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CORONARY DISEASE AND MODERN STRESS
694 done by Dr. Alexander Wiener’s laboratory and in this unit has established with certainty the manner of inheritance of the allelomorphs of Rh...." IRVING B. WEXLER. Brooklyn, New York. CORONARY DISEASE AND MODERN STRESS
and while the systolic pressure is raised the heart is well filled by the action of the muscles and valves in the veins and by the increased respiratory pumping action. Thus the diastolic supply to the coronary vessels is maintained. Mental activity, particularly with anxiety or stress of work in the sedentary professions, excites a rise of systolic pressure which, unaccompanied by muscular activity, does not produce that same maintenance of diastolic pressure which is needed for a good supply of blood to the heart by the coronary arteries. This, I suggest, accounts for the far greater prevalence of angina pectoris and coronary thrombosis in busy mental workers than in manual To compensate for sedentary mental work workers. I think the Exercises in the Bath worked out by Mr. T. R. Tognaare of considerable value. These exercises do not raise the systolic pressure and they increase the pulse-rate very little, but they secure a good return of blood to the heart and high oxygen use per pulse-beat. Patients with angina have used the exercises with success. LEONARD HILL. Corton, near .Lowestoft.
panied by bodily activity,
SiR,-May I offer a brief contribution to the problem of coronary disease in physicians and surgeons, mentioned by Dr. Rentoul (March 10) and Dr. Stewart (Dec. 23). Dunbar has drawn our attention to the factor of exposure. The impression from observing heart-disease and death from it is, according to her, an important stress agent in patients with relatives and close friends who have suffered from such disease. Dunbar concludes from her considerable material that heredity acts only in conjunction with this psychological factor. I have been for a long time occupied with the related problem of medical men who suppress the ordinary emotional reactions to the many illnesses they encounter. Habit does not wholly eliminate anxiety responses ; and these recurrent experiences together with responsibility for the patients may be a potent substitute for the close relationship referred to by Dunbar
S.
London, W.1.
LOWY.
WILL WE NEVER LEARN ?
SIR,-The subject of this provoking correspondence
always interested me, and I have worked out the mortality-rates for gastrectomy at two provincial hospitals where I have been a registrar. To continue with Mr. MacLellan’s metaphor (Feb. 3), the pitches were not like Lord’s (I have been a registrar-spectator there too) but good county grounds nevertheless. The mortality-rate for both hospitals combined over a period of three years (132 cases, 7 surgeons) was 13-5%. Your correspondents must agree that this is pretty fast bowling. A few bowled " slows " (gastro-enterostomy), and there were one or two googlies (vagotomies) ; these had a much lower bowling average. The point I wish to emphasise is that the cause of this poor bowling average was not, in my estimation, that the bowlers were bad, but that they were rushed. They bowled 8-ball overs in the time that a professional
has
at Lord’s would take to roll up his sleeve. I am not referring necessarily to operating-time but to time for investigation and preparation-time to think. Far
important than the " have a go" mentality March 10) is the " what’s the next case Brailsford, (Dr.
more
attitude and the
glance
at the list and the theatre
1. Togna, T. R. Exercises in the Bath. Pp. 67. 6s. 6d. able from the author, Tuscan Hotel, London, W.1.
clock. Obtain-
Orthodox and better bowling will be achieved by the pitch, but this will take a long time as we all know. An immediate partial solution to Sir Heneage’s problem (March 3) lies, not in edicts, a full-time service, and control, but in more bowlers. The bowlers are there, twice the age of Tattersall, fully trained, waiting. I would hazard a guess that the mortality for gastrectomy performed by senior surgical registrars is below the average for the country’s con. sultants. They are more careful-they have to be. The trouble is that the present bowlers do not want any additions to the team-there will be fewer benefits, and the bonuses will become more infrequent. Nor do the county committees wish to increase their staff, for financial reasons. Will Sir Heneage have the courage of the M.C.G. and
improving
urs’e
that
more
bowlers
are
sent outg
F.R.C.S. HEPATITIS FROM TATTOOING
letter from Dr. Robertson in your issue of adds still more support to the suggestion that jaundice may be transmitted by inoculation during tattooing. Dr. H. Still and I have described1 four cases of jaundice which we thought were very probably acquired in this way. Our four patients all attended a certain tattooing den on Feb. 5, 1949, and were tattooed in succession. Each developed jaundice between June 17 and 29 the same year. There was no infectious hepatitis prevalent at the time, and after full inquiry we could not resist the conclusion that the virus of serum hepatitis had been inoculated through the agency of the tattooing needle. Dr. Ballard F. Smith had presumably not seen our article when he presented his paper,2 but his conclusions were very similar to ours. Since our cases occurred we have made careful inquiries of all our jaundice patients, but have not again demon. strated this causal connection. There can be little doubt, however, that there is a real danger of virus transmission during tattooing as usually performed, and stricter control over " artists " is long overdue. R. HOWELL ROBERTS. Halifax, Nova Scotia.
