ISAMBARD KINGDOM BRUNEL
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1245 with a disabled employee." This seems to imply an undesirable attitude to the disabled. We also feel it to be an anomaly that-in an organisation for the severely disabled-only the able-bodied have a pension or super- annuation scheme. Do not imagine that we are ungrateful. Far from it : I have heard Remploy described as " a God’s blessing." But I have also heard it called the new Marxism : " from each according to his ability ; to the most productive, 80% of the district rate." This is a reference to the fact that after two years’ training a man can ask to be considered for the full district rate. This application is discussed by the manager and a full-time trade-union official; and according to the man’s proficiency he is granted all or part of the full rate. In practice, however, he is usually kept at his old rate of 75-80%, on the grounds that he is not proficient, or "not worth a penny more "— even though his work may be quantitatively and qualitatively better than that of others in the factory receiving the same rate. In these circumstances incentive is stifled, and some of the men go sour and say " We’re here only to cut down National Assistance costs. Don’t work too hard. You’ll be paid jut the same as the mugs." When production falls and wastages and costs rise, it is very often the fault of the workers, as they will admit. But it is not always their fault. The situation is often shrugged away with the comment, " Poor souls, they really can’t be expected to do very much "-an excuse which can be used to cover bad planning and buying, lack of skill, and lack of method. The mounting costs of Remploy, if not checked, must lead inevitably to the end of the experiment. The able- bodied would then find other employment ; but for almost all the disabled it would mean life-long unemploy- ment. They would go down with the ship. Glasgow. FRANK CARR. FRANK CARR. 1. Dugan, J. The Great Iron Ship. London, 1953. TEXTBOOK ILLUSTRATIONS H. WENDEROTH. First Medical Department, University Hospital, Hamburg, Germany. SIR,-I quite agree with the opinions and suggestions of Mr. Engel, expressed in his letter of May 8. It may interest your readers to know that the same problem was discussed at the First World Conference on Medical Education in London last August. Since the Proceedings of the Congress have not yet appeared, I should like to repeat here a few words of criticism, as an addition to Dr. Engel’s ideas : . " It must be regretted that latest editions of several good textbooks published in various countries still contain illustra- tions-e.g. of exanthemata, bacteria, blood and bone-marrow cells, &c.-which were skilfully drawn by an artist decades ago but are no longer in keeping with the eminent progresses of colour photography. I think that some authors should be more anxious to replace the out-of-date pictures by modern ones." ISAMBARD KINGDOM BRUNEL C. A. E. BRIGGS National Institute for Research. in Dairying, Shinfield, near Reading. SIR,—Your peripatetic correspondent’s remarks (May 29) on Isambard Kingdom Brunel as hospital architect demand enlargement. According to Dugan,l Brunel’s portable fifteen-hundred-bed military hospital used by the War Office was prefabricated in this country and erected by eighteen men in ten weeks at Renkioi, Turkey, no part of the structure being too heavy to be carried by two men. Plumbing was included, together with an " air-conditioned system " pumping 1300 cubic feet per minute of cooled humidified air around each bed. The apparatus Brunel designed for rapidly inverting himself and thus ejecting the sovereign lodged in his right bronchus has been likened by Dugan to the old- fashioned looking-glass on a horizontal pivot. Your correspondent states : "the manoeuvre was successful, and the coin was immediately coughed out." Lest this apparatus be thought unduly efficient and a sine qua non of hospital equipment, it should be pointed out that after six weeks of intermittent torture on the "rack" Brunel’s medical advisers forbade him to continue. Tracheotomy was advocated, Brunel himself sketching the special forceps to be used for reaching the coin. This instrument is now known as the Brodie forceps 1 after Sir Benjamin Brodie, Brunel’s brother- in-law, who carried out tracheotomy without anæs- thesia ; the operation was not successful. However, three days later Brunel, with the wound still open, took a further turn on his machine, at last coughing up the sovereign into his mouth. 2. Dalldorf, G., Sickles, G. M. Science, 1948, 108, 61. 3. Dalldorf, G. Ibid, 1949, 110, 594. 4. Huebner, J. R., Beeman, E. A., Cole, R. M., Beigelman, P. M., Bell, J. A. New Engl. J. Med. 1952, 247, 249. 5. Curnen, E. C. 2nd International Poliomyelitis Conference, Copenhagen, 1952. 6. Melnick, J. L., Walton, M., Myers, I. L. Publ. Hlth Rep., Wash. 1953, 68, 1178. 7. Stanley, N. F., Dorman, D. C., Ponsford, J. Aust. J. exp. Biol. med. Sci. 1953, 31, 31. 8. Galpine, J. F., Macrae, A. D. Lancet, 1953, i, 372. 9. Forrester, R. M., Tobin, J. O’H. Ibid, 1951, ii, 663. 10. Menut, G. Arch. franç. Pédiat. 1952, 9, 978. 