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OCCLUSIVE DRESSINGS
312 continues in spite of the fact that the Trevethin report, in 1923, recommended that the law should be altered. Dr. Forgan says that he has advocated prevention for many years " as a means of reducing the incidence of V.D." Then why does he disparage the idea now ? If practical prevention is allowed to be known generally, it will go on reducing the incidence until elimination is reached. At present not 1 % of the population know anything about it, and those who do cannot use their knowledge on account of the legal obstacle. The N.S.P.V.D. takes no part in the controversy about compulsory notification and compulsory treatment of v.D. All such suggestions are unnecessary because v.D. is easily preventable and its successful prevention is
being prevented. 47, Nottingham Place, London, W.l.
R. A. LYSTER Chairman, National Society for the Prevention of Venereal Disease.
SiR,-Lord Horder’s letter outlining the policy of the National Society for the Prevention of Venereal Disease will be welcomed by many medical men who have to deal directly with this problem. As port health officer, with experience of a number of ports in the tropics, I have always made a point of asking merchant seamen suffering from venereal disease wha precautions, if any, they took. I have been appalled by the high proportion of men who did not know how to protect themselves and by the number who thought that a condom was sufficient protection. As M.o., before the war, to a group of trading concerns in the Far East, I interviewed each new arrival and, after stressing the moral aspect, instructed him in simple methods of prophylaxis. The striking reduction in the incidence of venereal disease among the staff was ample compensation for the open disapproval of those who said that immorality was being encouraged. P.H.O.
MEDICAL RECORDS SIR,-Those who are aware of the conditions which now prevail in the majority of hospitals cannot but be sympathetic towards " Medical Secretary." Undoubtedly there is truth in some of the comments she makes in her letter of Aug. 14-. She and others may feel encouraged to learn that the Association of Medical Records Officers has under consideration an educational scheme whereby it would be possible to gain additional knowledge of anatomy, physiology, and medical terminology. It is recognised that no medical secretary or stenographer can really do justice to the tasks assigned to her without such a training. The association’s first responsibility is, however, -to augment the knowledge of the officers in charge of hospital medical records departments, and through them try to improve the standard of medical record keepingin so far as the laity can improve the standard. Records officers agree that medical secretaries are key people in the production and maintenance of medical records, and, as a result of the active-and long overdue-interest which has been shown in this sphere of hospital administration in the last year or two, I think they may look forward to a much greater appreciation of the value of their work, and to more satisfactory conditions of service, in the not too distant future. ELSIE ROYLE Honorary Secretary, Manchester.
Association of Medical Records Officers.
SiR,-"Medical Secretary " is, regrettably, correct in her statements. The qualifications and qualities outlined by her are essential for all who follow the profession of medical record keeping, which includes medical stenography whether in hospital or in private practice. It was -because of the universally acknowledged lack of training facilities for those engaged in this work in hospitals and allied organisations that an Association of Medical Records Officers was recently formed. This association aims at raising the standard of work done, by training courses and opportunities for the interchange of knowledge and experience for those already engaged in the work, and by laying down fundamental standards of education for those entering the profession. These requirements correspond with those of other ancillary medical services, and it is hoped thereby to gain recognition of the fact that the members of this association
specialists in their own sphere. So far as the stenographer in private practice is concerned, no doubt those are
interested would be welcomed in classes arranged for members of medical records departments in hospitals, as was the case in my own hospital, where private secretaries attended a course of lectures on medical records and subsequently a course of lectures on anatomy and physiology, though naturally they would not be able to qualify for membership of the association. The association also lays stress on the careful selection of staff-a necessity too often neglected in the past by The results have those responsible for appointments. sometimes been unfortunate, but the misguided selection has usually been due to (1) lack of appreciation of the technicalities and responsibilities of those employed in the medical records department ; and (2) the small salaries paid in comparison with commerce and industry, where considerably less strain and responsibility have to be borne by the stenographer. Most of the people who work in the medical records department, and in some cases in private practice too, do so because of their love of the work, its absorbing nature, and their desire to serve their fellow men. RECORDS OFFICER.
