- Email: [email protected]
THE BEDPAN
834 into the peritoneal cavity. But how does he know that the needle is so placed ; and does he obtain a manometric swing at the time this observation is made ? Edwards and Logan (Tubercle, 1945, 26, 11) state that refills of between 500 c.cm. and 1000 c.cm. should be given twice weekly and later once weekly and that this will usually produce "intra-abdominal pressures of + 6 to + 12 cm. of water on inspiration depending on the tone of the abdominal musculature." Bearing in mind the observations made above, I find such statements, from a physiological point of view,
quite meaningless. Effect on. the .DM!p/M’6tg.—Edwards
and Logan (Ibid) the average additional rise of the diaphragm 9 patients as the result of pneumoperitoneum and the average total rise was 8-5 cm. I have at least three cases with definitely paralysed hemidiaphragms (confirmed by X-ray screening) very large subdiaphragmatic accumulations of air, the only effect of which has been to push the liver down in the abdomen without raising the paralysed diaphragm. In two of these, adhesions between the upper surface of the liver and the under surface of the diaphragm have been observed. There is evidence that pneumoperitoneum can delay by several months the recovery of movement in the paralysed half of the diaphragm resulting from phrenic crush In my opinion there is a definite field of usefulness for P.P. treatment coupled with phrenic nerve interruption. Dr. Simmonds has performed a valuable service in presenting his incidence of complications in such a large series of cases. I have now treated a much larger number of record that obtained in was 6-5 em. observed in
operation.
than that on which a report of two deaths was based (Aslett, E., Jarman, T. F. Lancet, 1945, i, 304). No further complications or deaths attributable to the treatment have occurred. I am at present treating as outpatients a fair number of cases from among those who are awaiting admission to hospital and find that phrenic crush and p.p. is a useful adjunct to bed rest under these circumstances. In two cases the results have been good enough to render their admission to hospital unnecessary. I hope to report on these cases later. T. FRANCIS JARMAN. Tuberculosis Clinic, Neath. SECULAR TREND IN THE STILLBIRTH-RATE cases
SIR,—is not the answer to Ian Sutherland’sinteresting query in the tentative query he himself makes at the conclusion of the paragraph of his letter The hard core of stillbirth mortality is of May 18 ? prematurity, and it is stated with confidence by nutritionists that there is a relation between nutrition of the mother and prematurity. As to the national rise in nutritional levels, especially of milk and vegetables, during the war years, conclusive evidence is given by Magee in his Milroy lectures (abridged publication in Brit. med. J., March 30, 1946, p. 475).
penultimate
J. GREENWOOD WILSON. Public Health Department, Cardiff.
THE BEDPAN bedpan is undoubtedly
a major horror of hospital. aesthetically revolting and physiologically inadequate, it is a symbol of the humiliation that has to be endured by all those who are forced to
SiB,—The
life in
submit themselves to the medical machine. Medical men who fall into the hands of their colleagues usually stage an early revolt against this unattractive article of hospital furniture, yet when they are in charge of hospital patients they and the nursing staff accept it as part of the routine of life for all those in bed. The use of a bedpan involves a series of considerable gymnastic feats which are much more exhausting than the effort involved in a journey to the lavatory, or, if necessary, the use of a commode. Moreover, the design of a bedpan is so unsatisfactory that the faeces cannot fall away from the patient as they would if the physiological squatting position could be adopted ; nor is the receptacle deep enough to permit the use of sufficient water to cover the faeces and so mitigate the smell. Surely it is only necessary to inflict this discipline on whose who are acutely ill or really bedridden ? In these days of light metal alloys, tubular furniture, and plastic materials the makers of hospital equipment and the medical profession should be able to collaborate in the design of a light, highly mobile, and hygienic commode
suitable for hospital use. This could be brought to the bedside as easily as the surgical dressing trolleys now in general use and should involve any extra work for the nurses. The receptacle should be deep enough to allow for a covering of water or deodorant fluid, and it should have adequate flanges to allow for easy removal from the framework and for thorough cleansing of all the apparatus that has been in contact with the patient’s body. It is important that the cost should be as low as possible since every general ward would require several of them. Cubicles and private wards should be supplied with such commodes as part of their furniture, so that only the receptacle need be removed. These fixtures could be quite unobtrusive and inoffensive, and, despite the genteel title, need bear no resemblance to the formidable Victorian constructions of tapestry and mahogany, As a medical man who has recently been forced to enjoy what might be described as a "worm’s eye"" view of hospital life, I appeal to some of my colleagues to initiate this relatively simple reform. They would enjoy the blessings of countless invalids through the years and thus would earn a fair title to immortality. DOUGLAS MCCLEAN. Rabley Willow, nr. South Mimms, Herts. EPIDIDYMO-ORCHITIS SIR,-In your last issue Dr. Tunbridge and Dr. Gavey state that the finding of a slight polymorphonuclear leucocytosis in their cases of epididymo-orchitis is against causation by sandfly fever, because they doubt whether such a simple complication would materially alter the blood-picture. Uncomplicated mumps is, like sandfly fever, a leucopenic disease, but most observers agree that orchitis produces a polymorphonuclear leucocytosis. If epididymo-orchitis is an accepted complication of sandfly fever it may well be that it does (as in mumps) cause a neutrophil increase. R. N. HERSON. Bristol.
