Postgraduate Medical Journal

EDITORIAL BOARD

D. BarltropD.G. BeeversI. ChanarinK.M. CitronD.J. ColtartA.H. Crisp

I.J.T. Davies

B.I. HoffbrandEditor

C.D.M. DrewH. Ellis

R. GouldingJ.P. HopewellD. IngramH.S. JacobsD.G. JamesR.S. Kocen

L. KreelJ.G. LewisJ.S. MalpasA. PatonP. Turner

R.G. TwycrossD. Innes Williams

Editorial Representativefor AustraliaJ.R. Lawrence

Editorial Representativefor CanadaP. Tugwell

Editorial Representativefor USAM. Moser

Editorial AssistantMrs J.M. Coops

Volume 62, Number 733November 1986

-rn-I.£"

The Postgraduate Medical Journal is publishedmonthly on behalf of the Fellowship ofPostgraduate Medicine by the Scientific & MedicalDivision, The Macmillan Press Ltd, Houndmills,Basingstoke, Hampshire, RG21 2XS, UK.Telephone: Basingstoke (0256) 29242

Postgraduate Medical Journal publishes originalpapers on subjects of current clinical importanceand welcomes review articles with extensive, up-to-date bibliographies as guides to further reading.Several symposia are published each year, eachdevoted to a single subject and written byspecialists in different disciplines. Most issuesinclude authoritative current surveys of clinicalproblems, well documented reports ofcases ofparticular interest, and book reviews. Aninternational Postgraduate Diary is also includedeach month.

The Fellowship of Postgraduate Medicine wasfounded by a group ofLondon 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 provide amonthly review of all branches ofmedicine.

©) 1986 The Fellowship ofPostgraduate MedicineISSN 0032- 5473

Manuscripts and all editorial correspondence,including books for review should be sent to: TheEditor, 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 Editor reservesthe right to make changes which may clarify orcondense papers where this is considered desirable.The Journal is covered by Current Contents,Biological Abstracts, ASCA, ISI/BIOMED andScience Citation Index.

All business correspondence, reprint requests andenquiries concerning advertising space & ratesshould be addressed to the Scientific & MedicalDivision, The Macmillan Press Ltd, Houndmills,Basingstoke, Hampshire RG21 2XS.

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All rights ofreproduction are reserved in respect ofall papers, articles, illustrations, etc., published inthis journal in all countries of the world.

Authorization to photocopy items for internal or

personal use, or the internal or personal use ofspecific clients, is granted by The Fellowship ofPostgraduate Medicine for libraries and otherusers registered with the Copyright ClearanceCenter (CCC) Transactional Reporting Service,provided that the base fee of $01.00 per copy, plus0.10 per page is paid directly to CCC, 21 CongressSt., Salem, MA 01970, USA.0032- 5473/86 $1.00 + 0.10

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Circulation Services: A.L. Clark

Filmsetting by Vantage Photosetting Co. Ltd.,Eastleigh and London and printed in Great Britainby Unwin Brothers Ltd, The Gresham Press, OldWoking, Surrey.

Whilst every effort is made by the publishers and editorial board to see that no inaccurate or misleading data, opinion or statement appears in this Journal, they wish tomake it clear that the data and opinions appearing in the articles and advertisements herein are the reponsibility of the contributor or advertiser concemed.Accordingly, the publishers and The Fellowship, the editorial committee and their respective employees, officers and agents accept no liability whatsoever for theconsequences ofany such inaccurate or misleading data, opinion or statement. Whilst every effort is made to ensure that drug doses and other quantities are presentedaccurately, readers are advised that new methods and techniques involving drug usage, and described within this Journal, should only be followed in conjunction withthe drug manufacturer's own published literature.

