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ment of assistant nurses working in partnership andwith the guidance of State-registered nurses seems tobe essential.The future of the nursing service will be strengthened

if the concern of doctors in the training of the State-registered nurse is welcomed and encouraged, and ifthe latter concern themselves more than at presentwith the wider training of the assistant nurse.

Let each one choose the career within his or her abilityor in which can be found satisfaction, recognising theother’s greater knowledge rather than consideringlowering the standards of each.

Queen’s Institute of District Nursing,London, S.W.1. E. J. MERRY.

1. Murray, D. S. Lancet, 1954, i, 1274.

SUCCESSFUL ABSENTEES

Westminster Medical School,London, S.W.1. ANDREW SHEBRINGTON.

SiR,-Your readers have noted with interest theinnovation at St. Andrews University (reported in yourcolumns last week) whereby the final examinations maybe passed in the absence of the candidate. This innovationhas no doubt been designed to benefit those who havealso taken their medical course in absentia.

SYRINGE CARRIER

D. STARK MURRAY.Kingston Hospital,Surrey.

SIR,—Most people with experience of syringe carriersfor dry sterilisation will agree with Dr. McDonald andMr. Pirnie (Jan. 26) that the syringe carrier suggestedby Dr. Lerman (Jan. 12) is unlikely to solve the problemsof the angesthetist. But one cannot allow their dogmaticattack upon multiple syringe carriers to go unchallenged.

In our experience a properly designed multiple syringecontainer is the - only answer to the many problems,organisational, technical and financial, involved in

running a syringe service which will cover all hospitaldepartments, small outlying hospitals, the generalpractitioners, and the laboratory itself. After someyears of using the Kingston type of multiple syringecarrier,l and issuing it to some hundreds of users, we findit has none of the disadvantages alleged by Dr. McDonaldand Mr. Pirnie.

Firstly, it need not " contain a fixed set of syringes whichmay or may not accord with the demands of varying circum-stances." Just because our normal pack contains a varietyof syringes-2, 5, 10, and 20 ml.-it answers most demands.But the normal pack can easily be changed to meet specialneeds. As our anaesthetists do not all have the same viewsas to what is best we have now had a certain number ofboxes made with sides in distinctive colours (red, blue, andgreen) and by altering the clips can issue packs with allone size-and the theatre carries a stock of each. Otherusers have other needs and can have a box specially packedto meet them.

Secondly, in our experience with this type of box, whichwas designed with these points in view, the contents arenot " rendered potentially non-sterile on first opening."Nor can the needles or syringes be contaminated by " air,droplets, or hands." As for the " life " of one boxful ourturnover of 3500 syringes a week ensures that this is not

prolonged, but we do not in any case require all the syringesto be used before a box is returned. It is a very simple opera-tion to replace a few used syringes and sterilise the lot.

Thirdly, in the Kingston box the sign of sterility is thecontinued presence of the cotton-wool plug round the needle.To use the syringe this seal must be removed, and onceremoved it is quite clear that the syringe has been used(or at any rate taken out and exposed to air even if, for anyreason, not used). In practice, after turning these boxesover hundreds of times, after their use by all grades of medicaland nursing staff, after use for all hospital purposes, we arequite certain of their sterility and continuing sterility.The problems of a syringe service which neither

multiple nor single pack will absolutely abolish-theneedle that looks sharp but is not, the plunger that has

stuck, the imperfect fitting of needle to syringes-allremain unless one uses an extravagant number of peopleon the job. Our multiple pack has reduced these to aminimum because it saves time ; and it has reducedcosts because breakages are only about one per cent.of all the syringes issued.

Parliament

The Right Kind of BedMOST old people lead contented lives with their families

or friends but, as Lord AMULREE pointed out in the Houseof Lords on Jan. 22, many of the small group of oldpeople who live alone fall into the unfortunate adminis-trative gap between the National Health Service Actand the National Assistance Act. 40 % of the old peoplewho applied for admission to hospital, he said, belongedto this group, and after their hospital treatment it wasdifficult to find anywhere for them to go. They were notsick ; they were suffering from profound disability, andthough local authorities were providing more accommo-dation for people who were on the borderline betweenbeing really fit and in need of hospital accommodation,there was still not enough. As a result, many peoplewere forced to remain in hospital, occupying beds whichwere urgently needed for the care of the sick, and whichcost £12-15 a week each.Lord Amulree did not for a moment advocate a return

to the old poor law, but one principle in it which hethought was valuable was that people in need of care andattention, whether sick or well, were under the sameauthority. One of the disadvantages of the presentdivision was that old people were often reluctant to gointo a welfare home because for them it still had, howevermistakenly, a flavour of the workhouse. Another wasthat the welfare authorities would not accept peoplewho were not fit. In his view, while accommodation wasso straitened, it should be used for the people who reallyneeded it. In 1954, 65,000 old people were living in thesehomes compared with 47,000 in 1945. Were there somepeople living in these homes unnecessarily ? Couldsome of them, with the help of better domiciliary services,not live on their own, and free the homes for the less fit ?Indeed, if the right people were kept in the beds we had,he doubted if any big increase was needed.We should get away from the terms " acute sick " and

