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INFANTILE GASTROENTERITIS
1285 TOO MANY DOCTORS ?
SiR,-It is surprising that there has not been comment in the medical press on the suggestion that the intake into the medical schools in Great Britain should be decreased by about 10%. It is doubtless true, as has been stated,1- that applicants for general-practice vacancies average nearly 40 a vacancy, and it is certainly true of the applicants for consultant posts in the hospital service. When one looks at the junior hospital posts, however, the converse is the case and, as this Association stated in its evidence before the Commission, these vacancies can only be filled by employing doctors from other countries. By reducing the number of graduates from British medical schools and universities this position will become still more marked, and my Association regards this as highly undesirable from every point of view. The need is for more posts at the top and not for fewer posts at the bottom. If there is to be a reduction of 10% on entry of students into British universities and medical schools, we feel that there should be an equivalent quota placed upon the entry of graduates from Southern Ireland (and other countries) to this country. We also feel that the entry of postgraduates from medical schools in the Dominions and Eire, and the possibility of settling here, has been overlooked. There is much to be said for the view of the B.M.A. Scottish Committee2 that a decision should be postponed for five years. At least we hope that the Government will take the advice in your leader of Nov. 23 and leave the profession full responsibility for acting or not acting on more
-hf "’ANHYHY’lAY’liI".-HoY’l<< nAfo"’A.
i+
V. COTTON CORNWALL Joint honorary secretary, Regional Hospitals’ Consultants and Specialists Association.
CATHETER FOR EXCHANGE TRANSFUSION
1956 Dr. R. L. Denton, of Montreal, kindly attention to the advantages of a new type of plastic catheter for exchange transfusion via the umbilical vein. This catheter is a polyvinyl tube originally devised for the feeding of premature infants, but also admirably suited to the catheterisation of the umbilical veins The catheter consists of a length of transparent polyvinyl tubing ; one end is moulded to a plastic luer socket into which any luer nozzle will fit. The other end of the catheter is sealed into a rounded tip. Just proximal to the tip there are two holes in the wall of the tube. The catheter has the following advantages over a simple length of polyethylene tubing : (1) Because of the great flexibility of the-tube, movements
Sm,—In
drew
our
of that part which lies outside the umbilical vein are not transmitted to the part lying inside the vein. Thus, when a suitable position for the catheter within the vein has been found, the position is easily maintained ; the stillness of the tube within the vein helps to avoid spasm. (2) The smooth rounded tip of the catheter makes it easy to introduce and is a safeguard against perforation of the umbilical vein.
A clot occasionally forms in the distal (closed) end of the tube, and the clot may spread proximally and occlude the two lateral holes. If this happens the catheter must be withdrawn and rinsed out with heparin-saline solution. The catheter is designed to be expendable but may, if desired, be re-sterilised by boiling. Care must be exercised in handling the catheter when it is hot, since it is then easily deformed. The
catheter is manufactured by the Pharmaseal Glendale 1, California, U.S.A., and is the K-31
original
Laboratories,
1. Andrews, J. R. Brit. med. J. Nov. 20, 1957, suppl. 2. ibid. Nov. 16, 1957, suppl. p. 153. 3. Fischer, C. C., Agerby, H. A. Pediat. 1956. 17, 449.
p. 184.
expendable, plastic infant-feeding tube. Similar tubes are manufactured in this country by Capon Heaton & Co. Ltd., Hazelwell Mills, Stirchley, Birmingham, 30, and by Edwards Sursical Supplies. 83. Mortimer Street. London, W.I. Hammersmith Hospital, London, W.12.
P. L. MOLLISON J. P. M. TIZARD.
INFANTILE GASTROENTERITIS
SiR,,-I have read the article by Dr. Brown and Dr. Bailey (Dec. 14) on Esch. coli gastroenteritis with interest.
By and large their experience has been similar to ours, with one exception. We have not been nearly so impressed with the therapeutic effectiveness of antibiotics in this condition. They certainly reduce the number of organisms excreted and thus may lessen the risk of cross-infection, but I believe there has been a lessening of virulence of the disease over the last twenty years. The small number of babies requiring rehydration on admission to hospital is evidence of this. In fact we now find it difficult to give our residents experience in learning the technique of " drips " during their stay. I do not think therefore that the statement in the summary of their paper that " the use of antibiotics has greatly simplified treatment " should be allowed to pass unchallenged. Too much faith in antibiotics may be dangerous in this as in other conditions. Department of Child Health, Welsh National School of Medicine, Cardiff.
