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CONFLICTING EMOTIONS
812
CONFLICTING
expectant mothers, and I am taking steps to ensure that such services are available in reception areas ’for evacuated women as well as for the ordinary population. A Tribute from the Minister
Replying to Sir R. GLY, Mr. ELLIOTT said he would like to pay a tribute to the vigour and good will with which the receiving areas were tackling the evacuation problem, and to assure them that both in administration and in the development of policy their representations, notably on the difficulties of the reception of adults and the necessity for adequate medical examination of evacuated schoolchildren, were receiving full weight.
Overcrowding in Scottish Reception Areas Sir THOMAS MoonE asked the Secretary of State for Scotland whether, in the case of people who were receiving evacuees, local authorities were still enforcing the regula-
EMOTIONS
tions
against overcrowding ; and whether he would consuspending such regulations during the duration of the war.-Mr. COLVILLE replied: The standard of accommosider
dation recommended to local authorities in billeting evacuated persons is generally more favourable than the overcrowding standard.
Burning Pit Heaps Mr. LESLIE asked the Home Secretary what progress had been made in the elimination of burning pit-heaps in mining areas.-Sir JOHN ANDERSON replied : Burning pitheaps are visited frequently by inspectors of the Ministry of Health and of the Department of Health for Scotland with a view to ensuring that the measures taken for quenching the fires are adequate. Substantial progress has been made in the mining areas as a whole, and the latest reports show that in England fifty-five heaps, which were emitting some considerable glare, have been treated and are no longer openly on fire.
LETTERS TO THE EDITOR CONFLICTING EMOTIONS
SiR,—I have been watching sympathetically the reactions of some of our consultants to the tension of the last month, and reliving again the emotions of exultation, deflation, exasperation and financial anxiety many of us felt in similar circumstances in the last war. When the present war broke out we were led to expect furious air attacks on our great cities, and the Emergency Medical Service was rapidly improvised specially to provide against that contingency. So far the lightning attacks have not happened. The improvised hospitals are empty. Their staffs in consequence are standing by idle, and, instead of feeling grateful for the respite, many who rushed in enthusiastically are now almost angry that nothing has occurred to make their services necessary -all very human and very illogical. There is much grousing about the terms of service, complaints of square-pegging, complaints of inefficiency in high places, complaints of lack of equipment -much destructive criticism but little constructive help. Of course the terms of service are quite inadequate for anyone with the " overheads " of the Harley Street area ; but are we not much better off in this respect than the members of the Stock Exchange, the proprietors of the big empty hotels and restaurants, the unfortunate people who run theatres, even the Bloomsbury lodging-house keepers who formerly catered for our medical students‘ Of course there have been cases of bad staffing and inefficiency. Good men have been passed over for inferior ones. Men who think their experience in the last great war might have been useful have found themselves ignored. That is inevitable in any great improvisation. Also lack of equipment in one place, overplus in another, was bound to happen. But let us be thankful we have had time to find out these defects, and so been given a chance to remedy them before the inevitable attack comes. The framework of the emergency service has stood the test. It is the details that require overhaul. The closing down of both inpatient and outpatient departments of the great hospitals has been found to be a mistake. That is being remedied. Shutting up the special hospitals The staffs of some that refused was a great blunder. to have their outpatient departments closed now find themselves working overtime at hospital. Many of these are not on salary and consequently are rather inclined, perhaps a little unfairly, to resent the grumbles of their brethren living in outlying sector hospitals receiving Government pay for doing nothing.
This war is going to be a long war, and what we all have to face is that everyone in the country will be the poorer for it. But as a profession we are fortunate in that everyone of us will be necessary, everyone will be required for service. We shall not suffer from that feeling of futility so many of our friends in other professions experience, for we are indispensable, and in this lies our privilege. I am, Sir, yours faithfully,
J. JOHNSTON ABRAHAM.
SiR,-There must be many who saw some combatant service in the last war and who would face the same ordeal again in the present cause, but who shrink from contemplation of a repetition of the ghastly results of our last blockade on the infants and children of Central Europe. Our blockade is just and necessary, but it is permissible to hope earnestly that those organisations in neutral countries that rendered medical aid on the last occasion to these stricken children will set their machinery in motion to render the same aid again at the earliest moment that it is
required. I am, Sir, yours
faithfully, M. C. WILKINSON.
HICCUP
IN
OBSTRUCTION
SiR,-The following case is an example of intestinal obstruction in which the clinical picture was in some ways contradictory to the findings on laparotomy. Mrs. P., aged 30, three months pregnant, had had a uterine suspension and appendicectomy nine months previously. She had an attack of abdominal pain localised about one inch to the right of the umbilicus. With this came diarrhoea, followed by constipation, without the passage of flatus. Vomiting started with the pain, and persisted for 48 hours, by which time the vomit was green. Hiccup began after 24 hours and persisted. Two enemas were returned without result. Temp. normal ; pulse 80. Tongue moist. Abdomen a trifle full, but not more than could be accounted for by the easily palpable uterus, with local tenderness at the point where pain was complained of. Absence of distension suggested high small-bowel obstruction and persistent hiccup suggested peritonitis. At the same time her general condition was good, and there was no other evidence of peritoneal inflammation. Laparotomy showed obstruction of small bowel due to an adhesion in the right iliac fossa, which tore through on attempting to deliver the bowel. The raw area on the surface of
CONFLICTING
expectant mothers, and I am taking steps to ensure that such services are available in reception areas ’for evacuated women as well as for the ordinary population. A Tribute from the Minister
Replying to Sir R. GLY, Mr. ELLIOTT said he would like to pay a tribute to the vigour and good will with which the receiving areas were tackling the evacuation problem, and to assure them that both in administration and in the development of policy their representations, notably on the difficulties of the reception of adults and the necessity for adequate medical examination of evacuated schoolchildren, were receiving full weight.
