- Email: [email protected]
BACTERIOLOGICAL GRADING OF MILK
827 vascular functions both during the operations and in the convalescent period which is now complete. I am, Sir, yours faithfully,
GEORGE
A. MASON.
Newcastle-upon-Tyne, Sept. 24th. FIXED DENTAL APPLIANCES
To the Editor
of
THE LANCET
SiR,-With reference to the letter of Mr. Olver in your issue of Sept. 5th, actual experience is perhaps In more valuable than theoretical considerations. an the loss of accident and front 1905, following teeth, there was constructed for me a 4-tooth fixed bridge, which is attached to the roots of a canine and a central incisor. This has never given me the least trouble, and to-day, after some 31 years, the condition of the. surrounding tissues is entirely satisfactory, and X ray examination shows an equally satisfactory condition of the teeth roots. Perhaps I should add that the work was done by a highly skilled dentist, who has subsequently been responsible for after-care. I am, Sir, yours faithfully, NOEL BARDSWELL. 28th. Sept. ANTITOXIN TREATMENT OF SCARLET FEVER
To the Editor
SiR,—Dr. Burton
of queries
THE LANCET
the rarity of desquamation in my cases of scarlet fever treated with intravenous or intraperitoneal antitoxin and discharged from hospital after a short isolation period. In Table III. of my article the average isolation period in 2428 intravenous cases was shown to be 18-2 days and in 733 intraperitoneal cases 21-2 days. The series inevitably included many cases in which the The isolation was longer than the average. period of observation and the number of cases involved were therefore quite sufficient for the determination of the point with certainty. Dr. Burton has a " feeling " that the same immediate results can be produced by adequate doses given intramuscularly. One wonders upon what experience of intravenous and intraperitoneal antitoxin treatment of scarlet fever his feeling is based. I agree that in some mild cases immediate results may be similar, but even in these desquamation is not so consistently absent. In the sharper cases, however, and particularly in those of septic type, the great difference in immediate results between intramuscular antitoxin on the one hand and intravenous or intraperitoneal on the other is patent to any observer. "Adequate " doses given intramuscularly are usually from one and a half to four times the intravenous or intraperitoneal doses-a point well worth remembering when the cost of routine antitoxin treatment of scarlet fever is being considered. With regard to the " grave risks " to which Dr. Burton refers, I would say that the routine use of the intravenous route requires reasonable care and vigilance, some experience and judgment, and also some means of selecting and maintaining in stock those batches of antitoxin which prove to be relatively free from the unknown shock-producing constituent. These may be stringent but are by no means impracticable conditions. But what are the risks of intraperitoneal injection in a hospital I knew of none that cannot be avoided by the most elementary precautions and the simplest technique.
period
I am,
...
Sir, yours faithfully, H. STANLEY BANKS.
Park Hospital, Hither Green, London, S.E., Sept. 29th.
BACTERIOLOGICAL GRADING OF MILK
To the Editor
of THE
LANCET
SiR,-In milk examinations for report to the Ministry of Health from Jan. 1st next the plate count is to be superseded by the methylene-blue reduction test. Since the coliform presumptive test is retained the assumption is that the reduction test gives the same general results as the plate count. Now in spite of the acknowledged though over-emphasised inaccuracy of the latter, it does give results which are fairly comparable over a period of years, as a general indication of the cleanliness or otherwise of milk samples. Does the reduction test give the same1 In my hands there is frequently a marked disparity between the count and the reduction time in parallel tests. For instance such results as these :-
These results
disconcerting, and sugoperating in the reduction test influence the plate count. One wishes are
gest that factors
somewhat
are
that do not therefore to know which test is the better indication of cleanliness or otherwise. I should be interested in hearing the experience of others who are constantly engaged in milk examinations. I may add that in my experience the reduction test agrees far more closely with the coli content than with the plate count. I am, Sir, yours faithfully, A. H. PRIESTLEY. Public Health Laboratory, Burnley, Sept. 25th.
THE PATIENT LOOKS AT THE HOSPITAL
To the Editor
of
THE LANCET
SiR,—In the book which you reviewed last week Miss Florence Fidler, though kind to doctors, has some hard things to say about nurses and voluntary hospitals, and although many will not be able to go all the way with her, it must be admitted that certain of her criticisms strike home. The 1932 Report of THE LANCET Commission on Nursing left little to be said on this subject. Miss Fidler complains that little or nothing has been done to improve matters since its issue. In her view, nurses are stultified by a training which is too militaristic in conception and which sets too great store by trivial detail at the expense of more vital things. The nurse, she maintains, like the soldier, is taught slavishly to obey orders rather than to think for herself. Without contesting the point that " the best soldier is the stupidest," which could be better dealt with by the Staff College at Camberley, one is tempted to wonder to what extent a nurse should think for herself. That a probationer’s main duty is to obey orders few will deny. To adapt W. S. Gilbert, the awful prospect of a lot of bright young " pros." in close proximity, all thinking for themselves, is what no one could face with equanimity-not even, I suspect, the patient. Miss Fidler further contends that she would rather be nursed by an intelligent amateur than by a professional nurse. Not many, I imagine, will agree with her, and I must conclude either that she has been singularly fortunate with the amateurs or singularly unfortunate with the professionals whom she has met. Nor is she more kindly
