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RESEARCH IN GERONTOLOGY
180
mycin, 2 following oral chloramphenicol, 2 following streptomycin by mouth, 1 following streptomycin aerosol, and 1 following oral oxytetracycline’ (terramycin). Giunchi and Sorice observed 15 cases-6 after oral penicillin in the form of tablets or lozenges, 5 after penicillin aerosol, 3 after parenteral penicillin, and 1 after oral capsules of aureomycin. In 3 cases the soft palate and uvula were intensely red, and in 3 others there was erythema of the margins of the tongue accompanied by a burning sensation. The Italian workers reproduced the lesions by applying locally a solution of penicillin 1 million units per ml. of physiological saline. A drop of this solution was applied to the tongue of each of 12 normal people twice daily for ten consecutive days. 1 had to drop out of the experiment on the second day, because of painful aphthous stomatitis ; but in 10 of the remaining 11the lesion developed. Of 5 persons in whom aureomycin was applied in the same way, 2 developed the lesion ; and of 5 exposed to chloramphenicol, 1 developed the lesion. The disorder disappeared two to twelve days after the applications were discontinued. Inactivated penicillin or aureomycin did not produce the lesion, and the simultaneous administration of massive doses of B vitamins along with the active antibiotics did not prevent it. Giunchi and Sorice conclude that the antibacterial action of the antibiotics was an important factor in the development of the tongue lesion. They cultured Candida abbicans from 12 of the 15 clinical cases and from 9 of the 10 which developed after experimental application of penicillin. Escherichia coli was also isolated in several cases in both groups. They suggest that the overgrowth of C. albicans does not account alone for the lesion, since this is rare in moiiiliasis of the mouth. They believe that an additional factor-namely, the irritant or toxic effect of the antibiotic on the mucosa-must operate. Another possible explanation is the development of contact stomatitis due to hypersensitivity to the antibiotic ; and this might account for the irregular incidence of the condition. BrowWdescribed a case of penicillin contact glossitis in which exfoliation of the papille was preceded by a stage resembling black hairy tongue. _
HOSPITAL MEDICAL RECORDS WELL-WRITTEN case-notes play an essential part in establishing an accurate diagnosis, and progress notes are an important record of the response to treatment. Detailed notes are invaluable when a patient is readmitted or is treated at another hospital, and for medicolegal They also have a role in clinical research purposes. -though forward-planned research is more satisfactory. The storage of medical records is a serious problem in many hospitals, and a Ministry memorandum4 sets out various recommendations and clarifies the legal situation. All medical records are now subject to the provisions of the Public Records Office Acts, which means that a schedule of minimum times for retention of all hospital documents must be prepared. This will shortly be laid before Parliament. Meanwhile, strictly speaking, no medical records may be destroyed. Subject to parliamentary approval, the Ministry suggests that all records should be preserved for at least six years. There will be no obligation to destroy them then or subsequently, and the period of their retention should depend on advice given by unit medical advisory committees, bearing in mind the clinical and research requirements and storage facilities. Technically, the term"medical records " includes not only the case-sheets but also such diverse records as day and night nursing report books, outpatient appointment sheets, and radiographs. The retention of case-notes is of value only if they are fully cross-indexed by unit number, name, and
diagnosis,
3. Brown, R. L. 4. H.M.(54)47.
and the memorandum recommends
Arch. Otolaryng., Chicago, 1947, 45, 355.
