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PROGRESS WITH WAR-TIME NURSERIES
329 many of those who did not
answer
attend for interview
of
his letter
or
refused to
higher mental and social level than those who did. Thus his pessimistic views on illegitimate motherhood may not have general application. But the psychological constellations and conflicts which he analyses so fully and ably are probably the same everywhere. were
COTTON
AND
CATGUT
THERE is a revival in the use of non-absorbable suture materials in surgery for which both their intrinsic merits and motives of economy are responsible. Some surgeons, of course, have always preferred to follow Halsted and use silk rather than catgut wherever possible, and now .there are reports that cotton is even more satisfactory in some ways than silk. Meade and Longhave observed some 1800. cases in which cotton only was employed and noted a reduction of infection of clean wounds and of the period of sepsis in established infection. They found cotton pliable and strong and with a high coefficient of friction allowing secure and stable knots. It showed no tendency to excite the tissue reaction familiar to all who have had occasion to reopen a wound a few days after its suture with catgut ; nor did it give rise to allergic reactions, an occasional trouble with catgut and even with silk. While the tensile strength of cotton is less than that of silk or catgut of equivalent diameter it is less altered by sterilisation and actually increases on boiling while that of silk decreases, a fact pointed out by Localio, and Hinton,2 who advise sterilisation by boiling for 10-20i minutes. Since the individual fibres contract on heating and may rupture if wound on a rigid bobbin, rewinding’ on soft rubber tubing or in skeins before boiling is advised. In the actual operation the user, of cotton should adhere to Halsted’s original principles-interrupted sutures only, many fine sutures rather than a few coarse ones, no bridging of dead spaces, and the avoidance of a mixture of absorbable and non-absorbable materials. Meade and Long would use cotton in all cases except where a continuous suture is essential, as in some intestinal anastomoses. They found that, while 14% of clean wounds sewn with catgut became infected, the figures for silk and cotton were only 2-7 % and 4 % ; in primarily contaminated cases all of the catgut series and 70 % of the silk became infected, but nearly half of those sewn with cotton healed by first intention. They conclude that cotton is better adapted for use in a contaminated or infected field than any other material, since it gives rise to minimal oedema and cellular reaction. The economy of using cotton is obvious and this factor alone seems to justify some trials in this country.
by the deputation. They pointed out that over 300 nurseries are now in operation in the country as a whole (40 being in the London area) and 742 are in preparation. This figure is not, in fact, impressive. When the conference arranged by the Nursery School Association and the National Society of Day Nurseries met last November1 there were 163 day nurseries in the whole of the country. Thus the number in action has been barely doubled in four months ; but Miss Florence Horsbrugh estimated at the same conference that the need was for 10,000 day nurseries. Though this figure is probably beyond our powers of achievement for some time to come, we might at least try to progress on a scale which bears some relation to it ; at the present rate it will take 22 years. The Ministry, indeed, assured the deputation that it was hoped that the pace would now be considerably increased, so that the point will be reached where every mother with young children wishing to take up war work would have the choice between a nursery and private arrangements. At the House of Commons debate on woman-power on March 5, Miss Horsbrugh remarked that for those mothers who lacked helpful neighbours the registered guardians scheme of the Ministry of Labour should be able to provide help. AIR-RAID SHELTERS: NATURAL AND 11V
,
,
A
PROGRESS
WITH
WAR-TIME
NURSERIES
DEPUTATION
from the London Women’s
Parliament,
composed of factory workers, shop stewards, representatives of factory management, housewives, councillors, doctors and teachers, was received by the Ministry of Health
on
March
5, to discuss war-time nurseries.
Cases of
delay in setting up nurseries, and of the difficulties experienced by mothers in finding somewhere to put their children while they themselves were in the factories, were considered, and the deputation offered the cooperation of the Women’s Parliament in pushing forward with the establishment of war-time nurseries. The representatives of the management of three factories and the shop stewards were able to show how bad timekeeping, absenteeism, failure to respond to the demand for overtime and night shift work, and the continual loss of trained women from industry were all due to lack - of care for the children. In reply, representatives of the Ministry said that the Ministry was anxious that nurseries should be available in each area to meet the need, and undertook to inquire into every case of delay mentioned 1.
