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SMOKING BY ADOLESCENTS
710 infer that I condone the indiscriminate use of blood-transfusions. These comments are offered as a clarification of the current mortality-rate from bloodtransfusions and to erase the use of statistics which date from 1917. J. HARRIS JOSEPH.
however,
to
DISPOSABLE UNDERPADS FOR INCONTINENT PATIENTS NURSED AT HOME SIR,łThe letter of July 23 by Dr. Roberts and Miss Mann interested us not merely because we too manu-
facture disposable incontinence pads, but also because it is possible to use them with greater saving in cost than your correspondents indicated. The size of the pads mentioned, 30 x 23 in., is larger than may always be necessary, and for this reason we make pads of 24 x 161/2 in. Purchased in bulk, they cost approximately 4td. each. From this it will be evident that, in a great many cases, it is far more economical to use such pads than to launder soiled linen. Where larger pads are required, there is perhaps little actual saving in money but a considerable reduction in labour. With smaller pads, there is economy in both
wavs.
Wheat Bridge Mills, Chesterfield.
_
N. P. MANN Development Manager, Robinson & Sons, Ltd.
SIR,-Incontinence pads have been used in the geriatric unit at Stobhill General Hospital since 1955. I understand that since 1957 they have been available in Scotland to general practitioners on prescription form E.c.l0. The pads are available in two sizes-12 x 16 in. and 16 x 18 in.-and are made of cotton-wool, cellulose, and non-absorbent grey wool. The pad is covered in gauze in order to prevent it adhering to the patient’s skin. The cost to the hospital is approximately 6d. for the smaller size and 8d. for the larger size. I have been very satisfied with the type used. The makers are Smith & Nephew-Southalls Ltd., 5, Singer Street. London, E.C.2. W. FERGUSON ANDERSON Geriatric Unit, Stobhill General Hospital, Regional Adviser in Diseases of Old Age, Western Regional Hospital Board (Scotland). Glasgow, N.1. -
-
.
PERITONEAL SPLASH: A PHYSICAL SIGN
SiR,-It is sometimes difficult to differentiate between perforated peptic ulcer and perforated appendicitis. Examination by radiography before operation is invaluable, but in certain circumstances may impose delay, and even expense, on a patient in pain. The differentiation is important, because the correct placing of the incision makes surgical treatment of either condition easy. To be able to demonstrate diminished liver dullness is useful, but there is a wide variation of the normal area of liver dullness. There is, however, an additional physical sign which can demonstrate the presence of air in the peritoneal cavity. The rigid abdomen of the patient relaxes under a general anarsthetic, and allows the contained free air and fluid to give forth a splash, if vibrated. The splash is not so localised as that of an intragastric succussion splash, and has a note more highly pitched, and more superficial. As an example of the value of this physical sign, I would cite a recent case treated for Dr. J. A. Smart in the Victoria Hos-
pital at Lewes, a general-practitioner hospital with good radiological facilities, but without resident staff. A young man was admitted suffering from severe abdominal pain, which had settled in the right lower abdomen. The history and physical signs were equivocal, but it was clear that operation was indicated. Anxsthesia was induced by Dr. H. Rice, and the abdomen was exposed on the operating-table. The spongeholding forceps with the swab soaked in antiseptic was agitated gently but rapidly on the skin of the relaxed abdomen, a
was elicited, and all doubts were solved. A perforated duodenal ulcer was patched through an upper midline incision and the patient recovered quickly.
splash
I have read no description of this sign, which helpec in the management of this and other patients, anc therefore ask vou to oublish this letter. P. A. LANE ROBERTS. HYDROCORTISONE INHALATION IN ASTHMA
SiR,-Dr. Langlands and Dr. McNeill (Aug. 20) report hydrocortisone by inhalation did not improve the lung function in their 10 asthmatic patients. They gave 15 mg. per day by ’Medihaler ’, and they were awarealthough this is not mentioned in their paper-" that up to 50% of this amount may have been wasted " (personal communication). In my opinion, the medihaler technique that
Attention should cause even greater wastage. therefore be drawn to the possibility that their negative result, which is in contrast to that of other authors,1-3 mav be due to insufficient dosase. H. HERXHEIMER.
