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FATHER IN THE LABOUR WARD
815 removal of the mask and perhaps by
"
external " artificial
respiration-i.e., Sylvester’s method. If we had then possessed the means and the sophistication to ventilate these patients with oxygen at the first sign of circulatory collapse, the reputation of chloroform might not have suffered, and some of these deaths during induction of anaesthesia might have been prevented. Halothane is a superb anxsthetic, but the difficulties and dangers associated with its administration must be widely recognised, and the means whereby they can be overcome must be made familiar to all who use it. General Hospital, Southend-on-Sea, Essex.
J. ALFRED LEE.
pathy. Furthermore, it allows genuine dislike of a fellow member to be expressed in a way that would not be permissible in normal life. Other responsibilities are eliminated, and the patient can concentrate on his difficulty. The personal traits which are responsible for a patient’s difficulties may emerge in discussion with a therapist; but by living with a group he will learn how to control them in different social situations. St. Bernard’s Hospital, W. OWEN. Southall, Middlesex.
SONNE IN SCHOOLS SiR,ŃYour annotation (March 12) contains
a reminder not make assumptions in field epidemiology. You draw attention to the failure of modern sanitary installations to terminate outbreaks of Sonne dysentery in schools, and to the difficulty of assessing the value of hygiene measures adopted late in the course of any epidemic. May I add some observations ? It is the lightness and cleanliness of toilet premises that matters most, and new fittings are no good without diligent caretaking. Hand-washing can be a safeguard, but becomes a danger if carried out in shared basins with communal nailbrushes, soap, or towels. If drip-soap, slow-running water (even if cold) in unstopped basins, and paper towels are provided, a safe wash is possible.! A supervisor should turn the taps. Supervision is essential in primary schools, because the children most concerned are very young indeed. A visit to an infant-school at dinner-time is epidemiologically enlightening. Something like a knee-high football crowd rushes from the classrooms to the toilets. Close friends are tempted to share accommodation and equipment. Some are hungry and attempt to run straight from the lavatory to the diningroom without wasting time at the washbasin, others, perhaps also hungry, suck their thumbs before they have washed them. In some schools the " dinner ladies " supervise very effectively. But if supervision at this hand-washing stage is not good it is unsafe to trust to communal dips in dilute antiseptic to decontaminate really dirty hands, since in practice the hands will not be held long enough in such solutions for chemical disinfection to be complete. I have found Shigella sonnei surviving in fxcal fingerprints after holding the fingers in 2% (1/50) benzalkonium chloride solution for as long as 120 seconds; and I have recovered the live bacilli from a 0-33 % (1/300) solution 15 seconds after dipping a fxcally stained finger into it.2 Shigellm in naturally infected fasces can be harder to kill than the same strain in culture preparations. Very weak solutions of benzalkonium chloride, such as that of 0-1% (1/1000 or 1000 p.p.m.) to which you refer in your annotation, citing Beer et al.,3 might conceivably even serve as a vehicle for infection. Stronger solutions of 1% (1/100), or of greater strength, have sterilised themselves within 15 seconds. More effective preparations tend to be harsh and unsuitable for children. Thus 15-30 seconds’ immersion in 2%(1/50) ’ Lysol’ or in iodinated alcohol will generally disinfect the fingers but may hurt a tender skin. Perhaps the most realistic single measure of hygiene to limit the spread of dysentery in schools, particularly primary schools, is to encourage the teachers to make a habit of sending home any children with diarrhoea or vomiting until the medical officer of health has authorised their return after a negative laboratory report. Done consistently this makes less trouble than it saves: cases due to different causes are distinguished promptly, and the spread of disease within the school and into the community can be reduced. It is risky to allow shigella carriers to attend primary schools, except when a recent epidemic has already exhausted the reservoir of susceptibles. I concur with your view that in an uncontrolled (primary) school outbreak of Sonne dysentery a rate of infection of about two-thirds of the child population can be expected. In a series of households recently studied here the proved infection-rate
to
FATHER IN THE LABOUR WARD SiR,ŃYour annotation (March 26) is surprisingly unsympathetic to what many people-not just a group of enthusiasts -would regard as an important development in obstetric practice. That husbands can be with their wives during labour, if they both wish it, seems to me a medicopsychological advance of the same magnitude as the unrestricted visiting of children in hospital. If the motivation of husbands at this time merits investigation, as you imply, then so does that of those who wish to keep them out. I find it difficult to believe that the decisions of obstetricians or midwives will be influenced by relatives who, if necessary, can always firmly but gently be asked to leave. My wife and I, both doctors, recently had experience of an obstetric unit which was both efficient and kind, and which encouraged fathers to be present if they wished. As events turned out surgery had to give Nature a hand in the birth of our daughter, but we both felt extraordinarily disappointed, almost cheated, that, after the careful preparation for labour from antenatal lectures and classes, this experience could not be shared. I think the decision whether father should be in the labour ward should be an entirely personal one, under no direction either wav from authoritv. SIDNEY CROWN.
