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CHEWING THE CUD
404 with
minimum of effort to this field of hasten the accumulation of data relation to disease. a
thereby
knowledge on
and
physique in
CHEWING THE CUD
SHORTLY before the war there was a Frenchman who earned his living by swallowing live frogs, up to eight at a time, and regurgitating them at intervals, to the admiration of his audience. He prefaced his performance with liberal draughts of water, but apart from this there This was a dramatic was no clue as to his technique. illustration of the occasional occurrence in man of the bovine habit of rumination, mentioned by Aristotle and and " merycism," Galen under the names " merycasm and, according to Long,2 first described by Jerome Fabricius. Dambassis,3 in recording 9 cases, divides the clinical picture into three stages. In the preruminative phase the patient eats hastily or inattentively, often drinking copiously at the same time. Left-sided abdominal discomfort and heaviness, with a sensation of fullness and distension, develop rapidly, and after about an hour, at the peak of the discomfort, the phase of rumination appears. The patient eructates and involuntarily regurgitates into his mouth an undigested and still tasty bolus of food, which he chews and re-swallows. The process is repeated every two to five minutes for about an hour, with an increasing sense of relaxation. During the ensuing postruminative phase the subject returns to a normal state of comfort and well-being. The origin of the condition includes a considerable variety of pathological states, such as short oesophagus, para-oesophageal hernia, pylorospasm (sometimes with the persistence of a conditioned reflex since childhood), aerophagia, cardiospasm, diaphragmatic spasm, carcinoma of the oesophagus, and various forms of imbecility. As might be expected, treatment is a matter of regularity and self-discipline in eating, together with the commonsense selection of suitable food and specific therapy for any known underlying abnormality. "
half
THE INTERNATIONAL B C.G. CAMPAIGN THE evolution of the international B.C.G. campaign, since it was started by the Danish Red Cross in the spring of 1947, has lately been described by Ustvedt,4 who has been appointed its technical director in Europe. Since last March the campaign has been conducted by the Danish Red- Cross, the Swedish Red Cross, Norway’s Aid to Europe, UNICEF, and the World Health Organisation, in cooperation with the governments, health authorities, and Red Cross organisations in the countries concerned. The chief objective is the tuberculin-testing of everyone up to the age of 18, and the B.C.G. vaccination of all the negative reactors. In Europe alone it is expected that some 40 million people will be tested and that about a third of them will be vaccinated with B.C.G. Hitherto more than 7 million have been tested, and at the present time 1/2-1million are being tested every month. The Moro plaster tuberculin test is the first to be applied to children under 12 ; children between 12 and 14 are tested with Moro plus Mantoux (0-1 mg. of tuberculin), and older youngsters with Mantoux alone (0-01 and 0-1 mg.) ; the dosage for a Mantoux test is not raised above 0-1 mg. for fear of provoking too many non-specific reactions. In principle only one technique is adopted in each country ; so in the countries in which the Danish preference for the Mantoux test is endorsed, the Pirquet test (which is favoured in Norway) is not used ; but it is expected that when the Norwegians provide the necessary staff for B.C.G. work in Bulgaria and Italy, the standard test there will be the Pirquet with adrenaline. The B.C.G. is given by intra1. Lancet, 1939, ii, 461. 2. Long, C. F. Amer. J. med. Sci. 1929, 178, 814. 3. Dambassis, J. N. Amer. Pract. 1949, 3, 309. 4. Ustvedt, H. J. Tidsskri. norske Lœgeforen. Feb. 1, 1949.
injection ; its .effects are controlled by subsequent tuberculin-testing in only a few cases and cutaneous
random sampling. As mentioned in our news columns last week, the mass of data obtained is to be analysed in Copenhagen by Dr. Carroll Palmer and his colleagues working with a grant from W.H.O.
