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HOSPITAL ACCOUNTS
270 ELECTRIC HEATING ELEMENT FOR THE LIMBS SiR,-Last year I reported briefly that in rheumatoid arthritis the prolonged application to the lower half of the body of a large electric blanket at a temperature of 115°F, had a beneficial effect.l I pointed out that an electric blanket was a clumsy device for applying continuous heat, because it severely restricts leg movements. I also mentioned that an appliance used for this purpose should be shock-proof and safeguarded against short-circuiting and burning, and should have a temperature-regulating mechanism. For the last four months I have been using an appliance which appears to satisfy these conditions. This appliance, depicted in the accompanying illustration, consists of a 20 ft. ribbon containing a heating element of wire gauze mesh of stainless steel, 11/2 in. wide, which is embedded in insulating, chemical-resisting, plastic material. Flex-leads connect the two element
plugs
to
a
24-volt
One young woman, with large chronic discs on her and back, and additional lesions on the vulva which caused severe pruritus, was left wrapped up in an electric blanket at a temperature of 115°F for two weeks, with a typical response and well-marked improvement of the skin condition and the pruritus. It would be interesting to try these elements in conjunction with various local applications of proved value in psoriasis and also with the administ.ration of calciferol by mouth. arms.
abdomen, chest,
Finally, two patients with chronic varicose ulcers which had resisted prolonged bed rest and various local treatments, showed rapid healing of the ulcers when the elements were applied to the legs for two weeks. I wish to thank Mr. A.
Dudley,
Poynton, Cheshire, for supplying
of Windak Ltd., Woodside, with the equipment used
me
in this work.
ERIC FRANKEL Wanstead Hospital, London, E.11.
Physician.
safety HOSPITAL ACCOUNTS
8iR,—You do well to welcome (July 29) the improved system of subjective accounting which has been ordered; but beware of the
We
are
danger. managed by laymen
and
by
finance
depart.
ments who do not understand patients’ needs. They tend to be pleased when " So-and-So shows a low They are not so concerned to make sure that he gave the same amount or quality, and that the patients were made as happy or got well as quickly. Comparativee accounting is good when it avoids
ngure.’’
extravagance ; it is dangerous when relied on without discrimination, for it may then encourage parsimony and depress treatment. Your editorial help will be needed to protect patients from the latter. NOEL H. M. BURKE.
UNDECYLINIC ACID IN PSORIASIS
SIR,-In transformer. The use of the low voltage removes any danger of electric shook.. Two of these elements, one for each limb, can be applied at the same time, and both arms or legs can be treated. The skin is protected by a long woollen bedsock or crepe bandage, and the element is wound round the limb from foot to mid-thigh, or from wrist to shoulder. An insulating rectangular sheet of kapok of the correct length is then tied round the limb. The temperature of the element can be varied by switching the transformer from " high " through " " medium " to low," and also by making the coils wound round the limb overlap. Two layers of element will raise the temperature to 125°F when the transformer is on " high," whereas one layer will give a constant heat of 115°F of an equable distribution. Four cases of rheumatoid arthritis have been treated with these elements continuously for 2-3 weeks, and the results agree with those achieved by the electric-blanket method. One of these patients also had chronic severe psoriasis on the extensor surfaces of the limbs, and it was noted that the skin lesions improved considerably during the heat treatment. I therefore thought of trying the application of these elements to limbs affected by psoriasis, and I have now treated six patients suffering from chronic psoriasis who have failed to respond to other therapy. In 3-4 days thick yellow scales, which peel off easily, form the raised discs. New scales form until, after 7-14 days of no new scales develop and the skin of the affected area is no longer raised. It still looks red, but the covering layer is soft and smooth. The redness gradually fades from the centre to the periphery of the lesion, until the skin looks In three patients the psoriasis gradually normal again. reappeared, though in a less severe form. One patient with very large chronic lesions responded very well; but one month after he left hospital fresh lesions of the small, papular type developed, though the chronic psoriasis on his limbs on
treatment,
h.r1 nlParPr7 "n
1.
Twn n.t,iAnt,Q n.rl t,nA A1A1TIpnt, fn tha
Frankel,
E.
Lancet, 1949, ii, 1084.
an
annotationlast year you drew attention
report by Perlman2 on the beneficial effect on psoriasis of undecylinic acid given by mouth. Seventeen patients had received this medication and he noted the disappearance of itching, improvement in affected nails, resolution of subacute cases, and great benefit to chronic sufferers. Later he and Milberg3 reported a larger series to
v
a
of
cases in whom the effects were not so encouraging. Unfortunately, psoriasis is a common complaint and sufferers are ever ready to seize on new forms of treatment. As was to be expected, these American reports were widely publicised by the lay press, and St. John’s Hospital for Diseases of the Skin received constant inquiries about " the new American treatment " ; so it was decided to undertake comprehensive trials with this drug. These trials were started in May, 1949, and continued At the outset some cases over a twelve-month period. were treated as inpatients at the Middlesex Hospital under Dr. Ray Bettley, while the remainder were seen at a special outpatient clinic at St. John’s. The dosag&
schedules varied from case to advocated by Perlman. The three groups :
case
but
patients
the lines divided into
were on were
1. Receiving undecylinic acid capsules. 2. Receiving capsules containing an inertoil which identical in appearance with the " active ’’ capsules and given in similar amounts. 3. Receiving calciferol by mouth.
wer& were
As regards local applications, all the patients were treated in the same manner-i.e., those who had alreadv been receiving local treatment when they were referred to the special clinic continued with the same routine, whereas those who had not started on any topical applications received the oral medication only. The following table surnmarises the results obtained. 1. 2. 3.
