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ANOMALY OF ABDOMINAL MUSCULATURE
667 processes used in the large-scale ceuticals which have made it
production of pharmaimpossible for the pharmacist to dispense, extemporaneously, all the preparations which modern research has placed at the doctor’s disposal. This, of course, applies to the ethical proprietary. With the domestic proprietary the work of the Chemists Federation has made it possible to envisage the integration of all the pharmacist’s activities, since his professional interest in, and understanding of all C’.F. proprietary has been
justified. preparations Suggested Principles in Evolving ’
Controls.-Since
voluntary control is far healthier and far less expensive, both in money and personnel, than statutory controls, the latter should be kept to a minimum. To encourage progress and enterprise the State should be prepared Is not the inclusion of to offer appropriate rewards. the list of substituted proprietary preparations in the N.(W).F. directly opposed to such a principle ? The medical practitioner should be free to prescribe what he judges to be medically necessary for his patient, so that the initial responsibility for deciding what drugs are necessary is placed where it rightly belongs-in the doctor’s hands. This principle has been subscribed to by the Minister, though it remains to be seen how far it will be applied to proprietary medicines. The medical profession has been well, and often brilliantly, served by the pharmaceutical industry-a contribution to the health and prosperity of the nation which a narrow or shortsighted policy can destroy. E. W. GODDING. London, N.W.10. MEDICAL SECRETARIES SIR,—May a woman have the last word on this subject ? As a medical secretary myself, I should like to uphold the claim for special training of medical clerical workers. If I had wanted to take up nursing, physiotherapy, social service, or any other work connected with a hospital, I should certainly not have been accepted without suitable preliminary training ; yet I came into my job from one of the Services (and before that a commercial office) with the haziest knowledge of medical terms and hospital procedure. For the first week or two I was in despair, and probably the medical staff weren’t too happy either. Having, fortunately, a good memory for words. I worried through and now wouldn’t change my job for anything. But every day makes me realise what a lot of technical words I don’t know, and I should welcome a training course which would give me something of the general groundwork of a nurse’s training. Medical secretaries believethat their status would be raised if inducements were offered to young girls to make this -a career. With my seniors, housemen, and consultants to type for, and my clinics, waiting-lists, card indexes, two telephones, and other time-occupiers, I don’t feel I work any less hard than my colleagues in the technical sections : and I should like to feel that I will eventually reach their rate-of pay and length of holidays. Bearing in mind the number of hospitals and doctors needing clerical help, is it too much to ask for specialised training for youngsters who would " love to work for a doctor," but get panicky if asked to spell appendicitis ’? DOCTORS’ SECRETARY. "
ANOMALY OF ABDOMINAL MUSCULATURE SIR,—An unusual anatomical anomaly was found in a man who lately came to me for removal of a vesical pouch. The patient was aged 69. The abdominal wall was apparently healthy, and the bladder, which had a pouch the size of a billiards ball, was approached by a transverse incision through the aponeurosis overlying the rectus. Instead of the vertical disposition of the muscle beneath the sheath, T found subjacent fleshy fibres passing horizontally to the linea alba. Although momentarily stunned by this, to me, unique anomaly, I quickly realised that, instead of becoming aponeurotic at the linea semilunaris, the flesh of the internal oblique had continued over the face of the rectus abdominis. The right rectus appeared average, but the left some 40%
sub-average. This variant had apparently not impaired the efficiency parietes. The wound healed normally. A. WILFRID ADAMS. Bristol.
of the
UNDER TENSION all the sorts that read THE LANCET there SIR,—Among will be those who disapproved of your leader of Oct. 9. and those who approved of it. I should regret that only the former should be represented in your correspondence columns. To others of us your sober reflections round the theme that " it takes all sorts to make a world " contain
something
more
than
a
half-truth when
we
are
faced
with Dr. Chapman’s alternative-to look at one half of the world as one who " repeatedly attempts to destroy him and who proclaims, fortissimo, his intention of going on trying.... " Weseem to glimmer Dr. Chapman’s logical counter to that one. We are clearly enough in a dangerous situation. Dr. Chapman has heard voices and he isn’t the only one. Are those voices real ? Are they by any chance also heard in Russia ? There is always something of fact for international paranoia to batten on. But how little relative to the issues of sane settlement! And, taking the long view (say 40 years in this case), how fundamentally equal are the intolerances and the provocations of the opposing sides ! Are threats to vital interests (implied or felt) ever limited to one side in a major international
dispute ?
