- Email: [email protected]
A CONSULTATION FEE?
1262 tion. I think skipping is the best, but people are intolerant of it and, for the ordinary person, dancing of the Scottish country type is the most practicable proposition. Two final points : the most magnificent coronary arteries, related to age, I have ever seen were in a man who died recently under an anaesthetic and had an advanced degree of stenosis of the aortic valve ; and I wonder why the incidence is so much lower in women. Houston, EDGAR RENTOUL. Renfrewshire.
DIAGNOSIS OF CARBON-MONOXIDE POISONING StR,ŃThe alveolar air of patients with carbon-monoxide poisoning contains a1 small percentage of CO, according to the equilibrium
where HbCO is the percentage of carbogyhaemoglobin in the blood and Pco and P02 are the partial pressures of CO and O2 in the alveolar air. For example, 16% HbCO gives 1 part per 10,000 of CO. A method of estimating such traces of CO in air quite simply and accurately has been developed,2 using palladosulphite in silica gel. Air is sucked through tubes containing this material by means of a double aspirator A respiratory which gives the correct rate of flow. attachment suitable for obtaining an equilibrium sample of alveolar air has been designed for use with this instrument. This method can be carried out by a semi-skilled person in three minutes and appears to offer some advantages in clinical diagnosis compared with spectrometric or titrimetric tests on the patient’s blood. Such rough tests as I have made encourage me to think that this method would be effective in diagnosis, but more experience is needed. L. T. MINCHIN. London, N.W.3. A CONSULTATION FEE?
SiR,-Would a shilling per consultation, either as an alternative to or as an addition to the shilling per prescription, benefit the community as a whole ?’? It would in the first place reduce the cost of the health service, which so far has been an embarrassment to both post-war party governments. It might discourage some of the from like in growing perennials general practitioners’ waitingrooms. It would free these overworked benefactors from attending to numerous minor complaints and so enable them to spend more time on the cases that need their
is-your-visit-really-necessary
"
patients
care.
Indirect benefits to the
community resulting from greater proportion of the population retaining confidence in their own ability to lead healthy lives ; less wear and tear on general practitioners and their wives, and consequently on their families and households ; and less prescriptions being asked for and therefore less medicines being prescribed, but greater counter sales at the chemists of first-aid dressings, simple household remedies, and dietary this would include :
a
accessories. The cost of the latter would then be transferred from the nation’s to the individual’s pocket, while the main costs of diagnosis, of treatment, and of ethical medicines would continue to be borne by the National Health Service. The collection of this second " bob " is a domestic affair, the difficulties of which might be outweighed by the advantages gained. A shilling per consultation, as well as a shilling per prescription, would have the serious 1. Henderson, V., Haggard, H. W. Noxious Gases. New York, 1943; p. 165. 2. Methods for the Detection of Toxic Gases in Industry : no. 7, Carbon Monoxide. H.M. Stationery Office, 1950. See Minchin, L. T. Iron & Steel, Lond. September, 1953, p. 425.
that it would impose further financial burdens on those who depend on medical treatment for their health (and therefore for their happiness), and also on those who, with large families, are the first to feel the pinch caused by increases in the cost of living. But a shilling per consultation instead of a shilling per prescription has decided advantages. Although this point was the subject of debate in the earlier days of the health service, the years of experience that have since intervened may have thrown different light on the subject. It would be interesting to hear the reactions of those whom such a change would concern the most.
disadvantage
Woldingham, Surrey.
RAYMOND L. HANBURY.