that the unit
system of numbering should be generally
adopted. The memorandum includes suggestions for minimising the space required for storing records. Initial editing enable some forms with may purely administradealing tive arrangements to be discarded, but such editing must be done carefully-if necessary by the doctor in charge of the case. Another method for reducing the bulk would be to prepare a summary at the conclusion of inpatient treatment, if possible on the reverse of the front sheet of the’ patient’s.notes, on which would appear After a period his name and address, unit number, &c. exceeding the statutory minimum for retaining documents it should be possible to discard the original notes, retaining only the summary. At the end of inpatient treatment the case-papers may be marked so as to indicate whether they may be disposed of after the statutory minimum period ; if not, for how long they should be retained or whether (and if so how long after the expiration of the statutory minimum period) the main notes may be disposed of and only the summary kept. Whether the records are in fact destroyed after the time indicated will, of course, depend on developments in the interim period-for example, whether the patient has received further treatment-but continuous " weeding out " on these lines will clearly help to ease storage difficulties. There would be no objection to microfilming of records if the records were retained in the original for the first two years and then preserved on micro-film for at least the remainder of the statutory period. Micro-filming makes possible a 99% reduction in the amount of material to be stored, and may be invaluable when storage difficulties are great. The memorandum suggests that general responsibility for these arrangements should remain with the medical staff committee of the hospital. HYALURONIDASE AND PARAPHIMOSIS PARAPHiMOSis is a common and distressing condition, and its reduction, even with an anaesthetic, may not be easy. Reduction may be made easier by a dorsal slit, but this often results in disfigurement and chronic oedema so that circumcision is ultimately necessary. Immediate circumcision is sometimes the best treatment, but it may be most inconvenient for the patient to have an unexpected operation. Ratliff,1 at Ann Arbor, Michigan, has devised a method of reducing paraphimosis which seems to be painless, quick, and easy and leaves no wound. He injects into each side of the swollen ring of prepuce 1 ml. of normal saline containing 150 turbidity units of hyaluronidase. In two minutes the swelling can be pitted, and in twelve it has disappeared completely and the prepuce can be drawn forwards easily and without pain. This treatment has been applied in only four cases, but in each it was successful. Such a simple and promising method deserves thorough trial. RESEARCH IN GERONTOLOGY AT the colloquium on Ageing held by the Ciba Foundation last week, Dr. E. D. Adrian, o.M., P.R.S., announced the trustees’ plans to stimulate research in gerontology. Over the next five years the representatives of th& founder are to provide an extra sum of money for thi& purpose. The foundation intends to hold further colloquia on this subject and the proceedings of these meetings are to be published in a series of volumes similar to the foundation’s Colloquia on Endocrinology. An annual lectureship, awards for experimental work, and travelling fellowships will also be offered to encourage the investigations of problems in which age is a factor. Further particulars may be had from Dr. G. E. W. Wolstenhoime, the director of the foundation, 41, Portland Place, London, At.1. 1.
Ratliff, R. K. J. Amer. med. Ass. 1954, 155, 746.
mycin, 2 following oral chloramphenicol, 2 following streptomycin by mouth, 1 following streptomycin aerosol, and 1 following oral oxytetracycline’ (terramycin). Giunchi and Sorice observed 15 cases-6 after oral penicillin in the form of tablets or lozenges, 5 after penicillin aerosol, 3 after parenteral penicillin, and 1 after oral capsules of aureomycin. In 3 cases the soft palate and uvula were intensely red, and in 3 others there was erythema of the margins of the tongue accompanied by a burning sensation. The Italian workers reproduced the lesions by applying locally a solution of penicillin 1 million units per ml. of physiological saline. A drop of this solution was applied to the tongue of each of 12 normal people twice daily for ten consecutive days. 1 had to drop out of the experiment on the second day, because of painful aphthous stomatitis ; but in 10 of the remaining 11the lesion developed. Of 5 persons in whom aureomycin was applied in the same way, 2 developed the lesion ; and of 5 exposed to chloramphenicol, 1 developed the lesion. The disorder disappeared two to twelve days after the applications were discontinued. Inactivated penicillin or aureomycin did not produce the lesion, and the simultaneous administration of massive doses of B vitamins along with the active antibiotics did not prevent it. Giunchi and Sorice conclude that the antibacterial action of the antibiotics was an important factor in the development of the tongue lesion. They cultured Candida abbicans from 12 of the 15 clinical cases and from 9 of the 10 which developed after experimental application of penicillin. Escherichia coli was also isolated in several cases in both groups. They suggest that the overgrowth of C. albicans does not account alone for the lesion, since this is rare in moiiiliasis of the mouth. They believe that an additional factor-namely, the irritant or toxic effect of the antibiotic on the mucosa-must operate. Another possible explanation is the development of contact stomatitis due to hypersensitivity to the antibiotic ; and this might account for the irregular incidence of the condition. BrowWdescribed a case of penicillin contact glossitis in which exfoliation of the papille was preceded by a stage resembling black hairy tongue. _
HOSPITAL MEDICAL RECORDS WELL-WRITTEN case-notes play an essential part in establishing an accurate diagnosis, and progress notes are an important record of the response to treatment. Detailed notes are invaluable when a patient is readmitted or is treated at another hospital, and for medicolegal They also have a role in clinical research purposes. -though forward-planned research is more satisfactory. The storage of medical records is a serious problem in many hospitals, and a Ministry memorandum4 sets out various recommendations and clarifies the legal situation. All medical records are now subject to the provisions of the Public Records Office Acts, which means that a schedule of minimum times for retention of all hospital documents must be prepared. This will shortly be laid before Parliament. Meanwhile, strictly speaking, no medical records may be destroyed. Subject to parliamentary approval, the Ministry suggests that all records should be preserved for at least six years. There will be no obligation to destroy them then or subsequently, and the period of their retention should depend on advice given by unit medical advisory committees, bearing in mind the clinical and research requirements and storage facilities. Technically, the term"medical records " includes not only the case-sheets but also such diverse records as day and night nursing report books, outpatient appointment sheets, and radiographs. The retention of case-notes is of value only if they are fully cross-indexed by unit number, name, and
