to bring the project to fruition. The St Mary’s home-care scheme for sick children who would otherwise have been admitted to hospital is one such project. The fertility of the training ground that he established is shown by the subsequent appointment of two of his juniors as the first professors of paediatrics at the Universities of Oxford and

success of his own research into hyperchloraemic renal acidosis and idiopathic hypercalcaemia with Dr Wilfrid Paine was the result of his skill as a clinician. He was not greatly interested in private practice, and much of his time and energy was taken up in promoting international contacts in paediatrics between the UK and the rest of the world. He was a devoted supporter of the International Children’s Centre in Paris. At home he worked with equal devotion for the enhancement of the rapidly growing British Paediatric Association, acting first as honorary treasurer (1947-58) and then as president (1959-60). When in 1963, at the age of 65, he retired from Great Ormond Street and St Mary’s, many who did not know him might have thought that he had done enough. For him it was almost a new beginning. He became professor of paediatrics at the American University of Beirut (1964-65), professor of paediatrics and child health at the University College of Rhodesia (1966-69), visiting professor of the University of California, Los Angeles (1969), and consultant paediatrician to the International Grenfell Association, Newfoundland (1970-71). He was a valued consultant to the World Health Organisation, for whom he carried out many assignments all over the world. He was invited by a number of foreign governments, such as Egypt and Jordan, to act as consultant paediatric adviser. He was a loyal friend and an entertaining host of considerable wit and humour. He is survived by his wife and two sons, one of whom is now a consultant surgeon. F. S. W. B.

LAWRENCE JOHN CLAPHAM CBE, MD Lond, DPH, DTM&H

Dr Clapham, formerly director of medical services, Sabah, died on Feb 10 at his home near Lymington, Hampshire. He was 73. born in Cambridgeshire, the son of a doctor and the fifth generation of his family to practise medicine. He was educated at Wellington College and St Mary’s Hospital, London, qualifying in 1935. After a variety of posts at St Mary’s, he took the Liverpool DTM&H, joined the Malayan Medical Service, and was posted to Malaya and Singapore m 1940. In 1941 he was seconded to Sarawak, but after only six months there he was taken prisoner by the Japanese and remained in their hands until 1945, when he was repatriated. After the war he returned to Sarawak with Rajah Vyner Brooke and reorganised the devastated medical services in the capital. In 1949 he was transferred to Brunei where, among other duties as state medical officer, he was physician to the Royal household, forming a friendship with the Sultan, who conferred on him the title of Dato. In 1952, while on leave in England, he took his MD and DPH. He returned to Sarawak as deputy director of medical services. In 1953 he was appointed director of medical services, Sabah, North Borneo. His courteous and considerate approach won him the respect and affection of all those, of whatever nationality, with whom he came into contact. His outstanding work in the control of malaria and He

was