- Email: [email protected]
EASY CHILDBIRTH
740 and if he would give the areas which the scheme covered.-Mr. T. JOHNSTON replied : The supplementary medical service which has operated in the Clyde Valley since January last has now been extended to cover workers of all ages in the industrial areas of Scotland.-Mr. PETHICKLAWRENCE : Has the concurrence of the medical profession been obtained, and what is the approximate number of workers affected ? Mr. JOHNSTON : I have the entire concurI cannot give the precise renoe of the medical practitioners. number of workers covered by the extended operations of this act, but the first experiment covered 44% of the insured workers. Dr. E. SUMMERSKILL: Does this extension include dependants ? Mr. JOHNSTON : It deals only with workers, but it includes a housewife if she is a war worker. Mr. H. McNEIL : Is the Minister satisfied that there are sufficient beds to meet all kinds of cases referred for hospital treatment under this scheme ? Mr. JOHNSTON : Absolutely.
Clyde Valley,
now
Post-vaccinal Deaths in Scotland Mr. S. P. VIANT asked the Minister how many deaths had occurred during the recent smallpox outbreaks from vaccination and with vaccination as a contributory cause, respectively. - Mr. JOHNSTON replied : According to the information at present available there have been 9 deaths in Scotland following vaccination during the recent outbreaks of smallpox, when about a million vaccinations were performed. Seven of these, were registered as due to encephalitis (2 in Glasgow, 3 in Edinburgh and 2 in Fife), 1 in Glasgow due to erythema and 1 in Lanarkshire due to toxaemia. In addition there was 1 death in Glasgow due to measles, vaccination being stated to be a contributory cause.
Letters
to
the Editor
LABORATORY TECHNICIANS OF THE FUTURE SIR,—It would be unfortunate if your annotation of Nov. 28 (p. 649) should give the impression that the Association of Scientific Workers (AScW) has completed the formulation of its policy to improve the status and education of technicians, or is committed to some of the proposals criticised in your article. A memo on this subject is at present being considered by a joint subcommittee of the science education, medical sciences and
technicians committees of the AScW. When a final report has been prepared and approved it will be sent for criticism and suggestions as to appropriate action to other interested bodies, such as the Institute of Medical Laboratory Technology (when established), the Association of Clinical Pathologists, and so on. Although the AScW hopes that improvement in the status and education of technicians can be inaugurated in the near future and is working towards that end, it should not be assumed that the statements mentioned in your annotation represent its considered policy. DOUGLAS McCLEAN, Chairman of Medical Association of Scientific Workers, High Holborn, WC1.
’
Sciences Committee.
SiR,-Your annotation on laboratory technicians appears to me to discover difficulties where none need exist. The supply and training of laboratory assistants have been solved at this hospital and the routine adopted may be of interest to other hospitals. The laboratory is under the charge of a part-time pathologist and is run by a full-time technician who now has the diploma of the PBLAA. When it was found necessary to expand the staff a lad of 16 of matriculation standard was engaged as an apprentice under a three-year agreement. The hospital undertook to supply instruction and make him competent as a technician, paying him 10s., 21and 30s. a week for the three years ; he on his part undertook to attend technical college evening school and to sit for the two parts of the diploma in three and five years. At the end of three years he passed the first part and was given a further agreement at oB2 a week, rising by two annual increments to £3 a week at the age of 21. An additional apprentice was engaged. Such a system supplies a continuous series of recruits at little cost and yet making the employment worth while, with its prospect of entering what is becoming a remunerative profession. At the same time insistence on the seniors carrying out teaching quickens theit interest and leads to better work. It appears to me
to insist on training unnecessary "offering considerable facilities
only a few centres for’ teaching." The PBLAA already has an effective routine for the direction of training, for examination and qualification of its members. at
H. I. DEITCH.
General Hospital, Halifax.
