Nov 17, 1984 - year) would it not be possible to divert three month "old" copies of the .... says: "I am a very foolish fond old man, Fourscore and upward, not an ...
BRITISH MEDICAL JOURNAL
1384
VOLUME 289
17 NOVEMBER 1984
Points
The hospital's catchment area is predominantly rural with a large farming community providing plenty of opportunities for zoonotic determines the HbA,C as a percentage of the nearby, infection, thus helping to explain the high Time to push aside the diagnosis of but slower moving, HbA peak. In this case the autoincidence in this area. Obviously a larger infantile colic analyser gave HbAIC levels of 15-5%. Visual analya will be required series over longer period sis, however, revealed a large, slow moving peak far before a more representative picture will Professor R ILLINGWORTH (Sheffield S 1 9SD) to the left of the HbA which accounted for 38 3%/ emerge.
Microbiology Department, Friarage Hospital, Northallerton, North Yorkshire DL6 1JG
writes: Dr Albert Massarano's letter (20 October,
of the total haemoglobin. The HbA,C level was
suggests that he is neither conversant with therefore re-evaluated as the percentage of the total A S WYLLIE pthe1072) many published reports on evening colic haemoglobin present and found to be 8-30.
nor had personal experience of the problem. He Haematological investigation showed a normal full stated "no studies yet show a statistically significant blood count, and 10% target cells were present in improvement with infants treated with dicyclo- the peripheral blood film. Clearly it is necessary mine." I described a double blind trial,1 and this 1 Baxby D, Blundell N. Sensitive, rapid, simple method was fully confirmed in Australia in a double blind to recognise the presence of abnormal haemoglobin to determine correctly the HbA,C value-which for detecting Cryptosporidium in faeces. Lancet crossover trial.2 The word "colic" is used by many otherwise might be artificially high. All output 1983;ii:1149. 2 Casemore DP, Armstrong M, Jackson B. Screening for to explain any crying by an infant, and dicyclomine cards should therefore be checked visually to cryptosporidium in stools. Lancet 1984;i:734-5. 3 Nichols G, Thom BT. Screening for cryptosporidium is commonly and ineffectively used for its treatment. exclude haemoglobinopathies, even when other Much crying merely represents the baby's desire haematological indices are normal. in stools. Lancet 1984;i:735. to be picked up and cuddled (or at least is stopped by it), and dicyclomine is no substitute for love. But the typical rhythmical screaming attacks of "BNFs" for the Third World colic, predominantly in the evening, which are not Greenham Common stopped by picking up or a feed, are nearly always SIR,-In his recent paper on essential drugs prevented by the drug. It is true that meningitis is Dr ALAN DAVIS (Kyle, Ross-shire) writes: Dr Clare Professor P F D'Arcy mentioned the lack of often initially labelled as colic; and it is often Hamon is to be congratulated on her courageous reliable information in many Third World disastrously labelled as "teething." Teething does personal view (20 October, p 1069). Whatever one's countries on the indications, contraindications, occur; so does evening colic. Both diagnoses are views on Greenham Common women, I am sure that most National Health Service workers are and side effects of individual drugs (13 Octo- commonly wrong. appalled at the insidious increase in "defence" ber, p 982). In view of the notable lack of RS. Evening colic in infants. A double spending while hospital waiting lists lengthen, medical textbooks in many of these countries 1 Illingworth blind trial of dicyclomine hydrochloride. Lancet social services are stretched to the limit, and unand of the "disposable" form now adopted 1959 ;ii:1 1 19-20. F. Evaluation of the efficacy of dicyclomine employment increases remorselessly. Like Gosport, for the British National Formulary (a new edi- 2 Grunseit hydrochloride syrup in the treatment of infantile this area relies heavily on the Ministry of Defence tion of which is supplied free to every doctor colic. Curr Med Res Opin 1977;5:258-61. for jobs. Employees often express reservations in the National Health Service four times a about the nature of their work but, having families to feed and no real prospect of alternative employyear) would it not be possible to divert three month "old" copies of the BNF to Third Dr D M SYME (Killin, Perthshire FK21 8UH) ment, continue to contribute to the arms race. All Dr Albert Massarano assume that World doctors, nurses, and medical students ? writes: I can onlyfortune not to be closely associated the more reason, then, for the free individual to the good voice his protest. To remain silent is to condone Perhaps Oxfam or the