- Email: [email protected]
CŒLIAC-PLEXUS REFLEX IN MAN
836
apnoeic phase. The patients must be closely after operation, for the recovery stage, even after cyclopropane, is invariably most inelegant, with much laryngeal spasm, coughing, and cyanosis. In Damascus, hashish addiction is a positive indication for local anaesthesia where this is at all possible.
possible during
the
watched very
Department of Anæsthesia, Syrian University, Damascus.
L. T. SCOTT.
SiR,-From three years’ experience anaesthetist to
in the late
war as
combined British-Indian military hospital I can confirm Dr. Galley’s findings regarding dosage of short-acting intravenous barbiturates in Indian and Oriental patients. The average amount required for induction of anæsa
thesia is about two-thirds of that needed in a corresponding European. My initial ignorance of this fact nearly resulted in an unpleasant surprise ! I note that in his letter last week Dr. Clement advocates Lake’s technique for high and mid-spinal levels, where spinal analgsesia is the method of choice, mentioning that only 9 ml. of’Light Nupercaine’ will give satisfactory results for upper abdominal surgery in patients of average size. While this is true, I feel that this technique is rather more exacting and less comfortable than methods employing ’Heavy Nupercaine,’ using the equivalent of only 4 mg. more of the drug. As Professor Macintosh has pointed out,l the good and bad effects depend not on the administration of 10 or 15 mg. of nupercaine, but on the level within the dural canal reached by the drug. A. W. H. ASHBERY. Maidstone. PERIODIC MEDICAL OVERHAUL
SiR,ŅI was interested in Sir Adolphe Abrahams’s points of view (Sept. 26) and would agree with him that during medical examination emphasis should be placed health-mindedness rather than on the possibility of disease. I cannot, however, accept so heartily the suggestion that health guidance is not a matter for the doctor and should be handed over to someone else. Unfortunately it is all too true that the training of the medical student and the young graduate has not provided " the best milieu for health-mindedness." The reason is not far to seek : it is that teaching has been conducted almost exclusively by specialists in diseases of various groups of systems and parts of the body. One could scarcely expect people preoccupied with disease processes to think in terms of health." Surely, however (and particularly in view of the altered scene resulting from the National Health Service), health should be the prime concern of family doctors and of all who have to deal with individuals as whole beings." The trend is for specialism to be carried into evernarrowing fields, and it would seem that there is need for introducing at some stage of the curriculum a study of health as what might be termed a positive factor." There is no room for complacency in regard to the health of the nation as a whole. No medical man walking along the streets of any of our large towns and taking stock of the men and women between the ages of thirty and forty (when they should be at their prime) could fail to be impressed by the number who are already losing health and vigour. Probably riot many of these people would say that they were ill or in need of medical attention, but most of them would certainly benefit from judicious health guidance. I am not in favour of health education in bulk, since I am not sure that much of the propaganda being put across to the public is either of value or harmless. Health is normally a matter for individual advice, as and when required, but in my view periodic " health " examinations carried out in each decade of life and in proper on
"
"
"
1.
Macintosh, R. It. Edinburgh, 1951.
Lumbar
Puncture
and
Spinal Analgesia.
