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TREATMENT OF BARBITURATE POISONING
446
periods--e.g., paratroopers. But I am certain policy in Korea is the correct one. I am also fairly certain that the American equivalent of R.M.o.s
indefinite that the
and field ambulances did not carry blood though they could have it flown in by
as a
routine,
if necessary. I am quite sure that if we had a c.c.s. in Korea to which casualties were evacuated for primary surgery it would be adequately supplied with blood, as was the base hospital at Kure. P. D. HOOPER. Children’s Hospital, Birmingham.
helicopter
experiments2 with rabbits show that the effect of dialysis is much superior to that of forced polyuria, even When the output is as great as half the body-weight over a period of six hours. So far, we have treated only these 2 patients with severe barbiturate poisoning. During the dialysis the serum-barbiturate level was reduced by 60% and 85%, and both patients were conscious and lucid immediately after treatment. We suggest that dialysis should be used as early as possible in cases of severe poisoning with bar. Our
biturates, for these drusrs
are
Medical Clinic,
TREATMENT OF BARBITURATE POISONING
SIR,—Your annotation of Jan. 10 mentions the 2 patients with barbiturate poisoning whom we treated by the method of dialysis described in 1948.1 Your readers may be interested in some of the details. Two patients were treated with dialysis after the customary forms of treatment had been ineffective for The accompanying five and four days respectively. figure shows the changes in the serum-barbiturate level, the fluid intake, and the urinary output. CASE 1.—A woman, aged 29, was admitted to this clinic the respiratory tract contained much a poor condition : secretion. and there develoned nurulent bronchitis. bronchopneumonia, and in
pulmonary œdema.
The e
urinary output low in spite of an abundant fluid intake and the use of mercurial diuretics, suggesting that renal function
was
was
impaired.
Blood and dextran were given to combat
shock, and because on the second day the
University of Lund, Sweden.
CHILD-WELFARE CLINICS
SIR,—Dr. Gordon’s clear and reasoned letter last week contains, I think, some misunderstandings of the past and at least one very doubtful prophecy. He writes: " Local authorities do this work for the undeniable reason that in the past general practitioners have neglected to do it." It is undeniable that they did not do it; but the reason was not neglect on the doctor’s part but the poverty of the patient. This was also the reason for the inadequate accommodation and queues in the rain. Doctors working in slum areas before the health service saw a very meagre return for their labours, and suitably sized houses did not exist in those areas. As to Dr. Gordon’s prophecy that welfare clinics will I fear that he is himself something of a disappear, " theoretician." They represent a vested interest of the local authorities, and cannot simply disappear. Occasionally, of course, they can be converted to occupational centres or mother-and-baby homes. May I also comment on the remark of Dr. Owen (Jan. 31) that proprietary foods account for half the attendance at the clinics? I have proved that a general practitioner and a health visitor can achieve the maximum possible attendance from a practice without resorting to this rather paltry " draw." F. CHARLOTTE NAISH.
Parliament
h semoglob in level fell from 81 to 51 %. There was no sign of haemorrhage at the time, so the decrease was presumed to be due to dilution. By the fifth day the serum-barbiturate level had fallen to 5 mg. per 100 ml. Nevertheless, the patient became worse and more comatose. The pneumonia and pulmonary œdema produced persistent anoxia despite the use of oxygen. Treatment by dialysis began on the fifth day, when she was almost moribund. We undertook this particular treatment with great hesitation, for wefeared the possibility of pulmonary haemorrhage complicating the pneumonia and oedema. After seven hours’ dialvsis the serum-barbiturate level had fallen from5 to 2 mg. per 100 ml.-in other words, by 60%. The patient recovered consciousness and was able to speak to her relatives. However, severe intestinal haemorrhage occurred during the dialysis, and this later proved to be due to gastric erosions of the type sometimes met with at childbirth. The improvement was only temporary and she died of pneumonia and pulmonary oedema the following day. CASE 2.-A woman, aged 59, was admitted twelve hours after taking an overdose of a barbiturate. It proved impossible to induce polyuria by raising the fluid intake. Her condition deteriorated, and purulent bronchitis developed. Dialysis was started on the fourth day ; the narcosis was still so deep that the cannulae could be inserted without local The serum-barbiturate level fell rapidly from anaesthesia. At 8-2 mg. to about 1 mg. per 100 ml., or by about 85%. the end of the treatment, the patient had recovered consciousness completely, and she eventually went home, physically and mentally restored. 1. Alwall, N., Norviit, L., Steins, A. M.
