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Government recognises the difficulties which have accu-mulated because of the vigorous development of manyspecialties in inner London: these specialties have

acquired a high proportion of resources at the expenseof other basic services. This balance needs careful re-examination ; and difficult decisions will have to betaken.

By coincidence the Conservative Party is also settingup a study group to examine these issues. Dr GerardVaughan, Opposition spokesman on health, who willchair the group, said the matter was being treated with.great urgency. "We have kept a very open mind on howthis problem should be tackled. It is possible that theteaching hospitals and the major specialist centres

should be taken out of the ordinary consideration of theservice provision in London". The Conservative groupwill also give thought to the medical-school establish-ment, which particularly affects inner London, and iscausing concern. "We are now moving into a surplus",Dr Vaughan observed: "while we need more G.p.s, we donot have the money to pay them and it looks as if we are

producing twice as many doctors as we can use with thepresent arrangements".

Dr Kenneth MacLean, the Guy’s physician, whoretired recently after three years as chairman of the Uni-versity Hospitals Association, believes that the situationis now serious. He has warned that if the cuts in London

go ahead then one of the famous trio, Guy’s, Thomas’s,or King’s, will have to close within the next ten years.One reason for his dismay is the Government’s insis-tence on increasing the student intake of these hospitalsat a time when allocations are being cut; and another isthe lack of any satisfactory procedure for measuring theresources which university hospitals should receive fortheir specialties. Dr MacLean believes it should not beleft to the regions to decide between centres of excellencewithin their areas and other needs: it should be up to theD.H.S.S. A national method of funding regional andsupraregional specialties was required.

Meanwhile, no relief is in sight for the Lambeth A.H.A.in its efforts to meet its immediate difficulties. Ministersare sticking firmly by their policy of reallocatingresources between the regions and, as in this case, withinthem. As for those authorities which overspend (as Lam-beth is threatening to do to protect its famous institu-tions), the Government’s case is that it would be for theregional authority to recover the money through a cor-responding reduction of the area’s cash limit next year.This week Mr Ennals announced that he was consultingthe chairmen of the South East Thames R.H.A. and theLambeth A.H.A. in order to try to resolve the differencesbetween them. He added, however, that once the regionhad allocated its resources its decision must be acceptedby the area, whose services must be adjusted accord-ingly.The Elizabeth Garrett Anderson: Open or Shut?On Tuesday of last week the position appeared quite

clear. A statement from the D.H.S.S. declared unequi-vocally : "The Elizabeth Garrett Anderson Hospital is toclose on July 21, the Secretary of State for Social Ser-vices, Mr David Ennals announced today". But, twodays later, confusion arose as Mr Ennals told a meetingof Labour Nt.P.s that he would reconsider his decision toclose this hospital for women on July 21, so that he

might have a chance to hear the views of M.p.s andtrade-unions. The headlines responded with words like"retreat" and "reprieve". Yet no sooner had these

reports been digested than Mr Ennals was explainingthat there had been no retreat. The only point at issuewas when the hospital would be closed. The Govern-ment’s handling of the closure decision has been unsatis-factory, whatever the merits of the case. Mr Ennals wasless than tactful in not informing local M.P.s of his de-cision before last week’s press conference; and that onlyserved to stoke up an even greater furore inside and out-side the Commons. Staff at the 100-year-old hospital arenow digging in to fight the closure and they are beingbacked by the unions. But the Government is deter-mined to go ahead with the transfer of facilities for thetreatment of women by women to the Whittington Hos-pital. The switch by which Mr Ennals is to reconsiderthe date is subject to the proviso that staff are coopera-tive in considering the offer of the alternative accommo-dation.

Obituary

ROBERT DEBRE

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financial. status. Modern psediatrics meant for him that everychild was unique, with his own abilities and character, andshould be treated as such.

