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take a locum appointment at Hammersmith Hospital. While he wasthere Sir Harold Gillies was given four beds for plastic surgery at thehospital, and Mowlem became fascinated by the potential of suchsurgery. There seems little doubt that Gillies also rapidlyrealised the surgical ability of the new recruit, and he invitedMowlem to move with him when he went to a larger unit at Balham.In 1940 Mowlem was appointed to the staff of the MiddlesexHospital and also established a unit at Hill End Hospital, St Albans,where he dealt with a large number of war casualties. After the warthe unit was transferred to Mount Vernon Hospital, Northwood,where he developed it into a major plastic and burns unit, whichattracted plastic surgeons from all over the world. He was an artistand craftsman in handling living tissues, and he had a deep concernfor patients afflicted with disease or serious deformity. He had to beconvinced that there were valid reasons for "cosmetic" surgerybefore he would agree to operate in that field. At both the Middlesexand Mount Vernon hospitals he was heavily engaged in devising andputting into effect reconstructive procedures to overcome thedefects resulting from malignant disease or its treatment, and hedeveloped techniques for using skin homografts in conjunction withautografts.The regard in which he was held throughout the world is

illustrated by the fact that he was twice president of the BritishAssociation of Plastic Surgeons, an honorary member of theSocieties of Plastic Surgeons of America, France, Italy, and theNetherlands, and in 1959 president of the International Congress ofPlastic Surgery. He was an outstanding teacher, especially ofindividuals or small groups, and his unpretentious conversation wasinvariably stimulating and instructive. He did not regard formallectures as the ideal way of imparting knowledge, but whenever theoccasion demanded it he could deliver an inimitable lecture ororation.

In 1933 he married Margaret West Harvey. They had twodaughters.

D. R.

CHARLES ANTHONY STEWART WINK

MA, BM Oxon, BLitt

Dr Wink, executive editor of the World Medical Journal andmedical editor for Ciba-Geigy Scientific Publications, diedon Feb 16, aged 64.He was a patient and painstaking editor whose tolerance and skill

in conciliation helped to preserve the unity of the World MedicalAssociation. He served in the Gordon Highlanders in the 1939-45war, during which he was wounded at El Alamein, and started hismedical training at Oxford University in 1947. After qualifying in1953 and serving as houseman at the Radcliffe Infirmary and RushGreen Hospital, Romford, he became a general practitioner inOxford, where his humility and willingness to listen quickly won hispatients’ affection. He studied and wrote on the medical uses ofhypnosis and used the techniques to treat asthmatics and,sometimes with striking success, patients with skin disorders orstammers and those wanting to give up smoking. Despite thedifficulties of running a single-handed practice he obtained a B Littin 1970 and in the same year changed careers to become assistanteditor of the BMA’s Abstracts of World Medicine. The following yearhe became medical editor for Ciba-Geigy Scientific Publications,where the achievement of which he was most proud was the Englishedition of the Geigy Scientific Tables. In 1974 he became executiveeditor of the World Medical Journal. There he proved able to drawtogether the myriad divergent threads arising within the WorldMedical Association on the thorniest questions of medical ethics.Yet he also brought to the journal his own thoughtful approach anddistinctive style, often leavened with humour. Through his work forthe WMA he came to be better known and appreciated in manyother parts of the world. He edited a number of medical works andmade contributions of his own to the literature, but he will be bestremembered by those who knew him for his courtesy, kindness andunfailing good humour.He is survived by his wife, two daughters and son.

C. S. B.

How Many Nurses Does the NHS Need?

THE robust charm of the Baroness Trumpington was at alow ebb in the Lords last week by the time she came to reply toa debate on the reorganisation of the National Health Servicefollowing the Griffiths report. And understandably so: for thetwo hours which preceded her had virtually amounted to anUpper Chamber benefit night on behalf of the Royal Collegeof Nursing. Indeed, as Baroness Cox, a former GovernmentMinister in the Lords and herself a nurse, was succeeded by atrain of other speakers, every one of whom endorsed herfeelings of urgent alarm, it must almost have seemed to LadyTrumpington that what she was really facing was a

succession of appearances by the resourceful RCN generalsecretary, Mr Trevor Clay, in a wealth of different disguises.The essence of the RCN’s post-Griffiths grievances is

