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TREATMENT OF WOUNDED IN MALAYA
1244
corresponding figures for
the heart-rate were 134 and 96 an increase in the heart-beat volume from 18 to 28 ml.—i.e., about 55.5%-which is indeed a considerable haemodynamic effect. With these obaections,what can be attached to the assertion that " neither in the patients with sinus rhythm nor in those with auricular fibrillation is there any correlation between the relief of congestion and the slowing in heart-rate"; or to the sentence stating that " it is significant that atropine-induced acceleration did- not lower cardiac output or increase congestion " ? J. PLESCH. London, Z.1.
per min. ; this accounts for
weight
THE LIBRARIAN IN THE CHILDREN’S WARD
biB,—At
a
conference held
by
the Guild of
Hospital
Librarians on Nov. 9, the audience was surprised to learn that at several hospitals, including large and wellknown establishments, librarians were not allowed into the children’s wards at all. The opposition, so far as we could gather, comes mainly from the nursing staff, and the reason given is usually " infection." It is not clear whether the librarian or her books are held to be the conveyors of disease, but in any case we respectfully take leave to doubt whether the objection is a reasonable If it were valid, it would surely be applicable to one. all children’s wards, which is not found to be the case. Where the librarian is welcomed, difficulties about infection traceable to her presence or to the distribution of books do not arise in practice. It also emerged at the conference that where the teacher acts as children’s librarian, the books are sometimes locked up at the beginning of the school holidays and the children are deprived of this solace just when they need it most. A few old books left for the nurses to distribute do not in the least meet their wants. Do these defects in the hospital library service really matter ?The attention now being paid to the psychological effect of hospital admission on children has shown how bored and frightened and homesick they can be behind a mask of docility. It seems strange that the best and cheapest means of comfort, occupation, and mental stimulation-i.e., a good supply of suitable books-is still not being fully utilised. JOHN FORSDYKE President.
LETITIA FAIRFIELD Chairman. Guild of Hospital Librarians, 60, Beaufort Mansions, London, S.W.3.
JOAN COKE Secretary.
TREATMENT OF WOUNDED IN MALAYA
SIR,-I gather from my colleagues who served in the 1914-18 war that much of the surgical experience that was dearly bought in that war had to be gained all over again in the early years of the 1939-45 war. Those of us who served in the late war hoped that the lessons learned would not be quickly forgotten. The Royal Society of Medicine, in convening the Inter-Allied conferences on war medicine and in publishing these proceedings in book form, has done everything possible to ensure that the knowledge gained should not be lost. It is therefore all the more regrettable to learn from a statement by the Secretary of State for War 1 on the number of surgeons in Malaya that after less than five years so much has apparently been forgotten. The campaign in the Western Desert established the value of grouping the field surgical unit and field transfusion unit at the main dressing stations of a field ambulance, with instructions to deal with " life and limb " surgery. As a result of siting these units well forward, where they could deal with such cases as penetrating wounds of the abdomen and thorax and severe 1. See
Lancet, Dec. 24,
p. 1205.
compound fractures.
of the femur, countless lives were saved which would certainly have been lost if the patients had had to make-the journey back to a casualtyclearing station or general hospital. I appreciate that the problems,of the jungle are not those of the Western Desert; but those of us who went from the desert to Sicily and Italy, and later to Normandy, found that the principles of forward surgical organisation did not differ very greatly in the various theatres of war. It would appear from the War Minister’s statement that there are only four Army surgeons in Malaya and Singapore island ; and this number would seem quite inadequate to carry out early surgical treatment. I sincerely hope that in a subsequent statement the Minister will be able to assure us that the medical services in Malaya are no less efficient than in 1945. Meanwhile the information he has given must give rise to grave Hove.
misgivings. REX BINNING.
