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TONY LOTHROP REEVESM.D. Lond., F.R.C.P.

Dr T. L. Reeves, senior physician to Queen Mary’sHospital, Sidcup, died on Oct. 11 at the age of 58.He was educated at Tonbridge School and Guy’s Hospital,

London, where he graduated M.B. in 1943. He went to QueenMary’s Hospital at the end of the war; he was to spend theremainder of his professional life there, and during that timehe became a respected physician whose opinion was widelysought.

In the 1940s Queen Mary’s consisted of a conglomeration ofhuts built in the 1914-18 war as a military hospital for facialand plastic surgery. Reeves spent much of his life planning thenew hospital that was to replace it, and his influence was im-portant in trying to mould the new district general hospital tothe needs of the locality. His pride in the new hospital, openedin 1974, was tinged with regret at the passing of the old, andwith it the intimacy of the smaller community which he mis-sed.

His career was essentially one of service to his patients butalso to his colleagues. They recognised his qualities of integ-rity, fairness, and an unusual grasp of detail, and selected himto lead a variety of hospital and district committees up untilthe time of his death.

As a physician he was respected by his peers and as a manloved by a wider community. He was basically a placid andcalm person, but his passions could be aroused by any threat,as he saw it, to the integrity of his profession, of which he wasvery proud; its involvement in industrial action caused himmuch concern and distress. Tony Reeves will be sadly missed.

J.D.W.GEORGE GORDON CAMPBELL

M.B. Edin., F.R.C.S.E., Hon. LL.D. Edin., Hon. LL.D. Natal,F.R.S.S.A.

Dr G. G. Campbell, formerly chancellor of Natal Uni-versity and chairman of Natal Technical College, Dur-ban, South Africa, died on May 6 at the age of 83.He was educated at Maritzburg College, Natal University

College (as it then was), and the University of Edinburgh. Hewas mobilised into the Royal Artillery in 1914, and was ser-iously wounded at Gallipoli, but later transferred to the RoyalFlying Corps and served as a pilot in 1916 and 1917 in whatwas "German East" Africa. He returned to Edinburgh at theend of the war and graduated M.B. in 1922, moving back toDurban to join his father’s general practice for a while, andthen again to Edinburgh to become F.R.C.S.E. in 1933. He con-tinued to practise back in Durban until the outbreak of the1939-45 war, during which he served as o.c. S.A. 16th FieldAmbulance in the Western Desert, and was involved in thepreparation of the invasion of Madagascar, and also in secretplans for the invasion of Mozambique, should the Germanshave marched into Portugal.

For over 20 years Dr Campbell was chairman of the NatalTechnical College, and for a great many years chairman of thecouncil of the University of Natal. Between 1967 and 1974 heserved as chancellor of the University of Natal, but he resignedat the peak of his powers, saying that he "wanted to go beforehe became a nuisance".The death of "G. G." Campbell has weakened a long-lasting

link between Durban and Edinburgh. He was the son of anEdinburgh graduate, the brother of the poet Roy Campbell,and the brother and father of Edinburgh graduates. His inter-ests outside his work were wide and keen. At Edinburgh hewas a triple university blue and a Scottish rugby trialist; hewas a fervent wild-life conservationist; and he wrote two best-selling novels. The George Campbell Technical High Schooland the George Campbell biological sciences wing of the Dur-ban campus of the University of Natal, in bearing his name,testify to the importance of his contributions to the City ofDurban, which awarded him civic honours in 1970.He is survived by his wife and two sons, both doctors.

N.McE.L.

Notes and News

MONITORING OF NEW DRUGS

WHILE the Committee on Safety of Medicines deliberates onhow best to improve the detection of adverse effects of newdrugs, the pharmaceutical industry has put forward some pro-posals. Dr A. B. Wilson,’ medical director of the Associationof the British Pharmaceutical Industry, suggests that infor-

mation provided by the yellow-card system of voluntaryreporting of adverse effects be routinely fed to the industry,unless the reporting doctor specifically objects. The industry’sresources, such as laboratory facilities for determining serumlevels of drugs, could then be used in investigating suspecteddrug-related effects.

