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MANAGEMENT OF RESPIRATORY PARALYSIS
1340 She had been very good-so very sensible for a small person. The first night at home she woke a lot and did not want me to leave her once. We put her bed in our room so that I could be near and reassure her when she woke. She cried a lot the first week, but it grew less. After a fortnight she was ready to go back to her own room, and now sleeps quietly and soundly. But much less serious have been the effects on her, because I went to see her.
enough.
In addition to the matter of parents visiting, I would like to mention that in all these cases the anaesthetic was not given until the child had been taken into the operating-theatre. Just think of the young child’s feelings on seeing the strange white-gowned figuresno familiar faces-and feeling very frightened and alone. Is it not possible to give the anaesthetic befo_e leaving the ward, so that the child goes to sleep in bed and wakes up with it all over ? A MOTHER.
Fig. 2-Breathing-meter valve for measurement maximum breathing capacity, or tidal
It
should, therefore, be ideal for occasional or intermittent in a hospital ward, a house, or an ambulance. The new sucker (fig. 1) was powerful and reliable when solely employed
use
during a period of weeks for aspirating the air passages of a patient with respiratory paralysis and a tracheotomy. It consists, principally, of a spring-return foot-pump of about 100 mm. diameter and about 750 c.cm. capacity, and a
capacity,
the ventilation achieved with a respirator or to follow 2 progress in the recovery period.1 Such measurements can be made by leading the expired air to a dry or a water breathing meter and observing a series of breaths. In doing this it is inconvenient and inaccurate to have to displace, during inspiration, the face-mask or the connection to a cuffed endotracheal or tracheostomy tube. Though the difficulty is not present when an inspiratory;’ expiratory valve with a single expiratory vent is in operation; it is there at other times. The present device meets the problem by means of a pair of low-resistance inspiratory and expiratory valves arranged to allow inspiration only from air and expiration only into the spirometer (fig. 2). We are indebted to Capt. G. T. Smith-Clarke, chairman, Group 20 Hospital Management Committee, Birmingham Regional Hospital Board, for much technical and other advice.
measure
MANAGEMENT OF RESPIRATORY PARALYSIS SIR,-Two accessories designed primarily to aid the
management of respiratory paralysis have recently been made by Capt. G. T. Smith-Clarke, of Coventry. Foot-operated Suction Apparatus The obvious advantages of a foot-operated sucker are extreme portability, independence of a source of power (electricity, compressed gas, or water pressure), and cheapness.
of vital air.
_
Whitley Hospital, Coventry.
J. F. GALPINE COLM BRADY.
unidirectional
valve mounted on the lid of a suction bottle. The bottle sits in a deep recess
which gives protection, and the whole apparatus is robust
though light (12 lb. 2 oz., weighed with-
CANCER OF THE FEMALE BREAST
SIR,-In his article (Nov. 26) Dr. McKenzie compares the 5-year-survival rates of patients of very different But should not the difference between age-groups. survival-rate of these age-groups in the population as a whole be taken into account ? It seems to me that, for instance, the quotients of " normal " and patients’ survival-rate would be a better basis for comparison; and assessment on this basis leads to conclusions other than those reached by Dr. McKenzie.
out pressure
The Hague, Holland.
tubing). On testing it by pumping up a column of water the sucker
easily produces a partialI vacuum
of
a
half
atmosphere (about 15 in. Hg) and can
in fact suck almostt a n Fig. I-Foot-operated atmosphere if the suction catheter is blocked. The surprising power of this pump is due to its comparatively large bore which is a special feature. As suction is only exerted on the down-stroke of the foot the effect is discontinuous. This lessens the possibility of the suction catheter producing an undesirable degree of partial vacuum in the bronchi. At the same time nothing is lost in efficiency since with each stroke the build-up of suction is virtually instantaneous. The degree of suction can be varied If considerable resistance to suction suddenly at will. develops, as it may if the eye of the catheter becomes jammed against the mucous membrane, it is immediately reflected in the resistance of the pedal, release of which abolishes suction and prevents drag on the tissues. suction apparatus.
Valve Assembly for Use with a Spirometer In the management of respiratory paralysis, frequent estimates of tidal air, minute volume, and vital capacity must supplement clinical assessment of respiratory insufficiency, to
F. P. HOLTZER.
STAFFING LABORATORIES
SiR,—The consternation expressed by Mr. Snow colleagues (Dec. 10) is shared by others. The
and his
proposed new grading and salary-scales will increase difficulty of staffing laboratories in the smaller specialised hospitals. To attain the higher category in the senior-technologist grade, the technologist of such a hospital will presumably have to transfer to a laboratory with a larger staff. Replacement will be virtually impossible. Even within the laboratory, the proposed scale may mean that a technologist of average ability, but with sufficient juniors working under him, will be paid more than a technologist of first-class ability in whose " division " the number of juniors is less. Such a system smacks of the Civil Service at its worst. Remuneration in the higher grades of technology should depend on individual merit. Recommendation for the higher categories should be the prerogative of the pathologist-in-charge. An arbitrary formula, as in the new proposals, will lessen the responsibility of the pathologist and lead to discontent amongst his technical the
staff. Women’s and
Maternity Hospitals,
United Birmingham Hospitals.
CLAUD W. TAYLOR.
