- Email: [email protected]
MUSCLE RELAXANTS
336
patient is given nice clean water in his bath, and no management committee, however parsimonious, has urged that the water be not thrown away but kept in service. Is it merely an aesthetic whim to shrink from partial immersion for a few minutes in second- (or third-) hand bath water, but to tolerate total immersion for 24 hours a day in fouled air ? And yet may it not, by some wild stretch of the imagination, be a reason why a blameless citizen may go into hospital for treatment and develop a pyelitis, a pulmonary infection, or a P.u.o. which is resistant to all but the latest pound-a-dose antibiotics ? Does anyone care ? Physicians ? Surgeons ? Pathologists ? Biochemists ? Or is it just nobodv’s concern ? GEORGE DAY. Mundesley, Norfolk. each
MUSCLE RELAXANTS
SIR,-Your leading article last week mentions the mystery " of neostigmine-resistant curarisation. Surely it is time we stopped writing about persistent curarisation in this way ?It is easy to give a fit patient a dose of curare "
and demonstrate with the electromyograph failure of reversal with neostigmine. Is it surprising that patients with poor tissue perfusion, a contracted extracellular volume, and electrolyte deficiency should show an increased sensitivity to this drug ? St. Thomas’s
Hospital, London, S.E.1.
M. D. CHURCHER.
THE ILLS OF GENERAL PRACTICE
SIR,-As one who recently retired after forty years of general practice-first in Cornish country, then in central London, and finally in Midland market towns-may I offer a few suggestions ? 1. Notes.-To replace the present inefficient heartbreaking cover for the patient’s notes, could not a prize be offered for the design of a better holder, which could be taken on one’s rounds ? And rewards for good note-keeping ? 2. Unreasonable patients.-The hierarchy should give us more support against the patient who dishonestly or unreasonably demands certificates or drugs. At present, if we refuse these things, he goes round the town till he finds some struggling newcomer to take him on. If he is unsatisfied, let him appeal to the regional medical officer. 3. Bureaucratic methods.-No clerk of the executive council should sign letters of a disciplinary or " inquiry about complaints " nature. These should be signed by a member of the medical committee as doctor to doctor ". 4. Finance.-Even if the money were enough, the way in which it is distributed is intolerable. And so is the miserable on the total on retirement. Sources of irritation are found out bit by bit during one’s professional life, leading to frustration and the feeling of sharp practice by someone somewhere. 5. Drugs.-Why not financially encourage doctors to be economical ? Prescriptions of expensive tablets could be limited to a dozen at a time, and a refund could be given on those returned as unused or unsuitable. Anyhow any medicine, except in extreme cases or chronic cases, should be limited to four days. Should not a charge be made for bottles, 6d. returnable ? Where is the vested interest in bottles ? Chemists are only too pleased to have them back and reissue them free. The main cause of unhappiness in general practice is, I believe, the atmosphere in which it is conducted. And "
could help to improve this by courtesy between ourselves, good manners to patients, and a little more of the milk of human kindness.
to some extent we
Brockenhurst, Hants.
CHARLES H. CHAVASSE.
Parliament Smallpox Vaccine On Feb. 3, Mr. ANTHONY BARBER, the Minister of Health, made the following statement about the provision of smallpox vaccine : An urgent appeal has been received from the DirectorGeneral of the World Health Organisation for supplies offreezedried smallpox vaccine to meet temporary shortages in India and other countries where eradication campaigns are in progress. Her Majesty’s Government are informing the DirectorGeneral that they will make available free of charge 1 million doses a month for four months-a total of 4 million doses of vaccine in all. This gift will be a substantial help in the worldwide cause of combating the ravages of smallpox.