OCCLUSIVE DRESSINGS
SiB,—If Bull, Squire, and Topley (Aug. 7) have done nothing more than re-emphasise the deleterious effects of adhesive plaster and such-like occlusive dressings on the skin and on wounds in general, they have done a great service. It is commonplace experience that wounds do better when covered simply-a piece of gauze held in place by two narrow strips of strapping suffices for most wounds. I have never ceased to demonstrate this to my subordinates in peace and in war. However laudable your contributors’ effort to find a substance which will allow normal skin evaporation to take place without being permeable to outside fluids, we must be careful, now that the age of adhesive plaster is over, to ensure that our wounds never again have coverings with similar disadvantages. MARTIN FALLON. Dublin. DEATH WHILE BATHING
SIR,-It would be interesting to know whether some unexpected deaths while bathing might not be due to acute prolapse of a vertebral disc. About a year ago, in my bath I was suddenly, as it seemed, cut nearly in two by something from behind. For ten minutes I lay in that bath paralysed and nearly fainting with pain. Had this happened while bathing alone -in deep water I should certainly have died. I suggest that pathologists confronted with such cases might look and see, if there is no other obvious cause, before attributing death vaguely to cramp, heart-failure, full stomach, and the like ; also, that patients subject to such attacks be warned to be careful where they bathe. G. L. ALEXANDER. Bristol. CHARMS SiR,-Dr. Lowy has written a charming and disarming letter (Aug. 7) ; but if he is serious, isn’t he being more than a little naive ? There is, he tells us, in the human personality " the deep-rooted desire for the belief in the supernatural and unexplainable." We may deplore it but we cannot afford to ignore it, and " if we wish to be sincere " we must admit that in some people an approach’ on these lines promises better and speedier results than the employment .of scientific methods. Dr. Lowy does not say so, but it is self-evident that this deep-rooted desire for the supernatural and unexplainable must run counter to all advances in knowledge-advances which, of course, make the general body of scientific truth less supernatural and more explainable. Is Dr. Lowy implying that such supernatural and unexplainable methods of therapy should be encouraged in physical medicine as well (he will know that cures of organic diseases have been claimed by healers), or that while purely scientific investigation and treatment should be allowed to continue in general medicine, surgery, and other subjects there should be an honourable place for atavism and superstition
being prevented. 47, Nottingham Place, London, W.l.
R. A. LYSTER Chairman, National Society for the Prevention of Venereal Disease.
SiR,-Lord Horder’s letter outlining the policy of the National Society for the Prevention of Venereal Disease will be welcomed by many medical men who have to deal directly with this problem. As port health officer, with experience of a number of ports in the tropics, I have always made a point of asking merchant seamen suffering from venereal disease wha precautions, if any, they took. I have been appalled by the high proportion of men who did not know how to protect themselves and by the number who thought that a condom was sufficient protection. As M.o., before the war, to a group of trading concerns in the Far East, I interviewed each new arrival and, after stressing the moral aspect, instructed him in simple methods of prophylaxis. The striking reduction in the incidence of venereal disease among the staff was ample compensation for the open disapproval of those who said that immorality was being encouraged. P.H.O.
MEDICAL RECORDS SIR,-Those who are aware of the conditions which now prevail in the majority of hospitals cannot but be sympathetic towards " Medical Secretary." Undoubtedly there is truth in some of the comments she makes in her letter of Aug. 14-. She and others may feel encouraged to learn that the Association of Medical Records Officers has under consideration an educational scheme whereby it would be possible to gain additional knowledge of anatomy, physiology, and medical terminology. It is recognised that no medical secretary or stenographer can really do justice to the tasks assigned to her without such a training. The association’s first responsibility is, however, -to augment the knowledge of the officers in charge of hospital medical records departments, and through them try to improve the standard of medical record keepingin so far as the laity can improve the standard. Records officers agree that medical secretaries are key people in the production and maintenance of medical records, and, as a result of the active-and long overdue-interest which has been shown in this sphere of hospital administration in the last year or two, I think they may look forward to a much greater appreciation of the value of their work, and to more satisfactory conditions of service, in the not too distant future. ELSIE ROYLE Honorary Secretary, Manchester.
