- Email: [email protected]
THE E E G ELECTRODE
537 some knowledge of the regards Wolverhampton and the Royal Hospital, and the wider regional plans for develop-
so
that
they
went armed with
local-conditions, both
as
The proceedings began with a small dinner which members of the hospital planning comat party mittee, medical and lay, met the psediatricians and took part in a general informal discussion. The next day opened with a visit to the Women’s Hospital, where the arrangements for the newborn were inspected and the site was considered in the light of possible extensions. Next came " Penn," outside the city, where inpatient children’s beds of Hospital have been housed as a war-time measure, and during the afternoon the paediatricians inspected the existing facilities for outpatients and inpatients in the main building of the Royal Hospital. Over a cup of tea they gave their preliminary conclusions, which were later incorporated in a written report, approved by the executive committee of the BPA, and transmitted to the authorities at the Royal Hospital. The contents of this report and the plans of the Wolver-hampton committee are, of course, confidential at this stage, but from both sides the experiment appears to have been a success. The medical officer of health was present at some of the discussions to advise on vital statistics and likely developments in the local authority’s sphere. The hospital committee not only maintained a standard of entertainment which the paediatricians are said to have found somewhat overwhelming but also organised the whole visit excellently, even to the provisiodof a shorthand-typist to take down the visitors’ obiter dicta. This is probably the first time that a large hospital has sought the advice of outside medical experts in a special branch of its work and Wolverhampton’s lead might with advantage be followed elsewhere and in departments other than paediatrics. ment.
the Royal
THIOURACIL TOXICITY THE latest report concerning the toxicity of thiouracil comes from Harrogate, where Curtis Bain 1 has encountered a patient in whom thiouracil caused complete heart-block and pericarditis. Of the diagnosis there can be no doubt ; the electrocardiograms are unequivocal, and pericardial friction was audible for at least ten- days. Thiouracil, in doses of 0-2 gramme five times a day, had been given for a fortnight when the patient suddenly complained of a sharp pain in the chest ; when an electrocardiogram was. taken she was found to have complete heart-block. While the patient was known to haye tonsillar sepsis before treatment was initiated, she had never complained of a sore throat and there-was The fever never any suggestion of acute tonsillitis. accompanying the attack subsided on the day that thiouracil was stopped. Eight months later the woman was back at work and there was no evidence of a valvular lesion of her heart. It seems certain that thiouracil precipitated the cardiac disturbance ; to what extent the tonsillar sepsis was a contributory factor is problematical. THE
E E G
ELECTRODE
electroencephalography the design of the electrodes is more important than in electrocardiography. A low inter-electrode resistance is essential; so attention has been paid both to the method of attachment and to the construction of the electrode.. An entirely satisfactory electrode has not yet appeared. According to the Gibbs,22 the ideal device should not produce artefacts, but should be easy to apply, easy to keep on, easy to get off, cheap and painless." In -this country saline pad electrodes, pressed to the scalp by rubber bands, have been widely used.3 Such electrodes can be easily and rapidly applied, and for routine work have proved satisfactory, but for the restless or nervous patient or one with a scalp wound IN
"
1. Bain, C. W. C. Brit. Heart J. 1945, 7, 49. 2. Gibbs, P. A., Gibbs, E. L. Atlas of Electroencephalography, Boston, Mass. 1941. 3. Walter, W. Grey, J. Neurol. Psychiat. 1938, 1, 359.
