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PUNCH WITH CARE
833 case for it has been made out, though war conditions and policy must of necessity exert an influence. It is really extraordinary how equipment has been provided by the Ministry of Health in so short a time. An ordinary hospital gathers its equipment little by little over a period of years and it accumulates unnoticeably. When starting from nothing the demands of a general hospital Yet this equipping are staggering in amount and cost. has been done, and the result is a hospital able to grapple with almost any branch of work. Admittedly it is not perfect, but all the essential things, all those things absolutely necessary for first-class work are there. There is an atmosphere of comradeship and mutual help throughout the senior staff, the residents and nursing staff which makes for smooth working and efficiency. I cannot believethat our problems have been very different from those of other hospitals, and I do not think such a complete organisation could have been got together in so
short a time and under such difficult conditions unless it had had the drive and prestige of a Government department behind it. If Observer would visit this E.M.S. hospital I think he might revise his views of hospitals run by the state. CHARLES PANNETT. MEDICAL BENEVOLENCE
SiR,—A loss in income of 21292 sufficiently explains the reason for this letter. This loss to the Royal Medical Benevolent Fund is largely due to the fact that many of our regular subscribers practising in towns heavily bombed havesuffered serious financial loss, and have had to reduce or cancel their subscriptions. Their number may well increase before the war is over. Everybody knows the beneficent work of the fund in helping members of our profession and their wives, widows and children who are living in straitened circumstances ; and who, in many cases, are quite unable, through age and infirmities, to do anything to help themselves. The committee has done everything possible to cut down overhead charges. Administration is carried out with a reduced staff in less costly offices. Expensive annual reports have been abolished and one way and another we have managed to effect a very considerable saving in our annual expenditure. Unfortunately, however, this is not nearly enough, and if the work is not to be seriously crippled we must get more help. We need donations to meet the present emergency, and especially we need many more annual subscriptions. Poverty is hard to bear under any circumstances, but when accustomed help is curtailed and prices are soaring-as is the case today -the position may well become desperate. Here is a passage from a letter which reached me the other day : " I am sending you a donation as a thank-offering for the fact that circumstances have placed my life in a spot where there is*less danger from enemy action than is the case with my brother practitioners." I appeal to all of your readers who feel that they are in similar fortunate circumstances to come forward at this critical time to help in carrying out our duty to our distressed colleagues. Contributions should be sent to the Royal Medical Benevolent Fund, 1, Balliol House, Manor Fields, Putney, London, S.W.15, and will be
gratefully acknowledged. ARNOLD LAWSON, Chairman of the Committee of Management.
PUNCH WITH CARE
SiR,-The view expressed in your annotation of June 14 that punchdrunkenness is a condition mainly found in second-rate professional fighters of long standing is well supported by observation of a considerable number of boxers seen by Dr. E. Guttmann and myself during the past few years. We are, however, aware that our outlook may have become too pessimistic as the majority of these boxers were severely affected and only came because they were either worried about their health or had been urged to come by anxious relatives or managers. In order to obtain a well-balanced outlook on the problem of punchdrunkenness a controlled investigation should be carried out. A group of say 50 professional and 50 amateur boxers should be selected from recruits to the Services and members of these groups should undergo special individual examination.
Such a comprehensive investigation of a representative amateur boxers cross-section of professional and selected in this way would have several advantages. 1. The policy which should be followed by the various Services as regards boxing could be indicated. 2. Attention would be drawn to any recruits who have even the slightest damage to the central nervous system. 3. The very earliest symptoms of what is later termed punchdrunkenness could be assessed. 4. Definite instructions could be given to all doctors who have the responsibility of examining at regular intervals professional and amateur boxers both in the Forces and in civilian life. London, ’Y.1.
