942 free vitamin B12 will be absorbed by coal as easily as in a mixture of serum and vitamin B12. The abolition of the supposed trans- fer function of intrinsic factor therefore should have been tested with addition of vitamin B12 before the addition of serum. We have repeated the experiments of Dr. Ardeman and Dr. Chanarin, also with this variation. Twelve sera from ABSORPTION OF 58Co-vitamin-BI, FROM MIXTURES OF GASTRIC JUICE AND PERNICIOUS ANEMIA SERUM BY CHARCOAL (RADIOACTIVITY IN SUPERNATANT EXPRESSED AS PERCENTAGE OF RADIOACTIVITY ADDED) patients with pernicious anaemia were tested, of which six were known to contain antibody to intrinsic factor whereas the other six were negative in this respect. The data in the accompanying table show that the order of incubation considerably affected the results with the positive pemicious-ansemia sera. Absorp- tion of radioactivity was increased only in the mixtures in which free (=dialysable) vitamin B12 was present as a result of block- ing of vitamin-B12-binding sites on intrinsic factor by the antibody. J. ABELS H. O. NIEWEG A. J. M. SCHIPPERIJN. Department of Medicine, University of Groningen, Groningen, The Netherlands. THROMBOEMBOLISM FOLLOWING FRACTURE OF FEMUR P. A. RING. SIR,-Dr. Fagan’s article last week on the use of anti- coagulants to prevent thromboembolic phenomena follow- ing femoral neck fractures should remind all who care for the elderly of the importance of early diagnosis and treat- ment of these injuries. Pulmonary embolism does not occur in those patients treated by immediate operation and early weightbearing; and more than half these patients can be discharged to their own homes, or to a rehabilitation unit, within three weeks. Fractures which are unsuitable for early weightbearing are rare, and it seems surprising that Fagan found that only a quarter of his patients could be treated by this regimen. To leave them in bed is to invite femoral thrombosis and pulmonary embolism, and to say that this can then be reduced by anticoagulants is beside the point; it can be reduced much more cheaply and effectively by getting them up. The problem is not the fracture-internal fixation or prosthetic replacement will almost always permit early ambulation-but the patient. The deaths are due, not to the injury, but to bedsores, hypostatic pneumonia, and pulmonary embolism-all largely preventable by early and effective treatment. London .W.I. Notes and News STORAGE OF ANIESTHETIC EQUIPMENT Dr. A. W. GROGONO (department of anaesthetics, King’s College Hospital, London, S.E.5) writes: Well-designed anaesthetic rooms contribute to the safety and speed of anaesthesia. Suitable storage for basic equipment such as masks and tubes is most important, especially where several anesthetists follow each other in the same theatre. The introduction of autoclaves with an efficient preliminary vacuum cycle has made it possible to autoclave endotracheal tubes without rapid deterioration.1 Thus prepacked sterile endotracheal tubes can now be delivered to the theatres. Storing these prepacked tubes is difficult, selecting the correct tube can be tiresome, and it takes time to check that there is an adequate supply of each size. These prob- lems have been largely overcome by means of storage racks (fig. 1). The tubes are packed in disposable paper bags. Each hole is 3 x3 in., Fig. 3 which, to facilitate cleaning, is slightly larger than is necessary. The vertical edge of each box has a pronounced bevel, providing an adequate surface on which to write the size, and making it clear which number refers to which box. The present two systems of numbering necessitate each box having two numbers, but when old stock is exhausted the old numbers will be removed. At present the old numbers are in red, and the metric sizes are in white. 1. Stark, D. C. C., Pask, E. A. Anœsthesia, 1962, 17, 195.
