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ABNORMAL PERIODS OF GESTATION
161 So I gave another
telephone
number and went and sat in my The bleeding
club, ringing up again before going home. never
recurred.
Shortly after reading that address I met Mr. Trotter and spoke to him about it. He went as near to registering
excitement as I have ever seen him do. He told me he had tried it on himself when his nose bled in an attack of influenza. Fortunately, he said, his wife was out so he could do what he wanted instead of having to send for a colleague. He had thought the treatment out some time before, and so he went to the closet and stood over the pan in the desired position and the bleeding stopped at
once.
on to tell me the rationale of the treatment. It depends on the adhesion of the clot to the vessel wall. The veins of the nose (the bleeding is usually, if not always, venous) all stream back to pass through the sphenopalatine foramen ; and as they do so they are lodged in grooves on the medial aspect of the turbinal bones, with the result that if there is any tug on them this is exerted on the free side of the vessel which is not displaced from its bony bed. Therefore such a tug pulls the vessel wall from the underlying clot while this is in process of becoming adherent. The clot becomes detached and the bleeding recurs. The sphenopalatine foramen lies just above and behirid the hinder end of the middle turbinal. It is therefore at the junction of the nose and nasopharynx. Every time the soft palate goes up there is an initial negative pressure before it descends again, and this produces the tug on the veins as they converge on the sphenopalatine foramen. Inhibit movements of the palate and you stop this tug. Thus the clot can become adherent and the bleeding ceases. This is hard to put into writing, but it was as clear as daylight when Trotter spoke it. T. B. LAYTON. London, W.1.
He went
THE ROYAL COLLEGE OF SURGEONS
SIR,-Lord Webb-Johnson’s reply in your issue of July 3 ignores the essential point in our previous letternamely, his suppression from the medical profession of the resolutions passed at the fellows’ meeting on April 28. That suppression is maintained in Lord Webb-Johnson’s letter, in which, while mentioning the second and third resolutions, he does not disclose their nature. REGINALD L. MURLEY A. ROY DINGLEY CHARLES HAMBLEN-THOMAS REGINALD T. PAYNE ALEX. E. ROCHE JOHN HOSFORD W. ETHERINGTON WILSON. NORMAN A. JORY &
VENEREAL DISEASE SiR,-In his letter in your last issue, Lord Horder is less up to date than usual.. He refers to the appreciable increase in syphilis and gonorrhoea reported for the year 1945, but his purpose would have been better served had he referred to later figures ; for demobilisation and the Army of Occupation between them were to Latest figures, however, cause a further rise in 1946. show a decline, particularly in syphilis. For many years (both by private instruction at clinics and from the public platform) I have advocated personal disinfection as one of the means whereby the incidence of v.D. could be reduced ; and other medical men have done the same. During the late war I had the privilege of helping some of our Allies to improve methods of chemical disinfection. The National Society for the Prevention of Venereal Diseases might, therefore, I think, claim me as an ally ; but I part company with them when they pretend that the spread of knowledge on, disinfection will bring about the elimination of v.D. Lord Horder talks of ’’ a great campaign to set the people free from v.D.." saying that " the scope and magnitude of this great attack depends upon the support we receive from the profession and from the general public." And what is his great campaign ? To tell the world the virtues of urination after coitus, soap and water, potassium permanganate solution, and calomel cream ! He speaks of a scientific fact known for 40 years, but we are living now in a penicillin era in which it is claimed that a single injection, taking less than one minute to administer, can cure 90 % of cases of gonorrhoea.
Gonorrhosa has
largely been robbed of its terrors for
man, woman, and infant.
