- Email: [email protected]
" HUNTING THE NEEDLE "
1124 life but very seldom, if ever, later. Much of the evidence which we possess suggests that they were right and that the incidence of undescended testis remains almost constant from infancy onwards. The discrepancies noted at present can possibly be attributed to our failure to account fully for the phenomenon of retraction and to our uncertainty as to when the testis is undescended and when it is not. The correct treatment of undescended testis is a baffling problem which has teased many minds and which continues to elude us. There are still too many gaps in our knowledge of the natural history of descent. It may be that until we use some form of measurement to define the position of the testes, and thereby establish a criterion of what we regarded as normal, we shall make no progress. C. G. Gr. SCORER. Gerrards Cross. "
MUNCHAUSEN’S SYNDROME "
we fully agree with Dr. Mac Keith that patients presenting with the Munchausen syndrome are in need of psychiatric help, we feel that this is simply not practicable in a busy medical ward.
SiR,-While
It is unfortunate if Dr. Mac Keith feels that we have derived " mean glee " in warning others of the patient’s appearance. Our motive in so doing was solely to prevent the tedious and unrewarding business of admitting the patient to hospital. Finally, if Dr. Mac Keith will inquire further, he will find that in his own hospital’s outpatient department there is a black-book containing the names and descriptions of such patients who are on no account to be admitted. (At least that was so in 1951, and it is probably still in existence.) Whilst seeing the validity of the case for treating hysterics, we cannot see any good reason for cosseting
malingerers. Whittington Hospital, London, N.19.
B. H. BASS M. G. SELSON.
SIR,-Correspondence on Munchausen will recur, but what is surprising is the comparison with Munchausen of the type of clinical case described :they have nothing in common, Munchausen being a healthy adventurous type of liar, and I am sure he bore no wounds, certainly not of surgeon’s making. Why this very military and wholly admirable character should be degraded in this way I cannot understand, nor why these miserable psychopaths should ever have been granted such a distinguished forbear. Manchester. OLIVER JELLY. SHORTENING AND PARALYSIS IN POLIOMYELITIS
SiR,ŃI have studied limb shortening after polioin 225 children in whom paralysis was confined to one leg.1 I cannot agree with Mr. Ring (Nov. 16) that clinical measurements from the anterior superior spine to the medial malleolus are sufficiently accurate for the recognition of differences of the order of 0.5 cm. The method of measurement of leg length is vital to this study. Nichols and Bailey2 have shown that " the overall degree of accuracy of the clinical measurement of leg lengths is such that differences of half an inch or more may be accepted as diagnostically significant, but differences of less than half an inch are not reliable unless based on the average of at least four measurements". For this reason, radiographic measurements are essential. They were carried out wherever possible in my series. Mr. Ring considers that limb shortening in poliomyelitis is related directly to the extent of the paralysis.
myelitis
1. British 2.
Orthopædic Association meeting, October, 1957 ; see Lancet, Nov. 16, 1957, p. 986. Nichols, P. J. R., Bailey, N. T. J. British med. J. 1955, ii, 1247.
I also found that the
more
severe
the
paralysis
the
greater the shortening, but there are notable exceptions. (1) Patients with severe paralysis of muscles both above and below the knee may develop as little shortening as 1 in. or as much as 31/2 in. (2) The range of shortening which may occur in patients with paralysis below the knee is the same (i.e., none to 13/4 in.) no matter whether one or all muscles are affected. (3) It is quite impossible accurately to predict shortening. If paralysis and shortening are directly related such prediction would be possible.
University Department of Orthopædic Surgery, The Royal Infirmary, Manchester.
A. H. C. RATLIFF.
" HUNTING THE NEEDLE
"
Prof. LAMBERT ROGERS writes : "
Since the appearance of my article in your issue of Oct. 19 there have been so many requests for information as to where the locator can be obtained that I am finding it difficult to deal with all of them. May I state therefore that the instrument is made by the Berman Laboratories, 112, Rockaway Boulevard, Ozone Park 20, New York, and I understand an import licence is necessary to obtain it in this country."
