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CONVERSION OF GENERAL WARDS INTO PRIVATE WARDS
207
is a most useful skill, but whatever else it may do it does not reduce a nucleus pulposus which has herniated through a degenerated annulus fibrosus. What it does do is clinically objective, but it needs a tremendous amount more study. DUNCAN TROUP.
Specific joint manipulation
pigeons is less
severe
from parrots and
than the
dangerous infections acquired
budgerigars.
I thank my colleagues in the Public Health Department of Glasgow, Greenock, and Renfrewshire for assistance in tracing sources of infection in these cases.
University Department of Virology, Ruchill Hospital, Glasgow.
N. R GRIST.
SIR,-In the British Medical Journal of July 26, 1952, p. 189, there appeared an article entitled Psittacosis in a
CONVERSION OF GENERAL WARDS INTO PRIVATE WARDS
hospitals the traditional ward, with its Family by Dr. C. M. Miller and myself, in which we double row of beds and complete lack of privacy, is clear reported this condition in a father and his son who had evidence of past standards and attitudes to patients. Mr. handled domestic pigeons. In it Mr. Osman will Vaughan Hudson, in his imaginative article (July 9), find the proof he seeks of pigeons as the source of the reminds us that the hospital today should cater for all infection. Perhaps it would have been more accurate to have sections of the community and that the modern patient entitled our paper Ornithosis rather than Psittacosis. Had is not so inclined to accept the numerous auditory and done we so it might not have been overlooked by your visual assaults inflicted by an open ward. I am sure, however, that he is wrong in suggesting that recent correspondents. B. K. ELLENBOGEN. the whole ward should be converted to single rooms. A surprising number of patients feel acutely miserable and TREATMENT OF OBESITY BY INTESTINAL uncomfortable in a room by themselves and are much OPERATION happier in the company of others. Some people, left to SIR,-Severe obesity in individuals without the force their own devices in a single room, are inclined to be character to adhere to long and trying dietetic measures of introspective and full of self-pity. Their recovery is an is intractable and not uncommon condition. Attempts probably hastened by contact with other patients. There to help such patients surgically have hitherto been is much to applaud in Mr. Hudson’s arrangement, but I to mechanical removal of superficial adipose restricted think it would be wiser and more realistic to have one a difficult treatment which can be of value only in 4-bedded and a few 2-bedded rooms on his ward. Sister tissue, is usually very good at deciding which patients should go comparatively rare cases. A more physiological way is to attack the absorptive power of the organism by surgical where. With single rooms and a panel system of lights for means, a theoretically sound approach, but this seems summoning a nurse (as described by Mr. Hudson) there never to have been tried. At least such trials are unknown is always the possibility, particularly in a surgical ward, to me, and E. H. Rynearson and C. F. Gastineau do not that a patient in difficulties may not be able to attract mention this possibility in their book Obesity. With the efficiency of modern surgical technique and its attention. Much better would be a slightly raised nursing station with suitably placed glass windows so that the low operative mortality it seems worth trying to reduce the energy absorptive capacity of the organism by means of nurse on duty could see not only down the central corridor intestinal in selected cases. As the main site of the SIR,-In
many
but also into each
surgery
room.
Department of Midwifery and Gynæcology, Royal Victoria Infirmary, Newcastle upon Tyne.
J. K. RUSSELL.
ORNITHOSIS AND THE RAILWAY GUARDS SIR,-Idirect the attention of Mr. Osman (July 16) to the report1 of a recent outbreak of ornithosis in Glasgow
involving two pigeon-fanciers and their flock. Serological laboratory established the diagnosis in the two and in their sick and apparently healthy birds. Ornithosis virus was isolated from the birds. tests at this
cases
The general risk should not be exaggerated: over the past 11 years, our investigations have showed serological evidence of ornithosis in only 19 patients, of whom 2, aged 62 and, 75 years, died. None of these was a railway guard. No contact with birds was traceable in 12 cases, and apart from the 2 pigeon-fanciers I have mentioned only doubtful contact was recorded with budgerigars (3 cases), a sick canary (1), and wild
pigeons nesting
on
the windowsill
(1).