Another proposal is that the Prescription Pricing Authority(P.P.A.) be used to identify all patients who have been pre-scribed a drug under surveillance. The P.P.A. could eitherabstract the relevant patient identification data from the nor-mal FP 10 prescription forms, which it already collects for theDepartment of Health and Social Security, or make copies ofthe Fp 10s for a central agency controlling the data bank.Thus, if an adverse effect is reported, either by the yellow-cardsystem or in any other way, all patients being treated by thesame drug could be easily identified for follow-up. Otherwise,the central agency could send out at regular intervals question-naires to prescribing doctors asking for follow-up informationon their patients. Dr Wilson suggests that the first aim of datacollection by questionnaire should be to identify only the

potentially serious adverse effects: had the patient died sud-denly since receiving the new drug?, had he been referred toor admitted to hospital and, if so, why?, or had the patient con-sulted a general practitioner because of new symptoms and, ifso, had a new diagnosis been made? As with the informationon yellow cards, the facts collected by the central agency couldbe made available to the firm marketing the drug.The identification of all treated patients from FP 10s had

been suggested previously and shown to be feasible in studiesin Oxford; the P.P.A. returned copies of FP 10s more conscien-tiously than did general practitioners. Suggestions that doctorsmake copies of prescriptions at the time of prescribing havebeen criticised because it was felt that the extra work involved

might lead to a selection of patient-groups not representativeof subsequent users. A system using the P.P.A. to make copiesof prescription forms would be unlikely to result in patient-selection.The use of the P.P.A. has the further advantage that it

would identify patients to whom the drug had not only beenprescribed but also dispensed: no system can, of course, deter-mine whether the drug was actually taken. Dr Wilson’s propo-sals do not require patients to answer questionnaires, an ear-lier suggestion which was criticised for the damage it might doto doctor-patient relationships, and the anxiety it might giveto patients. No mention is made in Dr Wilson’s proposals ofhow long monitoring should continue, a particularly difficultjudgment because of the uncertainty about long-term adverseeffects. Neither do they allow for patients who may be lost tofollow-up when they move away from a district.

BOOSTER FOR CHILD VACCINATION

COMPLACENCY as well as fear generated by publicity aboutthe risk of brain damage from vaccination, particularly forpertussis, had led to an alarming fall in the number of childrenbeing vaccinated, Mr David Ennals, Secretary of State forSocial Services, warned at a seminar on Oct. 10. In the last few

1. Wilson, A. B. Br. med. J. Oct. 15, 1977. p. 1001.

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vears there had been a fall of over 5% in the number ofchildren vaccinated against poliomyelitis, tetanus, and diph-theria, while the number of children protected against whoop-ing cough was now a miserable 39%. What could happen hadbeen shown by the upsurge of polio in the current year, whichhad produced 14 cases in 9 months; and it was feared thatthere might be a big increase in whooping cough this winter.Yet vaccination, Mr Ennals pointed out, had been perhaps thebiggest success story in preventive medicine in the past 40years. Since the start of diphtheria vaccination the number ofcases in Britain had fallen from 50 000 in 1942 to under 10in 1976, and from 3000 deaths to none. Whooping cough wasdown from 90 000 cases and 85 deaths in 1956 to fewer than4000 cases and 4 deaths in 1976. The public assumed thatthese diseases were a thing of the past, and this was a dan-gerous belief. The risk of brain damage from vaccination wasvery small in relation to the risks from the diseases themselves,as the report from the Joint Committee on Vaccination andImmunisation had stated; the exact nature of the risk was nowbeing studied by the National Childhood Encephalopathy Sur-vey. The public campaign by the Association of Parents of Vac-cine-damaged Children had been called off now that the

Department had accepted in principle the need for a schemefor compensation in the rare cases where damage did occur;details of the scheme would be made known once the report ofthe Royal Commission on Civil Liability and Compensationhad been received and considered. In the meantime the

Department would launch a press and television publicity cam-paign in November aimed especially at improving the uptakefor diphtheria, pertussis, and polio vaccination.