surroundings by a doctor would serve a useful purpose and would amply repay time and money spent on them. It would be wrong to suggest to the public that such examinations would adequately safeguard against all, or even most, of the ills to which flesh is unfortunately heir, though even if limited to a physical examination they would have some predictable value. The spreading of a net to catch disease would, however, be only a part of their function. The main purpose would be to assess the standard of health and when this was found to be low to search, as with disease, for the cause. Such a search would involve many factors : heredity, home background, personal habits and interests, occupation, general environment, and of course the presence of disease processes. The value of such examinations would not be limited to the individual ; for the findings, if properly recorded and filed, would provide extremely valuable information for those entrusted with the nation’s health -information of no less, and probably much greater, value than that provided by morbidity figures. Student Health Service, H. A. MACKLIN. The University, Aberdeen. CASSETTE HOLDER FOR USE IN THE OPERATING-THEATRE
SiR,ŅReversal of the X-ray tube and
cassette during fracture of the neck of the operation pinning femur, as practised by Mr. Le Vay (Sept. 12), does not solve the irradiation problem. Most orthopaedic tables are not equipped to take a cassette between the patient’s legs, and the cassette is held in position by the surgeon. Moreover, this technique necessitates an X-ray machine on the " operating side " of the patient-an arrangement disliked by most orthopaedic surgeons and all theatre sisters, especially when only one X-ray machine is available-and it frequently has to be moved in order to take the anteroposterior and lateral views of the hip. The cassette holder I described (Aug. 29) protects the surgeon from X-ray irradiation and can be used for many other orthopaedic procedures in which X-ray control is desired. I do not doubt that Mr. Le Vay obtains excellent films. It is only fair to point out that the quality of the films obtained using either a curved cassette (as is necessary in Mr. Le Vay’s method) or an ordinary cassette, depends on the experience of the radiographer and the qualitv of the X-ra--v tube. Kent and Canterbury Hospital, MARK L. MASON. Canterbury.
the
for
a
CŒLIAC-PLEXUS REFLEX IN MAN
SiR,ŅA very similar reflex to that discussed by Dr. B. H. Smith (Aug. 1) occurs spontaneously in late pregnancy, probably as a result of foetal compression on the structures related to the solar plexus. While at Maternidade Escola (Universidade do Brasil, Rio de Janeiro) I observed five pregnant women who exhibited a distinct and progressive fall in blood-pressure leading to circulatory collapse when they assumed the dorsal recumbent position.1 McRoberts reported six similar cases, and named the disorder " postural shock."2 The postural circulatory collapse in pregnancy is evidently of a reflex nature ; in two cases I found that it was absent after paravertebral block. I have also noticed that atropine in a dose of 1-5 mg. (gr. 1/40) intramuscularly averted the fall in blood-pressure. When this drug was given in smaller doses it only weakened the reflex or delayed its appearance. As Dr. Smith action the of contradicts the accepted out, points atropine concept that the solar reflex is caused by sympatheticotonia-unless perhaps it could be proved that the 1. de Rezende, J. M. Arch. bras. Med. 1950, 40, 375. 2. McRoberts, W. A. jun. Amer. J. Obstet. Gynec. 1951, 62, 627.
837
sympathetic nervous system cholinergic fibres as in the dog.34 human
contains
depressor,
I measured the venous pressure in two of the patients, and there was a decrease parallel to the fall in the arterial blood-pressure, although of lesser degree. This fact accords with the suggestion of Gordh 5 that stimulation of the solar plexus might lead to loss of tone of the great veins. The hypothesis put forward by Dr. Smith to explain the solar reflex-that it is due to vagal cardiac inhibition and consequently diminished force of contraction of the heart-muscle-is a very attractive one but needs further data in its favour. JOFFRE MARCONDES DE REZENDE. -
Bela Vista, Matto Grosso, Brazil.
POLIOMYELITIS: WELSH REGIONAL BOARD AND MINISTRY OF HEALTH SiR,-It is regretted that the British Orthopaedic Association should have gained the impression, as suggested in Sir Reginald Watson-Jones’s letter last week, that orthopaedic surgeons are in any way excluded from their rightful place in the treatment of poliomyelitis in Wales. It is only fair to point out that the special committee of consultants which met some time ago were dealing essentially with one aspect of poliomyelitisthat of the respiratory complications. The recommendations in the memorandum, to which Sir Reginald refers, are additional to the already existing arrangements which are described and which make special mention of the necessity for orthopaedic supervision.
A. TREVOR JONES Welsh
Regional Hospital Board, Cardiff.
Senior Administrative Medical Officer.
