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EPIDEMIC VOMITING
938 otherwise identical, incisions-the pararectal approach to the lower end of ureter, and McEvedy’s repair of femoral hernia. For these reasons I maintain that Battle’s incision should continue to have the sanction of the standard works on operative surgery. PHILIP SHEMILT. Salisbury Hospital Group.
SiR,—I think that those who have to deal regularly with acute abdominal conditions will endorse the opinions expressed last week by Mr. Ewing and Mr. Monro. After three years in the tropics, despite the wider range of differential diagnoses, I remain strongly in favour of the McBurney type of approach (with a transverse skin incision), sited in accordance with the physical signs, or Kocher’s modification (Rutherford Morison). This applies unless a pelvic location is suspected. Naturally, where there is genuine -doubt the paramedian incision has a place ; but then the operation is a laparotomy rather than " for acute appendicitis." "
"
my patients were seen later than is usual in this country. In 12 of the last 25 consecutive cases the appendix had already perforated. In many an abscess had localised, or, in earlier cases, fragile adhesions were forming ; and approach through the unaffected part of the peritoneal cavity would have seemed indefensible. No-one would deliberately approach an appendix abscess by way of the unaffected peritoneal cavity, and I consider that all cases of acute appendicitis should be thought of as potential abscesses ; and if operation is performed, the approach should be the most direct route from the surface. My experience with antibiotics in intraabdominal infections has not led to any modification of this view.
Many of
In commenting on the frequency with which the acutely inflamed appendix is approached in this country by the midline or the paramedian routes, Ewing and Monro state that these approaches have the sanction of many of the standard works on operative surgery. On taking a random selection of textbooks from the shelves of a medical-school library, I did not find this confirmed, although it may be true of some of 5the more specialised works. Of six textbooks,’--6 one suggests that the McBurney incision is out of date except for opening an appendix abscess ; but the remainder express views which do not deviate from those of Ewing and Monro.
through intravenous needles have my sym. pathy, even though the needles be " fairly large." The diagram suggests connecting the babe directly to the oxygen supply. I think this is unwise and leads to the rebreathe
risk of burst babies. Department of Anaesthesia,
Royal Victoria Infirmary, E. A. PASK. Newcastle upon Tyne. EPIDEMIC VOMITING read SIR,-I your annotation of Oct. 3 and the letter Dr. French (Oct. 10) at a time when cases of this by condition were occurring in my practice. They have increased in number, and I myself became a victim 2 days ago.
Usually
there is
fatigue,
headache
(in
my
own case
temporal
,and in the tissues of the scalp), general aching, and hot and cold feelings, followed within a few hours or up to a day or two by bilious vomiting. Temperature varies from normal to 104°F and the pulse is usually rapid. Occasionally there is abdominal pain and slight giddiness, but never true vertigo.
no sign of liver tenderness or jaundice, and no meningeal signs ; but, as in Dr. French’s series, one case appeared which may or may not have belonged to the same group. This was in a woman who developed, after the usual onset, a 7th and llth cranial-nerve palsy and herpetic vesicles on the left side of the palate. In the occasional family
There is
infections the interval between cases has been about 5 The length of the illness varies from 1 to 7 days. Ilford, Essex.
days,
R. P. N. C. SMITH.
CONTRACEPTIVE TECHNIQUE 26 starts off well enough on firm ground but ends in a morass. Itis right and proper that he should quote the American figures and the immense amount of work done in that country on follow-up studies ;but this controversy about
SiR,ňDr. Maung Seiii’s letter of Sept.