MORE PAY BEDS TO GO

PAY-BED revocations amounting to 10% of the present totalin England, Scotland, and Wales (3444) have been recom-mended by the Health Services Board.’ In May 1000 pay bedswere abolished directly under the terms of the Health ServicesAct of 1976, which laid down that further progressive with-drawal of pay-bed authorisations should be made on therecommendations of the independent Health Services Board(chairman, Lord Wigoder). 317 pay beds in England and 4 inWales will be removed before Jan. 1, 1978, and 35 in Scotlandbefore April 1, 1978. In making their recommendations themembers of the Board looked only at those hospitals or groupswhere in 1975 and 1976 the average daily occupancy of bedswas no higher than 50% when measured against the currentnumber of such beds; often the occupancy rate was muchlower than this. They also considered evidence submitted byhealth and other authorities (for example on factors affectingoccupancy rates, such as the use of private beds by N.H.S.patients, and the use of pay beds for private day patients). TheBoard has also proposed the withdrawal of consulting-roomfacilities for private non-resident patients in 101 hospitals inEngland and 8 in Wales; these recommendations relate only toconsulting-rooms at particular hospitals where it had beenestablished beyond doubt that no use whatever had been madeof these facilities either in 1975 or 1976. The Act requires thatfurther recommendations for withdrawal of authorisationsshould be made at 6-monthly intervals, but the members of theBoard have pointed out, in the covering note to theirproposals, that their ability to carry this out will depend on theavailability of ever more detailed information about the prac-tice of private medicine in N.H.S. hospitals and private hospi-tals, and particularly in hospitals where, prima facie, thereappears to be a reasonable demand for the currently author-ised pay beds. The Board members also wished to emphasisethat the total number of revocations proposed was the cumula-tive result of applying stringent and reasonable tests to those

1 Withdrawal of Authorisations for the Use of N.H.S Hospital Accommodationand Services by Private Patients. Cmmd. 6963. H.M. Stationery Office.45p

authorisations which it had been possible to consider at thisstage. There had been no target figure in mind at the begin-ning of the exercise, and the total figure therefore could not beregarded as giving any indication of the rate at which pay-bedor other authorisations would be proposed for revocation infuture. In welcoming the Board’s recommendations, Mr DavidEnnals, Secretary of State for Social Services, has said that thereport confirmed the Government’s belief that in many partsof the country the present number of pay beds was more thanthat necessary to meet the demand for private practice, andthat many pay beds were not being much used.

VALUE FOR MONEY IN THE N.H.S.

OPTIMISM from the Government about the National HealthService is entirely inappropriate, Mr Patrick Jenkin, chiefConservative spokesman on social services, believes. Speakingin Cornwall on Oct. 7 and 8, he drew attention to public con-cern about declining standards, and said that while everyoneacknowledged that money was short, the Government stillseemed bent on policies that made things more and more diffi-cult for ordinary families and that were not directed towardsgetting the best value for money from the N.H.S. The deter-mination to close small hospitals in favour of large districtgeneral hospitals, for example, failed to take account of threeimportant human factors. In the first place, it was far moredifficult to promote good labour relations in a big hospital with800 or 1000 beds, than in a small unit, and the result was mis-understanding, bitterness, and strife, ending in disruption.Secondly, it was difficult for people to feel any sense of per-sonal commitment to a vast hospital building twenty or thirtymiles away; as the local hospitals closed down, so the sense ofcommunity involvement was lost, and with it much that wasvaluable in terms of quality of care to patients. And with thedeterioration or rural bus services and increases in fares, cen-tralising of patients in large towns often meant that visits torelatives in hospital were impossible, especially for the elderlyand for families with young children. The N.H.S. also sufferedintolerably from waste at working level, Mr Jenkin said. Atpresent hospitals which managed to save money one year wererewarded by getting less money the next; group incentives wereneeded to cut down waste. It should be possible to achieve con-siderable savings on the drugs bill, for example, by establishingprescribing norms for each hospital and family practitionercommittee area and by allowing any savings to be shared sothat part of the money could be spent on some badly neededfacility in that hospital or district. This approach would bemuch more positive than some of the blunter instrumentswhich Governments were tempted to use against the drug in-dustry and against the medical and pharmaceutical profes-sions.

WHERE IS MY DOCTOR?

THE doctor must be with his patient when he is wanted, andnot simply at the end of a telephone or represented by someoneelse: that is the first message of a new book’ by Dr L. DeWittWilcox, a practising physician in London, Ontario. But thebook is much more than this. It contains the accumulated wis-dom of years of intense interest in the advancement of medicalscience. Dr Wilcox is a physician who finds time to makeenlightened experiments and observations in the laboratory.His book, designed for the lay public, should be recommendedto anybody thinking of taking up medicine. Dr Wilcox empha-sises that those who are not really interested in people andthose who are not prepared to take an enormous amount oftrouble over their patients should abandon any idea of medi-cine for something in which the spirit of personal service is lessimportant.

