- Email: [email protected]
MEDICAL PLANNING RESEARCH
793
with its solubility. Powder sprays are commonly used, but many surgeons rub the powder gently into the tissues. A level teaspoonful represents 10 g. Hawking makes it clear that while sulphonamides are being used locally they should also be given by mouth. Locally they penetrate living tissues only to a depth of 2-3 mm. ; thus the live tissues round the wound can best be approached through the bloodstream. Reed and Orr have shown that the concentration in muscle is always approximately the same as in the blood, and in treating streptococcal infections a blood level of 5-10 mg. per 100 c.cm. must be maintained, as McIntosh and Selbiehave indicated. Blood estimations should be used to check the patient’s progress ; the technique is so simple that in France The experiences they are often done by the nurse. of Mitchell, Logie and Handley 9 in the Libyan campaign confirm that sulphonamides should be given both orally and locally ; they found that patients receiving the drugs by both routes were fitter and showed less local sepsis than others. They suggest that sulphanilamide (15 g.) should be applied to the wound immediately and a further 15 g. introduced at the end of operation. Orally, the patient is given 27 g. in 6 days ; doses are temporarily doubled in cases of severe infection. Sulphonamides gave better results, they found, than local antiseptics such as eusol and acrinavine ; where the response to chemotherapy was disappointing they found the infecting organism to be Staphylococcus aureU8. In the attack on this organism sulphadiazine seems to promise well : Perrin Long 10 finds it to be slightly superior to sulphathiazole in this respect. Feinstone 11 intimates that sulphadiazine is more effective against Clostridium welchii than any other sulphonamide. Its local value, according to Hawking’swork, is handicapped by its relative insolubility.
MEDICAL PLANNING
RESEARCH
THE several published designs for postwar medicine -from TAYLOR’s Plan for British Hospitals " of Future of General two years ago to RoBEBTS’s Practice ’’ last week-have at least demonstrated the vastness and complexity of the subject. No single planner or small body of planners can hope to design more than a part of it in any detail. This principle has been recognised by the B.M.A. Planning Commission in its appointment of five committees to deal with general practice, special practice, public health, hospitals, and the teaching hospitals-with a sixth to coordinate their ideas. It has been carried a step further by Dr. PERRY and his friends, who in drawing their rough sketch of postwar hospital services which we published on May 17 no doubt came to realise how much more information they needed before they could begin to make a finished picture. They have therefore gathered a team of some forty planners, which through their call for volunteers on another page they hope to expand to at least a hundred. These researchers will be split into groups to study the six general and nine special problems which together make up the large query of Medicine after the war. Finally the whole will be collated,* criticised and edited, and published in book form. With the "
"
9. Mitchell, G. A. G., Logie, N. J. and Handley, R. S. p. 713. 10. Long, P. H. Ibid. Feb. 22, p. 259. 11. Feinstone, W. H. Ibid, May 24, p. 681.
Ibid, June 7,
Dawson report, the findings of the B.M.A. commission, and the views of individual prophets, it will provide the Royal Commission on Medical Services, when it comes, with
something
to bite
on.
Annotations BIRTHDAY
HONOURS
THE list of honours (see p. 800) conferred on doctors is a striking record of the variety of ways in which themedical profession has served the commonwealth. Only civil honours have yet been announced ; decorations for the fighting services will follow. Six knighthoods head the list. Dr. Hone has deserved well of the city of Adelaide where he has spent his life as hospital physician, director of the radiotherapy clinic and councillor of theuniversity. Dr. Scott as director of the Bureau of Tropical Diseases in London has done much to help solve the health problems of the Empire. General’ Jolly with 33 years behind him in the Indian Medical Service has guided hospital policy and hygienic measuresin Burma and the Punjab and waged constant war on the mosquito. Dr. Macgregor, the people’s friend in Glasgow, has shown the ability of a city health department Dr. to handle the transition from peace to war. Manson-Bahr has added lustre to the name he bears and placed his unrivalled knowledge of tropical diseases atthe call of the Colonial Office. Professor Stopford’sbrilliant teaching of anatomy and deanship of theManchester medical school have been overlaid by sevenyears as vice-chancellor of the university. The thirteen: commanderships in three orders of chivalry are awarded for the most part for services in India, Mauritius, Malta, Newfoundland and Tasmania. Dr.AIison Glover receives the C.B.E. on his well-earned retirement from the Board of Education. Dr. Massey’s devoted workas M.O.H. for Coventry and Dr. Knox’s organisation of Scottish emergency hospitals receive like recognition. Three awards of the O.B.E. also are for municipal health. officers : Dr. Ethel Cassie (Birmingham), Dr. J. A. Scott (Fulham) and Dr. Williams (Southampton). To those we have named and to the many others on the list we offer the sincere congratulation of colleagues who rejoice with them in their honourable estate. The medical profession will also welcome the C.B.E. conferred on Mr. Walter Deacon, just re-elected president of the Pharmaceutical Society.
