HOSPITAL DISCIPLINE

440 mine

neostigmine desensitisation in those giving a intradermal test,2 is encouraging often enough positive to warrant universal trial in place of the routine " aspirin and bed." This type of therapy is directed to eradicating the attacks, or at least reducing their number and severity, rather than to aborting a headache when it arrives. NEVIL LEYTON. London, W.1. or

-

-

A LIGHTWEIGHT RESPIRATOR SIR,—The account 01 tlie monagnan respirator given

in your issue of Aug. 13 (p. 308) did not describe its mechanism. It acts on the principle of alternating negative and normal pressures within the dome of the cuirass, through which movement of the abdominal wall and anterior part of the chest effects descent and relaxation of the diaphragm and some expansion of the chest. It is therefore merely a limited application of the principle which operates in the Drinker respirator. There are six sizes of cuirass. I recently saw and tried the machine in the U.S.A. and feel that it has a value in cases which require some assistance but not complete

dependence

upon a

respirator. W. HOWLETT KELLEHER

Western Hospital, London, S.W.6.

Physician-Sup erintendent.

PROS AND CONS

SiR,-Professor Alstead’sstatement, in discussing the membership examination last week, that " nobody submits to the depravity of acting as an examiner save from a sense of duty or out of regard for the financial reward," must not be allowed to go

willingly

unchallenged. It has been my privilege and pleasure to examine for of the specialist diplomas, and my term of office was not only enjoyable but also instructive. Meeting one’s colleagues, and learning from them and the candidates, has been a stimulating experience which has done much to remove my sense of isolation as a provincial teacher. I hope examining boards, when appointing their examiners, will keep this aspect in mind and recognise the value of an examinership to younger provincial teachers. one

EX-EXAMINER.

OSTRACISM OF THE TUBERCULOUS am grateful to Dr. Foster-Carter (July 30) for his generous support of my plea for the tuberculous

SIR,—I

(July 16). The evil is not confined to the British Isles. I have personal knowledge of a family of healthy people who were emigrating to the U.S.A. to join relations long resident in that country. No symptoms or signs of disease were present in any member of this household ; but because an obsolete, calcified lesion was discovered in the wife’s chest her visa was cancelled, the family’s and a outlive.

plans ruined, may

never

stigma placed

upon them that

they

A naval pensioner for tuberculosis was discharged from the Service with his disease quiescent, and obtained work as a clerk with a gas undertaking. Whilst so employed tion and

he was

unfortunately developed signs admitted to

a

of reactiva-

sanatorium, from which he

with a selective artificial disease quiescent. He was but a deputation of his now fit to return to work ; fellow workers told the manager that if he came back they would leave, as they had no intention of taking tuberculosis back to their families. The manager, in spite of medical reassurances, timorously gave in and referred the matter to London. There the matter rests. The patient is left in agony of mind, fearful that without was ultimately discharged pneumothorax and with his

2. J. Lab. clin. Med. 1942, 27, 1546. Leyton, N. Med. Pr. 1944, 211, 302. Halasy, M. Brit. Med. J. 1949, i, 1121.

cause and by the influence of ignorance, prejudice, and uncharitableness his livelihood may be taken from him. Sir, these problems are now a national concern, and they ought to be dealt with at national level. Tuberculosis is a scourge of no less magnitude than syphilis, gonorrhoea, and diphtheria ; and it is difficult to understand why, when the menace of venereal disease is shouted from every hoarding and newspaper by the Ministry of Health, the quiet facts of tuberculosis and the truth about its infectivity and means of spread are not similarly advertised. Tubercle is indeed a disease that walketh in darkness ; and it will continue to do so, despite the efforts of workers in this specialty, until a blaze of light is thrown upon it. Finally, may I reply to the adverse criticism of Dr. Snell (Aug. 6) My suggestion that "active cases of pulmonary tuberculosis can be nursed in general wards without the smallest danger " plainly states a fact; and the need for precautions is so obvious as not to require mention. There are unavoidable hazards in all walks of life, and that of tuberculous infection is one which the nursing and medical professions naturally take. The relatively higher incidence in these groups is doubtless due partly to the absence of routine precautions in general hospitals. In two such hospitals with which I am associated no Mantoux testing at all was done until it had been repeatedly insisted on ; but that omission did not prevent complaints being made when ...

