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USELESS QUARANTINE?
946 The eggs of both groups were turned by hand three times daily up to the 18th day, and after 21 days an almost equal hatch was obtained from the battery and free-range groups
respectively. The experiment
was so organised that the chicks from both groups hatched within a 24-hour period. A random sample of 11 one-day-old chicks was taken from each group for necropsy. Chicks were examined in pairs, one from each group; and the pair was killed by ether anaesthesia. The aorta: were exposed and opened in situ; they were then removed and fixed in buffered 10% formol-saline for two hours. After fixation aortx were stained in pairs for 15 min. in a saturated solution of Oil Red 0 in equal parts of acetone and 70% ethanol. The preparations were then differentiated for 11/2 min. in 90% ethanol, rinsed in formol-saline, and examined under a dissecting microscope at a magnification of 35.
The paraaortic adipose tissue stained bright red, and a few red droplets were visible beneath the adventitia in both groups. No intimal sudanophilia was detected in either group. We found, therefore, nothing to support Dr. Sinclair’s suggestion that battery hens’ eggs are nutritionally inferior to those from free-range birds as determined by the aortic development of the day-old chick. Further work on gas-liquid chromatographic analysis of the lipids of these two types of aorta will be published later. Spillers Limited, J. B. M. COPPOCK Technological Research Station, N. W. R. DANIELS. Cambridge. G. A. GRESHAM Department of Pathology, A. N. HOWARD. Cambridge. USELESS
QUARANTINE?
SIR,-It was pleasure to read the common-sense views expressed by Colonel H. Foster in his letter (April a
1). I am sure that he is right in advocating considerable relaxation in quarantine restrictions applied to the common infectious diseases. I agree that far too many children are excluded from school quite unnecessarily, and for too long. For the past eleven years in this city we have not routinely excluded contacts in any of the common infectious diseases such as scarlet fever, chickenpox, measles, whooping-cough,
rubella, and mumps; and four
years ago Sonne
dysentery
policy.
JOHN F. WARIN Medical Officer of Health.
" A DEPARTURE FROM NORMAL PRACTICE "
SIR,-The remarks of Dr. Tredgold and Dr. Soddy (March 25) about the case of Landau v. Werner are apposite and, as they say, the outcome in this case is of great concern to psychiatrists and general practitioners. And there are other aspects which they did not mention which are very disturbing: (1) Since letters written many years earlier were admitted in evidence, the case is a lesson to psychiatrists and practitioners who might not keep letters they receive from patients. If such letters are to be admissible in evidence it will mean that they will have to be kept for many years and probably until the patients die. (2) The only psychiatric evidence which seemed to confirm the contentions of the prosecution was based on one psychiatric interview with the patient eight years previously. Would it not be an advantage if psychiatrists appearing for the parties were to examine any mentally ill patient within a short period before the case is heard ?
DONALD BLAIR.
London, W. 1.
FŒTAL ABNORMALITY SIR,-In your account of April 8 of the conference on this subject you reported that I had observed that " an
abnormal facies was not renal lesion in the foetus,
always associated with a even
severe
if the pregnancy had been
complicated by hydramnios ". What I said, in fact, was that Potter’s facies could be found, not only in bilateral renal agenesis, but also in association with other congenital abnormalities of the urinary tract, including urethral obstruction by mucosal folds and severe phimosis. In all the cases observed, there had been oligohydramnios or anhydramnios, which might possibly be the decisive factor in the causation of the abnormal facial features. I am also reported to have said that " catheterisation of the infant’s oesophagus was useful when hydramnios was found in pregnancy " (and no external malformation apparent at birth). This is correct, but the point of my contribution to the discussion was, that even where the oesophagus had been found to be patent, one could not exclude the possibility of some malformation causing outside pressure on the upper alimentary tract. A relevant observation was referred to: a case of severe hydramnios with no external deformity of the infant; catheterisation revealed patency of the oesophagus. At necropsy, however, a persistent truncus arteriosus (grade 4) was found with a very high and wide aortic arch, closely apposed to the oesophagus and likely to interfere with deglutition. Department of Pathology, H. G. KOHLER. Birmingham Maternity Hospital.
