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INSTITUTIONAL CARE OF THE MENTALLY ILL
798
Perhaps the crux of the matter lies in the discovery of the " great heterogeneity of personality organisation " which defies classification and asks for a patient and sympathetic understanding of each situation in its own right. Finally I would call attention to the serious danger of using pathological reactions as a basis on which to erect standards of behaviour for normal people; in so doing are we not putting a premium on the element of adventure in really healthy living ? H. EDELSTON. Bradford .
UNUSUAL URINE PROTEIN IN MYELOMATOSIS
SiR,—The
technique of electron microscopy has towards the helped understanding of the physical principle of glomerular ultrafiltration. Glomerular capillary walls of kidney are structurally specialised, with channels and spaces somewhat similar to those of collodion membranes prepared for use as an ultrafilter.l
1. 2. 3. 4.
As the discussion in your correspondence columns shows 5-7 a similar phenomenon was sometimes seen in the sieving effect of the biological glomerular membrane on the blood-proteins passing into the urine. In this connection the idea of an analogy between the glomerular membrane and the artificial collodion membrane may be useful. Department of Experimental Pathology, Masaryk University, Brno, Czechoslovakia.
D. WIEDERMANN.
new
experiments, by ultrafiltration of normal and pathological sera through collodion membranes of suitable porosity, ultrafiltrates were obtained, the patterns of which corresponded to the patterns of pathological urine proteins.23 The concentrated ultrafiltrates of sera were investigated by paper electrophoresis. We also examined serum ultrafiltrates from patients with myelomatosis and macroglobulinxmia. In each case, electrophoresis revealed an additional electrophoretically homogeneous serum-protein fraction. Even here we were able to find a similarity between natural and artificial ultrafiltrates. In one patient with myelomatosis we saw an interesting phenomenon.4, The simple paraproteinxmic serum fraction split, after filtration through membrane of a known porosity, into two clearly separated components, during analysis of ultrafiltrate proteins by paper electrophoresis (see figure). The splitting of this fraction we took to be a result of a change In
in the electrical charge on colloidal molecules caused by mutual action of membrane pores and protein particles during the filtration process.
our
Hall, V. Amer. Heart J. 1957, 54, 1. Wiedermann, D., &Sbreve;marda, J. Schweiz. med. Wschr. 1956, 86, 930. Wiedermann, D., &Sbreve;marda, J. Physiol. Bohemoslov. 1957, 6, 232. Wiedermann, D., &Sbreve;marda, J., Wiedermann, B. Z. exp. Med. 1957, 129, 286.
INSTITUTIONAL CARE OF THE MENTALLY ILL SiR,—In the article by Dr. Garratt and his colleagues think should (March 29) there is one point which I do not " " supervision go unchallenged. Under the heading of they say that there " could be no reasonable objection " to the employment of general-trained nurses to attend to some of the less disturbed psychiatric patients. When this survey was being made, the psychiatrists were asked to designate patients who needed no (or minimal) psychiatric nursing supervision. But this does not mean that general-trained nurses would be acceptable. What such patients require emotionally is the kind of competent mothering which is a fairly common skill in married women of mature age (our untrained part-time nurses tend to have it in good measure). Unfortunately, the pattern of general nursing training, with its emphasis on purely technical abilities, is still such as to spoil rather than to foster this kind of skill in human relationships. Nurses in general hospitals tend to be far more upset by the presence of a " psychiatric patient " than is the com-
munity
at
large.
I would therefore recommend that the psychiatric patient with minimal disability should be cared for either by untrained nurses (under psychiatric supervision); or, if the general-trained nurse is the only possibility, she should have been away from general nursing for long enough to have recovered from it-say, at least five years. Hollymoor Hospital, Northfield, Birmingham.
J. R. MATHERS.
PSYCHOSIS AND TREMOR DUE TO MECAMYLAMINE have a SIR,-We gentleman in the ward at the moment with what we believe to be the mecamylamine toxic
syndrome described by Dr. Harington and Dr. KincaidSmith (March 8). months ago as an emergency with an of hypertensive encephalopathy, and while in the ward had a minor subarachnoid haemorrhage. His blood-pressure was 260+/110 mm. Hg and blood-urea 27 mg. per 100 ml. His recovery from these complications was uneventful but we found it necessary to keep him on a dose of 30 mg. of mecamylamine six-hourly and he was later discharged on this dosage. At this time his blood-pressure was 180/120 and his bloodurea 25 mg. per 100 ml. He was followed up at regular intervals and made good progress. In February he was normotensive and had a bloodurea of 45 mg. per 100 ml. Two weeks ago he was readmitted because of a generalised coarse tremor and difficulty with his speech. There was also some pruritus of the legs. The tremor affected his whole body and was present at rest so that his bed shook. It was accentuated by voluntary movement and so much so that he was unable to He
came to us seven
episode
Above: Electrophoretic protein pattern of serum from a patient with myelomatosis shows a single y-globulin fraction ; below: Electrophoretic pattern of concentrated ultrafiltrate of the same Both electroserum shows two y-globulin components. phoretograms were done under the same conditions.
