- Email: [email protected]
PRACTICE OUTSIDE THE SERVICE
500
’Veganin’ for themselves and their own families, nor many who would do so for their paying patients ; and since the Minister of Health stated clearly that prescriptions under N.H.S. must be for the most effective medi-
HODGKIN’S DISEASE
SIR,—Your leading article of March 5 again emphasises fact-recognised fully by pathologists but not so fully by clinicians-that Hodgkin’s disease affects the whole reticulo-endothelial system. The technique of deep X-ray therapy used by Mr. T. Anthony Green is based on recognition of the pathological picture. Since radiotherapy can only be palliative, intense local treatment to a mass of glands, for with severe resultant reactions, is not justified ; lower dosage can achieve the same symptomatic The technique adopted in this department result. (equally effective in other reticuloses, such as the leukaemias) is as follows : The symptom-producing mass of glands is treated first, using a dosage of approximately 500r tissue in one week, blood-colmts being performed before and after treatment. If the patient’s condition is satisfactory, the remainder of the body from neck to groins is then treated in strips, the method being referred to as the " step-ladder " technique. Two fields 30 X 12 em., one anterior and the other posterior, are used to give a dose of 300-500r in one week per strip according to the patient’s condition. The blood-count is recorded weekly and whenever possible the strips are treated the
cines, practitioners are increasingly prescribing ’Veganin ’ under N.H.S. too. " indignation," to which Professor Alstead refers. directed to the misuse of our trade-markVeganin.’ which misleads patients into believing that the effects. or otherwise, of anonymous tab. codein. co. are attributable to our product. The professor teaches his pupils that tab. codein. co. are as good ; we trust that he will them that these should not masquerade as warn Veganin,’ either in hospitals or elsewhere. The price per 100 quoted by Professor Alstead includes purchase-tax, which will not be chargeable on dispensing packs after May 2, and, so far as N.H.S. is concerned, is only a transfer from one Government pocket to another meanwhile. ELIOT WARBURTON. William R. Warner & Co. Ltd.,
My
was
London, W.4.
PEPTIC DISORDERS IN A FAMILY SIR,—The occurrence of gastric and duodenal disorders in succeeding generations of a single family is indicated by the accompanying figure. The following is a summary of the patients’ histories :s (1) died, aged 72, of cancer of the stomach ; (2) died, aged 71, of cancer of the stomach ; (3) operation for cancer of the stomach, still living, aged 68 ; (4) died, aged 66, after operation for
in consecutive weeks until the whole neck and trunk have been covered. If the patient’s condition is poor or the leucocyte-count has dropped significantly, the course can be interrupted at any strip. ’
By this means an effective dose (which cannot be achieved by the body-bath method) is given to the patient without any severe constitutional effects. It gives long periods of remission without precluding further treatment when required. R. F. HENDTLASS. Radiotherapy Department, Royal Northern Hospital
and
Prince of Wales’s General Hospital, London,
PRACTICE OUTSIDE THE SERVICE femate) : btaek gastric carcinoma, Symbols (square == male, circie duodenal ulcer, unshaded gastric ulcer. stippled ==
SIR,—Would your peripatetic correspondent of two weeks back please give us some grounds for his assumption that the N.H.S. patient who needs 45 minutes of his doctor’s individual attention does not, in fact, get it ? It
seems
rather
a
=
serious statement to make without the
VEGANIN
SIR,—In his letter of March 5 Professor Alstead agrees that ’Veganin’ tablets disintegrate in water and in gastric juice more rapidly than do tab. codein co. (whereas Veganin’ tablets disintegrate in 20 seconds or less, we have reports of failure of tab. codein. co. to do so in 24 hours) ; but he claims that this is unimportant, because the tablets should be pulverised. My information is that patients do not pulverise analgesic tablets. T can assure him that the solubility of the active ingredients in’Veganin’ is at least equal to that of those in any tab. codein. co. I would not presume to argue with a professor of pharmacology as to whether a simple addition of the weights of active ingredients decides the effectiveness of an analgesic tablet, irrespective of the balance of the formula, the quality of the ingredients, and the skill and care exercised in production ; but the view of practising physicians who have been observing the results for some There seem to be years may be accepted as evidence. very few who use tab. codein. co. in preference to
the stomach ; (5) died in hospital, aged 63, of the stomach ; (6) died of cancer of the stomach ; (7) ? cancer of stomach, still living, aged 71 ; (8) died in hospital of gastric ulcer ; (9) operation when aged 67 for cancer of the stomach, still living, aged 75 ; (10) duodenal ulcer when aged 39, still living, aged 45 ; (11) operation for duodenal ulcer when aged 44, still living, aged 48. The 75-year-old man and his two sons have been patients of mine for the past tenyears. C. H. BATEMAN. Rayleigh, Essex. cancer of cancer
of
support of direct evidence. I would assure him that the only unhurried thing still left in a doctor’s life is the examination of the patient and any discussion that may arise from it-in sickness or in health. This is not the occasion for economising in time. If your correspondent is anxious to reassure himself on this point, I suggest that he ask the patients themselves. I can put him in touch with random selections of our N.H.S. patients representing every income-group from zero to four figures ; I feel sure that they would all have something helpful to say about the National Health Service. Armed with such first-hand evidence from people who have personally " suffered " the service, he would be assured of a respectful hearing from us " insiders." S. GRAHAM. Bagshot.