Dail, C. W. Acute Phase of Poliomyelitis. Baltimore, 1954; p. 164. 2. Smith, A. C., Spalding, J. M. K., Russell, W. R. Lancet, 1954, i, 939. 1.
enough.
In addition to the matter of parents visiting, I would like to mention that in all these cases the anaesthetic was not given until the child had been taken into the operating-theatre. Just think of the young child’s feelings on seeing the strange white-gowned figuresno familiar faces-and feeling very frightened and alone. Is it not possible to give the anaesthetic befo_e leaving the ward, so that the child goes to sleep in bed and wakes up with it all over ? A MOTHER.
Fig. 2-Breathing-meter valve for measurement maximum breathing capacity, or tidal
It
should, therefore, be ideal for occasional or intermittent in a hospital ward, a house, or an ambulance. The new sucker (fig. 1) was powerful and reliable when solely employed
use
during a period of weeks for aspirating the air passages of a patient with respiratory paralysis and a tracheotomy. It consists, principally, of a spring-return foot-pump of about 100 mm. diameter and about 750 c.cm. capacity, and a
capacity,
the ventilation achieved with a respirator or to follow 2 progress in the recovery period.1 Such measurements can be made by leading the expired air to a dry or a water breathing meter and observing a series of breaths. In doing this it is inconvenient and inaccurate to have to displace, during inspiration, the face-mask or the connection to a cuffed endotracheal or tracheostomy tube. Though the difficulty is not present when an inspiratory;’ expiratory valve with a single expiratory vent is in operation; it is there at other times. The present device meets the problem by means of a pair of low-resistance inspiratory and expiratory valves arranged to allow inspiration only from air and expiration only into the spirometer (fig. 2). We are indebted to Capt. G. T. Smith-Clarke, chairman, Group 20 Hospital Management Committee, Birmingham Regional Hospital Board, for much technical and other advice.
measure
MANAGEMENT OF RESPIRATORY PARALYSIS SIR,-Two accessories designed primarily to aid the
management of respiratory paralysis have recently been made by Capt. G. T. Smith-Clarke, of Coventry. Foot-operated Suction Apparatus The obvious advantages of a foot-operated sucker are extreme portability, independence of a source of power (electricity, compressed gas, or water pressure), and cheapness.
of vital air.
_
Whitley Hospital, Coventry.
J. F. GALPINE COLM BRADY.
unidirectional
valve mounted on the lid of a suction bottle. The bottle sits in a deep recess
which gives protection, and the whole apparatus is robust
though light (12 lb. 2 oz., weighed with-
CANCER OF THE FEMALE BREAST
SIR,-In his article (Nov. 26) Dr. McKenzie compares the 5-year-survival rates of patients of very different But should not the difference between age-groups. survival-rate of these age-groups in the population as a whole be taken into account ? It seems to me that, for instance, the quotients of " normal " and patients’ survival-rate would be a better basis for comparison; and assessment on this basis leads to conclusions other than those reached by Dr. McKenzie.
out pressure
The Hague, Holland.
tubing). On testing it by pumping up a column of water the sucker
easily produces a partialI vacuum
of
a
half
atmosphere (about 15 in. Hg) and can
in fact suck almostt a n Fig. I-Foot-operated atmosphere if the suction catheter is blocked. The surprising power of this pump is due to its comparatively large bore which is a special feature. As suction is only exerted on the down-stroke of the foot the effect is discontinuous. This lessens the possibility of the suction catheter producing an undesirable degree of partial vacuum in the bronchi. At the same time nothing is lost in efficiency since with each stroke the build-up of suction is virtually instantaneous. The degree of suction can be varied If considerable resistance to suction suddenly at will. develops, as it may if the eye of the catheter becomes jammed against the mucous membrane, it is immediately reflected in the resistance of the pedal, release of which abolishes suction and prevents drag on the tissues. suction apparatus.
Valve Assembly for Use with a Spirometer In the management of respiratory paralysis, frequent estimates of tidal air, minute volume, and vital capacity must supplement clinical assessment of respiratory insufficiency, to
F. P. HOLTZER.
STAFFING LABORATORIES
SiR,—The consternation expressed by Mr. Snow colleagues (Dec. 10) is shared by others. The
and his
proposed new grading and salary-scales will increase difficulty of staffing laboratories in the smaller specialised hospitals. To attain the higher category in the senior-technologist grade, the technologist of such a hospital will presumably have to transfer to a laboratory with a larger staff. Replacement will be virtually impossible. Even within the laboratory, the proposed scale may mean that a technologist of average ability, but with sufficient juniors working under him, will be paid more than a technologist of first-class ability in whose " division " the number of juniors is less. Such a system smacks of the Civil Service at its worst. Remuneration in the higher grades of technology should depend on individual merit. Recommendation for the higher categories should be the prerogative of the pathologist-in-charge. An arbitrary formula, as in the new proposals, will lessen the responsibility of the pathologist and lead to discontent amongst his technical the
staff. Women’s and
Maternity Hospitals,
United Birmingham Hospitals.
CLAUD W. TAYLOR.
Dail, C. W. Acute Phase of Poliomyelitis. Baltimore, 1954; p. 164. 2. Smith, A. C., Spalding, J. M. K., Russell, W. R. Lancet, 1954, i, 939. 1.