- Email: [email protected]
In England Now
1122 due to the inadequate feed amounts prescribed on the tins ; and if he would see that the prescribed amounts were altered so as to bring them up to the requirements of the British babies of today.-Mr. MACLEOD replied : I am aware of the recent study on artificial feeding of infants in Aberdeen 1 and, with the Minister of Food and Secretary of State for Scotland, I am considering the results. But it should be realised that the feeding-tables issued with National dried milk are designed only to guide the mother until she can consult a doctor or clinic, as she is expressly advised to do before starting artificial feeding, or if the baby is not thriving.
N.H.S. Specialists reply to a question asking the number of full and part time specialists serving in the National Health Service Mr. MACLEOD gave the following figures ::. In
*
These figures
are
derived from limited returns made by the
employing boards. In
to a question Mr. MACLEOD gave the following consultants in the four Metropolitan regions :
answer
figures for
G.P.s in the N.H.S. Mr. G. R. MITCHISON asked the Minister how many doctors were serving in the National Health Service, respectively, as trainee-assistants, as assistants, and otherwise as general practitioners.-Mr. MACLEOD replied: The most nearly comparable figures available for England and Wales are as follows : _
In A
England Now
Running Commentary by Peripatetic Correspondents
Nov. 12 is Dr. Sun-Yat-Sen’s birthday, and where am now living it is celebrated as one of the public holidays that relieve the round of the Chinese seven-day week. In the afternoon the local doctors gathered in strength at the city hall to play their part in the celebrations. Though there are several uniformed and imposing consultants in the capital, I am the sole unworthy representative of Western Medicine; so, I was placed in solitary state in the front row, while the society’s president sat with the mayor and the president of the People’s Party on one side. The president led the chant which opens most official sessions, and the prayers as he stood before Dr. Sun’s portrait. My Taiwanese " counterpart," who interprets, shops, and drives for me, had slipped into the next chair to tell me that I was expected to give an address on the British health service. I followed the official speakers, and spoke most briefly, interlarding my account of the last six years with what I could remember about Dr. Sun’s adventures in London. After the presentation of scrolls to three doctors with more than 40 years’ service in the community, a forensic expert gave some advice on what to do when threatened with litigation-as common, it seems, in Formosa as in England. Then we all adjourned to the garden of an obstetrician whom I had previously met. I had thought that the " garden-party " on the invitation would be a misnomer for me. There were a few wives. but they were kept firmly out of hearing and only just in sight. It was about 5 P.M. ;so I began with bananas, peanuts, and a little rice wine ;but that was not to be for long. The garden had little grass and few flowers, but a pond with goldfish twisted among the trees and at the back grew a large banyan. There were two batteries of charcoal stoves, for Japanese and Chinese food. I began with Japanese, but someone brought me Chinese too : and then soon began the series of toasts—designed, I always feel, to see how much this foreigner can hold. Then the egrets came, like white arrows against the darkening sky, till the banyan was filled with their whiteness as they argued and jostled for the best positions. People began to move, and I went indoors with our host to listen to one of the doctors playing the Chinese harp and to drink tea. The children slipped away from their mothers and came in through the windows and doors: for all the screens had been removed. When the playing stopped, you could hear the grumbles- of the egrets in the dusk. I
I do not think I ever carried a bucket of coal until married. My Oriental status as the Lord and Master of the household would have lasted much longer than that if my mother-in-law had not come to stay. She had the unshakeable conviction that women who carried coal buckets invariably twisted their innards into some weird knots that inhibited procreation. She brushed aside my professional opinion that it strengthened the pelvic floor ; she had set her mind on being a grandmother. I spat on my lily-white hands and reported for duty below. Many a bag of fine gold has passed between the evasive breadwinner and a regiment of hewers of wood and drawers of water, professional pelvic-twisters, with gnarled bucket-clutching fingers. and an unfailing repertoire of local gossip. Still a gap remained. Fifteen years of Sundays, fourteen hols with pay, six weeks when their legs were bad, and two that went astray. The shades of my mother-in-law bound me to the crackling scrunch of anthracite and the choking dust of slack. As a ruthlessly efficient fuel-overseer she watched me from Valhalla. But fifteen years of bondage have never eased my shame. I have slunk around the cornet in the half-light of dawn or dusk and pretended to the neighbourhood that a well-ordered household lay behind At least until my façade of professional dignity. last Monday. Our obliger failed to come at 8:my wife was horribly bilious and decided to stay in bed. I scraped the nucleus of three scrambled eggs from the russet cortex of a saucepan, fed the kids, and shood