TRAUMATIC RUPTURE OF THE BILE-DUCTS
SiR,-The comprehensive review of this rare abdominal injury given by Mr. Milnes Walker (Nov. 7) prompts me to give details of a case at the Royal Hospital, Wolverhampton, 16 months ago. According to Mr. Milnes Walker’s record, it would be the fourth reported since 1938 and the fifty-second in the literature. The
young, fit, intelligent man of 21, was injured accident on June 16, 1952. On admission to hospital he was shocked, and had a compound fracture of the right tibia and fractures of the right patella and right femoral shaft. He improved considerably with resuscitation, but 2-3 hours after the accident he began to complain of pain in the upper right abdomen. There was tenderness in the right hypochondrium, and localised rigidity, with normal liver dullness. There was no sign of bruising in this area, though it was clear that the right side of his body had received the main force of the impact. Catheterisation showed a clear urine. It seemed probable that there was injury to one of the organs in the right upper quadrant, probably the liver. It was decided, therefore, to explore the abdomen, while the orthopaedic surgeon, Mr. E. A. Freeman, would deal with the fractures at the same time, when the abdominal condition became clear. was a small quantity of thin bile-stained - LapcM’o<
in
a
patient, a motor-cycle
DIAGNOSIS OF CARBON-MONOXIDE POISONING StR,ŃThe alveolar air of patients with carbon-monoxide poisoning contains a1 small percentage of CO, according to the equilibrium
where HbCO is the percentage of carbogyhaemoglobin in the blood and Pco and P02 are the partial pressures of CO and O2 in the alveolar air. For example, 16% HbCO gives 1 part per 10,000 of CO. A method of estimating such traces of CO in air quite simply and accurately has been developed,2 using palladosulphite in silica gel. Air is sucked through tubes containing this material by means of a double aspirator A respiratory which gives the correct rate of flow. attachment suitable for obtaining an equilibrium sample of alveolar air has been designed for use with this instrument. This method can be carried out by a semi-skilled person in three minutes and appears to offer some advantages in clinical diagnosis compared with spectrometric or titrimetric tests on the patient’s blood. Such rough tests as I have made encourage me to think that this method would be effective in diagnosis, but more experience is needed. L. T. MINCHIN. London, N.W.3. A CONSULTATION FEE?
SiR,-Would a shilling per consultation, either as an alternative to or as an addition to the shilling per prescription, benefit the community as a whole ?’? It would in the first place reduce the cost of the health service, which so far has been an embarrassment to both post-war party governments. It might discourage some of the from like in growing perennials general practitioners’ waitingrooms. It would free these overworked benefactors from attending to numerous minor complaints and so enable them to spend more time on the cases that need their
is-your-visit-really-necessary
"
patients
care.
Indirect benefits to the
community resulting from greater proportion of the population retaining confidence in their own ability to lead healthy lives ; less wear and tear on general practitioners and their wives, and consequently on their families and households ; and less prescriptions being asked for and therefore less medicines being prescribed, but greater counter sales at the chemists of first-aid dressings, simple household remedies, and dietary this would include :
a
accessories. The cost of the latter would then be transferred from the nation’s to the individual’s pocket, while the main costs of diagnosis, of treatment, and of ethical medicines would continue to be borne by the National Health Service. The collection of this second " bob " is a domestic affair, the difficulties of which might be outweighed by the advantages gained. A shilling per consultation, as well as a shilling per prescription, would have the serious 1. Henderson, V., Haggard, H. W. Noxious Gases. New York, 1943; p. 165. 2. Methods for the Detection of Toxic Gases in Industry : no. 7, Carbon Monoxide. H.M. Stationery Office, 1950. See Minchin, L. T. Iron & Steel, Lond. September, 1953, p. 425.
that it would impose further financial burdens on those who depend on medical treatment for their health (and therefore for their happiness), and also on those who, with large families, are the first to feel the pinch caused by increases in the cost of living. But a shilling per consultation instead of a shilling per prescription has decided advantages. Although this point was the subject of debate in the earlier days of the health service, the years of experience that have since intervened may have thrown different light on the subject. It would be interesting to hear the reactions of those whom such a change would concern the most.
disadvantage
Woldingham, Surrey.
RAYMOND L. HANBURY.
TRAUMATIC RUPTURE OF THE BILE-DUCTS
SiR,-The comprehensive review of this rare abdominal injury given by Mr. Milnes Walker (Nov. 7) prompts me to give details of a case at the Royal Hospital, Wolverhampton, 16 months ago. According to Mr. Milnes Walker’s record, it would be the fourth reported since 1938 and the fifty-second in the literature. The
young, fit, intelligent man of 21, was injured accident on June 16, 1952. On admission to hospital he was shocked, and had a compound fracture of the right tibia and fractures of the right patella and right femoral shaft. He improved considerably with resuscitation, but 2-3 hours after the accident he began to complain of pain in the upper right abdomen. There was tenderness in the right hypochondrium, and localised rigidity, with normal liver dullness. There was no sign of bruising in this area, though it was clear that the right side of his body had received the main force of the impact. Catheterisation showed a clear urine. It seemed probable that there was injury to one of the organs in the right upper quadrant, probably the liver. It was decided, therefore, to explore the abdomen, while the orthopaedic surgeon, Mr. E. A. Freeman, would deal with the fractures at the same time, when the abdominal condition became clear. was a small quantity of thin bile-stained - LapcM’o<
in
a
patient, a motor-cycle