Document 9L4N2j889g0r1OOQpbLwbrkzq

~Y"Vv DIGS] THE JCURNAX OF THE BRITISH MEDICAL ASSOCIATION s * Editor , HUGI CLEGG, M.A., M.D., F.R.C.P. Deputy Editor J. W. P THOMPSON, M.A., M.B., D.P.H. * VOLUME II, 1962 JULY TO DECEMBER PRICE 12s. 6d. LONDON (RITISH MEDICAL ASSOCIATION TAVISTOCK. SQUARE, W.C.1 UNIVERSITY OF OKLAHOMA  4 r. 1194 Nov. 3, 1952 CORRESPONDENCE Mzwcttmi Jmovwux with good grace. Are the teachers asking for medical scientists rather than doctors? Are the medical journals of to-day enjoying the prestige which seems unreason ably to accumulate around the science rather than the art aod 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 littie gain the patient gets from it all. 4 do not say that research is unnecessary: only that as k 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^ . ; Looden E.17. . > .* J. H. S. MORGAN. , " , Fluoridation of Water : Snt,--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 fn 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.MA take a lead is the matter ?--I am, etc, Warminster, W2ts. D. LoNGBOURNE. . . Raracto ' * Trulsoa, M. F,, Clancy, R. E, aod Sure, F. &, Practitioner, 196X 139. 510. Blankets and Hospital Infection Sir.--We were disappointed to read in your leading article (August 4, p. 314) that " particles of wool from blankets make a -targe contribution to the dust of a hospital ward.** Published analyses*'* have all shown that air-borne fibtes. 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 cycles4 are unrealistic. This value-. was obtained in an unrepiicated test* using blankets that lost almost 9% of their weight during shrinkproofing. Usual industrial losses are below 2% and articles losing 4% sre regarded as severely damaged.* Other shrmkproof wool blankets bought under contract by institutions have lasted 300 and 350 high-temperature {boiling) wash cydes.* * High- temperature laundering of wool is a practical laundry procedure used on a scale large enough to cause a demand for an Austntisa Sundsrd method.11 AvaD- ' * -- of blankets1* 11 show that wool blankets are warmer than alternatives, both^",'., before and after laundering. <*2^ . The variance of medical opinioo betweeo 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 e shrink-resist finish on a British plain weave blanket with dissimilar warp and weft yarns, but this can be donei^ Alternatively twill weave blankets of Australian type), can be woven and shrink-resistance thus simplified. Since your journal's opinion on public-health matters a is widely followed, we must advise workers in this field'* to be careful to avoid condemnation of established *', practice by Inadequate lest A newspaper announce- f" ment condemning the use of wool blankets in home-- - nursing1* on the basis ofa test1* involving so-called.5 * "wool " blankets which were later shown to be essen-*-- .tially a rayon/cotton mixture1' is an illustration of this! *\ point Many hospital "woollens'* are actually mixed* r* fabrics1* with properties very different from shrink-)*] resistant pure wool.--We are, etc, :*.* " ^ The Royal Melbourne Hospital, Melbourne, Australia. ksreuwss D. C Cowuno.^?. . T. A. PRSSLEY_/ui ' 1 Pressley, T. Lancet. 1958, X 712. ' - 7? * Rubbo. S. S,, ibid, D_ Pressley, 1960, X 397. T. A, Stratford, B. C, and Dixsoal. .\ t b * Lsrfcm. 1. M,, Sndson, E. Y,, Grieve, W. S. M, asd Gibson. 3. W,, J din. Path,, 1961. 14. 80. . It * Newcastle Rrtiona! Hospital Board Working Party, /. Hyt. t - \i(LnndJ. 196X 60. 5. . -. - * Williams, R. E. O- Noble. W. CL, Jevens. M. P, UdwdL O. M, Shooter, R. Taylor. G. W,, Brit. A, White, R- G, Tbom, med. 196X X 275. B. T,, . aad - : i * -Rountree, P, M, Locwemhal, Med. J. Ausi* 196X X 367. J, Tedder, E, and . Gye, R, ..... ; t f Newcastle Regional Hospital Board, Report an Shrinkat* of' Woollen Blankets. 1957. Newcastle upon Tyne* --i * Moncned, R. W, Wool Shrinkage and its Prevention, 1953.^ ; p. 218. National Trade Press, London. * Pressley, T. A- and Morris, F. P,, Med. J. Aust- 1962. 1. 43. j. * James L_ Auxt. National Drydeanar and Launderer.196X. 13. ;' No. X t 5. * Standards Association of Australia. Australian Standod \ No. CL2. Laundering of Shrink-resistant Wool Blankea 196X Sydney. * " Pierce, F. T,, and Rees, W. H J. Text InxU 1946, 37, Till.? . ** Rowlands, R. J, Text. Ret. J. la press. '* w Wool Science Review, 1961, No. 20, 45. International Wool l Secretarial, London. . ` | * Sunday Times Medical Panel, Sunday Timex. 