165

Following brief suction of the nostrils and oropharynx, those with a score of 4 received no active treatment, those with a score of 3 received oxygen and were stimulated, those with a score of 2 were ventilated by bag and mask, and those with a score of 1 or 0 were immediately intubated and ventilated. If no improvement occurred after 1-1 minutes, 1 was subtracted from the score and the new treatment indicated was commenced. Treatment continued until the score was 4. While experienced neonatologists will modify treatment on an individual basis, we have found these guidelines extremely valuable for the occasional resuscitator, junior resident staff, and medical students. I congratulate Mr Chamberlain and Mr Banks on their welcome contribution to simplification in assessment and management of the newborn. Mount Sinai Hospital, Fifth Avenue and 100th Street, New York, N.Y. 10029,

U.S.A.

R. BRYAN ROBERTS.

ORAL GLUCOSE ELECTROLYTE THERAPY FOR ACUTE DIARRHŒA

palaeontology of the British Museum (Natural History), X-ray and the information about the Kanam mandible. Chester Beatty Research Institute, Fulham Road, London SW3.

QUALITY AND QUANTITY

for the

G. STATHOPOULOS. IN CHEMICAL

PATHOLOGY

SIR,-Dr Carter and his colleagues (Dec. 28, p. 1555) inject a refreshing element of reasoned thought into the vexed and much discussed problem of what still appears to be the exponential increase in demand for chemical pathology. There are two areas, however, in which their article may

give

a

wrong

impression.

The statistics quoted for hospital inpatients hide a considerable increase in turnover of patients through acute beds in the past 13 years. There has also been a considerable increase in the work-load performed directly for general practitioners-an important aspect of the work in district general hospitals (see accompanying table). In addition, geriatricians and psychiatrists investigate their patients HOSPITAL DATA (ENGLAND AND WALES 1) FOR ALL EXCEPT PSYCHIATRY AND GERIATRICS

SPECIALTIES

SIR,-Having spent the last few days designing an elegant plastic scoop to measure the four dry constituents needed to make glucose electrolyte solution, I am delighted to see it discussed in your editorial (Jan. 11, p. 79). You rightly point out that the greatest difficulty will be getting it to the homes and health centres where it is needed. Besides encouraging pharmaceutical firms to pack the dry powder in plastic bags, could I also ask them to pack it in tins of a litre, or multiples of a litre, and to include a measuring scoop in the tin ? Perhaps one of them would be prepared to make a measuring scoop so that the solution could be made from the raw materials without the use of a balance ? The cost of such a scoop would be trifling, and, in default of any more laudable reason for its manufacture, it would make an admirable means of advertisement. Lembaga Kesehatan Nasional, Jalan Inderapura, Surabaya, Indonesia.

MAURICE KING.

KANAM MANDIBLE’S TUMOUR

SiR,—The Kanam mandible, recovered by Dr Leakey in 1932 from deposits in Kenya, probably belongs to an early hominid that lived during the middle pleistocene age, 500,000 to 1,000,000 years ago.,2 The mandible is " rean asymmetrical fullness situated largely to the left of the symphyseal surface which has been diagnosed In Burkitt’s as a subperiosteal ossifying sarcoma ". lymphoma the jaw is involved in the majority of cases.3 Could the Kanam tumour be a Burkitt’s lymphoma ? The Kanam mandible’s two remaining teeth suggest that its owner was young. Burkitt’s lymphoma, too, is a disease of children and young adults. It is thought that the inhabitants of central Africa have not changed much over the centuries. The climatic conditions in Kenya during the pleistocene age were similar to those in South Africa today-wetter and about 6°C cooler than in present-day Kenya.4 The X-ray of the Kanam mandible fossil is too obscure to show details of the tumour. Are the other indications enough to make Burkitt’s the oldest known tumour ?

presented by

I should like to thank Miss T. 1. 2. 3. 4.

Molleson, of the department of

Tobias, P. V. Nature, 1960, 185, 946. Tobias, P. V. in Evolution and Humanisation (edited by G. Kurtm); p. 181. Stuttgart, 1965. Burkitt, D. Br. J. Surg. 1958, 46, 218. Markou, A. P. Personal communication.

These data have been extracted from tables 4.6 and 4-9.1

fully than they did in the past. The improvement in enzyme and endocrine analysis in the past 15 years has given the clinician more powerful diagnostic tools which, employed more widely, add significantly to the work-load. Since these same analytical tools are necessary for monitoring the progress of patients (and very often the effect of drugs and other therapy), should one expect a consistent relationship between the extent of their use and the length of stay in hospital ? Up to 50% of admissions to acute beds in district general hospitals may be the result of emergencies, and the length of stay is surely more closely related to the

more

effectiveness of treatment. Since the average length of stay in an acute bed is now 10 days (which includes 8 full laboratory working days) there would seem to be a greater pressure on clinicians to ask for a larger number of simultaneous analyses on specimens rather than adopt the more time-consuming sequential ordering of tests. The introduction of multichannel analysers has in some ways eased the work-load for the laboratory and improved turn-around time. These machines have rightly drawn much criticism, for the way in which they produce redundant data, for their contribution on occasion to sagging laboratory morale, and for their relative failure to provide readable reports as direct output. Certainly there is room for improvement in flexibility selectivity, and easier grouping of clinically related tests. Despite the present emphasis on mechanisation the major resource deployed in our laboratories is still the time of skilled staff. Multiple automated tests, which account for the bulk (70-90%) of the numerical work-load, consume less time and labour than do the more complex manual tests. The most important result of mechanisation is the ability it gives us to devote the maximum time of skilled staff to a wide variety of manual procedures. 1. Health and Personal Social Services Statistics for England (with Summary Tables for Great Britain). H.M. Stationery Office, 1973.

Letter: Kanam mandible's tumour.

165 Following brief suction of the nostrils and oropharynx, those with a score of 4 received no active treatment, those with a score of 3 received ox...
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