- Email: [email protected]
HOSPITAL, DOCTOR, AND PATIENT
731 of these lists have been vague ane’uncritical. Chronic constipation, eructation, nervouE(’4mptoms, of vertigo, etc., have been reported, but the occurrence these with trichuriasis may well be coincidental."2 The diagnosis of trichuriasis, while usually based on stool examinations for ova, may be confirmed jn some cases by sigmoidoscopy, when the helminths may be seen attached to the mucosa of the colon or rectum. The most effective treatment appears to be retention enemata of 0-2% hexylresorcinol, in water or glycerin solution, the technique of which is described elsewhere.l
in the next bed had been in hospital eight months and his parents had seen the specialist once-on the night he was admitted as an emergency.
Tommy
repetitions ...
Department of Medicine, University College of the West Indies, Jamaica.
D. B. JELLIFFE.
WATER INTOXICATION
SIR,-I should like to congratulate Dr. Wynn and Professor Rob on their very valuable paper (March 20), which should be a great help to those concerned with postoperative care and the management of fluid balance. It is clear that water intoxication must now rank with potassium loss as a new hazard to be watched for by house-surgeons and registrars, and dealt with appro-
priately
and
expeditiously.
(actually 461) ?
Although of no great importance, this small aberration makes things even more difficult for us biochemical neophvtes. MICHAEL REILLY.
HOSPITAL, DOCTOR, AND PATIENT
SiR,-May I,
legal
as
a
layman,
venture to comment on hospital boards and.
actions between
patients ? The National Health Service is young, and most people realise that growing pains are inevitable ; but until the relations between specialists on the one hand and general practitioners, patients, and patients’ relatives on the other have regained some of the mutual trust which existed in my childhood, these actions will continue.
Thirty years ago, my brother, then a child of six, nearly through an error of diagnosis. Our family doctor freely admitted that a mistake had been made, and did everything in his power to put the damage right. After many months the child recovered. Although this story was freely discussed by the neighbours, I doubt if a single patient left the doctor because of it. Everybody was impressed by his honesty, his devotion to duty, his genuine understanding of the family’s anxiety, and by his many simple kindnesses. It would never have occurred to my family to sue this doctor. " To died
is human." - Had not he saved my mother’s life on several occasions, brought me through a bad attack of appendicitis, and cared for the whole family during these crises ?‘? Recently my young son had to go into hospital for observation. It was a good hospital with modern ideas on visiting so we saw him every evening. During the twelve weeks he was in hospital, my husband and I saw the specialist twice and the house-physician once. Our anxiety was very great, and on one occasion, when we could stand the silence of the hospital no longer, my husband spoke to the ward-sister. Her reply was terse : " Oh, you intellectual parents are the worst people we have to deal with." She did not seem to realise our concern for our most cherished possession. After, my son was discharged from hospital it took our doctor a fortnight and many telephone calls before he could get even a short report from the hospital on the child’s condition. Four months later the clinic that we were told to attend was still waiting for a hospital report. Still, we were lucky.
err
In these days when medical knowledge is put out for public consumption by radio, television, and the newspapers, as well as by the British Medical Association through Family Doctor; is it too much to asks that parents and relatives be given an opportunity of discussing with the doctors the patient’s condition, and be given a simple explanation of what is being done for him’? Certainly, I met very few parents who would not have preferred to know-even the worst-rather than face the many weeks of anxiety and uncertainty that they were
forced to go through. Would it not be possible to build up relations between hospitals, doctors, patients, and relatives into those which exist in the best parent-teacher associations of some schools, and with the same amount of good will on both sides ? I cannot believe the doctors would lose of their status by this, and certainly some of anything the young housemen might benefit by supplementing their academic knowledge of disease by an understanding of the environment of their patients. PARENT.
There is one minor criticism. I have, for the good of my surgical soul and to familiarise myself with the process, developed the habit of turning mg. per 100 ml. into m.eq. per litre and back again whenever I meet them. Whereas the other m.eq. quoted in the article are correct to the nearest 10, 450 ml. of 6% NaCl are twice given, in table 11 and caserecord 1, as containing 480 m.eq. Surely this should be 460
the recent
..
