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UTERINE ELECTROLYTES IN PREGNANCY AND LABOUR
890
( ]) The total cortified days off work (obtained from the Ministry of National Insurance). (2) ’i’ho total proscrtbing costs (obtainod from tho Pricing Bureau). (3) The number of inpatient days and outpatient appointments (obtained froi-n the hospital).
By some sort of a points system in each of the a bove Kerns taken respectively over a year, I feel sure that. a payment in addition to ordinary capitation fees could be made, which would provide incentive to good practice and would in effect be a merit award to the good general practitioner. R. N. R. GRANT.
disturbed more than I care to admit by wrangle with the Government caused by the profession’s 24% salary claim, though there are doubltess many worthy reasons why some feel justified in this claim. There is an atmosphere of wronged virtue in the profession’s publications, which assumes that we have not broken our obligations to the Government ; can we honestly say all doctors have done their work as they should in the National Health Service ? In my opinion the answer is No. I am not surprised the Government’s attitude is unhelpful when so many doctors have abused the N.H.S. Before we press our claim further I believe doctors should come forward with a scheme embodying the I cannot agree much-needed reforms in the N.H.S. that this is primarily the Government’s obligation to us. I would like to see the following incorporated :
SIR,—I
am
the current
(1) General practitioners should be paid according to work done, not for the number of patients on their lists. (2) Patients should pay for treatment and advice np to a certain fixed annual amount according to a means test. (3) Diagnostic facilities should be made available to general
practitioners. (4) Casualty departments
should receive
part-time statling
at consultant level.
Doctors’ we
position of esteem has been won by service public without counting the remuneration. If take arbitrary action, as is at present recommended,
we
shall do ourselves
to the
a
areat disservice.
EDWIN J. WRIGLEY. ASEPTIC MENINGITIS
SIR,—I have seen several cases in Marche, in Central Italy, in 1955, with clinical features partly reseinbliiithose described by Dr. Garnett and his Dr. Rotem (March 9).
colleagues and
by
Between June and November, 1955, 38 patients with this illness were admitted to hospital in Urbino.12 Many patients were from mountainous places (the Urbino area is mainly mountainous) and most of them were children and young The adults. There was no difference in sex prevalence. predominant signs and symptoms were fever, frontal headache, vomiting, photophobia, and neck rigidity. The cerebrospinal fluid (C.S.F.) was under increased pressure. There was a positive reaction for globulin and moderate increase in albumin ; the number of cells was raised (20-1500 per c.mm.), with lymphocytes predominant. 30% of our patients had rather different signs and symptoms. In many cases the liver was involved, with abnormal function tests ; 3 patients had nephritis and 1 herpangina. 10 had signs of myelo-encephalitic disorders (ataxia paresis of the limbs, lethargy, mental changes). Electrocardiographic examination often indicated myocardial damage of diffuse type, of which there was no clinical indication. Wassermann and Paul-Bunnell tests were constantly negative. At the virus laboratory of the University of Siena, Coxsackie virus was isolated from faeces and C.S.F,. in about half the cases. Recovery was quick and complete in all except 1 patient who had severe encephalitic manifestations and died. The Cuppini, R., Carnevali, G., Carotti, A. Aggiorn. Mal. Infez. 1956, 2, 21. Acta cardiol., Brux. 2. Cuppini, R., Carotti, A., Carnevali, G. (in the press). 1.
virus
was
not isolated from this that it,
opidemiological grounds,
patient, was
but
we
presume,
on
present.
Owing to the presence ill our cases of disturbances related to different parts of the meuraxis (central nervous system), we ha.ve enlled this illness acute epidemic neuraxitis due to Coxsackie virus. G. CARNEVALI. UTERINE ELECTROLYTES IN PREGNANCY AND LABOUR
SIR,—In their article of April fi Dr. R. L. and Dr. J. II. Cort drew attentionto the possible occurrence of potas. sium. depletion in pregnancy and suggested that an inadequate intake of potassiurn may have contributed to such a loss in their patients. It is likely that if potassium salts were given by mouth there would be a high proportion of digestive disturbance. The concentrated orange juice provided by the Welfare Food Service for pregnant women in this country contains a considerable quantity of potassium. Analyses of from several batches show that the concentrasamples tion is of the order of 250 iii.eq. per litre. At present it is possible, to obtain 1 bottle (171 nil.) each week, containing about 43 m.eq. of potassium. This is not a significant addit ion to dietary potassium, but it would be possible to achieve this if the dose were increased and with little likelihood of uatient resistance. The Queen Elizabeth Hospital, Birmingham, 15.
