not always sustained, while the modifications achievedin

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Journal of the Royal Society of Medicine Volume 87 April 1994

alike. After all it only means a teacher, and to a greater or lesser extent, we all have to teach. GEORGE E RAY Old 28 Ringshall Hertfordshire HP4 1ND, UK

Non-sexist grammar in medical literature Finn (March 1993 JRSM, p 184), sadly, was quick to 'stand corrected' for apparently not knowing that sex-neutral pronouns somehow are good and sex-positive pronouns are bad, or so the feminists have decreed. However, the improvements they have in mind for the English tongue would make your hair stand, assuming you care something about the language. Words (to use the term loosely barbarisms would be more accurate) that no caregiver but only a mother could love. 'Themself' is one particularly atrocious example. Orwell's Newspeak and Bowdler rolled into one. William the Conqueror had more respect for the English language than these modern worshippers of the epicene. JAMES KALIVAS 12300 Pawnee Lane Leawood, Kansas 66209, USA

George Frederic Still While delighted to learn that medical students are interested in the history of medicine (June 1993 JRSM, p 369), I could hardly believe my eyes when the first English paediatrician is described as George Frederick Still. I have before me Common Disorders and Diseases of Childhood by George Frederic Still'. That 'Frederick' is not merely a typing error is evident from the fact that it occurs three times on the same page. On a more personal note, I am indebted to Frederic Still when someone commented adversely on my bachelor status implying that I should not be a paediatrician, the late John Peter Mills Tizard remarked: 'And so was Still'. THOMAS STAPLETON

The Foundry Cottage Lane End, High Wycombe Buckinghamshire HP14 3JS, UK

Reference 1 Still George Frederic. Common Disorders and Diseases of Childhood, 3rd edn. Oxford: Oxford Medical Publications, 1915

Health promotion In a recent issue, pride ofplace was given to a paper by ILord Butterfield in which he extolled Health Promotion and uiged occupational physicians to join the campaign (December 1993 JRSM, pp 683-4). He surely could not have overlooked those real problems of occupational health, which still beset the workforce and which can be effectively resolved only by those practitioners who are specially and, might I add, uniquely trained and experienced for dealing with them. In this process, their recommendations may call for significant changes in the pattern of operations, possibly incurring, initially at least, some interference with productivity. No wonder that the response on the part of management is not always enthusiastic. On the other hand, the demands made by health promotion are financially minimal, seldom intrude directly into working activities and tend to create a caring image for the organization concerned. Manament, therefore, is supportive. Yet before already overburdened occupational physicians have their energies dissipated in this way, would it be unreasonable to enquire to what extent these schemes for Health Promotion have been critically and objectively appraised for the modifications they actually make to the morbidity and mortality among those engaging in them? In the same issue of the Journal, Brodie and Dugdill (December 1993 JRSM, pp 694-6) describe their efforts among a small group of motivated volunteers in Liverpool, for whom the changes achieved have been, in all conscience, minimal and not always sustained, while the modifications achieved in their chosen parameters for any real effect upon health are

no more than conjectural. Likewise, Vickers et aL (December 1993 JRSM, pp 697-8) report impressively on their findings from a breast cancer screening exercise, though they are honest enough to admit that 'The long-term effects of the UK swreening p a me on breast cancer mortality are not known'. Today, in the National Health Service, the slogan is 'audit'. It might be timely to apply this discipline to health promotion in all its various facets, heeding the cautionary words of Robert Boyle, that 'Sceptical Chymist', when he wrote of those who: were carried along by the genius of the age in which they lived, being satisfied with assertions instead of proofs, or, at least, often admitting as proofs the slightest degree of probability, unsupported by that strictly rigorous analysis which is required by modern philosophy. RoY GOULDING Keats' House, Guy's Hospital London SE1 9RT, UK

Unethical behaviour of Nazi doctors The paper by Drobniewski (September 1993 JRSM, pp 541-3) about the unethical behaviour of Nazi doctors asks, amongst others, the question why there was so little resistance from peers against medical atrocities. Several possible answers are given but one is neglected. It seems important to understand that many of the peers were 'exchanged' when the Nazi regime took over. For instance, in the medical faculty of Vienna more than 70% of all members were fired the moment the Nazi troops marched into Vienna in 1938. Obviously this change-over had very profound effects. It goes almost without saying that the 'replacements' of the former peers were chosen not according to medical quality but according to political 'trustworthiness'. After these drastic events, which in many cases ended with the death of the former faculty member, there were no more peers in the true and traditional sense. In other words, the evildoers amongst the medical profession had not just little resistance from above but rather much support from the newly instituted, high level 'superiors'. In view of this, the lack of peer intervention was an inevitable result. The events that took place in the medical faculty of Vienna of 1938 not only opened the door to atrocities taking place, but had additional sequelae which unfortunately lasted much longer than the Third Reich. The loss of peers meant an unprecedented loss of knowledge and authority which cannot possibly be filled in one or even two generations. Even after the war, faculty members instituted by the Nazis did everything to remain in place; the return of the survivors of the former colleagues was actively discouraged. Thus, the Nazi regime meant the end of the once famous school of medicine in Vienna and the persistence of a spirit that can be felt even today. E ERNST

Department of Physical Medicine and Rehabilitation Formerly: University of Vienna Wahringer Gurtel 18-20 1090 Wien, Austria Present address: Postgraduate Medical School University of Exeter, Barrack Road Exeter, UK

Exclusion diets Dr Hodson's letter (August 1993 JRSM, p 493) I regard as important, not only for its intrinsic merit but because, reporting one case only, you, Sir, had the percipience to publish. I approved his discussion paper (September 1992 JRSM, p 566) which I urged him to offer for publication, for his conclusions were very similar to my own. Although I have known him for more than a decade as a result of our shared interest in allergy, I remained ignorant of his own food intolerance, the publication of the details of which I regard as important as his objective studies of his patients, since I believe there is much to be learned from doctors reporting their own symptoms and their management. I am an allergic of long standing, having had recurrent 'bilious attacks' as a child, and frequent respiratory infections and occasional acute otitis media. In early adult life I developed recurrent sino-bronchitis, with in late life mild asthma, nasal catarrh, deafness, blepharitis and conjunctivitis, irritable colon, pruritus ani, and other