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SPLENECTOMY IN ICTERUS GRAVIS
411 SPLENECTOMY IN ICTERUS GRAVIS SIR,-The paper by Hardwick and Lloyd in your issue of Sept. 20 will have been read with interest by paediatricians. Recovery in this case does not justify the assumption that splenectomy is of any value in the treatment of this disease. The operation was practised for a short time in the United States, but this treatment is now regarded as irrational. It is generally accepted that the splenomegaly is a reaction to the disease rather than the cause. In the last few years I have observed about fifty cases of erythroblastosis of which icterus gravis is the commonest clinical type. Many were closely studied from the time of birth in a maternity hospital. Spontaneous recovery often occurs and the recognised sequelas are exceptional. I have recorded several cases (Trans. Edinb. obstetr. Soc. 1939, p. 63), and have since seen a number of others, in which a very active reticulocytosis and rapid rise of haemoglobin occurred without any treatment. So long as the setiology remains obscure, blood transfusion is likely to remain the therapeutic mainstay. The object of blood transfusion is to maintain the hsemoglobin at a safe level until the rate of regeneration outstrips that of haemolysis. Definite blood coagulability with hsemorrhagic signs often occurs in severe cases of the disease and can be efficiently treated by the administration of vitamin K. J. L. HENDERSON. Dept. of Child Life and Health, Edinburgh. WAR-TIME BEHAVIOUR
SrR,-The Mental Health Emergency Committee has been making an inquiry into the behaviour of children
and adults under war conditions. Questionnaires have been sent out to child guidance clinics, mental treatment clinics, psychiatric wards of emergency hospitals, and to psychiatric social workers in reception areas. This inquiry was intended to be only a, preliminary survey and before proceeding further the committee would be much interested to learn whether any similar investigations are being carried out, either by groups or by individuals, and if so would welcome opportunities of
cooperation.
-
Mental Health Emergency Committee, 24, Buckingham Palace Road, S.W.1.
-
EVELYN FOX, Hon. Secretary.
Public Health From the School Reports HOLLAND
(LINCS)
Dr. W. G. Booth throws some light on the cost of the school medical service in a small county. The number of school-children on the roll at the end of 1940 was 10,180, and the net cost of their medical service was 5202, or 10s. a head per annum. The Board of Education grants supplied 23282, the remainder came from the rates and absorbed 2d. out of the general elementaryeducation rate of 4s. The use of paper towels was continued in some schools, and it was hoped to extend this system throughout the county, but that is of course impossible at present. In view of the increasing prevalence of scabies this is unfortunate, for the communal school towel is open to suspicion of spreading the acarus. Mr. C. A. Johnston, senior school dentist, calls attention to the very bad state of the mouths of school entrants. Caries of the temporary teeth seems to be increasing in spite of the undoubted improvement in the general nutrition of children and of expectant mothers. _
KETTERING
The average number of children on the school registers in 1940 was 4119 and the number of received children who remained in the borough at the end of the year was 2863. The ebb and flow of the evacuated population, most of which came from London, is interesting. There was a steady reduction from 2533 in January to 1434 in August, the number doubled in September, and in October reached 4397. It has not been fully realised how great is the strain of this fluctuation on billeting and education in reception areas. During the year 112 children were admitted to hostels because they were unfit
for
Of these 26 were taken home by their returned to billets because they were cured. Dr. Cecil Hogg, in his school report, gives some information on unsatisfactory evacuees which will be useful in the future, for evacuation has given us the only chance we have ever had to find out the number of objectionable children, what percentage of them can be cured and how long it will take to cure theen.