‘ ‘ chronic sick." A more useful division, he suggested,was people who were sick and needed medical care andtreatment, and people who were disabled and neededdifferent care and attention. He also thought it wouldhelp if regional boards and local authorities made jointappointments so that the same doctors looked after oldpeople in hospitals and the local-authority homes, andif the welfare services could be transferred to the healthcommittee of the local authority.Lord COTTESLOE, in his work as chairman of the North

West Metropolitan Regional Hospital Board, had seensomething of the difficulties which arose from shortageof accommodation. He agreed that the wrong peoplewere often in what beds there were. To his mind thegreatest cause for concern was the substantial number ofmental-hospital patients who should never have goneinto a mental hospital at all but should have found aplace in a welfare home. Once these people had beensent to a mental hospital it was difficult to transplantthem to a home. He was anxious that we should becareful that for the future no old people who were merelya little confused should find their way into the mentalhospitals.The EARL OF HOME, the secretary of State for Common-

wealth Relations, replying for the Government, offeredsome support for Lord Amulree’s view. In 1955 some4500 elderly people who no longer needed full hospitaltreatment occupied hospital beds. On the other hand.there were 2000 old people who would be better in

hospital than in the premises in which they were housed.So by transfers, and if additional premises and home-helps were available, some 2500 beds could be used t4L)better purpose for others in more urgent need.

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Reviewing what had been done for old people he saidthat in the past nine years 70 geriatric units had beenstarted, while the number of elderly outpatients hadrisen from 7000 in 1950 to 27,000 in 1955. Localauthorities had opened 900 small residential homes.The home-nursing service made 121/2 million visits ayear to old people. We could thus, he thought, con-scientiously say that we were not neglecting the old.But it would be unrealistic against the background of thenational income to expect that there should be a greatincrease in capital investment. Further help- for theelderly must rest on greater efficiency in organisation,greater coordination of the efforts of hospitals, doctors,and welfare authorities, and greater appreciation by thelocal authorities of the needs of the old. In 1954-56the Ministry of Health’s officers made a survey of theservices for the elderly sick throughout England- andWales. The results had been assessed on a national basisand the Minister proposed to issue memoranda withsuggestions arising from the survey and to send them toall hospitals and local authorities.

QUESTION TIMEDoctors’ Remuneration

Mr. MARcus LIPTON asked the Minister of Health whatnegotiations were pending to increase the salaries of doctors.- Mr. DENNIS VospER replied : The Secretary of State forScotland and I have agreed to meet representatives of theprofession towards the middle of February. For the present,I have no statement to make.Mr. JOHN RANKIN asked the Minister if he was now prepared

to accept the contractual obligation implied in the Spensreport as the basis of all future salary negotiations with themedical profession? Mr. VOSPER : I am advised that no legalcontractual obligation exists. Mr. RANKIN: Does the Ministernot realise that now he has properly decided to meet thedoctors in negotiations over their claim for higher remunera-tion, it will be necessary for him to face up to what are calledthe implications, alleged or otherwise, of the Spens reports ?Would it not be wise of him to take this matter into con-sideration in the negotiations ? Mr. VosipER : I have justsaid in my original reply that no legal contractual obligationexists. That opinion was conveyed to the doctors at anearlier meeting, and when they meet in February they willbe well aware of the position. Mr. RANKIN : Is the Ministernot aware that this is one of the points which has causedevery scalpel in Scotland at least to be drawn during theweek-end and that there will be no satisfactory issue unlessthe matter is dealt with ? The doctors do not accept theexplanation he has given. Mr. VOSPER : I have already saidthat I will meet the doctors, and I shall look forward to thatmeeting; but I shall not be meeting them on the basis thata legal contractual obligation exists.

Cigarette- smokingMr. LIPTON asked the Minister whether he would appoint

a select committee to consider what immediate and practicalsteps can be taken to reduce cigarette-smoking.-Mr. VOSPERreplied: I do not consider that a select committee would bean appropriate body for this purpose.

