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CHEMOTHERAPY OF BLOOD DISEASES
679 "
albumin globulin ratio of just over 1. Pushing water by mouth as mentioned in your article) and hypertonic and isotonic fluids intravenously were not only useless but actually aggravated the fluid and salt imbalance. In some of these cases, however, wesucceeded in restoring the balance by giving a plasma-transfusion (5-10 ml. per kg. body-weight), followed by a slow drip of saline solution.
Our observations clearly showed that chronic urinary obstruction commonly leads to dehydration. The main
inability of the damaged kidney to crystalloids. A second cause is a change in plasma-proteins leading to altered plasma-osmotic pressure. It has been known for many years that no simple kidney-function test reflects true kidney functioh in cases of long-standing urinary obstruction. I think that careful study of the water and salt balance, as well as of the changes in blood-proteins and haemoglobin level, is cause
of this is the
reabsorb
essential if prostatectomy is
to
be made safer.
Medical School, Dunedin, New Zealand.
C. H. G. HORVATH.
HEADACHE OF MUSCULAR ORIGIN SIR,-Of all the ill-defined diseases headache
of muscular origin is perhaps the commonest, and one which occupies much of a general practitioner’s surgery hours. I seek the courtesy of your columns to emphasise what was once well known before the army of drugs started its march-namely, the value of massage in treating this condition. Often called fibrositic headache, its cause is either incoordination of the neuromuscular architecture of the head and neck. or fibrotic changes in the soft tissues; sometimes a psychological overlay is present, but this is not so much a cause as an aggravator. In the main, however, its aetiology is rarely clearly or wholly defined, and treatment often consists of ringing the changes " with various salicylates or vitamin preparations. While successful such treatment is symptomatic only, seldom "
of bsnng value, and places a dependence on drugs which, when obtained apart from prescription, are commonly nostrums. My experience of over forty years has shown that reference of these patients to a physiotherapist versed in facial and cervical massage can result in a relief of greater satisfaction and permanency, and release the practitioner to treat headache of more serious imoort.
AGNES RUDÉ.
11"Cls ,
CHEMOTHERAPY OF BLOOD DISEASES SIR,—In reviewing 25,000 cases of malignant blood discase I have found several areas of therapy which do Oft seem to have been explored within the past decade. Perhaps these apparent gaps may be due to my own failures in searching or to shortcomings in the index journals. I should be grateful for references to any clinical data on the following: The treatment of polycythaemia vera with 6-MP, busulphan
Myleran antibiotics,
or corticotrophin/cortisone. (Only 1 has been found of polycythaonia treated with folic-acid antagonists and colchicine.) the control of chronic granulocytic leukæmia with folic-acid
x
antagonists, antibiotics, or corticotrophin/cortisone. (Myleran ’%c!i,v of mycosis fungoides and urethane therapy of reti-=«.-cl1 sarcoma also appear to be
the latter disease
M 1::.-d
seems to
untried, and only 1 have been treated with
antagonists.)
III the present empirical state of the chemotherapeutic of malignant blood diseases it would be <’Boit ssont to know if these possible methods of treatment t in fact been tried.
Firman University,
, South Carolina.
JOHN R. SAMPEY.
