28

fractured femur-these were not taken too tragically,since the great benefits hoped for would outweighthem. Whether this is so cannot yet be decided, butgraver complications are now reported. On p. 17of this issue Dr. Tooth and Dr. Blackburn publishevidence that the cerebral changes occurring duringa cardiazol fit may give rise to impairment of intellec-tual capacity and memory. This would be a highprice to pay especially if the patient depended on hisintellect and memory for his livelihood. It isexcessively high when one considers that the " spon-taneous " remission-rate in schizophrenia is, in anycase, not much below that claimed for cardiazoltreatment. Gelperin,l in a recent communication,reports 94 schizophrenic patients who were dischargedimproved out of a total of 235 admitted to a psychiatricward, though they had had no other treatment thansuperficial psychotherapy. This would dispose of theargument sometimes put forward that a little hebetudeis better than a chronic insanity. Both the chronicinsanity and the hebetude can be averted in the caseof many schizophrenics if the psychiatrist can affordto be patient and satisfied with the general psychiatricmethods that were available before cardiazol andinsulin had been introduced. Tooth and Blackburnare cautious in their inferences and would not damnthe cardiazol method outright because of its occasionaluntoward results: but the difficulty is to knowwhich cases are the right ones to select for it. Thedeterioration they report, remarkably confirmed bypsychological testing, is not the only complication ofcardiazol treatment. The high incidence of vertebralfracture in cardiazol-treated patients has recentlybeen noted in America.

PRIVATE WARDS FOR CHILDREN

IT is said that when a certain royal personage wasill his surgeon assured him that he would be lookedafter as well as if he was a hospital patient, and hewas comforted. Some such thoughts must have beenin the minds of the management committee andmedical staff of the Hospital for Sick Children,Great Ormond Street, in their rebuilding, for inproviding private wards on the seventh floor theyseem to have set out to give the child whose parentscan afford to pay for it as happy and as profitable(in the health sense) a time in hospital as his poorerbrothers and sisters in the floors below. There are

single-cot rooms, which can be curtained off for privacyor opened into one another to provide for a nannyor other social amenities, for twenty children, and twosmall wards of four cots each provide that type ofcompanionship in disease which is so often of greatdisciplinary value in treating minor behaviourproblems. Each room opens on a large balcony,well protected by railings and wire netting, with anunrestricted south aspect to let in sun and air. Whileforming an integral part of the whole hospital andthus sharing in all the modern services available-with oxygen on tap, mobile electric lamps and otheraccessories-the private floor has its own entrance,waiting-room, consulting-rooms and operating-theatre.Rooms are set aside for nursing mothers, and" at the absolute discretion of the medical staff "

single rooms, if available, may be used for mothers andnannies. It is probable that in this phrase quotedfrom the regulations lies the greatest advantage of thehospital over the home in the treatment of the sickchild. Handed over to the care of skilled nursesaccustomed to humouring and amusing the sick childon a basis far removed from that of the home nursery,

1. Gelperin, J., J. Amer. med. Ass. June 10, 1939, p. 2393.

the small patient makes quick adjustments which areonly slowly reached, if ever, in the atmosphere of ahome upset by the advent of illness. For surgicalprocedures such a programme has obvious advan-tages, and for the many medical disorders in which apsychological process is playing a dominant or evensubservient part the complete change in environment,human as well as physical, produces results whichhave long been recognised among the ordinary hos-pital patients. Great Ormond Street is not thefirst children’s hospital to open accommodation forprivate patients, but thanks to the generosity ofLord Nuffield it has been possible to incorporate inthe rebuilding scheme a unit which should serve asa model of its kind.

A COLLEGE FELLOWSHIP IN CLINICAL

SCIENCE

WITH the inauguration of a department of medicinethe opportunities at Cambridge for clinical andcorrelative research work are now greatly improved.But whereas numerous college fellowships in thepast have been available for graduate students of

physiology and pathology there has hitherto beenno recognition of clinical science as an appropriatesubject for a fellowship, partly because facilitieswere lacking and partly because clinical science wasnot yet accepted as worthy of inclusion among theother natural sciences. This acceptance is now

becoming general, and the announcement that a

Stringer fellowship at King’s College may on thisoccasion be awarded to a candidate whose studyor research falls within the group of subjects includingclinical medicine marks a further stage in the develop-ment of scientific medicine at Cambridge. For aman of suitable qualities the prospects and amenitiesof the appointment should offer strong inducements.Candidates must be members of the university,under thirty years of age on Dec. 6, 1939. Any candi-date who is in doubt if his study or research fallswithin the prescribed group should consult the Provost,to whom applications should be sent by Oct. 16.

ASEPTIC NECROSIS OF BONE

WHEN the pressure in a diving-bell is reduced toosuddenly gas is liberated from the tissues more

quickly than it can be removed by the blood, and thesymptoms of caisson sickness may result. In discuss-ing the aseptic necrosis of bone that sometimesfollows, and quoting four cases with autopsy or

biopsy findings, Kahlstrom, Burton and Phemister 1 ,point out that when the body is exposed to highatmospheric pressure the gases of the air are absorbedin different degree according to the nature of thetissues. Thus fat or lipoid tissue such as the nervoussystem absorbs about five times the amount ofnitrogen that water or serum will take up, and it issuch tissues that are likely to be most damaged bythe liberation of gases during decompression. Oxygenis relatively easily dissolved and got rid of, but thebubbles of nitrogen set free in the fatty marrow oflong bones give rise to emboli which may obstructend-arteries and produce necrosis. If this necrosisaffects the bone bordering a joint the weight-bearingportions of the bones may collapse and there maybe lesions of joints, sometimes with the formationof intra-articular foreign bodies. This process lendssupport to the view that arthritis deformans, inwhich the lesions are much the same, may be due to

1. Kahlstrom, S. C., Burton, C. C., and Phemister, D. B.,Surg. Gynec. Obstet. Feb. 1, 1939, p. 129.