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SODIUM AND POTASSIUM IN NORMAL AND PRE-ECLAMPTIC PREGNANCY
1180
and you are clearly determined to do what you influence professional (and public) opinion in the direction of preventing these serious outbreaks. There i nothing wrong in asepsis as such; there are, however, good and bad varieties of asepsis. No doubt it is bad asepsis that has aroused your justifiable wrath.
increase the body sodium, and so bring it to the level of the normotensive pregnancy, and presumably cure the
Jellardapplied triple dye the umbilicus with encouraging results. Gillespiefound that the prophylactic application oj antiseptic ointment to the anterior nares of adult inpatients prevented nasal carriage of staphylococci; and he suggests that this treatment might be extended to infants. It would seem an advantage to treat the anterior nares of all newborn infants in this way, perhaps renewing the application every time the baby is bathed. Strictures on the sterilisation of bedding and clothing seem to be quite unjustified; it is significant that pillows and mattresses are nowhere mentioned. Disinfection of bedding, leaving out pillows and mattresses, is quite useless, and may be responsible for the bad results described. It is very clear that much cross-infection is due to hand-borne organisms. Gloves for nurses3 seem to be the remedy.
Miss Stephen and Dr. Whatley (Nov. 22) that believe this unit sponsored my film A Twodo year-old Goes to Hospital without considerable preliminary experience of the behaviour of young children in hospitals and other institutions ?
hospitals, can to
to
The recommendations of Prof. Rocke Robertson (all eighteen of them), set out in your annotation of Nov. 22 (p. 1110), should be taken to heart by all responsible for patients in hospitals. Your leader sounds rather pessimistic : truly, the battle for improvement is long and hard, the opposition is very stiff, but enlightenment already exists in some quarters and will gradually spread; and even public interest may be aroused. FRANK MARSH. STAPHYLOCOCCAL DIARRHŒA
SIR,-During the 1914-18 war and for several years after it, staphylococcal infection in wounds, and as boils and carbuncles, was extremely common. At that time in the laboratory of the Charterhouse Rheumatism Clinic stock of staphylococcal bacteriophage was at hand for treating the infection. It was given by mouth on an empty stomach (a tablespoon of the phage broth with a grain or two of sodium bicarbonate in a little water). This was immediately followed by a glass of cold water to encourage a quick passage through the pylorus before the acid destroyed the phage. Phage by mouth generally cured even longstanding infection. Now that the exact phage type of staphylococci can be determined, and presumably obtained, the effect in staphylococcal diarrhoea might well be even more successful. Judging by Mr. Webster’s experience described in your issue of Nov. 15, when 5 out of 8 patients died, it is surely worth trying this very simple method. H. WARREN CROWE. a
SODIUM AND POTASSIUM IN NORMAL AND PRE-ECLAMPTIC PREGNANCY SIR,-I was most interested in the paper by Dr. MacGillivray and Dr. Buchanan (Nov. 22) on sodium and potassium in pregnancy, but was surprised to read that
they found it difficult
to reconcile their findings with my claim that increased intake of salt during pregnancy will prevent or cure pre-eclampsia ". Earlier in their paper they state that " the decrease of body-sodium per kilogramme in pre-eclampsia compared with late normotensive pregnancy is statistically significant ". If this is true, then giving extra salt to pre-eclamptic patients should "
Jellard, J. Brit. med. J. 1957, i, 925. Gillespie, W. A. in Symposium on Hospital Coccal Infections (edited by R. E. O. Williams and R. A. Shooter). London, 1957. 3. Marsh, F. Lancet, Sept. 13, 1958, p. 588.
1. 2.
pre-eclampsia. Public Health Department, Derby.
MARGARET ROBINSON.
CHILDREN IN HOSPITAL
SIR,-Surely not
The film is an objective study of one child and is not offered proof of a hypothesis. But our view that the behaviour shown is a very common response to separation from the mother consequent upon admission to hospital is supported by many observers in different countries-including Faust,’ Godfrey,2 2 Illingworth,3 Prugh,4 and others whose work is referred to in my recent book.5 Furthermore, there is ample evidence that if separation is avoided by admitting young child and mother to hospital together, such distressed behaviour is greatly diminished. This is illustrated in my new film Going to Hospital With Mother, which will shortly be shown to the Pxdiatric Section of the Royal Society of Medicine. as
The Tavistock Institute of Human Relations, London, W.1.
JAMES ROBERTSON.
SEARCH FOR ABNORMAL HÆMOGLOBINS IN
ORIENTAL JEWS for abnormal hæmoglobins
has been SIR,—A search carried out among Oriental Jews, with a view to the ethnic and anthropological definition of our population. Cooley’s trait and full-blown thalassæmia 6-9 as well as elliptocytosis 10 and an increased red-cell susceptibility to hæmolysis accompanied by a reduced glutathione content 11 12 have been found among Oriental Jews previously. We have now examined hæmoglobin samples taken from 397 Oriental and Sephardi Jews (137 men and 260 women) by the standard technique of hæmoglobin paper electrophoresis.13 The patients’ countries of origin were as follows: 100 Kurdistan 18 Iraq ..
