ContentsLord Hunt of Fawley................................................. 87NEWS* * R.J.F.H. Pinsent ............... .................................. 88New structure for College .89Wart Charming Stone; 'No Cost Computers .93Dispense with Confusion; Cancer education .94Editor: Nicola Roberts RCGP Examination.............. 95First GP President; New Year's Honours; Dr Edwin Martin.96

Lord Hunt of FawleyCBE, MA, DM Oxon, FRCP, FRCS, he organized the setting up of a diagnosticFRCGP X-ray unit. As the practice grew he had

JOHN HENDERSON HUNT, LordHunt of Fawley, who died on

December 28 at the age of 82, was one ofthe foremost GPs of his era, the leader ofthe movement which set and introducedthe highest standards in family medicine,and the chief begetter of the Royal Col-lege of General Practitioners.John Hunt was born in Hyderbad,

where his father was surgeon to theHyderbad State Railways, and to the Rulerand his family, with whom he alwaysmaintained a friendly professional con-nection. Some of his Indian experienceswere the basis of a lecture on the Fakirsof India, illustrated with truly gruesomelantern slides. He was educated atCharterhouse School, of which he laterbecame a governor, Balliol College Ox-ford, where he had a distinguished career,and St Bartholemew's Hospital. At Bartshe was appointed House Surgeon to Pro-fessor George Gask and later Chief Assis-tant to Professor Sir Francis Fraser. Afterworking as Chief Assistant in theNeurological Department at Barts, hebecame House Physcian at the NationalHospital for Nervous Diseases, QueenSquare, and became a member of theRoyal College of Physicians. He developeda particular interest in peripheral vasculardiseases, and later wrote on them inseveral publications.

But it was already becoming clearbefore the Second World War that Hunt'sbroad interests were leading him towardsgeneral practice, and a year or two beforewar broke out he joined Dr GeorgeCregan in his Chelsea practice. During thewar he served in the RAF, where hebecame a Wing Commander MedicalSpecialist. Afterwards he returned togeneral practice and started on his own at54 Sloane Street, which later became thesecond headquarters of the College ofGeneral Practitioners. Here he installed asmall pathological laboratory, staffed bya technician with whom he had workedin the RAF, and in the mews house behind

several assistants and eventually formeda partnership that prospered until hisretirement.

His practice was one of the largest inLondon and attracted patients from allwalks of life and from all parts of theworld. The depth and breadth of hisknowledge of medicine and of people,together with his infinite capacity for pur-suing any turn of thought which wouldbenefit his patients, marked him as an ex-ceptional doctor by any standards. His

patients knew his wise and kindly counsel,and his colleagues recognised his clinicalskill and judgement, which helpedspecialists and other family doctors alike.Those who were fortunate enough to workwith him in his practice drew continuallyon his strength of character and immenseexperience; no problem was too small forhim to discuss and give advice, all leaven-ed with those well-remembered gusts oflaughter which relieved moments of ten-sion and anxiety. Above all, he had therare gift of inspiring excitment andanticipation.

But there was also in his character asingle-minded determination that wouldbrook no obstruction, together with a wily

sense of how men and events could be in-fluenced. After the Second World War,when the National Health Service was be-ing planned, the position of GPs wasoften uncertain and unsatisfactory. Thenotion of an academic body to promotethe efficiency of general practice had beenput forward as long ago as 1844, butwidespread efforts came to naught. Withthe advent of the National Health Servicea new purpose was seen in uniting thewidely-felt aspirations of many GPs, tobring order out of disorder through a col-lege of their own. Following a crucialmeeting at the BMA in October 1951,John Hunt and Fraser Rose wrote a let-ter which was published in the BritishMedical Journal and the Lancet propos-ing 'a possible College of General Prac-tice'. Memoranda from them both werepublished two weeks later and much com-ment, both favourable and unfavourable,was provoked. Many influential people,even some close colleagues, and in par-ticular the Presidents of the royal colleges,expressed their opposition to the wholeproject, but the newly-formed SteeringCommittee which was chaired by SirHenry Willink with Hunt as secretary,pressed on undeterred with its plans. On19 November 1952, after the most carefulconsultations, a Memorandum andArticles of Association of the College ofGeneral Practitioners were signed by themembers of the Steering Committee andthe Committee's Report was published amonth later.There was widespread support for the

initiative from both medical and laysources, and within six months of its foun-dation the College had been joined byover 2000 doctors. It would be fair to saythat, of the many men and women whohad worked so hard to form the College,none had worked harder or displayed suchdetermined leadership as the Secretary ofthe Steering Committee and the firstHonorary Secretary of Council, JohnHunt. His work in developing the role ofthe College in this country and extendingits influence across the world, was to con-tinue for the rest of his professional life,Continued on page 88

Journal of the Royal College of General Practitioners, February 198887

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R.J.E.H. PinsentOBE, MA, MD, FRCGP

DOBERT John Francis Homfray Pin-sent, known to all as Robin, died sud-

denly and unexpectedly on Christmas dayat his home in Devon. He was born 71 yearsago and spent his childhood in the villageof Horrabridge where his funeral was held.He received his medical education at SelwynCollege, Cambridge, and Charing CrossMedical School before serving in the RoyalArmy Medical Corps. After demobilizationhe entered practice in Birmingham two yearsbefore the National Health Service beganbut soon moved into partnership with DrLaurie Pike and built up a group practicewhere he stayed until retirement in 1978. Heput an immense amount of effort into thepractice and soon it developed a reputationfor quality of clinical work and innovativeideas with supporting staff, patient par-ticipation and practice organization. To thiswas added research and undergraduate andpostgraduate teaching and the practicebecame a teaching practice of the Depart-ment of General Practice at BirminghamUniversity.

Doctor George Macfeat of Lanarkshirepublished a paper in the British MedicalJournal in 1951 suggesting the formation ofa royal college of general practice and, partlyas a result of this, Fraser Rose and John

Hunt sent letters to the British MedicalJournal and the Lancet inviting suggestionsabout this proposal. Robin Pinsent was oneof those who responded early and he wasinvited to join first the steering group andthen the Foundation Council. He played theseminal role in making research a centralfeature of College activity and he remainedin this position for nearly 30 years. He hadalready demonstrated his ability to enthuseothers as a student when, for example, hehad organized his fellows to prepare thedefence of Charing Cross Hospital against'flying bombs' and rockets, so it was quitetypical that he should have convened the firstmeeting of the Research Committee of theFoundation Council in Bath in March 1953.Here the initial steps were taken in two Col-lege ventures whose subsequent success owedmuch to his drive, a research newsletter thatafterwards grew into the Journal and a studyof morbidity that grew into the three na-tional morbidity surveys published between1958 and 1986.

