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INTESTINAL OBSTRUCTION IN INFANTS
701
large muscles. Thus in poliomyelitis paralysis usually appears
large muscles and rarely in small ones. 6. By intersecting the axon between the nerve-cell and its corresponding field of action and thus giving the greatest possible rest to the nerve-cell, this may be spared from complete destruction by the virus.2 in
complete physical and mental quiet the patient with poliomyelitis. indispensable Therefore it is logical to intensify rest and relaxation by giving sedatives systematically, in order to achieve over several days in the preparalytic stage the " state of sleep" suggested by Scheidt,6 Weidner,’ and NonnenWe conclude that
for
is
bruch.8
DISCLAIMER
Mr. Cyril Cooper, joint Products Ltd., writes :
managing
director of Clinical
.
"
As manufacturers of Persomnia ’ tablets we should like to the letter (March 21) from Dr. M. G. L. Lucas, who has been coroner for Bedford since Oct. 1, 1952. The findings which we circulated to the medical profession were those of the coroner who conducted both the original inquest to
reply
and the resumed inquest on Sept. 23, 1952. They were given by him after hearing the evidence of expert witnesses provided both by the Crown and by ourselves at the invitation of the No suggestion was made in the accompanying letter coroner. that Dr. Lucas was in any way associated with the
A detailed account is to appear in the Xiinchener medizinische W ochenschnft. TH. BREHME W. LEUTERER.
proceedings."
MENTAL ACTIVITY IN INFANCY SiR,—I was very interested in the paper by Mrs. Collis (Feb. 28). The assessment of the intelligence of older children with cerebral palsy is a matter of considerable difficulty, and for that reason alone it is unlikely to be easy to predict intelligence in a 4-month-old baby with that condition. Some of us, furthermore, think that it is difficult to predict intelligence at 4 months in an
Registration Service Bill THIS Bill, which was introduced in the House of Lords on March 24, is a consolidating measure dealing with the central and local organisation of the service which, under the Registrar-General, administers the law on registration of births, marriages, and deaths and many aspects of solemnisation of marriages in England and Wales. This body of law has been contained in a large number of scattered enactments, some of them old and not easy to read together.
apparently normal baby without cerebral palsy. Mrs. Collis has given no evidence that she is able to predict intelligence in the cerebral palsy babies, and it would be most interesting if she would produce this evidence. Though admittedly neuromuscular development in babies is closely related to mental development, there are other very important features in a ’baby which one also uses in assessing his mental development-such as his alertness, his interest in his surroundings, his social responsiveness, his response to sound, his desire to achieve acts, such as grasping objects, for which his neuromuscular coordination is not quite ready, his so on. Does Mrs. Collis pay no attention to these in the babies which she examines’I
vocalisations, and
Department of Child Health,
University
of Sheffield.
R. S. ILLINGWORTH.
INTESTINAL OBSTRUCTION IN INFANTS
SiR,—There has in recent years been
a
striking
reduction in the mortality from intestinal obstruction in infants, particularly in cases of intussusception and intestinal obstruction of the newborn. You suggest in your annotation of March 7 that these results can be further improved by treating such infants in special psediatric units where nurses and surgeons have a wide experience of these conditions. All authorities agree that early diagnosis and treatment (preoperative and surgical) are essential. Available statistics suggest that after 96 hours the mortalityrate, even in the most capable hands, is practically 100%. While the provision of special units in major regional centres serving densely populated areas is very desirable, it is questionable whether the delay and disturbance necessarily involved in transferring these infants (many of them premature) from outlying hospitals is justified. Practically all peripheral hospital centres now have paediatric units ; furthermore, at these centres it is now normal and beneficial for paediatric surgery to be a special interest of a general surgeon who, owing to the development of other branches of surgery, is a specialist in abdominal surgery. This interest should be carefully fostered, and abdominal surgery of infants should rightly remain within his province. W. P. SWEETNAM Royal Infirmary,
Consultant pædiatrician to the Huddersfield and Halifax
Huddersfield.
Hospital Groups.
6. Scheldt, W. Das vegetative System. Hamburg, 1948 ; vols. 6 and 7. 7. Weidner, K. Med. Klin. 1951, 46, 240 ; Ibid, 1952, 47, 1093. 8. Nonnenbruch, W. Personal communication.
