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MEASUREMENT OF CENTRAL VENOUS PRESSURE
756 considerable discrepancy between their verbal and performance i.Q. scales, the former being much higher than the latter. This means that the child has the intelligence to recognise his own shortcomings in performance and the resulting frustration often creates a personality problem. Moreover there is no compensation in other skills. These children are often emotionally immature, lethargic, and pathologically untidy. It is far harder to help children of this second group, and their plight has yet to receive even the recognition that dyslexia now has in this country. a
lation ; and an alternative method, cutting-down on the median cubital vein and inserting a long catheter, is timeconsuming and complicated. The ideal solution, I have found, is to insert an ’Angiocath ’, remove the central needle as usual, and thread a nylon intravenous catheter through the remaining short plastic cannula (see figure). Department of Obstetrics, Dudley Road Hospital,
Birmingham.
Down House,
Brickwall, Sussex.
WHERE TO MEASURE TEMPERATURE
H. M. RITCHIE.
SiR,ńDr. Chaudhuri could have further strengthened his hypothesis (March 6, p. 480) by giving some of the evidence from experiments on the human uterus, in addition to those on rodents. For example, the Lippes loop brings forward well into the luteal phase the strong contractions normally associated with menstruation.’ The menstrual contractions are caused by release of endometrial prostaglandins 2,3about which much is already known. Cardiff CF1 1XL.
SIR,-We were surprised that in your editorial (Feb. 27, p. 439) no mention was made of using the external auditory rather than the rectum in assessment of body temperature. Rectal readings have been shown to vary by almost one degree centigrade according to the position of the sensing probe within the rectum, and may be particularly misleading in hypothermia.2,33 Measurement of temperature by a thermoelectric probe in the external auditory meatus has been extensively used by T. H. Benzinger,4,5 who has clearly demonstrated its reproducibility and relationship to such thermoregulatory responses as skin temperature, heat loss from the skin, and sweating. No such reproducible relationship could be found between these responses and rectal temperature. Ear-temperature measurements have been shown to correlate closely with readings obtained using an ideally placed cesophageal probe, without the practical disadvantages of this method.s We have found ear thermometry convenient and acceptable to a wide variety of hospital patients. We have also used a new transcutaneous deep-body-temperature technique,7 and feel that perhaps this or ear thermometry may be more useful than conventional rectal thermometry in cases where continuous monitoring is required. meatus
PROSTAGLANDINS AND THE I.U.D.
Physiology Department, University College,
KENNETH S. STEWART.
V. R. PICKLES.
MEASUREMENT OF CENTRAL VENOUS PRESSURE SiR,ńI agree with your correspondents who favour the measurement of central venous pressure for assessment of blood requirements after acute haemorrhage. It may be for
University Department of Medicine, St. James’s Hospital, Leeds LS9 7TF
S. G. BALL D. MCM. CHALMERS A. G. MORGAN.
PATTERN RECOGNITION FOR RADIOGRAPHERS
SIR,-I congratulate you on publishing Dr. Swinburne’s Point of View (March 20, p. 589). It is so full of sound, practical common sense. After reading it I realise how wasted all the years of training in medicine and radiology have been, when by applying Gestalt principles I could have been issuing my unread reports of radiological examinations within a year or two of leaving school. What surprises me is that Dr. Swinburne stops at radiology. Surely the time has come to drop the pretence that any special skills are required to diagnose and treat patients. We should train nurses to sort out the sick from the healthy. This would save physicians and surgeons a great deal of time in outpatients and would solve the problem of professional frustration among nurses. The same principles could then be applied to therapy. Most nurses would soon pick up the technique of doing gastrectomies after a few months’ training, whilst theatre technicians were learning how to give anxsthetics. If this resulted in a shortage of nurses they could be augmented by secretarial staff and porters, who would soon pick up the simpler diagnostic and therapeutic skills. must
(a) Components of angiocath, (b) angiocath cannula with nylon intravenous cannula introduced through it.
Angiocath cannula, 14 g x 2in.; angiocath needle, 21 in.; Luer 7 Luer-lock fitting. Intravenous cannula: white " (Luer fitting); outer diameter 0.52 in.; F.G. 4.
17 g x Portex
"
technical reasons that this method is not more widely used: the use of the ’Intracath ’has fallen into disrepute because of the readiness with which the catheter can be severed on the needle point and thereafter enter the circu1.
Moawad, A. H., Bengtsson, L. P. Am. J. Obstet. Gynec. 1967, 98, 957.
2.
Eglinton, G., Raphael, R. A., Smith, G. N., Hall, W. J., Pickles, V. R. Nature, 1963, 200, 960. 3. Pickles, V. R., Hall, W. J., Best, F. A., Smith, G. N. J. Obstet. Gynœc. Br. Commonw. 1965, 72, 185.
1. 2. 3. 4. 5. 6. 7.
