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RUBELLA AND CONGENITAL MALFORMATIONS
710
sulphadiazine (by far the least toxic of all sulphonamides) applied over a long period. The experiment proved successful. The boy had 3 grammes of sulphadiazine daily for a fortnight, 1.25 g. daily for the next four weeks, 0.75 g. for a fortnight, and then 0’375 g. daily. Altogether about 100 g. He made slow but definite progress was given in two months. and the weeping ulcers healed up. He became a lively and gay child and was soon out of bed all day, only now and then small blisters appeared on his skin which contained only and no pus. His mother asked to take him home, and could allow him to go after the dramatic change the illness had taken. serum we
I would like to end with two remarks. First, the child was not cured of his fundamental condition-in spite of sulphadiazine, new blisters appeared now and again. - Secondly, sulphapyridine and also sulphadiazine had been tried several times during the years of his illness in the form of two or three day " courses " without effect. Sulphonamides are not harmless drugs to be given in every low-grade infection which heals up
spontaneously (sore throat, upper respiratory infections, &c.), but if there is a real indication they should be used with courage and without ’the physician’s mind being fixed on the rare event of agranulocytosis. Is the surgeon kept’from performing an appendix operation because of the rare accidents which may happen, if the indications for the operation are well founded ?c Perthshire.
PAUL KAZNELSON.
RUBELLA AND CONGENITAL MALFORMATIONS
Sm,-I have read your annotation
on
p.
316 of
March
4. Among the inaccuracies are the following : (1) Geographical. (a) Dr. Gregg’s work was performed in New South Wales. (b) There are no states in South Australia. South Australia (population about 600,000) is a state of "
"
the Commonwealth of Australia.
(2) Medical. Only one case, not " two," was described of congenital malformation following maternal mumps in pregnancy. As far as the remainder of the annotation goes I hope
that
a
few of your readers will find time to read the
original articles for themselves. Institute of Medical and Veterinary
CHARLES SWAN. Science, Adelaide, S. Australia. *** The articles to which Dr. Swan refers are by N. McA. Gregg (Trans. ophthal. Soc. Aust. 1941, 3,35) and by C. Swan and others (Med. J. Aust. 1943, ii, 201). A further article is in course of publication in the latter journal.-ED. L. THE LABORATORY TECHNICIAN SiB,—Your article of April 29 (p. 575) suggests that the intermediate technical examination shall consist of subjects which would level out the standard of education of entrants, but already one of the generally accepted school certificates is required of candidates before they are registered as students of this Institute, on the same principle as that adopted by other qualifying bodies. It is realised that potential entrants will not always be in possession of such an educational standard, for the Institute, as yet, cannot and is not willing to control the recruitment of juniors into medical laboratories ; and in these cases the proposed student is referred to the local educational authorities or, where facilities do not exist, to a recognised correspondence course. Only on the acceptance of their educational qualifications are they admitted to student membership of the Institute. They then continue their studies in the basic scientific subjects of physics, chemistry, biology and physiology, until, at the age of 18, they can commence the Institute tutorial classes. Our instructional classes are to be conducted at many centres in the country, by fellows and associates of the Institute, in preparation for the Institute’s diplomas. There is much to be said for your suggestion regarding the personal, as against the class, system of teaching during the professional training proper, provided that there is some standardisation of the quality of the teaching and also of the teaching methods, and my council have prepared their syllabus, and have chosen their instructors and tutors, so that this standard teaching shall exist. The periods of professional
are three years for the intermediate examination further two years for the subjects of the final
training and
a
examination-i.e., pathological technique, bacteriological technique and chemical pathology technique. J. M. SIGNY, Secretary and Registrar.
Institute of Medical
Laboratory Technology, Buckingham Street, W.C.2.
THE BRIDGE IN GALL-BLADDER SURGERY SIR,-Mr. Holman has questioned the usefulness of the bridge in gall-bladder surgery. It is difficult to see how the use of a bridge could affect the incidence of pulmonary embolism-its incidence is notoriously capricious. But on another count I believe its use is to be discouraged. Hyperextension of the lumbar spine is likely to be conducive to pain in that region afterwards, particularly in the type of patient who is most liable to suffer from gall-stones. I have not used a bridge in gall-bladder operations for the last twenty years, having learned from the late Lord Moynihan that it was quite unnecessary. His teaching that an adequate incision and proper use of the assistant’s left hand would always provide an excellent exposure has seemed to me to be
fully justified. GEOFFREY KEYNES.
London.
