Download - SCOTLAND
The place of ergometrine in clinical practice hasrecently been described by Moir.8 He concludesthat ergometrine is likely to prove a valuable alter-native to pituitary extract in the treatment of post-partum haemorrhage, and he thinks it is worth tryingin third-stage haemorrhage when simple methodshave failed, especially if the uterus is relaxed.When all the evidence from chemical, pharma-
cological, and clinical sources is considered together,it is very difficult to believe that ergometrine andergotocin are distinct substances. If they are indeedidentical, the question arises of a single internationallyrecognised official name. The position is, however,complicated by the existence of two other substanceseach claiming to be the active principle of aqueousextract of ergot, but about which less informationis available. Stoll and Burckhardt 9 have describeda substance with the same structural formula as
ergometrine, extracted from ergot in a similar wayand with similar chemical properties. This theyhave called ergobasine. Its pharmacological actionsas described by Rothlin "0 are essentially those ofergometrine, and it is almost certainly the samesubstance. It is less easy to place Thompson’s 1112ergostetrine (" alkaloid X ") as relatively few detailsof its chemical and pharmacological properties aregiven. It is, however, a similar principle althoughits toxicity in animals appears to be greater thanthat of ergometrine.The isolation from ergot by Smith and Timmis 13
of a substance isomeric with ergometrine may helpto explain some of these discordant results. Thissubstance, ergometrinine, is said to bear the same
relationship to ergometrine as ergotoxinine does toergotoxine. Its pharmacological properties havenot yet been investigated and it probably will proveto be relatively inert, but its admixture withthe pure principle may well account for minor
discrepancies in the findings of different investigators.The state of affairs with regard to these substances
is very unsatisfactory, and there is a real dangerthat, as they become more widely used, the confusionin nomenclature may spread to the clinical field.The general position has been admirably summed upby Dale.14 It can hardly be disputed that Moir’sobservations published 15 in 1932 afforded the originalimpetus to work in this field. As a direct outcome,Dudley and Moir isolated a new active principle andgave the first full and clear account of its chemicalcharacteristics and clinical effects. Subsequentevents have shown that this active principle, nowwell defined and fully investigated pharmacologically,is almost certainly the same as that to which otherobservers have given different names. Ergometrinewould certainly appear,therefore, to have the strongestclaims to official international recognition as
the name for that active principle upon which thetherapeutic action of ergot mainly depends.
8 Moir, C.: Proc. Roy. Soc. Med., October, 1935, p. 165.9 Stoll, A., and Burckhardt, E.: Compt. rend. Acad. des
Sci., 1935, cc., 680.10 Rothlin : Compt. rend. Soc. de biol., 1935, cxix., 1302.11 Thompson, M. R. : Jour. Amer. Pharm. Assoc., 1935,
xxiv., 185.12 Thompson, M. R.: Science, 1935, lxxxii., 62.
13 Smith, S., and Timmis, G. M. : Nature, 1935, cxxxvi., 259.14 Dale, H. H. : Science, 1935, lxxxii., 99.15 Moir, C.: Brit. Med. Jour., 1932, i., 1119.
ROYAL BUCKINGHAMSHIRE HOSPITAL.-On Nov.21st Mrs. Bernard laid the foundation-stone of theextensions to this institution. The committee is hopingto raise 50,000 for the extensions and E16,500 has beenreceived. A new contributory scheme is being drawn upto give the hospital a continuous and regular income.
