A COLLEGE FELLOWSHIP IN CLINICAL SCIENCE

A COLLEGE FELLOWSHIP IN CLINICAL SCIENCE

28 fractured femur-these were not taken too tragically, since the great benefits hoped for would outweigh them. Whether this is so cannot yet be decid...

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28 fractured femur-these were not taken too tragically, since the great benefits hoped for would outweigh them. Whether this is so cannot yet be decided, but On p. 17 graver complications are now reported. of this issue Dr. Tooth and Dr. Blackburn publish evidence that the cerebral changes occurring during a cardiazol fit may give rise to impairment of intellectual capacity and memory. This would be a high price to pay especially if the patient depended on his It is intellect and memory for his livelihood. excessively high when one considers that the " spontaneous " remission-rate in schizophrenia is, in any case, not much below that claimed for cardiazol treatment. Gelperin,l in a recent communication, reports 94 schizophrenic patients who were discharged improved out of a total of 235 admitted to a psychiatric ward, though they had had no other treatment than superficial psychotherapy. This would dispose of the argument sometimes put forward that a little hebetude is better than a chronic insanity. Both the chronic insanity and the hebetude can be averted in the case of many schizophrenics if the psychiatrist can afford to be patient and satisfied with the general psychiatric methods that were available before cardiazol and insulin had been introduced. Tooth and Blackburn are cautious in their inferences and would not damn the cardiazol method outright because of its occasional untoward results: but the difficulty is to know which cases are the right ones to select for it. The deterioration they report, remarkably confirmed by psychological testing, is not the only complication of cardiazol treatment. The high incidence of vertebral fracture in cardiazol-treated patients has recently been noted in America. PRIVATE WARDS FOR CHILDREN

IT is said that when a certain royal personage was ill his surgeon assured him that he would be looked after as well as if he was a hospital patient, and he Some such thoughts must have been was comforted. in the minds of the management committee and medical staff of the Hospital for Sick Children, Great Ormond Street, in their rebuilding, for in providing private wards on the seventh floor they seem to have set out to give the child whose parents can afford to pay for it as happy and as profitable (in the health sense) a time in hospital as his poorer brothers and sisters in the floors below. There are single-cot rooms, which can be curtained off for privacy or opened into one another to provide for a nanny or other social amenities, for twenty children, and two small wards of four cots each provide that type of companionship in disease which is so often of great disciplinary value in treating minor behaviour problems. Each room opens on a large balcony, well protected by railings and wire netting, with an unrestricted south aspect to let in sun and air. While forming an integral part of the whole hospital and thus sharing in all the modern services availablewith oxygen on tap, mobile electric lamps and other accessories-the private floor has its own entrance, waiting-room, consulting-rooms and operating-theatre. Rooms are set aside for nursing mothers, and " at the absolute discretion of the medical staff " single rooms, if available, may be used for mothers and nannies. It is probable that in this phrase quoted from the regulations lies the greatest advantage of the hospital over the home in the treatment of the sick child. Handed over to the care of skilled nurses accustomed to humouring and amusing the sick child on a basis far removed from that of the home nursery,

the small

patient makes quick adjustments which are only slowly reached, if ever, in the atmosphere of a home upset by the advent of illness. For surgical procedures such a programme has obvious advantages, and for the many medical disorders in which

A COLLEGE

Ass. June

10, 1939, p. 2393.

FELLOWSHIP SCIENCE

IN

CLINICAL

WITH the inauguration of a department of medicine the opportunities at Cambridge for clinical and correlative research work are now greatly improved. But whereas numerous college fellowships in the past have been available for graduate students of physiology and pathology there has hitherto been no recognition of clinical science as an appropriate subject for a fellowship, partly because facilities were lacking and partly because clinical science was not yet accepted as worthy of inclusion among the other natural sciences. This acceptance is now becoming general, and the announcement that a Stringer fellowship at King’s College may on this occasion be awarded to a candidate whose study or research falls within the group of subjects including clinical medicine marks a further stage in the development of scientific medicine at Cambridge. For a man of suitable qualities the prospects and amenities of the appointment should offer strong inducements. Candidates must be members of the university, under thirty years of age on Dec. 6, 1939. Any candidate who is in doubt if his study or research falls within the prescribed group should consult the Provost, to whom applications should be sent by Oct. 16. ASEPTIC NECROSIS OF BONE

WHEN the pressure in a diving-bell is reduced too suddenly gas is liberated from the tissues more quickly than it can be removed by the blood, and the symptoms of caisson sickness may result. In discussing the aseptic necrosis of bone that sometimes follows, and quoting four cases with autopsy or biopsy findings, Kahlstrom, Burton and Phemister 1 , point out that when the body is exposed to high atmospheric pressure the gases of the air are absorbed in different degree according to the nature of the tissues. Thus fat or lipoid tissue such as the nervous system absorbs about five times the amount of nitrogen that water or serum will take up, and it is such tissues that are likely to be most damaged by the liberation of gases during decompression. Oxygen is relatively easily dissolved and got rid of, but the bubbles of nitrogen set free in the fatty marrow of long bones give rise to emboli which may obstruct end-arteries and produce necrosis. If this necrosis affects the bone bordering a joint the weight-bearing portions of the bones may collapse and there may be lesions of joints, sometimes with the formation of intra-articular foreign bodies. This process lends support to the view that arthritis deformans, in which the lesions are much the same, may be due to 1. Kahlstrom, S.

1. Gelperin, J., J. Amer. med.

a

process is playing a dominant or even subservient part the complete change in environment, human as well as physical, produces results which have long been recognised among the ordinary hospital patients. Great Ormond Street is not the first children’s hospital to open accommodation for private patients, but thanks to the generosity of Lord Nuffield it has been possible to incorporate in the rebuilding scheme a unit which should serve as a model of its kind.

psychological

C., Burton, C. C., and Phemister, D. B., Surg. Gynec. Obstet. Feb. 1, 1939, p. 129.