fBRITJSH

MEDICAL JOURN \TALT

LEADING ARTICLES

Breast feeding and atopic eczema DAVID J ATHERTON 775 Recognition and management of lacunar strokes

E M R CRITCHLEY

SATURDAY 17 SEPTEMBER 1983
Compliance and cancer chemotherapy JOHN A GREEN 778 Action on Alcohol Abuse is born. 779 Trinnung fat or cutting bone?. 780
CLINICAL RESEARCH * PAPERS AND SHORT REPORTS * PRACTICE OBSERVED
Renal handling of calcium in hypoparathyroidism G H NEWMAN, M WADE, D J HOSKING.. Presence of human papillomavirus DNA sequences in cervical intraepithelial neoplasia D J MCCANCE, P G WALKER, J L DYSON, D V COLEMAN, A SINGER... Bacterial contamination of the small intestine is an important cause of occult malabsorption in the elderly A MCEVOY, J DUTTON, 0 F W JAMES.. Dorsal column stimulation in multiple sclerosis: effects on bladder and long term findings C H HAWKES, R BEARD, D FAWCETT, E A PAUL, D G T THOMAS... Risk of early death in extremely overweight young men S SONNE-HOLM, T I A SORENSEN, U CHRISTENSEN.. Piroxicam poisonng GEORGE C C LO, JOHN Y W CHAN.. Prophylactic topical acyclovir for frequent recurrent herpes simplex infection with and without erythema multiforme H A FAWCETT, M H WANSBROUGH-JONES, A E CLARK, I M LEIGH... Effect of thalidomide on orogenital ulceration P W BOWERS, R J POWELL... Immediate heart rate response to lying down: simple test for cardiac parasympathetic damage in diabetics E A RODRIGUES, D J EWING Practice Research: Does home monitoring of blood glucose work in general practice? R L GIBBINS, J SAUNDERS, C J ROWLANDS, J HARDING-DEMPSTER, A J M CAVENAGH.. Image of General Practice: Me and the general practitioners NICK ROSS.. Papers That Have Changed My Practice: Morbidity and prescribing TA CARNEY.. New Idea: Marriage counselling in our practice JEAN M WATKINS..

801 804

MEDICAL PRACTICE
Learning Medicine: Qualification and the year as a preregistration house officer PETER RICHARDS.. Personal Paper: Polyhydramnios: threat of a handicapped child ANNE WALLING... ABC of Computing: Computers in the laboratory JOHN DRURY... Letter from Chicago: Trifles soothe the mind GEORGE DUNEA... Lesson of the Week: Sporadic disseminated histoplasmosis simulating miliary tuberculosis P TONG, W C TAN, M PANG. Communicable Diseases: Surveillance of necrotising enterocolitis, 1981-2 BRITISH ASSOCIATION FOR PERINATAL PAEDIATRICS AND THE w.v f A -64"iTtURk PUBLIC HEALTH LABORATORY SERVICE COMMUNICABLE DISEASE SURVEILLANCE CENTRE NATIONAL AGRICULTURAL LIBRARY.824. Legionella infection 1981-2
Medicine and Books.. AnyQuestions?.. Personal View PATRICK BENNETT..
CORRESPONDENCE-List of Contents.
For Debate: Influence of an increase in excise duty on alcohol consumption and its adverse effects R E KENDELL, M DE ROUMANIE, E B RITSON.. 809

815 820

THE PUBLIC HEALTH LABORATORY SERVICE COMMUNICABLE DISEASE SURVEILLANCE CEN1

RECEIVED OCT 4 1983

1, 814,821, 823.. 832

OBITUARi CURRENT SERIAL

OROCUREMENT SECTION

KRm11TODS

NEWS AND NOTES Views. 842 Medical NewsAIDS and blood donations.. 843 BMA Notices.. 844 One Man's Burden

MICHAEL O'DONNELL.

No 6395
SUPPLEMENT iThe Week.. 847 BMA and RCN act on NHS cuts. 848. BMA agrees increased fees.. 848 Assessing and allocating beds in acute medicine in east London

DUNCAN W VERE.

Government wants action on competitive tendering for NHS's support services.. 850
WEEKLY. ISSN 0007-1447 ASTM CODEN: BMJOAE 287 (6395) 775-850 (1983)
BRITISH MEDICAL JOURNAL 1983 VOLUME 287 775-850 BRITISH MEDICAL ASSOCIATION TAVISTOCK SQUARE LONDON WClH 9JR.

BRITISH MEDICAL JOURNAL

VOLUME 287

17 SEPTEMBER 1983

CORRES PONDENCE
Unemployment among 1983 medical

graduates D Gentleman, FRCS.. 833 Changing pattern of poisoning in children A D Greig, MB; S Wilkinson, MRCPSYCH; R H Jackson, FRCP, and others. 833 Guidelines for community menopausal clinics Gillian M Craig, MD, and M Smith, DOBST
General practice advertisements G F E Edmondson-Jones. 836 "I have been back from holiday for a week and still have diarrhoea" A T L Chin, MRCPATH, and T W J Kelly, MRCPATH; A M Geddes, MRCP. 837 The incidental malignant melanoma R W Griffiths, FRCS, and J C Briggs,

FRCPATH

"Locomotor disability in general practice"