Robin's genius was for inspiring others.He had a great talent for organization andwas a master at encouraging others to takethose first few uncertain steps into research.Once that was done they were committed butnot abandoned for he was ever ready withhelp and advice. He was a modest man andmuch of the research that he inspired was

published by others so his name does not oc-cur as often in references as it should buthe was not only the 'godfather' of generalpractice research in this country but inCanada, the USA and Australia as well. Hewas never undervalued by those who werelucky enough to work with him and his gen-tle courtesy and unfailing politeness werecombined with a penetrating intellect whichmade a lasting impression.

His doctoral thesis, obtained from generalpractice in 1971, was an early example of thepainstaking and systematic recording thatmarked much of College research during themany years that he was Research Advisor tothe College. He gave the James Mackenzielecture in 1962, was invited to give the Vic-tor Johnson Oration in Canada, was award-ed the OBE in 1970 and the Baron Dr VerHeyden de Lancey Award in 1977. He hada total laryngectomy for carcinoma andshowed enormous courage by continuing towork and to speak publicly until his retire-ment. Even here his concern was for othersand he tried, with Jack Hawkins, to producea teaching book and tape to help other suf-ferers with oesophageal speech.He spent nine happy years in retirement

in his beloved Tamar Valley, still stimulatingothers in research, but mainly thinking,fishing, gardening and enjoying the com-pany of Ruth who had supported him andthe College so much. He leaves a family ofone son and three daughters and the Col-lege has much cause to be grateful for hislife. f

Michael Drury

Continued from page 87

Lord Hunt of Fawleymost notably as Honorary Secretary ofCouncil from 1953 until 1966, and later asPresident from 1967 until 1970.

It was just before he became Presidentthat Her Majesty The Queen graciouslygranted the Royal Prefix, and the Collegebecame the Royal College of General Prac-titioners. The Royal Charter followed in 1972when His Royal Highness Prince Philip,Duke of Edinburgh, was appointed anHonorary Fellow and elected as Presidentfor the following year, following which hebecame Patron of the College.The story of the first 25 years of the Col-

lege is told in A History of the Royal Col-lege ofGeneral Practitioners, edited by JohnHunt with John Fry and Robin Pinsent, thelast of the many publications for which hewas wholly or in part responsible. It waspublished in 1983, two years after his retire-ment, after which failing health frustratedhis wish to write more. The History isnecessarily concerned more with the Collegethan with individuals, but much of it ismarked with John Hunt's particular blendof clarity and humour. Although in Who's

Who he only listed gardening under 'hob-bies' (and his garden at Fawley gave himgreat pleasure), he was heard more than onceto declare that the College was his realhobby.He was honoured many times by medical

and lay organizations throughout the world.The award of the CBE in 1970, as he finishedhis three years as President of the College,was followed three years later, to the delightof his friends and colleagues all over theworld, by his elevation to the House ofLords. In the Upper House he spoke withthe wisdom of wide experience in manydebates on medical affairs, and the prepara-tion of each speech was marked by the samescrupulous research and consultation thatcharacterized all his orations. His LloydRoberts Lecture 'The Renaissance of GeneralPractice' delivered in 1957 was, in manyways, the keynote speech of his life, for itwas uncannily prescient in its proposals forthe future work of the College and of GPs.And in that lecture, discussing and gentlydeflating the popular notion of the 'bedsidemanner', he epitomized his own approach

to his patients as he said: "Its components,I think most people will agree, are personalinterest, kindness, sympathy, friendliness,understanding, cheerfulness and humour".Perhaps unconsciously he was describing hisown personality, ethos and example.

In all his busy life John was singularly for-tunate in the help and support of his wife,Elizabeth, whom he married in 1941. Shebore even more than the usual burden of adoctor's wife, for not only his large practicebut his work for the College and his writingand travelling made immense inroads on histime. They had five children, two daughters,a son who sadly died in early childhood, andtwin sons, both of whom are GPs, one inhis father's own practice.John was unique in British medicine, and

the effects of the work he did to secure therenaissance of general practice have extendedround the world. The College that resultedfrom his leadership will always rememberhim with admiration, gratitude and affec-tion, and must continue to strive for thehuman, clinical and academic standards ofwhich he was himself the example. LI

Michael Linnett

A Memorial Service of Thanksgivingfor thelife and work ofJohn Hunt will be held atAll Souls, Langham Place, London SW], at1.00 pm on Wednesday 16 March.

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Reorganization at the

College

THIS month sees the first part of ashort series which looks at the Col-

lege, its divisions and committees. Dr BillStyles introduces the series by putting therecent divisional changes into context.

In November 1985 the College publish-ed its policy statement Quality in GeneralPractice,I and throughout 1986 preparedits response to the Govern-ment's discussion paper onprimary health care Thiswas published in March1987 as The Front Line ofthe Health Service.2 Both _these documents presentedimportant policies. In thelight of these, and the dif-ficult events surrounding _the MRCGP examinationin 1986, Council undertooka review of the constitu-tional arrangements withinthe College during 1987.The aim of this was toclarify lines of responsibili-

ty and authority within theCollege and to ensure moredemocracy in its electoralprocesses. At the same

time, the divisional struc-ture of Council was review-ed. This paper gives detailsof the changes that wereagreed and the responsibili-ties of the new divisions.

Some have questionedwhether a reorganization ofCollege structure wasnecessary at this stage giventhat the previous divisionalstructure had been estab-lished only six years before.

