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HOLIDAYS AND COMMON SENSE
808
X-ray examination for various complaints, approximately a fifth have proved to be suffering from duodenal or gastric ulcer, and as the time advances and more of these cases recur so the percentage is rising. The majority of these men were doing moderate work before the war, and were keeping well on light diet and alkalis, but they have broken down under the increased muscular exertion, the nervous strain and unsuitable food which are in fact the very conditions against which ulcer patients are usually warned. It is therefore logical to suppose that any known case of peptic ulcer, even if quiescent, should be exempted from active service; many no doubt could render valuable home service and keep well. The
suggestion that chronic cases should undergo partial gastrectomy, which is not without its mortality and recurrences, seems very undesirable, as Sir Arthur Hurst pointed out. With adequate medical treatment many chronic cases should become quiescent, and younger cases be cured, and some will necessitate surgery, but it is surely inadvisable to readmit them to the Army where their conditions will once more be aggravated by the unsuitable circumstances. I am, Sir, yours faithfully, Botleys Park War Hospital.
G. DOEL.
HOLIDAYS AND COMMON SENSE
SIR,—As one familiar with the coal-mining industry I read with pained surprise in THE LANCET of March 30 your comment on the action of the Bolsover miners in part of their holiday in order to further the national cause in this grave hour in our national
foregoing
historv.
struggle in which we are engaged. Thousands of them have " enjoyed " too much enforced leisure during the last few years and are glad of the higher earnings the fuller employment brings to them. Even when working full time (5 shifts below ground) they have a 44-hour week, and on THE LANCET’S own showing they are not only willing but physically well able to stand this without any injury to health after such There is no a long spell of short-time working. men who have not been in the that argument validity able to get as much work as they would like are being " persuaded to surrender their leisure." As for holidays, the " holidays with pay" system is now an established feature of the industry. Regarding health and social welfare, no industry does so much for its workers as coal-mining. In the last 20 years over £19 million has been provided by the industry for these purposes. Of this, approximately f4 million has been devoted to health services (apart from pithead baths or recreation) by grants to hospitals, ambulance and nursing services and the establishment of convalescent homes for miners and their wives. The latter have cost over £2 million, and in addition three-quarters of a million pounds has been set aside as a trust fund for sending miners and their wives to other homes. In view of these facts it seems singularly unfortunate that the splendid gesture of the patriotic Notts miners should have called forth such a commentary from an influential medical journal like THE LANCET. I am, Sir, yours faithfully, J. P. DICKIE, S.W.16.
M.P. Consett 1931-35. Author of " The Coal Problem."
Norbury, It seem quite straightforward to the writer to deal in general terms with such an important matter, EXTRACRANIAL LIGATURE OF THE MIDDLE but in doing so he conveys a most unfortunate impresMENINGEAL ARTERY sion. Thus after a reference to "short holidays or none " THE LAXCET for April 6 Dr. M. WasserSIR,—In at all," he says: Added to this, they are to mann describes an operation for ligaturing the middle work longer hours than sedentary workers." And it enters the skull. His paper before meningeal artery again, the heading in one report " Miners give a lead ends with the statement: " The subdural hœmatoma is described as a " lapse from common sense." could be removed by a second operation at a later These observations applied to the Bolsover case indicate quite clearly that the writer is not well date if necessary." Apart from the fact that the informed regarding the conditions in this and other middle meningeal artery and the hsematoma which results from its rupture are extradural, it is usually Machine mining has very of the newer coalfields. the brain compression which matters in this injury, labour of manual underreduced amount the greatly ground. Owing to the operation of the quota system not the arrest of hæmorrhage, which may have ceased by thrombosis by the time the skull is opened. If and reduced demand, short-time working has for long intracranial haemorrhage is present craniotomy is been a regular feature of the working of the mines called for to relieve the brain of the ill effects of in these areas. Thus, so far as the " longer hours" In such circumstances are concerned, the fact is that under normal conditions compression by blood-clot. the working week is a very short one. In the first six ligation of the middle meningeal artery outside the skull would appear to be both futile and dangerous months of 1939 the average number of shifts worked and if survived by the patient to have the added risk, The per week in the Notts coalfield was only 4. of the shift is 7 hours, plus one winding which Dr. Wassermann admits, of some damage to length or 8 hours in all from bank to bank. Time branches of the facial nerveand to the auriculotime, consumed in travelling to the coal face and a short temporal nerve. If extra cranial ligature of the middle break for a meal reduce the " effective working time " meningeal artery is ever required for primary heemorat the face to approximately 6 hours; 4 shifts of rhage in the absence of brain compression Dr. Wasser6hours each give an actual average working week mann’s description of his procedure is marred by numerous of 31 hours, and even the full time of 8 hours gives inaccuracies-e.g., the facial nerve is only an average working week of 38 hours. This described as passing "behind the styloid process." This is apparently a portmanteau word for the styloid means that 38 hours were devoted to work out of 168 in the week, leaving 130 out of the 168 for sleep and (to which the nerve is superficial) and the mastoid leisure. With 8 hours sleep per night, there are left process (to which it is deep). Again he states: " All 74 hours a week or 10a day for recreation and the other important foramina of the cranial base in amusement. this region-ovale, rotundum and lacerum-are placed The truth is that the miners have welcomed the more medially, with the important vessels and nerves additional employment provided by the increased that enter the cranial cavity through them, such as the mandibular part of the trigeminal nerve, the demand for coal and responded patriotically to the call of the Government for an intensive effort to prointernal jugular vein, the hypoglossal nerve, the duce an extra 30 or 40 million tons of the commodity accessory nerve and the internal carotid artery." Only the material in the first of these structures is correctly placed. Finally which is our asset (coal) greatest
may
required
X-ray examination for various complaints, approximately a fifth have proved to be suffering from duodenal or gastric ulcer, and as the time advances and more of these cases recur so the percentage is rising. The majority of these men were doing moderate work before the war, and were keeping well on light diet and alkalis, but they have broken down under the increased muscular exertion, the nervous strain and unsuitable food which are in fact the very conditions against which ulcer patients are usually warned. It is therefore logical to suppose that any known case of peptic ulcer, even if quiescent, should be exempted from active service; many no doubt could render valuable home service and keep well. The
suggestion that chronic cases should undergo partial gastrectomy, which is not without its mortality and recurrences, seems very undesirable, as Sir Arthur Hurst pointed out. With adequate medical treatment many chronic cases should become quiescent, and younger cases be cured, and some will necessitate surgery, but it is surely inadvisable to readmit them to the Army where their conditions will once more be aggravated by the unsuitable circumstances. I am, Sir, yours faithfully, Botleys Park War Hospital.
