Parliament

1158 of the central nervous system, but it is worth recalling that thiocyanate has a recognised hypotensive effect," which may be due to the release of cyanide in vivo. Moreover, the detoxification of cyanide to thiocyanate requires a substrate ultimately derived from sulphur-containing aminoacids,18 and therefore cyanide exposure as from smoking in pregnancy may compete with the fcetus for available protein, although a direct depressant effect of thiocyanate or cyanide on foetal metabolism is a possibility also worth investigating. M.R.C. Clinical Genetics Research Unit, Institute of Neurology, The National Hospital, Queen Square, London W.C.1.

regularly held at the Ministry of Health. The proposed review of the specialty by

the Ministry of Health will take probably a further two years, and meanwhile this minority group of the profession will continue to get inadequate reward for eking out the comparatively small sums available to (as opposed to the need of) the hospital services. J. D. W. WHITNEY.

Parliament

JOHN WILSON.

Dr. Victoria Terrell

MEDICAL ADMINISTRATION SiR,-Paragraphs 143-146 of the ninth report of the Review Body on Doctors’ and Dentists’ Remuneration prompt me to raise the problems at present afflicting this specialty and in particular the medical staff at regional hospital boards (R.H.B.s). Appendix xi of the B.M.A. evidence to the Review Body gives in some detail the scope of the duties of a senior administrative medical officer (S.A.M.o.) and his staff. In most R.H.B.s the assistant senior medical officer (A.s.M.o.) accepts most of the responsibilities defined in para. 3 of the memorandum. It is an accepted principle of management that managers must be paid in excess of the staff that they manage in order to compensate them for their responsibilities and to give them the required status to effectively manage. The A.S.M.O. grade (and not the principal assistant senior medical officer as suggested in the B.M.A. memorandum) should have at least the consultant salary scale, because n.s..o.s deal almost exclusively on the medical side at hospital level with consultants. If the A.S.M.O. is to effectively manage the hospital service in his area of a region then he must be given a salary equivalent at least to the senior medical staff whom he has to look after. It would appear that the profession’s representatives did not fully realise that to be an effective medical administrator skills foreign to medicine are demanded as well as medical knowledge and a maturity of judgment. I refer to such skills as the effective planning of future hospital services, hospital activity analysis, and the use of computers. With the ever-increasing demand for hospital services a medical administrator is the only person who can humanely apply economic principles to the many patients in a R.H.B. area. Paragraph 145 of the report states that there is no serious difficulty in recruiting " medical administrators. This is patently untrue; at the R.H.B. to which I was attached until recently the establishment for medical staff was less than half filled. It is clear that R.H.B.S will be unable to attract the topquality staff which they need until salaries are exclusively based on the consultant scale. It should perhaps be added that medical officers are usually being trained, so that a seniorregistrar scale would be the appropriate salary. When they are fully trained they are usually promoted to A.S.M.O., when they should get the consultant scale. The B.M.A. does not effectively represent the interests of this specialty. Medical staff at R.H.B.S seldom meet en masse (other than at the Ministry of Health), especially at junior level. These hard-working members of the profession are afflicted by the classic autocracy of " divide and rule ". The B.M.A. will point out that a s.A.M.o. has recently been appointed as a member of the Central Committee for Hospital Medical Services and that as a consequence the specialty is fully represented. Since the B.M.A. has no special committee to look after this specialty, either on a territorial basis or with representatives at all levels, the difficulty is in briefing its representative. Great difficulty was found, in compiling

IN the adjournment debate on May 15, Sir CYRIL BLACK raised the case of Dr. Victoria Terrell,! a Polish national with Polish medical qualifications, who had held a hospital post for about two years while on the temporary register. She later found that, as a result of marrying a British citizen and taking out British citizenship, she was deemed no longer eligible for temporary registration: she was thus unable to return to her former post even though the hospital concerned was both willing and anxious to re-engage her. Sir CYRIL quoted a letter he had received from Dr. Derek Stevenson, secretary of the British Medical Association, who said: "... I should hope that ways and means could be found to retain the services of doctors who have worked satisfactorily on the Temporary Medical Register for some time. This is a viewpoint which I have already expressed, and willcontinue to express to the General Medical Council and to the Minister of Health." Sir CYRIL thought that the Minister did have certain powers of representation and hoped that he would feel able to confer with the General Medical Council with a view to its being able to deal with exceptional cases. Replying, Mr. JULIAN SNOW, Parliamentary Secretary to the Ministry of Health, took the House briefly through the relevant provisions of the Medical Act, 1956,2 and noted that the G.M.C. had no power to continue Dr. Terrell’s registration once she ceased to be a temporary resident. The Minister of Health and other Ministers are examining the report of the Royal Commission on Medical Education. None the less, he said, some amendments could be made immediately, and the Government proposed to introduce legislation making relatively small changes.

