international diary

1156

telephone survey. In the UK a prevalence survey is to be conductedin Tower Hamlets (London), and money is being sought for twoothers in Staffordshire. Policy development seems random anduncoordinated--only two district health authorities in Englandhave policies and procedures for identifying and intervening insuspected or confirmed cases of elder abuse.What needs to be done? The report of the exploratory study gives

a long list of ideas for future research. Experience in the USA isinstructive. For instance, means of screening for abuse seem worthdeveloping, but the efforts at using legislative measures to protectadults from abuse have been much criticised.

1. Claudine McCreadie. Elder Abuse: an exploratory study. London: Age ConcernInstitute of Gerontology, King’s College London, London SE1 8TX. 1991. Pp 67.£7 (including postage and packing).

Worries about effects of NHS reforms

Unease about how the NHS S reforms will affect the ability of someteaching hospitals to survive or to offer medical students an

adequate educational programme is expressed in a report! from theMedical Committee of the Universities Funding Council. Hospitalswill be able to survive only if they attract enough contracts tomaintain their current level of work. To do so some teachinghospitals in central and inner city areas will have to contract with 60or 70 health districts, a task described in the report as being ofdaunting complexity. Furthermore, if hospitals are forced to

specialise to be financially viable, they will not have the broad mix ofpatients with common conditions necessary for undergraduateteaching. The committee is worried by the absence of a satisfactorymechanism to evaluate the implications of these issues for all parties,and fears that the problems are too big to be solved locally.

Another issue that the committee believes needs more thanlocal consideration-and deserves high level attention at the

Departments of Health and of Education and Science-is that ifnew buildings are required for academic units as a result of NHSrationalisation, the UFC may not be able to contribute to the costs.The report is based on discussions held in January to March this

year with representatives of universities and health authorities, andit has been sent to the Steering Group on Undergraduate Medicaland Dental Education and Research set up by the Secretaries ofState for Health and for Education and Science. The exercise is

expected to be repeated next year.

1. Universities Funding Council Medical Committee. First Report on the Effects of theNHS Reforms on Medical and Dental Education and Research. 1991. Pp 40.

Batting orders

Do cats eat bats? ... Do bats eat cats?-Lewis Carroll

The answer to this poser in Alice in Wonderland is the former.One result of the general heightening of environmentalconsciousness is that more and more wild animals, including bats,are now taken to veterinary surgeons for treatment rather thansummarily dispatched on the spot. Many of the bats brought in withinjuries have suffered at the paws of domestic felines. This and otheritems of information about British bats (15 species of

Microchiroptera reside in the British Isles) are presented by Routh’in his review of bats in the surgery. Some aspects of managementwill sound familiar to medical practitioners-eg, revival of weak andexhausted animals with oral electrolyte solutions, or the pinning offractures under general anaesthesia. Other recommendations playno part in human clinical practice-tempting diets of mealwormlarvae (tinned catfood will do if worms are unavailable); rehousingof orphans; and methods of euthanasia. Even bats living in captivitymay require attention; feeds containing cottage cheese can be a wayto aid calcium supplementation. An unfortunate complication ofcaptivity is obesity: some bats became so fat that they were incapableof climbing the wall of the cage and had to roost on the floor.

1 Routh A. Bats in the surgery. a practitioner’s guide. Vet Rec 1991; 128: 316-18.

In England Now

Now that I have arrived at the more senior portion of life,everyone seems to be taking a sudden interest in my health. I amabjured to keep myself warm in winter; I do, though the fuel bills eatinto the sum of money Her Majesty’s Paymaster General is kindenough to send me every month.A more personal interest is taken. The Sister from the practice

that has me on its list keeps wanting me to bring her a sample ofurine for "sugar testing". The practice manager sends me circularletters inviting me to have an appointment at the "Well ManClinic". My GP is wont to nobble me, if he comes across me onsocial occasions, and ask me to make an appointment to have mycholesterol level checked; this may be because he sees me wolfingdown any goodies that are on offer whereas he merely toys with acracker faintly smeared with some oleaginous substance allegedlyindistinguishable from butter. All these offers I decline, firmly.With late-onset diabetes on both sides of my family I keep my ownsupply of test strips for the occasional check, usually when polyuriafrom too much tea, coffee, and other liquid refreshment has causedme to pay more than the usual single nocturnal oblation to myageing prostate. I do not want to go to a "Well Man Clinic" because,if I am feeling well, I would rather not have my complacencyshattered by being told what my BP is doing. Above all, I do not carewhat my blood cholesterol may be-there are many worse ways todie than from a coronary, as years of working with the elderly havetaught me. Indeed, there are worse ways of living, or ratherexisting-for example, frail, forgetful, and vulnerable in someso-called "home".But I suppose what really astonishes me, angers me, even, about

all this concern for my wellbeing is that it is completely mistimed. Iam retired. I am non-productive. I have done my work for society,such as it was. In our present youth-centred culture, I am not evenof value as a repository of tribal wisdom. Yet it was only a few yearsago that I was working, as a consultant, and working undertremendous strain. No-one was concerned then with my health. Itried to tell the Region, my employers; they were not interested,even when I had to have increasing periods of sick leave. I tried totell my colleagues; with one exception, they did not want to know,were embarrassed by me. If I met my GP socially, he would begiving me a couple of referrals, not offering to listen to my troubles.Eventually I broke; after a long illness I was retired on healthgrounds; Region did not even write a note to say "Thank you andgood luck", not that I really expected it.And now everyone pretends they care about me.

International Diary

82nd annual meeting of the American Association for CancerResearch is to be held in Houston, Texas, on May 15-18: Molino andAssociates, c/o American Association for Cancer Research, Public LedgerBuilding, Suite 816, 6th and Chestnut Streets, Philadelphia, Pennsylvania19106, USA (212-689 7370).

A list of lectures in the series Disorders of the Hand can be obtained fromthe Institute of Orthopaedics, Postgraduate Office, Middlesex Hospital,Mortimer Street, London WIN 8AA, UK (071-380 9418).

A meeting entitled Computers in Medical Education is to take place inLondon on Friday, May 24: Maureen Gyle, Administrative Secretary,Association for the Study of Medical Education, Level 10, NinewellsHospital and Medical School, Dundee DD 9SY, Scotland (0382-65235).

A congress of the European Society for the Study and Prevention ofInfant Death will take place in Rouen on June 5-7: Prof E. Mallet, HospitalCharles Nicolle, 76031 Rouen, France (33-35 08 8187).

An annual symposium on The European Dream in 1993-A FlexibleStrait-Jacket is to be held in London on Tuesday, June 25: Elizabeth Borg,Administrator, British Association of Pharmaceutical Physicians, I WimpoleStreet, London WIM 8AE, UK (071-4918610).