may
SMOKING BY ADOLESCENTS SIR,-Most doctors who have looked at the evidence must be convinced that children who start smoking are exposing themselves to a serious risk of lung cancer in later life. If they live in an industrial area in England, they also risk developing chronic bronchitis. In our society we often prevent people from doing things they want to do, if it is agreed that the proposed action would be harmful to the doer; for example, we try to prevent people from committing suicide, becoming morphine addicts, or marrying under the age of 16. Nevertheless very few doctors have suggested that we should prevent adolescents from smoking if they want to, and most people will approve; freedom should not lightly be curtailed. However, I for one find it difficult to understand why we allow freedom to the tobacco manufacturers to spend very large sums of money bn advertising which is directly opposed to the truth as we know it. Much of this advertising is, moreover, directed by subtle psychological means to appeal to the fears and hopes of adolescents. As I see it, this kind of advertising is a systematic attempt to mislead the young for personal gain. It is really very difficult"to know how to answer a fifteen-yearold boy who asks : If smoking is as bad as you say, why don’t the doctors tell the Government to stop cigarette
advertising ?
"
R. E. W. FISHER.
Medicine and the Law Death after AT
an
inquest
at
Wasp Sting
Woodbridge, Suffolk,
on a
68-year-old
who died shortly after being stung by a wasp, it was stated that she had also been stung about a month earlier, when the only ill effect was swelling of a finger. After receiving the sting which led to her death the woman complained of feeling faint and she started to tremble. A doctor was called, and within minutes adrenaline was administered; but the patient nevertheless died. A pathologist testified that the cause of death was anaphylactic shock, the patient having been sensitised by the earlier sting. A verdict of death by misadventure was recorded. 1. Brockbank, W., Pengelly, C. D. R. Lancet, 1958, i, 187.
woman
2. Helm, W. H., Heyworth, F. Brit. med. J. 1958, ii, 768. 3. Herxheimer, H., McAllen, M. K., Williams, D. A. ibid. p. 762. 4. East Anglian Daily Times, Sept. 15, 1960.
however,
to
DISPOSABLE UNDERPADS FOR INCONTINENT PATIENTS NURSED AT HOME SIR,łThe letter of July 23 by Dr. Roberts and Miss Mann interested us not merely because we too manu-
facture disposable incontinence pads, but also because it is possible to use them with greater saving in cost than your correspondents indicated. The size of the pads mentioned, 30 x 23 in., is larger than may always be necessary, and for this reason we make pads of 24 x 161/2 in. Purchased in bulk, they cost approximately 4td. each. From this it will be evident that, in a great many cases, it is far more economical to use such pads than to launder soiled linen. Where larger pads are required, there is perhaps little actual saving in money but a considerable reduction in labour. With smaller pads, there is economy in both
wavs.
Wheat Bridge Mills, Chesterfield.
_
N. P. MANN Development Manager, Robinson & Sons, Ltd.
SIR,-Incontinence pads have been used in the geriatric unit at Stobhill General Hospital since 1955. I understand that since 1957 they have been available in Scotland to general practitioners on prescription form E.c.l0. The pads are available in two sizes-12 x 16 in. and 16 x 18 in.-and are made of cotton-wool, cellulose, and non-absorbent grey wool. The pad is covered in gauze in order to prevent it adhering to the patient’s skin. The cost to the hospital is approximately 6d. for the smaller size and 8d. for the larger size. I have been very satisfied with the type used. The makers are Smith & Nephew-Southalls Ltd., 5, Singer Street. London, E.C.2. W. FERGUSON ANDERSON Geriatric Unit, Stobhill General Hospital, Regional Adviser in Diseases of Old Age, Western Regional Hospital Board (Scotland). Glasgow, N.1. -
-
.
