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MEPHENESIN IN INTRA-OCULAR OPERATIONS
388 PANCREATICOGASTROSTOMY SIR,—In their paper (Aug. 9), Professor Ingebrigtsen and Professor Langfeldt say that they " resected the antrum of the stomach so that it contained no free acid postoperatively." They make the same point in their " summary. Their use of the phrase " extensive resection of the antrum in the second place suggests that the word does not refer to the pyloric antrum in Norwegian nomenclature as it would in British, but in any case it is difficult to see how any partial resection of the stomach, however extensive, could get rid of the gastric hydrochloric acid unless the vagi were resected at the same time-
HENEAGE OGILVIE.
London, W.1.
MEPHENESIN IN INTRA-OCULAR OPERATIONS SIR,—As is well known, in intra-ocular operations it is essential that the extra-ocular muscles should be relaxed, thus keeping the vitreous back and preventing the patient from " squeezing " the eye. I have, in the past, hesitated to use curare for this purpose. Some two years ago, however, I started to use mephenesin (’ Myanesin Elixir ’), which I have found produces relaxation with no danger to the patient. I have used this preparation in 26 cataract operations, 22 glaucoma operations, about 70 iridectomy operations, and 4 cases of nystagmus. One
preparation was administered two hours before the operation, followed by a further tablespoonful one and a half hours later. This dosage was used tablespoonful
of the
whether or not tension was present. Half an hour after the second dose, the eye muscles became relaxed and the patients experienced a slight " numb sensation " throughout the body. During operation the vitreous remained in place and did not present forward, and the operation could proceed with ease and safety. In the cases of nystagmus, mephenesin either stopped oscillations or minimised them in 2 children, lessened them in a girl of 15, and appeared to abolish them (after repeated administration) in a man of 45.
I should be interested to know whether anyone else has tried mephenesin in these conditions. Coptic Hospital, ABDEL MESSIII GIRGIS. Cairo, Egypt. THE PROSPECT OF GENERAL PRACTICE
,-IR,-Your anonymous and egotistic correspondent (Aug. 16) has decided that his "intellectual thirst" cannot he satisfied in general practice as it is. and goes on to give about the most distorted account of a G.P.’S life and work I have ever read. To answer his 4 points in order :
very livelihood endangered." This is an amazing statement. and I confess I cannot conceive how a G.P. could possibly be affected in any way by a competitor " being appointed to a regional board. Sir, may I ask your anonymous correspondem to give chapter and verse for his statement and explain wha* he means ? For his information a G.P.’s authority in the N.H.S. is the executive council, and we are only too grateful for the work and time spent on this council by those of our colleagues who are appointed to it. If this statement ;indicative of your anonymous correspondent’sideas of how G.r.s treat each other, then it is no wonder that he has not considered working an off-duty or holiday rota with his "
neighbours.
suggestion that there should be more research general practice I have no quarrel, but I strongly object to his picture of general practice, and his con. descending attitude as exemplified by his suggestion that a-G.P. would be ridiculous in a professorial chair. I can think of many G.p.s who would bring dignity, knowledge, common sense, and much-needed liaison as professors in With his
in
universities. Research in general practice will, in my opinion, best be stimulated by increasing liaison between hospital and G.r.s, and by making G.P. beds available in hospitals. It will not be helped by articles such as your anonymous correspondent’s, which can only have the effect of discouraging’ this desirable and necessary liaison. J. F. HANRATTY. Wingerworth, near Chesterfield. our
PRESERVATION OF ARTERIAL GRAFTS BY FREEZING
SIR,—The article by Professor Hufnagel and myselfi included a reference to the work of Smith and Parked at Mill Hill on recovery of frozen stored ovarian tissue and red blood-cells. Our comment that " survival is quite unpredictable, even with constant technique," though it certainly applied to previous methods of frozen storage, does less than justice to the work of the Mill Hill group. A recent visit to that centre confirmed that the glycerol-saline technique provides consistently viable tissues after storage. Ovary, sperm, and testis, and some endocrine tissues seem to be perfectly preserved. It is to be hoped that this method may soon be applied to problems of stored functioning transplants in man: such tissue preparations are now being banked along with the arterial grafts in this department. Surgical Unit, Hospital, London, W.2.