A COOLING UNIT IN CLOSED-CIRCUIT ANÆSTHESIA
SiR,ŁI have successfully used a closed respiratory circuit cooled down to 16°F to maintain heat-balance in therapeutic sweating, and I believe that a similar system in a closed-circuit unit for anaesthesia could lower bodytemperature and metabolism during operations. The fall in circulation-rate with " artificial hibernation decreases bleeding in the operation area and reduces the danger of surgical shock ; but anaesthetic techniques that lower the body-temperature by drugs and/or physical cooling introduce other drug hazards difficult to control. Before the induction of anaesthesia there is usuallv constriction of the skin vessels, which is often followed by a cold sweat due to mental stimuli or shock. During normal anaesthesia with a closed-circuit unit with an average volume of about 21/2 litres, including corrugated tubes and mask, there is a steady rise in blood-temperature because of the continuous inhalation of warm gas of high relative and absolute humidity. The temperature of the inspired gas at the face-mask averages 102°-105°F for a Waters’s absorber, and 89°-91°F for a circle unit. These temperatures relate to a breathing rate of 18 per a tidal volume of 500 c.cm., _and a canister of soda lime 8 cm. by 13 cm.1 The temperature of the inspired gases in a Waters’s absorber are higher than the blood-temperature, while in the closed-circuit unit they are only 8-4Ł7’4°F lower than blood-temperature ; but both their absolute and relative humidities are high. Thus the gases in the Waters’s absorber, In the instead of cooling the lung vascular bed, warm it. circle unit there is a slight tendency to cool the blood, but the cooling effect on the lung bed cannot compare with that produced by the inhalation of gas at normal atmospheric temperatures and low absolute and relative humidities.
min.,
The steady rise in temperature turns the cold sweat into a hot sweat and the skin vessels are dilated. The soda-lime container also adds its quota of heat and water to the inspired gases, for each gramme-molecule of CO2 produces 310 calories and water. Under normal conditions only a small proportion of the heat produced is used in warming the inspired air. These considerations suggest that we might regulate the temperature of the inspired gases by means of a cooling system before attempting to lower the bodytemperature by drugs and physical cooling. A cooling system in the return circuit to the face-mask could bring down the temperature of the inspired gases to 32°F, 1.
Adrian, J. Chemistry
of Anesthesia.
Springfield,
1946.
in the next bed had been in hospital eight months and his parents had seen the specialist once-on the night he was admitted as an emergency.
Tommy
repetitions ...
Department of Medicine, University College of the West Indies, Jamaica.
D. B. JELLIFFE.
WATER INTOXICATION
SIR,-I should like to congratulate Dr. Wynn and Professor Rob on their very valuable paper (March 20), which should be a great help to those concerned with postoperative care and the management of fluid balance. It is clear that water intoxication must now rank with potassium loss as a new hazard to be watched for by house-surgeons and registrars, and dealt with appro-
priately
and
expeditiously.
(actually 461) ?
Although of no great importance, this small aberration makes things even more difficult for us biochemical neophvtes. MICHAEL REILLY.
HOSPITAL, DOCTOR, AND PATIENT
SiR,-May I,
legal
as
a
layman,
venture to comment on hospital boards and.
actions between
patients ? The National Health Service is young, and most people realise that growing pains are inevitable ; but until the relations between specialists on the one hand and general practitioners, patients, and patients’ relatives on the other have regained some of the mutual trust which existed in my childhood, these actions will continue.