Transcript
942
free vitamin B12 will be absorbed by coal as easily as in a mixtureof serum and vitamin B12. The abolition of the supposed trans-fer function of intrinsic factor therefore should have been testedwith addition of vitamin B12 before the addition of serum.We have repeated the experiments of Dr. Ardeman and
Dr. Chanarin, also with this variation. Twelve sera from
ABSORPTION OF 58Co-vitamin-BI, FROM MIXTURES OF GASTRIC JUICEAND PERNICIOUS ANEMIA SERUM BY CHARCOAL (RADIOACTIVITY INSUPERNATANT EXPRESSED AS PERCENTAGE OF RADIOACTIVITY ADDED)
patients with pernicious anaemia were tested, of which six wereknown to contain antibody to intrinsic factor whereas the othersix were negative in this respect. The data in the accompanyingtable show that the order of incubation considerably affectedthe results with the positive pemicious-ansemia sera. Absorp-tion of radioactivity was increased only in the mixtures in whichfree (=dialysable) vitamin B12 was present as a result of block-ing of vitamin-B12-binding sites on intrinsic factor by theantibody.
J. ABELSH. O. NIEWEGA. J. M. SCHIPPERIJN.
Department of Medicine,University of Groningen,
Groningen, The Netherlands.
THROMBOEMBOLISM FOLLOWING
FRACTURE OF FEMUR
P. A. RING.
SIR,-Dr. Fagan’s article last week on the use of anti-coagulants to prevent thromboembolic phenomena follow-ing femoral neck fractures should remind all who care forthe elderly of the importance of early diagnosis and treat-ment of these injuries. Pulmonary embolism does notoccur in those patients treated by immediate operationand early weightbearing; and more than half these patientscan be discharged to their own homes, or to a rehabilitationunit, within three weeks.
Fractures which are unsuitable for early weightbearingare rare, and it seems surprising that Fagan found thatonly a quarter of his patients could be treated by thisregimen. To leave them in bed is to invite femoralthrombosis and pulmonary embolism, and to say that thiscan then be reduced by anticoagulants is beside the point;it can be reduced much more cheaply and effectively bygetting them up.The problem is not the fracture-internal fixation or
prosthetic replacement will almost always permit earlyambulation-but the patient. The deaths are due, not tothe injury, but to bedsores, hypostatic pneumonia, andpulmonary embolism-all largely preventable by earlyand effective treatment.
London .W.I.
Notes and News
STORAGE OF ANIESTHETIC EQUIPMENTDr. A. W. GROGONO (department of anaesthetics, King’s
College Hospital, London, S.E.5) writes:Well-designed anaesthetic rooms contribute to the safety and speed
of anaesthesia. Suitable storage for basic equipment such as masksand tubes is most important, especially where several anesthetistsfollow each other in the same theatre.The introduction of autoclaves with an efficient preliminary vacuum
cycle has made it possible to autoclave endotracheal tubes withoutrapid deterioration.1 Thus prepacked sterile endotracheal tubes cannow be delivered to the theatres. Storing these prepacked tubes is
difficult, selecting the correct tube can be tiresome, and it takes timeto check that there is an adequate supply of each size. These prob-lems have been largely overcome by means of storage racks (fig. 1).The tubes are packed in disposable paper bags. Each hole is 3 x3 in.,
Fig. 3
which, to facilitate cleaning, is slightly larger than is necessary. Thevertical edge of each box has a pronounced bevel, providing anadequate surface on which to write the size, and making it clear whichnumber refers to which box. The present two systems of numberingnecessitate each box having two numbers, but when old stock isexhausted the old numbers will be removed. At present the oldnumbers are in red, and the metric sizes are in white.
1. Stark, D. C. C., Pask, E. A. Anœsthesia, 1962, 17, 195.
943
In any theatre where several anaesthetists work there are probablytwo or more sets of endotracheal connectors, and the loss of a connector
may go unnoticed. A piece of drilled stainless-steel sheet (fig. 2) hasprovided convenient storage. There is a numbered hole of the rightsize for each connector, and thus the fact that a connector is missingis noticed at once. If desired, the connectors and rack can be sterilisedby boiling or autoclaving.Ancestheticface masks can be stored conveniently if each mask has
its own place. For this purpose sloping pegs have been mounted ona stainless-steel sheet (fig. 3), and a glance is enough to check thatthere is a mask of each size in each type.
