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may well be such a one. But at present, while the newantibiotics are still under trial, there are sound reasonsfor supporting Professor Long’s plea that a combinationof drugs should more frequently be used from the start(and not after one or two failures) in bacterial infectionswhere resistance to drugs is known to arise readily.

Llandaff, near Cardiff. A. C. T. VAUGHAN.

ARTERIAL CALCIFICATION

SiR,—We have read with interest the article ofMarch 4 by Sir Adolphe Abrahams.

In the course of a study which we are making ofcalcification elsewhere in the body, we have takenX-ray pictures of the calves of 69 men over the age ofsixty, none of whom had any symptoms of intermittentclaudication. We also examined them and palpatedthe dorsalis pedis and posterior tibial arteries. Dividingour cases into those with and those without calcificationof the tibial arteries, we found that in the calcificationgroup (29 cases) all the foot arteries were palpable in13, while none was felt in 4 ; in the non-calcificationgroup (40 cases) the figures were 21 and 5, respectively.That is, the proportions are roughly the same for bothgroups.

Thus, calcification has no relation to arterial patency,as judged by palpation of the foot arteries, and it cancertainly be extensive in the absence of symptoms.Royal Northern Hospital,

London.C. SYMONS

Medical Registrar.DAVID PYKE

Assistant Medical Registrar.

HEALTH CENTRES

SiR,-Lurking in the obscurities of the local pressare occasional jewels of revelation. The Hampstead andHighgate Observer (Jan. 26) recently reported Mr. ReginaldStamp, chairman of the L.C.C. health committee, as

saying that the Minister of Health had agreed to ninehealth centres being built in London-" but the doctorswould not come in," said Mr. Stamp. His remarkshave now been gently and firmly corrected by theSecretary of the Local Medical Committee for London,who has pointed out (Ibid, Feb. 10) that " many doctorsare perfectly willing to enter health centres whenthe details have been worked out. In London alone29 groups of doctors have asked the L.C.C. to find healthcentre premises for them to work in."

This answer, by Dr. Gray, would be less forceful butmore accurate if he had said " only 29 groups." Mr.

Stamp is certainly wide of the mark, and one wonderswhether his lame excuses were made for want of betterones. Nevertheless as long as the profession is so

uninterested in a measure so vital for the nation’s health,Mr. Stamp may succeed in throwing the blame for thefailure to build health centres on to the shoulders ofthe medical profession, which, as every schoolboy knows,directs the financial policies of the Government and actsas bricklayers’ labourers in its spare time.

Mr. Bevan has called the health centre " the pivot ofthe health service " ; yet no attempt has been made toencourage the profession as a whole and more parti-cularly the general practitioners, who will have to staffand run the centres, when they are built, to voice theiropinions and their difficulties on the widest scale possible.The B.M.A. has a health centre committee which has

recently reported favourably on the introduction of

group practice from health centres, but is now beingforced by present economic difficulties to consider othermeans of grouping in general practice. Nowhere do wefind the inspiration and the foresight among the seniormembers of the profession which not merely acknow-ledges the inevitability of health centres but organisesmedical opinion so that we can overcome the diffi-culties before they arise, and can even exert some very

desirable pressure on the Minister to keep his promises.Alas ! we may not be the oldest profession, but we seemto be the most backward.The health centre must be the centre of attraction

locally not only for the man in the street, but also for thedoctor. Local committees of doctors and laymen shouldbe constituted now by any responsible organisations-the local authorities, who are responsible for building thehealth centres, might reasonably sponsor such a move-ment. Most important is the dissemination of knowledgeand the firing of the doctors’ enthusiasm for this mostfundamentally important weapon of medical progress.When the time comes for further excuses we mightthen expect an answer of a different Stamp.

London, S.W.17. DAVID L. KERR.

THE FORGOTTEN SWAB

SIR,-The forgotten swab is a lurking nightmare ofevery surgeon and theatre sister. As Sister Kent(March 4) writes, sudden and unexpected haemorrhagein a deep and inaccessible cavity may cause the surgeonto pack a small swab down on to the bleeding vessel;finding this stops the haemorrhage he leaves it there,intending to remove it later when the bleeding may notrecur. In the meantime he carries on with the operation,but possibly after a long and difficult procedure heforgets about the swab. Swab counts are not alwayscorrect, and sometimes a prolonged search fails to pro-duce an alleged lost swab. This leads to an anxious

feeling of uncertainty.

Various methods have been devised to render swabstraceable by X rays, such as the metal thread referredto by Miss Alexander (Feb. 25). Being unable to getspecial gadgets I devised a simple method. The theatresister, Sister Shaw, of the Royal Sussex County Hospital,inserts into each gauze swab a small metal staple witha. little press for clipping letters which we got from the