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EYE INJURIES FROM DISRUPTED GOLF BALLS
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conceded that the profession has a special responsibility not to create conflict purely to further the advantage of its own members). At the centre of potential conflict, in the working-party’s view, is the dilemma that the desire not to harm patients by direct action may result in harming them by doing nothing: it is unreasonable to
profession to remain passive in the face of destandards, inadequate resources, and lay interclining vention in the doctor-patient relationship in a way that may affect it adversely. Nevertheless, without calling in question the present concern, not to say despair, of doctors working in the N.H.S., are doctors right in assuming that the interests of the profession necessarily coincide with those of the patient-who is after all himselfa representative of the lay community? expect
a
The fact remains that the medical profession feels itself to be in a well-nigh impossible position, and there is every likelihood of a new explosion to rock the Health Service unless some better means of handling disputes is discovered. Prevention of conflict is the ideal objectivebut this may be achieved only if the Government grants the profession a more direct say in the policy-making process. More realistic is the plea for both sides to admit that the existing conciliation procedures have proved inadequate and to get together to discuss the introduction of more effective machinery. Thus, the challenge now lies with the Government-and the profession has made it clear that any attempt at a delaying tactic, such as suggesting the referral of the whole question to the Royal Commission, would be dangerous. Simply, therefore, as a cry for help, the working-party’s report demands respect and attention.
EYE INJURIES FROM DISRUPTED GOLF BALLS CHILDREN are much given to taking things apart to how they work, and some youngsters seem particularly attracted to the dissection of old golf balls. The mass of rubber thread visible beneath the cracked skin of an ancient golf ball is almost irresistible, and the patience needed to unwind it is rewarded with a prize of a piece of elastic a mile long (or so it seems). There is danger in this game, however; for the centre of most golf balls contains a liquid under high pressure, and eye injuries have been caused by its sudden release. 12 cases of injury to the eyelid, conjunctiva, and orbit have been recorded in the past 12 years,.l-7 and Lucas and others have now reported on the tissue damage in 9 further cases." In all 9 cases the excised tissue contained clear or pale-staining crystalline material, to which there was a mild inflammatory reaction. The crystals were mainly barytes (barium sulphate), with small quantities of other minerals found in natural barytes deposits. Lucas and his colleagues also examined microscopically the liquid contents of nine different types of golf ball, and, not sursee
1. Br.
med. J Jan, 15, 1977, p. 157. 2. Johnson, F. B., Zimmerman, L. E. Am. J. clin. Path. 1965, 44, 533. 3. Penner, R. Archs Ophthal., N.Y. 1966, 75, 68. 4 Slusher, M. M., Jaegers, K. R., Annesley, W. H. Am. J. Ophthal. 1976, 64, 736 5 Taylor, J. N , Greer, C. H. Med. J. Aust. 1969, i, 632. 6.Nelson, C. Br. J. Ophthal. 1970, 54, 670. 7.O’Grady,R.,Schoch,D.Am. J. Ophthal. 1973, 76, 148. 8.Lucas, D. R., Dunham, A. C., Lee, W. R., Weir, W., Wilkinson, F. C. F. Br. J.Ophthal 1976, 60,740.
