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SERUM REPLACEMENT IN BURNS
454
country but also show that, in doses well above the danger level for children, it is not effective against the threadworm (Oxyuris vermicularis). Of 10 patients they treated 8 failed to give the three negative swabs regarded as necessary to establish a cure. Fortunately there is no need to lament the departure of phenothiazine, for its place in the treatment of threadworms has been taken by gentian-violet which is given in coated capsules of grain . The dose is one capsule a day for each year of age up to six years, and this dose is continued for a week. A second course may be given after an interval if worms are seen in the faeces or ova With these doses no are still discovered on the swabs. toxic effects have been recorded. Wright and Brady 18 obtained 60-90 % cures by its use in adults and children, and subsequent clinical experience rates its efficiency more highly still. FERTILITY
AS A CONTROLLABLE
FACTOR
JUST now population trends are exciting the oppositeminded to argument-some saying let us have more of one kind of men and others saying let us have less of every kind. Across the controversy the statement of experts convened by the British Social Hygiene Council breathes like a voice from the laboratory. Whatever we think about man, few of us want to picture him as a dying race ; and whether we want to extend fertility or reduce it we should prefer not to have the issue taken out of our hands by biological failure. The experts produce evidence (see p. 457) of involuntary impaired fertility in the population which is striking. Experience has shown that in many cases the reproductive function can be restored or improved. Since devices for reducing fertility have stimulated investigators, and are now becoming reliable, treatment for improving it should excite at least equal interest. The plea for better facilities for skilled diagnosis and treatment of all grades of infecundity is sensible and timely.
uninterrupted recoveries. Unfortunately the parsimonious equipment of many hospitals precludes any attempt at accurately controlled treatment on these lines; and indeed where the patient may have been ansemic before sustaining the burn any attempt to maintain a normal hsematocrit value might meet with disaster. Presman and his colleagues therefore conclude with a simple rule to follow in the treatment of severe burns. They recommend that 50 c.cm. of serum should be given into a vein immediately for every 1 % of body surface which has been burned, with an additional 20-30 c.cm. for every 1 % during the first 24 hours and another 20-30 c.cm. in the first 72 hours following the burn, thus totalling 100-110 c.cm. for each 1% of body surface burnt. These recommendations may be summarised as
follows
:-
Immediately
Volume of serum to be given for each 1% of burnt surface. 50 c.cm.
During first During first
20-30 c.cm. 20-30 c.cm. f
24 hours.. 72 hours..
in addition. III
They state further that no crystalloid fluid should be given during the first 24 hours, but that fluids and a high-protein diet by mouth should begin as soon as possible. It is to be hoped that others will have the same measure
of
success
with their method.
THE LAST OF DR. THORNDYKE Dr. Austin Freeman, whose death is announced on another page, gave more pleasure to his colleagues, in his time, than perhaps is usual in our profession. If Conan Doyle set the standard for scientific crime investigators, Austin Freeman, in his stories of Dr. John Thorndyke, has carried,on the Holmes tradition scrupulously. Like Holmes, Thorndyke is credibly-but only just credibly-well informed ; he has the same passion for accuracy, the same meticulous attention to detail couple with a considerably greater knowledge of laboratory technique, and an equal disregard for the lure of He lacks Holmes’s more spectaSERUM REPLACEMENT IN BURNS no cular and endearing side, perhaps : opium, no THE most profound change that can be demonstrated and no contrived for theatrical effect violin situations in the blood of a burnt patient is loss of protein and water. When serum and plasma transfusion was made available find their way into Thorndyke’s well-regulated life. Here is a serious-minded scientist, and the reader is some years ago there seemed to be a good chance of to get his fun out of the hard labour of desaving the lives of those whose burns extended beyond expectednot out of the foibles of the detective. He tecting, the critical one-third of the total body surface. Untoo. Whether helping Dr. Thorndyke to look does, these realised and it were not fortunately hopes always or into the manners and customs of marine worms,< seemed possible that other factors were of greater importbreathing down his neck while he examines (for arsenic) ance than simple plasma loss. Presman and his assoa lock of hair from a long-dead girl, the reader gets his ciates 19 however believe that the failure of intravenous of interest and excitement ; and he is blessed with ration serum therapy has been due to the use of insufficient an encydopaedic mind who puts down an Austin Freeman refer to the work of ZYolff Elkinton, quantities. They without having learned some odd new fact or