Herpes zoster of the stomach
1
1144 HERPES ZOSTER OF THE STOMACH SIR,-Dr Wisl0fT and his colleagues (Nov. 3, p. 953) showed by endoscopy that the zoster virus can attack the mucosa of the stomach. Other unusual manifestations of this disorder are segmental colitis resembling ulcerative colitis,’ dysuria from bladder involvement, and pleurisy. The Ramsey Hunt syn- drome and weakness of a limb also sometimes occurs, when the inflammation spreads into motor tracts. Visceral zoster is rare, but possibly other and undiagnosable cases are occurring with- out skin lesions. A method of boosting the immunity of the elderly will perhaps be achieved in the future, preventing the pain and visual complications of this unpleasant disease. St. Luke’s Hospital, Guildford, Surrey GU1 3NT GERALD A. MACGREGOR 1. MacGregor GA. Three reasons for ulcerative colitis. Lancet 1973; i: 825. ted alternative proposals those proposals had to achieve sav- ings on the same scale. Having decided that the C.H.c. had to be consulted, there was no justification, in Mr Justice Woolf’s s view, on the part of the Commissioners for limiting or circum- scribing the role of the council. The Regulations did not pro- vide any limitation on the role of the council. It had to be remembered, however, that as time elapsed it would be more difficult to make the necessary savings. There had been a number of letters giving information passing between the Commissioners and the c.H.c. The Commissioners had examined the c.H.c.’s proposals and the decision to transfer the inpatient service was not taken until late in the afternoon of Oct. 29. Although the time span had been short, there had been proper consultation. The Commissioners might still consider the c.H.c.’s proposal for economies if additional savings were required. The c.H.c.’s application for a judicial review of the matter was dismissed. Queen’s Bench Division: Nov. 12-13, 1979. MARY BRYN DAVIES Medicine and the Law Consultation on Closure of St Olave’s Hospital Mr J. T. Nelligan, chairman of Guy’s District Community Health Council, and Mrs C. A. Newman, a member of the Council, sought a judicial review of a decision made by the Commissioners who have replaced the Lambeth, Southwark and Lewisham Area Health Authority (Teaching). The Com- missioners decided that inpatient services at St Olave’s Hospi- tal, Rotherhithe, should be suspended temporarily as an economy measure. For the c.H.c. it was submitted that the de- cision to close was taken hastily and without proper consul- tation. It was said that the Commissioners had invited the C.H.C. to make alternative proposals. The c.H.c. had submitted proposals to the Commissioners by 8.30 A.M. on Oct. 29. The decision to close had been taken on the same day. The council formed the view that their proposals had been given only a cursory glance by the Commissioners and that there had been no proper consultation at all within the meaning of Regulation 20 of the National Health Service (Community Health Coun- cil) Regulations of 1973. Giving judgment, Mr Justice WooLF said that when tier upon tier of administration was required to provide health ser- vices, it was important that someone should represent the in- terests of the public in the locality so as to ensure that the ad- ministration had a proper regard to the interests of the local community. Community health councils had an important role in the administration of the N.H.S. The Secretary of State had a statutory duty to establish c.H.c.s in health authorities. It was also clear from the terms of the 1973 Regulations that c.H.c.s and area health authorities were intended to work with one another. The council was a consultative body and had a duty to make recommendations to the authority as it thought fit. The authority was under a duty to consult with the council. That consultation had to be meaningful. The authority had an obligation to give information to the council and was also obliged to give the council reasonable time in which to perform its function. It was reasonable for the area authority to impose time limits, which sometimes had to be relatively short. Length of time for consultation must be judged within the existing cir- cumstances. The Commissioners had no alternative. They had to make substantial economies. On the proposal to transfer the inpatient services at St Olave’s the Commissioners accepted that there had to be consultation with the c.H.c. They invited comment and also suggested to the council that if they submit- Commentary from Westminster N.H.S. Closures: Temporary or Permanent? THE Department of Health and Social Security is to remind all area health authorities of the difference between temporary and permanent closure of facilities, after Parliamentary complaints that many authorities are deliberately fudging the distinction, so they can steer round consultation rules. But the D.H.S.S. reminder is a gentle one, which will not satisfy sceptical M.P.S. A cir- cular due to go to A.H.A.S from the Health Minister, Dr Gerard Vaughan, will reiterate that if major facilities are "temporarily" closed there must be evidence that the A.H.A. is seriously considering how and when they can be reopened. No change in the rules is proposed however, nor any new procedure for checking the genuineness of the intention to reopen. The complaints surfaced in the Commons when Mr Reg Race, (Lab, Haringey) told Dr Vaughan that "a number of health authorities are seeking to use tempor- ary closures to evade completely the responsibility of consultation ... in this way they avoid the need to con- sult the community health council and to refer the de- cision to the Minister if the c.H.c. disagrees with the clo- sure." Dr Vaughan replied that he was not aware of any such abuses of temporary closure procedure, but he con- ceded that the guidelines "may need clarification". Two Conservative members, Mr Toby Jessel (Twickenham) and Mr Michael Neubert (Romford) had similar com- plaints ; and Mr Race told me he had heard the same story from other M.P.S. A.H.A.S were sometimes using the smokescreen of cash limits to shut down units which, in their long-term plans, they had decided to do away with anyway. But, knowing of local opposition to such clo- sures, some avoided confrontation with local objectors by calling the closures "temporary". "The onus should be very much on health authorities to make firm com- mitments, saying when they are going to reopen. I sug- gest there should be a six-month limit after which the
Transcript of Herpes zoster of the stomach
1144
HERPES ZOSTER OF THE STOMACH
SIR,-Dr Wisl0fT and his colleagues (Nov. 3, p. 953) showedby endoscopy that the zoster virus can attack the mucosa ofthe stomach. Other unusual manifestations of this disorder are
segmental colitis resembling ulcerative colitis,’ dysuria frombladder involvement, and pleurisy. The Ramsey Hunt syn-drome and weakness of a limb also sometimes occurs, when theinflammation spreads into motor tracts. Visceral zoster is rare,but possibly other and undiagnosable cases are occurring with-out skin lesions. A method of boosting the immunity of theelderly will perhaps be achieved in the future, preventing thepain and visual complications of this unpleasant disease.
