672 13 June 1970 Correspondence and special with children's depart- ments tend to lag behind children's hospi- Points from Letters tals; but as for the golden. age of paediat- "Neutered Ladies" medicine stamps found in Scotland. The caption rics, we fear that with present policies it Dr. MARY M. RAYNER (King's Norton, Bir- read: "Small squares of oblong stones were used will never arrive.-We are, etc., mingham) writes: After over two decades of by oculists to stamp their medicines, which working as a general practitioner my attention were made up in sticks. The inscription usually D. I. K. EvANS. has been increasingly drawn to the "neutered" contains the name,of the practitioner, then the little name of the medicine, and lastly the name of H. B. MARSDEN. ladies of . I have seen a pretty the disease for which it was a remedy." Department of Pathology, protective mother of six leave her home town Royal Manchester Children's , and turn into a prostitute literally overnight. Pendlebury, Manchester. This happened to one mother in her late twen- What Do You Mean by That? REFERENCE ties about 15 years ago and was rather a dra- Central Health Services Council, The Functions of matic introduction to sterilization for me. Before DR. J. H. BARON (London N.3) writes: It is not the District General Hospital, London, this unfortunate experience I had noticed that surprising that Mr. C. M. Boyle (2 May, p. 286) H.M.S.O. 1969. many "neutered" ladies were living with should have found "Differences between gentlemen who were not legally their husbands. patients' and doctors' interpretation of some I have also been called in to see "neutered" common medical terms." It is surprising that Free Thyroxine Index ladies in tears and having little breakdowns two out of 35 doctors at a teaching hospital because their husbands have gone off with "a should believe that the heart lies between the SIR,-The Figure shows the results proper woman; not like you".... clavicle and the left nipple. obtained for protein-bound iodine, P.B.I. With the increase in demand for male and "free thyroxine index", FT4I: sterilization I hate to think of the situations we Children in Hospital shall have to face in our waiting rooms. Men in 237 patients (108 euthyroid, may mistrust their wives, but I sometimes get a DR. W. E. ST. C. CROSBIE (Bangor, Co. Thyopac-3P,B,I,_), feeling that all wives distrust their husbands. If Down, N. Ireland) writes: . . . You rightly say 64 thyrotoxic, 28 hypothyroid, and 37 this is the tendency of the sexes then I would (9 May, p. 309) that children in hospital need like to know whether any other family doctors not be deprived of affectionate care even if they clinically euthyroid women who were preg- are separated from their parents. It is the duty oral have noticed the long-term results of "tying the nant or taking oestrogen-containing tubes" and hysterectomies and also hear any of everyone on the staff to ensure that this contraceptives). comments on the future of family life with a does not happen, but especially is it the duty of "doctored" daddy. My mind boggles.... the nursing staff. The nurse acts in loco parentis while the child is in hospital. She must have the necessary time to "care" for the Diagnosis of Croha's Disease patients in the widest sense of the term. In order to do this in an efficient manner her Dr. T. G. GIRDWOOD (Department of work-load must be regulated. This can best be Radiology, Cumberland Infirmary, Carlisle) done by the system of case assignment. A nurse writes: I was very much interested in Dr. N. H. should not be asked to "care" for more than Dyer and Dr. A. M. Dawson's article on the four small children, and she should be assigned diagnosis of Crohn's disease (21 March, p. 735) the same patients each time she is on duty. I am in no doubt that by replacing the The nurse in a children's hospital has a more 18 1 follow through method of small bowel investiga- important role than her counterpart in an adult tion with the small bowel enema, and by the ward. She must enter into the lives of her routine use of the double contrast colon enema patients while under her care. The nurse/child the errors in diagnosis and the number of in- patient relationship is a close personal one. adequate and inconclusive examinations could be Hospital authorities must recognize that the very significantly reduced. I firmly believe that minimum ratio of nursing staff to patients in a 14 there are now no indications for the use of the children's hospital or a children's ward should traditional barium enema without gas contrast, be one for one. If this is not possible for all and very few indications for the routine follow the children in a ward it should apply to the through examination of the small intestine in the child patients in the younger age groups. investigation of intrinsic pathology of the intes- 20 tinal tract. Hearing Aids in Glue Ear Dr. A. MARES (Rush Green Hospital, Rom- Problems of Migraine ford, Essex) writes: I should like to voice my Dr. F. MANN (London W.1) writes: In a lead- agreement with Mr. J. T. F. Keohane (9 May, r ing article of (9 May, p. 310) various drugs that p. 367). In the past ten years or so I have may be used in the treatment of migraine were treated at least 2,000 cases of glue ear, and mentioned. The author has forgotten acupunc- have never used a hearing aid for alleviating ture. With acupuncture a large proportion of the deafness but managed to improve the hear- patients may be cured or alleviated of migraine, ing either by aspiration or by insertion of .4 without any of the side-effects sometimes expe- grommets (after having dealt with infected ade- 6rr rienced by other methods.... noids or sinuses). I have not seen a permanent perforation as a result of the treatment with a grommet. Pensions and Inflation Dr. H. RANDLE LUNT (Derby) writes: ... With monetary inflation due to taxation and strikes Breathlessness and Anxiety etc., our pension position is beginning to look Dr. D. R. REDMAN (Royal Hospital, Sheffield) ridiculous. With all our eggs in one basket and writes: Neither Dr. N. C. Oswald and others no employer other than this disreputable Health (4 April, p. 14) nor Drs. A. K. Zealley and .pa1win bou iodho freetlwroxnew indw Service, agitation for better condition of R. C. B. Aitken (9 May, p. 363) have acknow- remuneration seems essential, particularly with ledged the excellent paper by Burns and Howell,' regard to new contracts offered to consultants. Is which analyses the interaction of personality and it too much to hope that we can obtain a new associated factors on the symptoms of a group of group of negotiators? patients with chronic bronchitis. They showed The normal range for FT4I (3-7 - 8-6) quite clearly that there is a group of patients was obtained from the euthyroid group. As with disproportionately severe breathlessness- can be seen, diagnostic accuracy was Clear Labelling that is, not tallying with the results of full lung improved in all groups when the index was DR. S. G. HAMILTON (Thornton Heath, Surrey) function studies-in whom there was a much used.-We are, etc., writes: As an old advocate of the labelling of higher incidence of depression, anxiety, and FREDERICK CLARK. all medicines except for a minority where it hysteria than in the otherwise comparable control HAZEL J. BROWN. might not be in the interest of the patient, I groups. In addition there was an excess of agree with Dr. J. S. Stewart's suggestion of obsessional personality traits, and of psychogenic Newcastle General Hospital and Royal Victoria Infirmary printing N.P. on the E.C. 10 Forms, which a stress in the environment-bereavement in par- . stroke of the pen can cancel (2 May, p. 299). ticular-in the test group..... *The Figure should have been printed with the In this connexion, last month I was in the REFERENCE original letter on this subject on 30 May, p. 543. National of Scotland, Burns, B. H., and Howell, J. B. L., Quarterly We apologize for this omission. ED., B.M.J. and was interested} to see a display of Roman Yournal of Medicine, 1969, 38, 277.