TECHNIQUE
was
added to this list. Very occasionally individual contacts may be excluded on the advice of the general practitioner or the school medical officer, but these are the exception rather than the rule. I have at no time had cause to regret this more liberal Oxford.
(3) The delay in bringing the case was evidently responsible in part for the heavy damages, and this is a warning to psychiatrists and other doctors to inform their defence societies if they seriously suspect that a patient may sooner or later take legal action against them. (4) Some of Miss Landau’s evidence was accepted as true and some as untrue. Do the legal authorities understand the full significance and implications of legal action taken by patients with mental illness against their doctors, and do they realise the difficulties they are likely to meet in the future in dealing with a case of amorous or litigious paranoia, since this is the type of patient who may well take action against the doctor ?
OF CRANIOTOMY
SIR,-Iwonder how many neurosurgeons still avoid making burr-holes in the midline when performing a craniotomy near it? Some surgeons mark the midline meticulously with a scratch or bradawl marks on the bone, in order to avoid damage to the sagittal sinus. In fact the dura over the sinus is tougher and less adherent the bone than it is 1/2 in. on either side of it, where large cortical veins enter the layers of the dura. A line of burr-holes and Gigli-saw cuts linking them can be made almost blood-
to
lessly, by keeping strictly over the sinus itself, without danger of calamity, and with better access to the region of the falx. If angiographic details of the cortical veins are available, these also can be avoided in making the coronal saw cuts; even then they will occasionally ooze when the bone-flap is lifted, but this bleeding is easily stopped without sacrificing a vein, which is sometimes necessary when it has been torn by guide or saw. Brook General Hospital, London, S.E.18.
JOHN R. GIBBS.
RESPIRATORY COLLAPSE DUE TO PLASTIC SPRAY DRESSING
SiR,-An unusual incident happened to a five-month-old baby on whom I operated for ileocsecal intussusception. After the operation was finished, while the anaesthetist was aspirating the baby, who was now fully conscious, I decided to dress the right paramedian incision with’ Aerofilm ’ (Laboratoires
respectively. The experiment
was so organised that the chicks from both groups hatched within a 24-hour period. A random sample of 11 one-day-old chicks was taken from each group for necropsy. Chicks were examined in pairs, one from each group; and the pair was killed by ether anaesthesia. The aorta: were exposed and opened in situ; they were then removed and fixed in buffered 10% formol-saline for two hours. After fixation aortx were stained in pairs for 15 min. in a saturated solution of Oil Red 0 in equal parts of acetone and 70% ethanol. The preparations were then differentiated for 11/2 min. in 90% ethanol, rinsed in formol-saline, and examined under a dissecting microscope at a magnification of 35.
The paraaortic adipose tissue stained bright red, and a few red droplets were visible beneath the adventitia in both groups. No intimal sudanophilia was detected in either group. We found, therefore, nothing to support Dr. Sinclair’s suggestion that battery hens’ eggs are nutritionally inferior to those from free-range birds as determined by the aortic development of the day-old chick. Further work on gas-liquid chromatographic analysis of the lipids of these two types of aorta will be published later. Spillers Limited, J. B. M. COPPOCK Technological Research Station, N. W. R. DANIELS. Cambridge. G. A. GRESHAM Department of Pathology, A. N. HOWARD. Cambridge. USELESS
QUARANTINE?
SIR,-It was pleasure to read the common-sense views expressed by Colonel H. Foster in his letter (April a
1). I am sure that he is right in advocating considerable relaxation in quarantine restrictions applied to the common infectious diseases. I agree that far too many children are excluded from school quite unnecessarily, and for too long. For the past eleven years in this city we have not routinely excluded contacts in any of the common infectious diseases such as scarlet fever, chickenpox, measles, whooping-cough,
rubella, and mumps; and four
years ago Sonne
dysentery
policy.
JOHN F. WARIN Medical Officer of Health.