we were
Merit Awards question, Mr. MACLEOD said that 9 people Replying not medically qualified were in receipt of distinction or merit awards in connection with the National Health Service in England and Wales. All held dental qualifications. to
a
Recruitment of
Mental-hospital Staff question, Sir WALTER MONCKTON, Minister of Labour, said that since April this year special efforts had been made to improve recruitment of mental-hospital staff by local campaigns. Statistics were not yet available to show how much these campaigns had achieved, but immediate results did not appear to have been very substantial, and the problem remained serious. He looked for an improvement when the publicity campaigns had had time to produce their effect. Replying
to
a
Hares and Myxomatosis Mr. HEATHCOAT AMORY, Minister of said that no case of myxomatosis had been confirmed in hares in Great Britain, but he understood that the disease had been confirmed in three brown hares in France.
Replying
to
a
question,
Agriculture,
1.
Hytten,
F.
E., MacQueen,
I. A. G.
Lancet, Oct. 23, 1954,
p.
836.
-
.
1123 Just time for my Boy Scout act them off to school. with the coal buckets before I started the day’s round. I spun around the corner in my smooth crepe soles. The flagstones in the yard were wet. The buckets flew
singing past
my
Letters to the Editor INTRINSIC FACTOR
ear.
>
I sat there in the rain, looking down at the shaft of my left radius poking up the skin. Unmasked at last ; a bitter thought.. I could hide the truth no longer. My colleague came and slabbed me up in welcome plaster, the familiar doors swung open at the hospital. " He did it carrying coal buckets ! " echoed the whispers through the dark-room and the stairs up to the ward. A cruel twist of irony put me in the theatre on the end of The soothing dreams of’Pentothal’ the gynae list. glided into the grip of wet plaster and the hum of conversation. " How nice to meet another man who has to carry coals ! " I recognised the heart-cry of an Orthopod. I doodled under the electric cradle all the afternoon, chatting to the rest of the medical staff as they popped their heads around the door. I never knew At 10 o’clock so many of us were slaves of the bucket. that night old George rang up to suggest that we found Anti-Housework League. The virgin a Husbands’ whiteness of my plaster has been raised aloft as a banner for the slaves of the drooping scapulse, a rallying-point for our emancipation. *
*
*
I sat down at the table, waited-and hoped-in My examiner sat back in his chair and, grasping his lapel firmly with one hand, said : I have a headache, Doctor."
expectancy. "
I was nonplussed. This was different do-you-treat-so-and-so approach.
from the " How-
SIR,—A preliminary communication, concerned with the isolation of Castle’s intrinsic factor, has already appeared in this journal last March.1 The biological activity was demonstrated by the radioactive vitamin-B 13 absorption technique (Heinle et al.,2 Callender et al.3). Glass4 has commented that this technique is not sufficient to demonstrate intrinsic factor activity with certainty. We have now carried out clinical trials of the preparation administered orally to patients with pernicious anaemia in relapse, and have obtained clear evidence of clinical activity in a single dose of 40 mg. (one case), and in doses of 4 mg. per day for ten days (two cases). In both these patients there was a satisfactory reticulocytosis, and the rise in’hoemoglobin, erythrocyte-count, and hæmatocrit continued for over twenty-five days. Slight but definite effects were observed with a dosage of 1 mg. per day for ten days (two cases). A single dose of 20 mg. (two cases) also gave clinical responses but these were not nearly so marked as with the single dose of 40 One patient who developed pernicious anaemia mg. after a total gastrectomy showed no response to a daily dosage of 1 mg. When given as a single dose the material was given together with 50 µg. vitamin B12’ and the daily doses were given together with 5 µg. These cases will be reported elsewhere in greater detail. Departments of Medicine and Pathology, King’s College, University of Durham, R. B. THOMPSON and Royal Victoria Infirmary, A. L. LATNER. Newcastle upon Tyne.
