Postgraduate Medical Journal

EDITORIAL BOARD

B.I. Hoffbrand, LondonEditor

D. Barltrop, LondonP.J. Barnes, London

D.G. Beevers, BirminghamD.J. Coltart, London MA.H. Crisp, London

I.J.T. Davies, InvernessH. Ellis, CambridgeR.B. Heath, London M

T.E.J. Healy, ManchesterJ.P. Hopewell, LondonG.R.V. Hughes, London

D. Ingram, LondonD.G. James, LondonR.S. Kocen, London

CURRENTCOLUMBIA UM\l\/JrQITV

SEP 18 198iHEALTH SCIENCES

LIBRARY

J.G. Lewis, LondonJ.S. Malpas, LondonP.J.A. Moult, London

[.W.N. Nicholls, ChichesterA. Paton, London

M.J. Peckham, LondonR.E. Pounder, London

[.C. Sheppard, BirminghamD.R.J. Singer, LondonI. Taylor, Southampton

P. Turner, LondonJ.A. Vale, BirminghamP.D. Welsby, Edinburgh

International Editorial RepresentativesG.J. Schapel, AustraliaP. Tugwell, Canada

J.W.F. Elte, The NetherlandsM. Moser, USA

L. Kreel, Hong Kong

Editorial AssistantMrs J.M. Coops

Volume 65, Number 759January 1989

00

The Postgraduate Medical Journal is publishedmonthly on behalf of the Fellowship ofPostgraduate Medicine by the Scientific &Medical Division, The Macmillan Press Ltd,Houndmills, Basingstoke, HampshireRG21 2XS, UK.Telephone: Basingstoke (0256) 29242Telex: 858493. fax (0256) 479476

Postgraduate Medical Journal publishes originalpapers on subjects ofcurrent clinical importanceand welcomes review articles with extensive,up-to-date bibliographies as guides to furtherreading. Several symposia are published eachyear, each devoted to a single subject andwritten by specialists in different disciplines.Most issues include authoritative currentsurveys of clinical problems, well documentedreports of cases of particular interest, and bookreviews. An international Postgraduate Diary isalso included each month.

The Fellowship of Postgraduate Medicine wasfounded by a group of London consultants afterthe First World War to assist postgraduates,particularly those coming to London from theCommonwealth, to pursue their studies. TheFellowship first published the PostgraduateMedical Journal to give information aboutlectures, conferences and courses and to providea monthly review of all branches of medicine.

i) 1989 The Fellowship of PostgraduateMedicineISSN 0032-5473

Manuscripts and all editorial correspondence,including books for review should be sent to:The Editor, Postgraduate Medical Journal,6 St Andrew's Place, London NW1 4LB, UK.Telephone: 01-935 5556.A 'Notice to Contributors' is published on theinside back cover of this issue. The Editorreserves the right to make changes which mayclarify or condense papers where this isconsidered desirable. The Journal is covered byCurrent Contents, Biological Abstracts, ASCA,ISI/BIOMED and Science Citation Index.

All business corespondence, reprint requestsand enquiries concerning advertising space andrates should be addressed to the Scientific &Medical Division, The Macmillan Press Ltd,Houndmills, Basingstoke, HampshireRG21 2XS.

Subscription price per volume of twelve issuesUK £90.00; Rest of the World £105.00 orequivalent in any other currency. Orders mustbe accompanied by remittance. Cheques shouldbe made payable to Macmillan Press, and sentto: The Macmillan Press Ltd, PO Box 500,Leicester LE99 OAA, UK. Where appropriate,subscribers may make payments into UK PostOffice. Giro Account No. 519 2455. Full detailsmust accompany payments.

All rights of reproduction are reserved in respectof all papers, articles, illustrations, etc.published in this journal in all countries of theworld.