"CARDIOSPASM" leader on this subject (Aug. 15) does not SiR,-Your mention the comprehensive contributions of Irwin Moore 6and Brown Kelly.s These include many illustrations of museum specimens, all of which fail to reveal any organic stricture at the cardia, even where there is gross cesophagectasia. The first necropsy specimen of cardiospasm was described by Cruveilhier in 1821. Many facts favour a neurogenic origin-i.e., paralysis affecting, in particular, the longitudinal musculature of the oesophagus (" the inhibition of contraction of the longitudinal coats " of Einhorn and Rolleston). Pavlov (1887), in his classic experiment in the dog, showed the effect of section of both vagi and demonstrated " paralysis of the lower third of the oesophagus with the cardia only opened, as a result of which not all the swallowed food could pass into the stomach but would stagnate in the lower part of the oesophagus ; the frequent vomiting would exhaust the animal." 9 This work of Pavlov’s was carried out before the X rays. discovery of Sjoberg 10 repeated Pavlov’s experiment in the cat. Bilateral vagotomy produced tightly constricted sphincters at the upper and lower ends of the oesophagus. He demonstrated radiographically that an opaque meal introduced into the oesophagus of such an animal became trapped there. If the animal was suspended by the head, the opaque meal was held up at the cardia : if suspended by the tail the meal was held up at the crico-pharyngeus. Paralysis of both recurrent laryngeal nerves results in achalasia of the crico-pharyngeus.ll 12 This is observed also in poliomyelitis. Knight and Adamson 13 found that stimulation of the vagus produced relaxation of the cardia and that stimulation of the 3. 4. 5. 6.
Bülbring, F., Burn, J. H. J. Physiol. 1935, 83, 483. Burn, J. H. Physiol. Rev. 1938, 18, 137. Gordh, T. Acta chir. scand. 1945, 92, suppl. 102. Moore, I. Proc. R. Soc. Med. 1919, 12, 67. 7. Moore I. J. Laryng. 1927, 42, 577. 8. Brown Kelly, A. Ibid, p. 221. 9. Babkin, B. P. Pavlov. London, 1951; p. 201. 10. Sjoberg, A. Arch. Otolaryng. 1952, 52, 323. 11. Asherson, N. Trans. med. Soc. Lond. 1950, 66, 398. 12. Asherson, N. J. Laryng. 1950, 64, 747; Brit. J. Tuberc. 1952, 46, 95. 13. Knight, G. C., Adamson, W. A. D. Proc. R. Soc. Med. 1935, 28, 891.
sympathetic produced contraction. They also found that excision of the vagus produced the clinical and radiological picture of achalasia ; when the vagus and the sympathetic Brown were excised, there was no obstruction at the cardia. Kelly 8 and Rake 14 showed that there was destruction of the nerve elements in Auerbach’s plexus. E7ztalacao
(known
tropical cardiospasm, tropical d’engasgo) is a disease characterised attacks of severe difficulty in swallowing. It is confined solely to certain geographical regions of South America. Gray 15 drew attention to this type of mega-oesophagus and confirmed its peculiar geographical
dyspha,gia, by recurrent
or
as
mal
distribution. He attributes the cause to avitaminosis, but in its distribution it acknowledges no economic barrier. The cause is probably viral (akin to poliomyelitis). This produces paralysis of the longitudinal muscles of the oesophagus, the contraction of which plays an important part in the opening, during deglutition, of the normally closed cardia. Much has been written on what opens the cardia (or for that matter the crico-pharyngeus), but little on how each is opened. If a thin-walled rubber tube of wide calibre has in its course a constriction, closing its lumen (as a sphincter), it may be opened by stretching-i.e., in the same way that the bulge of a de Pezzer catheter is flattened out by stretching. Contraction of the longitudinal muscles of the oesophagus will open the cardia ; in the same way contraction of the oblique fibres of the constrictors opens up the crico-pharyngeus by its longitudinal pull. Thus paralysis of the longitudinal musculature will result in cardiospasm," and a correct appellation of this condition is " paralysis of the longitudinal muscles of the oesophagus." Occasionally carcinoma of the cardiac end of the stomach will hamper the contraction of the cesophageal musculature and prevent the opening of the cardia. As a result from time to time there develops great dilatation of the oesophagus with vigorous peristalsis, visible on screening. Radiologically this simulates cardiospasm.16 The dilatation passes off but returns at intervals. This " intermittent cardiospasm may be for many months the first and only indication of the presence of cancer of the cardiac end of the stomach. Ogilvie 17 and Park 18 have noted this association. N. AsHERSON. ASHERSON. London, W.1. "
"
Public Health Pneumoconiosis THE National Coal Board and the National Union of Mineworkers have made plans for a survey of pneumoconiosis in British coalfields.19 One of the aims of the survey, which will be conducted in collaboration with the Medical Research Council, will be to discover the safe limit of dustiness in which miners can work without dangerto their health. A mobile unit with X-ray equipment will visit 24 pits throughout the country, and it is hoped that every person employed in these mines will be examined. The 24 pits have been selected as representative of the various conditions found in British mines. The mobile unit working from Edinburgh will make a start soon and another from Cardiff will do so later. ".
