- Email: [email protected]
SPLINTAGE FOR HAND SURGERY
285 called for, is the choice of applicants to be admitted to the relatively few available beds, and reference in case of need to some final authority is essential. The article ended with a quotation which pointed to the danger confronting us all today-namely, that hospital work may be divorced from the needs of the community. In this context those needs are medical needs, and no vested interest or preconceived idea should be allowed to blind us to the danger of subordinating them to a bureaucratic ideal. For a hospital to be effective in meeting those needs and efficient in its maintenance adequate professional, nursing, and business managements are essential. All must cooperate to the highest degree, but none can take precedence over the
professional. St. Stephen’s Hospital, London, S.W.10.
R. KELSON FORD.
SPLINTAGE FOR HAND SURGERY
splint for some time and cannot speak too highly of its usefulness. The hand is difficult to control on the operating-table, and frequently an extra assistant is needed simply for this purpose. The lead splint performs this function admirably and has become an indispensable part of my equipment. Mr. Fisk is to be congratulated on designing a simple and efficient instrument. R. GUY PULVERTAFT. Derby. -
ESTIMATION OF BASAL METABOLIC RATE the chemical pathology department of St. George’s Hospital we have for some years used the Benedict-Roth method for measuring basal metabolic rate. We believe that this method is used in many laboratories throughout the country. Dr. Bene’s article, published in your issue of Jan. 22, was therefore of
SIR,—In
conside r a b e
interest to us. We have
plotted here 50 unselected cases from
records,
graphing the "R.P. index"
according to Dr.
Bene
the basal metabolic rate
against 800
1000
1200
PULSE-RATE
x
1400 1600 1800 2000 2200
RESPIRATION RATE
can
SENIORS AND JUNIORS
SIR,—Your correspondent of Jan. 29 is evidently
blissfully unaware of the intentions of the Ministry with regard to senior and junior consultant staff. The assessing committees appointed to advise the regional hospital boards on the status of their consultant staffs instructed to cut down the present quota of consultants by relegating the more junior ones to a nebulous " category of senior hospital officers "-thereby achieving economy in one direction, since this category will be paid at a lower rate than full consultants. As Spens recommends appointment to full consultant status at the age of 32, the present junior full consultants with higher degrees will presumably have to be lowered in status (to senior hospital officers) on the sole remaining ground of insufficient experience, wherever this can be
are
SIR,—I have read with interest Mr. Fisk’s description (Dec. 25) of his splint for hand surgery. I have used the
our
and medical education alike. Least of all patients the aged be labelled like laboratory specimens, and their problems recur each day in the general practice of medicine. To create a specialty of geriatrics might well, give the signal for yet other artificial subdivisions, and would throw to the wind Walshe’s contention that the " specialist must cling fast to the foundations of medicine for only thus can he integrate his contributions to medicine and orient them." PHILIP ELLMAN. London, W.1.
the Benedict
method. On t h e graph
the frame encloses the normal range for R.P. index as outlined by Dr. Bene and the normal range obtained by the Benedict technique. We follow Boothby and Sandiford in taking +10 as the normal limits. It is clear that if a reasonable relationship exists between the two methods, the majority of normals should fall within the frame. They did not. Dr. Bene claims, moreover, that an R.P. index above 1500 indicates a raised basal metabolic rate. Again the graph shows a
striking discrepancy.
It would seem that whatever the R.p. index measures, it does not tally with the basal metabolic rate as measured by such a well-established technique as that laid down by Benedict and Roth. J. J. LOVELL St. George’s Hospital Medical School, N. H. MARTIN. London, S.W.1 OBJECTS OF RESEARCH
SIR,—Professor Alstead (Jan. 29) warns us against the present dangerous trends towards ultra-specialisation. It is true that specialisation has permitted great developments in certain branches, and the physician should have specialised leanings ; but it would certainly be a mistake, as he says, if geriatrics were to become departmentalised, as is now threatened. His contention that the ordinary care of the aged comes within the province of the general practitioner and general consultant should be wholeheartedly endorsed, for the sake of physician, patient,
fairly (?) justified.
Further economy will be practised on those senior consultants who have escaped the former type of axe, by cutting down the number of sessions at present allocated to part-timers. PHYSICIAN. -
Medicine and the Law After-effects of Intravenous Anaesthesla A CASE which was successfully taken up by the Medical Protection Society exemplifies the need for close supervision of patients recovering from anaesthesia by a barbiturate injected intravenously. A dental surgeon intended to extract seven teeth in a patient for whom nitrous oxide was deemed unsuitable. The patient was told that he was to be given an intravenous anaesthetic and that he would " probably be very drowsy for at least an hour after the extractions." The patient’s own doctor injected 5-5 ml. (0-55 g.) of soluble hexobarbitone ; the teeth were extracted, and the patient was carried to a couch in the surgery. Nikethamide was injected to accelerate recovery.About a quarter of an hour later the dental surgeon went to lunch, instructing the nurse to report to him if the patient began to come round. Within a few minutes the nurse reported that the patient was fingering’ his shirt at the neck. Returning immediately, the dental surgeon found the patient apparently asleep ; so he returned to lunch. Twenty minutes later the nurse, who had kept looking into the surgery, found that the patient had gone. It transpired that he had driven off in his car, and that, when stopped by traffic lights, had been addressed by a policeman who, suspecting that something was amiss, kept him in conversation. The constable learned that the patient had just had teeth extracted ; he offered to drive the patient home, but the offer was refused. On reaching his garage, about a mile farther on, the patient collided with a wall and a petrol pump, and on getting out of the. car he collapsed and was helped he remained semiconscious for a further upstairs ; 4-5 hours. The dental surgeon’s claim for the amount of his fee was met by a counter claim for damage to the car, arising through negligence in that, inter alia, the nurse had not prevented the patient from leaving the surgery while still under the influence of the drug. The patient also claimed damages for having been stopped by a
police-constable.