A PATIENT’S VIEW OF GROUP THERAPY SIR,-As a patient who has been treated for alcoholic addiction both by consultation with a psychotherapist and by group therapy, may I compare the help I received from each ? From individual therapy I gained insight into my relations with parents and relatives and learnt a great deal about my personality problems. I regarded the therapist to some degree as my strict father, to whom I had continually sought to justify myself. During treatment, I was unwilling to reveal my inability to cope and lessened the importance of day-to-day
problems. I believe that group therapy lessens the need for reticence, and benefit is gained from sharing a common problem, with no barriers of social or professional status. I had not been able to accept help in coping with my alcoholism from friends and employers. In the group, unexposed to superior judgment or criticism, I found relief and reassurance; advice could be given and accepted on equal terms. Help is gained from formal meetings held under medical guidance, but perhaps even more comes from living with the other group members and sharing duties in the unit. There is no escape from the group; living in a community, it is difficult for a member to cover up his faults or to dissemble in any way. He is often caught off guard during informal moments and he must express opinions spontaneously. When contributing to formal discussions, he is aware that his remarks must be sincere and in line with his general behaviour. It is a relief when the real " you " is accepted and liked, as opposed to the illusory image that may have been presented to the outside world. Group therapy helps to discriminate between apparent conflicts of social behaviour and fosters tolerance and true sym-
1. 2.
Thomas, M. Br. med. J. 1966, i, 52. Thomas, M. Demonstration to Pathology Section of Royal Society of Medicine, Nov. 2, 1965. 3. Beer, B., O’Donnell, G. M., Henderson, R. J. Mon. Bull. Minist. Hlth, 1966, 25, 36.
"
external " artificial
respiration-i.e., Sylvester’s method. If we had then possessed the means and the sophistication to ventilate these patients with oxygen at the first sign of circulatory collapse, the reputation of chloroform might not have suffered, and some of these deaths during induction of anaesthesia might have been prevented. Halothane is a superb anxsthetic, but the difficulties and dangers associated with its administration must be widely recognised, and the means whereby they can be overcome must be made familiar to all who use it. General Hospital, Southend-on-Sea, Essex.
J. ALFRED LEE.
pathy. Furthermore, it allows genuine dislike of a fellow member to be expressed in a way that would not be permissible in normal life. Other responsibilities are eliminated, and the patient can concentrate on his difficulty. The personal traits which are responsible for a patient’s difficulties may emerge in discussion with a therapist; but by living with a group he will learn how to control them in different social situations. St. Bernard’s Hospital, W. OWEN. Southall, Middlesex.