Poliomyelitis
Poliomyelitis notifications (uncorrected) in England and Wales during the week ended Oct. 3 (39th week of the year) were (previous. week in parentheses) : paralytic, 79 (119) ; non-paralytic, 78 (99) ; total, 157 (218). The reduction in notifications of 40 paralytic and 21 non-paralytic cases is satisfactory, and there is no doubt that the drop to the winter levels of the disease is under way. 14. Rake, G. W. Guy’s Hosp. Rep. 1927, 77, 141. 15. Gray, G. Trans. med. Soc. Lond. 1950, 66, 398. 16. Asherson, N. Brit. J. Tuberc. 1953, 47, 39. 17. Ogilvie, H. Brit. med. J. 1947, ii, 406. 18. Park, W. D. Ibid, 1952, ii, 599. 19. Times, Oct. 13, 1953.
apnoeic phase. The patients must be closely after operation, for the recovery stage, even after cyclopropane, is invariably most inelegant, with much laryngeal spasm, coughing, and cyanosis. In Damascus, hashish addiction is a positive indication for local anaesthesia where this is at all possible.
possible during
the
watched very
Department of Anæsthesia, Syrian University, Damascus.
L. T. SCOTT.
SiR,-From three years’ experience anaesthetist to
in the late
war as
combined British-Indian military hospital I can confirm Dr. Galley’s findings regarding dosage of short-acting intravenous barbiturates in Indian and Oriental patients. The average amount required for induction of anæsa
thesia is about two-thirds of that needed in a corresponding European. My initial ignorance of this fact nearly resulted in an unpleasant surprise ! I note that in his letter last week Dr. Clement advocates Lake’s technique for high and mid-spinal levels, where spinal analgsesia is the method of choice, mentioning that only 9 ml. of’Light Nupercaine’ will give satisfactory results for upper abdominal surgery in patients of average size. While this is true, I feel that this technique is rather more exacting and less comfortable than methods employing ’Heavy Nupercaine,’ using the equivalent of only 4 mg. more of the drug. As Professor Macintosh has pointed out,l the good and bad effects depend not on the administration of 10 or 15 mg. of nupercaine, but on the level within the dural canal reached by the drug. A. W. H. ASHBERY. Maidstone. PERIODIC MEDICAL OVERHAUL
SiR,ŅI was interested in Sir Adolphe Abrahams’s points of view (Sept. 26) and would agree with him that during medical examination emphasis should be placed health-mindedness rather than on the possibility of disease. I cannot, however, accept so heartily the suggestion that health guidance is not a matter for the doctor and should be handed over to someone else. Unfortunately it is all too true that the training of the medical student and the young graduate has not provided " the best milieu for health-mindedness." The reason is not far to seek : it is that teaching has been conducted almost exclusively by specialists in diseases of various groups of systems and parts of the body. One could scarcely expect people preoccupied with disease processes to think in terms of health." Surely, however (and particularly in view of the altered scene resulting from the National Health Service), health should be the prime concern of family doctors and of all who have to deal with individuals as whole beings." The trend is for specialism to be carried into evernarrowing fields, and it would seem that there is need for introducing at some stage of the curriculum a study of health as what might be termed a positive factor." There is no room for complacency in regard to the health of the nation as a whole. No medical man walking along the streets of any of our large towns and taking stock of the men and women between the ages of thirty and forty (when they should be at their prime) could fail to be impressed by the number who are already losing health and vigour. Probably riot many of these people would say that they were ill or in need of medical attention, but most of them would certainly benefit from judicious health guidance. I am not in favour of health education in bulk, since I am not sure that much of the propaganda being put across to the public is either of value or harmless. Health is normally a matter for individual advice, as and when required, but in my view periodic " health " examinations carried out in each decade of life and in proper on
"
"
"
1.