=
=
-
THE CUTS SIR,—The diagnosis of the financial situation presented in last week’s leading article lacks some of the history of the case and so may fail to provide a satisfactory basis for treatment. It dates not from the appointed day but from the assurance given by the Coalition Government to the voluntary hospitals that their work should not suffer through lack of funds. Added to that was the extraordinarily generous method of payment for beds to be available for emergencies. The first gave the voluntary hospitals a sense of financial security such as they had never known before. - The second provided them with funds on a large scale so that bank overdrafts disappeared to a quite remarkable extent before the end of the war. knew Unlike the municipal hospitals the "voluntaries no kind of budgetary control, with the result that, led by the teaching hospitals, they indulged in a financial debauch of which they are now feeling the after-effects. Months before the appointed day the more sober-minded realised that indulgence on that scale was bound to be followed by headaches. To the suggestion that there must be in the background some system of checking the comparative costs. the simple answer is’’ take the figures for 1938 and add a reasonable percentage." Even if it is the fancy figure of 185 % suggested last week in another connexion (p. 446),1. it will be interesting to see to what extent the accounts for 1948 exceed it. LONDONER. "
’Veganin’ for themselves and their own families, nor many who would do so for their paying patients ; and since the Minister of Health stated clearly that prescriptions under N.H.S. must be for the most effective medi-
HODGKIN’S DISEASE
SIR,—Your leading article of March 5 again emphasises fact-recognised fully by pathologists but not so fully by clinicians-that Hodgkin’s disease affects the whole reticulo-endothelial system. The technique of deep X-ray therapy used by Mr. T. Anthony Green is based on recognition of the pathological picture. Since radiotherapy can only be palliative, intense local treatment to a mass of glands, for with severe resultant reactions, is not justified ; lower dosage can achieve the same symptomatic The technique adopted in this department result. (equally effective in other reticuloses, such as the leukaemias) is as follows : The symptom-producing mass of glands is treated first, using a dosage of approximately 500r tissue in one week, blood-colmts being performed before and after treatment. If the patient’s condition is satisfactory, the remainder of the body from neck to groins is then treated in strips, the method being referred to as the " step-ladder " technique. Two fields 30 X 12 em., one anterior and the other posterior, are used to give a dose of 300-500r in one week per strip according to the patient’s condition. The blood-count is recorded weekly and whenever possible the strips are treated the
cines, practitioners are increasingly prescribing ’Veganin ’ under N.H.S. too. " indignation," to which Professor Alstead refers. directed to the misuse of our trade-markVeganin.’ which misleads patients into believing that the effects. or otherwise, of anonymous tab. codein. co. are attributable to our product. The professor teaches his pupils that tab. codein. co. are as good ; we trust that he will them that these should not masquerade as warn Veganin,’ either in hospitals or elsewhere. The price per 100 quoted by Professor Alstead includes purchase-tax, which will not be chargeable on dispensing packs after May 2, and, so far as N.H.S. is concerned, is only a transfer from one Government pocket to another meanwhile. ELIOT WARBURTON. William R. Warner & Co. Ltd.,
My
was
London, W.4.
