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ARTIFICIAL RESPIRATION
821 These patients -’have often had years of experience of doctors and are quick to distinguish one who is experienced from one who is not. The hysteria which followed the intradural injection may have originated in the preoperative visit in the ward. to These principles apply equally emergencies at night and during the weekend. Registrars are in sole charge in many hospitals, and however well they work a comsultant should be able to do better on some occasions. There should therefore always be a consultant available The case mentioned by for difficult and serious cases. Had she Dr. Mushin would come into this category. been ansesthetised by a more experienced person the serious sequelae would probably not have occurred. H. B. C. SANDIFORD. Portsmouth. TREATMENT OF SCARLET FEVER SiR,-I share Dr. Krarup’s surprise (March 29) that there exist doctors who do not use penicillin in the treatment of " scarlet fever." I am always bewildered when I hear of cases of scarlet fever " being admitted to hospital, of isolation of contacts, of stovings and "
fumigations. When I qualified ten years ago-in England, I hope Dr. Krarup will note-I had already been taught that at least thirty different types of group-A (Lancefield and Hare) streptococci had been isolated by Griffith from cases of " scarlet fever," and that any streptococcal throat infection, whether due to organisms which produced an erythrogenic toxin or not, might be clinically as serious, and as liable to immediate and late complications, "
as scarlet fever." Accordingly I have never diagnosed, nor used the term, " scarlet fever," nor yet notified a case. I often seescarlet fever in association with acute tonsillitis ; I have seen it when the only lesion is a boil on the buttock, or when a slight purulent infection of a laparotomy scar has been the cause. As the use of the term still causes dismay to patients, time nurses, and allschool authorities, is it not high that tonsillitis (with or without a " scarlet fever " rash) " replaced’the term scarlet fever "R C. GLAISHER. Hildenborough, Kent. "
WHAT SHOULD THE NURSE BE TAUGHT ? SiR,-As matron of a nurse-training school, I read the letter from Dr. Cropper and Dr. Houghton (April 5) both with interest and with dismay. I am fully in agreement with their desire for a simplified theoretical syllabus, and am glad to see the.revised State examinations giving greater prominence to practical nursing, that essential of the training which theoretical work can augment but never replace. The first part of the letter, however, caused me great concern. Many senior members of the nursing and
teaching professions are greatly disturbed by the growing number and wide acceptance of schemes whereby young people from 15 years of age are employed in hospitals. From a purely material point of view these schemes are a heavy financial burden upon our already overtaxed health service, and are already tending to defeat their
ends. A number of girls, attracted by the salaries offered and by the excitement of working in hospital, and commonly under the delusion that they are starting their nursing career in the best possible way, are leaving school earlier than they would normally have done, thus creating the gap between school and training which the cadet course is intended to fill. When training eventually starts, the wastage among these candidates is, in my experience, very high-from lack of basic education, from disillusionment when confronted with genuine nursing duties, or from sheer weariness and loss of enthusiasm after so long a period of J.n.stitution,al work. Because ’PI this, I have own
than one promising student when half-way her training. Worst of all is the danger of permitting junior nurses to do any work in a hospital when at present there is no means of ensuring that the recommended conditions of service are enforced. Although in recognised cadet schemes every care is taken that the approved conditions are strictly adhered to, there are far too many hospitals where, for lack of other staff, young girls are regularly employed in actual nursing duties-not only on day but
lost
more
through
on
night duty.
Years ago child labour was abolished in the mines and the factories of this land. In our twentieth-century health service children are engaged in nursing the sick. Can we of all people, members of the medical and nursing professions, view such a situation with equanimity ?z L. J. OTTLEY Addenbrooke’s Hospital, Cambridge.
Matron.
ARTIFICIAL RESPIRATION SiR,-In -answer to Dr. Hicks (April 5), I did not mean to condemn any method of resuscitation, but I objected to the suggestion that Schafer’s method should be
officially replaced by Nielsen’s. I adhere to my opinion, not only
because thousands have been trained to carry out the Schafer method efficiently, but because it is the only -method which makes full use of the diaphragm. At the same time it allows other methods, such as Nielsen’s, to be used if help is at hand. If the value of the diaphragm is to be disregarded, the rocking stretcher must also retire to the
background. Only four days ago, a fellow practitioner witnessed my resuscitation of a patient with acute asphyxia by Schafer’s method, along with the principle of the rocking stretcher. The heart-sounds were inaudible with the stethoscope ; and it was exactly twenty minutes before the welcome grunt washeard, and another five minutes before we could say that breathing was established. In this case, as in others which I have experienced, the regular diaphragmatic movements, in my opinion, served to stimulate contraction of the heart. I consider therefore that Schafer’s method should beretained. If advantage is to be taken of the value of the, diaphragm, either the Schafer or the rocking-stretcher method should be used ; but these may be combined with other methods. GILBERT BURNET. Hemel Hempstead. ’
.
SELF-DEMAND FEEDING OF INFANTS the article by ProfessorIllingworth and Dr. Stone (April 5) on the merits ’of If it serves to draw self-demand feeding of infants. attention to the need to avoid a rigid routine in babyfeeding the results will prove most valuable. On the other hand, I think it would be a mistake to create theimpression that any routine in baby-feeding is undesirable. I think that some confusion may arise as a result of the terms used. The authors refer at the beginning of thearticle to the benefits of an " elastic feeding schedule " and later refer to their results as showing the advantages self-demand breast-feeding." I think it is important of to distinguish between these two phrases. Most mothers-
SIR,—I have read with interest
"
welcome
some guidance regarding the frequency and duration of feeds, and they will find an elastic feeding
a help. On the other hand, they are likely to into difficulties if they are led to think that everything can be left to Nature and that baby can be fed at any time of the day or night. Babies as a rule naturally get into fairly regular habits, and if the mother without being in the least rigid can help to form habits that involve feeding baby at reasonable hours she will save herself a lot of troubleto the benefit of both herself and her baby.
schedule
get
’
L.C.C. Divisional Offices, 128, Brook Drive, London, S.E.11.
