338

the auspices of the Society, by an acknowledged medicalauthority on the theory and practice of this very importantbranch of anaesthesia.

Full details of the activities of the Society are published inthe dental journals.

A. G. LUNTHon. Secretary,

Romford, Essex. Society of Dental Anaesthetists.

A. G. LUNTHon. Secretary,

Society of Dental Anæsthetists.

1. Lancet, 1960, ii, 1336.

THE OXFORD CLINICAL SCHOOL

SIR,- The letter from " Oxoniensis" (Jan. 28) doesnot greatly help. He says that much of the factual informa-tion contained in my letter is now happily out of date.Considering that in my account of the reasons why onepromising student was lost to this school I only madetwo points, the use of the word " much " seems a little odd.Either one of the snags has been put right or both, not" much of them "! Perhaps " Oxoniensis " would be

good enough to state which.He says also that I have blurred the distinction between the

University and the clinical school. It is true that one reasonwas the refusal of the University to exempt from first M.B. onG.C.E. at advanced level, and this in itself does not necessarilyrestrict the recruits to the clinical school. But in the caseI mentioned it most certainly did. Surely if students are

discouraged from going to Oxford University for preclinicalstudies they are less likely to proceed to the Oxford clinicalschool afterwards.

I should be glad if your correspondent could explain whathas happened to alter the case. Perhaps at the same time hemight come out from behind the smoke-screen of verbiageand tell us exactly what he meant by his last sentence: " Yourown annotation might be faulted on other grounds".

If he seriously believes this why does he not detail thegrounds of complaint ? Could it be that he is piqued by yourremarks on non-cooperation between departments ? I do notknow’ Oxford well, but his letter has not made me any morekeen to recommend it as a school for medical students.

CANTAB. SEMPER ANON.

A MASSIVE OVARIAN CYST

JOHN S. CORNES.Westminster School of Medicine,

Research Laboratories,London, S.W.1.

SIR,-I was interested to read Mr. Foreman’s case-history (Nov. 26) of a massive ovarian cyst weighing147 lb., and of Mr. Rose’s example (Dec. 10) weighing72 lb. I was asked to see a similar case when workingwith the Friends Service Unit in South Korea in April,1955.A South Korean woman, aged 47 (48 Korean age), was

admitted to the

gynecological de-

partment of theKunsan Provincial

Hospital under Dr.Kim Ki Tae. Sincethe age of 25 (26Korean age) she hadnoticed a gradualswelling of her abdo-men, and sufferedfrom increasingbreathlessness onexertion. For thepast two years the

swelling had greatlyincreased in size,the patient was un-

able to leave the room in which she was living, and had becomebreathless on the slightest exertion.In April, 1955, Dr. Herbert Bowles, gynaecologist to the

Straub Clinic in Honolulu and adviser in obstetrics to the

State Government of Hawaii, gave up his annual leave, flew toKorea, and without recompense assisted our Quaker medicalteam for a period of four weeks. His arrival was reported inthe local newspapers and this was seen by the patient’srelatives. Against the advice of the local herb doctors, whoinsisted that the patient would die if the tumour was removed,the relatives, who were all poor country folk, brought thepatient in a wheelbarrow from her home in the Cholla NamdoMountains some 60 miles away. The journey took 21/a days.

She was a small wizened lady, about 5 ft. tall, who lookedmuch older than 47. There was a large tumour filling thepelvis and abdomen, causing the ribs to splay outwards. Herrespiration-rate at rest was 24 per minute, and the slightestexertion produced severe dyspnoea.On April 8, 1955 (4288 Korean date), a massive cyst of the

right ovary was removed by Dr. Kim Ki Tae and Dr. HerberlBowles, and the general anaesthetic was given by myself. Th!operation lasted 21/4 hours, for there were dense adhesion!between the abdominal wall, the small intestine, and the wdof the cyst. Giving the anaesthetic was a nightmare in msinexperienced hands, because the smallest dose of ethe:rapidly produced a deep anaesthesia. A trainee newspape:reporter (now with the Baltimore Sun) was in the building athe time, and I persuaded him to take a photograph of tboperation (see figure).The tumour measured approximately 36 x 34 x 14 cm,

and weighed 42-6 kg. (94 lb.). On sectioning, the massivtumour was seen to be a multilocular pseudomucinous cystadenoma. I could find no evidence of malignancy.The patient made a good recovery, and was discharged froi

hospital 3 weeks after the operation. Her return journey WIby bus, and the fare was paid by the American Friends ServicCommittee.

I am grateful to Mr. Donald Bremner for the photograph.

1. See Lancet, 1960, ii, 968.

DIASTOLIC BLOOD-PRESSURE

SiR,—The recording of blood-pressure findings appearsto me to have reached a stage when an authoritativepronouncement should be made by the teachers and seniorpractitioners of medicine, surgery, and obstetrics.As a country general practitioner who qualified in 1925,

I have always been accustomed to recording the blood-pressurein the form 140/80 or 140 systolic 80 diastolic, the systolicbeing taken at the commencement of sound, and the diastolicat the time of change in its intensity.A few years ago I noticed that some assurance companies

were asking that the diastolic reading should be that at whichthe sound disappeared. On making inquiries of neighbouringphysicians as to the generally accepted standards, I found thatsome were using the change of sound, some the disappearanceof sound, and that in addition a third method was used.

I have been taught over the years that though the systolicvalue is so variable as to be of minor importance, the diastolicvalue is the bedrock of blood-pressure recordings. We are nowin a position where at least three methods of recording thediastolic reading exist, and the readings must of necessitydiffer.

Especially when the importance of serial blood-pressurereadings by different people is considered, this is a prepos-terous state of affairs. As an example I might mention the useof hypotensive drugs and the recordings of blood-pressure intoxaemia of pregnancy.

I suggest that an authoritative ruling be given to clarify theposition; and that in the meantime-and that right urgently-some rules should be drawn up so as to indicate the mediumsof diastolic values that are recorded.

I put forward as a tentative suggestion that the blood-pressure be recorded as 140/80/- or 130/-/70, the firstmeaning that the diastolic value is that taken when the