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MEDICAL TERMINATION OF PREGNANCY
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bacterial agents prophylactically. In Nicaragua postoperative malaria attacks often confused the clinical picture. Nevertheless, we documented 5 wound infections in the isolator series (3-9%) and 4 in the controls (6-2%). The difference is insignificant. We were unable to identify the source of infection in any of the controls, but obtained presumptive evidence in 4 of the isolator cases (table v). In 3 of the infected isolator cases, the wound was handled without aseptic process on the first postoperative day, and in none was an occlusive dressing used postoperatively. Discussion The isolator eliminates or greatly reduces airborne contaminants as well as those emanating from the respiratory tract and clothing of the surgical team and the patient, but it is evident that the isolator does not obviate the need for adequate surgical skin preparation. Our results also suggest that isolation of the wound should be continued in the early postoperative period, particularly when drains are used. We found no consistent correlation in the types of bacteria cultured from the incision, from those found elsewhere in the environment, or from those identified in infected wounds. Culbertson et al. (1961) and Howe (1964) reported similar findings. Although we were able to culture coagulase-positive staphylococci from the nostrils of many patients and hospital personnel, we seldom recovered them from the incisions, and only once from an infected wound. This finding was particularly surprising, because in some of the hospitals where we worked local physicians told us that the rate of wound infection was very high. Relative humidity within the isolator was high, and toward the end of many operations approached 100%which may be lethal to airborne bacteria that might find their way into the isolator (Bernard et al. 1963). The danger of sparking should also be lessened as a result of the humidity: the enclosure provided by the plastic bag could add to safety when the cautery is used with explosive gas in the operating-room. A gas mixture within the isolator would be even less likely to explode if the air intake were on a relatively high table or instrument stand. In extreme hazard, nitrogen or carbon dioxide could be used to replace part or all of the air entering the system. The cost of the isolator units was not compared with that of standard draping procedures, but its simple design should lend itself to mass production. The elimination of
This work was supported in part by grants E 3605 and E 3605 Cl from the National Institutes of Health, U.S. Public Health Service, from the Atkinson Foundation and the Myrtle L. Atkinson Foundation, and from a U.S.P.H.S. training grant in tropical health n° 5 Tl AI-88-06 (Dr. Quentin M. Geiman, Stanford University). For advice, cooperation, and assistance, we are indebted to numerous members of the departments of surgery, infectious disease, and preventive medicine at the Universidad de El Salvador, Universidad de Guadalajara, Universidad Nacional de Nicaragua, and Stanford University, as well as to the surgical staffs of the various hospitals mentioned in the text. Excellent engineering assistance was rendered by Mr. Philip Mac Hale, Mr. Robert Clapper and Mr. Edward Stirm. Metallic parts were manufactured by Peninsula Steel Products Company, San Jose, California.’Vi-hesive’ was supplied through the courtesy of the Aeroplast Corporation, Dayton, Ohio. Requests for reprints should be addressed to Dr. Charles B. Beal, Corps de la Paix des Etats-Unis d’Amerique, B.P. 1127, Abidjan, Ivory Coast.
drapes and gowns plus a possible reduction in morbidity and in antibiotic use may make the isolator economically feasible wherever surgery is undertaken. If several operations could go on simultaneously in the same room, additional economy could be expected. Moreover, one surgeon with adequately trained assistants could supervise several simultaneous operations and assist when necessary. Studies are continuing in a contaminated environment to determine more precisely the potential value of the isolator in preventing postoperative wound infection. In hospitals where the infection-rate is already low, the advantages of slightly improved wound protection would have to be weighed against unknown drawbacks in the isolation technique itself. Patients who are highly susceptible to exogenous infection should profit by the additional security of an isolator. These patients, however, may need complex operative procedures, and the surgeon may be reluctant to employ a technique which he fears might itself adversely affect the final result.
REFERENCES
Beal, C., Stites, D. P. (1961) 15th Annual Meeting of the American Society of Tropical Medicine and Hygiene, Washington D.C. Nov. 2. Bernard, H. R., Cole, W. R., Gravens, D. L., Monsour, V. (1963) Surgery,
54,
195.
