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report of a controlled clinical trial from the PneumoconiosisResearch Unit of the Medical Research Council. They con-cluded that " the weight of evidence now strongly supportsthe idea that recovery from the common cold can be speededup by treatment with ahtibiotics (i.e., with a short course inthe viral or prodromal stage). The most suitable antibioticand the optimal dosage have not yet been determined ". That,as I understand it, is how the matter now stands, and furtherelucidation is obviously required.

H. STANLEY BANKS.

DELIBERATE EMERGENCIES

G. W. GARLAND.

SiR,-The Cranbrook Committee’s recommendationthat beds should be available for 70% of all confinementsmay be right for some parts of England, but it is certainlywrong for London. For a start, at least 70 pregnantwomen out of every 100 in London insist on having theirbabies in hospital, irrespective of need. Of the remaining30 who would like to have their babies at home, many haveunsuitable homes and most of the others are medicallyunsuitable-e.g., the grande multiparae. The result is thatbeds have to be found for at least 90% of all pregnantwomen, and this figure will, I am sure, soon rise to 100%.In my opinion, this is as it should be. A woman should nomore have her baby at home than she should have adilatation and curettage on the kitchen table.In your leader of Oct. 14 you urge that more beds

should be provided; and there is no doubt that more bedsare needed. But not so many as you suggest. We cannot

expect that every pregnant woman should have a bed forher confinement and her lying-in; if she did, the numberof maternity beds would be disproportionately large.Maternity is no doubt fashionable at the moment, buteven so it should not take precedence over all other partsof the National Health Service.

I only have figures for my own area of London, butthere at least we have enough consultant beds. The newones should be general-practitioner beds-provided ofcourse the general practitioners could be found to usethem. They should be sited near, or in, a consultant unit,not only so that the consultant can exercise supervision butalso so that the practitioner has access to ancillary services.Patients would be admitted to them for social rather thanmedical reasons, and antenatal care should be providedby a practitioner-obstetrician working in a clinic in theunit or a clinic provided by the local authority.But if we are not to ask for beds to cover all confine-

ments and all lying-in periods, then some mothers must bedischarged from hospital soon after delivery. Providedthe mother and her baby are fit and home circumstancesare satisfactory, there is nothing against this. Moreover, amother’s wish to stay in hospital should not influence thedoctor’s decision. Every woman should, as a right,expect a bed from the National Health Service for her

confinement, but not necessarily for her lying-in. After

all, she is not ill.Early discharge would allow greater use of beds,

especially in the general-practitioner units where thepatients would be normal. It would also mean that ahigher proportion of labour wards must be provided, and(even more important) a much higher establishment ofmidwives. If the maternity services were put under onehead, as many of us hoped the Cranbrook Committeewould recommend, the system of early discharge wouldbe easier to run, for there would be no. dividing linebetween hospital and district midwives. Midwives wouldwork in both on a rota, delivering in hospital for a time,

looking after lying-in mothers at home for a time. Thismore elastic system would also probably reduce the

shortage of midwives. Fewer would be lost to the serviceby marriage if we could give them work to suit theiraltered circumstances instead of forcing them to workunder the old rigid regulations. Many married midwiveswith families might be willing to look after lying-inmothers in their homes. Nor need there be any break inthe continuity of nursing care if the nurses, working bothin hospital and on the district, were under the same head.A service such as this would need the backing of an

adequate and efficient home-help service-as has beenshown in Holland. Home-helps are said to be hard torecruit; but perhaps this is again a matter of conditions ofemployment, especially financial.

. I ask the Ministry of Health to consider these proposalsurgently. The present state of affairs cannot continuewithout a breakdown. It takes time to build new beds, butplanning should start at once. The general practitionersshould consider whether they can use more beds, and Iwould ask them to consider their decision carefully. Morebeds will mean much extra work, for which, I would add,they should be paid. But they must not expect cover fromresident medical officers, for there are not enough ofthese.An overall maternity nursing service such as I have

suggested should be organised immediately, so that thebeds we have can be used to greater effect. The increasingnumbers of confinements will not wait upon the comple-tion of new beds, but an integrated midwifery servicewould at once make possible the introduction of a systemof early discharge and home lying-in where medicallyand socially suitable.My suggestions are made with London in mind; for I

do not know conditions in other parts of England. But Ithink it probable that the whole country will in the endneed such an organisation; indeed some areas already haveit and it is working well.

COLLES’ FRACTURE

J. F. STONE.

SIR,-I read with interest and some astonishment yourannotation of Oct. 28. In my experience, the use ofSteinmann’s pins and plaster, as you advise, has neverbeen necessary, and the results of any pin-track sepsis,with so many tendons related to the lower fragment,hardly need be emphasised.There seem to be three types of these fractures:

(a) In the age-group 20-40: a good reduction is obtainedand held until the fracture is united, and a good result is therule.

(b) In the age-group 40-60: such fractures are often com-minuted and the dorsal surface of the radius is crushed. A

good initial reduction is easily obtained but tends to slipbecause of the " missing bone ". If a remanipulation is carriedout after 2-3 weeks, the reduction can be held and a goodresult obtained. Finger and shoulder exercises are important.

(c) 60 and over: the same applies as in (b) except in thesenile patient, when no special efforts are justifiable. Manyladies of 70-80 live alone, do their own housework, and needa good wrist if they are to remain independent.

It may be argued that two anaesthetics and manipulationsare unjustified for such an injury, but I submit that suchtrouble is worth while: it is certainly safer than pin and plaster.In all cases too much importance cannot be attached to immo-bilising the wrist in full ulnar deviation, as emphasised byL. W. Plewes in Recent Advances in Surgery (1961).