" Q " AND ANTIBODY SIR,-Sir Arthur Quiller-Couch’s book, On the Art of must have helped many to improve their writings. In it he states, " But, though less important, it is good to recognise that, as sons of Cambridge, we equally offend against her breeding when in our scientific writings we allow ourselves to talk of a microbe as anantibody.’ The word, ugly as well as hybrid, did not convey to Q " that its antibody fought the microbe. Cannot we cease to offend against our breeding by coining a new word ? Having learnt just enough Latin to pass the matriculation examination (alas, twenty-five years ago !) and no Greek, I will leave it to others to propose a word, but remind them of Quiller-Couch’s advice, " Almost always prefer the direct word to the circumlocution." I sincerely hope some son of Cambridge will produce a single generic word for the chemical substances fighting in our blood and tissues. This will show our appreciation of Q " who, as the obituary notice in the Times said, may not have founded a famous school but certainly helped the average man to rise
Writing,
scientific
"
"
"
above his
mediocrity.
R. E. SMITH. Rugby. SUPPLY OF BODIES FOR DISSECTION SiR,-In Dr. Goodman’s Arris and Gale Lecture, smnmarised in your issue of May 20, he expresses the belief that there will be a gradual falling off in the number of unclaimed bodies available. In this he is no doubt right, for when we are all insured against every contingency in life from the womb to the tomb and given in addition a handsome tip to Charon in the form of a burial allowance, few bodies are likely to be unclaimed. But is he not too sanguine in thinking that if the method of leaving bodies by bequest was better known the gap would rapidly be filled ? Some years ago a friend of mine asked his executors to bequeath his body to a medical school, but the professor of anatomy did not jump at the offer on account of the tiresome formalities to be observed, although-my friend being an agnostic-there was no occasion for a burial service. In any case one need not be a sentimentalist to have qualms about handing over that old friend the body, which has served one pretty faithfully for perhaps 70 odd years, to be pickled in formalin, laid on a table and cut to shreds by the scalpels of a group of young men and women. Better by far for it to be picked to pieces by real vultures on the Towers of Silence like a Parsee ! No ; the solution of the problem is not more corpses but less anatomy. Let us give up the fetish that the whole body must be dissected by every medical student, reduce drastically the amount of anatomical detail that he is expected to know, make more use of ready-pre-, pared specimens, models and drawings, and call in the help of X rays used on the living subject, and also of the cinema as in the case of the Harvey film. Far fewer bodies would then be wanted. FRCP.
sulphadiazine (by far the least toxic of all sulphonamides) applied over a long period. The experiment proved successful. The boy had 3 grammes of sulphadiazine daily for a fortnight, 1.25 g. daily for the next four weeks, 0.75 g. for a fortnight, and then 0’375 g. daily. Altogether about 100 g. He made slow but definite progress was given in two months. and the weeping ulcers healed up. He became a lively and gay child and was soon out of bed all day, only now and then small blisters appeared on his skin which contained only and no pus. His mother asked to take him home, and could allow him to go after the dramatic change the illness had taken. serum we
I would like to end with two remarks. First, the child was not cured of his fundamental condition-in spite of sulphadiazine, new blisters appeared now and again. - Secondly, sulphapyridine and also sulphadiazine had been tried several times during the years of his illness in the form of two or three day " courses " without effect. Sulphonamides are not harmless drugs to be given in every low-grade infection which heals up
spontaneously (sore throat, upper respiratory infections, &c.), but if there is a real indication they should be used with courage and without ’the physician’s mind being fixed on the rare event of agranulocytosis. Is the surgeon kept’from performing an appendix operation because of the rare accidents which may happen, if the indications for the operation are well founded ?c Perthshire.
PAUL KAZNELSON.
RUBELLA AND CONGENITAL MALFORMATIONS
Sm,-I have read your annotation
on
p.
316 of
March
4. Among the inaccuracies are the following : (1) Geographical. (a) Dr. Gregg’s work was performed in New South Wales. (b) There are no states in South Australia. South Australia (population about 600,000) is a state of "
"
the Commonwealth of Australia.
