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SWEET CIGARETTES
355
Using the Papanicolaou technique and of late acridineorange fluorescence microscopy, serous fluids from 295 cases have been examined at the Royal Free Hospital in the past three years. Of 99 cases categorically reported as positive, 95 have been confirmed and 4 proved to have been wrong. Of 9 cases reported as suspicious of malignancy, 4 have proved malignant and 5 remain unconfirmed. The answer to the problem is surely not to disapprove of the method but to train more cytologists. Cytology Department, Department of Pathology, Royal Free Hospital, London,
W.C.1.
J. G. S. CRABBE C. GRUBB.
DANGER: MEN AT WORK SiR,—The recent articles on operating-theatre design are timely, although the totally different ideas of what is, and what is not, important show that agreement is unlikely to be reached about the design and layout of
theatres. The only possible exceptions to this are the environmental conditions which are desirable for efficient work. The work done in theatres is a very important part of the service offered by a hospital. It is inevitable that the hours worked by surgical teams have no parallel in other professions, beginning early in the day and going on until long after
new
lists midnight being the hours
are
work is done
no rarity in a hospital accepting emergencies: uncontrollable, but the conditions in which the
are not.
the newest theatres in this group are seven years old. They closely resemble the plan shown in fig. 4 of the Ministry’s Bulletin on Operating Theatre Suites. They have four doubleended autoclaves, which radiate and convect heat into the space between the theatres. The result is that, even in this cool summer, surgeons have found them barely tolerable during the afternoons, and the sink-rooms are less comfortable to work in than the engine-room of a ship in the tropics. The high cost of cooling air which is not recirculated is obvious. The cost of not doing so is occult, and therefore factitious arguments based on dry-bulb temperatures are adduced to formulate the official policy that such plant is unnecessary. No work has been done to designate the upper acceptable limit of the corrected effective temperaturein working positions of theatres, or of total heat in positions particularly affected by radiant heat.
patient requiring a long and difficult operation-for example, on his bile-ducts-may be entrusting his health and earning capacity for the rest of his life to the skill A
and care he receives in the four hours he is in the theatre. The cost of failure is very high indeed-is it therefore right that such work may have to be done in conditions which most commercial firms would consider to be unacceptable for their employees ? Southampton General Hospital, Southampton.
P. J. HORSEY.
COMPLICATIONS OF RUBELLA SiR,-We have been impressed by the number of complications in patients other than pregnant women during the recent epidemic of rubella. It is hard to estimate the total number, since several may have treated themselves and abortive attacks are common, but among 75 patients, including 5 adults, seen by medical officers of this unit the following 6 complicated cases arose.
Arthritis and
peripheral
neuritis. A
42-year-old
housewife
complained of pain and swelling of the left knee on the first day of illness, followed by pain and swelling of the right knee some twelve hours later, the left one having recovered by that time. The hand joints became painful and there was swelling of the metacarpophalangeal and interphalangeal joints. At the same time a typical rubella rash appeared. Peripheral neuritis (pain and numbness in the fingers) persisted for three weeks. The swelling of hand joints lasted for only fourteen days. Mild peripheral neuritis of the hands, lasting ten days, in a 40-year-old housewife. Patchy localised scaling at flexures two weeks after the onset of typical rubella in a 31-year-old housewife. There were three or four dry scaling lesions some 5 mm. across in each of the flexures of the elbows and in the axillae, followed two days later by similar lesions on the medial surfaces of the thighs. The process lasted four days at each site. Intense headache and neck stiffness for one day, without other neurological signs, in a boy of 12 years. In 4 other cases, the rash, although typical in distribution and colour, was raised above the skin surface. The time of contact with cases of typical rubella, however, makes it virtually certain that it was the rubella virus which had caused the eruption and not some other one.
Scott1 regards complications as rarities, but Johnson and Hall2 describe 10 cases of an arthritis resembling rheumatoid with positive tests for " rheumatoid factor " which followed rubella, and Barber3 mentions a case of peripheral neuritis which necessitated iron-lung treatment as a complication of rubella. We should be glad to hear of other people’s experiences with complications of rubella. We are indebted to the Director-General of Medical Service of the Royal Air Force for permission to publish these details. Air Force, Benson,
Royal
Oxfordshire.
R. J. MOYLAN-JONES P. T. PENNY.
SWEET CIGARETTES Six,-There is one approach to the anti-smoking campaign which seems to me to have been overlookedthe sale of sweets in the form of toy cigarettes. These are very popular with children who see their parents smoking. Requests to friends and relatives that they should stop supplying my own small child with them have met with incredulous surprise, so it seems reasonable to infer that the public in general sees nothing wrong with them. I suggest that their sale should be banned. ROSEMARY HART. Wrexham. ISOLATION OF ADENOVIRUS TYPE 21
SIR,-During the past five years systematic studies have been in progress at the Pasteur Institute, Coonoor, to determine the role of adenoviruses in respiratory infections. The following serotypes have so far been isolated:
Arthritis of hand joints in
an 11-year-old girl. The joints and there was a little swelling of metacarpophalangeal joints. This condition lasted three days. Similar arthritis of hands lasting ten days in an 11-year-old
were
all
moderately painful
.
girl: 1. Bedford, T. Environmental Warmth and its Measurement. (War) Memor. 1946, no. 17.
M.R.C.
Most of the throat swabs examined were from sick children in the neighbouring areas; sera were not collected from them. The only isolation of adenovirus from a
attending hospitals 1. 2. 3.
Scott, R. B. in Price’s Textbook of Medicine; p. 156. London, 1956. Johnson, R. E., Hall, A. P. New Engl. J. Med. 1958, 258, 743. Barber, G. Practitioner, 1961, 187, 269.
