669

(2) Mr. B, who had had a severe but symptomless methyl-thiouraeil neutropenia, showed an exactly similar pig-mentation.....

-

In 8 of the cases (3 non-thyrotoxic, 1 thyrotoxictreated with methyl thiouracil who had shown no toxicsymptoms, and 4 thyrotoxic treated with methyl orpropyl thiouracil who had ,shown toxic reactions) testswere performed as described above but, in addition, wererepeated with sterile distilled water instead of methyl orpropyl thiouracil for all injections. They were read atthe same intervals as before and were all negative.The fact that, in the cases investigated, skin tests

alone were of no value is not surprising. In general,skin reactions are not constant or reliable in alimentaryallergy. With the exception of true eczematous and,occasionally, true urticarial eruptions, it is generallyimpossible to predict by skin tests whether a personwill or will not show hypersensitivity to a given drug.Nor do responses to skin tests indicate the type of clinicalreaction which may develop.2 1

In the 8 above-mentioned cases total and differentialJeucocyte counts were made before each of the fourtests and at the time of each reading thereafter. Onefurther test was performed on these patients-leucocytecounts were made at the same intervals after an

arbitrary fixed time, no injection having been given.The number of cases in this series is far too small for

generalisation, but test no. 1 showed that the totalleucocyte and absolute granulocyte counts fell moreprecipitously in the thyrotoxic patients who hadpreviously shown toxic reactions (leucopenia andneutropenia) than in either the controls or the singlethyrotoxic patient on methyl thiouracil who had notpreviously shown toxic manifestations.Further work is being done to confirm or refute our

original impressions.

We are -indebted to Prof. E. J. Wayne and Dr. H. P.Brody for access to their cases ; and to Mr. H. J. Benziesand his staff, and Dr. D. Hobson, for their help and technicalassistance.

Sheffield.

E. K. BLACKBURNJ. F. GOODWINR. H. CANTER.

COMPULSORY ADMISSION

SIR,-This morning I was compelled to go to therescue of one of the casualty officers of my hospital,who had been ordered to admit a chronic patient to alion-existent bed by an individual, apparently a doctor,stated to be speaking on behalf of the EmergencyBed Service. If this is a foretaste of official policy,I feel its implications should be clearly understood.A few years ago the world was shocked by revelationsof the workings of an institution run on a comparableprinciple. Though I am not concerned to defend theofficial who was in charge of that institution, there wasjustice in his contention that, as he had no controlover admissions and his protests to central bureaucracywere ignored, he was not responsible for the overcrowdingand neglect within his walls. His name was Kramerand his institution was at Belsen. Let us not build thelike for the chronic sick of England.

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X.Y.

* Since July 5, the Emergency Bed Service of theKing’s Fund has continued to assist doctors who askfor its help with the admission of urgent cases to hospitalsin London. The E.B.S. has no power to compel anyhospital to admit a patient. On the other hand, a doctorhas been appointed to represent the Metropolitanregional hospital boards at the E.B.S., so that when novacant bed can be found for an urgent case he maycall on the appropriate hospital to make special arrange-ments for the patient’s admission. It seems to us thatthe boards must retain the right to do this, though inpresent circumstances the right should be very sparinglyexercised. We should be interested to hear more aboutthis " chronic patient."-ED.L.1. Dameshek, W., Colmes, A. J. clin. Invest. 1936, 15, 85. Holten, C.

Amer. J. med. Sci, 1937, 194, 229.2. 1945 Year Book of Dermatology and Syphilology. Chicago ;

p. 27.

REGIONAL SPECIALIST COMMITTEES

SIR,-It is only six months to -the end of next March,and many regions have not yet formed a representativeregional specialist committee which can be certain thatits delegates to the central committee really speak forthe region as a whole.

In the Liverpool region we have two associations, theHospital Staffs Association and the Regional HospitalsMedical Association, that ibetween them cover themajority of the specialists working in the region. Thesetwo bodies have sponsored a suggestion that the LiverpoolRegional Specialists Committee be reconstituted withrepresentatives nominated as follows :

2 by the Liverpool University faculty of medicine.8 by the Hospital Staffs Association for the teaching

hospitals.8 by the Liverpool Regional Hospitals Medical Association

for the regional board hospitals.. 2 by the north-western branch of the Medical Superinten-dents Society.

2 by the registrars, 1 to be from the teaching hospital groupand 1 from the regional hospital group.

1 from the Isle of Man. _

This will give a completely representative committee,and we believe that all sections will feel satisfied. Wehope that any above the rank of house officer who arenot already members of the Regional Hospitals MedicalAssociation, if employed in a regional board hospital,will join us.We are most anxious that the old difference between

voluntary and municipal hospitals should not reappearin a different guise in those now set up, and we welcomethe cooperation that we have received from -the HospitalStaffs Association. - :

The Poplars, LowerLane, Liverpool, 9.

V. COTTON CORNWALLHon. Secretary, Liverpool Regional

Hospitals Medical Association.

THE YOUNG CONSULTANT

SiR,-It is interesting and an occasion for sympathyto read in your leading article of Oct. 16 of the meagreamount paid to general practitioners in the first quarterof the National Health Service. But the plight of thejunior consultant is considerably worse than that ofthe general practitioner. Having spent double the timelearning his job, and a not inconsiderable sum on instru-ments, consulting-room, and a dwelling-place, the youngconsultant finds that private practice has practicallyvanished. Conversely, hospital work has increased anda considerable amount of time and petrol has beenconsumed since July 5 in journeys to cottage hospitalsand on domiciliary visits, to say nothing of telephonecalls, stationery, and the like. The only acknowledg-ment of claims for payment so far received is a referenceto certain domiciliary visits which are apparently notallowed for payment!

Incidentally, a promised interim payment of the staffof my hospital is still owed from July, 1947. It wouldbe interesting to see what would be the result if sectionsof the so-called working class were kept waiting forfifteen months for their wages.

JUNIOR PROVINCIAL CONSULTANT.

MEDICAL RECORDS

SIR,-As a medical student, and later as a juniorresident, one had the impression that potential abilitywas largely assessed by the accuracy and completenessof one’s case-notes. Slovenly notes implied a sloverilystudent or house-physician, and such records used to betorn to shreds verbally and actually before an: awe-struck assembly of clerks or dressers. This attitude .ofthe chief was surely correct. Complete records can onlyproceed from a complete anamnesis and examination-the twin foundations of medical craftsmanship.

It would perhaps be too harsh a generalisation totranslate this thesis into broader terms and state thatthe work of a hospital may be appraised by its clinicalrecords, yet it is quite certain that no hospital can fulfilits purposes to best effect when encumbered by archaicmethods of record-keeping. The truth of thisis apparentto anyone who has experienced the contrast of work inhospitals well served and badly served in-this respect.