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GASTROSTOMY VERSUS INTUBATION

To the Editor of THE LANCETSiR,—In his interesting letter Mr. E. Watson-

Williams states as one of the disadvantages of

gastrostomy :-Food is not taken by the natural channel, and is not tasted.

The psychic effect, when the patient realises that he willnever taste or swallow anything again, is often very bad.(Italics mine.)

During my hospital practice I tried to overcomethis difficulty by the following method : Whenfeeding by gastrostomy I always put in the patient’smouth one or two table-spoons of the food fromthe syringe, asked him to chew it properly andslowly, and then to spit it out with the saliva. I was

brought to this simple method by the remark ofone of our patients who was being given mincedveal, " What a pity I cannot taste the meat; I likeit so much." The patients were always very pleasedand sometimes asked for some more spoonfuls.

I am, Sir, yours faithfuly,Masaryk University Anthropological Institute, V. SUK.

Czechoslovakia, Jan. 9th, 1933.

PAIN AND THE DOCTOR

To the Editor of THE LANCETSiR,-Prof. Robertson often asserted that " all

pain is mental," and those who practise his branchof medicine mostly agree with that dictum. If thatis accepted, how does it work in with the variousstatements as they appear in an article in your issuefor the 14th inst. under the above heading 1 Are notsuch statements very much on a line with the state-ment often heard from a nurse in reply to a doctor’sinquiry-viz., " he has no temperature."

Is it not as futile to expect to avoid pain as it isto expect to avoid a temperature ?

I am, Sir. vours faithfullv.

Hove, Jan. 16th, 1933. E. ROWLAND FOTHERGILL.

NEW PREPARATIONS

To the Editor of THE LANCETSiR,-Under this heading in your issue of Dec. 24th

last (p. 1416) the statement is made that Essogenis ten times U.S. cod-liver oil strength. The officialU.S.P. standard for cod-liver oil is that it shouldcontain 50 curative doses for rats per gramme-i.e.,the effective rat unit is 20 mg. Admittedly thisstandard is a very low one-much lower than theminimum blue value of 6 specified in the new issueof the British Pharmacopoeia. Exact comparisonis impossible because of the weaknesses of the testspecified by the U.S.P., but Essogen on the basisof blue value is more than 300 times the B.P.standard, and therefore must be of even higherrelative potency as compared with the U.S.P.standard.

We are, Sir, yours faithfully,LEVER BROTHERS, LIMITED.

Biological Laboratories, Port Sunlight,Cheshire, Jan. 12th, 1933.

VENOUS STAGNATION FROM GRAVITY

To the Editor of THE LANCETSIR,-In his article on Phlebitis in THE LANCET

of Jan. 14th, Mr. A. Dickson Wright mentions

stagnation in the veins, due to rest in bed and

cessation of muscular contractions, as a contributoryfactor. The following movement which can bemade periodically by the patient is important forprophylaxis. The patient should lie or recline withhis foot against a firm surface, such as a bolsteror a bed-table up-ended with a pair of legs underthe mattress. The big toe and heel are then appliedto this surface, arching up the dorsum of the footby means of the intrinsic muscles, and the back ofthe knee is pressed down against the mattress.There should be a slight extension of the hip-joint,and the patient should not press back his head andshoulders but should momentarily increase the

pressure between the lumbar region and the mattress.During this very mild activity a large proportion

of the muscles in the limb are in use. Apart fromthe prime-movers the following muscles co6perate -those whose tendons cross the ankle-joint, musclesin the thigh and buttocks, also those in the lowerabdominal wall. An adequate pumping effect on thevenous system occurs throughout the limb with aminimum expenditure of energy. The psychologicaleffect of getting the feet against a firm surface,and of doing something to shorten convalescence,encourages the patient to make periodically thissmall effort.

I am, Sir, yours faithfully,London, Jan. 13th, 1933. JAMES K. MCCONNEL.

THE SERVICES

ROYAL NAVAL MEDICAL SERVICE

The following Surg. Lts. (D.) to be Surg. Lt.-Comdrs. (D.) :S. Mawer, L. F. Fairey, L. A. Moules, and G. Baker.

F. W. Chippindale to be Surg. Lt.The following appts. are notified: Surg. Lt.-Comdrs.

W. Flynn to President for course and to President forExperimental Stn., Porton; R. L. G. Proctor to Vernonand A. G. L. Brown to Despatch.

Surg. Capts. H. E. E. Stephens to Victory, for HaslarHospital; and F. J. Gowans and A. G. V. French to Egmont,for Maine and R.N. Hospital, Malta, respectively.

Surg. Comdrs. F. H. Vey to Pembroke, for ChathamDockyard ; and F. E. Fitzmaurice to Leander, on coming.

I Surg. Lts. M. G. Ross to Glorious; M. J. Brosnan to Vivid,for Devonport Barracks ; A. S. Cox to Valiant; and T. L.Cleve to Maine.

I ROYAL NAVAL VOLUNTEER RESERVE

! Surg. Capt. R. J. Willan is placed on the retd. list.Surg. Lt. F. W. Chippindale, Commission terminated ontransfer to R.N.

Surg. Lt. R. H. Berry is apptd. to Victory, for HaslarHospital.

’

TERRITORIAL ARMY

Lt. J. V. Morris to be Capt.

INDIAN MEDICAL SERVICE

Lts. (on prob.) Sangham Lal and B. L. Taneja to be Capts.(prov.) (on prob.).

ACCIDENT CASES AT RATE-AIDED HOSPITALS.-At a recent health committee meeting of the Essexcounty council it was reported that certain insurancecompanies had refused to meet claims made upon themunder Section 36 (2) of the Road Traffic Act, 1930, inconnexion with accident cases admitted to the committee’sinstitutions, on the grounds that the Section did not applyto rate-aided hospitals. From counsel’s opinion, sinceobtained, it would appear that the committee has a rightof recourse to the insurance companies for a paymentup to 225 in each case where it can be proved that liabilityattaches to a company under a policy, and when the personconcerned or his relatives are unable to meet the cost ofmaintenance. The committee has therefore instructedits collectors in all cases where the cost of maintenancecannot be obtained from the patient themselves to applyagain to the insurance companies involved. If satisfactioncannot be obtained, the committee intends to settle thematter by bringing a test case in the High Court.