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THE PATHOLOGICAL SERVICE OF THE GENERAL HOSPITAL.
520 THE TREATMENT OF MENORRHAGIA.
his using nearly five times as much sodium citrate as is really necessary. I understand that he uses 4’5 g. of citrate for each 400 c.cm. of blood. My own practice is to use 1 g. of citrate for each 450 c.cm. of blood, and with the ordinary technique this need never be
To the Editor of THE LANCET. SIR,—In the recent discussion at the British Medical Association, and in your leading article of August 21st, it is surprising to find no mention of the exceeded. I must apologise to Dr. Gibson for thus criticising method of intra-uterine ionisation for the treatment of obstinate menorrhagia. Electrotherapists have his apparatus, but I do so only in the interests of long known of its efficacy, even in cases which have patients and operators. If transfusion is to be used to resisted every other method by drugs and endocrine full advantage the apparatus required must be as preparations, and even curetting. In 1917 the late simple as possible, and in view of the possible toxicity Dr. Samuel Sloan drew attention to the fact that of more than a small quantity of sodium citrate the copper ionisation cured almost every case of menor- amount injected into the patient must be as small as Over rhagia, except that arising from fibroids. GEOFFREY KEYNES. 20 years ago Dr. A. E. Zimmern, of the Salpetriere, published a large book on the subject, giving minute details of many cases of every type. Dr. Zimmern THE PATHOLOGICAL SERVICE OF THE described his method and showed his instruments in London in January, 1922, at a meeting! of the ElectroGENERAL HOSPITAL. Therapeutic Section of the Royal Society of To the Editor of THE LANCET. 3/ledicine. His good results were confirmed by the experiences of several of the English electrotheraSIR,—In your issue of August 14th Dr. Dyke has pists present at the meeting. In the Prccctitioner some suggestions as to the relation of the hospital of July, 1921, I described fully the case of a young pathological department to outside practice. In girl of 23 who was sent to me for ionisation as connexion with this I ask again as I haveasked before : a last resort by the gynaecologist who had already Why should hospitals and universities compete twice curetted her. It may be objected that intra- with pathologists in their private practice when they uterine ionisation is difficult to employ in virgirs, but do not do so with clinicians ? It is a pitiful thing its use is not more complicated than the introduction to see clinicians encouraging this competition with of radium, and has at least the great advantage that pathologists when they would not think of encouraging it can never cause sterilisation. a similar competition in their own branches of medical I am, Sir, yours faithfully, practice. Pathologists are consultants as much as AGNES SAVILL. are other specialists and should be treated as such. 6. Dr. Dyke apparently suggests that the hospital should under-take the outside work and should derive an income from it, paying part of the fees to the Such a scheme is, in my opinion, THE TECHNIQUE OF BLOOD TRANSFUSION. pathologist. unfair to the pathologist. The only way in which To the Editor of THE LANCET. could fairly take part in outside hospitals, &c., is somewhat on the following pathological practice SIR,—In the course of his article on this subject in your issue of August 21st Dr. P. C. Gibson is good lines. The hospital could :(1) Provide and equip a laboratory in the hospital precincts ; enough to refer in favourable terms to the apparatus (2) Pay a stipend to the pathologist to cover all work described by me in 1920. He claims, however, now to haveintroduced various improvements into the done for the hospital or, alternatively, pay the pathologist a retaining fee and agreed fees for hospital work. the hospital apparatus. I may be allowed, perhaps, to express a work, in either case, to take precedence over private work ; doubt as to whether Dr. Gibson’s additions really are (3) Allow the pathologist perfect freedom to make his improvements. I should view them as unnecessary own arrangements as regards private practice and work complications which will in no way render blood for outside authorities ; (1) Allow the pathologist the use of the laboratory for transfusion easier of performance, but rather the private purposes on payment of expenses and a reasonable reverse. The defects in my original apparatus he regards rent. The relation of the pathologist to outside work as being (1) the risk of contamination of the blood because the mouth of the flask is not closed by a would thus be a personal one. He would decide on bung ; (2) the liability to the formation of a clot in the fees to be charged and would pay