- Email: [email protected]
MEGALOBLASTIC ANÆMIA IN PREGNANCY
737
point which their
caused
some
regret
they have
now
policy. proposal
of the Royal Commission to make the medical officer " the medical superintendent " responsible would really be unworkable. Under the new Bill patients who are liable to be detained will often be admitted to general hospitals which have no superintendents. On the other hand, there are a few general hospitals which have superintendents who are doctors but not psychiatrists. It would be absurd to make them legally responsible for renewal of, or discharge from, detention (which appear to be the new terms for recertification The old
decertification). The only doctor who can meaningfully that responsibility is the consultant psychiatrist who is in charge of the patient’s treatment. If a special rule in respect of special legal powers of the superintendent were to be applied to the mental hospitals-and there is nothing in favour of itthese hospitals would have to be once again designated ". The de-designation proposed in the Bill, which is one of its great advances, would thereby be lost. or
assume
"
As regards the question of administration of mental hospitals, this is unaffected by the Bill. It seems to me that there are both advantages and disadvantages in the various proposals made by your correspondents. Perhaps the question should be left to each hospital to solve in
their own way. The decision would rest with the medical advisory committee, the management committee, and the regional hospital board, who come to an agreement between them. There seems to be a growing group of consultants and superintendents who feel that the medical superintendents in mental hospitals should be replaced by non-medical administrators. It goes against the grain of any consultant physician to have another doctorsome kind of super-consultant-interfere in his relationship with his patient. If, however, the superintendent is not obliged by law to do that any more there may be many consultants who at the present juncture prefer a doctor at the head of the administration to a lav administrator. University Department of Psychiatry, The Royal Infirmary, Manchester.
J. HOENIG.
MEGALOBLASTIC ANÆMIA IN PREGNANCY
SIR,-Dr. Forshaw’s letter of Jan. 10, in which he comments on our experience with megaloblastic anxmia of pregnancy, was of great interest to us. His remarks on the normal blood-group distribution in megaloblastic anxmia of pregnancy and the puerperium stimulated us to compile a similar survey of our own cases. The blood-group distribution of 100 cases of megaloblastic anxmia of pregnancy is contrasted below with that of 1000 random antenatal patients who were not suffering from the disease. Blood-group
Megaloblastic ancemia
0 A B AB
42-0% 51-0% 5-0% 2-0%
Controls
45-6% 42-9% 8-3% 3’2°0 increase of group A in our series
These figures suggest an of megaloblastic pregnancy anxmias, already known to exist in addisonian pernicious anaemia. However, the series is as yet too small to draw any conclusions from it which could be regarded as statistically significant. It might perhaps be of interest to note that 7 out of 9 patients who showed diminished fat absorption belonged to group A.
nationwide survey of megaloblastic anxmias of pregnancy could establish an accurate blood-group distribution on the lines of the investigation of bloodgroups in pernicious anxmia by Professor Aird and
Only
a
others.! C. GILES City General Hospital, Stoke-on-Trent. 1. Brit.
EILEEN M. SHUTTLEWORTH. med. J. 1956, ii,
723.
A REMEDY FOR AGEING ?
changed
SiR,—Ihave read with great interest your annotation of March 14 referring to the work of Aslan and Vrbiesco. I agree that the claims may well be exaggerated, but I have had very encouraging results from an improved form of H3, produced by a German firm and called’Ruticain ’. Ruticain is a compound of procaine, vitamin B12, and rutin (a flavonoid), and I have now treated ten patients with the preparation (their ages ranged from 60 to 75). I have found that the presenile
especially have responded very well; tiredness, depression, and tremor of the hands disappeared after thirty injections, and memory, which was very much impaired in four cases, has improved considerably. All the patients came to my consulting-room for treatment and continued to lead their normal lives, and I feel confident therefore that the improvements were not due to rest or suggestion. cases
No definite conclusions can be drawn from ten cases, of course, but the results do support your suggestion that the time has come for properly controlled trials to prove or disprove the value of these new methods of treatment in relation to the problems of senility.
MAX ODENS.
London, W.1.