Using the Papanicolaou technique and of late acridineorange fluorescence microscopy, serous fluids from 295 cases have been examined at the Royal Free Hospital in the past three years. Of 99 cases categorically reported as positive, 95 have been confirmed and 4 proved to have been wrong. Of 9 cases reported as suspicious of malignancy, 4 have proved malignant and 5 remain unconfirmed. The answer to the problem is surely not to disapprove of the method but to train more cytologists. Cytology Department, Department of Pathology, Royal Free Hospital, London,
W.C.1.
J. G. S. CRABBE C. GRUBB.
DANGER: MEN AT WORK SiR,—The recent articles on operating-theatre design are timely, although the totally different ideas of what is, and what is not, important show that agreement is unlikely to be reached about the design and layout of
theatres. The only possible exceptions to this are the environmental conditions which are desirable for efficient work. The work done in theatres is a very important part of the service offered by a hospital. It is inevitable that the hours worked by surgical teams have no parallel in other professions, beginning early in the day and going on until long after
new
lists midnight being the hours
are
work is done
no rarity in a hospital accepting emergencies: uncontrollable, but the conditions in which the
are not.
the newest theatres in this group are seven years old. They closely resemble the plan shown in fig. 4 of the Ministry’s Bulletin on Operating Theatre Suites. They have four doubleended autoclaves, which radiate and convect heat into the space between the theatres. The result is that, even in this cool summer, surgeons have found them barely tolerable during the afternoons, and the sink-rooms are less comfortable to work in than the engine-room of a ship in the tropics. The high cost of cooling air which is not recirculated is obvious. The cost of not doing so is occult, and therefore factitious arguments based on dry-bulb temperatures are adduced to formulate the official policy that such plant is unnecessary. No work has been done to designate the upper acceptable limit of the corrected effective temperaturein working positions of theatres, or of total heat in positions particularly affected by radiant heat.
patient requiring a long and difficult operation-for example, on his bile-ducts-may be entrusting his health and earning capacity for the rest of his life to the skill A
and care he receives in the four hours he is in the theatre. The cost of failure is very high indeed-is it therefore right that such work may have to be done in conditions which most commercial firms would consider to be unacceptable for their employees ? Southampton General Hospital, Southampton.
P. J. HORSEY.
COMPLICATIONS OF RUBELLA SiR,-We have been impressed by the number of complications in patients other than pregnant women during the recent epidemic of rubella. It is hard to estimate the total number, since several may have treated themselves and abortive attacks are common, but among 75 patients, including 5 adults, seen by medical officers of this unit the following 6 complicated cases arose.
Arthritis and
peripheral
neuritis. A
42-year-old
housewife
complained of pain and swelling of the left knee on the first day of illness, followed by pain and swelling of the right knee some twelve hours later, the left one having recovered by that time. The hand joints became painful and there was swelling of the metacarpophalangeal and interphalangeal joints. At the same time a typical rubella rash appeared. Peripheral neuritis (pain and numbness in the fingers) persisted for three weeks. The swelling of hand joints lasted for only fourteen days. Mild peripheral neuritis of the hands, lasting ten days, in a 40-year-old housewife. Patchy localised scaling at flexures two weeks after the onset of typical rubella in a 31-year-old housewife. There were three or four dry scaling lesions some 5 mm. across in each of the flexures of the elbows and in the axillae, followed two days later by similar lesions on the medial surfaces of the thighs. The process lasted four days at each site. Intense headache and neck stiffness for one day, without other neurological signs, in a boy of 12 years. In 4 other cases, the rash, although typical in distribution and colour, was raised above the skin surface. The time of contact with cases of typical rubella, however, makes it virtually certain that it was the rubella virus which had caused the eruption and not some other one.
Scott1 regards complications as rarities, but Johnson and Hall2 describe 10 cases of an arthritis resembling rheumatoid with positive tests for " rheumatoid factor " which followed rubella, and Barber3 mentions a case of peripheral neuritis which necessitated iron-lung treatment as a complication of rubella. We should be glad to hear of other people’s experiences with complications of rubella. We are indebted to the Director-General of Medical Service of the Royal Air Force for permission to publish these details. Air Force, Benson,
Royal
Oxfordshire.
R. J. MOYLAN-JONES P. T. PENNY.
SWEET CIGARETTES Six,-There is one approach to the anti-smoking campaign which seems to me to have been overlookedthe sale of sweets in the form of toy cigarettes. These are very popular with children who see their parents smoking. Requests to friends and relatives that they should stop supplying my own small child with them have met with incredulous surprise, so it seems reasonable to infer that the public in general sees nothing wrong with them. I suggest that their sale should be banned. ROSEMARY HART. Wrexham. ISOLATION OF ADENOVIRUS TYPE 21
SIR,-During the past five years systematic studies have been in progress at the Pasteur Institute, Coonoor, to determine the role of adenoviruses in respiratory infections. The following serotypes have so far been isolated:
Arthritis of hand joints in
an 11-year-old girl. The joints and there was a little swelling of metacarpophalangeal joints. This condition lasted three days. Similar arthritis of hands lasting ten days in an 11-year-old
were
all
moderately painful
.
girl: 1. Bedford, T. Environmental Warmth and its Measurement. (War) Memor. 1946, no. 17.
M.R.C.
Most of the throat swabs examined were from sick children in the neighbouring areas; sera were not collected from them. The only isolation of adenovirus from a
attending hospitals 1. 2. 3.
Scott, R. B. in Price’s Textbook of Medicine; p. 156. London, 1956. Johnson, R. E., Hall, A. P. New Engl. J. Med. 1958, 258, 743. Barber, G. Practitioner, 1961, 187, 269.