QUESTION
TIME
Dangerous Drugs Mr. B. T. PARKIN asked the Home Secretary if he would take steps to make illegal the possession of all compounds containing amphetamine and its derivatives including dexamphetamine except when they had been prescribed for the person possessing them; whether he would take steps to impose a control of the wholesale and retail sale of amphetamine and its derivatives similar to that imposed by the Dangerous Drugs Acts on other substances.-Mr. HENRY BROOKE replied: I am gravely concerned about the misuse of amphetamine-like drugs, especially by young people. I have drawn the attention of the pharmaceutical industry to the need to take closer precautions to ensure that such drugs do not get into the hands of those who traffic in or misuse them. I am also in contact with the Pharmaceutical Society about retail trade in these drugs. The Minister of Health has recently suggested to the medical profession steps to make forgery or alteration of prescriptions for drugs of this kind more difficult and to avoid the prescription of drugs which are not needed for therapeutic purposes. If further action proves necessary, I will not hesitate to take it.
Smoking Among Young People Mr. L. A. PAVITT asked the Prime Minister what steps were being taken to coordinate the actions of the Minister for Science, the Minister of Health, and the Postmaster-General in securing an agreed programme of action to prevent young people acquiring the habit of smoking.-Sir ALEC DouGLAS-Hot replied: My three right hon. Friends and the other Ministers concerned already work closely together in this matter. Mr. PAVITT: Is the right hon. Gentleman aware that these Ministers are working with singularly little effect ? Does he recall that the Government declared their policy on this matter on June 27, 1957, and that we have now reached the stage when E32,000is being spent on dissuading people and f.;1O million on advertising to persuade people to smoke ? Will he not give a lead and try to get some real action in response to his own Government’s policy?-Sir ALEC DOUGLAS-HOME: I think that we have taken a lead and action. Local education and local health authorities do a great deal and, for instance, the Minister of Health the other day told the House how 440,000 posters carrying the slogan " Cigarettes cause lung cancer " had been distributed. I do not think that there is any excuse for anyone not to know the connection between cigarette smoking and cancer. Mr. KENNETH ROBINSON: Is the Prime Minister aware that neither the medical profession nor the public will take this campaign seriously until the Government do something about cigarette advertising ? Will he discuss this with his right hon. Friends ?-Sir ALEC DOUGLAS-HOME: I am always willing to discuss this with my right hon. Friends. Numbers of Medical Students The numbers of medical students registered at universities in October for the years 1959-63 were:
patient is given nice clean water in his bath, and no management committee, however parsimonious, has urged that the water be not thrown away but kept in service. Is it merely an aesthetic whim to shrink from partial immersion for a few minutes in second- (or third-) hand bath water, but to tolerate total immersion for 24 hours a day in fouled air ? And yet may it not, by some wild stretch of the imagination, be a reason why a blameless citizen may go into hospital for treatment and develop a pyelitis, a pulmonary infection, or a P.u.o. which is resistant to all but the latest pound-a-dose antibiotics ? Does anyone care ? Physicians ? Surgeons ? Pathologists ? Biochemists ? Or is it just nobodv’s concern ? GEORGE DAY. Mundesley, Norfolk. each
MUSCLE RELAXANTS
SIR,-Your leading article last week mentions the mystery " of neostigmine-resistant curarisation. Surely it is time we stopped writing about persistent curarisation in this way ?It is easy to give a fit patient a dose of curare "
and demonstrate with the electromyograph failure of reversal with neostigmine. Is it surprising that patients with poor tissue perfusion, a contracted extracellular volume, and electrolyte deficiency should show an increased sensitivity to this drug ? St. Thomas’s
Hospital, London, S.E.1.