"
" " " "
Wel—er, Sir,
how
Thirty years !
"
When does it
long
on, Sir ?
come
In the
morning So far so good.
have you had it ?
and
"
off
wears
"
during
the
HÆMOPHILIA
day."
But I had ten minutes to
fill,
so
I
played for time by asking further questions. " Anything else trouble you, Sir ? "
" Yes, I’m sick
in the
mornings."
mind became blank. Come on, lad, have you drawn no conclusions ? "Well, Sir, the history is too long for a cerebral tumour
Silence.
My
"
"
and-er-meningitis." I looked at him hopefully ; spectacles-a clue.
he
was
playing
with his
"
" Eye strain, Sir ? Could be. Anything else ? At this moment the bell rang. scraping of chairs as candidates "
"
Time up. There was a to go. What else ? What else ? I racked my brain. All this time he looked at me with a rather devilish smile on his face. I took a I couldn’t think of chance and crossed my fingers. anything else. rose
"
" Well, Sir, it could be-er-chronic alcoholism ? I don’t know if my diagnosis was correct, but at any rate I
passed.
*
*
*
Each year I write to the survivors of our penicillin trials for bacterial endocarditis to see how they are getting along. One of the most faithful of my flock is a woman who has moved away from our district. This year she wrote that she was doing well. She was sure I would be pleased to know that a few months ago she gave birth to a baby and that both she and the child Were
flourishing.
Indeed she
was so
satisfied, she said,
that she intended visiting a heart specialist to was strong enough to get married. *
’
.
*
see
*
werheard in the surgery ‘‘ What’s your work ?" "I’m a sheeter-jack."
"What’s " No, no.
a
do ? " sheeter. I was
a
A. L., Merrills, R. A., Raine, L. Lancet, 1954, i, 497. Heinle, R. W., Welch, A. D., Scharf, V., Meacham, G. C., Prusoff, W. H. Trans. Ass. Amer. Phycns. 1952, 65, 214. 3. Callender, S. T. E., Turnbull, A., Wakisaka, G. Brit. med. J. 1954, i, 10. 4. Glass, G. B. J. Lancet, 1954, i, 1082. 1. 2.
sheeter-jack
I’m
if she
SIR,—It has been suggested that patients suffering from haemophilia would find it helpful to carry with them at all times an explanatory card, so as to ensure that any practitioner called upon to treat them in an emergency would be made aware of their clotting defect and would not inadvertently embark on operations or other procedures which might, without preparation, have unfortunate results. In recent years advances have been made in the diagnosis of haemophilia, and refined tests have been introduced to distinguish this disease from other clotting disorders which, although clinically similar, require different treatment. It is therefore, increasingly important that the diagnosis should be conclusively proved before a patient’s clotting defect is ascribed to haemophilia. With these objects in mind, the Medical Research Council havejoined with the Ministry of Health and the Department of Health for Scotland in preparing a card for issue to haemophilic patients. The names of those to whom a card is issued (see next paragraph) will be filed centrally, initially at the offices of the Medical Research Council, and will thus indirectly provide a register which is likely to prove of value not only to the patients but also to research-workers. A number of clinics and laboratories have agreed to act as reference centres for applications to ensure that diagnostic standards are uniform, and hsematologists in charge of these centres are among those forming the Medical Research Council’s Haemophilia Committee. Any practitioner who has under his care a patient with haemophilia, or one of the closely related diseases such as Christmas disease, and who wishes him to have a card, should apply in writing to the nearest reference centre, enclosing full clinical and haematological findings. (A
calling
you Jack."
