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WAS LUCAS-CHAMPIONNIÈRE RIGHT ?
1040 If the pathological services of Great Britain are to maintain their high standard, then the technologist must be given his rightful place, proper training must be provided in each laboratory, and he must be given a salary commensurate with the service he performs and a status that will encourage suitable new entrants to the
profession. A new salary structure has recently been published for biochemists employed in medical laboratories which illustrates the fallacies that exist in the pathological service today. We agree that biochemists are experts and deserve their salaries, but the ridiculous position may arise in which a biochemist in charge of one department in a large establishment will get double or more the salary of the chief technician in charge of all
departments. D. W. PLAMPIN A. L. C. HUNT E. LENNON P. CAHILL.
Salisbury. Southern Rhodesia.
SMOKING AND THE HEART
SiR,-The patient with coronary disease should be strictly forbidden smoking. There are two diseases in which prohibition should be absolute-gastric ulcer and coronary heart-disease. Every compromise would be a failure. TH. OLBERT.
Diisseldorf.
THE PALLIATION OF BRONCHIAL CARCINOMA BY RADIOTHERAPY
SiR,—I have read Dr. Blanshard’s article (Oct. 29) with great interest. It is a pity, however, that no accurate assessment of the palliative value of radiotherapy can be made from his results. Although he lists the percentage of improvement in each symptom he does not record either the degree of improvement or how long it lasted. It is also unfortunate that his survey includes only 35. cases-information of statistical value cannot be obtained from such a small series. The accompanying table shows the results in 175 cases The only criteria for their treated at this hospital. selection were : (a) that the X-ray dosage was such as would be likely to effect palliation only ; and (b) that only one course of treatm,ent was given. In 124 cases (71%) histological confirmation of the diagnosis was obtained, the histological types being as follows : CARCINOMA OF BRONCHUS :
ANALYSIS OF
175
BY PALLIATIVE RADIOTHERAPY
CASES TREATED
squamous cell
32%, columnar 53%, pleomorphic 7%.
cell
7%, undifferentiated
The average survival-times were : from appearance of first symptom 11-5 months ; from completion of treat. ment 4.25 months. Although the overall results are extremely disappointing, I do not think that we are justified in concluding that palliative irradiation in bronchial carcinoma is not worth while. The response of individual patients is very variable, and it often happens that when two apparently similar cases are treated in the same way, one obtains good symptomatic relief for many months, while the other gets no relief at all. Also local symptomatic improvement may be masked by a general deterioration due to metastases. Radiotherapy Department, St. Thomas’s Hospital, London, S.E.1.
I. CHURCHILL-DAVIDSON.
WAS LUCAS-CHAMPIONNIÈRE RIGHT ?
SIR,-Last week (p. 959) you reported some remarks of mine at the British Orthopaedic Association’s meeting in Liverpool, but you have considerably altered the sense of my remarks in one respect, which I should be grateful if you would allow me to correct. You report me as saying that " the principles of reduction, maintenance of reduction, and restoration of function [in the treatment of fractures] were out of proportion." In fact, I consider these principles absolute. What I said was that we had come to confuse maintenance of reduction with immobilisation. If reduction can be maintained (as it often can) without immobilisa. tion, the fracture may well unite more readily. F. G. ST. CLAIR STRANGE. Canterbury. ENURESIS
SiR,-In your leader early this year, 1 . you drew attention to an article by Bostock,2 who reported relief in 8 out of 12 cases of enuresis treated by means of a machine designed by Crosby to wake the patient when the bladder empties. The original article by Crosby3 reported cure of 28 out of 29 children with essential enuresis. This letter is written to draw attention to Crosby’s paper and to give my experiences in the treatment of an occasional case of enuresis. The machine has been used for some 12 patients, mostly young women, of whom 4 were engaged to be married. Medical and urinary examination was negative in all. The ’ Drinite ’ apparatus was demonstrated and the working of it explained in detail, the mothers being included in the instruction of the younger patients. Of these patients, all but 2 have been cured. 2 required two and three courses of treatment respectively to effect a cure. 2 patients were not relieved ; 1 of them, a delinquent girl of 14, relapsed on falling into the hands of the police and treatment was abandoned ; the other was inadequately instructed in the use of the machine, and discontinued its use after one night, declining further treatment. The usual type of response is illustrated by the following case-history. A stenographer of 15 had wet the bed every night of her life. No treatment had been any help. She was given the apparatus for one month. She was awakened by the machine on each of the first 5 nights. Its use was stopped for the next 3 days during menstruation. (This was unnecessary; a thin pad or an internal tampon permits the efficient use of the machine during menstruation.) On the 9th and 10th nights she remained dry. On the llth night and subsequently, she drank a pint of water on retiring. On the llth night she was awakened once and on the 12th night three times by the machine. Each subsequent night till the 20th she was awakened by the desire to empty her bladder, and she got out of bed and did so. On the 20th night she was awakened by the machine for the last time. On the 21st night she was awakened by the full bladder, but thereafter she 1. Lancet, 1955, i, 391. 2. Bostock, J. Med. J. Aust. 1954, ii, 141. 3. Crosby, N. D. Ibid, 1950, ii, 533.
profession. A new salary structure has recently been published for biochemists employed in medical laboratories which illustrates the fallacies that exist in the pathological service today. We agree that biochemists are experts and deserve their salaries, but the ridiculous position may arise in which a biochemist in charge of one department in a large establishment will get double or more the salary of the chief technician in charge of all
departments. D. W. PLAMPIN A. L. C. HUNT E. LENNON P. CAHILL.