Authorization to photocopy items for internalor personal use, or the internal or personal useof specific clients, is granted by The Fellowshipof Postgraduate Medicine for libraries and otherusers registered with the Copyright ClearanceCenter (CCC) Transactional Reporting Service,provided that the base fee of $01.00 per copy,plus $0.10 per page is paid directly to CCC, 27Congress St., Salem, MA 01970, USA.0032-5473/89 $1.00 + $0.10

Publisher: Alex Williamson

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Typeset by Elite Typesetting Techniques,Southampton

Printed in Great Britain by Bell and Bain Ltd,Glasgow

Whilst every effort is made b the ublishers and editorial board to see that no inaccurate or misleading data, opinion or statement appears in this Joumal,they wish to make it clear t at the data and opinions appeanng in the articles and advertisements herein are the responsibility of the contributor oradvertiser concemed. Accordingly, the publishers and The Fellowship, the editorial committee and their respective employees, officers and agents acceptno liability whatsoever for the consequences ofany such inaccurate or misleading data, opinion or statement. Whilst every effort is made to ensure thatdrug doses and other quantities are presented accurately, readers are advised that new methods and techniques involving drug usage, and described withinthis Joumal, should only be followed in conjunction with the drug manufacturer's own published literature.

BOOK REVIEWS 61

parasites and entomology is better indexed. The section onlaboratory diagnosis has been completely revised andtogether with helpful diagrams provides useful and practicalguidelines for side-laboratory techniques.The chapter on malnutrition follows the style of previous

editions in not offering a classification, equating PEM withkwashiorkor and giving only half a page to marasmus.Marasmus and marasmic kwashiorkor are the commonestproblems in most developing countries and need to be put intheir proper perspective. Vitamin A deficiency suffers frombeing divided between the chapters on vitamin deficiency andeye diseases.There is more attempt to make reference to children than in

previous editions, particularly in offering suggested paediat-ric drug dosage. However, for most paediatricians, theinformation on some subjects is too scant to be of practicalvalue.

This nineteenth edition with its considerable revision is anexcellent textbook on medical disorders in the tropics. Thosewondering whether to invest in it or hold on to their previousedition would be strongly advised to do the former.

J.B.S. CoulterLiverpool School of Tropical Medicine,

Pembroke Place, Liverpool L3 5QA

Social Aspects of AIDS, edited by Peter Aggleton & HilaryHomans. Pp. vii + 194. The Falmer Press (a member of theTaylor & Francis Group), London, New York, Philadelphia,1988. Cloth £19.95; paper £7.95.

This book is blatantly political and would be better retitled 'APolitical account of HIV infection and AIDS: homosexualaspects.' There is only passing mention of social aspects ofAIDS in haemophiliacs, heterosexuals, or intravenous drugabusers (all of whom have numerous social aspects): thesestriking omissions would, despite the contributors' obviousintentions, lead the naive to think, quite wrongly, that therewas some unique association between AIDS and homosex-uality.

There is too much inductive reasoning with generalizedconclusions being drawn from single instances. It is surely

ludicrous to draw general conclusions from blatantlyidiosyncratic utterances made by individual police cons-tables, politicians, or doctors, or made in newspaper articles(one contributor, seemingly to his surprise, discovered thatnot everything in print is correct and that there is indeedrubbish in the gutter press). There is no significance in thesuggestion that some doctors have recommended massquarantine; there are only a few of these doctors who wouldfreely admit that their views are not the conventionalwisdom. There are surely more important things for theauthors to become enraged about and the only conclusionthat should be reached is that the publicity that unconven-tional views receive is the price we have to pay for freedom ofspeech.

It is easy to be wonderously wise in retrospect. Yes, there isa small group of people who may have made errors, havebeen misunderstood, harshly criticised, and blamed fordeliberately furthering the epidemic, this group is the govern-ment who in retrospect, may have acted too late or inapprop-riately.The last chapter contains opinions which suggest that the

author or the reviewer are on a different planet. 'Shockingand obnoxious ... way in which the social group mostaffected. . . has simply been left to suffer and die.' 'Lesbiansand gay men ... erased from public consideration. AIDS isnot just a homosexual disease ... is a "shocking anddisgraceful statement" (because it suggests that gay men aredisposable)'. Gay men 'have been efficiently kept (my italics)in ignorance of AIDS throughout the 1980s by courtesy ofthis government'. 'The government's AIDS initiative ...couched in ... blood-lust, hatred, and thinly veiled contempt... offered a heady brew of racism, misogeny, andhomophobia.' (Why misogeny is included I'm not sure, butno doubt our Prime Minister will take this to heart.)

Strangely, I conclude by recommending that this book beread. To read a book which reinforces your views is merely areassurance: to read a book which offers insights into thevastly differing views of others based on the same facts is aneducation.

P.D. WelsbyDepartment of Infectious Diseases,

City Hospital,Edinburgh EJO SSB.