Morocco
Sephardi Turkey
..
..
..
.. .. .. 78 Jews born in Israel 49 .. .. .. 41 .. .. .. 39
Yemen Persia .. .. .. .. 39
..
..
North Africa
Syria .. .. .. India .. .. ..
Afghanistan Cochin
..
15 11 5 1 1
.. ..
..
..
..
..
..
..
..
..
hæmoglobin electrophoretically different from hæmoglobin A was found. There was one apparent exception: a small slower-moving hæmoglobin fraction, apart from hæmoglobin A, was found in a woman with severe macrocytic anemia. No
When she recovered she showed only hæmoglobin A. The additional fraction had been, most probably, hæmoglobin F and clearly did not represent a genetically determined anomaly.
Consequently, abnormal hæmoglobins,
defined
by
occur or must
be
grateful to the Hematology Research Foundation enabling us to carry out this work.
in
paper electrophoresis, either do not rare among Oriental Jews in Israel. We
are
Chicago
for
Department of Medicine A and Laboratory of Clinical Investigation, Rothschild-Hadassah University Hospital, and the Hebrew UniversityHadassah Medical School, Jerusalem, Israel.
as
F. DREYFUSS J. PINKHAS.
2. 3. 4. 5. 6. 7. 8. 9. 10. 11.
Faust, O. A. et al. Reducing Emotional Trauma in Hospitalized Children. Report by Departments of Pediatrics and Anesthesiology, Albany Medical College, N.Y. 1952. Godfrey, A. E. Nursing Res. 1955, 4, 52. Illingworth, R. S., Holt, K. S. Lancet, 1955, ii, 1257. Prugh, D. G. et al. Amer. J. Orthopsychiat. 1953, 23, 70. Robertson, J. Young Children in Hospital. London, 1958. Matoth, Y., Shamir, Z., Freundlich, E. Blood, 1955, 10, 176. Dreyfuss, F. Bull. Res. Counc. Israel, 1955, 4, 402. Dreyfuss, F. J. genet. Hum. 1955, 4, 143. Matoth, Y. Harefuah, 1955, 49, 87. Dreyfuss, F., Mundel, G., Salomon, H. ibid. 1954, 47, 56. Szeinberg, A., Sheba, C., Hirshhorn, N., Bodonyi, E. Blood, 1957, 12,
12. 13.
Szeinberg, A., Chari-Bitron, A. Acta hœmatol. 1957, 18, 229. Smith, E. W., Conley, C. L. Bull. Johns Hopk. Hosp. 1953, 93, 94.
1.
603.
and you are clearly determined to do what you influence professional (and public) opinion in the direction of preventing these serious outbreaks. There i nothing wrong in asepsis as such; there are, however, good and bad varieties of asepsis. No doubt it is bad asepsis that has aroused your justifiable wrath.
increase the body sodium, and so bring it to the level of the normotensive pregnancy, and presumably cure the
Jellardapplied triple dye the umbilicus with encouraging results. Gillespiefound that the prophylactic application oj antiseptic ointment to the anterior nares of adult inpatients prevented nasal carriage of staphylococci; and he suggests that this treatment might be extended to infants. It would seem an advantage to treat the anterior nares of all newborn infants in this way, perhaps renewing the application every time the baby is bathed. Strictures on the sterilisation of bedding and clothing seem to be quite unjustified; it is significant that pillows and mattresses are nowhere mentioned. Disinfection of bedding, leaving out pillows and mattresses, is quite useless, and may be responsible for the bad results described. It is very clear that much cross-infection is due to hand-borne organisms. Gloves for nurses3 seem to be the remedy.
Miss Stephen and Dr. Whatley (Nov. 22) that believe this unit sponsored my film A Twodo year-old Goes to Hospital without considerable preliminary experience of the behaviour of young children in hospitals and other institutions ?
hospitals, can to
to
The recommendations of Prof. Rocke Robertson (all eighteen of them), set out in your annotation of Nov. 22 (p. 1110), should be taken to heart by all responsible for patients in hospitals. Your leader sounds rather pessimistic : truly, the battle for improvement is long and hard, the opposition is very stiff, but enlightenment already exists in some quarters and will gradually spread; and even public interest may be aroused. FRANK MARSH. STAPHYLOCOCCAL DIARRHŒA
SIR,-During the 1914-18 war and for several years after it, staphylococcal infection in wounds, and as boils and carbuncles, was extremely common. At that time in the laboratory of the Charterhouse Rheumatism Clinic stock of staphylococcal bacteriophage was at hand for treating the infection. It was given by mouth on an empty stomach (a tablespoon of the phage broth with a grain or two of sodium bicarbonate in a little water). This was immediately followed by a glass of cold water to encourage a quick passage through the pylorus before the acid destroyed the phage. Phage by mouth generally cured even longstanding infection. Now that the exact phage type of staphylococci can be determined, and presumably obtained, the effect in staphylococcal diarrhoea might well be even more successful. Judging by Mr. Webster’s experience described in your issue of Nov. 15, when 5 out of 8 patients died, it is surely worth trying this very simple method. H. WARREN CROWE. a
SODIUM AND POTASSIUM IN NORMAL AND PRE-ECLAMPTIC PREGNANCY SIR,-I was most interested in the paper by Dr. MacGillivray and Dr. Buchanan (Nov. 22) on sodium and potassium in pregnancy, but was surprised to read that
they found it difficult
to reconcile their findings with my claim that increased intake of salt during pregnancy will prevent or cure pre-eclampsia ". Earlier in their paper they state that " the decrease of body-sodium per kilogramme in pre-eclampsia compared with late normotensive pregnancy is statistically significant ". If this is true, then giving extra salt to pre-eclamptic patients should "
Jellard, J. Brit. med. J. 1957, i, 925. Gillespie, W. A. in Symposium on Hospital Coccal Infections (edited by R. E. O. Williams and R. A. Shooter). London, 1957. 3. Marsh, F. Lancet, Sept. 13, 1958, p. 588.
