MORE PAY FOR MENTAL NURSES

MORE PAY FOR MENTAL NURSES

209 of less than 20-weeks gestation ; as however 83 per cent. of all abortions are reported from hospitals it is probable that many early abortions ar...

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209 of less than 20-weeks gestation ; as however 83 per cent. of all abortions are reported from hospitals it is probable that many early abortions are missed. MORE PAY FOR MENTAL NURSES

THE London County Council has decided to increase the pay of both male and female nurses in its mental hospitals, and to increase holidays. Male hospital assistants and male nurses of all grades between staff nurse and head nurse are to be granted an increase of 3s. a week, and an increase of 2s. a week will be granted to women hospital assistants and women The annual nurses between staff nurse and sister. leave for head nurses and sisters is to be increased to 4 weeks-one week more than staff under their immediate control. The additional expenditure will be 10,580 in 1939-40, 22,855 in 1940-41 and about jE19,313 in each subsequent year. These increases are fully justified. The apparently lavish pay of the female mental staff nurse of 46. a week suffers a large compulsory deduction for board and lodging ; and the advent of women social workers and occupational therapists on professional salaries has caused much heart-burning among mental nurses. The council’s action should remove grumbles and help

recruitment. PULSUS ALTERNANS

OF late years little attention has been paid to pulsus alternans, either as a guide to prognosis or as a guide to the mechanism of heart-failure, yet it has never been adequately explained. The earlier observations of Wenckebach1 suggested that at the

end of the smaller beat blood remains in the heart, that the diastolic filling and the initial tension of the fibres at the beginning of the next beat are greater, and therefore the heart-working at a better mechanical advantage-empties more completely. At the next beat diastolic filling and initial tension are smaller and a feebler beat results. More recently Greenhas shown that derangement of one portion of the myocardium may give rise to alternation. With an electromagnetic clamp he was able to exclude a main coronary artery of the dog for part of the cardiac cycle so that the blood-supply was impaired though not entirely suppressed. In a number of hearts so treated alternation took place, and by means of optical myocardiograms it was shown that during the smaller beats the affected areas contracted only slightly if at all. Thus it seems possible that alternation in the mammalian heart may arise from a relative failure of the whole or a portion of the heart to contract at alternate beats. In using pulsus alternans for prognosis the first essential is to be able to decide when it is present. Only in cases where it is pronounced can it be recognised by palpation of the radial pulse. Though it becomes apparent when the radial pulse is graphically recorded, this entails the use of apparatus to which few are accustomed; and actually the alternation may be equally well discovered by careful attention when taking the blood-pressure. As the cuff pressure is being lowered, there is a stage at which only each alternate beat can force its way through ; then when the pressure is further lowered to the second systolic level all beats come through, so that the cardiac rate appears to be abruptly doubled. The degree of alternation may be expressed as the difference between the two levels, in millimetres of mercury. Occasionally

only appears for a few beats after an extra-systole or when the heart is beating rapidly. Occasionally it may be seen in the electrocardiogram and still more rarely it appears in the electrocardio3 gram though it cannot be detected in the pulse.3 the alternation

Pulsus alternans is to be distinguished from alternate extra-systoles by the fact that in alternation the beats are regular, whereas in extra-systoles a longer pause follows the shorter beat. White4 found the condition in a third of all cases showing any degree of cardiac failure and in 71 of 300 cases with cardiac or cardiorenal disease. From the standpoint of he said, prognosis, patients with pulsus alternans should be divided into two groups. The first consists of those in whom it is associated with a very rapid heart-rate (e.g., in paroxysmal tachycardia) ; in this group its presence does not seem to affect the prognosis. The second group is that in which the heart-rate is relatively slow ; and here it is of serious significance. Thompson and Levine s observed over a twelve-year period 117 patients with constant pulsus alternans, the date of death of 71 being known. Of this series the 50 males lived an average of seventeen months after the detection of the abnormality, and the females eight and a half months. Only 5 of the 71 patients were under forty and in them the average duration of life was only six months after the detection of the abnormality ; generally speaking it was found that the seriousness of the sign decreased with the increase in age of the person in whom it was detected. Such an easily elicited and important sign of failure of the left ventricle should be carefully looked for in all cases of hypertensive heart disease, coronary thrombosis and luetic aortitis.

so

1.

Wenckebach,

K. F., and Winterberg, H., Die unregalmässige Herztätigkeit, Leipzig, 1927. 2. Green, H. D., Amer. J. Physiol. 1936, 114, 407.

BEDBUGS IN SHIPS

THE Association of Port Health Authorities of the British Isles has issued6 a pamphlet on the prevention of infestation of ships by bedbugs, illustrated with a coloured plate reproduced from Memo 180 Med. of the Ministry of Health. Bedbugs can be a worse nuisance on board than they are ashore, but owing to the confined nature of cabins infestation is easier to prevent. Introduction can only occur at ports, mainly through the clothing of the crew ; inspection and personal cleanliness can prevent bugs from reaching the quarters. Even should they do so, infestation is unlikely to result if the quarters are kept scrup-ulously clean and if attention is paid to nooks and crannies which might afford suitable cover. This is less difficult in ships than it is in houses. Should infestation occur from neglect of the cleanliness requisite to prevent it, disinfestation must be adopted. The pamphlet recommends fumigation with sulphur dioxide which is safe but not always efficient, or with hydrogen cyanide which is highly dangerous but efficient if carried out properly. Fumigation with cyanide is only practicable in port in a ship temporarily laid up and carried out by experts. An old boat badly infested may be as impossible to free as is an old house, but even a reasonable degree of cleanliness together with attack on the first sign of infestation should be sufficient to assure freedom. The moral is clear enough. As with all insect pests, it is comparatively easy to prevent bugs from getting a foothold, but once they establish themselves they are Hamburger, W. W., Katz, L. N., and Saphir, O., J. Amer. med. Ass. 1936, 106, 902. 4. White, P. D., Amer. J. med. Sci. 1915, 150, 82. 5. Thompson, W. P., and Levine, S. A., Amer. Heart J. 1936, 11, 135. 3.

6. The hon. secretary of the association is Dr. J. Greenwood Wilson, medical officer of health for Cardiff.