11. De Góes, P., Travassos, J., Pinheiro-Campos, O., Bruno-Lobo, M., Vasconcellos, J. V. An. Microbiol. 1952-53, 2, 101. COXSACKIE INFECTIONS PAULO DE GÓES J. TRAVASSOS. Department of Microbiology, School of Pharmacy, University of Brazil, Rio de Janeiro. SIR,—After the discovery of Coxsackie viruses,2 3 many papers reported the isolation of these viruses in a number of different conditions 4 : epidemic pleurodynia (Born- holm disease), herpangina,4 " minor illnesses," 6 and diseases of the nervous system-aseptic meningitis,5 encephalitis,7 meningo-encephalitis,8 and Guillain-Barre syndrome.9 10 Coxsackie viruses were also isolated from cases of poliomyelitis, but the significance of these findings was not established.ll It has been shown that in some of these diseases the strains isolated belong to a definite group-e.g., in cases of Bornholm disease, Dalldorf’s group-B strains are present, and in cases of herpangina the group-A strains are isolated.4 We have adopted the term coxsackioses for these conditions. This name is in line with those used in other infections, where the organisms produce a variety of clinical manifestations brucellosis, salmonellosis, rickettsiosis, &c. A tentative classification of the Coxsackie infections is as follows : (1) Indefinite febrile forms. (2) Typical forms: epidemic pleurodynia (Bornholm disease), herpangina. (3) Nervous forms: " aseptic meningitis," encephalitis, meningo-encephalitis, Guillain-Barré syndrome. RISKS OF LEUCOTOMY SiR,-I have read with interest your account (May 22) of the address by Dr. Radzan and Dr. Cook, of Bexley Hospital. This reveals the overcrowding of hospital wards, which, I understand, prevails elsewhere, and the urgent need of removing the obstacle to individual care and continuous observation of patients under treatment, without which hardly any successful result can reasonably be expected. Dr. Cook is also reported as saying that sedation itself, if prolonged, produces more serious mental deterioration than electroconvulsion therapy combined with pre- frontal leucotomy. This may be so, but I know of 2 cases in which the results of leucotomy are nothing short of tragic. In suicidal and homicidal maniacs, such rapid deterioration may be beneficial, in that leucotomy renders the patient more docile and more easily managed, even if at the same time he is turned
Transcript of ISAMBARD KINGDOM BRUNEL
1245
with a disabled employee." This seems to imply anundesirable attitude to the disabled. We also feel it tobe an anomaly that-in an organisation for the severelydisabled-only the able-bodied have a pension or super-annuation scheme.Do not imagine that we are ungrateful. Far from it :
I have heard Remploy described as " a God’s blessing."But I have also heard it called the new Marxism : " fromeach according to his ability ; to the most productive,80% of the district rate."
This is a reference to the fact that after two years’ traininga man can ask to be considered for the full district rate.This application is discussed by the manager and a full-timetrade-union official; and according to the man’s proficiencyhe is granted all or part of the full rate. In practice, however,he is usually kept at his old rate of 75-80%, on the groundsthat he is not proficient, or "not worth a penny more "—even though his work may be quantitatively and qualitativelybetter than that of others in the factory receiving the same rate.
In these circumstances incentive is stifled, and some of themen go sour and say " We’re here only to cut down NationalAssistance costs. Don’t work too hard. You’ll be paid jutthe same as the mugs."When production falls and wastages and costs rise, it
is very often the fault of the workers, as they will admit.But it is not always their fault. The situation is often
shrugged away with the comment, " Poor souls, theyreally can’t be expected to do very much "-an excusewhich can be used to cover bad planning and buying,lack of skill, and lack of method.The mounting costs of Remploy, if not checked, must
lead inevitably to the end of the experiment. The able-bodied would then find other employment ; but foralmost all the disabled it would mean life-long unemploy-ment. They would go down with the ship.
Glasgow. FRANK CARR.FRANK CARR.
1. Dugan, J. The Great Iron Ship. London, 1953.
TEXTBOOK ILLUSTRATIONS
H. WENDEROTH.First Medical Department,University Hospital,Hamburg, Germany.
SIR,-I quite agree with the opinions and suggestionsof Mr. Engel, expressed in his letter of May 8. It mayinterest your readers to know that the same problemwas discussed at the First World Conference on MedicalEducation in London last August. Since the Proceedingsof the Congress have not yet appeared, I should liketo repeat here a few words of criticism, as an additionto Dr. Engel’s ideas :
.
" It must be regretted that latest editions of several goodtextbooks published in various countries still contain illustra-tions-e.g. of exanthemata, bacteria, blood and bone-marrowcells, &c.-which were skilfully drawn by an artist decadesago but are no longer in keeping with the eminent progressesof colour photography. I think that some authors should bemore anxious to replace the out-of-date pictures by modernones."