Culbertson, W. R., Altemier, W. A., Gonzales, L. L., Hill, E. O. (1961) Ann. Surg. 154, 599. Howe, C. W. (1964) Am. J. Surg. 107, 696. Landy, J. J. (1961) J. Ark. med. Soc. 57, 503. Levenson, S. M., Trexler, P. C., Malm, O. J., Horowitz, R. E., Moncrief, W. H. (1960) Surg. Forum 11, 306. Le Conte, M., Poleski, E. J. (1964) Am. J. Surg. 107, 710. Reyniers, J. A. (1932) Proc. Indiana Acad. Sci. 42, 35. Trexler, P. C., Reynold, L. K. (1957) Appl. Microbiol. 5, 406 —
—
MEDICAL TERMINATION OF PREGNANCY A NEWLY formed organisation, the Society for the Protection of Unborn Children, plans to tell the public of what the society feels are potentially dangerous paragraphs in the Medical Termination of Pregnancy Bill. This private member’s Bill received its second reading in the House of Commons on July 22 and should reach committee stage on Jan. 18. In a statement issued this week, the society says it is not opposed to abortion where there is serious risk to life or grave injury to the physical or mental health of the mother, but the grounds set out in section 1, clause 1, paragraphs (b)-(d) of the Bill in its present form could lead to the unnecessary deaths of " many potentially normal babies and to abortion on demand ". The statement discusses the Bill under four main heads-legal, social, medical, and moral. The society sees the Bill as confusing, not clarifying, the existing law: doctors would be required to take decisions on non-medical grounds which they would not be qualified to take and they would be left with no clear grounds for refusing to terminate a pregnancy. The society cites a report of the Council of the Royal College of Obstetricians and Gynxcologists in support of the view that the Bill could lead to an increase in illegal abortions. The committee of the Society for the Protection of Unborn Children includes Mr. Aleck Bourne, Sir Andrew Claye, Prof. Ian Donald, Prof. J. C. McClure Browne, Dr. R. A. Newton, and Prof. James Scott. A statement on the Bill was also published this week by twelve well-known people interested in this subject, including Sir Dugald Baird, Prof. G. M. Carstairs, Prof. Douglas Hubble, Prof. Henry Miller, and Dr. Eliot Slater. They recognise that the human embryo is a potential human being, but " we are unable to accept that the fertilized egg has the same status as a new-born child or as an adult." "We think it is illusory to seek some stage of development beyond which tht embryo can be given a special legal and ethical status: instead we suggest that the facts of medicine and of social behavioui force us to take difficult decisions." They welcome the pro. visions of the Bill and they believe it will give doctors " thi freedom to make the best choice for the mother, her establishe< family, and the embryo within her".
bacterial agents prophylactically. In Nicaragua postoperative malaria attacks often confused the clinical picture. Nevertheless, we documented 5 wound infections in the isolator series (3-9%) and 4 in the controls (6-2%). The difference is insignificant. We were unable to identify the source of infection in any of the controls, but obtained presumptive evidence in 4 of the isolator cases (table v). In 3 of the infected isolator cases, the wound was handled without aseptic process on the first postoperative day, and in none was an occlusive dressing used postoperatively. Discussion The isolator eliminates or greatly reduces airborne contaminants as well as those emanating from the respiratory tract and clothing of the surgical team and the patient, but it is evident that the isolator does not obviate the need for adequate surgical skin preparation. Our results also suggest that isolation of the wound should be continued in the early postoperative period, particularly when drains are used. We found no consistent correlation in the types of bacteria cultured from the incision, from those found elsewhere in the environment, or from those identified in infected wounds. Culbertson et al. (1961) and Howe (1964) reported similar findings. Although we were able to culture coagulase-positive staphylococci from the nostrils of many patients and hospital personnel, we seldom recovered them from the incisions, and only once from an infected wound. This finding was particularly surprising, because in some of the hospitals where we worked local physicians told us that the rate of wound infection was very high. Relative humidity within the isolator was high, and toward the end of many operations approached 100%which may be lethal to airborne bacteria that might find their way into the isolator (Bernard et al. 1963). The danger of sparking should also be lessened as a result of the humidity: the enclosure provided by the plastic bag could add to safety when the cautery is used with explosive gas in the operating-room. A gas mixture within the isolator would be even less likely to explode if the air intake were on a relatively high table or instrument stand. In extreme hazard, nitrogen or carbon dioxide could be used to replace part or all of the air entering the system. The cost of the isolator units was not compared with that of standard draping procedures, but its simple design should lend itself to mass production. The elimination of
This work was supported in part by grants E 3605 and E 3605 Cl from the National Institutes of Health, U.S. Public Health Service, from the Atkinson Foundation and the Myrtle L. Atkinson Foundation, and from a U.S.P.H.S. training grant in tropical health n° 5 Tl AI-88-06 (Dr. Quentin M. Geiman, Stanford University). For advice, cooperation, and assistance, we are indebted to numerous members of the departments of surgery, infectious disease, and preventive medicine at the Universidad de El Salvador, Universidad de Guadalajara, Universidad Nacional de Nicaragua, and Stanford University, as well as to the surgical staffs of the various hospitals mentioned in the text. Excellent engineering assistance was rendered by Mr. Philip Mac Hale, Mr. Robert Clapper and Mr. Edward Stirm. Metallic parts were manufactured by Peninsula Steel Products Company, San Jose, California.’Vi-hesive’ was supplied through the courtesy of the Aeroplast Corporation, Dayton, Ohio. Requests for reprints should be addressed to Dr. Charles B. Beal, Corps de la Paix des Etats-Unis d’Amerique, B.P. 1127, Abidjan, Ivory Coast.
