Document 7O4NVnpkxaQ1X3Vmm8wjN45na

** hV(vy<: , | 11!,| m H ill| 0 ^ || | II 1194 Nov. 3. 1962 `^^feORRESPO^EffeNCE DY A W-------------------------------- M*PCAi. JOUKMAL with good grace. Are the teacher^hftlng'fgisntefKsp} scientists rather than doctors? Are the medical jourhait f to-day enj ying the prestige which seems unreason ably to accumulate around the science rather than the art and practice of medicine? And do not the con tributors feed the journals for the prestige necessary to gain a laboratory, an appointment, or a grant ? And yet what little gain the patient gets from it all. I do not say that research is unnecessary: only that as it thrives it does so at the expense of the doctors who practise medicine. This is probably inevitable, but this thriving plant of research must not overwhelm the others. Medical scientists often have no medical degree. It is not necessary. It may not even be desirable in the future. What will be desirable in the future is a popular form of service named family doctoring, which is aided in its organization, its recruitment, and its advances by a powerful medical press.--I am, etc., London E.17. J- H. S. MORGAN. Fluoridation of Water Sir,--We hear that the incidence of dental caries in this country is alarmingly high, and that the under staffed dental profession is having difficulty in keeping pace with the problem. A recent report1 states that in those drinking fluoridated water all- their lives the incidence of caries amongst them is 66% less than in other communities. It also states that in fluoridation the dental, medical, chemical, engineering, and legal aspects have been solved to the satisfaction of those qualified to judge. If these statements are true, what are we waiting for ? Fluoridation of the water supply in all parts of the country would seem to be an excellent way of dealing with an urgent problem, and might not the B.M.A. take a lead in the matter ?--I am, etc., Warminster, Wilts. LONGBOORNE. Reference * Trulsoo, M. F., Clancy, R. E, and Stare, F. S., Practitioner. 1962, 189, 510. Blankets and Hospital Infection StR.--We were disappointed to read in your leading article (August 4, p. 314) that. " particles of wool from blankets make a large contribution to the dust of a hospital ward." Published analyses1*3 have all shown that air-borne fibres are essentially cotton. Wool blankets have suffered unjustly from errors which have gained widespread credence through frequent repetition, and it is perhaps opportune to draw attention to other popular misconceptions. The claims that the population of airborne bacteria or the incidence of wound sepsis can be reduced by a change from wool have now been disproved.4-* but dubious economic assertions are now taking their place. Calcu lations based on a wool blanket life of 60 wash cycles* are unrealistic. This value was obtained in an unreplicated test' using blankets that lost almost 9% of their weight during shrinkproofing. Usual industrial losses are below 2% and articles losing 4% are regarded as severely damaged,* Other shrinkproof wool blankets bought under contract by institutions have lasted 300 and 350 high-temperature (boiling) wash cycles.* I,J Hightemperature laundering of wool is a practical laundry procedure used on a scale large enough to cause a demand for an Australian Standard method.11 Avail able figures for thermal insulation of blankets1513, that wool blankets are warmer than alternatives, both before and after laundering. The variance of medical opinion between British and Australian sources is due in part to the different weaves traditionally used for blankets in the two countries.*14 Precautions are necessary to obtain a satisfactory shrink-resist finish on a British plain weave blanket witli dissimilar warp and weft yams, but this can be done. Alternatively -twill weave blankets of Australian type, can be woven and shrink-resistance thus simplified. | Since your journal's opinion on public-health matters i is widely followed, we must advise workers in this field: to be careful to avoid condemnation of established practice by inadequate test. A newspaper announce ment condemning the use of wool blankets in home > nursing1* on the basis of a test14 involving so-called j wool" blankets which were later shown to be essen- t dally a rayon/cotton mixture1* is an illustration of this 4 point Many hospital "woollens" are actually mixed fabrics14 with properties very different from shrink- * resistant pure wool,--We are, etc, TV Royal Melbourne Hospital. Melbourne, Australia. *?' 