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REVOLT FROM THE BEDPAN
702
splenomegaly, but, we are told, this case was not clinically
matriculated students with the dual object of raising the standard of student health by giving advice and of obtaining information about the student morbidity-rate and its relationship to the varying factors in university life."
Compulsion was agreed on after considerable discussion because the delegates from all over the country realised that voluntary student-health schemes, where they existed, have left a good deal to be desired. It must be further pointed out that entrance to university will in no way be influenced by medical examination as this will take place after students have already matriculated. It is hoped that the first resolution will be acceptable to many schools in the very near future. The second resolution will be sent on to the National Union of Students and the Scottish Union of Students with the hope of formulating a united student Dolicv on this important problem. S. M. DRANCZ President, B.M.S.A.
SOCIAL MEDICINE 81R,-In reply to Mr. Bedwell’s letter in your issue of Oct. 18, I would like to say how invaluable I have found the help of the district nurses ever since I have been in practice. But I would not dream of wasting a nurse’s time on the type of case I outlined in my original letter. Such a case needs no nursing. Welfare of the simplest variety (such as that offered in many instances by the Family Welfare Association) is all that is necessary. It could be supplied by any woman with sound common sense, who has knowledge of local facilities for healthy recreation, and knowledge of how best to help the new arrival from the country to adapt him or herself to the hostel-cum-office life of our big cities. Once more I would reiterate that I am acutely aware of the necessity of economising our use of our trained welfare and health workers. Any amount of work of the sort I have in mind could be done by voluntary workers, provided trained supervision is organised.
examined. The illusory family tree depicts 3 " proved cases " ; sternal puncture was performed on only 1 of these. In the other 5 cases of " suspected Gaucher’s disease" it is not known whether splenomegaly was present or absent. The diagnosis of Gaucher’s disease without splenomegaly would be difficult enough to satisfy anyone with critical standards, and I would suggest that the remainder of the material submitted by Dr. Morgans, though providing her with interesting speculations, was grossly inadequate for a diagnosis of Gaucher’s disease, of the disease in the absence ot’ splenomegaly, and as being of an hereditary nature. G. A. MATTHEWS West Herts Hospital, Hemel Hempstead. Pathologist, E.P.S. Laboratory.
BRITAIN’S CALORIE REQUIREMENTS SiR,—In the paper by myself and others to the Nutrition Society on Oct. 25, it was suggested that, compared with pre-war, the consumptions of sugar, meat, &c., fruit, and grain could advantageously be decreased by 14 %, 5 %, 1 %, and 6 % respectively-not increased as stated in your report last week. Only the figures for dairy products, potatoes, and vegetables represented percentage increases. Ministry of Health, London, S.W.1.
HOMOLOGOUS SERUM JAUNDICE SiR,-In your report of the discussion on infective hepatitis at the International Conference of Physicians
(Sept. 20,
p. 435) you say : " Dr. F. 0. MACCALLUM proposed that the virus giving rise to epidemic hepatitis should be known as’hepatitis virus A,’ and that giving rise to homologous serum jaundice While with virus A the organism ashepatitis virus B.’ is absent from the nasopharynx and present in the faeces, urine, and serum, with virus-B infections it is present in the nasopharynx and absent from faeces and serum..." ...
A. E. B. HARDING.
GRANULAR PROCTITIS SiR,-Following Dr. Cluer’s article of Aug. 2, we had a request for 3 g. suppositories of succinyl sulphathiazole for treatment of a further case of granular
proctitis. We decided to
use a 120-grain pessary mould, which suppository of about 13/$in. length and 3/ in. diameter. In making the suppositories we found that the medicament had a density of about 1-2 compared with oil of theobroma. A good suppository, which set rapidly on cooling, was obtained as follows : Succinyl sulphathiazole gr. 45.
yields
a
Cocoa butter gr. 83. We believe that this method is less laborious than that employed by Mr. Barclay for Dr. Cluer’s cases. KENNETH MACDONALD Westminster Hospital, London, S.W.1. Deputy Chief Pharmacist. GAUCHER’S DISEASE WITHOUT SPLENOMEGALY SIR,-I should like to offer some criticism of Dr. article of Oct. 18. In the summary she writes: Morgans’s " A family affected by Gaucher’s disease, but in whom none of those affected show splenomegaly, is described. The diagnosis was made by the detection of Gaucher cells in the bone-marrow and by the presence of typical radiological lesions in the bones. The family history suggests that in this series the disease was not only congenital and familial but also hereditary." If we accept case 1 as a case of Gauclier’s disease, diagnosed in the absence of splenomegaly on the basis of (1) a myelogram containing 0-4% of Gaucher cells, and (2) radiological translucencies in the bones, then, I suggest, the evidence submitted in regard to the other " familial cases permits of no more than a diagnosis of radiological translucencies "-to misuse the word diagnosis. Why were not cases 2, 3, and 4, submitted to sternal punctures ? We are not told that they refused. Cases 2 and 3 are included as " proved Gaucher’s disease," on the basis of radiological translucencies, while case 4 is excluded on a lesser degree of translucency. Case 3 is described as a proved case of Gaucher’s disease without .