billeting. parents and 65
were
Infectious Disease in England and Wales WEEK ENDED SEPT. 20 Notifications.-The following cases of infectious disease were notified during the week : smallpox 0 ; scarlet
fever, 1140 ; whooping-cough, 2289 ; diphtheria, 957 ; paratyphoid, 125 ; typhoid, 27 ; measles (excluding rubella), 612 ; pneumonia (primary or influenzal), 434 ; puerperal pyrexia, 134 ; cerebrospinal fever, 121 ; poliomyelitis, 28 ; polio-encephalitis, 3 ; encephalitis lethargica, 6 ; dysentery, 102 ; ophthalmia neonatorum, 76. No case of cholera, plague or typhus fever was notified during the week. The number of civilian and service sick in the Infectious Hospitals of the London County Council on Sept. 17 was 1266 ; including scarlet fever, 129 ; diphtheria, 252 ; measles, 28 ; whooping-cough,
571 ; enteritis, 22 ; chicken-pox, 24 ; erysipelas, 20 ; mumps, 6 ; poliomyelitis, 2 ; dysentery, 14 ; cerebrospinal fever, 21 ; puerperal sepsis, 12 ; enteric fevers, 45 ; german measles, 3 ; malaria, 1 ; polio-encephalitis, 2 ; other diseases (non-infectious), 44 ; not yet diagnosed, 75. Deaths.-In 126 great towns there were no deaths from enteric fever, 1 (0) from measles, 1 (0) from scarlet fever, 14 (1) from whooping-cough, 23 (1) from diphtheria, 38 (1) from diarrhoea and enteritis under 2 years, and 8 (0) from influenza. The figures in parentheses are those for London itself. Birmingham reported 9 deaths from diarrhoea. There were 3 fatal cases of diphtheria at Liverpool. The number of stillbirths notified during the week was 170 (corresponding to a rate of 32 per thousand total births), including 14 in London. ,
Obituary ROBERT THIN M.B., LL.D. EDIN., F.R.C.P.E. Dr. Thin who died at Stow on Sept. 18 in his 81st year had spent the greater part of his professional life in general practice in Edinburghwhere his energy and kindly disposition earned him the esteem and admiration of colleagues and patients. For fifty years he was associated with the Royal College of Physicians, becoming president 1931-33 when the LL.D. Edin. was conferred on him. After qualifying in 1887 and working in the Royal Infirmary and Maternity Hospital he went to Vienna and Prague studying diseases of the ear, nose and throat and the use of obstetrical forceps. Then as assistant to Dr. George Hunter of Linlithgow he lived in South Queensferry where he was assistant surgeon to the Forth Bridge works during the period of erection. Later his practice became very large and he did not find much time for writing, but he recorded in the Edinburgh Medical Journal a study of five generations of familial cysteinuria. He was a lively member of the Old Edinburgh Club and his’antiquarian interest found expression in " The Old Infirmary and Earlier Hospitals " and " Medical Quacks of the Eighteenth Century," while at the request of his college he wrote biographical sketches for the portraits hung on the college walls. He carried his own years lightly and continued in practice until a few weeks of his death. WILLIAM NEIL CAMPBELL M.D.
EDIN.,
1Z.R.C.P.E.
THE death of Dr. Neil Campbell is announced from Africa where he was serving with the South African Forces. Dr. Campbell graduated in Edinburgh in 1927, taking the M.D. in 1939. After a house appointment at the Royal Infirmary he went out to Natal and set up in practice at Durban where his ability was recognised by his election to the staff of the King Edward Hospital, Durban. During his student days he was a keen angler and athlete with a good record at rugby and field athletics. He leaves a widow and two young children.
SrR,-The Mental Health Emergency Committee has been making an inquiry into the behaviour of children
and adults under war conditions. Questionnaires have been sent out to child guidance clinics, mental treatment clinics, psychiatric wards of emergency hospitals, and to psychiatric social workers in reception areas. This inquiry was intended to be only a, preliminary survey and before proceeding further the committee would be much interested to learn whether any similar investigations are being carried out, either by groups or by individuals, and if so would welcome opportunities of
cooperation.
-
Mental Health Emergency Committee, 24, Buckingham Palace Road, S.W.1.
-
EVELYN FOX, Hon. Secretary.
Public Health From the School Reports HOLLAND
(LINCS)
Dr. W. G. Booth throws some light on the cost of the school medical service in a small county. The number of school-children on the roll at the end of 1940 was 10,180, and the net cost of their medical service was 5202, or 10s. a head per annum. The Board of Education grants supplied 23282, the remainder came from the rates and absorbed 2d. out of the general elementaryeducation rate of 4s. The use of paper towels was continued in some schools, and it was hoped to extend this system throughout the county, but that is of course impossible at present. In view of the increasing prevalence of scabies this is unfortunate, for the communal school towel is open to suspicion of spreading the acarus. Mr. C. A. Johnston, senior school dentist, calls attention to the very bad state of the mouths of school entrants. Caries of the temporary teeth seems to be increasing in spite of the undoubted improvement in the general nutrition of children and of expectant mothers. _
KETTERING
The average number of children on the school registers in 1940 was 4119 and the number of received children who remained in the borough at the end of the year was 2863. The ebb and flow of the evacuated population, most of which came from London, is interesting. There was a steady reduction from 2533 in January to 1434 in August, the number doubled in September, and in October reached 4397. It has not been fully realised how great is the strain of this fluctuation on billeting and education in reception areas. During the year 112 children were admitted to hostels because they were unfit
for
Of these 26 were taken home by their returned to billets because they were cured. Dr. Cecil Hogg, in his school report, gives some information on unsatisfactory evacuees which will be useful in the future, for evacuation has given us the only chance we have ever had to find out the number of objectionable children, what percentage of them can be cured and how long it will take to cure theen.