already well known, thanks to much assiduous lobbying andan advertising campaign estimated to have cost them some250 000. Lady Cox, and several of those who followed her,were anxious to insist that the nurses’ campaign was notsimply born of a feeling that too many of the top jobs in thereorganised services had gone to other people. It was the

neglect of nursing skills at all levels, their relegation to theperiphery when they should be at the heart of health care,they said, which had awakened fears for the welfare of thepatients and the NHS.What especially worried them was the needless sacrifice of

traditional and honoured skills. Threnodies over the declineand fall of the British hospital matron punctuated the debate.There was more than an echo, too, of the warning given in theHugill report on Stanley Royd Hospital about the possibleloss of established expertise in community health-a sectionof the report which moved the Social Services Secretary, MrNorman Fowler, to set up an inquiry into the future

development of the public health function. BaronessMcFarlane ofLlandaff, speaking as a nurse and a professor ofnursing, cited three cases known to her of senior people whohad chosen to take early retirement: "not only are thesepeople being lost to the NHS, but so is their expertise lost tothe nursing service and to patient care. The lack of theirreplacement means that any advice on nursing is beingpushed further and further down in the level of the nursingservice".

Senior nurses, it was said, were being abruptly dismissedafter years of service, or sent on "gardening leave". A veryexperienced sister from a London obstetrics department hadfelt driven to resign after a general manager had forbiddenstaff the use of a kettle. A chief nursing officer had been senton attachment to British Leyland to learn about qualitycontrol. One health authority, it was claimed, saw no need forward sisters. "Some of these gentlemen," Lady McFarlanewarned of the new style managers, "come from concerns suchas the Royal Navy, Tesco’s, and Woolworth’s..." "Next day the Government were under attack again as one of

the most senior and respected select committees of the

Commons, the Public Accounts Committee, published itsreport on the control of nursing manpower. 2 Where thelanguage of confrontation on the floor of the House is

invariably ripe and bruising, the assaults of these eminent all-

1 Lancet, Feb 1, 1986, p 2782 Control of nursing manpower 14th report from the Committee of Public Accounts

HM Stationery Office. £4 40.

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party committees are traditionally worded with icy restraint."We were surprised to find..." ; "we were disturbed tolearn ..."-in the mouth of the Public Accounts Committeesuch formulas amount to serious reprimand.What disturbed the PAC on this occasion was the discovery

that seventeen years after their predecessor committee hadexpressed dissatisfaction on this score, DHSS witnesses werestill unable to tell them whether the country had too fewnurses or too many. Shortages in some areas were admitted,confirming the report of the Comptroller and AuditorGeneral, who serves this committee, that despite overallincreases in numbers there were still not enough nurses goinginto mental health and mental handicap work. The DHSSwas not happy about the high proportion of nursing entrantswho never actually started work in the profession, nor aboutthe numbers of those who left the service and never returned.And the chairman of the NHS Management Board, MrVictor Paige, shared the concern of committee members thaton present trends there could be serious problems withstaffing in two years’ time.But for much of the time Mr Paige and his colleagues, in

evidence to the committee, fended off complaints with acourteous agnosticism. Whether manpower levels were

generally adequate or not was not for them to say. The peopleat local level must know best: just as the people at local levelwould have to find solutions for the manpower problemswhich might confront the NHS in two years’ time.

It is a very devolved strategy that the Government is

operating. You could not manage 1 million people, and themany units which existed within the NHS, directly from theElephant and Castle, Mr Paige insisted. The NHS must bemanaged by the people at the sharp end. And he had

absolutely no doubt that the new management structureswould give the best possible hope of dealing with the issuesthat were troubling the PAC.Some members of the committee could not quite see how

this agnostic approach to manpower planning squared withthe Government’s decision in 1983 to order reductions inNHS manpower overall, leading to consequential reductionsin nursing manpower. But that was not manpower planning,Mr Paige assured them: it simply reflected the need for "someglobal awareness and understanding of the sorts of figuresthat ministers were not wishing to see exceeded".For a more comprehensive examination of the NHS post-

Griffiths, you will probably need to turn to a debate takingplace on March 14 on a private member’s motion from MrSteve Norris, Conservative MP for Oxford East. ThoughRCN briefings are bound to shine through several of thespeeches, Mr Norris himself, who as a former vice-chairmanof the West Berkshire District Health Authority has somepersonal experience of trying to make the reorganisationwork, aims to look much more widely at the way initialexpectations have worked out. Some early misgivings-overdifferential pay rates for appointees from within and withoutthe service; the use of fixed contracts, as if to provide for aperiod of probation; the loss of pension entitlement by somewho are switching within the service-seem to him to havebeen confirmed by experience.

