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MENTAL OBSERVATION WARDS
1399 Your readers will doubtless be interested to learn that this matter has engaged our attention and research for the past two and a half years, and that a foreign-body locator is now in production. While one of the initial production batch was in use at a leading Midlands hospital, recommendation was made for us to attend the physics department of a London hospital particularly interested in this subject, with a view to adapting our machine for work other than the purely ophthalmological uses for which it
primarily designed. Accordingly the machine equipped with only the standard ophthalmological probes was tested for location of a needle fragment in a patient’s back. The test was immediately and outstandingly successful, as a result of which further specifically designed probes are being prototyped for location work on parts of the human body has been
other than the eyes. This company will be happy to reply to all inquiries concerning the detailed specification of this foreign-body locator. F. N. HAM General Manager, Keeler Optical Products, Ltd.
COST OF THE HOSPITAL SERVICE SIR,-A daily newspaper has drawn the attention of its readers to the alarming rise in the cost of the Hospital Service. I suggest that the fault lies partly in the Government’s attitude to general practioners in this country. The cost of the Hospital Service together with the long period of waiting for outpatient appointments could be reduced in two ways: Firstly, pathological and X-ray facilities should be available to
all practitioners. Secondly, some
form of grant and inducement payment should be made to general practitioners who wish to do their own minor surgery. This would allow the consultants more time to devote to the more important cases while allowing the young practitioner to exercise the skill he acquired when doing his numerous house-jobs, which is at the present moment entirely wasted. Newport. Isle of
Wight.
J. A. C. TERRY.
POSTPARTUM PRE-ECLAMPSIA
SIR,-Dr. Salzmann (Dec. 3) is largely though essentially in agreement with my hypothesis.
not
He agrees that (a) corticosteroid increase is not of primary significance in pre-eclampsia; (b) the contracting uterus post partum and intrapartum provokes renal ischsemia, and (c) ergometrine heightens uterine activity. He differs from me in believing that the products of decomposition of the red infarct provoke renal ischxmia, whereas I have shown that the resistance to stretch of the myometrium is responsible for this renal change in pregnancy and post partum, both experimentally and from clinical data. Franklin and I have further shown that renal ischaemia can be produced by nephrotoxins even to the extent of a complete renal shutdown, and Dr. Salzmann’s view based on Professor Young’s observation cannot be entirely denied. But we do know that red infarcts are present without preeclampsia accompanying them, while the toxasmic state can exist in their entire absence; and there is no correlation between their extent and the degree of toxaemia. Neither can they be used to explain the difference in incidence of pre-eclampsia in
primiparae
and multiparx. Dr. Salzmann raises the point that even in the premature and very small baby toxaemia can supervene and thereby appear to upset the uterorenal thesis. This apparent contradiction can be explained by the following facts. The kidney of chronic
hypertension (in which evidence is accruing of renal ischamic changes 1) would reasonably be expected to be more responsive to the uterorenal reflex; the vascular effect on myometrium showing chronic hypertensive changes would be earlier and more marked and foetal growth thereby impeded. This is supported by the brilliant research of Mr. G. W. Theobald, who, in interrupting the uterorenal reflex pathway by denervation of its tract, succeeded both in increasing the foetal size (and securing viability) and in preventing toxaemia, hitherto an accompaniment of these pregnancies. J. SOPHIAN. BLOOD-CHOLESTEROL AND ASPIRIN SIR,-In a preliminary communication (Nov. 19) Dr. Eidlitz reported that aspirin (1-5 g. daily) reduced the blood-cholesterol level in 10 patients with cardiovascular disease. In a group of 21 hypercholesterolaemic patients, to whom aspirin was administered for eight weeks, we2 found that doses of less than 4 g. daily usually failed to lower serum-cholesterol. More than 5 g. of aspirin a daily produced significant and consistent fall in serumcholesterol but no change in the cholesterol-phospholipid ratio or the beta-lipoprotein cholesterol. These observations also indicated that during aspirin therapy the serum-cholesterol levels are inversely related to the level of serum salicylate. With a dose of 5 g. aspirin daily, the incidence of side-effects was so high that we did not think that aspirin was a practicable treatment for the reduction of hypercholesterolasmia. A satisfactory explanation of these contrasting findings is not immediately obvious. W. D. ALEXANDER A. I. MACDOUGALL. M. F. OLIVER G. S. BOYD. MENTAL OBSERVATION WARDS
SiR,-Although I am more concerned myself with the psychological conclusions to be drawn from mental observation-ward practice, I think Dr. Gooddy and his colleagues (Dec. 10) may be interested in a clinical table of patients seen in the unit at St. Francis Hospital, East Dulwich, during part of the years 1949-50.3 Stone House, near Dartford, Kent. J. P. CRAWFORD. " THEY NEVER TELL YOU ANYTHING ..." SIR,-Iagree with Dr. Loudon (Dec. 3) that the " of course they never tell you anything " of those patients that leave hospital is seldom true in its literal sense-but not always. Everybody knows that many patients leave hospital with little knowledge of what is wrong with them,
because somebody has forgotten or failed to explain to them their diseases in plain language. Everybody talks as well of how overcrowded the outpatient department is, but this is no excuse for the many who say they cannot waste time explaining " everything to the patient. All every patient wants to know is the answer to the questions: (1) what is wrong with me ? (2) how bad is it ? (3) how long will it last ? (4) "what treatment are you going all right " afterwards ? By to give me? (5) shall I be making a rule to answer all these 5 questions for every patient before he asks them, very little time is spent and very many worries and troubles are spared to the anxious
patient. Cook, W. F. Renal Association meeting, Oct. 27, 1960. Alexander, W. D., Macdougall, A. I., Oliver, M. F., Boyd, G. S. Clin. Sci. 1959, 18, 195. 3. Practitioner, 1954, 173, 696 1. 2.
primarily designed. Accordingly the machine equipped with only the standard ophthalmological probes was tested for location of a needle fragment in a patient’s back. The test was immediately and outstandingly successful, as a result of which further specifically designed probes are being prototyped for location work on parts of the human body has been
other than the eyes. This company will be happy to reply to all inquiries concerning the detailed specification of this foreign-body locator. F. N. HAM General Manager, Keeler Optical Products, Ltd.
