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REACTION TO TRACHEOSTOMY TUBES
554
fact, the first reference to this type of test
was
published3
in 1955. Professor Owren’s discussion under " Sources of Error " was very clear and helpful. I should like to call attention to the work of Dr. Manchester and should also like to know how Owren’s method differs from the Manchester method. Department of the Air Force, Headquarters United States Air Force, Washington, D.C.
The X-ray at least must be repeated annually even in those receiving B.c.G. vaccination. There are a few medical schools, university, or college health services who are doing all they can to prevent and control tuberculosis by these methods and by instruction -but whv not all ? Chest Clinic,
M. E. GROOVER, JR.
RISKS OF DEFERRING VALVOTOMY
SIR,-In advising a patient to submit to a major operation of any sort-gastrectomy, colectomy, or valvotomy-the postoperative morale is a matter to be carefully weighed. To avoid a variety of minor symptoms and perhaps even general or local deterioration, the patient must feel really satisfied with the results of the operation. To feel better after the operation the patient must feel worse before, and if she is symptom-free this is difficult to
achieve.
Fleet, Hants.
DAVID HAMILTON.
REACTION TO TRACHEOSTOMY TUBES SIR,-In order to reduce tissue reaction to tracheostomy tubes Mr. Salt and his colleagues (Aug. 20) suggest that the tubes should be made of latex rubber reinforced with a nylon thread. In the single case-report in their article the patient appears to be sensitive to the rubber of the Radcliffe tracheostomy tube. The change to latex rubber was undoubtedly beneficial in this instance, but I doubt whether this finding justifies a general change. The inflatable cuffs on armoured latex endotracheal tubes
entirely satisfactory when used for anaesthetic purposes. Perhaps an extended trial is in progress in Oxford. If so, then the results would be valuable, and would show clearly whether or not the modified tube represents a useful advance on the current design. have
not
been
I should like to add that much of the soreness of a tracheoused with a breathing machine is caused by twisting of the tracheostomy tube when either the patient or the breathing hose is moved. This can be much alleviated by using the universal joint catheter connection described some years ago by Dr. R. A. Beaver.4 Unfortunately this will not fit the Radcliffe tracheostomy tube, but it works very well with the stome
ordinary
ones.
London Hospital, E.1.
J. V. I. YOUNG.
TUBERCULIN-TESTING IN DOCTORS SIR,-Dr. McCann (Aug. 20) is concerned that the " occasional student may be missed when routine tuberculin-testing is done ". It is not uncommon for a young doctor to join the staff of a provincial hospital never having had a tuberculin test nor an X-ray of his chest. It is therefore not surprising that during the past twelve years I have had to deal with 5 young doctors suffering from tuberculosis. In a population of 250 medical practitioners and hospital medical staff I know 12 who have had treatment for pulmonary tuberculosis. Of 32 students qualifying at the same time as I did, 7 I know have had treatment for pulmonary tuberculosis. Such a high incidence in any other section of the population would almost certainly result in intensive action by those of us concerned with the control of the disease. Yet there is another aspect which is just as important. One doctor coughing up tubercle bacilli unknowingly in the course of his daily round may do irreparable harm, particularly in an obstetric or pxdiatric department. One tuberculin test and one X-ray examination is not sufficient. 3. Modern Medicine, July 15, 1955, p. 4. Beaver, R. A. Lancet, 1947, i, 163.
109.
C. J. STEWART.
Ipswich.
