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flush with the skin; this was described as a disaster, particularlyby the two representatives of the appliance makers-Mr. P.PAYNE (London) and Mr. E. SALT (Birmingham). Mr. PAYNEalso urged surgeons to place stomas in line horizontally whenboth intestinal and urinary conduits were necessary in thesame patient, as was sometimes the case, since it was otherwisevery difficult to maintain application of the necessary appliances.Mr. N. HALL emphasised the importance of choosing the

site on the abdominal wall for the stoma: he stuck the bag tothe abdomen for several days before operation since thisrevealed the correct site to ensure that the bag was no encum-brance. It was particularly important to do so in these childrensince their other deformities, as of the spine, and weakness ofthe abdominal wall made the site unpredictable in the indi-vidual case. Though the right iliac fossa was the site of choice,it was agreed that any part of the abdominal wall could be used.Moreover, the parents were invited to visit the child at thisstage to accustom themselves to the idea of the appliance andits significance.Representing parents, Mr. F. ARMOUR, from the Association

for Spina Bifida and Hydrocephalus, emphasised the need fortheir instruction and education; they published literature forthis purpose. But outside the special centres represented atthis meeting, his Association, which had only been in existencefor two years, experienced difficulty in obtaining contact withhospitals and their staffs.

Mrs. D. HARRIS and Mrs. N. ALEXANDER (Ileostomy Associa-tion of Great Britain and Ireland), explained how their associa-tion had achieved this slowly over ten years and how trainingprogrammes for nurses had been instituted and conducted byits members using films and personal demonstrations; thesewere now not only accepted but in demand.Miss M. BLACKMORE (Matron, Chailey Heritage) drew

attention to the need for such instruction in urinary conduitsfor domiciliary nurses, since these children needed continuingcare after returning home. In nursing these patients Miss R.DE STEPHANIE had encountered difficulty with bag managementwhen other appliances such as callipers had to be worn. More-over her patients were troubled by excoriation of the skin(described by some as ammoniacal dermatitis) and chafingfrom the supporting belt. Karaya powder and silicone oint-ment were suggested for excoriation and a girdle or tyre-typebelt for the chafing.Mr. Eckstein had found plastic flanges less inclined to cause

excoriation than rubber. He presented a plastic bag he hadrecently designed; this was disposable and cost 3s. 6d., but theprice should fall to 2s. It usually remained in situ for aboutfour days. Bag sterilisation was thus eliminated; moreover itwas designed so that urine would not flow back onto thestoma on recumbancy.Mr. PAYNE and Mr. SALT recommended rubber rather than

plastic; though not disposable there was no difficulty in steril-isation. Mr. ELLISON NASH used rubber bags and there wasno odour problem if hibitane was used; he refuted Mr. R.HESLOP’s (Hull) suggestion that in an institution such as ChaileyHeritage, with many such patients, bags might inadvertently beexchanged after cleaning and thus be a cause of cross-infection.Mr. R. TURNER WARWICK felt that much further develop-

ment of appliances was required and that this would be impededby attempts to standardise them.Assurances were given by Dr. G. BUXTON (Ministry of

Health) that standardisation was not expected and that theMinistry would continue to support their development.

It was evident that urinary diversion was not only savinglives but relieving disability. Dr. LORBER was able to reportthat mothers found it considerably easier to manage theirchildren with a conduit and its appliance than with the urinarydisability which preceded its institution. Mr. PooLE WILSONhad followed 14 children operated upon between 1952 and1959; their ages at the time ranged from 18 months to 15 years.There had been 3 late deaths, 1 from obstruction, 2 fromuraemia after 5 and 6 years. The remaining 11 are healthy andliving an active life; 2 of the girls have become pregnant,1 already being delivered of a normal baby by caesarean section.

In England Now

A Running Commentary by Peripatetic Correspondents

ONE looks to the Royal Society of Medicine for many things:but last of all, probably, for excitement. It was, therefore,with total incredibility that fellows working in the library lastweek received the news, calmly given by an assistant, that thebuilding was on fire. We were instructed which fire-exit andfire-escape to use, and dutifully we obeyed and filed out intothe street below. It was very cold on the pavement, where wejoined the crowds of rubber-neckers who gazed hypnotised atthe occasional tongue of flame, the billowing smoke, and thehigh drama of the va-et-vient of fire-engines and their operators.

Admittedly it wasn’t much of a fire, and before long wewere allowed back to the Barnes Hall to thaw out, getting ourfirst glance of the heart-breaking damage to the foyer sorecently and so elegantly appointed. Then, by some miracle,lashings of hot cups of tea were produced which were passedround to the assembled throng. Somebody said, " It takes

you back twenty years or more to the blitz, doesn’t it ? " Itwas all highly emotional, and more than one gulp wasswallowed and one tear suppressed. But maybe it was justthe smoke.

* * *

When on holiday I always attempt to conceal my profession,for everyone has some pet illness they want to talk about. Ifit does leak out I am luckier than many, for an ashamedmurmur from me that I am not a proper doctor, only apsychiatrist, usually (but these days not, alas, invariably)causes would-be storytellers to back quickly away, henceforthlimiting social intercourse to a quick " Good day."

This year, however, I was really caught. We were holidaying,out of the season, in a pretty remote spot, so when a motherbrought her baby to me with a badly injured eye, my disclaimerof any knowledge of real medicine was made but half-heartedly.She showed such a simple and absolute trust in my abilitiesthat I knew I would never be at ease with myself if I didnot help.The injury was a penetrating wound of the sclera, just

missing the cornea, but with extrusion of the contents of theeyeball. I had no materials, no instruments, and was at mywits’ end what to do, when my wife-luckily a nurse-sug-gested the fibre-glass repair outfit lying, with all the otheraccumulated junk, in the back of the car. So I mixed someof the paste and used it to effect as neat a repair as possibleand, when it was all over and the baby was asleep, thedistraught mother was persuaded to rest too.

In the morning I hastened to examine the patient-to myrelief the repair was perfect. I heaved a sigh of relief, beforegoing to collect the grateful hugs and kisses bestowed on meby the baby’s mother. I wondered how I could ever havefaced my four-year-old daughter again if the operation on herdolly had been a failure.

* * *

One of life’s minor mysteries for me has been the frequencywith which apparently literate fellow-countrymen mispro-nounce my name—which begins GL, the traditions of thiscolumn permit me to reveal no more-as though it beganGr. It is not just that they mishear it on introduction, forthey will carefully and correctly take it down in writing andthen say, " Yes Mr. Gr-, what can I do for you ?" Some-times I feel there is nothing for it but to emigrate to Chinain the hope of being collectly addlessed at last.A couple of months ago I descended from the skies into

East Africa, there to be mispronounced in the usual way bythe very first contact I made, the immigration officer. But

I whereas the reason in England was beyond my ken, here itl is well known that R and L are more or less interchangeable, in the Bantu languages. All is clear at last: Leakey is right,, this is where we all began.