- Email: [email protected]
DOCTORS FOR NIGERIA
583
impossible to extract their contents without contamination from dust on the outside-fig. 4 is an example. To make matters worse, many are
in wrappers that fracture
or tear
easily. Some are sealed so badly that they may open spontaneously during storage. All these deficiencies
much
too
be overcome without very much trouble or expense. We write this note because we have reason to believe that not all those who purchase for hospitals are aware of what constitutes safe packaging of sterile articles. We would like to suggest that, when articles of this nature are being purchased, attention should be paid to the packaging as well as to the cost. can
King’s College Hospital, London, S.E.5. St. Thomas’s Hospital,
A. C. CUNLIFFE.
London. S.E.1.
R. HARE.
Guy’s Hospital, London, S.E.1.
P.
Westminster Hospital,
J. HELLIWELL.
B. W. LACEY.
London, S.W.1. St. Bartholomew’s Hospital, London, B.C.1. St. George’s Hospital, London, S.W.1. Middlesex Hospital, London, W.1.
SMOKER.
SPINAL
EILEEN E. WOOD.
DOCTORS FOR NIGERIA
SIR,-Dr. Walker (Aug. 24) has done
a service by secondment to impressions 21/2 years’ recording I far am sure his was more valuable to that Nigeria. stay country than he realised. In view of the present interest in medical aid to developing countries I should like to add to his remarks from experience in south-east Asia. Each country has to be assessed separately and no one pattern will suit all countries. For this reason a variety of methods of assistance must continue to be offered. There is one aspect, however, in the training which is often overlooked -that is, training for leadership. A man may be an expert clinician or surgeon but fail to stimulate or even cooperate with other members of his staff and other departments. This may not be noticeable until he is in a position of power, when it is usually too late to correct. Dr. Walker’s suggestion that good men from developing countries might be given good junior appointments in the United Kingdom would be helpful; I should like to add senior appointments too. However, I still think the best method is to establish a good professorial department in the developing country where the influence of the teaching and
of
E. Brit.
med. J. 1960, i,
1760.
INJURIES
SiR,—The correspondence following
R. E. M. THOMPSON.
Penzance.
Wood, E.
Sir,- used to suffer from the finger callosities due to tension habit described by Dr. Pritchard (Aug. 31). I acquired these by biting my knuckles when I realised how unsightly my bitten nails were. Since taking up smoking my hands have become unblemished.
J. L. STAFFORD.
Department of Pathology, West Cornwall Hospital,
1.
FINGER CALLOSITIES
R. A. SHOOTER.
LEUKÆMIA CLUSTERS SiR,—Your annotation (Aug. 10) refers to a report1 on leukarmia clusters in Cornish towns. Further investigations in Newquay have confirmed that this group may be of some interest; no fewer than 17 out of 20 cases in this town are located within a radius of half a mile, and the incidence has now risen to 14 per 100,000. Although the number of cases in Fowey appears greater, there are reasons for discounting this group. Other small and isolated clusters have been found where the incidence in the district as a whole is not high. It appears that the geographical siting of individual cases on large-scale maps may yield useful clues as to the setiology of leukxmia which are submerged in larger surveys, but so far nothing has been found in the Cornish clusters to suggest any link; they are made up of varied types and usually in older people. The incidence in very young children in Cornwall is low.
his
is so arranged that it extends throughout the whole country; and this means postgraduate as well as undergraduate teaching. The professor should be seconded for at least 5 years and the lecturers for not less than 2 years. Their aim should be to train the local doctors to ultimately take full leadership. In spite of this, developing countries will continue to lose some of their best men because they do not make their posts sufficiently attractive medically or financially. C. ELAINE FIELD.
