- Email: [email protected]
TREATMENT OF ACUTE PANCREATITIS WITH CORTISONE
733
Mire-ratp, and the comparative ease of the diagnostic referred to. It should be emphasised that :.TmpMms referable to the urinary tract are often absent in thi5 condition, ,although a previous history of sudden flank pain and/or haematuria is certainly suggestive, and This represents a radical departure __-; uncommon. a unilaterally diseased- kidney in that the dictum from hypertensive patient should not be removed unless here exists some indication for its removal in addition to the hypertension." 4 PAUL J. ROSCH. RoSCH. Antonio. Texas, U.S.A..
Obituary
procedure
"
DISMISSAL ON MEDICAL GROUNDS
SIR.—May I, as a health visitor working with tuberculous patients, comment on Dr. Todd’s letter (Sept. 1) Pr. Todd appeals for a more realistic approach to the needs of persons seeking employment on recovery from iujury or illness of long standing. It is encouraging to those of us who meet persons iacmg these problems to find a doctor with courage pointing out the hardship and, indeed, injustice suffered hv many. On the face of it the only reason for the " medical " is to assure the employing authority that a prospective employee will not become a liability on the superannuation scheme before reaching the latest possible retiring age. While the solvency of superannuation schemes is important to those of us who will need to depend on them when we come to retire, it is unfortunate that to mention only those public bodies within our own arlait) Ministries, local authorities, hospital authorities, and banks regularly refuse training and employment t’i young people and others whose only disadvantage have had pulmonary tuberculosis. The fact i- that that they have recovered is not considered. Could we, who are interested, campaign for a more generous attitude*? The examining doctor has a great ideal of authority as well as responsibility and could do much to help overcome this stumbling-block. Would an alternative pension scheme for certain special cases be an advantage-something in the nature f an endowment policy which could only be surrendered at pension age or on previous retirement through illness ? lu this way the, often wrongly, anticipated burden on ordinary pension schemes would be avoided and the employee given some safeguard for his future. SUPERINTENDENT HEALTH VISITOR.
they
TREATMENT OF ACUTE PANCREATITIS WITH CORTISONE SIR,—It is strange that so little attention has been paid to the role of the adrenal glands in acute pancrea. The standard surgical and pathological texts emphasise the oedema and necrosis, which often extend some distance from the pancreas itself, but do not mention involvement of the adrenal glands by the inflammatory process. The left adrenal gland is in direct contact with the tail of ’ire pancreas, and on the right side the head of the pancreas is separated from the adrenal gland by only a In fatal verysmall amount of retroperitoneal tissue. of acute pancreatitis examined post mortem the are not infrequently found surrounded by necrotic tissue. It would not be surprising if, in circumstances, there were some disturbance of
function. shock in patients with this condition is recognised. It may well be that the beneficial results ’treatment with cortisone, described last week by Mr. Rogers and his colleagues, are due to the drug’s action during a period of temporary adrenal . ALLAN JACOBS. The
4.
severe
Green, D. M. In Third Annual Report on Stress. H. Selye and A. Horava. Montreal, 1953 ; p. 277.
Edited by
WILLIAM GILLIATT
K.C.V.O.; M.D., M.S. Lond., F.R.C.P., F.R.C.S., F.R.C.O.G., Hon. M.M.S.A.