Play-groups

"

xi, in getting views expressed by the junior levels at all R.H.B.s, because the junior staffs of different R.H.B.s. never meet. There is greater opportunity for exchange of views at deputy-s.A.M.o. and S.A.M.O. level, since s.A.M.o. meetings are

appendix

M. in The Pharmacological Basis of Therapeutics (edited L. S. Goodman and A. Gilman); p. 726. New York, 1965. 18. Monekosso, G. L., Wilson, J. Lancet, 1966, i, 1062.

17.

Nickerson,

by

May 15, under the ten-minute rule, Miss JOAN LESTER was given leave to introduce a Bill for the development of play-groups for preschool children. She pointed out that a growing number of under-5s, particularly in the 3-5 ageOn

group, did not attend nursery

schools, and that

many

were

being taught by unqualified people. The educational aspects of play-groups should be brought under the Department of Education and Science, and their standards raised, and local authorities should be made to provide them, if necessary by Government compulsion.

QUESTION

TIME

Rabies In answer to a question, Mr. JOHN MACKIE, a joint parliamentary secretary to the Ministry of Agriculture, Fisheries, and Food, said that the last death of a dog from rabies in quarantine was in October, 1949, and that the last death of a feline animal was of a leopard cub in November, 1965.

Antibiotics in Animal Husbandry question, Mr. CLEDWYN HuGs, the Minister of Agriculture, Fisheries, and Food, said that he would shortly be announcing the membership of a committee to obtain information about the present and prospective uses of antibiotics in animal husbandry and veterinary medicine, with particular reference to the phenomenon of infective drug resistance and to consider the implications for animal husIn

answer to a

1. Lancet, 1967, ii, 408, 1192. 2. See ibid. p. 1200.

1159

bandry and for human and animal health. Its chairman would be Prof. M. M. Swann, principal and vice-chancellor of the University of Edinburgh. Remuneration of General Practitioners The estimated gross annual remuneration of a general practitioner, after implementation of the Review Body’s latest recommendations, will be in the order of E5800. On the basis of the Review Body’s assumptions about practice expenses, the net total will be about E3800. A precisely comparable figure for the first full year of the National Health Service 1949-50 is not available, but the increase is around 120%.

Financing the Health and Welfare Services The following are the figures of the sources of finance for the health and welfare services in England and Wales: 1958-59 958 59

(a) Exchequer (excluding grants to local authorities) .... (b) National Health Service contributions

......

(c) Other (including rates and Exchequer grants to local authorities, payments by persons using the services, &c.).. Total

......

Professional

1966-67 1966 67

1967-:68

(provisional) %

EM

%

Em

%

505

70-3

987

72-7

1106

74-0

92

12-8

147

10-8

141

9-4

121

16-9

224

16-5

247

16-6

1358

718

Qualifications

EM

1494

of Commonwealth

Immigrants Of the 4978 Commonwealth immigrant voucher-holders admitted in 1967 to this country, 2590 were professionally Qualified’

Notes and News THE ROYAL SOCIETY

RIBONUCLEASE, now a familiar word to one or two readers of journals, contains 12 letters-and somewhere

the medical around 2000

atoms.

Yet it is the smallest known enzyme,

atomically speaking: perhaps that was why the molecular biologists were keen to display, at the Royal Society’s annual show of scientific splendour last week, how they had mastered some of this simple fellow’s secrets. They did so with a model that made an arrangement of atoms seem enough for the total explanation of the universe. A curiosity of this enzyme is the way in which its digestive action is concentrated in a tiny part of the molecule. What purpose, its students ask, is served by the rest of the enormous and intricate structure? As for the haemoglobin molecule, which tosses around some of its 10,000 atoms at each rapid drop or gain of oxygen, visitors were left to marvel at the dexterity of Dr. M. F. Perutz and his colleagues in uncovering how its chains move as oxygen passes to and fro. Leprosy, after centuries of resistance, is open to defeat, now that the pictures of human infection may be copied experimentally in thymectomised and irradiated mice. The story related by Dr. R. J. W. Rees and his associates at Mill Hill and Oxford was, for the sum of human welfare, probably the most significant of the evening. Nevertheless, a film about the effects of icing on trawlers that fish in Arctic seas made a bigger impression, for its message was bitter. Experiments in a climatic chamber at Weybridge had made plain what might to fish-laden boats in sub-zero winds. Skippers of Hull trawlers did their best last winter to overcome extreme conditions; yet some lost their ships and many fishermen their lives. The film which the Royal Society put on asked, in effect, why these disasters were allowed to happen.