INTRAGASTRIC ADMINISTRATION OF OXYGEN SIR,-During a study of the absorption of oxygen from the gastrointestinal tract of premature and newborn infants, we made the following observations which may be of interest to your readers: A 20-week-old foetus weighing 400 g. was delivered preof a mother with antepartum hxmorrhage. Initially the infant made a few feeble ineffectual gasps, but remained limp and cyanotic. Nevertheless, the heart continued to beat and several minutes later a tube was passed into the trachea and the lungs were gently expanded under positive pressure. Within seconds the skin became pink, tone and movement appeared in the limbs, and regular respirations ensued. Blood drawn from a small catheter inserted ’through the umbilical artery into the aorta was 93% saturated with oxygen and had a pH of 7-24. The mean aortic pressure, measured with a saline manometer, was 33 cm. Intragastric oxygen was then administered at 1 litre per minute. When gas was returning well from the escape tube, the endotracheal catheter was occluded. Three minutes later the aortic oxygen saturation was 24% and after five minutes had fallen further to 8%, the pH being 7-10. The infant appeared dusky and limp. Upon reopening the endotracheal tube and reoxygenating the lungs the infant dramatically recovered. His oxygen saturation rose to 94% and his pH to 7-25.
maturely
In view of the many clinical impressions regarding the of intragastric oxygen for resuscitation, these are somewhat thought-provoking.
efficacy findings
Columbia-Presbyterian Medical Center, New York.
L. F. E. V.
S. JAMES MOYA D. BURNARD APGAR.
Appointments CURRIE, A. B. M., M.B. Glasg., F.R.C.S.E. : senior casualty officer, Greenock Royal Infirmary. KLEE, D. W. S., M.B. Lond.: assistant M.O.H. and school M.o., Dudley. LEE, J. E., M.R.C.S. : assistant M.o. and school M.o., Batley and Heckmondwike, Yorkshire. O’LEARY, D. C., M.B. N.U.I.: school M.o., Durham. TINNE, J. E., M.B., B.sc. Edin., D.P.H.: consultant bacteriologist, Glasgow Royal Infirmary, and honorary lecturer, Glasgow University. WARD, BRIAN, M.B. Manc., D.P.M. : assistant senior M.o., Leeds Regional Hospital Board.
point which their
caused
some
regret
they have
now
policy. proposal
of the Royal Commission to make the medical officer " the medical superintendent " responsible would really be unworkable. Under the new Bill patients who are liable to be detained will often be admitted to general hospitals which have no superintendents. On the other hand, there are a few general hospitals which have superintendents who are doctors but not psychiatrists. It would be absurd to make them legally responsible for renewal of, or discharge from, detention (which appear to be the new terms for recertification The old
decertification). The only doctor who can meaningfully that responsibility is the consultant psychiatrist who is in charge of the patient’s treatment. If a special rule in respect of special legal powers of the superintendent were to be applied to the mental hospitals-and there is nothing in favour of itthese hospitals would have to be once again designated ". The de-designation proposed in the Bill, which is one of its great advances, would thereby be lost. or
assume
"
As regards the question of administration of mental hospitals, this is unaffected by the Bill. It seems to me that there are both advantages and disadvantages in the various proposals made by your correspondents. Perhaps the question should be left to each hospital to solve in
their own way. The decision would rest with the medical advisory committee, the management committee, and the regional hospital board, who come to an agreement between them. There seems to be a growing group of consultants and superintendents who feel that the medical superintendents in mental hospitals should be replaced by non-medical administrators. It goes against the grain of any consultant physician to have another doctorsome kind of super-consultant-interfere in his relationship with his patient. If, however, the superintendent is not obliged by law to do that any more there may be many consultants who at the present juncture prefer a doctor at the head of the administration to a lav administrator. University Department of Psychiatry, The Royal Infirmary, Manchester.
