Mar 1, 1975 - port as against the Cyriax approach. . . . Dr. J. H. EBBETTS (London, W.1) writes. ... Minor disc lesions and "arthritis" of the spine (by which Mr.
BRITISH MEDICAL JOURNAL
519
1 MARCH 1975
Points from Letters Hair in Down's Syndrome Dr. D. A. SPENCER (Meanwood Park Hospital, Leeds) writes: With reference to the paper by Drs. A. du Vivier and D. D. Munro (25 January, p. 191) ... in a group of 45 women with Down's syndrome, three had a distinctive white lock of hair over the occiput ... which was discovered only by lifting the black or brown superficial head hair. These patients showed no evidence of alopecia.. . Tihis characteristic would appear to be not uncommon but does not receive special mention in the literature on Down's syndrome. Deaths in the Dental Chair Mr. R. W. SLEE (University College Hospital, London W.C.1) writes: ... Your leading article (8 February, p. 293) makes the point that dental practitioners who administer anaesthetics are often inexperienced, particularly in the use of equipment for emergencies which may arise. The remedy for such a situation would therefore seem to be, firstly, an adequate training programme available to those interested and, secondly, a great effort to ensure that surgeries are properly equipped and that ancillary staff also know how to use such equipment. The first requirement could be met if the Faculty of Anaesthetists in consultation with the British Dental Association would set up the necessary training schemes and devise a suitable qualification, perhaps a Diploma in Dental Anaesthesia. Secondly, surgeries could be subject to -a licensing scheme whereby the presence of apparatus for giving oxygen, adequate suction, facilities for intubation, and provision of suitable emergency drugs would be mandatory. Small courses could be quite simply arranged for ancillary staff so that they would be capable of giving useful and intelligent help when needed. .
Shortage of Organs for Transplantation Dr. J. SHACKLETON BAILEY (Moreton-inMarsh, Glos) writes: The British Transplantation Society (1 February, p. 251) has concluded that the Human Tissue Act and, to a less extent the Coroners Act, are the main stumbling blocks in the way of greater availability of organs and that these Acts should now be amended accordingly. In the meantime the society appears to classify those responsible for upholding the laws as they stand into "helpful" sand "unhelpful" in a way that must suggest an element of "bending" in the former. The Coroners Act overrides laws and sentiment for the sole and specific purpose of the duty it lays on coroners to inquire into the cause of death where there is reasonable doubt. The police, the doctors, and the coroners have been generally conscientious about this duty and in operating the law have also felt it a point of honour that bodies should not be
seized from relatives for more hn the mininum amvunt of disturbance and interference required to fulfil tihe specific object of the law under wbich this takes place. However laudible the object in mind, there must still be many who feel it is wrong to
conmend the sort of legal opportunism account in deciding the need for, and involved in a coroner perverting his strictly timing of splenectomy for I.T.'P. in children limited jurisdiction over bodies under the and also in the evaluation of treatment Coroners Act. Why indeed should a coroner Walker, J. H., and Walker, W., Archives of be expected to exceed his powers wthere Disease in Childhood, 1961, 36, 649. pathologists more directly oDncerned dare 2 Watson-Williams, E. J., MacPherson, A. I. S., and Davidson, S., Lancet, 1958, 2, 221. not? ...
Treatment of Low Back Pain in General Practice Dr. C. F. J. CROPPER (Bath) writes: I have always been mystified by the advocates of spinal supports and, with respect, wonder if Mr. M. P. Robinson (25 January, p. 209) has ever tried wearing one. As both prescriber and recipient of treatment for lumbar disc lesions it has been my experience that no support can brace the spine without being drawn so tightly across the abdomen as to become intolerable. For tihis reason, there must be innumerable supports lying discarded in cupboards up and down the country. But my basic point is that, bearing in mind the mechanics of disc lesions, it is hard to see the rationale of the spinal support as against the Cyriax approach. . . .
Screening Procedures for Breast Cancer Mrs. ELIZABETH MEADE (London N.6) writes: [With reference to the letter from Mr. G. Adamson (1 February, p. 279)] . . . most patients would accept the necessity for a "conveyor belt" system, with no pauses for explanations, provided there is some opportunity for questions at the end of it. If, however, at this stage the patient is oonfronted by an unexplained room full of people, and after several examinations muttered discussion takes place among them to the excliusion of the patient, anxieties are almost certain to arise. A previously confident woman can easily leave with more unallayed fears than she had at the beginning.
Cigarette Advertising Mr. M. DAUBE (Executive Director, Action on Smoking and Health (A.S.H.), London S.E.1) writes: Dr. A. T. M. Wilson (8 February, p. 335) rightly argues for a ban on cigarette advertising.... Since its inception as a result of the Royal College of Physicians' report "Smoking and Health Now" in 1971 A.S.H. has campaigned for an overall ban on not only cigarette advertising, but all promotional activities undertaken by the tobacco industry (coupon schemes, sports sponsorship, gift offers, etc.). We have not yet achieved the total ban, but our actions have resulted in a number of cigarette advertisements being withdrawn and further curbs being placed on the tobacco industry. Largely as a result of A.S.H. pressure a new code of advertising practice is shortly to be introduced by the Terminology of Reorganization Advertising Standards Authority which will Dr. M. GOLDMAN (Fazakerly Hospital, take regulation of advertising out of the Liverpool) writes: I have just been invited hands of the tobao industry and out down to meet our new "sector administrator." On on the appeal of cigarette advertisements.... inquiry I gather that this is N.H.S. newtalk for "hospital secretary." Personally I enjoy working in a hospital and do not wish Undated Resignations to appear to be part of what sounds like the Dr. C. E. PmuuN (Chichestier) writes: I old civil defence organization.... suggest that the undated resignations which I am certain the vast majority of general practitioners will be forwarding to the Splenectomy in Idiopathic B.MA. should be retained even if we obtain Thrombocytopenic Purpura a 40% increase in our remuneration in Dr. W. WALKER (Royal Victoria Infirmary, April, wthich I am sure moot of us consider Newcastle upon Tyne) writes: Mr. A. I. S. the minimum acceptable. These resignations Macpherson and Professor John Richmond should not be destroyed until all the con(11 January, p. 64) unfortunately did not tentious items relating to our terms of give a breakdown of the age distribution of service bave been resolved to our satisfiactheir patients with idiopathic tbrombo- tion. I feel that the inceasng work load cytopenic purpura (I.T.P.). This- is im- and the unsatisfactory nature of the fivemin-ute consultation are driving as manY portnt... in children it can be anticipated that in over 70% I.T.P. will run an acute doctors abroad as is the issue of pay. There but spontaneously remitting coursel where sbould be very firm undertkings given by in adults far fewer remit spontaneously.2 It the Department of Health about inc is also in childhoo that serious infectin the number of doctors so that our avrage following splenectomy is most likely to list size could be considerably ceduced over occur. These factors too must be taken into the next few years....
Dr. J. H. EBBETTS (London, W.1) writes. ... Minor disc lesions and "arthritis" of the spine (by which Mr. M. P. Robinson (25 January, p. 209) can mean only osteoarthrosis of apophyseal joints) are not always best treated or even effectively treated by the prescription of corsets. The general practitioner members of the British Association of Manipulative Medicine use manipulative and injection methods with satisfyingly good effect in a number of these cases. We can provide some amelioration of the situation highlighted in Mr. Robinson's letter with the courses on looomotor medicine which are run annually for general practitioners, orthopaedic surgeons, and others.....
