- Email: [email protected]
DOCTORS AND ADMINISTRATORS
537 tion into ether and then into sodium bicarbonate. In seventeen cases of paracetamol overdose the colorimetric method yielded
lower plasma concentrations (p
Routh method
/0
w8ml) 109 53 136 177 206 170 16 115 143
81 33 119 160 221 142 9 80 110
Since
paired t test):
Glynn
method
Routh method
(41mi)
(tigiml)
108 39 53 272 142 64 42 230
137 51 87 270 146 58 48 261
prepared for the institution of treatment dependent on paracetamol blood levels.9 When paracetamol results reported the method of analysis should be recorded.
have
of the difficulties outlined in your is editorial, experience that in other respects the problems you envisage can be overcome. Certainly we would not agree with your view of the price the student has to pay for the undoubted advantages of experience in a district hospital. The university has found it feasible to programme successive residential attachments to districts and teaching hospitals for long enough to make it viable for students to give up accommodation, and therefore suffer no financial penalty. It has also proved practical to arrange for all students to have a thorough grounding in clinical methods before going to the periphery since this never happens earlier than the second clinical year. Administrative tasks have been lightened by appointing as undergraduate clinical tutor one of the consultants in the district hospital. This appointment is analogous to the district postgraduate tutors, and as with these it has been found possible to allocate sessional time within the contracts of the consultants undertaking the organisation of the undergraduate attachments, though the appointments are made by the university. I would, however, confirm that sometimes it has proved difficult for N.H.S. staff to find sufficient time for the necessary work of teaching undergraduates. This is something which is we
met some
our
the are
P. J. MARTIN J. P. POWELL
DIARRHŒA CAUSED BY CANDIDA
SIR,-Dr Kane and his colleagues (Feb. 14, p. 335) draw attention to an easily treatable type of chronic and occasionally intractable diarrhoea. However, their statement that "reviews of candida infections of the gastrointestinal tract fail to mention the symptom of diarrhoea" is not entirely correct. The possibility of candida being responsible for chronic diarrhoea as well as for some of the manifestations of the "irritable colon" syndrome and the likely pathogenesis of this process are discussed in my chapter in Candida Infections.1O I have also discussed the problems and the management of Candida diarrhoea," 12 emphasising the importance of adequate anti-candida treatment of the oral cavity, especially in denture wearers, in order to prevent reinfection of the lower alimentary tract. None of the titles of these publications indicate that they deal with candida diarrhoea as well as with other clinical aspects of candidiasis, so it is not surprising that Dr Kane and his colleagues had not read them. The wider use of "key-word indexing" of the contents of papers published in journals and textbooks should perhaps be considered in this context. Royal Victoria Infirmary, Department of Dermatology, Newcastle upon Tyne NE14LP
provision for postgraduate education and the enlightened use by the new Medical School at Southampton of the rich clinical resources available to undergraduates at peripheral hospitals. For a number of years now in the North Western region, undergraduates of the Manchester Medical School have spent a proportion of the second clinical year in district hospitals, notably in general medicine and general surgery. Whilst
Department of Chemical Pathology,
Poplar Grove, Stockport
S!R,—You rightly praise (Feb. 14, p. 348) the Wessex region for its generous
the introduction of cysteamine, guidelines have been
Stepping Hill Hospital,
EDUCATION ON THE PERIPHERY
being steadily overcome as additional appointments are made, since the regional health authority takes the view that undergraduate teaching is of such strategic importance to the future of the region that it must take first place in priority when additional consultant appointments are made. Medical Department, North Western Regional Health Authority,
Gateway House, Piccadilly South,
A. J. LANE
Manchester M60 7LP
DOCTORS AND ADMINISTRATORS
SIR,-Dr Grimes’
statement
G. HOLTI
SIR,-I would like
to point out a complication of intestinal mentioned by Dr Kane and his colleagues, but apparently familiar to skin specialists. In such a case the patient complains of "wind" and diarrhcea. but no mucus and no blood, stools varying from watery to formed. The complication is "angioneurotic oedema" exhibited in various parts of the face and throat; severe and disfiguring. On another occasion irritating spots are noted on the body and thighs, suggestive of insect bites. Both attributed at first to an unknown allergy. Both of these skin complaints clear up together with the diarrhcea when treated with oral nystatin and do not recur, after having been present many times over the previous 12 months.
District Pathology Laboratory, North Lonsdale Hospital,
11
Barrow-in-Furness, Cumbria LA14 2JD
candida
not
Glenmead, Palmerston Road, Buckhurst Hill, Essex
p.
that
413)
on
his
catering, pharmacy, dentistry, science, technology, nursing, medicine, and finance, we would not like to think we need a course from any department of social administration to get to know and cooperate with them. But if we need educating on these points we would always be happy to congregate (at the expense of the D.H.S.S.) in any modern building providing "catering facilities of a very high standard". -
J. E. HORROCKS D. STANSFIELD
D. M. KERSLAKE FAMILY PLANNING IN HOSPITALS
9. Lancet, 1975, ii, 1189. 10. Holti. G. in Candida Infections (edited by H. I. Winner and R. Hurley); p. 73. Edinburgh, 1966. 11.Holti. G.Br. med. J. 1967, i, 155.
