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PROTHROMBIN CONSUMPTION DURING MENSES
460 to enter the new National Health superannuation scheme will now receive considerably smaller pensions than under the asylum officers’ scheme, and at a retiring age of 60. Not only that, but the refusal to classify these workers as mental-health officers has at one clean administrative stroke reduced their status to that of the mental-hospital
clerical worker. It would seem that the position in the health service cf small groups of ancillary workers, possessing no strong political lobby, is sorry indeed. M. POTT. London, S.W.5. PROTHROMBIN CONSUMPTION DURING MENSES SIR,-Impairment of blood-coagulation in women
during
menses
has often been
suspected. By
means
Quick’sconsumption test, which has enabled
us
of to
detect some latent deficiencies of blood-coagulation in various disorders, such as thrombocytopenia,2 we have found quite constantly that, in normal women with normal menses, during the menstrual period and especially at its beginning there is a slight but significant reduction of prothrombin consumption, compared with intermenstrual intervals. In many cases the percentage of residual prothrombin 3 hours after coagulation has been about twice as great on the 28th day as on the 14th day. The number of platelets varies inversely with the residual
prothrombin. Slight thrombocytopenia immediately before and at the beginning of the menses has often been described 3 ; this was accurately demonstrated by our co-worker, Rovatti,4 and was confirmed by us. The decrease of prothrombin consumption during the menses is, however, greater than would be expected from a simple premenstrual and menstrual diminution in the number of
platelets ; and this leads us to suspect a functional, transitory insufficiency of platelets (their agglutinability and adhesiveness are diminished during menses) ; but perhaps during menses there is also deficiency of other coagulation factors. A. BASERGA Department of Internal Medicine, University of Pavia.
P. ROSTI R. FURIAN.
for the benefit of future Institute of
practitioners.
Psychiatry, Denmark Hill, London, S.E.5.
D. STAFFORD-CLARK.
Obituary ERNEST BOSDIN LEECH M.A., M.D. CAMB., HON. M.A. 3ZANC., F.R.C.P.; D.P.H. Dr. E. Bosdin Leech, consulting physician to the Manchester Royal Infirmary, was the son of Sir Bosdin Leech, a mayor of Manchester who was one of the main promoters of the ship canal and wrote its history, and a nephew of Daniel John Leech, the first professor of£ pharmacology in the university. He went to school at Cheltenham College, and in 1894 he entered Christ’s College, Cambridge. At that time he had thoughts of reading for the Church, but soon he turned to medicine, and four years later he went to the Manchester Royal Infirmary, where his uncle was a physician. Qualifying in 1901 he held the usual resident appointments at the infirmary before he set up as a consultant, and when an emergency arose in the resident staff of the infirmary he felt it his duty to give up his consulting-rooms and to return as resident medical officer. In this post he gave valuable service in the removal of the infirmary from Piccadilly to the new site in Oxford Road. Shortly afterwards he was appointed to the honorary staff, on which he continued to serve until he reached the retiring age in 1938. He was also physician to the Christie Hospital, and he was for many years a most conscientious and respected medical referee under the Workmen’s Compensation Act. At the medical school he was an enthusiastic teacher, who knew how to share his enthusiasm with his students. In 1937 the university awarded him the honorary degree of M.A. Leech was president of the Manchester Medical Society in its centenary year. Although his antiquarian knowledge was wide, Manchester, and above all Manchester medical history, was his specialty. His gift to the university medical library of his collection of books and papers on this subject, including his own monographs on Medicine in the Provinces in England, Picturesque Episodes of Manchester Medical History, and Early Medicine and Quackery in Lancashire, was an important and generous contribution. A former president of the Manchester Ancient Monuments Society, he was also a mainstay of the Lancashire Parish Register Societv. E. T. writes : " Bosdin Leech was much more than a good physician. He came of a family which, on both sides, had a great tradition of public service, and this tradition inspired his work and outlook to the end of his life. The