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URINE AS MEDIUM FOR BACTERIAL GROWTH
1136 URINARY INFECTION IN THE TWO SEXES SIR,-Children’s micturating cystograms may show reflux of urine into the vagina: and one occasionally sees it coming from the vagina some time after micturition in young girls troubled
by dysuria, damp knickers, or persistent vaginal discharge. Perhaps such urine is one of the sources of ascending infection postulated by Dr. Smallpeice in her wise article (Nov. 5, p. 1019). Advice to separate the labia at micturition is simple, and sometimes works. Squatting might be more effective, and could have a part in epidemiology. T. H. HUGHES-DAVIES.
URINE AS MEDIUM FOR BACTERIAL GROWTH SIR,-We must apologise for inadvertently submitting an incorrect drawing of figure 3 in the article (Nov. 12, p. 1037) by our colleagues and us. The figure published refers to a pilot
The method of Dr. Child and his colleagues is indeed an improvement, deriving both thickness and diameter from four measurements of erythrocytes in two solutions by a precision optical instrument. It seems a long way from briefly looking through an unstained thin smear at two candles seven-odd feet away-a technique which seemed helpful enough at the time.6 BENNETT M. DERBY.
TRAINING OF CONSULTANTS SIR,-For a first breakfast reading after two months as an Association for the Study of Medical Education fellow studying residency-training programmes in internal medicine across North America your report last week (p. 1073) filled me with were broad-based despair. The main " recommendations " regional committees and a small central committee which would keep itself fully informed of regional events, give advice when necessary, and negotiate with the two sources of finance ..." (my italics). Does this country now have such a death-wish that whenever it is faced with a really serious situation such as the mass emigration by doctors it must compulsorily react by forming a committee, committees, or more terminally a Royal Commission ? Are there not already too many highly paid men locked in negated action, a state to which they become so happily habituated that they fail to seek alternatives ? Is it not time for someone to say: The buck stops here " ? Prof. G. A. Smart is right when he says that the present system is chaotic-it is also anachronistic, but tinkering with the nomenclature of registrars will not cure it, nor will the mere " " adoption of the apparatus which helps the American residency-training programme to function so smoothly, however desirable and necessary this may be. The truth is that no residency-training reform will succeed in keeping doctors in this country unless those 50-60% who do not aspire to or achieve the academic noose can find at the end of their residency training at about the age of 30-32, irrespective of examinational gymnastics but on the merit of the training they have received, a rewarding professional life, not as boys but as men. Politicians and their advisers should note that rewarding for most doctors means conditions of work in precedence to financial return. Anyone who doubts this should examine current powerful trends in the U.S.A. towards academic medicine, which is notoriously more poorly paid than private practice; they should also carry out a survey among the hundreds of very good British doctors who have emigrated, asking their reasonsI had the privilege of meeting many of them in British Columbia where they provide an excellent health service for that Province, the broad pattern of which we should copy here if our own National Health Service is to survive. "
...
"
"
Growth-rates of Escherichia coli grown in the urines obtained from the Rhondda Valley survey measured at original pH of the urine, and after adjustment of the pH to 6-0.
study carried
out in the Rhondda Valley and tive survey described in the article. The shown here.
Departments of Medicine and Bacteriology, Welsh National School of Medicine, Cardiff Royal Infirmary.
not to
the definifigure is
correct
A. W. ASSCHER M. SUSSMAN.
SIZES AND SHAPES OF RED BLOOD-CELLS SiR,ŁThe preliminary communication by Dr. Child and his colleagues (Oct. 22, p. 891) leaves the impression that they have devised a new optical technique for determining erythrocyte diameters. Their brief note did not allow full historical consideration, which doubtless is incorporated in their full manuscript scheduled for publication in 1967. Thomas Young showed the value of the principle of diffraction for the measurement of small objects, including red cells, in 1813.1 Pijper rediscovered the diffraction technique for measuring erythrocytes in 1919and made effective use of it in the diagnosis of pernicious anaemia.3 This very simple method was further used by Pryce,4 and the widespread adoption and instrumentation of the diffraction technique of red-cell measurement was reviewed by Haden,l who called his own instrument an
erythrocytometer.5õ
Haden, R. L. J. Lab. clin. Med. 1938, 23, 508. Pijper, A. S. Afr. Med. Rec. Sept. 27, 1919; Med. J. S. Afr. 1919, 14, 472; J. Lab. clin. Med. 1947, 32, 857. 3. Pijper, A. Lancet, 1924, ii, 367; Br. med. J. 1929, i, 635. 4. Pryce, D. M. Lancet, 1929, ii, 275. 5. Haden, R. L. J. Lab. clin. Med. 1940, 25, 399.
1. 2.
"
J. W. PAULLEY.
FIBRINOGEN IN CEREBRAL MALARIA SIR,-The suggestion of Dr. Hetherington (Oct. 29, p. 971) that fibrinolysis may be part of the therapeutic action of antimalarials is interesting. The mechanism of antimalarial action by chloroquine is unknownand I am not aware of any published studies of its influence on coagulation or fibrinolysis. Dr. Hetherington also suggests that blackwater fever may be partly caused by excessive fibrinolysis. Blackwater fever is often accompanied by acute renal failure, in which I think disseminated intravascular coagulation is a more likely mechanism,8 with excessive fibrinolysis as a result rather than a cause.
School of Tropical Medicine,
Liverpool
3.
H. A. REID.
Bray, W. E. Clinical Laboratory Methods; p. 157. St. Louis, 1951. Goodman, L. S., Gilman, A. The Pharmacological Basis of Therapeutics; p. 1093. New York, 1965. 8. Wardle, E. N. Br. med. J. 1966, ii, 1010.