Association of Medical Records Officers.
SiR,-"Medical Secretary " is, regrettably, correct in her statements. The qualifications and qualities outlined by her are essential for all who follow the profession of medical record keeping, which includes medical stenography whether in hospital or in private practice. It was -because of the universally acknowledged lack of training facilities for those engaged in this work in hospitals and allied organisations that an Association of Medical Records Officers was recently formed. This association aims at raising the standard of work done, by training courses and opportunities for the interchange of knowledge and experience for those already engaged in the work, and by laying down fundamental standards of education for those entering the profession. These requirements correspond with those of other ancillary medical services, and it is hoped thereby to gain recognition of the fact that the members of this association
specialists in their own sphere. So far as the stenographer in private practice is concerned, no doubt those are
interested would be welcomed in classes arranged for members of medical records departments in hospitals, as was the case in my own hospital, where private secretaries attended a course of lectures on medical records and subsequently a course of lectures on anatomy and physiology, though naturally they would not be able to qualify for membership of the association. The association also lays stress on the careful selection of staff-a necessity too often neglected in the past by The results have those responsible for appointments. sometimes been unfortunate, but the misguided selection has usually been due to (1) lack of appreciation of the technicalities and responsibilities of those employed in the medical records department ; and (2) the small salaries paid in comparison with commerce and industry, where considerably less strain and responsibility have to be borne by the stenographer. Most of the people who work in the medical records department, and in some cases in private practice too, do so because of their love of the work, its absorbing nature, and their desire to serve their fellow men. RECORDS OFFICER.
OCCLUSIVE DRESSINGS
SiB,—If Bull, Squire, and Topley (Aug. 7) have done nothing more than re-emphasise the deleterious effects of adhesive plaster and such-like occlusive dressings on the skin and on wounds in general, they have done a great service. It is commonplace experience that wounds do better when covered simply-a piece of gauze held in place by two narrow strips of strapping suffices for most wounds. I have never ceased to demonstrate this to my subordinates in peace and in war. However laudable your contributors’ effort to find a substance which will allow normal skin evaporation to take place without being permeable to outside fluids, we must be careful, now that the age of adhesive plaster is over, to ensure that our wounds never again have coverings with similar disadvantages. MARTIN FALLON. Dublin. DEATH WHILE BATHING
SIR,-It would be interesting to know whether some unexpected deaths while bathing might not be due to acute prolapse of a vertebral disc. About a year ago, in my bath I was suddenly, as it seemed, cut nearly in two by something from behind. For ten minutes I lay in that bath paralysed and nearly fainting with pain. Had this happened while bathing alone -in deep water I should certainly have died. I suggest that pathologists confronted with such cases might look and see, if there is no other obvious cause, before attributing death vaguely to cramp, heart-failure, full stomach, and the like ; also, that patients subject to such attacks be warned to be careful where they bathe. G. L. ALEXANDER. Bristol. CHARMS SiR,-Dr. Lowy has written a charming and disarming letter (Aug. 7) ; but if he is serious, isn’t he being more than a little naive ? There is, he tells us, in the human personality " the deep-rooted desire for the belief in the supernatural and unexplainable." We may deplore it but we cannot afford to ignore it, and " if we wish to be sincere " we must admit that in some people an approach’ on these lines promises better and speedier results than the employment .of scientific methods. Dr. Lowy does not say so, but it is self-evident that this deep-rooted desire for the supernatural and unexplainable must run counter to all advances in knowledge-advances which, of course, make the general body of scientific truth less supernatural and more explainable. Is Dr. Lowy implying that such supernatural and unexplainable methods of therapy should be encouraged in physical medicine as well (he will know that cures of organic diseases have been claimed by healers), or that while purely scientific investigation and treatment should be allowed to continue in general medicine, surgery, and other subjects there should be an honourable place for atavism and superstition