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MEMORIAL TO SIR JOHN GRAHAM KERR
646
difference in the regression coefficients is significant in terms of the total index, the value is (P<0001); increased by treatment from 0 47 to 0-69% per min., the higher value remaining, however, within the diabetic range. The - mode of action of carbutamide is still uncertain, and it is difficult to accept data from oral-glucose-tolerance tests and the daily fluctuations in blood glucose as proof of the absence of small differences in glucose utilisation; the apparent inconstancy of the " total " index may therefore reflect a real change in rate of ulilisation-an observation of some interest. Research Department, Runwell Hospital,
Wickford,
Essex.
I. G. PRYCE.
INCIDENCE OF WOUND INFECTION SIR,-In the study recorded in their article of Feb. 15 Mr. Jeffrey and Mr. Sklaroff found a much higher incidence of wound infection in general surgical cases than in orthopxdic and neurosurgical cases. Among the possible factors contributing to this difference they did not consider suture material. It is likely that the practice in Edinburgh is that found in most centres-i.e., that orthopaedic surgeons and neurosurgeons use little or no catgut in wounds while general surgeons use a great deal. Of the many studies which have shown the effect of catgut in wounds one of the most striking was that by Jones et al. who reduced the incidence of wound infection in the abdominal wounds after abdominoperineal resections of the rectum from 27-5% to 0-85% by substituting alloy steel wire for catgut in the peritoneal and muscle layers. When the catgut was only partially replaced by wire the rate of wound infection lay between these two extremes.
From my own observations I agree with Jeffrey and Sklaroff that the contamination of wounds occurs usually in the operating-theatre, and the above-mentioned study indicates that the presence of dead animal tissue, in the form of catgut, allows the organisms to establish an obvious wound infection much more readily than they do when catgut is absent. HERBERT HAXTON. Manchester. MYOCARDIAL INFARCTION AND TRANSIENT GLYCOSURIA on accidental the occurrence of ascribes hypothermia (March 15), 2 and noted in case to hypohyperglycaemia glycosuria thermia. I wish to take the opportunity to point out that transient glycosuria is a common complication of myocardial infarction-a fact which does not appear to be widely appreciated. Thus, the association is not mentioned in standard textbooks of medicine, and is ignored by most textbooks of cardiology.
SIR,-Dr. Rees, in his interesting article
Scherfdescribed the association in 5 cases collected over period of eight months, and estimated the frequency at 10%. During the past two years the association was found in 12 patients in a consecutive series of 129 cases of proven myocardial infarction admitted to a general medicine unit, where the patient had been seen within forty-eight hours of the onset and where the urine had been tested (a further 12 patients had myocardial infarction complicating diabetes mellitus). This series suffers from bias in several respects and is probably not representative; nevertheless there is no doubt that this is a common phenomenon. The xtiology is not understood, though Scherf advances several interesting hypotheses. 1. Jones, T. E., Newell, E. T., Brubaker, R. E. Surg. Gynec. Obstet 1941, a
2.
72, 1056. Scherf, D. Wien. klin. Wschr. 1933, 46, 69.
This is an aspect of myocardial infarction which appears to have been neglected and which might repay fuller study. The Royal Infirmary,
J. KNOX.
Edinburgh. MEMORIAL TO SIR
JOHN
GRAHAM KERR
Lord BOYD ORR writes: " A committee has been formed for the promotion of
a
the late Sir John Graham Kerr who occupied the chair of zoology at Glasgow University from 1902 to 1935. Many medical graduates of Glasgow will remember with affection and respect the distinguished and congenial professor they met in the first year of their studies. Those who wish to be associated with the memorial should send a contribution, however small, to Miss A. E. Miller, Department of Zoology, The University, Glasgow, W.2." fund
to commemorate
Parliament Children Bill THIS Bill, which was read a second time in the House of Lords on March 11, deals with the welfare and protection of foster children and adopted children. The first part, which covers foster children, consolidates and modifies the present law. It lays on local authorities a more positive duty to ensure the wellbeing of these children and gives it new powers to help it to do so. A local authority, for instance, is empowered to prohibit a child received in an unsuitable home; it must arrange that foster children within its area are visited; its officers are entitled to inspect premises in which foster children are to be kept or are being kept and may make requirements about the medical arrangements; and it may also remove a child from an unsuitable home.
