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CARS FOR DOCTORS
158 The latest development is that the rural district council’s rat-catcher has called, a large, fresh-faced man who shook his head when I asked whether the council would deal with a hornets’ nest, when and if found. As a private citizen, though, he had dealt with one of his own, and he described with gusto how he did it. He arranged a box to stand a few inches below the nest -as large as the bucket my daily help, an interested .listener, was holding. On the box he placed a rag soaked with " the stuff "-i.e., cyanide. Next day every hornet was dead. Feeling sure that I should be dead too if I attempted these manoeuvres, I said that my husband was in poor health and could not be asked to do such things, and it did not seem quite the job for me. He suggested kindly that I "could fix the rag on the end of the stuff," and hold it to the a long stick, soak it in entrance of the nest until they were all killed. This seemed even more hazardous. It was an impasse and the rat-catcher was regretful. " Fleas ? " he asked hope" fully. I repudiated fleas. " Bugs ? Blackbeetles ? He was lyrical over the number of blackbeetles he had lately killed. But I was firm that my only pests were hornets, and he left. I forgot to mention the adder which lives in the corner of the garden near the garage, and which I strongly suspect of having bitten the cat. My rat-catching friend would probably have advised me to catch it by the neck and nip off its head with a quick flick of my teeth. *
*
*
The differential diagnosis of " numismatist’s thumb (described in this column on July 17, p. 118) is obviously from " miller’s thumb," a well-known occupational trauma familiar to Chaucer : " The Miller was a stout earl for the nones... Wel coude he stelen corn and tollen thryes : And yet he hadde a thombe of gold, pardee.", The allusion is to the acquisition by the miller of a smooth, broad, and rounded terminal phalanx to his pollex through the constant habit of applying it to the mealspout to test the meal by rubbing it between fingers and thumb. By seeing that his meal was properly ground the miller was likely to make more profit-hence a " golden thumb. ** *
Writing a book is difficult enough but procuring the photographs with which to illustrate it presents frustra-
tions and disappointments which are hard to bear. The infinite trouble and the large element of chance required to gather the patient, the photographer, and the lesions to be recorded together at any one time almost make one regret the old days when a drawing had to suffice, for this could be attempted unaided and the indifferent results handed at one’s leisure to a proper artist for improvement.
Tonight a colleague excitedly brought me a specimen glass with its contents still warm to demonstrate a large object like a herring-roe vertically suspended in a hazy urine. It is many years since I last saw a complete vesicular cast, so putting the precious object in a place of safety, dropping my pen, and even leaving my pipe behind, I rushed off to find the photographer. Being at that twilight time when those engaged in more respectable occupations are buying their evening papers and making for home, I realised that this might be a difficult task. However, after many false hopes he was run to earth in the animal house, and all was tied up and arrangements completed for the picture to be made
within the hour. I spent a few minutes in admiring some golden hamsters of which the photographer was particularly proudentertaining little fellows with large cheek pouches in which their recent meal could easily be palpated. Then, returning to the clinic, I was horrified to find that the precious cast could not even be classified as a thread but had melted away to leave just one more " urine : hazy in the first glass." *
iff
*
The recent headline, A Meeting of Child Psychiatrists," conjures up in my mind a picture of a group of infant prodigies, their bulging brows wrinkled as they dogmatise over Freud. And talking about misleading titles, as a student my college boasted a Small Bore Club-I hate to think what its members have become by now.
Letters
to
the Editor
CARS FOR DOCTORS
SiR,—In his letter last week Dr. Boucher raises the
question of doctors having absolute priority for car delivery. The reasons why this has not been granted ‘
are as
follows :
1. If the whole medical profession had new cars, this would absorb very nearly the whole of the home quota for new cars for one year. 2. Human nature being what it is, and the second-hand pr.ices of one-year-old cars being what they are, the temptation would be for every doctor to claim absolute priority and renew his car every year. This would mean that there would be practically no cars for other essential users.