diagnosis,
3. Brown, R. L. 4. H.M.(54)47.
and the memorandum recommends
Arch. Otolaryng., Chicago, 1947, 45, 355.
that the unit
system of numbering should be generally
adopted. The memorandum includes suggestions for minimising the space required for storing records. Initial editing enable some forms with may purely administradealing tive arrangements to be discarded, but such editing must be done carefully-if necessary by the doctor in charge of the case. Another method for reducing the bulk would be to prepare a summary at the conclusion of inpatient treatment, if possible on the reverse of the front sheet of the’ patient’s.notes, on which would appear After a period his name and address, unit number, &c. exceeding the statutory minimum for retaining documents it should be possible to discard the original notes, retaining only the summary. At the end of inpatient treatment the case-papers may be marked so as to indicate whether they may be disposed of after the statutory minimum period ; if not, for how long they should be retained or whether (and if so how long after the expiration of the statutory minimum period) the main notes may be disposed of and only the summary kept. Whether the records are in fact destroyed after the time indicated will, of course, depend on developments in the interim period-for example, whether the patient has received further treatment-but continuous " weeding out " on these lines will clearly help to ease storage difficulties. There would be no objection to microfilming of records if the records were retained in the original for the first two years and then preserved on micro-film for at least the remainder of the statutory period. Micro-filming makes possible a 99% reduction in the amount of material to be stored, and may be invaluable when storage difficulties are great. The memorandum suggests that general responsibility for these arrangements should remain with the medical staff committee of the hospital. HYALURONIDASE AND PARAPHIMOSIS PARAPHiMOSis is a common and distressing condition, and its reduction, even with an anaesthetic, may not be easy. Reduction may be made easier by a dorsal slit, but this often results in disfigurement and chronic oedema so that circumcision is ultimately necessary. Immediate circumcision is sometimes the best treatment, but it may be most inconvenient for the patient to have an unexpected operation. Ratliff,1 at Ann Arbor, Michigan, has devised a method of reducing paraphimosis which seems to be painless, quick, and easy and leaves no wound. He injects into each side of the swollen ring of prepuce 1 ml. of normal saline containing 150 turbidity units of hyaluronidase. In two minutes the swelling can be pitted, and in twelve it has disappeared completely and the prepuce can be drawn forwards easily and without pain. This treatment has been applied in only four cases, but in each it was successful. Such a simple and promising method deserves thorough trial. RESEARCH IN GERONTOLOGY AT the colloquium on Ageing held by the Ciba Foundation last week, Dr. E. D. Adrian, o.M., P.R.S., announced the trustees’ plans to stimulate research in gerontology. Over the next five years the representatives of th& founder are to provide an extra sum of money for thi& purpose. The foundation intends to hold further colloquia on this subject and the proceedings of these meetings are to be published in a series of volumes similar to the foundation’s Colloquia on Endocrinology. An annual lectureship, awards for experimental work, and travelling fellowships will also be offered to encourage the investigations of problems in which age is a factor. Further particulars may be had from Dr. G. E. W. Wolstenhoime, the director of the foundation, 41, Portland Place, London, At.1. 1.
Ratliff, R. K. J. Amer. med. Ass. 1954, 155, 746.