A quarter of a century ago, the Trevethin Committee, gave its blessing to " properly and promptly applied disinfection," but no-one who understands the significance of the operative words " properly and promptly " will suggest that the average man, however well instructed, will, after venery, efficiently disinfect himself ; and
Lord Horder knows that the relatively successful disinfection in the Fighting Services during the war was carried out largely under skilled supervision, which he does not propose for the civil community. The Trevethin Committee recommended also the trial for a period in a limited area, of powers to compel defaulters and suspected sources of infection to undergo treatment. Far more is to be expected from tracing and treating contacts than from teaching disinfection, although both are required. By all means tell the public about calomel and Condy’s fluid, but tell them also that in England today there Is no law to assist the v.D. officer and the medical officer of health to bring under treatment men and women known to be spreading gonorrhoea and syphilis, the contacts of fresh infectious cases, the man who has infected his wife, the wife who has infected her husband, the parents of infected children, or the brothers and sisters of young congenital syphilitics. ROBERT FORGAN. Brentwood. PAIN (July 3) method of recording pain is certainly appropriate for testing the efficiency of analgesics. But he omits consideration of sensitivity. If in one individual sensitivity to pain were always the same, we might ignore it altogether; we could compare the effects of, say, morphine and distilled water on this particular individual, as Dr. Keele has done. But if we assume that sensitivity even in the course of the same illness is different at different times ; if we assume, for instance, that sensitivity is greater during the first minutes or hour after a period of freedom from pain, or that sensitivity to pain wears off the longer it lasts (and these are quite feasible assumptions)-then the conclusions about the effect of an analgesic appear in a very different light. For example in chart 5, distilled water was ineffective when the pain had lasted only 2 hours, but pethidine was effective when it had lasted 4 hours. May not this difference be explained, partly at least, by the time factor and a reduction in sensitivity due to this lapse of time ? In chart 6, pethidine was ineffective when the pain had lasted 1 hour, but distilled water was effective when it had lasted 5 hours. Does this observation prove, as Dr. Keele thinks, that the pain in this case was psychogenic, or was it partly due to the fact that after 5 hours the pain was felt less keenly and was therefore more responsive to medication ? I think that the factor of sensitivity cannot be left out of consideration ; but this recording of pain may help in determining how sensitivity is correlated to the time factor. Perhaps a record of untreated pain would be useful, though it might be difficult to achieve this
SiR,-Dr. Keele’s
humanely. Alverstoke.
W. J. PINOFF.
ABNORMAL PERIODS OF GESTATION Sin,—In my early years as a surgeon I often had to deal with obstetric abnormalities, and I still have notes of some unusual cases. In the light of last week’s article, the following case-report may interest some of our legal friends. In May, 1929, a farmer’s wife, aged 37, pregnant for the second time, was sent into hospital, and gave a history that her first child was born 9 years previously, after an 8 months’ pregnancy. Since then her menstrual periods had been somewhat irregular, the intervals varying from 3 to 6 weeks. Her last period began on June 10, 1928. She made a note in her diary of coitus on June 30. Medical induction of labour was attempted on May 13. The child, weighing 8 lb., was born on May 18, after a gestation period of 342 days. I had no This is the story, for what it is worth. reason to doubt the accuracy of the patient’s statements. C. C. HOLMAN. Northampton.
telephone
number and went and sat in my The bleeding
club, ringing up again before going home. never
recurred.
Shortly after reading that address I met Mr. Trotter and spoke to him about it. He went as near to registering
excitement as I have ever seen him do. He told me he had tried it on himself when his nose bled in an attack of influenza. Fortunately, he said, his wife was out so he could do what he wanted instead of having to send for a colleague. He had thought the treatment out some time before, and so he went to the closet and stood over the pan in the desired position and the bleeding stopped at
once.
on to tell me the rationale of the treatment. It depends on the adhesion of the clot to the vessel wall. The veins of the nose (the bleeding is usually, if not always, venous) all stream back to pass through the sphenopalatine foramen ; and as they do so they are lodged in grooves on the medial aspect of the turbinal bones, with the result that if there is any tug on them this is exerted on the free side of the vessel which is not displaced from its bony bed. Therefore such a tug pulls the vessel wall from the underlying clot while this is in process of becoming adherent. The clot becomes detached and the bleeding recurs. The sphenopalatine foramen lies just above and behirid the hinder end of the middle turbinal. It is therefore at the junction of the nose and nasopharynx. Every time the soft palate goes up there is an initial negative pressure before it descends again, and this produces the tug on the veins as they converge on the sphenopalatine foramen. Inhibit movements of the palate and you stop this tug. Thus the clot can become adherent and the bleeding ceases. This is hard to put into writing, but it was as clear as daylight when Trotter spoke it. T. B. LAYTON. London, W.1.