Mead, J., Bonmarito, C. L. J. appl. Physiol. 1949, 2, 97. Cooper, K. E., Kenyon, J. R. Br. J. Surg. 1957, 44, 616. Severinghaus, J. W. Ann. N.Y. Acad. Sci. 1959, 80, 515. Benzinger, T. H. Physiol. Rev. 1969, 49, 671. Benzinger, T. H. J. Am. med. Ass. 1969, 209, 1200. Benzinger, M. ibid. p. 1207. Fox, R. H., Solman, A. J. J. Physiol., Lond. (in the press).
lation ; and an alternative method, cutting-down on the median cubital vein and inserting a long catheter, is timeconsuming and complicated. The ideal solution, I have found, is to insert an ’Angiocath ’, remove the central needle as usual, and thread a nylon intravenous catheter through the remaining short plastic cannula (see figure). Department of Obstetrics, Dudley Road Hospital,
Birmingham.
Down House,
Brickwall, Sussex.
WHERE TO MEASURE TEMPERATURE
H. M. RITCHIE.
SiR,ńDr. Chaudhuri could have further strengthened his hypothesis (March 6, p. 480) by giving some of the evidence from experiments on the human uterus, in addition to those on rodents. For example, the Lippes loop brings forward well into the luteal phase the strong contractions normally associated with menstruation.’ The menstrual contractions are caused by release of endometrial prostaglandins 2,3about which much is already known. Cardiff CF1 1XL.
SIR,-We were surprised that in your editorial (Feb. 27, p. 439) no mention was made of using the external auditory rather than the rectum in assessment of body temperature. Rectal readings have been shown to vary by almost one degree centigrade according to the position of the sensing probe within the rectum, and may be particularly misleading in hypothermia.2,33 Measurement of temperature by a thermoelectric probe in the external auditory meatus has been extensively used by T. H. Benzinger,4,5 who has clearly demonstrated its reproducibility and relationship to such thermoregulatory responses as skin temperature, heat loss from the skin, and sweating. No such reproducible relationship could be found between these responses and rectal temperature. Ear-temperature measurements have been shown to correlate closely with readings obtained using an ideally placed cesophageal probe, without the practical disadvantages of this method.s We have found ear thermometry convenient and acceptable to a wide variety of hospital patients. We have also used a new transcutaneous deep-body-temperature technique,7 and feel that perhaps this or ear thermometry may be more useful than conventional rectal thermometry in cases where continuous monitoring is required. meatus
PROSTAGLANDINS AND THE I.U.D.
Physiology Department, University College,
KENNETH S. STEWART.
V. R. PICKLES.
MEASUREMENT OF CENTRAL VENOUS PRESSURE SiR,ńI agree with your correspondents who favour the measurement of central venous pressure for assessment of blood requirements after acute haemorrhage. It may be for
University Department of Medicine, St. James’s Hospital, Leeds LS9 7TF
S. G. BALL D. MCM. CHALMERS A. G. MORGAN.
PATTERN RECOGNITION FOR RADIOGRAPHERS
SIR,-I congratulate you on publishing Dr. Swinburne’s Point of View (March 20, p. 589). It is so full of sound, practical common sense. After reading it I realise how wasted all the years of training in medicine and radiology have been, when by applying Gestalt principles I could have been issuing my unread reports of radiological examinations within a year or two of leaving school. What surprises me is that Dr. Swinburne stops at radiology. Surely the time has come to drop the pretence that any special skills are required to diagnose and treat patients. We should train nurses to sort out the sick from the healthy. This would save physicians and surgeons a great deal of time in outpatients and would solve the problem of professional frustration among nurses. The same principles could then be applied to therapy. Most nurses would soon pick up the technique of doing gastrectomies after a few months’ training, whilst theatre technicians were learning how to give anxsthetics. If this resulted in a shortage of nurses they could be augmented by secretarial staff and porters, who would soon pick up the simpler diagnostic and therapeutic skills. must
(a) Components of angiocath, (b) angiocath cannula with nylon intravenous cannula introduced through it.
Angiocath cannula, 14 g x 2in.; angiocath needle, 21 in.; Luer 7 Luer-lock fitting. Intravenous cannula: white " (Luer fitting); outer diameter 0.52 in.; F.G. 4.
17 g x Portex
"
technical reasons that this method is not more widely used: the use of the ’Intracath ’has fallen into disrepute because of the readiness with which the catheter can be severed on the needle point and thereafter enter the circu1.
Moawad, A. H., Bengtsson, L. P. Am. J. Obstet. Gynec. 1967, 98, 957.
2.
Eglinton, G., Raphael, R. A., Smith, G. N., Hall, W. J., Pickles, V. R. Nature, 1963, 200, 960. 3. Pickles, V. R., Hall, W. J., Best, F. A., Smith, G. N. J. Obstet. Gynœc. Br. Commonw. 1965, 72, 185.
1. 2. 3. 4. 5. 6. 7.
Mead, J., Bonmarito, C. L. J. appl. Physiol. 1949, 2, 97. Cooper, K. E., Kenyon, J. R. Br. J. Surg. 1957, 44, 616. Severinghaus, J. W. Ann. N.Y. Acad. Sci. 1959, 80, 515. Benzinger, T. H. Physiol. Rev. 1969, 49, 671. Benzinger, T. H. J. Am. med. Ass. 1969, 209, 1200. Benzinger, M. ibid. p. 1207. Fox, R. H., Solman, A. J. J. Physiol., Lond. (in the press).