other. and Lee,20 who maintain that damaged capillaries do not Doctors, many of whom are martyrs to detective literawill their normal therefore permeability (and regain go ture, nearly always enjoy the details of medical jurison leaking plasma) for up to 40 hours after a burn. Thorndyke had at his finger tips. It is During this time not only must the normal bodily prudencea which measure of Freeman’s skill that he often disperhaps loss must be be but met, requirements any continually pensed with surprise in his puzzles ; he could tell his made good if a fatal reduction of blood-volume is to be story backwards-beginning with the culprit and avoided. They cite two cases in which 45% and 50% of working through the steps by which he was undonethe body surface had been burnt and whose haemoglobin, protein, non-protein nitrogen and haematocrit values without losing his reader’s attention. An estimation of the were recorded during treatment. blood and plasma volume was made from the body ROYAL COLLEGE OF PHYSICIANS OF LONDON.-On Monday, weight. Each patient received 4250 c.cm. of serum Oct. 18, at 2.30 rn2, Dr. W. E. Hume will deliver the during the 68 hours following’the burn, 1750 c.cm. Harveian oration. ROYAL SOCIETY OF MEDICINE.-On Tuesday, Oct. 12, atbeing given during the first four hours. In addition 5 rM, Dr. W. Norwood East will deliver his presidential other fluids were given by mouth and vein, so that one address to the section of psychiatry on the state, the criminal patient took no less than 19,970 c.cm. of fluid during and the psychiatrist. Mr. Malcolm Donaldson will give his the 68 hours after the burn-that is, 7000 c.cm. in excess presidential address to the section of obstetrics and gynaecology of normal requirement in 24 hours. As a result, it is at 3.30 PM. on Oct. He will speak on the cancer problem said, of these heroic measures, both patients made from the15, of view of the and a
matrimony.
18. Wright, W. H. and Brady, F. J. Ibid. 1940. 114, 861. 19. Presman, D. L., Janota, M., Weston, R. E., Levinson, S. O. and Necheles, H. J. Amer. med. Ass. 1943, 122, 924. 20. Elkinton, J. R., Wolff, W. A., and Lee, W. E. Ann. Surg. 1940, 112, 150.
point young gynaecologist discussion will follow. There will also be a discussion after Dr. N. S. Finzi’s presidential address to the section of radiology at 4.45 rm on the same day. The subject is to be impending new developments in radiotherapy. "
.
country but also show that, in doses well above the danger level for children, it is not effective against the threadworm (Oxyuris vermicularis). Of 10 patients they treated 8 failed to give the three negative swabs regarded as necessary to establish a cure. Fortunately there is no need to lament the departure of phenothiazine, for its place in the treatment of threadworms has been taken by gentian-violet which is given in coated capsules of grain . The dose is one capsule a day for each year of age up to six years, and this dose is continued for a week. A second course may be given after an interval if worms are seen in the faeces or ova With these doses no are still discovered on the swabs. toxic effects have been recorded. Wright and Brady 18 obtained 60-90 % cures by its use in adults and children, and subsequent clinical experience rates its efficiency more highly still. FERTILITY
AS A CONTROLLABLE
FACTOR
JUST now population trends are exciting the oppositeminded to argument-some saying let us have more of one kind of men and others saying let us have less of every kind. Across the controversy the statement of experts convened by the British Social Hygiene Council breathes like a voice from the laboratory. Whatever we think about man, few of us want to picture him as a dying race ; and whether we want to extend fertility or reduce it we should prefer not to have the issue taken out of our hands by biological failure. The experts produce evidence (see p. 457) of involuntary impaired fertility in the population which is striking. Experience has shown that in many cases the reproductive function can be restored or improved. Since devices for reducing fertility have stimulated investigators, and are now becoming reliable, treatment for improving it should excite at least equal interest. The plea for better facilities for skilled diagnosis and treatment of all grades of infecundity is sensible and timely.
uninterrupted recoveries. Unfortunately the parsimonious equipment of many hospitals precludes any attempt at accurately controlled treatment on these lines; and indeed where the patient may have been ansemic before sustaining the burn any attempt to maintain a normal hsematocrit value might meet with disaster. Presman and his colleagues therefore conclude with a simple rule to follow in the treatment of severe burns. They recommend that 50 c.cm. of serum should be given into a vein immediately for every 1 % of body surface which has been burned, with an additional 20-30 c.cm. for every 1 % during the first 24 hours and another 20-30 c.cm. in the first 72 hours following the burn, thus totalling 100-110 c.cm. for each 1% of body surface burnt. These recommendations may be summarised as
follows
:-
Immediately
Volume of serum to be given for each 1% of burnt surface. 50 c.cm.