SONNE IN SCHOOLS SiR,ŃYour annotation (March 12) contains
a reminder not make assumptions in field epidemiology. You draw attention to the failure of modern sanitary installations to terminate outbreaks of Sonne dysentery in schools, and to the difficulty of assessing the value of hygiene measures adopted late in the course of any epidemic. May I add some observations ? It is the lightness and cleanliness of toilet premises that matters most, and new fittings are no good without diligent caretaking. Hand-washing can be a safeguard, but becomes a danger if carried out in shared basins with communal nailbrushes, soap, or towels. If drip-soap, slow-running water (even if cold) in unstopped basins, and paper towels are provided, a safe wash is possible.! A supervisor should turn the taps. Supervision is essential in primary schools, because the children most concerned are very young indeed. A visit to an infant-school at dinner-time is epidemiologically enlightening. Something like a knee-high football crowd rushes from the classrooms to the toilets. Close friends are tempted to share accommodation and equipment. Some are hungry and attempt to run straight from the lavatory to the diningroom without wasting time at the washbasin, others, perhaps also hungry, suck their thumbs before they have washed them. In some schools the " dinner ladies " supervise very effectively. But if supervision at this hand-washing stage is not good it is unsafe to trust to communal dips in dilute antiseptic to decontaminate really dirty hands, since in practice the hands will not be held long enough in such solutions for chemical disinfection to be complete. I have found Shigella sonnei surviving in fxcal fingerprints after holding the fingers in 2% (1/50) benzalkonium chloride solution for as long as 120 seconds; and I have recovered the live bacilli from a 0-33 % (1/300) solution 15 seconds after dipping a fxcally stained finger into it.2 Shigellm in naturally infected fasces can be harder to kill than the same strain in culture preparations. Very weak solutions of benzalkonium chloride, such as that of 0-1% (1/1000 or 1000 p.p.m.) to which you refer in your annotation, citing Beer et al.,3 might conceivably even serve as a vehicle for infection. Stronger solutions of 1% (1/100), or of greater strength, have sterilised themselves within 15 seconds. More effective preparations tend to be harsh and unsuitable for children. Thus 15-30 seconds’ immersion in 2%(1/50) ’ Lysol’ or in iodinated alcohol will generally disinfect the fingers but may hurt a tender skin. Perhaps the most realistic single measure of hygiene to limit the spread of dysentery in schools, particularly primary schools, is to encourage the teachers to make a habit of sending home any children with diarrhoea or vomiting until the medical officer of health has authorised their return after a negative laboratory report. Done consistently this makes less trouble than it saves: cases due to different causes are distinguished promptly, and the spread of disease within the school and into the community can be reduced. It is risky to allow shigella carriers to attend primary schools, except when a recent epidemic has already exhausted the reservoir of susceptibles. I concur with your view that in an uncontrolled (primary) school outbreak of Sonne dysentery a rate of infection of about two-thirds of the child population can be expected. In a series of households recently studied here the proved infection-rate
to
FATHER IN THE LABOUR WARD SiR,ŃYour annotation (March 26) is surprisingly unsympathetic to what many people-not just a group of enthusiasts -would regard as an important development in obstetric practice. That husbands can be with their wives during labour, if they both wish it, seems to me a medicopsychological advance of the same magnitude as the unrestricted visiting of children in hospital. If the motivation of husbands at this time merits investigation, as you imply, then so does that of those who wish to keep them out. I find it difficult to believe that the decisions of obstetricians or midwives will be influenced by relatives who, if necessary, can always firmly but gently be asked to leave. My wife and I, both doctors, recently had experience of an obstetric unit which was both efficient and kind, and which encouraged fathers to be present if they wished. As events turned out surgery had to give Nature a hand in the birth of our daughter, but we both felt extraordinarily disappointed, almost cheated, that, after the careful preparation for labour from antenatal lectures and classes, this experience could not be shared. I think the decision whether father should be in the labour ward should be an entirely personal one, under no direction either wav from authoritv. SIDNEY CROWN.
A PATIENT’S VIEW OF GROUP THERAPY SIR,-As a patient who has been treated for alcoholic addiction both by consultation with a psychotherapist and by group therapy, may I compare the help I received from each ? From individual therapy I gained insight into my relations with parents and relatives and learnt a great deal about my personality problems. I regarded the therapist to some degree as my strict father, to whom I had continually sought to justify myself. During treatment, I was unwilling to reveal my inability to cope and lessened the importance of day-to-day
problems. I believe that group therapy lessens the need for reticence, and benefit is gained from sharing a common problem, with no barriers of social or professional status. I had not been able to accept help in coping with my alcoholism from friends and employers. In the group, unexposed to superior judgment or criticism, I found relief and reassurance; advice could be given and accepted on equal terms. Help is gained from formal meetings held under medical guidance, but perhaps even more comes from living with the other group members and sharing duties in the unit. There is no escape from the group; living in a community, it is difficult for a member to cover up his faults or to dissemble in any way. He is often caught off guard during informal moments and he must express opinions spontaneously. When contributing to formal discussions, he is aware that his remarks must be sincere and in line with his general behaviour. It is a relief when the real " you " is accepted and liked, as opposed to the illusory image that may have been presented to the outside world. Group therapy helps to discriminate between apparent conflicts of social behaviour and fosters tolerance and true sym-
1. 2.
Thomas, M. Br. med. J. 1966, i, 52. Thomas, M. Demonstration to Pathology Section of Royal Society of Medicine, Nov. 2, 1965. 3. Beer, B., O’Donnell, G. M., Henderson, R. J. Mon. Bull. Minist. Hlth, 1966, 25, 36.