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THROMBOSIS OF THE SUPERIOR VENA CAVA
718 much has been gained. A conclusion of that kind is fortified by the students’ own verdict which, so far as it can be ascertained, is friendly to the system. They live in the sector hospitals and their number in any The large class is gone. In one institution is small. its place there is intimate contact between student and teacher. The teacher is always in the hospital, the student shares his day. And when the work is done student and teacher go to the same building, they talk and play together, they live together, with incalculable gain to both. This means much ; it is a new relationship that is worth preserving. The physicians and surgeons of the Emergency Medical Service have built better than they knew."
early days
The words Sir Ernest quotes-namely, the final sentence-plainly refer to medical education; in the rest of the letter there is not a word of eulogy of that service. I ask you to print the passage to emphasise In once more a memorable educational experiment. normal circumstances a student has to rest content with a fraction of the physician’s day, whereas for some months after the outbreak of war the teacher was always in the hospital and the student shared his working hours. With the return to London of many teachers on part-time service these conditions have already passed away. They will not recur in my time but I cannot doubt that we have seen the birth of a new relationship between the student and his teacher, of which more will be heard. Meanwhile to record the student’s appreciation of his unusual fortune is not to argue that the London schools and their Government grants should be scrapped. I am sure that Sir Ernest is at heart more interested in an educational adventure of this kind than in scoring debating points, which is perhaps hardly a game for grown-ups in these times. I am, Sir, yours faithfully, C. M. WILSON.
the
it has been recognised that juvenile rheumatism not only attacks the heart but all the vascular system, from the origin of the aorta to the superior vena cava, including the blood capillaries. There is a good illustration of this venous thrombosis by B. Schlesinger in " Recent Advances in the Study of Rheumatism" (2nd ed. 1937). I am, Sir, your faithfully, F. JOHN POYNTON. Bath. STRETCHER FOR ABDOMINAL WOUNDS
SIR,—Mr. T. B. Layton in his instructive article on Transport of Wounded has stressed the impor-
placing a patient with abdominal wounds in the Fowler position as early as possible and of trans. porting him in this position. Sergeants Harris and tance of
Service stretcher adapted for Fowler position : (a) suspension bar of Thomas splint ; (b) stretcher pillow tied to suspension bar ; (c) spare pillow ; (d) spare pillow, to be placed under the three blankets so as to be able to be made fast to the suspension bar, thus acting as donkey and firmly holding patient ; (e) strong tape fastened to each end of donkey and to suspension bar.
both of the R.A.M.C., have worked out a of carrying this out, making use simply of the ordinary service stretcher, and the suspension bar of the Thomas splint. The accompanying illustration serves best to describe the means of transport, and the patient can be wrapped in three blankets, a method which, as Mr. Layton rightly states, has saved many lives. I am, Sir, yours faithfully,
Young,
means
THROMBOSIS OF THE SUPERIOR VENA CAVA
SIR,—The annotation under tins neaciing in your issue of March 23 (p. 559) recalls to my mind a note which I contributed more than forty years ago to your Mirror of Hospital Practice (Lancet, 1898, 2, 206). It was entitledThree cases of extensive venous thrombosis associated with severe rheumatic carditis," under the care of W. B. Cheadle and D. B. Lees. One of these was a case of thrombosis of the superior vena cava and its tributaries, fatal from pulmonary embolism due to detachment of a portion of the clot in the vena cava. The illustration was reprinted with your permission in " Researches in Rheumatism and Paine, 1913). The note is historic because it was the first attempt in this country to show by pathological investigation that this thrombosis was not merely obstructive in origin but due to rheumatic inflammation of the wall of the vein, and an indication of the infective nature of juvenile rheumatism; it was quoted in several editions of Osler’s Textbook of Medicine. Since then I have seen at least ten cases of venous thrombosis in juvenile rheumatism, several affecting the innominate veins, the most interesting being a thrombosis of the inferior vena cava in a case of severe rheumatic chorea, with a result strictly comparable to that seen in the same condition associated with typhoid fever. Later (Lancet, 1933, 2, 966) Bruce Perry confirmed and carried further the study of these cases as probably infective. The original drawing together with all the other original illustrations by Paine and myself, published and not published, are in the safe custody of the medical school of Harvard University. Since those
(Poynton
M. DE
LACEY,
Major, R.A.M.C.