During first During first
20-30 c.cm. 20-30 c.cm. f
24 hours.. 72 hours..
in addition. III
They state further that no crystalloid fluid should be given during the first 24 hours, but that fluids and a high-protein diet by mouth should begin as soon as possible. It is to be hoped that others will have the same measure
of
success
with their method.
THE LAST OF DR. THORNDYKE Dr. Austin Freeman, whose death is announced on another page, gave more pleasure to his colleagues, in his time, than perhaps is usual in our profession. If Conan Doyle set the standard for scientific crime investigators, Austin Freeman, in his stories of Dr. John Thorndyke, has carried,on the Holmes tradition scrupulously. Like Holmes, Thorndyke is credibly-but only just credibly-well informed ; he has the same passion for accuracy, the same meticulous attention to detail couple with a considerably greater knowledge of laboratory technique, and an equal disregard for the lure of He lacks Holmes’s more spectaSERUM REPLACEMENT IN BURNS no cular and endearing side, perhaps : opium, no THE most profound change that can be demonstrated and no contrived for theatrical effect violin situations in the blood of a burnt patient is loss of protein and water. When serum and plasma transfusion was made available find their way into Thorndyke’s well-regulated life. Here is a serious-minded scientist, and the reader is some years ago there seemed to be a good chance of to get his fun out of the hard labour of desaving the lives of those whose burns extended beyond expectednot out of the foibles of the detective. He tecting, the critical one-third of the total body surface. Untoo. Whether helping Dr. Thorndyke to look does, these realised and it were not fortunately hopes always or into the manners and customs of marine worms,< seemed possible that other factors were of greater importbreathing down his neck while he examines (for arsenic) ance than simple plasma loss. Presman and his assoa lock of hair from a long-dead girl, the reader gets his ciates 19 however believe that the failure of intravenous of interest and excitement ; and he is blessed with ration serum therapy has been due to the use of insufficient an encydopaedic mind who puts down an Austin Freeman refer to the work of ZYolff Elkinton, quantities. They without having learned some odd new fact or other. and Lee,20 who maintain that damaged capillaries do not Doctors, many of whom are martyrs to detective literawill their normal therefore permeability (and regain go ture, nearly always enjoy the details of medical jurison leaking plasma) for up to 40 hours after a burn. Thorndyke had at his finger tips. It is During this time not only must the normal bodily prudencea which measure of Freeman’s skill that he often disperhaps loss must be be but met, requirements any continually pensed with surprise in his puzzles ; he could tell his made good if a fatal reduction of blood-volume is to be story backwards-beginning with the culprit and avoided. They cite two cases in which 45% and 50% of working through the steps by which he was undonethe body surface had been burnt and whose haemoglobin, protein, non-protein nitrogen and haematocrit values without losing his reader’s attention. An estimation of the were recorded during treatment. blood and plasma volume was made from the body ROYAL COLLEGE OF PHYSICIANS OF LONDON.-On Monday, weight. Each patient received 4250 c.cm. of serum Oct. 18, at 2.30 rn2, Dr. W. E. Hume will deliver the during the 68 hours following’the burn, 1750 c.cm. Harveian oration. ROYAL SOCIETY OF MEDICINE.-On Tuesday, Oct. 12, atbeing given during the first four hours. In addition 5 rM, Dr. W. Norwood East will deliver his presidential other fluids were given by mouth and vein, so that one address to the section of psychiatry on the state, the criminal patient took no less than 19,970 c.cm. of fluid during and the psychiatrist. Mr. Malcolm Donaldson will give his the 68 hours after the burn-that is, 7000 c.cm. in excess presidential address to the section of obstetrics and gynaecology of normal requirement in 24 hours. As a result, it is at 3.30 PM. on Oct. He will speak on the cancer problem said, of these heroic measures, both patients made from the15, of view of the and a
matrimony.
18. Wright, W. H. and Brady, F. J. Ibid. 1940. 114, 861. 19. Presman, D. L., Janota, M., Weston, R. E., Levinson, S. O. and Necheles, H. J. Amer. med. Ass. 1943, 122, 924. 20. Elkinton, J. R., Wolff, W. A., and Lee, W. E. Ann. Surg. 1940, 112, 150.
point young gynaecologist discussion will follow. There will also be a discussion after Dr. N. S. Finzi’s presidential address to the section of radiology at 4.45 rm on the same day. The subject is to be impending new developments in radiotherapy. "
.