prisingly, they found that the dried slurry from each ball contained large amounts.of barytes. In 6 of the 12 cases reported earlier, crystals had been deposited in the cornea, but none of Lucas’s patients had any significant corneal damage. Since the cornea must usually be in the direct line of fire in such accidents, it is remarkable that it should have escaped damage in the majority of reported cases. Lucas and his colleagues attribute its relative resistance to injury to the tight adhesion of the corneal epithelium to the underlying Bowman’s membrane-together they form a tough layer which probably prevents deep penetration. By contrast, the conjunctiva and the dermis of the eyelid are relatively slack and are thus less resistant to mechanical damage. In Lucas’s series the interval between injury and presentation for treatment ranged from 18 hours to 20 weeks. The authors suggest that this great variation was related to the intensity of the initial conjunctival reaction, and that this, in turn, probably depended on the nature of the organic binding material in the golf-ball centres (which, however, they did not identify). Excised tissue from patients presenting within a few days of injury showed a mild imflammatory response; small crystals were seen in the cytoplasm of macrophages, and larger crystals were surrounded by multinucleate cells. After a few weeks, evidence of inflammation and necrosis had been superseded by fibrosis. Migration of macrophages to adjacent blood-vessels, not mentioned in earlier reports, was seen a few weeks after injury and
presumably part of an ineffectual attempt to remove foreign material. At the beginning of this century disruption of golf was
balls caused several cases of serious loss of vision.y-" Golf balls at that time contained barium sulphate, soap, and free alkali. The severity of the injuries was presumably due to the alkali, and this was not used in.golf balls manufactured after 1914. Golf-ball eye injuries are less serious these days, but in 2 cases6 among the 12 previously reported cases reviewed by Lucas et al.8 injury resulted in permanent though slight disability; and although 5 of Lucas’s patients made an uneventful recovery, the other 4 had some residual scarring. RUSTERS CORROSION of metal after handling is a bane in industries which manufacture and assemble highly finished metal products. A few individuals are unusually corrosive to iron and steel: they are "rusters", and once their idiosyncracy is detected they are often in danger of losing their jobs. A freshly polished metal surface is more susceptible to attack than one retaining its protective oxide film; U and greasing will not protect the metal unless all traces of sweat are first removed. Two primary factors seem responsible for the ruster’s disability-the quantity of palmar sweat and its composition.13 Sodium chloride, the principal solute in eccrine sweat, is the main determinant of the electroc., -, ical process which produces rusting in the presence of atmos9. Crigler, L. W. J. Am. med. Ass. 1913, 60, 1297. 10. Lowell, H. ibid. 1913, 61, 2303. 11. Thomason, H. E. ibid. p. 965. 12 vernon, W. H. J. Trans. Faraday Soc. 1935, 31, 1668. 13 Collins, K. J.Br. J. md.Med. 1957, 14, 191.
conceded that the profession has a special responsibility not to create conflict purely to further the advantage of its own members). At the centre of potential conflict, in the working-party’s view, is the dilemma that the desire not to harm patients by direct action may result in harming them by doing nothing: it is unreasonable to
profession to remain passive in the face of destandards, inadequate resources, and lay interclining vention in the doctor-patient relationship in a way that may affect it adversely. Nevertheless, without calling in question the present concern, not to say despair, of doctors working in the N.H.S., are doctors right in assuming that the interests of the profession necessarily coincide with those of the patient-who is after all himselfa representative of the lay community? expect
a
The fact remains that the medical profession feels itself to be in a well-nigh impossible position, and there is every likelihood of a new explosion to rock the Health Service unless some better means of handling disputes is discovered. Prevention of conflict is the ideal objectivebut this may be achieved only if the Government grants the profession a more direct say in the policy-making process. More realistic is the plea for both sides to admit that the existing conciliation procedures have proved inadequate and to get together to discuss the introduction of more effective machinery. Thus, the challenge now lies with the Government-and the profession has made it clear that any attempt at a delaying tactic, such as suggesting the referral of the whole question to the Royal Commission, would be dangerous. Simply, therefore, as a cry for help, the working-party’s report demands respect and attention.
EYE INJURIES FROM DISRUPTED GOLF BALLS CHILDREN are much given to taking things apart to how they work, and some youngsters seem particularly attracted to the dissection of old golf balls. The mass of rubber thread visible beneath the cracked skin of an ancient golf ball is almost irresistible, and the patience needed to unwind it is rewarded with a prize of a piece of elastic a mile long (or so it seems). There is danger in this game, however; for the centre of most golf balls contains a liquid under high pressure, and eye injuries have been caused by its sudden release. 12 cases of injury to the eyelid, conjunctiva, and orbit have been recorded in the past 12 years,.l-7 and Lucas and others have now reported on the tissue damage in 9 further cases." In all 9 cases the excised tissue contained clear or pale-staining crystalline material, to which there was a mild inflammatory reaction. The crystals were mainly barytes (barium sulphate), with small quantities of other minerals found in natural barytes deposits. Lucas and his colleagues also examined microscopically the liquid contents of nine different types of golf ball, and, not sursee
