BRITISH MEDICAL JOURNAL VOLUME 287
described under up to 10 fields of the user's
choice and provides macros, which, among
other functions, allow editing, sorting, merging,
indexing, producing a vocabulary of words in
a chosen field (with or without counting),
automatically entering non-trivial words from
a title field into the keyword field, searching
the keyword field for any combination of
words, and printing out a listing of all or
selected parts of the bibliography. There is
no restriction in the number of records;
individual records are limited to a maximum
of 4000 characters.
Famulus is extremely easy to use, once one
is familiar with the system. I keep all necessary
control programs in a permanent library on
the ICL 2980; to update a bibliography by
adding a new data file of references, resorting,
indexing, listing, and returning to magnetic
tape storage only takes five minutes of
interactive editing at the terminal followed by
a single line "run job" instruction.
A simple manual giving a full description
of the system for users is available from the
University of London, Computer Centre,
Guildford Street, London WC1.
A J WADE
The London Hospital Medical College,
London El 2AD
Causes and management of anal
irritation
SIR,-Mr John Alexander-Williams (19
November, p 1528) rightly emphasises the
parts to be played in anal irritation by in-
adequate hygiene and by contact sensitisation
due to perfumes, detergents, and a legion of
other medicaments obtainable over the counter,
such as local anaesthetic creams.
Unfortunately, having made this point, he
then goes on (rule 3) to recommend medicated
wipes such as Wet Ones or Baby Wipes for
"away from home cleansing." Many of these
medicated wipes contain sensitisers. For
instance, Boots Baby Wipes contain 0 5%/0
cetrimide and Cosifit Poppets are "impregnated
with lanolin for softness." In addition, most
contain ethyl alcohol, which may irritate
broken skin, and are perfumed, another source
for sensitisation. We believe, therefore, that
use of these tissues should not be encouraged
in the management of anal irritation.
In addition, in rule 8 he suggests using
crotamiton as an antipruritic in unbroken skin.
In our experience this has not been a successful
treatment for perineal itch, other than in that
secondary to infestations. In our opinion these
points detract from an otherwise useful article
for the "obsessive personality" with anal
irritation.
STEPHEN JONES
VALERIE DOHERTY
Department of Dermatology,
Western Infirmary,
Glasgow GIl 6NT
ANGELA FORSYTH
Contact Dermatitis Clinic,
Belvidere Hospital,
Glasgow
New criteria and classification for
diabetes mellitus
SIR,-Two comments in your correspondence
columns of 15 October (p 1142) relate to the
criteria and classification for diabetes mellitus
recommended by the British Diabetic
Association.
10 DECEMBER 1983
Mr C Sanderson quite rightly points to a
possible anomaly in the operation of these
new recommendations-diabetes mellitus may
be diagnosed with either a raised fasting or a
raised two hour value in the oral glucose
tolerance test, so that a "normal" fasting
value may accompany a diagnostic two hour
value. This is a very unlikely event, however;
by the time the two hour concentration is in
the diagnostic range for diabetes the fasting
value is almost invariably raised too. Of more
concern perhaps is diagnosis based on a
raised fasting blood sugar concentration alone.
Not everyone obeys the injunctions to eat and
drink nothing on the morning of the test, and
a brisk emotional response to the sight of
syringe and needle may itself raise blood
glucose concentrations. All this reinforces the
advice not to rest the diagnosis on a single
measurement of blood glucose concentration
unless the value is so high and the accompany-
ing circumstances so suggestive that it would
be overcautious (or perhaps even dangerous)
not to do so.
To the point made by Mr Hindle and
Mr Rostron about anhydrous and hydrated
glucose, we agree that the difference in the
quantity administered if 75 g of each were
consumed is small and insignificant in
individual diagnosis. For epidemiological
study, however, some differences might be
attributable to systematic variation in dose.
