- Email: [email protected]
NEW MEDICAL SCHOOL IN LAGOS
658
disability or extreme frailty bring them down. At this point it is most appropriate that the doctor should be turned to, and that he, being aware of the difficulties, should convince himself, that pathological processes are absent before old age ".
"
accepting that the breakdown is due to just
Ipswich and East Suffolk Hospital, Ipswich.
J. N. AGATE.
SIR,-It would be dangerous if Dr. Kemp’s genial aphorisms (Sept. 15) were to influence the appointment and disposition of proper medical facilities for old people. No-one would dispute the importance of unmet physical and emotional needs as a cause of ill health and unhappiness amongst the general elderly population; and his appeal for timeous correction of such external factors in a friendly, personal, optimistic, and tactful manner cannot fail to meet with universal approval. But prominent "
"
pronouncements about old age need as much support from references or recorded observations as would be insisted on in any other field of inquiry, particularly when it comes to such specific matters as the definition of
normality, disability, prevention, prognosis,
and
hospital
care.
The borderland between physiological and pathological ageing is an uneasy one. But ageing is compatible with good physical and mental health, and just as it is normal for an elderly person to be well, we should regard it as abnormal for him to be ill. It is certainly not normal, as Dr. Kemp maintains, to be frail and unsteady, confused about people and places, forgetful and untidy, and consumed by fear of death. Indeed, his concept of disability arising from " simple old age " is a naive one. In our own hospital practice careful clinical examination has always uncovered a considerable and often unsuspected weight of multiple pathological processes.! Even in patients overwhelmed and made miserable by circumstances from without, we have been impressed by the complexity of the environmental situations (which involved much more than simple deprivation) and by the high incidence of organic disease.2 We are less optimistic than Dr. Kemp about prevention of disability solely by the provision of the type of personal support which he outlines. Dr. Kemp’s handling of mental changes lacks the diagnostic precision he himself demands. He regards as normal classical evidence of organic mental deterioration; he ignores established classifications of mental illness, and the enormous contributions of psychiatry and other disciplines to this field. In the matter of hospital organisation, if Dr. Kemp’s wards carry so many patients who are not ill, we would commend to him the domiciliary screening of admissions, which is practised in most geriatric services. His idea of " institutionalisation " with its faulty attitudes of staff and a worsening of what is already afoot " are a far cry from the atmosphere of the modern geriatric unit.2 Dr. Arnold and Dr. Exton-Smith (Sept. 15) have demonstrated the benefits which may accrue from treatment in such active departments, with their flexible services and their well-fostered links with general practitioners and local-authority and other supportive agencies. "
The challenge which old people present to our profession is of such size and complexity that it requires all the " resources of scientific medicine " at our disposal. Medical care of the elderly demands that the physician should attempt some understanding of the breadth and depth of the technical and human problems which he meets in his practice. He will be doing his patients a disservice if he retreats to the comfortable role of " friendly counsellor ". Geriatric Unit, L. A. WILSON Woodend General Hospital, I. R. LAWSON. Aberdeen. 1. 2.
Wilson, Wilson,
L. A., Lawson, I. R., Brass, W. Lancet (in the press). L. A., Lawson, I. R. Addit. ad. Geront. clin. 1962, 4, 59.
NEW MEDICAL SCHOOL IN LAGOS
SIR,-We express appreciation for the comments in your annotation of June 30. One of the many problems a new medical school and teaching hospital is to disseminate information to professional persons who may be interested in seeking appointment on the staff. Judging by inquiries received since their appearance, your comments have been of some help in this direction. We are sure you will understand that it is not with any wish to cavil that we call attention to two passages in your annotation which may be misunderstood. One is: " All these projects are part of a large six-year development plan for the reorganisation of the medical services of Nigeria on which the Federal Government propose to spend more than E10 million." And the other: "It is perhaps not unfair to comment that even E10 million may
facing
far in realising the many fine projects planned, if the standard is to be kept up to that of the General Medical Council and of medical practice of more highly developed countries." The impression is that the Government of the Federation of Nigeria propose to spend E10 million in six years on medical education and on improving medical services throughout the Federation of Nigeria (population, 40 million) whereas, in fact, E10 million (less E2’05 million which is allocated to University College Hospital, Ibadan 1) is to be spent during that period in developing the Lagos University Medical School and Teaching Hospital, and on improving medical facilities in the Federal not go very
Territory of Lagos (population, 400,000-i.e.,
one-
hundredth of the population of the Federation). Read correctly, it will be seen that the jam is in fact more thickly spread in the hope that the richer nourishment thus proffered will produce doctors of as high a standard as one would expect of more highly developed countries. H. ORISHEJOLOMI THOMAS Dean, University of Lagos Medical School.