GENERAL PRACTICE FIFTY YEARS AGO
Dr. H. C. FAULKNER, 55, Russell W.C.1, writes :
Square, London,
"
I am collecting material for a book on the organisation of general practice in Britain. I should be most grateful if any of your readers who have unpublished material on the content and organisation of family doctoring in the early part of the century would be kind enough to lend it to me. I particularly require material on the work of the contract practices and other forms of local organisation of medical care before 1911. All diaries or letters of &.?.s of this period would be particularly useful. Material sent will be looked after most carefully and returned as soon as copies have been made."
Obituary ALICE HELEN ANNE BOYLE M.D. Brux., L.R.C.P.E. Dr. Helen Boyle, who died at her home in Sussex on Nov. 20, the day after her 88th birthday, was a founder of the Lady Chichester Hospital for Nervous Disorders and the National Council for Mental Hygiene. These two institutions were the practical expression of her belief in the value of early treatment for patients with mental disorders and in the need for health education for the community. Their continuing success is a measure of her farsightedness, courage, and hard work. She was born in Dublin, the daughter of Richard Boyle. She studied medicine at the London School of Medicine for Women, qualifying in 1893. After holding a resident appointment at Claybury Asylum she became medical superintendent of the Canning Town Medical Mission. Her work there showed her the need for hospital care for some patients with early mental disorder, and in 1905 she started the Lady Chichester Hospital at Hove £ 200 and a lot of faith." on, as she later used to relate, She was anxious that her hospital should be associated with a general hospital, but at first the Royal Sussex County Hospital was unwilling to join forces. Slowly the Lady Chichester Hospital grew and proved its worth, particularly during the 1914-18 war when it accepted patients who had broken down as a result of war service and air-raids. During these years Dr. Boyle herself served with the Berrys’ unit in Serbia and was awarded the Order of St. Sava. After the war the Lady Chichester Hospital moved to larger premises, and in 1930 the Royal Sussex County Hospital itself suggested a liaison between the hospitals, and Dr. Boyle was appointed the first woman member of the honorary staff of the Royal Sussex. Meanwhile she had interested Sir Maurice Craig in her idea of an organisation to improve the mental health of the community. She had studied the possibility of this project during a lecture tour in Canada and the United States in 1920, when she had met Clifford Beers, the founder of the American National Committee for Mental Hygiene. In 1923 she and Craig founded the National "
MUNCHAUSEN’S SYNDROME "
we fully agree with Dr. Mac Keith that patients presenting with the Munchausen syndrome are in need of psychiatric help, we feel that this is simply not practicable in a busy medical ward.
SiR,-While
It is unfortunate if Dr. Mac Keith feels that we have derived " mean glee " in warning others of the patient’s appearance. Our motive in so doing was solely to prevent the tedious and unrewarding business of admitting the patient to hospital. Finally, if Dr. Mac Keith will inquire further, he will find that in his own hospital’s outpatient department there is a black-book containing the names and descriptions of such patients who are on no account to be admitted. (At least that was so in 1951, and it is probably still in existence.) Whilst seeing the validity of the case for treating hysterics, we cannot see any good reason for cosseting
malingerers. Whittington Hospital, London, N.19.
B. H. BASS M. G. SELSON.
SIR,-Correspondence on Munchausen will recur, but what is surprising is the comparison with Munchausen of the type of clinical case described :they have nothing in common, Munchausen being a healthy adventurous type of liar, and I am sure he bore no wounds, certainly not of surgeon’s making. Why this very military and wholly admirable character should be degraded in this way I cannot understand, nor why these miserable psychopaths should ever have been granted such a distinguished forbear. Manchester. OLIVER JELLY. SHORTENING AND PARALYSIS IN POLIOMYELITIS
SiR,ŃI have studied limb shortening after polioin 225 children in whom paralysis was confined to one leg.1 I cannot agree with Mr. Ring (Nov. 16) that clinical measurements from the anterior superior spine to the medial malleolus are sufficiently accurate for the recognition of differences of the order of 0.5 cm. The method of measurement of leg length is vital to this study. Nichols and Bailey2 have shown that " the overall degree of accuracy of the clinical measurement of leg lengths is such that differences of half an inch or more may be accepted as diagnostically significant, but differences of less than half an inch are not reliable unless based on the average of at least four measurements". For this reason, radiographic measurements are essential. They were carried out wherever possible in my series. Mr. Ring considers that limb shortening in poliomyelitis is related directly to the extent of the paralysis.