Latner,
N.H.S. Specialists reply to a question asking the number of full and part time specialists serving in the National Health Service Mr. MACLEOD gave the following figures ::. In
*
These figures
are
derived from limited returns made by the
employing boards. In
to a question Mr. MACLEOD gave the following consultants in the four Metropolitan regions :
answer
figures for
G.P.s in the N.H.S. Mr. G. R. MITCHISON asked the Minister how many doctors were serving in the National Health Service, respectively, as trainee-assistants, as assistants, and otherwise as general practitioners.-Mr. MACLEOD replied: The most nearly comparable figures available for England and Wales are as follows : _
In A
England Now
Running Commentary by Peripatetic Correspondents
Nov. 12 is Dr. Sun-Yat-Sen’s birthday, and where am now living it is celebrated as one of the public holidays that relieve the round of the Chinese seven-day week. In the afternoon the local doctors gathered in strength at the city hall to play their part in the celebrations. Though there are several uniformed and imposing consultants in the capital, I am the sole unworthy representative of Western Medicine; so, I was placed in solitary state in the front row, while the society’s president sat with the mayor and the president of the People’s Party on one side. The president led the chant which opens most official sessions, and the prayers as he stood before Dr. Sun’s portrait. My Taiwanese " counterpart," who interprets, shops, and drives for me, had slipped into the next chair to tell me that I was expected to give an address on the British health service. I followed the official speakers, and spoke most briefly, interlarding my account of the last six years with what I could remember about Dr. Sun’s adventures in London. After the presentation of scrolls to three doctors with more than 40 years’ service in the community, a forensic expert gave some advice on what to do when threatened with litigation-as common, it seems, in Formosa as in England. Then we all adjourned to the garden of an obstetrician whom I had previously met. I had thought that the " garden-party " on the invitation would be a misnomer for me. There were a few wives. but they were kept firmly out of hearing and only just in sight. It was about 5 P.M. ;so I began with bananas, peanuts, and a little rice wine ;but that was not to be for long. The garden had little grass and few flowers, but a pond with goldfish twisted among the trees and at the back grew a large banyan. There were two batteries of charcoal stoves, for Japanese and Chinese food. I began with Japanese, but someone brought me Chinese too : and then soon began the series of toasts—designed, I always feel, to see how much this foreigner can hold. Then the egrets came, like white arrows against the darkening sky, till the banyan was filled with their whiteness as they argued and jostled for the best positions. People began to move, and I went indoors with our host to listen to one of the doctors playing the Chinese harp and to drink tea. The children slipped away from their mothers and came in through the windows and doors: for all the screens had been removed. When the playing stopped, you could hear the grumbles- of the egrets in the dusk. I
I do not think I ever carried a bucket of coal until married. My Oriental status as the Lord and Master of the household would have lasted much longer than that if my mother-in-law had not come to stay. She had the unshakeable conviction that women who carried coal buckets invariably twisted their innards into some weird knots that inhibited procreation. She brushed aside my professional opinion that it strengthened the pelvic floor ; she had set her mind on being a grandmother. I spat on my lily-white hands and reported for duty below. Many a bag of fine gold has passed between the evasive breadwinner and a regiment of hewers of wood and drawers of water, professional pelvic-twisters, with gnarled bucket-clutching fingers. and an unfailing repertoire of local gossip. Still a gap remained. Fifteen years of Sundays, fourteen hols with pay, six weeks when their legs were bad, and two that went astray. The shades of my mother-in-law bound me to the crackling scrunch of anthracite and the choking dust of slack. As a ruthlessly efficient fuel-overseer she watched me from Valhalla. But fifteen years of bondage have never eased my shame. I have slunk around the cornet in the half-light of dawn or dusk and pretended to the neighbourhood that a well-ordered household lay behind At least until my façade of professional dignity. last Monday. Our obliger failed to come at 8:my wife was horribly bilious and decided to stay in bed. I scraped the nucleus of three scrambled eggs from the russet cortex of a saucepan, fed the kids, and shood