Postgraduate Medical Journal (1986) 62, 1065

Conference Report

Joint meeting US and UK Associations of Physicians

The Association of American Physicians (AAP) iscelebrating its centenary this year, so they kindlyinvited the Association of Physicians of Great Britainand Ireland to partake in these celebrations duringMay 1986. The AAP was founded in New York Cityby seven distinguished American physicians - FrancisDelafield, William Draper, George Peabody, RobertEdes, William Pepper, William Osler and JamesTyson. Each of these seven was a distinguishedclinician and they have all attained immortality fortheir contributions in different disciplines of medicine.Their contributions and their photographs are nowrevived in Professor A. McGehee Harvey's splendidcentennial volume published as A Century ofProgressin Medical Science. The founders decided that this newsociety should meet annually, and limit themselves to100 members from the United States and Canada.The first meeting was held in Washington so it was

appropriate that the centenary meeting this year wasalso in this lovely capital city. The 1886 communica-tions included: Knee-jerk and muscle-jerk in disease;Typhoid fever; Spasm of the larynx in rickets; Aclinico-pathological correlation of rheumatism, gout,diabetes and chronic Bright's disease; Diaphragmaticpleurisy; Certain elements found in the blood ofmalarial fever; Tabes dorsalis; Diseases of the appen-dix caeci; Peri-uterine inflammation; Glomerulo-nephritis; Bicuspid condition of the semilunar valves.By way of contrast, this year's meeting was heavily

into molecular biology, recombinant DNA, geneticsand the gravity of typhoid fever was replaced by thehorror of AIDS.

Harvey's centennial volume has a fascinating chap-ter on the benefactions of George M. Kober who isquoted '. . . It has been truly said that a single flowerin a man's buttonhole is worth a ton of roses piledupon his grave'. He was a German from the Duchy ofHessen who migrated to the USA when aged 16 yearsand eventually became assistant to Dr John S. Billingsin the library of the Surgeon General. Kober assistedBillings in his creation ofthe Index Medicus catalogue,using his native language helpfully with the Germanmedical literature. Eventually he became an army

surgeon, professor of hygiene at Georgetown Univer-sity, founder of the national tuberculosis association,and a member of the AAP. He created an endowmentfund to award a George M. Kober Medal annually to amember of the AAP who has contributed to theprogress and achievement of the medical sciences orpreventive medicine. The first medallist was Dr Nogu-chi, followed over the years by Theobald Smith,William Welch, Minot, Herrick, Joslin, Mallory,Whipple, Van Slyke, Goodpasture, Dubois, Long-cope, Dochez, Kendall, Peyton Rous, Arnold Rich,Robert Loeb, Castle, Beeson and McGehee Harvey,all giants of American medicine. Helen Taussig waschosen as the recipient of this distinction at the 1987meeting to be held in San Diego. In her ninetieth year,she attended this year's dinner in Washington andreceived a standing ovation from the 400 diners at theCorcoran Gallery of Art. She died two weeks later.The Annual Dinner is an important part of the

meeting, enjoyed by members only. A few distingui-shed foreign guests are occasionally invited. Thisscarce privilege was generously afforded to membersof the Association of Great Britain and Irelandattending this year's meeting. James Means once madea tantalizing entry in his diary 'Dinner in the evening,speeches by Flexner, Popsy Welch and Councilman -Absolutely priceless!' This year's dinner was equallypriceless - Salmon, veal, cheese; music by theMaryland Flute Quartet; speeches by Stanley Peart,McGehee Harvey and Lewis Thomas.The limited membership of 100, so jealously guar-

ded yesteryear has swelled to 700 members from theUnited States and Canada, and a few very specialhonorary members. It remains a blue riband member-ship much in the same way as its British oppositenumber, which is also one of its offshoots. WilliamOsler was one of the founders of the AmericanAssociation and he played a large part in founding theAssociation ofGreat Britain and Ireland in 1907, soonafter his arrival in Oxford. Both societies were proudof this year's successful joint venture. It is now up to usto return the compliment.

D.G. James, M.A., M.D., F.R.C.P.,Royal Northern Hospital,

London N7 6LD, UK.

c) The Fellowship of Postgraduate Medicine, 1986

Reference

THE ASSOCIATION OF AMERICAN PHYSICIANS1886-1986. (1986). A century of progress in medicalscience, by A. McGehee Harvey. Waverly Press: Bal-timore.