the relative over-all effectiveness and acceptability of the combined methods of contraception (cap or sheath plus jelly, paste, or suppositories) versus the single methods (jelly or paste or suppositories or -condom used alone) is a very old one and still rages. Unfortunately simply to quote pregnancy-rates means very little ; it is necessary to know quite a lot about the background of the various series before it is possible to judge whether the comparison is a fair one (e.g., number of nullipars; age range ;previous fertility ; duration of use ; social, economic, educational, and religious background ; and MICHAEL FLINDT. London, so forth). Still more unfortunately one cannot always discover these important facts even in the authors’ ASPHYXIA IN THE NEWBORN paper, and this applies to a large extent to the SiR,ňDr. Noel Jackson in his letter (Oct. 17) quotes originalpublished onPreceptin.’ papers me as follows : In any case all this talk about pregnancy-rates is only " Writing on artificial ventilation of the lungs, Professor confusing the original issue’: I was not concerned with Pask7 evidently prefers efficient artificial respiration to pregnancy-rates but with one particular patient, a highly inadequate spontaneous respiration, for he remarksPositive fertile, sick woman, most willing to cooperate with her pressure ventilation can be carried out ... without causing medical advisers in every way ;in fact she cooperated disturbance in the cardiovascular system.’ " with them so well that she used preceptin when she With the first part of this sentence I agree, but the was advised to do so, with disastrous consequences, quotation fromoiny letter seems to have changed rather having previously used a combined method with success. strangely, for it ran as follows : Dr. Maung Sein will have a job to convince me that, "I believe that many physiologists will be surprised to learn all other things being equal, it is possible to offer a woman that positive pressure ventilation can be carried out at all as complete protection against pregnancy by giving her without causing some disturbance in the cardiovascular a paste or suppository to use alone as by providing her system." with a mechanical barrier to prevent direct insemination of the cervix plus a chemical one to kill the sperm. Dr. Jackson’s diagram and explanation of his me. If rubber the surgical glove really This is not to deny that preparations such as preceptut apparatus worry and various suppositories have their place in contracepfunctions as a rebreathing bag, I think it is too big. Furthermore, babies who are called upon to breathe or tion, and, as I said in my letter of Aug. 15, this ne1í paste will in time find its correct level of usefulness. A Short Practice of Surgery. 1. Bailey, H., Love, R. J. McN. It will undoubtedly be of value in the first of Dickinson’s London, 1952. 2. Handfield-Jones, R. M., Porritt, A. E. The Essentials of but I very much doubt if it will be the answer categories Modern Surgery Edinburgh, 1951. for in the other three. many Edin3. Illingworth, C. F. W. Textbook of Surgical Treatment. The last part of Dr. Maung Sein’s letter had best be burgh, 1947. 4. Maingot, R. Abdominal Operations. London, 1940. left unanswered-not because it is unanswerable but 5. Romanis, W. H. C., Mitchiner, P. H. The Science and Practice of Surgery. because it starts a number of irrelevant hares. London, 1952. 6. Souttar, H. S. The Art of Surgery. London, 1937. MARGARET HADLEY JACKSON JACKSOS, 7. Brit. med. J. 1953, i, 1048. Crediton, Devon. ...
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SiR,—I think that those who have to deal regularly with acute abdominal conditions will endorse the opinions expressed last week by Mr. Ewing and Mr. Monro. After three years in the tropics, despite the wider range of differential diagnoses, I remain strongly in favour of the McBurney type of approach (with a transverse skin incision), sited in accordance with the physical signs, or Kocher’s modification (Rutherford Morison). This applies unless a pelvic location is suspected. Naturally, where there is genuine -doubt the paramedian incision has a place ; but then the operation is a laparotomy rather than " for acute appendicitis." "
"
my patients were seen later than is usual in this country. In 12 of the last 25 consecutive cases the appendix had already perforated. In many an abscess had localised, or, in earlier cases, fragile adhesions were forming ; and approach through the unaffected part of the peritoneal cavity would have seemed indefensible. No-one would deliberately approach an appendix abscess by way of the unaffected peritoneal cavity, and I consider that all cases of acute appendicitis should be thought of as potential abscesses ; and if operation is performed, the approach should be the most direct route from the surface. My experience with antibiotics in intraabdominal infections has not led to any modification of this view.
Many of
In commenting on the frequency with which the acutely inflamed appendix is approached in this country by the midline or the paramedian routes, Ewing and Monro state that these approaches have the sanction of many of the standard works on operative surgery. On taking a random selection of textbooks from the shelves of a medical-school library, I did not find this confirmed, although it may be true of some of 5the more specialised works. Of six textbooks,’--6 one suggests that the McBurney incision is out of date except for opening an appendix abscess ; but the remainder express views which do not deviate from those of Ewing and Monro.
through intravenous needles have my sym. pathy, even though the needles be " fairly large." The diagram suggests connecting the babe directly to the oxygen supply. I think this is unwise and leads to the rebreathe
risk of burst babies. Department of Anaesthesia,
Royal Victoria Infirmary, E. A. PASK. Newcastle upon Tyne. EPIDEMIC VOMITING read SIR,-I your annotation of Oct. 3 and the letter Dr. French (Oct. 10) at a time when cases of this by condition were occurring in my practice. They have increased in number, and I myself became a victim 2 days ago.