by
A QUESTION OF COST MOST minds are stirred by the mention of large sums of money ; a hundred thousand pounds, if not within our ken, is still not beyond our imagining. But when the talk shifts into millions, imagination baulks ; the ordinary man’s experience sets up no landmark in the sea of high Thus the news that the anticipated cost of the finance. National Health Service in Great Britain in the next fiscal year is £259,727,6001is unlikely to cause much stir except perhaps among those responsible for administering the country’s affairs. The significance of this figure is perhaps more readily grasped in personal terms : it means that the cost will be some £5 15s. per head of population. It means also a slight advance on the perdiem cost of operating the service in the first nine months ; the total of which is reckoned at about £208 million,2 including S19 million of non-recurring expenses in the’form of liabilities transferred to the _Government. In the coming year there is to be a tighter grasp at the centre on expenditure ; and the Minister of Health has already asked hospital authorities to reduce their estimates by £91/2 million. He urges that expenditure affecting the wellbeing of patients should not be curtailed; but some capital works which would otherwise have been put in hand will be postponed. The Daily Telegraph (March 1) reports Mr. T. Knox-Shaw, chairman of the board of governors of Cambridge United Hospitals, as saying : " The only way we can carry out the instructions is by reducing staff and closing wards." For these Cambridge hospitals, expenditure is to be reduced from a proposed £451,000 to £425,000, even though the larger estimate did not include increased payments from the application of the Spens report on specialists’ pay, entailing a further £48,000. The Ministry of Health is reported to have said that this increment will have to be met out of the sum now allowed. NO ROOM AT THE HOSPITAL THE rising pressure on London’s hospitals is reflected in the parallel growth of the demands on the Emergency Bed Service. Early in February the service was receiving each day some 185 applications for admission, of which 50 could not be met. Undoubtedly some at least of these 50 patients were in real need of hospital treatment; and it is unlikely that where the E.B.S. had failed in securing immediate admission, any other agency would succeed. Dissatisfaction has been expressed in the terms ,gravest by the local medical committee for London, which is especially perturbed by the delay in admission of patients with acute-on-chronic disorders ; the committee is concerned by reports of " many patients who " have died but whose lives might have been saved if energetic action had been taken to secure prompt attention. There is no hint that serious illness is more prevalent now than a year ago, but there is every indication that more patients are being referred for admission. In the long run the agreed solution is to use hospital beds more economically and to bring greater numbers into use. But the need of short-term expedients is daily On IPec: 18 we discussed some of the more evident. Another is that the London hospitals possibilities. perhaps increase the proportion of beds allotted to emergencies, deferring admissions which, though desirable, are not vital. Civil Estimates : Estimates for 1. 1949-50 : Vote on Account. Revenue Departments and Estimate for the Ministry of Defence. H.M. Stationery Office. Pp. 8. 2d. 2. See Lancet, Feb. 19, p. 312.
minimum of effort to this field of hasten the accumulation of data relation to disease. a
thereby
knowledge on
and
physique in
CHEWING THE CUD
SHORTLY before the war there was a Frenchman who earned his living by swallowing live frogs, up to eight at a time, and regurgitating them at intervals, to the admiration of his audience. He prefaced his performance with liberal draughts of water, but apart from this there This was a dramatic was no clue as to his technique. illustration of the occasional occurrence in man of the bovine habit of rumination, mentioned by Aristotle and and " merycism," Galen under the names " merycasm and, according to Long,2 first described by Jerome Fabricius. Dambassis,3 in recording 9 cases, divides the clinical picture into three stages. In the preruminative phase the patient eats hastily or inattentively, often drinking copiously at the same time. Left-sided abdominal discomfort and heaviness, with a sensation of fullness and distension, develop rapidly, and after about an hour, at the peak of the discomfort, the phase of rumination appears. The patient eructates and involuntarily regurgitates into his mouth an undigested and still tasty bolus of food, which he chews and re-swallows. The process is repeated every two to five minutes for about an hour, with an increasing sense of relaxation. During the ensuing postruminative phase the subject returns to a normal state of comfort and well-being. The origin of the condition includes a considerable variety of pathological states, such as short oesophagus, para-oesophageal hernia, pylorospasm (sometimes with the persistence of a conditioned reflex since childhood), aerophagia, cardiospasm, diaphragmatic spasm, carcinoma of the oesophagus, and various forms of imbecility. As might be expected, treatment is a matter of regularity and self-discipline in eating, together with the commonsense selection of suitable food and specific therapy for any known underlying abnormality. "
half
THE INTERNATIONAL B C.G. CAMPAIGN THE evolution of the international B.C.G. campaign, since it was started by the Danish Red Cross in the spring of 1947, has lately been described by Ustvedt,4 who has been appointed its technical director in Europe. Since last March the campaign has been conducted by the Danish Red- Cross, the Swedish Red Cross, Norway’s Aid to Europe, UNICEF, and the World Health Organisation, in cooperation with the governments, health authorities, and Red Cross organisations in the countries concerned. The chief objective is the tuberculin-testing of everyone up to the age of 18, and the B.C.G. vaccination of all the negative reactors. In Europe alone it is expected that some 40 million people will be tested and that about a third of them will be vaccinated with B.C.G. Hitherto more than 7 million have been tested, and at the present time 1/2-1million are being tested every month. The Moro plaster tuberculin test is the first to be applied to children under 12 ; children between 12 and 14 are tested with Moro plus Mantoux (0-1 mg. of tuberculin), and older youngsters with Mantoux alone (0-01 and 0-1 mg.) ; the dosage for a Mantoux test is not raised above 0-1 mg. for fear of provoking too many non-specific reactions. In principle only one technique is adopted in each country ; so in the countries in which the Danish preference for the Mantoux test is endorsed, the Pirquet test (which is favoured in Norway) is not used ; but it is expected that when the Norwegians provide the necessary staff for B.C.G. work in Bulgaria and Italy, the standard test there will be the Pirquet with adrenaline. The B.C.G. is given by intra1. Lancet, 1939, ii, 461. 2. Long, C. F. Amer. J. med. Sci. 1929, 178, 814. 3. Dambassis, J. N. Amer. Pract. 1949, 3, 309. 4. Ustvedt, H. J. Tidsskri. norske Lœgeforen. Feb. 1, 1949.