It may one day become clearer that the threat which 1948 offered to our world was not primarily that the policy of any power-group aimed at the destruction of the vital interests of any other power-group, but that everywhere people came to think this so. Some individuals and some peoples may have more of suspicion to unlearn than others ; some undoubtedly have more to unlearn of cruelty to their foes. But shall that thwart our peaceful solution ? Such complaints are perennial. Grotius, a Dutchman, tried to set up international law in 1625 but decided thatone couldn’t cope with the Portuguese. What we lack is scientific machinery for settling international disputes despite the froth of irresponsible journalism and the honest prejudice of so many men and women. What more appropriate, then, to THE LANCET’S last than that it should chase the mental health of peoples a little further than did our recent international congress by reminding us where we stand today ? To secure world order, international legal machinery has to be made just as calm, dispassionate, and secure as our own domestic courts of law-simply because it takes all sorts to make a world and (may I add ?), because to err is human. RANYARD WEST. Edinburgh. HOW MANY NURSES ?
SIR,—Dr. Cohen takes as the criterion of nursing and medical effectiveness in hospital the patient’s duration of stay " which is assumed to be an index of his duration of sickness." Is this assumed by anyone who stops to examine and consider the factors governing admissions to and discharges from hospital ? It is possible that duration of sickness might be accepted as one criterion (among several) of effective care, but it is surely very dangerous to single out that chapter in any individual’s ill health which he is allowed or persuaded to spend in hospital, and which may occur at an early or a late stage of his illness, as the index of the duration of sickness. One hopes that at present the hospitals, hard-pressed though they
are
by waiting-lists,
take into consideration the home circumstances of the patients before deciding at what stage of invalidism or of recovery they may safely be allowed to leave. I know that this is an important factor to the good ward sister, whether surgical, medical, or obstetric. To take the simplest instance, has the anxious primipara sent out on the 8th day to a comfortless home (where she immediately ‘‘ loses her milk" and learns by failure) really. received more effective care than the one who goes out on the 14th day or later with a little additional confidence, stability, and knowledge of her new responsibilities? The same applies in the fields of surgery and of medicine. It may be expedient sometimes to shorten duration of stay in the interests of the total sick population, but we need not pretend that it means better nursing or medical care for the individual. One hates to think that a hospital might be led by Dr. Cohen’s hypothesis to make quick turnover of
-
production of pharmaimpossible for the pharmacist to dispense, extemporaneously, all the preparations which modern research has placed at the doctor’s disposal. This, of course, applies to the ethical proprietary. With the domestic proprietary the work of the Chemists Federation has made it possible to envisage the integration of all the pharmacist’s activities, since his professional interest in, and understanding of all C’.F. proprietary has been
justified. preparations Suggested Principles in Evolving ’
Controls.-Since
voluntary control is far healthier and far less expensive, both in money and personnel, than statutory controls, the latter should be kept to a minimum. To encourage progress and enterprise the State should be prepared Is not the inclusion of to offer appropriate rewards. the list of substituted proprietary preparations in the N.(W).F. directly opposed to such a principle ? The medical practitioner should be free to prescribe what he judges to be medically necessary for his patient, so that the initial responsibility for deciding what drugs are necessary is placed where it rightly belongs-in the doctor’s hands. This principle has been subscribed to by the Minister, though it remains to be seen how far it will be applied to proprietary medicines. The medical profession has been well, and often brilliantly, served by the pharmaceutical industry-a contribution to the health and prosperity of the nation which a narrow or shortsighted policy can destroy. E. W. GODDING. London, N.W.10. MEDICAL SECRETARIES SIR,—May a woman have the last word on this subject ? As a medical secretary myself, I should like to uphold the claim for special training of medical clerical workers. If I had wanted to take up nursing, physiotherapy, social service, or any other work connected with a hospital, I should certainly not have been accepted without suitable preliminary training ; yet I came into my job from one of the Services (and before that a commercial office) with the haziest knowledge of medical terms and hospital procedure. For the first week or two I was in despair, and probably the medical staff weren’t too happy either. Having, fortunately, a good memory for words. I worried through and now wouldn’t change my job for anything. But every day makes me realise what a lot of technical words I don’t know, and I should welcome a training course which would give me something of the general groundwork of a nurse’s training. Medical secretaries believethat their status would be raised if inducements were offered to young girls to make this -a career. With my seniors, housemen, and consultants to type for, and my clinics, waiting-lists, card indexes, two telephones, and other time-occupiers, I don’t feel I work any less hard than my colleagues in the technical sections : and I should like to feel that I will eventually reach their rate-of pay and length of holidays. Bearing in mind the number of hospitals and doctors needing clerical help, is it too much to ask for specialised training for youngsters who would " love to work for a doctor," but get panicky if asked to spell appendicitis ’? DOCTORS’ SECRETARY. "
ANOMALY OF ABDOMINAL MUSCULATURE SIR,—An unusual anatomical anomaly was found in a man who lately came to me for removal of a vesical pouch. The patient was aged 69. The abdominal wall was apparently healthy, and the bladder, which had a pouch the size of a billiards ball, was approached by a transverse incision through the aponeurosis overlying the rectus. Instead of the vertical disposition of the muscle beneath the sheath, T found subjacent fleshy fibres passing horizontally to the linea alba. Although momentarily stunned by this, to me, unique anomaly, I quickly realised that, instead of becoming aponeurotic at the linea semilunaris, the flesh of the internal oblique had continued over the face of the rectus abdominis. The right rectus appeared average, but the left some 40%
sub-average. This variant had apparently not impaired the efficiency parietes. The wound healed normally. A. WILFRID ADAMS. Bristol.