C. E. WINTERSTEIN LAMBERT.
THE SHORTAGE OF DOCTORS Sir,,-The shortage of medical personnel has been sadly overemphasised both by political statement and the press. That there is a shortage cannot be denied but it is only in two classes of the profession. It is unfortunate that these two classes are so important, for their importance has in part caused the overemphasis. The other cause has been the unwillingness of hospitals and the authorities in charge of them to let men whom they have trained to be competent surgeons and physicians go into the Services as regimental medical officers and corresponding ranks, to look after 500 fit men and the requisite number of latrines. It is this feeling of uncertainty about the proper utilisation of medical man power which is worrying the hospitals and the profession generally, and hence the unwillingness, which has created a spurious atmosphere of shortage. It should be made quite clear that there is no shortage of medical or surgical specialists in the country or in the Services, and that the training of many more is still going on. The first class in which there is a true shortage is in the most important branch of the profession-general practitioners. This has resulted, first, from the overriding demands of the Services, and secondly, from the method by which the recruitment of G.P.s was done. The Central Medical War Committee, acting on behalf of the Government, delegated the duty of recommending who should be taken and who left to their local medical No other method of recruiting G.P.s war committees. was at hand, and to institute another would have cost both time and money. It is a pity that local’selections should have contributed to this shortage, though naturally the final decision was not taken locally but by the Committee of Reference of the C.M.W.C., to whom all practitioners have a right of appeal. The system of local recommendation has resulted in the moreactive practitioners in many spheres of medical interest being recommended and finally taken into the Services. So the elderly and the relatively inactivehave been left. It must be remembered that many active practitioners were territorials and many more volunteered, and there was no court of appeal to whom their patients could apply for their retention. All this seems inevitable but is scarcely fair to the public. The cure for this shortage is obvious but costly. The E.M.S. already has a comprehensive regional hospital scheme in operation. If inpatient treatment for cases referred to these hospitals by G.P.s was started it would greatly relieve the burden of the over-worked G.P. If outpatient treatment was also allowed at these hospitals it would serve the double purpose of solving the G.P.’s problem and giving the hospitals more to do between blitzes. The second class in which there is a true shortage is the house-officer, who as the youngest member of the profession is naturally taken by the Services. This shortage too could be alleviated if all the newly qualified men were compelled to work in hospital pending their recruitment. Too much blame should not be attached to those of them who prefer to do locums in general practice, for in the six months before they are called up they can earn .E200-E250 (all found) in this way, whereas as a house-officer they would only get 60 (all found). Much has been written and said lately about the employment of alien doctors to replace our deficiencies, and more and more are being so employed, but, as Professor Greenwood pointed out in his letter of May 31, there are difficulties in their employment. In the main they are not suitable for general practice, even if they
short a time and under such difficult conditions unless it had had the drive and prestige of a Government department behind it. If Observer would visit this E.M.S. hospital I think he might revise his views of hospitals run by the state. CHARLES PANNETT. MEDICAL BENEVOLENCE
SiR,—A loss in income of 21292 sufficiently explains the reason for this letter. This loss to the Royal Medical Benevolent Fund is largely due to the fact that many of our regular subscribers practising in towns heavily bombed havesuffered serious financial loss, and have had to reduce or cancel their subscriptions. Their number may well increase before the war is over. Everybody knows the beneficent work of the fund in helping members of our profession and their wives, widows and children who are living in straitened circumstances ; and who, in many cases, are quite unable, through age and infirmities, to do anything to help themselves. The committee has done everything possible to cut down overhead charges. Administration is carried out with a reduced staff in less costly offices. Expensive annual reports have been abolished and one way and another we have managed to effect a very considerable saving in our annual expenditure. Unfortunately, however, this is not nearly enough, and if the work is not to be seriously crippled we must get more help. We need donations to meet the present emergency, and especially we need many more annual subscriptions. Poverty is hard to bear under any circumstances, but when accustomed help is curtailed and prices are soaring-as is the case today -the position may well become desperate. Here is a passage from a letter which reached me the other day : " I am sending you a donation as a thank-offering for the fact that circumstances have placed my life in a spot where there is*less danger from enemy action than is the case with my brother practitioners." I appeal to all of your readers who feel that they are in similar fortunate circumstances to come forward at this critical time to help in carrying out our duty to our distressed colleagues. Contributions should be sent to the Royal Medical Benevolent Fund, 1, Balliol House, Manor Fields, Putney, London, S.W.15, and will be
gratefully acknowledged. ARNOLD LAWSON, Chairman of the Committee of Management.