C. T. G. FLEAR.
Obituary THORVALD JOHANNES MARIUS MADSEN Hon. C.B.E.. M.D. Copenhagen Dr. Thorvald Madsen, who died on April 15 in Denmark, was long known in his own country as the head of the State Serum Institute. In the rest of the world he will also be long remembered for his work with the League of Nations and later with UNICEF. He was born in Copenhagen in 1870 and he took his medical degree at the university there in 1893. A year later lie became an assistant in the university laboratory for medical bacteriology. In 1902 he was appointed head of the State Serum Institute. Many scientists from all over the world were drawn to the Institute by his work on diphtheria toxin and antitoxin, and this was one of the subjects which he discussed in the lectures which he gave, in faultless English, to the University of London in 1929. His work for the League of Nations began after the 1914-18 war, when as chairman of the League’s Health Committee he was faced with the task of containing the epidemics raging in Eastern Europe. Cholera, typhus, and smallpox were being brought by refugees returning from Russia and Turkestan to the newly formed Eastern European States whose health services were still incomplete. Through Madsen’s administration the League was able to give timely and practical help to these governments and also to Greece, where severe epidemics had broken out after the return of refugees from Asia Minor. In 1928 when dengue fever became rife in Athens the Greek government again turned to Madsen for advice, and with his help the health services of the country were reorganised. Dr. Madsen had served so many countries so well that his record of international honours was as impressive as it was deserved. In this country he was a member of the Society of Medical Officers of Health and the Pathological Society. He was also an honorary graduate
( ]) The total cortified days off work (obtained from the Ministry of National Insurance). (2) ’i’ho total proscrtbing costs (obtainod from tho Pricing Bureau). (3) The number of inpatient days and outpatient appointments (obtained froi-n the hospital).
By some sort of a points system in each of the a bove Kerns taken respectively over a year, I feel sure that. a payment in addition to ordinary capitation fees could be made, which would provide incentive to good practice and would in effect be a merit award to the good general practitioner. R. N. R. GRANT.
disturbed more than I care to admit by wrangle with the Government caused by the profession’s 24% salary claim, though there are doubltess many worthy reasons why some feel justified in this claim. There is an atmosphere of wronged virtue in the profession’s publications, which assumes that we have not broken our obligations to the Government ; can we honestly say all doctors have done their work as they should in the National Health Service ? In my opinion the answer is No. I am not surprised the Government’s attitude is unhelpful when so many doctors have abused the N.H.S. Before we press our claim further I believe doctors should come forward with a scheme embodying the I cannot agree much-needed reforms in the N.H.S. that this is primarily the Government’s obligation to us. I would like to see the following incorporated :
SIR,—I
am
the current
(1) General practitioners should be paid according to work done, not for the number of patients on their lists. (2) Patients should pay for treatment and advice np to a certain fixed annual amount according to a means test. (3) Diagnostic facilities should be made available to general
practitioners. (4) Casualty departments
should receive
part-time statling
at consultant level.
Doctors’ we
position of esteem has been won by service public without counting the remuneration. If take arbitrary action, as is at present recommended,
we
shall do ourselves
to the
a
areat disservice.
