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MASS MINIATURE RADIOGRAPHY
540
Letters
to
the Editor
DISTINCTION AWARDS SIR,-The letter from " A.B.C." in your last issue prompts me to write and explain how those who have a similar dislike for and reluctance to accept Distinction Awards can give the maximum benefit to any charitable object of their choice. If they give a subscription out of their taxed income without covenanting to continue it for seven years that nett amount is the total received by the " charity " ; but if they enter into a covenant to give the same amount each year for seven years or during their lifetime (whichever period is the shorter) the income-tax can be recovered by the charity in whose favour the covenant is drawn. The benefit is thereby
nearly doubled. I hope that many
who may follow the example of A.B.C." will feel inclined to support the Royal Medical Others may have other objects Benevolent Fund. foremost in their minds-such as the Royal Medical Foundation of Epsom College, their own schools or universities, the restoration fund of the Royal College of Surgeons, the extension of the Royal Society of Medicine-or they may wish to divide their gifts between two or more objects. The officers of any of these institutions will be anxious to provide prospective donors with the appropriate forms of covenant. WEBB-JOHNSON "
President, Royal Medical Benevolent Fund. 1, Balliol House, Manor Fields, London, S.W.15.
DANGER OF HEXAMETHONIUM IODIDE SIR,-During the last eight months while using methonium halides, and hexamethonium iodide in particular, on more than one occasion we have observed a marked fall in systolic blood-pressure in robust men. These patients initially had a normal blood-pressure, and the state of circulatory coJlapse which resulted was an incidental finding to our clinical researches. We feel that the dangers accompanying the use of these substances in domiciliary practice should be stressed, and also that insufficient publicity has been given to the use of ephedrine hydrochloride as an antidote. We have confirmed the finding of others, that ephedrine hydrochloride administered intramuscularly in a dose of 1-2 grains will rapidly raise the systolic pressure
again. University Medical Clinic, Stobhill Hospital, Glasgow.
B. R. HILLIS JOHN C. C. KELLY.
MASS MINIATURE RADIOGRAPHY SIR,-Last August I was visited by a doctor from Victoria, Australia. In his opinion, mass miniature radiography would be much more successful in this country if the volunteers were not made to undress for the examination. I was impressed with the idea and proceeded cautiously to ascertain the correct technique for X-raying volunteers without their undressing fully. Our results up till now are very striking. The miniature X-ray films are of a very high quality and are certainly not inferior to those taken in the ordinary way. Women are asked to remove overcoats and coats, necklaces, and metal objects or ornaments, such as brooches, from their blouses. Men remove their jackets and waistcoats, and slip their braces down to the waist. In the case of women, the X-ray films show small metallic buckles and fasteners or clips associated with brassieres, but as a rule these are readily recognised as such and are situated in places where they do not interfere with the reading of the miniature film. The great advantage is that men and women can be X-rayed at the same sessions. This is most beneficial,
especially
at
public
or
"
open " sessions, and at contact can be X-rayed, one after
sessions, when whole families
another. At the moment all male members are invited to attend on one day, and the female members on another. When the whole family can attend at the same time, the response is likely to be very much better. Moreover, much time is saved. Chest Radiography Centre,
Nottingham.
A. E. BEYNON Medical Director.
HOSPITAL ADMINISTRATION
SIR,-I think your correspondent (Sept. 30, p. 450) rather underrates the amount of thought that has been given to administration since the days of Florence
Nightingale. Hospital administration
is merely a part of health. service administration, which is itself a special field of human relations. Principles may be selected at various levels. Those which your correspondent has chosen apply purely at hospital level, but I think that considera. tion of more general principles might be beneficial to the service. In his Linacre lecture Dr. F. M. R. Walshequoted from R. J. Collingwood’s book The Idea of Nature as follows : "
A man who has never reflected upon the principles of his work has not achieved a grown-up man’s attitude to it.... A man who has never enjoyed a certain type of experience cannot reflect upon it."
All doctors in this country have had experience of voluntary teaching hospitals, their obligations and their methods of administration, but only a limited number have had, in addition, experience of local-authority hospitals. The tendency of the Ministry of Health to follow the voluntary-hospital pattern may possibly be due to the fact that those whose reflections have influenced the Ministry have had only limited experience. I suggest as principles the following from my own observations : The purpose, scope, and range of the activity should be enunciated. The duties and obligations of voluntary hospitals were different from those of local-authority hospitals, and the functions of hospitals in a complete coordinated health service are different from either. The organisation should be for human beings in their complete social environment. People should be regarded as free individuals and not as abstractions, such as masses of clinical material. Primary aims should be kept clearly in view, and secondary aims such as, for example, medical education should not be allowed to take first place. The administration should be for the whole of the activity, and the tendency of specialists to organise for parts of people or for narrow sections of the population should be corrected and checked or supplemented. The limitations of technicians-clerical, financial, archi. tectural, engineering, medical, and so on-should be admitted and the interests of the consumer for whom the organisation primarily exists be safeguarded. Responsibility should be clearly defined. Power should not be given without responsibility. Power and responsibility should be placed close together and in proportion to each other. They should be placed close to the point of activity. Power should not be remote and anonymous. The sense of responsibility should not be weakened by the evasions possible in committee control or by diffusion over too wide a field. The consequences of decisions should be demonstrated to the person making the decisions. Duties and responsibilities should be placed in appropriate hands-medical administration should be vested in doctors, clerical in secretaries, financial in accountants, and so forth.
clearly
,
1.
Humanism, History, and Natural Science in Medicine. Edinburgh, 1950.