GEORGE
A. MASON.
Newcastle-upon-Tyne, Sept. 24th. FIXED DENTAL APPLIANCES
To the Editor
of
THE LANCET
SiR,-With reference to the letter of Mr. Olver in your issue of Sept. 5th, actual experience is perhaps In more valuable than theoretical considerations. an the loss of accident and front 1905, following teeth, there was constructed for me a 4-tooth fixed bridge, which is attached to the roots of a canine and a central incisor. This has never given me the least trouble, and to-day, after some 31 years, the condition of the. surrounding tissues is entirely satisfactory, and X ray examination shows an equally satisfactory condition of the teeth roots. Perhaps I should add that the work was done by a highly skilled dentist, who has subsequently been responsible for after-care. I am, Sir, yours faithfully, NOEL BARDSWELL. 28th. Sept. ANTITOXIN TREATMENT OF SCARLET FEVER
To the Editor
SiR,—Dr. Burton
of queries
THE LANCET
the rarity of desquamation in my cases of scarlet fever treated with intravenous or intraperitoneal antitoxin and discharged from hospital after a short isolation period. In Table III. of my article the average isolation period in 2428 intravenous cases was shown to be 18-2 days and in 733 intraperitoneal cases 21-2 days. The series inevitably included many cases in which the The isolation was longer than the average. period of observation and the number of cases involved were therefore quite sufficient for the determination of the point with certainty. Dr. Burton has a " feeling " that the same immediate results can be produced by adequate doses given intramuscularly. One wonders upon what experience of intravenous and intraperitoneal antitoxin treatment of scarlet fever his feeling is based. I agree that in some mild cases immediate results may be similar, but even in these desquamation is not so consistently absent. In the sharper cases, however, and particularly in those of septic type, the great difference in immediate results between intramuscular antitoxin on the one hand and intravenous or intraperitoneal on the other is patent to any observer. "Adequate " doses given intramuscularly are usually from one and a half to four times the intravenous or intraperitoneal doses-a point well worth remembering when the cost of routine antitoxin treatment of scarlet fever is being considered. With regard to the " grave risks " to which Dr. Burton refers, I would say that the routine use of the intravenous route requires reasonable care and vigilance, some experience and judgment, and also some means of selecting and maintaining in stock those batches of antitoxin which prove to be relatively free from the unknown shock-producing constituent. These may be stringent but are by no means impracticable conditions. But what are the risks of intraperitoneal injection in a hospital I knew of none that cannot be avoided by the most elementary precautions and the simplest technique.
period
I am,
...
Sir, yours faithfully, H. STANLEY BANKS.
Park Hospital, Hither Green, London, S.E., Sept. 29th.
BACTERIOLOGICAL GRADING OF MILK
To the Editor
of THE
LANCET
SiR,-In milk examinations for report to the Ministry of Health from Jan. 1st next the plate count is to be superseded by the methylene-blue reduction test. Since the coliform presumptive test is retained the assumption is that the reduction test gives the same general results as the plate count. Now in spite of the acknowledged though over-emphasised inaccuracy of the latter, it does give results which are fairly comparable over a period of years, as a general indication of the cleanliness or otherwise of milk samples. Does the reduction test give the same1 In my hands there is frequently a marked disparity between the count and the reduction time in parallel tests. For instance such results as these :-
These results
disconcerting, and sugoperating in the reduction test influence the plate count. One wishes are
gest that factors
somewhat
are
that do not therefore to know which test is the better indication of cleanliness or otherwise. I should be interested in hearing the experience of others who are constantly engaged in milk examinations. I may add that in my experience the reduction test agrees far more closely with the coli content than with the plate count. I am, Sir, yours faithfully, A. H. PRIESTLEY. Public Health Laboratory, Burnley, Sept. 25th.
THE PATIENT LOOKS AT THE HOSPITAL
To the Editor
of
THE LANCET
SiR,—In the book which you reviewed last week Miss Florence Fidler, though kind to doctors, has some hard things to say about nurses and voluntary hospitals, and although many will not be able to go all the way with her, it must be admitted that certain of her criticisms strike home. The 1932 Report of THE LANCET Commission on Nursing left little to be said on this subject. Miss Fidler complains that little or nothing has been done to improve matters since its issue. In her view, nurses are stultified by a training which is too militaristic in conception and which sets too great store by trivial detail at the expense of more vital things. The nurse, she maintains, like the soldier, is taught slavishly to obey orders rather than to think for herself. Without contesting the point that " the best soldier is the stupidest," which could be better dealt with by the Staff College at Camberley, one is tempted to wonder to what extent a nurse should think for herself. That a probationer’s main duty is to obey orders few will deny. To adapt W. S. Gilbert, the awful prospect of a lot of bright young " pros." in close proximity, all thinking for themselves, is what no one could face with equanimity-not even, I suspect, the patient. Miss Fidler further contends that she would rather be nursed by an intelligent amateur than by a professional nurse. Not many, I imagine, will agree with her, and I must conclude either that she has been singularly fortunate with the amateurs or singularly unfortunate with the professionals whom she has met. Nor is she more kindly