Books Received

Advanced Geriatric Medicine, J. Grimley Evans & F.I. Caird.Pp. viii + 192. Wright, London, Boston, Singapore, Sydney,Toronto, Wellington, 1988. £40.00.

Diagnostic Tests in Neurology, G.D. Perkin. Pp. viii + 322,illustrated. Chapman and Hall Medical, London, 1988.£19.95.

Diagnostic Tests in Respiratory Medicine, John Rees.Pp. vii + 240, illustrated. Chapman and Hall Medical,London, 1988. £19.95.

Essential Radiology in Head Injury, D. Mok & L. Kreel.Pp. 215, illustrated. Heinemann Professional Publishing,Oxford, 1988. £35.00.

A Manual of Normal Neonatal Care, N.R.C. Roberton.Pp. xi +240. Edward Arnold, London, Baltimore, Mel-bourne, Auckland, 1988. £7.95.

Protein C and Related Proteins, R.M. Bertina. Pp. x + 233.Churchill Livingstone, Edinburgh, London, New York,Melbourne, 1988. £45.00.

Radiotherapy, Susan Holmes. Pp. 223. Austen Cornish Pub-lishers, London, 1988. £6.50.

Postgraduate Medical Journal (1989), 65, 62 - 63

Postgraduate Diary

Institute of Cancer ReseachRegular programme of seminars and teaching sessions

throughout the year.Information: The Dean, Institute ofCancer Research, Haddow

Laboratories, 15 Cotswold Road, Belmont, SurreySM25NG, UK.

National Heart and Lung InstituteCourses leading to award of University Diplomas in Car-

diology and Thoracic Medicine. Short Courses, meetingsand symposia are held throughout the year.

Postgraduate Office, National Heart and Lung Institute,Dovehouse Street, London SW3 6LY. Tel: 01-351 8172.

Institute of Child HealthShort courses booklet for year 1988-89 now available.For further details please apply to: Anne Crowley, Short

Courses Office (Room 6), Institute of Child Health, 30Guilford Street, London WCIN JEH. Tel: 01-829 8692(direct).

Institute of Dental SurgeryCourses for M.Sc. in various aspects of dentistry, Diploma in

Dental Public Health, basic medical sciences, etc.Information: The Dean, Institute ofDental Surgery, Eastman

Dental Hospital, Gray's Inn Road, London WCIX8LD,UK.

Hunterian InstituteLong and short courses in basic medical sciences for primaryFRCS (including revision courses in Anatomy/Physiology/Pathology), Primary FDS, FFA part 2 heldthrough the year.

Courses in Clinical Surgery for final FRCS held in Spring andAutumn. Anastomosis Workshop; AO course of fracturetreatment.

Short revision courses for Surgeons: anatomy/physiology/pathology, 10 -28 April 1989.

Anaesthetists, 20 March-7 April 1989.Details and applications: The Hunterian Institute, Royal

College of Surgeons, Lincoln's Inn Fields, LondonWC2A 3PN. Tel: 01-405 3474.

Institute of Laryngology and OtologyPre-FRCS and DLO exam courses. Advanced courses on:Temporal bone surgery - November and June. Anaes-thesia for ENT - October. Rhinology and Surgery of theNasal Cavity and Paranasal Sinuses - October. NasalPlastic and Facial Soft Tissue Surgery - February.Pathology of the Ear, Nose and Throat - June.

Applications and enquiries: Cheryl Overington, Secretary tothe Dean, Institute of Laryngology and Otology, 330/332Gray's Inn Road, London WC1X8EE.

Institute of NeurologySandoz Foundation advanced lectures on clinical and experi-

mental neurology. Each Wednesday evening throughoutacademic year.

Details: Institute Registrar, National Hospital, Queen Square,London WC1N3BG, UK.

RPMS Institute of Obstetrics and GynaecologyDetails ofsymposia and coursesfrom: Symposium Secretary,RPMS Institute of Obstetrics and Gynaecology, QueenCharlotte's Hospitalfor Women, Goldhawk Road, LondonW6 OXG, UK.

Institute of OphthalmologyRegular courses in ophthalmology held throughout the year.17/25 Cayton Street, London EC] 9A T, UK.