EASY
CHILDBIRTH
SIR,—The review of Dr. Dick Read’s Revelation of Childbirth in the Lancet of Nov. 28 prompts me to put
down my experiences during the birth of my first baby two months ago. Up to the fourth month of my pregnancy I was terrified of labour, having seen what I thought to be unbearable suffering while doing my midwifery cases (I am a final-year student). Then I read Dr. Dick Read’s chapter on relaxation in F. J. Browne’s Antenatal and Postnatal Care (1942, p. 77). His argument appeared reasonable, and from that moment I made up my mind to have a painless and normal labour. Labour started at 3.30 AM. I noticed that the pains were merely uncomfortable while lying down whereas pain was very real when walking about, because then I was unable to relax properly. When I got into bed at the hospital I read an ear, nose and throat book much to the amusement of everybody. Sister came to see how I was getting on every hour or so. I was having fairly frequent pains at the time, but she thought I was telling stories. At 2 PM the registrar arrived to have a look at me. Sister was sure I was " not doing anything," or how could I be reading about otitis media ? I told him I had read the article on relaxation in Browne and was trying to act accordingly. He smiled indulgently and later told Sister that in that case one did not really know how far on I was ; but still he did not think At 3 PM the ward much would happen for many hours. maid asked why I had come in if I was not in labour. At 4 PM I was moved into the labour ward. I had previously asked for theMinnitt’ but after two attempts gave it up as unnecessary. The end of the first stage was the only really uncomfortable time. At 5 PM the HS told me I need not be brave and should scream as much as I liked ; they would give me a whiff of chloroform when the head was being born. He thought me mad when I refused because I wanted to hear the first cry. During the end of the first stage and throughout the second stage I found two things extremely important : first, though I knew what was happening and was not frightened, it was terrifying to be left alone in the room ; secondly, it was important that there should be somebody’s hand to hold while pushing. The second stage lasted 50 minutes. As long as I pushed as hard as I could during pains and relaxed completely between them it was not painful at all ; only if I did not push hard for just a moment was it painful. I certainly did not find the crowning of the head " a moment of extreme agony for the mother.’’ The feeling of relief afterwards was indescribable. The staff, and particularly the midwives, were impressed by the fact that a normal labour of 15-hours duration could be so painless. "Relaxation" was a topic of conversation in the hospital for the next few days. A friend of mine who was having her first infant about the same time had similar experiences both as regards painlessness and the incredulity of the midwife. To sum up : most doctors and midwives regard labour as necessarily very painful ; but, judging from my own case, relaxation during the first stage and hard pushing during the second make labour almost painless except for the last few pains of the first stage. Apaesthesia or even analgesia is not necessary in a normal labour. It should be a rule that a woman in labour should never be left alone. ELENA ZADIK. MERCURIAL DIURETICS
SIR,—In your annotation of Nov. 28 (p. 651) you
point out that the number of recorded fatalities is astonishingly low considering the wide use of mercurial diuretics. Among more than 5000 injections ofmersalyl, ’Novurit,’Neptal ’ and ’Esidrone,’ given or watched by myself, I remember only few untoward and no fatal reactions. Of the two types of toxic reaction-that due
to the mercury and that due to the diuresis-the latter is much rarer than the former. When these drugs were first used there was much speculation about the risk of cardiac asthma and dehydrational shock from over-
.
.
Clyde Valley,
now
Post-vaccinal Deaths in Scotland Mr. S. P. VIANT asked the Minister how many deaths had occurred during the recent smallpox outbreaks from vaccination and with vaccination as a contributory cause, respectively. - Mr. JOHNSTON replied : According to the information at present available there have been 9 deaths in Scotland following vaccination during the recent outbreaks of smallpox, when about a million vaccinations were performed. Seven of these, were registered as due to encephalitis (2 in Glasgow, 3 in Edinburgh and 2 in Fife), 1 in Glasgow due to erythema and 1 in Lanarkshire due to toxaemia. In addition there was 1 death in Glasgow due to measles, vaccination being stated to be a contributory cause.
Letters
to
the Editor
LABORATORY TECHNICIANS OF THE FUTURE SIR,—It would be unfortunate if your annotation of Nov. 28 (p. 649) should give the impression that the Association of Scientific Workers (AScW) has completed the formulation of its policy to improve the status and education of technicians, or is committed to some of the proposals criticised in your article. A memo on this subject is at present being considered by a joint subcommittee of the science education, medical sciences and
technicians committees of the AScW. When a final report has been prepared and approved it will be sent for criticism and suggestions as to appropriate action to other interested bodies, such as the Institute of Medical Laboratory Technology (when established), the Association of Clinical Pathologists, and so on. Although the AScW hopes that improvement in the status and education of technicians can be inaugurated in the near future and is working towards that end, it should not be assumed that the statements mentioned in your annotation represent its considered policy. DOUGLAS McCLEAN, Chairman of Medical Association of Scientific Workers, High Holborn, WC1.
’
Sciences Committee.