BOOK REVIEWS 1073

enthusiasm according to taste but without doubt the growthin public participation in 'fitness' makes it essential for the upto date rheumatologist to recognise sport-induced syndromesamong his patients - but I failed to find anything new in thischapter. A section on say, crystal arthropathies, might havebeen more valuable. Similarly the chapter on Rehabilitationof Rheumatic Patients fails to tell us anything new andcontrasts with others in having a number of entirely super-fluous photographs which will have helped only to make thevolume more expensive than others in the series. There is littlesign that proper evaluation of physical treatments is neces-sary let alone that it is being done. Curiously it falls to theauthor of a concluding chapter on Fringe RheumaticTherapy to cover this area in relation to ultrasonic therapy.Unfortunately this comes as part of a misconception that'The Chartered Society of Physiotherapy has aligned itselfwith alternative medicine' whereas as the CSP briefings makeclear physiotherapy is and has long been an option availableto patients within orthodox medicine and does not exposethem to the quackery of fringe practitioners.

I found this a readable and engaging addition to the series;it inspired, informed and infuriated me by turns and thusachieved its aim; the most experienced rheumatologist willfind refreshing new ideas. It will be of value to those intraining and even more to those hesitating on the threshold ofthis exciting speciality who will be impelled to enter. It will bean essential purchase for every postgraduate and hospitallibrary.

Anthony G. WhiteDepartment of Rheumatology,

The Royal Free Hospital,London NW3 2QG.

Tics and Related Disorders, by A.J. Lees. Clinical Neurologyand Neurosurgery Monographs. Vol. 7. Pp. vii + 276, illus-trated. Churchill Livingstone, Edinburgh, London, Mel-bourne, New York, 1985. £30.00.

In recent years the expansion of knowledge into pathologiesunderlying disorders ofmovement has confronted neurolog-ists with a wealth ofnew information which is often complexand confusing to those without specific experience in thisfield of neurology.The clinical and scientific content ofthis monograph is well

presented. Following an initial classification each tic anddisorder of movement is defined and its historical back-ground reviewed. The clinical descriptions are superb, par-ticularly in the chapters covering the Gilles de la TouretteSyndrome and focal dystonias. The complexities of theunderlying neurochemical changes and pathophysiology areclearly presented. The current treatment, both medical andneurosurgical, of these often intractable conditions is com-prehensively reviewed.

This book is undoubtedly well written and enhanced by theinclusion of well researched quotations and the chapter oncelebrated ticqueurs. It will surely be received with acclaimand Dr Lees is to be congratulated for providing a muchneeded source of neurological reference as well as one of themost readable and enjoyable of specialist textbooks.

John JesticoEssex Regional Neurology Unit,

Oldchurch Hospital,Romford,

Essex.

Books Received

Annual Review ofPublic Health. Vol. 7, 1986, edited by LesterBreslow, Jonathan E. Fielding and Lester B. Lave.Pp. viii x 566 illustrated. Annual Reviews, Palo Alto,California, 1986. $31.00 (USA), £34.00 (elsewhere). Pricesinclude postage and handling.

Basic Principles of Auditory Assessment, by Maureen Han-nley. Pp. xiii + 235, illustrated. Taylor & Francis, London,1986. £19.00.

Diagnostic Bronchoscopy: a Teaching Manual, Fifth edition,by Peter Stradling with the assistance of John R. Stradling.Pp. vi + 182, illustrated. Churchill Livingstone, Edinburgh,London, Melbourne, New York, 1986. £40.00.

Essentials of Clinical Anatomy, by Ralph Ger and PeterAbrahams. Pp. vii + 530, illustrated. Pitman, London, 1986.£24.95.

Handbook of Clinical Phonology: Approaches to Assessmentand Treatment, by Mary Elbert and Judith A. Gierut.Pp. xi + 170, illustrated. Taylor & Francis, London, 1986.£15.00.

Handbook of Voice Therapy for the School Clinician, byWilliam R. Leith and Robert G. Johnston. Pp. xv + 189.Taylor & Francis, London, 1986. £15.00.

IC-Process-PC (International Classification of Process inPrimary Care). Prepared by the Classification Committee ofWONCA (World Organization of National Colleges,Academies, and Academic Associations of General Prac-titioners/Family Physicians) in collaboration with the Clas-sification Committee of NAPCRG (North AmericanPrimary Care Research Group). Pp. i + 61. Oxford Univer-sity Press, Oxford, New York, Tokyo, 1986. £8.50.