CARCINOMA OF BRONCHUS AND CUSHING’S SYNDROME
SiR,-The interesting report of Dr. Thompson and his me to record a further association between carcinoma of bronchus and the adrenal glands which is of some interest. A 48-year-old slightly built woman (who had been a heavy smoker) presented with cough and haemoptysis and was found
colleagues (Sept. 15) prompts
have right basal consolidation, ascites, and hepatomegaly. There was no clinical evidence of Cushing’s syndrome: bloodpressure was 155/80 mm. Hg. Death followed 12 days after admission, and at necropsy the only external abnormalities were mild icterus and abdominal protuberance. There was no facial hair, and body hair was normal. Dissection revealed a right main lower-lobe bronchial carcinoma with distal suppurative bronchopneumonia and metastases in the hilar and mediastinal lymph-nodes and liver. The brain and pituitary appeared normal; the thyroid was small (9’0 g.); the uterus and ovaries had been removed surgically; the adrenals were enlarged to about twice normal size, the cortex being buff coloured and 4 mm. thick. Microscopy showed the cancer to be of oat-cell type in lung, nodes, and liver. No microscopic secondaries were found in the other organs examined. Breast parenchyma and vaginal mucosa were atrophic and the thyroid was inactive and rather fibrosed. There was considerable diminution in the number of beta-cells in the pars anterior of pituitary, as shown by Pearse’s tri-P.A.S. method: those remaining werelarge,grosslyvacuolated, to
1. Federal
Paper,
Government no.
Development Programme 1962-68 (Sessional 1 of 1962); p. 37. Lagos.
disability or extreme frailty bring them down. At this point it is most appropriate that the doctor should be turned to, and that he, being aware of the difficulties, should convince himself, that pathological processes are absent before old age ".
"
accepting that the breakdown is due to just
Ipswich and East Suffolk Hospital, Ipswich.
J. N. AGATE.
SIR,-It would be dangerous if Dr. Kemp’s genial aphorisms (Sept. 15) were to influence the appointment and disposition of proper medical facilities for old people. No-one would dispute the importance of unmet physical and emotional needs as a cause of ill health and unhappiness amongst the general elderly population; and his appeal for timeous correction of such external factors in a friendly, personal, optimistic, and tactful manner cannot fail to meet with universal approval. But prominent "
"
pronouncements about old age need as much support from references or recorded observations as would be insisted on in any other field of inquiry, particularly when it comes to such specific matters as the definition of
normality, disability, prevention, prognosis,
and
hospital
care.
The borderland between physiological and pathological ageing is an uneasy one. But ageing is compatible with good physical and mental health, and just as it is normal for an elderly person to be well, we should regard it as abnormal for him to be ill. It is certainly not normal, as Dr. Kemp maintains, to be frail and unsteady, confused about people and places, forgetful and untidy, and consumed by fear of death. Indeed, his concept of disability arising from " simple old age " is a naive one. In our own hospital practice careful clinical examination has always uncovered a considerable and often unsuspected weight of multiple pathological processes.! Even in patients overwhelmed and made miserable by circumstances from without, we have been impressed by the complexity of the environmental situations (which involved much more than simple deprivation) and by the high incidence of organic disease.2 We are less optimistic than Dr. Kemp about prevention of disability solely by the provision of the type of personal support which he outlines. Dr. Kemp’s handling of mental changes lacks the diagnostic precision he himself demands. He regards as normal classical evidence of organic mental deterioration; he ignores established classifications of mental illness, and the enormous contributions of psychiatry and other disciplines to this field. In the matter of hospital organisation, if Dr. Kemp’s wards carry so many patients who are not ill, we would commend to him the domiciliary screening of admissions, which is practised in most geriatric services. His idea of " institutionalisation " with its faulty attitudes of staff and a worsening of what is already afoot " are a far cry from the atmosphere of the modern geriatric unit.2 Dr. Arnold and Dr. Exton-Smith (Sept. 15) have demonstrated the benefits which may accrue from treatment in such active departments, with their flexible services and their well-fostered links with general practitioners and local-authority and other supportive agencies. "
The challenge which old people present to our profession is of such size and complexity that it requires all the " resources of scientific medicine " at our disposal. Medical care of the elderly demands that the physician should attempt some understanding of the breadth and depth of the technical and human problems which he meets in his practice. He will be doing his patients a disservice if he retreats to the comfortable role of " friendly counsellor ". Geriatric Unit, L. A. WILSON Woodend General Hospital, I. R. LAWSON. Aberdeen. 1. 2.
