- Email: [email protected]
PLASTIC SURGEONS AND THE G.M.C.
1410 roll not merely for months but, frequently, for years at a time. To describe not only the strait-jacket but also the " padded-room as instruments of torture ", as Dr. Kidd does, is merely to make meaningless certain words in common use in the English language, and it is as well, Sir, that your readers should be made aware of this. To state that no British mental hospital known to Dr. Kidd, " however backward ", has made use of the padded-room during the last quarter-century merely serves to prove that Dr. Kidd’s knowledge of these hospitals is considerably more limited than he can suppose. It may surprise him to be told that certain progressive hospitals possessed and used such rooms up to a very few years ago. They have now been replaced by stripped and shuttered siderooms, and it is a debatable point whether padded-rooms, shorn of those intense emotional overtones which surround them, and which seem to have so affected Dr. Kidd, are in any way more unpleasant than these side-rooms.
prison
So long
prison hospitals must cater for overcrowded prisons (and this means a lack of side-rooms with adequately protected or strategically placed windows), so long will the padded-room be required if self-inflicted injuries and the putting out of commission of much-needed hospital accommodation are to be prevented. Although the padded-room is essential, only comparatively rarely, in our experience, has it to be brought into use. as
That every doctor in the Prison Service would welcome the opportunity to spend a period of study in a psychiatric hospital is probably true. We are not attempting to be patronising, however, when we suggest that, among those consultant psychiatrists who find themselves engaged, however occasionally, in the forensic branch of this specialty, not a few, in our opinion, would equally benefit from a similar period among the varied and unusual psychiatric material to be found in the prisons. H.M. Prison, Winchester.
J.
I. A. ANGUS K. LOTINGA.
NIGHT-CALL SERVICES
SiR,-II have followed this correspondence with interest because in the course of my duties as regional medical admissions officer I have not infrequently had cause to lament the advent of the deputy night-call service. When the scheme started I determined to await developwith an open mind. To begin with I even welcomed the influx of cases from what were obviously part-time postgraduate registrars: here was an opportunity for the specialist of tomorrow to learn at first hand something of the problems of general practice. Since those early days the postgraduate deputy has been much less in evidence. With an ever-increasing case-load, particularly during the worst months of the winter, considerations of expediency seem to have crept into the service. When efforts to find a bed have failed I generally try to assess the urgency of a case by direct discussion with the doctor concerned. Usually a general practitioner can be contacted during the night without undue delay. In the case of a deputy service, when the doctor may have several patients to visit, anything up to two hours may elapse before contact is established. In theory, one is supposed to be able to locate a doctor via the service control and short-wave radio: in practice the " chap " I want to contact nearly always seems to be using a car without radio, or if it has one, he seems unable to answer it. On one occasion when I did manage to speak to the doctor I was told quite frankly " Oh well, we have been told to get everything into hospital ". On another occasion, when discussing the possibility of morphine at home, I got the reply " I ments
quite agree, doctor, but you see we are not allowed to use morphine ". (This seems to corroborate " Diplomate "’s comment of Dec. 2.) These considerations apart, one cannot help feeling that under the night-call scheme the complete stranger called to an apparent emergency is more likely to decide on hospital admission than the patient’s family practitioner or partner to whom Mrs. X’s " abdominal emergency " has always been assessed at its true value. Then again, an appeal to a local practitioner in times of acute bed shortage is likely to be considered with due regard to this shortage of beds and. staff, and in loyalty to that situation-considerations that scarcely apply to the peripatetic, here today, gone tomorrow locum. I appreciate that to the single-handed practitioner a deputy is essential, but to my mind a rota of four or five is more realistic. Metropolitan Regional Hospital Boards, Regional Admissions Office, London, S.E.1.
A. L.
DE
SILVA.
PLASTIC SURGEONS AND THE G.M.C.
SIR,-The British Association of Plastic Surgeons has taken notice of the observations of the President of the Disciplinary Committee of the General Medical Council on Nov. 25 with the respect which is due to the authoritative tribunal of all registered British medical practitioners. Our colleagues of the medical profession may be assured that the serious misgivings will be allayed. GEORGE H. MORLEY London, W.C.2.
President, British Association of Plastic Surgeons.
COLLES’ FRACTURE SIR,-Imust congratulate Mr. Stone (Dec. 9) on his efforts to prevent the so-called inevitable late deformity in Colles’ fractures in the elderly. Like him, I repudiate the oft-repeated notion that collapse of the reduction cannot be prevented, but I have tried to solve the problem at an earlier stage in treatment. Instead of waiting two weeks for the relapse and then repeating the reduction, I change the plaster after three or four days and again, if necessary, after one week. I have found that the repeated application of moulded plasters with the forearm fully pronated gives a very high proportion of good results. My failures I attribute to lack of vigilance in carrying out this regimen. The key to success in holding Colles’ fractures is correct moulding of the plaster. Many textbooks show faulty plasters which will inevitably lead to relapse. The secret is to mould the
plaster with a concavity opposite the upper fragment -that is, well up the forearm (fig. a). If the plaster is moulded over the front of the lower fragment, as is com-
monly illustrated, plaster will actively encourage relapse of deformity (fig. b). Another common fallacy is the notion that a poor reduction of a Colles’ fracture in the elderly usually gives good results. This may be merely a reflection on the tolerance and patience of the elderly. A pertinent question is, how long does it take to achieve this result ? I agree with Mr. Stone that the elderly female living alone needs the best reduction possible, because good reductions always lead to rapid recovery of function without the need for physiotherapy.