Of 14
pigeon-
fanciers investigated in 1950, only 1 showed a low and probably insignificant titre of antibodies. Both by isolation of the virus and by serological tests ornithosis infection was found in the wild pigeons of Glasgow, as has been reported in many cities of this and other countries. No evidence of infection was found in 12 starlings. My own view is that ornithosis infection in Glasgow is usually acquired from wild pigeons. The chance of effectively intimate contact with an infective pigeon-dropping is small, and human cases of the disease are correspondingly few. Human disease caused by ornithosis strains derived from 1. Grant, W. State vet. J. 1960, 15, 70.
absorption of energy-producing nutrients is the jejunum, the simplest approach would be resection of a suitable portion of this part of the small intestine, beginning somewhere below the ampulla of Vater, and making an end-to-end anastomosis. This would not be very complicated, and the only difficulty apparently is to decide how large a part of the jejunum it is If too little is resected the effect on the may be too small to combat the obesity, and if too much is resected progressive intractable emaciation may result. In each case it is necessary to reduce the absorptive capacity sufficiently to curtail the energy absorption (on a diet the patient is able to adhere to indefinitely) to well below his daily energy requirement. This brings us to a difficulty, for if treatment is successful it seems likely that weight-loss will continue after the normal weight has been reached. Only if the reduced absorptive capacity obtained is sufficient to maintain the normal weight of the patient, because the weight loss has been followed by reduced energy requirement, can one hope to reach equilibrium on the patient’s normal weight and a diet to which he can adhere. Intestinal resection is not therefore very attractive, and it would be better and less traumatic to use a by-pass operation where part of the jejunum below the ampulla of Vater was transformed into a cul-de-sac not traversed by food. With such an operation it would be possible to raise the absorptive capacity later by reoperation if necessary. It has the drawback that pernicious anxmia may follow ; but this could easily be mastered by hasmatological control and adequate treatment. If other difficulties, such as ileus or severe dyspepsia, should develop as a sequel to such jejunal cul-desacs, one might as an alternative operation remove part of suitable
to remove.
absorptive capacity
is a most useful skill, but whatever else it may do it does not reduce a nucleus pulposus which has herniated through a degenerated annulus fibrosus. What it does do is clinically objective, but it needs a tremendous amount more study. DUNCAN TROUP.
Specific joint manipulation
pigeons is less
severe
from parrots and
than the
dangerous infections acquired
budgerigars.
I thank my colleagues in the Public Health Department of Glasgow, Greenock, and Renfrewshire for assistance in tracing sources of infection in these cases.
University Department of Virology, Ruchill Hospital, Glasgow.
N. R GRIST.
SIR,-In the British Medical Journal of July 26, 1952, p. 189, there appeared an article entitled Psittacosis in a
CONVERSION OF GENERAL WARDS INTO PRIVATE WARDS
hospitals the traditional ward, with its Family by Dr. C. M. Miller and myself, in which we double row of beds and complete lack of privacy, is clear reported this condition in a father and his son who had evidence of past standards and attitudes to patients. Mr. handled domestic pigeons. In it Mr. Osman will Vaughan Hudson, in his imaginative article (July 9), find the proof he seeks of pigeons as the source of the reminds us that the hospital today should cater for all infection. Perhaps it would have been more accurate to have sections of the community and that the modern patient entitled our paper Ornithosis rather than Psittacosis. Had is not so inclined to accept the numerous auditory and done we so it might not have been overlooked by your visual assaults inflicted by an open ward. I am sure, however, that he is wrong in suggesting that recent correspondents. B. K. ELLENBOGEN. the whole ward should be converted to single rooms. A surprising number of patients feel acutely miserable and TREATMENT OF OBESITY BY INTESTINAL uncomfortable in a room by themselves and are much OPERATION happier in the company of others. Some people, left to SIR,-Severe obesity in individuals without the force their own devices in a single room, are inclined to be character to adhere to long and trying dietetic measures of introspective and full of self-pity. Their recovery is an is intractable and not uncommon condition. Attempts probably hastened by contact with other patients. There to help such patients surgically have hitherto been is much to applaud in Mr. Hudson’s arrangement, but I to mechanical removal of superficial adipose restricted think it would be wiser and more realistic to have one a difficult treatment which can be of value only in 4-bedded and a few 2-bedded rooms on his ward. Sister tissue, is usually very good at deciding which patients should go comparatively rare cases. A more physiological way is to attack the absorptive power of the organism by surgical where. With single rooms and a panel system of lights for means, a theoretically sound approach, but this seems summoning a nurse (as described by Mr. Hudson) there never to have been tried. At least such trials are unknown is always the possibility, particularly in a surgical ward, to me, and E. H. Rynearson and C. F. Gastineau do not that a patient in difficulties may not be able to attract mention this possibility in their book Obesity. With the efficiency of modern surgical technique and its attention. Much better would be a slightly raised nursing station with suitably placed glass windows so that the low operative mortality it seems worth trying to reduce the energy absorptive capacity of the organism by means of nurse on duty could see not only down the central corridor intestinal in selected cases. As the main site of the SIR,-In
many
but also into each
surgery
room.