(FROM OUR OWN CORRESPONDENT)
A PUBLIC MEDICAL SERVICE
As I reported at the time, the Edinburgh PublicMedical Service was started in October, 1934, to meetthe needs of the dependants of insured persons.The progress so far made was reviewed at a meetinglast week, when Dr. John Young, who presided,said that the committee were quite satisfied with theresult of the first year’s working. The number ofdoctors in the service was 130, and during the year3500 subscribers joined it, representing over 8000people. The subscriptions were JE3232, out of whichthe committee had to meet the expense of adminis-tration and the cost of prescribing. The latter provedto be heavy, amounting to 18’2 per cent. of the
subscriptions received, whereas the figure under theNational Health Insurance scheme was 14 per cent.The high cost was found to be due to the large numberof scripts and not to expensive prescribing ; 11,251scripts were issued at a cost of 593, the averagecost being about ls. Old. The committee have been
considering methods by which subscribers to theservice may receive special treatment at reducedrates, and arrangements for special terms have beenmade with the radiologists in the city and with theNational Ophthalmic Board.An appeal is made to practitioners with small lists
to do what they can to add suitable subscribers.The benefits which should ensue from this to thedoctor are stated as follows : (1) The goodwill of hispractice will become more valuable for he will havea saleable asset. (2) He is relieved of trouble andcorrespondence in connexion with the collection ofsmall accounts, a proportion of which would otherwiseprobably be irrecoverable. (3) He can rely on receivinghis payments quarterly. (4) He can pay calls onhis patients when he happens to be in their districtwithout making the patient think that he is runningup an account. (5) The burden of the expense ofadministration will be reduced, and the doctor’s
remuneration thereby increased. (6) - The doctorswho have large lists are quite satisfied with theremuneration they had received during the first year.In a small list the law of average does not operateproperly. (7) In comparing the Service with NationalHealth Insurance practitioners should rememberthat they are freed from filling up various certificatesand returns, and that no insurance committee or
other Government department can interfere withthem in the treatment of their patient.
Improvements in the penal system were discussedby doctors and lawyers at a meeting recentlyarranged by the local branch of the National Councilof Women and Edinburgh Women Citizens’ Asso-
ciation, with Prof. D. K. Henderson in the chair.Dr. C. D. Bruce, medical superintendent of theCriminal Lunatic Department, Perth, who spokefirst, pointed out that unless the antisocial attitudeof the offender could be corrected during the termof imprisonment, he would again become a dangeror at any rate a nuisance. He might be worse thanbefore. Both the probation and the Borstal systemhad proved of great value. The policy in Scotlandwas to attempt to train the prisoner for citizenship.Training did not mean more comfort in the prison,but more effort by the prisoner-the building-up ofcharacter and self-respect. Mr. James Adair,procurator-fiscal, said that the courts could not
possibiy wait until tnere ilacl Deen me iong examina-tion necessary to decide how long the person wasgoing to require for treatment or incarceration beforehe began to benefit. He thought it should be
seriously considered whether all sentences should notbe indeterminate. Such sentence having been
pronounced, a committee of investigation shoulddecide what was best for the particular prisoner.Sheriff-Principal Brown, K.C., referred to the distinc-tion between the criminal and the delinquent. He
spoke of the relief it would be if psychiatrists wouldsay which were born bad and which had become so.Whatever the type of criminal, he always favouredkindliness so far as that was possible with safety ;but punishment was no use unless it hurt, andsociety had to be protected.
Dr. Angus MacNiven said that a person might beinsane and yet perform a crime, know the nature ofhis act, and know that he was doing wrong. Whetherhe was guilty or not was a matter for the lawyers.Medical men could claim that once a person hadbeen pronounced guilty, they should have somethingto say about treatment. He thought that theyshould be careful not to exaggerate the value of
psychotherapy as a means of treating a criminal.Dr. W. R. D. Fairbairn described the present’systemas a failure. Short sentences were hopeless, and therewas no place for prison at all unless the sentenceswere indeterminate. As a deterrent and reformingagency it was inefficient. What was important wasresearch into the cause of crime. Dr. D. J. Forbes
regarded high-grade mental defectives as a serioussocial danger.