the hospital I dis- for expenses and rent. The only income which the the tube during the collection of the blood. pensed with the bung in my apparatus because, with hospital ought to receive from outside work is that the tube hanging freely into the flask, the needle paid as rent by the pathologist. It is iniquitous that seemed to be less likely to be dislodged from the a hospital should make an income out of the private donor’s vein by the movements of the flask during practice of a member of its staff. If the hospital the mixing of blood and citrate. At least one junction pathologist were granted this independence there between rubber and glass tubes was also eliminated. would be an inducement for him to settle down The risk of contamination of the blood by infective permanently in pathological practice. It is quite time that pathologists should combine material " falling into it I regard as a purely academic point which need not be considered by any competent to resist the idea that they are the tools of the clinicians.-I am, Sir, yours faithfully, operator. As regards the second point, I can only state that, CHARLES POWELL WHITE. during eight years’ experience of the apparatus since I first used it, I have not been troubled by this supposed defect. If the ordinary technique is properly carried SOPHOCLES AND CONFUSIONAL INSANITY. out the rate of flow of the blood is quite as fast can stand without fainting. as most donors Very To the Editor of THE LANCET. occasionally a clot forms in the needle (never in the SIR,—In the short resume of a paper on the tube) before all the blood is collected if the amount Madness of Ajax as Conceived by Sophocles, read Should this needed is rather large. happen the remainder of the blood can easily be taken with a before the Royal Medico-Psychological Association, Dr. Gibson’s which was published in THE LANCET of July 24th second needle from another vein. (p. 177), I am represented as maintaining that " in a clot from additions will not prevent forming in the his delineation Sophocles probably had in mind an needle. attack of malaria." This is, however, a complete for in the Dr. device Gibson’s running Lastly, s citrate solution with the blood apparently results in perversion of the theory which I maintained, but is a reference to a suggestion which I put forward clearly 1 THE LANCET, 1922, i., 178. many years ago that in his description of the sufferings .-
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his using nearly five times as much sodium citrate as is really necessary. I understand that he uses 4’5 g. of citrate for each 400 c.cm. of blood. My own practice is to use 1 g. of citrate for each 450 c.cm. of blood, and with the ordinary technique this need never be
To the Editor of THE LANCET. SIR,—In the recent discussion at the British Medical Association, and in your leading article of August 21st, it is surprising to find no mention of the exceeded. I must apologise to Dr. Gibson for thus criticising method of intra-uterine ionisation for the treatment of obstinate menorrhagia. Electrotherapists have his apparatus, but I do so only in the interests of long known of its efficacy, even in cases which have patients and operators. If transfusion is to be used to resisted every other method by drugs and endocrine full advantage the apparatus required must be as preparations, and even curetting. In 1917 the late simple as possible, and in view of the possible toxicity Dr. Samuel Sloan drew attention to the fact that of more than a small quantity of sodium citrate the copper ionisation cured almost every case of menor- amount injected into the patient must be as small as Over rhagia, except that arising from fibroids. GEOFFREY KEYNES. 20 years ago Dr. A. E. Zimmern, of the Salpetriere, published a large book on the subject, giving minute details of many cases of every type. Dr. Zimmern THE PATHOLOGICAL SERVICE OF THE described his method and showed his instruments in London in January, 1922, at a meeting! of the ElectroGENERAL HOSPITAL. Therapeutic Section of the Royal Society of To the Editor of THE LANCET. 