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TREATMENT OF ASPHYXIA NEONATORUM
433 The unembroidered baldness of this note is determined in part by war conditions and also by the fact that the number of cases of the type is necessarily small. A. GUIRDHAM. Bath.
" IN GRATITUDE TO MY MEDICAL
COLLEAGUES
SiR.—I desire to acknowledge through your columns a donation of 250 from a doctor as a mark of appreciation of the kindness and consideration received from his medical colleagues during his, wife’s recent illness, which necessitated an extensive abdominal operation. He adds : " It is a very small return for all the kindness and skill that has been expended on my wife. I wish my means allowed for a bigger cheque but I hope that I may be helping, through the Royal Medical Benevolent Fund, some unfortunate fellow medico or his dependants." LEWIS G. GLOVER, 1, Balliol House, Manorfields,
ANURIA WITH CASTS his account (Lancet, March 15, p. 345) of the SzR,-In in nine women who had recently findings pathological aborted, and who had died of suppression of urine, Dr. Bratton says that the toxic process is not necessarily puerperal in origin ; as these are not the post-mortem appearances of toxaemia of pregnancy, he might have gone further and said that this process is not puerperal in origin. Mr. Discombe and I have recently recorded (Brit. med. J.1940,1, 525) the clinical and pathological notes of a patient who died with post-mortem findings identical to those which he has described, but the result of quinine poisoning. In our case 5-04 g. (76 grain" of the pure alkaloid had been taken by the mouth. A search through the literature revealed only two similar instances, (Terplan, K. L. and Javert, C. T. J. Amer. med. Assoc. 1936, 106, 509 ; and Raven, H. M. (Brit. med. J. 1927, 2,
S.W.15.
towards floor dust as a source of cross-infection in hospital wards and elsewhere (Andrewes, C. H. Lancet, 1940, 2, 770), it being known that a number of organisms, particularly Streptococcus _pyogenes, may remain there viable and at least potentially pathogenic for periods extending into weeks. In the course of an extensive investigation into the preventive aspects of cross-infection now being made in this hospital son behalf of the War Office and in conjunction with the team of workers at the National Institute for Medical Research, Hampstead, we have assayed the streptococcal content of a number of dust samples from hospital wards. Our complete data will be published later, but the results of these analyses are so striking that they deserve mention now to emphasise this aspect of such a commonplace as dust. During a mild outbreak of streptococcal sore throats and follicular tonsillitis in one ward a few weeks ago, all the dust swept up one morning was assayed, each sample being labelled as to its origin and treated separately. The ward is an ordinary 26-bed hospital ward divided into two by a glass partition and door ; the main corridor with the offices, &c. and two single-bed isolation cubicles, runs off the ward at right angles. At the end of this there is a large day-room which is only used by patients from the ward beneath, although the patients in this ward have to traverse it to reach their kitchen. On the day in question there were 22 patients in the ward, all of whom except 3 exhibited Strep. pyogenes (mainly type 6) in their throats. One of the most severe cases (F) was isolated in a side ward. The initial cases occurred nine days previously ; the epidemic spread did not begin until four days before this experiment. The total weight of the dust was 29-06 g., which, for a morning sweeping, reflects a clean, well-kept ward. The haemolytic streptococci were distributed among the various samples as follows :-
I hope it may not be too late for Dr. Bratton to be able to trace whether quinine had been taken in his As they are all abortions the presumption is cases. strong, and if so then the diagnosis of the disease process associated with his pathological findings is complete. C. K. VARTAN.
TREATMENT OF ASPHYXIA NEONATORUM
SiR,-As you say, the methods of resuscitation outlined in your annotation of March 15 (p. 355) are rather beyond the capacity of the general practitioner, and the proportion of babies requiring resuscitation (200 out of 1200) seems abnormally high. Apparently the authors on
Hon. Treasurer, R.M.B.F.
INFECTION FROM DUST SiR,-Considerable attention is being directed today
59).
