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PAPILLŒDEMA IN CHRONIC RESPIRATORY DISEASE
894 suction is that complete deflation of the lung can occur/ and it has been shown2 that once the lung has been deflated it will behave as though it had never been inflated and will again need higher pressures to expand it.
hypothyroidism because the raised level returns to normal a few days after the infarction.
Apart from these criticisms, we would urge that all obstetric units, including general-practitioner units, should be ready and competent to aid the apnoeic child on the lines indicated by Dr. Barrie and that medical students, as part of their routine obstetric training, should havedemonstrations, using fresh stillbirths or stillborn lambs, on the use and misuse of oxygen at positive pressures and the importance of time on pressure. G. F. WILLIAMS General Hospital, W. H. BEASLEY. Aberystwyth.
PAPILLŒDEMA IN CHRONIC RESPIRATORY DISEASE of April 6 refers to this complicaannotation SIR, Your with tion as a prognostic sign regard to the patient’s survival. However, the papilloedema is in itself an occasional menace, and may jeopardise vision. Cameron,1 whom you quote, suggested that consecutive optic atrophy might ensue. A case of blindness due to this cause has been reported2 in a 48-year-old man. The papillcedema was of long standing and vision was lost two years before death. Dulwich Hospital, BERNARD FREEDMAN.
SIR,-In an endeavour to discourage the reintroduction of intracardiac injections as a method of resuscitating the asphyxiated neonate, as recently suggested by Dr. Leak (April 6), I should like to draw attention to the work of Dr. Saling 34 in Berlin. By serial measurements of arterial oxygen saturation in the newborn infant he has shown the irrefutable value of endotracheal insufflation with oxygen in the treatment of neonatal asphyxia. Further, he demonstrated that the intravenous injection of analeptic drugs (including ’Cardiazol ’ in much smaller doses than those recommended by Dr. Leak), in spite of provoking respiratory effort, led to a fall in arterial oxygen saturation. His experiments suggest that this undesirable effect of so-called analeptic drugs is caused by vasoconstriction in the pulmonary circulation. This evidence speaks for
Guy’s Hospital,
St. Thomas’s
Hospital, London, S.E.1.
PETER
J. HUNTINGFORD.
CREATINEPHOSPHOKINASE LEVELS IN HYPOTHYROIDISM
SIR,-Graig and Ross5 report that they have found a significant rise in the level of creatinephosphokinase (C.P.K.) in 10 out of 15 sera of hypothyroid patients. I have made a similar observation in 7 out of 10 patients CREATINEPHOSPHOKINASE LEVELS IN MYXCEDEMA DISEASE
AND
HASHIMOTO’S
J.
London, S.E.22.
A MISPRINTED DOSE
Dr. DONALD HUNTER and Dr. R. R. BOMFORD write: "
We should be grateful if you would give publicity to a potentially dangerous misprint in the recently published 14th edition of Clinical Methods. The dose of histamine in the augmented histamine test meal (p. 52) should read 0-04 mg. per kg. body-weight and not 0-4 mg. An erratum slip is being inserted."
Parliament Homes Bill ON April 5, Mr. ALAN BROWN’S Bill to authorise the Minister
Nursing
of Health
itself.
P. D. GRIFFITHS.
London, S.E.1.