Lancet, 1948, i, 60.
otherwise slowly eliminated. NILS ALWALL ANDERS LUNDERQUIST.
Endowments IN the House of Lords on Feb. 18, the EARL OF SELKRIK moved the second reading of the Hospital Endowments (Scotland) Bill.3 He explained that under the health service legislation the procedure followed in Scotland in transferring hospital endowments was different from that in England. In Scotland all endowments were transferred to the hospital boards of management and at the same time the Hospital Endowments Commission was set up to prepare schemes for the management of these endowments. In England, on the other hand, endowments were transferred to the Endowments Fund and then distributed by the Minister of Health. The Endowments Commission, under the chairman- ’ ship of Sir Sydney -Smith, M.D., had recommended that part of these funds should be devoted to research.[ Though individual hospital boards could use their funds for research, Sir Sydney had felt that this could be more usefully done by an independent body of trustees acting for the whole country. He estimated the funds available at £120,000 a year. There was a wide measure of support for the scheme both from the hospitals and from the universities. In proposing this arrangement Sir Sydney had, of course, borne in mind that adequate funds must be available to provide reasonable amenities at individual hospitals and that the spirit of the intention of the original founders of an endowment must be respected. The chairman and members of the new trust would be appointed by the Secretary of State, and it was considered that a small body would be adequate probably about seven people. The trust could also receive legacies
Scottish
2.
Hospital
Alwall, N., Lindgren, P., Lunderquist,
143, 299. 3. See Lancet, 1952, ii, 251.
A. Acta med. scand. 1952,
periods--e.g., paratroopers. But I am certain policy in Korea is the correct one. I am also fairly certain that the American equivalent of R.M.o.s
indefinite that the
and field ambulances did not carry blood though they could have it flown in by
as a
routine,
if necessary. I am quite sure that if we had a c.c.s. in Korea to which casualties were evacuated for primary surgery it would be adequately supplied with blood, as was the base hospital at Kure. P. D. HOOPER. Children’s Hospital, Birmingham.
helicopter
experiments2 with rabbits show that the effect of dialysis is much superior to that of forced polyuria, even When the output is as great as half the body-weight over a period of six hours. So far, we have treated only these 2 patients with severe barbiturate poisoning. During the dialysis the serum-barbiturate level was reduced by 60% and 85%, and both patients were conscious and lucid immediately after treatment. We suggest that dialysis should be used as early as possible in cases of severe poisoning with bar. Our
biturates, for these drusrs
are
Medical Clinic,
TREATMENT OF BARBITURATE POISONING
SIR,—Your annotation of Jan. 10 mentions the 2 patients with barbiturate poisoning whom we treated by the method of dialysis described in 1948.1 Your readers may be interested in some of the details. Two patients were treated with dialysis after the customary forms of treatment had been ineffective for The accompanying five and four days respectively. figure shows the changes in the serum-barbiturate level, the fluid intake, and the urinary output. CASE 1.—A woman, aged 29, was admitted to this clinic the respiratory tract contained much a poor condition : secretion. and there develoned nurulent bronchitis. bronchopneumonia, and in
pulmonary œdema.
The e
urinary output low in spite of an abundant fluid intake and the use of mercurial diuretics, suggesting that renal function
was
was
impaired.
Blood and dextran were given to combat
shock, and because on the second day the
University of Lund, Sweden.
