973

Examination of 50 men three months after diagnosisshowed no evidence of chronic rickettsxmia, although 3had slight increase of antibody to R. burneti.We thank the Medical Director General of the Navy for permission

to publish; Prof. A. Bradford Hill for statistical advice; SurgeonRear Admiral G. Phillips and Dr. K. E. A. Hughes, director, PublicHealth Laboratory, Portsmouth, for their advice and encouragementthroughout; the medical dfficers of the Royal Navy for their assistancein supplying information and serum samples without which thisinvestigation would have been impossible; Dr. P. V. Pritchard,medical officer of health for Gosport, for his interest in the indexcase; Surgeon Captain J. H. Nicolsoh, R.N., who afforded us allfacilities in his area; the medical officers of health and the directorsof the Public Health Laboratories in the areas concerned for their

cooperation; and Mr. E. H. O’Connor, A.I.M.L.T., for his technicalassistance.

REFERENCES

Evans, A. D. (1956) Mon. Bull. Minist. Hlth Lab. Serv. 15, 215.— Baird, T. T. (1959) Proc. R. Soc. Med. 52, 616.— Powell, D. E. B., Burrell, C. D. (1959) Lancet, i, 864.

Fraser, P. K., Hatch, L. A. (1959) Brit. med. J. i, 470.Holland, W. W., Rowson, K. E. K., Taylor, C. E. D., Allen, A. B., Ffrench-

Constant, M., Smelt, C. M. C. (1960) ibid. i, 387.MacCallum, F. O., Marmion, B. P., Stoker, M. G. P. (1949) Lancet, ii, 1026.Marmion, B. P., Stoker, M. G. P. (1958) Brit. med. J. ii, 809.Robbins, F. C., Gould, R. L., Warner, F. B. (1946) Amer. J. Hyg. 44, 23.Robson, A. C., Shimmin, C. D. G. L. (1959) Brit. med. J. ii, 980.Stoker, M. G. P. (1949) Lancet, i, 178.

The Widdicombe File

LXV.—" PLUCKED FROM THE BURNING"

DEAR WHIDDON,Jan wanted me to slip over and see his son at Wither-

bridge. As you’ll know, he’s out of danger now. I

suppose a fractured femur, ruptured gut, and a fewburns are not really a very high price to pay for wrappingthat sports car round a tree at 85 m.p.h. Thank God

nobody was in the way. The local boys did a wonderfuljob; they’re slick on accidents and my second opinioncouldn’t add much.

Jim was certainly lucky in choosing his spot, for the

chaps at Witherbridge had him transfused and on thetable within an hour. I reckon that if his track-rod hadchosen to snap half an hour before it did, there wouldhave been a good three-quarter-hour journey by theMilvercombe ambulance, with a ten-minute delay onSuffering Hill where the road’s up, plus any amount oftime in getting to the telephone in the first place. St.Ethelred’s is quite good of its sort, but the casualty officerhasn’t had much experience and finds conversationdifficult except in Tarhil; though they’re lucky to havehim, for the job was unfilled for a couple of months.

If Jim had arrived there, a cubicle would have beenquickly cleared of a patient with multiple boils andanother with athlete’s foot; and those two old porterswould have done their best to heave him off the stretcheron to a couch. It’s usually possible to trace the EgyptianR.s.o. within 20 minutes (there’s still no call-system youknow) but he wouldn’t have been able to do much exceptcall the surgeon from one of the other hospitals andorder blood. The consultant, when he got away from theadvanced carcinoma he was trying to remove, wouldhave found shifting dullness and things and orderedimmediate operation, though being a general man hewouldn’t have liked plating that femur. Still, Sisterwould take about half an hour to get the theatre ready,and by then maybe an orthopod could have been found.The moves from couch to trolley and trolley to operating-table wouldn’t have helped, not to mention the trip downto X-ray, a couple of hundred yards away.Jim needed arterial transfusion with assisted respiration

and quite a lot of tissue grafting, which called for resourcesand personnel of a very high order. St. Ethelred’s, I’mafraid, has neither. So I might easily have been writinga letter of condolence, instead of this fairly cheerful one toyou. (So I might, in point of fact, if he’d been broughtto my own hospital.)Would it help, do you think, if we started calling the

motor-car Captain of the Men of Death? Both the

Industry and the Government seem incredibly obliviousof the enormous suffering that surrounds us. If anyonewere seriously interested in prevention, then safety-design in roads and cars, an overall speed-limit, and aban on high-powered motor-bikes for youngsters seemobvious; and theh there’s liquor, and why riot make seat-harness compulsory on Motorways ? Punishment for thedelinquent driver should become realistic, and not just thepresent meaningless penny-penances and vague warnings.

Still, some accidents are bound to happen, even if wereturn to stage-coaches. What do you think we oughtto be doing on the medical side to halt the rising tide ofdeath and disablement? What, for that matter, is yourown ex-teaching hospital saying or doing? Some havewhole-time accident surgeons on a 24-hour service,though mine, I regret to admit, has no consultants

working no time; and lots of departments are mannedat night only by a reluctant H.s. or H.P., heavy-liddedfrom a hard day’s work. Obviously we can’t have theWitherbridge sort of accident team in every hospital,but we could have more of them. Some people want25 or so centres to cover the whole country, and it soundssense to me, though probably far too few. Probably youhave views on staffing; but I hope you’ll agree anywaythat the centres need to be specially designed, in or neara large and efficient general hospital with ambulances(and helicopters ?) going straight to them.

All this seems so obvious and desirable and importantthat I suppose it’s quite impossible; and that’s what itdoes in fact seem to be when one puts it to one’s col-

leagues. " What, close our Casualty ?" they say; "’ whata blow to our prestige. G.P.S won’t send us cases, and howwill Matron train the nurses ? " General and orthopxdicsurgeons get at each other’s throats, and the whole affairgets bogged down in petty politics and silly jealousies.I suppose it’s hard to expect cooperation between adjoin-ing hospitals whose senior staff haven’t recognised eachother’s existence since 1893. But eventually, if we don’tdo something effective, the Ministry will decree a CentralPlan of some kind-and not before time perhaps. Weall khow now-thanks to the independent Nuffield set-up-just how bad some old casualty departments are andhow little thought sometimes goes into the planning evenof new ones. No doubt you kriow, too, that a confusionof committees has been set up to look into this and that.Make life safer for Jim’s children maybe. But the best

hope (as I think has happened in two, or perhaps threeregions) is for the local men themselves, and the S.A.M.O.,to take a long hard look around.

Accident surgery has been remarkably neglectedcompared with things like plastics and chests, though thepeople it works on could hardly be of greater value tosociety. It’s funny, too, that most of the chaps who aretrying to do something about it seem to be near-descen-dants of those Colonial pioneers who lately made ourgreat Dominions what they are. Maybe it takes an

outsider to see where we fall short.As ever,

P.G.