Rhodesia,.
OF X-RADIATION cells is followed by microscopic changes, among which are decrease of cells in mitosis and in resting cells, and an increase in differentiating and degenerate cells. Cell degeneration is the visible sign of lethal action ; a tendency towards differentiation is commonly seen in irradiated squamous car-cinomata in which large masses of keratin are formed. A decrease in the number of cells showing mitotic activity can be determined only by counting. Its occurrence depends on dosage : an insufficient dose is followed by restoration to the ordinary rate of divisiononly an adequate dose causes a real decrease.! An attempt has been made by Glftcksmann2 to find a quantitative relationship between these changes and the* number of cells which appear unaffected (called resting cells) by irradiation. He claims that there is a numerical relationship and that it forms a good guide to prognosis in certain forms of human cancer. Biopsies from thegrowing edge of tumours are examined before, and as often as possible after, irradiation. The number of dividing, degenerate, differentiating and resting cells iscounted. About 500 cells are thus classified and plotted in a graph as percentages of the total number of cells, A
BIOLOGICAL
RADIATION of
MEASURE
malignant
1. Lasnitzki, I. Brit. J. Radiol. 1940, 13, 279. 2. Glücksmann, A. Ibid, June, 1941, p. 187.
with its solubility. Powder sprays are commonly used, but many surgeons rub the powder gently into the tissues. A level teaspoonful represents 10 g. Hawking makes it clear that while sulphonamides are being used locally they should also be given by mouth. Locally they penetrate living tissues only to a depth of 2-3 mm. ; thus the live tissues round the wound can best be approached through the bloodstream. Reed and Orr have shown that the concentration in muscle is always approximately the same as in the blood, and in treating streptococcal infections a blood level of 5-10 mg. per 100 c.cm. must be maintained, as McIntosh and Selbiehave indicated. Blood estimations should be used to check the patient’s progress ; the technique is so simple that in France The experiences they are often done by the nurse. of Mitchell, Logie and Handley 9 in the Libyan campaign confirm that sulphonamides should be given both orally and locally ; they found that patients receiving the drugs by both routes were fitter and showed less local sepsis than others. They suggest that sulphanilamide (15 g.) should be applied to the wound immediately and a further 15 g. introduced at the end of operation. Orally, the patient is given 27 g. in 6 days ; doses are temporarily doubled in cases of severe infection. Sulphonamides gave better results, they found, than local antiseptics such as eusol and acrinavine ; where the response to chemotherapy was disappointing they found the infecting organism to be Staphylococcus aureU8. In the attack on this organism sulphadiazine seems to promise well : Perrin Long 10 finds it to be slightly superior to sulphathiazole in this respect. Feinstone 11 intimates that sulphadiazine is more effective against Clostridium welchii than any other sulphonamide. Its local value, according to Hawking’swork, is handicapped by its relative insolubility.