Professor Debre was banished from the University duringthe German occupation, and he made use of this time to pre-pare his plans for the reform and reorganisation of Frenchmedicine in 1944. As father of General de Gaulle’s primeminister, Michel Debre, he chaired the interministerial councilfor the reform of medical studies and could enforce in 1958 the

Reforme hospitalo-universitaire, commonly called the ReformeDebre. The introduction of full-time doctors in hospitals, theunification of the teaching faculty with hospital practice, andthe obligation for staff to be involved in teaching, research,and patient care, may have disturbed many personal interestsand not surprisingly gave rise to violent attacks. I rememberhim during those days, resembling more and more a memberof the Spanish court as painted by El Greco, in his elegantapartment located in the rue de l’Université, where many animportant person paid regular visits. He told me that from nowon the development of French medical achievement would lieupon the shoulders of our generation; time has passed, pas-sions have cooled, and the success of the endeavour cannot anymore be denied.

Another of Professor Debre’s outstanding and rare charac-teristics was his ability to translate intellectual speculationsinto practical action. He will remain as the only statesman whohas been recognised by the world of medicine. The honoursand decorations awarded to him are too numerous to name:

they are a tribute to his worldwide recognition. A particularsatisfaction to him must have been not only that his oldest sonwas an outstanding prime minister, his second son a highlyappreciated painter, and his daughter an able physician, butthat the medical and political tradition of the family is beingwell maintained by succeeding generations. G.M.

Appointments

Trent Regional Health Authority:FRASER-MOODIE, W. A., M.B.Lond., F.R.C.S., F.R.C.S.E., D.C.H. : consultant in

accident and emergency, based at Derbyshire Royal Infirmary.HUTTON, 1. M., M.B., B.sc.Lond., F.R.C.S. : consultant general surgeon, North

Lincolnshire health district, based at County Hospital, Lincoln.LEGGETT, R. J. E., M.B.Lond., M.R.C.P. : consultant physician with an interest

in chest diseases, based at Doncaster Royal Infirmary.MARTIN, J. L., M.B.Lond., F.F.A., R.c.s.: consultant anaesthetist, based at

County Hospital, Lincoln.MAYNE, STEWART, M.B., B.sc.Wales, M.R.C.PATH. : consultant haematologist,

based at Derby City Hospital.PATNAIK, B. K., M.B., B.sc.Utkal, PH.D. Edin., T.D.D. : consultant physician in

geriatric medicine, South Lincolnshire district, based at Grantham andKesteven General Hospital.

SINHA, P. K., M.B.Bihar, B.sc.Patna, M.R.C.P.I.: consultant physician in geriat-ric medicine, North Derbyshire district, based at Walton Hospital,Chesterfield.

WILKINSON, J. M., M.B.Lond., F.R.C.S. : consultant orthopaedic surgeon, NorthLincolnshire health district, based at St. George’s Hospital, Lincoln.

Northern Regional Health Authority:ALLEN, W. M. C., M.B.Manc., D.M.R.D.: consultant radiologist, South West

Durham and Darlington health district, Durham area.ATTARD, RAPHAEL, M.D., B.sc.Malta, F.R.C.S. : consultant general surgeon,

South Tyneside health area.BATES, DAVID, M.B.Cantab., M.R.C.P. : consultant neurologist, East and West

Cumbria health districts and Cumbria area, Newcastle A.H.A. (teaching).BERRY, MAUREEN, M.B.Leeds, F.F.A. R.c.s.I.: consultant anaesthetist, Hartle-

pool health district, Cleveland area.COOK, A. 1. M., M.B.L’pool, F.R.C.S., F.R.C.S.E. : consultant general surgeon,

Durham health district, Durham area.CRAFT, A. W., M.B.N’castle, M.R.C.P. : consultant padiatriclan, North Tyneside

health area.

EDWARDS, M. H., M.B.L’pool, F.R.C.S. : consultant general surgeon, Darlingtonand Northallerton health districts, Durham and North Yorkshire areas.