THE death of Sir William Gilliatt after a road accident Sept. 27 brings to a tragic end a life-time of service to his patients and to our profession. He was born at Boston in Lincolnshire in 1884, and entered the Middlesex Hospital for his medical training. During his distinguished career as a student he won the Hetley scholarship, the junior Broderip scholarship, the Hudson scholarship, and the Lyell gold medal. After qualification in 1908 he held the posts of house-physician, house-surgeon, obstetric house-physician, and obstetric and gynaecological registrar and tutor at the Middlesex. Bv 1912 he had acauired the degrees of M.D. (with the gold medal) and M.S., and He was also the F.R.C.S. evidently a man of high promise, marked out for a consultant career at a time when competition was more open, and also perhaps more difficult, because there was then no fixed pattern of The Middlesex training. school had a high reputation for gynaecological surgery, founded on the work of Bland-Sutton, Victor Bonney, and Comyns Berkeley, and Gilliatt had the good fortune to be trained in this tradition. There was no vacancy on the staff of the Middlesex, and it proved to be to the great gain of King’s College Hospital when he [P.A,—Reuter Photo was appointed assistant obstetric and gynaecological surgeon there in 1916. He became full surgeon in 1925, and remained at King’s until he reached the age of retirement in 1946, when he was appointed consulting surgeon. His services to King’s continued until his death, for he later became vicechairman of the board of governors and chairman of the medical school council, and to these tasks he brought the same wise care and enthusiasm as he had shown in his clinical work. As chairman of the nursing committee the welfare and education of the nurses became his particular interest. Gilliatt was also appointed obstetric physician (as the title then was), to Queen Charlotte’s Hospital, and surgeon to the Samaritan Hospital, and he served as consultant surgeon to Bromley Hospital, the Maudsley Hospital, and St. Saviour’s Hospital. Gilliatt was an excellent clinical teacher. His outpatien clinic and his ward rounds were always attended by a crowd of students, in spite of the hazard of his invariabl method of asking questions round the class, from which there was no escape and which soon exposed the ignorant His outstandingly good judgment and his gift for seizin upon the essential point of any subject or clinical problem were the secrets of his success. His skill, quiet authority and charm of manner brought him a large privat practice, and this was augmented as his students qualifie and not only sent to him their patients but their wives and many an old King’s man owes "Bill" a debt bot for his teaching and for advice to his family. He was real consultant, and his help was not infrequently sough by other obstetricians in particularly difficult cases. The time came when he was called upon to undertak the responsibility of advising the Royal Family. Afte attending the Duchess of Kent at the births of her thre children, he attended the Queen (then Princess Elizabeth at the birth of the Duke of Cornwall in 1948 and o Princess Anne in 1950. But even when his practice wa large and his responsibility was great he always foun time for his hospital work, and old patients still atten who refer appreciatively to their treatment by ’’ Mr Gilliatt," and who seem to gain satisfaction and som reflected glory from his subsequent promotion. on
--
Mire-ratp, and the comparative ease of the diagnostic referred to. It should be emphasised that :.TmpMms referable to the urinary tract are often absent in thi5 condition, ,although a previous history of sudden flank pain and/or haematuria is certainly suggestive, and This represents a radical departure __-; uncommon. a unilaterally diseased- kidney in that the dictum from hypertensive patient should not be removed unless here exists some indication for its removal in addition to the hypertension." 4 PAUL J. ROSCH. RoSCH. Antonio. Texas, U.S.A..
Obituary
procedure
"
DISMISSAL ON MEDICAL GROUNDS
SIR.—May I, as a health visitor working with tuberculous patients, comment on Dr. Todd’s letter (Sept. 1) Pr. Todd appeals for a more realistic approach to the needs of persons seeking employment on recovery from iujury or illness of long standing. It is encouraging to those of us who meet persons iacmg these problems to find a doctor with courage pointing out the hardship and, indeed, injustice suffered hv many. On the face of it the only reason for the " medical " is to assure the employing authority that a prospective employee will not become a liability on the superannuation scheme before reaching the latest possible retiring age. While the solvency of superannuation schemes is important to those of us who will need to depend on them when we come to retire, it is unfortunate that to mention only those public bodies within our own arlait) Ministries, local authorities, hospital authorities, and banks regularly refuse training and employment t’i young people and others whose only disadvantage have had pulmonary tuberculosis. The fact i- that that they have recovered is not considered. Could we, who are interested, campaign for a more generous attitude*? The examining doctor has a great ideal of authority as well as responsibility and could do much to help overcome this stumbling-block. Would an alternative pension scheme for certain special cases be an advantage-something in the nature f an endowment policy which could only be surrendered at pension age or on previous retirement through illness ? lu this way the, often wrongly, anticipated burden on ordinary pension schemes would be avoided and the employee given some safeguard for his future. SUPERINTENDENT HEALTH VISITOR.