Alvin lbffler in his bookFuture Shock3 has com-mented on the need fororganizations to modifytheir structure at relativelyfrequent intervals in res-

ponse to rapidly changingneeds. He states that, in a world ofchange, reorganization is a continuingprocess and that for many large industrialcorporations this results in a majorrestruduring every two years or so. For theCollege, the last few years has been a timeof considerable and rapid change. Ours isan organization whose membership sizeincreases by about 1001 every year our

membership has doubled in the last sevenyears. There are changes in the disciplineof general practice - as a more preven-tive approach is developed, as the resultsof clinical research are incorporated intopractice, as a more multidisciplinarysystem is developed and as modern infor-mation technology, and in particular

creases in the financial resources madeavailable to faculties through the facultydevelopment fund, so that now almosttwo-thirds have paid administrativeassistance to support local College work.A review of the last 10 years of annualCollege reports highlghts the considerableincrease in the volume of work undertaken

throughout the College.

The CollegeRestructuringIn considering proposalsfor a new divisional struc-ture, Council reaffirmed

w the main task of the Col-lege to encourage high stan-

dards of care for patients.It agreed that the Collegeshould continue to supportGPs throughout theircareers, from vocationaltraining to continuingeducation, throughout alifetime in practice. TheCollege should adopt a

positive approach with theemphasis on defining and

promoting good care.

Council wish to encouragefaculties to develop theirroles further in this such

a development would bevery important, since muchof the work could beundertaken only by localcolleagues working to-gether. Council agreed at

the outset that any reviewof the role of divisions andtheir terms of referenceshould ensure that thedefinition and promotionof good general practice re-mained a top Collegepriority.

computers, is incorporated into practices.This has been reflected in the high inten-sity of work within the College inagreeing policy, in responding to theGovernment's green paper on primaryhealth care and in developing the range

of services and educational opportunitiesavailable to members. In the last fouryears there have been considerable in-

Council and theGeneral PurposesCommitteeBefore considering the remit of its divi-sions, Council reviewed its own role andthat of its General Purposes Committee(GPC). It reaffirmed that Council should

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continue as the democratically electedgoverning body of the College, accoun-table to the membership of the Collegewho elect it. Council should continue tobe responsible for all major policy deci-sions and for the development and im-plementation of College policy.The GPC should continue as the ex-

ecutive arm of Council. In fulfilling thisresponsibility, it should continue to meetfor a whole day each month, and shouldbe responsible for carrying out Council'spolicies and for dealing with all urgentbusiness on behalf of Council. The workof divisions and committees of Councilwould continue to be coordinated hereThe GPC should be directly accountableto Council and should report to it at eachmeeting on action that it has taken onCouncil's behalf. In order to ensure suchaccountability, its chairman should, ashitherto, continue to be the Chairman ofCouncil.

Council agreed that the membership ofthe GPC should be as follows:* The five officers of the Council

(Chairman, Vice-Chairman, DeputyVice-Chairman, Honorary Treasurerand Honorary Treasurer of Council)

* The three divisional chairmen* The Chairman of the Examination

Board* Five members of Council elected by

Council itself.The President of the College also attendsGPC meetings.There are two differences in this com-

position from previous arrangements.First, divisional chairmen would no longerbe officers of the College. This change wasmade because in the past not all divisionalchairmen have wanted to be officers of theCollege. Also, there might be cir-cumstances when the most suitable can-didate for the chairmanship of a divisionmight not be able to undertake the timecommitment which being an officerinvolves.

Secondly, a new officer post was in-troduced that of Deputy Vice-Chairman. The posts of Vice-Chairmanand Deputy Vice-Chairman were intend-ed to be those of 'ministers without port-folio'. The responsibilities of these officerswould include the assistance and advisingof the Chairman of Council and wouldalso provide officers who would be ableto undertake specific areas of responsibili-ty that would be identified during theirperiod in post.

DivisionRestructuringThe introduction of divisions into thestructure of the College in 1981 has prov-ed to be an important and valuable reformof the Colleges structure. The divisions

are major organizational units and eachhas important coordinating functions.They bring together aspects of College ac-tivity which relate together and enableCouncil to delegate large sections of itswork. Each has a key role in policy for-mation within Council and for this reasonCouncil agreed that each divisional chair-man should continue to be a member ofits GPC ex officia Council also agreedthat the divisional chairmen should beelected by Council from its own member-ship and in this way the accountability ofeach division to Council should bemaintained.The responsibilities of divisions should

reflect priorities within the College. Theseresponsibilities will have to be adjustedfrom time to time to take account ofchanging circumstances and changingCollege priorities. Divisions should,therefore, be regarded as flexible struc-tures whose size and areas of responsibili-ty can be varied to tackle the main Col-lege targets of the day.

Council agreed that from November1987 there should be three divisions withinthe College, and that they should be asfollows:* The Clinical and Research Division* The Services to Members and Faculties

Division* The Education Division.

The Clinical andResearch DivisionIn establishing this division, Council wish-ed to reflect its view that clinical care, inthe widest sense, should be seen as themain focus for the College's work. The

need to analyse and to develop goodgeneral practice is central to the pursuitof the policies presented in 1985 in Qualityin General Practice.I Such developmentshould be based on the results of soundresearch hence the link between clinicalcare and research is a logical one in fulfl-ing the responsibilities of this division.The College was founded primarily to im-prove clinical care, and in working towardsthis Council established this division withthe following terms of reference:1. lb advise Council about all policies

and protocols for the care of patients,including practical measurements ofclinical performance in generalpractice.

2. To coordinate climcal advice from theCollege, including preventive and an-ticipatory care.

3. To assist the Honorary Secretary ofCouncil in preparing evidence onclinical topics on behalf of the Collegefor outside bodies.

4. To ensure that clinical advice from theCollege is consistent with other clinicalpolicies.

5. To devise practical measures of perfor-mance review for clinical care and en-courage their use in day-to-daypractice.

6. lb advise Council on all mattersrelating to research and to carry outsuch policies as Council shall fromtime to time determine.This division will provide the College

with a forum in which clinicaldevelopments can be considered, andpriorities for action determined.

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The Services toMembers andFaculties DivisionIn addition to clarifying matters of clinicalcare, the College will always have todevelop a range of services to help itsgrowing number of members do theirwork better. The College Journal andother College publications will continueto report on research and new ideas anddevelopments in the discipline of generalpractice. The need to develop informationsources and data banks will continue togrow. The College will have to provide apackage of services, including high qualitypublications and information services, in-cluding the College library and the on-linesearch facility.The need to develop more local College

services and activity has been recognizedby Council and this division will haveresponsibility for continuing the task offaculty development that was started bythe Faculty Liaison Group.