CHILD-WELFARE CLINICS
SIR,—Dr. Gordon’s clear and reasoned letter last week contains, I think, some misunderstandings of the past and at least one very doubtful prophecy. He writes: " Local authorities do this work for the undeniable reason that in the past general practitioners have neglected to do it." It is undeniable that they did not do it; but the reason was not neglect on the doctor’s part but the poverty of the patient. This was also the reason for the inadequate accommodation and queues in the rain. Doctors working in slum areas before the health service saw a very meagre return for their labours, and suitably sized houses did not exist in those areas. As to Dr. Gordon’s prophecy that welfare clinics will I fear that he is himself something of a disappear, " theoretician." They represent a vested interest of the local authorities, and cannot simply disappear. Occasionally, of course, they can be converted to occupational centres or mother-and-baby homes. May I also comment on the remark of Dr. Owen (Jan. 31) that proprietary foods account for half the attendance at the clinics? I have proved that a general practitioner and a health visitor can achieve the maximum possible attendance from a practice without resorting to this rather paltry " draw." F. CHARLOTTE NAISH.
Parliament
h semoglob in level fell from 81 to 51 %. There was no sign of haemorrhage at the time, so the decrease was presumed to be due to dilution. By the fifth day the serum-barbiturate level had fallen to 5 mg. per 100 ml. Nevertheless, the patient became worse and more comatose. The pneumonia and pulmonary œdema produced persistent anoxia despite the use of oxygen. Treatment by dialysis began on the fifth day, when she was almost moribund. We undertook this particular treatment with great hesitation, for wefeared the possibility of pulmonary haemorrhage complicating the pneumonia and oedema. After seven hours’ dialvsis the serum-barbiturate level had fallen from5 to 2 mg. per 100 ml.-in other words, by 60%. The patient recovered consciousness and was able to speak to her relatives. However, severe intestinal haemorrhage occurred during the dialysis, and this later proved to be due to gastric erosions of the type sometimes met with at childbirth. The improvement was only temporary and she died of pneumonia and pulmonary oedema the following day. CASE 2.-A woman, aged 59, was admitted twelve hours after taking an overdose of a barbiturate. It proved impossible to induce polyuria by raising the fluid intake. Her condition deteriorated, and purulent bronchitis developed. Dialysis was started on the fourth day ; the narcosis was still so deep that the cannulae could be inserted without local The serum-barbiturate level fell rapidly from anaesthesia. At 8-2 mg. to about 1 mg. per 100 ml., or by about 85%. the end of the treatment, the patient had recovered consciousness completely, and she eventually went home, physically and mentally restored. 1. Alwall, N., Norviit, L., Steins, A. M.
Lancet, 1948, i, 60.
otherwise slowly eliminated. NILS ALWALL ANDERS LUNDERQUIST.
Endowments IN the House of Lords on Feb. 18, the EARL OF SELKRIK moved the second reading of the Hospital Endowments (Scotland) Bill.3 He explained that under the health service legislation the procedure followed in Scotland in transferring hospital endowments was different from that in England. In Scotland all endowments were transferred to the hospital boards of management and at the same time the Hospital Endowments Commission was set up to prepare schemes for the management of these endowments. In England, on the other hand, endowments were transferred to the Endowments Fund and then distributed by the Minister of Health. The Endowments Commission, under the chairman- ’ ship of Sir Sydney -Smith, M.D., had recommended that part of these funds should be devoted to research.[ Though individual hospital boards could use their funds for research, Sir Sydney had felt that this could be more usefully done by an independent body of trustees acting for the whole country. He estimated the funds available at £120,000 a year. There was a wide measure of support for the scheme both from the hospitals and from the universities. In proposing this arrangement Sir Sydney had, of course, borne in mind that adequate funds must be available to provide reasonable amenities at individual hospitals and that the spirit of the intention of the original founders of an endowment must be respected. The chairman and members of the new trust would be appointed by the Secretary of State, and it was considered that a small body would be adequate probably about seven people. The trust could also receive legacies
Scottish
2.
Hospital
Alwall, N., Lindgren, P., Lunderquist,
143, 299. 3. See Lancet, 1952, ii, 251.
A. Acta med. scand. 1952,