THE NAME OF INFLUENZA
SIR,—Renaming diseases is never easy and many, like the Secretary of State for War who has been told he ought not to call epidemic influenza by that name, will continue to refuse the advice (La.ncet, March 23, 1940, p. 571). Common sense on this occasion is in agreement with the present medical evidence. Dr. Stuart-Harris and his co-workers (Lancet, Feb. 3, 1940, p. 205) wish to use "epidemic influenza " to indicate only the condition of influenzavirus infection and we others must be content with "febrile catarrh " for our old familiar influenza" or "flu." Clinical experience never supported the idea that virus influenza was distinct from other conditions usually called influenza. Any two epidemics of virus influenza or any two epidemics of ordinary influenza show as much dissimilarity as is shown in Stuart-Harris’s table demonstrating the percentage frequency of symptoms. I wish that your statement that " It is highly probable therefore that a disease exists which is clinically indistinguishable from epidemic influenza yet is not apt to occur in such widespread epidemics" were true. The
early days
The words Sir Ernest quotes-namely, the final sentence-plainly refer to medical education; in the rest of the letter there is not a word of eulogy of that service. I ask you to print the passage to emphasise In once more a memorable educational experiment. normal circumstances a student has to rest content with a fraction of the physician’s day, whereas for some months after the outbreak of war the teacher was always in the hospital and the student shared his working hours. With the return to London of many teachers on part-time service these conditions have already passed away. They will not recur in my time but I cannot doubt that we have seen the birth of a new relationship between the student and his teacher, of which more will be heard. Meanwhile to record the student’s appreciation of his unusual fortune is not to argue that the London schools and their Government grants should be scrapped. I am sure that Sir Ernest is at heart more interested in an educational adventure of this kind than in scoring debating points, which is perhaps hardly a game for grown-ups in these times. I am, Sir, yours faithfully, C. M. WILSON.
the
it has been recognised that juvenile rheumatism not only attacks the heart but all the vascular system, from the origin of the aorta to the superior vena cava, including the blood capillaries. There is a good illustration of this venous thrombosis by B. Schlesinger in " Recent Advances in the Study of Rheumatism" (2nd ed. 1937). I am, Sir, your faithfully, F. JOHN POYNTON. Bath. STRETCHER FOR ABDOMINAL WOUNDS
SIR,—Mr. T. B. Layton in his instructive article on Transport of Wounded has stressed the impor-
placing a patient with abdominal wounds in the Fowler position as early as possible and of trans. porting him in this position. Sergeants Harris and tance of
Service stretcher adapted for Fowler position : (a) suspension bar of Thomas splint ; (b) stretcher pillow tied to suspension bar ; (c) spare pillow ; (d) spare pillow, to be placed under the three blankets so as to be able to be made fast to the suspension bar, thus acting as donkey and firmly holding patient ; (e) strong tape fastened to each end of donkey and to suspension bar.
both of the R.A.M.C., have worked out a of carrying this out, making use simply of the ordinary service stretcher, and the suspension bar of the Thomas splint. The accompanying illustration serves best to describe the means of transport, and the patient can be wrapped in three blankets, a method which, as Mr. Layton rightly states, has saved many lives. I am, Sir, yours faithfully,
Young,
means
THROMBOSIS OF THE SUPERIOR VENA CAVA
SIR,—The annotation under tins neaciing in your issue of March 23 (p. 559) recalls to my mind a note which I contributed more than forty years ago to your Mirror of Hospital Practice (Lancet, 1898, 2, 206). It was entitledThree cases of extensive venous thrombosis associated with severe rheumatic carditis," under the care of W. B. Cheadle and D. B. Lees. One of these was a case of thrombosis of the superior vena cava and its tributaries, fatal from pulmonary embolism due to detachment of a portion of the clot in the vena cava. The illustration was reprinted with your permission in " Researches in Rheumatism and Paine, 1913). The note is historic because it was the first attempt in this country to show by pathological investigation that this thrombosis was not merely obstructive in origin but due to rheumatic inflammation of the wall of the vein, and an indication of the infective nature of juvenile rheumatism; it was quoted in several editions of Osler’s Textbook of Medicine. Since then I have seen at least ten cases of venous thrombosis in juvenile rheumatism, several affecting the innominate veins, the most interesting being a thrombosis of the inferior vena cava in a case of severe rheumatic chorea, with a result strictly comparable to that seen in the same condition associated with typhoid fever. Later (Lancet, 1933, 2, 966) Bruce Perry confirmed and carried further the study of these cases as probably infective. The original drawing together with all the other original illustrations by Paine and myself, published and not published, are in the safe custody of the medical school of Harvard University. Since those
(Poynton
M. DE
LACEY,
Major, R.A.M.C.
THE NAME OF INFLUENZA
SIR,—Renaming diseases is never easy and many, like the Secretary of State for War who has been told he ought not to call epidemic influenza by that name, will continue to refuse the advice (La.ncet, March 23, 1940, p. 571). Common sense on this occasion is in agreement with the present medical evidence. Dr. Stuart-Harris and his co-workers (Lancet, Feb. 3, 1940, p. 205) wish to use "epidemic influenza " to indicate only the condition of influenzavirus infection and we others must be content with "febrile catarrh " for our old familiar influenza" or "flu." Clinical experience never supported the idea that virus influenza was distinct from other conditions usually called influenza. Any two epidemics of virus influenza or any two epidemics of ordinary influenza show as much dissimilarity as is shown in Stuart-Harris’s table demonstrating the percentage frequency of symptoms. I wish that your statement that " It is highly probable therefore that a disease exists which is clinically indistinguishable from epidemic influenza yet is not apt to occur in such widespread epidemics" were true. The