Council established this new division inplace of the Communications Divisionand agreed that its terms of reference shallbe:

1. To advise Council on all mattersrelating to members and faculty ser-

vices, with a view to building up thefaculties in order to carry out suchpolicies as Council shall from time totime determine.

2. To advise Council on all matters con-

cerning the College publications, in-cluding the Journal, but excluding thecontent of the Journal and the contentof occasional papers.

Dr David Murfin, Chairman, Services to Members and Faculties Division.

The EducationDivisionThe original divisional structure includ-ed the Education Division and Councilagreed that this division should continuein future. It should be responsible for ad-vising Council on all matters relating toeducation, including advising about theGeneral Medical Council, the Joint Com-mittee on Postgraduate Training forGeneral Practice, and the otherpostgraduate educational organizations.

In its policy statement Quality inGeneral Practice, I the College hadpresented the need to encourage higherstandards of patient care by incorporatingperformance review as an everyday prac-tice activity. Council identified the needto make continuing education relevant

Dr Bob Colville, Chairman, Education Division.

and practical by linking it to measuredperformance in the practice setting, andfor this reason it allotted to the Educa-tion Division the responsibility fordeveloping and coordinating all aspects ofperformance review within the College.

The ExaminationBoard of CouncilThe relationship between the Panel of Ex-aminers and the Council of the Collegehad been at the heart of the difficultiessurrounding the MRCGP examination in1986. At its meeting in September 1986,Council established a working party withthe following terms of reference:

'To consider the place of the MRCGPexamination within the College and therelationship between the examinationand the Panel of Examiners, theMembership Division and Council'.

This working party was chaired by thePresident, Professor Michael Drury, andits other members were Dr Colin Waineand Professor John Walker. Councilreceived the report of this working partyat its June 1987 meeting, the occasion ofits first discussions on the Collegerestructuring.The working party report highlighted

the need to bring the body of examinersclosely into the structure of the Collegeand into contact with Council. In orderto achieve this, Council agreed inSeptember 1987 that an ExaminationBoard of Council should be. establishedwith the following remit:1. The selection, training, appointment

and retirement of examiners, togetherwith the monitoring of examinerperformance.

2. The assessment of written examinationpapers and marking schedules.

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Dr John Ferguson, Chairman, Examination Board.

3. The definition of the subject matter ofthe oral examinations.

4. The maintenance of validity andreliability of the written and oral com-ponents of the MRCGP examination.

5. The maintenance and development ofthe examination.

6. Responsibilities relating to other ex-aminations, such as the DCCH, theDRCOG and the Diploma of FamilyMedicine (RCGP/Kuwait).At its December 1987 meeting, Coun-

cil agreed that the composition of its Ex-amination Board should be as follows:* Chairman of the Examination Board

of Council to be elected by Council* Four other members of Council to

be elected by Council* Convenor of the Panel of Examiners

to be elected by the Panel ofExaminers

* Three members who are examinersto be elected by the Panel ofExaminers.

Council also agreed that the Convenorsof the four separate sections of theMRCGP examination should sit on thisBoard as observers.

Other Committees ofCouncilDuring the year Council established othercommittees with specific remits. These in-cluded the International Committee, withresponsibility for 'promoting the objec-tives of the College through its relation-ship and activities with primary care out-side the United Kingdom', and the Com-mittee on Ethics whose remit is to 'con-sider the ethical problems that are en-

countered by the College and to makerecommendations to Council on how bestto respond to them'

Other committees, that is, Finance,Awards and Fellowship remainunchanged.

Absk ForcesIn developing its new divisional structure,Council emphasized the need to allow for'task forces' to undertake specific ac-tivities. Council proposed that each divi-sion should have a series of task forcesworking in specific areas identified by thatdivision, as being essential for the achieve-ment of its objectives. Task forces wouldbe the executive arm of each division.

Their membership could be extended toinclude people who were not members ofthe division itself. Indeed, they might in-clude those who were not members of theCollege, as well as those outside themedical profession. Task forces wouldenable a more flexible approach to thework of the College to be developed. Mostwould operate for a fixed period andwould disband when their objectives hadbeen achieved.

Toffler3 has described task forces as'the new ad-hocracy'. In his view, each taskforce would be a team assembled to workon specific short term problems - someoperating for only a few days, otherspossibly for a few years. In industry taskforce teams are temporary by design andeach is assembled to fulfil a specific func-tion, be it to design and build giantmilitary air transports or to prepare a bidfor a new contract. Task forces are an im-portant way of maintaining momentumwithin an organization and of deployingits members to the best effect. Thechallenge for the College will be to relatethe ad-hocracy of its new task forces tothe work of its more permanent structuresand thereby to pursue the objects of theCollege with efficiency and effective-ness. F

Bill Styles

References1. Royal College of General Practitioners.

Policy statement 2. Quality in generalpractice. London: RCGP, 1985.

2. Royal College of General Practitioners.The front line of the health service:College response to primary healthcare - an agenda for discussion.Report from general practice 25.London: RCGP, 1987.

3. Toffler A. Future shock. London: PanBooks, 1971.

COUNCIL

Examination Boardof Council

Education

Divisions Committees including:International

Ethics

Clinical and AwardsResearch Finance

FellowshipServices to Members

and Faculties

The Divisions, Boards and Committees of Council

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Wart Charming StoneCure warts and corns, with applicationOf med'cines to th'imagination.Fright agues into dogs, and scareWith nimes, the tooth-ach and catarrh.

(Hudibras, Pt. II, Canto 3)

OGRES and demons of mythicalfolklore and the awesome perils sur-

rounding superstition are early visitors toinnocent childhood days and often remainwith us as mature adults. How many timeshave we avoided walking under laddersand crossed our fingers for luck? Wheredo we turn, however, when plagued byminor ailments or when feeling 'offcolour'?