St. Mary’s
H. H. G. EASTCOTT.
FLYING AND LIFE ASSURANCE
SIR,—A peripatetic correspondent writes in your issue of
July
26 :
"
I. After enlarging on his -kill and intellect, he states : I shall be too busy to examine or follow any case adequately. ’ I would say that any f;.r. who fails to examine or follow any If we organise case adequately soon be in trouble. our work properly by making special appointments, &c., we can always ensure that a patient requiring a detailed examination is given it at leisure. Now that X-ray and laboratory "
will very
facilities
are
generally
available
we can
fully investigate
the
of our oases without troubling the consultant. 2. this is his idea of a G.P.S family life even before Danckwerts, then I am truly sorry for him- Has he never heard of arrangements with his colleagues?—but, of course, he doe not trust them (see point 4). Has he never heard of a rota for night work. group practice, or partnership ?: 3 Whatever insult, stupidity, thoughtlessness, or unnecessubmit me to. I must sary dt-mands he [the State smiles and comply." Does he really think G.P.S are as spineless as this? Anyone with this outlook would soon collect a and be treated by his patients and pr.t4-ti,-ee of colleagues with the contempt he deserved. Every practice must have some discipline, and the patients respect their doctor for applying it. 4....if an influential competitor gets a seat on the Regional Board not only are my hopes of advancement killed, but my
majority
If
"
"
patient; may
malingerers
I wonder how many of my peripatetic colleagues ... realise that if they fly more than 15,000 miles in the course of one year they are automatically depriving their dependants of all benefits under their F.S.S.U. scheme should they be involved in a fatal accident ? Apparently all the leading life-assurance societies have a clause in their policies which imposes this limit on flying unless an extra premium is paid."
This conveys an entirely wrong impression, sincf British life offices issue, whenever possible, polices unrestricted as regards airline travel. So far as I am aware, no life-assurance policy issued in this country. whether under the F.S.S.U. scheme or otherwise, would contain any clause b, which cover would cease after the had’ flown in one year 15,000 miles, or indeed any other distance. The future flying prospects of a proposer for life assurance are elicited at the time of his proposal. In the great majority of cases the expected yearly amount of passenger flying is less than 15,000 miles, and the issue
policy-holder
1. Hufnagel, C., Eastcott, H. H. G. Lancet, 1952, i, 531. 2. Smith, A. U. Ibid, 1950, ii, 910. Smith, A. U., Parkes, A. S. Ibid, 1951, ii, 570.
HENEAGE OGILVIE.
London, W.1.
MEPHENESIN IN INTRA-OCULAR OPERATIONS SIR,—As is well known, in intra-ocular operations it is essential that the extra-ocular muscles should be relaxed, thus keeping the vitreous back and preventing the patient from " squeezing " the eye. I have, in the past, hesitated to use curare for this purpose. Some two years ago, however, I started to use mephenesin (’ Myanesin Elixir ’), which I have found produces relaxation with no danger to the patient. I have used this preparation in 26 cataract operations, 22 glaucoma operations, about 70 iridectomy operations, and 4 cases of nystagmus. One
preparation was administered two hours before the operation, followed by a further tablespoonful one and a half hours later. This dosage was used tablespoonful
of the
whether or not tension was present. Half an hour after the second dose, the eye muscles became relaxed and the patients experienced a slight " numb sensation " throughout the body. During operation the vitreous remained in place and did not present forward, and the operation could proceed with ease and safety. In the cases of nystagmus, mephenesin either stopped oscillations or minimised them in 2 children, lessened them in a girl of 15, and appeared to abolish them (after repeated administration) in a man of 45.
I should be interested to know whether anyone else has tried mephenesin in these conditions. Coptic Hospital, ABDEL MESSIII GIRGIS. Cairo, Egypt. THE PROSPECT OF GENERAL PRACTICE
,-IR,-Your anonymous and egotistic correspondent (Aug. 16) has decided that his "intellectual thirst" cannot he satisfied in general practice as it is. and goes on to give about the most distorted account of a G.P.’S life and work I have ever read. To answer his 4 points in order :
very livelihood endangered." This is an amazing statement. and I confess I cannot conceive how a G.P. could possibly be affected in any way by a competitor " being appointed to a regional board. Sir, may I ask your anonymous correspondem to give chapter and verse for his statement and explain wha* he means ? For his information a G.P.’s authority in the N.H.S. is the executive council, and we are only too grateful for the work and time spent on this council by those of our colleagues who are appointed to it. If this statement ;indicative of your anonymous correspondent’sideas of how G.r.s treat each other, then it is no wonder that he has not considered working an off-duty or holiday rota with his "
neighbours.