not
y
ACUTE
BENIGN DRY PLEURISY SiR,-After reading Dr. J. G. Scadding’s paper of May 25, I thought it might be of interest to record a similar outbreak which I observed in the closed -community of a frigate in the Indian Ocean in May-June, 1945. I described this in detail in my official journal, but haveno written records of my own and am here speaking from memory. The epidemic affected about 15 of a ship’s company of 135. One only was an officer, and the remainder The were not confined to any particular mess-decks. outbreak followed epidemic form in its case-incidence, with a rise to a peak followed by a decline and a small recrudescence later. The whole outbreak was over in about three weeks. Pleural pain was the marked feature of about half the cases, but there were some minor febrile cases without pain, and these of course would not normally be seen in a hospital. There was one case of lobar pneumonia with normal response to sulphonamide therapy, and one case of bronchitis. A pleural rub was heard in about 5, and in 1 there was acute diaphragmatic pleurisy simulating an abdominal condition but with shoulder-tip pain. The remainder presented few signs or symptoms other than pleural pain with or without an audible rub, pyrexia, and headache. In the blood-counts I was able to do, I particularly noticed leucopenia with a relative lymphocytosis. In one case there was an absolute monocytosis. I do not remember at what precise stage of the illness the counts were made. No sulphonamides had been given. I was particularly impressed by the fact that about 4 patients showed the secondary rise of temperature mentioned by Dr. Scadding in his review of the literature ; in fact, I was tempted to suggest that the condition was an atypical form of dengue, in which the affection of the synovial membranes of joints had been replaced by a similar affection of the pleura. However, the absence of other characteristic signs and the circumstances of the outbreak made this very improbable. Radiography of 2 patients who had had a very loud pleural rub showed nothing abnormal when, after their recovery, it was possible to get them ashore for ,
investigation. Coulsdon.
V. H. MARTINDALE.
quite meaningless. Effect on. the .DM!p/M’6tg.—Edwards
and Logan (Ibid) the average additional rise of the diaphragm 9 patients as the result of pneumoperitoneum and the average total rise was 8-5 cm. I have at least three cases with definitely paralysed hemidiaphragms (confirmed by X-ray screening) very large subdiaphragmatic accumulations of air, the only effect of which has been to push the liver down in the abdomen without raising the paralysed diaphragm. In two of these, adhesions between the upper surface of the liver and the under surface of the diaphragm have been observed. There is evidence that pneumoperitoneum can delay by several months the recovery of movement in the paralysed half of the diaphragm resulting from phrenic crush In my opinion there is a definite field of usefulness for P.P. treatment coupled with phrenic nerve interruption. Dr. Simmonds has performed a valuable service in presenting his incidence of complications in such a large series of cases. I have now treated a much larger number of record that obtained in was 6-5 em. observed in
operation.
than that on which a report of two deaths was based (Aslett, E., Jarman, T. F. Lancet, 1945, i, 304). No further complications or deaths attributable to the treatment have occurred. I am at present treating as outpatients a fair number of cases from among those who are awaiting admission to hospital and find that phrenic crush and p.p. is a useful adjunct to bed rest under these circumstances. In two cases the results have been good enough to render their admission to hospital unnecessary. I hope to report on these cases later. T. FRANCIS JARMAN. Tuberculosis Clinic, Neath. SECULAR TREND IN THE STILLBIRTH-RATE cases
SIR,—is not the answer to Ian Sutherland’sinteresting query in the tentative query he himself makes at the conclusion of the paragraph of his letter The hard core of stillbirth mortality is of May 18 ? prematurity, and it is stated with confidence by nutritionists that there is a relation between nutrition of the mother and prematurity. As to the national rise in nutritional levels, especially of milk and vegetables, during the war years, conclusive evidence is given by Magee in his Milroy lectures (abridged publication in Brit. med. J., March 30, 1946, p. 475).