1958. October IX ^ ** Schwahacher. H., Sabbury, A. J, and Finchain, W. J, Lancet. * 1958. X 709. { *f Lennox. F. G,, ibid, 1959, X 63. : * Harwood, F. C_ Powney. J., asd Edwards, CL W, Brit, med 1944, 1, 615. -ri - Mesotheliomas and Asbestos Dost Sir,--Investigations in South Africa,1* and recent:, inquiries in Crest Britain and elsewhere,*4 have- indicated that there may be an association between diffuse mesotheliomas of the pleura and peritoneal avines and exposure to asbestos dusL There apP^. to be no correlation between the severity of any P0**; monary asbestosis and the occurrence of these turnouts- In a number of- cases the exposure to asbestos dw appears to have been minimal, and the only histolop- evidence of asbestos exposure is the presence of j**. asbestos bodies and fibres in the lung tissue. Howler; a detailed occupational history has, in nearly * revealed some contact with asbestos fibre. ^ More information is required on this S'1**61 establish what proportion of these uncommon ttun ^ t Nov. "3,1$62 CORRESPONDENCE trwren ftO< Mcstcu. JOuWtU. * v occur io people who have been exposed at some time to >$ dusL A histochemical method has been sed for differentiating between pleural meso- me., mas and peripheral pulmonary adenocarcinomata.* We would appreciate, therefore, information con cerning any patient in whom this type of tumour has bees diagnosed; -and suggest that this information be sent to the Director, Medical Research Council, Pneumo coniosis Research Unit, Uandough Hospital, Penarth, Glamorgan, South Wales, where we are compiling a register of these cases.--We are, etc4` . .. Cape Insulation <fc Asbestos Produet- Lid* Barking, Esso. . W. J. Smttheh, ' ' Chairman, Asbestos Research Council. . Medical Research CouncaL . . ** Pneumoconiosis Research Unit, * '-> WAGNER. Uaadough Hospital, Peaarth, CIiol ... - - - .. ` . Rzpcunces .. ; * 5!eggs, C A.. Mardtand, P-, aad Wagner, J. C, S. Afr. med. Jm 1961, 35. 23. * Wagner, S. G. Slegp, C A^ tad * Marcbaod, P,,. Brit. V. InJusn. Med* I960. 17. 260- . .. * KL E. E, Lancet. I960. 2. 1211. ' ' *" 4 Konig, i* Arch. Grwerbepath. Geerbthyg* 1960, 18. 159. * Wagner, j. C. Munday, D. ,. aad Hariogtoo, J. S. J. Path. 3acU 1962. H 73. -- .' - . .Loss of Protein is the Gut - . . Sir,--Your recent leader (September 29, p. 84!) dy" *sing protein-losing enteropathy mentioned the )e value of **Cr albumin in the diagnosis of this jnmtion. While there is oo doubt that this substance is theoretically superior to 13,1 PVP we have found that its preparation is scarcely justifiable economically. The method described by Waldmann,1 to which free chromium is removed by passage 'through MB1-- amberKte resin--results in the loss of 80%-90% of the original radioactivity. There is, however, free chromium still present after this procedure, and dialysis for 24 hours to remove it is advisable. The proportions of chromium and albumin used . .were suggested by Gray and Sterling.* Using this modification approximately 85%-93% of the original radioactivity is lost in preparation a procedure which, it must be added, takes about two days to complete. ~ It will interest us to know what experience others have had.--We are, etc^ ' *. Manchester Royal Infirmary, ^ ^ ASHCROFT. Manchester 13. - - O. P. GaLPIN. Rptwai ' Waldmann. T. A- Lanctu 1961, 2. 121. 1 Cray, S. J,, and Sterling. K* J. din. Invest* 1950, 29. 1604. Long-term Anticoagulant Therapy Sir,--The results of the trial of long-term anti coagulant therapy in cerebrovascular disease by Hill, Marshall, and Shaw (October 20, p. 1003) are in agree- with those of most British workers in this field. 1 authors rightly stress the dangers of this treatment ^nd its failure to prevent recurrence of cerebral tnfarchn. and my own much smaller series confirms this, although the difference in the fate of the control groups * remarkable. of 201 patients admitted to Ashford Hospital, Middlesex, in 1956, 1957, and 1958 with the diagnosis of recent atheromatous cerebral infarction, only 32 were found who were under 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 giveo at the Dundee conference, I960.1 This showed six deaths, six recurrent infarctions, one minor recurrence, and threeasymptomatic 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, aod of the 15 total 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 pan 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 H3J, Marshall, and Shaw's surprising figure of only one cerebrovascular death out of 65 patients in the control group with the trial lasting up to four yean. The othgr 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 ami, etc. Neurological Unit. Ashford Hospital, Middlesex. A. Barham Carter. ' * RcFERSMea . . . : 1 Thrombosis and Anticoagulant Therapy. I960, p. 64, edited by W. Waiter. Liviagstone, Loedoa. . M Iatrogenic " Sir. -- Mr. Aleck W. Bourne criticizes tbe use of the word "iatrogenic" (September I, p. 610). He says that the word ts derived from the Greek Uepoc, a doctor, and 1 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* ye\ir?ic means both the begetter and the begotten. Indeed the adjective yevvj}?oe means begotten or produced. Therefore I submit that the adjective "iatrogenic" is a very appropriate word to describe a disease that a doctor has produced.--I am, etc^ University College, Galway. ' B. J. O'DlUSCOU-- " RarotEMca * A Lexicon Abridged from Liddell and Scotts Greeb-Engllsh Lexicon. Oxford, 1871, at the Clartodoo Press. Impression of 1958, p. 140. .