Herbs, plants and suggestive therapyare well-known contributors to folkmedicine, and in many parts of the worldthe 'mind over matter", hypnotic power ofmystery, magic and ritual has had a roleto play in healing mental and physical suf-fering: American Indians with their witchdoctors, Europe with its white witches,who used their magical powers for thegood of the community.Most people, of course, visit their fami-

ly doctor for words of comfort andmedication where appropriate. But as thefollowing extract from a 1956 edition ofRadiography indicates, irritations such aswarts may be dealt with differently:

'In the West country wart charming isaccepted by a large majority of therural population as a routinetherapeutic measure. Application formore orthodox forms of treatmentunder the National Health Scheme isnot necessarily a reflection on charm-ing, although it may indicate that noconvenient charmer lives in theneighbourhood'(E.O. Goss, FSR, Radiography, 1956)There are many local remedies available

for the removal of warts involving incan-tations, the sun and moon, animals andmagic charms. In Cornwall, for example,users of folk medicine swear by "show-ing them to the moon when she is full"and at the same time saying "moon,moon, release me from this vermin". Less

pleasant is the practice of rubbing a slugagainst the warts and then impaling it onthe north side of a blackthorn bush on thenight of a full or waning moon. As theslug withers the warts should disappear.The College museum has recently ac-

quired an old witch's wart charming stone,donated by the Scottish Council. Thestone, which had originally belonged toDr D. Hutchison of Musselburgh, was

found in a house he purchased on the Isleof Wight in Hampshire.While renovating the house, Dr Hut-

chison came across a mass of gypsumcrystals. He had earlier learnt that theprevious occupant of the house was an old

Wellcome Institute Library, London. The deviland young woman making witches broth.

lady reputed to be a witch with a passionfor purchasing warts from children. Herealized that the gypsum crystals musthave been her wart charming stone, whichwhen rubbed across affected areas woulddeposit a white substance. On payment of6d per wart, application of the stone andappropriate witch-like mumblings, theritual was complete. The old lady wouldthen inform the children that the exchangehad been successful and the warts werenow her property.

Dr Hutchison later had an opportuni-ty to witness the power of the stone, whenin 1975 he was approached by a concern-ed mother who urged him to use the

stone's magic on her daughter. Althoughsceptical about the stone and his owncredentials for such a delicate job, 5 pencewas paid and, with accompanying mumbl-ings, Dr Hutchison rubbed the stoneacross her warts. TWo months later he wassurprised to learn that the procedure hadworked.Of course, there are some people who

are content with their appearance, wartsand all. Oliver Cromwell is quoted assaying:

"Mr Lely, I desire you would use allyour skill to paint my picture truly likeme, and not flatter me at all; butremark all these roughnesses, pimples,warts, and everything as you see me,otherwise I will never pay a farthingfor it"

('Remark' Walpole's Anecdotes ofPainting, ch.12)The RCGP wart charming stone is cur-

rently on display at Princes Gate. It maybe found in the cabinet on the groundfloor outside The James CleminsonRoom. [1

Nicola Roberts

'No Cost'ComputerSystemsT HE College has been looking into the

'free computer systems presently beingoffered to 3000 UK practices by companiesVAMP andAAH Meditel. After careful con-sideration, the College has produced a paperdesigned to introduce members to bothpackages, and to provide guidance to prac-tices who may be interested in participatingin one of these schemes.Although the College is unable to provide

members with yes and no answers as to theadvisability of entering into an agreementof this kind, it hopes that this paper willassist members in considering relevant issues,such as the confidentiality of patient data,the practice workload and the terminationof contracts. The paper also looks at thebackground behind both the VAMP andAAH Meditel schemes.The honorary secretary, Dr Bill Styles, has

recently sent copies of this paper to all Facul-ty Secretaries. Members interested in obtain-ing their own copy should contact the Cen-tral Secretariat at Princes Gate. C1

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Dispense with Confusion!'We should engender as good a workingrelationship as possible with our col-leagues in the health care field with whomwe have any professional relationship. Ourwork and contact should be collaborativeand complementary.'

THIS positive statement was written bythe President of the Pharmaceutical

Society in a letter to pre-registrationstudents. However, despite this encourage-ment at the highest level, no facility toestablish and encourage such workingrelationships has ever been built into thepre-registration manual which lays downguidelines for pharmacy tutors andstudents.

Before a pharmacy student is able toregister, he or she must undertake 12months work under the guidance of aqualified pharmacist. Since 1983, oursmall, mainly dispensing pharmacy, hashad one student a year. Our pharmacyserves an inner city area of Bristol whichhas retained its strong community spiritand over the years we have establishedgood working relationships with the localhealth care team. In an attempt to pro-vide our students with insight into thework of health care teams and, indeed, to

The students' 12 month programmeplacedgreat emphass on contact with

local GP surgeries.

promote two-way communication, we ap-proached local GPs requesting their par-ticipation. Everyone we approached gavetheir consent, and a programme of ac-tivities was arranged for students, each ac-tivity designed to occur at the correct stageof their development over the year. As thestudents gained experience and con-fidence, a practice visit was arranged, afterwhich a written report was submitted. Thevisit and report were later discussed ingreater detail at the dispensary. Atquarterly assessment interviews, thesevisits were discussed in the context of thestudent's training and of the role of thepharmacy in community health care.

Visits arranged included:* surgeries with both GPs and

administrative staff,* a day with a district nurse on home

visits,* an exchange with a pre-registration

student working in a hospitalpharmacy,

* a visit from an ostomy nurse,

* a domestic visit with an incontinencenurse.

As well as being given refreshing breaksfrom daily pharmacy practice, studentsbecame familiar with the many aspects ofcommunity health care, and gained avaluable appreciation of other health careprofessionals with whom they could workas they established their own phar-maceutical careers. In turn, health careteams became aware of the contributionthat community pharmacies have to offer.

