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SALT-POISONING IN INFANCY
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towards means of detecting latent coronary heart-disease 1; and this is an obvious approach for the screening of astronauts, who are subjected to every possible physiological investigation before selection and before each flight. Infectious disease is hardly a hazard to aviators whose flights, compared with incubation periods, are exceedingly brief; but on two counts it must now enter the reckoning of Space medicine: first because it can affect the astronaut in transit; and secondly because it is " It an undesirable export. In the words of Generales: would be well to recall that the medical profession has still not eradicated syphilis since its introduction into Europe about 1493 and the explosive epidemic of Naples in 1495-an onerous heritage among the blessings and countless commodities that followed in the wake of the comparatively simple exploration of the Western
Hemisphere 11" There may not be a man in the moon, nor life but we ought to act as though there were.
on
Mars,
NEAR RETIRING
IN its own modest words, this Nuffield study3 is a "minor contribution to fuller understanding of the problems of ageing among manual workers in industry ". Based on interviews with older men employed in Slough factories, it reports the kind of jobs they were doing, their subjective experience of strain at work, the foremen’s attitudes towards them, and changes of job in later working life. Though the material consists more of impressions than facts, the style is readable, the conclusions are cautious, and useful suggestions are made for more precise and detailed studies. Though nothing very new emerges, this succinct statement of the problems of an ageing labour force is valuable in a period of rapidly increasing industrial technology. In particular, the report brings out the opinions and attitudes of older workers themselves and shows how few give any serious consideration to the impact retirement will make on their lives. Work involving time-stress again appears as the main difficulty of older workers, and the report confirms the finding from other studies that men in paced jobs often move in middle age to relatively unskilled tasks which offer opportunities for self-regulation of speed of work. On the whole, foremen seem to be helpful and understanding about adjustments of this kind, and indeed to show foresight inasmuch as they try to move older men to suitable work before they break down. By these internal transfers industry can reduce the casualty-rate among its own employees, but in the favourable employment conditions of Slough the older men were prepared to search for more attractive jobs elsewhere and to make a success of them; furthermore, supervisors did not seem to be unduly prejudiced in their attitudes to older workers. Any report that draws attention to the need for a preventive approach to ageing in industry is to be welcomed. Though a good deal is now known about what to expect in groups of men reaching middle age in certain kinds of work, industry itself seems to have a low awareness of this knowledge and how to apply it; and people in responsible positions in management and labour could read this study with profit. It prompts a further thought. How does
ageing affect
1. Rumball, A., Acheson, E. D. Brit. med. J. Feb. 16, 1963, p. 423. 2. N.Y. St. J. Med. 1963, 63, 1310. 3. Workers Nearing Retirement. Nuffield Foundation, Nuffield Lodge, Regent’s Park, London, N.W.1. 1963. Pp. 53. 5s.
medical occupations today ? So far, little seems to be known about time-stress and fatigue in older doctors. Some information about the attitudes to, and use of, retirement by physicians might help us to decide whether the retirement policy in the health service is sound. We also need information on the most suitable occupations for doctors in their late sixties. Perhaps the Nuffield Foundation will provide us with some of the answers in a future study in this series.
SALT-POISONING IN INFANCY
DANGEROUS salt retention in infancy may result from injudicious intravenous therapy, and troublesome salt retention may result from the use of corticosteroids. Accidental salt-poisoning must be very rare, and we are indebted to three Baltimore workersI for an account of a serious incident in a newborn nursery, in which salt was put into the infants’ feeds in place of sugar. 14 infants received the salt-containing feeds, and 6 of them died5 of them before the condition was recognised. Symptoms developed in 11. All had convulsions or twitching, and all became feverish. All but 1 vomited. 5 showed respiratory distress, with tachypnoea and flaring of the alae nasi. All showed intense thirst until they became seriously ill. In the 5 cases where necropsy was carried out this revealed a haemorrhagic encephalopathy, with severe capillary and venous congestion, subarachnoid and parenchymatous haemorrhages, and sinus thromboses. 4 of the patients were treated by peritoneal dialysis, followed by low-electrolyte oral feeds, and 3 of these survived. The highest serum-sodium recorded was 274 mEq. per litre, and this child survived. Prolonged hypernatrasmia is known to damage the brain, and children with inadequately treated nephrogenic diabetes insipidus, in which hypernatrsemia is a feature, undergo mental deterioration. A form of hypernatrxmic mental deficiency has been described. Consequently it is noteworthy that all the survivors of this episode are apparently physically and mentally normal. This is not the first time that infants’ feeds have been poisoned by a substance accidentally added in place of sugar, and it is valuable that we should be reminded of the fact. Perhaps we should add immunity to accidental poisoning of this nature to the list of advantages of
breast-feeding. INGROWING TOENAILS
SURGERY is never so meddlesome as in the treatment of ingrowing toenails. The accolade of the aspiring orthopaedic surgeon seems to depend on his ingenuity in devising a new operation for this common affliction. Yet, properly handled, ingrowing toenails scarcely ever need operative treatment. Lloyd-Davies and Brill2 say that the policy of the toe clinic at St. Thomas’s Hospital is primarily conservative, but that many patients arrive after their nails have already been avulsed in the casualty department. The drawback to operative treatment is that, for a short time afterwards, the patient is disabled from walking, and that often he has to hobble about in slippers or split shoes for some time. A new nail takes about six months to grow, and the end-result of operation nearly always leaves an unsightly toe. 1. 2.
Finberg, L., Kiley, J., Luttrell, C. N. J. Amer. med. Ass. 1963, 184, Lloyd-Davies, R. W., Brill, G. C. Brit. J. Surg. 1963, 50, 592.