the method is not ideal. Further, the saline pad tends to dry after a long period of recording, and the electrodes shift with movements of the jaw when they are held by This is particularly a cap secured beneath the chin. the case during hyperventilation. In America some of these disadvantages have been overcome by using small solder pellets, attached to fine wires and fixed to the scalp with collodion. But the technique requires much practice and the time taken for preparing the patient is more than doubled. Greville and St. John-Loe4 have now developed a technique which has some of the advantages of both methods; the electrodes are easily and rapidly applied, no cap is required, and the attachment to the scalp is "relatively firm. A small silver cup containing electrode paste or jelly is held to the scalp and covered with collodion from a syringe having a nozzle attachment which is of slightly greater diameter than that of the cup over which it fits. lead is subsequently attached by clipping it to a light ring attached on the electrode, thus allowing the electrode time to become firmly stuck to the scalp before the drag of the wire is placed on it. The designers claim that the resistance is usually lower than that of saline pads and that twelve electrodes can be applied in less than ten minutes-a favourable comparison with the American
The input
technique. TYPHUS IN GERMANY liberating Allied Armies push even deeper into Germany, some of the crimes committed by the Nazis and condoned by their government are being revealed. Apart from their other aspects, the concentration camps are of epidemiological importance, since typhus and other infections have been found in many of those already over-run. The discovery confirms only too well the trickle of epidemiological information from Germany which has been forthcoming in the past three years. The policy of the Nazis toward the population of the eastern European countries has transferred the typhus which has been epidemic for years in these areas to the virgin soil of the west. - From the scanty information so far available, it seems that the Nazis have largely confined the typhus within the walls of their infamous prisons, though in the latter every condition of typhus, except clothing, has been favouring encouraged. The story of Belsen camp recorded in the Times of April 14 and 19 suggests the existence at present of at least 1000 cases of typhus among the 40,000 inmates, as well as many thousands of cases of tuberculosis and typhoid, and similar reports come from elsewhere. The effort needed to control this infection and to prevent its spread throughout the milling population of the broken State can well be imagined. Here is a situation which is going to test to the full our newly-won powers over one of the historical enemies of mankind. If the outcome in Naples last year had not been so strikingly successful, we might consider the situation to be extremely menacing. As it is, with Naples behind us, we can at least feel holwful of the outcome of the struggle, though the immensity of the problem should not beminimised. In the first place, we are nearing the month of May and therefore the close of the typhus season. Lousiness always decreases as climatic temperature rises and increase dissemination though other factors of lice, time is clearly on our side. Then too, Naples taught us it was unnecessary to eradicate all the lice in the population in order to control the typhus. The rickettsial.-laden lice which constitute the menace are concentrated on the bodies of the actual patients and their contacts, and on convalescents. Search for actual cases and saturation of their environs with’a persistent insecticide such as DDT are the two key measures to be taken. The presence of many medical officers in the 4. Greville, G. D., St. John-Loe, P. Electronic Engineering, As the
spread
may tend to
February, 1945,
p. 377.
so
that
they
went armed with
local-conditions, both
as
The proceedings began with a small dinner which members of the hospital planning comat party mittee, medical and lay, met the psediatricians and took part in a general informal discussion. The next day opened with a visit to the Women’s Hospital, where the arrangements for the newborn were inspected and the site was considered in the light of possible extensions. Next came " Penn," outside the city, where inpatient children’s beds of Hospital have been housed as a war-time measure, and during the afternoon the paediatricians inspected the existing facilities for outpatients and inpatients in the main building of the Royal Hospital. Over a cup of tea they gave their preliminary conclusions, which were later incorporated in a written report, approved by the executive committee of the BPA, and transmitted to the authorities at the Royal Hospital. The contents of this report and the plans of the Wolver-hampton committee are, of course, confidential at this stage, but from both sides the experiment appears to have been a success. The medical officer of health was present at some of the discussions to advise on vital statistics and likely developments in the local authority’s sphere. The hospital committee not only maintained a standard of entertainment which the paediatricians are said to have found somewhat overwhelming but also organised the whole visit excellently, even to the provisiodof a shorthand-typist to take down the visitors’ obiter dicta. This is probably the first time that a large hospital has sought the advice of outside medical experts in a special branch of its work and Wolverhampton’s lead might with advantage be followed elsewhere and in departments other than paediatrics. ment.