make
regulations governing the conduct of a third reading. Mr. BERNARD BRAINE, received nursing-homes joint parliamentary secretary to the Ministry, said that the Minister already had powers to make regulations for mental nursing-homes and residential homes for the elderly and disabled. He welcomed this Bill which would extend his powers to nursing-homes. There were, Mr. Braine continued, 1100 nursing-homes in England and Wales, providing 18,000 beds. There was thus 1 nursing-home bed for every 12 hospital beds, apart from the beds for the mentally disordered. This was a substantial contribution to the care of the sick. 1500-1600 of these beds were for maternity cases. 85% of the other beds were occupied by patients of pensionable age. These patients were a particularly vulnerable group, and on their account it was especially necessary that there should be effective control by the registration authorities. Local authorities, who were at present responsible for registration, had been finding increasing difficulty in securing the maintenance of reasonable standards in certain homes. They felt that additional powers were needed, and had been pressing the Ministry for some time for the kind of regulations which the Bill would now enable the Minister to make. to
Work after Childbirth studied in the course of a larger survey (see table). With successful treatment, the levels revert to normal usually within a month. As a paper has now been published which corroborates my so far small series of observations, I feel attention should be drawn to the raised levels of C.P.K. in hypothyroidism as a possible source of error in the diagnosis of other conditions in which C.P.K. is already known to be high, notably muscular dystrophy (patients and carriers) and cardiac infarction. As far as the latter is concerned serial estimations will soon differentiate it from 1. 2. 3. 4. 5. 6.
Rosen, M., Hillard, E. K. Brit. J. Anœsth. 1960, 32, 486. Wilson, J. L., Farber, S. Amer. J. Dis. Child. 1933, 46, 590. Saling, E. Geburtsch. u. Frauenheilk. 1960, 20, 325. Saling, E. ibid. 1961, 21, 237. Graig, F. A., Ross, G. Metabolism, 1963, 12, 57. Ennor, A. H., Rosenberg, H. Biochem. J. 1954, 57, 203.
Lord Balniel’s Employment of Women Bill,3 which sought give the Minister of Health power to restrict the paid employment of women for a period after childbirth, received an unopposed, second reading on Jan. 25 and emerged from the Standing Committee unamended. But opposition to it has been growing among some women’s organisations, and it was talked out at the report stage in the House of Commons on April 5.
to
Inconvenient Turnstiles ON April 5 the Public Lavatories (Turnstiles) Bill which makes it the duty of local authorities to abolish turnstiles in public lavatories was read a second time and sent to a standing committee. 69 authorities have refused to remove some or all of their turnstiles and have declined to reconsider their decision; 18 authorities are still undecided. _______
1. Cameron, A. J. Brit. J. Ophthal. 1933, 17, 167. 2. Freedman, B. J. ibid. 1963 (in the press). 3. See Lancet, March 30, 1963, p. 708.
hypothyroidism because the raised level returns to normal a few days after the infarction.
Apart from these criticisms, we would urge that all obstetric units, including general-practitioner units, should be ready and competent to aid the apnoeic child on the lines indicated by Dr. Barrie and that medical students, as part of their routine obstetric training, should havedemonstrations, using fresh stillbirths or stillborn lambs, on the use and misuse of oxygen at positive pressures and the importance of time on pressure. G. F. WILLIAMS General Hospital, W. H. BEASLEY. Aberystwyth.
PAPILLŒDEMA IN CHRONIC RESPIRATORY DISEASE of April 6 refers to this complicaannotation SIR, Your with tion as a prognostic sign regard to the patient’s survival. However, the papilloedema is in itself an occasional menace, and may jeopardise vision. Cameron,1 whom you quote, suggested that consecutive optic atrophy might ensue. A case of blindness due to this cause has been reported2 in a 48-year-old man. The papillcedema was of long standing and vision was lost two years before death. Dulwich Hospital, BERNARD FREEDMAN.
SIR,-In an endeavour to discourage the reintroduction of intracardiac injections as a method of resuscitating the asphyxiated neonate, as recently suggested by Dr. Leak (April 6), I should like to draw attention to the work of Dr. Saling 34 in Berlin. By serial measurements of arterial oxygen saturation in the newborn infant he has shown the irrefutable value of endotracheal insufflation with oxygen in the treatment of neonatal asphyxia. Further, he demonstrated that the intravenous injection of analeptic drugs (including ’Cardiazol ’ in much smaller doses than those recommended by Dr. Leak), in spite of provoking respiratory effort, led to a fall in arterial oxygen saturation. His experiments suggest that this undesirable effect of so-called analeptic drugs is caused by vasoconstriction in the pulmonary circulation. This evidence speaks for
Guy’s Hospital,
St. Thomas’s
Hospital, London, S.E.1.