-
’
E. R. BRANSBY.
Surely the whole point of homologous serum jaundice is that it can be transmitted by serum, so that the virus must be present in the serum of infected persons. Incidentally, why cannot the illness be called just " serum jaundice"? As soon as a successful animal recipient has been found the term " homologous " will lose what little point it had. As it is, we do not say homologous ringworm," even when we catch it from "
our own
species.
-
RICHARD ASHER. are Dr. Asher for *We to ** obliged pointing out this error. Terminology is discussed in our leader columns.-ED. L.
E.B.S. PHONE NO.
SIR,-As from Friday, Nov. 7, the telephone number of the Emergencv Bed Service has been changed to R. E. PEERS Secretary. DUE ACKNOWLEDGMENT Sm,—As deputy chairman of the medical group of the Royal Photographic Society, I have been asked by the committee to point out to you that although excellent, reproductions of photographs are published in your journal to illustrate articles, in many instances no recognition is given to the photographers concerned by the authors. If acknowledgments of this kind could be made’regularly, my committee feel sure that it would-give great encouragement to all medical photographers. Monarch 3000.
H. MANDIWALL.
REVOLT FROM THE BEDPAN was most interested to read in your issue of SiR,—I Oct. 4 the article by Professor Bohmansson and Dr. Malmros. Messrs. Down Bros. and Mayer & Phelps Ltd., made for us a wheel-chair with w.c. seat copied from the Bohmansson chair. This has now been in use in one of the male surgical wards in the Royal Northern Infirmary, Inverness, for over three months ; it is a great success and is much liked by both patients and It has all the advantages claimed for it by nurses. Professor Bohmansson. We have ordered another chair for the corresponding female ward. A. J. C. HAMILTON.
splenomegaly, but, we are told, this case was not clinically
matriculated students with the dual object of raising the standard of student health by giving advice and of obtaining information about the student morbidity-rate and its relationship to the varying factors in university life."
Compulsion was agreed on after considerable discussion because the delegates from all over the country realised that voluntary student-health schemes, where they existed, have left a good deal to be desired. It must be further pointed out that entrance to university will in no way be influenced by medical examination as this will take place after students have already matriculated. It is hoped that the first resolution will be acceptable to many schools in the very near future. The second resolution will be sent on to the National Union of Students and the Scottish Union of Students with the hope of formulating a united student Dolicv on this important problem. S. M. DRANCZ President, B.M.S.A.
SOCIAL MEDICINE 81R,-In reply to Mr. Bedwell’s letter in your issue of Oct. 18, I would like to say how invaluable I have found the help of the district nurses ever since I have been in practice. But I would not dream of wasting a nurse’s time on the type of case I outlined in my original letter. Such a case needs no nursing. Welfare of the simplest variety (such as that offered in many instances by the Family Welfare Association) is all that is necessary. It could be supplied by any woman with sound common sense, who has knowledge of local facilities for healthy recreation, and knowledge of how best to help the new arrival from the country to adapt him or herself to the hostel-cum-office life of our big cities. Once more I would reiterate that I am acutely aware of the necessity of economising our use of our trained welfare and health workers. Any amount of work of the sort I have in mind could be done by voluntary workers, provided trained supervision is organised.
examined. The illusory family tree depicts 3 " proved cases " ; sternal puncture was performed on only 1 of these. In the other 5 cases of " suspected Gaucher’s disease" it is not known whether splenomegaly was present or absent. The diagnosis of Gaucher’s disease without splenomegaly would be difficult enough to satisfy anyone with critical standards, and I would suggest that the remainder of the material submitted by Dr. Morgans, though providing her with interesting speculations, was grossly inadequate for a diagnosis of Gaucher’s disease, of the disease in the absence ot’ splenomegaly, and as being of an hereditary nature. G. A. MATTHEWS West Herts Hospital, Hemel Hempstead. Pathologist, E.P.S. Laboratory.