B
SOMATIC EXPRESSIONS OF PSYCHIC EVENTS SiR,-In your annotation of Dec. 10, in which Dr. Harry Stalker is quoted, I was surprised to read that gastric hypersecretion and motility, and intestinal
hypermotility are manifestations of an active sympathetic system. Surely it is generally accepted that the nervous control of gastric secretion comes from the vagus, and that this nerve is also responsible for all intestinal movement apart from sphincteric activity. Practical applications of this fact are the use of atropine and vagotomy to diminish gastric secretion. Redruth, Cornwall.
J. SANDILANDS.
** * Dr. Sandilands is of course quite thank him for the correction.-ED. L.
right,
and
we
FOREIGN BODIES IN THE ABDOMEN
61R,-The correspondence on this subject reminds me a case I saw some twenty years ago. The patient, a man of 70, had complained of pain ill’ the right iliac fossa for weeks ; his doctor had told him 11 that it was not appendicitis." On examination, I felt a long thin object lying under the skin at approximately McBurney’s point. I removed this under local anaesthesia, and it proved to be a fish-bone about 12 in. long. Presumably this had perforated the colon and had come to the surface without much local reaction in the -
of
peritoneum. F. A. BEARN.
Buxton.
DEOXYCORTONE ACETATE AND ASCORBIC ACID IN RHEUMATOID ARTHRITIS
SIR,—The lively correspondence arising from Lewin and Wassen’s
prompts
me
preliminary communication of Nov. 26 experiences in respect of their
to record my
treatment. In five rheumatoids the recommended dosage of 5 mg. of deoxycortone intramuscularly followed by 1 g. of ascorbic acid intravenously was used. There were one male and four female patients. A favourable response in three females and the male was striking and immediate. Not only was pain relieved, but a certain sense of exhilaration was also noticed. The effect passed off in two hours on the first day. Treatment given daily resulted in a longer action-in fact up to seven hoursby the end of a week. The most striking objective evidence of benefit was seen in the return of ability to flex the fingers and form a fist. Such a degree of flexion had previously been impossible over periods of six months to three years. Whether or not this new line of approach will give rise to permanent gain has yet to be determined, but it is clear that the combination of drugs is by no means inert. Lewin and Wassen made no extravagant claims,
corresponding figures for
the heart-rate were 134 and 96 an increase in the heart-beat volume from 18 to 28 ml.—i.e., about 55.5%-which is indeed a considerable haemodynamic effect. With these obaections,what can be attached to the assertion that " neither in the patients with sinus rhythm nor in those with auricular fibrillation is there any correlation between the relief of congestion and the slowing in heart-rate"; or to the sentence stating that " it is significant that atropine-induced acceleration did- not lower cardiac output or increase congestion " ? J. PLESCH. London, Z.1.
per min. ; this accounts for
weight
THE LIBRARIAN IN THE CHILDREN’S WARD
biB,—At
a
conference held
by
the Guild of
Hospital
Librarians on Nov. 9, the audience was surprised to learn that at several hospitals, including large and wellknown establishments, librarians were not allowed into the children’s wards at all. The opposition, so far as we could gather, comes mainly from the nursing staff, and the reason given is usually " infection." It is not clear whether the librarian or her books are held to be the conveyors of disease, but in any case we respectfully take leave to doubt whether the objection is a reasonable If it were valid, it would surely be applicable to one. all children’s wards, which is not found to be the case. Where the librarian is welcomed, difficulties about infection traceable to her presence or to the distribution of books do not arise in practice. It also emerged at the conference that where the teacher acts as children’s librarian, the books are sometimes locked up at the beginning of the school holidays and the children are deprived of this solace just when they need it most. A few old books left for the nurses to distribute do not in the least meet their wants. Do these defects in the hospital library service really matter ?The attention now being paid to the psychological effect of hospital admission on children has shown how bored and frightened and homesick they can be behind a mask of docility. It seems strange that the best and cheapest means of comfort, occupation, and mental stimulation-i.e., a good supply of suitable books-is still not being fully utilised. JOHN FORSDYKE President.
LETITIA FAIRFIELD Chairman. Guild of Hospital Librarians, 60, Beaufort Mansions, London, S.W.3.