’

Mr. SOMERVILLE HASTINGS : Short of appointing a RoyalCommission, does not the Minister feel that the evidence issufficiently strong for something definite to be done by hisdepartment ? Ought not young people and children in theschools at any rate to be warned of the dangers of cigarette-smoking ? Mr. VOSPEP. : I do intend to look further intothis matter and to take the advice of those concerned. I donot believe at the moment that a select committee would bethe right vehicle. The Minister of Education has, of course,recently issued further advice to the schools.

Prices of Pharmaceutical Products

Replying to a question Mr. VOSPER said that the currentnegotiations with the pharmaceutical industry concerned theprices of proprietary preparations. Discussions had recentlybeen concluded, and in the light of these the industry hadrevised their proposals, which he was now considering.

Prescription ChargesMr. S. S. AWBERY asked the Minister if he was aware that

many chronic sick, cancer patients, diabetics, those sufferingIrlJrn ulcers, and others with long-standing complaints are not

receiving the treatment they need and which was intendedby the National Health Act, 1948 ; that chemists are reportinga reduction of 50% in the prescriptions since the new chargeswere made on Dec. 1. Mr. VOSPER : I have no evidencefrom professional organisations or elsewhere that patients arenot receiving the treatment they need, or that there has beensuch a reduction in prescriptions dispensed.

Number of Patients and Hospital SalariesMr. C. J. A. DOUGHTY asked the Minister which officials

of mental hospitals were responsible for the discharge of

patients ; on what basis they were remunerated ; and whethertheir remuneration was related in any way to the number ofpatients in the hospital.-Mr. VosPER replied : No officialis authorised to discharge a patient in a mental hospital, butany two members of the hospital management committee.when ordering the discharge of a temporary or certified patient,must do so with the advice in writing of the medical super-intendent. The salary of medical superintendents is generallybased on length of service in their clinical grade and not onthe number of patients. Mr. DouGHTY: It therefore follows,does it not, that if beds in a mental hospital are empty, theofficials responsible for the discharge of patients suffer nofinancial loss ? Mr. VOSPER: Yes, that is true.

Mr. N. N. DODDS asked the Minister on what basis thesalaries of senior nursing officers in mental institutions werefixed.-Mr. VOSPER replied : The salaries of both matronsand chief male nurses in mental and mental-deficiency hos-pitals are determined by the status of the hospital and thenumber of staffed beds for which the officer is responsible.The classification of deputy matrons and deputy chief malenurses for salary purposes is governed by that of their chiefs.

Health of ImmigrantsCaptain H. B. KERBY asked the Minister of Health if he

was aware that Great Britain was the only Commonwealthcountry that any immigrant could enter without producinga certificate of good health ; and what steps he proposedtaking to safeguard Great Britain from imported com-municable diseases. Mr. VosPER replied : The existingPublic Health (Ships) and (Aircraft) Regulations, 1952, givewide powers to port medical officers to deal with any caseor suspected case of communicable disease arriving in thiscountry. In addition, alien immigrants may,be medicallyexamined under the Aliens Order, 1953.

ObituaryJOHN McGRATHM.Sc.,M.D. N.U.I.

THE death, on Jan. 11, of John McGrath, professor ofpathology and bacteriology and dean of the faculty ofmedicine in University College, Dublin, leaves a gap inIrish medical life.Born in co. Waterford in 1901 he was educated at

Clongowes Wood College, graduating B.sc. at UniversityCollege, Dublin, in 1921. The following year he proceededM.sc. and he graduated in medicine in 1925. He spentsome years abroad in postgraduate study in Vienna,Heidelberg, and Mannheim before returning to Dublin.where he was appointed assistant pathologist and bio-chemist at St. Vincent’s Hospital with which he was tobe associated for the next quarter of a century.In 1929 he was appointed lecturer in medical juris-

prudence in University College and also State pathologist,and in 1933 he was called to the Irish Bar. It was inforensic medicine that he became, perhaps, most widelyknown, and there can have been few courthouses in thecountry in which he had not given evidence. He studiedevery case with scrupulous attention to detail, and theIrish courts were fortunate in having at their disposala man of such vast experience whose evidence was alwaysso clearly expressed.He was an exceptionally good lecturer, and for many

years he was external examiner to Dublin University andto the Queen’s University of Belfast. In 1952 he wasappointed to the chair of pathology and bacteriology atUniversity College, Dublin, and last year he was electeddean of the faculty of medicine. Unfortunately, almostimmediately afterwards he became seriously ill.He was a member of the Royal Irish Academy, of the

senate of the National University of Ireland, and of the