SPRAY-PACK THERAPY IN DERMATOLOGY SiR,—Recently hydrocortisone has been marketed in the form of sprays. The earliest of these contained isopropanol as the diluent, with a propellant; but the intense stinging evoked when the spray was used on broken skin limited its use. A spray1 has now been developed which does not contain isopropanol, and this can be used without stinging the patient. This method of topical therapy is economical. Not only is a fine and even dispersal of the active ingredient obtained, so that as much as eight square yards of skin can be effectively covered by 100 ml. of lotion, but the efficacy is greatly enhanced by virtue of the volatility of the medium. Hydrocortisone in a dilution of 1 ’1000 in a volatile medium seems as good as 1 100, where the medium is non-volatile and remains on the skin. The principal benefit of this method of therapy is seen in the acute and exudative phases of eczema and dermatitis, particularly where large areas are involved. Application is both clean and easy, and results in much time being saved where nursing staff are carrying out treatments. I. S. HODGSON-JONES. Northampton. REINSTATEMENT AFTER WRONGFUL DISMISSAL SIR,—Iread with concern in your issue of March 14 of the discussion in the House of Lords on the wrongful dismissal of a consultant. The Earl of Onslow made statements which, I feel, it is only proper I should correct. The Earl stated that this was a takeover case from the voluntary hospital to the National Health Service. The consultant was employed at the Boundary Park General Hospital which was administered by the Oldham County Borough Council, and at no time has it been a voluntary hospital. The Earl also said: I understand that he has a large private "
The source of this information is not disclosed. It is. certainly not contained in the judgment because Mr. Justice Barry states " that the Plaintiff’s private practice fell off quite substantially after his employment at the Boundary Park Hospital had terminated ". Through his wrongful dismissal this consultant is excluded from all private beds in the Hospital Service and there are no nursing-homes in the district. It is correct that he is employed by a local authority. The consultant was on the " appointed day " the consultant obstetrician (part-time) to the Oldham local health authority and his appointment has never been terminated by the council, as the council were satisfied that his appeal should have been heard. The Earl of Onslow also said: " I understand that this doctor has received substantial tax-free damages, as awarded by the Judge, who at the time said that there was no possibility Mr. Justice Barry made no mention of of reinstatement." reinstatement in his judgment, but he did make a declaration against the Minister that he acted wrongfully and in breach of his statutory duty. The damages paid are described as substantial and tax-free. They were based on the loss of salary for five years together with £ 1500 for loss of private practice over this period. The hearing was in December, 1957, eight months after the five-year period of loss of earnings. Two years have now almost passed and the consultant has no hospital appointment. In view of recent decisions Mr. Justice Barry had to take income-tax into account, otherwise the damages would have been nearly El 5,000. Nor was the consultant at the time of his dismissal in a post which the hospital board chose to divide into two. An additional post was created some six months before this and an additional consultant appointed before he was dismissed. None of the advocates for justice to be done in this case have ever suggested that either of the two consultants now employed should suffer any loss of sessions. This would be creating further injustice. The Earl finally says and he is earning a good living in his own profession". This cannot be the case since the only appointment the consultant holds is with the Oldham County
practice."
"
1. ’
Cortril’, Pfizer.
albumin globulin ratio of just over 1. Pushing water by mouth as mentioned in your article) and hypertonic and isotonic fluids intravenously were not only useless but actually aggravated the fluid and salt imbalance. In some of these cases, however, wesucceeded in restoring the balance by giving a plasma-transfusion (5-10 ml. per kg. body-weight), followed by a slow drip of saline solution.
Our observations clearly showed that chronic urinary obstruction commonly leads to dehydration. The main
inability of the damaged kidney to crystalloids. A second cause is a change in plasma-proteins leading to altered plasma-osmotic pressure. It has been known for many years that no simple kidney-function test reflects true kidney functioh in cases of long-standing urinary obstruction. I think that careful study of the water and salt balance, as well as of the changes in blood-proteins and haemoglobin level, is cause
of this is the
reabsorb
essential if prostatectomy is
to
be made safer.
Medical School, Dunedin, New Zealand.
C. H. G. HORVATH.
HEADACHE OF MUSCULAR ORIGIN SIR,-Of all the ill-defined diseases headache
of muscular origin is perhaps the commonest, and one which occupies much of a general practitioner’s surgery hours. I seek the courtesy of your columns to emphasise what was once well known before the army of drugs started its march-namely, the value of massage in treating this condition. Often called fibrositic headache, its cause is either incoordination of the neuromuscular architecture of the head and neck. or fibrotic changes in the soft tissues; sometimes a psychological overlay is present, but this is not so much a cause as an aggravator. In the main, however, its aetiology is rarely clearly or wholly defined, and treatment often consists of ringing the changes " with various salicylates or vitamin preparations. While successful such treatment is symptomatic only, seldom "
of bsnng value, and places a dependence on drugs which, when obtained apart from prescription, are commonly nostrums. My experience of over forty years has shown that reference of these patients to a physiotherapist versed in facial and cervical massage can result in a relief of greater satisfaction and permanency, and release the practitioner to treat headache of more serious imoort.
AGNES RUDÉ.