Contraception for Girls under 16One event which failed to make the expected splash last

week was the revised set of guidelines issued by the HealthMinister, Mr Barney Hayhoe, on the provision ofcontraception for girls under 16. Even Mrs MaryWhitehouse was too tied up with the fight over Winston

Churchill’s Bill on obscene publications to trumpet her viewsto the nation. Hopes among Westminster supporters of MrsVictoria Gillick that Mr Hayhoe would endorse the recentcontroversial guidance offered by the General MedicalCouncil were disappointed. He simply stipulated thecircumstances in which prescription without parentalconsent would be justified, leaving undiscussed the preciseethical dilemmas which have set the GMC and BMA at

loggerheads.In effect, that amounted to something of a boost for the

BMA position, and the Labour front benchers, Miss JoRichardson, who deals with women’s issues, and Mr FrankDobson, who handles health, were quick to approve andcongratulate the Minister. Maybe agnosticism is the mood ofthe moment at the Elephant and Castle.

DAVID MCKIE

International Diary1986

International meeting on Cataract, Implant and Microsurgery: MtElizabeth, Singapore, May 29-31 (Dr A. S. M. Lim, 3 Mt Elizabeth

0605-0608, Mt Elizabeth Medical Centre, Singapore 0922).

International symposium on Health and Environment in DevelopingCountries: Haikko, Finland, Aug 27-30 (Congress Office-HEDC-86, POBox 189, SF-00171 Helsinki, Finland).

2nd international conference on Blood Vessel Imaging UsingUltrasound Techniques: Southampton, UK, Sept 4-5 (Mr K. N.

Humphries, Scientific Director, Vascular Unit, Medical Physics Department,Level D, Centre Block, Southampton General Hospital, SouthamptonS09 4XY).

16th European conference on Psychosomatic Research: Athens, Greece,Sept 6-11 (Prof G. N. Christodoulou, Athens University Department ofPsychiatry, Eginition Hospital, Vasilissis Sofias 74, Athens 11528).

International conference on Recent Advances in PsychiatricTreatment: San Francisco, California, Sept 14-19 (Congress Team Inter-national (UK) Ltd, 30 Deane Way, Ruislip, Middlesex, UK).

International meeting on Nutritional and Pharmacological Treatmentof Brain Tumors: Pavia, Italy, Sept 18 (Professor R. Paoletti, NutritionFoundation of Italy, Via S. Pietro All’Orto 17, 20121 Milano, Italy).

Conference on Progress in Impotence-Diagnosis and Therapy: SanDiego, California, Sept 19-20 (Edith Bookstein, Conference ManagementAssociates, PO Box 2586, La Jolla, CA 92038, USA).

International course on Amyloidosis: Groningen, Netherlands, Oct 10-11(Dr J. Marrink, Department of Internal Medicine, University Hospital,Oostersingel 59, 9713 EZ Gromgen).

Programme on The Skin From A to Z: San Francisco, CA, Oct 11-12(Extended Programs in Medical Education, School of Medicine, Room 569-U,San Francisco, California 94143).

9th international symposium on Drugs Affecting Lipid Metabolism:Florence, Italy, Oct 22-25 (Fondazione Giovanni Lorenzini, Via MonteNapoleone 23, 20121 Milan, Italy).

International symposium on Medical Virology: California, Nov 12-14(Dr L. M. de la Maza, Department of Pathology, Route 84, University ofCalifornia, Irvine Medical Center, 101 City Drive South, Orange, California92668).

Amended notice-7th symposIUm on Innovative Cancer Chemotherapyfor Tomorrow: New York, USA, Nov 12-14 (Director, The Page andWilliam Black Post-Graduate School of Medicine, One Gustave L. LevyPlace, New York, NY 10029).