With regard to cases of genuine need, where the doctor really has not got a serviceable car, then the retail trade is doing its best to advance delivery to a really early date. In such cases a high degree of preference is given. A difference of opinion often arises In some instances which as to what is a serviceable car. I have come across, the dealer claims with justice that the car regarded by the doctor as unserviceable can, with a little attention, easily run perhaps tens of thousands more miles. We leave these cases to be settled between the local dealer and the doctor concerned. R. GRESHAM COOKE Director, Society of Motor 148, Piccadilly, London, W.1.
Manufacturers and Traders Ltd.
BEDS FOR TUBERCULOSIS
SrB,—In his article of May 8, Dr. Bentley, inspired by visits to Swiss sanatoria, advocates the adoption of a less rigid regime of bed rest in British institutions. He hopes in this way to alleviate the gloomy outlook for thousands of patients waiting in vain for admission to sanatoria, where wards have been closed because of the shortage of nurses. Having been trained in very strict principles of bed rest and ample and efficient nursing’ while working in a municipal institution in England during the late war, I had to face quite a different situation when I returned to my native’country and took up work in a municipal institution here. For 300 patients there were 28 nurses (most fully trained), including theatre staff and others
of them not not
working
in the wards. There was no matron, no assistant matron, no senior sister, and no night superintendent or night sister; and I found the regime very lax. I admit to a long fit of despondency over this appalling state of affairs. I decided that I should have either to lower my own standards very considerably, or to try to make the best of existing conditions. I decided on the latter course, and after a few months’ struggle (aided by 3 or 4, mostly very junior, medical officers) we managed to introduce and maintain a regime which included a fair amount of collapse therapy and major thoracic surgery, falling not very far short of that practised in most similar institutions in Britain. Needless to.say, the disease in many of our patients was far advanced ; and these had to be kept The standard of nursing was, of on very strict bed rest. course, far from ideal.
After two years in this environment I found myself in charge of a sanatorium in the country witlr 14 nurses (only 2 fully trained) for 310 patients. The patients were very much of the same type as those in the hospital, but the proportion of really advanced cases was somewhat lower. Again there was no matron or senior
placed
sister, and no night supervising staff (the night staff consists of 5 nurses). The total of 14 nurses includes 4 serving in the
operating-theatres, &c. Fortunately, there was an enthusiastic experienced doctors, later increased to 5, including
team of 3
2 with excellent war-time experience in Britain. While not claiming to have a model establishment, we succeeded in introducing a fairly strict regime of graded bed rest and exercise, including modest attempts at rehabilitation by graded work. The nursing staff are not overworked; in fact about a quarter of them are ex-patients. Again, the standard of nursing is not ideal, for there is precious little blanket-bathing, treatment of pressure -points, or similar items of good classical nursing ; but the bedridden patients are fairly well looked after, and the nursing in the thoracic-
*
*
The differential diagnosis of " numismatist’s thumb (described in this column on July 17, p. 118) is obviously from " miller’s thumb," a well-known occupational trauma familiar to Chaucer : " The Miller was a stout earl for the nones... Wel coude he stelen corn and tollen thryes : And yet he hadde a thombe of gold, pardee.", The allusion is to the acquisition by the miller of a smooth, broad, and rounded terminal phalanx to his pollex through the constant habit of applying it to the mealspout to test the meal by rubbing it between fingers and thumb. By seeing that his meal was properly ground the miller was likely to make more profit-hence a " golden thumb. ** *
Writing a book is difficult enough but procuring the photographs with which to illustrate it presents frustra-
tions and disappointments which are hard to bear. The infinite trouble and the large element of chance required to gather the patient, the photographer, and the lesions to be recorded together at any one time almost make one regret the old days when a drawing had to suffice, for this could be attempted unaided and the indifferent results handed at one’s leisure to a proper artist for improvement.