leadership
your
leading
articledoes not confirm the statement made in that article and in your reply to Mr. Guttmann’s letter2 that " most surgeons now accept Holdsworth’s classification and treatment 34 and Beatson’s indications for operative fixation of unstable fracture dislocation of the cervical spine when there is little or no cord damage ".5 Mr. Holdsworth (Aug. 24) now writes: " How in the early stages an unstable fracture can be made stable by adequate conservative treatment beats me. " Mr. Holdsworth himself treats patients with identical bony injuries without neurological damage conservatively in a plaster bed, his reason for not using plaster beds for paraplegic patients being that they inevitably develop pressure sores.4 Mr. Holdsworth must surely be aware of the method of postural reduction introduced by Guttmann 67 buy which the fracture dislocation can be reduced and stabilised by extension or hyperextension on sorbo packs with one or two soft rolls underneath the dislocated vertebrar. This method has proved to lead to firm union usually without deformity, and is used as the method of choice in many spinal injuries units as well as by individual surgeons in this and other countries. Moreover, the patient’is not subjected to any operation, whereas open reduction and fixation by metal plates often necessitates a second operation to remove the metal plates. On reading Mr. Beatson’s paper5 and his letter of Aug. 24, it is apparent not only that bilateral facet dislocation without neurological involvement is an extremely rare condition but also that an early operation was not performed on any such patients in his series, the only relevant case shown in table 2 of his paper having been operated upon 5 weeks after injury. In his letter, he quotes four cases: two had undiagnosed fracture dislocations and received no treatment, conservative or surgical, and subsequently developed permanent tetraplegia; it cannot, however, be argued that operative fixation would have been superior to adequate treatment with skull traction, as the patients were in fact undiagnosed and untreated up to the time they developed tetraplegia. The other two cases I cannot were successfully treated by late operation. 1. Lancet, 1963, i, 1088. 2. ibid. p. 1216. 3. Holdsworth, F. W., Hardy, A. J. Bone Jt Surg. 4. Holdsworth, F. W. ibid. 1963, 45B, 6. 5. Beatson, T. R. ibid. p. 21. 6. Guttmann, L. Proc. R. Soc. Med. 1954, 47, 12.
7.
1953, 35B, 540.
Guttman, L. in Modern Trends in Diseases of the Vertebral Column (edited by R. Nessim and H. Jackson Burrows); p. 245. London, 1959.
impossible to extract their contents without contamination from dust on the outside-fig. 4 is an example. To make matters worse, many are
in wrappers that fracture
or tear
easily. Some are sealed so badly that they may open spontaneously during storage. All these deficiencies
much
too
be overcome without very much trouble or expense. We write this note because we have reason to believe that not all those who purchase for hospitals are aware of what constitutes safe packaging of sterile articles. We would like to suggest that, when articles of this nature are being purchased, attention should be paid to the packaging as well as to the cost. can
King’s College Hospital, London, S.E.5. St. Thomas’s Hospital,
A. C. CUNLIFFE.
London. S.E.1.
R. HARE.
Guy’s Hospital, London, S.E.1.
P.
Westminster Hospital,
J. HELLIWELL.
B. W. LACEY.
London, S.W.1. St. Bartholomew’s Hospital, London, B.C.1. St. George’s Hospital, London, S.W.1. Middlesex Hospital, London, W.1.
SMOKER.
SPINAL
EILEEN E. WOOD.
DOCTORS FOR NIGERIA
SIR,-Dr. Walker (Aug. 24) has done
a service by secondment to impressions 21/2 years’ recording I far am sure his was more valuable to that Nigeria. stay country than he realised. In view of the present interest in medical aid to developing countries I should like to add to his remarks from experience in south-east Asia. Each country has to be assessed separately and no one pattern will suit all countries. For this reason a variety of methods of assistance must continue to be offered. There is one aspect, however, in the training which is often overlooked -that is, training for leadership. A man may be an expert clinician or surgeon but fail to stimulate or even cooperate with other members of his staff and other departments. This may not be noticeable until he is in a position of power, when it is usually too late to correct. Dr. Walker’s suggestion that good men from developing countries might be given good junior appointments in the United Kingdom would be helpful; I should like to add senior appointments too. However, I still think the best method is to establish a good professorial department in the developing country where the influence of the teaching and
of
E. Brit.
med. J. 1960, i,
1760.