billeting. parents and 65
were
Infectious Disease in England and Wales WEEK ENDED SEPT. 20 Notifications.-The following cases of infectious disease were notified during the week : smallpox 0 ; scarlet
fever, 1140 ; whooping-cough, 2289 ; diphtheria, 957 ; paratyphoid, 125 ; typhoid, 27 ; measles (excluding rubella), 612 ; pneumonia (primary or influenzal), 434 ; puerperal pyrexia, 134 ; cerebrospinal fever, 121 ; poliomyelitis, 28 ; polio-encephalitis, 3 ; encephalitis lethargica, 6 ; dysentery, 102 ; ophthalmia neonatorum, 76. No case of cholera, plague or typhus fever was notified during the week. The number of civilian and service sick in the Infectious Hospitals of the London County Council on Sept. 17 was 1266 ; including scarlet fever, 129 ; diphtheria, 252 ; measles, 28 ; whooping-cough,
571 ; enteritis, 22 ; chicken-pox, 24 ; erysipelas, 20 ; mumps, 6 ; poliomyelitis, 2 ; dysentery, 14 ; cerebrospinal fever, 21 ; puerperal sepsis, 12 ; enteric fevers, 45 ; german measles, 3 ; malaria, 1 ; polio-encephalitis, 2 ; other diseases (non-infectious), 44 ; not yet diagnosed, 75. Deaths.-In 126 great towns there were no deaths from enteric fever, 1 (0) from measles, 1 (0) from scarlet fever, 14 (1) from whooping-cough, 23 (1) from diphtheria, 38 (1) from diarrhoea and enteritis under 2 years, and 8 (0) from influenza. The figures in parentheses are those for London itself. Birmingham reported 9 deaths from diarrhoea. There were 3 fatal cases of diphtheria at Liverpool. The number of stillbirths notified during the week was 170 (corresponding to a rate of 32 per thousand total births), including 14 in London. ,
Obituary ROBERT THIN M.B., LL.D. EDIN., F.R.C.P.E. Dr. Thin who died at Stow on Sept. 18 in his 81st year had spent the greater part of his professional life in general practice in Edinburghwhere his energy and kindly disposition earned him the esteem and admiration of colleagues and patients. For fifty years he was associated with the Royal College of Physicians, becoming president 1931-33 when the LL.D. Edin. was conferred on him. After qualifying in 1887 and working in the Royal Infirmary and Maternity Hospital he went to Vienna and Prague studying diseases of the ear, nose and throat and the use of obstetrical forceps. Then as assistant to Dr. George Hunter of Linlithgow he lived in South Queensferry where he was assistant surgeon to the Forth Bridge works during the period of erection. Later his practice became very large and he did not find much time for writing, but he recorded in the Edinburgh Medical Journal a study of five generations of familial cysteinuria. He was a lively member of the Old Edinburgh Club and his’antiquarian interest found expression in " The Old Infirmary and Earlier Hospitals " and " Medical Quacks of the Eighteenth Century," while at the request of his college he wrote biographical sketches for the portraits hung on the college walls. He carried his own years lightly and continued in practice until a few weeks of his death. WILLIAM NEIL CAMPBELL M.D.
EDIN.,
1Z.R.C.P.E.
THE death of Dr. Neil Campbell is announced from Africa where he was serving with the South African Forces. Dr. Campbell graduated in Edinburgh in 1927, taking the M.D. in 1939. After a house appointment at the Royal Infirmary he went out to Natal and set up in practice at Durban where his ability was recognised by his election to the staff of the King Edward Hospital, Durban. During his student days he was a keen angler and athlete with a good record at rugby and field athletics. He leaves a widow and two young children.