Thirty years ago, my brother, then a child of six, nearly through an error of diagnosis. Our family doctor freely admitted that a mistake had been made, and did everything in his power to put the damage right. After many months the child recovered. Although this story was freely discussed by the neighbours, I doubt if a single patient left the doctor because of it. Everybody was impressed by his honesty, his devotion to duty, his genuine understanding of the family’s anxiety, and by his many simple kindnesses. It would never have occurred to my family to sue this doctor. " To died
is human." - Had not he saved my mother’s life on several occasions, brought me through a bad attack of appendicitis, and cared for the whole family during these crises ?‘? Recently my young son had to go into hospital for observation. It was a good hospital with modern ideas on visiting so we saw him every evening. During the twelve weeks he was in hospital, my husband and I saw the specialist twice and the house-physician once. Our anxiety was very great, and on one occasion, when we could stand the silence of the hospital no longer, my husband spoke to the ward-sister. Her reply was terse : " Oh, you intellectual parents are the worst people we have to deal with." She did not seem to realise our concern for our most cherished possession. After, my son was discharged from hospital it took our doctor a fortnight and many telephone calls before he could get even a short report from the hospital on the child’s condition. Four months later the clinic that we were told to attend was still waiting for a hospital report. Still, we were lucky.
err
In these days when medical knowledge is put out for public consumption by radio, television, and the newspapers, as well as by the British Medical Association through Family Doctor; is it too much to asks that parents and relatives be given an opportunity of discussing with the doctors the patient’s condition, and be given a simple explanation of what is being done for him’? Certainly, I met very few parents who would not have preferred to know-even the worst-rather than face the many weeks of anxiety and uncertainty that they were
forced to go through. Would it not be possible to build up relations between hospitals, doctors, patients, and relatives into those which exist in the best parent-teacher associations of some schools, and with the same amount of good will on both sides ? I cannot believe the doctors would lose of their status by this, and certainly some of anything the young housemen might benefit by supplementing their academic knowledge of disease by an understanding of the environment of their patients. PARENT.
There is one minor criticism. I have, for the good of my surgical soul and to familiarise myself with the process, developed the habit of turning mg. per 100 ml. into m.eq. per litre and back again whenever I meet them. Whereas the other m.eq. quoted in the article are correct to the nearest 10, 450 ml. of 6% NaCl are twice given, in table 11 and caserecord 1, as containing 480 m.eq. Surely this should be 460
the recent
..
A COOLING UNIT IN CLOSED-CIRCUIT ANÆSTHESIA
SiR,ŁI have successfully used a closed respiratory circuit cooled down to 16°F to maintain heat-balance in therapeutic sweating, and I believe that a similar system in a closed-circuit unit for anaesthesia could lower bodytemperature and metabolism during operations. The fall in circulation-rate with " artificial hibernation decreases bleeding in the operation area and reduces the danger of surgical shock ; but anaesthetic techniques that lower the body-temperature by drugs and/or physical cooling introduce other drug hazards difficult to control. Before the induction of anaesthesia there is usuallv constriction of the skin vessels, which is often followed by a cold sweat due to mental stimuli or shock. During normal anaesthesia with a closed-circuit unit with an average volume of about 21/2 litres, including corrugated tubes and mask, there is a steady rise in blood-temperature because of the continuous inhalation of warm gas of high relative and absolute humidity. The temperature of the inspired gas at the face-mask averages 102°-105°F for a Waters’s absorber, and 89°-91°F for a circle unit. These temperatures relate to a breathing rate of 18 per a tidal volume of 500 c.cm., _and a canister of soda lime 8 cm. by 13 cm.1 The temperature of the inspired gases in a Waters’s absorber are higher than the blood-temperature, while in the closed-circuit unit they are only 8-4Ł7’4°F lower than blood-temperature ; but both their absolute and relative humidities are high. Thus the gases in the Waters’s absorber, In the instead of cooling the lung vascular bed, warm it. circle unit there is a slight tendency to cool the blood, but the cooling effect on the lung bed cannot compare with that produced by the inhalation of gas at normal atmospheric temperatures and low absolute and relative humidities.
min.,
The steady rise in temperature turns the cold sweat into a hot sweat and the skin vessels are dilated. The soda-lime container also adds its quota of heat and water to the inspired gases, for each gramme-molecule of CO2 produces 310 calories and water. Under normal conditions only a small proportion of the heat produced is used in warming the inspired air. These considerations suggest that we might regulate the temperature of the inspired gases by means of a cooling system before attempting to lower the bodytemperature by drugs and physical cooling. A cooling system in the return circuit to the face-mask could bring down the temperature of the inspired gases to 32°F, 1.
Adrian, J. Chemistry
of Anesthesia.
Springfield,
1946.