Institute of OrthopaedicsRadiodiagnosis demonstrations - Mondays at 5 p.m. during

the academic year.Lecture courses - Wednesdays at 6 p.m. during the academic

year.Courses on skeletal radiology - 2 March 1989.Details: Miss A.M. Lucas, Postgraduate Secretary, Institute

ofOrthopaedics, The Middlesex Hospital, London W1. Tel:01-380 9418.

Institute of PsychiatryProgramme of courses and lectures.Details: Nadine Morgan, Conference Office, Institute of

Psychiatry, De Crespigny Park, London SE4 8AG. Tel:01-703 5411 ext 3170.

Institute of UrologyShort courses on aspects of urology and nephrology -

throughout the year.One year Diploma courses in urology and nephrologycommencing September each year.

Advanced stone management course - held twice yearly.Applications and enquiries: The Dean, Institute of Urology,172-176 Shaftesbury Avenue, London WC2H8JE, UK.

Royal Postgraduate Medical SchoolRegular courses on advanced topics.School Office, Royal Postgraduate Medical School, Hammers-

mith Hospital, Du Cane Road, London W12 OHS, UK.

University of ManchesterM.A. in Health Care Ethics.Details: Mrs S. Ibbotson, Department of Education, Univer-

sity of Manchester, Oxford Road, Manchester M13 9PL,UK.

International Union Against CancerDetails of fellowship programmes from: 3 rue du Conseil-

General, 1205 Geneva, Switzerland.

Liverpool, Newsham General HospitalLunchtime meetings twice monthly.Secretary, Postgraduate Centre, BelmontL6 4AF, UK.

Road, Liverpool

London School of Hygiene and Tropical MedicineMSc, diploma and research degree courses in public healthand tropical medicine.

Enquiries: The Registrar, LSHTM, Keppel Street, LondonWCIE 7HT.

© The Fellowship of Postgraduate Medicine, 1989

POSTGRADUATE DIARY 63

Forum on Clinical Pharmacology and Therapeutics17 March 1989 Drug formularies - the way forward,6 October 1989 The anxiolytic jungle: what drug for whom?Details: Miss Barbara Komoniewska, Royal Society of

Medicine, 1 Wimpole Street, London WIM 8AE. Tel:01-408 2119 ext 301.

European Medical Research GroupRegular meetings consisting of poster session followed by

guest lecture. Held at Medical Society of London, LettsomHouse, 11 Chandos Street, London W1.

Next meeting 21 February 1989.Details from: Dr D.R.J. Singer, cdo Fellowship of Post-

graduate Medicine, 6 St Andrew's Place, LondonNW] 4LB. Tel: 01-935 5556.

European Sociey of Gynaecological Oncology6th International Congress, April 27-29 1989, Palais de

Congres de Versailles, France.Details: Professor A. Gorins, Centre d'Oncologie et des

Maladies du Sein, H6pital Saint-Louis, 38 rue Bichet, 75101Paris.

Loughborough UniversityHazardous wastes: legislation, monitoring and disposal, 2- 5May 1989.

Occupational health management, 22-26 May 1989.Brochure of short courses run by University Training Group

available from: Loughborough University of Technology,University Training Group, Centre for Extension Studies,Loughborough, Leicestershire LEI] 3TU, UK.

Barrow Neurological InstituteThird Annual Magnetic Resonance Imaging Conference,Camelback Inn Resort, Scottsdale, Arizona, USA, 4-8March 1989.

Details: Kevin King, Education Coordinator, BarrowNeurological Institute, 350 W. Thomas Road, Phoenix, AZ85013, USA.

Charing Cross and Westminster Medical SchoolAdvanced course on 'Changing concepts in children's

orthopaedics', 15-17 March 1989.Details: Postgraduate Medical Centre, Charing Cross Hos-

pital, Fulham Palace Road, London W6 8RF.

European Society of Gynaecological Oncology (ESGO)6th International Congress, April 27-29 1989, Palais desCongres de Versailles, France.

Details: Professor A. Gorins, Centre d'Oncologie et desMaladies Du Sein, Hopital Saint-Louis, 38 Rue Bichet,75010 Paris, France.

15th International Cancer CongressHamburg, FRG, 16-22 August 1990.Details: cdo Hamburg Messe und Congress GmbH, P.O. Box30 24 80. D-2000 Hamburg 36 FRG.