Manual of Chest Medicine, by John E. Stark, John M.

1074 BOOK REVIEWS

Shneerson, Tim Higenbottam and Christopher D.R. Flower.Manuals Series. Pp. iv + 255. Churchill Livingstone, Edin-burgh, London, Melbourne, New York, 1986. £9.95.

Practical Psychiatry ofOld Age, by John Wattis and MichaelChurch. Pp. x + 195, illustrated. Croom Helm, London,Sydney, 1986. £19.95 (hardback), £8.95 (paperback).

Primary Anaesthesia, edited by Maurice H. King. OxfordMedical Publications. Pp. ix + 169, illustrated. Oxford Un-iversity Press, Oxford, Delhi, Kuala Lumpur, 1986. £7.95.

Recent Advances in Gastroenterology, No. 6, edited by R.E.Pounder. Pp. v + 367, illustrated. Churchill Livingstone,Edinburgh, London, Melbourne, New York, 1986. £35.00.

Recent Advances in Sexually Transmitted Diseases, No.3,edited by J.D. Oriel and J.R.W. Harris. Pp. ix + 277, illus-trated. Churchill Livingstone, Edinburgh, London, Mel-bourne, New York, 1986. £35.00.

Routine Cytological Staining Techniques: Theoretical Back-ground and Practice, by Mathilde E. Boon and Johanna S.Drijver. Pp. xi + 238, illustrated. Macmillan, Basingstoke,1986. £25.00 (hardback), £10.95 (paperback).

Slide Interpretation in Oral Diseases and the Oral Manifesta-tions of Systemic Diseases, by Crispian Scully and JonathanShepherd. Oxford Medical Publications. Pp. iii + 156, illus-trated. Oxford University Press, Oxford, New York, Tokyo,1986. £11.95.

Smoking Out the Barons: the Campaign Against the TobaccoIndustry. A Report of the British Medical Association PublicAffairs Division. Wiley Medical Publication. Pp. vii + 192.John Wiley, Chichester, New York, Brisbane, Toronto,Singapore. Published on behalf of The British MedicalAssociation, 1986. £6.95.

Terminal Care at Home, edited by Roy Spilling. OxfordGeneral Practice Series 10. Pp. xi + 153, illustrated. OxfordUniversity Press, Oxford, New York, Tokyo, 1986. £10.50.

Textbook of Psoriasis, edited by Paul D. Mier and Peter C.M.van de Kerkhof. Pp. v + 292, illustrated. Churchill Living-stone, Edinburgh, London, Melbourne, New York, 1986.£45.00.

Transcultural Psychiatry, edited by John L. Cox.Pp. vii + 337, illustrated. Croom Helm, London, Sydney,Dover, New Hampshire, 1986. £29.50.

The Troubled Gut: the Causes and Consequences ofDiarrhoea,by Bryan Brooke. Pp. 172, illustrated. King Edward's Hosp-ital Fund for London. Distributed by Oxford UniversityPress, Oxford, 1986. £7.50.

Vocal Fold Histopathology: a Symposium, edited by John A.Kirchner. Pp. xi + 126, illustrated. College Hill Press, SanDiego. Distributed by Taylor & Francis, London, 1986.£35.00.

Postgraduate Medical Journal (1986) 62, 1075-1076

Postgraduate Diary

British Postgraduate Medical Federation

Liver disease course 15-19 December 1986Advanced course in gastroenterology 3-21 November 1986

(multicentre)Educational development courses - programme of coursesand workshops continuing until March 1987:

Seminar on a new paradigm for health education - 19, 20November.

GP Course Organisers' training workshop - 3 -4 December.

Central Office, 33 Millman Street, London, WCIN 3EJ, UK.

Institute of Basic Medical Sciences

Courses in Basic Medical Sciences suitable for FRCSPrimary and FFA Part 2, in Basic Dental Sciences suitablefor FDS Primary, in Anatomy suitable for FRCS Primary,and in Physiology and Pathology suitable for FRCSPrimary.