5. Cummings, A. J. Lancet, 1957, ii, 598. 6. Gobert-Jones, J. A. ibid. p. 1068. 7. Owen, J. A. ibid. p. 1286.
Perhaps the crux of the matter lies in the discovery of the " great heterogeneity of personality organisation " which defies classification and asks for a patient and sympathetic understanding of each situation in its own right. Finally I would call attention to the serious danger of using pathological reactions as a basis on which to erect standards of behaviour for normal people; in so doing are we not putting a premium on the element of adventure in really healthy living ? H. EDELSTON. Bradford .
UNUSUAL URINE PROTEIN IN MYELOMATOSIS
SiR,—The
technique of electron microscopy has towards the helped understanding of the physical principle of glomerular ultrafiltration. Glomerular capillary walls of kidney are structurally specialised, with channels and spaces somewhat similar to those of collodion membranes prepared for use as an ultrafilter.l
1. 2. 3. 4.
As the discussion in your correspondence columns shows 5-7 a similar phenomenon was sometimes seen in the sieving effect of the biological glomerular membrane on the blood-proteins passing into the urine. In this connection the idea of an analogy between the glomerular membrane and the artificial collodion membrane may be useful. Department of Experimental Pathology, Masaryk University, Brno, Czechoslovakia.
D. WIEDERMANN.
new
experiments, by ultrafiltration of normal and pathological sera through collodion membranes of suitable porosity, ultrafiltrates were obtained, the patterns of which corresponded to the patterns of pathological urine proteins.23 The concentrated ultrafiltrates of sera were investigated by paper electrophoresis. We also examined serum ultrafiltrates from patients with myelomatosis and macroglobulinxmia. In each case, electrophoresis revealed an additional electrophoretically homogeneous serum-protein fraction. Even here we were able to find a similarity between natural and artificial ultrafiltrates. In one patient with myelomatosis we saw an interesting phenomenon.4, The simple paraproteinxmic serum fraction split, after filtration through membrane of a known porosity, into two clearly separated components, during analysis of ultrafiltrate proteins by paper electrophoresis (see figure). The splitting of this fraction we took to be a result of a change In
in the electrical charge on colloidal molecules caused by mutual action of membrane pores and protein particles during the filtration process.
our
Hall, V. Amer. Heart J. 1957, 54, 1. Wiedermann, D., &Sbreve;marda, J. Schweiz. med. Wschr. 1956, 86, 930. Wiedermann, D., &Sbreve;marda, J. Physiol. Bohemoslov. 1957, 6, 232. Wiedermann, D., &Sbreve;marda, J., Wiedermann, B. Z. exp. Med. 1957, 129, 286.
INSTITUTIONAL CARE OF THE MENTALLY ILL SiR,—In the article by Dr. Garratt and his colleagues think should (March 29) there is one point which I do not " " supervision go unchallenged. Under the heading of they say that there " could be no reasonable objection " to the employment of general-trained nurses to attend to some of the less disturbed psychiatric patients. When this survey was being made, the psychiatrists were asked to designate patients who needed no (or minimal) psychiatric nursing supervision. But this does not mean that general-trained nurses would be acceptable. What such patients require emotionally is the kind of competent mothering which is a fairly common skill in married women of mature age (our untrained part-time nurses tend to have it in good measure). Unfortunately, the pattern of general nursing training, with its emphasis on purely technical abilities, is still such as to spoil rather than to foster this kind of skill in human relationships. Nurses in general hospitals tend to be far more upset by the presence of a " psychiatric patient " than is the com-
munity
at
large.
I would therefore recommend that the psychiatric patient with minimal disability should be cared for either by untrained nurses (under psychiatric supervision); or, if the general-trained nurse is the only possibility, she should have been away from general nursing for long enough to have recovered from it-say, at least five years. Hollymoor Hospital, Northfield, Birmingham.
J. R. MATHERS.
PSYCHOSIS AND TREMOR DUE TO MECAMYLAMINE have a SIR,-We gentleman in the ward at the moment with what we believe to be the mecamylamine toxic
syndrome described by Dr. Harington and Dr. KincaidSmith (March 8). months ago as an emergency with an of hypertensive encephalopathy, and while in the ward had a minor subarachnoid haemorrhage. His blood-pressure was 260+/110 mm. Hg and blood-urea 27 mg. per 100 ml. His recovery from these complications was uneventful but we found it necessary to keep him on a dose of 30 mg. of mecamylamine six-hourly and he was later discharged on this dosage. At this time his blood-pressure was 180/120 and his bloodurea 25 mg. per 100 ml. He was followed up at regular intervals and made good progress. In February he was normotensive and had a bloodurea of 45 mg. per 100 ml. Two weeks ago he was readmitted because of a generalised coarse tremor and difficulty with his speech. There was also some pruritus of the legs. The tremor affected his whole body and was present at rest so that his bed shook. It was accentuated by voluntary movement and so much so that he was unable to He
came to us seven
episode
Above: Electrophoretic protein pattern of serum from a patient with myelomatosis shows a single y-globulin fraction ; below: Electrophoretic pattern of concentrated ultrafiltrate of the same Both electroserum shows two y-globulin components. phoretograms were done under the same conditions.
5. Cummings, A. J. Lancet, 1957, ii, 598. 6. Gobert-Jones, J. A. ibid. p. 1068. 7. Owen, J. A. ibid. p. 1286.