Letters
to
the Editor
DISTINCTION AWARDS SIR,-The letter from " A.B.C." in your last issue prompts me to write and explain how those who have a similar dislike for and reluctance to accept Distinction Awards can give the maximum benefit to any charitable object of their choice. If they give a subscription out of their taxed income without covenanting to continue it for seven years that nett amount is the total received by the " charity " ; but if they enter into a covenant to give the same amount each year for seven years or during their lifetime (whichever period is the shorter) the income-tax can be recovered by the charity in whose favour the covenant is drawn. The benefit is thereby
nearly doubled. I hope that many
who may follow the example of A.B.C." will feel inclined to support the Royal Medical Others may have other objects Benevolent Fund. foremost in their minds-such as the Royal Medical Foundation of Epsom College, their own schools or universities, the restoration fund of the Royal College of Surgeons, the extension of the Royal Society of Medicine-or they may wish to divide their gifts between two or more objects. The officers of any of these institutions will be anxious to provide prospective donors with the appropriate forms of covenant. WEBB-JOHNSON "
President, Royal Medical Benevolent Fund. 1, Balliol House, Manor Fields, London, S.W.15.
DANGER OF HEXAMETHONIUM IODIDE SIR,-During the last eight months while using methonium halides, and hexamethonium iodide in particular, on more than one occasion we have observed a marked fall in systolic blood-pressure in robust men. These patients initially had a normal blood-pressure, and the state of circulatory coJlapse which resulted was an incidental finding to our clinical researches. We feel that the dangers accompanying the use of these substances in domiciliary practice should be stressed, and also that insufficient publicity has been given to the use of ephedrine hydrochloride as an antidote. We have confirmed the finding of others, that ephedrine hydrochloride administered intramuscularly in a dose of 1-2 grains will rapidly raise the systolic pressure
again. University Medical Clinic, Stobhill Hospital, Glasgow.
B. R. HILLIS JOHN C. C. KELLY.
MASS MINIATURE RADIOGRAPHY SIR,-Last August I was visited by a doctor from Victoria, Australia. In his opinion, mass miniature radiography would be much more successful in this country if the volunteers were not made to undress for the examination. I was impressed with the idea and proceeded cautiously to ascertain the correct technique for X-raying volunteers without their undressing fully. Our results up till now are very striking. The miniature X-ray films are of a very high quality and are certainly not inferior to those taken in the ordinary way. Women are asked to remove overcoats and coats, necklaces, and metal objects or ornaments, such as brooches, from their blouses. Men remove their jackets and waistcoats, and slip their braces down to the waist. In the case of women, the X-ray films show small metallic buckles and fasteners or clips associated with brassieres, but as a rule these are readily recognised as such and are situated in places where they do not interfere with the reading of the miniature film. The great advantage is that men and women can be X-rayed at the same sessions. This is most beneficial,
especially
at
public
or
"
open " sessions, and at contact can be X-rayed, one after
sessions, when whole families
another. At the moment all male members are invited to attend on one day, and the female members on another. When the whole family can attend at the same time, the response is likely to be very much better. Moreover, much time is saved. Chest Radiography Centre,
Nottingham.
A. E. BEYNON Medical Director.
HOSPITAL ADMINISTRATION
SIR,-I think your correspondent (Sept. 30, p. 450) rather underrates the amount of thought that has been given to administration since the days of Florence
Nightingale. Hospital administration
is merely a part of health. service administration, which is itself a special field of human relations. Principles may be selected at various levels. Those which your correspondent has chosen apply purely at hospital level, but I think that considera. tion of more general principles might be beneficial to the service. In his Linacre lecture Dr. F. M. R. Walshequoted from R. J. Collingwood’s book The Idea of Nature as follows : "
A man who has never reflected upon the principles of his work has not achieved a grown-up man’s attitude to it.... A man who has never enjoyed a certain type of experience cannot reflect upon it."
All doctors in this country have had experience of voluntary teaching hospitals, their obligations and their methods of administration, but only a limited number have had, in addition, experience of local-authority hospitals. The tendency of the Ministry of Health to follow the voluntary-hospital pattern may possibly be due to the fact that those whose reflections have influenced the Ministry have had only limited experience. I suggest as principles the following from my own observations : The purpose, scope, and range of the activity should be enunciated. The duties and obligations of voluntary hospitals were different from those of local-authority hospitals, and the functions of hospitals in a complete coordinated health service are different from either. The organisation should be for human beings in their complete social environment. People should be regarded as free individuals and not as abstractions, such as masses of clinical material. Primary aims should be kept clearly in view, and secondary aims such as, for example, medical education should not be allowed to take first place. The administration should be for the whole of the activity, and the tendency of specialists to organise for parts of people or for narrow sections of the population should be corrected and checked or supplemented. The limitations of technicians-clerical, financial, archi. tectural, engineering, medical, and so on-should be admitted and the interests of the consumer for whom the organisation primarily exists be safeguarded. Responsibility should be clearly defined. Power should not be given without responsibility. Power and responsibility should be placed close together and in proportion to each other. They should be placed close to the point of activity. Power should not be remote and anonymous. The sense of responsibility should not be weakened by the evasions possible in committee control or by diffusion over too wide a field. The consequences of decisions should be demonstrated to the person making the decisions. Duties and responsibilities should be placed in appropriate hands-medical administration should be vested in doctors, clerical in secretaries, financial in accountants, and so forth.
clearly
,
1.
Humanism, History, and Natural Science in Medicine. Edinburgh, 1950.