- Email: [email protected]
BIOGASTRONE IN INPATIENT TREATMENT OF GASTRIC ULCER
1161 other than by looking for qualities which are favoured even by the informed layman ? Those apparently well-qualified candidates who complained to the Department of Education on being rejected after interview may have had some trait or disability which the committee (all. well-qualified and senior medical men and women) considered unsuitable or undesirable. In many such cases it would be much more traumatic for the candidate to know why he or she were turned down in favour of someone else. Much of what you criticise is discussed in my letter 1; although justice is done by the selection committees of the various medical schools, there will always be the complaining few. University of London, King’s College,
D. L. BILBEY.
London, W.C.2.
BIOGASTRONE IN INPATIENT TREATMENT
OF
GASTRIC ULCER
SIR,-’Biogastrone ’ is been shown to effect on the healing of trials on outpatients.
already
preparation which has have an appreciable beneficial gastric ulcer in two controlled a new
In their paper (May 15) Dr. Skyring and his colleagues have been able to confirm this beneficial effect in their trial on inpatients and conclude that biogastrone has " no effect on the rate of healing of gastric ulcer ". I suggest that this conclusion is premature on the evidence of their small series. I note that their largest ulcers all healed better with biogastrone than with the dummy tablets. Furthermore, I know there is some evidence to show that both antacids and anticholinergic drugs may inhibit the healing effect of biogastrone; this might have affected their results. not
I agree with the Australian workers that more assessments of this new treatment are needed. The experience of my colleagues and myself with this new treatment has been most encouraging. F. AVERY JONES. STERILISATION OF INSTRUMENTS AND DRESSINGS IN GENERAL PRACTICE
SiR,ŁIcannot accept some of the ideas Dr. Grahame (May 22) puts forward as a solution for sterilising medical equipment. In the first place, if the pressure-cooker he describes can be guaranteed to turn out a sterile article, I cannot think why the hospitals are spending thousands of pounds buying highvacuum autoclaves. The first principle in sterilising dressings to remove the air steam can penetrate;
is
equipment permeable
which surrounds the fibres so that the this could never be achieved with the described. Secondly, damp paper wrapping is
to
microorganisms.
The modern cardboard boxes which are used to pack dressings for the sterilisation are dried in the autoclave under vacuum; the dry boxes provide a suitable container for the storage of sterile dressings, provided that the boxes are kept drv. Cuckfield
Hospital, Haywards Heath, Sussex.
F. A. HUGHES Group Pharmacist.
SIR,-The excellent article by Dr. Grahame shows that it is possible for a general practitioner, who has either the intention and the skill or the necessary ancillary staff, to provide himself with sterile instruments and dressings both in his surgery and on his rounds. But it would be much easier and quite economic and much more helpful to the general practitioner to supply him from a hospital C.S.S.D. with all the packs he needs. We have
long supplied packs of sterile syringes 1.
Bilbey, D. L. Br. med. J. 1963, ii,
870.
to
all
general
practitioners who want them 1; and, as these are in aluminium boxes, they can be carried in the general practitioner’s car and used in consulting-room or patient’s home. Now we sterilise " procedure packs " in aluminium containers2 protected by a paper bag, to hospital wards and departments, and transport them easily within our group. These packs would be admirable in general practice, particularly our dressings and suture packs.3 General practitioners could collect these as easily as they collect their sterile syringes. There is no legal or administrative problem. Packs could be provided as an extension of those pathological and bacteriological services to which the N.H.S. is committed under the National Health Service Acts. But, as usual, the problem of finance prevents our expanding in this way. If in the present negotiations it was agreed that such a service could be paid for by the local executive council, so that hospitals could count on additional money, we would certainly have no difficulty or hesitation in further assisting our general practitioners in this way. Pathological Laboratory, Kingston Hospital, Kingston upon Thames, Surrey.