IBMS, Royal College of Surgeons, Lincoln's Inn Fields,London WC2A 3PN, UK

Institute of Cancer Research

Regular programme of seminars and teaching sessionsthroughout the year. Courses for DMRT (overseasstudents), FRCR etc

Information: The Dean, Institute of Cancer Research, DBlock, Clifton Avenue, Sutton, Surrey SM25PX

Cardiothoracic Institute

Course for diplomas in Cardiac Medicine and ThoracicMedicine - one year starting October 1986

Pharmacology of asthma - starting November 1986

Details: Cardiothoracic Institute, Fulham Road, LondonSW3 6HP.

Institute of Child Health

Developmental paediatrics- 1-2 weeks throughout the year

The Dean's Office, Institute of Child Health, 30 GuildfordStreet, London WCIN IEH

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, EastmanDental Hospital, Gray's Inn Road, London WCIX8LD

Institute of Laryngology & OtologyNasal plastic surgery - 3 days full time February 1987Facial soft tissue surgery- 3 days full time- February 1987Temporal bone surgery, advanced course. 7 days full time,November.

Applications and enquiries to the Dean, Institute of Laryn-gology and Otology, 330/336 Gray's Inn Road, LondonWCIX8EE

Institute of NeurologySandoz Foundation advanced lectures on clinical and ex-

perimental neurology. Each Wednesday evening through-out Academic Year

Details: Institute Registrar, National Hospital, Queen Square,London WCIN 3BG, UK

Institute of Obstetrics and Gynaecology

Neonatal course for senior paediatricians from abroad. 1-4December 1986

Teach-in on Obstetric Anaesthesia and Analalgesia - 19-21November

Symposium for midwives, health visitors and neonatal nurses- 28 November.

Details: The Secretary, Institute of Obstetrics and Gyn-aecology, Queen Charlotte's Maternity Hospital, GoldhawkRoad, London W6 OXG

Institute of Ophthalmology

Regular courses in ophthalmology held throughout the year

17/25 Cayton Street, London EC] V 9AT, UK.

Institute of OrthopaedicsRadiodiagnosis demonstrations- Mondays at 5.00 p.m.

during the academic yearRadiology of bones and joints - 2 days full time, November

Applications and enquiries to Professor of Orthopaedic Sur-gery, Jules Thorn Building, The Middlesex Hospital, Mor-timer Street, London WIP 7PN

Institute of PsychiatryLectures in preparation for DPM and MRCPsych. 10 weeks

part-time starting October

The Dean's Office, Institute of Psychiatry, De CrespignyPark, London SE5 8AF

Institute of UrologyShort courses on aspects of urology and nephrology -

throughout the yearUro-radiology meeting - 2 days full time, December

Applications and enquiries: The Dean, Institute of Urology,172-176 Shaftesbury Avenue, London WC2H8JE

Royal Postgraduate Medical School

Regular courses on advanced topics

School Office, Royal Postgraduate Medical School, Hammer-smith Hospital, Du Cane Road, London W12 OHS, UK.

International Union Against Cancer

Details of fellowship programmes from3 rue du Conseid-General, 1205 Geneva, Switzerland.

1076 POSTGRADUATE DIARY

Liverpool, Newsham General Hospital

Lunchtime meetings twice monthly

Secretary, Postgraduate Centre, Belmont Road, Liverpool, L64AF, UK.

London School of Hygiene and Tropical Medicine

Courses in community health, occupational health andpreventive medicine

The Registrar, LSHTM, Keppel Street, London WCIE 7HT,UK.

Loughborough University

Centre for Extension Studies.

Details: Anne Hill, Centre for Extension Studies, Lough-borough University, Loughborough, Leics LEJJ 3TU

XI World Congress on Sarcoidosis

Milan, 7-11 September 1987

Details from Dr D. G. James, Royal Northern Hospital,London N7 6LD

10th International Congress of PharmacologyAugust 23-28, 1987. Sydney, Australia

Details: The Secretariat, 10th IUPHAR Congress, GPO Box2609, Sydney, NSW 2001, Australia

International College of Nutrition

The annual conference will be held in January 1987 atMadurai.

Details: Dr R.B. Singh, 398 Civil Lines, Moradabad-10, India.