being
The second part of the Bill, which covers adopted children, is based on the main recommendations of the Hurst report’1 and VISCOUNT KILMUIR, the Lord Chancellor, in his opening speech said that many of the recommendations which did not find a place in the Bill would be implemented by means of rules and regulations. One of the important changes which the Bill makes is to provide a further ground on which the court may dispense with the consent of a parent to an adoption of a child. The proper balance between the best interests of the child and the rights of the natural parent was, Lord Kilmuir said, often very difficult to obtain. Adoption was not a case in which the welfare of the child could be the sole and paramount consideration : the courts must consider also the reasonable wishes of the natural parent. But there were occasional cases in which a parent had for long shown no sign of carrying out the ordinary responsibilities of a parent and no sign of any intention to do so; yet nevertheless refused to consent to an adoption which would in every way be in the interests of the child. The Bill provided that a court might dispense with the consent of the parent when the parent had persistently failed, without reasonable cause, and when that parent seemed likely to continue to do so if the adoption order was not made. Other provisions of the Bill extend the circumstances in which an adopted child is treated as a child of the family for the purposes of succession to property and in which a child, under safeguards, may be taken abroad for adoption. This last provision should enable more coloured children and more Catholic children to find adopting families. The only important recommendation of the Hurst Committee which the Government have not accepted is the recommendation that in England and Wales an adopted person on reaching the age of 21 should have the right to be told the names of his natural parents. (In Scotland he is able to do so at the age of 17; in England only at the order of a court of competent jurisdiction). As this proposed innovation, had 1. See
Lancet, 1954, ii, 710.
difference in the regression coefficients is significant in terms of the total index, the value is (P<0001); increased by treatment from 0 47 to 0-69% per min., the higher value remaining, however, within the diabetic range. The - mode of action of carbutamide is still uncertain, and it is difficult to accept data from oral-glucose-tolerance tests and the daily fluctuations in blood glucose as proof of the absence of small differences in glucose utilisation; the apparent inconstancy of the " total " index may therefore reflect a real change in rate of ulilisation-an observation of some interest. Research Department, Runwell Hospital,
Wickford,
Essex.
I. G. PRYCE.
INCIDENCE OF WOUND INFECTION SIR,-In the study recorded in their article of Feb. 15 Mr. Jeffrey and Mr. Sklaroff found a much higher incidence of wound infection in general surgical cases than in orthopxdic and neurosurgical cases. Among the possible factors contributing to this difference they did not consider suture material. It is likely that the practice in Edinburgh is that found in most centres-i.e., that orthopaedic surgeons and neurosurgeons use little or no catgut in wounds while general surgeons use a great deal. Of the many studies which have shown the effect of catgut in wounds one of the most striking was that by Jones et al. who reduced the incidence of wound infection in the abdominal wounds after abdominoperineal resections of the rectum from 27-5% to 0-85% by substituting alloy steel wire for catgut in the peritoneal and muscle layers. When the catgut was only partially replaced by wire the rate of wound infection lay between these two extremes.
From my own observations I agree with Jeffrey and Sklaroff that the contamination of wounds occurs usually in the operating-theatre, and the above-mentioned study indicates that the presence of dead animal tissue, in the form of catgut, allows the organisms to establish an obvious wound infection much more readily than they do when catgut is absent. HERBERT HAXTON. Manchester. MYOCARDIAL INFARCTION AND TRANSIENT GLYCOSURIA on accidental the occurrence of ascribes hypothermia (March 15), 2 and noted in case to hypohyperglycaemia glycosuria thermia. I wish to take the opportunity to point out that transient glycosuria is a common complication of myocardial infarction-a fact which does not appear to be widely appreciated. Thus, the association is not mentioned in standard textbooks of medicine, and is ignored by most textbooks of cardiology.