Alaska 89 - Cruise the Inland Passage8-15 July 1989. Professor L. Bassett, Department of

Radiological Sciences, University of California. Prog-ramme of lectures, seminars and case discussion.

Information: ALASKA 89, cdo Medical Seminars Interna-tional Inc, 9800 D Topanga Canyon Blvd, Suite 232,Chatsworth Ca 91311, USA.

Anglo French Medical SocietyAnnual Scientific Meetings alternating between Britain and

France. 1989 - Toulouse (theme, aviation medicine). Alsoweek-long medical language courses in France.

Information: Secretary, Anglo French Medical Society, TheMoat House, Lymm Hall, Lymm, Cheshire WA13 OAJ.

4th South-East European Symposium of Paediatric Surgery'Normal and Disturbed Oesophageal Function in Child-

hood'.7-9 September 1989, Graz, Austria.

Details: Professor Dr M. Hollwarth, Department ofPaediatricSurgery, University of Graz, Heinrichstrasse 31, A-8010,Graz, Austria.

2nd European Congress of EndocrinologyLjubljana, Yugoslavia, 1-6 July 1990.Information: Secretariat, Kompas Jugoslavia, Congress

Department, Prazakova 4, 61000 Ljubljana, Yugoslavia.

The Fourth British Arthroscopy Symposium8 -10 March 1989.Details: Metaphor Conferences and Meetings, 21 Kirklees

Close, Farsley, Pudsey, W. Yorkshire.

Management Forum SeminarsThe fundamentals of biotechnology, 3 February 1989.Details of this and other seminarsfrom: Management Forum

Ltd, 48 Woodbridge Road, Guildford, Surrey GU] 4RL.

Caring for the Chronically Ml in the Community24-25 January 1989, Westminster Central Hall, London.Details: Miss S. Lobkowicz, Edsall Professional Group, cdoHome and Law Publishing Ltd, Greater London House,Hampstead Road, London NW] 7QQ.

Full details of the courses, meetings and symposia listedabove, and of others of interest to medical postgraduates,can be obtained from the individual organisations.

Postgraduate Medical Journal (1989), 65, 64

News

1889 And All That

The Johns Hopkins Hospital was opened on May 7, and theJohns Hopkins University School of Medicine on October 2,1893. Its generous benefactor, Johns Hopkins, made certainthat the hospital would be linked to the medical school, andthe medical school to the university as a whole, therebycreating a powerful foundation for the advancement ofmedical care, education and research. The close inter-relationship ofhospital and university medical school make itimpossible to celebrate the Centenary of the hospital withoutalso saluting the medical school for they are now bound bythe communal term Johns Hopkins Institutions. Mr JohnsHopkins, a Baltimore Quaker bachelor, left seven milliondollars to be divided equally, one half to found a universityand the other halfto establish a hospital. He believed that twoaspects were sure to endure, namely, a university, for therewill always be youth to train, and a hospital, for there willalways be suffering to relieve. 1.2The trustees for this vast endowment chose Daniel Coit

Gilman, once librarian of Yale University, to develop theUniversity and John Shaw Billings to develop the hospital.The hospital was under slow and tedious construction fortwelve years but Billings moulded it very carefully to thewishes ofJohns Hopkins. At first sight it would be surprisingto learn how long it had taken to build the hospital. Thetrustees chose not to touch the endowment's capital but onlyuse the annual income for hospital construction. Conse-quently the building proceeded year by year, halting wheneach year's funds were exhausted. The result was a close-knitcommunity of students, scholars and academic staff housedin a complex of hospital and medical school. The hospitalcontained laboratories and class rooms in close proximity tothe wards. It was therefore every inch a teaching hospital inits fullest sense, and this community was to become aspringboard for academic medical advancement throughoutthe United States. Billings should have become the firstDirector of the hospital but he declined, so Daniel Gilman,who had become founding President of the University, alsobecame founding Director of the hospital. This again wouldhave pleased Johns Hopkins who had always stipulated thatthere should be a cohesive union of hospital and medicalschool. This has been the strength of the foundation whichhas now weathered one hundred years. Students werereceived in the autumn of 1893 and the first class graduated in

June 1897. The faculty comprised fulltime professors,graduate fellows in the preclinical sciences and residents inthe clinical sciences. The students were only accepted if theyhad a bachelor's degree and a knowledge of French andGerman. Women were accepted on equal terms with men.