5OWUNOT. A- PRESSLEY. References I Pressley, T. A, Lancet. 1958, 2, 712. * Rubbo, S. D- Pressley, T. A, Stratford, B. C, and Dotson, S, ibid, 1960, 2. 397. * Larkin, 1. M,, Bndson. E. Y,, Grieve, W. S. M, and Gibson. J. W,, J din. Path., 1961. 14. 80. * Newcastle Regional Hospital Board Working Party, /. Bye. ILand.), 1962, 60, 85. 4 Williams, R. E. O, Noble, W. C,, Jevons, M. P, Lidweti. O. M., Shooter, R, A, White, R. G., Thom. B. T, and Taylor. G. W,, Brit. med. 1962. 2, 275. * Rountree, P. M,, Loewenlhal, J, Tedder, E, and Gye, R., Mrd. J. A list.. 1962, 2. 367. ' Newcastle Regional Hospital Board, Report on Shrinkage of Woollen Blankets, 1957. Newcastle upon Tyne. * Moncrieft, R. W , WooI Shrinkage and its Prevention. 1953, p. 218. National Trade Press, London. * Pressley, T. A, and Morris, F. P, Med. 1. Aust.. 1962. I. 43. 14 James L, Aust. National DrycUaner and Launderer. 1962, 13, No. 8. II Standards Association of Australia, Australian Standard No. CL2. Laundering of Shrinkwesistant Wool Blankets. 1962. Sydney. ** Pierce, F. T, and Rees, W. H,, J. Text. Inst., 1946, 37, TI81. " Rowlands, R: J, Text. Res. J. In press. 11 Wool Science Review. 1961, No. 20, 45, International Wool Secretariat, London. >* Sunday Times Medical Panel, Sunday Times, 1958, October 12. . . .* Schwahacher, H., Salsbury, A. J., and Fincham, W. J.. Lancet 1958 2 709 " Lennox. F. G,, ibid, 1959. 2. 63. '* Harwood, F. C,, Powrtey, J., and Edwards, C. W, Brit. med. J.. 1944, 1, 615. Mesotheliomas and Asbestos Dust Sir,--Investigations in South Africa,1 * and recent inquiries in Great Britain and elsewhere,3 4 have indicated that there may be an association between diffuse mesotheliomas of the pleura and peritoneal cavities and exposure to asbestos dust. There appears to be no correlation between the severity of any pul monary asbestosis and the occurrence of these tumours. In a number of cases the exposure to asbestos dust appears to have been minimal, and the only histological evidence of asbestos exposure is the presence of a few asbestos bodies and fibres in the lung tissue. However, a detailed occupational history has, in nearly all cases, revealed some contact with asbestos fibre. More information is required on this subject to proportion of these uncommon tumours GG 14705 l l ^v> >i., v* . - it'a - ? s ' _*_, 1 BB 0Q0553T7 Ej 19& Hfc-- correspondence utjraa 1195 kUXXCAJ- JOV1ML people who have been exposed at some time to (sbest s dust. A histochemical method has been tevcloped for differentiating between pleural meso- Vliomas and peripheral pulmonary adenocarcinomata.* lA^would appreciate, therefore, information con- er^^any patient in whom this, type of tumour has *e^^gnosed : and suggest that this information be ent to the Director, Medical Research Council, Pneumo- oniosis Research Unit. Llandough Hospital, Penarth, llamorgan, South Wales, where we are compiling a egister of these cases.--We are, Wetc. .J. Smither. Cepe Insulation A Asbestos ' Chairman, Product* Ltd, . Barking, Essex. Asbestos Research Council. Medical Research Council, WILSON* Pneumoconiosis Research Unit, J* C. WAGNER. Uandougb Hospital, Penarth, Clam. Kepubces Slcegs, C. A, Marcband, P, and Wagner, J. C, S. Afr. med. J* 1961, 35, 28. Wagner. J. C, Sieges, C. A, and Marcband, P,, Bril. J. tnduttr. Med* I960, 17. 260. Real, E. E_ Lancet. 1960. 2. 1211. Konig, J, Arch. Cewerbepath. Cewerbehyg,, I960, 18. 159. Wagne!. J. C, Monday, D. E, and Haringtoo, J. S-, J. falh. Bad* 1962, 84, 73. Loss of Protein in the Gut Sm,--'Your recent leader (September 29, p. 841) scussing protein-losing enteropathy mentioned the issible value of ilCr albumin in the diagnosis of this mdition. While there is no doubt that this substance theoretically superior to 1,11 PVP we have found that preparation is scarcely justifiable economically. Zb thod described by Waldmann,1 in which free ro. i is removed by passage through MB1-- iberlite resin--results in the loss of S0%-90% of the iginal radioactivity. There is, however, free chromium U present after this procedure, and dialysis for 24 urs to remove it is advisable. The proportions of romium and albumin used initially were those ggested by Gray and Sterling.1 Using this modification proximately 85%-93% of the original radioactivity is t in preparation, a procedure which, it must be added, *es about two days to complete. It will interest us to know what experience others ve had.