INTUSSUSCEPTION

958

LETTERS TO THE EDITOR SIR,-Some

of the

suggestions in the

letters

by

Drs. Kimber, Pilkington and Spencer, in your issues of March 11 and 25 and April 1 respectively, seem open to criticism. The welfare of the patients in mental hospitals on the fully trained staff and only to a lesser extent on the probationer nurses. The problem seems to be that of producing more efficient trained nurses, but the practical aspect must not be overlooked. It has been suggested that teaching of normal psychology from an earlier date in a probationer’s career would add to this efficiency. Personally I doubt very much whether anything beyond a few introductory lectures on broad principles would be of advantage in the early stages of a mental nurse’s training. Psychology is not an easy subject and is more easily grasped by those with some experience of patients in the wards. Dr. Spencer’s ideas for special training centres seem impracticable. Most mental hospitals have great difficulty in keeping their female staff up to quota. They have to attend some of the lectures during their hours on duty, and the difficulty is to spare them from the wards for the lectures being given already, let alone additional ones. Has Dr. Spencer considered how many probationer nurses, especially women, fail to qualify, or having qualified leave soon after ? It is obviously impossible to afford the luxury of letting them spend the first six months of their all too short careers at the occupational centre and lectures, to the exclusion of all ward work. Practical points that seem to me of importance in mental nursing reform are :1. A short general introductory course at the beginning of each series of lectures for the preliminary examinations. 2. Insistence that before qualifying each nurse shall produce a certificate to say that she has attended

depends mainly

fixed number of months in each type of ward-i.e., open, chronic, refractory, epileptic and infirmary wards-and at the occupational centre. 3. Prohibition of the allocation of probationer nurses starting their careers to refractory wards. 4. Concentration of nurses specially picked for their ability to establish contact with patients in the admission wards. 5. Opportunity for each qualified nurse to specialise in some useful sideline such as chiropody or physicalculture instruction. a

I am,

Sir,

yours

faithfully, DONALD BLAIR.

Cane Hill Hospital, Coulsdon, Surrey, April 15.

INTUSSUSCEPTION

SiR,-Mr. Ian Fraser, in his account of a case of recurrent intussusception in a young child, published in your issue of April 15, remarks with much truth that " the subject of enlarged glands in intussusception is of

great interest " and questions whether the enlargement be primary or secondary and whether it may be tuberculous. Some light might be shed on this problem by removal and microscopical examination of these glands; but, failing such information, certain clinical impressions may be noted. In the first place, cases of intussusception usually to operation within a few hours of the onset, and it is difficult to conceive that the degree of enlargement of the glands which is frequently seen

come

have arisen in so short a time as a secondary effect of the intussusception. As regards Mr. Fraser’s query as to the possibility of the enlargement being due to tuberculosis, I have not observed any evidence of caseation in the affected glands, nor have I seen any other signs of intra-abdominal tuberculosis in any of these cases. My own impression is that the glands are the site of a simple inflammatory enlargement due to an acute enteritis, which causes colicky contractions of the bowel, which are the exciting cause of the intussusception. I have frequently observed the relaxed stools typical of infantile diarrhoea during the days immediately following the reduction of an intussusception, and neither this nor the enlargement of the glands appears to be characteristic of ordinary intestinal strangulation with which intussusception is closely comparable in its mechanical effects on the bowel. If, as I believe, intussusception in infants is caused in many instances by an attack of enteritis, the recurrence of the condition in subsequent attacks of enteritis would be a reasonable expectation. The matter is one which is difficult to prove conclusively, but the usual coincidence of the ageperiods of enteritis and of intussusception seems to lend some support to my contentions. It would be interesting to know if Mr. Fraser or any of your readers has made any observations on this problem. I am, Sir, yours faithfully, can

MENTAL NURSING

FRANK FORTY. Redhill County Hospital, Edgware, April 17.

LIFE-STORY OF SIMPLE HERPES

SIR,-I was interested in the leading article on this subject in The Lancet of March 18 and also in Dr. Edwin Goodall’s letter in your last issue. The latter presents certain statements from a contribution by Naegeli (Munchener Medizinische Wochenschrift of Feb. 28, 1936) which, if substantiated by adequate clinical and experimental investigation, might constitute an addition to the present treatment of neurosyphilis. If the previous inoculation of herpes virus is proved to increase the efficacy of the malarial therapy of neurosyphilis an advance of some value would be achieved. The determination of the incidence of simple herpes in cases of neurosyphilis undergoing malarial therapy is an easy matter of clinical observation. After a considerable experience Dr. Goodall has the impression that the incidence is small and my own more limited experience is in agreement with this view. Through the kindness of Dr. L. Findlay, the medical superintendent, I have reviewed my own notes on forty-two cases of neurosyphilis treated by malaria in the V.D. wards of Mill Road Infirmary, Liverpool. All cases were inoculated with the benign tertian parasite except for one in which quartan malaria was used. Two cases developed simple after the second and third rigors respectively herpes and a third case developed herpes two days after the exhibition of quinine. The incidence in this small series is thus 7 per cent., and it is interesting to note that the herpes was confined to cases of taboparesis and was not met with in cases of pure general paralysis although the latter constituted half of the series. One case of asymptomatic general paralysis had an attack of simple herpes a week before inoculation with malaria, and although parasites were seen in blood films no fever developed. This group of patients