MEDICAL PLANNING
RESEARCH
THE several published designs for postwar medicine -from TAYLOR’s Plan for British Hospitals " of Future of General two years ago to RoBEBTS’s Practice ’’ last week-have at least demonstrated the vastness and complexity of the subject. No single planner or small body of planners can hope to design more than a part of it in any detail. This principle has been recognised by the B.M.A. Planning Commission in its appointment of five committees to deal with general practice, special practice, public health, hospitals, and the teaching hospitals-with a sixth to coordinate their ideas. It has been carried a step further by Dr. PERRY and his friends, who in drawing their rough sketch of postwar hospital services which we published on May 17 no doubt came to realise how much more information they needed before they could begin to make a finished picture. They have therefore gathered a team of some forty planners, which through their call for volunteers on another page they hope to expand to at least a hundred. These researchers will be split into groups to study the six general and nine special problems which together make up the large query of Medicine after the war. Finally the whole will be collated,* criticised and edited, and published in book form. With the "
"
9. Mitchell, G. A. G., Logie, N. J. and Handley, R. S. p. 713. 10. Long, P. H. Ibid. Feb. 22, p. 259. 11. Feinstone, W. H. Ibid, May 24, p. 681.
Ibid, June 7,
Dawson report, the findings of the B.M.A. commission, and the views of individual prophets, it will provide the Royal Commission on Medical Services, when it comes, with
something
to bite
on.
Annotations BIRTHDAY
HONOURS
THE list of honours (see p. 800) conferred on doctors is a striking record of the variety of ways in which themedical profession has served the commonwealth. Only civil honours have yet been announced ; decorations for the fighting services will follow. Six knighthoods head the list. Dr. Hone has deserved well of the city of Adelaide where he has spent his life as hospital physician, director of the radiotherapy clinic and councillor of theuniversity. Dr. Scott as director of the Bureau of Tropical Diseases in London has done much to help solve the health problems of the Empire. General’ Jolly with 33 years behind him in the Indian Medical Service has guided hospital policy and hygienic measuresin Burma and the Punjab and waged constant war on the mosquito. Dr. Macgregor, the people’s friend in Glasgow, has shown the ability of a city health department Dr. to handle the transition from peace to war. Manson-Bahr has added lustre to the name he bears and placed his unrivalled knowledge of tropical diseases atthe call of the Colonial Office. Professor Stopford’sbrilliant teaching of anatomy and deanship of theManchester medical school have been overlaid by sevenyears as vice-chancellor of the university. The thirteen: commanderships in three orders of chivalry are awarded for the most part for services in India, Mauritius, Malta, Newfoundland and Tasmania. Dr.AIison Glover receives the C.B.E. on his well-earned retirement from the Board of Education. Dr. Massey’s devoted workas M.O.H. for Coventry and Dr. Knox’s organisation of Scottish emergency hospitals receive like recognition. Three awards of the O.B.E. also are for municipal health. officers : Dr. Ethel Cassie (Birmingham), Dr. J. A. Scott (Fulham) and Dr. Williams (Southampton). To those we have named and to the many others on the list we offer the sincere congratulation of colleagues who rejoice with them in their honourable estate. The medical profession will also welcome the C.B.E. conferred on Mr. Walter Deacon, just re-elected president of the Pharmaceutical Society.
Rhodesia,.
OF X-RADIATION cells is followed by microscopic changes, among which are decrease of cells in mitosis and in resting cells, and an increase in differentiating and degenerate cells. Cell degeneration is the visible sign of lethal action ; a tendency towards differentiation is commonly seen in irradiated squamous car-cinomata in which large masses of keratin are formed. A decrease in the number of cells showing mitotic activity can be determined only by counting. Its occurrence depends on dosage : an insufficient dose is followed by restoration to the ordinary rate of divisiononly an adequate dose causes a real decrease.! An attempt has been made by Glftcksmann2 to find a quantitative relationship between these changes and the* number of cells which appear unaffected (called resting cells) by irradiation. He claims that there is a numerical relationship and that it forms a good guide to prognosis in certain forms of human cancer. Biopsies from thegrowing edge of tumours are examined before, and as often as possible after, irradiation. The number of dividing, degenerate, differentiating and resting cells iscounted. About 500 cells are thus classified and plotted in a graph as percentages of the total number of cells, A
BIOLOGICAL
RADIATION of
MEASURE
malignant
1. Lasnitzki, I. Brit. J. Radiol. 1940, 13, 279. 2. Glücksmann, A. Ibid, June, 1941, p. 187.