Obituary SAMUEL ROY BURSTON
K.B.E., C.B., D.S.O., M.B. Melb., F.R.C.P., F.R.C.P.E., F.R.A.C.P. Major-General Sir Samuel Burston died at his home in Melbourne on Aug. 21, at the age of 72. He was a great Australian who served his country, his profession, and his fellow men with outstanding courage, wisdom, and loyalty, both in peacetime and in war. He was a son of Major-General James Burston who fought at Gallipoli in the 1914-18 war and later became lord mayor of Melbourne. Samuel Burston graduated in medicine at the University of Melbourne in 1910, and soon afterwards was appointed to the staff of the Royal Adelaide Hospital. In World War I, like his father, he served with distinction at Gallipoli. For his work there and in the later campaigns he was awarded the D.S.o. and created c.B.E. Between the wars he continued his work as a consultant in Adelaide; but he also maintained his interest in military medicine and soon after the outbreak of war in 1939 he was appointed to direct the Australian medical services in the Middle East. In this appointment he showed his ability to establish and maintain a close and warm friendship with the leaders of the British, New Zealand, and South African Forces. Burston had a formidable task in maintaining efficient medical treatment in the Armed Forces during the rapidly moving desert campaign, the prolonged siege of Tobruk, and the fighting and evacuation of Greece and Crete. He showed remarkable insight in his ability to select capable officers to assist him in his task. Returning to Australia in 1942, he was created directorgeneral of medical services and had the responsibility of controlling the Australian Medical Corps during the arduous campaigns in New Guinea and the Pacific Islands. He gave every help to Hamilton Fairley and his team in their classical experiments at Cairns, Queensland, to determine the best methods of controlling malaria. The fall in the malaria-rate amongst the Australian Forces was a triumph and played a major part in the defeat of the Japanese in New Guinea. After the war he journeyed overseas to arrange for the rehabilitation of many young doctors who had served under him. He was deeply gratified by the generous help afforded by the Nuffield Foundation in the United Kingdom, and the Carnegie Corporation and Rockefeller Foundation in the United States of America. He was also medical director of the Australian Red Cross Society. In 1945 he was appointed honorary physician to King George VI, and he was promoted K.B.E. in 1952. He held the fellowship of the Royal Colleges of Physicians of London and Edinburgh as well as of Australasia. A colleague writes: " Sir Samuel Burston’s impeccable honesty and his warm and sympathetic approach to his colleagues and patients formed a pattern which he maintained throughout his long and distinguished career. These qualities endeared him to all, both young and old. He served his country till his passing: his loss will be deeply mourned by the medical profession
throughout the
British Commonwealth."
fact, the first reference to this type of test
was
published3
in 1955. Professor Owren’s discussion under " Sources of Error " was very clear and helpful. I should like to call attention to the work of Dr. Manchester and should also like to know how Owren’s method differs from the Manchester method. Department of the Air Force, Headquarters United States Air Force, Washington, D.C.
The X-ray at least must be repeated annually even in those receiving B.c.G. vaccination. There are a few medical schools, university, or college health services who are doing all they can to prevent and control tuberculosis by these methods and by instruction -but whv not all ? Chest Clinic,
M. E. GROOVER, JR.
RISKS OF DEFERRING VALVOTOMY
SIR,-In advising a patient to submit to a major operation of any sort-gastrectomy, colectomy, or valvotomy-the postoperative morale is a matter to be carefully weighed. To avoid a variety of minor symptoms and perhaps even general or local deterioration, the patient must feel really satisfied with the results of the operation. To feel better after the operation the patient must feel worse before, and if she is symptom-free this is difficult to
achieve.
Fleet, Hants.
DAVID HAMILTON.
REACTION TO TRACHEOSTOMY TUBES SIR,-In order to reduce tissue reaction to tracheostomy tubes Mr. Salt and his colleagues (Aug. 20) suggest that the tubes should be made of latex rubber reinforced with a nylon thread. In the single case-report in their article the patient appears to be sensitive to the rubber of the Radcliffe tracheostomy tube. The change to latex rubber was undoubtedly beneficial in this instance, but I doubt whether this finding justifies a general change. The inflatable cuffs on armoured latex endotracheal tubes
entirely satisfactory when used for anaesthetic purposes. Perhaps an extended trial is in progress in Oxford. If so, then the results would be valuable, and would show clearly whether or not the modified tube represents a useful advance on the current design. have
not
been
I should like to add that much of the soreness of a tracheoused with a breathing machine is caused by twisting of the tracheostomy tube when either the patient or the breathing hose is moved. This can be much alleviated by using the universal joint catheter connection described some years ago by Dr. R. A. Beaver.4 Unfortunately this will not fit the Radcliffe tracheostomy tube, but it works very well with the stome
ordinary
ones.
