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NURSES AND WORLD HEALTH
533
personal contact with the local press through regular press-conferences ;public opinion is thereby kept steady
backward ; and where this is
so the health of the people does not reflect the advanced stage of medicine. The nurses, in fact, among their many other functions, are Yet as the comthe chief teachers of public health. mittee pointed out in their first report,’- we do not yet know whether these functions succeed in meeting the real health needs of the people. The committee therefore recommended that W.H.O. should study the needs of two or more societies, and investigations of this kind have been undertaken in France, and in England under the direction of Dr. A. L. Banks, professor of human ecology at Cambridge. The committee also asked that national healthadministrations should include among their officers highly competent nurses with authority to help in planning health services and to define the part nursing should play in them. Four countries, in consequence, have asked W.H.O. to help them in establishing nursing divisions. The International Labour Organisation (I.L.O.) is already making, on behalf of W.H.O., a study of the working conditions of nurses ; and the committee recommended that W.H.O. should invite the cooperation of the I.L.O. in a joint investigation not only of conditions but of qualifications of nurses, standards of service, and recruitment. Another important recommendation dealt with the need to review basic education programmes, so as to ensure that they prepare nurses for the continuous evolution of modern health work.
and informed. If contacts have to be traced the assistance of the national press and the B.B.C. should be sought. The multiple-pressure method of insertion, which causes little or no reaction or scarring, is greatly preferable to the linear scratch of 1/4 in. (in epidemics two scratches should be made). With neither method should the needle penetrate below the epidermis. With marked secondary infection penicillin tulle should be applied,
ordinarily no dressing is advocated. Allergic eczema, septic skin lesions, and febrile states are contra-indications to vaccination. The society adopts the definitions of reactions accepted by the W.H.O. Expert Committee but
on
Epidemiology
and Quarantine.
Of these the most
important is the "precocious non-vesicular reaction" (Pirquet’s "papule of immunity"). This is characterised by the appearance, after the first day, of a lesion which does not develop beyond the papulomacular stage ; it is pruriginous and disappears at latest on the third day. The reaction is an allergic antigen-antibody phenomenon and does not necessarily indicate immunity. Such a reaction should thus be regarded as suspect, as should also a complete failure to "take." In either event vaccination should be repeated, preferably by the multiple-puncture method, with lymph of indubitable potency. Potency cannot be assured if lymph is kept at room-temperature for more than 7 days, or in a domestic refrigerator for more than 14 days. At subzero temperatures potency remains unimpaired for a year ; the closest approximation ordinarily attainable in practice is the ice-making compartment of the domestic
-
refrigerator. The policy of the Society is primarily concerned with public. Having regard to
of Medical Officers of Health the protection of the general the tragic deaths of unvaccinated members of the staff of hospitals to which cases of smallpox have been inadvertently admitted, hospital authorities should keep in mind the advice of the Medical Research Council’s Committee on Cross-Infection in Hospitals,8that they should continually review the arrangements in their hospitals for protecting the staff by vaccination. NURSES AND WORLD
HEALTH
WHEN the World Health Organisation (W.H.O.), in 1946, defined health as " a state of complete physical, mental and social well-being, and not- merely the absence of disease or infirmity," health services all over the world were placed under a heavy responsibility. Describing the mechanism of W.H.O., at a conference of the Royal College of Nursing on Sept. 14, Dr. Brock Chisholm, the director-general, explained that the permanent secretariat of experts found their programmes on the recommendations of some 28 panels. The panel on nursing is composed of selected nurses from most of the 79 member countries. Tvluch of the work of the panels is done by correspondence, the members giving information to the secretariat as individuals ; but from time to time members chosen from the panel meet as an expert committee to discuss a specific question. W.H.O. receives further information and advice on nursing, Dr. Chisholm added, from the International Council of Nurses, to which all difficult questions are referred. The expert committees have on easy task; because of the uneven development in the member nations ; and recommendations have to be framed in the widest
-
possible terms. Miss M. I. Lambie, chairman of the Expert Committee on Nursing, said that even in countries where medicine is highly developed, nursing may be 7. Ministry of Health memo. 312/MED, 1948. 8. Control of Cross-Infection in Hospitals. Medical Research Council, memorandum no. 11. H.M. Stationery Office, 1951.
