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NOISE IN HOSPITALS
1269
enabled to compete on an equal basis in the employment market. At the same time social workers and social agencies will be required to give them support and reassurance during this very difficult transitional stage. Here the settlements, community centres, youth clubs, churches, and schools have a vital role to play in encouraging these submerged people to achieve social competence and to assimilate the norms of the wider community. Sociologists have revealed the existence of these subcultural pockets. Social justice and social hygiene alike demand that a strenuous endeavour should be made to eliminate them once and for all.
Annotations NOISE IN HOSPITALS "
DEPRIVED of rest, all prematurely die ", wrote Ovid. It is by no means easy to ensure that hospital patients have the rest they need; necessary nursing and medical attention is itself a disturbance, and lights which must be left burning during the night make sleep difficult for some
patients.
But the main cause of disturbed rest is usually noise; that much of this is unnecessary has been shown by an inquiry by King Edward’s Hospital Fund For London.l A questionary was sent to more than two thousand patients in fifteen hospitals; they were asked to comment on the noises which disturbed them most. Most patients are not worried by a background roar of traffic, at least by day, but this and all other noises become more disturbing at night. Most of the disturbing noises arise either within, or just outside the ward, and are due to faulty (and therefore noisy) equipment, or to thoughtlessness on the part of the staff. These internal disturbances can usually be prevented at little cost, whereas those arising further away (milk crates, a dance hall next door to the hospital) cannot usually be prevented without heavy expenditure. Many patients returned the questionary without comment, and the report concludes that " nearly 50% were not bothered by noises ". This is a surprising conclusion-surprising, at any rate, to those of us who have been patients ourselves-and it may be ,-suspected that some of the patients were unable to express their views. Trolleys, telephones, and lifts are often the noisiest equipment. Trolleys can be greased and lift doors adjusted, but the only solution to the telephone problem is to change the call system. Perhaps the suggestion which patients will welcome most is that polyethylene bowls should replace those of aluminium. To be woken up in what, for most people, is the middle of the night is unpleasant enough; to be woken to the nerve-tearing sound of aluminium bowls clanging against a stainless-steel sink is very much worse. But the best results will probably be achieved by encouraging staff not only to be quiet themselves, but to report noisy equipment. Nurses are not the only offenders; many doctors, called to the ward in the middle of the night, would do well to recall what Hilton said a hundred years ago. In many cases patients themselves are the cause of the disturbance. This is a more intractable problem, and probably the side-ward is the only solution at present. Perhaps the hospitals of the 1. Noise Control in Hospitals. 34, King Street, E.C.2.
King
Edward’s Hospital Fund for
London,
future will include a sound-proof ward for senile patients who become manic at about 3 A.M. The extent to which illness is prolonged by lack of rest cannot be assessed. Many sound-proofing schemes are considered impracticable owing to their expense; but, now that the care of each inpatient costs over E20 a week, nothing that will hasten recovery can be lightly set aside because of its price. ANTIBODIES IN CELLS
MUCH work has been done to determine the site of antibody formation and to identify the cells in the body responsible for the synthesis of antibodies.1 Ingenious techniques have been devised to determine whether a single cell can produce a variety of antibodies simultaneously or whether there must be a separate cell or clone of cells to synthesise each kind of antibody. Nossal and Lederberg2 (the winner of a Nobel prize this year) used a micromanipulation technique to study isolated single cells from the lymph-nodes of rats immunised with two distinct strains of salmonella. Some of the isolated cells formed agglutinating antibodies to one of the strains and some to the other, but no single cell produced detectable amounts of antibody to both strains. It can be concluded therefore that when an animal is stimulated with two con- ’ trasting antigens, individual cells tend to form only one kind of antibody. Antibodies labelled with fluorescent dyes 34 have now been used to investigate the problem.5 Frozen sections of tissues suspected of containing antibodies to an antigen are first treated with the antigen and then with specific antibody coupled to a fluorescent dye. Cells containing the antibody will bind the antigen and then the labelled antibody so that they will show fluorescence when exposed to ultraviolet light. Two different modifications of the technique are used to detect the presence of two different antibodies. In the first modification the tissue section is first exposed to one of the antigens and the corresponding labelled antibody, and the distribution of fluorescent cells is noted. This fluorescence is quenched by exposure to long-wave ultraviolet irradiation. Then the section is treated with the second antigen, and fluorescent antibody and the distribution of fluorescence are again noted. The second method depends on labelling the two antibodies with dyes which fluoresce different colours, so that the presence of two antibodies can be detected simultaneously in the tissue section after treating it first with the mixed antigens and then with the mixture of antibodies each labelled with a different dye. These methods have been applied to sections of spleen and popliteal lymph-nodes from rabbits immunised with mixtures of two different antigens, either pneumococci and hen-egg albumin or diphtheria toxoid and hen-egg albumin. In each case the immunisation caused proliferation of plasma cells and their precursors in the pulp of the spleen and the medulla of the lymph-nodes. Both methods revealed that the two antibodies were located within distinct systems of plasma-cell elements. In no case was evidence obtained of two different antibodies within the same cell-which confirms the view that individual cells tend to form only one kind of antibody. If the two groups of cells forming different antibodies were derived by repeated division from widely dispersed precursors, there tended to be a characteristic grouping of 1. Lancet, 1958, i, 1321. 2. Nature, Lond., 1958, 181, 1419. 3. Coons, A. H. Int. Rev. Cytol. 1956, 5, 1. 4. Chadwick, C. S., McEntegart, M. G., Nairn, R. C. Lancet, 1958, 5. White, R. G. Nature, Lond., 1958, 182, 1383.
i, 412.
enabled to compete on an equal basis in the employment market. At the same time social workers and social agencies will be required to give them support and reassurance during this very difficult transitional stage. Here the settlements, community centres, youth clubs, churches, and schools have a vital role to play in encouraging these submerged people to achieve social competence and to assimilate the norms of the wider community. Sociologists have revealed the existence of these subcultural pockets. Social justice and social hygiene alike demand that a strenuous endeavour should be made to eliminate them once and for all.