BRITAIN’S CALORIE REQUIREMENTS SiR,—In the paper by myself and others to the Nutrition Society on Oct. 25, it was suggested that, compared with pre-war, the consumptions of sugar, meat, &c., fruit, and grain could advantageously be decreased by 14 %, 5 %, 1 %, and 6 % respectively-not increased as stated in your report last week. Only the figures for dairy products, potatoes, and vegetables represented percentage increases. Ministry of Health, London, S.W.1.
HOMOLOGOUS SERUM JAUNDICE SiR,-In your report of the discussion on infective hepatitis at the International Conference of Physicians
(Sept. 20,
p. 435) you say : " Dr. F. 0. MACCALLUM proposed that the virus giving rise to epidemic hepatitis should be known as’hepatitis virus A,’ and that giving rise to homologous serum jaundice While with virus A the organism ashepatitis virus B.’ is absent from the nasopharynx and present in the faeces, urine, and serum, with virus-B infections it is present in the nasopharynx and absent from faeces and serum..." ...
A. E. B. HARDING.
GRANULAR PROCTITIS SiR,-Following Dr. Cluer’s article of Aug. 2, we had a request for 3 g. suppositories of succinyl sulphathiazole for treatment of a further case of granular
proctitis. We decided to
use a 120-grain pessary mould, which suppository of about 13/$in. length and 3/ in. diameter. In making the suppositories we found that the medicament had a density of about 1-2 compared with oil of theobroma. A good suppository, which set rapidly on cooling, was obtained as follows : Succinyl sulphathiazole gr. 45.
yields
a
Cocoa butter gr. 83. We believe that this method is less laborious than that employed by Mr. Barclay for Dr. Cluer’s cases. KENNETH MACDONALD Westminster Hospital, London, S.W.1. Deputy Chief Pharmacist. GAUCHER’S DISEASE WITHOUT SPLENOMEGALY SIR,-I should like to offer some criticism of Dr. article of Oct. 18. In the summary she writes: Morgans’s " A family affected by Gaucher’s disease, but in whom none of those affected show splenomegaly, is described. The diagnosis was made by the detection of Gaucher cells in the bone-marrow and by the presence of typical radiological lesions in the bones. The family history suggests that in this series the disease was not only congenital and familial but also hereditary." If we accept case 1 as a case of Gauclier’s disease, diagnosed in the absence of splenomegaly on the basis of (1) a myelogram containing 0-4% of Gaucher cells, and (2) radiological translucencies in the bones, then, I suggest, the evidence submitted in regard to the other " familial cases permits of no more than a diagnosis of radiological translucencies "-to misuse the word diagnosis. Why were not cases 2, 3, and 4, submitted to sternal punctures ? We are not told that they refused. Cases 2 and 3 are included as " proved Gaucher’s disease," on the basis of radiological translucencies, while case 4 is excluded on a lesser degree of translucency. Case 3 is described as a proved case of Gaucher’s disease without .
-
’
E. R. BRANSBY.
Surely the whole point of homologous serum jaundice is that it can be transmitted by serum, so that the virus must be present in the serum of infected persons. Incidentally, why cannot the illness be called just " serum jaundice"? As soon as a successful animal recipient has been found the term " homologous " will lose what little point it had. As it is, we do not say homologous ringworm," even when we catch it from "
our own
species.
-
RICHARD ASHER. are Dr. Asher for *We to ** obliged pointing out this error. Terminology is discussed in our leader columns.-ED. L.
E.B.S. PHONE NO.
SIR,-As from Friday, Nov. 7, the telephone number of the Emergencv Bed Service has been changed to R. E. PEERS Secretary. DUE ACKNOWLEDGMENT Sm,—As deputy chairman of the medical group of the Royal Photographic Society, I have been asked by the committee to point out to you that although excellent, reproductions of photographs are published in your journal to illustrate articles, in many instances no recognition is given to the photographers concerned by the authors. If acknowledgments of this kind could be made’regularly, my committee feel sure that it would-give great encouragement to all medical photographers. Monarch 3000.
H. MANDIWALL.
REVOLT FROM THE BEDPAN was most interested to read in your issue of SiR,—I Oct. 4 the article by Professor Bohmansson and Dr. Malmros. Messrs. Down Bros. and Mayer & Phelps Ltd., made for us a wheel-chair with w.c. seat copied from the Bohmansson chair. This has now been in use in one of the male surgical wards in the Royal Northern Infirmary, Inverness, for over three months ; it is a great success and is much liked by both patients and It has all the advantages claimed for it by nurses. Professor Bohmansson. We have ordered another chair for the corresponding female ward. A. J. C. HAMILTON.