D. STARK MURRAY.
MISUSE OF SECTION 29
SIR,-We have been requested information about admissions to our
supply further sample of 27 mental to
hospitals (April 3). During 1961, 1962, and 1963 section-29 admissions exceeded the total of all other forms of compulsory admission and were over one and a half times the number of section-25 admissions during 1962 and 1963. Our figures roughly paralleled the estimated national figures for mental hospital admissions
during
1963: Total
Informal
Section 29
Section 25
Section 26
Estimated national
figures 173,718 138,575 (80%) 22,184 (13%) 8170(5%) 2059(1%) 31,540 24,041 (76%) 4261 (13-5%) 2510 (8%) 491 (1-5%) Sample Our sample represented about a fifth of the national figures for 1962 and the estimated figures for 1963.4 Between 1961 and 1963 roughly 30% of patients were admitted compulsorily to the sample of hospitals in the Sheffield, North East Metropolitan, Manchester, Liverpool, and Wessex regions, which is well above the national average. After adding the figures supplied to us from the two hospitals in each region for 1963, the proportion of section-29 admissions to the total admissions varied between 26% in the Sheffield region to 3% in the South East Metropolitan region. Only in the Manchester, Oxford, and South East Metropolitan regions did the total of section-25 admissions to the hospitals in our sample exceed those under section 29 in this year. We were not concerned with admissions to non-psychiatric hospitals, but it might prove informative to examine these later. Dr. Atkin (April 17) accuses us of failing to provide evidence for our assumption that many section-29 patients who become informal after three days " could have been admitted informally in the first instance ". In our paper we wrote that further research was necessary to determine what kind of case should be dealt with under this section and why, since we had to collect the basic facts first. But because these patients were admitted under section 29 instead of other sections, it seemed reasonable to us to examine the problem retrospectively by ascertaining what happened to them. We demonstrated that approximately two-thirds of our hospitals regraded between 25% and 75% of their section-29 admissions to informal status within three days, and at two hospitals over 75%of the section-29 admissions were dealt with in this way. 1963, at one hospital, 2 patients admitted under section 29 were discharged directly, and 2 died within three days. It is therefore questionable whether section 29 was the correct admission procedure for many of these patients.
During
1. 2. 3. 4.
Murray, D. S. Lancet, 1954, i, 1274. Murray, D. S. ibid. 1964, i, 1207. Hospital, March, 1964. Brooke, E. M. Personal communication.
D. L. BILBEY.
London, W.C.2.
BIOGASTRONE IN INPATIENT TREATMENT
OF
GASTRIC ULCER
SIR,-’Biogastrone ’ is been shown to effect on the healing of trials on outpatients.
already
preparation which has have an appreciable beneficial gastric ulcer in two controlled a new
In their paper (May 15) Dr. Skyring and his colleagues have been able to confirm this beneficial effect in their trial on inpatients and conclude that biogastrone has " no effect on the rate of healing of gastric ulcer ". I suggest that this conclusion is premature on the evidence of their small series. I note that their largest ulcers all healed better with biogastrone than with the dummy tablets. Furthermore, I know there is some evidence to show that both antacids and anticholinergic drugs may inhibit the healing effect of biogastrone; this might have affected their results. not
I agree with the Australian workers that more assessments of this new treatment are needed. The experience of my colleagues and myself with this new treatment has been most encouraging. F. AVERY JONES. STERILISATION OF INSTRUMENTS AND DRESSINGS IN GENERAL PRACTICE
SiR,ŁIcannot accept some of the ideas Dr. Grahame (May 22) puts forward as a solution for sterilising medical equipment. In the first place, if the pressure-cooker he describes can be guaranteed to turn out a sterile article, I cannot think why the hospitals are spending thousands of pounds buying highvacuum autoclaves. The first principle in sterilising dressings to remove the air steam can penetrate;
is
equipment permeable
which surrounds the fibres so that the this could never be achieved with the described. Secondly, damp paper wrapping is
to
microorganisms.