A. G. WATKINS.
TRICHOMONAS VAGINITIS
SiR,—Much of the value of the paper by Dr. Stewart and his colleagues (Nov. 23) is lost through three
discrepancies. (1) Although two ’Locan,’ or two acetarsol pessaries, were prescribed daily in two of the three series, the patients included in the Penotrane’ series were instructed to insert only one pessary at night. It is only fair to point out that the makers’ recommended dosage has been, and is, two penotrane pessaries at night for fourteen days. (2) The second unfortunate factor concerns the selection of patients. In the locan series in the clinical trial, " All patients with trichomonas vaginitis (with or without any additional infection) were included, except those who were professionally promiscuous" (my italics), whereas " The controls were unselected and consisted of 66 patients taken consecutively from those attending the clinic." (3) There is no mention of clinical reactions to the drug
except in the sentence " Only 1 patient, however, comof any symptom which she attributed to the treatment itself. This was a Negress with irritation of the vulva ; she used
plained
continued treatment and was controlled by the second course." I may have been unlucky, but in the few cases I have seen treated (not more than 12) I have encountered 3 severe cases of local vaginitis and moist eczematous dermatitis of the vulva after the use of locan pessaries.
I have recently used penotrane in a series of 125 consecutive patients attending the leucorrhoea clinic of the Edinburgh Infirmary and Elsie Inglis Maternity Hospital. I have found it as effective as any other preparation used topically in the treatment of trichomonal vaginitis, and better than most. It is notoriously difficult to assess the value of any drug in this condition, but further investigation on the lines suggested by Dr. Stewart and his colleagues, may well advance our, at present incomplete, understanding of this uncomfortable and socially distressing condition. Royal Infirmary, MARJORIE MURRELL. Edinburgh.
SIR,-I read with interest the article by Dr. Stewart and his
colleagues on the treatment of trichomonas Locan ’ pessaries containing amethocaine, with vaginitis amylocaine, and benzalkonium chloride. I have used this preparation in the treatment of 31 patients, ranging in age from 22 to 80 years, whose presenting symptoms were vaginal discharge and vulval
SiR,-It is surprising that there has not been comment in the medical press on the suggestion that the intake into the medical schools in Great Britain should be decreased by about 10%. It is doubtless true, as has been stated,1- that applicants for general-practice vacancies average nearly 40 a vacancy, and it is certainly true of the applicants for consultant posts in the hospital service. When one looks at the junior hospital posts, however, the converse is the case and, as this Association stated in its evidence before the Commission, these vacancies can only be filled by employing doctors from other countries. By reducing the number of graduates from British medical schools and universities this position will become still more marked, and my Association regards this as highly undesirable from every point of view. The need is for more posts at the top and not for fewer posts at the bottom. If there is to be a reduction of 10% on entry of students into British universities and medical schools, we feel that there should be an equivalent quota placed upon the entry of graduates from Southern Ireland (and other countries) to this country. We also feel that the entry of postgraduates from medical schools in the Dominions and Eire, and the possibility of settling here, has been overlooked. There is much to be said for the view of the B.M.A. Scottish Committee2 that a decision should be postponed for five years. At least we hope that the Government will take the advice in your leader of Nov. 23 and leave the profession full responsibility for acting or not acting on more
-hf "’ANHYHY’lAY’liI".-HoY’l<< nAfo"’A.
i+
V. COTTON CORNWALL Joint honorary secretary, Regional Hospitals’ Consultants and Specialists Association.
CATHETER FOR EXCHANGE TRANSFUSION
1956 Dr. R. L. Denton, of Montreal, kindly attention to the advantages of a new type of plastic catheter for exchange transfusion via the umbilical vein. This catheter is a polyvinyl tube originally devised for the feeding of premature infants, but also admirably suited to the catheterisation of the umbilical veins The catheter consists of a length of transparent polyvinyl tubing ; one end is moulded to a plastic luer socket into which any luer nozzle will fit. The other end of the catheter is sealed into a rounded tip. Just proximal to the tip there are two holes in the wall of the tube. The catheter has the following advantages over a simple length of polyethylene tubing : (1) Because of the great flexibility of the-tube, movements
Sm,—In
drew
our
of that part which lies outside the umbilical vein are not transmitted to the part lying inside the vein. Thus, when a suitable position for the catheter within the vein has been found, the position is easily maintained ; the stillness of the tube within the vein helps to avoid spasm. (2) The smooth rounded tip of the catheter makes it easy to introduce and is a safeguard against perforation of the umbilical vein.
