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arterial line in selected cases, but in our opinion it is neither necessary nor justifiable to insert routinely intra-arterial lines in all patients admitted to a general medical intensive care unit.Flexibility is the essence of modular monitoring apparatus. It allows the clinician to decide which physiological variables he wishes to monitor, and he should never regard such a system as a "panindicator" unit. Therefore each separate system must be reliable in its own right, and reliability in the clinical environment can be assessed only by intensive study in a clinical situation. The technique we used seems to give a useful indication of whether a particular system is suitable for routine clinical use. Moreover, we would suggest that to be of value in hospital conditions an automatic monitor needs to be at least 90% reliable.We would like to acknowledge the unstinted co-operation of the nursing staff of Starling Ward; Mr. A.

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The incidence and type of neuropathy in patients with chronic obstructive pulmonary disease (COPD) were assessed. In a selected group of 89 patients, abnormal nerve conduction studies were found in 44%. Electrophysiological signs of a generalized peripheral neuropathy were found in 5-18%, depending on diagnostic criteria. Lesions which were thought to be due to compression or other forms of trauma were present in a further 24%. In the patients with peripheral neuropathy, the changes were distally predominant, affected mainly sensory fibres, and were consistent with an axonal type of neuropathy. There was a significant correlation between age and the incidence of peripheral neuropathy. Electrophysiological evidence of neuropathy was three times as common as clinical evidence. Much of the variation in the reported incidence of neuropathy in COPD is probably due to imprecise diagnostic criteria.