FELLOWSHIP OF THE ROYAL COLLEGE OF PHYSICIANS

FELLOWSHIP OF THE ROYAL COLLEGE OF PHYSICIANS

563 SPECIMENS IN THE POST SiR.—We have been asked by the mails branch of the Edinburgh G.P.O. to draw the attention of practitioners regulations gov...

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563 SPECIMENS IN THE POST

SiR.—We have been asked by the mails branch of the

Edinburgh G.P.O. to draw the attention of practitioners regulations governing the sending of pathological specimens through the post. The following paragraphs relevant to the transmission of deleterious liquids or substances by letter post have been abstracted from the

to the

Post Office Guide :

(1) Any such liquid or substance must be enclosed in a receptacle, hermetically sealed or otherwise securely closed, and this receptacle must itself be placed in a strong wooden, leather or metal case in such a way that it cannot shift about, and with a sufficient quantity of some absorbent material (such as sawdust or cotton-wool) so packed about the receptacle as absolutely to prevent any possible leakage from the package in the event of damage to the receptacle. The packet so made marked " Fragile with care " and up must be conspicuously " bear the words Pathological specimen." (2) Any packet of the kind found in the parcel post, or found in the letter post not packed and marked as directed, will be at once stopped and destroyed with all its wrappings and enclosures. Further, any person who sends by post a deleterious liquid or substance for medical examination or analysis otherwise than as provided by these regulations is liable to prosecution.

Although in response to a previous appeal the number breakages has been reduced over the past two years, specimens are breaking in transit at the rate of twenty The complaint is that such breakages, per month. occurring as they do amongst the letter post, contaminate and make unpleasant the handling of the mail. It is not suggested that breakages are wholly the fault of the sender. There are, however, a number of unduly optimistic members of the medical profession who consider that a single wrapping of paper constitutes adequate packing. The destruction of wrappings and enclosures (para. 2) means that in the majority of cases the laboratory is unaware that a specimen has been sent and the sender is left waiting for a report on a specimen which he believes is held by the laboratory.

of

A blood-level of 58 mg. per 100 ml. means that there was about 24 grammes (384 grains) in the body, as barbiturates are distributed evenly throughout the bodywater. Next apply Dr. Wright’s rate of disappearance, 15% per day, to this amount. We find that this person must have taken over 600 grains of phenobarbitone. As our highest recorded dose has been 100 grains I am not surprised that barbiturate was present 5 days after ingestion. I do wonder perhaps whether such a dose was taken or whether one should regard the analysis with

suspicion. Department of Pharmacology, University of Melbourne.

F. H. SHAW.

THE UTER AND THE UTERUS

SIR,-I favour an alternative explanation to that given Mr. Burnett (Aug. 6) concerning the derivation of uterus." The word uterus belongs to the sphere of Indo-German languages, and its root is related to the old Indian word udaram (abdomen). It is not in the nature of men to call so holy and mysterious an organ after such a profane object as a bag made of goat skin. The German word is Gebdrntutter (gebdren is related to the English bear). The Slav is maternica. from oc + (uterus) and is the one which comes from the same uterus, and not the other way round. This explanation seems to be more logical following the etymology.

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TONSILLECTOMY WITHOUT TEARS

SIR,-During to anaesthetise

the

been my lot for tonsillectherefore with much interest

past five years it has upwards of 1000 children

tomy by dissection. It

was

that I read Dr. Gusterson’s papery Like Dr. Gusterson, I have tried a variety of premedications. The popular barbiturates by mouth I find very unsatisfactory. Their effect is uncertain, and too often they are vomited by the child before arrival in the Pregnancy Diagnosis Laboratory, theatre. Whether the child arrives in theatre asleep or Usher Institute, B. M. HOBSON. Warrender Park Road, Edinburgh, 9. not, it is liable to be confused and uncooperative and may struggle during induction. Crying at this stage is liable FELLOWSHIP OF THE ROYAL COLLEGE OF to increase bleeding during the operation. Even when PHYSICIANS amnesia is complete, this is outweighed by the other SIR,-On p. 443 of your Educational Number (Aug. 27) drawbacks. When it is not, memories seem to have a the higher diplomas of the Royal College of Physicians nightmarish quality. Postoperatively the children tend to be restless and cry, so that additional sedation with an and it is stated that " Fellows are are mentioned; opiate is required. elected annually at a general meeting of the college." Until recently my cases have normally been preThis is, unfortunately, not the case. The procedure is medicated by an injection of pethidine and scopolamine. that any fellow may propose the name of a member for This has proved reasonably satisfactory. The great election to the fellowship ; then, after deletion of some in theatre arrive the and will tranquil majority permit a of the names by a committee, the other names are voted with little careful protest. Vomiting or on by the body of fellows. There are no general meetings venepuncture retching is occasionally produced, and a few children of the college : only the fellows are entrusted with the become flushed. Postoperatively the children are calmer task of adding to their number-and even they can only and quieter than with barbiturates. select from the names that have passed through the I routinely induce ansssthesia in these cases with a meshes of the president’s net. It is not unfair to regard mixture of thiopentone and gallamine (’Flaxedil’) the College of Physicians as a very limited democracy. followed by endotracheal nitrous oxide and oxygen. An A. PINEY. London, W.1. armoured tube is used under the tongue-plate. I have long felt that it would be an advantage if preA BARBITURATE ANTAGONIST medication could be given entirely by mouth. I am sure SiR,-Dr. Leurer (Aug. 13) quotes the results of a case that where a child is unduly apprehensive of veneof barbiturate (type unstated) poisoning in which there puncture, this is partly due to a painful experience of was a blood-level of 58 mg. per 100 ml. some 5 days after premedication-and let us face it, the pain of an injection ingestion. He then says : " These figures confirm the varies between quite wide limits, as many adult patients estimate of Dr. Wright,! as opposed to Professor Shaw’s can testify ! view2 that on the 6th day only little barbiturate is I had considered using methylpentynol (’ Oblivon’), left in the body." but reports were on the whole unfavourable, and it seemed that atropine by injection would still be required. Let us assume that the barbiturate was phenobarbitone, the most common stable barbiturate derivative. I was therefore particularly grateful to Dr. Gusterson for his suggestion that oblivon and hyoscine given by mouth -



.

1. Wright, J. T. Lancet, 1955, i, 1073. 2. Shaw, F. H. Ibid, p. 969.

1.

Gusterson,

F. R.

Lancet, 1955, i, 940.