It is a pleasure to thank the engineering department of King’sCollege Hospital for their interest and close cooperation in the pro-duction of these racks, and Mr. W. Smith and Dr. J. F. Cam fortaking the photographs.
NEW WELLCOME LABORATORY ATCHARING CROSS HOSPITAL
THE new Wellcome Laboratory in the department ofobstetrics and gynaecology at the Charing Cross HospitalMedical School was opened on April 16 by Lord Inman, chair-man of the council of the medical school. The laboratory,under the direction of Prof. Norman Morris, will be devotedalmost exclusively to the investigation of biochemical changesin the human placenta in health and disease-a subject of whichsurprisingly little is known. This splendidly equipped labora-tory will first undertake the basic inquiries which, it is hoped,will lead on to work of direct clinical significance. The Well-come Trust provided El 0,000 towards the cost; the clinicalresearch subcommittee of Charing Cross Hospital made a
contribution; and support also came from the UniversityGrants Committee, the Ministry of Health, the Dan MasonFoundation, the British Heart Foundation, the British DiabeticAssociation, the British Empire Cancer Campaign, and a
number of pharmaceutical companies.PROJECT MAYFLOWER
LAST year a study was made in the United States of the inci-dence of heart-disease and bronchitis among 32,000 British and18,000 Norwegian emigrants. This year Prof. D. D. Reid is todirect a survey in this country of 10,000 of the emigrants’relatives. A similar inquiry is to be made in Norway. The sur-veys are all being financed by the American National HeartInstitute. The death-rates for these diseases for youngermiddle-aged people vary in the three countries-the UnitedStates has a higher death-rate for heart-disease, Britain has ahigher death-rate for bronchitis, and Norway has a lowerdeath-rate for both. From comparison of the health and habitsof the emigrants and their stay-at-home relatives Professor Reidhopes to find out how much the British environment and theAmerican way of life have got to do with these variations.
MEDICAL EXAMINATIONS FOR NATIONAL INSURANCESICKNESS BENEFIT
THE Minister of Pensions and National Insurance has askedthe National Insurance Advisory Committee to report on thepreliminary draft of the National Insurance (Unemploymentand Sickness Benefit) and (Medical Certification) AmendmentRegulations, 1964. (H.M. Stationery Office, 3d.)Under the proposed regulations the notice requiring the claimant
to attend for examination will not be sent until after the usual stepshave been taken to ascertain whether he is fit to attend. A claimantwho fails, without good cause, to attend for examination can bedisqualified for receiving benefit only if the day fixed for examinationwas not earlier than the third day following the issue of the notice.When incapacity for work has lasted 4 weeks and is likely to beprolonged, doctors will be enabled to issue medical certificates cover-ingup to 13 weeks in advance. At present they can do so only whenincapacity has lasted 6 months.Representations on the draft regulations should be sent in
Writing to the secretary of the committee, 10, John AdamStreet, London, W.C.2, not later than May 12.
University of LondonDr. B. M. Richards, of the Medical Research Council
Biophysics Research Unit in the department of biophysics atKing’s College, has been appointed to the readership in biologyat the college.
University of St. AndrewsOn June 26 the honorary degree ofLL.D. is to be conferred on
Dr. R. W. Gerard, professor of neurophysiology in the
University of Michigan.University of Queensland
Dr. F. A. Whitlock, consultant psychiatrist to the NewcastleGeneral Hospital and associate physician in the department ofpsychological medicine of the University of Newcastle, has beenappointed to the chair of psychological medicine.Monash University, Melbourne
Dr. J. A. Smith, lecturer in bacteriology in AberdeenUniversity, has been appointed to a lectureship in microbiology.Yale University
Dr. Roy M. Acheson has been promoted professor of
epidemiology and medicine at the School of Medicine. Hejoined the Yale faculty in 1962 as an associate professor.