1. Where is my Doctor? By L. DEWITT WILCOX, F.R.C.P.(C), F.A.C.P. Toronto:Fitzhenry & Whiteside. 1977 Pp. 246. $12.50.

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Nobel Prize

This year’s Nobel prize for medicine is shared between DrRosalyn Yalow (New York) for her work on the developmentof the radioimmunoassay and Dr Roger Guillemin (San Diego)and Dr Andrew Schally (New Orleans) for their work on thepeptide hormones of the brain.

University of Oxford

A donation of 1 million has been made by Dr and MrsCecil H. Green of Dallas, Texas, to the new graduate medicalsociety. Part of the donation will be used to convert the Rad-cliffe Observatory and associated buildings, which will beknown as Green College.

Royal College of Physicians of London

The Baly medal for physiology has been awarded to DrJohn Vane, research director of the Wellcome Foundation, forhis research work on prostaglandins. Prof. Alastair Dudgeon,professor of microbiology and dean of the Institute of ChildHealth, London, has received the Bisset Hawkins medal for hiscontributions to the welfare of the unborn child as a result ofhis work on german-measles vaccine. The Ambuj Nath Boseprize has been awarded to Dr Derrick Brewerton, consultantphysician to the Westminster Hospital, for his research intorheumatic diseases.

Diary of the Week

OCT. 23 To 29

Monday, 24thRESEARCH DEFENCE SOCIETY

5.30 P.M. (Royal Society, 6 Carlton House Terrace, London SW1Y 5AG.)Prof. Sam Shuster: Science, Safety, Sentiment, and the Skin-aTopical Debate on Biomedical Research. (Stephen Paget lecture.)

Tuesday, 25thINSTITUTE OF DERMATOLOGY, St. John’s Hospital for Diseases of the Skin, Lisle

Street, Leicester Square, London WC2H 7BJ4.30 P.M. Dr R. A. J. Eady: The Melanocyte System and Mechanism of

Melanin Pigmentation.NORTHWICK PARK HOSPITAL, Watford Road, Harrow, Middlesex HA1 3UJ

8 P.M. Dr Richard Hunter: History and Medicine

Wednesday, 26thROYAL COLLEGE OF SURGEONS OF ENGLAND, Lincoln’s Inn Fields, London WC2A

3PN -

5 P.M. Dr A. Batty Shaw: Sir Thomas Browne-the Man and the Physician.(Thomas Vicary lecture.)

INSTITUTE OF NEUROLOGY, National Hospital, Queen Square, London WC1N3BG

6 P.M. Mr Lindsay Symon: Experimental Pathophysiology of Chronic Hemis-phere Infarction.

7 P.M. Dr Maurice Gross: Management of Cerebral Infarction.INSTITUTE OF PSYCHIATRY, de Crespigny Park, Denmark Hill, London SE5

3.30 P.M. Prof. D. P. Goldberg: Psychiatric Illness and the General Practi-tioner.

NORTHWICK PARK HOSPITAL1 P.M. Dr R. S. Elkeles: Current Ideas on the Treatment of Diabetes.

KING’S FUND COLLEGE, 2 Palace Court, London W2 4HS8 P.M. Sir Alan Parks: Representing the Profession.

RADCLIFFE INFIRMARY, Oxford5 P.M. Prof. D. A. Price Evans: Pharmacogenetics.

Thursday, 27thKING’S COLLEGE HOSPITAL MEDICAL SCHOOL, Denmark Hill, London SE5 8RX

4.30 P.M. Dr Carleton B. Chapman (New York): The Professional Ethic andthe Common Law of Malpractice. (Wiltshire lecture.)

ST. MARY’S HOSPITAL MEDICAL SCHOOL, Praed Street, London W2 1NY5 15 P.M. Dr Peter Nathanielsz (California): Influence of the Fetus on the

Onset of Labour. (Aleck Bourne lecture.)

Friday, 28thROYAL COLLEGE OF SURGEONS OF ENGLAND

S P.M. Mr W. G. Cross: Gold and Decorative Art in Dentistry. (MenziesCampbell lecture.)