Annotations NOISE IN HOSPITALS "
DEPRIVED of rest, all prematurely die ", wrote Ovid. It is by no means easy to ensure that hospital patients have the rest they need; necessary nursing and medical attention is itself a disturbance, and lights which must be left burning during the night make sleep difficult for some
patients.
But the main cause of disturbed rest is usually noise; that much of this is unnecessary has been shown by an inquiry by King Edward’s Hospital Fund For London.l A questionary was sent to more than two thousand patients in fifteen hospitals; they were asked to comment on the noises which disturbed them most. Most patients are not worried by a background roar of traffic, at least by day, but this and all other noises become more disturbing at night. Most of the disturbing noises arise either within, or just outside the ward, and are due to faulty (and therefore noisy) equipment, or to thoughtlessness on the part of the staff. These internal disturbances can usually be prevented at little cost, whereas those arising further away (milk crates, a dance hall next door to the hospital) cannot usually be prevented without heavy expenditure. Many patients returned the questionary without comment, and the report concludes that " nearly 50% were not bothered by noises ". This is a surprising conclusion-surprising, at any rate, to those of us who have been patients ourselves-and it may be ,-suspected that some of the patients were unable to express their views. Trolleys, telephones, and lifts are often the noisiest equipment. Trolleys can be greased and lift doors adjusted, but the only solution to the telephone problem is to change the call system. Perhaps the suggestion which patients will welcome most is that polyethylene bowls should replace those of aluminium. To be woken up in what, for most people, is the middle of the night is unpleasant enough; to be woken to the nerve-tearing sound of aluminium bowls clanging against a stainless-steel sink is very much worse. But the best results will probably be achieved by encouraging staff not only to be quiet themselves, but to report noisy equipment. Nurses are not the only offenders; many doctors, called to the ward in the middle of the night, would do well to recall what Hilton said a hundred years ago. In many cases patients themselves are the cause of the disturbance. This is a more intractable problem, and probably the side-ward is the only solution at present. Perhaps the hospitals of the 1. Noise Control in Hospitals. 34, King Street, E.C.2.
King
Edward’s Hospital Fund for
London,
future will include a sound-proof ward for senile patients who become manic at about 3 A.M. The extent to which illness is prolonged by lack of rest cannot be assessed. Many sound-proofing schemes are considered impracticable owing to their expense; but, now that the care of each inpatient costs over E20 a week, nothing that will hasten recovery can be lightly set aside because of its price. ANTIBODIES IN CELLS
MUCH work has been done to determine the site of antibody formation and to identify the cells in the body responsible for the synthesis of antibodies.1 Ingenious techniques have been devised to determine whether a single cell can produce a variety of antibodies simultaneously or whether there must be a separate cell or clone of cells to synthesise each kind of antibody. Nossal and Lederberg2 (the winner of a Nobel prize this year) used a micromanipulation technique to study isolated single cells from the lymph-nodes of rats immunised with two distinct strains of salmonella. Some of the isolated cells formed agglutinating antibodies to one of the strains and some to the other, but no single cell produced detectable amounts of antibody to both strains. It can be concluded therefore that when an animal is stimulated with two con- ’ trasting antigens, individual cells tend to form only one kind of antibody. Antibodies labelled with fluorescent dyes 34 have now been used to investigate the problem.5 Frozen sections of tissues suspected of containing antibodies to an antigen are first treated with the antigen and then with specific antibody coupled to a fluorescent dye. Cells containing the antibody will bind the antigen and then the labelled antibody so that they will show fluorescence when exposed to ultraviolet light. Two different modifications of the technique are used to detect the presence of two different antibodies. In the first modification the tissue section is first exposed to one of the antigens and the corresponding labelled antibody, and the distribution of fluorescent cells is noted. This fluorescence is quenched by exposure to long-wave ultraviolet irradiation. Then the section is treated with the second antigen, and fluorescent antibody and the distribution of fluorescence are again noted. The second method depends on labelling the two antibodies with dyes which fluoresce different colours, so that the presence of two antibodies can be detected simultaneously in the tissue section after treating it first with the mixed antigens and then with the mixture of antibodies each labelled with a different dye. These methods have been applied to sections of spleen and popliteal lymph-nodes from rabbits immunised with mixtures of two different antigens, either pneumococci and hen-egg albumin or diphtheria toxoid and hen-egg albumin. In each case the immunisation caused proliferation of plasma cells and their precursors in the pulp of the spleen and the medulla of the lymph-nodes. Both methods revealed that the two antibodies were located within distinct systems of plasma-cell elements. In no case was evidence obtained of two different antibodies within the same cell-which confirms the view that individual cells tend to form only one kind of antibody. If the two groups of cells forming different antibodies were derived by repeated division from widely dispersed precursors, there tended to be a characteristic grouping of 1. Lancet, 1958, i, 1321. 2. Nature, Lond., 1958, 181, 1419. 3. Coons, A. H. Int. Rev. Cytol. 1956, 5, 1. 4. Chadwick, C. S., McEntegart, M. G., Nairn, R. C. Lancet, 1958, 5. White, R. G. Nature, Lond., 1958, 182, 1383.
i, 412.