- Email: [email protected]
ACCIDENT SERVICES
500
Points of View
practice, but we believe it may be an improvethe present procedures which have possibly others besides ourselves with an expensive and
method in ment on
provided disappointing experience.
CYTOCLESIS What do Cells say
We are grateful for the help and criticism of Prof. R. W. B. Ellis and of Dr. H. E. Seiler, Medical Officer of Health.
M.D. Adelaide
Berry, H. K., Sutherland, B., Guest, G. M., Warkany, J. (1958) J. Amer. med. Ass. 167, 2189. Boyd, M. M. M. (1961) Brit. med. J. i, 771. Centerwall, W. R., Chinnock, R. F., Pusavat, A. (1960) Amer. J. publ. Hlth, 50, 1667. See Scot. med. J. (1961) 6, 436. Woolf, L. I. (1961) Cerebr. Palsy Bull. 3, 244.
ACCIDENT SERVICES IN 1959 the Standing Medical Advisory Committee set up a subcommittee, with Sir Harry Platt as chairman, to consider the organisation of hospital casualty and accident services. This subcommittee has now reported.1 Its recommendations include the following: What is now known as the casualty service should be called the accident and emergency service. An accident and emergency department should include a reception unit for all undiagnosed emergency cases. The department should be designed to allow patients to be brought direct from the street, and seen at once and treated by an experienced doctor or passed on without delay for the
appropriate treatment. All injured patients requiring hospital
equipped
to
treatment should be accident and emergency unit staffed and deal immediately at any time with major injuries
and other emergency cases. An accident and emergency unit should have at least 50 accident beds. A ratio of 30-35 accident beds per 100,000 population should be used for planning, provided that these beds are supplemented by enough associated geriatric beds. A unit of 50 beds would serve a population of some 150,000, and there are very few areas where distances are so great and transport is so difficult that a single unit could not provide an efficient service for such a population. The junior medical staff should be adequately supervised by consultants. A consultant orthopaEdic surgeon should normally be in administrative charge of the accident and emergency unit. Supervision should be specifically mentioned in the consultant’s contract, which should include an allowance for the An accident and cover given at night and at the weekend. emergency unit should have at least three consultant surgeons, each giving a substantial part of his time to this work. Below the consultants there should be three doctors of intermediate grade and an adequate number of senior house-officers. Rotation of staff between accident and general surgical work is valuable, especially at registrar level. At least six months of training of all surgeons should be in an accident and emergency unit. The introduction of the " medical assistant " grade should allow accident and emergency units and hospitals receiving minor injuries to be staffed by experienced doctors. In remote areas cottage hospitals may have to give first-aid treatment to major injuries and deal with minor ones. An effective rota of general practitioners able to attend at short notice is therefore required. A survey of casualty departments in one week of Of the
MELBOURNE
in danger, Frederic Wood Jones (1923) said, of the regarding body as a test-tube where chemical reactions The ultimate goal of all biology is to grasp the occur. nature of living tissue; and this is not related to chemistry, physics, or electricity. Observed electrically, the passage of an impulse in 1/1000 second weaves spatiotemporal patterns of such unimaginable complexity that Eccles (1958) haf called for new concepts to simplify biology. How celL influence cells seems paramount to me. But there is no accepted word to describe this. Wood Jones suggested cytoclesis or the call of cell to cell:
WE
are
" though neurobiotaxis has seemed to some to be too fanciful a to take its place in the ordinary routine of teaching, what a parochial manifestation it is of a much wider phenomenon that is displayed everywhere, in every system, in every tissue of the animal body ... there is a general phenomenon of cell call, a wonderful influence which living cells exert, and this strange force we shall here concept
name CYTOCLESIS
to
light
some
striking figures:
in these by a senior
patients departments, 2% were seen by a consultant, 7% hospital medical officer (or equivalent), 7% by a general practitioner, 8% by a registrar, 9% by a junior hospital medical officer, 34% by a senior houseofficer, 23% by a house-officer, and 8% not by a doctor at all. new
seen
1. Central Health Services Council: Standing Medical Advisory Committee. Accident and Emergency Services: report of the subcommittee. H.M. Stationery Office. Pp. 66. 3s. 6d.