COST OF THE HOSPITAL SERVICE SIR,-A daily newspaper has drawn the attention of its readers to the alarming rise in the cost of the Hospital Service. I suggest that the fault lies partly in the Government’s attitude to general practioners in this country. The cost of the Hospital Service together with the long period of waiting for outpatient appointments could be reduced in two ways: Firstly, pathological and X-ray facilities should be available to
all practitioners. Secondly, some
form of grant and inducement payment should be made to general practitioners who wish to do their own minor surgery. This would allow the consultants more time to devote to the more important cases while allowing the young practitioner to exercise the skill he acquired when doing his numerous house-jobs, which is at the present moment entirely wasted. Newport. Isle of
Wight.
J. A. C. TERRY.
POSTPARTUM PRE-ECLAMPSIA
SIR,-Dr. Salzmann (Dec. 3) is largely though essentially in agreement with my hypothesis.
not
He agrees that (a) corticosteroid increase is not of primary significance in pre-eclampsia; (b) the contracting uterus post partum and intrapartum provokes renal ischsemia, and (c) ergometrine heightens uterine activity. He differs from me in believing that the products of decomposition of the red infarct provoke renal ischxmia, whereas I have shown that the resistance to stretch of the myometrium is responsible for this renal change in pregnancy and post partum, both experimentally and from clinical data. Franklin and I have further shown that renal ischaemia can be produced by nephrotoxins even to the extent of a complete renal shutdown, and Dr. Salzmann’s view based on Professor Young’s observation cannot be entirely denied. But we do know that red infarcts are present without preeclampsia accompanying them, while the toxasmic state can exist in their entire absence; and there is no correlation between their extent and the degree of toxaemia. Neither can they be used to explain the difference in incidence of pre-eclampsia in
primiparae
and multiparx. Dr. Salzmann raises the point that even in the premature and very small baby toxaemia can supervene and thereby appear to upset the uterorenal thesis. This apparent contradiction can be explained by the following facts. The kidney of chronic
hypertension (in which evidence is accruing of renal ischamic changes 1) would reasonably be expected to be more responsive to the uterorenal reflex; the vascular effect on myometrium showing chronic hypertensive changes would be earlier and more marked and foetal growth thereby impeded. This is supported by the brilliant research of Mr. G. W. Theobald, who, in interrupting the uterorenal reflex pathway by denervation of its tract, succeeded both in increasing the foetal size (and securing viability) and in preventing toxaemia, hitherto an accompaniment of these pregnancies. J. SOPHIAN. BLOOD-CHOLESTEROL AND ASPIRIN SIR,-In a preliminary communication (Nov. 19) Dr. Eidlitz reported that aspirin (1-5 g. daily) reduced the blood-cholesterol level in 10 patients with cardiovascular disease. In a group of 21 hypercholesterolaemic patients, to whom aspirin was administered for eight weeks, we2 found that doses of less than 4 g. daily usually failed to lower serum-cholesterol. More than 5 g. of aspirin a daily produced significant and consistent fall in serumcholesterol but no change in the cholesterol-phospholipid ratio or the beta-lipoprotein cholesterol. These observations also indicated that during aspirin therapy the serum-cholesterol levels are inversely related to the level of serum salicylate. With a dose of 5 g. aspirin daily, the incidence of side-effects was so high that we did not think that aspirin was a practicable treatment for the reduction of hypercholesterolasmia. A satisfactory explanation of these contrasting findings is not immediately obvious. W. D. ALEXANDER A. I. MACDOUGALL. M. F. OLIVER G. S. BOYD. MENTAL OBSERVATION WARDS
SiR,-Although I am more concerned myself with the psychological conclusions to be drawn from mental observation-ward practice, I think Dr. Gooddy and his colleagues (Dec. 10) may be interested in a clinical table of patients seen in the unit at St. Francis Hospital, East Dulwich, during part of the years 1949-50.3 Stone House, near Dartford, Kent. J. P. CRAWFORD. " THEY NEVER TELL YOU ANYTHING ..." SIR,-Iagree with Dr. Loudon (Dec. 3) that the " of course they never tell you anything " of those patients that leave hospital is seldom true in its literal sense-but not always. Everybody knows that many patients leave hospital with little knowledge of what is wrong with them,
because somebody has forgotten or failed to explain to them their diseases in plain language. Everybody talks as well of how overcrowded the outpatient department is, but this is no excuse for the many who say they cannot waste time explaining " everything to the patient. All every patient wants to know is the answer to the questions: (1) what is wrong with me ? (2) how bad is it ? (3) how long will it last ? (4) "what treatment are you going all right " afterwards ? By to give me? (5) shall I be making a rule to answer all these 5 questions for every patient before he asks them, very little time is spent and very many worries and troubles are spared to the anxious
patient. Cook, W. F. Renal Association meeting, Oct. 27, 1960. Alexander, W. D., Macdougall, A. I., Oliver, M. F., Boyd, G. S. Clin. Sci. 1959, 18, 195. 3. Practitioner, 1954, 173, 696 1. 2.