suggestion that there should be more research general practice I have no quarrel, but I strongly object to his picture of general practice, and his con. descending attitude as exemplified by his suggestion that a-G.P. would be ridiculous in a professorial chair. I can think of many G.p.s who would bring dignity, knowledge, common sense, and much-needed liaison as professors in With his
in
universities. Research in general practice will, in my opinion, best be stimulated by increasing liaison between hospital and G.r.s, and by making G.P. beds available in hospitals. It will not be helped by articles such as your anonymous correspondent’s, which can only have the effect of discouraging’ this desirable and necessary liaison. J. F. HANRATTY. Wingerworth, near Chesterfield. our
PRESERVATION OF ARTERIAL GRAFTS BY FREEZING
SIR,—The article by Professor Hufnagel and myselfi included a reference to the work of Smith and Parked at Mill Hill on recovery of frozen stored ovarian tissue and red blood-cells. Our comment that " survival is quite unpredictable, even with constant technique," though it certainly applied to previous methods of frozen storage, does less than justice to the work of the Mill Hill group. A recent visit to that centre confirmed that the glycerol-saline technique provides consistently viable tissues after storage. Ovary, sperm, and testis, and some endocrine tissues seem to be perfectly preserved. It is to be hoped that this method may soon be applied to problems of stored functioning transplants in man: such tissue preparations are now being banked along with the arterial grafts in this department. Surgical Unit, Hospital, London, W.2.
St. Mary’s
H. H. G. EASTCOTT.
FLYING AND LIFE ASSURANCE
SIR,—A peripatetic correspondent writes in your issue of
July
26 :
"
I. After enlarging on his -kill and intellect, he states : I shall be too busy to examine or follow any case adequately. ’ I would say that any f;.r. who fails to examine or follow any If we organise case adequately soon be in trouble. our work properly by making special appointments, &c., we can always ensure that a patient requiring a detailed examination is given it at leisure. Now that X-ray and laboratory "
will very
facilities
are
generally
available
we can
fully investigate
the
of our oases without troubling the consultant. 2. this is his idea of a G.P.S family life even before Danckwerts, then I am truly sorry for him- Has he never heard of arrangements with his colleagues?—but, of course, he doe not trust them (see point 4). Has he never heard of a rota for night work. group practice, or partnership ?: 3 Whatever insult, stupidity, thoughtlessness, or unnecessubmit me to. I must sary dt-mands he [the State smiles and comply." Does he really think G.P.S are as spineless as this? Anyone with this outlook would soon collect a and be treated by his patients and pr.t4-ti,-ee of colleagues with the contempt he deserved. Every practice must have some discipline, and the patients respect their doctor for applying it. 4....if an influential competitor gets a seat on the Regional Board not only are my hopes of advancement killed, but my
majority
If
"
"
patient; may
malingerers
I wonder how many of my peripatetic colleagues ... realise that if they fly more than 15,000 miles in the course of one year they are automatically depriving their dependants of all benefits under their F.S.S.U. scheme should they be involved in a fatal accident ? Apparently all the leading life-assurance societies have a clause in their policies which imposes this limit on flying unless an extra premium is paid."
This conveys an entirely wrong impression, sincf British life offices issue, whenever possible, polices unrestricted as regards airline travel. So far as I am aware, no life-assurance policy issued in this country. whether under the F.S.S.U. scheme or otherwise, would contain any clause b, which cover would cease after the had’ flown in one year 15,000 miles, or indeed any other distance. The future flying prospects of a proposer for life assurance are elicited at the time of his proposal. In the great majority of cases the expected yearly amount of passenger flying is less than 15,000 miles, and the issue
policy-holder
1. Hufnagel, C., Eastcott, H. H. G. Lancet, 1952, i, 531. 2. Smith, A. U. Ibid, 1950, ii, 910. Smith, A. U., Parkes, A. S. Ibid, 1951, ii, 570.