(FROM OUR OWN CORRESPONDENT)
RESIGNATIONS IN THE SCHOOL OF PHYSIC
THE resignation of the dean of the faculty of
physic, Dr. Andrew Francis Dixon, both from his
post as dean and from the chair of anatomy in theUniversity of Dublin, following closely on that ofhis colleague, Dr. Harold Pringle from the King’sprofessorship of the institutes of medicine, hascaused much regret to his colleagues, to his pastand present pupils, and to the medical profession ofDublin. This regret is increased by the fact that inboth cases the resignation has been brought aboutby reasons of health. Dixon, a pupil and assistantof Daniel John Cunningham, was professor of anatomyin Cardiff from 1897 to 1903, when he succeeded hisold master in Dublin. Since then he has conductedthe department of anatomy with ability and energy.For several years past he has also been dean of thefaculty. He devoted himself to the interest of hispupils, kept in touch with them when they had goneout into the world, and was always the first to bevisited when they returned to their old school. Tohis colleagues he was an elder brother whose wisecounsel was sought and generously given wheneverdifficulties arose. Pringle was also a former studentof the school in which he taught, having been apupil of John Mallet Purser. He was appointedKing’s professor of the institutes of medicine in 1919,having held a lecturership in Edinburgh Universityfor some years previously. He, too, was held inesteem and affection by his pupils f.nd colleagues.It is unfortunate that the school of physic in TrinityCollege should be deprived of the heads of two of itsimportant departments at the same moment. Theycarry with them to their retirement the affection and
sympathy of all their colleagues and pupils.
(FROM OUR OWN CORRESPONDENT)
THE FAMILY DOCTOR’S FORUM
THE " Assises de Medecine " is a movement startedby Dr. Henri Godlewski for the pooling of medicalobservations by general practitioners throughoutFrance, and not long ago he was able to tell theAcademy of Medicine that his offspring has developedastonishingly since its birth in March, 1932. Alreadyin April of the same year groups had been formedin a third of all the departments in France. Thesystem adopted is to choose a certain subject sometime in advance, to discuss it at local meetings, andthen to submit the information thus collected todiscussion at headquarters, at the Hôtel-Dieu inParis. The first session of the " Assises de Medecine "
dealt with rural tuberculosis and the means of com-bating it. The next subject was cancer houses.The subsequent subjects have been : regional clinicalmanifestations of alcoholism, the part played bydomestic animals in human pathology, conjugaltuberculosis, the prevention of tetanus with serum,the prognosis in pleurisy, the incidence and presentcharacteristics of syphilis, the prognosis in infantileconvulsions, goitre in France, the present positionof acute articular rheumatism, local dietetic customs,diphtheria, the prognosis in hyperpiesis, consan-
guinity and heredity, family predisposition to thelocalisation of disease, and the late results of lungcollapse treatment. During the three years of itsexistence, the " Assises de Medecine" have heldmore than 500 scientific meetings. At every meetingat the Hotel-Dieu a prize is awarded for the bestscientific contribution; and the voting, which is
secret, is usually unanimous in favour of the recipientof this prize. As Dr. Godlewski pointed out, the" Assises de Medecine " have done much to demon-strate the importance of the part played by thefamily doctor in preventive as well as in clinicalmedicine. It is the family doctor who can providemost information about the ultimate fate of thepatient, particularly in those villages in which themedical succession is from father to son.
ROYAL DENTAL HOSPITAL
AT this hospital’s 26th annual clinical At Home,held last Saturday, a full and interesting programmehad been arranged for the many visitors. Themorning was devoted to demonstrations-surgical,orthodontic, and prosthetic. These included a
routine operating session in the in-patient departmentof Charing Cross Hospital, with Mr. S. A. Ridett asoperator and Dr. T. B. Vaile as anaesthetist, andoperations under regional anaesthesia by Mr. S. F.St. J. Steadman in the Royal Dental Hospital.Mr. L. E. Claremont performed apical resection ofteeth and Mr. H. L. Hardwick demonstrated thetreatment of pyorrhoea by gingivectomy. A demon-stration of orthodontic cases and their treatmentwas given by Miss K. C. Smyth, Mr. H. R. Evans, andMr. J. H. Hovell. The complicated technique involvedin the construction of porcelain jacket crowns wasshown by Mr. W. I. Robertson, while Miss van Thalshowed what can be done by speech training tochildren with cleft palate. The afternoon was
devoted to clinical cases, and the hospital was filledalmost to overflowing by old students and others.A large number of patients were present illustratingrare or instructive clinical conditions, such as cystsand tumours, supernumerary teeth, and deficiencies