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MORE MATERNITY BEDS
444 MORE MATERNITY BEDS
SIR,-I was interested in Prof. J. K. Russell’s comments (Feb. 9) on the excellent paper by Dr. Oddie and Mr. Jobson. I would, of course, agree that noise should be reduced to a minimum in hospitals, and especially in wards, but a great deal can be done in this respect by the suitable use of soundabsorbent materials for floors, walls, and ceilings, such as has been achieved in the new general-practitioner maternity unit at
Corby, Northamptonshire. With regard to the type of ward nursery reported and apparently approved by Professor Russell, I think we should not lose sight of the reason why a baby is placed in any nursery in any maternity unit. As I see it, a baby is placed in a nursery for the purpose of observation by the nursing and medical staff, not the mother. This is a regrettable medical necessity and is particularly important in a maternity unit dealing with " mothers at risk ", by which I mean those mothers so clearly defined in the National Birthday Trust Perinatal Mortality Survey, where perinatal difficulties are anticipated, as opposed to the kind of mother to be delivered in a general-practitioner maternity unit. At other times, a baby is at the side of the mother’s bed for the specific purpose that the mother may learn the way the baby behaves before she takes her infant home, when nursing and medical supervision and advice become less easily available. Also the baby has to be picked up and fed by the mother on demand for short periods whenever the infant is hungry or thirsty. This is particularly important in the establishment of breast-feeding in the early days, when the amount of colostrum and milk in the breast is small and the baby has not yet settled into the routine of feeding, which eventually usually works out at a 3-4-hourly regimen. If, in spite of being adequately fed on demand, the baby is still abnormally noisy, then this is a reason for a baby being removed to a nursery for nursing and medical observation, examination, and investigation to find the reason, and then for the application of the appropriate treatment. The central nurseries in our units are known colloquially as " sin bins ", to emphasise that they are for infants where there has been a departure from the physiological normal and not just a place in which to put babies. As I see it, the 4-crib nursery, placed between 2-bedded mothers’ rooms, may defeat the objects we are trying to achieve. On the one hand, there is loss of the close mother-baby relationship which is so necessary in the early days for the establishment of breast-feeding and for
getting to know her baby. Also it seems to be partial return to the appalling " iron-curtain mentality where mothers and babies are entirely separated from each other in the maternity ward, except for the brief feeding sessions based on the clock and not on the infants’ appetite or the mothers’ milk-supply. On the other hand, there may be loss of the careful, continuous, and competent nursing and medical observation of the babies who have deviated from physiological normality. Like so many compromises, this one may " fall between two stools " and give us, not the best, but the worst of both the mother
"
a
worlds.
tration of small amounts. Chronic poisoning can lead to neurological symptoms comparable to Parkinson’s disease, F. H. Levy of Berlin produced these effects in rabbits in his research on encephalitis after the epidemic of this disease in 1918. Clinically, a picture similar to the postencephalitic state was observed in men who worked with rock containing larger amounts of manganese. Since the paper of Rubinstein et al. may stimulate a series of human experiments, I think it worth mentioning these rather forgotten observations. RUDOLPH E. SIEGEL. DISCLOSURE OF CONFIDENCES
SIR,-I agree with your annotation (Feb. 9) that the Clough case reopens the old debate on professional secrecy and the Law. Mr. Clough has shown the medical profession that he is prepared to suffer in defence of his principles. University College, B. J. O’DRISCOLL. Galway, Eire. TRIETHYLENE MELAMINE (T.E.M.) IN ACUTE LEUKÆMIA
SIR,-Although some published reports 1-3 suggest that triethylene melamine (T.E.M.) is contraindicated in acute leukxmia, 45 out of 78 patients treated with the drug have been reported to show some improvement. Rundles and Barton4 gave T.E.M. by mouth to 19 patients with acute lymphocytic leukaemia, and recorded great improvement in 4 and slight improvement in 8; in 2 the results were inconclusive. Beyers and Meyer5 induced brief remissions of up to twenty-two days in 7 of 12 acute cases (9 myelocytic and 3 lymphoblastic). Koyama and Tokuyama s described 5 objective remissions in 12 patients after treatment with T.E.M. Heilmeyer7 noted a complete response in 1 patient and 7 partial responses in 11 patients with acute myelocytic leukaemia. Marmont and Fusco8 found that T.E.M. gave the best remissions in chronic granulocytic leukaemia, and the poorest in acute leukaemia; they recorded remissions in 2 patients with acute lymphocytic leukaemia, 2 with acute myelocytic leukaemia, and 1 with monocytic leukaemia out of 7 acute cases. Pavlovsky and Vilasego9 achieved a reduction in the white-blood-cell count in 3 of 5 acute cases. Sanchez Medal 10 observed no improvement in 5 patients with acute leukaemia, after T.E.M, Axelrod et al.11 reported a fair remission in 1 of 3 patients; and Haga et a1.12 a brief response in 1 of 2 patients. Osamura and Ito 13 induced clinical remissions with some prolongation of life but no hsematological response in 1 patient. Brief improvement in single cases of acute leukaemia which were treated with T.E.M. have been reported by Radford," ‘ Shimkin et al.,15 and Winkler and Cerny." One must conclude from the remissions cited that T.E.M. can scarcely be thought to be contraindicated in acute leukxmia, even though the response falls far short
of that which
mercaptopurine, 1.