1. 2.
pre-eclampsia. Public Health Department, Derby.
MARGARET ROBINSON.
CHILDREN IN HOSPITAL
SIR,-Surely not
The film is an objective study of one child and is not offered proof of a hypothesis. But our view that the behaviour shown is a very common response to separation from the mother consequent upon admission to hospital is supported by many observers in different countries-including Faust,’ Godfrey,2 2 Illingworth,3 Prugh,4 and others whose work is referred to in my recent book.5 Furthermore, there is ample evidence that if separation is avoided by admitting young child and mother to hospital together, such distressed behaviour is greatly diminished. This is illustrated in my new film Going to Hospital With Mother, which will shortly be shown to the Pxdiatric Section of the Royal Society of Medicine. as
The Tavistock Institute of Human Relations, London, W.1.
JAMES ROBERTSON.
SEARCH FOR ABNORMAL HÆMOGLOBINS IN
ORIENTAL JEWS for abnormal hæmoglobins
has been SIR,—A search carried out among Oriental Jews, with a view to the ethnic and anthropological definition of our population. Cooley’s trait and full-blown thalassæmia 6-9 as well as elliptocytosis 10 and an increased red-cell susceptibility to hæmolysis accompanied by a reduced glutathione content 11 12 have been found among Oriental Jews previously. We have now examined hæmoglobin samples taken from 397 Oriental and Sephardi Jews (137 men and 260 women) by the standard technique of hæmoglobin paper electrophoresis.13 The patients’ countries of origin were as follows: 100 Kurdistan 18 Iraq ..
Morocco
Sephardi Turkey
..
..
..
.. .. .. 78 Jews born in Israel 49 .. .. .. 41 .. .. .. 39
Yemen Persia .. .. .. .. 39
..
..
North Africa
Syria .. .. .. India .. .. ..
Afghanistan Cochin
..
15 11 5 1 1
.. ..
..
..
..
..
..
..
..
..
hæmoglobin electrophoretically different from hæmoglobin A was found. There was one apparent exception: a small slower-moving hæmoglobin fraction, apart from hæmoglobin A, was found in a woman with severe macrocytic anemia. No
When she recovered she showed only hæmoglobin A. The additional fraction had been, most probably, hæmoglobin F and clearly did not represent a genetically determined anomaly.
Consequently, abnormal hæmoglobins,
defined
by
occur or must
be
grateful to the Hematology Research Foundation enabling us to carry out this work.
in
paper electrophoresis, either do not rare among Oriental Jews in Israel. We
are
Chicago
for
Department of Medicine A and Laboratory of Clinical Investigation, Rothschild-Hadassah University Hospital, and the Hebrew UniversityHadassah Medical School, Jerusalem, Israel.
as
F. DREYFUSS J. PINKHAS.
2. 3. 4. 5. 6. 7. 8. 9. 10. 11.
Faust, O. A. et al. Reducing Emotional Trauma in Hospitalized Children. Report by Departments of Pediatrics and Anesthesiology, Albany Medical College, N.Y. 1952. Godfrey, A. E. Nursing Res. 1955, 4, 52. Illingworth, R. S., Holt, K. S. Lancet, 1955, ii, 1257. Prugh, D. G. et al. Amer. J. Orthopsychiat. 1953, 23, 70. Robertson, J. Young Children in Hospital. London, 1958. Matoth, Y., Shamir, Z., Freundlich, E. Blood, 1955, 10, 176. Dreyfuss, F. Bull. Res. Counc. Israel, 1955, 4, 402. Dreyfuss, F. J. genet. Hum. 1955, 4, 143. Matoth, Y. Harefuah, 1955, 49, 87. Dreyfuss, F., Mundel, G., Salomon, H. ibid. 1954, 47, 56. Szeinberg, A., Sheba, C., Hirshhorn, N., Bodonyi, E. Blood, 1957, 12,
12. 13.
Szeinberg, A., Chari-Bitron, A. Acta hœmatol. 1957, 18, 229. Smith, E. W., Conley, C. L. Bull. Johns Hopk. Hosp. 1953, 93, 94.
1.
603.