St. Luke’s Hospital,Guildford, Surrey GU1 3NT GERALD A. MACGREGOR
1. MacGregor GA. Three reasons for ulcerative colitis. Lancet 1973; i: 825.
ted alternative proposals those proposals had to achieve sav-ings on the same scale. Having decided that the C.H.c. had tobe consulted, there was no justification, in Mr Justice Woolf’s sview, on the part of the Commissioners for limiting or circum-scribing the role of the council. The Regulations did not pro-vide any limitation on the role of the council.
It had to be remembered, however, that as time elapsed itwould be more difficult to make the necessary savings. Therehad been a number of letters giving information passingbetween the Commissioners and the c.H.c. The Commissionershad examined the c.H.c.’s proposals and the decision to
transfer the inpatient service was not taken until late in theafternoon of Oct. 29. Although the time span had been short,there had been proper consultation. The Commissioners mightstill consider the c.H.c.’s proposal for economies if additionalsavings were required. The c.H.c.’s application for a judicialreview of the matter was dismissed.
Queen’s Bench Division: Nov. 12-13, 1979.
MARY BRYN DAVIES
Medicine and the Law
Consultation on Closure of St Olave’s HospitalMr J. T. Nelligan, chairman of Guy’s District Community
Health Council, and Mrs C. A. Newman, a member of theCouncil, sought a judicial review of a decision made by theCommissioners who have replaced the Lambeth, Southwarkand Lewisham Area Health Authority (Teaching). The Com-missioners decided that inpatient services at St Olave’s Hospi-tal, Rotherhithe, should be suspended temporarily as an
economy measure. For the c.H.c. it was submitted that the de-cision to close was taken hastily and without proper consul-tation. It was said that the Commissioners had invited theC.H.C. to make alternative proposals. The c.H.c. had submittedproposals to the Commissioners by 8.30 A.M. on Oct. 29. Thedecision to close had been taken on the same day. The councilformed the view that their proposals had been given only acursory glance by the Commissioners and that there had beenno proper consultation at all within the meaning of Regulation20 of the National Health Service (Community Health Coun-cil) Regulations of 1973.
Giving judgment, Mr Justice WooLF said that when tierupon tier of administration was required to provide health ser-vices, it was important that someone should represent the in-terests of the public in the locality so as to ensure that the ad-ministration had a proper regard to the interests of the localcommunity. Community health councils had an important rolein the administration of the N.H.S. The Secretary of State hada statutory duty to establish c.H.c.s in health authorities. Itwas also clear from the terms of the 1973 Regulations thatc.H.c.s and area health authorities were intended to work withone another. The council was a consultative body and had aduty to make recommendations to the authority as it thoughtfit. The authority was under a duty to consult with the council.That consultation had to be meaningful. The authority had anobligation to give information to the council and was alsoobliged to give the council reasonable time in which to performits function. It was reasonable for the area authority to imposetime limits, which sometimes had to be relatively short. Lengthof time for consultation must be judged within the existing cir-cumstances. The Commissioners had no alternative. They hadto make substantial economies. On the proposal to transfer theinpatient services at St Olave’s the Commissioners acceptedthat there had to be consultation with the c.H.c. They invitedcomment and also suggested to the council that if they submit-
Commentary from Westminster
N.H.S. Closures: Temporary or Permanent?THE Department of Health and Social Security is to
remind all area health authorities of the differencebetween temporary and permanent closure of facilities,after Parliamentary complaints that many authoritiesare deliberately fudging the distinction, so they can steerround consultation rules. But the D.H.S.S. reminder isa gentle one, which will not satisfy sceptical M.P.S. A cir-cular due to go to A.H.A.S from the Health Minister, DrGerard Vaughan, will reiterate that if major facilitiesare "temporarily" closed there must be evidence that theA.H.A. is seriously considering how and when they can bereopened. No change in the rules is proposed however,nor any new procedure for checking the genuineness ofthe intention to reopen.The complaints surfaced in the Commons when Mr
Reg Race, (Lab, Haringey) told Dr Vaughan that "anumber of health authorities are seeking to use tempor-ary closures to evade completely the responsibility ofconsultation ... in this way they avoid the need to con-sult the community health council and to refer the de-cision to the Minister if the c.H.c. disagrees with the clo-sure." Dr Vaughan replied that he was not aware of anysuch abuses of temporary closure procedure, but he con-ceded that the guidelines "may need clarification". TwoConservative members, Mr Toby Jessel (Twickenham)and Mr Michael Neubert (Romford) had similar com-plaints ; and Mr Race told me he had heard the samestory from other M.P.S. A.H.A.S were sometimes using thesmokescreen of cash limits to shut down units which, intheir long-term plans, they had decided to do away withanyway. But, knowing of local opposition to such clo-sures, some avoided confrontation with local objectorsby calling the closures "temporary". "The onus shouldbe very much on health authorities to make firm com-mitments, saying when they are going to reopen. I sug-gest there should be a six-month limit after which the