A clot occasionally forms in the distal (closed) end of the tube, and the clot may spread proximally and occlude the two lateral holes. If this happens the catheter must be withdrawn and rinsed out with heparin-saline solution. The catheter is designed to be expendable but may, if desired, be re-sterilised by boiling. Care must be exercised in handling the catheter when it is hot, since it is then easily deformed. The
catheter is manufactured by the Pharmaseal Glendale 1, California, U.S.A., and is the K-31
original
Laboratories,
1. Andrews, J. R. Brit. med. J. Nov. 20, 1957, suppl. 2. ibid. Nov. 16, 1957, suppl. p. 153. 3. Fischer, C. C., Agerby, H. A. Pediat. 1956. 17, 449.
p. 184.
expendable, plastic infant-feeding tube. Similar tubes are manufactured in this country by Capon Heaton & Co. Ltd., Hazelwell Mills, Stirchley, Birmingham, 30, and by Edwards Sursical Supplies. 83. Mortimer Street. London, W.I. Hammersmith Hospital, London, W.12.
P. L. MOLLISON J. P. M. TIZARD.
INFANTILE GASTROENTERITIS
SiR,,-I have read the article by Dr. Brown and Dr. Bailey (Dec. 14) on Esch. coli gastroenteritis with interest.
By and large their experience has been similar to ours, with one exception. We have not been nearly so impressed with the therapeutic effectiveness of antibiotics in this condition. They certainly reduce the number of organisms excreted and thus may lessen the risk of cross-infection, but I believe there has been a lessening of virulence of the disease over the last twenty years. The small number of babies requiring rehydration on admission to hospital is evidence of this. In fact we now find it difficult to give our residents experience in learning the technique of " drips " during their stay. I do not think therefore that the statement in the summary of their paper that " the use of antibiotics has greatly simplified treatment " should be allowed to pass unchallenged. Too much faith in antibiotics may be dangerous in this as in other conditions. Department of Child Health, Welsh National School of Medicine, Cardiff.
A. G. WATKINS.
TRICHOMONAS VAGINITIS
SiR,—Much of the value of the paper by Dr. Stewart and his colleagues (Nov. 23) is lost through three
discrepancies. (1) Although two ’Locan,’ or two acetarsol pessaries, were prescribed daily in two of the three series, the patients included in the Penotrane’ series were instructed to insert only one pessary at night. It is only fair to point out that the makers’ recommended dosage has been, and is, two penotrane pessaries at night for fourteen days. (2) The second unfortunate factor concerns the selection of patients. In the locan series in the clinical trial, " All patients with trichomonas vaginitis (with or without any additional infection) were included, except those who were professionally promiscuous" (my italics), whereas " The controls were unselected and consisted of 66 patients taken consecutively from those attending the clinic." (3) There is no mention of clinical reactions to the drug
except in the sentence " Only 1 patient, however, comof any symptom which she attributed to the treatment itself. This was a Negress with irritation of the vulva ; she used
plained
continued treatment and was controlled by the second course." I may have been unlucky, but in the few cases I have seen treated (not more than 12) I have encountered 3 severe cases of local vaginitis and moist eczematous dermatitis of the vulva after the use of locan pessaries.
I have recently used penotrane in a series of 125 consecutive patients attending the leucorrhoea clinic of the Edinburgh Infirmary and Elsie Inglis Maternity Hospital. I have found it as effective as any other preparation used topically in the treatment of trichomonal vaginitis, and better than most. It is notoriously difficult to assess the value of any drug in this condition, but further investigation on the lines suggested by Dr. Stewart and his colleagues, may well advance our, at present incomplete, understanding of this uncomfortable and socially distressing condition. Royal Infirmary, MARJORIE MURRELL. Edinburgh.
SIR,-I read with interest the article by Dr. Stewart and his
colleagues on the treatment of trichomonas Locan ’ pessaries containing amethocaine, with vaginitis amylocaine, and benzalkonium chloride. I have used this preparation in the treatment of 31 patients, ranging in age from 22 to 80 years, whose presenting symptoms were vaginal discharge and vulval