myelitis
1. British 2.
Orthopædic Association meeting, October, 1957 ; see Lancet, Nov. 16, 1957, p. 986. Nichols, P. J. R., Bailey, N. T. J. British med. J. 1955, ii, 1247.
I also found that the
more
severe
the
paralysis
the
greater the shortening, but there are notable exceptions. (1) Patients with severe paralysis of muscles both above and below the knee may develop as little shortening as 1 in. or as much as 31/2 in. (2) The range of shortening which may occur in patients with paralysis below the knee is the same (i.e., none to 13/4 in.) no matter whether one or all muscles are affected. (3) It is quite impossible accurately to predict shortening. If paralysis and shortening are directly related such prediction would be possible.
University Department of Orthopædic Surgery, The Royal Infirmary, Manchester.
A. H. C. RATLIFF.
" HUNTING THE NEEDLE
"
Prof. LAMBERT ROGERS writes : "
Since the appearance of my article in your issue of Oct. 19 there have been so many requests for information as to where the locator can be obtained that I am finding it difficult to deal with all of them. May I state therefore that the instrument is made by the Berman Laboratories, 112, Rockaway Boulevard, Ozone Park 20, New York, and I understand an import licence is necessary to obtain it in this country."
GENERAL PRACTICE FIFTY YEARS AGO
Dr. H. C. FAULKNER, 55, Russell W.C.1, writes :
Square, London,
"
I am collecting material for a book on the organisation of general practice in Britain. I should be most grateful if any of your readers who have unpublished material on the content and organisation of family doctoring in the early part of the century would be kind enough to lend it to me. I particularly require material on the work of the contract practices and other forms of local organisation of medical care before 1911. All diaries or letters of &.?.s of this period would be particularly useful. Material sent will be looked after most carefully and returned as soon as copies have been made."
Obituary ALICE HELEN ANNE BOYLE M.D. Brux., L.R.C.P.E. Dr. Helen Boyle, who died at her home in Sussex on Nov. 20, the day after her 88th birthday, was a founder of the Lady Chichester Hospital for Nervous Disorders and the National Council for Mental Hygiene. These two institutions were the practical expression of her belief in the value of early treatment for patients with mental disorders and in the need for health education for the community. Their continuing success is a measure of her farsightedness, courage, and hard work. She was born in Dublin, the daughter of Richard Boyle. She studied medicine at the London School of Medicine for Women, qualifying in 1893. After holding a resident appointment at Claybury Asylum she became medical superintendent of the Canning Town Medical Mission. Her work there showed her the need for hospital care for some patients with early mental disorder, and in 1905 she started the Lady Chichester Hospital at Hove £ 200 and a lot of faith." on, as she later used to relate, She was anxious that her hospital should be associated with a general hospital, but at first the Royal Sussex County Hospital was unwilling to join forces. Slowly the Lady Chichester Hospital grew and proved its worth, particularly during the 1914-18 war when it accepted patients who had broken down as a result of war service and air-raids. During these years Dr. Boyle herself served with the Berrys’ unit in Serbia and was awarded the Order of St. Sava. After the war the Lady Chichester Hospital moved to larger premises, and in 1930 the Royal Sussex County Hospital itself suggested a liaison between the hospitals, and Dr. Boyle was appointed the first woman member of the honorary staff of the Royal Sussex. Meanwhile she had interested Sir Maurice Craig in her idea of an organisation to improve the mental health of the community. She had studied the possibility of this project during a lecture tour in Canada and the United States in 1920, when she had met Clifford Beers, the founder of the American National Committee for Mental Hygiene. In 1923 she and Craig founded the National "