Parliament ,
’
QUESTION TIME Using Hospital Endowments Mr. JOHN PATON asked the Minister of Health if, in view of the curtailment and postponement of the capital expenditure programmes of the National Hospital Service, owing to the need for national economy, he would sanction the realisation of certain of the investments of the Hospital Endowments Fund and allow the proceeds to be used for capital projects of an urgent nature.-Mr. MACLEOD replied : I regret that this interesting suggestion is not practicable at present. Mr. PATON : Is the Minister aware of the widespread feeling of frustration and deep anxiety about the inevitable stoppage of hospital development ? Mr. MACLEOD : It is quite untrue that there is a stoppage of hospital development. The amount of money allocated for capital resources is more or less the same. The difficulty of the proposal is that the fact that new money is put in does not increase the resources available for capital investment. Replying to Mr. G. R. HOWARD, Mr. MACLEOD said he was not anxious to get into a position in which free moneys were used for purposes for which the Exchequer should be primarily responsible. He appreciated, however, that there was considerable difficulty, to which the Select Committee on Estimates had drawn attention, in the use and spending of free moneys. He was constantly studying whether better guidance could be given.
-
Cost of
Prescriptions
Replying to a question, Miss M. P. HORNSBY
-SMITH said that and Wales the estimated average number of prescriptions per form was 1-71 in February, 1953, 1-57 in May, 1952, and 1-59 in February, 1952. The estimated average cost was about 4s. 2d. in December, 1952, 4s. 14d. in May, 1952, and 3s. 10d.in December, 1951. in
England
Group Medical Practice Mr. H. A. MARQUAND asked the Minister whether he had drawn the attention of executive councils and their medical committees to the fact that both he and the General Medical Services Committee had accepted the encouragement of group practice as a desirable objective.—Mr. MACLEOD replied: I have now received advice from the Central Health Services Council on the definition of group practice, and I propose shortly to discuss with representatives of the medical profession how best to implement the recommendation on group practice of the Working Party on the distribution of remuneration of general practitioners. I will consider what publicity should be given to the conclusions which Sir Henry Cohen’s committee have reached. Doctors’ Surgeries and Waiting-rooms Dr. SANTO JEGER asked the Minister what regulations- had been made on the standard of surgery and waiting-room
large muscles. Thus in poliomyelitis paralysis usually appears
large muscles and rarely in small ones. 6. By intersecting the axon between the nerve-cell and its corresponding field of action and thus giving the greatest possible rest to the nerve-cell, this may be spared from complete destruction by the virus.2 in
complete physical and mental quiet the patient with poliomyelitis. indispensable Therefore it is logical to intensify rest and relaxation by giving sedatives systematically, in order to achieve over several days in the preparalytic stage the " state of sleep" suggested by Scheidt,6 Weidner,’ and NonnenWe conclude that
for
is
bruch.8
DISCLAIMER
Mr. Cyril Cooper, joint Products Ltd., writes :
managing
director of Clinical
.
"
As manufacturers of Persomnia ’ tablets we should like to the letter (March 21) from Dr. M. G. L. Lucas, who has been coroner for Bedford since Oct. 1, 1952. The findings which we circulated to the medical profession were those of the coroner who conducted both the original inquest to
reply
and the resumed inquest on Sept. 23, 1952. They were given by him after hearing the evidence of expert witnesses provided both by the Crown and by ourselves at the invitation of the No suggestion was made in the accompanying letter coroner. that Dr. Lucas was in any way associated with the
A detailed account is to appear in the Xiinchener medizinische W ochenschnft. TH. BREHME W. LEUTERER.
proceedings."
MENTAL ACTIVITY IN INFANCY SiR,—I was very interested in the paper by Mrs. Collis (Feb. 28). The assessment of the intelligence of older children with cerebral palsy is a matter of considerable difficulty, and for that reason alone it is unlikely to be easy to predict intelligence in a 4-month-old baby with that condition. Some of us, furthermore, think that it is difficult to predict intelligence at 4 months in an
Registration Service Bill THIS Bill, which was introduced in the House of Lords on March 24, is a consolidating measure dealing with the central and local organisation of the service which, under the Registrar-General, administers the law on registration of births, marriages, and deaths and many aspects of solemnisation of marriages in England and Wales. This body of law has been contained in a large number of scattered enactments, some of them old and not easy to read together.
apparently normal baby without cerebral palsy. Mrs. Collis has given no evidence that she is able to predict intelligence in the cerebral palsy babies, and it would be most interesting if she would produce this evidence. Though admittedly neuromuscular development in babies is closely related to mental development, there are other very important features in a ’baby which one also uses in assessing his mental development-such as his alertness, his interest in his surroundings, his social responsiveness, his response to sound, his desire to achieve acts, such as grasping objects, for which his neuromuscular coordination is not quite ready, his so on. Does Mrs. Collis pay no attention to these in the babies which she examines’I
vocalisations, and
Department of Child Health,
University
of Sheffield.