Macintosh, R. It. Edinburgh, 1951.
Lumbar
Puncture
and
Spinal Analgesia.
surroundings by a doctor would serve a useful purpose and would amply repay time and money spent on them. It would be wrong to suggest to the public that such examinations would adequately safeguard against all, or even most, of the ills to which flesh is unfortunately heir, though even if limited to a physical examination they would have some predictable value. The spreading of a net to catch disease would, however, be only a part of their function. The main purpose would be to assess the standard of health and when this was found to be low to search, as with disease, for the cause. Such a search would involve many factors : heredity, home background, personal habits and interests, occupation, general environment, and of course the presence of disease processes. The value of such examinations would not be limited to the individual ; for the findings, if properly recorded and filed, would provide extremely valuable information for those entrusted with the nation’s health -information of no less, and probably much greater, value than that provided by morbidity figures. Student Health Service, H. A. MACKLIN. The University, Aberdeen. CASSETTE HOLDER FOR USE IN THE OPERATING-THEATRE
SiR,ŅReversal of the X-ray tube and
cassette during fracture of the neck of the operation pinning femur, as practised by Mr. Le Vay (Sept. 12), does not solve the irradiation problem. Most orthopaedic tables are not equipped to take a cassette between the patient’s legs, and the cassette is held in position by the surgeon. Moreover, this technique necessitates an X-ray machine on the " operating side " of the patient-an arrangement disliked by most orthopaedic surgeons and all theatre sisters, especially when only one X-ray machine is available-and it frequently has to be moved in order to take the anteroposterior and lateral views of the hip. The cassette holder I described (Aug. 29) protects the surgeon from X-ray irradiation and can be used for many other orthopaedic procedures in which X-ray control is desired. I do not doubt that Mr. Le Vay obtains excellent films. It is only fair to point out that the quality of the films obtained using either a curved cassette (as is necessary in Mr. Le Vay’s method) or an ordinary cassette, depends on the experience of the radiographer and the qualitv of the X-ra--v tube. Kent and Canterbury Hospital, MARK L. MASON. Canterbury.
the
for
a
CŒLIAC-PLEXUS REFLEX IN MAN
SiR,ŅA very similar reflex to that discussed by Dr. B. H. Smith (Aug. 1) occurs spontaneously in late pregnancy, probably as a result of foetal compression on the structures related to the solar plexus. While at Maternidade Escola (Universidade do Brasil, Rio de Janeiro) I observed five pregnant women who exhibited a distinct and progressive fall in blood-pressure leading to circulatory collapse when they assumed the dorsal recumbent position.1 McRoberts reported six similar cases, and named the disorder " postural shock."2 The postural circulatory collapse in pregnancy is evidently of a reflex nature ; in two cases I found that it was absent after paravertebral block. I have also noticed that atropine in a dose of 1-5 mg. (gr. 1/40) intramuscularly averted the fall in blood-pressure. When this drug was given in smaller doses it only weakened the reflex or delayed its appearance. As Dr. Smith action the of contradicts the accepted out, points atropine concept that the solar reflex is caused by sympatheticotonia-unless perhaps it could be proved that the 1. de Rezende, J. M. Arch. bras. Med. 1950, 40, 375. 2. McRoberts, W. A. jun. Amer. J. Obstet. Gynec. 1951, 62, 627.
