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HOSPITAL, DOCTOR, AND PATIENT
982 a very few minutes, with an accuracy which is quite satisfactory for most purposes. The extraction and estimation techniques serve equally well for the measurement of dinitro-butylphenol, another toxic chemical used for controlling weeds in peas, beans, and other legumes. If, for any reason, plasma or serum is used instead of whole blood, the measurements will be approximately twice as high as the whole-blood levels, since the vast majority of the chemical is held in the plasma, with little in the
within
cells. The comparator and special‘ D.N.O.C. ’ disc from Messrs. Tintometer Ltd., Waterloo Road,
are
available
Salisbury.
E. F. EDSON
Pest Control Ltd.,
Medical officer.
Cambridge.
HOSPITAL, DOCTOR, AND PATIENT
SIR,—May
I
crave a
little
more
of your valuable space
to enter the arena again ? Mr. King (April 17) is acting with admirable intention and no doubt in his hospital it works. But may I ask what steps he, or the management committee, take to
inform the parents of his availability for interview ?f Is it printed on the admission note ? Patients have a great fear of authority, and particularly when it is shrouded in the grand mystery of imposing hospital buildings. I am sure a parent would not ask a sister for this privilege (if privilege it is) unless directly
It is to such as these-the common people if I may be allowed without offence to call them-that the .book is addressed by one of their number. I do not claim to be anything better than a verbal social worker or missioner in the linguistic slums in which I was myself reared, and which have been created not by any fault of the inhabitants but by the over-population of scientific terms. Those precious and delicate minds who have "any considerable knowledge of words " and who are "sensitive to inaccuracy " (even to trifling misprints) should shun the book like the plague. I have certainly But Heaven help us from no wish to cause them pain. clever people ! My derivation of anaphylaxis " is linguistically correct. If Richet coined the word for the sake of euphony (which you seem to approve) all I can say is that were this example to be generally followed the language of medicine would soon degenerate into the nomenclature of modern drugs and detergents in which a higher commercial value naturally attaches to euphony than to sense. You would no doubt be delighted at such an outcome ; I should regard it with dismay. If my modest contribution to the subject does something to prevent such a consummation I shall feel that I have not written it in vain. PFRANGCON EOBEKTS. "
guided to do so. Secondly, is the sister always on duty at visiting-time ? During my recent stay as a patient in hospital, visitinghours were often manned by junior staff. Are they allowed to,conduct a policy other than that of sealed lips" ? Thirdly, how many of us take up an opportunity for an interview, or write about our queries ? This universal lassitude, or desire not to give trouble, is, I think, a
SIR,—Dr. Terry’s extremely accurate and detailed description (April 10) of white nails in hepatic cirrhosis is of particular interest to me, because I have been closely observing what I assume to be a similar phenomenon in a man of 79 with a grossly dilated heart, angina, and cardiac failure, following myocardial infare-
national characteristic and may account for the fact that many ill-conducted dirty surgeries (do not think I condone them) are still beloved by the patients, because there they can always find their doctor without appointment and -can talk to him without prior notice of their
at rest (though there was no electrocardiographic sign of recent infarction) and early cardiac decompensation (there was little indication of it but fine rales at the bases) since last September, when I was horrified to notice, on Feb. 15, the
"
queries. York.
F. CHARLOTTE NAISH, NAISH. MEDICAL TERMS
SiR,-In your review last week you
seem
to have
completely misunderstood the purpose of this book. Owing to the accidental omission of a "t" in "ballottement" and other " small errors" the reader is warned " that he is being addressed by a fellow doctor rather than a professional philologist." If this warning is intended to convey that the reader must not expect philological perfection I am grateful, though I haveyet to learn that works by professional philologists are invariably free from minor errors. But since you evidently imply that a " fellow doctor " is unqualified to write on the subject I must beg to differ. It is just because no professional philologist has attempted the task that I have stepped in, though fully conscious of my limitations, where angels havebeen too superior to tread. You sneer at the book because it is designed on an level." will condescend to elementary Perhaps you tell me from your Olympian heights on what other level it should have been designedRecollection of my student days and a lifetime’s experience of students, nurses, and auxiliaries have forcibly impressed upon me the confusion and difficulties arising from their ignorance of the meaning of words. One student, at his Final Examination at one of our older universities, had no idea why the lingual artery was so called. Nor are some of their instructors in better case. One of them, a, consultant of high standing, was astonished to learn how " cyanosis" was constructed. "
°
WHITE NAILS
tion in 1938. I had been
treating
him for
severe
and intractable
angina
deathly pallor of all but the terminal 3-4 mm. of his fingernails (see accompanying sketch). There was also striking blanching of the skin on the dorsum of the fingers distal to the proximal interphalangeal joints, and several scars on the forearms stood out startlingly white against the rather dusky surrounding skin. It may have been the gas-light that emphasised these features. Despite their appearance, his fingers were perfectly warm, and his conjunctivas belied their suggestion of ansemia.. His pulse volume was fairly good, and his haemoglobin I found next day to be"132 g. per
100 ml. Now that he is no longer in failure, the nail-beds remain as white as they were, though the skin has resumed its normal hue, and, as far as I can make out in the presence of onychauxis, his toe-nails are similarly affected. There is no abnormal ridgingof the nails ; and, although his liver was admittedly tender and slightly enlarged at the height of his decompensation, there is no clinical evidence of liver damage now.