12. Holti. G. ibid. 1969, i, 781.
(Feb. 21,
"doctors learned that the doctor-patient relationship is not the be-all and end-all in the Health Service" took us aback. For a quarter of a century we have believed that doctor-patient relationship was the difference between a caring Health Service and an impartial uncaring machine. We shall be sorry to abandon our patient Mr Smith for ANO/1234/76M and we feel he will not be so keen either. As for our friends in administration, trades unionism, engineering, course
Sm,—Iwould like to add my support to the views of ProfesHuntingford and his colleagues (Feb. 7, p. 300). If sterilisa-
sor
tion
were an extra
service there
might
be
an
argument in
lower plasma concentrations (p
Routh method
/0
w8ml) 109 53 136 177 206 170 16 115 143
81 33 119 160 221 142 9 80 110
Since
paired t test):
Glynn
method
Routh method
(41mi)
(tigiml)
108 39 53 272 142 64 42 230
137 51 87 270 146 58 48 261
prepared for the institution of treatment dependent on paracetamol blood levels.9 When paracetamol results reported the method of analysis should be recorded.
have
of the difficulties outlined in your is editorial, experience that in other respects the problems you envisage can be overcome. Certainly we would not agree with your view of the price the student has to pay for the undoubted advantages of experience in a district hospital. The university has found it feasible to programme successive residential attachments to districts and teaching hospitals for long enough to make it viable for students to give up accommodation, and therefore suffer no financial penalty. It has also proved practical to arrange for all students to have a thorough grounding in clinical methods before going to the periphery since this never happens earlier than the second clinical year. Administrative tasks have been lightened by appointing as undergraduate clinical tutor one of the consultants in the district hospital. This appointment is analogous to the district postgraduate tutors, and as with these it has been found possible to allocate sessional time within the contracts of the consultants undertaking the organisation of the undergraduate attachments, though the appointments are made by the university. I would, however, confirm that sometimes it has proved difficult for N.H.S. staff to find sufficient time for the necessary work of teaching undergraduates. This is something which is we
met some
our
the are
P. J. MARTIN J. P. POWELL
DIARRHŒA CAUSED BY CANDIDA
SIR,-Dr Kane and his colleagues (Feb. 14, p. 335) draw attention to an easily treatable type of chronic and occasionally intractable diarrhoea. However, their statement that "reviews of candida infections of the gastrointestinal tract fail to mention the symptom of diarrhoea" is not entirely correct. The possibility of candida being responsible for chronic diarrhoea as well as for some of the manifestations of the "irritable colon" syndrome and the likely pathogenesis of this process are discussed in my chapter in Candida Infections.1O I have also discussed the problems and the management of Candida diarrhoea," 12 emphasising the importance of adequate anti-candida treatment of the oral cavity, especially in denture wearers, in order to prevent reinfection of the lower alimentary tract. None of the titles of these publications indicate that they deal with candida diarrhoea as well as with other clinical aspects of candidiasis, so it is not surprising that Dr Kane and his colleagues had not read them. The wider use of "key-word indexing" of the contents of papers published in journals and textbooks should perhaps be considered in this context. Royal Victoria Infirmary, Department of Dermatology, Newcastle upon Tyne NE14LP
provision for postgraduate education and the enlightened use by the new Medical School at Southampton of the rich clinical resources available to undergraduates at peripheral hospitals. For a number of years now in the North Western region, undergraduates of the Manchester Medical School have spent a proportion of the second clinical year in district hospitals, notably in general medicine and general surgery. Whilst
Department of Chemical Pathology,
Poplar Grove, Stockport
S!R,—You rightly praise (Feb. 14, p. 348) the Wessex region for its generous
the introduction of cysteamine, guidelines have been
Stepping Hill Hospital,
EDUCATION ON THE PERIPHERY
being steadily overcome as additional appointments are made, since the regional health authority takes the view that undergraduate teaching is of such strategic importance to the future of the region that it must take first place in priority when additional consultant appointments are made. Medical Department, North Western Regional Health Authority,
Gateway House, Piccadilly South,
A. J. LANE
Manchester M60 7LP
DOCTORS AND ADMINISTRATORS
SIR,-Dr Grimes’
statement
G. HOLTI
SIR,-I would like
to point out a complication of intestinal mentioned by Dr Kane and his colleagues, but apparently familiar to skin specialists. In such a case the patient complains of "wind" and diarrhcea. but no mucus and no blood, stools varying from watery to formed. The complication is "angioneurotic oedema" exhibited in various parts of the face and throat; severe and disfiguring. On another occasion irritating spots are noted on the body and thighs, suggestive of insect bites. Both attributed at first to an unknown allergy. Both of these skin complaints clear up together with the diarrhcea when treated with oral nystatin and do not recur, after having been present many times over the previous 12 months.
District Pathology Laboratory, North Lonsdale Hospital,
11
Barrow-in-Furness, Cumbria LA14 2JD
candida
not
Glenmead, Palmerston Road, Buckhurst Hill, Essex
p.
that
413)
on
his
catering, pharmacy, dentistry, science, technology, nursing, medicine, and finance, we would not like to think we need a course from any department of social administration to get to know and cooperate with them. But if we need educating on these points we would always be happy to congregate (at the expense of the D.H.S.S.) in any modern building providing "catering facilities of a very high standard". -
J. E. HORROCKS D. STANSFIELD
D. M. KERSLAKE FAMILY PLANNING IN HOSPITALS
9. Lancet, 1975, ii, 1189. 10. Holti. G. in Candida Infections (edited by H. I. Winner and R. Hurley); p. 73. Edinburgh, 1966. 11.Holti. G.Br. med. J. 1967, i, 155.
12. Holti. G. ibid. 1969, i, 781.
(Feb. 21,
"doctors learned that the doctor-patient relationship is not the be-all and end-all in the Health Service" took us aback. For a quarter of a century we have believed that doctor-patient relationship was the difference between a caring Health Service and an impartial uncaring machine. We shall be sorry to abandon our patient Mr Smith for ANO/1234/76M and we feel he will not be so keen either. As for our friends in administration, trades unionism, engineering, course
Sm,—Iwould like to add my support to the views of ProfesHuntingford and his colleagues (Feb. 7, p. 300). If sterilisa-
sor
tion
were an extra
service there
might
be
an
argument in