- Email: [email protected]
HÆMORRHAGIC LESIONS DUE TO STAPHYLOCOCCAL TOXIN
700
practitioners doing the same with patients, but as these do not usually report at the beginning of a cold, the early opportunity is apt to be missed. It has been found that, although there is
CHILDREN IN HOSPITAL difficult to criticise constructively the long is SIR,-It letter of Mr. Herzog in your issue of Sept. 6, as there is so much with which a psychiatrist can agree. I am sure he is right when he implies that patients over five years, and certainly those over eight years of age, can do with weekly or even less frequent visiting. This is especially true when the community atmosphere is highly developed and when all the adults surrounding the children are able to make good and happy relationships that are warm and permissive, not cold and punitive, as still happens in
considerable degree of constancy in the mouth flora, it is better to repeat the sensitivity test each autumn. (3) Influenza.-Many practitioners have noticed that treating some early cases of influenza with systemic antibiotics, on purely empirical grounds, appears to have reduced the incidence and severity of complications. It is perfectly logical to assume that, if the cold virus is essentially a starting-handle, the influenza virus may be the same, albeit on a different scale. The continued prophylactic use of systemic antibiotics may lead to the production of resistant bacteria and is therefore to be condemned, but their administration for a few days in an emergency like an imminent attack of influenza is open to no such objection. As the result of a sensitivity test can be read after overnight incubation, there is no reason why the antibiotic appropriate to the patient’s nasopharyngeal flora should not be used in an attempt to reduce the effects of bacterial invasion, even in cases of influenza. Public Health Laboratory, MORRISON RITCHIE.
a
Birkenhead.
children’s wards. It is, however, one of the disadvantages of boarding schools that they weaken family relationships, at least in the pre-adolescent. It is imperative that we constantly remember that family loyalty is something far more precious and important than group or national loyalty.
some
With regard to the under fives, and especially to those of and three years of age, frequent and if possible daily visiting is vital to the proper development of their personality and emotional stability. One recognises that at times this may be very difficult and require great sacrifice on the part of parents, and that in some cases it is impossible. However, it is our duty to see that parents who say they cannot visit frequently are, in fact, not unaware of the intense suffering of small children separated from their parents. They should be helped to be made aware of the emotional needs of those small children and then perhaps they will realise that making tea for their husbands coming home from work is not in itself a good reason for staying away. Any husband worth his salt can get his own evening meal. Of course, it is not just the frequent contact with parent and child that is important but the depth and quality of their unconscious non-verbal relationship. This cannot, of course, be produced by ministerial directives on visiting. Where it is deficient it can only be produced by analytically orientated group or individual discussions with parents. Sometimes, of course, so malignant are the unconscious forces in a mother’s personality that this happy relationship can never be produced. Would not Mr. Herzog agree that the child in the film A Twoyear-old Goes to Hospital suffered ? Would he not agree that the clinging and demanding behaviour after that child returned home is at the very least distressing to parent and child? Surely it is our duty to minimise all suffering to the utmost of For those who have eyes to see the film is quite our limits. conclusive. A recent letter in the Manchester Guardian clearly demonstrated the after-effects of a prolonged stay in orthopxdic hospitals, which were in essence a permanent and more severe form of those demonstrated by the film. The remark that disturbed me most in Mr. Herzog’s letter was that " crippled children stand out because of their quiet, non-complaining behaviour ". By writing such a statement he has unwittingly vindicated the work of Dr. Bowlby and others. Quiet passivity is the depressive picture seen in those who have suffered severely from prolonged emotional deprivaand is particularly seen in many displaced persons who have for years been emotionally starved in concentration camps, a sign therefore of serious maladjustment rather than
two
J.
