61

would be associated with penetrating wounds of theupper lobe, and (2) that* haemothorax without grosspulmonary injury, as in the majority of closed chestinjuries, would very rarely be followed by failure ofpulmonary re-expansion. Our experience of nearly700- cases of chest injury has borne out both theseexpectations.

BLA.

JOAN M. CHEALE.G. QVIST.N. LLOYD RUSBY.

PLASMA IN STARVATIONSIR,—Dr. Edge writes (June 30) of the subjective and

objective improvement following plasma administrationin cases of malnutrition oedema among prisoners-of-war.He notes, however, that the amount of oedema is notnecessarily correlated with the level of serum proteins,and concludes that " one has to consider whether theproteins are in fact the most important constituents ofserum for this type of case."We know that the osmotic effects of the various

fractions of plasma proteins varies greatly, and-that thesmaller albumin molecule exerts a proportionately higherosmotic pressure. If determinations of the albumin/globulin ratio had been made in Dr..Edge’s patients,might not a close correlation have been found betweenthe amount of oedema and the level of serum albumin-oedema being present when the latter fell below a criticallevel of 1-5-2-0 grammes per 100 c.cm. ?

Should this indeed prove to be the case, then theadministration of purified human albumin (at- presentbeing worked on in Boston) may well be even morevaluable than the use of whole plasma in the treatment of

. cedema caused by malnutrition, as well as that due toother causes of hypo-albuminaemia.London, WC2. D. E. CULLINGTON.

PROFIT AND LOSS IN THE SERVICES

SIR,—Now that the European war is over, one is inclined to take stock of oneself. As ’an ex-GP whathas one learnt, forgotten, or gained in the Services ? C

I have learnt office routine which will surely help me todeal with the directives that will no doubt emanate from L

the Minister of National Insurance. I shall almost look forward to those unintelligible amendments, Ref. ourletter NI/C/ &c. dated ? ? ? Para 6 line 3 delete " not."I have forgotten the ailments of children and old people,that mother needs exact detailed advice. No longer will a chit to the orderly " Routine BB

" suffice for a scabies case. I have gained a far greater insight into men andtheir reactions to work than one could have gained in Cgeneral practice. Today I can give a fair and helpfulanswer to the problem,

" Can a man do a certain job of work in my unit ? "-a. question I could rarely answer ingeneral practice to my own satisfaction. ,

This is my "

post-war plan " for doctors : -

1. Every man, woman, and child in the country should beentitled to medical treatment. If a person likes to buy C

treatment, that is their own -concern. It’s a free country.2. Doctors undertaking to treat "National" patients must have c

premises equipped to a certain scale of instruments, and drugs. Today so long as one has a pencil for prescriptions Cand a pen for a letter to a hospital one can treat anyailment. If a diagnostic set was compulsory there wouldbe a reasonable prospect of wax in the ear being dis- covered, rather than diagnosed, as a cause of deafness. A scale of equipment will encourage examinations and ’ Chence raise the standard of medicine.

3. The equipment can be provided, on a hire-purchase system Cif necessary, from closed-down units of the armed forces.

4. Every doctor should be entitled to a nursing orderly or C

receptionist paid, like the doctor, from the national C

exchequer. The receptionist would be responsible for clerical work, dressings, and the preparation of the patient for an examination.

I feel that the above scheme would take the best of Service medicine into civil life and at least could form oneof the bricks of a National Health Service.

L’

RAFMO.

BIOCHEMICAL SOCIETY.—A meeting of the society will be -E2,held in the School of Medicine, Thoresby Place, Leeds, 2, onFriday, July 20, at 2.3U Par, when short communications will be given. °

On Active Service..

CASUALTIES‘DIED WOUNDED

Lieut.-Colonel E. F. W. GRIEL- Captain D. R. HUGHES, MRCSLIER, MB CAMB. Captain L. G. KILOH, MRCSMISSING Captain F. H. LECKIE, MC,

Squadron-Leader R. W. S. LRCPE

MARSHALL, MB BELF.

AWARDS .

CB

Major-General EDWARD PHILLIPS, CBE, DSO. MC, MB DURH.CBE

Brigadier J. H. BAYLEY, MC,. ! Brigadier J. G. MORGAN, OBE,MRCS, RAMC

’’

TD, MB LOND., RAMC

Brigadier W. E. R. DIMOND, Brigadier F. A. R. STAMMERS,CIE, OBE, LRCPI, IMS li MB BIRM., FROS, RAMC

Brigadier J. M. MACKENZIE,OBE, MC, MB ABERD., RAMC !