If this is the condition described by Dr. Terry, as I feel it must be, I cannot offer any hypothesis as to its cause, but I had assumed the condition to be a vascular one. It seemed to me that the arterioles, if not dilated, were certainly not constricted as in Raynaud’s phenomenon, because the fingers were warm ; similarly the
within
cells. The comparator and special‘ D.N.O.C. ’ disc from Messrs. Tintometer Ltd., Waterloo Road,
are
available
Salisbury.
E. F. EDSON
Pest Control Ltd.,
Medical officer.
Cambridge.
HOSPITAL, DOCTOR, AND PATIENT
SIR,—May
I
crave a
little
more
of your valuable space
to enter the arena again ? Mr. King (April 17) is acting with admirable intention and no doubt in his hospital it works. But may I ask what steps he, or the management committee, take to
inform the parents of his availability for interview ?f Is it printed on the admission note ? Patients have a great fear of authority, and particularly when it is shrouded in the grand mystery of imposing hospital buildings. I am sure a parent would not ask a sister for this privilege (if privilege it is) unless directly
It is to such as these-the common people if I may be allowed without offence to call them-that the .book is addressed by one of their number. I do not claim to be anything better than a verbal social worker or missioner in the linguistic slums in which I was myself reared, and which have been created not by any fault of the inhabitants but by the over-population of scientific terms. Those precious and delicate minds who have "any considerable knowledge of words " and who are "sensitive to inaccuracy " (even to trifling misprints) should shun the book like the plague. I have certainly But Heaven help us from no wish to cause them pain. clever people ! My derivation of anaphylaxis " is linguistically correct. If Richet coined the word for the sake of euphony (which you seem to approve) all I can say is that were this example to be generally followed the language of medicine would soon degenerate into the nomenclature of modern drugs and detergents in which a higher commercial value naturally attaches to euphony than to sense. You would no doubt be delighted at such an outcome ; I should regard it with dismay. If my modest contribution to the subject does something to prevent such a consummation I shall feel that I have not written it in vain. PFRANGCON EOBEKTS. "
guided to do so. Secondly, is the sister always on duty at visiting-time ? During my recent stay as a patient in hospital, visitinghours were often manned by junior staff. Are they allowed to,conduct a policy other than that of sealed lips" ? Thirdly, how many of us take up an opportunity for an interview, or write about our queries ? This universal lassitude, or desire not to give trouble, is, I think, a
SIR,—Dr. Terry’s extremely accurate and detailed description (April 10) of white nails in hepatic cirrhosis is of particular interest to me, because I have been closely observing what I assume to be a similar phenomenon in a man of 79 with a grossly dilated heart, angina, and cardiac failure, following myocardial infare-
national characteristic and may account for the fact that many ill-conducted dirty surgeries (do not think I condone them) are still beloved by the patients, because there they can always find their doctor without appointment and -can talk to him without prior notice of their
at rest (though there was no electrocardiographic sign of recent infarction) and early cardiac decompensation (there was little indication of it but fine rales at the bases) since last September, when I was horrified to notice, on Feb. 15, the
"
queries. York.
F. CHARLOTTE NAISH, NAISH. MEDICAL TERMS
SiR,-In your review last week you
seem
to have
completely misunderstood the purpose of this book. Owing to the accidental omission of a "t" in "ballottement" and other " small errors" the reader is warned " that he is being addressed by a fellow doctor rather than a professional philologist." If this warning is intended to convey that the reader must not expect philological perfection I am grateful, though I haveyet to learn that works by professional philologists are invariably free from minor errors. But since you evidently imply that a " fellow doctor " is unqualified to write on the subject I must beg to differ. It is just because no professional philologist has attempted the task that I have stepped in, though fully conscious of my limitations, where angels havebeen too superior to tread. You sneer at the book because it is designed on an level." will condescend to elementary Perhaps you tell me from your Olympian heights on what other level it should have been designedRecollection of my student days and a lifetime’s experience of students, nurses, and auxiliaries have forcibly impressed upon me the confusion and difficulties arising from their ignorance of the meaning of words. One student, at his Final Examination at one of our older universities, had no idea why the lingual artery was so called. Nor are some of their instructors in better case. One of them, a, consultant of high standing, was astonished to learn how " cyanosis" was constructed. "
°
WHITE NAILS
tion in 1938. I had been
treating
him for
severe
and intractable
angina
deathly pallor of all but the terminal 3-4 mm. of his fingernails (see accompanying sketch). There was also striking blanching of the skin on the dorsum of the fingers distal to the proximal interphalangeal joints, and several scars on the forearms stood out startlingly white against the rather dusky surrounding skin. It may have been the gas-light that emphasised these features. Despite their appearance, his fingers were perfectly warm, and his conjunctivas belied their suggestion of ansemia.. His pulse volume was fairly good, and his haemoglobin I found next day to be"132 g. per
100 ml. Now that he is no longer in failure, the nail-beds remain as white as they were, though the skin has resumed its normal hue, and, as far as I can make out in the presence of onychauxis, his toe-nails are similarly affected. There is no abnormal ridgingof the nails ; and, although his liver was admittedly tender and slightly enlarged at the height of his decompensation, there is no clinical evidence of liver damage now.
If this is the condition described by Dr. Terry, as I feel it must be, I cannot offer any hypothesis as to its cause, but I had assumed the condition to be a vascular one. It seemed to me that the arterioles, if not dilated, were certainly not constricted as in Raynaud’s phenomenon, because the fingers were warm ; similarly the