We were aware of this problem, and reference
has been made to it earlier. A simple defence
is that when we said glucose, we meant
glucose and not glucose monohydrate: 75 g
of glucose would be equivalent to 82 5 g of
glucose monohydrate; or perhaps more
practically 75 g of glucose monohydrate would
be equivalent to 68-2 g of glucose. We would
prefer the more literal interpretation.
H KEEN
A BLOOM
P WATKINS
British Diabetic Association,
London WIM OBB
A better deal for overseas doctors
SIR,-The proposed sponsorship scheme for
overseas doctors outlined by Mr Innes-
Williams and Dr Paton (19 November, p 1492)
is one of the most promising recent develop-
ments in medical manpower. The inordinate
difficulty that overseas doctors have in
acquiring good training in Britain has been a
matter of concern to the profession, and
particularly to the Hospital Junior Staff
Committee, for some time.
This problem shows every sign of worsening,
and as the number of unemployed doctors
increases, overseas doctors are suffering
particularly severely. Although many details
of the scheme remain to be worked out it has
the enthusiastic support of the Hospital
Junior Staff Committee in principle.
There is, however, an important miscon-
ception emerging that the scheme can solve
our intractable career structure problems. In
the last paragraph of the leading article the
authors say: "Allocating the excess posts to
sponsored overseas trainees would be much
more sensible than reducing numbers....
In many specialties the excess of registrars
over likely career vacancies is about five or
six to one. It would clearly be unacceptable
to patients, government, and the profession
if 80% or more of our registrars were to be
1801
sponsored overseas doctors. So few posts
would be available to British graduates that
massive unemployment would result, while
funds that are vitally needed for consultant
expansion would be tied down. A change in
the proportions of consultants and registrars
is inescapable, and a Joint Consultants Com-
mittee working party is near to agreeing a
mechanism for bringing this about that should
be acceptable to all parties.
This, in coniunction with the sponsorship
scheme, holds out the hope of a solution to
the current problem; the sponsorship scheme
on its own cannot provide such a solution.
STEPHEN BREARLEY
Chairman
Hospital Junior Staff Committee,
BMA House,
London WC1H 9JP
SIR,-Mr David Innes Williams and Dr Alex
Paton (19 November, p 1492) highlight clearly
the problems of overseas doctors and also
suggest a solution through a National Overseas
Doctors' Sponsorship Organisation. While
fully supporting such scheme I nevertheless
believe that posts created under the sponsor-
ship scheme could work out to the advantage
of overseas doctors only if equal opportunity
and equal responsibility are attached to these
posts; otherwise such a scheme will create
the same parallel unattractive training for
overseas doctors it is designed to eliminate.
To my mind one way of safeguarding against
this possible outcome would be to have a
regular and organised rotation between the
parallel posts in the particular specialty
concerned.
Moreover, though such a sponsorship
scheme is a welcome suggestion for the future,
I am afraid the immediate problem faced by
many hundreds of overseas doctors is their
five years' limited registration which will finish
in February 1984; the irony of it is that if by
that time they fail to obtain full registration
they will cease to have any registration at all.
Unfortunately, many of these doctors have
held temporary and then limited registration
for 10 to 12 years already, providing in-
dispensable service to the National Health
Service, and fell into the five year rule of
limited registration only in 1979.
Perhaps it may be practicable for an overseas
doctor to return to his country of origin after
five years, but I am not sure he could do so
after 10 or 12 years and I feel that such overseas
doctors also deserve a better deal from the
profession.
M SHAUKAT ALI
President,
Bangladesh Medical
Association in the UK
Greenwich District Hospital,
London SE10 9HE
SIR,-Besides failing to address themselves to
the career problems harassing the overseas
doctors already working in this country,
Mr David Innes Williams and Dr Alex Paton
have contradicted themselves in prescribing
their utopian deal for overseas doctors. The
central theme of their proposals is the
availability of "an excess of junior posts with
training facilities," but by their own admission,
"if more British doctors continue to enter
popular specialties ... overseas doctors will
be forced into taking posts which are not of
their choosing." What mechanism, may I ask,