He went
THE ROYAL COLLEGE OF SURGEONS
SIR,-Lord Webb-Johnson’s reply in your issue of July 3 ignores the essential point in our previous letternamely, his suppression from the medical profession of the resolutions passed at the fellows’ meeting on April 28. That suppression is maintained in Lord Webb-Johnson’s letter, in which, while mentioning the second and third resolutions, he does not disclose their nature. REGINALD L. MURLEY A. ROY DINGLEY CHARLES HAMBLEN-THOMAS REGINALD T. PAYNE ALEX. E. ROCHE JOHN HOSFORD W. ETHERINGTON WILSON. NORMAN A. JORY &
VENEREAL DISEASE SiR,-In his letter in your last issue, Lord Horder is less up to date than usual.. He refers to the appreciable increase in syphilis and gonorrhoea reported for the year 1945, but his purpose would have been better served had he referred to later figures ; for demobilisation and the Army of Occupation between them were to Latest figures, however, cause a further rise in 1946. show a decline, particularly in syphilis. For many years (both by private instruction at clinics and from the public platform) I have advocated personal disinfection as one of the means whereby the incidence of v.D. could be reduced ; and other medical men have done the same. During the late war I had the privilege of helping some of our Allies to improve methods of chemical disinfection. The National Society for the Prevention of Venereal Diseases might, therefore, I think, claim me as an ally ; but I part company with them when they pretend that the spread of knowledge on, disinfection will bring about the elimination of v.D. Lord Horder talks of ’’ a great campaign to set the people free from v.D.." saying that " the scope and magnitude of this great attack depends upon the support we receive from the profession and from the general public." And what is his great campaign ? To tell the world the virtues of urination after coitus, soap and water, potassium permanganate solution, and calomel cream ! He speaks of a scientific fact known for 40 years, but we are living now in a penicillin era in which it is claimed that a single injection, taking less than one minute to administer, can cure 90 % of cases of gonorrhoea.
Gonorrhosa has
largely been robbed of its terrors for
man, woman, and infant.
A quarter of a century ago, the Trevethin Committee, gave its blessing to " properly and promptly applied disinfection," but no-one who understands the significance of the operative words " properly and promptly " will suggest that the average man, however well instructed, will, after venery, efficiently disinfect himself ; and
Lord Horder knows that the relatively successful disinfection in the Fighting Services during the war was carried out largely under skilled supervision, which he does not propose for the civil community. The Trevethin Committee recommended also the trial for a period in a limited area, of powers to compel defaulters and suspected sources of infection to undergo treatment. Far more is to be expected from tracing and treating contacts than from teaching disinfection, although both are required. By all means tell the public about calomel and Condy’s fluid, but tell them also that in England today there Is no law to assist the v.D. officer and the medical officer of health to bring under treatment men and women known to be spreading gonorrhoea and syphilis, the contacts of fresh infectious cases, the man who has infected his wife, the wife who has infected her husband, the parents of infected children, or the brothers and sisters of young congenital syphilitics. ROBERT FORGAN. Brentwood. PAIN (July 3) method of recording pain is certainly appropriate for testing the efficiency of analgesics. But he omits consideration of sensitivity. If in one individual sensitivity to pain were always the same, we might ignore it altogether; we could compare the effects of, say, morphine and distilled water on this particular individual, as Dr. Keele has done. But if we assume that sensitivity even in the course of the same illness is different at different times ; if we assume, for instance, that sensitivity is greater during the first minutes or hour after a period of freedom from pain, or that sensitivity to pain wears off the longer it lasts (and these are quite feasible assumptions)-then the conclusions about the effect of an analgesic appear in a very different light. For example in chart 5, distilled water was ineffective when the pain had lasted only 2 hours, but pethidine was effective when it had lasted 4 hours. May not this difference be explained, partly at least, by the time factor and a reduction in sensitivity due to this lapse of time ? In chart 6, pethidine was ineffective when the pain had lasted 1 hour, but distilled water was effective when it had lasted 5 hours. Does this observation prove, as Dr. Keele thinks, that the pain in this case was psychogenic, or was it partly due to the fact that after 5 hours the pain was felt less keenly and was therefore more responsive to medication ? I think that the factor of sensitivity cannot be left out of consideration ; but this recording of pain may help in determining how sensitivity is correlated to the time factor. Perhaps a record of untreated pain would be useful, though it might be difficult to achieve this
SiR,-Dr. Keele’s
humanely. Alverstoke.
W. J. PINOFF.
ABNORMAL PERIODS OF GESTATION Sin,—In my early years as a surgeon I often had to deal with obstetric abnormalities, and I still have notes of some unusual cases. In the light of last week’s article, the following case-report may interest some of our legal friends. In May, 1929, a farmer’s wife, aged 37, pregnant for the second time, was sent into hospital, and gave a history that her first child was born 9 years previously, after an 8 months’ pregnancy. Since then her menstrual periods had been somewhat irregular, the intervals varying from 3 to 6 weeks. Her last period began on June 10, 1928. She made a note in her diary of coitus on June 30. Medical induction of labour was attempted on May 13. The child, weighing 8 lb., was born on May 18, after a gestation period of 342 days. I had no This is the story, for what it is worth. reason to doubt the accuracy of the patient’s statements. C. C. HOLMAN. Northampton.