they
TREATMENT OF ACUTE PANCREATITIS WITH CORTISONE SIR,—It is strange that so little attention has been paid to the role of the adrenal glands in acute pancrea. The standard surgical and pathological texts emphasise the oedema and necrosis, which often extend some distance from the pancreas itself, but do not mention involvement of the adrenal glands by the inflammatory process. The left adrenal gland is in direct contact with the tail of ’ire pancreas, and on the right side the head of the pancreas is separated from the adrenal gland by only a In fatal verysmall amount of retroperitoneal tissue. of acute pancreatitis examined post mortem the are not infrequently found surrounded by necrotic tissue. It would not be surprising if, in circumstances, there were some disturbance of
function. shock in patients with this condition is recognised. It may well be that the beneficial results ’treatment with cortisone, described last week by Mr. Rogers and his colleagues, are due to the drug’s action during a period of temporary adrenal . ALLAN JACOBS. The
4.
severe
Green, D. M. In Third Annual Report on Stress. H. Selye and A. Horava. Montreal, 1953 ; p. 277.
Edited by
WILLIAM GILLIATT
K.C.V.O.; M.D., M.S. Lond., F.R.C.P., F.R.C.S., F.R.C.O.G., Hon. M.M.S.A.
THE death of Sir William Gilliatt after a road accident Sept. 27 brings to a tragic end a life-time of service to his patients and to our profession. He was born at Boston in Lincolnshire in 1884, and entered the Middlesex Hospital for his medical training. During his distinguished career as a student he won the Hetley scholarship, the junior Broderip scholarship, the Hudson scholarship, and the Lyell gold medal. After qualification in 1908 he held the posts of house-physician, house-surgeon, obstetric house-physician, and obstetric and gynaecological registrar and tutor at the Middlesex. Bv 1912 he had acauired the degrees of M.D. (with the gold medal) and M.S., and He was also the F.R.C.S. evidently a man of high promise, marked out for a consultant career at a time when competition was more open, and also perhaps more difficult, because there was then no fixed pattern of The Middlesex training. school had a high reputation for gynaecological surgery, founded on the work of Bland-Sutton, Victor Bonney, and Comyns Berkeley, and Gilliatt had the good fortune to be trained in this tradition. There was no vacancy on the staff of the Middlesex, and it proved to be to the great gain of King’s College Hospital when he [P.A,—Reuter Photo was appointed assistant obstetric and gynaecological surgeon there in 1916. He became full surgeon in 1925, and remained at King’s until he reached the age of retirement in 1946, when he was appointed consulting surgeon. His services to King’s continued until his death, for he later became vicechairman of the board of governors and chairman of the medical school council, and to these tasks he brought the same wise care and enthusiasm as he had shown in his clinical work. As chairman of the nursing committee the welfare and education of the nurses became his particular interest. Gilliatt was also appointed obstetric physician (as the title then was), to Queen Charlotte’s Hospital, and surgeon to the Samaritan Hospital, and he served as consultant surgeon to Bromley Hospital, the Maudsley Hospital, and St. Saviour’s Hospital. Gilliatt was an excellent clinical teacher. His outpatien clinic and his ward rounds were always attended by a crowd of students, in spite of the hazard of his invariabl method of asking questions round the class, from which there was no escape and which soon exposed the ignorant His outstandingly good judgment and his gift for seizin upon the essential point of any subject or clinical problem were the secrets of his success. His skill, quiet authority and charm of manner brought him a large privat practice, and this was augmented as his students qualifie and not only sent to him their patients but their wives and many an old King’s man owes "Bill" a debt bot for his teaching and for advice to his family. He was real consultant, and his help was not infrequently sough by other obstetricians in particularly difficult cases. The time came when he was called upon to undertak the responsibility of advising the Royal Family. Afte attending the Duchess of Kent at the births of her thre children, he attended the Queen (then Princess Elizabeth at the birth of the Duke of Cornwall in 1948 and o Princess Anne in 1950. But even when his practice wa large and his responsibility was great he always foun time for his hospital work, and old patients still atten who refer appreciatively to their treatment by ’’ Mr Gilliatt," and who seem to gain satisfaction and som reflected glory from his subsequent promotion. on
--