" ...
The Cell
to an
October, 1960, brought
Cells ?
MICHAEL KELLY
REFERENCES
taken direct
to
Impulse of Mackenzie
Sir
James Mackenzie (1926) recognised in the cell impulse a separate form of physical energy distinct from all other kinds (heat, light, sound, electricity, motion, magnetism, chemical change). Each one of these forms is completely distinct from all the others; our knowledge of each kind of energy has been built up by scientists who used methods suitable for that particular form and for no other. But during its production each kind of energy also produces all the other forms, usually in minute quantities. Now, in discussing Mackenzie’s views let us say cytoclesis (a word he would have approved of had he known it) instead of cell impulse. Knowledge of cytoclesis, wrote Mackenzie, will come only from methods peculiarly adapted to its study. Electrical, chemical, and thermal methods are unsuitable because they measure only byproducts; cytoclesis produces all other forms of energy in minute quantities. In cytoclesis-the attraction or repulsion between cells -their main action cannot be recorded by known methods. But electrical and chemical changes are too easily recorded with instruments which multiply their effects millions of times. If we had the means of magnifying the sounds made by single cells, we would doubtless have a phonophysiology as aggressive as electrophysiology. But there the confidence of the electricians is not justified; the total electric power generated by the adult brain would not light a 20-watt globe (Kety 1961). A nerve-fibre is only an elongated branch of a cell; an impulse passing at the speed "
"
of sound cannot be related to the current in a conductor at the speed of light. Electricity passes through a nerve in which sensory messages have been blocked by ligature
(Muller 1838)
or
by procaine (Fulton 1921).
The ceaseless changes in the cell are both chemical and physical." The prefix bio- has not sobered the " golden of the chemist, who finds a hundred new dreams enzymes in every cell. He still hopes by playing with the nucleic acid molecule to influence genetics. But a molecule and a gene represent orders of magnitude as different as a
Points of View
practice, but we believe it may be an improvethe present procedures which have possibly others besides ourselves with an expensive and
method in ment on
provided disappointing experience.
CYTOCLESIS What do Cells say
We are grateful for the help and criticism of Prof. R. W. B. Ellis and of Dr. H. E. Seiler, Medical Officer of Health.
M.D. Adelaide
Berry, H. K., Sutherland, B., Guest, G. M., Warkany, J. (1958) J. Amer. med. Ass. 167, 2189. Boyd, M. M. M. (1961) Brit. med. J. i, 771. Centerwall, W. R., Chinnock, R. F., Pusavat, A. (1960) Amer. J. publ. Hlth, 50, 1667. See Scot. med. J. (1961) 6, 436. Woolf, L. I. (1961) Cerebr. Palsy Bull. 3, 244.