Overcrowding in Scottish Reception Areas Sir THOMAS MoonE asked the Secretary of State for Scotland whether, in the case of people who were receiving evacuees, local authorities were still enforcing the regula-
EMOTIONS
tions
against overcrowding ; and whether he would consuspending such regulations during the duration of the war.-Mr. COLVILLE replied: The standard of accommosider
dation recommended to local authorities in billeting evacuated persons is generally more favourable than the overcrowding standard.
Burning Pit Heaps Mr. LESLIE asked the Home Secretary what progress had been made in the elimination of burning pit-heaps in mining areas.-Sir JOHN ANDERSON replied : Burning pitheaps are visited frequently by inspectors of the Ministry of Health and of the Department of Health for Scotland with a view to ensuring that the measures taken for quenching the fires are adequate. Substantial progress has been made in the mining areas as a whole, and the latest reports show that in England fifty-five heaps, which were emitting some considerable glare, have been treated and are no longer openly on fire.
LETTERS TO THE EDITOR CONFLICTING EMOTIONS
SiR,—I have been watching sympathetically the reactions of some of our consultants to the tension of the last month, and reliving again the emotions of exultation, deflation, exasperation and financial anxiety many of us felt in similar circumstances in the last war. When the present war broke out we were led to expect furious air attacks on our great cities, and the Emergency Medical Service was rapidly improvised specially to provide against that contingency. So far the lightning attacks have not happened. The improvised hospitals are empty. Their staffs in consequence are standing by idle, and, instead of feeling grateful for the respite, many who rushed in enthusiastically are now almost angry that nothing has occurred to make their services necessary -all very human and very illogical. There is much grousing about the terms of service, complaints of square-pegging, complaints of inefficiency in high places, complaints of lack of equipment -much destructive criticism but little constructive help. Of course the terms of service are quite inadequate for anyone with the " overheads " of the Harley Street area ; but are we not much better off in this respect than the members of the Stock Exchange, the proprietors of the big empty hotels and restaurants, the unfortunate people who run theatres, even the Bloomsbury lodging-house keepers who formerly catered for our medical students‘ Of course there have been cases of bad staffing and inefficiency. Good men have been passed over for inferior ones. Men who think their experience in the last great war might have been useful have found themselves ignored. That is inevitable in any great improvisation. Also lack of equipment in one place, overplus in another, was bound to happen. But let us be thankful we have had time to find out these defects, and so been given a chance to remedy them before the inevitable attack comes. The framework of the emergency service has stood the test. It is the details that require overhaul. The closing down of both inpatient and outpatient departments of the great hospitals has been found to be a mistake. That is being remedied. Shutting up the special hospitals The staffs of some that refused was a great blunder. to have their outpatient departments closed now find themselves working overtime at hospital. Many of these are not on salary and consequently are rather inclined, perhaps a little unfairly, to resent the grumbles of their brethren living in outlying sector hospitals receiving Government pay for doing nothing.
This war is going to be a long war, and what we all have to face is that everyone in the country will be the poorer for it. But as a profession we are fortunate in that everyone of us will be necessary, everyone will be required for service. We shall not suffer from that feeling of futility so many of our friends in other professions experience, for we are indispensable, and in this lies our privilege. I am, Sir, yours faithfully,
J. JOHNSTON ABRAHAM.
SiR,-There must be many who saw some combatant service in the last war and who would face the same ordeal again in the present cause, but who shrink from contemplation of a repetition of the ghastly results of our last blockade on the infants and children of Central Europe. Our blockade is just and necessary, but it is permissible to hope earnestly that those organisations in neutral countries that rendered medical aid on the last occasion to these stricken children will set their machinery in motion to render the same aid again at the earliest moment that it is
required. I am, Sir, yours
faithfully, M. C. WILKINSON.
HICCUP
IN
OBSTRUCTION
SiR,-The following case is an example of intestinal obstruction in which the clinical picture was in some ways contradictory to the findings on laparotomy. Mrs. P., aged 30, three months pregnant, had had a uterine suspension and appendicectomy nine months previously. She had an attack of abdominal pain localised about one inch to the right of the umbilicus. With this came diarrhoea, followed by constipation, without the passage of flatus. Vomiting started with the pain, and persisted for 48 hours, by which time the vomit was green. Hiccup began after 24 hours and persisted. Two enemas were returned without result. Temp. normal ; pulse 80. Tongue moist. Abdomen a trifle full, but not more than could be accounted for by the easily palpable uterus, with local tenderness at the point where pain was complained of. Absence of distension suggested high small-bowel obstruction and persistent hiccup suggested peritonitis. At the same time her general condition was good, and there was no other evidence of peritoneal inflammation. Laparotomy showed obstruction of small bowel due to an adhesion in the right iliac fossa, which tore through on attempting to deliver the bowel. The raw area on the surface of