PERITONEAL SPLASH: A PHYSICAL SIGN
SiR,-It is sometimes difficult to differentiate between perforated peptic ulcer and perforated appendicitis. Examination by radiography before operation is invaluable, but in certain circumstances may impose delay, and even expense, on a patient in pain. The differentiation is important, because the correct placing of the incision makes surgical treatment of either condition easy. To be able to demonstrate diminished liver dullness is useful, but there is a wide variation of the normal area of liver dullness. There is, however, an additional physical sign which can demonstrate the presence of air in the peritoneal cavity. The rigid abdomen of the patient relaxes under a general anarsthetic, and allows the contained free air and fluid to give forth a splash, if vibrated. The splash is not so localised as that of an intragastric succussion splash, and has a note more highly pitched, and more superficial. As an example of the value of this physical sign, I would cite a recent case treated for Dr. J. A. Smart in the Victoria Hos-
pital at Lewes, a general-practitioner hospital with good radiological facilities, but without resident staff. A young man was admitted suffering from severe abdominal pain, which had settled in the right lower abdomen. The history and physical signs were equivocal, but it was clear that operation was indicated. Anxsthesia was induced by Dr. H. Rice, and the abdomen was exposed on the operating-table. The spongeholding forceps with the swab soaked in antiseptic was agitated gently but rapidly on the skin of the relaxed abdomen, a
was elicited, and all doubts were solved. A perforated duodenal ulcer was patched through an upper midline incision and the patient recovered quickly.
splash
I have read no description of this sign, which helpec in the management of this and other patients, anc therefore ask vou to oublish this letter. P. A. LANE ROBERTS. HYDROCORTISONE INHALATION IN ASTHMA
SiR,-Dr. Langlands and Dr. McNeill (Aug. 20) report hydrocortisone by inhalation did not improve the lung function in their 10 asthmatic patients. They gave 15 mg. per day by ’Medihaler ’, and they were awarealthough this is not mentioned in their paper-" that up to 50% of this amount may have been wasted " (personal communication). In my opinion, the medihaler technique that
Attention should cause even greater wastage. therefore be drawn to the possibility that their negative result, which is in contrast to that of other authors,1-3 mav be due to insufficient dosase. H. HERXHEIMER.
may
SMOKING BY ADOLESCENTS SIR,-Most doctors who have looked at the evidence must be convinced that children who start smoking are exposing themselves to a serious risk of lung cancer in later life. If they live in an industrial area in England, they also risk developing chronic bronchitis. In our society we often prevent people from doing things they want to do, if it is agreed that the proposed action would be harmful to the doer; for example, we try to prevent people from committing suicide, becoming morphine addicts, or marrying under the age of 16. Nevertheless very few doctors have suggested that we should prevent adolescents from smoking if they want to, and most people will approve; freedom should not lightly be curtailed. However, I for one find it difficult to understand why we allow freedom to the tobacco manufacturers to spend very large sums of money bn advertising which is directly opposed to the truth as we know it. Much of this advertising is, moreover, directed by subtle psychological means to appeal to the fears and hopes of adolescents. As I see it, this kind of advertising is a systematic attempt to mislead the young for personal gain. It is really very difficult"to know how to answer a fifteen-yearold boy who asks : If smoking is as bad as you say, why don’t the doctors tell the Government to stop cigarette
advertising ?
"
R. E. W. FISHER.
Medicine and the Law Death after AT
an
inquest
at
Wasp Sting
Woodbridge, Suffolk,
on a
68-year-old
who died shortly after being stung by a wasp, it was stated that she had also been stung about a month earlier, when the only ill effect was swelling of a finger. After receiving the sting which led to her death the woman complained of feeling faint and she started to tremble. A doctor was called, and within minutes adrenaline was administered; but the patient nevertheless died. A pathologist testified that the cause of death was anaphylactic shock, the patient having been sensitised by the earlier sting. A verdict of death by misadventure was recorded. 1. Brockbank, W., Pengelly, C. D. R. Lancet, 1958, i, 187.
woman
2. Helm, W. H., Heyworth, F. Brit. med. J. 1958, ii, 768. 3. Herxheimer, H., McAllen, M. K., Williams, D. A. ibid. p. 762. 4. East Anglian Daily Times, Sept. 15, 1960.