- Email: [email protected]
SIR ROBERT PLATT ON EDUCATION
420
LANG AND SCHATZ
therapy of the patient with rheumatic heart disease and embolism is indicated. There is a small group of patients in whom anticoagulant therapy fails to prevent recurrence. It is emphasized that such therapy should not be proclaimed a failure if the Quick one-stage prothrombin time has not been within therapeutic range (1.6 times control value or greater) at the time of, or just prior to, embolism. In our view, the interposition of surgical procedures with significant immediate and remote hazards is justified only when pulmonary embolism recurs in the face of acceptable anticoagulant treatment. In such situations, both caval interruption and anticoagulant therapy may represent the best available protection for the patient. ACKNOWLEDGMENT: Diane Singer Carol Oudemolen, and Alfreda Matyniak provided technicai assistance. REFERENCES
1 THO~fAS, D. P.: Treatment of pulmonary embolic disease, New Eng.]. Med., 273:885,1965.
2
3
4
5
6 7
8
SALZ~{AN, E. W., HARRIS, W. H., AND DE SANCTIS, R. W.: Anticoagulation for prevention of thromboembolism following frachlres of the hip, New Eng. ]. Med., 275:122, 1966. FREI~IAN, D. G., SUYE~IOTO, J., AND WESSLER, S.: Frequency of pulmonary thromboembolism in man, New Eng. ]. Med., 272:1278, 1965. BEALL, A. C., JR., AND COOLEY, D. A.: Current status of embolectomy for acute massive pulmonary embolism, Amer. ]. Cardiol., 16:828, 1965. BARKER, N. W., AND PRIESTLEY, J. T.: Postoperative thrombophlebitis and embolism, Surgery, 12:411, 1942. MURRAY, D. W. G., AND BEST, C. H.: Use of heparin in thrombosis, Ann. Surg., 108: 163, 1938. BARRITf, D. W., AND JORDAN, S. C.: Anticoagulant drugs in treatment of pulmonary embolism; controlled mal, Lancet, 1:1309, 1960. SCHATZ, I. J., AND KEYES, J. W.: Long-term anticoagulant therapy; complications and control of 978 cases, In: Anticoagulant therapy in ischemic heart disease, Nichol, E. S., Editor, Grone and Stratton, New York, 1965.
Reprint requests: Dr. Schatz, 1400 Chrysler Freeway, Detroit 48207
IN VINO VERITAS Theodoric (Teodorico Borgognoni, 1205-1296) was the disciple and apparently the son of Hugh of Lucca, the city physician of Bologna, who first challenged the doctrine of "laudable pus". Theodoric joined the Dominican Order and became the bishop of Cervia where in 1266 he wrote his textbook of surgery, the Cyrurgia. He \\'ashed the wounds with wine only, scrupulously
removing every foreign particle; then he brought the edges together, forbidding any of the wine or other dressing to remain within. As with the genuine Hippocratic school, a dry and
adhesive edge was their desire. Nature, they said, produces the means of union in a viscous exudation, or balm. In stale w~~nds they did their best to obtain union by cleansing, desiccation, and refreshing of the edges. Upon the outer surface they laid lint steeped in wine; . . . wine, after washing, purifying, and drying the ra\\' surfaces, evaporates. Allbutt, T. C. Quoted in Lucia, S. P.: A History of Wine as Therapy, J. B. Lippincott, Philadelphia, 1963.
SiR ROBERT PLATT ON EDUCATION Given a few lectures and diagrams, the principles of lung function could be grasped by anyone with a scientific background. Given three lectures on the violin, with suitable illustrations, the student wouldn't be able to pIay a note (Of course, if university deparhnents
22
of music ever did stoop to such irrelevances as actually teaching people how to play, they would start with a year's instruction in physics and mathematics). Strauss, M. B. (Ed): Familiar Medical Quotations, Little, Brown and Company, Boston, 1968.