Usually
there is
fatigue,
headache
(in
my
own case
temporal
,and in the tissues of the scalp), general aching, and hot and cold feelings, followed within a few hours or up to a day or two by bilious vomiting. Temperature varies from normal to 104°F and the pulse is usually rapid. Occasionally there is abdominal pain and slight giddiness, but never true vertigo.
no sign of liver tenderness or jaundice, and no meningeal signs ; but, as in Dr. French’s series, one case appeared which may or may not have belonged to the same group. This was in a woman who developed, after the usual onset, a 7th and llth cranial-nerve palsy and herpetic vesicles on the left side of the palate. In the occasional family
There is
infections the interval between cases has been about 5 The length of the illness varies from 1 to 7 days. Ilford, Essex.
days,
R. P. N. C. SMITH.
CONTRACEPTIVE TECHNIQUE 26 starts off well enough on firm ground but ends in a morass. Itis right and proper that he should quote the American figures and the immense amount of work done in that country on follow-up studies ;but this controversy about
SiR,ňDr. Maung Seiii’s letter of Sept.
the relative over-all effectiveness and acceptability of the combined methods of contraception (cap or sheath plus jelly, paste, or suppositories) versus the single methods (jelly or paste or suppositories or -condom used alone) is a very old one and still rages. Unfortunately simply to quote pregnancy-rates means very little ; it is necessary to know quite a lot about the background of the various series before it is possible to judge whether the comparison is a fair one (e.g., number of nullipars; age range ;previous fertility ; duration of use ; social, economic, educational, and religious background ; and MICHAEL FLINDT. London, so forth). Still more unfortunately one cannot always discover these important facts even in the authors’ ASPHYXIA IN THE NEWBORN paper, and this applies to a large extent to the SiR,ňDr. Noel Jackson in his letter (Oct. 17) quotes originalpublished onPreceptin.’ papers me as follows : In any case all this talk about pregnancy-rates is only " Writing on artificial ventilation of the lungs, Professor confusing the original issue’: I was not concerned with Pask7 evidently prefers efficient artificial respiration to pregnancy-rates but with one particular patient, a highly inadequate spontaneous respiration, for he remarksPositive fertile, sick woman, most willing to cooperate with her pressure ventilation can be carried out ... without causing medical advisers in every way ;in fact she cooperated disturbance in the cardiovascular system.’ " with them so well that she used preceptin when she With the first part of this sentence I agree, but the was advised to do so, with disastrous consequences, quotation fromoiny letter seems to have changed rather having previously used a combined method with success. strangely, for it ran as follows : Dr. Maung Sein will have a job to convince me that, "I believe that many physiologists will be surprised to learn all other things being equal, it is possible to offer a woman that positive pressure ventilation can be carried out at all as complete protection against pregnancy by giving her without causing some disturbance in the cardiovascular a paste or suppository to use alone as by providing her system." with a mechanical barrier to prevent direct insemination of the cervix plus a chemical one to kill the sperm. Dr. Jackson’s diagram and explanation of his me. If rubber the surgical glove really This is not to deny that preparations such as preceptut apparatus worry and various suppositories have their place in contracepfunctions as a rebreathing bag, I think it is too big. Furthermore, babies who are called upon to breathe or tion, and, as I said in my letter of Aug. 15, this ne1í paste will in time find its correct level of usefulness. A Short Practice of Surgery. 1. Bailey, H., Love, R. J. McN. It will undoubtedly be of value in the first of Dickinson’s London, 1952. 2. Handfield-Jones, R. M., Porritt, A. E. The Essentials of but I very much doubt if it will be the answer categories Modern Surgery Edinburgh, 1951. for in the other three. many Edin3. Illingworth, C. F. W. Textbook of Surgical Treatment. The last part of Dr. Maung Sein’s letter had best be burgh, 1947. 4. Maingot, R. Abdominal Operations. London, 1940. left unanswered-not because it is unanswerable but 5. Romanis, W. H. C., Mitchiner, P. H. The Science and Practice of Surgery. because it starts a number of irrelevant hares. London, 1952. 6. Souttar, H. S. The Art of Surgery. London, 1937. MARGARET HADLEY JACKSON JACKSOS, 7. Brit. med. J. 1953, i, 1048. Crediton, Devon. ...
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