Department of Midwifery and Gynæcology, Royal Victoria Infirmary, Newcastle upon Tyne.
J. K. RUSSELL.
ORNITHOSIS AND THE RAILWAY GUARDS SIR,-Idirect the attention of Mr. Osman (July 16) to the report1 of a recent outbreak of ornithosis in Glasgow
involving two pigeon-fanciers and their flock. Serological laboratory established the diagnosis in the two and in their sick and apparently healthy birds. Ornithosis virus was isolated from the birds. tests at this
cases
The general risk should not be exaggerated: over the past 11 years, our investigations have showed serological evidence of ornithosis in only 19 patients, of whom 2, aged 62 and, 75 years, died. None of these was a railway guard. No contact with birds was traceable in 12 cases, and apart from the 2 pigeon-fanciers I have mentioned only doubtful contact was recorded with budgerigars (3 cases), a sick canary (1), and wild
pigeons nesting
on
the windowsill
(1).
Of 14
pigeon-
fanciers investigated in 1950, only 1 showed a low and probably insignificant titre of antibodies. Both by isolation of the virus and by serological tests ornithosis infection was found in the wild pigeons of Glasgow, as has been reported in many cities of this and other countries. No evidence of infection was found in 12 starlings. My own view is that ornithosis infection in Glasgow is usually acquired from wild pigeons. The chance of effectively intimate contact with an infective pigeon-dropping is small, and human cases of the disease are correspondingly few. Human disease caused by ornithosis strains derived from 1. Grant, W. State vet. J. 1960, 15, 70.
absorption of energy-producing nutrients is the jejunum, the simplest approach would be resection of a suitable portion of this part of the small intestine, beginning somewhere below the ampulla of Vater, and making an end-to-end anastomosis. This would not be very complicated, and the only difficulty apparently is to decide how large a part of the jejunum it is If too little is resected the effect on the may be too small to combat the obesity, and if too much is resected progressive intractable emaciation may result. In each case it is necessary to reduce the absorptive capacity sufficiently to curtail the energy absorption (on a diet the patient is able to adhere to indefinitely) to well below his daily energy requirement. This brings us to a difficulty, for if treatment is successful it seems likely that weight-loss will continue after the normal weight has been reached. Only if the reduced absorptive capacity obtained is sufficient to maintain the normal weight of the patient, because the weight loss has been followed by reduced energy requirement, can one hope to reach equilibrium on the patient’s normal weight and a diet to which he can adhere. Intestinal resection is not therefore very attractive, and it would be better and less traumatic to use a by-pass operation where part of the jejunum below the ampulla of Vater was transformed into a cul-de-sac not traversed by food. With such an operation it would be possible to raise the absorptive capacity later by reoperation if necessary. It has the drawback that pernicious anxmia may follow ; but this could easily be mastered by hasmatological control and adequate treatment. If other difficulties, such as ileus or severe dyspepsia, should develop as a sequel to such jejunal cul-desacs, one might as an alternative operation remove part of suitable
to remove.
absorptive capacity