--We are, etc.. tanchester Rova< Infirmary, Manchester 13. C. E. Ashcroft. O. P. GALPIN. ReroiENces v'aldmann, T. K* Lancet. 196J. 2. 121. 'ray, S. J,, and Sterling. K_, J. clin. Invert* 1950, 29, 1604. Long-terra Anticoagulant Therapy >ir,--The results of the trial of long-term antt.gulant therapy in cerebrovascular disease by Hill, ;rshall. and Shaw (October 20, p. 1003) are in agreent with those of most British workers in this field. ' authors rightly stress the dangers of this treatment 1 its failure to prevent recurrence of cerebral mfarc* i, and my own much smaller series confirms this, iough the difference in the fate of the control groups f m^^ble. -ut Akoi patients admitted to Ashford Hospital, ddl^^ in 1956, 1957, and 1958 with the diagnosis ecent atheromatous cerebral infarction, only 32 were found who were Un3ter.70 years of age, had experienced a previous stroke, had a diastolic blood-pressure of below 110 mm. Hg, and had no contraindication to anti coagulant therapy. These 32 were divided at random into 16 controls and 16 on anticoagulant therapy, and a preliminary report of the results was given at the Dundee conference, i960.1 This showed six deaths, six recurrent infarctions, one minor recurrence, and three asymptomatic in the controls; with four deaths, three recurrent infarctions, three minor recurrences, and six asymptomatic in the treated group--very little differ ence. The trial was stopped and a recent follow-up (now from four to six years) shows eight deaths, five recurrent infarctions, two minor recurrences, and one asymptomatic in the controls; with seven deaths, three recurrent infarctions, four minor recurrences, and two asymptomatic ,in the treated group. One of the treated deaths was due, to cerebral haemorrhage, and of the 15 tout deaths 10 were due to extracranial causes--fairly evenly distributed between the groups. This selection of patients who have had at least two cerebral infarcts probably explains in part the difference in morbidity and mortality between my series, where half the patients were dead in each group from four to eight years after their' second or third stroke, and Hill, Marshall, and Shaw's surprising figure of only one cerebrovascular death out of 65 patients in the control group with the trial tasting up to four years.' The other reason for this discrepancy may be that the aver age of their series was 57 years, and,of mine -66 years, so that the normal survival rates would be quite different. It will, however, be a pity, as the authors suggest, if these results are interpreted as showing that anti coagulants should never be given for any length of time in cerebrovascular disease, because the results of using them as a prophylaxis against recurrence of cerebral embolism and against continuation of disabling transient ischaemic attacks are well established.--I am, etc, . Neurological Unit. Ashford Hospital, Middlesex. A. BARHAM CARTER. Reference * Thrombosis and Anticoagulant Therapy. 1960, p. 64, edited by V/. Waiver, Livingstone, London. " Iatrogenic " Sir, -- Mr. Aleck W. Bourne criticizes the use of the word " iatrogenic" (September 1, p. 610). He says that the word is derived from the Greek Caepoc, a doctor, and yewdua. I produce or create. He argues that "iatrogenic" as an adjective means something which produces a doctor and not something which a doctor produces. Every philologist knows that most Greek words like those of other languages have several meanings usually. Therefore the Greek noun* yestr^c means both the begetter and the begotten. Indeed the adjective i-cvvr,Toc means begotten or produced. Therefore 1 submit that the adjective " iatrogenic '' is a very appropriate word to describe a disease that a doctor has produced.--1 am, etc., University College, Galway. B. J. O'Driscoll. Reference 1 A Lexicon Abridged from Liddell and Scott's Gretk-Engllsh Lexicon. Oxford, 1871, l the Clarendon Press. Impression of 1958, p. 140. t 3 C/3 TM U-i "o JLi CL> 3o --V iJZ. --t kij ; ! .. C O" . - rT --- c 00 05 532 J