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KERNICTERUS AND PREMATURITY
74 these factors may not be wholly absent. Human frailties of this kind we shall always have, but what is now implied is worse than this ; it is an error of thinking and method, a true quackery now to be introduced into medicine. In the last resort, such a censorship of hospital research work as is now adumbrated must be the responsibility of a single individual who will have to decide which research project is to be encouraged and which banned. However catholic his knowledge of the vast and variegated field of medical research, no one man can exercise this function rationally or equitably, and he must, in undertaking it, become an administrative medical quack. Moreover, the whole notion betrays an abysmal ignorance of the nature of clinical research. The spirit bloweth where it listeth, and no-one can foretell of any research project, within wide limits, what possibilities of fruit it holds. Equally it cannot be foreseen what light a single piece of research may throw upon another and an independent one which covers the same field. We should not say to Goethe : " there is no need for you to write a drama about Faust, for a very excellent one has already been written by Marlowe ; and we really can’t allow you to spend your time and our money this way, for after all, you are a State salaried official." Yet, mutatis mutandis, something as absurd and as intolerable as this is what is now proposed. That a single central authority or person should be imposed upon us to decide which infant idea is to be strangled at birth and which conceded nourishment is a development which will take no wise spectator of what is happening to medicine by surprise, but even the most guileless of us must view it with grave disquiet. F. M. R. WALSHE. London, BV.l.
though
GENERAL ANÆSTHESIA FOR BRONCHOGRAPHY IN CHILDREN
SIR,-I have read with interest, in your issue of June 10, the technique employed by Dr. Way and Mr. James for anaesthetising children for bronchography ; but I agree with Dr. Wright (June 24) that the dosages of thiopentone mentioned may be dangerously large. I have known 0.5 g. of 5% thiopentone solution given to a boy, aged 5 and of average weight, prior to intubation for bronchography, prove to be a gross overdose. A technique which I have found satisfactory in a small series of cases is as follows : Approx.
Premedication (1 hr. before op.) ’Omnopon’ (gr.) + hyoscine (gr.) 2-4 1/12 + 1/600 2-21/2 4-10 1/9 + 1/450 21/2-41/2 10-12 1/6 + 1/3000 41/2-’51/2 Anaesthesia is induced with a mixture of 5% thiopentone and d-tubocurarine chloride. If age and body-weight tally, 1 ml. of thiopentone is given per year of age and 2 mg. of tubocurarine per st. body-weight. The injection is given through a no. 19’Vim’ needle, and after insufflation with oxygen a special endotracheal tube with side tube (which I rightly or wrongly have called a Jones’s tube), lubricated with
Age (years)
normal
weight (st.)
1%Anethaine
’ cream, is introduced into the trachea. Macintosh laryngoscope is used, and intubation is facilitated by the use of a stilette passing through a Cobbs union with the cap removed and three-quarters of the length of the endotracheal tube. The pharynx is then packed off with gauze soaked in normal saline. Anaesthesia is maintained with nitrous oxide and oxygen (30%), given through a closed circuit. Respiration is assisted ; and if the tidal exchange is inadequate at the end of the bronchography a small dose of neostigmine and atropine is administered. A
This method has produced most satisfactory bronchograms. There is no explosion hazard, and the children have left the X-ray department with brisk reflexes. W. N. ROLLASON. Hull.
KERNICTERUS AND PREMATURITY SIR,-I was interested in the article of June 24 by Dr. Aidin and his colleagues, showing that the pathological findings of kernicterus " are not limited to cases of Rh incompatibility. There is clinical evidence that "
incompatibility is not the only cause of neonatal jaundice with neurological sequelae. In a series of 55 athetoids recently seen at this hospital, 31 had a history of severe neonatal jaundice. Of these, 19 were proved In 5 cases the Rh groups aases of Rh incompatibility. of mother and child were compatible ; in 4 others, whose blood was not investigated, the history did not suggest haemolytic disease of the newborn, as the children were Rh
firstborn and the mothers had had no blood-transfusion. Children with other varieties of cerebral palsy seldom have a history of birth jaundice. In our series (shortly to be published) only 7 out of 313 spastics and mixed cases had such a history, although a higher percentage of these children than of the athetoids had been premature babies. Nor is neonatal jaundice followed by athetosis found only among premature babies-only 5 of our 12 cases in which Rh incompatibility was not proved had birth weights of 51b. Soz. or under. Department of Pædiatrics and Child PATRIA ASHER. Health, University of Birmingham. MEDICAL PEACE CAMPAIGN
number of members of the medical then associated with the late profession, Prof. J. A. Ryle and the late Dr. Cecile Booysen, initiated a Medical Peace Campaign. Its purpose will be obvious from its name. In 1939 the organisation discontinued its activities, after holding various meetings and publishing several reports and a number of issues of its bulletin. Since the close of the war it has been found difficult, for one reason or another, to assemble the members of the original committee. Finally, at a committee meeting held on May 19 last it was agreed to devote the remaining funds of the organisation to the relief of distress caused by war ; and the sum of f:65 has accordingly been donated to the Friends Relief Council with the request that it be used particularly for relief in China. The committee appreciated that the cause of peace in the world is as much in need of support as ever it was in the past ; but it expressed the view that its members could best serve that cause by associating themselves with one or other of the active organisations working for
SIR,-In 1937 who
t’ht-.