M. D. CHURCHER.
THE ILLS OF GENERAL PRACTICE
SIR,-As one who recently retired after forty years of general practice-first in Cornish country, then in central London, and finally in Midland market towns-may I offer a few suggestions ? 1. Notes.-To replace the present inefficient heartbreaking cover for the patient’s notes, could not a prize be offered for the design of a better holder, which could be taken on one’s rounds ? And rewards for good note-keeping ? 2. Unreasonable patients.-The hierarchy should give us more support against the patient who dishonestly or unreasonably demands certificates or drugs. At present, if we refuse these things, he goes round the town till he finds some struggling newcomer to take him on. If he is unsatisfied, let him appeal to the regional medical officer. 3. Bureaucratic methods.-No clerk of the executive council should sign letters of a disciplinary or " inquiry about complaints " nature. These should be signed by a member of the medical committee as doctor to doctor ". 4. Finance.-Even if the money were enough, the way in which it is distributed is intolerable. And so is the miserable on the total on retirement. Sources of irritation are found out bit by bit during one’s professional life, leading to frustration and the feeling of sharp practice by someone somewhere. 5. Drugs.-Why not financially encourage doctors to be economical ? Prescriptions of expensive tablets could be limited to a dozen at a time, and a refund could be given on those returned as unused or unsuitable. Anyhow any medicine, except in extreme cases or chronic cases, should be limited to four days. Should not a charge be made for bottles, 6d. returnable ? Where is the vested interest in bottles ? Chemists are only too pleased to have them back and reissue them free. The main cause of unhappiness in general practice is, I believe, the atmosphere in which it is conducted. And "
could help to improve this by courtesy between ourselves, good manners to patients, and a little more of the milk of human kindness.
to some extent we
Brockenhurst, Hants.
CHARLES H. CHAVASSE.
Parliament Smallpox Vaccine On Feb. 3, Mr. ANTHONY BARBER, the Minister of Health, made the following statement about the provision of smallpox vaccine : An urgent appeal has been received from the DirectorGeneral of the World Health Organisation for supplies offreezedried smallpox vaccine to meet temporary shortages in India and other countries where eradication campaigns are in progress. Her Majesty’s Government are informing the DirectorGeneral that they will make available free of charge 1 million doses a month for four months-a total of 4 million doses of vaccine in all. This gift will be a substantial help in the worldwide cause of combating the ravages of smallpox.
QUESTION
TIME
Dangerous Drugs Mr. B. T. PARKIN asked the Home Secretary if he would take steps to make illegal the possession of all compounds containing amphetamine and its derivatives including dexamphetamine except when they had been prescribed for the person possessing them; whether he would take steps to impose a control of the wholesale and retail sale of amphetamine and its derivatives similar to that imposed by the Dangerous Drugs Acts on other substances.-Mr. HENRY BROOKE replied: I am gravely concerned about the misuse of amphetamine-like drugs, especially by young people. I have drawn the attention of the pharmaceutical industry to the need to take closer precautions to ensure that such drugs do not get into the hands of those who traffic in or misuse them. I am also in contact with the Pharmaceutical Society about retail trade in these drugs. The Minister of Health has recently suggested to the medical profession steps to make forgery or alteration of prescriptions for drugs of this kind more difficult and to avoid the prescription of drugs which are not needed for therapeutic purposes. If further action proves necessary, I will not hesitate to take it.
Smoking Among Young People Mr. L. A. PAVITT asked the Prime Minister what steps were being taken to coordinate the actions of the Minister for Science, the Minister of Health, and the Postmaster-General in securing an agreed programme of action to prevent young people acquiring the habit of smoking.-Sir ALEC DouGLAS-Hot replied: My three right hon. Friends and the other Ministers concerned already work closely together in this matter. Mr. PAVITT: Is the right hon. Gentleman aware that these Ministers are working with singularly little effect ? Does he recall that the Government declared their policy on this matter on June 27, 1957, and that we have now reached the stage when E32,000is being spent on dissuading people and f.;1O million on advertising to persuade people to smoke ? Will he not give a lead and try to get some real action in response to his own Government’s policy?-Sir ALEC DOUGLAS-HOME: I think that we have taken a lead and action. Local education and local health authorities do a great deal and, for instance, the Minister of Health the other day told the House how 440,000 posters carrying the slogan " Cigarettes cause lung cancer " had been distributed. I do not think that there is any excuse for anyone not to know the connection between cigarette smoking and cancer. Mr. KENNETH ROBINSON: Is the Prime Minister aware that neither the medical profession nor the public will take this campaign seriously until the Government do something about cigarette advertising ? Will he discuss this with his right hon. Friends ?-Sir ALEC DOUGLAS-HOME: I am always willing to discuss this with my right hon. Friends. Numbers of Medical Students The numbers of medical students registered at universities in October for the years 1959-63 were: