INFECTIOUS DISEASE

728 be much safer to treat cases thought to be pneumonia -perhaps erroneously-rather than to wait and see. In these 28 cases I can state that (1) full doses of 693 seemed to do no harm except in causing mild vomiting in 2 cases which ceased when the drug was stopped ; (2) in an extensive experience of Wynn’s vaccine I have never seen the slightest evidence of bad effect and the mortality has been very low ( 5 per cent.) (the " negative phase " bugbear has been clinically invisible); (3) my impression is that 693 shortened the pneumonia. Antipneumococcal serum was never given, as in children it is much less applicable than vaccine owing to the lack of sputum for typing, The doses used were : Wynn’s vaccine (Evans Sons Lescher and Webb) c.cm., i c.cm. and 1 c.cm. on the first, second and third days of admission, but not started later than the fourth day of pneumonia. M. & B. 693 was given 4-hourly : under 6 months 4 tablet, under 2 years 2 tablet, under 5 years! tablet-reduced to 6-hourly after a few days without fever. The -1 gramme tablets were

crushed. Thanksare due to Dr. W. M. Davidson, my housethese facts and figures. I am, Sir, yours faithfully, F. C. EVE. Royal Infirmary, Hull, March 20.

physician,

for

extracting

STORED BLOOD FOR TRANSFUSION

SiR,—The use of stored blood in two carefully observed series of transfusions is recorded in your issue of Feb. 18. Unfortunately the writers may in some measure have defeated their own object by over-emphasising the risk of infection, since it is just this bogy which has hitherto prevented the extended use of the method. In this hospital we have used stored blood as a routine for nearly four years, and besides adding greatly to the convenience of our donors and ourselves it has undoubtedly saved a number of lives. The blood has been collected into the open neck of a bottle of 3’8 per cent. citrate. Within the limits of this method exposure to the atmosphere is avoided, but no exceptional precautions have been taken. The blood has been stored at 4° C. for periods up to three weeks before use. We have now carried out over 300 transfusions in this way and neither from the appearance of the blood nor from its effect on the patient has there ever been any reason to suspect contamination. Sterility tests have been carried out occasionally, but no organisms have grown. The use of a closed method for collection, and I.H.T. solution as a preservative, are improvements to which I have been recently converted, and are to be strongly recommended. With such improved technique there need not be the slightest anxiety about contamination, and sterility tests are quite unnecessary. The method will undoubtedly come into general use. I am, Sir, yours faithfully, R. VAUGHAN FACEY. Royal Victoria

and West Hants

Hospital,

Bournemouth, March 18.

MENTAL NURSING

SIR,-Dr. Kimber, in your issue of March 11, brings into prominence an urgent problem regarding the training of mental nurses. The topsy-turvy order in which the probationer nurse is officially expected to acquire her knowledge of nursing demands early reform. It is entirely illogical that the preliminary examination, for which she works during her first twelve months of training, should consist

of anatomy and

physiology, accidents and emerand some elementary general nursing, to the total exclusion of anything relating to the management of psychiatric patients. It is true that in the Royal Medico-Psychological Association’s syllabus for the preliminary examination there is a section on the " general duties of nurses in a mental hospital," but in the association’s handbook a bare twenty pages are apportioned to this subject, only two of which are devoted to consideration of " the relation of nurse to patient." I am not qualified to express an opinion as to whether it is practical politics to prevail on the General Nursing Council at the present time to include an elementary course in normal psychology in their preliminary examination (which is taken by probationer nurses in general and mental training alike), and I doubt whether such a course would be of very much value to either the general or the mental probationer; but in my opinion a more practical step would be for the Royal MedicoPsychological Association to insist on a short course of lectures on how to understand and handle different types of psychiatric patients, to be taken during the first three months of training for their diploma. gencies, hygiene

The

General

Nursing

Council

should

then

be

encouraged to follow this lead by making it compulsory that those candidates intending to qualify as mental nurses should receive a similar course of lectures before taking their preliminary examination. I am, Sir, yours faithfully, FRANCIS PILKINGTON. Maudsley Hospital, S.E.5, March 21.

INFECTIOUS DISEASE IN ENGLAND AND WALES DURING THE WEEK MARCH 1939

ENDED

11,

JVocctHoM-s.—The following cases of infectious disease were notified during the week : Smallpox, 0 ; scarlet fever, 1679 ; diphtheria, 1044 ; enteric fever, 12 (29 " expected ") ; pneumonia (primary or

influenzal), 1396 ; puerperal pyrexia, 198 ; cerebrospinal fever, 48 ; acute poliomyelitis, 3 ; acute polio-encephalitis, 1 ; encephalitis lethargica, 1 ; dysentery, 61 ; ophthalmia neonatorum, 96. No case of cholera, plague or typhus fever was notified during the week. The number of cases in the Infectious Hospitals of the London County Council on March 17 was 3338, which included : Scarlet fever, 666; diphtheria, 750 (carriers, 46); measles, 8; whooping-cough, 880 ; puerperal fever, 11 mothers (plus 5 babies); encephalitis lethargica, 300 ; poliomyelitis, 2. At St. Margaret’s Hospital there were 26 babies (plus 15 mothers) with ophthalmia neonatorum. Deaths.-In 126 great towns, including London, there was no death from smallpox or from enteric fever, 7 (0) from measles, 2 (0) from scarlet fever, 18 (4) from whooping-cough, 24 (2) from diphtheria, 44 (8) from diarrhoea and enteritis under two years, and 261 (75) from influenza. The figures in parentheses are those for London itself. The number of deaths attributed to influenza has fallen, the totals for this week and the ten preceding weeks (working backwards) being 261, 284, 285, 255, 265, 210, 173, 223, 214, 144, 89. Of these 261 deaths 167 were reported from the southeastern area, Portsmouth contributing 8, Luton 7, Southend-onSea 6, Croydon, Willesden, and Southampton each 5; 51 were reported from the northern area, Sheffield contributing 7 and Leeds 6 ; 28 from the midland area, Birmingham contributing 6 and Bristol 5 ; and 14 from Wales, Rhondda contri-

buting 7 and Cardiff 5. Fatal cases of diphtheria were scattered over 17 great towns, South Shields reporting’ 3.

The number of stillbirths notified during the week was 265 (corresponding to a rate of 41 per 1000 total births), including 54 in London.

’