ISAMBARD KINGDOM BRUNEL
C. A. E. BRIGGSNational Institute for Research.
in Dairying, Shinfield, near Reading.
SIR,—Your peripatetic correspondent’s remarks (May29) on Isambard Kingdom Brunel as hospital architectdemand enlargement. According to Dugan,l Brunel’sportable fifteen-hundred-bed military hospital used
by the War Office was prefabricated in this countryand erected by eighteen men in ten weeks at Renkioi,Turkey, no part of the structure being too heavy to becarried by two men. Plumbing was included, togetherwith an " air-conditioned system " pumping 1300 cubicfeet per minute of cooled humidified air around each bed.The apparatus Brunel designed for rapidly inverting
himself and thus ejecting the sovereign lodged in hisright bronchus has been likened by Dugan to the old-fashioned looking-glass on a horizontal pivot. Your
correspondent states : "the manoeuvre was successful,and the coin was immediately coughed out." Lestthis apparatus be thought unduly efficient and a sine
qua non of hospital equipment, it should be pointedout that after six weeks of intermittent torture on the"rack" Brunel’s medical advisers forbade him tocontinue. Tracheotomy was advocated, Brunel himselfsketching the special forceps to be used for reaching thecoin. This instrument is now known as the Brodie
forceps 1 after Sir Benjamin Brodie, Brunel’s brother-in-law, who carried out tracheotomy without anæs-
thesia ; the operation was not successful. However,three days later Brunel, with the wound still open,took a further turn on his machine, at last coughingup the sovereign into his mouth.
2. Dalldorf, G., Sickles, G. M. Science, 1948, 108, 61.3. Dalldorf, G. Ibid, 1949, 110, 594.4. Huebner, J. R., Beeman, E. A., Cole, R. M., Beigelman, P. M.,
Bell, J. A. New Engl. J. Med. 1952, 247, 249.5. Curnen, E. C. 2nd International Poliomyelitis Conference,
Copenhagen, 1952.6. Melnick, J. L., Walton, M., Myers, I. L. Publ. Hlth Rep.,
Wash. 1953, 68, 1178.7. Stanley, N. F., Dorman, D. C., Ponsford, J. Aust. J. exp.
Biol. med. Sci. 1953, 31, 31.8. Galpine, J. F., Macrae, A. D. Lancet, 1953, i, 372.9. Forrester, R. M., Tobin, J. O’H. Ibid, 1951, ii, 663.
10. Menut, G. Arch. franç. Pédiat. 1952, 9, 978.11. De Góes, P., Travassos, J., Pinheiro-Campos, O., Bruno-Lobo,
M., Vasconcellos, J. V. An. Microbiol. 1952-53, 2, 101.
COXSACKIE INFECTIONS
PAULO DE GÓESJ. TRAVASSOS.
Department of Microbiology,School of Pharmacy,University of Brazil,
Rio de Janeiro.
SIR,—After the discovery of Coxsackie viruses,2 3 manypapers reported the isolation of these viruses in a numberof different conditions 4 : epidemic pleurodynia (Born-holm disease), herpangina,4 " minor illnesses," 6 anddiseases of the nervous system-aseptic meningitis,5encephalitis,7 meningo-encephalitis,8 and Guillain-Barresyndrome.9 10 Coxsackie viruses were also isolated fromcases of poliomyelitis, but the significance of these
findings was not established.ll It has been shown that insome of these diseases the strains isolated belong to adefinite group-e.g., in cases of Bornholm disease,Dalldorf’s group-B strains are present, and in cases ofherpangina the group-A strains are isolated.4We have adopted the term coxsackioses for these
conditions. This name is in line with those used in other
infections, where the organisms produce a variety ofclinical manifestations brucellosis, salmonellosis,rickettsiosis, &c. A tentative classification of theCoxsackie infections is as follows :
(1) Indefinite febrile forms.(2) Typical forms: epidemic pleurodynia (Bornholm
disease), herpangina.(3) Nervous forms: " aseptic meningitis," encephalitis,
meningo-encephalitis, Guillain-Barré syndrome.
RISKS OF LEUCOTOMY
SiR,-I have read with interest your account (May 22)of the address by Dr. Radzan and Dr. Cook, of BexleyHospital. This reveals the overcrowding of hospitalwards, which, I understand, prevails elsewhere, and theurgent need of removing the obstacle to individualcare and continuous observation of patients undertreatment, without which hardly any successful resultcan reasonably be expected. -
Dr. Cook is also reported as saying that sedation itself,if prolonged, produces more serious mental deteriorationthan electroconvulsion therapy combined with pre-frontal leucotomy. This may be so, but I know of 2cases in which the results of leucotomy are nothingshort of tragic. In suicidal and homicidal maniacs,such rapid deterioration may be beneficial, in that
leucotomy renders the patient more docile and moreeasily managed, even if at the same time he is turned