HÆMORRHAGIC LESIONS DUE TO STAPHYLOCOCCAL TOXIN SiR,—The production of hasmorrhagic consolidation of
the lungs, in mice, using filtrates of staphylococcal cultures, reported by Professor Ogasawara and Dr. Tanaka 1, is an important observation. The experiments reinforce the suggestion that fatal hasmorrhagic staphylococcal pneumonia, in man, is due to the production of staphylococcal toxin in the colonised lungs.2 Furthermore they reemphasise that the rapidly lethal effect of staphylococcal toxin in experimental animals can be prevented by antitoxin ; we hope this will encourage further trials of the treatment of acute staphylococcal toxxmia, in man, with staphylococcal antitoxin.33 It might, however, be unwise to risk aggravating the characteristic systemic hypotension of staphylococcal toxxmia by the use of tetra-ethyl ammonium compounds or by chlorpromazine until there is further evidence of the efficacy of these drugs in protecting the pulmonary circulation from the acute pressor effects of staphylococcal toxin.4 G. A. GRESHAM Department of Pathology, M. H. GLEESON-WHITE. University of Cambridge. COLOUR INDEX IN NORMAL SUBJECTS SIR,-Dr. Pooley (Sept. 13) gives values for the colourindex to the nearest 0-01. Such supposed accuracy is surely without meaning, for to be able to estimate the colour-index to within a range of 0-01 the haemoglobin must be estimated to within 0-25%, and the red cells to within 12,500 per c.mm. Even the more rational calculation within 0-05 requires a haemoglobin + 1’25 % and red cells:::!:: 62,500 per c.mm.-anl accuracy beyond that of a routine hospital laboratory. Briggs and Allington, using the M.R.C. photometer, foundl a standard deviation of 4’5% for successive hsemoglobini estimations on the same subject, and I have seen a teaching; hospital laboratory vary by as much as 10%.
tion
I therefore doubt whether there is much practical value, reporting the colour-index to a second decimal place, using laboratory methods at present available.
in
_
Department of
Pathology, Royal Infirmary, Blackburn.
KEITH HORSFIELD.
1. Lancet, Sept. 13, 1958, p. 589. 2. Gresham, G. A., Gleeson-White, M. H. ibid. 1957, 3. Gresham, G. A. Brit. J. clin. Pract. 1958, 12, 247. 4. Burnet, F. M., Kellaway, C. H. Med. J. Aust. 1930,
i, 651.
ii,
295.
good adjustment.
Might I suggest that Mr. Herzog and those who think like him could perhaps find time to study more closely with their psychiatric colleagues the sometimes hidden and subtle effects of hospitalisation. Carlton Hayes Hospital, Narborough, nr. Leicester.
SiR,—Iam delighted
H. B. KIDD.
to read that hospitals are not so after all. I congratulate Miss Stephen bad for children and Dr. Whatley (Sept. 20) on their most enlightened approach to this question.
practitioners doing the same with patients, but as these do not usually report at the beginning of a cold, the early opportunity is apt to be missed. It has been found that, although there is
CHILDREN IN HOSPITAL difficult to criticise constructively the long is SIR,-It letter of Mr. Herzog in your issue of Sept. 6, as there is so much with which a psychiatrist can agree. I am sure he is right when he implies that patients over five years, and certainly those over eight years of age, can do with weekly or even less frequent visiting. This is especially true when the community atmosphere is highly developed and when all the adults surrounding the children are able to make good and happy relationships that are warm and permissive, not cold and punitive, as still happens in
considerable degree of constancy in the mouth flora, it is better to repeat the sensitivity test each autumn. (3) Influenza.-Many practitioners have noticed that treating some early cases of influenza with systemic antibiotics, on purely empirical grounds, appears to have reduced the incidence and severity of complications. It is perfectly logical to assume that, if the cold virus is essentially a starting-handle, the influenza virus may be the same, albeit on a different scale. The continued prophylactic use of systemic antibiotics may lead to the production of resistant bacteria and is therefore to be condemned, but their administration for a few days in an emergency like an imminent attack of influenza is open to no such objection. As the result of a sensitivity test can be read after overnight incubation, there is no reason why the antibiotic appropriate to the patient’s nasopharyngeal flora should not be used in an attempt to reduce the effects of bacterial invasion, even in cases of influenza. Public Health Laboratory, MORRISON RITCHIE.
a
Birkenhead.
children’s wards. It is, however, one of the disadvantages of boarding schools that they weaken family relationships, at least in the pre-adolescent. It is imperative that we constantly remember that family loyalty is something far more precious and important than group or national loyalty.