Daniel Gilman and John Shaw Billings were joined asHospital Trustees by William Henry Welch who had arrivedin 1885 as the founding professor of pathology. Thisremarkable trio helped to realise Johns Hopkins' vision andendowment not only with the correct alignment of hospitaland medical school buildings but also by attracting a nationalor even international faculty for both preclinical and clinicaldepartments. They laid a foundation of excellence whoseheritage is now being celebrated after one hundred years.William Osler became founding professor of medicine in1888. William Stewart Halsted became professor of surgeryin 1892, and Howard Kelly became professor of obstetricsand gynaecology in 1889.3 Osler stressed the importance ofaccurate history taking and physical examination, clinicalclerkships, bedside teaching, and bridging the gap betweenlaboratory and the ward. The microscope became a bedsideclinical tool rather than a mere toy.4The Johns Hopkins Medical Institutions hold their

Centennial academic programme in June 7-9, 1989. Topicsinclude health care, education and research in the nextcentury, public health issues, genes and medicine, AIDS,diagnostic imaging, diagnosis and treatment of the unborn,and a session on women in medicine since Hopkins womenhave contributed so much to international medicine. Theprogramme is a veritable Janus at the crossroads of worldmedicine. It will look back on the achievements ofyester-yearand proudly salute those who have gone before, but it willalso look ahead to the health of the future. On its pastperformances the Johns Hopkins has every right to beauthoritative in calling the tune of the future. Professor A.McGehee Harvey5 is bringing out a new book for theoccasion, exploring the innovations that made Johns Hop-kins a model of its kind and he traces the development ofeachinnovation to the present and implications for the future ofmedicine worldwide.

D. GeraintJames

References

1. Bordley, J. & Harvey, A.M. Two Centuries of AmericanMedicine. W.B. Saunders, Philadelphia, 1976.

2. Fulton, J.F. Harvey Cushing, a Biography. C.C. Thomas,Springfield, Illinois. 1946.

3. James, D.G. The Big Five: a centenary tribute to JohnsHopkins Hospital. J R Coll Physicians. 1989 (in press).

4. Osler, W. The natural method of teaching the subject ofmedicine. JAMA 1901, 36: 1673.

5. Harvey, A.M. Centennial of The Johns Hopkins Hospital1989 (in press).

t' The Fellowship of Postgraduate Medicine, 1989

FELLOWSHIP OF POSTGRADUATE MEDICINE

Grants for research

The Fellowship of Postgraduate Medicine is offering grants for travel, or towards the cost ofequipment, for young graduates entering careers in clinical research. Successful applicants will beexpected to submit reports of their research for publication in the Postgraduate Medical Journal.

Further information may be obtained from Mrs J.M. Coops, Fellowship of PostgraduateMedicine, 6 St Andrew's Place, London NW1 4LB (Tel. 01-935 5556), to whom applicationsshould be made, giving a concise summary of the research project, the sum requested and acurriculum vitae of the applicant.

Come to

Heidelberg

Come to the

1st European Congress ofEricksonian Hypnosis and

PsychotherapySeptember, 20.-24. 1989

Second announcement and last call for papers(to Dr. G.Schmidt, M.E.G., Im Weiher 12, D-6900 Heidelberg)

Milton Erickson Gesellschaft fur klinische Hypnose (M.E.G.)Konradstr. 16, D-8000 Munchen 40, West-Germany

Registration Fee prior to June 1st afterregular DM 350.- DM 390.-members of a society of hypnosis DM 300.- DM 350.-students DM 200.- DM 250.-

Registration: M.E.G., Konradstr. 16, 8000 Munchen, West-Germany(valid only with a check enclosed)

Admission to hypnosis-workshops is limited to individuals who are eligible formembership in the various national societies of hypnosis