social and cultural life of medicine in Manchester He founded the owes much to his devoted work. Cambridge Medical Graduates’ Club and the very popular Old Infirmary Residents’ Club. He took his full share in the activities of the various medical societies in the town, and whenever a dinner or anniversary or presentation had to be arranged it was always Leech who did the work. He may well be remembered chiefly for his services to the University Medical Library to which he gave many years of devoted work. It is due to Leech that we have so fine an instrument of research in all branches of medicine. His interests were not exclusively medical, and his days of retirement were made happy by a study of the personal and place names of Lancashire and Cheshire and by the publication of parish registers. His motives were ever selfless and without thought of rewards; and he has left his friends many pleasant memories." Dr. Leech married Miss Mary Walder and they had two daughters. He died at his home in Manchester on Sept. 19 at the age of 75. _
PSYCHOSOMATIC MEDICINE
SiR,-Professor Pickering’ss somewhat
most needs skilled help and understanding, and whose case most needs adequate demonstration and elucidation
disingenuous
reference to psychosomatic medicine (July 15) has evoked a spate of trenchant replies, of which Dr. Halliday’s (Sept. 2) stands out. But while any physician aware of the interrelationship of mind and body cannot fail to agree with Dr. Ellis (Sept. 23) that the earliest phase of clinical teaching should emphasise, for example, the importance of anxiety no less than of cancer in the production of anorexia, can such initial emphasis satisfy the student even in his first week of clinical medicine unless it attempts to include some reference to the causes of this anxiety ? It is surely here that a confident working liaison between the teacher who is a general physician and the teacher who is a psychiatrist is indispensable to sound or stimulating teaching. For lack of it may still lead the student to regard anorexia or any other syndrome based on anxiety as a comparatively trivial or even contemptible complaint in contrast to the same condition when due to cancer or some other " real " cause. Encouragement of this attitude of mind by a few general physicians who hold it themselves only aggravates the problem. Yet it is precisely the patient whose basic anxiety is neither superficially reasonable nor capable of resolution by purely common-sense measures who Quick, A., Shanberge, J. N., Stefanini, M. Amer. J. med. Sci. 1949, 217, 198. 2. Baserga, A., de Nicola, P. Schweiz. med. Wschr. 1949, 79, 801. 1.
Le Malattie Emorragiche. Milan : Società Editrice Libraria. 1950. 3. Rebaudi. Arch. ital. Ginec. 1907, 10, 1. 4. Rovatti, B., Ottolenghi-Preti, G. Fol. gynœc., Paria, 1948, 43, 331.
clerical worker. It would seem that the position in the health service cf small groups of ancillary workers, possessing no strong political lobby, is sorry indeed. M. POTT. London, S.W.5. PROTHROMBIN CONSUMPTION DURING MENSES SIR,-Impairment of blood-coagulation in women
during
menses
has often been
suspected. By
means
Quick’sconsumption test, which has enabled
us
of to
detect some latent deficiencies of blood-coagulation in various disorders, such as thrombocytopenia,2 we have found quite constantly that, in normal women with normal menses, during the menstrual period and especially at its beginning there is a slight but significant reduction of prothrombin consumption, compared with intermenstrual intervals. In many cases the percentage of residual prothrombin 3 hours after coagulation has been about twice as great on the 28th day as on the 14th day. The number of platelets varies inversely with the residual
prothrombin. Slight thrombocytopenia immediately before and at the beginning of the menses has often been described 3 ; this was accurately demonstrated by our co-worker, Rovatti,4 and was confirmed by us. The decrease of prothrombin consumption during the menses is, however, greater than would be expected from a simple premenstrual and menstrual diminution in the number of
platelets ; and this leads us to suspect a functional, transitory insufficiency of platelets (their agglutinability and adhesiveness are diminished during menses) ; but perhaps during menses there is also deficiency of other coagulation factors. A. BASERGA Department of Internal Medicine, University of Pavia.
P. ROSTI R. FURIAN.
for the benefit of future Institute of
practitioners.
Psychiatry, Denmark Hill, London, S.E.5.