J Noble,

Non-steroidal analgesic and anti-inflammatory agents R W Fowler, MRCP, and K G Arnold, MRCP 835 Abnormalities of lymphocyte subsets in polymyositis A A Zoma, MRCP, and H Capell, MRCP; Wilhelmina M H Behan, FRCPATH, and P 0 Behan, MD.. 835 Congenital toxoplasmosis Paula H Gosling, MB. 835 Cyclical oedema J B Young, MRCP, and others. 835 SWOP (Speakers Who Oppose Publication) R G Richardson, BM; F Nour-Eldin,
Severe acute asthma or acute severe asthma? I W B Grant, FRCP; C Picado, MD. Recovery of renal function after transplantation R Sipila, MD, and B Kuhlback, MD. Influence of ranitidine on plasma metoprolol concentrations H Spahn, PHD, and others. Climacteric flushing in a man E Varenhorst, MD, and others. Medicine without signs Anne L Zweig. Cardiac arrest after crush injury P B James, MB. Low C4 concentrations in insulin dependent diabetes mellitus R L Dawkins, FRACP, and others.

837 838

839 839
Screening in general practice M Watson, MRCGP. Efficiency savings K Haywood, MB.. Points Plight of the course organiser (W V Anderson); Amputation of both legs in the elderly (C P U Stewart); Coronary bypass (R Smith); Death certification (Sylvia M Watkins); College and non-college (C Manning); Changing patterns of cervical cancer rates (H C McLaren); Rotavirus (E C H Huddy); Necrotomy, necropsy, and autopsy (Eleanor Dafforn-Ierodiaconou); Twelfth rib syndrome (P Donnelly); Informed consent (L Douglas, and others); Recognising placental steroid sulphatase deficiency (E H Epstein, Jr, and others); Successful pregnancy in a patient maintained on home parenteral nutrition (L I G Worthley); Antiemetics and cytotoxic drugs (Wendy B Taylor and D N Bateman); An Institute of Health (R J Maxwell); Aviation medicine: manned spacecraft (G Duncan)
We may return unduly long letters to the author for shortening so that we can offer readers as wide a selection as possible. We receive so many letters each week that we have to omit some of them. Letters should be typed with double spacing between lines and must be signed personally by all their authors, who should include their degrees. Letters critical of a paper may be sent to the authors of the paper so that their reply may appear in the same issue. Correspondents should present their references in the Vancouver style (see examples in these columns). In particular, the names and initials of all authors must be given unless there are more than six, when only the first three should be given, followed by et al; and the first and last page numbers of articles and chapters should be included.

Unemployment among 1983 medical graduates
SIR,-Several doctors who graduated this year from medical schools in the United Kingdom have been unable to find preregistration house officer posts for 1 August. The BMA and the councils for postgraduate medical education are aware of 31 newly qualified doctors who were unemployed on that date, 28 in England and Wales and three in Scotland. This information is based on returns from individual medical schools and on personal approaches to the BMA by some of these doctors, so that the true number in this plight may be higher. There is evidence that some preregistration house officer posts are being used to employ doctors who have full or limited registration, perhaps because the worsening imbalance in the hospital career structure is bringing the bottleneck for promotion further back towards graduation. Certainly, some job advertisements ask for "preregistration house officers or senior house officers." Earlier this year the Council for Postgraduate Medical Education in England and Wales was informed that in England there was a total of 2865 approved and funded preregistration house officer posts, of which 2710 were occupied by preregistration house officers. It therefore seems probable that in England up to about 5%/' of preregistration house officer posts may be held by doctors who do not need them for registration purposes. Further evidence for this has come from a survey this August of around 200 posts in the west of Scotland, when six posts (3%) were found to be occupied by senior house officers.
When calculating the necessary establishment of preregistration house officer posts, it is generally assumed that 9%0 of the annual intake of medical students will fail to qualify. This estimate is probably too high, given the exacting academic standards expected of today's medical students. At a time when medical school output has risen steadily for several years, this factor may contribute to the shortfall in preregistration house officer posts that has now become apparent. The immediate priority is to find preregistration house officer posts for those who still lack them. A few extra posts have been established, partly funded from local savings in overtime payments achieved by reducing the hours of work of junior doctors. Most of the 31 unemployed graduates remain in urgent need of help if their full registration is not to be delayed by six months. In the longer term more information is needed about the number of preregistration house officer posts that are occupied by other types of doctor, and pressure must be put on employing authorities not to fill these posts with senior house officers before a specific date each year. A more flexible system than the present "safety net" is needed to identify unfilled preregistration house officer posts throughout the United Kingdom and match them with unplaced graduates at the earliest possible stage. Finally, the Department of Health and Social Security should be asked to review the number of preregistration house

officer posts needed to allow every medical graduate in the United Kingdom to obtain the experience necessary for full registration.

DOUGLAS GENTLEMAN

Deputy chairman Hospital Junior Staff Committee (UK), BMA House, London WCIH 9JP
Changing pattern of poisoning in children
SIR,-Many papers have been published showing that there has been a reduction in the incidence of salicylate and paracetamol poisonings in England and Wales regionally since the selective introduction of child resistant containers for salicylates and paracetamol on 1 January 1976.1 Furthermore, Dr Lawson and others (2 July, p 15) use this argument persuasively in favour of extending the compulsory use of child resistant containers to other groups of drugs. The most vulnerable group is the under 5s, accounting for most accidental poisonings in children. From 1964 to 1976 the admission rates for accidental poisonings in the 0-4 age group were consistently 10 times those of the 5-9 age group.2 The figure shows that the total number of admissions due to accidental poisoning by medicinal agents has fallen dramatically since 1973.3 The latest figure from Hospital In-