H. S. S. WALLACE. WALLACE. W. H. W.
fumigations. When I qualified ten years ago-in England, I hope Dr. Krarup will note-I had already been taught that at least thirty different types of group-A (Lancefield and Hare) streptococci had been isolated by Griffith from cases of " scarlet fever," and that any streptococcal throat infection, whether due to organisms which produced an erythrogenic toxin or not, might be clinically as serious, and as liable to immediate and late complications, "
as scarlet fever." Accordingly I have never diagnosed, nor used the term, " scarlet fever," nor yet notified a case. I often seescarlet fever in association with acute tonsillitis ; I have seen it when the only lesion is a boil on the buttock, or when a slight purulent infection of a laparotomy scar has been the cause. As the use of the term still causes dismay to patients, time nurses, and allschool authorities, is it not high that tonsillitis (with or without a " scarlet fever " rash) " replaced’the term scarlet fever "R C. GLAISHER. Hildenborough, Kent. "
WHAT SHOULD THE NURSE BE TAUGHT ? SiR,-As matron of a nurse-training school, I read the letter from Dr. Cropper and Dr. Houghton (April 5) both with interest and with dismay. I am fully in agreement with their desire for a simplified theoretical syllabus, and am glad to see the.revised State examinations giving greater prominence to practical nursing, that essential of the training which theoretical work can augment but never replace. The first part of the letter, however, caused me great concern. Many senior members of the nursing and
teaching professions are greatly disturbed by the growing number and wide acceptance of schemes whereby young people from 15 years of age are employed in hospitals. From a purely material point of view these schemes are a heavy financial burden upon our already overtaxed health service, and are already tending to defeat their
ends. A number of girls, attracted by the salaries offered and by the excitement of working in hospital, and commonly under the delusion that they are starting their nursing career in the best possible way, are leaving school earlier than they would normally have done, thus creating the gap between school and training which the cadet course is intended to fill. When training eventually starts, the wastage among these candidates is, in my experience, very high-from lack of basic education, from disillusionment when confronted with genuine nursing duties, or from sheer weariness and loss of enthusiasm after so long a period of J.n.stitution,al work. Because ’PI this, I have own
than one promising student when half-way her training. Worst of all is the danger of permitting junior nurses to do any work in a hospital when at present there is no means of ensuring that the recommended conditions of service are enforced. Although in recognised cadet schemes every care is taken that the approved conditions are strictly adhered to, there are far too many hospitals where, for lack of other staff, young girls are regularly employed in actual nursing duties-not only on day but
lost
more
through
on
night duty.
Years ago child labour was abolished in the mines and the factories of this land. In our twentieth-century health service children are engaged in nursing the sick. Can we of all people, members of the medical and nursing professions, view such a situation with equanimity ?z L. J. OTTLEY Addenbrooke’s Hospital, Cambridge.
Matron.
ARTIFICIAL RESPIRATION SiR,-In -answer to Dr. Hicks (April 5), I did not mean to condemn any method of resuscitation, but I objected to the suggestion that Schafer’s method should be
officially replaced by Nielsen’s. I adhere to my opinion, not only
because thousands have been trained to carry out the Schafer method efficiently, but because it is the only -method which makes full use of the diaphragm. At the same time it allows other methods, such as Nielsen’s, to be used if help is at hand. If the value of the diaphragm is to be disregarded, the rocking stretcher must also retire to the
background. Only four days ago, a fellow practitioner witnessed my resuscitation of a patient with acute asphyxia by Schafer’s method, along with the principle of the rocking stretcher. The heart-sounds were inaudible with the stethoscope ; and it was exactly twenty minutes before the welcome grunt washeard, and another five minutes before we could say that breathing was established. In this case, as in others which I have experienced, the regular diaphragmatic movements, in my opinion, served to stimulate contraction of the heart. I consider therefore that Schafer’s method should beretained. If advantage is to be taken of the value of the, diaphragm, either the Schafer or the rocking-stretcher method should be used ; but these may be combined with other methods. GILBERT BURNET. Hemel Hempstead. ’
.
SELF-DEMAND FEEDING OF INFANTS the article by ProfessorIllingworth and Dr. Stone (April 5) on the merits ’of If it serves to draw self-demand feeding of infants. attention to the need to avoid a rigid routine in babyfeeding the results will prove most valuable. On the other hand, I think it would be a mistake to create theimpression that any routine in baby-feeding is undesirable. I think that some confusion may arise as a result of the terms used. The authors refer at the beginning of thearticle to the benefits of an " elastic feeding schedule " and later refer to their results as showing the advantages self-demand breast-feeding." I think it is important of to distinguish between these two phrases. Most mothers-
SIR,—I have read with interest
"
welcome
some guidance regarding the frequency and duration of feeds, and they will find an elastic feeding
a help. On the other hand, they are likely to into difficulties if they are led to think that everything can be left to Nature and that baby can be fed at any time of the day or night. Babies as a rule naturally get into fairly regular habits, and if the mother without being in the least rigid can help to form habits that involve feeding baby at reasonable hours she will save herself a lot of troubleto the benefit of both herself and her baby.
schedule
get
’
L.C.C. Divisional Offices, 128, Brook Drive, London, S.E.11.
H. S. S. WALLACE. WALLACE. W. H. W.