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commonest injuries were foot lacerations (64%), which were causedby stepping on broken glass. Infection developed in 34% of thesewounds. 22% of injuries were caused by motor-vehicle accidents.Significantly fewer injuries of all types were found among childrenwho played near fire hydrants with sprinkler attachments thatreduced the flow of water from 3800 1/min to 266 1/min and thatdirected the jet upwards.

Joffe et al point to the demographic characteristics of this patientgroup as being the key factors that led to their injuries. Theprovision of an alternative means of cooling in hot weather mightreduce the frequency of these accidents. Joffe et al also estimate thatroutine attachment of sprinkler systems might save much of theannual US$1’5 million that is spent on these impromptu streetshowers.

1. Joffe M, Towney SB, Baker MD. Fire hydrant play: injuries and their prevention.Pediatrics 1991; 87: 900-03.

Rebound out of court?

Rebound tenderness, as a test for peritonitis in the diagnosis ofabdominal pain, is widely and credulously looked for bypractitioners and surgical examiners alike. But does it signifyanything more than simple tenderness, which may have manycauses other than peritonitis? Liddington and Thomas1 describe142 unselected patients with abdominal tenderness: of the 88 withrebound tenderness, 43 had peritonitis and 45 did not, whereas ofthe 54 without rebound tenderness, 10 had peritonitis and 44 didnot. The authors observe that the demonstration of reboundtenderness suffers the twin disadvantages of being unpleasant forthe patient and diagnostically useless. Sadly, they also note thatthese drawbacks were known over 20 years ago.2

1. Liddington MI, Thomson WHF. Rebound tenderness test. Br J Surg 1991; 78:795-96.

2. Prout WG. The significance of rebound tenderness in the acute abdomen. Br J Surg1970; 57: 508-10.

Hip hop in minor op

Many readers may have treasured memories of their rathereccentric surgical teachers cutting out a gallbladder to the

accompaniment of Wagner, chopping out some small bowel in timewith Mahler, or excavating an abscess to the gentle lyrics of theBeastie Boys. However, the therapeutic benefits of music to thepatient, rather than the doctor, may be worthy of further scrutiny.Researchers from Pittsburgh, USA, have reported on the effects ofmusic during treatment of lacerations.1 38 adults were randomisedto receive either standard laceration repair without music or repairwith music that was chosen from fifty available styles and artists.Music was delivered via a headset and all patients receivedintradermal lignocaine as a local anaesthetic. Mean laceration lengthand the number of sutures required for wound closure were similarfor both groups. Pain scores, based on a visual analogue scale rating,were significantly lower among the group receiving musicaldiversion than among controls. There were no significant changesin measures of anxiety or physiological function, such as heart rate,blood pressure, or respiratory rate. Music may offer a valuableclinical benefit by reducing the subjective experience of pain duringminor surgical procedures.

1. Menegazzi JJ, Paris PM, Kersteen CH, Flynn B, Trautman DE. A randomised,controlled trial of the use of music during laceration repair. Ann Emerg Med 1991;20: 348-50.

Triazolam case settled

A case in which an American woman sued Upjohn,manufacturers of triazolam (’Halcion’), on the grounds that thedrug caused her to kill her mother, was due for trial on Aug 21.Legal arguments over the status of documents relating to the drugwere discussed in our issue of July 27 (p 243). The case has nowbeen settled out of court; Upjohn is reputed to have agreed to payseveral million dollars to the plaintiffs.

In England Now

THE RIME OF THE ANCIENT EXAMINER

(Thoughts on failing thefellowship examination)It is an ancient examinerAnd he stoppeth two of three."By thy long grey beard and glittering eye,Now wherefore stopp’st thou me?

"The college doors are open wideAnd I’m the next one in.The court is met, the sherry’s setWhat’s that in formalin?"

He held me with a skinny hand,"It is a hip", he quoth.He fixed me with his glittering eye,"Is it TB or Perthes’—or both?"

I sat as though I’d turned to stone;On my heart there was a chill;Eftsoons went on that ancient man,The examiner hath his will!

The pang, the curse with which I dried,Has never passed away:I could not draw my eyes from hisNor turn them up to pray.

Upon that point where sank my hopes,My head spun round and round.And all was still, save that the billStill read: "Three Hundred Pounds".

(after Samuel Taylor Coleridge.)

* * *

The Manic Depressive Fellowship meetings took a bit of gettingused to. Everyone else had been quite seriously ill, and I was veryconscious of being one of "them"-a doctor- and never havinghad to take time off work because of mood swings. The others wereor had been on alarming doses of psychotropics, and had lost jobs,spouses, and driving licences. I took an instant liking to the ladies,who swapped hilarious advice on how to abscond from our localpsychiatric unit. The group has settled down now: we take it inturns to meet at each others’ houses. We talk for an hour about howwe are all getting on, who is new in the lithium clinic, and what’shappening at the hospital day centre. We have coffee and cakes andthen a vigorous work-out with ’Trivial Pursuits’. All in all, youcouldn’t meet a friendlier or saner bunch of people.The other meeting I go to once a month is different. Bolting down

our teas, we drive furiously across the county to be punctual; wecompete to see who has the most impressive collection of papers inour brief-cases. We play the "old pals act" and put each other downwith subtle politeness. The young women are coquettish, and themen posture. We discourse for two hours on the ritualisedobsessional behaviour of which we are victims. Far from trying tocontain this problem, we think up ingenious ways to fill our timewith ever-more pointless fatiguing tasks. We gripe paranoicallyabout the Government and consume, but do not allow ourselves to

enjoy, the biscuits and coffee. We are too busy for jokes-it’s worktomorrow morning. Perfunctory "Goodnights", and the BMWsand Volvos race away to the ulcers and coronaries. You’ve guessedit. This bunch of lunatics is the local audit group for GPs.

Do gardens, like dogs, grow to resemble their owners? Aneighbour recently suggested this to my wife, adding that ours wasquaint and old-fashioned, but colourful and exuberant and trying toescape out of its borders. As I undid my belt by another notch, I hadto admit that the resemblance was all too apt.