837
sympathetic nervous system cholinergic fibres as in the dog.34 human
contains
depressor,
I measured the venous pressure in two of the patients, and there was a decrease parallel to the fall in the arterial blood-pressure, although of lesser degree. This fact accords with the suggestion of Gordh 5 that stimulation of the solar plexus might lead to loss of tone of the great veins. The hypothesis put forward by Dr. Smith to explain the solar reflex-that it is due to vagal cardiac inhibition and consequently diminished force of contraction of the heart-muscle-is a very attractive one but needs further data in its favour. JOFFRE MARCONDES DE REZENDE. -
Bela Vista, Matto Grosso, Brazil.
POLIOMYELITIS: WELSH REGIONAL BOARD AND MINISTRY OF HEALTH SiR,-It is regretted that the British Orthopaedic Association should have gained the impression, as suggested in Sir Reginald Watson-Jones’s letter last week, that orthopaedic surgeons are in any way excluded from their rightful place in the treatment of poliomyelitis in Wales. It is only fair to point out that the special committee of consultants which met some time ago were dealing essentially with one aspect of poliomyelitisthat of the respiratory complications. The recommendations in the memorandum, to which Sir Reginald refers, are additional to the already existing arrangements which are described and which make special mention of the necessity for orthopaedic supervision.
A. TREVOR JONES Welsh
Regional Hospital Board, Cardiff.
Senior Administrative Medical Officer.
"CARDIOSPASM" leader on this subject (Aug. 15) does not SiR,-Your mention the comprehensive contributions of Irwin Moore 6and Brown Kelly.s These include many illustrations of museum specimens, all of which fail to reveal any organic stricture at the cardia, even where there is gross cesophagectasia. The first necropsy specimen of cardiospasm was described by Cruveilhier in 1821. Many facts favour a neurogenic origin-i.e., paralysis affecting, in particular, the longitudinal musculature of the oesophagus (" the inhibition of contraction of the longitudinal coats " of Einhorn and Rolleston). Pavlov (1887), in his classic experiment in the dog, showed the effect of section of both vagi and demonstrated " paralysis of the lower third of the oesophagus with the cardia only opened, as a result of which not all the swallowed food could pass into the stomach but would stagnate in the lower part of the oesophagus ; the frequent vomiting would exhaust the animal." 9 This work of Pavlov’s was carried out before the X rays. discovery of Sjoberg 10 repeated Pavlov’s experiment in the cat. Bilateral vagotomy produced tightly constricted sphincters at the upper and lower ends of the oesophagus. He demonstrated radiographically that an opaque meal introduced into the oesophagus of such an animal became trapped there. If the animal was suspended by the head, the opaque meal was held up at the cardia : if suspended by the tail the meal was held up at the crico-pharyngeus. Paralysis of both recurrent laryngeal nerves results in achalasia of the crico-pharyngeus.ll 12 This is observed also in poliomyelitis. Knight and Adamson 13 found that stimulation of the vagus produced relaxation of the cardia and that stimulation of the 3. 4. 5. 6.