the Royal
THIOURACIL TOXICITY THE latest report concerning the toxicity of thiouracil comes from Harrogate, where Curtis Bain 1 has encountered a patient in whom thiouracil caused complete heart-block and pericarditis. Of the diagnosis there can be no doubt ; the electrocardiograms are unequivocal, and pericardial friction was audible for at least ten- days. Thiouracil, in doses of 0-2 gramme five times a day, had been given for a fortnight when the patient suddenly complained of a sharp pain in the chest ; when an electrocardiogram was. taken she was found to have complete heart-block. While the patient was known to haye tonsillar sepsis before treatment was initiated, she had never complained of a sore throat and there-was The fever never any suggestion of acute tonsillitis. accompanying the attack subsided on the day that thiouracil was stopped. Eight months later the woman was back at work and there was no evidence of a valvular lesion of her heart. It seems certain that thiouracil precipitated the cardiac disturbance ; to what extent the tonsillar sepsis was a contributory factor is problematical. THE
E E G
ELECTRODE
electroencephalography the design of the electrodes is more important than in electrocardiography. A low inter-electrode resistance is essential; so attention has been paid both to the method of attachment and to the construction of the electrode.. An entirely satisfactory electrode has not yet appeared. According to the Gibbs,22 the ideal device should not produce artefacts, but should be easy to apply, easy to keep on, easy to get off, cheap and painless." In -this country saline pad electrodes, pressed to the scalp by rubber bands, have been widely used.3 Such electrodes can be easily and rapidly applied, and for routine work have proved satisfactory, but for the restless or nervous patient or one with a scalp wound IN
"
1. Bain, C. W. C. Brit. Heart J. 1945, 7, 49. 2. Gibbs, P. A., Gibbs, E. L. Atlas of Electroencephalography, Boston, Mass. 1941. 3. Walter, W. Grey, J. Neurol. Psychiat. 1938, 1, 359.
the method is not ideal. Further, the saline pad tends to dry after a long period of recording, and the electrodes shift with movements of the jaw when they are held by This is particularly a cap secured beneath the chin. the case during hyperventilation. In America some of these disadvantages have been overcome by using small solder pellets, attached to fine wires and fixed to the scalp with collodion. But the technique requires much practice and the time taken for preparing the patient is more than doubled. Greville and St. John-Loe4 have now developed a technique which has some of the advantages of both methods; the electrodes are easily and rapidly applied, no cap is required, and the attachment to the scalp is "relatively firm. A small silver cup containing electrode paste or jelly is held to the scalp and covered with collodion from a syringe having a nozzle attachment which is of slightly greater diameter than that of the cup over which it fits. lead is subsequently attached by clipping it to a light ring attached on the electrode, thus allowing the electrode time to become firmly stuck to the scalp before the drag of the wire is placed on it. The designers claim that the resistance is usually lower than that of saline pads and that twelve electrodes can be applied in less than ten minutes-a favourable comparison with the American
The input
technique. TYPHUS IN GERMANY liberating Allied Armies push even deeper into Germany, some of the crimes committed by the Nazis and condoned by their government are being revealed. Apart from their other aspects, the concentration camps are of epidemiological importance, since typhus and other infections have been found in many of those already over-run. The discovery confirms only too well the trickle of epidemiological information from Germany which has been forthcoming in the past three years. The policy of the Nazis toward the population of the eastern European countries has transferred the typhus which has been epidemic for years in these areas to the virgin soil of the west. - From the scanty information so far available, it seems that the Nazis have largely confined the typhus within the walls of their infamous prisons, though in the latter every condition of typhus, except clothing, has been favouring encouraged. The story of Belsen camp recorded in the Times of April 14 and 19 suggests the existence at present of at least 1000 cases of typhus among the 40,000 inmates, as well as many thousands of cases of tuberculosis and typhoid, and similar reports come from elsewhere. The effort needed to control this infection and to prevent its spread throughout the milling population of the broken State can well be imagined. Here is a situation which is going to test to the full our newly-won powers over one of the historical enemies of mankind. If the outcome in Naples last year had not been so strikingly successful, we might consider the situation to be extremely menacing. As it is, with Naples behind us, we can at least feel holwful of the outcome of the struggle, though the immensity of the problem should not beminimised. In the first place, we are nearing the month of May and therefore the close of the typhus season. Lousiness always decreases as climatic temperature rises and increase dissemination though other factors of lice, time is clearly on our side. Then too, Naples taught us it was unnecessary to eradicate all the lice in the population in order to control the typhus. The rickettsial.-laden lice which constitute the menace are concentrated on the bodies of the actual patients and their contacts, and on convalescents. Search for actual cases and saturation of their environs with’a persistent insecticide such as DDT are the two key measures to be taken. The presence of many medical officers in the 4. Greville, G. D., St. John-Loe, P. Electronic Engineering, As the
spread
may tend to
February, 1945,
p. 377.