Lancet, 1949, i, 575. Perlman, H. H. J. Amer. med. Ass. 1949, 139, 444. Perlman, H. H., Milberg, I. L. Ibid, 1949, 140, 865.
plugs
to
a
24-volt
One young woman, with large chronic discs on her and back, and additional lesions on the vulva which caused severe pruritus, was left wrapped up in an electric blanket at a temperature of 115°F for two weeks, with a typical response and well-marked improvement of the skin condition and the pruritus. It would be interesting to try these elements in conjunction with various local applications of proved value in psoriasis and also with the administ.ration of calciferol by mouth. arms.
abdomen, chest,
Finally, two patients with chronic varicose ulcers which had resisted prolonged bed rest and various local treatments, showed rapid healing of the ulcers when the elements were applied to the legs for two weeks. I wish to thank Mr. A.
Dudley,
Poynton, Cheshire, for supplying
of Windak Ltd., Woodside, with the equipment used
me
in this work.
ERIC FRANKEL Wanstead Hospital, London, E.11.
Physician.
safety HOSPITAL ACCOUNTS
8iR,—You do well to welcome (July 29) the improved system of subjective accounting which has been ordered; but beware of the
We
are
danger. managed by laymen
and
by
finance
depart.
ments who do not understand patients’ needs. They tend to be pleased when " So-and-So shows a low They are not so concerned to make sure that he gave the same amount or quality, and that the patients were made as happy or got well as quickly. Comparativee accounting is good when it avoids
ngure.’’
extravagance ; it is dangerous when relied on without discrimination, for it may then encourage parsimony and depress treatment. Your editorial help will be needed to protect patients from the latter. NOEL H. M. BURKE.
UNDECYLINIC ACID IN PSORIASIS
SIR,-In transformer. The use of the low voltage removes any danger of electric shook.. Two of these elements, one for each limb, can be applied at the same time, and both arms or legs can be treated. The skin is protected by a long woollen bedsock or crepe bandage, and the element is wound round the limb from foot to mid-thigh, or from wrist to shoulder. An insulating rectangular sheet of kapok of the correct length is then tied round the limb. The temperature of the element can be varied by switching the transformer from " high " through " " medium " to low," and also by making the coils wound round the limb overlap. Two layers of element will raise the temperature to 125°F when the transformer is on " high," whereas one layer will give a constant heat of 115°F of an equable distribution. Four cases of rheumatoid arthritis have been treated with these elements continuously for 2-3 weeks, and the results agree with those achieved by the electric-blanket method. One of these patients also had chronic severe psoriasis on the extensor surfaces of the limbs, and it was noted that the skin lesions improved considerably during the heat treatment. I therefore thought of trying the application of these elements to limbs affected by psoriasis, and I have now treated six patients suffering from chronic psoriasis who have failed to respond to other therapy. In 3-4 days thick yellow scales, which peel off easily, form the raised discs. New scales form until, after 7-14 days of no new scales develop and the skin of the affected area is no longer raised. It still looks red, but the covering layer is soft and smooth. The redness gradually fades from the centre to the periphery of the lesion, until the skin looks In three patients the psoriasis gradually normal again. reappeared, though in a less severe form. One patient with very large chronic lesions responded very well; but one month after he left hospital fresh lesions of the small, papular type developed, though the chronic psoriasis on his limbs on
treatment,
h.r1 nlParPr7 "n
1.
Twn n.t,iAnt,Q n.rl t,nA A1A1TIpnt, fn tha
Frankel,
E.
Lancet, 1949, ii, 1084.
an
annotationlast year you drew attention
report by Perlman2 on the beneficial effect on psoriasis of undecylinic acid given by mouth. Seventeen patients had received this medication and he noted the disappearance of itching, improvement in affected nails, resolution of subacute cases, and great benefit to chronic sufferers. Later he and Milberg3 reported a larger series to
v
a
of
cases in whom the effects were not so encouraging. Unfortunately, psoriasis is a common complaint and sufferers are ever ready to seize on new forms of treatment. As was to be expected, these American reports were widely publicised by the lay press, and St. John’s Hospital for Diseases of the Skin received constant inquiries about " the new American treatment " ; so it was decided to undertake comprehensive trials with this drug. These trials were started in May, 1949, and continued At the outset some cases over a twelve-month period. were treated as inpatients at the Middlesex Hospital under Dr. Ray Bettley, while the remainder were seen at a special outpatient clinic at St. John’s. The dosag&
schedules varied from case to advocated by Perlman. The three groups :
case
but
patients
the lines divided into
were on were
1. Receiving undecylinic acid capsules. 2. Receiving capsules containing an inertoil which identical in appearance with the " active ’’ capsules and given in similar amounts. 3. Receiving calciferol by mouth.
wer& were
As regards local applications, all the patients were treated in the same manner-i.e., those who had alreadv been receiving local treatment when they were referred to the special clinic continued with the same routine, whereas those who had not started on any topical applications received the oral medication only. The following table surnmarises the results obtained. 1. 2. 3.
Lancet, 1949, i, 575. Perlman, H. H. J. Amer. med. Ass. 1949, 139, 444. Perlman, H. H., Milberg, I. L. Ibid, 1949, 140, 865.