DIS. CHEST, VOL. 54, NO.5, NOVEMBER 1968
LANG AND SCHATZ
therapy of the patient with rheumatic heart disease and embolism is indicated. There is a small group of patients in whom anticoagulant therapy fails to prevent recurrence. It is emphasized that such therapy should not be proclaimed a failure if the Quick one-stage prothrombin time has not been within therapeutic range (1.6 times control value or greater) at the time of, or just prior to, embolism. In our view, the interposition of surgical procedures with significant immediate and remote hazards is justified only when pulmonary embolism recurs in the face of acceptable anticoagulant treatment. In such situations, both caval interruption and anticoagulant therapy may represent the best available protection for the patient. ACKNOWLEDGMENT: Diane Singer Carol Oudemolen, and Alfreda Matyniak provided technicai assistance. REFERENCES
1 THO~fAS, D. P.: Treatment of pulmonary embolic disease, New Eng.]. Med., 273:885,1965.
2
3
4
5
6 7
8
SALZ~{AN, E. W., HARRIS, W. H., AND DE SANCTIS, R. W.: Anticoagulation for prevention of thromboembolism following frachlres of the hip, New Eng. ]. Med., 275:122, 1966. FREI~IAN, D. G., SUYE~IOTO, J., AND WESSLER, S.: Frequency of pulmonary thromboembolism in man, New Eng. ]. Med., 272:1278, 1965. BEALL, A. C., JR., AND COOLEY, D. A.: Current status of embolectomy for acute massive pulmonary embolism, Amer. ]. Cardiol., 16:828, 1965. BARKER, N. W., AND PRIESTLEY, J. T.: Postoperative thrombophlebitis and embolism, Surgery, 12:411, 1942. MURRAY, D. W. G., AND BEST, C. H.: Use of heparin in thrombosis, Ann. Surg., 108: 163, 1938. BARRITf, D. W., AND JORDAN, S. C.: Anticoagulant drugs in treatment of pulmonary embolism; controlled mal, Lancet, 1:1309, 1960. SCHATZ, I. J., AND KEYES, J. W.: Long-term anticoagulant therapy; complications and control of 978 cases, In: Anticoagulant therapy in ischemic heart disease, Nichol, E. S., Editor, Grone and Stratton, New York, 1965.
Reprint requests: Dr. Schatz, 1400 Chrysler Freeway, Detroit 48207
IN VINO VERITAS Theodoric (Teodorico Borgognoni, 1205-1296) was the disciple and apparently the son of Hugh of Lucca, the city physician of Bologna, who first challenged the doctrine of "laudable pus". Theodoric joined the Dominican Order and became the bishop of Cervia where in 1266 he wrote his textbook of surgery, the Cyrurgia. He \\'ashed the wounds with wine only, scrupulously
removing every foreign particle; then he brought the edges together, forbidding any of the wine or other dressing to remain within. As with the genuine Hippocratic school, a dry and
adhesive edge was their desire. Nature, they said, produces the means of union in a viscous exudation, or balm. In stale w~~nds they did their best to obtain union by cleansing, desiccation, and refreshing of the edges. Upon the outer surface they laid lint steeped in wine; . . . wine, after washing, purifying, and drying the ra\\' surfaces, evaporates. Allbutt, T. C. Quoted in Lucia, S. P.: A History of Wine as Therapy, J. B. Lippincott, Philadelphia, 1963.
SiR ROBERT PLATT ON EDUCATION Given a few lectures and diagrams, the principles of lung function could be grasped by anyone with a scientific background. Given three lectures on the violin, with suitable illustrations, the student wouldn't be able to pIay a note (Of course, if university deparhnents
22
of music ever did stoop to such irrelevances as actually teaching people how to play, they would start with a year's instruction in physics and mathematics). Strauss, M. B. (Ed): Familiar Medical Quotations, Little, Brown and Company, Boston, 1968.
DIS. CHEST, VOL. 54, NO.5, NOVEMBER 1968