SIR,-Dr. Rees, in his interesting article
Scherfdescribed the association in 5 cases collected over period of eight months, and estimated the frequency at 10%. During the past two years the association was found in 12 patients in a consecutive series of 129 cases of proven myocardial infarction admitted to a general medicine unit, where the patient had been seen within forty-eight hours of the onset and where the urine had been tested (a further 12 patients had myocardial infarction complicating diabetes mellitus). This series suffers from bias in several respects and is probably not representative; nevertheless there is no doubt that this is a common phenomenon. The xtiology is not understood, though Scherf advances several interesting hypotheses. 1. Jones, T. E., Newell, E. T., Brubaker, R. E. Surg. Gynec. Obstet 1941, a
2.
72, 1056. Scherf, D. Wien. klin. Wschr. 1933, 46, 69.
This is an aspect of myocardial infarction which appears to have been neglected and which might repay fuller study. The Royal Infirmary,
J. KNOX.
Edinburgh. MEMORIAL TO SIR
JOHN
GRAHAM KERR
Lord BOYD ORR writes: " A committee has been formed for the promotion of
a
the late Sir John Graham Kerr who occupied the chair of zoology at Glasgow University from 1902 to 1935. Many medical graduates of Glasgow will remember with affection and respect the distinguished and congenial professor they met in the first year of their studies. Those who wish to be associated with the memorial should send a contribution, however small, to Miss A. E. Miller, Department of Zoology, The University, Glasgow, W.2." fund
to commemorate
Parliament Children Bill THIS Bill, which was read a second time in the House of Lords on March 11, deals with the welfare and protection of foster children and adopted children. The first part, which covers foster children, consolidates and modifies the present law. It lays on local authorities a more positive duty to ensure the wellbeing of these children and gives it new powers to help it to do so. A local authority, for instance, is empowered to prohibit a child received in an unsuitable home; it must arrange that foster children within its area are visited; its officers are entitled to inspect premises in which foster children are to be kept or are being kept and may make requirements about the medical arrangements; and it may also remove a child from an unsuitable home.
being
The second part of the Bill, which covers adopted children, is based on the main recommendations of the Hurst report’1 and VISCOUNT KILMUIR, the Lord Chancellor, in his opening speech said that many of the recommendations which did not find a place in the Bill would be implemented by means of rules and regulations. One of the important changes which the Bill makes is to provide a further ground on which the court may dispense with the consent of a parent to an adoption of a child. The proper balance between the best interests of the child and the rights of the natural parent was, Lord Kilmuir said, often very difficult to obtain. Adoption was not a case in which the welfare of the child could be the sole and paramount consideration : the courts must consider also the reasonable wishes of the natural parent. But there were occasional cases in which a parent had for long shown no sign of carrying out the ordinary responsibilities of a parent and no sign of any intention to do so; yet nevertheless refused to consent to an adoption which would in every way be in the interests of the child. The Bill provided that a court might dispense with the consent of the parent when the parent had persistently failed, without reasonable cause, and when that parent seemed likely to continue to do so if the adoption order was not made. Other provisions of the Bill extend the circumstances in which an adopted child is treated as a child of the family for the purposes of succession to property and in which a child, under safeguards, may be taken abroad for adoption. This last provision should enable more coloured children and more Catholic children to find adopting families. The only important recommendation of the Hurst Committee which the Government have not accepted is the recommendation that in England and Wales an adopted person on reaching the age of 21 should have the right to be told the names of his natural parents. (In Scotland he is able to do so at the age of 17; in England only at the order of a court of competent jurisdiction). As this proposed innovation, had 1. See
Lancet, 1954, ii, 710.