The students' 12 month programmeplaced great emphasis on contact withlocal GP surgeries. Initially, students wereencouraged to deai with straightforwardprescription enquiries, for example, theabsence of quantity or strength. As theygained experience and confidence,students undertook more complicated en-quiries, such as possible drug interactionsor strange doses.To familiarize themselves with a typical

practice setting, students spent an after-noon with a receptionist. They wereshown the procedures for making ap-pointments and domestic visits, recordkeeping, treatment room facilities and theway in which various clinics, such as pre-and postnatal, are arranged. As with othervisits, a written report was later preparedfor discussion between student and tutor.Towards the end of their training year,students sat in on a patient consultation.After the patient had left, the student wasencouraged to discuss what he or she hadobserved, in particular the choice of drugsused, side effects and possible alternatives.Our students invariably found that

visits to GPs' practices had a profound ef-fect on their perception of their own rolewithin a health care environment, and that

their four years' pharmaceutical educationand training had been put into context.We are pleased to find that our initiative

has stimulated the interest of local GPs,and since 1983 we have been arrangingreciprocal visits. GPs are usually shownaround the dispensary and the dispensingpractice. We also demonstrate equipmentsuch as the computer labellers and showthe type and size of stocks held. We findthe visits provide an opportunity todiscuss prescription problems which com-monly occur. Most of the GPs who havevisited our pharmacy expressed a par-ticular interest in the cost of drugsprescribed, generic prescribing and theprescribing of items such as surgicalhosiery, ostomy items and those items re-quiring extemporaneous dispensing.We believe that these visits have prov-

ed to be a very beneficial exercise for allinvolved and that as a result clearer linesof communication have been establishedbetween the local pharmaceutical andmedical professions. La

AF Pipe, MPS

CancerEducationA CANCER information week is beingorganized by the EEC in an attempt

to create a better understanding of thedisease. 'Europe Against Cancer' is to beheld from 8-15 May 1988 and con-tributors include the DHSS, BMA andrepresentatives from individual cancerorganizations. As part of the informationweek, a 10 commandment European codeagainst cancer will be produced in variouslanguages.

This initiative will be carried throughto 1989 which is the European CancerYear. It is hoped that during 1989 infor-mation on cancer will be publicizedregularly, and projects from individualsand organizations may be considered forfunding.

Faculties interested in 'Europe AgainstCancer' or possible funding for a projectin 1989, should contact: The Secretary,UK Coordinating Committee on CancerResearch, MRC, 20 Park Crescent, Lon-don WIN 4AL. Applications for fundingshould be made by the end of February1988. E

Journal of the Royal College of General Practitioners, February 198894

RCGP Examination

THE following candidates were suc-cessful in the membership examina-

tion of the Royal College of General Prac-titioners in October/December 1987 (*denotes distinction):

S.J. Adams, S.A. Al-Shammari, Claire S.Allen, D.S. Allen, G.J. Allwright, D.S. Ames,M.F. Andrew, Carolyn M. Andrews, S.J. An-drews, M.S.M. Arnott, Eleanor J. Arthur,Elizabeth C. Ash, D.T. Ashbridge, P.J. Ather-ton, *S.P. Attwood.

S.R. Baird, C.D. Baker, F.G. Baker, TW.F.Banks, Kathleen M.C. Barclay, Paul Bamett,J.A. Barratt, M.D. Barrowclough, A.S.Bartlam, W.B.A. Barwell, Karen J. Bates,Stella L. Bawden, Maire S. Beales, AnnabelS. Beard, I.F.R. Beasley, *Hazel K. Bell, PA.Bell, D.C. Bellamy, Carol L. Benn, Judy A.Bennett, R.P. Bentley, J.Y. Berkley, RosemaryC. Berrisford, Jane F. Berry, J.R. Bestwick,P.E. Biggs, Judith M. Blair, Katherine M.Bland, Yvonne H. Bohm, Gillian Bonn, PaulBowron, Suzan M. Bradley, Alison J. Brad-shaw, N.M. Brierley, Alison C. Brooks, A.G.Brown, Barbara A. Brown, Elizabeth A.Brown, R.P. Bryce, *R.E. Bull, Janet A.Butlin, Sarah A. Butt.Margaret M. Cahill, Mary R.H.

Calladine, W.T. Campbell, Angela M.E.T.Carlyon, Sheila M. Casey, R.F.E. Cervenak,R.H. Chappell, I.P. Charles, P.N. Charlton,J.W. Charters, J.N.H. Cheetham, NicoletteM. Cheetham, J.C.D. Clark, M.J. Clarke,W.L. Clarke, A.M. Cole, Catherine A. Con-nolly, R.G. Cook, Rosemary J. Cook, GillianCorble, Carol A. Cornmell, Jill E. Coton,Susan M. Coupe, G.N.D. Cowland, P.M.Craig-McFeely, G.M. Crawford, Elizabeth D.Crothers, M.A.B. Crow, Lesley M. Cunn-ingham, D.P. Curtis, W.D. Cussen.

Caryl E. Daniel, Elaine K. Dare, D.C.Davidson, G.T. Davies, *Dante De Rosa,T.R. Debenham, P.A. Dedman, ChristineDeighton, Garry Dickson, F.J. Dignan,Angela M. Dodd, D.T. Donovan, N.P.Dowdall, J.M. Dowling, Timothy Dowson,B.M. Duncan, *Ruth M. Dunlop, C.T.P.Dunne, lain Duthie, M.J.A. Dwyer.Ann Egan, Mairead B. Ellis, Mary M.

Ellis, J.H. Entrican, D.J. Evans, A.J.Eynon-Lewis.Wendy M. Faerestrand, M.P.M. Fallon,

Janet L. Fellowes, Janet M.L. Feloy, J.N.Fenner, M.A.A.M. Fernandes, I.R. Ferrer,D.G. Finch, D.J. Findlay, Helen V. Firth,A.P. Fiske, Helen M. Fitzgerald, Mary K.Flanagan, Mary G. Flynn, P.G. Flynn, AnneL. Forbes, Christine A. Foster, David Frost,W.G. Fulford, Ann R. Fursdon.

J.E.S. Gale, A.R. Galloway, AlisonGalloway, P.S. Garcha, Anne E. Gardiner,Helen Gaskell, A.J.R. Gates, Carolyn G.George, T.C. Gilhooly, Vivienne T.Gillanders, Julie Glenn, P.M. Glynn, K.B.Gohil, Louisa C. Goodhart, M.F. Goold,Rosanna L. Gorard, Ernest Gordon, H.N.Grahame-Smith, Beverley A. Gray, Ever

Grech, Heather Greenwood, Jeremy Green-wood, Hilary F. Guite.