Mantoux-negative probationers developed primary com. plexes. General hospitals are casual not through ignorance but by reason of their firm conviction that pulmonary tuberculosis is no business of theirs and that it should never sully their wards. No-one, except possibly the general hospitals, will quarrel with Dr. Toussaint’s pertinent remarks in your issue of Aug. 13. Those of us who are less fortunate than he will continue to hope that one day other general hospitals will accept their share of responsibility. Chest Clinic, Folkestone.

B. G. EDELSTON.

HOSPITAL DISCIPLINE not long ago :

SIR,—Miss McManus said

" Discipline

is necessary in all walks of life, Services, business, and the home. It instils into the minds of student nurses the need for complete accuracy and reliability, for even young nurses carry life and death in their hands." But discipline in hospital is not related to that in the or other professions. Significantly, I think, hospital discipline and etiquette is And this a mongrel-half military, half conventual. stuff about discipline strengthening the hands that " carry life and death " needs looking into. Doctors, too, have a hand in carrying life and death. So do bus-drivers, passenger-train drivers, and traffic policeBut does the bus-conductor deferentially place men.

home, business, industry,

his hands behind his back and escort the driver to and from the bus, opening the door and standing respectfully till the driver is seated ? Does the university lecturer interest himself if his medical students refuse porridge? Does the medical superintendent decide whether the doctors may wear whiskers, moustache, coloured socks, ? I remember a nurse being told at or the wrong studs the dinner-table on pay-day : " Now you can go out and buy studs the same as those the other nurses have." I was at a training-school which, to use a vulgar phrase, " thought itself the whole cheese." Discipline was inflexible. We were required to account for our lateness if half a minute overdue ; we were not allowed to appear without cuffs, cap, and full regalia in the sitting-room ; to be seen smoking-even off duty in town or cafe or cinema-rendered us liable to instant dismissal; senior nurses ignored junior nurses when passing in corridors-it was all in fact like an Arthur

441 Marshall parody of a girls’ school. Nurses were terrified of the sisters and staff nurses. Now how reliable were they as nurses’? Regardless of the number of patients, work had to be finished at the time expected by the sister of the ward ; and miraculously, it always seemed to be done in time. I was perplexed, and wondered why I alone could not wash sixteen children in twenty minutes. A " smart guy " nurse came to help me, and this is how she did it. A basin-one basin-was brought into the , ward and set on the enamel table. Then she went round the sixteen children and collected " face-cloths." (These were strips of old blanket curiously transformed into something like a strip of cold porridge or tripe.) All facecloths were put together into the basin, then wrung out and nung to each child. Delighting in this catch-ball jumped and caught the cloths, gave game, the children their faces a " dicht " as we say in Scotland, then stuffed the porridgy bits of blanket into their lockers. The job was done in the appointed time-before sister returned from tea. I assure you that nowhere is white paint and glass more tenderly nursed than in that hospital. I will not multiply instances. I think nursing is a very adult job, and it is incongruous and unrewarding to model our training on either the nineteenth-century Army or a girls’ prep-school. I know nurses are little more than schoolgirls when they start, but need we do our best to keep them still schoolgirls at sixty ? RACHAEL. THE SEVEN SINS OF MEDICINE

SIR,—I hope someone has told the students who listened to Dr. Asher, whose address you published last week, that : (1) cerebral tumours are not common, but are not rare either ; (2) some of them are curable ; (3) if therefore you dismiss every case of headache and vomiting with the word " migraine," from time to time you will contribute to a horrible and unnecessary death ; (4) migraine, despite Dr. Asher’s implication to the contrary, is sometimes a symptom of a cerebral tumour ; (5) even patients with rare diseases need diagnosis and advice ; and (6) if you have any love of knowledge, you are bound to be both a lover of common things and A LOVER OF THE .KARE.