SiR,-Your annotation on laboratory technicians appears to me to discover difficulties where none need exist. The supply and training of laboratory assistants have been solved at this hospital and the routine adopted may be of interest to other hospitals. The laboratory is under the charge of a part-time pathologist and is run by a full-time technician who now has the diploma of the PBLAA. When it was found necessary to expand the staff a lad of 16 of matriculation standard was engaged as an apprentice under a three-year agreement. The hospital undertook to supply instruction and make him competent as a technician, paying him 10s., 21and 30s. a week for the three years ; he on his part undertook to attend technical college evening school and to sit for the two parts of the diploma in three and five years. At the end of three years he passed the first part and was given a further agreement at oB2 a week, rising by two annual increments to £3 a week at the age of 21. An additional apprentice was engaged. Such a system supplies a continuous series of recruits at little cost and yet making the employment worth while, with its prospect of entering what is becoming a remunerative profession. At the same time insistence on the seniors carrying out teaching quickens theit interest and leads to better work. It appears to me
to insist on training unnecessary "offering considerable facilities
only a few centres for’ teaching." The PBLAA already has an effective routine for the direction of training, for examination and qualification of its members. at
H. I. DEITCH.
General Hospital, Halifax.
EASY
CHILDBIRTH
SIR,—The review of Dr. Dick Read’s Revelation of Childbirth in the Lancet of Nov. 28 prompts me to put
down my experiences during the birth of my first baby two months ago. Up to the fourth month of my pregnancy I was terrified of labour, having seen what I thought to be unbearable suffering while doing my midwifery cases (I am a final-year student). Then I read Dr. Dick Read’s chapter on relaxation in F. J. Browne’s Antenatal and Postnatal Care (1942, p. 77). His argument appeared reasonable, and from that moment I made up my mind to have a painless and normal labour. Labour started at 3.30 AM. I noticed that the pains were merely uncomfortable while lying down whereas pain was very real when walking about, because then I was unable to relax properly. When I got into bed at the hospital I read an ear, nose and throat book much to the amusement of everybody. Sister came to see how I was getting on every hour or so. I was having fairly frequent pains at the time, but she thought I was telling stories. At 2 PM the registrar arrived to have a look at me. Sister was sure I was " not doing anything," or how could I be reading about otitis media ? I told him I had read the article on relaxation in Browne and was trying to act accordingly. He smiled indulgently and later told Sister that in that case one did not really know how far on I was ; but still he did not think At 3 PM the ward much would happen for many hours. maid asked why I had come in if I was not in labour. At 4 PM I was moved into the labour ward. I had previously asked for theMinnitt’ but after two attempts gave it up as unnecessary. The end of the first stage was the only really uncomfortable time. At 5 PM the HS told me I need not be brave and should scream as much as I liked ; they would give me a whiff of chloroform when the head was being born. He thought me mad when I refused because I wanted to hear the first cry. During the end of the first stage and throughout the second stage I found two things extremely important : first, though I knew what was happening and was not frightened, it was terrifying to be left alone in the room ; secondly, it was important that there should be somebody’s hand to hold while pushing. The second stage lasted 50 minutes. As long as I pushed as hard as I could during pains and relaxed completely between them it was not painful at all ; only if I did not push hard for just a moment was it painful. I certainly did not find the crowning of the head " a moment of extreme agony for the mother.’’ The feeling of relief afterwards was indescribable. The staff, and particularly the midwives, were impressed by the fact that a normal labour of 15-hours duration could be so painless. "Relaxation" was a topic of conversation in the hospital for the next few days. A friend of mine who was having her first infant about the same time had similar experiences both as regards painlessness and the incredulity of the midwife. To sum up : most doctors and midwives regard labour as necessarily very painful ; but, judging from my own case, relaxation during the first stage and hard pushing during the second make labour almost painless except for the last few pains of the first stage. Apaesthesia or even analgesia is not necessary in a normal labour. It should be a rule that a woman in labour should never be left alone. ELENA ZADIK. MERCURIAL DIURETICS
SIR,—In your annotation of Nov. 28 (p. 651) you
point out that the number of recorded fatalities is astonishingly low considering the wide use of mercurial diuretics. Among more than 5000 injections ofmersalyl, ’Novurit,’Neptal ’ and ’Esidrone,’ given or watched by myself, I remember only few untoward and no fatal reactions. Of the two types of toxic reaction-that due
to the mercury and that due to the diuresis-the latter is much rarer than the former. When these drugs were first used there was much speculation about the risk of cardiac asthma and dehydrational shock from over-
.
.