we were
Merit Awards question, Mr. MACLEOD said that 9 people Replying not medically qualified were in receipt of distinction or merit awards in connection with the National Health Service in England and Wales. All held dental qualifications. to
a
Recruitment of
Mental-hospital Staff question, Sir WALTER MONCKTON, Minister of Labour, said that since April this year special efforts had been made to improve recruitment of mental-hospital staff by local campaigns. Statistics were not yet available to show how much these campaigns had achieved, but immediate results did not appear to have been very substantial, and the problem remained serious. He looked for an improvement when the publicity campaigns had had time to produce their effect. Replying
to
a
Hares and Myxomatosis Mr. HEATHCOAT AMORY, Minister of said that no case of myxomatosis had been confirmed in hares in Great Britain, but he understood that the disease had been confirmed in three brown hares in France.
Replying
to
a
question,
Agriculture,
1.
Hytten,
F.
E., MacQueen,
I. A. G.
Lancet, Oct. 23, 1954,
p.
836.
-
.
1123 Just time for my Boy Scout act them off to school. with the coal buckets before I started the day’s round. I spun around the corner in my smooth crepe soles. The flagstones in the yard were wet. The buckets flew
singing past
my
Letters to the Editor INTRINSIC FACTOR
ear.
>
I sat there in the rain, looking down at the shaft of my left radius poking up the skin. Unmasked at last ; a bitter thought.. I could hide the truth no longer. My colleague came and slabbed me up in welcome plaster, the familiar doors swung open at the hospital. " He did it carrying coal buckets ! " echoed the whispers through the dark-room and the stairs up to the ward. A cruel twist of irony put me in the theatre on the end of The soothing dreams of’Pentothal’ the gynae list. glided into the grip of wet plaster and the hum of conversation. " How nice to meet another man who has to carry coals ! " I recognised the heart-cry of an Orthopod. I doodled under the electric cradle all the afternoon, chatting to the rest of the medical staff as they popped their heads around the door. I never knew At 10 o’clock so many of us were slaves of the bucket. that night old George rang up to suggest that we found Anti-Housework League. The virgin a Husbands’ whiteness of my plaster has been raised aloft as a banner for the slaves of the drooping scapulse, a rallying-point for our emancipation. *
*
*
I sat down at the table, waited-and hoped-in My examiner sat back in his chair and, grasping his lapel firmly with one hand, said : I have a headache, Doctor."
expectancy. "
I was nonplussed. This was different do-you-treat-so-and-so approach.
from the " How-
SIR,—A preliminary communication, concerned with the isolation of Castle’s intrinsic factor, has already appeared in this journal last March.1 The biological activity was demonstrated by the radioactive vitamin-B 13 absorption technique (Heinle et al.,2 Callender et al.3). Glass4 has commented that this technique is not sufficient to demonstrate intrinsic factor activity with certainty. We have now carried out clinical trials of the preparation administered orally to patients with pernicious anaemia in relapse, and have obtained clear evidence of clinical activity in a single dose of 40 mg. (one case), and in doses of 4 mg. per day for ten days (two cases). In both these patients there was a satisfactory reticulocytosis, and the rise in’hoemoglobin, erythrocyte-count, and hæmatocrit continued for over twenty-five days. Slight but definite effects were observed with a dosage of 1 mg. per day for ten days (two cases). A single dose of 20 mg. (two cases) also gave clinical responses but these were not nearly so marked as with the single dose of 40 One patient who developed pernicious anaemia mg. after a total gastrectomy showed no response to a daily dosage of 1 mg. When given as a single dose the material was given together with 50 µg. vitamin B12’ and the daily doses were given together with 5 µg. These cases will be reported elsewhere in greater detail. Departments of Medicine and Pathology, King’s College, University of Durham, R. B. THOMPSON and Royal Victoria Infirmary, A. L. LATNER. Newcastle upon Tyne.