do not think that Barcroft’s work
"
the initiation of
respiration (Lancet, 1939, 2, 838, and see Leak, Ibid, p. 1004) has much clinical bearing on this problem. As a contribution to the treatment by the G.P. of those really bad cases which occasionally arise, I should like to record
such a case which occurred about 15 months ago. After a not very difficult forceps delivery the infant completely failed to respond to all my methods of resuscitation which included the administration of lobeline and t c.cm. of Cardiazol-ephedrine, which latter I usually find more effective than lobeline itself. After over 10 minutes’ effort the baby seemed hopeless so I injected into the heart the remaining 2 c.cm. of cardiazol-ephedrine. The effect was instantaneous, the heart began to beat at once, respiration rapidly followed and within 2 minutes the baby was breathing almost normally. No ill effects seemed to follow this treatment and the child is still alive and well. Naturally, I do not recommend such a measure as a routine, but it may be a help to other practitioners who have not all the facilities of Russ and Strong in New Orleans, and anything which will avert the tragedy of a stillbirth is well worth while. W. N. LEAK. Winsford, Cheshire. "WHOLEMEAL ENTHUSIASM "
SiR,-On reading the article under this heading in your issue of March 15 (p. 370) I rubbed my eyes in amazement. Can this be the same journal, I asked myself, which published as far back as Sept. 14, 1912, a lengthy and generally favourable notice of Our Children’s Health at Home and at School containing a report of the society’s first guildhall school conference, and in recent years welcomed its offer to submit evidence to THE LANCET Commission on Nursing ? The Food Education Society had no connexion with Miss May Yates and the Bread and Food Reform League beyond cooperating in the effort to make wholewheat generally available. It never advocated, as your reviewer suggests, " the exclusive use of wholemeal bread." Nor is it committed to the views of speakers at its conferences, or of others figuring in Bread in Peace and War. This society, which is said to be the oldest in the world for the education of the people in nutrition, has the support of the medical, dental, nursing and educational professions, and of social workers. It is undogmatic and concerned with every aspect of dietetics, including food habits. CHARLES E. HECHT, Hon. Sec. Food Education Society. London, N.W.3.
The total number of heemolytic the various parts of this
from
streptococci swept up ward that particular on
morning was nearly 102,000,000. These experiments, apart from demonstrating the enormous numbers of bacteria which are present on the floor of an apparently clean ward, illustrate two import-_ ant facts. First, that veryhigh bacterial concentrations may be met with even in small, single-bed isolation wards, and unless these are effectively dealt with they may represent a semi-permanent reservoir of infection for succeeding patients in the same ward. Secondly, that the highest number of organisms is present, not in the dust of the annexe with its w.c.’s, lav.atories and baths. This observation confirms the work of Miles et al. (Brit. med. J. 1940, 2, 855, 895) on the r6le of baths in hospital cross-infections. If the organisms remained on the floor the risk of infection would be greatly reduced. In ordinary wards, of course, without special floor treatment this is not so, and millions are re-projected into the air with each sweeping. Parallel air counts during this work showed that while F’s cubicle was being swept,1 : 500,000 gentian violet
ward, but in the dust of the ward
.
" IN GRATITUDE TO MY MEDICAL
COLLEAGUES
SiR.—I desire to acknowledge through your columns a donation of 250 from a doctor as a mark of appreciation of the kindness and consideration received from his medical colleagues during his, wife’s recent illness, which necessitated an extensive abdominal operation. He adds : " It is a very small return for all the kindness and skill that has been expended on my wife. I wish my means allowed for a bigger cheque but I hope that I may be helping, through the Royal Medical Benevolent Fund, some unfortunate fellow medico or his dependants." LEWIS G. GLOVER, 1, Balliol House, Manorfields,
ANURIA WITH CASTS his account (Lancet, March 15, p. 345) of the SzR,-In in nine women who had recently findings pathological aborted, and who had died of suppression of urine, Dr. Bratton says that the toxic process is not necessarily puerperal in origin ; as these are not the post-mortem appearances of toxaemia of pregnancy, he might have gone further and said that this process is not puerperal in origin. Mr. Discombe and I have recently recorded (Brit. med. J.1940,1, 525) the clinical and pathological notes of a patient who died with post-mortem findings identical to those which he has described, but the result of quinine poisoning. In our case 5-04 g. (76 grain" of the pure alkaloid had been taken by the mouth. A search through the literature revealed only two similar instances, (Terplan, K. L. and Javert, C. T. J. Amer. med. Assoc. 1936, 106, 509 ; and Raven, H. M. (Brit. med. J. 1927, 2,
S.W.15.