J. HOENIG.
MEGALOBLASTIC ANÆMIA IN PREGNANCY
SIR,-Dr. Forshaw’s letter of Jan. 10, in which he comments on our experience with megaloblastic anxmia of pregnancy, was of great interest to us. His remarks on the normal blood-group distribution in megaloblastic anxmia of pregnancy and the puerperium stimulated us to compile a similar survey of our own cases. The blood-group distribution of 100 cases of megaloblastic anxmia of pregnancy is contrasted below with that of 1000 random antenatal patients who were not suffering from the disease. Blood-group
Megaloblastic ancemia
0 A B AB
42-0% 51-0% 5-0% 2-0%
Controls
45-6% 42-9% 8-3% 3’2°0 increase of group A in our series
These figures suggest an of megaloblastic pregnancy anxmias, already known to exist in addisonian pernicious anaemia. However, the series is as yet too small to draw any conclusions from it which could be regarded as statistically significant. It might perhaps be of interest to note that 7 out of 9 patients who showed diminished fat absorption belonged to group A.
nationwide survey of megaloblastic anxmias of pregnancy could establish an accurate blood-group distribution on the lines of the investigation of bloodgroups in pernicious anxmia by Professor Aird and
Only
a
others.! C. GILES City General Hospital, Stoke-on-Trent. 1. Brit.
EILEEN M. SHUTTLEWORTH. med. J. 1956, ii,
723.
A REMEDY FOR AGEING ?
changed
SiR,—Ihave read with great interest your annotation of March 14 referring to the work of Aslan and Vrbiesco. I agree that the claims may well be exaggerated, but I have had very encouraging results from an improved form of H3, produced by a German firm and called’Ruticain ’. Ruticain is a compound of procaine, vitamin B12, and rutin (a flavonoid), and I have now treated ten patients with the preparation (their ages ranged from 60 to 75). I have found that the presenile
especially have responded very well; tiredness, depression, and tremor of the hands disappeared after thirty injections, and memory, which was very much impaired in four cases, has improved considerably. All the patients came to my consulting-room for treatment and continued to lead their normal lives, and I feel confident therefore that the improvements were not due to rest or suggestion. cases
No definite conclusions can be drawn from ten cases, of course, but the results do support your suggestion that the time has come for properly controlled trials to prove or disprove the value of these new methods of treatment in relation to the problems of senility.
MAX ODENS.
London, W.1.
INTRAGASTRIC ADMINISTRATION OF OXYGEN SIR,-During a study of the absorption of oxygen from the gastrointestinal tract of premature and newborn infants, we made the following observations which may be of interest to your readers: A 20-week-old foetus weighing 400 g. was delivered preof a mother with antepartum hxmorrhage. Initially the infant made a few feeble ineffectual gasps, but remained limp and cyanotic. Nevertheless, the heart continued to beat and several minutes later a tube was passed into the trachea and the lungs were gently expanded under positive pressure. Within seconds the skin became pink, tone and movement appeared in the limbs, and regular respirations ensued. Blood drawn from a small catheter inserted ’through the umbilical artery into the aorta was 93% saturated with oxygen and had a pH of 7-24. The mean aortic pressure, measured with a saline manometer, was 33 cm. Intragastric oxygen was then administered at 1 litre per minute. When gas was returning well from the escape tube, the endotracheal catheter was occluded. Three minutes later the aortic oxygen saturation was 24% and after five minutes had fallen further to 8%, the pH being 7-10. The infant appeared dusky and limp. Upon reopening the endotracheal tube and reoxygenating the lungs the infant dramatically recovered. His oxygen saturation rose to 94% and his pH to 7-25.
maturely
In view of the many clinical impressions regarding the of intragastric oxygen for resuscitation, these are somewhat thought-provoking.
efficacy findings
Columbia-Presbyterian Medical Center, New York.
L. F. E. V.
S. JAMES MOYA D. BURNARD APGAR.
Appointments CURRIE, A. B. M., M.B. Glasg., F.R.C.S.E. : senior casualty officer, Greenock Royal Infirmary. KLEE, D. W. S., M.B. Lond.: assistant M.O.H. and school M.o., Dudley. LEE, J. E., M.R.C.S. : assistant M.o. and school M.o., Batley and Heckmondwike, Yorkshire. O’LEARY, D. C., M.B. N.U.I.: school M.o., Durham. TINNE, J. E., M.B., B.sc. Edin., D.P.H.: consultant bacteriologist, Glasgow Royal Infirmary, and honorary lecturer, Glasgow University. WARD, BRIAN, M.B. Manc., D.P.M. : assistant senior M.o., Leeds Regional Hospital Board.