JOAN COKE Secretary.
TREATMENT OF WOUNDED IN MALAYA
SIR,-I gather from my colleagues who served in the 1914-18 war that much of the surgical experience that was dearly bought in that war had to be gained all over again in the early years of the 1939-45 war. Those of us who served in the late war hoped that the lessons learned would not be quickly forgotten. The Royal Society of Medicine, in convening the Inter-Allied conferences on war medicine and in publishing these proceedings in book form, has done everything possible to ensure that the knowledge gained should not be lost. It is therefore all the more regrettable to learn from a statement by the Secretary of State for War 1 on the number of surgeons in Malaya that after less than five years so much has apparently been forgotten. The campaign in the Western Desert established the value of grouping the field surgical unit and field transfusion unit at the main dressing stations of a field ambulance, with instructions to deal with " life and limb " surgery. As a result of siting these units well forward, where they could deal with such cases as penetrating wounds of the abdomen and thorax and severe 1. See
Lancet, Dec. 24,
p. 1205.
compound fractures.
of the femur, countless lives were saved which would certainly have been lost if the patients had had to make-the journey back to a casualtyclearing station or general hospital. I appreciate that the problems,of the jungle are not those of the Western Desert; but those of us who went from the desert to Sicily and Italy, and later to Normandy, found that the principles of forward surgical organisation did not differ very greatly in the various theatres of war. It would appear from the War Minister’s statement that there are only four Army surgeons in Malaya and Singapore island ; and this number would seem quite inadequate to carry out early surgical treatment. I sincerely hope that in a subsequent statement the Minister will be able to assure us that the medical services in Malaya are no less efficient than in 1945. Meanwhile the information he has given must give rise to grave Hove.
misgivings. REX BINNING.
B
SOMATIC EXPRESSIONS OF PSYCHIC EVENTS SiR,-In your annotation of Dec. 10, in which Dr. Harry Stalker is quoted, I was surprised to read that gastric hypersecretion and motility, and intestinal
hypermotility are manifestations of an active sympathetic system. Surely it is generally accepted that the nervous control of gastric secretion comes from the vagus, and that this nerve is also responsible for all intestinal movement apart from sphincteric activity. Practical applications of this fact are the use of atropine and vagotomy to diminish gastric secretion. Redruth, Cornwall.
J. SANDILANDS.
** * Dr. Sandilands is of course quite thank him for the correction.-ED. L.
right,
and
we
FOREIGN BODIES IN THE ABDOMEN
61R,-The correspondence on this subject reminds me a case I saw some twenty years ago. The patient, a man of 70, had complained of pain ill’ the right iliac fossa for weeks ; his doctor had told him 11 that it was not appendicitis." On examination, I felt a long thin object lying under the skin at approximately McBurney’s point. I removed this under local anaesthesia, and it proved to be a fish-bone about 12 in. long. Presumably this had perforated the colon and had come to the surface without much local reaction in the -
of
peritoneum. F. A. BEARN.
Buxton.
DEOXYCORTONE ACETATE AND ASCORBIC ACID IN RHEUMATOID ARTHRITIS
SIR,—The lively correspondence arising from Lewin and Wassen’s
prompts
me
preliminary communication of Nov. 26 experiences in respect of their
to record my
treatment. In five rheumatoids the recommended dosage of 5 mg. of deoxycortone intramuscularly followed by 1 g. of ascorbic acid intravenously was used. There were one male and four female patients. A favourable response in three females and the male was striking and immediate. Not only was pain relieved, but a certain sense of exhilaration was also noticed. The effect passed off in two hours on the first day. Treatment given daily resulted in a longer action-in fact up to seven hoursby the end of a week. The most striking objective evidence of benefit was seen in the return of ability to flex the fingers and form a fist. Such a degree of flexion had previously been impossible over periods of six months to three years. Whether or not this new line of approach will give rise to permanent gain has yet to be determined, but it is clear that the combination of drugs is by no means inert. Lewin and Wassen made no extravagant claims,