Imperial Cancer Research Fund

Prof. Walter Bodmer, F.R.S., professor of genetics at the

University of Oxford, has been appointed director of theResearch Laboratories of the Imperial Cancer Research Fund,from July 1, 1979, on the retirement of Dr M. G. P. Stoker,F.R.S.

Modern Neonatal Care

The Institute of Obstetrics and Gynaecology will be holdinga symposium on this subject on Thursday, Dec. 1, at QueenCharlotte’s Hospital; the fee is 15. Application forms anddetails may be had from the Symposium Secretary, Institute ofObstetrics and Gynaecology, Queen Charlotte’s Maternity Hos-pital, Goldhawk Road, London W6 OXG.

Health Care Finance

The Conservative Medical Society will be holding a sympo-sium on this subject at the Pharmaceutical Society, London,on Saturday, Oct. 29. Tickets ([5) may be had from the Con-servative Medical Society at 101 Harley Street, London Wl.

The 3rd International Meeting of Pharmaceutical Physicians will beheld in Brussels on Oct. 4-6,1978. Details may be had from the Secre-tary of the 3rd I.M.P.P., Postbox No. 1796, B-1000, Brussels 1, Bel-gium

Corrections

Mortality among Oral-contraceptive Users.-When we publishedthis article (Oct. 8, p. 727) the Conclusions appeared before the Discus-sion-an unintentional transposition, for which we apologise to DrKay and his colleagues.

Treatment of Diabetes with Guar Gum.-The first line of the paperby Dr David J. A. Jenkins and his colleagues (Oct. 15, p. 779), shouldread, "When seven diabetic patients ......"

11

Appointments

South East Thames Regional Health Authority:

BOSTOCK, J. F., M.B.Lond., M.R.C.O.G. : consultant obstetrician and gynxcolo-gist, Brighton General Hospital, Brighton health district.

DARBY, CARYL, W., M.B.Lond., M.R.C.P. : consultant paedlatrician, Farn-

borough Hospital, Bromley and Lewisham health district.GAMMANPILA, S. W., M.B.Moscow, F.F.A. R.c.s.: consultant anaesthetist, Kent

County Hospital, Maidstone health district. -

GEADAH, M. W., M.B.Cairo, F.F.A..R.C.S., F.F.A..R.C.S.I.: consultant ansthe-tist, Preston Hall Hospital, Maidstone health district.

GOVER, PAMELA, A., M.B.Manc., M.R.C.P., M.R.C.PATH. : consultant haematolo-gist, Eastbourne District General Hospital, Eastbourne health district.

HARRISON, N. W., M.B.Lond., F.R.C.S.: consultant urologist, Hove GeneralHospital, Brighton health district.

HAYES, J. P. L. A., M.B., B.sc.Lond., M.R.C.P., M.R.C.PATH.: consultant haema-tologist, All Saints’ Hospital, Medway health district.

KHALIL, K. I., M.B.Cairo, F.F.A. R.C.S.: consultant anaesthetist, Medway Hospi-tal, Medway health district.

MACKEtTH, J. A. C., M.B.Dubl., M.R.C.PATH., D.P.M.: consultant forensic psy-chiatnst. South East Thames region.

MARSDEN, PHILIP, M.B., B.sc.Lond., M.R.C.P. : consultant in general medicme.Greenwich District Hospital, Greenwich health district.

MAURICE-WILLIAMS, R. S., M.B.Cantab., M.R.C.P., F.R.C.S. : consultant neuro-surgeon, Brook General Hospital, Greenwich health district.

NASH, P. J., M.B.Sheff., F.F.A. R.C.S.: consultant anaesthetist, Eastbourne Dis-trict General Hospital, Eastbourne health district.

SMALL, G. !., M.B.Lond., F.R.C.S.: consultant orthopaedic surgeon, West Hi!!Hospital, Dartford and Gravesham health district.

STAVROU, MARGARET, M.B.Lond., M.R.C.PATH.: consultant tnstopathologiHMJmorbid anatomist, Bromley Hospital, Bromley health district

SYMONDS, R L., M.B.Birm., M.R.C.PSYCH., D.P.M.: consultant in psychologizaimedicine, Oakwood Hospital, Tunbridge Wells and Maidstone healthdistrict.