Dr. Acheson was born in Belfast and graduated in arts from TrinityCollege, Dublin, in 1945. He continued his studies at BrasenoseCollege, Oxford, and graduated B.M. in 1951. He spent a year asresearch assistant at the Institute of Social Medicine in Oxford andheld several house-appointments and a clinical registrarship at theRadcliffe Infirmary before he returned to Dublin in 1955. For fouryears he was senior lecturer in social medicine at Trinity College. In1959 he became senior lecturer in social and preventive medicine atGuy’s Hospital Medical School and the London School of Hygieneand Tropical Medicine, and he was promoted to a readership at thebeginning of 1962. His published work includes papers on childdevelopment and a study of morbidity from coronary-artery diseaseand myocardial degeneration in Eire. At present he is directing acity-wide investigation in New Haven of the causes and effects ofjoint diseases, such as arthritis, rheumatism, and gout, which is beingsupported by the United States Public Health Service.
Society for the Study of FertilityThis society is to hold a conference from July 8 to 11 at the
department of anatomy, University of Oxford. Further
particulars may be had from Dr. C. A. Simmons, 129, HarleyStreet, London, W.I.
Hospital TransfersOn April 1 Bristol Homreopathic Hospital (97 beds) was
transferred to the United Bristol Hospitals board of governorsand Dulwich Hospital (378 beds) to King’s College Hospitalboard of governors. On July 1 Lambeth Hospital (502 beds)will be transferred to St. Thomas’s Hospital board of governors.Mother Care for Children in HospitalThe Mother Care for Children in Hospital Association is to
hold a conference on the Platt report on May 7 at 10 A.M. atBush House, Aldwych, London, W.C.2. The speakers willinclude Dr. David Lawson, Mr. G. J. Piller, and Miss M. A.Duncombe. Further particulars may be had from the centralcommittee of the Association, 41, York Mansions, S.W.11.British Association for the Advancement of Science
The annual meeting of this Association is to be held inSouthampton from Aug. 26 to Sept. 2, when Lord Brain, F.R.S.,will give a presidential address on Science and Behaviour.Further particulars may be had from the secretary of theAssociation, 3, Sanctuary Buildings, 20, Great Smith Street,London, S.W.I.World Congress on Prevention of OccupationalAccidents and Diseases
The theme of this congress, which is to be held in Londonfrom July 13 to 18, is Reducing Risks at Work. On July 20 theOrganisme Professionnel de Prevention du Bâtiment et desTravaux Publiques of France, the London Building and Engin-eering Construction Accident Prevention Group, and the com-mittee on the prevention of occupational risks of the Inter-national Social Security Association are to hold a symposiumon the prevention of occupational accidents in the constructionand public work industries. Further particulars of both meet-ings may be had from the organising secretary of the congress,Royal Society for the Prevention of Accidents, 52, GrosvenorGardens, London, S.W.I.
944
International Cancer CongressThis congress is to be held in Tokyo in October, 1966,
under the auspices of the International Union Against Cancer.Particulars may be had from the secretariat, c/o Cancer Institute,Nishisugamo, Toshima-ku, Tokyo, Japan.
Royal Medico-Psychological AssociationThis Association is to hold a meeting at Whitchurch Hos-
pital, Cardiff, on May 5 and 6, under the presidency of Prof.Desmond Curran. The programme will include papers onsocial aspects of psychiatry and a symposium on indicationsand side-effects of the drug treatment of depression. Further
particulars may be had from the general secretary of the
Association, 11, Chandos Street, London, W.1.
Byssinosis Among Flax and Hemp WorkersThe Minister of Pensions and National Insurance has asked
the Industrial Injuries Advisory Council to consider whetherbyssinosis exists among workers in the flax and hemp industriesand, if so, whether and to what extent it should be a prescribeddisease under the National Insurance (Industrial Injuries)Acts. Written evidence should be submitted to the secretaryof the Council, 10, John Adam Street, London, W.C.2, byMay 29.
___________
Dr. A. J. Roncoroni, from Buenos Aires, will give a seminar onrespiratory management of tetanus and other conditions on Friday,May 1, at 4 P.M. at Hammersmith Hospital, London, W.12.A symposium on hand surgery is to be held on Thursday, May 7,
at 8 P.M., at the Plastic, Burns, and Oral Surgery Centre, QueenMary’s Hospital, Roehampton, London, S.W.15. The speakers willinclude Mr. 0. J. Vaughan-Jackson, Mr. A. J. Evans, and Mr. C. R.McCash.