towards floor dust as a source of cross-infection in hospital wards and elsewhere (Andrewes, C. H. Lancet, 1940, 2, 770), it being known that a number of organisms, particularly Streptococcus _pyogenes, may remain there viable and at least potentially pathogenic for periods extending into weeks. In the course of an extensive investigation into the preventive aspects of cross-infection now being made in this hospital son behalf of the War Office and in conjunction with the team of workers at the National Institute for Medical Research, Hampstead, we have assayed the streptococcal content of a number of dust samples from hospital wards. Our complete data will be published later, but the results of these analyses are so striking that they deserve mention now to emphasise this aspect of such a commonplace as dust. During a mild outbreak of streptococcal sore throats and follicular tonsillitis in one ward a few weeks ago, all the dust swept up one morning was assayed, each sample being labelled as to its origin and treated separately. The ward is an ordinary 26-bed hospital ward divided into two by a glass partition and door ; the main corridor with the offices, &c. and two single-bed isolation cubicles, runs off the ward at right angles. At the end of this there is a large day-room which is only used by patients from the ward beneath, although the patients in this ward have to traverse it to reach their kitchen. On the day in question there were 22 patients in the ward, all of whom except 3 exhibited Strep. pyogenes (mainly type 6) in their throats. One of the most severe cases (F) was isolated in a side ward. The initial cases occurred nine days previously ; the epidemic spread did not begin until four days before this experiment. The total weight of the dust was 29-06 g., which, for a morning sweeping, reflects a clean, well-kept ward. The haemolytic streptococci were distributed among the various samples as follows :-
I hope it may not be too late for Dr. Bratton to be able to trace whether quinine had been taken in his As they are all abortions the presumption is cases. strong, and if so then the diagnosis of the disease process associated with his pathological findings is complete. C. K. VARTAN.
TREATMENT OF ASPHYXIA NEONATORUM
SiR,-As you say, the methods of resuscitation outlined in your annotation of March 15 (p. 355) are rather beyond the capacity of the general practitioner, and the proportion of babies requiring resuscitation (200 out of 1200) seems abnormally high. Apparently the authors on
Hon. Treasurer, R.M.B.F.
INFECTION FROM DUST SiR,-Considerable attention is being directed today
59).
do not think that Barcroft’s work
"
the initiation of
respiration (Lancet, 1939, 2, 838, and see Leak, Ibid, p. 1004) has much clinical bearing on this problem. As a contribution to the treatment by the G.P. of those really bad cases which occasionally arise, I should like to record
such a case which occurred about 15 months ago. After a not very difficult forceps delivery the infant completely failed to respond to all my methods of resuscitation which included the administration of lobeline and t c.cm. of Cardiazol-ephedrine, which latter I usually find more effective than lobeline itself. After over 10 minutes’ effort the baby seemed hopeless so I injected into the heart the remaining 2 c.cm. of cardiazol-ephedrine. The effect was instantaneous, the heart began to beat at once, respiration rapidly followed and within 2 minutes the baby was breathing almost normally. No ill effects seemed to follow this treatment and the child is still alive and well. Naturally, I do not recommend such a measure as a routine, but it may be a help to other practitioners who have not all the facilities of Russ and Strong in New Orleans, and anything which will avert the tragedy of a stillbirth is well worth while. W. N. LEAK. Winsford, Cheshire. "WHOLEMEAL ENTHUSIASM "
SiR,-On reading the article under this heading in your issue of March 15 (p. 370) I rubbed my eyes in amazement. Can this be the same journal, I asked myself, which published as far back as Sept. 14, 1912, a lengthy and generally favourable notice of Our Children’s Health at Home and at School containing a report of the society’s first guildhall school conference, and in recent years welcomed its offer to submit evidence to THE LANCET Commission on Nursing ? The Food Education Society had no connexion with Miss May Yates and the Bread and Food Reform League beyond cooperating in the effort to make wholewheat generally available. It never advocated, as your reviewer suggests, " the exclusive use of wholemeal bread." Nor is it committed to the views of speakers at its conferences, or of others figuring in Bread in Peace and War. This society, which is said to be the oldest in the world for the education of the people in nutrition, has the support of the medical, dental, nursing and educational professions, and of social workers. It is undogmatic and concerned with every aspect of dietetics, including food habits. CHARLES E. HECHT, Hon. Sec. Food Education Society. London, N.W.3.
The total number of heemolytic the various parts of this
from
streptococci swept up ward that particular on
morning was nearly 102,000,000. These experiments, apart from demonstrating the enormous numbers of bacteria which are present on the floor of an apparently clean ward, illustrate two import-_ ant facts. First, that veryhigh bacterial concentrations may be met with even in small, single-bed isolation wards, and unless these are effectively dealt with they may represent a semi-permanent reservoir of infection for succeeding patients in the same ward. Secondly, that the highest number of organisms is present, not in the dust of the annexe with its w.c.’s, lav.atories and baths. This observation confirms the work of Miles et al. (Brit. med. J. 1940, 2, 855, 895) on the r6le of baths in hospital cross-infections. If the organisms remained on the floor the risk of infection would be greatly reduced. In ordinary wards, of course, without special floor treatment this is not so, and millions are re-projected into the air with each sweeping. Parallel air counts during this work showed that while F’s cubicle was being swept,1 : 500,000 gentian violet
ward, but in the dust of the ward
.