PEPTIC DISORDERS IN A FAMILY SIR,—The occurrence of gastric and duodenal disorders in succeeding generations of a single family is indicated by the accompanying figure. The following is a summary of the patients’ histories :s (1) died, aged 72, of cancer of the stomach ; (2) died, aged 71, of cancer of the stomach ; (3) operation for cancer of the stomach, still living, aged 68 ; (4) died, aged 66, after operation for
in consecutive weeks until the whole neck and trunk have been covered. If the patient’s condition is poor or the leucocyte-count has dropped significantly, the course can be interrupted at any strip. ’
By this means an effective dose (which cannot be achieved by the body-bath method) is given to the patient without any severe constitutional effects. It gives long periods of remission without precluding further treatment when required. R. F. HENDTLASS. Radiotherapy Department, Royal Northern Hospital
and
Prince of Wales’s General Hospital, London,
PRACTICE OUTSIDE THE SERVICE femate) : btaek gastric carcinoma, Symbols (square == male, circie duodenal ulcer, unshaded gastric ulcer. stippled ==
SIR,—Would your peripatetic correspondent of two weeks back please give us some grounds for his assumption that the N.H.S. patient who needs 45 minutes of his doctor’s individual attention does not, in fact, get it ? It
seems
rather
a
=
serious statement to make without the
VEGANIN
SIR,—In his letter of March 5 Professor Alstead agrees that ’Veganin’ tablets disintegrate in water and in gastric juice more rapidly than do tab. codein co. (whereas Veganin’ tablets disintegrate in 20 seconds or less, we have reports of failure of tab. codein. co. to do so in 24 hours) ; but he claims that this is unimportant, because the tablets should be pulverised. My information is that patients do not pulverise analgesic tablets. T can assure him that the solubility of the active ingredients in’Veganin’ is at least equal to that of those in any tab. codein. co. I would not presume to argue with a professor of pharmacology as to whether a simple addition of the weights of active ingredients decides the effectiveness of an analgesic tablet, irrespective of the balance of the formula, the quality of the ingredients, and the skill and care exercised in production ; but the view of practising physicians who have been observing the results for some There seem to be years may be accepted as evidence. very few who use tab. codein. co. in preference to
the stomach ; (5) died in hospital, aged 63, of the stomach ; (6) died of cancer of the stomach ; (7) ? cancer of stomach, still living, aged 71 ; (8) died in hospital of gastric ulcer ; (9) operation when aged 67 for cancer of the stomach, still living, aged 75 ; (10) duodenal ulcer when aged 39, still living, aged 45 ; (11) operation for duodenal ulcer when aged 44, still living, aged 48. The 75-year-old man and his two sons have been patients of mine for the past tenyears. C. H. BATEMAN. Rayleigh, Essex. cancer of cancer
of
support of direct evidence. I would assure him that the only unhurried thing still left in a doctor’s life is the examination of the patient and any discussion that may arise from it-in sickness or in health. This is not the occasion for economising in time. If your correspondent is anxious to reassure himself on this point, I suggest that he ask the patients themselves. I can put him in touch with random selections of our N.H.S. patients representing every income-group from zero to four figures ; I feel sure that they would all have something helpful to say about the National Health Service. Armed with such first-hand evidence from people who have personally " suffered " the service, he would be assured of a respectful hearing from us " insiders." S. GRAHAM. Bagshot.
=
=
-
THE CUTS SIR,—The diagnosis of the financial situation presented in last week’s leading article lacks some of the history of the case and so may fail to provide a satisfactory basis for treatment. It dates not from the appointed day but from the assurance given by the Coalition Government to the voluntary hospitals that their work should not suffer through lack of funds. Added to that was the extraordinarily generous method of payment for beds to be available for emergencies. The first gave the voluntary hospitals a sense of financial security such as they had never known before. - The second provided them with funds on a large scale so that bank overdrafts disappeared to a quite remarkable extent before the end of the war. knew Unlike the municipal hospitals the "voluntaries no kind of budgetary control, with the result that, led by the teaching hospitals, they indulged in a financial debauch of which they are now feeling the after-effects. Months before the appointed day the more sober-minded realised that indulgence on that scale was bound to be followed by headaches. To the suggestion that there must be in the background some system of checking the comparative costs. the simple answer is’’ take the figures for 1938 and add a reasonable percentage." Even if it is the fancy figure of 185 % suggested last week in another connexion (p. 446),1. it will be interesting to see to what extent the accounts for 1948 exceed it. LONDONER. "