R. S. ILLINGWORTH.
INTESTINAL OBSTRUCTION IN INFANTS
SiR,—There has in recent years been
a
striking
reduction in the mortality from intestinal obstruction in infants, particularly in cases of intussusception and intestinal obstruction of the newborn. You suggest in your annotation of March 7 that these results can be further improved by treating such infants in special psediatric units where nurses and surgeons have a wide experience of these conditions. All authorities agree that early diagnosis and treatment (preoperative and surgical) are essential. Available statistics suggest that after 96 hours the mortalityrate, even in the most capable hands, is practically 100%. While the provision of special units in major regional centres serving densely populated areas is very desirable, it is questionable whether the delay and disturbance necessarily involved in transferring these infants (many of them premature) from outlying hospitals is justified. Practically all peripheral hospital centres now have paediatric units ; furthermore, at these centres it is now normal and beneficial for paediatric surgery to be a special interest of a general surgeon who, owing to the development of other branches of surgery, is a specialist in abdominal surgery. This interest should be carefully fostered, and abdominal surgery of infants should rightly remain within his province. W. P. SWEETNAM Royal Infirmary,
Consultant pædiatrician to the Huddersfield and Halifax
Huddersfield.
Hospital Groups.
6. Scheldt, W. Das vegetative System. Hamburg, 1948 ; vols. 6 and 7. 7. Weidner, K. Med. Klin. 1951, 46, 240 ; Ibid, 1952, 47, 1093. 8. Nonnenbruch, W. Personal communication.
Parliament ,
’
QUESTION TIME Using Hospital Endowments Mr. JOHN PATON asked the Minister of Health if, in view of the curtailment and postponement of the capital expenditure programmes of the National Hospital Service, owing to the need for national economy, he would sanction the realisation of certain of the investments of the Hospital Endowments Fund and allow the proceeds to be used for capital projects of an urgent nature.-Mr. MACLEOD replied : I regret that this interesting suggestion is not practicable at present. Mr. PATON : Is the Minister aware of the widespread feeling of frustration and deep anxiety about the inevitable stoppage of hospital development ? Mr. MACLEOD : It is quite untrue that there is a stoppage of hospital development. The amount of money allocated for capital resources is more or less the same. The difficulty of the proposal is that the fact that new money is put in does not increase the resources available for capital investment. Replying to Mr. G. R. HOWARD, Mr. MACLEOD said he was not anxious to get into a position in which free moneys were used for purposes for which the Exchequer should be primarily responsible. He appreciated, however, that there was considerable difficulty, to which the Select Committee on Estimates had drawn attention, in the use and spending of free moneys. He was constantly studying whether better guidance could be given.
-
Cost of
Prescriptions
Replying to a question, Miss M. P. HORNSBY
-SMITH said that and Wales the estimated average number of prescriptions per form was 1-71 in February, 1953, 1-57 in May, 1952, and 1-59 in February, 1952. The estimated average cost was about 4s. 2d. in December, 1952, 4s. 14d. in May, 1952, and 3s. 10d.in December, 1951. in
England
Group Medical Practice Mr. H. A. MARQUAND asked the Minister whether he had drawn the attention of executive councils and their medical committees to the fact that both he and the General Medical Services Committee had accepted the encouragement of group practice as a desirable objective.—Mr. MACLEOD replied: I have now received advice from the Central Health Services Council on the definition of group practice, and I propose shortly to discuss with representatives of the medical profession how best to implement the recommendation on group practice of the Working Party on the distribution of remuneration of general practitioners. I will consider what publicity should be given to the conclusions which Sir Henry Cohen’s committee have reached. Doctors’ Surgeries and Waiting-rooms Dr. SANTO JEGER asked the Minister what regulations- had been made on the standard of surgery and waiting-room