SIR,—The
Jan. 6
,
NURSING INFECTIOUS DISEASES SIR,—The belief that there is no longer a case for fever hospitals, which is widely held and is expressed by Mr. Crabb in his letter of March 10, is one of the main obstacles to the recruitment of nurses for these hospitals. The would-be nurse is advised that fever nursing is a thing of the past. This view has been strengthened by the publication of a proposal to abolish the special certificate in fever nursing. Thus, the high standard of nursing and nurse-training which fever hospitals maintained is being undermined. Yet the demand for their services, as the Emergency Bed Service could testify, remains greater than the fever hospitals at present
functioning can satisfy. Despite Mr. Crabb’s
final remark, general hospitals have very little accommodation suitable for infectious The extensive reconstruction needed to increase cases. such accommodation is not likely to be undertaken for many years to come. The general hospitals realise this, and not only refuse to admit patients suffering from many of the common infections but are anxious to transfer patients who develop such infections while in hospital. Meanwhile, those who decry the value or necessity of fever hospitals bear a considerable part of the responsibility for the grave nursing position described by Dr. Banks (Feb. 3) and Dr. Kennedy (Jan. 20). Waddon
Hospital,
Croydon.
J. J. LINEHAN.
1. Roberts, R. H., Still, H. Canad. med. Ass. J. 1950, 2. Smith, B. F. J. Amer. med. Ass. 1950, 144, 1074.
62, 75.
and while the systolic pressure is raised the heart is well filled by the action of the muscles and valves in the veins and by the increased respiratory pumping action. Thus the diastolic supply to the coronary vessels is maintained. Mental activity, particularly with anxiety or stress of work in the sedentary professions, excites a rise of systolic pressure which, unaccompanied by muscular activity, does not produce that same maintenance of diastolic pressure which is needed for a good supply of blood to the heart by the coronary arteries. This, I suggest, accounts for the far greater prevalence of angina pectoris and coronary thrombosis in busy mental workers than in manual To compensate for sedentary mental work workers. I think the Exercises in the Bath worked out by Mr. T. R. Tognaare of considerable value. These exercises do not raise the systolic pressure and they increase the pulse-rate very little, but they secure a good return of blood to the heart and high oxygen use per pulse-beat. Patients with angina have used the exercises with success. LEONARD HILL. Corton, near .Lowestoft.
panied by bodily activity,
SiR,-May I offer a brief contribution to the problem of coronary disease in physicians and surgeons, mentioned by Dr. Rentoul (March 10) and Dr. Stewart (Dec. 23). Dunbar has drawn our attention to the factor of exposure. The impression from observing heart-disease and death from it is, according to her, an important stress agent in patients with relatives and close friends who have suffered from such disease. Dunbar concludes from her considerable material that heredity acts only in conjunction with this psychological factor. I have been for a long time occupied with the related problem of medical men who suppress the ordinary emotional reactions to the many illnesses they encounter. Habit does not wholly eliminate anxiety responses ; and these recurrent experiences together with responsibility for the patients may be a potent substitute for the close relationship referred to by Dunbar
S.
London, W.1.
LOWY.
WILL WE NEVER LEARN ?