THE EUROPEAN IN KENYA WHEN asked whether Kenya suits children, or the elderly, or asthmatics, or people with high blood-pressure or tuberculosis, it is not at all easy for the doctor to answer. Even those who have practised in that country find may difficulty in giving an opinion based on more than a general vague impression; for government medical reports deal more with Africans than Europeans, and what information there is about Europeans mostly concerns government officials, who are not often per manent residents. Accurate records of the health of European settlers are hard to come by ; and ChartersB has therefore done well to record his observations during the 91/2 years, from 1932, when he practised at Nakuru, in the Kenya Highlands, between 5800 and 9200 feet above sea-level. The community included 150 children at two schools ; and Charters refers to 2864 patients, treated. In giving the rates per 1000 for the various. diseases over the 9] /2- year period, he counts each case only once : for instance, a patient with asthma is. counted no more than once, however many times he was treated. The common diseases were hypertension (25-2 per 1000), asthma (13-6, mostly adults) and other allergic conditions (hay-fever, angioneurotic cedema, urticaria, eczema), nasal sinusitis (24-1), tonsillitis (22-4), migraine, (18-1), cyclical vomiting (30 per 1000 children), appendixe. citis (20), and pneumonia (10-1). Malaria (60) was more, common than any other disease, but the infection was. usually acquired outside the district ; Kenya, from the highlands, is a malarious country. Tick-typhus (14) was also found, and amoebiasis (5-9) and bacillary dysentery (11-5) ; but the other diseases conventionallyregarded as tropical were rare in this pleasant country. The incidence even of typhoid (2-4) was low. Charters concludes that many of the disadvantages of heat are avoided at these altitudes, where the air can be remark-, ably crisp in the early morning and wood fires are a comfort at night. But the air is on the whole dry, and engenders thirst, which is easily dealt with, and also nasal sinusitis, which is not. Thus the effect of high altitude on the health of Europeans in Kenya is in general
apart
1. Expert Committee on Nursing. Geneva : World Health sation Technical Report Series, no. 24. 1950. Pp. 30. 2. Charters, A. D. E. Afr. med. J. 1951, 28, 41, 174, 204.
Organi1s. 6d.
personal contact with the local press through regular press-conferences ;public opinion is thereby kept steady
backward ; and where this is
so the health of the people does not reflect the advanced stage of medicine. The nurses, in fact, among their many other functions, are Yet as the comthe chief teachers of public health. mittee pointed out in their first report,’- we do not yet know whether these functions succeed in meeting the real health needs of the people. The committee therefore recommended that W.H.O. should study the needs of two or more societies, and investigations of this kind have been undertaken in France, and in England under the direction of Dr. A. L. Banks, professor of human ecology at Cambridge. The committee also asked that national healthadministrations should include among their officers highly competent nurses with authority to help in planning health services and to define the part nursing should play in them. Four countries, in consequence, have asked W.H.O. to help them in establishing nursing divisions. The International Labour Organisation (I.L.O.) is already making, on behalf of W.H.O., a study of the working conditions of nurses ; and the committee recommended that W.H.O. should invite the cooperation of the I.L.O. in a joint investigation not only of conditions but of qualifications of nurses, standards of service, and recruitment. Another important recommendation dealt with the need to review basic education programmes, so as to ensure that they prepare nurses for the continuous evolution of modern health work.
and informed. If contacts have to be traced the assistance of the national press and the B.B.C. should be sought. The multiple-pressure method of insertion, which causes little or no reaction or scarring, is greatly preferable to the linear scratch of 1/4 in. (in epidemics two scratches should be made). With neither method should the needle penetrate below the epidermis. With marked secondary infection penicillin tulle should be applied,
ordinarily no dressing is advocated. Allergic eczema, septic skin lesions, and febrile states are contra-indications to vaccination. The society adopts the definitions of reactions accepted by the W.H.O. Expert Committee but
on
Epidemiology
and Quarantine.