The county-court judge who heard the case ruled that the dental surgeon and his nurse had given all the attention the circumstances seemed to require. The patient had been warned of possible after-effects, and
professional. St. Stephen’s Hospital, London, S.W.10.
R. KELSON FORD.
SPLINTAGE FOR HAND SURGERY
splint for some time and cannot speak too highly of its usefulness. The hand is difficult to control on the operating-table, and frequently an extra assistant is needed simply for this purpose. The lead splint performs this function admirably and has become an indispensable part of my equipment. Mr. Fisk is to be congratulated on designing a simple and efficient instrument. R. GUY PULVERTAFT. Derby. -
ESTIMATION OF BASAL METABOLIC RATE the chemical pathology department of St. George’s Hospital we have for some years used the Benedict-Roth method for measuring basal metabolic rate. We believe that this method is used in many laboratories throughout the country. Dr. Bene’s article, published in your issue of Jan. 22, was therefore of
SIR,—In
conside r a b e
interest to us. We have
plotted here 50 unselected cases from
records,
graphing the "R.P. index"
according to Dr.
Bene
the basal metabolic rate
against 800
1000
1200
PULSE-RATE
x
1400 1600 1800 2000 2200
RESPIRATION RATE
can
SENIORS AND JUNIORS
SIR,—Your correspondent of Jan. 29 is evidently
blissfully unaware of the intentions of the Ministry with regard to senior and junior consultant staff. The assessing committees appointed to advise the regional hospital boards on the status of their consultant staffs instructed to cut down the present quota of consultants by relegating the more junior ones to a nebulous " category of senior hospital officers "-thereby achieving economy in one direction, since this category will be paid at a lower rate than full consultants. As Spens recommends appointment to full consultant status at the age of 32, the present junior full consultants with higher degrees will presumably have to be lowered in status (to senior hospital officers) on the sole remaining ground of insufficient experience, wherever this can be
are
SIR,—I have read with interest Mr. Fisk’s description (Dec. 25) of his splint for hand surgery. I have used the
our
and medical education alike. Least of all patients the aged be labelled like laboratory specimens, and their problems recur each day in the general practice of medicine. To create a specialty of geriatrics might well, give the signal for yet other artificial subdivisions, and would throw to the wind Walshe’s contention that the " specialist must cling fast to the foundations of medicine for only thus can he integrate his contributions to medicine and orient them." PHILIP ELLMAN. London, W.1.
the Benedict
method. On t h e graph
the frame encloses the normal range for R.P. index as outlined by Dr. Bene and the normal range obtained by the Benedict technique. We follow Boothby and Sandiford in taking +10 as the normal limits. It is clear that if a reasonable relationship exists between the two methods, the majority of normals should fall within the frame. They did not. Dr. Bene claims, moreover, that an R.P. index above 1500 indicates a raised basal metabolic rate. Again the graph shows a
striking discrepancy.
It would seem that whatever the R.p. index measures, it does not tally with the basal metabolic rate as measured by such a well-established technique as that laid down by Benedict and Roth. J. J. LOVELL St. George’s Hospital Medical School, N. H. MARTIN. London, S.W.1 OBJECTS OF RESEARCH
SIR,—Professor Alstead (Jan. 29) warns us against the present dangerous trends towards ultra-specialisation. It is true that specialisation has permitted great developments in certain branches, and the physician should have specialised leanings ; but it would certainly be a mistake, as he says, if geriatrics were to become departmentalised, as is now threatened. His contention that the ordinary care of the aged comes within the province of the general practitioner and general consultant should be wholeheartedly endorsed, for the sake of physician, patient,
fairly (?) justified.
Further economy will be practised on those senior consultants who have escaped the former type of axe, by cutting down the number of sessions at present allocated to part-timers. PHYSICIAN. -
Medicine and the Law After-effects of Intravenous Anaesthesla A CASE which was successfully taken up by the Medical Protection Society exemplifies the need for close supervision of patients recovering from anaesthesia by a barbiturate injected intravenously. A dental surgeon intended to extract seven teeth in a patient for whom nitrous oxide was deemed unsuitable. The patient was told that he was to be given an intravenous anaesthetic and that he would " probably be very drowsy for at least an hour after the extractions." The patient’s own doctor injected 5-5 ml. (0-55 g.) of soluble hexobarbitone ; the teeth were extracted, and the patient was carried to a couch in the surgery. Nikethamide was injected to accelerate recovery.About a quarter of an hour later the dental surgeon went to lunch, instructing the nurse to report to him if the patient began to come round. Within a few minutes the nurse reported that the patient was fingering’ his shirt at the neck. Returning immediately, the dental surgeon found the patient apparently asleep ; so he returned to lunch. Twenty minutes later the nurse, who had kept looking into the surgery, found that the patient had gone. It transpired that he had driven off in his car, and that, when stopped by traffic lights, had been addressed by a policeman who, suspecting that something was amiss, kept him in conversation. The constable learned that the patient had just had teeth extracted ; he offered to drive the patient home, but the offer was refused. On reaching his garage, about a mile farther on, the patient collided with a wall and a petrol pump, and on getting out of the. car he collapsed and was helped he remained semiconscious for a further upstairs ; 4-5 hours. The dental surgeon’s claim for the amount of his fee was met by a counter claim for damage to the car, arising through negligence in that, inter alia, the nurse had not prevented the patient from leaving the surgery while still under the influence of the drug. The patient also claimed damages for having been stopped by a
police-constable.
The county-court judge who heard the case ruled that the dental surgeon and his nurse had given all the attention the circumstances seemed to require. The patient had been warned of possible after-effects, and