of the
UNDER TENSION all the sorts that read THE LANCET there SIR,—Among will be those who disapproved of your leader of Oct. 9. and those who approved of it. I should regret that only the former should be represented in your correspondence columns. To others of us your sober reflections round the theme that " it takes all sorts to make a world " contain
something
more
than
a
half-truth when
we
are
faced
with Dr. Chapman’s alternative-to look at one half of the world as one who " repeatedly attempts to destroy him and who proclaims, fortissimo, his intention of going on trying.... " Weseem to glimmer Dr. Chapman’s logical counter to that one. We are clearly enough in a dangerous situation. Dr. Chapman has heard voices and he isn’t the only one. Are those voices real ? Are they by any chance also heard in Russia ? There is always something of fact for international paranoia to batten on. But how little relative to the issues of sane settlement! And, taking the long view (say 40 years in this case), how fundamentally equal are the intolerances and the provocations of the opposing sides ! Are threats to vital interests (implied or felt) ever limited to one side in a major international
dispute ?
It may one day become clearer that the threat which 1948 offered to our world was not primarily that the policy of any power-group aimed at the destruction of the vital interests of any other power-group, but that everywhere people came to think this so. Some individuals and some peoples may have more of suspicion to unlearn than others ; some undoubtedly have more to unlearn of cruelty to their foes. But shall that thwart our peaceful solution ? Such complaints are perennial. Grotius, a Dutchman, tried to set up international law in 1625 but decided thatone couldn’t cope with the Portuguese. What we lack is scientific machinery for settling international disputes despite the froth of irresponsible journalism and the honest prejudice of so many men and women. What more appropriate, then, to THE LANCET’S last than that it should chase the mental health of peoples a little further than did our recent international congress by reminding us where we stand today ? To secure world order, international legal machinery has to be made just as calm, dispassionate, and secure as our own domestic courts of law-simply because it takes all sorts to make a world and (may I add ?), because to err is human. RANYARD WEST. Edinburgh. HOW MANY NURSES ?
SIR,—Dr. Cohen takes as the criterion of nursing and medical effectiveness in hospital the patient’s duration of stay " which is assumed to be an index of his duration of sickness." Is this assumed by anyone who stops to examine and consider the factors governing admissions to and discharges from hospital ? It is possible that duration of sickness might be accepted as one criterion (among several) of effective care, but it is surely very dangerous to single out that chapter in any individual’s ill health which he is allowed or persuaded to spend in hospital, and which may occur at an early or a late stage of his illness, as the index of the duration of sickness. One hopes that at present the hospitals, hard-pressed though they
are
by waiting-lists,
take into consideration the home circumstances of the patients before deciding at what stage of invalidism or of recovery they may safely be allowed to leave. I know that this is an important factor to the good ward sister, whether surgical, medical, or obstetric. To take the simplest instance, has the anxious primipara sent out on the 8th day to a comfortless home (where she immediately ‘‘ loses her milk" and learns by failure) really. received more effective care than the one who goes out on the 14th day or later with a little additional confidence, stability, and knowledge of her new responsibilities? The same applies in the fields of surgery and of medicine. It may be expedient sometimes to shorten duration of stay in the interests of the total sick population, but we need not pretend that it means better nursing or medical care for the individual. One hates to think that a hospital might be led by Dr. Cohen’s hypothesis to make quick turnover of
-