EDWIN J. WRIGLEY. ASEPTIC MENINGITIS
SIR,—I have seen several cases in Marche, in Central Italy, in 1955, with clinical features partly reseinbliiithose described by Dr. Garnett and his Dr. Rotem (March 9).
colleagues and
by
Between June and November, 1955, 38 patients with this illness were admitted to hospital in Urbino.12 Many patients were from mountainous places (the Urbino area is mainly mountainous) and most of them were children and young The adults. There was no difference in sex prevalence. predominant signs and symptoms were fever, frontal headache, vomiting, photophobia, and neck rigidity. The cerebrospinal fluid (C.S.F.) was under increased pressure. There was a positive reaction for globulin and moderate increase in albumin ; the number of cells was raised (20-1500 per c.mm.), with lymphocytes predominant. 30% of our patients had rather different signs and symptoms. In many cases the liver was involved, with abnormal function tests ; 3 patients had nephritis and 1 herpangina. 10 had signs of myelo-encephalitic disorders (ataxia paresis of the limbs, lethargy, mental changes). Electrocardiographic examination often indicated myocardial damage of diffuse type, of which there was no clinical indication. Wassermann and Paul-Bunnell tests were constantly negative. At the virus laboratory of the University of Siena, Coxsackie virus was isolated from faeces and C.S.F,. in about half the cases. Recovery was quick and complete in all except 1 patient who had severe encephalitic manifestations and died. The Cuppini, R., Carnevali, G., Carotti, A. Aggiorn. Mal. Infez. 1956, 2, 21. Acta cardiol., Brux. 2. Cuppini, R., Carotti, A., Carnevali, G. (in the press). 1.
virus
was
not isolated from this that it,
opidemiological grounds,
patient, was
but
we
presume,
on
present.
Owing to the presence ill our cases of disturbances related to different parts of the meuraxis (central nervous system), we ha.ve enlled this illness acute epidemic neuraxitis due to Coxsackie virus. G. CARNEVALI. UTERINE ELECTROLYTES IN PREGNANCY AND LABOUR
SIR,—In their article of April fi Dr. R. L. and Dr. J. II. Cort drew attentionto the possible occurrence of potas. sium. depletion in pregnancy and suggested that an inadequate intake of potassiurn may have contributed to such a loss in their patients. It is likely that if potassium salts were given by mouth there would be a high proportion of digestive disturbance. The concentrated orange juice provided by the Welfare Food Service for pregnant women in this country contains a considerable quantity of potassium. Analyses of from several batches show that the concentrasamples tion is of the order of 250 iii.eq. per litre. At present it is possible, to obtain 1 bottle (171 nil.) each week, containing about 43 m.eq. of potassium. This is not a significant addit ion to dietary potassium, but it would be possible to achieve this if the dose were increased and with little likelihood of uatient resistance. The Queen Elizabeth Hospital, Birmingham, 15.
C. T. G. FLEAR.
Obituary THORVALD JOHANNES MARIUS MADSEN Hon. C.B.E.. M.D. Copenhagen Dr. Thorvald Madsen, who died on April 15 in Denmark, was long known in his own country as the head of the State Serum Institute. In the rest of the world he will also be long remembered for his work with the League of Nations and later with UNICEF. He was born in Copenhagen in 1870 and he took his medical degree at the university there in 1893. A year later lie became an assistant in the university laboratory for medical bacteriology. In 1902 he was appointed head of the State Serum Institute. Many scientists from all over the world were drawn to the Institute by his work on diphtheria toxin and antitoxin, and this was one of the subjects which he discussed in the lectures which he gave, in faultless English, to the University of London in 1929. His work for the League of Nations began after the 1914-18 war, when as chairman of the League’s Health Committee he was faced with the task of containing the epidemics raging in Eastern Europe. Cholera, typhus, and smallpox were being brought by refugees returning from Russia and Turkestan to the newly formed Eastern European States whose health services were still incomplete. Through Madsen’s administration the League was able to give timely and practical help to these governments and also to Greece, where severe epidemics had broken out after the return of refugees from Asia Minor. In 1928 when dengue fever became rife in Athens the Greek government again turned to Madsen for advice, and with his help the health services of the country were reorganised. Dr. Madsen had served so many countries so well that his record of international honours was as impressive as it was deserved. In this country he was a member of the Society of Medical Officers of Health and the Pathological Society. He was also an honorary graduate