Wilson, Wilson,
L. A., Lawson, I. R., Brass, W. Lancet (in the press). L. A., Lawson, I. R. Addit. ad. Geront. clin. 1962, 4, 59.
NEW MEDICAL SCHOOL IN LAGOS
SIR,-We express appreciation for the comments in your annotation of June 30. One of the many problems a new medical school and teaching hospital is to disseminate information to professional persons who may be interested in seeking appointment on the staff. Judging by inquiries received since their appearance, your comments have been of some help in this direction. We are sure you will understand that it is not with any wish to cavil that we call attention to two passages in your annotation which may be misunderstood. One is: " All these projects are part of a large six-year development plan for the reorganisation of the medical services of Nigeria on which the Federal Government propose to spend more than E10 million." And the other: "It is perhaps not unfair to comment that even E10 million may
facing
far in realising the many fine projects planned, if the standard is to be kept up to that of the General Medical Council and of medical practice of more highly developed countries." The impression is that the Government of the Federation of Nigeria propose to spend E10 million in six years on medical education and on improving medical services throughout the Federation of Nigeria (population, 40 million) whereas, in fact, E10 million (less E2’05 million which is allocated to University College Hospital, Ibadan 1) is to be spent during that period in developing the Lagos University Medical School and Teaching Hospital, and on improving medical facilities in the Federal not go very
Territory of Lagos (population, 400,000-i.e.,
one-
hundredth of the population of the Federation). Read correctly, it will be seen that the jam is in fact more thickly spread in the hope that the richer nourishment thus proffered will produce doctors of as high a standard as one would expect of more highly developed countries. H. ORISHEJOLOMI THOMAS Dean, University of Lagos Medical School.
CARCINOMA OF BRONCHUS AND CUSHING’S SYNDROME
SiR,-The interesting report of Dr. Thompson and his me to record a further association between carcinoma of bronchus and the adrenal glands which is of some interest. A 48-year-old slightly built woman (who had been a heavy smoker) presented with cough and haemoptysis and was found
colleagues (Sept. 15) prompts
have right basal consolidation, ascites, and hepatomegaly. There was no clinical evidence of Cushing’s syndrome: bloodpressure was 155/80 mm. Hg. Death followed 12 days after admission, and at necropsy the only external abnormalities were mild icterus and abdominal protuberance. There was no facial hair, and body hair was normal. Dissection revealed a right main lower-lobe bronchial carcinoma with distal suppurative bronchopneumonia and metastases in the hilar and mediastinal lymph-nodes and liver. The brain and pituitary appeared normal; the thyroid was small (9’0 g.); the uterus and ovaries had been removed surgically; the adrenals were enlarged to about twice normal size, the cortex being buff coloured and 4 mm. thick. Microscopy showed the cancer to be of oat-cell type in lung, nodes, and liver. No microscopic secondaries were found in the other organs examined. Breast parenchyma and vaginal mucosa were atrophic and the thyroid was inactive and rather fibrosed. There was considerable diminution in the number of beta-cells in the pars anterior of pituitary, as shown by Pearse’s tri-P.A.S. method: those remaining werelarge,grosslyvacuolated, to
1. Federal
Paper,
Government no.
Development Programme 1962-68 (Sessional 1 of 1962); p. 37. Lagos.