6. 7.
by dysuria, damp knickers, or persistent vaginal discharge. Perhaps such urine is one of the sources of ascending infection postulated by Dr. Smallpeice in her wise article (Nov. 5, p. 1019). Advice to separate the labia at micturition is simple, and sometimes works. Squatting might be more effective, and could have a part in epidemiology. T. H. HUGHES-DAVIES.
URINE AS MEDIUM FOR BACTERIAL GROWTH SIR,-We must apologise for inadvertently submitting an incorrect drawing of figure 3 in the article (Nov. 12, p. 1037) by our colleagues and us. The figure published refers to a pilot
The method of Dr. Child and his colleagues is indeed an improvement, deriving both thickness and diameter from four measurements of erythrocytes in two solutions by a precision optical instrument. It seems a long way from briefly looking through an unstained thin smear at two candles seven-odd feet away-a technique which seemed helpful enough at the time.6 BENNETT M. DERBY.
TRAINING OF CONSULTANTS SIR,-For a first breakfast reading after two months as an Association for the Study of Medical Education fellow studying residency-training programmes in internal medicine across North America your report last week (p. 1073) filled me with were broad-based despair. The main " recommendations " regional committees and a small central committee which would keep itself fully informed of regional events, give advice when necessary, and negotiate with the two sources of finance ..." (my italics). Does this country now have such a death-wish that whenever it is faced with a really serious situation such as the mass emigration by doctors it must compulsorily react by forming a committee, committees, or more terminally a Royal Commission ? Are there not already too many highly paid men locked in negated action, a state to which they become so happily habituated that they fail to seek alternatives ? Is it not time for someone to say: The buck stops here " ? Prof. G. A. Smart is right when he says that the present system is chaotic-it is also anachronistic, but tinkering with the nomenclature of registrars will not cure it, nor will the mere " " adoption of the apparatus which helps the American residency-training programme to function so smoothly, however desirable and necessary this may be. The truth is that no residency-training reform will succeed in keeping doctors in this country unless those 50-60% who do not aspire to or achieve the academic noose can find at the end of their residency training at about the age of 30-32, irrespective of examinational gymnastics but on the merit of the training they have received, a rewarding professional life, not as boys but as men. Politicians and their advisers should note that rewarding for most doctors means conditions of work in precedence to financial return. Anyone who doubts this should examine current powerful trends in the U.S.A. towards academic medicine, which is notoriously more poorly paid than private practice; they should also carry out a survey among the hundreds of very good British doctors who have emigrated, asking their reasonsI had the privilege of meeting many of them in British Columbia where they provide an excellent health service for that Province, the broad pattern of which we should copy here if our own National Health Service is to survive. "
...
"
"
Growth-rates of Escherichia coli grown in the urines obtained from the Rhondda Valley survey measured at original pH of the urine, and after adjustment of the pH to 6-0.
study carried
out in the Rhondda Valley and tive survey described in the article. The shown here.
Departments of Medicine and Bacteriology, Welsh National School of Medicine, Cardiff Royal Infirmary.
not to
the definifigure is
correct
A. W. ASSCHER M. SUSSMAN.
SIZES AND SHAPES OF RED BLOOD-CELLS SiR,ŁThe preliminary communication by Dr. Child and his colleagues (Oct. 22, p. 891) leaves the impression that they have devised a new optical technique for determining erythrocyte diameters. Their brief note did not allow full historical consideration, which doubtless is incorporated in their full manuscript scheduled for publication in 1967. Thomas Young showed the value of the principle of diffraction for the measurement of small objects, including red cells, in 1813.1 Pijper rediscovered the diffraction technique for measuring erythrocytes in 1919and made effective use of it in the diagnosis of pernicious anaemia.3 This very simple method was further used by Pryce,4 and the widespread adoption and instrumentation of the diffraction technique of red-cell measurement was reviewed by Haden,l who called his own instrument an
erythrocytometer.5õ
Haden, R. L. J. Lab. clin. Med. 1938, 23, 508. Pijper, A. S. Afr. Med. Rec. Sept. 27, 1919; Med. J. S. Afr. 1919, 14, 472; J. Lab. clin. Med. 1947, 32, 857. 3. Pijper, A. Lancet, 1924, ii, 367; Br. med. J. 1929, i, 635. 4. Pryce, D. M. Lancet, 1929, ii, 275. 5. Haden, R. L. J. Lab. clin. Med. 1940, 25, 399.
1. 2.
"
J. W. PAULLEY.
FIBRINOGEN IN CEREBRAL MALARIA SIR,-The suggestion of Dr. Hetherington (Oct. 29, p. 971) that fibrinolysis may be part of the therapeutic action of antimalarials is interesting. The mechanism of antimalarial action by chloroquine is unknownand I am not aware of any published studies of its influence on coagulation or fibrinolysis. Dr. Hetherington also suggests that blackwater fever may be partly caused by excessive fibrinolysis. Blackwater fever is often accompanied by acute renal failure, in which I think disseminated intravascular coagulation is a more likely mechanism,8 with excessive fibrinolysis as a result rather than a cause.
School of Tropical Medicine,
Liverpool
3.
H. A. REID.
Bray, W. E. Clinical Laboratory Methods; p. 157. St. Louis, 1951. Goodman, L. S., Gilman, A. The Pharmacological Basis of Therapeutics; p. 1093. New York, 1965. 8. Wardle, E. N. Br. med. J. 1966, ii, 1010.
6. 7.