drapes and gowns plus a possible reduction in morbidity and in antibiotic use may make the isolator economically feasible wherever surgery is undertaken. If several operations could go on simultaneously in the same room, additional economy could be expected. Moreover, one surgeon with adequately trained assistants could supervise several simultaneous operations and assist when necessary. Studies are continuing in a contaminated environment to determine more precisely the potential value of the isolator in preventing postoperative wound infection. In hospitals where the infection-rate is already low, the advantages of slightly improved wound protection would have to be weighed against unknown drawbacks in the isolation technique itself. Patients who are highly susceptible to exogenous infection should profit by the additional security of an isolator. These patients, however, may need complex operative procedures, and the surgeon may be reluctant to employ a technique which he fears might itself adversely affect the final result.
REFERENCES
Beal, C., Stites, D. P. (1961) 15th Annual Meeting of the American Society of Tropical Medicine and Hygiene, Washington D.C. Nov. 2. Bernard, H. R., Cole, W. R., Gravens, D. L., Monsour, V. (1963) Surgery,
54,
195.
Culbertson, W. R., Altemier, W. A., Gonzales, L. L., Hill, E. O. (1961) Ann. Surg. 154, 599. Howe, C. W. (1964) Am. J. Surg. 107, 696. Landy, J. J. (1961) J. Ark. med. Soc. 57, 503. Levenson, S. M., Trexler, P. C., Malm, O. J., Horowitz, R. E., Moncrief, W. H. (1960) Surg. Forum 11, 306. Le Conte, M., Poleski, E. J. (1964) Am. J. Surg. 107, 710. Reyniers, J. A. (1932) Proc. Indiana Acad. Sci. 42, 35. Trexler, P. C., Reynold, L. K. (1957) Appl. Microbiol. 5, 406 —
—
MEDICAL TERMINATION OF PREGNANCY A NEWLY formed organisation, the Society for the Protection of Unborn Children, plans to tell the public of what the society feels are potentially dangerous paragraphs in the Medical Termination of Pregnancy Bill. This private member’s Bill received its second reading in the House of Commons on July 22 and should reach committee stage on Jan. 18. In a statement issued this week, the society says it is not opposed to abortion where there is serious risk to life or grave injury to the physical or mental health of the mother, but the grounds set out in section 1, clause 1, paragraphs (b)-(d) of the Bill in its present form could lead to the unnecessary deaths of " many potentially normal babies and to abortion on demand ". The statement discusses the Bill under four main heads-legal, social, medical, and moral. The society sees the Bill as confusing, not clarifying, the existing law: doctors would be required to take decisions on non-medical grounds which they would not be qualified to take and they would be left with no clear grounds for refusing to terminate a pregnancy. The society cites a report of the Council of the Royal College of Obstetricians and Gynxcologists in support of the view that the Bill could lead to an increase in illegal abortions. The committee of the Society for the Protection of Unborn Children includes Mr. Aleck Bourne, Sir Andrew Claye, Prof. Ian Donald, Prof. J. C. McClure Browne, Dr. R. A. Newton, and Prof. James Scott. A statement on the Bill was also published this week by twelve well-known people interested in this subject, including Sir Dugald Baird, Prof. G. M. Carstairs, Prof. Douglas Hubble, Prof. Henry Miller, and Dr. Eliot Slater. They recognise that the human embryo is a potential human being, but " we are unable to accept that the fertilized egg has the same status as a new-born child or as an adult." "We think it is illusory to seek some stage of development beyond which tht embryo can be given a special legal and ethical status: instead we suggest that the facts of medicine and of social behavioui force us to take difficult decisions." They welcome the pro. visions of the Bill and they believe it will give doctors " thi freedom to make the best choice for the mother, her establishe< family, and the embryo within her".