happen

VALUE FOR MONEY IN THE HOSPITAL SERVICE

Appointments M. G., M.B. St. And., M.R.C.P.E., D.P.M. : consultant psychiatrist, Bristol clinical area. BEAVER, M. W., M.B. Lond., D.P.H.: deputy M.o.H., Nottinghamshire. BERSTOCK, REVA L., M.B. Dubl., D.P.M. : consultant child psychiatrist, Hertfordshire child-guidance service. BUCKLEY, M. ELIZABETH, M.B. N.U.I., D.P.H.: M.O. Torbay. CASH, J. D., M.B., PH.D. Edin., M.R.C.P.E. : deputy director, blood-transfusion service, South-Eastern region, Scotland. CLEMENT, J. A. I. T., M.B. Lond., F.F.A. R.C.S.: consultant anxsthetist, United Bristol Hospitals and South Western R.H.B. DALL, J. L. C., M.D. Glasg., M.R.C.P.G. : consultant geriatrician, Victoria Infirmary sector, Glasgow. EAKINS, D., M.D.Belf., M.C.PATH., D.OBST.: consultant pathologist, Peterborough, Stamford, King’s Lynn, and Wisbech areas. GOTEA-LoWEG, JOHN, M.D. Beirut, L.A.H. Dubl., D.P.M. : consultant psychiatrist, State Hospital, Carstairs. McEvoy, J., M.D. Belf., M.R.C.P. : consultant nephrologist, Belfast and South Belfast hospital groups. McNEIL, NEIL, M.B. Glasg., D.P.H.: M.o.H., Aldershot, Farnborough, Fleet, Hartley Wintney and assistant M.O.H., Hampshire. MITRA, A. M., M.B. Birm., F.R.C.S. : consultant E.N.T. surgeon, Romford

BARKER,

hospital

group.

RUSSELL, J. A.,

M.B. Lond., F.R.C.S.E. : consultant neurosurgeon, Western R.H.B., Scotland. THORPE, G. J., M.D. Lond., M.R.C.P., D.T.M. & H.: consultant in medicine, Isle of Wight. TURNER, J. A., M.B. Lond., F.R.C.S.E. : consultant neurosurgeon, Western R.H.B., Scotland. WALKER, P. J. C., M.B. Birm., D.P.H.: deputy M.o.H., Kensington and

Chelsea.

WILSON,

R. R., M.D. Cantab., M.R.c.p.G., F.C.PATH. : consultant in administracharge of the pathology department, Stobhill General and associated hospitals, Glasgow. Northern Ireland Ministry of Health and Social Services: ANDRESS, JOHN, M.B. Belf., D.P.H.: senior M.O. CAREY, G. C. R., M.D., B.SC. Belf., D.P.H., D.I.H.: senior M.O. HOOD, W. H., M.D. Belf., M.R.C.P.I., D.P.H.: M.O.

tive

GREATER economy in hospital management was the main theme of the speech by Mr. Kenneth Robinson, Minister of Health, to the Conference of Association of Hospital Management Committees at Douglas, Isle of Man, on May 15. He estimated capital expenditure in the current year, during which 17 hospital projects costing more than Elmillion each were starting, at E96-5 million-" almost double the expenditure of five years ago, and five times that of ten years ago ". Following procedures introduced in 1967 for handling projects submitted to his Department, nearly three times as much work was approved that year as in 1966, while the time taken to give such approval had been cut to a half. Hospitals, said Mr. Robinson, could not work " at full efficiency with [bed] occupancies of less than 60% ", and many of the older, smaller ones would have to close-so would some of the psychiatric hospitals, in which in 1966 the ratios of patients to population varied by nearly 100% between the different regions. The new Hospital Supply Branch of his Department, and specification working-groups of hospital officers, were helping to standardise specifications for equipment and buy it more efficiently. Mr. Robinson also analysed the obsolescent structure of the National Health Service, for the review of which there was " at the very least a prima facie case ", but left the exposition of his ideas to the forthcoming green-paper.! HOOKWORM INFESTATION

meeting of the Royal Society of Tropical Medicine on May 16 Mr. T. A. MILLER read a paper on Pathogenesis and Immunity in Hookworm Infection. The AT

a

and Hygiene

association of abdominal worms with anxmia had been known for 3500 years but the mechanism which causes this is controversial. Opinions differ too on the existence of human 1. See

Lancet, 1967,ii, 1047.