The modern cardboard boxes which are used to pack dressings for the sterilisation are dried in the autoclave under vacuum; the dry boxes provide a suitable container for the storage of sterile dressings, provided that the boxes are kept drv. Cuckfield
Hospital, Haywards Heath, Sussex.
F. A. HUGHES Group Pharmacist.
SIR,-The excellent article by Dr. Grahame shows that it is possible for a general practitioner, who has either the intention and the skill or the necessary ancillary staff, to provide himself with sterile instruments and dressings both in his surgery and on his rounds. But it would be much easier and quite economic and much more helpful to the general practitioner to supply him from a hospital C.S.S.D. with all the packs he needs. We have
long supplied packs of sterile syringes 1.
Bilbey, D. L. Br. med. J. 1963, ii,
870.
to
all
general
practitioners who want them 1; and, as these are in aluminium boxes, they can be carried in the general practitioner’s car and used in consulting-room or patient’s home. Now we sterilise " procedure packs " in aluminium containers2 protected by a paper bag, to hospital wards and departments, and transport them easily within our group. These packs would be admirable in general practice, particularly our dressings and suture packs.3 General practitioners could collect these as easily as they collect their sterile syringes. There is no legal or administrative problem. Packs could be provided as an extension of those pathological and bacteriological services to which the N.H.S. is committed under the National Health Service Acts. But, as usual, the problem of finance prevents our expanding in this way. If in the present negotiations it was agreed that such a service could be paid for by the local executive council, so that hospitals could count on additional money, we would certainly have no difficulty or hesitation in further assisting our general practitioners in this way. Pathological Laboratory, Kingston Hospital, Kingston upon Thames, Surrey.
D. STARK MURRAY.
MISUSE OF SECTION 29
SIR,-We have been requested information about admissions to our
supply further sample of 27 mental to
hospitals (April 3). During 1961, 1962, and 1963 section-29 admissions exceeded the total of all other forms of compulsory admission and were over one and a half times the number of section-25 admissions during 1962 and 1963. Our figures roughly paralleled the estimated national figures for mental hospital admissions
during
1963: Total
Informal
Section 29
Section 25
Section 26
Estimated national
figures 173,718 138,575 (80%) 22,184 (13%) 8170(5%) 2059(1%) 31,540 24,041 (76%) 4261 (13-5%) 2510 (8%) 491 (1-5%) Sample Our sample represented about a fifth of the national figures for 1962 and the estimated figures for 1963.4 Between 1961 and 1963 roughly 30% of patients were admitted compulsorily to the sample of hospitals in the Sheffield, North East Metropolitan, Manchester, Liverpool, and Wessex regions, which is well above the national average. After adding the figures supplied to us from the two hospitals in each region for 1963, the proportion of section-29 admissions to the total admissions varied between 26% in the Sheffield region to 3% in the South East Metropolitan region. Only in the Manchester, Oxford, and South East Metropolitan regions did the total of section-25 admissions to the hospitals in our sample exceed those under section 29 in this year. We were not concerned with admissions to non-psychiatric hospitals, but it might prove informative to examine these later. Dr. Atkin (April 17) accuses us of failing to provide evidence for our assumption that many section-29 patients who become informal after three days " could have been admitted informally in the first instance ". In our paper we wrote that further research was necessary to determine what kind of case should be dealt with under this section and why, since we had to collect the basic facts first. But because these patients were admitted under section 29 instead of other sections, it seemed reasonable to us to examine the problem retrospectively by ascertaining what happened to them. We demonstrated that approximately two-thirds of our hospitals regraded between 25% and 75% of their section-29 admissions to informal status within three days, and at two hospitals over 75%of the section-29 admissions were dealt with in this way. 1963, at one hospital, 2 patients admitted under section 29 were discharged directly, and 2 died within three days. It is therefore questionable whether section 29 was the correct admission procedure for many of these patients.
During
1. 2. 3. 4.
Murray, D. S. Lancet, 1954, i, 1274. Murray, D. S. ibid. 1964, i, 1207. Hospital, March, 1964. Brooke, E. M. Personal communication.