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can be forged the most important link in the chain-general medical cooperation-so that the National EyeBank Service will be made to work throughout the entirecountry.

If an ophthalmic surgeon wants eyes all he ought tohave to do is to pick up the telephone; the regional bankwill send him at once two eyes which are sterile and notmore than three days old-entirely suitable for a penetra-tion corneal graft. The general practitioner can make thispossible by knowing the name of his nearest regional eyebank and by bearing in mind the problem of donor-eyeshortages on his daily rounds.London. W.l. BENJAMIN RYCROFT.BENJAMIN RYCROFT.

VACUUM EXTRACTION IN OBSTETRICS

J. A. CHALMERS.Ronkswood Hospital,

Worcester.

SIR,-I read with much interest your annotation ofFeb. 3, but I feel it may give a somewhat untrue view ofthe foetal risk of the procedure.Huntingford’s series is a small one and represents a selected

group in which vacuum extraction was used in extremelyunfavourable circumstances. Even here, 7 children were bornin good condition. In those who died, a number of factorsmust have contributed to the unhappy result, including a

probable extreme postmaturity in case 10 and prolonged labourin case 1. The results of the Singapore series are so verydifferent from those of other authors that there may be somenutritional or other factor operating, and the obstetric detailsof this series will be awaited with much interest.In recent surveys the overall foetal mortality in deliveries by

the vacuum extractor, compared with similar series deliveredby forceps, has shown a considerable variation in favour of theextractor. Bergman and Malmstrom,l in 1389 cases from 29Swedish hospitals, found a perinatal mortality of 1-5% forvacuum extraction and 4-1% for forceps. Holtorff 2 had acorrected mortality-rate of 6-3% for forceps extraction, com-pared with 0-8% for vacuum extraction. Zilliacus and Sjostedt 3

gave a figure of 8-6% for forceps and 3-5% for vacuumextraction.Our experience in Worcester now amounts to 297 vacuum

extractions, of which one-sixth have been undertaken with thecervix incompletely dilated. There has been no perinatalmortality whatever in our last 250 cases, and in the total seriesthere have been 6 deaths. 2 of these children died in uterobefore delivery was attempted, 1 was a second twin weighing1 lb. 3 oz., and another was stillborn after forceps delivery whenan attempt at vacuum extraction had been abandoned. 1

child showing severe intrauterine distress died after birthwithout evidence of intracranial damage, and only 1 child inour entire series died of intracranial hxmorrhage after vacuumextraction. This child weighed only 4 lb. 8 oz., and in suchcases intracranial haemorrhage is not uncommon even afterspontaneous delivery.

I feel that it would be a pity if the development of thismethod, which we have come to regard as a very realadvance, were to be hindered by overapprehension aboutdangers to the foetus. As with any other obstetric operationstrict indications should be observed, and it is importantthat the technique should be exact. We believe that

attempts at delivery should rarely be prolonged beyondforty minutes, and exact orientation of the position of thepresenting part and precise application of the cup isalmost as important as in forceps delivery. With theselimitations we believe the instrument to be safer for bothmother and child than the forceps, and we hope that itsuse in this country will continue to increase.

1. Bergman, P., Malmstrom, T. Nord. med. 1961, 65, 544.2. Holtorff, J. Zbl. Gynäk. 1961, 83, 261.3. Zilliacus, H., Sjostedt, J. E. Proceedings of the 3rd World Congress of

Obstetrics and Gynaecology, Vienna, 1961; vol. I, p. 84.

MENTALLY HANDICAPPED CHILDREN:

THE PARENTS’ VIEW

Miss D. MCCLELLAN, press officer of the NationalAssociation for Mental Health, writes:

" Mr. Fortune (Jan. 20) makes many cogent points. It wasin the hope of helping parents in this tragic situation that theNational Association for Mental Health published ’A Letter tothe Parents of a Mongol Baby’ by a consultant paediatrician.This is available from the Association at 39, Queen AnneStreet, London, W.1, price ls. 6d. post free."

CANCER CHEMOTHERAPY BY INTRA-ARTERIAL

INFUSION

Mr. H. J. ESPINER writes:" In our paper of Jan. 27 (p. 177) we referred to cyclo-

phosphamide only as Cytoxan ’, the name currently used inAmerica. In order to avoid further confusion, it should bestated that the approved name of the drug is cyclophosphamideand that it is marketed in this country as ’ Endoxana ’ by Ward,Blenkinsop & Co. Ltd."

Parliament

Purchase Tax on FireworksBy the Purchase Tax (No. 4) Order 1961, which was approved

in the House of Commons on Feb. 12, fireworks were added tothe list of goods carrying a purchase tax of 25 % of the wholesalevalue.

QUESTION TIME

Shortage of NursesSir RICHARD PILKINGTON asked the Minister of Health what

was the present shortage of nurses in hospitals; and what planshe had to recruit sufficient nurses to meet the requirements ofhis new hospital plan. Mr. ENOCH PowELL replied: No preciseestimate of shortage can be given; but I understand that justunder 20,000 vacancies for hospital nurses of all grades werecurrent at Ministry of Labour offices in England and Wales atDec. 31 last. The hospital plan will not increase the nursingstaff required.Mr. W. A. WILKINS : Will the Minister confirm or deny the

suggestion made very recently to me in a letter that it is

possible for the domestic staff, the unskilled staff if I may putit in that way, in hospitals to earn far more than the professionalnursing staff ? If this is a fact, would it not be one of the majorcauses of the lack of recruitment of professional staff in nursing ?Mr. POWELL : It is not possible to institute a comparison merelyby looking at weekly pay between one grade and another. Thestrength of the whole nursing force is at its highest ever at themoment and the figures for student intake are on the uptrend.

Hospital PlanMr. KENNETH ROBINSON asked the Minister if he would

state the estimated aggregate cost of the capital developmentproposals submitted to him last year by regional boards andboards of governors for inclusion in the hospital plan. Mr.PowELL replied: For 1970-71, about 60% above that of theproposals included in the plan. Mr. ROBINSON: Does not thisindicate that the proposals included in the plan represent a verysubstantial cut in what hospital boards and boards of governorsthought was desirable for a ten-year hospital programme ? Isthis not the reason why many of them are very disappointedwith the outcome? Mr. POWELL: I do not believe that manyof them were disappointed with the outcome. All the evidenceand indications are the reverse. It was clearly right, in askinghospital authorities to put forward a programme, not to seekto limit them unduly in the financial assumptions they shouldmake. It was much better that they should put forward a pro-gramme which might have to be extended over a somewhatlonger period. This is what happened here. But it was the

right way to go about this operation.