Salisbury. Southern Rhodesia.
SMOKING AND THE HEART
SiR,-The patient with coronary disease should be strictly forbidden smoking. There are two diseases in which prohibition should be absolute-gastric ulcer and coronary heart-disease. Every compromise would be a failure. TH. OLBERT.
Diisseldorf.
THE PALLIATION OF BRONCHIAL CARCINOMA BY RADIOTHERAPY
SiR,—I have read Dr. Blanshard’s article (Oct. 29) with great interest. It is a pity, however, that no accurate assessment of the palliative value of radiotherapy can be made from his results. Although he lists the percentage of improvement in each symptom he does not record either the degree of improvement or how long it lasted. It is also unfortunate that his survey includes only 35. cases-information of statistical value cannot be obtained from such a small series. The accompanying table shows the results in 175 cases The only criteria for their treated at this hospital. selection were : (a) that the X-ray dosage was such as would be likely to effect palliation only ; and (b) that only one course of treatm,ent was given. In 124 cases (71%) histological confirmation of the diagnosis was obtained, the histological types being as follows : CARCINOMA OF BRONCHUS :
ANALYSIS OF
175
BY PALLIATIVE RADIOTHERAPY
CASES TREATED
squamous cell
32%, columnar 53%, pleomorphic 7%.
cell
7%, undifferentiated
The average survival-times were : from appearance of first symptom 11-5 months ; from completion of treat. ment 4.25 months. Although the overall results are extremely disappointing, I do not think that we are justified in concluding that palliative irradiation in bronchial carcinoma is not worth while. The response of individual patients is very variable, and it often happens that when two apparently similar cases are treated in the same way, one obtains good symptomatic relief for many months, while the other gets no relief at all. Also local symptomatic improvement may be masked by a general deterioration due to metastases. Radiotherapy Department, St. Thomas’s Hospital, London, S.E.1.
I. CHURCHILL-DAVIDSON.
WAS LUCAS-CHAMPIONNIÈRE RIGHT ?
SIR,-Last week (p. 959) you reported some remarks of mine at the British Orthopaedic Association’s meeting in Liverpool, but you have considerably altered the sense of my remarks in one respect, which I should be grateful if you would allow me to correct. You report me as saying that " the principles of reduction, maintenance of reduction, and restoration of function [in the treatment of fractures] were out of proportion." In fact, I consider these principles absolute. What I said was that we had come to confuse maintenance of reduction with immobilisation. If reduction can be maintained (as it often can) without immobilisa. tion, the fracture may well unite more readily. F. G. ST. CLAIR STRANGE. Canterbury. ENURESIS
SiR,-In your leader early this year, 1 . you drew attention to an article by Bostock,2 who reported relief in 8 out of 12 cases of enuresis treated by means of a machine designed by Crosby to wake the patient when the bladder empties. The original article by Crosby3 reported cure of 28 out of 29 children with essential enuresis. This letter is written to draw attention to Crosby’s paper and to give my experiences in the treatment of an occasional case of enuresis. The machine has been used for some 12 patients, mostly young women, of whom 4 were engaged to be married. Medical and urinary examination was negative in all. The ’ Drinite ’ apparatus was demonstrated and the working of it explained in detail, the mothers being included in the instruction of the younger patients. Of these patients, all but 2 have been cured. 2 required two and three courses of treatment respectively to effect a cure. 2 patients were not relieved ; 1 of them, a delinquent girl of 14, relapsed on falling into the hands of the police and treatment was abandoned ; the other was inadequately instructed in the use of the machine, and discontinued its use after one night, declining further treatment. The usual type of response is illustrated by the following case-history. A stenographer of 15 had wet the bed every night of her life. No treatment had been any help. She was given the apparatus for one month. She was awakened by the machine on each of the first 5 nights. Its use was stopped for the next 3 days during menstruation. (This was unnecessary; a thin pad or an internal tampon permits the efficient use of the machine during menstruation.) On the 9th and 10th nights she remained dry. On the llth night and subsequently, she drank a pint of water on retiring. On the llth night she was awakened once and on the 12th night three times by the machine. Each subsequent night till the 20th she was awakened by the desire to empty her bladder, and she got out of bed and did so. On the 20th night she was awakened by the machine for the last time. On the 21st night she was awakened by the full bladder, but thereafter she 1. Lancet, 1955, i, 391. 2. Bostock, J. Med. J. Aust. 1954, ii, 141. 3. Crosby, N. D. Ibid, 1950, ii, 533.