820 THE LANCET, OCTOBER 25,1975

There are many more serious problems to worry about.Laboratory services will contract and clinical care deteriorateunless more funds become available immediately. Let us avoidthe smoke screens, ignore the minutiee of SI, forget privatepractice, and be patient over our contracts. The professionmust unite to ensure that adequate finance is available for thereal business of medicine--that is, providing the best possiblecare for our patients.

shared a conviction that these payments should be refused onthe grounds that they would have to be made out of districtfunds to the detriment of other services and that they wouldrepresent payment for work which was already being done.

I have now been assured that part of the £600 million allo­cated to the Health Service took into account the extra cost tothe N.H.S. of former F.P.A. work and that these paymentswere to be made for new work done in addition to that alreadycarried out on present operating-lists. Remunerable operationswill therefore be done either on new operating-lists or afternormal lists have been completed. This being so the objectionsno longer stand but I doubt if "silencing by gold" will proveto be a very accurate description of the deal.

University Department ofChemical Pathology,General Hospital,Southampton S094XY. K. G. M. M. ALBERTI

SIR,-I cannot see how the present free contraceptive ser­vice can be fully effective and reach all patients unless the co­operation of doctors is achieved: extending family-planningclinics, as you suggested is not enough.

The Government has discovered it takes "a touch of gold"to interest doctors in this scheme: rather than consider this asa "money-spinner", it must surely be the best-ever investmentfor a crowded, ailing country such as Britain. My regret is thatit was not introduced years ago, when thousands of unwantedchildren and their ensuing problems or terminations mighthave been prevented. What a tragedy if discontent at theGovernment's means prevent the end being achieved.

SI UNITS

SIR,-I read with morbid delight the article by Dr Clarkand Dr Sheldon on SI units (Oct. 11, p. 700). What skill theD.H.S.S. displays in firing off diversionary volleys at a timewhen all our attention should be focused on the grave and veryreal problems that beset the N.H.S. The D. H. S. S. has care­fully ordered a change which actually has some benefits andwhich was certain to rouse our conservative doctors. Theyhave thus been able to sit back and enjoy watching furiousclinicians battering the beleaguered biochemists. Churchillwould have been proud of the physicians of Sussex standing intheir last ditch on Brighton beach resisting to the end the inva­sion by the dread SI units. Sadly their ditch has already-touse their analogy-been flattened by the steam roller; the molehas burrowed to the very heart of the system.

I would also ask our clinical colleagues to be charitable tothe humble biochemist. Considered rationally the SI unit is atworst harmless, although a waste of money, and at best anadvance in communication. Scientists have already invadedmany of the bastions of clinical medicine and it is perhaps evensensible to talk to them in the same language. Think, too, ofthe joy that SI has brought to the clinical biochemist. Up anddown the country committees of biochemists have sat forweeks, if not months, in total ecstasy compiling conversiontables, wall charts, booklets, new tables of normal values, andmaking myriads of new rules. A new spotlight has, if briefly,focused on the clinical chemist as posters round the hospitalsannounce the coming of SI, like a new Messiah. What joy.

In hospitals where the change has already taken place therehave been few problems. There are even advantages like thegreater ease in calculating plasma osmolality. Think of thechaos that could ensue if we now stick halfway with half ourhospitals working in the new and half in the old units. The faithas already been accompli. Perhaps it would be wise if we fol­lowed the advice of the disciple of Confucius who said: "Whenrape is inevitable, lie back and enjoy it". By and large thecoming of the SI unit is a major non-event.

MENTAL HEALTH ACT 1959

1. Rosner, F., Muntoer, S. The Medical Writings of Moses Maimonidcs. Vol.Ill. Treatise on Hemorrhoids & Responsa. Philadelphia, 1969.

J. NEWCOMBE

NORMAN A. PUNT57 Egerton Crescent,London SW3 2ED.

SIR,-For some time it has been apparent that the MentalHealth Act 1959 is not working as well as it might be, and nowtwo more cases have given rise to further doubt. The first caseconcerned a married woman who killed two of her childrenand was detained under Section 60 of the Mental Health Act1959. As there was no restriction order, the responsible medi­cal officer was entitled to discharge her when he saw fit. Thesecond case concerned a patient from Broadmoor who wasallowed out for the day with a social worker. The social workerand patient went to London, separated, and arranged to meetagain at a specific time and place; not surprisingly, the patientfailed to turn up. However, the Department of Health issuedan assurance that the patient was perfectly harmless; thisbeing so, one wonders why he was detained at Broadmoor.

Where the safety of the public is involved, I feel the decisionto discharge a patient from hospital should not be that of theresponsible medical officer alone. Such a decision should betaken by an independent body, such as a mental health tri­bunal. The most simple way to deal with this problem wouldbe to abolish Section 60 and to apply Section 65 in all cases.This would mean extra work for the mental health tribunals,but would go far towards alleviating public anxiety.

Claypenny Hospital,Easingwold,Yorks. Y06 3PR.

PILES: THEIR NATURE AND MANAGEMENT

SIR,-The point of view of Mr Thomson concerning themodern management of piles (Sept. 13, p. 494) was alreadyenunciated in the 12th century by Moses Maimonides in hisTreatise on Hemorrhoids. I

This work was written for a nobleman, as Maimonides de­scribes in the introduction-probably a member of the Sul­tan's family. There are seven chapters dealing with normaldigestion, foods harmful to patients with hsernorrhoids, benefi­cial foods, and general and local therapeutic measures such assitz baths, oils, and fumigations. Maimonides disapproves ofblood-letting or surgery for harnorrhoids except in very severecases. His whole approach to the problem seems to bespeak amodern medical trend. Maimonides states:

"Because this illness [i.e., hremorrhoids] recurred many times, thepatient considered having them extirpated in order to uproot thismalady from its source so that it not return again. I informed him of

SIR,-There is only one thing to be done about the directivefrom the Department of Health concerning SI units, and thatis to ignore it. If clinicians and pathologists refuse to use thissystem, a deal of trouble and much paper will be saved. Itwould help, Sir, if you and other editors of medical journalswould also refuse to use SI, and say so forthwith.

P. J. HORSEY

PENELOPE A. WATSON42, Dreghorn Loan,Edinburgh EHI3 ODE.

Department of Anesthetics,Southampton General Hospital,Southampton.