2. 3.
MANGANESE-INDUCED HYPOGLYCÆMIA SIR,-Rubinstein et al.1 discussed the effect of manganese salts on diabetics. I will not analyse the possible mechanism of this effect, but I want to express my doubts about the safety of this metal in human experiments. In 1925, in a paper on manganese poisoning,2 I stated that the acute poisoning by larger doses of this metal is very different from the effect of chronic adminis1. Lancet, 1962, ii, 1348. 2. Münch. med. Wschr. 1925,
72, 259.
or
Furman University,
4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16.
be achieved with adrenal steroids, folic-acid antagonists.
Greenville, JOHN R. SAMPEY. Carolina, U.S.A. Brimi, R. J. J. Tenn. med. Ass. 1956, 49, 261. Fowler, W. M., Jolly, W. P. J.-Lancet, 1956, 76, 221. Wintrobe, M. M., Cartwright, G. E., Fessas, P. Ann. intern. med. 1954, 41, 447. Rundles, R. W., Barton, W. B. Blood, 1952, 7, 483. Beyers, M. R., Meyer, L. M. Acta hœmat. 1952, 8, 117. Koyama, Y., Tokuyama, H. Ann. N.Y. Acad. Sci. 1958, 68, 1105. Heilmeyer, L. Bull. schweiz. Akad. med. Wiss. 1954, 10, 159. Marmont, A., Fusco, F. Maragliano Path. Clin. 1954, 9, 1179. Pavlovsky, A., Vilasega, G. Sang, 1953, 25, 578. Sanchez Medal, L. Gac. méd. Méx. 1953, 83, 443. Axelrod, A. R., Berman, L., Murphy, R. V. Amer. J. Med. 1953, 15, 684. Haga, A. L., Wasastjerna, C., Hortling, H., Teir, H. Finska LäkSällsk. Handl. 1953, 96, 151. Osamura, S., Ito, K. Acta Un. int. Cancr. 1959, 15, 232. Radford, J. G. Ann. gen. Pract. 1957, 2, 73. Shimkin, M. B., Bierman, H. R., Kelly, K. K., Lowenhaupt, E., Furst, A. Calif. Med. 1951, 75, 26. Winkler, A., Cerny, V. Čsl. Onkol. 1954, 1, 30.
South
ROBERT WIGGLESWORTH.
can
SIR,-I was interested in Prof. J. K. Russell’s comments (Feb. 9) on the excellent paper by Dr. Oddie and Mr. Jobson. I would, of course, agree that noise should be reduced to a minimum in hospitals, and especially in wards, but a great deal can be done in this respect by the suitable use of soundabsorbent materials for floors, walls, and ceilings, such as has been achieved in the new general-practitioner maternity unit at
Corby, Northamptonshire. With regard to the type of ward nursery reported and apparently approved by Professor Russell, I think we should not lose sight of the reason why a baby is placed in any nursery in any maternity unit. As I see it, a baby is placed in a nursery for the purpose of observation by the nursing and medical staff, not the mother. This is a regrettable medical necessity and is particularly important in a maternity unit dealing with " mothers at risk ", by which I mean those mothers so clearly defined in the National Birthday Trust Perinatal Mortality Survey, where perinatal difficulties are anticipated, as opposed to the kind of mother to be delivered in a general-practitioner maternity unit. At other times, a baby is at the side of the mother’s bed for the specific purpose that the mother may learn the way the baby behaves before she takes her infant home, when nursing and medical supervision and advice become less easily available. Also the baby has to be picked up and fed by the mother on demand for short periods whenever the infant is hungry or thirsty. This is particularly important in the establishment of breast-feeding in the early days, when the amount of colostrum and milk in the breast is small and the baby has not yet settled into the routine of feeding, which eventually usually works out at a 3-4-hourly regimen. If, in spite of being adequately fed on demand, the baby is still abnormally noisy, then this is a reason for a baby being removed to a nursery for nursing and medical observation, examination, and investigation to find the reason, and then for the application of the appropriate treatment. The central nurseries in our units are known colloquially as " sin bins ", to emphasise that they are for infants where there has been a departure from the physiological normal and not just a place in which to put babies. As I see it, the 4-crib nursery, placed between 2-bedded mothers’ rooms, may defeat the objects we are trying to achieve. On the one hand, there is loss of the close mother-baby relationship which is so necessary in the early days for the establishment of breast-feeding and for
getting to know her baby. Also it seems to be partial return to the appalling " iron-curtain mentality where mothers and babies are entirely separated from each other in the maternity ward, except for the brief feeding sessions based on the clock and not on the infants’ appetite or the mothers’ milk-supply. On the other hand, there may be loss of the careful, continuous, and competent nursing and medical observation of the babies who have deviated from physiological normality. Like so many compromises, this one may " fall between two stools " and give us, not the best, but the worst of both the mother
"
a
worlds.