ACCIDENT SERVICES IN 1959 the Standing Medical Advisory Committee set up a subcommittee, with Sir Harry Platt as chairman, to consider the organisation of hospital casualty and accident services. This subcommittee has now reported.1 Its recommendations include the following: What is now known as the casualty service should be called the accident and emergency service. An accident and emergency department should include a reception unit for all undiagnosed emergency cases. The department should be designed to allow patients to be brought direct from the street, and seen at once and treated by an experienced doctor or passed on without delay for the
appropriate treatment. All injured patients requiring hospital
equipped
to
treatment should be accident and emergency unit staffed and deal immediately at any time with major injuries
and other emergency cases. An accident and emergency unit should have at least 50 accident beds. A ratio of 30-35 accident beds per 100,000 population should be used for planning, provided that these beds are supplemented by enough associated geriatric beds. A unit of 50 beds would serve a population of some 150,000, and there are very few areas where distances are so great and transport is so difficult that a single unit could not provide an efficient service for such a population. The junior medical staff should be adequately supervised by consultants. A consultant orthopaEdic surgeon should normally be in administrative charge of the accident and emergency unit. Supervision should be specifically mentioned in the consultant’s contract, which should include an allowance for the An accident and cover given at night and at the weekend. emergency unit should have at least three consultant surgeons, each giving a substantial part of his time to this work. Below the consultants there should be three doctors of intermediate grade and an adequate number of senior house-officers. Rotation of staff between accident and general surgical work is valuable, especially at registrar level. At least six months of training of all surgeons should be in an accident and emergency unit. The introduction of the " medical assistant " grade should allow accident and emergency units and hospitals receiving minor injuries to be staffed by experienced doctors. In remote areas cottage hospitals may have to give first-aid treatment to major injuries and deal with minor ones. An effective rota of general practitioners able to attend at short notice is therefore required. A survey of casualty departments in one week of Of the
MELBOURNE
in danger, Frederic Wood Jones (1923) said, of the regarding body as a test-tube where chemical reactions The ultimate goal of all biology is to grasp the occur. nature of living tissue; and this is not related to chemistry, physics, or electricity. Observed electrically, the passage of an impulse in 1/1000 second weaves spatiotemporal patterns of such unimaginable complexity that Eccles (1958) haf called for new concepts to simplify biology. How celL influence cells seems paramount to me. But there is no accepted word to describe this. Wood Jones suggested cytoclesis or the call of cell to cell:
WE
are
" though neurobiotaxis has seemed to some to be too fanciful a to take its place in the ordinary routine of teaching, what a parochial manifestation it is of a much wider phenomenon that is displayed everywhere, in every system, in every tissue of the animal body ... there is a general phenomenon of cell call, a wonderful influence which living cells exert, and this strange force we shall here concept
name CYTOCLESIS
to
light
some
striking figures:
in these by a senior
patients departments, 2% were seen by a consultant, 7% hospital medical officer (or equivalent), 7% by a general practitioner, 8% by a registrar, 9% by a junior hospital medical officer, 34% by a senior houseofficer, 23% by a house-officer, and 8% not by a doctor at all. new
seen
1. Central Health Services Council: Standing Medical Advisory Committee. Accident and Emergency Services: report of the subcommittee. H.M. Stationery Office. Pp. 66. 3s. 6d.
" ...
The Cell
to an
October, 1960, brought
Cells ?
MICHAEL KELLY
REFERENCES
taken direct
to
Impulse of Mackenzie
Sir
James Mackenzie (1926) recognised in the cell impulse a separate form of physical energy distinct from all other kinds (heat, light, sound, electricity, motion, magnetism, chemical change). Each one of these forms is completely distinct from all the others; our knowledge of each kind of energy has been built up by scientists who used methods suitable for that particular form and for no other. But during its production each kind of energy also produces all the other forms, usually in minute quantities. Now, in discussing Mackenzie’s views let us say cytoclesis (a word he would have approved of had he known it) instead of cell impulse. Knowledge of cytoclesis, wrote Mackenzie, will come only from methods peculiarly adapted to its study. Electrical, chemical, and thermal methods are unsuitable because they measure only byproducts; cytoclesis produces all other forms of energy in minute quantities. In cytoclesis-the attraction or repulsion between cells -their main action cannot be recorded by known methods. But electrical and chemical changes are too easily recorded with instruments which multiply their effects millions of times. If we had the means of magnifying the sounds made by single cells, we would doubtless have a phonophysiology as aggressive as electrophysiology. But there the confidence of the electricians is not justified; the total electric power generated by the adult brain would not light a 20-watt globe (Kety 1961). A nerve-fibre is only an elongated branch of a cell; an impulse passing at the speed "
"
of sound cannot be related to the current in a conductor at the speed of light. Electricity passes through a nerve in which sensory messages have been blocked by ligature
(Muller 1838)
or
by procaine (Fulton 1921).
The ceaseless changes in the cell are both chemical and physical." The prefix bio- has not sobered the " golden of the chemist, who finds a hundred new dreams enzymes in every cell. He still hopes by playing with the nucleic acid molecule to influence genetics. But a molecule and a gene represent orders of magnitude as different as a