DSO ,

Lieut.-Colonel J. N. GROVES, Lieut.-Colonel NAWABZABA Ai,iMB CAMB., RAMC AHMED KHAN, k]3, IAMC

Lieut.-Colonel H. F. T. MAC- Lieut.-Colonel D. WRIGHT, MBFETRIDGE, MB DUBL., IAMC GLASG., RAMC

OBE

Lieut.-Colonel T. M. R. AHERN, Lieut.-Colonel J. H. HUTCHISON,MB DUBL., RAMC MD GLASG., FRFPS, RAMO

Lieut.-Colonel C. G. BAKER, MD Lieut.-Colonel K. McNEILL,LOND., MROP, RAMC MB EDIN., RAMO

Lieut.-Colonel J. B. BUNTING, Lieut.-Colonel J. B. M. MILNE,MB CAMB., RAMC Colonel F. K. BUSH, MB MELB., MBE, MB EDIN., RAMC

RAMO Lieut.-Colonel M. M. PATERSON,Lieut.-Colonel T. E. A. CARR, MB ABERD., RAMO

TD., MB LOND., RAMO ! Colonel R. L. RAYMOND, MBColonel F. R. CAWTHORN, MB SYDNEY, FRCS, IAMC

MELB., IMS Lieut.-Colonel H. R. SHEPPARD,Lieut.-Colonel V. J. DOWNIE, MRCS.RAMCDSO, MC, MB BIBM., BAMO -, . , Lieut.-Colonel R. P. SMYTH, MBColonel R. V. FRANKLIN, MB DUBL.,RAMC , I BELF..RAMC

Lieut.-Colonel W. H. GABB, Lieut.-Colonel W.. H. A.

MB CAMB., MRCP, RAMO THORNE, MRCS, IAlVlC ;

Lieut.-Colonel W. GRAHAM, MB Lieut.-Colonel R. L. TuRNER, ’BELF., RAMC MB EDIN., FRCSE, RAMC

_

MBE

Major ANur KUMAR DUTT, MB, ! Major J. M. McKIDDIE, MBIAMC ABERD., RAMC

Major F. W. BUNTING, MD Major B. J. MALLEY, MB NUI,GLASG., RAMC MRCP,RAMC

Captain W. N. CALDER, MB Major J. MASON, BM OXFD,ABERD., RAMC RAMC

Major G. J. CLELAND, MB EDIN., Captain MOHD MOHSIN KHANFRCSE, RAMC NAJAM, IAMO

Major H. G. ESTCOURT, MD Major R L ORCHARDSON, MBLOND., FRCSE, RAMC GLASG., RAMC Major T. E. FIELD, MB BELF., I

RAMC Major D. L. OWEN, MB EDIN.,Captain CHAUDHRI KHURSHID RAMC

HASSAN, MB, IMS Major J. McL. Ross, MB EDIN.,Captain L. McA. HOGG, MB, IMS RAMC

-

Major D. B. JAGGER, MB BIRM., Captain SURAT SINGH GREWAL,RAMC , IMS

Captain R. J. A. MACDoNALD, Captain J. B. WYMAN, MROS,MB ST. AND., RAMO RAMC .

,

MC .

CaptainCHADALAVADAKRISHNA ; Captain G. D. KoSHAL, MB,RAO, IMS IAMC

Captain J. A. CHAMBERLIN, Captain S. MASCARENHAS, MB,MB LOND., RAMC , IAMC

Captain H. D. CocKi3LTR-N, MROS, Major H. J. MINFORD, MB BELF.,RAMC

RAMCCaptain H. M. JAhIISON, MBE, Captain G. PATTON, MB BEMMB LOND., RAMC RAMCCaptain E. D. KERR, MB DUBL., ’, RAMC - Major R. WADDELL, MB GLASG.,Captain S. KESAvuLU, MB, IAMC , RAMC

MENTIONED IN DESPATCHES

BCAilIC- J. U. COLEMAN, G. A. W.

Lieut.-Colonels.—M.R.ELLIOTT, CUBRIE, W. S. KEITH, J. A.E. C. JANES. LANGILLE, H. V. G. LATOUR,

Majors.—E. H. ANDERSON, J. ST. C. D’IOFFATT, A. ST. C.

DSO, R. W. BOYDEN, DSO, RUMBALL.

Erratum.—In a corrected notice the London Gazette states thatLieut.-Colonel D. L. Owen. who has received the DSO, is Lieut.-Colonel D. L. Lloyd-Owen. of the Queen’s Royal Regt. TheLancet list of July 7 needs a corresponding correction.