879

enced a similar problem can often reassure and calm a parentin crisis. This help is immediately available and non-threaten-ing (and therefore, perhaps, more readily sought than profes-sional help by a distraught parent), and parents can subse-quently be referred with the help of P.A. to the appropriateagency. Parents participating in the scheme say that continu-ing contact with P.A. helps them to understand their problemsand thus to cope with their family situation.

276 Drewry Avenue,Willowdale, Ontario, Canada M2M 1E5. LINDA TU

SURVIVAL AFTER DROWNING

SIR,—The important claim of Dr Wind (Oct. 4, p. 656) con-cerning recovery of cortical function in a child who survivedfor 14 hours after drowning in cold water is not, in our view,supported by convincing evidence. The E.E.G. was "virtuallyisoelectric" at 5 hours after intubation, and the evidence ofreturning cortical function was believed to be the seizures andthe mother’s claim that the infant responded to her.

Seizures can occur without a normally functioning cerebral

cortex, and the return of brainstem functions is well recognisedin patients with neocortical death’ who may survive for longperiods in a vegetative state.2 As Jennett and Plum2 pointedout, reflex responses at spinal or brainstem level can be inter-preted by "a hopeful family" as "purposeful or voluntary".

In contrast to the cases previously reported3 in which rec-tal temperature was 25°C, the degree of hypothermia (35OC)at the time of hypoxia in this case could not have afforded sig-nificant protection for the brain. The available evidence indi-cates that a child’s brain and heart could be deprived ofoxygen for half-an-hour and regain their function only if therehad been considerable hypothermia.Section of Neurological Sciences,The London Hospital,London E1 1BB,and Medical Research Council Laboratories,Carshalton, Surrey.

PAMELA F. PRIOR

J. B. BRIERLEY

1. Brierley, J. B., Adams, J. H., Graham, D. I., Simpson, J. A. Lancet, 1971,ii, 560.

2. Jennett, B., Plum, F. ibid. 1972, i, 734.3. Siebke, H., Breivik, H., Rød, T., Lind, B. ibid. 1975, i, 1275.4. Kvittingen, T. D., Naess, A. Br. med. J. 1963, i, 1315.

Parliament

Abortion

THE Government’s plans for tightening up on abuses of theabortion law were announced in the House of Commons onOct. 21. In her statement Mrs BARBARA CASTLE, Secretary ofState for Social Services, said that the Government acceptedin principle all the recommendations made by the Select Com-mittee which had been considering Mr James White’s Abortion(Amendment) Bill; many of those recommendations had beenput forward originally by the Lane Committee on the Workingof the Abortion Act. Action had already been taken with theobject of requiring private nursing-homes which concentratedon abortion to give an assurance concerning the total fees

charged to patients. Assurances had also been sought from allapproved nursing-homes about financial arrangements withreferral agencies. Only those private nursing-homes with ade-quate facilities would be authorised to carry out terminationsof pregnancy after the 20th week. Nursing-homes had alsobeen asked for information on the number of foreign patientstreated during the 18 months to June 30, 1975, and similar in-formation would be sought from all approved nursing-homesat quarterly intervals in future. A review was being made ofthe arrangements which nursing-homes made for the recep-tion, counselling, and after-care of foreign patients, and

changes would be required where necessary. As recommendedby the Select Committee, the Health Ministers would be issu-ing a list of approved referral bureaux, and would refuse toapprove clinics which accepted patients from unlisted bureaux;application forms had been issued to bureaux and agencies. Adraft paper giving guidance on counselling would be circulatedfor consultation to bodies representing the medical, nursing,and social-work professions.The Select Committee had recommended that in the N.H.S.

terminations after the 20th week of pregnancy should be car-ried out only in hospitals possessing appropriate facilities, in-cluding resuscitation equipment, and this recommendation hadbeen accepted. A circular had been issued to health authoritiesasking for the adoption of the code of practice of the Peel Advi-sory Group on the Use of Fetuses and Fetal Material, and asimilar request would be put to the private nursing-homes.Some of the other recommendations of the Select Committeewould require amendment of the Abortion Regulations of

1968, Mrs Castle went on to say, and the Department of

Health would be considering the whole question of the proced-ure for the certification and notification of abortions. It had

already been decided, however, that the Regulations would beamended to allow the disclosure to the General Medical Coun-

cil, on request, of information taken from the notification tothe chief medical officers of the Health Departments. It hadfurther been accepted that the Regulations would be amendedto ensure that doctors who certified that the conditions of theAbortion Act were met in a particular case should always ex-amine the patient.

Guidance had been issued to health authorities on day-caresystems, and the Department was hoping to authorise day-careservices in some private clinics with a record of high standards.The most important preventive action which the Governmenthad taken was to introduce as part of the N.H.S. a comprehen-sive family-planning service, which started to function fullythis summer. Mrs Castle concluded her statement by explain-ing that under the procedure whereby Mr White’s Bill hadbeen committed to a Select Committee, the Bill and the Com-mittee would lapse at the end of the present Parliamentary ses-sion. The Government felt that Parliament should be given anopportunity to decide whether the Select Committee should bere-established, as the Committee itself had requested, and amotion would be tabled early in the next session.

In answer to a question suggesting that hospitals had beendirected not to employ obstetricians unless they were willing tocarry out abortions, Mrs Castle said that there had been a mis-understanding on this point. Doctors with a conscientious

objection to abortion were not being excluded from working inthe N.H.S.; however, it had to be accepted that the N.H.S. wasunder an obligation to provide an abortion service as laid downby Parliament, and if the service was to continue it was essen-tial to ensure that doctors were available to carry out abor-tions. Of 70 appointments in obstetrics and gynaecology and inanaesthetics made since March 1 this year, there had been only9 where the need for a willingness to carry out abortions hadbeen specified. Mrs RENEE SHORT asked what exactly the

Department had in mind for the women who presented them-selves after 20 weeks for a termination of pregnancy; if the

Secretary of State intended that they should all be dealt within N.H.S. hospitals, then a guarantee should be given now thatfacilities would be made available in every region of thecountry. Mrs Castle agreed that there were areas of the N.H.S.where facilities were not available for abortions as provided forby legislation; this was connected with the question of doctorsand conscientious objections. The Department would do thebest it could in difficult circumstances to provide a uniform ser-vice.