Joint Mission Hospi- has had any infants who have suffered from infantile what is happening. tal Equipment Board (ECHO) would be able with in no be doubt he would I am sure had colic. If he to arrange a collection depot, and a note of the as to the reality of this condition. His observation relevant address could be prominently dis- "that if the baby is removed from the vicious circle played by the publishers on the cover of future by admission to a paediatric ward the screaming or How old is old? editions. Although distribution costs might colic ceases" may well be explained, as Professor G D PIRRIE (Eastbourne, East Sussex BN20 be substantial, the small print used makes for Illingworth has noted,1 by the fact that "a busy Dr 7DA) writes: Dr Denis Gibbs is a little confused extremely good value for money. Finally, nursery staff may not notice a baby's cries as much in his quotations from Shakespeare and the some British drug manufacturers might be as a mother does at home." psalmists in his review of Gastrointestinal Disorders since the exercise to underwrite the prepared 1 Illingworth RS. The normal child. 7th ed. Edinburgh: of the Elderly (20 October, p 1065). King Lear value of their products, in my own Third Churchill Livingstone, 1979:27-31. says: "I am a very foolish fond old man, Fourscore World experience, almost always exceeds that and upward, not an hour more or less: And to deal plainly, I fear I am not in my right mind." This of those from other countries. is thus very close to the psalmist who says: "The Too many doctors-or too few? days of our age are threescore years and ten: And R D S FAWDRY Dr J R W HANGARTNER (Chairman, Hospital though men be so strong that they come to Milton Keynes Hospital, Junior Staff Committee, London SE3 OHA) writes: fourscore years: Yet is their strength but labour Eaglestone, Milton Keynes MK6 5LD Dr David Stevenson suggests that one's prospects and sorrow." of coping with unemployment are better if one has received higher education than if one has not (20 October, p 1070). He may well be correct, but Metabolic effects of bicarbonate in How to beautify your old hospital he is not correct to suggest that training fewer diabetic ketoacidosis students will deny those SIR,-Sadly it is not only apathy or antipathy individuals as medical higher education. True it will restrict Dr JULIAN M LEIGH (Royal Surrey County that deters the hospital beautifier (29 Sep- individuals choice, but provided the resources remain Hospital, Guildford, Surrey GU2 5XX) writes: tember, p 807). The physical task itself may their devoted to higher education more individuals Dr P J Hale and colleagues (20 October, p 1035) be quite impossible. would be able to benefit from higher educationto be congratulated on their contribution to Here we have no main hospital entrance, assuming their courses were for three rather than are the knowledge of this subject. Though one cannot only a series of holes and doors into the cor- five or six years. It may be selfish to deny a medical dispute their findings, I think that their conclusion ridors, which are festooned with loose cables education, but is it not cruel and callous to add is overstated. Surely it is more realistic to say to a career graduates medical of numbers increasing in rows, loops, and straggles. The leaks in that, according to assessment by intermediary the various roofs appear to defy repair-and structure that cannot accommodate them ? metabolites, sodium bicarbonate administered according to the regimen of this study appeared to be our redecorated postgraduate centre (which is neither beneficial nor deleterious. hung with some lovely old photographs) was Haemoglobinopathies and glycosylated The case for not administering sodium bicarbowaterstained within a month. The positioning nate under any circumstances is not made. The of strategic buckets in the ward above my haemoglobin estimation danger is that registrars who deal with patients office is a regular feature of rainy days. Dr R J I BAIN (Claughton, Birkenhead L43 lTB) with severe diabetic ketoacidosis and follow the What hope is there for the interior when the writes: Like Dr G Pulman and others (13 October, saline only regimen may do so to the detriment of exterior cannot be maintained in a sound p 1001) I have recently diagnosed unsuspected a few patients. As director of an intensive care state, and what emotion for beautification heterozygous HbC trait in a longstanding diabetic unit I receive only the failures-that is, patients other than despair? What is worse, the fine after glycosylated haemoglobin (HbA,,) esti- who have been rendered hypernatraemic with carved brickwork is ignored by Pevsner while mation. A 54 year old black woman was diagnosed saline and are still acidaemic (pH