Mr. Maxwell Ellis is to give the Maurice Sorsby lecture to theHebrew University of Jerusalem. He is to speak on cancer of theupper jaw and sinuses.
Dr. C. J. Fuller, who has retired from his appointment as consult-ant physician to the Royal Devon and Exeter Hospital after 35
years as a member of the hospital staff, has been appointed anemeritus and honorary consultant physician to the hospital by theSouth Western Regional Hospital Board.
CORRIGENDUM: An Interesting Case in Ward 6.-The author of thesecond letter on p. 825 (April 11) should have been shown on thecontents page as Mr. J. P. Mitchell, F.R.C.S.
AppointmentsBLANDY, J. P., M.A., D.M., M.CH. Oxon, F.R.C.S.: consultant surgeon, The
London Hospital.CLARK, P. B., M.A., M.D., M.CHIR. Cantab., F.R.C.S.: consultant urological
and gynaecologist. North West Durham hospital group.DAYAN, ELIA, M.B. Cairo, F.R.C.S.: consultant general surgeon, South
Shields hospital group.FRANKLIN, C. B., M.B. Birm., F.F.A. R.c.S.: consultant anesthetist. West
Cumberland hospital group.HARRIS, D. W. T., M.R.C.S., D.P.M., D.P.H.: consultant psychiatrist and
deputy medical superintendent, Northgate and district hospital group.KOLVIN, ISRAEL, M.B. W’srand, D.P.M.: consultant child psychiatrist,
Newcastle General Hospital.SPANTON, D. B., M.B. Lond., M.R.C.O.G., D.OBST.: consultant obstetrician
and gynaecologist. West Cumberland hospital group.WILLIAMS, H. I., M.A., M.B. Cantab., D.c.P.: consultant pathologist,
South Tees-side hospital group.Western Regional Hospital Board, Scotland:
INGLIS, MARGARET R., M.B. Aberd., D.P.M.: consultant psychiatrist, AilsaHospital, Ayr.
SCHOFIELD, C. B. S., M.D. Durh., M.R.C.P.E.: consultant in venereology(regional adviser and duties in the Glasgow clinics).
TODD, N. A., M.B. Glasg., M.R.C.P.E., D.P.M.: consultant psychiatrist,Hawkhead Hospital, and Victoria Infirmary, Glasgow.
Dr. J. M. Ritchie, professor of pharmacology in the Albert EinsteinCollege of Medicine, New York, has been elected to a fellowship atChurchill College, Cambridge.
Prof. W. Melville Arnott is visiting Syria as a W.H.O. consultant.He returns on May 8.
Dr. G. T. Stewart is to spend a year at the University of NorthCarolina as visiting professor of epidemiology and pathology. Hehas received an award from the National Science Foundation as asenior visiting foreign scientist.
St. Matthew’s Hospital, London, N. 1, which is being developed as ageriatric centre for the East End, is holding open days on May 8and 9 (from 2 P.M. to 5 P.M.) to show the services available to oldpeople.On April 3 the general-practitioner medical staff of Leatherhead
Hospital entertained the staffs of local hospitals, the local authority,the Ministry of Labour, and voluntary organisations. The companyof about 50 included medical officers of health, health visitors,district nurses, social workers, mental-health officers, occupationaltherapists, moral-welfare workers, hospital almoners, disablementresettlement officers, and home teachers for the blind.
Diary of the WeekAPRIL 26 TO MAY 2
Monday, 27thUNIVERSITY OF LONDON
5 P.M. (St. Mary’s Hospital Medical School, W.2.) Prof. H. Bartels(University of Tubingen): Gas Exchange of the Human Placenta.(First of two lectures.)