3/ledicine. His good results were confirmed by the experiences of several of the English electrotheraSIR,—In your issue of August 14th Dr. Dyke has pists present at the meeting. In the Prccctitioner some suggestions as to the relation of the hospital of July, 1921, I described fully the case of a young pathological department to outside practice. In girl of 23 who was sent to me for ionisation as connexion with this I ask again as I haveasked before : a last resort by the gynaecologist who had already Why should hospitals and universities compete twice curetted her. It may be objected that intra- with pathologists in their private practice when they uterine ionisation is difficult to employ in virgirs, but do not do so with clinicians ? It is a pitiful thing its use is not more complicated than the introduction to see clinicians encouraging this competition with of radium, and has at least the great advantage that pathologists when they would not think of encouraging it can never cause sterilisation. a similar competition in their own branches of medical I am, Sir, yours faithfully, practice. Pathologists are consultants as much as AGNES SAVILL. are other specialists and should be treated as such. 6. Dr. Dyke apparently suggests that the hospital should under-take the outside work and should derive an income from it, paying part of the fees to the Such a scheme is, in my opinion, THE TECHNIQUE OF BLOOD TRANSFUSION. pathologist. unfair to the pathologist. The only way in which To the Editor of THE LANCET. could fairly take part in outside hospitals, &c., is somewhat on the following pathological practice SIR,—In the course of his article on this subject in your issue of August 21st Dr. P. C. Gibson is good lines. The hospital could :(1) Provide and equip a laboratory in the hospital precincts ; enough to refer in favourable terms to the apparatus (2) Pay a stipend to the pathologist to cover all work described by me in 1920. He claims, however, now to haveintroduced various improvements into the done for the hospital or, alternatively, pay the pathologist a retaining fee and agreed fees for hospital work. the hospital apparatus. I may be allowed, perhaps, to express a work, in either case, to take precedence over private work ; doubt as to whether Dr. Gibson’s additions really are (3) Allow the pathologist perfect freedom to make his improvements. I should view them as unnecessary own arrangements as regards private practice and work complications which will in no way render blood for outside authorities ; (1) Allow the pathologist the use of the laboratory for transfusion easier of performance, but rather the private purposes on payment of expenses and a reasonable reverse. The defects in my original apparatus he regards rent. The relation of the pathologist to outside work as being (1) the risk of contamination of the blood because the mouth of the flask is not closed by a would thus be a personal one. He would decide on bung ; (2) the liability to the formation of a clot in the fees to be charged and would pay the hospital I dis- for expenses and rent. The only income which the the tube during the collection of the blood. pensed with the bung in my apparatus because, with hospital ought to receive from outside work is that the tube hanging freely into the flask, the needle paid as rent by the pathologist. It is iniquitous that seemed to be less likely to be dislodged from the a hospital should make an income out of the private donor’s vein by the movements of the flask during practice of a member of its staff. If the hospital the mixing of blood and citrate. At least one junction pathologist were granted this independence there between rubber and glass tubes was also eliminated. would be an inducement for him to settle down The risk of contamination of the blood by infective permanently in pathological practice. It is quite time that pathologists should combine material " falling into it I regard as a purely academic point which need not be considered by any competent to resist the idea that they are the tools of the clinicians.-I am, Sir, yours faithfully, operator. As regards the second point, I can only state that, CHARLES POWELL WHITE. during eight years’ experience of the apparatus since I first used it, I have not been troubled by this supposed defect. If the ordinary technique is properly carried SOPHOCLES AND CONFUSIONAL INSANITY. out the rate of flow of the blood is quite as fast can stand without fainting. as most donors Very To the Editor of THE LANCET. occasionally a clot forms in the needle (never in the SIR,—In the short resume of a paper on the tube) before all the blood is collected if the amount Madness of Ajax as Conceived by Sophocles, read Should this needed is rather large. happen the remainder of the blood can easily be taken with a before the Royal Medico-Psychological Association, Dr. Gibson’s which was published in THE LANCET of July 24th second needle from another vein. (p. 177), I am represented as maintaining that " in a clot from additions will not prevent forming in the his delineation Sophocles probably had in mind an needle. attack of malaria." This is, however, a complete for in the Dr. device Gibson’s running Lastly, s citrate solution with the blood apparently results in perversion of the theory which I maintained, but is a reference to a suggestion which I put forward clearly 1 THE LANCET, 1922, i., 178. many years ago that in his description of the sufferings .-
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