Notice to Contributors

The Postgraduate Medical Journal considers manu-scripts prepared in accordance with the guidelines laiddown by the International Committee of MedicalJournal Editors (Br Med J 1988, 296: 401-405). Allmaterial submitted is assumed to be submitted exclus-ively to the Postgraduate Medical Journal unless thecontrary is stated.Typescripts Two complete copies should be sent tothe Editor, Postgraduate Medical Journal, 6 StAndrew's Place, London NW1 4LB. Papers must betypewritten, double-spaced, on one side of paper notlarger than A4 (297 mm x 210 mm), with a 5 cmmargin. The first page ofthe typescript should bear thenames of the author(s) and the name and address ofthe laboratory or institution where the work has beencarried out, in addition to the title of the paper. Thefull address of the principal author to whom proofswill be sent should be given as a footnote, as shouldany permanent changes of address and/or appoint-ment. A short (running) title of not more than 45characters should be given. All pages should benumbered including the title page. In line with manyother journals, we do not normally return rejectedmanuscripts.The principal author must ensure that any co-authorslisted agree to submission of the typescript. Anywritten or illustrative material which has been or willbe published elsewhere must be duly acknowledgedand accompanied by the written consent of theauthors and publishers concerned.Arrangement Papers should be divided into; (a) Titlepage, (b) Summary, (c) Introduction, (d) Materialsand methods, (e) Results, (f) Discussion, (g) Ack-nowledgements, (h) References, (i) Tables, (j) Figuresand captions. The summary should not exceed 250words and should state concisely what was done, themain findings and how the work was interpreted. In allsections of the paper numbered paragraphs should beavoided if at all possible.Style Abbreviations and symbols must be standardand SI units used throughout. Acronyms should beused sparingly and must be fully explained when firstused. Whenever possible drugs should be given theirapproved generic name. Where a proprietary (brand)name must be used, it should begin with a capitalletter. Statistical analyses must explain the methodsused. The use of footnotes is not permitted. Singlequotation marks should be used and words to beitalicized should be underlined. The Concise OxfordEnglish Dictionary is used as a reference for all spellingand hyphenation.References should follow the Vancouver format. Inthe text, they should appear as numbers starting at 1.At the end of the paper they should be listed (double-spaced) in numerical order corresponding to the orderofcitation in the text. All authors should be quoted forpapers with up to six authors; for papers with morethan six authors, the first three only should be quotedfollowed by el al. Abbreviations for titles of medicalperiodicals should conform to those used in the latest

edition of Index Medicus. The first and last pagenumbers for each reference should be provided.Abstracts and letters must be identified as such.1. Clements, R. & Gravelle, I.H. Radiological

appearances of hydatid disease in Wales. PostgradMed J 1986, 62: 167-173.

2. Greenberger, J.S. Long-term hematopoietic cul-tures. In: Golde, W. (ed) Hematopoiesis. Churchill-Livingstone, New York, 1984, pp 203-242.

Figures In the text Arabic numbers should be usedand all illustrations should be specifically referred to inthe text, e.g. (Figure 2). All illustrations should besubmitted at about Ij times the intended final size andshould be numbered as figures whether they arephotographs, representational drawings or line diag-rams and graphs.Photographs and photomicrographs should beunmounted glossy prints and should not be retouched,and should be chosen to exclude technical artefacts.Magnification is best indicated by a line representing adefined length included within the photographs. Areasof key interest and/or critical reproduction should beindicated on a flimsy overlay attached to the photo-graph or on a photocopy. All annotations and letter-ing should be indicated in the same way, andpreferably not included on the original print. Clearlycontrasted and focused prints are essential for ade-quate reproduction.Line diagrams and graphs should be on separate sheets;they must be drawn with black Indian ink on whitepaper, or supplied as photographic prints of suchoriginals. Lettering on figures should be minimal andmust not duplicate the legend. The use of symbolsshould be consistent within papers, and explanationsof symbols should be included in the caption, not onthe figure.A photocopy of all illustrations should be submitted.Tables These should be as few as possible and shouldpresent only essential data. They should be typewrit-ten on separate sheets, have a title or caption, andgiven Roman numbers.Proofs Two marked copies of the proofs will be sentto the principal author which should be read carefullyfor errors. One corrected copy must be returned to theeditor within 3 days. Major alterations to the textcannot be accepted.Copyright assignment The principal author mustcomplete and return to the Publisher the CopyrightAssignment Form enclosed with the proofs.Offprints Twenty-five offprints will be supplied freeof charge to the principal author. Additional offprintsmay be ordered on the form accompanying proofs.The charges are necessarily higher if orders arereceived after the issue has gone to press.Drug side effects Manuscripts reporting adverse drugreactions should be accompanied by evidence showingthat the reaction has been reported on a 'yellow card'or to the appropriate drug licensing authority, and tothe drug manufacturer.