ELECTRICAL ANESTHESIA

electrical engineer interested in the effects of electric currents introduced into physiological the body, I particularly noticed the annotation on this subject in your issue of Aug. 6. With regard to Leduc’s work in 1902, I should like to draw attention to relevant contemporary investigations. Kouwenhoven1 reports that neither he nor other investigators have succeeded in reproducing Leduc’s results; while Hertzhas found that anæsthesia was achieved in neither animals nor man. The patient would be rendered unconscious and breathing would cease unless the shock was carefully controlled. Concerning the electrical stunning mentioned in the annotation, its principal use in abattoirs in this country is for the slaughtering of hogs ; the consequent increase in blood-pressure is greater, and thus gives better bleeding, than with other methods. In this connexion. the term " narcosis " is preferable anaesthesia as the unconsciousness rarely lasts for to more than a few minutes after the shock, and in practice the current cannot be passed continuously through the brain. Moreover, unless the current is carefully restricted to a low value, convulsions are likely to occur. T. J. WYNN. Bradford.

SIR,—As

"

an

"

1. Kouwenhoven, W.B. J. Amer. Inst. elect. Engrs, 2. Hertz, J. Rev. Path. comp. 1933, 33, 385.

1949, 68, 199.

Obituary HIBBERT ALAN STEPHEN NEWTON KT., M.S. MELB, F.R.C.S., F.R.A.C.S. Sir Alan Newton, a former president of the Royal Australasian College of Surgeons, who died on Aug. 4, was one of the acknowledged leaders of surgery in Australia. Hibbert Alan Stephen Newton was born in Melbourne in 1887, the son of Hibbert H. Newton, Clerk of Parliaments, Victoria, and he was educated at Haileybury College, Melbourne, and the University of Melbourne, where he graduated M.B. in 1909, obtaining first place in the final honours lists and the Beaney scholarship in surgery. After holding posts at the Melbourne Hospital as resident medical officer and as registrar he was appointed an honorary surgical clinical assistant in 1912. In the same year he obtained the M.S. of the University of Melbourne. Before his appointment the following year as surgeon to outpatients at the Melbourne hospital he spent several months in London working under Sir Victor Horsley at University College Hospital and at Queen Square. During the 1914-18 war, with the rank of captain and later of major in the A.A.M.C., he served for a time in a casualty-clearing station in France, and in 1919 he was attached to the 3rd Australian auxiliary hospital at Dartford ; it was while holding this appointment that he obtained the fellowship of the English taanaeas

college.

After his return to Australia he resumed his appointment as surgeon to outpatients at the Melbourne Hospital, and in 1927 he was appointed surgeon to inpatients and lecturer in clinical surgery. Although he had one of the busiest surgical practices in Melbourne, Newton had many other interests. He was associated with the early formation of the Melbourne Permanent Postgraduate Committee, and he was one of the prime movers in the foundation of the Royal Australasian College of Surgeons. Its development owes much to his influence, and he held the offices of censorin-chief, vice-president, and from 1942 to 1945 of president. He was also a member of the councils of Trinity College and the University of Melbourne, the board of the Walter and Eliza Hall Institute of Medical Research, the medical board of Victoria, and the council of the Victorian centre of the St. John Ambulance Association. He was’ an honorary fellow of the American College of Surgeons and a fellow of the British Association of Surgeons. In 1936 he was appointed knight bachelor. During the late war, with characteristic vigour, he did not spare himself despite his failing health. From 1939 to 1945 he was a member of the Central Medical Coördination Committee and for three years he was deputy chairman. He was appointed consulting surgeon to Army Headquarters in Melbourne, and from 1940 to 1945 he held the highly important post of chairman of the Medical Equipment Control Committee. In 1942 he was as quick to realise the vital necessity of getting all the quinine possible out of Java. as he was later to appreciate the need to speed the manufacture of other essential drugs such as sulphaguanidine. . In his later years, Newton’s health did not permit him to continue his practice, but in 1947 he was appointed Stewart lecturer in surgery at Melbourne, and here he carried on with determination but at last succumbed to an illness which had almost carried him off a year earlier. An Australian correspondent adds : " A general surgeon of great merit, Newton was particularly interested in the surgery of the thyroid. He was devoted to teaching and in this he excelled. His students, who held him in great affection, flocked to his ward-rounds and lectures. A man of outstanding personality, he had a tall and imposing presence and a grand manner. He had a great