G. DOEL.
HOLIDAYS AND COMMON SENSE
SIR,—As one familiar with the coal-mining industry I read with pained surprise in THE LANCET of March 30 your comment on the action of the Bolsover miners in part of their holiday in order to further the national cause in this grave hour in our national
foregoing
historv.
struggle in which we are engaged. Thousands of them have " enjoyed " too much enforced leisure during the last few years and are glad of the higher earnings the fuller employment brings to them. Even when working full time (5 shifts below ground) they have a 44-hour week, and on THE LANCET’S own showing they are not only willing but physically well able to stand this without any injury to health after such There is no a long spell of short-time working. men who have not been in the that argument validity able to get as much work as they would like are being " persuaded to surrender their leisure." As for holidays, the " holidays with pay" system is now an established feature of the industry. Regarding health and social welfare, no industry does so much for its workers as coal-mining. In the last 20 years over £19 million has been provided by the industry for these purposes. Of this, approximately f4 million has been devoted to health services (apart from pithead baths or recreation) by grants to hospitals, ambulance and nursing services and the establishment of convalescent homes for miners and their wives. The latter have cost over £2 million, and in addition three-quarters of a million pounds has been set aside as a trust fund for sending miners and their wives to other homes. In view of these facts it seems singularly unfortunate that the splendid gesture of the patriotic Notts miners should have called forth such a commentary from an influential medical journal like THE LANCET. I am, Sir, yours faithfully, J. P. DICKIE, S.W.16.
M.P. Consett 1931-35. Author of " The Coal Problem."
Norbury, It seem quite straightforward to the writer to deal in general terms with such an important matter, EXTRACRANIAL LIGATURE OF THE MIDDLE but in doing so he conveys a most unfortunate impresMENINGEAL ARTERY sion. Thus after a reference to "short holidays or none " THE LAXCET for April 6 Dr. M. WasserSIR,—In at all," he says: Added to this, they are to mann describes an operation for ligaturing the middle work longer hours than sedentary workers." And it enters the skull. His paper before meningeal artery again, the heading in one report " Miners give a lead ends with the statement: " The subdural hœmatoma is described as a " lapse from common sense." could be removed by a second operation at a later These observations applied to the Bolsover case indicate quite clearly that the writer is not well date if necessary." Apart from the fact that the informed regarding the conditions in this and other middle meningeal artery and the hsematoma which results from its rupture are extradural, it is usually Machine mining has very of the newer coalfields. the brain compression which matters in this injury, labour of manual underreduced amount the greatly ground. Owing to the operation of the quota system not the arrest of hæmorrhage, which may have ceased by thrombosis by the time the skull is opened. If and reduced demand, short-time working has for long intracranial haemorrhage is present craniotomy is been a regular feature of the working of the mines called for to relieve the brain of the ill effects of in these areas. Thus, so far as the " longer hours" In such circumstances are concerned, the fact is that under normal conditions compression by blood-clot. the working week is a very short one. In the first six ligation of the middle meningeal artery outside the skull would appear to be both futile and dangerous months of 1939 the average number of shifts worked and if survived by the patient to have the added risk, The per week in the Notts coalfield was only 4. of the shift is 7 hours, plus one winding which Dr. Wassermann admits, of some damage to length or 8 hours in all from bank to bank. Time branches of the facial nerveand to the auriculotime, consumed in travelling to the coal face and a short temporal nerve. If extra cranial ligature of the middle break for a meal reduce the " effective working time " meningeal artery is ever required for primary heemorat the face to approximately 6 hours; 4 shifts of rhage in the absence of brain compression Dr. Wasser6hours each give an actual average working week mann’s description of his procedure is marred by numerous of 31 hours, and even the full time of 8 hours gives inaccuracies-e.g., the facial nerve is only an average working week of 38 hours. This described as passing "behind the styloid process." This is apparently a portmanteau word for the styloid means that 38 hours were devoted to work out of 168 in the week, leaving 130 out of the 168 for sleep and (to which the nerve is superficial) and the mastoid leisure. With 8 hours sleep per night, there are left process (to which it is deep). Again he states: " All 74 hours a week or 10a day for recreation and the other important foramina of the cranial base in amusement. this region-ovale, rotundum and lacerum-are placed The truth is that the miners have welcomed the more medially, with the important vessels and nerves additional employment provided by the increased that enter the cranial cavity through them, such as the mandibular part of the trigeminal nerve, the demand for coal and responded patriotically to the call of the Government for an intensive effort to prointernal jugular vein, the hypoglossal nerve, the duce an extra 30 or 40 million tons of the commodity accessory nerve and the internal carotid artery." Only the material in the first of these structures is correctly placed. Finally which is our asset (coal) greatest
may
required