Bülbring, F., Burn, J. H. J. Physiol. 1935, 83, 483. Burn, J. H. Physiol. Rev. 1938, 18, 137. Gordh, T. Acta chir. scand. 1945, 92, suppl. 102. Moore, I. Proc. R. Soc. Med. 1919, 12, 67. 7. Moore I. J. Laryng. 1927, 42, 577. 8. Brown Kelly, A. Ibid, p. 221. 9. Babkin, B. P. Pavlov. London, 1951; p. 201. 10. Sjoberg, A. Arch. Otolaryng. 1952, 52, 323. 11. Asherson, N. Trans. med. Soc. Lond. 1950, 66, 398. 12. Asherson, N. J. Laryng. 1950, 64, 747; Brit. J. Tuberc. 1952, 46, 95. 13. Knight, G. C., Adamson, W. A. D. Proc. R. Soc. Med. 1935, 28, 891.
sympathetic produced contraction. They also found that excision of the vagus produced the clinical and radiological picture of achalasia ; when the vagus and the sympathetic Brown were excised, there was no obstruction at the cardia. Kelly 8 and Rake 14 showed that there was destruction of the nerve elements in Auerbach’s plexus. E7ztalacao
(known
tropical cardiospasm, tropical d’engasgo) is a disease characterised attacks of severe difficulty in swallowing. It is confined solely to certain geographical regions of South America. Gray 15 drew attention to this type of mega-oesophagus and confirmed its peculiar geographical
dyspha,gia, by recurrent
or
as
mal
distribution. He attributes the cause to avitaminosis, but in its distribution it acknowledges no economic barrier. The cause is probably viral (akin to poliomyelitis). This produces paralysis of the longitudinal muscles of the oesophagus, the contraction of which plays an important part in the opening, during deglutition, of the normally closed cardia. Much has been written on what opens the cardia (or for that matter the crico-pharyngeus), but little on how each is opened. If a thin-walled rubber tube of wide calibre has in its course a constriction, closing its lumen (as a sphincter), it may be opened by stretching-i.e., in the same way that the bulge of a de Pezzer catheter is flattened out by stretching. Contraction of the longitudinal muscles of the oesophagus will open the cardia ; in the same way contraction of the oblique fibres of the constrictors opens up the crico-pharyngeus by its longitudinal pull. Thus paralysis of the longitudinal musculature will result in cardiospasm," and a correct appellation of this condition is " paralysis of the longitudinal muscles of the oesophagus." Occasionally carcinoma of the cardiac end of the stomach will hamper the contraction of the cesophageal musculature and prevent the opening of the cardia. As a result from time to time there develops great dilatation of the oesophagus with vigorous peristalsis, visible on screening. Radiologically this simulates cardiospasm.16 The dilatation passes off but returns at intervals. This " intermittent cardiospasm may be for many months the first and only indication of the presence of cancer of the cardiac end of the stomach. Ogilvie 17 and Park 18 have noted this association. N. AsHERSON. ASHERSON. London, W.1. "
"
Public Health Pneumoconiosis THE National Coal Board and the National Union of Mineworkers have made plans for a survey of pneumoconiosis in British coalfields.19 One of the aims of the survey, which will be conducted in collaboration with the Medical Research Council, will be to discover the safe limit of dustiness in which miners can work without dangerto their health. A mobile unit with X-ray equipment will visit 24 pits throughout the country, and it is hoped that every person employed in these mines will be examined. The 24 pits have been selected as representative of the various conditions found in British mines. The mobile unit working from Edinburgh will make a start soon and another from Cardiff will do so later. ".
Poliomyelitis
Poliomyelitis notifications (uncorrected) in England and Wales during the week ended Oct. 3 (39th week of the year) were (previous. week in parentheses) : paralytic, 79 (119) ; non-paralytic, 78 (99) ; total, 157 (218). The reduction in notifications of 40 paralytic and 21 non-paralytic cases is satisfactory, and there is no doubt that the drop to the winter levels of the disease is under way. 14. Rake, G. W. Guy’s Hosp. Rep. 1927, 77, 141. 15. Gray, G. Trans. med. Soc. Lond. 1950, 66, 398. 16. Asherson, N. Brit. J. Tuberc. 1953, 47, 39. 17. Ogilvie, H. Brit. med. J. 1947, ii, 406. 18. Park, W. D. Ibid, 1952, ii, 599. 19. Times, Oct. 13, 1953.