770

MECHANICAL RESPIRATORS

SIR,—To the interesting list of conditions treatedwith the Both respirator given in your annotation ofNov. 25 may I add a personal case of myasthenia gravisso treated in 1940?_ The patient was readmitted tohospital in serious relapse with acute respiratoryembarrassment. It was decided to use the respiratorfor a few hours in addition to the usual remedies.Though successful, it may be argued that this treatmentwas not life-saving in itself and that it therefore did notjustify the acute anxiety of the patient during thepreliminary manipulations.

Chertsey, Surrey. JOAH BATES.

SIR,—1 have no doubt that Mr. Marshall, who in yourissue of Oct. 28 described the use of a slightly alteredBoth respirator in the treatment of crush injuries, hasdesigned a satisfactory modification. I hope howeverthat others who may attempt to adopt his methods willfirst make sure that the alteration they plan will notinterfere with the prime function of the machine as arespirator.

’

In your issue of NTov. 25 Mushin and Faux (p. 685)point out that the respirator may be of considerablevalue in the prevention of postoperative chest complica-tions. This suggests a greatly extended field for thenormal use of the machine, and makes it still more desir-able to avoid alteration to the design which might leadto mechanical weakness precipitating a breakdown withdisastrous results to some urgent case of respiratoryfailure. I suggest, therefore, that sooner than interferewith the planned design of the cabinet a more effective(and, for the patient, a considerably more comfortable)adaptation may be provided by the use of a box or boxeslarge enough to encompass the affected limb or even thebody from the waist down. Such a box could becoupled direct to the mechanically operated bellows viathe flexible hose. Any competent handyman should beable to construct a set of boxes from strong plywood orother material capable of withstanding the necessarypressure. In the absence of the professional handymanit might be possible to make a " box " by applying asuitable thickness of plaster-of-paris bandage over a wirecradle or similar skeleton frame. No great amount ofingenuity would be required to make the necessaryconnexions. The leak valve on the bellows-unit willserve to control the negative pressure. Adequate con-trol of positive pressure must be arranged, and shouldpresent no difficulty if the simple design of the valve inthe Both cabinet is studied. The small capacity of theunit relative to the bellows should be remembered, andpressure-check with a manometer must not be omitted.Western Hospital,

Fulham.W. HOWLETT KELLEHER.

A CENTRALISED AMBULANCE SERVICE

SIR,—In your annotation of Oct. 21 (p. 540), attentionis drawn to certain shortcomings in existing ambulanceservices, which may or may not be due to the war.It is stated that (a) "... unhappy incidents havearisen from the rule that ambulances should not operateoutside the area of the authority which provides them " ;(b) " ... those engaged in the ambulance service should beproperly trained whole-time workers " ; (c) " there is notalways anyone to accompany the drivers of an ambu-lance... " .

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The- Home Ambulance Service of the Order of St. Johnand the British Red Cross Society is administeredthroughout England and Wales on a county basis withheadquarters in London. The organisation lends itselfreadily to any regional or national scheme. The service,free from red tape, is always ready to meet emergenciesas they arise. No ill-judged rules or regulations as to

areas or boundaries are permitted to delay the promptaid that may mean the difference of life or death to thepatient. In such a service the welfare of the sick andinjured must be the first consideration. Its 530 ambu-lances work in a field where they are self-dependent, toa very large extent, for the preparations of the patientsfor safe transport. They must not only be equippedwith first-aid materials and sick-room requisites butmust include staffs trained and -qualified to deal withcasualties and invalids under the most difficult con-ditions. It is for just such work that the training

demanded by the Order of St. John and the British RedCross Society equip their members. Duties are moreor less evenly divided between the men and women ofthe divisions and detachments. The nurse escort isan aspect of the work which has been developed con-siderably in recent years and with the return to normalthe ambulance staffs of the Order and the Society willbe available as a trained and sympathetic body of menand women ready to take their place in the Nationaltleaitn Service.

Order of St. John and BritishRed Cross Society,

, London, SW1.

H. ATTENBROW,HENRY T. FERRIER,

Joint Secretaries, Home ServiceAmbulance Committee.

A COMPREHENSIVE DENTAL SERVICE

SIR,—My boy aged 10 will not enter dentistry, forthe following reasons.(1) The financial return is not comparable with that of the

allied professions of medicine, law, accountancy andeducation. Bursaries and grants will never alter theentry to the profession until this is changed.

(2) The work is far more exacting, and in time of illnessincome ceases, except for any payment due under asickness or accident policy. This is not applicable tothe other professions mentioned. ’

(3) Owing to the abominable piecework system institutedunder National Health Insurance, the dental surgeon isonly paid by returns ; and now this is also true ofmost private work.

I should perhaps add that I have not been entirelyunsuccessful in the profession. Aged nearly 42, I amdental surgeon to the local voluntary hospital, to themunicipal hospital, and to the school for the deaf anddumb. My work starts at 9.15 AM and goes on till9.15 PM with 1 hours’ break for meals-six days to theweek. Returns and balance-sheets are at your disposal.

Preston, Lanes. A. E. J. BERRY.

DOCTORS FOR GERMANY

SIR,—I imagine that I am not the only serving doctorwho rubbed his eyes in astonishment on reading the letterfrom Dr. Andrew Topping of UNRRA which appearedin your issue of Nov. 18. Dr. Topping states that hehas the names and records of a considerable number ofdoctors who have offered and who are available to assistin the control of displaced persons in Germany. Heimplies, moreover, that he will not need anything like_the number who have volunteered. =

While appreciating the needs of UNRRA and the" arduous and possibly thankless task ahead," I feelthat an explanation is called for. Just who are thislarge body of volunteers, and how does it happen thatthey are in a position to be spared ?Can it be that the acute shortage of doctors has been

suddenly relieved ?, If this is so and if, as I assume,these gentlemen are more interested in working abroadthan at home I have a suggestion to offer. Let any whoare not needed by UNRRA and who are of military ageenter the Services. This would, no doubt, release anumber of men and women who would be only too glad,of the opportunity of working at home for a change.

It is, of course, just possible that the Far East mightnot have the same appeal as the Continent.

’ FIVE YEARS.’

** * We understand that in response to Dr. Topping’sappeal 84 doctors volunteered through their local medicalwar committees. Another 12 had already approachedUNRRA directly, making a total of 96. The CentralMedical War Committee decided that 51 of these werereleasable : all of them were unsuitable for the Serviceseither from age or on medical grounds. A total of 34(20 British and 14 Allies) have so far been interviewed,and 9 British and 11 Allies selected for appointment.None of the 20 are recruitable for the Services.-ED. L.

FROZEN FRESH MILK FOR HOSPITAL SHIPS.—UnitedStates army hospital ships will soon be supplied with

enough frozen milk to provide each patient with a quartof milk a day. Graded pasteurised homogenised whole milkwill be used, frozen immediately after pasteurisation. Itis expected to remain palatable for at least six weeks afterfreezing.