PUNCH WITH CARE
SiR,-The view expressed in your annotation of June 14 that punchdrunkenness is a condition mainly found in second-rate professional fighters of long standing is well supported by observation of a considerable number of boxers seen by Dr. E. Guttmann and myself during the past few years. We are, however, aware that our outlook may have become too pessimistic as the majority of these boxers were severely affected and only came because they were either worried about their health or had been urged to come by anxious relatives or managers. In order to obtain a well-balanced outlook on the problem of punchdrunkenness a controlled investigation should be carried out. A group of say 50 professional and 50 amateur boxers should be selected from recruits to the Services and members of these groups should undergo special individual examination.
Such a comprehensive investigation of a representative amateur boxers cross-section of professional and selected in this way would have several advantages. 1. The policy which should be followed by the various Services as regards boxing could be indicated. 2. Attention would be drawn to any recruits who have even the slightest damage to the central nervous system. 3. The very earliest symptoms of what is later termed punchdrunkenness could be assessed. 4. Definite instructions could be given to all doctors who have the responsibility of examining at regular intervals professional and amateur boxers both in the Forces and in civilian life. London, ’Y.1.
C. E. WINTERSTEIN LAMBERT.
THE SHORTAGE OF DOCTORS Sir,,-The shortage of medical personnel has been sadly overemphasised both by political statement and the press. That there is a shortage cannot be denied but it is only in two classes of the profession. It is unfortunate that these two classes are so important, for their importance has in part caused the overemphasis. The other cause has been the unwillingness of hospitals and the authorities in charge of them to let men whom they have trained to be competent surgeons and physicians go into the Services as regimental medical officers and corresponding ranks, to look after 500 fit men and the requisite number of latrines. It is this feeling of uncertainty about the proper utilisation of medical man power which is worrying the hospitals and the profession generally, and hence the unwillingness, which has created a spurious atmosphere of shortage. It should be made quite clear that there is no shortage of medical or surgical specialists in the country or in the Services, and that the training of many more is still going on. The first class in which there is a true shortage is in the most important branch of the profession-general practitioners. This has resulted, first, from the overriding demands of the Services, and secondly, from the method by which the recruitment of G.P.s was done. The Central Medical War Committee, acting on behalf of the Government, delegated the duty of recommending who should be taken and who left to their local medical No other method of recruiting G.P.s war committees. was at hand, and to institute another would have cost both time and money. It is a pity that local’selections should have contributed to this shortage, though naturally the final decision was not taken locally but by the Committee of Reference of the C.M.W.C., to whom all practitioners have a right of appeal. The system of local recommendation has resulted in the moreactive practitioners in many spheres of medical interest being recommended and finally taken into the Services. So the elderly and the relatively inactivehave been left. It must be remembered that many active practitioners were territorials and many more volunteered, and there was no court of appeal to whom their patients could apply for their retention. All this seems inevitable but is scarcely fair to the public. The cure for this shortage is obvious but costly. The E.M.S. already has a comprehensive regional hospital scheme in operation. If inpatient treatment for cases referred to these hospitals by G.P.s was started it would greatly relieve the burden of the over-worked G.P. If outpatient treatment was also allowed at these hospitals it would serve the double purpose of solving the G.P.’s problem and giving the hospitals more to do between blitzes. The second class in which there is a true shortage is the house-officer, who as the youngest member of the profession is naturally taken by the Services. This shortage too could be alleviated if all the newly qualified men were compelled to work in hospital pending their recruitment. Too much blame should not be attached to those of them who prefer to do locums in general practice, for in the six months before they are called up they can earn .E200-E250 (all found) in this way, whereas as a house-officer they would only get 60 (all found). Much has been written and said lately about the employment of alien doctors to replace our deficiencies, and more and more are being so employed, but, as Professor Greenwood pointed out in his letter of May 31, there are difficulties in their employment. In the main they are not suitable for general practice, even if they