London Hospital, E.1.
J. V. I. YOUNG.
TUBERCULIN-TESTING IN DOCTORS SIR,-Dr. McCann (Aug. 20) is concerned that the " occasional student may be missed when routine tuberculin-testing is done ". It is not uncommon for a young doctor to join the staff of a provincial hospital never having had a tuberculin test nor an X-ray of his chest. It is therefore not surprising that during the past twelve years I have had to deal with 5 young doctors suffering from tuberculosis. In a population of 250 medical practitioners and hospital medical staff I know 12 who have had treatment for pulmonary tuberculosis. Of 32 students qualifying at the same time as I did, 7 I know have had treatment for pulmonary tuberculosis. Such a high incidence in any other section of the population would almost certainly result in intensive action by those of us concerned with the control of the disease. Yet there is another aspect which is just as important. One doctor coughing up tubercle bacilli unknowingly in the course of his daily round may do irreparable harm, particularly in an obstetric or pxdiatric department. One tuberculin test and one X-ray examination is not sufficient. 3. Modern Medicine, July 15, 1955, p. 4. Beaver, R. A. Lancet, 1947, i, 163.
109.
C. J. STEWART.
Ipswich.
Obituary SAMUEL ROY BURSTON
K.B.E., C.B., D.S.O., M.B. Melb., F.R.C.P., F.R.C.P.E., F.R.A.C.P. Major-General Sir Samuel Burston died at his home in Melbourne on Aug. 21, at the age of 72. He was a great Australian who served his country, his profession, and his fellow men with outstanding courage, wisdom, and loyalty, both in peacetime and in war. He was a son of Major-General James Burston who fought at Gallipoli in the 1914-18 war and later became lord mayor of Melbourne. Samuel Burston graduated in medicine at the University of Melbourne in 1910, and soon afterwards was appointed to the staff of the Royal Adelaide Hospital. In World War I, like his father, he served with distinction at Gallipoli. For his work there and in the later campaigns he was awarded the D.S.o. and created c.B.E. Between the wars he continued his work as a consultant in Adelaide; but he also maintained his interest in military medicine and soon after the outbreak of war in 1939 he was appointed to direct the Australian medical services in the Middle East. In this appointment he showed his ability to establish and maintain a close and warm friendship with the leaders of the British, New Zealand, and South African Forces. Burston had a formidable task in maintaining efficient medical treatment in the Armed Forces during the rapidly moving desert campaign, the prolonged siege of Tobruk, and the fighting and evacuation of Greece and Crete. He showed remarkable insight in his ability to select capable officers to assist him in his task. Returning to Australia in 1942, he was created directorgeneral of medical services and had the responsibility of controlling the Australian Medical Corps during the arduous campaigns in New Guinea and the Pacific Islands. He gave every help to Hamilton Fairley and his team in their classical experiments at Cairns, Queensland, to determine the best methods of controlling malaria. The fall in the malaria-rate amongst the Australian Forces was a triumph and played a major part in the defeat of the Japanese in New Guinea. After the war he journeyed overseas to arrange for the rehabilitation of many young doctors who had served under him. He was deeply gratified by the generous help afforded by the Nuffield Foundation in the United Kingdom, and the Carnegie Corporation and Rockefeller Foundation in the United States of America. He was also medical director of the Australian Red Cross Society. In 1945 he was appointed honorary physician to King George VI, and he was promoted K.B.E. in 1952. He held the fellowship of the Royal Colleges of Physicians of London and Edinburgh as well as of Australasia. A colleague writes: " Sir Samuel Burston’s impeccable honesty and his warm and sympathetic approach to his colleagues and patients formed a pattern which he maintained throughout his long and distinguished career. These qualities endeared him to all, both young and old. He served his country till his passing: his loss will be deeply mourned by the medical profession
throughout the
British Commonwealth."