SIR,-The subject of this provoking correspondence
always interested me, and I have worked out the mortality-rates for gastrectomy at two provincial hospitals where I have been a registrar. To continue with Mr. MacLellan’s metaphor (Feb. 3), the pitches were not like Lord’s (I have been a registrar-spectator there too) but good county grounds nevertheless. The mortality-rate for both hospitals combined over a period of three years (132 cases, 7 surgeons) was 13-5%. Your correspondents must agree that this is pretty fast bowling. A few bowled " slows " (gastro-enterostomy), and there were one or two googlies (vagotomies) ; these had a much lower bowling average. The point I wish to emphasise is that the cause of this poor bowling average was not, in my estimation, that the bowlers were bad, but that they were rushed. They bowled 8-ball overs in the time that a professional
has
at Lord’s would take to roll up his sleeve. I am not referring necessarily to operating-time but to time for investigation and preparation-time to think. Far
important than the " have a go" mentality March 10) is the " what’s the next case Brailsford, (Dr.
more
attitude and the
glance
at the list and the theatre
1. Togna, T. R. Exercises in the Bath. Pp. 67. 6s. 6d. able from the author, Tuscan Hotel, London, W.1.
clock. Obtain-
Orthodox and better bowling will be achieved by the pitch, but this will take a long time as we all know. An immediate partial solution to Sir Heneage’s problem (March 3) lies, not in edicts, a full-time service, and control, but in more bowlers. The bowlers are there, twice the age of Tattersall, fully trained, waiting. I would hazard a guess that the mortality for gastrectomy performed by senior surgical registrars is below the average for the country’s con. sultants. They are more careful-they have to be. The trouble is that the present bowlers do not want any additions to the team-there will be fewer benefits, and the bonuses will become more infrequent. Nor do the county committees wish to increase their staff, for financial reasons. Will Sir Heneage have the courage of the M.C.G. and
improving
urs’e
that
more
bowlers
are
sent outg
F.R.C.S. HEPATITIS FROM TATTOOING
letter from Dr. Robertson in your issue of adds still more support to the suggestion that jaundice may be transmitted by inoculation during tattooing. Dr. H. Still and I have described1 four cases of jaundice which we thought were very probably acquired in this way. Our four patients all attended a certain tattooing den on Feb. 5, 1949, and were tattooed in succession. Each developed jaundice between June 17 and 29 the same year. There was no infectious hepatitis prevalent at the time, and after full inquiry we could not resist the conclusion that the virus of serum hepatitis had been inoculated through the agency of the tattooing needle. Dr. Ballard F. Smith had presumably not seen our article when he presented his paper,2 but his conclusions were very similar to ours. Since our cases occurred we have made careful inquiries of all our jaundice patients, but have not again demon. strated this causal connection. There can be little doubt, however, that there is a real danger of virus transmission during tattooing as usually performed, and stricter control over " artists " is long overdue. R. HOWELL ROBERTS. Halifax, Nova Scotia.
SIR,—The
Jan. 6
,
NURSING INFECTIOUS DISEASES SIR,—The belief that there is no longer a case for fever hospitals, which is widely held and is expressed by Mr. Crabb in his letter of March 10, is one of the main obstacles to the recruitment of nurses for these hospitals. The would-be nurse is advised that fever nursing is a thing of the past. This view has been strengthened by the publication of a proposal to abolish the special certificate in fever nursing. Thus, the high standard of nursing and nurse-training which fever hospitals maintained is being undermined. Yet the demand for their services, as the Emergency Bed Service could testify, remains greater than the fever hospitals at present
functioning can satisfy. Despite Mr. Crabb’s
final remark, general hospitals have very little accommodation suitable for infectious The extensive reconstruction needed to increase cases. such accommodation is not likely to be undertaken for many years to come. The general hospitals realise this, and not only refuse to admit patients suffering from many of the common infections but are anxious to transfer patients who develop such infections while in hospital. Meanwhile, those who decry the value or necessity of fever hospitals bear a considerable part of the responsibility for the grave nursing position described by Dr. Banks (Feb. 3) and Dr. Kennedy (Jan. 20). Waddon
Hospital,
Croydon.
J. J. LINEHAN.
1. Roberts, R. H., Still, H. Canad. med. Ass. J. 1950, 2. Smith, B. F. J. Amer. med. Ass. 1950, 144, 1074.
62, 75.