"
" " " "
Wel—er, Sir,
how
Thirty years !
"
When does it
long
on, Sir ?
come
In the
morning So far so good.
have you had it ?
and
"
off
wears
"
during
the
HÆMOPHILIA
day."
But I had ten minutes to
fill,
so
I
played for time by asking further questions. " Anything else trouble you, Sir ? "
" Yes, I’m sick
in the
mornings."
mind became blank. Come on, lad, have you drawn no conclusions ? "Well, Sir, the history is too long for a cerebral tumour
Silence.
My
"
"
and-er-meningitis." I looked at him hopefully ; spectacles-a clue.
he
was
playing
with his
"
" Eye strain, Sir ? Could be. Anything else ? At this moment the bell rang. scraping of chairs as candidates "
"
Time up. There was a to go. What else ? What else ? I racked my brain. All this time he looked at me with a rather devilish smile on his face. I took a I couldn’t think of chance and crossed my fingers. anything else. rose
"
" Well, Sir, it could be-er-chronic alcoholism ? I don’t know if my diagnosis was correct, but at any rate I
passed.
*
*
*
Each year I write to the survivors of our penicillin trials for bacterial endocarditis to see how they are getting along. One of the most faithful of my flock is a woman who has moved away from our district. This year she wrote that she was doing well. She was sure I would be pleased to know that a few months ago she gave birth to a baby and that both she and the child Were
flourishing.
Indeed she
was so
satisfied, she said,
that she intended visiting a heart specialist to was strong enough to get married. *
’
.
*
see
*
werheard in the surgery ‘‘ What’s your work ?" "I’m a sheeter-jack."
"What’s " No, no.
a
do ? " sheeter. I was
a
A. L., Merrills, R. A., Raine, L. Lancet, 1954, i, 497. Heinle, R. W., Welch, A. D., Scharf, V., Meacham, G. C., Prusoff, W. H. Trans. Ass. Amer. Phycns. 1952, 65, 214. 3. Callender, S. T. E., Turnbull, A., Wakisaka, G. Brit. med. J. 1954, i, 10. 4. Glass, G. B. J. Lancet, 1954, i, 1082. 1. 2.
sheeter-jack
I’m
if she
SIR,—It has been suggested that patients suffering from haemophilia would find it helpful to carry with them at all times an explanatory card, so as to ensure that any practitioner called upon to treat them in an emergency would be made aware of their clotting defect and would not inadvertently embark on operations or other procedures which might, without preparation, have unfortunate results. In recent years advances have been made in the diagnosis of haemophilia, and refined tests have been introduced to distinguish this disease from other clotting disorders which, although clinically similar, require different treatment. It is therefore, increasingly important that the diagnosis should be conclusively proved before a patient’s clotting defect is ascribed to haemophilia. With these objects in mind, the Medical Research Council havejoined with the Ministry of Health and the Department of Health for Scotland in preparing a card for issue to haemophilic patients. The names of those to whom a card is issued (see next paragraph) will be filed centrally, initially at the offices of the Medical Research Council, and will thus indirectly provide a register which is likely to prove of value not only to the patients but also to research-workers. A number of clinics and laboratories have agreed to act as reference centres for applications to ensure that diagnostic standards are uniform, and hsematologists in charge of these centres are among those forming the Medical Research Council’s Haemophilia Committee. Any practitioner who has under his care a patient with haemophilia, or one of the closely related diseases such as Christmas disease, and who wishes him to have a card, should apply in writing to the nearest reference centre, enclosing full clinical and haematological findings. (A
calling
you Jack."
Latner,