POSTGRADUATE MEDICAL SCHOOL OF LONDON, Ducane Road, W.124 P.M. Dr. John Marshall: Current Concepts in the Management of
Cerebrovascular Disease.WRIGHT-FLEMING INSTITUTE OF MICROBIOLOGY, St. Mary’s Hospital Medical
School, W.25 P.M. Dr. R. Dulbecco: Transformation of Tissue Culture Cells by
D.N.A.-containing Viruses. (Almroth Wright lecture.)MANCHESTER MEDICAL SOCIETY
9 P.M. (Medical School, University of Manchester.) Section of GeneralPracnes. Dr. H. B. Kilroe: The Arches of the Years. (Presidentialaddress.)
Tuesday, 28thINSTITUTE OF OBSTETRICS AND GYNaeCOLOGY
2 P.M. (Hammersmith Hospital, W.12.) Mr. T. E. C. Barns: PelvicTuberculosis.
ROYAL STATISTICAL SOCIETY5 P.M. (London School of Hygiene and Tropical Medicine, Keppel
Street, W.C.1.) Sir Austin Bradford Hill: Statistical Evidence.(100th meeting of the medical section.)
SOCIETY FOR THE STUDY OF ADDICTION8 P.M. (11, Chandos Street, W.1.) Dr. P. H. Connell: Amphetamine
Misuse.
Wednesday, 29thROYAL COLLEGE OF SURGEONS OF ENGLAND, Lincoln’s Inn Fields, W.C.2
5 P.M. Mr. David Band: Idiopathic Retroperitoneal Fibrosis.UNIVERSITY OF LONDON
5 P.M. (St. Mary’s Hospital Medical School.) Professor Bartels: Compara-tive Physiology of Oxygen Transport in Mammalia. (Second oftwo lectures.)
POSTGRADUATE MEDICAL SCHOOL OF LONDON2 P.M. Dr. T. M. Pollock: Assessment of Vaccines by Field Trial.
INSTITUTE OF DISEASES OF THE CHEST, Brompton, S.W.35 P.M. Mr. Donald Barlow: Intestinal Duplications, with special reference
to the (Esophagus.ROYAL FREE HOSPITAL, Gray’s Inn Road, W.C.1
5.15 P.M. Dr. Eleanor Mears: Contraception and Population Control.BIRMINGHAM MEDICAL INSTITUTE, 36, Harborne Road, Edgbaston
8.30 P.M. Dr. G. W. Hearn: Industrial Bronchitis.
Thursday, 30thPOSTGRADUATE MEDICAL SCHOOL OF LONDON
4 P.M. Mr. W. P. Cleland: Present Position of Mitral Valvotomy.INSTITUTE OF LARYNGOLOGY AND OTOLOGY
5.30 P.M. (Royal College of Surgeons of England.) Dr. R. B. Wright:Emergency Resuscitation in Hospital.
SANDOZ FOUNDATION LECTURE5 P.M. (University College Hospital Medical School, W.C.I.) Prof. J.
Chassar Moir: The Obstetrician Bids and the Uterus Contracts.UNIVERSITY OF ST. ANDREWS
5 P.M. (Queen’s College, Dundee.) Dr. Jean Bertrand (University ofLyons): Study of Cortisol Secretion and Metabolism in Newbornsand Infants.
UNIVERSITY OF ABERDEEN4.30 P.M. (University Medical Buildings, Foresterhill.) Prof. W. M.
Davidson: Genetic Determination of Sex and ChromosomeAbnormalities.
Friday, 1stPOSTGRADUATE MEDICAL SCHOOL OF LONDON
10 A.M. Mr. Donald Ross: Reconstruction and Replacement of the AorticValve.
INSTITUTE OF OBSTETRICS AND GYNACOLOGY3 P.M. (Queen Charlotte’s Hospital, W.6.) Miss J. Burton-Browne,
Dr. Ursula Shelley: Breast Feeding.INSTITUTE OF LARYNGOLOGY AND OTOLOGY, 330, Gray’s Inn Road, W.c.!
3.30 P.M. Dr. Simon Yudkin: Paediatric Problems in E.N.T. Practice.