D. STAFFORD-CLARK.
Obituary ERNEST BOSDIN LEECH M.A., M.D. CAMB., HON. M.A. 3ZANC., F.R.C.P.; D.P.H. Dr. E. Bosdin Leech, consulting physician to the Manchester Royal Infirmary, was the son of Sir Bosdin Leech, a mayor of Manchester who was one of the main promoters of the ship canal and wrote its history, and a nephew of Daniel John Leech, the first professor of£ pharmacology in the university. He went to school at Cheltenham College, and in 1894 he entered Christ’s College, Cambridge. At that time he had thoughts of reading for the Church, but soon he turned to medicine, and four years later he went to the Manchester Royal Infirmary, where his uncle was a physician. Qualifying in 1901 he held the usual resident appointments at the infirmary before he set up as a consultant, and when an emergency arose in the resident staff of the infirmary he felt it his duty to give up his consulting-rooms and to return as resident medical officer. In this post he gave valuable service in the removal of the infirmary from Piccadilly to the new site in Oxford Road. Shortly afterwards he was appointed to the honorary staff, on which he continued to serve until he reached the retiring age in 1938. He was also physician to the Christie Hospital, and he was for many years a most conscientious and respected medical referee under the Workmen’s Compensation Act. At the medical school he was an enthusiastic teacher, who knew how to share his enthusiasm with his students. In 1937 the university awarded him the honorary degree of M.A. Leech was president of the Manchester Medical Society in its centenary year. Although his antiquarian knowledge was wide, Manchester, and above all Manchester medical history, was his specialty. His gift to the university medical library of his collection of books and papers on this subject, including his own monographs on Medicine in the Provinces in England, Picturesque Episodes of Manchester Medical History, and Early Medicine and Quackery in Lancashire, was an important and generous contribution. A former president of the Manchester Ancient Monuments Society, he was also a mainstay of the Lancashire Parish Register Societv. E. T. writes : " Bosdin Leech was much more than a good physician. He came of a family which, on both sides, had a great tradition of public service, and this tradition inspired his work and outlook to the end of his life. The social and cultural life of medicine in Manchester He founded the owes much to his devoted work. Cambridge Medical Graduates’ Club and the very popular Old Infirmary Residents’ Club. He took his full share in the activities of the various medical societies in the town, and whenever a dinner or anniversary or presentation had to be arranged it was always Leech who did the work. He may well be remembered chiefly for his services to the University Medical Library to which he gave many years of devoted work. It is due to Leech that we have so fine an instrument of research in all branches of medicine. His interests were not exclusively medical, and his days of retirement were made happy by a study of the personal and place names of Lancashire and Cheshire and by the publication of parish registers. His motives were ever selfless and without thought of rewards; and he has left his friends many pleasant memories." Dr. Leech married Miss Mary Walder and they had two daughters. He died at his home in Manchester on Sept. 19 at the age of 75. _
PSYCHOSOMATIC MEDICINE
SiR,-Professor Pickering’ss somewhat
most needs skilled help and understanding, and whose case most needs adequate demonstration and elucidation
disingenuous
reference to psychosomatic medicine (July 15) has evoked a spate of trenchant replies, of which Dr. Halliday’s (Sept. 2) stands out. But while any physician aware of the interrelationship of mind and body cannot fail to agree with Dr. Ellis (Sept. 23) that the earliest phase of clinical teaching should emphasise, for example, the importance of anxiety no less than of cancer in the production of anorexia, can such initial emphasis satisfy the student even in his first week of clinical medicine unless it attempts to include some reference to the causes of this anxiety ? It is surely here that a confident working liaison between the teacher who is a general physician and the teacher who is a psychiatrist is indispensable to sound or stimulating teaching. For lack of it may still lead the student to regard anorexia or any other syndrome based on anxiety as a comparatively trivial or even contemptible complaint in contrast to the same condition when due to cancer or some other " real " cause. Encouragement of this attitude of mind by a few general physicians who hold it themselves only aggravates the problem. Yet it is precisely the patient whose basic anxiety is neither superficially reasonable nor capable of resolution by purely common-sense measures who Quick, A., Shanberge, J. N., Stefanini, M. Amer. J. med. Sci. 1949, 217, 198. 2. Baserga, A., de Nicola, P. Schweiz. med. Wschr. 1949, 79, 801. 1.
Le Malattie Emorragiche. Milan : Società Editrice Libraria. 1950. 3. Rebaudi. Arch. ital. Ginec. 1907, 10, 1. 4. Rovatti, B., Ottolenghi-Preti, G. Fol. gynœc., Paria, 1948, 43, 331.