iiiir-nogt-.-
a
were
T-
T__
HORACE JOULES
STELLA CHURCHILL F. LE GROS CLARK. SELF-HELP OF UNDEREMPLOYED DOCTORS SiR,-It is proposed to form a team-or several teamsof doctors, men and women who, like myself, are now without appropriate work or income. This team is going to offer its services to the National Health Service and will settle wherever it is most needed. This may be in an underdoctored area or in support of overworked outpatient departments. Its members are going to pool their resources of brains and skill, equipment, and money. They will acquire two houses and adapt the one for use as a central surgery with all facilities for diagnosis and outpatient treatment, the other as living quarters for themselves and their families. Work, service, and expenses will be shared by members and their wives (or husbands). So will the income. Each member will be required to practise as a general practitioner besides having a chance of using special experience. All must be prepared to share fully the risks and hard ships of the first years. All will be stimulated by the knowledge that they are fighting common adversity by a combined effort, and that the success of their venture will lead to a decent livelihood earned by work of a high standard.
though
GENERAL ANÆSTHESIA FOR BRONCHOGRAPHY IN CHILDREN
SIR,-I have read with interest, in your issue of June 10, the technique employed by Dr. Way and Mr. James for anaesthetising children for bronchography ; but I agree with Dr. Wright (June 24) that the dosages of thiopentone mentioned may be dangerously large. I have known 0.5 g. of 5% thiopentone solution given to a boy, aged 5 and of average weight, prior to intubation for bronchography, prove to be a gross overdose. A technique which I have found satisfactory in a small series of cases is as follows : Approx.
Premedication (1 hr. before op.) ’Omnopon’ (gr.) + hyoscine (gr.) 2-4 1/12 + 1/600 2-21/2 4-10 1/9 + 1/450 21/2-41/2 10-12 1/6 + 1/3000 41/2-’51/2 Anaesthesia is induced with a mixture of 5% thiopentone and d-tubocurarine chloride. If age and body-weight tally, 1 ml. of thiopentone is given per year of age and 2 mg. of tubocurarine per st. body-weight. The injection is given through a no. 19’Vim’ needle, and after insufflation with oxygen a special endotracheal tube with side tube (which I rightly or wrongly have called a Jones’s tube), lubricated with
Age (years)
normal
weight (st.)
1%Anethaine
’ cream, is introduced into the trachea. Macintosh laryngoscope is used, and intubation is facilitated by the use of a stilette passing through a Cobbs union with the cap removed and three-quarters of the length of the endotracheal tube. The pharynx is then packed off with gauze soaked in normal saline. Anaesthesia is maintained with nitrous oxide and oxygen (30%), given through a closed circuit. Respiration is assisted ; and if the tidal exchange is inadequate at the end of the bronchography a small dose of neostigmine and atropine is administered. A
This method has produced most satisfactory bronchograms. There is no explosion hazard, and the children have left the X-ray department with brisk reflexes. W. N. ROLLASON. Hull.
KERNICTERUS AND PREMATURITY SIR,-I was interested in the article of June 24 by Dr. Aidin and his colleagues, showing that the pathological findings of kernicterus " are not limited to cases of Rh incompatibility. There is clinical evidence that "
incompatibility is not the only cause of neonatal jaundice with neurological sequelae. In a series of 55 athetoids recently seen at this hospital, 31 had a history of severe neonatal jaundice. Of these, 19 were proved In 5 cases the Rh groups aases of Rh incompatibility. of mother and child were compatible ; in 4 others, whose blood was not investigated, the history did not suggest haemolytic disease of the newborn, as the children were Rh
firstborn and the mothers had had no blood-transfusion. Children with other varieties of cerebral palsy seldom have a history of birth jaundice. In our series (shortly to be published) only 7 out of 313 spastics and mixed cases had such a history, although a higher percentage of these children than of the athetoids had been premature babies. Nor is neonatal jaundice followed by athetosis found only among premature babies-only 5 of our 12 cases in which Rh incompatibility was not proved had birth weights of 51b. Soz. or under. Department of Pædiatrics and Child PATRIA ASHER. Health, University of Birmingham. MEDICAL PEACE CAMPAIGN
number of members of the medical then associated with the late profession, Prof. J. A. Ryle and the late Dr. Cecile Booysen, initiated a Medical Peace Campaign. Its purpose will be obvious from its name. In 1939 the organisation discontinued its activities, after holding various meetings and publishing several reports and a number of issues of its bulletin. Since the close of the war it has been found difficult, for one reason or another, to assemble the members of the original committee. Finally, at a committee meeting held on May 19 last it was agreed to devote the remaining funds of the organisation to the relief of distress caused by war ; and the sum of f:65 has accordingly been donated to the Friends Relief Council with the request that it be used particularly for relief in China. The committee appreciated that the cause of peace in the world is as much in need of support as ever it was in the past ; but it expressed the view that its members could best serve that cause by associating themselves with one or other of the active organisations working for
SIR,-In 1937 who
t’ht-.
iiiir-nogt-.-
a
were
T-
T__
HORACE JOULES
STELLA CHURCHILL F. LE GROS CLARK. SELF-HELP OF UNDEREMPLOYED DOCTORS SiR,-It is proposed to form a team-or several teamsof doctors, men and women who, like myself, are now without appropriate work or income. This team is going to offer its services to the National Health Service and will settle wherever it is most needed. This may be in an underdoctored area or in support of overworked outpatient departments. Its members are going to pool their resources of brains and skill, equipment, and money. They will acquire two houses and adapt the one for use as a central surgery with all facilities for diagnosis and outpatient treatment, the other as living quarters for themselves and their families. Work, service, and expenses will be shared by members and their wives (or husbands). So will the income. Each member will be required to practise as a general practitioner besides having a chance of using special experience. All must be prepared to share fully the risks and hard ships of the first years. All will be stimulated by the knowledge that they are fighting common adversity by a combined effort, and that the success of their venture will lead to a decent livelihood earned by work of a high standard.