INJURIES
SiR,—The correspondence following
R. E. M. THOMPSON.
Penzance.
Wood, E.
Sir,- used to suffer from the finger callosities due to tension habit described by Dr. Pritchard (Aug. 31). I acquired these by biting my knuckles when I realised how unsightly my bitten nails were. Since taking up smoking my hands have become unblemished.
J. L. STAFFORD.
Department of Pathology, West Cornwall Hospital,
1.
FINGER CALLOSITIES
R. A. SHOOTER.
LEUKÆMIA CLUSTERS SiR,—Your annotation (Aug. 10) refers to a report1 on leukarmia clusters in Cornish towns. Further investigations in Newquay have confirmed that this group may be of some interest; no fewer than 17 out of 20 cases in this town are located within a radius of half a mile, and the incidence has now risen to 14 per 100,000. Although the number of cases in Fowey appears greater, there are reasons for discounting this group. Other small and isolated clusters have been found where the incidence in the district as a whole is not high. It appears that the geographical siting of individual cases on large-scale maps may yield useful clues as to the setiology of leukxmia which are submerged in larger surveys, but so far nothing has been found in the Cornish clusters to suggest any link; they are made up of varied types and usually in older people. The incidence in very young children in Cornwall is low.
his
is so arranged that it extends throughout the whole country; and this means postgraduate as well as undergraduate teaching. The professor should be seconded for at least 5 years and the lecturers for not less than 2 years. Their aim should be to train the local doctors to ultimately take full leadership. In spite of this, developing countries will continue to lose some of their best men because they do not make their posts sufficiently attractive medically or financially. C. ELAINE FIELD.
leadership
your
leading
articledoes not confirm the statement made in that article and in your reply to Mr. Guttmann’s letter2 that " most surgeons now accept Holdsworth’s classification and treatment 34 and Beatson’s indications for operative fixation of unstable fracture dislocation of the cervical spine when there is little or no cord damage ".5 Mr. Holdsworth (Aug. 24) now writes: " How in the early stages an unstable fracture can be made stable by adequate conservative treatment beats me. " Mr. Holdsworth himself treats patients with identical bony injuries without neurological damage conservatively in a plaster bed, his reason for not using plaster beds for paraplegic patients being that they inevitably develop pressure sores.4 Mr. Holdsworth must surely be aware of the method of postural reduction introduced by Guttmann 67 buy which the fracture dislocation can be reduced and stabilised by extension or hyperextension on sorbo packs with one or two soft rolls underneath the dislocated vertebrar. This method has proved to lead to firm union usually without deformity, and is used as the method of choice in many spinal injuries units as well as by individual surgeons in this and other countries. Moreover, the patient’is not subjected to any operation, whereas open reduction and fixation by metal plates often necessitates a second operation to remove the metal plates. On reading Mr. Beatson’s paper5 and his letter of Aug. 24, it is apparent not only that bilateral facet dislocation without neurological involvement is an extremely rare condition but also that an early operation was not performed on any such patients in his series, the only relevant case shown in table 2 of his paper having been operated upon 5 weeks after injury. In his letter, he quotes four cases: two had undiagnosed fracture dislocations and received no treatment, conservative or surgical, and subsequently developed permanent tetraplegia; it cannot, however, be argued that operative fixation would have been superior to adequate treatment with skull traction, as the patients were in fact undiagnosed and untreated up to the time they developed tetraplegia. The other two cases I cannot were successfully treated by late operation. 1. Lancet, 1963, i, 1088. 2. ibid. p. 1216. 3. Holdsworth, F. W., Hardy, A. J. Bone Jt Surg. 4. Holdsworth, F. W. ibid. 1963, 45B, 6. 5. Beatson, T. R. ibid. p. 21. 6. Guttmann, L. Proc. R. Soc. Med. 1954, 47, 12.
7.
1953, 35B, 540.
Guttman, L. in Modern Trends in Diseases of the Vertebral Column (edited by R. Nessim and H. Jackson Burrows); p. 245. London, 1959.