tration of small amounts. Chronic poisoning can lead to neurological symptoms comparable to Parkinson’s disease, F. H. Levy of Berlin produced these effects in rabbits in his research on encephalitis after the epidemic of this disease in 1918. Clinically, a picture similar to the postencephalitic state was observed in men who worked with rock containing larger amounts of manganese. Since the paper of Rubinstein et al. may stimulate a series of human experiments, I think it worth mentioning these rather forgotten observations. RUDOLPH E. SIEGEL. DISCLOSURE OF CONFIDENCES
SIR,-I agree with your annotation (Feb. 9) that the Clough case reopens the old debate on professional secrecy and the Law. Mr. Clough has shown the medical profession that he is prepared to suffer in defence of his principles. University College, B. J. O’DRISCOLL. Galway, Eire. TRIETHYLENE MELAMINE (T.E.M.) IN ACUTE LEUKÆMIA
SIR,-Although some published reports 1-3 suggest that triethylene melamine (T.E.M.) is contraindicated in acute leukxmia, 45 out of 78 patients treated with the drug have been reported to show some improvement. Rundles and Barton4 gave T.E.M. by mouth to 19 patients with acute lymphocytic leukaemia, and recorded great improvement in 4 and slight improvement in 8; in 2 the results were inconclusive. Beyers and Meyer5 induced brief remissions of up to twenty-two days in 7 of 12 acute cases (9 myelocytic and 3 lymphoblastic). Koyama and Tokuyama s described 5 objective remissions in 12 patients after treatment with T.E.M. Heilmeyer7 noted a complete response in 1 patient and 7 partial responses in 11 patients with acute myelocytic leukaemia. Marmont and Fusco8 found that T.E.M. gave the best remissions in chronic granulocytic leukaemia, and the poorest in acute leukaemia; they recorded remissions in 2 patients with acute lymphocytic leukaemia, 2 with acute myelocytic leukaemia, and 1 with monocytic leukaemia out of 7 acute cases. Pavlovsky and Vilasego9 achieved a reduction in the white-blood-cell count in 3 of 5 acute cases. Sanchez Medal 10 observed no improvement in 5 patients with acute leukaemia, after T.E.M, Axelrod et al.11 reported a fair remission in 1 of 3 patients; and Haga et a1.12 a brief response in 1 of 2 patients. Osamura and Ito 13 induced clinical remissions with some prolongation of life but no hsematological response in 1 patient. Brief improvement in single cases of acute leukaemia which were treated with T.E.M. have been reported by Radford," ‘ Shimkin et al.,15 and Winkler and Cerny." One must conclude from the remissions cited that T.E.M. can scarcely be thought to be contraindicated in acute leukxmia, even though the response falls far short
of that which
mercaptopurine, 1.
2. 3.
MANGANESE-INDUCED HYPOGLYCÆMIA SIR,-Rubinstein et al.1 discussed the effect of manganese salts on diabetics. I will not analyse the possible mechanism of this effect, but I want to express my doubts about the safety of this metal in human experiments. In 1925, in a paper on manganese poisoning,2 I stated that the acute poisoning by larger doses of this metal is very different from the effect of chronic adminis1. Lancet, 1962, ii, 1348. 2. Münch. med. Wschr. 1925,
72, 259.
or
Furman University,
4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16.
be achieved with adrenal steroids, folic-acid antagonists.
Greenville, JOHN R. SAMPEY. Carolina, U.S.A. Brimi, R. J. J. Tenn. med. Ass. 1956, 49, 261. Fowler, W. M., Jolly, W. P. J.-Lancet, 1956, 76, 221. Wintrobe, M. M., Cartwright, G. E., Fessas, P. Ann. intern. med. 1954, 41, 447. Rundles, R. W., Barton, W. B. Blood, 1952, 7, 483. Beyers, M. R., Meyer, L. M. Acta hœmat. 1952, 8, 117. Koyama, Y., Tokuyama, H. Ann. N.Y. Acad. Sci. 1958, 68, 1105. Heilmeyer, L. Bull. schweiz. Akad. med. Wiss. 1954, 10, 159. Marmont, A., Fusco, F. Maragliano Path. Clin. 1954, 9, 1179. Pavlovsky, A., Vilasega, G. Sang, 1953, 25, 578. Sanchez Medal, L. Gac. méd. Méx. 1953, 83, 443. Axelrod, A. R., Berman, L., Murphy, R. V. Amer. J. Med. 1953, 15, 684. Haga, A. L., Wasastjerna, C., Hortling, H., Teir, H. Finska LäkSällsk. Handl. 1953, 96, 151. Osamura, S., Ito, K. Acta Un. int. Cancr. 1959, 15, 232. Radford, J. G. Ann. gen. Pract. 1957, 2, 73. Shimkin, M. B., Bierman, H. R., Kelly, K. K., Lowenhaupt, E., Furst, A. Calif. Med. 1951, 75, 26. Winkler, A., Cerny, V. Čsl. Onkol. 1954, 1, 30.
South
ROBERT WIGGLESWORTH.
can