Tonight a colleague excitedly brought me a specimen glass with its contents still warm to demonstrate a large object like a herring-roe vertically suspended in a hazy urine. It is many years since I last saw a complete vesicular cast, so putting the precious object in a place of safety, dropping my pen, and even leaving my pipe behind, I rushed off to find the photographer. Being at that twilight time when those engaged in more respectable occupations are buying their evening papers and making for home, I realised that this might be a difficult task. However, after many false hopes he was run to earth in the animal house, and all was tied up and arrangements completed for the picture to be made
within the hour. I spent a few minutes in admiring some golden hamsters of which the photographer was particularly proudentertaining little fellows with large cheek pouches in which their recent meal could easily be palpated. Then, returning to the clinic, I was horrified to find that the precious cast could not even be classified as a thread but had melted away to leave just one more " urine : hazy in the first glass." *
iff
*
The recent headline, A Meeting of Child Psychiatrists," conjures up in my mind a picture of a group of infant prodigies, their bulging brows wrinkled as they dogmatise over Freud. And talking about misleading titles, as a student my college boasted a Small Bore Club-I hate to think what its members have become by now.
Letters
to
the Editor
CARS FOR DOCTORS
SiR,—In his letter last week Dr. Boucher raises the
question of doctors having absolute priority for car delivery. The reasons why this has not been granted ‘
are as
follows :
1. If the whole medical profession had new cars, this would absorb very nearly the whole of the home quota for new cars for one year. 2. Human nature being what it is, and the second-hand pr.ices of one-year-old cars being what they are, the temptation would be for every doctor to claim absolute priority and renew his car every year. This would mean that there would be practically no cars for other essential users.
With regard to cases of genuine need, where the doctor really has not got a serviceable car, then the retail trade is doing its best to advance delivery to a really early date. In such cases a high degree of preference is given. A difference of opinion often arises In some instances which as to what is a serviceable car. I have come across, the dealer claims with justice that the car regarded by the doctor as unserviceable can, with a little attention, easily run perhaps tens of thousands more miles. We leave these cases to be settled between the local dealer and the doctor concerned. R. GRESHAM COOKE Director, Society of Motor 148, Piccadilly, London, W.1.
Manufacturers and Traders Ltd.
BEDS FOR TUBERCULOSIS
SrB,—In his article of May 8, Dr. Bentley, inspired by visits to Swiss sanatoria, advocates the adoption of a less rigid regime of bed rest in British institutions. He hopes in this way to alleviate the gloomy outlook for thousands of patients waiting in vain for admission to sanatoria, where wards have been closed because of the shortage of nurses. Having been trained in very strict principles of bed rest and ample and efficient nursing’ while working in a municipal institution in England during the late war, I had to face quite a different situation when I returned to my native’country and took up work in a municipal institution here. For 300 patients there were 28 nurses (most fully trained), including theatre staff and others
of them not not
working
in the wards. There was no matron, no assistant matron, no senior sister, and no night superintendent or night sister; and I found the regime very lax. I admit to a long fit of despondency over this appalling state of affairs. I decided that I should have either to lower my own standards very considerably, or to try to make the best of existing conditions. I decided on the latter course, and after a few months’ struggle (aided by 3 or 4, mostly very junior, medical officers) we managed to introduce and maintain a regime which included a fair amount of collapse therapy and major thoracic surgery, falling not very far short of that practised in most similar institutions in Britain. Needless to.say, the disease in many of our patients was far advanced ; and these had to be kept The standard of nursing was, of on very strict bed rest. course, far from ideal.
After two years in this environment I found myself in charge of a sanatorium in the country witlr 14 nurses (only 2 fully trained) for 310 patients. The patients were very much of the same type as those in the hospital, but the proportion of really advanced cases was somewhat lower. Again there was no matron or senior
placed
sister, and no night supervising staff (the night staff consists of 5 nurses). The total of 14 nurses includes 4 serving in the
operating-theatres, &c. Fortunately, there was an enthusiastic experienced doctors, later increased to 5, including
team of 3
2 with excellent war-time experience in Britain. While not claiming to have a model establishment, we succeeded in introducing a fairly strict regime of graded bed rest and exercise, including modest attempts at rehabilitation by graded work. The nursing staff are not overworked; in fact about a quarter of them are ex-patients. Again, the standard of nursing is not ideal, for there is precious little blanket-bathing, treatment of pressure -points, or similar items of good classical nursing ; but the bedridden patients are fairly well looked after, and the nursing in the thoracic-