187.
towards means of detecting latent coronary heart-disease 1; and this is an obvious approach for the screening of astronauts, who are subjected to every possible physiological investigation before selection and before each flight. Infectious disease is hardly a hazard to aviators whose flights, compared with incubation periods, are exceedingly brief; but on two counts it must now enter the reckoning of Space medicine: first because it can affect the astronaut in transit; and secondly because it is " It an undesirable export. In the words of Generales: would be well to recall that the medical profession has still not eradicated syphilis since its introduction into Europe about 1493 and the explosive epidemic of Naples in 1495-an onerous heritage among the blessings and countless commodities that followed in the wake of the comparatively simple exploration of the Western
Hemisphere 11" There may not be a man in the moon, nor life but we ought to act as though there were.
on
Mars,
NEAR RETIRING
IN its own modest words, this Nuffield study3 is a "minor contribution to fuller understanding of the problems of ageing among manual workers in industry ". Based on interviews with older men employed in Slough factories, it reports the kind of jobs they were doing, their subjective experience of strain at work, the foremen’s attitudes towards them, and changes of job in later working life. Though the material consists more of impressions than facts, the style is readable, the conclusions are cautious, and useful suggestions are made for more precise and detailed studies. Though nothing very new emerges, this succinct statement of the problems of an ageing labour force is valuable in a period of rapidly increasing industrial technology. In particular, the report brings out the opinions and attitudes of older workers themselves and shows how few give any serious consideration to the impact retirement will make on their lives. Work involving time-stress again appears as the main difficulty of older workers, and the report confirms the finding from other studies that men in paced jobs often move in middle age to relatively unskilled tasks which offer opportunities for self-regulation of speed of work. On the whole, foremen seem to be helpful and understanding about adjustments of this kind, and indeed to show foresight inasmuch as they try to move older men to suitable work before they break down. By these internal transfers industry can reduce the casualty-rate among its own employees, but in the favourable employment conditions of Slough the older men were prepared to search for more attractive jobs elsewhere and to make a success of them; furthermore, supervisors did not seem to be unduly prejudiced in their attitudes to older workers. Any report that draws attention to the need for a preventive approach to ageing in industry is to be welcomed. Though a good deal is now known about what to expect in groups of men reaching middle age in certain kinds of work, industry itself seems to have a low awareness of this knowledge and how to apply it; and people in responsible positions in management and labour could read this study with profit. It prompts a further thought. How does
ageing affect
1. Rumball, A., Acheson, E. D. Brit. med. J. Feb. 16, 1963, p. 423. 2. N.Y. St. J. Med. 1963, 63, 1310. 3. Workers Nearing Retirement. Nuffield Foundation, Nuffield Lodge, Regent’s Park, London, N.W.1. 1963. Pp. 53. 5s.
medical occupations today ? So far, little seems to be known about time-stress and fatigue in older doctors. Some information about the attitudes to, and use of, retirement by physicians might help us to decide whether the retirement policy in the health service is sound. We also need information on the most suitable occupations for doctors in their late sixties. Perhaps the Nuffield Foundation will provide us with some of the answers in a future study in this series.
SALT-POISONING IN INFANCY
DANGEROUS salt retention in infancy may result from injudicious intravenous therapy, and troublesome salt retention may result from the use of corticosteroids. Accidental salt-poisoning must be very rare, and we are indebted to three Baltimore workersI for an account of a serious incident in a newborn nursery, in which salt was put into the infants’ feeds in place of sugar. 14 infants received the salt-containing feeds, and 6 of them died5 of them before the condition was recognised. Symptoms developed in 11. All had convulsions or twitching, and all became feverish. All but 1 vomited. 5 showed respiratory distress, with tachypnoea and flaring of the alae nasi. All showed intense thirst until they became seriously ill. In the 5 cases where necropsy was carried out this revealed a haemorrhagic encephalopathy, with severe capillary and venous congestion, subarachnoid and parenchymatous haemorrhages, and sinus thromboses. 4 of the patients were treated by peritoneal dialysis, followed by low-electrolyte oral feeds, and 3 of these survived. The highest serum-sodium recorded was 274 mEq. per litre, and this child survived. Prolonged hypernatrasmia is known to damage the brain, and children with inadequately treated nephrogenic diabetes insipidus, in which hypernatrsemia is a feature, undergo mental deterioration. A form of hypernatrxmic mental deficiency has been described. Consequently it is noteworthy that all the survivors of this episode are apparently physically and mentally normal. This is not the first time that infants’ feeds have been poisoned by a substance accidentally added in place of sugar, and it is valuable that we should be reminded of the fact. Perhaps we should add immunity to accidental poisoning of this nature to the list of advantages of
breast-feeding. INGROWING TOENAILS
SURGERY is never so meddlesome as in the treatment of ingrowing toenails. The accolade of the aspiring orthopaedic surgeon seems to depend on his ingenuity in devising a new operation for this common affliction. Yet, properly handled, ingrowing toenails scarcely ever need operative treatment. Lloyd-Davies and Brill2 say that the policy of the toe clinic at St. Thomas’s Hospital is primarily conservative, but that many patients arrive after their nails have already been avulsed in the casualty department. The drawback to operative treatment is that, for a short time afterwards, the patient is disabled from walking, and that often he has to hobble about in slippers or split shoes for some time. A new nail takes about six months to grow, and the end-result of operation nearly always leaves an unsightly toe. 1. 2.
Finberg, L., Kiley, J., Luttrell, C. N. J. Amer. med. Ass. 1963, 184, Lloyd-Davies, R. W., Brill, G. C. Brit. J. Surg. 1963, 50, 592.
187.