Ian Haczewski, K.M. Haggerty, P.F.Haimes, John Hambly, James Hampton,*J.M. Hancock, *C.H. Hand, N.S.P. Han-dysides, M.T. Hanley, D.J. Hannon, P.W.Harborow, Judith M. Hardwick, Tessa C.M.Harffey, Rosemary E. Hargreaves, MiriamR. Harvey, J.A.F. Haughney, P.C. Heaney,Helen M. Hibbs, Jacqueline A. Holdsworth,P.M. Hoole, Christine Hopper, S.J. Homer,Anne Hughes, C.P. Hughes, Sharon A.Humphreys, J.R. Hurst.

J.P. Isherwood.C.J. Jackson, Bettina L. James, J.S.B.

Jarallah, R.M. Jenkins, D.R. Jenner, *M.R.Jezierski, P.C. Johnson, T.M. Johnson,Kathryn M. Jones, Glyn Jones-Elwyn,*Delyth Judd.

Leela A. Kalra, Ranjan Kandasamy,Mokshad Kansagra, H.J. Kateb, J.W. Keen,D.F. Kennedy, Barbara A.K. Kenney, Bar-bara Kent, D.A.J. Ker, Denyse Kershaw, NoraC.J. Killeen, J.M. Kirby, Janet L. Kirton,R.C.B. Kneen, M.J.M. Knight, Sheryl A.Knight, Jean M. Knowles, G.T. Knowlson,K.T.C. Koh, S.B. Kotecha, P.K. KunjuMohamed.

Brian Lambert, Elizabeth Larkin, P.S.Larkin, Catherine A. Latham, J.A. Lawrie,Catherine L. Leach, C.H. Ledger, Bronia E.Lee, Julia Lee, Martha F.M. Leigh,Rosemary A. Leonard, Julie Lethbridge,K.H. Levere, R.D. Levy, Malcolm Lewis,R.J.P. Lewis, Myrna Liberman, GeraldineM. Linehan, Bernita A. Lloyd, J.R. Lubin,P.A. Lynch, Susan C. Lynch, Laura K.Lyttelton.

Ellen Maclnnes, Antonia J. Machin,Nesta Mackenzie, M.J. Macrae, Catherine A.Madden, S.P.M. Magennis, D.P. Maher, P.P.Male, H.Y. Man, R.W. Manning, Anne J.Mantell, Christopher Marr, H.S. Marsh,Christopher Marshall, Elizabeth M. Martin,P.A.B. Martin, Sarah Martin, J.E. Masters,Elizabeth D. Mathews, S.R. Mathews, T.F.May, Alison C. McAlpine, K.N. McBride,S.J. McCann, R.N.J. McCartney, J.F.McCaughan, Janet E. McCredie, ClementMcCrory, Sarah K. McDonald, D.R.McGlade, Avril C. McMillan, JohnMcRorie, R.N. McWilliams, G.J. Meehan,D.H. Melville, A.R. Michie, *G.P.M. Millar,J.E. Miller, Susan J. Mills, P.V. Moon, W.J.Moore, I.D.P. Morgan, Jennifer M. Mor-rison, Valerie S. Morrow, *Susan M. Moss,Elizabeth H. Muir, Samar Mukherjee,Catriona J. Munro, Debra J. Munslow, DW.Murphy, Elizabeth J. Mushens, M.W. Mutch.

S.R. Naylor, Margaret C. Naysmith, IanNelemans, S.A.B. Nelson, M.E. Nicholas,J.K. North, R.F. North, Amanda J.Northridge.

P.G. O'Dwyer, Jill O'Hagan, Bridget B.O'Halloran, A.M. O'Leary, Maria D.O'Loan, C.R. O'Shea, Valerie E.M. Oates,Katherine E. Ogilvie, Jane L. Owen-Jones.

Sally E. Paget, D.M. Parker, Jean H.

Parker, B.D. Parkin, Caroline M.E. Pascall,Heenakumari G. Patel, M.C. Patel, Juliet A.Pearlman, D.S. Peck, Naomi K. Penn, M.L.Pennell, J.H. Perkins, Jonathan Peters,Violet M.G. Pettigrew, Anne M. Phelan, J.G.Pickard, C.G.L. Pidsley, Natalie R. Plot-nikoff, S.F. Pooley, D.A.C.G. Pouncey,Ronald Pounder, W.J.P. Price, Virginia A.Priestley, Kathryn A. Pritchard, A.A. Pryer,Diana J. Purvis, Rajiv Purwar, C.M. Putt.Mary E. Quigley, W.J. Quigley.Syliva A. Rafters, J.W. Raphael, A.P.

Redgrave, K.A. Redhead, J.H. Redman, C.J.Ree, A.N.C. Reid, P.C. Reilly, Margaret M.Reynolds, J.C.G. Rice, A.D. Richards, DawnRichards, M.J. Richardson, C.D. Ristic,Alison M. Roberts, Vivienne M. Roberts,A.J. Robinson, Frances A.L. Rogers, KarenE. Rogstad, M.J. Rooney, Susan E.Rosenberg, Rosemary L. Rosser, N.T. Rowell,Lesley H.F. Russell, J.R. Rutherford, J.F.Ryan, *P.B. Ryan.C.M. Saffer, J.C. Salter, Anne P. Saunders,

*George Savage, A.J. Schamroth, HeatherW. Scopes, P.J. Scott, R.L. Seal, M.A.Searle, D.J. Seddon, M.R. Shah, *ElizabethG.M. Shannon, P.E. Sharples, Jean M.Shaw, E.N. Shea, Jimmy Shroff, ElisabethR.C. Sigsworth, Karen Silkoff, Fiona M.Simpson, G.T. Simpson, R.G. Simpson,R.N.R. Simpson, P.J. Slater, Anne-MarieSlowther, M.C. Smith, Elizabeth E. Snape,*Kathryn A. Solesbury, D.R. Spiers,Kathleen M. Spoor, Elizabeth J.R. Stewart,Pauline M. Stewart, Elizabeth J. Stirling,Emma F. Storr, M.A. Stott, Gary Sullivan,P.A. Sutton.

J.E. Tabor, James Thomas, K.L. Thomas,P.A. Thomas, Susan B. Thomas, Sarah A.Thompson, M.A. Thorpe, Anne M. Tinkler,Ruth E. Titheridge, Kusum J. Iblia, HelenD. Towner, Nicola J. Ibynton, PhyllidaTravis, Joanne C. Tremlett, M.R. iWne, D.J.l1yers.Marguerite M. Vassallo, Alison J.