1. Br.
med. J Jan, 15, 1977, p. 157. 2. Johnson, F. B., Zimmerman, L. E. Am. J. clin. Path. 1965, 44, 533. 3. Penner, R. Archs Ophthal., N.Y. 1966, 75, 68. 4 Slusher, M. M., Jaegers, K. R., Annesley, W. H. Am. J. Ophthal. 1976, 64, 736 5 Taylor, J. N , Greer, C. H. Med. J. Aust. 1969, i, 632. 6.Nelson, C. Br. J. Ophthal. 1970, 54, 670. 7.O’Grady,R.,Schoch,D.Am. J. Ophthal. 1973, 76, 148. 8.Lucas, D. R., Dunham, A. C., Lee, W. R., Weir, W., Wilkinson, F. C. F. Br. J.Ophthal 1976, 60,740.
prisingly, they found that the dried slurry from each ball contained large amounts.of barytes. In 6 of the 12 cases reported earlier, crystals had been deposited in the cornea, but none of Lucas’s patients had any significant corneal damage. Since the cornea must usually be in the direct line of fire in such accidents, it is remarkable that it should have escaped damage in the majority of reported cases. Lucas and his colleagues attribute its relative resistance to injury to the tight adhesion of the corneal epithelium to the underlying Bowman’s membrane-together they form a tough layer which probably prevents deep penetration. By contrast, the conjunctiva and the dermis of the eyelid are relatively slack and are thus less resistant to mechanical damage. In Lucas’s series the interval between injury and presentation for treatment ranged from 18 hours to 20 weeks. The authors suggest that this great variation was related to the intensity of the initial conjunctival reaction, and that this, in turn, probably depended on the nature of the organic binding material in the golf-ball centres (which, however, they did not identify). Excised tissue from patients presenting within a few days of injury showed a mild imflammatory response; small crystals were seen in the cytoplasm of macrophages, and larger crystals were surrounded by multinucleate cells. After a few weeks, evidence of inflammation and necrosis had been superseded by fibrosis. Migration of macrophages to adjacent blood-vessels, not mentioned in earlier reports, was seen a few weeks after injury and
presumably part of an ineffectual attempt to remove foreign material. At the beginning of this century disruption of golf was
balls caused several cases of serious loss of vision.y-" Golf balls at that time contained barium sulphate, soap, and free alkali. The severity of the injuries was presumably due to the alkali, and this was not used in.golf balls manufactured after 1914. Golf-ball eye injuries are less serious these days, but in 2 cases6 among the 12 previously reported cases reviewed by Lucas et al.8 injury resulted in permanent though slight disability; and although 5 of Lucas’s patients made an uneventful recovery, the other 4 had some residual scarring. RUSTERS CORROSION of metal after handling is a bane in industries which manufacture and assemble highly finished metal products. A few individuals are unusually corrosive to iron and steel: they are "rusters", and once their idiosyncracy is detected they are often in danger of losing their jobs. A freshly polished metal surface is more susceptible to attack than one retaining its protective oxide film; U and greasing will not protect the metal unless all traces of sweat are first removed. Two primary factors seem responsible for the ruster’s disability-the quantity of palmar sweat and its composition.13 Sodium chloride, the principal solute in eccrine sweat, is the main determinant of the electroc., -, ical process which produces rusting in the presence of atmos9. Crigler, L. W. J. Am. med. Ass. 1913, 60, 1297. 10. Lowell, H. ibid. 1913, 61, 2303. 11. Thomason, H. E. ibid. p. 965. 12 vernon, W. H. J. Trans. Faraday Soc. 1935, 31, 1668. 13 Collins, K. J.Br. J. md.Med. 1957, 14, 191.