11"Cls ,
CHEMOTHERAPY OF BLOOD DISEASES SIR,—In reviewing 25,000 cases of malignant blood discase I have found several areas of therapy which do Oft seem to have been explored within the past decade. Perhaps these apparent gaps may be due to my own failures in searching or to shortcomings in the index journals. I should be grateful for references to any clinical data on the following: The treatment of polycythaemia vera with 6-MP, busulphan
Myleran antibiotics,
or corticotrophin/cortisone. (Only 1 has been found of polycythaonia treated with folic-acid antagonists and colchicine.) the control of chronic granulocytic leukæmia with folic-acid
x
antagonists, antibiotics, or corticotrophin/cortisone. (Myleran ’%c!i,v of mycosis fungoides and urethane therapy of reti-=«.-cl1 sarcoma also appear to be
the latter disease
M 1::.-d
seems to
untried, and only 1 have been treated with
antagonists.)
III the present empirical state of the chemotherapeutic of malignant blood diseases it would be <’Boit ssont to know if these possible methods of treatment t in fact been tried.
Firman University,
, South Carolina.
JOHN R. SAMPEY.
SPRAY-PACK THERAPY IN DERMATOLOGY SiR,—Recently hydrocortisone has been marketed in the form of sprays. The earliest of these contained isopropanol as the diluent, with a propellant; but the intense stinging evoked when the spray was used on broken skin limited its use. A spray1 has now been developed which does not contain isopropanol, and this can be used without stinging the patient. This method of topical therapy is economical. Not only is a fine and even dispersal of the active ingredient obtained, so that as much as eight square yards of skin can be effectively covered by 100 ml. of lotion, but the efficacy is greatly enhanced by virtue of the volatility of the medium. Hydrocortisone in a dilution of 1 ’1000 in a volatile medium seems as good as 1 100, where the medium is non-volatile and remains on the skin. The principal benefit of this method of therapy is seen in the acute and exudative phases of eczema and dermatitis, particularly where large areas are involved. Application is both clean and easy, and results in much time being saved where nursing staff are carrying out treatments. I. S. HODGSON-JONES. Northampton. REINSTATEMENT AFTER WRONGFUL DISMISSAL SIR,—Iread with concern in your issue of March 14 of the discussion in the House of Lords on the wrongful dismissal of a consultant. The Earl of Onslow made statements which, I feel, it is only proper I should correct. The Earl stated that this was a takeover case from the voluntary hospital to the National Health Service. The consultant was employed at the Boundary Park General Hospital which was administered by the Oldham County Borough Council, and at no time has it been a voluntary hospital. The Earl also said: I understand that he has a large private "
The source of this information is not disclosed. It is. certainly not contained in the judgment because Mr. Justice Barry states " that the Plaintiff’s private practice fell off quite substantially after his employment at the Boundary Park Hospital had terminated ". Through his wrongful dismissal this consultant is excluded from all private beds in the Hospital Service and there are no nursing-homes in the district. It is correct that he is employed by a local authority. The consultant was on the " appointed day " the consultant obstetrician (part-time) to the Oldham local health authority and his appointment has never been terminated by the council, as the council were satisfied that his appeal should have been heard. The Earl of Onslow also said: " I understand that this doctor has received substantial tax-free damages, as awarded by the Judge, who at the time said that there was no possibility Mr. Justice Barry made no mention of of reinstatement." reinstatement in his judgment, but he did make a declaration against the Minister that he acted wrongfully and in breach of his statutory duty. The damages paid are described as substantial and tax-free. They were based on the loss of salary for five years together with £ 1500 for loss of private practice over this period. The hearing was in December, 1957, eight months after the five-year period of loss of earnings. Two years have now almost passed and the consultant has no hospital appointment. In view of recent decisions Mr. Justice Barry had to take income-tax into account, otherwise the damages would have been nearly El 5,000. Nor was the consultant at the time of his dismissal in a post which the hospital board chose to divide into two. An additional post was created some six months before this and an additional consultant appointed before he was dismissed. None of the advocates for justice to be done in this case have ever suggested that either of the two consultants now employed should suffer any loss of sessions. This would be creating further injustice. The Earl finally says and he is earning a good living in his own profession". This cannot be the case since the only appointment the consultant holds is with the Oldham County
practice."
"
1. ’
Cortril’, Pfizer.