Ear, Nose and Throat Diseases in Children

13th Annual Symposium presented by Depts of Otolaryn-gology and Pediatrics, Children's Hospital of Pittsburgh.Palm Beach, Florida, December 3-7, 1986.

Information: Dept of Otolaryngology, Children's Hospital ofPittsburgh, 125 De Soto St, Pittsburgh, Pa., 15213, USA.

1987 International Symposium on Viral Hepatitis and LiverDiseaseThe Barbican Centre, London 26-28 May 1987

Information: Dr. R. Kohn, Advisory Services Medical Sym-posia Ltd., 79 Wimpole Street, London W1M 7DD

Centre de Recherche Pierre Fabre and Central National de laRecherche ScientifiqueInternational Symposium on New Concepts in Depression.Castres, France. March 18-20, 1987.Information: M. Briley, Symposium Secretariat, BiochemicalPharmacology Department, Centre de Recherche PierreFabrem 17 Avenue Jean Moulin, 81100 Castres, France

Barrow Neurological InstituteLST Annual Barrow Neurological Institute Magnetic Reson-

ance Imaging Conference. Marriott's Mountain ShadowsResort, Scottsdale, Arizona. February 22-25, 1987.

information: Toby Jardine, Special Projects Coordinator,Barrow Neurological Institute, 350 West Thomas Road,Phoenix, AZ 85103, USA

Brain Research Association/Alzheimer's Disease SocietyJoint meeting on Alzheimer's Disease. Southampton, July

22-24, 1987.

Information: John Hardy, Dept of Biochemistry, St Mary'sHospital Medical School, London W2 IPG, or PeterRoberts, Dept of Pharmacology, University of Southamp-ton, Southampton S09 3TU.

John Hopkins University School of Medicine28th Annual Postgraduate Institute for Pathologists in

Clinical Cytopathology. Feb. to April 1987 Home StudyCourse A. April 27 to May 8, 1987. In-residence Course B.

Details: J. K. Frost, M.D., 604 Pathology Building, The JohnsHopkins Hospital, Baltimore MD 21205, U.S.A.

European Medical Research Group (Young AEMIE)Poster Session and invited lecture. December 11, 1986 at

Lettsom House, 11 Chandos Street, London W. 1. 5.30p.m.to 7.30p.m.

Further detailsfrom: Dr D. R. J. Singer, cdo Fellowship ofPostgraduate Medicine, 6 St Andrew's Place, London NWJ4LB. Telephone. 01 935-5556.

Full details of the courses, meetings and symposia listedabove, and of others ofinterest to medical postgraduates, canbe obtained from the individual organizations.

Notice to Contributors

The Postgraduate Medical Journal considers manus-cripts prepared in accordance with the guidelines laiddown by the International Committee of MedicalJournal Editors (Br Med J 1982, 284: 1766-70). Allmaterial submitted is assumed to be submitted ex-clusively to the Postgraduate Medical Journal unlessthe contrary 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 (297mm x 210mm), with a 5 cm mar-gin. The first page of the 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.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 ofthe authorsand publishers concerned.Arrangement Papers should be divided into; (a) Titlepage, (b) Summary, (c) Introduction, (d) Materialsand methods, (e) Results, (f) Discussion, (g) Ackn-owledgements, (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. In thetext, they should appear as numbers starting at 1. Atthe 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 et al. Abbreviations for titles of medicalperiodicals should conform to those used in the latestedition of Index Medicus. The first and last page

numbers for each reference should be provided. Abs-tracts and letters must be identified as such.1. Clements, R. & Gravelle, I.H. Radiological

appearances of hydatid disease in Wales. PostgradMed J 1986, 62: 167-73.

2. Greenbeerger, 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 1I times the intended final size andshould be numbered as figures whether they arephotographs, representational drawings or linediagrams and graphs.Photographs and photomicrographs should be un-mounted 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 ffimsy overlay attached to thephotograph or on a photocopy. All annotations andlettering should be indicated in the same way, andpreferably not included on the original print. Clearlycontrasted and focused prints are essential for ad-equate reproduction.Linediams 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 freeofcharge 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 adversedrug reactions should be accompanied by evidenceshowing that the reaction has been reported on a'yellow card' or to the appropriate drug licensingauthority, and to the drug manufacturer.