Vaughan, Clare P. Vaughan, *Stephen Ver-coe, Alison Vickers, M.E. Vincent.M.O. Wain, I.R. Wakefield, Philippa M.

Walker, Rosalie A. Walker, Julia D. Wallace,T.D. Wallam, J.D.M. Walsh, Elizabeth J.Walter, Wendy-Jane Walton, A.P.R Warren,D.M. Weakliam, Alan Weatherup, Fiona C.Webber, M.H. Webster, Jennifer M. Wells,Lynda T. Wells, G.P. West, Pamela M.Wheatley, D.M. Wheeler, M.C.W. Whiteley,Margaret H. Wicks, Anne-Marie Wild,Caroline J. Willey, A.J. Williams, Angela J.Williams, R.M. Williams, Katriona J.Williamson, P.D. Williamson, Margaret F.Willox, Anne E. Wilson, C.E. Wilson, G.D.Wilson, J.W. Wilson, Jocelyn A. Wilson,Madeleine A. Wilson, P.M.J. Wilson, P.N.Wilson, S.M. Winter, Judith M. Wright,R.W.J. Wybrew, S.W. Wyeth, Graeme Wylie.

Patricia M. Young. 0

Journal of the Royal College of General Practitioners, February 1988 95

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First GP President

A\MEMBER of the RCGP's Foun-dation Council has been elected

president of the Royal Academy ofMedicine in Ireland. Dr John Fleetwoodis the first GP to be elected to the officesince the Academy was set up over 100years ago.The Royal Academy was founded in

1882 by the amalgamation of the medical,

surgical, obstetrical and pathological

societies. Since then other disciplines have

been added, including general practice.The Academy is the academic forum formedicine in Ireland and is open to anyoneinterested in the science and practice of D l Fleiiwnnd

medicine membership is currentlyaround 1500. The Academy is proud thatits list of honorary fellows include suchhistoric names as Pasteur, Lister, vonRecklinghausen, Koch and Stroganoff.Dr Fleetwood has been involved in

many College activities, including the 1953Postgraduate Education and RegionalOrganization Committee. He held thepost of chairman and provost of the Eastof Ireland Faculty in 1978, and is a pastchairman of the Irish Council. Dr Fleet-wood works as a GP in Dublin where hehas concentrated on care of the elderly.

Dr Edwin

MartinA FTER 18 months as HonoraryA tor of the Journal's news section,

Dr Edwin Martin has resigned. In future thissection of the Journal wil deal exclusivelywith news items about the College both cen-trally and in the faculties. Comments andviews about general practice and about theCollege will be published in the main sec-tion of the Journal.Dr Martin will continue to be involved in

College activities as a member of Counciland one of the new examiners. He representsthe College on the Prisons Standards Com-mittee and on the board of the Beds andHerts faculty which is shortly to become in-volved in the 'What Sort of Doctor' in-itiative. Dr Martin is also the secretary ofthe General Practie section of the RoyalSociety of Medicine.The Journal would like to thank Dr Mar-

tin for all the work that he has done for thenews section, particularly in attracting con-tributions to the Journal from thefaculties.

The HandicappedChild

Who Cares?R C.M. Ni Bhrolchain was recently

IJawarded the Minnit Medal at theMersey faculty's research symposium inChester. The chairman, Dr BrianMcGuinness, said that the judges were

unanimous in their decision and felt thather paper on 'The Handicapped Child,Who Cares?' was outstanding.Dr Bhrolchain prepared her paper while

working as a trainee in Crewe. 'The Han-dicapped Child, Who Cares?' assesses therelationship between GPs and handicap-ped children under their care, and DrBhrolchAin believes that this may be thefirst study to look at this particular area.

The R.J. Minnit Prize for clinicalresearch in general practice was in-augurated in December 1985 and is award-ed annually by the Mersey faculty.

New Year'sHonours

IVE College members were named inI'the New Year's Honours Lists. DrJohn Fry from Beckenham was awardedthe CBE, Dr R.A. Keable-Elliott fromHigh Wycombe and Dr D.J. Llewellynfrom South Glamorgan were awarded theOBE and Dr R.M. Berrington from Cam-bridgeshire and Dr A.L. Hodgson fromLondon the MBE. We congratulate themall. Ul

Smoking symposium[HE South West Thames faculty's one-day symposium on the cessation and

prevention of smoking, which wasreported in the January news, is to be heldin London on 15 April. Further detailsfrom: Mrs Judith Parker, The Health Cen-tre, Wharf Road, Ash Vale, Aldershot,Hants (Tel: 0252 317551).

MRCGP PRACTICE EXAMSRevision book available edited by John Sandars, GeneralPractice Tutor, Stockport, Cheshire and Secretary of Educa-tion Subcommittee, North West Faculty RCGP. This bookcontains essential advice and tips for every MRCGP candidate- two complete MCQ practicp examinations with markingsystem, answers and teaching explanations, two MEQpapers, two PTQ papers both with samples and markingschedules. Oral and Log Diary techniques and presentationsrevision index and recommended book list. Send cheque nowfor £8.50 plus 75p p&p. The books are despatched the sameday by first class mail. Barclaycard and Visa accepted.

Dept. GP PasTest Service, 304Galley Hill, Hemel Hempstead,Herts HP1 3LE. Tel: Hemel

(1003) Hempstead (0442) 52113.

Journal of the Royal College of Generd Prctitioners, February 1988

A UNITED MEDICAL AND DENTAL SCHOOLS OF GUY'SAND ST THOMAS'S HOSPITALS

(University of London)

MASTER'S DEGREE IN GENERALPRACTICE

This programme is intended for established practitioners who wish to con-tinue in practice whilst studying part-time over two years commencing inOctober 1988.The course will include modules on:

(i) research methods(ii) clinical reasoning, social science and medical ethics

(iii) leaming and teaching in general practiceCandidates will critically examine primary care and undertake a researchproject.The number of places is limited. Further information and application formsmay be obtained from Dr Leone Ridsdale, Division of General Practice, UMDS,Guy's Campus, London SE1 9RT, tel: 01-407 7600 ext. 2155.

A.#f iursrg I'MV& rrvLfw.

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