then the
How much valuable time is being spent in therapy departments up and down the country,
physiowaxing,
prison
So long
prison hospitals must cater for overcrowded prisons (and this means a lack of side-rooms with adequately protected or strategically placed windows), so long will the padded-room be required if self-inflicted injuries and the putting out of commission of much-needed hospital accommodation are to be prevented. Although the padded-room is essential, only comparatively rarely, in our experience, has it to be brought into use. as
That every doctor in the Prison Service would welcome the opportunity to spend a period of study in a psychiatric hospital is probably true. We are not attempting to be patronising, however, when we suggest that, among those consultant psychiatrists who find themselves engaged, however occasionally, in the forensic branch of this specialty, not a few, in our opinion, would equally benefit from a similar period among the varied and unusual psychiatric material to be found in the prisons. H.M. Prison, Winchester.
J.
I. A. ANGUS K. LOTINGA.
NIGHT-CALL SERVICES
SiR,-II have followed this correspondence with interest because in the course of my duties as regional medical admissions officer I have not infrequently had cause to lament the advent of the deputy night-call service. When the scheme started I determined to await developwith an open mind. To begin with I even welcomed the influx of cases from what were obviously part-time postgraduate registrars: here was an opportunity for the specialist of tomorrow to learn at first hand something of the problems of general practice. Since those early days the postgraduate deputy has been much less in evidence. With an ever-increasing case-load, particularly during the worst months of the winter, considerations of expediency seem to have crept into the service. When efforts to find a bed have failed I generally try to assess the urgency of a case by direct discussion with the doctor concerned. Usually a general practitioner can be contacted during the night without undue delay. In the case of a deputy service, when the doctor may have several patients to visit, anything up to two hours may elapse before contact is established. In theory, one is supposed to be able to locate a doctor via the service control and short-wave radio: in practice the " chap " I want to contact nearly always seems to be using a car without radio, or if it has one, he seems unable to answer it. On one occasion when I did manage to speak to the doctor I was told quite frankly " Oh well, we have been told to get everything into hospital ". On another occasion, when discussing the possibility of morphine at home, I got the reply " I ments
quite agree, doctor, but you see we are not allowed to use morphine ". (This seems to corroborate " Diplomate "’s comment of Dec. 2.) These considerations apart, one cannot help feeling that under the night-call scheme the complete stranger called to an apparent emergency is more likely to decide on hospital admission than the patient’s family practitioner or partner to whom Mrs. X’s " abdominal emergency " has always been assessed at its true value. Then again, an appeal to a local practitioner in times of acute bed shortage is likely to be considered with due regard to this shortage of beds and. staff, and in loyalty to that situation-considerations that scarcely apply to the peripatetic, here today, gone tomorrow locum. I appreciate that to the single-handed practitioner a deputy is essential, but to my mind a rota of four or five is more realistic. Metropolitan Regional Hospital Boards, Regional Admissions Office, London, S.E.1.
A. L.
DE
SILVA.
PLASTIC SURGEONS AND THE G.M.C.
SIR,-The British Association of Plastic Surgeons has taken notice of the observations of the President of the Disciplinary Committee of the General Medical Council on Nov. 25 with the respect which is due to the authoritative tribunal of all registered British medical practitioners. Our colleagues of the medical profession may be assured that the serious misgivings will be allayed. GEORGE H. MORLEY London, W.C.2.
President, British Association of Plastic Surgeons.
COLLES’ FRACTURE SIR,-Imust congratulate Mr. Stone (Dec. 9) on his efforts to prevent the so-called inevitable late deformity in Colles’ fractures in the elderly. Like him, I repudiate the oft-repeated notion that collapse of the reduction cannot be prevented, but I have tried to solve the problem at an earlier stage in treatment. Instead of waiting two weeks for the relapse and then repeating the reduction, I change the plaster after three or four days and again, if necessary, after one week. I have found that the repeated application of moulded plasters with the forearm fully pronated gives a very high proportion of good results. My failures I attribute to lack of vigilance in carrying out this regimen. The key to success in holding Colles’ fractures is correct moulding of the plaster. Many textbooks show faulty plasters which will inevitably lead to relapse. The secret is to mould the
plaster with a concavity opposite the upper fragment -that is, well up the forearm (fig. a). If the plaster is moulded over the front of the lower fragment, as is com-
monly illustrated, plaster will actively encourage relapse of deformity (fig. b). Another common fallacy is the notion that a poor reduction of a Colles’ fracture in the elderly usually gives good results. This may be merely a reflection on the tolerance and patience of the elderly. A pertinent question is, how long does it take to achieve this result ? I agree with Mr. Stone that the elderly female living alone needs the best reduction possible, because good reductions always lead to rapid recovery of function without the need for physiotherapy.
then the
How much valuable time is being spent in therapy departments up and down the country,
physiowaxing,