injection ; its .effects are controlled by subsequent tuberculin-testing in only a few cases and cutaneous
random sampling. As mentioned in our news columns last week, the mass of data obtained is to be analysed in Copenhagen by Dr. Carroll Palmer and his colleagues working with a grant from W.H.O.
by
A QUESTION OF COST MOST minds are stirred by the mention of large sums of money ; a hundred thousand pounds, if not within our ken, is still not beyond our imagining. But when the talk shifts into millions, imagination baulks ; the ordinary man’s experience sets up no landmark in the sea of high Thus the news that the anticipated cost of the finance. National Health Service in Great Britain in the next fiscal year is £259,727,6001is unlikely to cause much stir except perhaps among those responsible for administering the country’s affairs. The significance of this figure is perhaps more readily grasped in personal terms : it means that the cost will be some £5 15s. per head of population. It means also a slight advance on the perdiem cost of operating the service in the first nine months ; the total of which is reckoned at about £208 million,2 including S19 million of non-recurring expenses in the’form of liabilities transferred to the _Government. In the coming year there is to be a tighter grasp at the centre on expenditure ; and the Minister of Health has already asked hospital authorities to reduce their estimates by £91/2 million. He urges that expenditure affecting the wellbeing of patients should not be curtailed; but some capital works which would otherwise have been put in hand will be postponed. The Daily Telegraph (March 1) reports Mr. T. Knox-Shaw, chairman of the board of governors of Cambridge United Hospitals, as saying : " The only way we can carry out the instructions is by reducing staff and closing wards." For these Cambridge hospitals, expenditure is to be reduced from a proposed £451,000 to £425,000, even though the larger estimate did not include increased payments from the application of the Spens report on specialists’ pay, entailing a further £48,000. The Ministry of Health is reported to have said that this increment will have to be met out of the sum now allowed. NO ROOM AT THE HOSPITAL THE rising pressure on London’s hospitals is reflected in the parallel growth of the demands on the Emergency Bed Service. Early in February the service was receiving each day some 185 applications for admission, of which 50 could not be met. Undoubtedly some at least of these 50 patients were in real need of hospital treatment; and it is unlikely that where the E.B.S. had failed in securing immediate admission, any other agency would succeed. Dissatisfaction has been expressed in the terms ,gravest by the local medical committee for London, which is especially perturbed by the delay in admission of patients with acute-on-chronic disorders ; the committee is concerned by reports of " many patients who " have died but whose lives might have been saved if energetic action had been taken to secure prompt attention. There is no hint that serious illness is more prevalent now than a year ago, but there is every indication that more patients are being referred for admission. In the long run the agreed solution is to use hospital beds more economically and to bring greater numbers into use. But the need of short-term expedients is daily On IPec: 18 we discussed some of the more evident. Another is that the London hospitals possibilities. perhaps increase the proportion of beds allotted to emergencies, deferring admissions which, though desirable, are not vital. Civil Estimates : Estimates for 1. 1949-50 : Vote on Account. Revenue Departments and Estimate for the Ministry of Defence. H.M. Stationery Office. Pp. 8. 2d. 2. See Lancet, Feb. 19, p. 312.