(2) Medical. Only one case, not " two," was described of congenital malformation following maternal mumps in pregnancy. As far as the remainder of the annotation goes I hope
that
a
few of your readers will find time to read the
original articles for themselves. Institute of Medical and Veterinary
CHARLES SWAN. Science, Adelaide, S. Australia. *** The articles to which Dr. Swan refers are by N. McA. Gregg (Trans. ophthal. Soc. Aust. 1941, 3,35) and by C. Swan and others (Med. J. Aust. 1943, ii, 201). A further article is in course of publication in the latter journal.-ED. L. THE LABORATORY TECHNICIAN SiB,—Your article of April 29 (p. 575) suggests that the intermediate technical examination shall consist of subjects which would level out the standard of education of entrants, but already one of the generally accepted school certificates is required of candidates before they are registered as students of this Institute, on the same principle as that adopted by other qualifying bodies. It is realised that potential entrants will not always be in possession of such an educational standard, for the Institute, as yet, cannot and is not willing to control the recruitment of juniors into medical laboratories ; and in these cases the proposed student is referred to the local educational authorities or, where facilities do not exist, to a recognised correspondence course. Only on the acceptance of their educational qualifications are they admitted to student membership of the Institute. They then continue their studies in the basic scientific subjects of physics, chemistry, biology and physiology, until, at the age of 18, they can commence the Institute tutorial classes. Our instructional classes are to be conducted at many centres in the country, by fellows and associates of the Institute, in preparation for the Institute’s diplomas. There is much to be said for your suggestion regarding the personal, as against the class, system of teaching during the professional training proper, provided that there is some standardisation of the quality of the teaching and also of the teaching methods, and my council have prepared their syllabus, and have chosen their instructors and tutors, so that this standard teaching shall exist. The periods of professional
are three years for the intermediate examination further two years for the subjects of the final
training and
a
examination-i.e., pathological technique, bacteriological technique and chemical pathology technique. J. M. SIGNY, Secretary and Registrar.
Institute of Medical
Laboratory Technology, Buckingham Street, W.C.2.
THE BRIDGE IN GALL-BLADDER SURGERY SIR,-Mr. Holman has questioned the usefulness of the bridge in gall-bladder surgery. It is difficult to see how the use of a bridge could affect the incidence of pulmonary embolism-its incidence is notoriously capricious. But on another count I believe its use is to be discouraged. Hyperextension of the lumbar spine is likely to be conducive to pain in that region afterwards, particularly in the type of patient who is most liable to suffer from gall-stones. I have not used a bridge in gall-bladder operations for the last twenty years, having learned from the late Lord Moynihan that it was quite unnecessary. His teaching that an adequate incision and proper use of the assistant’s left hand would always provide an excellent exposure has seemed to me to be
fully justified. GEOFFREY KEYNES.
London.
" Q " AND ANTIBODY SIR,-Sir Arthur Quiller-Couch’s book, On the Art of must have helped many to improve their writings. In it he states, " But, though less important, it is good to recognise that, as sons of Cambridge, we equally offend against her breeding when in our scientific writings we allow ourselves to talk of a microbe as anantibody.’ The word, ugly as well as hybrid, did not convey to Q " that its antibody fought the microbe. Cannot we cease to offend against our breeding by coining a new word ? Having learnt just enough Latin to pass the matriculation examination (alas, twenty-five years ago !) and no Greek, I will leave it to others to propose a word, but remind them of Quiller-Couch’s advice, " Almost always prefer the direct word to the circumlocution." I sincerely hope some son of Cambridge will produce a single generic word for the chemical substances fighting in our blood and tissues. This will show our appreciation of Q " who, as the obituary notice in the Times said, may not have founded a famous school but certainly helped the average man to rise
Writing,
scientific
"
"
"
above his
mediocrity.
R. E. SMITH. Rugby. SUPPLY OF BODIES FOR DISSECTION SiR,-In Dr. Goodman’s Arris and Gale Lecture, smnmarised in your issue of May 20, he expresses the belief that there will be a gradual falling off in the number of unclaimed bodies available. In this he is no doubt right, for when we are all insured against every contingency in life from the womb to the tomb and given in addition a handsome tip to Charon in the form of a burial allowance, few bodies are likely to be unclaimed. But is he not too sanguine in thinking that if the method of leaving bodies by bequest was better known the gap would rapidly be filled ? Some years ago a friend of mine asked his executors to bequeath his body to a medical school, but the professor of anatomy did not jump at the offer on account of the tiresome formalities to be observed, although-my friend being an agnostic-there was no occasion for a burial service. In any case one need not be a sentimentalist to have qualms about handing over that old friend the body, which has served one pretty faithfully for perhaps 70 odd years, to be pickled in formalin, laid on a table and cut to shreds by the scalpels of a group of young men and women. Better by far for it to be picked to pieces by real vultures on the Towers of Silence like a Parsee ! No ; the solution of the problem is not more corpses but less anatomy. Let us give up the fetish that the whole body must be dissected by every medical student, reduce drastically the amount of anatomical detail that he is expected to know, make more use of ready-pre-, pared specimens, models and drawings, and call in the help of X rays used on the living subject, and also of the cinema as in the case of the Harvey film. Far fewer bodies would then be wanted. FRCP.