NIRMAL, J. M., M.B.Kampala, M.R.C.P., D.C.H. : consultant paediatricianHartlepool health district, Cleveland area.

ROBINSON, A. J., M.B.Belf, M.R.C.PSYCH., D.P.M. : consultant in mental illness,St. George’s Hospital, Morpeth, Northumberland health area.

ROZNER, LORNA M., M.B.Durh., M.R.C.PSYCH., D.P.H.: consultant in mental ill-ness, South Tyneside and Sunderland health areas.

SINGH, T. M., M.B.Assam, M.R.C.P., M.R.C.PSYCH., D.P.M. : consultant in mentalillness, East Cumbria health district, Cumbria area.

Notes and News

U.K. RADIATION REGISTRY

THE National Radiological Protection Board’s researchreport for 1977’ contains a summary of progress on theNational Registry for Radiation Workers. Data are comingfrom the U.K. Atomic Energy Authority, British Nuclear FuelsLimited, the Ministry of Defence, and te electricity generatingboards, and also from a potential 1500 non-coal miners whomay inhale dust to which decay products of radon havebecome attached. Restricted initially to current workers theregistry could include 30 000 names, but not all workers havebeen enthusiastic so far, and consent-rates vary from 50% to95%, figures that should improve with more publicity. Thenews that ex-radiation workers are being given low priority inthe registry will not please everyone. The N.R.P.B. thinks thatthere is not much to be gained from this less accessible andmore expensive source of data, but a decision will not be madeuntil a pilot study on 12 000 former Windscale workers is com-plete.

GENETIC MANIPULATION

THE Genetic Manipulation Advisory Group has so faradvised on over a hundred proposed experiments in twenty-seven centres, involving 236 people. Only four of the proposalswere classed as category IV-that is, to be conducted only inconditions appropriate for handling of the most dangerouspathogens. (These experiments are in abeyance, pending com-pletion of category-IV facilities at Porton.) The G.M.A.G.’sfirst report2 is largely a commentary on the proposals of theWilliams working-party, and it offers advice on such mattersas safety committees, containment, transport of materials, andhealth monitoring (ending with the slightly sinister recommen-dation that workers involved in genetic manipulation shouldnot act as blood-donors). Unlike the National Institutes ofHealth scheme in the U.S.A., the G.M.A.G.’s scheme includesindustrial processes. A system has been devised for protectingcommercial secrets. Being British, the G.M.A.G.’s scheme is"flexible"; but it may become less so when notification of

experiments becomes compulsory and D.N.A. recombinationstarts on an industrial scale.

EYE PROTECTION AT WORK

SINCE workers may decline to wear protective equipmentat work because they find it burdensome, management shouldprovide a choice of such equipment. This advice from theChemical Industry Safety and Health Council is contained ina booklet3 which gives guidance to employers on their legalobligations and the precautions they can take to protect the eyesof their employees. Although the risk of wearing contact lenseshas not been studied in detail, the wearing of contact lenses byworkers in the chemical industry is discouraged. Removal ofcontact lenses can be difficult when chemical injury to the eyescauses spasm and swelling of the eyelids and conjunctivx. Ifthe lenses are left in place, the noxious chemical may be heldin close contact with the cornea. Moreover, removal of contactlenses for any reason can alter visual acuity for up to 24 hours,even if spectacles are worn instead. Sudden accidental dis-

placement of the lenses could therefore produce immediate anddangerous loss of corrected vision.

1. N.R.P.B. Annual Research and Development Report 1977. H.M. StationeryOffice. 1978. £4.50.

2. First Report of the Genetic Manipulation Advisory Group. Cmnd. 7215.H.M. Stationery Office, £1.60.

3. Protection of the Eyes. Chemical Industry Safety and Health Council of theChemical Industries Association. 1978. Pp. 17. £2 (£1.50 to C.I.A. mem-bers). Available from C.I.A. Publications, 93 Albert Embankment, Lon-don SE17TU.