penultimate
J. GREENWOOD WILSON. Public Health Department, Cardiff.
THE BEDPAN bedpan is undoubtedly
a major horror of hospital. aesthetically revolting and physiologically inadequate, it is a symbol of the humiliation that has to be endured by all those who are forced to
SiB,—The
life in
submit themselves to the medical machine. Medical men who fall into the hands of their colleagues usually stage an early revolt against this unattractive article of hospital furniture, yet when they are in charge of hospital patients they and the nursing staff accept it as part of the routine of life for all those in bed. The use of a bedpan involves a series of considerable gymnastic feats which are much more exhausting than the effort involved in a journey to the lavatory, or, if necessary, the use of a commode. Moreover, the design of a bedpan is so unsatisfactory that the faeces cannot fall away from the patient as they would if the physiological squatting position could be adopted ; nor is the receptacle deep enough to permit the use of sufficient water to cover the faeces and so mitigate the smell. Surely it is only necessary to inflict this discipline on whose who are acutely ill or really bedridden ? In these days of light metal alloys, tubular furniture, and plastic materials the makers of hospital equipment and the medical profession should be able to collaborate in the design of a light, highly mobile, and hygienic commode
suitable for hospital use. This could be brought to the bedside as easily as the surgical dressing trolleys now in general use and should involve any extra work for the nurses. The receptacle should be deep enough to allow for a covering of water or deodorant fluid, and it should have adequate flanges to allow for easy removal from the framework and for thorough cleansing of all the apparatus that has been in contact with the patient’s body. It is important that the cost should be as low as possible since every general ward would require several of them. Cubicles and private wards should be supplied with such commodes as part of their furniture, so that only the receptacle need be removed. These fixtures could be quite unobtrusive and inoffensive, and, despite the genteel title, need bear no resemblance to the formidable Victorian constructions of tapestry and mahogany, As a medical man who has recently been forced to enjoy what might be described as a "worm’s eye"" view of hospital life, I appeal to some of my colleagues to initiate this relatively simple reform. They would enjoy the blessings of countless invalids through the years and thus would earn a fair title to immortality. DOUGLAS MCCLEAN. Rabley Willow, nr. South Mimms, Herts. EPIDIDYMO-ORCHITIS SIR,-In your last issue Dr. Tunbridge and Dr. Gavey state that the finding of a slight polymorphonuclear leucocytosis in their cases of epididymo-orchitis is against causation by sandfly fever, because they doubt whether such a simple complication would materially alter the blood-picture. Uncomplicated mumps is, like sandfly fever, a leucopenic disease, but most observers agree that orchitis produces a polymorphonuclear leucocytosis. If epididymo-orchitis is an accepted complication of sandfly fever it may well be that it does (as in mumps) cause a neutrophil increase. R. N. HERSON. Bristol.
not
y
ACUTE
BENIGN DRY PLEURISY SiR,-After reading Dr. J. G. Scadding’s paper of May 25, I thought it might be of interest to record a similar outbreak which I observed in the closed -community of a frigate in the Indian Ocean in May-June, 1945. I described this in detail in my official journal, but haveno written records of my own and am here speaking from memory. The epidemic affected about 15 of a ship’s company of 135. One only was an officer, and the remainder The were not confined to any particular mess-decks. outbreak followed epidemic form in its case-incidence, with a rise to a peak followed by a decline and a small recrudescence later. The whole outbreak was over in about three weeks. Pleural pain was the marked feature of about half the cases, but there were some minor febrile cases without pain, and these of course would not normally be seen in a hospital. There was one case of lobar pneumonia with normal response to sulphonamide therapy, and one case of bronchitis. A pleural rub was heard in about 5, and in 1 there was acute diaphragmatic pleurisy simulating an abdominal condition but with shoulder-tip pain. The remainder presented few signs or symptoms other than pleural pain with or without an audible rub, pyrexia, and headache. In the blood-counts I was able to do, I particularly noticed leucopenia with a relative lymphocytosis. In one case there was an absolute monocytosis. I do not remember at what precise stage of the illness the counts were made. No sulphonamides had been given. I was particularly impressed by the fact that about 4 patients showed the secondary rise of temperature mentioned by Dr. Scadding in his review of the literature ; in fact, I was tempted to suggest that the condition was an atypical form of dengue, in which the affection of the synovial membranes of joints had been replaced by a similar affection of the pleura. However, the absence of other characteristic signs and the circumstances of the outbreak made this very improbable. Radiography of 2 patients who had had a very loud pleural rub showed nothing abnormal when, after their recovery, it was possible to get them ashore for ,
investigation. Coulsdon.
V. H. MARTINDALE.