some
With regard to the under fives, and especially to those of and three years of age, frequent and if possible daily visiting is vital to the proper development of their personality and emotional stability. One recognises that at times this may be very difficult and require great sacrifice on the part of parents, and that in some cases it is impossible. However, it is our duty to see that parents who say they cannot visit frequently are, in fact, not unaware of the intense suffering of small children separated from their parents. They should be helped to be made aware of the emotional needs of those small children and then perhaps they will realise that making tea for their husbands coming home from work is not in itself a good reason for staying away. Any husband worth his salt can get his own evening meal. Of course, it is not just the frequent contact with parent and child that is important but the depth and quality of their unconscious non-verbal relationship. This cannot, of course, be produced by ministerial directives on visiting. Where it is deficient it can only be produced by analytically orientated group or individual discussions with parents. Sometimes, of course, so malignant are the unconscious forces in a mother’s personality that this happy relationship can never be produced. Would not Mr. Herzog agree that the child in the film A Twoyear-old Goes to Hospital suffered ? Would he not agree that the clinging and demanding behaviour after that child returned home is at the very least distressing to parent and child? Surely it is our duty to minimise all suffering to the utmost of For those who have eyes to see the film is quite our limits. conclusive. A recent letter in the Manchester Guardian clearly demonstrated the after-effects of a prolonged stay in orthopxdic hospitals, which were in essence a permanent and more severe form of those demonstrated by the film. The remark that disturbed me most in Mr. Herzog’s letter was that " crippled children stand out because of their quiet, non-complaining behaviour ". By writing such a statement he has unwittingly vindicated the work of Dr. Bowlby and others. Quiet passivity is the depressive picture seen in those who have suffered severely from prolonged emotional deprivaand is particularly seen in many displaced persons who have for years been emotionally starved in concentration camps, a sign therefore of serious maladjustment rather than
two
J.
HÆMORRHAGIC LESIONS DUE TO STAPHYLOCOCCAL TOXIN SiR,—The production of hasmorrhagic consolidation of
the lungs, in mice, using filtrates of staphylococcal cultures, reported by Professor Ogasawara and Dr. Tanaka 1, is an important observation. The experiments reinforce the suggestion that fatal hasmorrhagic staphylococcal pneumonia, in man, is due to the production of staphylococcal toxin in the colonised lungs.2 Furthermore they reemphasise that the rapidly lethal effect of staphylococcal toxin in experimental animals can be prevented by antitoxin ; we hope this will encourage further trials of the treatment of acute staphylococcal toxxmia, in man, with staphylococcal antitoxin.33 It might, however, be unwise to risk aggravating the characteristic systemic hypotension of staphylococcal toxxmia by the use of tetra-ethyl ammonium compounds or by chlorpromazine until there is further evidence of the efficacy of these drugs in protecting the pulmonary circulation from the acute pressor effects of staphylococcal toxin.4 G. A. GRESHAM Department of Pathology, M. H. GLEESON-WHITE. University of Cambridge. COLOUR INDEX IN NORMAL SUBJECTS SIR,-Dr. Pooley (Sept. 13) gives values for the colourindex to the nearest 0-01. Such supposed accuracy is surely without meaning, for to be able to estimate the colour-index to within a range of 0-01 the haemoglobin must be estimated to within 0-25%, and the red cells to within 12,500 per c.mm. Even the more rational calculation within 0-05 requires a haemoglobin + 1’25 % and red cells:::!:: 62,500 per c.mm.-anl accuracy beyond that of a routine hospital laboratory. Briggs and Allington, using the M.R.C. photometer, foundl a standard deviation of 4’5% for successive hsemoglobini estimations on the same subject, and I have seen a teaching; hospital laboratory vary by as much as 10%.
tion
I therefore doubt whether there is much practical value, reporting the colour-index to a second decimal place, using laboratory methods at present available.
in
_
Department of
Pathology, Royal Infirmary, Blackburn.
KEITH HORSFIELD.
1. Lancet, Sept. 13, 1958, p. 589. 2. Gresham, G. A., Gleeson-White, M. H. ibid. 1957, 3. Gresham, G. A. Brit. J. clin. Pract. 1958, 12, 247. 4. Burnet, F. M., Kellaway, C. H. Med. J. Aust. 1930,
i, 651.
ii,
295.
good adjustment.
Might I suggest that Mr. Herzog and those who think like him could perhaps find time to study more closely with their psychiatric colleagues the sometimes hidden and subtle effects of hospitalisation. Carlton Hayes Hospital, Narborough, nr. Leicester.
SiR,—Iam delighted
H. B. KIDD.
to read that hospitals are not so after all. I congratulate Miss Stephen bad for children and Dr. Whatley (Sept. 20) on their most enlightened approach to this question.