Of these the most
important is the "precocious non-vesicular reaction" (Pirquet’s "papule of immunity"). This is characterised by the appearance, after the first day, of a lesion which does not develop beyond the papulomacular stage ; it is pruriginous and disappears at latest on the third day. The reaction is an allergic antigen-antibody phenomenon and does not necessarily indicate immunity. Such a reaction should thus be regarded as suspect, as should also a complete failure to "take." In either event vaccination should be repeated, preferably by the multiple-puncture method, with lymph of indubitable potency. Potency cannot be assured if lymph is kept at room-temperature for more than 7 days, or in a domestic refrigerator for more than 14 days. At subzero temperatures potency remains unimpaired for a year ; the closest approximation ordinarily attainable in practice is the ice-making compartment of the domestic
-
refrigerator. The policy of the Society is primarily concerned with public. Having regard to
of Medical Officers of Health the protection of the general the tragic deaths of unvaccinated members of the staff of hospitals to which cases of smallpox have been inadvertently admitted, hospital authorities should keep in mind the advice of the Medical Research Council’s Committee on Cross-Infection in Hospitals,8that they should continually review the arrangements in their hospitals for protecting the staff by vaccination. NURSES AND WORLD
HEALTH
WHEN the World Health Organisation (W.H.O.), in 1946, defined health as " a state of complete physical, mental and social well-being, and not- merely the absence of disease or infirmity," health services all over the world were placed under a heavy responsibility. Describing the mechanism of W.H.O., at a conference of the Royal College of Nursing on Sept. 14, Dr. Brock Chisholm, the director-general, explained that the permanent secretariat of experts found their programmes on the recommendations of some 28 panels. The panel on nursing is composed of selected nurses from most of the 79 member countries. Tvluch of the work of the panels is done by correspondence, the members giving information to the secretariat as individuals ; but from time to time members chosen from the panel meet as an expert committee to discuss a specific question. W.H.O. receives further information and advice on nursing, Dr. Chisholm added, from the International Council of Nurses, to which all difficult questions are referred. The expert committees have on easy task; because of the uneven development in the member nations ; and recommendations have to be framed in the widest
-
possible terms. Miss M. I. Lambie, chairman of the Expert Committee on Nursing, said that even in countries where medicine is highly developed, nursing may be 7. Ministry of Health memo. 312/MED, 1948. 8. Control of Cross-Infection in Hospitals. Medical Research Council, memorandum no. 11. H.M. Stationery Office, 1951.
THE EUROPEAN IN KENYA WHEN asked whether Kenya suits children, or the elderly, or asthmatics, or people with high blood-pressure or tuberculosis, it is not at all easy for the doctor to answer. Even those who have practised in that country find may difficulty in giving an opinion based on more than a general vague impression; for government medical reports deal more with Africans than Europeans, and what information there is about Europeans mostly concerns government officials, who are not often per manent residents. Accurate records of the health of European settlers are hard to come by ; and ChartersB has therefore done well to record his observations during the 91/2 years, from 1932, when he practised at Nakuru, in the Kenya Highlands, between 5800 and 9200 feet above sea-level. The community included 150 children at two schools ; and Charters refers to 2864 patients, treated. In giving the rates per 1000 for the various. diseases over the 9] /2- year period, he counts each case only once : for instance, a patient with asthma is. counted no more than once, however many times he was treated. The common diseases were hypertension (25-2 per 1000), asthma (13-6, mostly adults) and other allergic conditions (hay-fever, angioneurotic cedema, urticaria, eczema), nasal sinusitis (24-1), tonsillitis (22-4), migraine, (18-1), cyclical vomiting (30 per 1000 children), appendixe. citis (20), and pneumonia (10-1). Malaria (60) was more, common than any other disease, but the infection was. usually acquired outside the district ; Kenya, from the highlands, is a malarious country. Tick-typhus (14) was also found, and amoebiasis (5-9) and bacillary dysentery (11-5) ; but the other diseases conventionallyregarded as tropical were rare in this pleasant country. The incidence even of typhoid (2-4) was low. Charters concludes that many of the disadvantages of heat are avoided at these altitudes, where the air can be remark-, ably crisp in the early morning and wood fires are a comfort at night. But the air is on the whole dry, and engenders thirst, which is easily dealt with, and also nasal sinusitis, which is not. Thus the effect of high altitude on the health of Europeans in Kenya is in general
apart
1. Expert Committee on Nursing. Geneva : World Health sation Technical Report Series, no. 24. 1950. Pp. 30. 2. Charters, A. D. E. Afr. med. J. 1951, 28, 41, 174, 204.
Organi1s. 6d.