" A DEPARTURE FROM NORMAL PRACTICE "
SIR,-The remarks of Dr. Tredgold and Dr. Soddy (March 25) about the case of Landau v. Werner are apposite and, as they say, the outcome in this case is of great concern to psychiatrists and general practitioners. And there are other aspects which they did not mention which are very disturbing: (1) Since letters written many years earlier were admitted in evidence, the case is a lesson to psychiatrists and practitioners who might not keep letters they receive from patients. If such letters are to be admissible in evidence it will mean that they will have to be kept for many years and probably until the patients die. (2) The only psychiatric evidence which seemed to confirm the contentions of the prosecution was based on one psychiatric interview with the patient eight years previously. Would it not be an advantage if psychiatrists appearing for the parties were to examine any mentally ill patient within a short period before the case is heard ?
DONALD BLAIR.
London, W. 1.
FŒTAL ABNORMALITY SIR,-In your account of April 8 of the conference on this subject you reported that I had observed that " an
abnormal facies was not renal lesion in the foetus,
always associated with a even
severe
if the pregnancy had been
complicated by hydramnios ". What I said, in fact, was that Potter’s facies could be found, not only in bilateral renal agenesis, but also in association with other congenital abnormalities of the urinary tract, including urethral obstruction by mucosal folds and severe phimosis. In all the cases observed, there had been oligohydramnios or anhydramnios, which might possibly be the decisive factor in the causation of the abnormal facial features. I am also reported to have said that " catheterisation of the infant’s oesophagus was useful when hydramnios was found in pregnancy " (and no external malformation apparent at birth). This is correct, but the point of my contribution to the discussion was, that even where the oesophagus had been found to be patent, one could not exclude the possibility of some malformation causing outside pressure on the upper alimentary tract. A relevant observation was referred to: a case of severe hydramnios with no external deformity of the infant; catheterisation revealed patency of the oesophagus. At necropsy, however, a persistent truncus arteriosus (grade 4) was found with a very high and wide aortic arch, closely apposed to the oesophagus and likely to interfere with deglutition. Department of Pathology, H. G. KOHLER. Birmingham Maternity Hospital.
TECHNIQUE
was
added to this list. Very occasionally individual contacts may be excluded on the advice of the general practitioner or the school medical officer, but these are the exception rather than the rule. I have at no time had cause to regret this more liberal Oxford.
(3) The delay in bringing the case was evidently responsible in part for the heavy damages, and this is a warning to psychiatrists and other doctors to inform their defence societies if they seriously suspect that a patient may sooner or later take legal action against them. (4) Some of Miss Landau’s evidence was accepted as true and some as untrue. Do the legal authorities understand the full significance and implications of legal action taken by patients with mental illness against their doctors, and do they realise the difficulties they are likely to meet in the future in dealing with a case of amorous or litigious paranoia, since this is the type of patient who may well take action against the doctor ?
OF CRANIOTOMY
SIR,-Iwonder how many neurosurgeons still avoid making burr-holes in the midline when performing a craniotomy near it? Some surgeons mark the midline meticulously with a scratch or bradawl marks on the bone, in order to avoid damage to the sagittal sinus. In fact the dura over the sinus is tougher and less adherent the bone than it is 1/2 in. on either side of it, where large cortical veins enter the layers of the dura. A line of burr-holes and Gigli-saw cuts linking them can be made almost blood-
to
lessly, by keeping strictly over the sinus itself, without danger of calamity, and with better access to the region of the falx. If angiographic details of the cortical veins are available, these also can be avoided in making the coronal saw cuts; even then they will occasionally ooze when the bone-flap is lifted, but this bleeding is easily stopped without sacrificing a vein, which is sometimes necessary when it has been torn by guide or saw. Brook General Hospital, London, S.E.18.
JOHN R. GIBBS.
RESPIRATORY COLLAPSE DUE TO PLASTIC SPRAY DRESSING
SiR,-An unusual incident happened to a five-month-old baby on whom I operated for ileocsecal intussusception. After the operation was finished, while the anaesthetist was aspirating the baby, who was now fully conscious, I decided to dress the right paramedian incision with’ Aerofilm ’ (Laboratoires