PETER
J. HUNTINGFORD.
CREATINEPHOSPHOKINASE LEVELS IN HYPOTHYROIDISM
SIR,-Graig and Ross5 report that they have found a significant rise in the level of creatinephosphokinase (C.P.K.) in 10 out of 15 sera of hypothyroid patients. I have made a similar observation in 7 out of 10 patients CREATINEPHOSPHOKINASE LEVELS IN MYXCEDEMA DISEASE
AND
HASHIMOTO’S
J.
London, S.E.22.
A MISPRINTED DOSE
Dr. DONALD HUNTER and Dr. R. R. BOMFORD write: "
We should be grateful if you would give publicity to a potentially dangerous misprint in the recently published 14th edition of Clinical Methods. The dose of histamine in the augmented histamine test meal (p. 52) should read 0-04 mg. per kg. body-weight and not 0-4 mg. An erratum slip is being inserted."
Parliament Homes Bill ON April 5, Mr. ALAN BROWN’S Bill to authorise the Minister
Nursing
of Health
itself.
P. D. GRIFFITHS.
London, S.E.1.
make
regulations governing the conduct of a third reading. Mr. BERNARD BRAINE, received nursing-homes joint parliamentary secretary to the Ministry, said that the Minister already had powers to make regulations for mental nursing-homes and residential homes for the elderly and disabled. He welcomed this Bill which would extend his powers to nursing-homes. There were, Mr. Braine continued, 1100 nursing-homes in England and Wales, providing 18,000 beds. There was thus 1 nursing-home bed for every 12 hospital beds, apart from the beds for the mentally disordered. This was a substantial contribution to the care of the sick. 1500-1600 of these beds were for maternity cases. 85% of the other beds were occupied by patients of pensionable age. These patients were a particularly vulnerable group, and on their account it was especially necessary that there should be effective control by the registration authorities. Local authorities, who were at present responsible for registration, had been finding increasing difficulty in securing the maintenance of reasonable standards in certain homes. They felt that additional powers were needed, and had been pressing the Ministry for some time for the kind of regulations which the Bill would now enable the Minister to make. to
Work after Childbirth studied in the course of a larger survey (see table). With successful treatment, the levels revert to normal usually within a month. As a paper has now been published which corroborates my so far small series of observations, I feel attention should be drawn to the raised levels of C.P.K. in hypothyroidism as a possible source of error in the diagnosis of other conditions in which C.P.K. is already known to be high, notably muscular dystrophy (patients and carriers) and cardiac infarction. As far as the latter is concerned serial estimations will soon differentiate it from 1. 2. 3. 4. 5. 6.
Rosen, M., Hillard, E. K. Brit. J. Anœsth. 1960, 32, 486. Wilson, J. L., Farber, S. Amer. J. Dis. Child. 1933, 46, 590. Saling, E. Geburtsch. u. Frauenheilk. 1960, 20, 325. Saling, E. ibid. 1961, 21, 237. Graig, F. A., Ross, G. Metabolism, 1963, 12, 57. Ennor, A. H., Rosenberg, H. Biochem. J. 1954, 57, 203.
Lord Balniel’s Employment of Women Bill,3 which sought give the Minister of Health power to restrict the paid employment of women for a period after childbirth, received an unopposed, second reading on Jan. 25 and emerged from the Standing Committee unamended. But opposition to it has been growing among some women’s organisations, and it was talked out at the report stage in the House of Commons on April 5.
to
Inconvenient Turnstiles ON April 5 the Public Lavatories (Turnstiles) Bill which makes it the duty of local authorities to abolish turnstiles in public lavatories was read a second time and sent to a standing committee. 69 authorities have refused to remove some or all of their turnstiles and have declined to reconsider their decision; 18 authorities are still undecided. _______
1. Cameron, A. J. Brit. J. Ophthal. 1933, 17, 167. 2. Freedman, B. J. ibid. 1963 (in the press). 3. See Lancet, March 30, 1963, p. 708.