Meade, W. H. and Long, C. H. J. Amer. med. Ass. 1941, 117,
2140. 2. Localio, S. A. and Hinton, J. W. Surg. Gynec. Obstet. 1941, 72, 615.
lilU1S1i IntI’lilS
01 L11C
cuu11liry lS11ellierlS
ACQUIRED
am 11U Ilium Mian
waiting-rooms, used for brief periods at long .intervals protection against an infernal but temporary hailstorm. As such they have no special hygienic requirements other than ventilation and sanitary conveniences. But in towns liable to severe bombardment the hygiene
as
of shelters must be appropriate to overcrowded underhouses in which conditions favour the spread of infection and infestation. Mr. G. Morley Davies,22 sanitary inspector for Bristol, has discussed the problems which arise in artificial " shelters, and Dr. Edward Hughes,3medical officer of health for Dover, has done the same for natural shelters.. In the cave shelters of Dover the chief disadvantages are dampness and laok of ventilation ; and in all shelters the dangers of spread of infection and vermin must be specially guarded against. Following the suggestion in the Horder report, spraying with hypochlorite solution is now a routine measure. In Bristol, shelters habitually occupied at night are sprayed daily, those used intermittently at night are sprayed every three days, and surface shelters used only during alerts are sprayed once every ten days. In Dover shelters are sprayed daily. In addition a method of disinfestation is used regularly in the Bristol shelters ; a 6% solution of an organic thiocyanate (known in America asLethane 384 special’) is used as a fumigant, being disseminated through an atomising spray-gun by a petrol-driven compressor. This was used and found to be effective where vermin were presumed to be present; when their presence is certain a concentration of 10% can be used, and is believed to be strong enough to destroy live insects and all accessible ova. Dormitory shelters in Bristol are fumigated regularly once a week with the 6% solution, and it has been found that only food need be protected against it-everything else can safely be sprayed. There is some evidence that fabrics and fittings regularly treated in this way are no longer regarded by vermin as desirable residences, and thus the method is a safeguard against re-infestation. In Dover similar measures do not seem to have been necessary, but bedding is often inspected, and it has rarely been necessary to order disinfestation or destruction. The dampness of cave-shelters has been partly overcome by putting in concrete or tarmac floors, and sprinkling them with clean sawdust, and by improving ventilation. in Bristol the installation of mechanical ventilators in four shelters made a great difference in relative humidity as
ground
"
1. See
Lancet, 1941, ii, 583. 2. J. R. Sanit. Inst. 1942, 62, 54. 3. Med. Offr, 1942, 67, 13.
answer
attend for interview
of
his letter
or
refused to
higher mental and social level than those who did. Thus his pessimistic views on illegitimate motherhood may not have general application. But the psychological constellations and conflicts which he analyses so fully and ably are probably the same everywhere. were
COTTON
AND
CATGUT
THERE is a revival in the use of non-absorbable suture materials in surgery for which both their intrinsic merits and motives of economy are responsible. Some surgeons, of course, have always preferred to follow Halsted and use silk rather than catgut wherever possible, and now .there are reports that cotton is even more satisfactory in some ways than silk. Meade and Longhave observed some 1800. cases in which cotton only was employed and noted a reduction of infection of clean wounds and of the period of sepsis in established infection. They found cotton pliable and strong and with a high coefficient of friction allowing secure and stable knots. It showed no tendency to excite the tissue reaction familiar to all who have had occasion to reopen a wound a few days after its suture with catgut ; nor did it give rise to allergic reactions, an occasional trouble with catgut and even with silk. While the tensile strength of cotton is less than that of silk or catgut of equivalent diameter it is less altered by sterilisation and actually increases on boiling while that of silk decreases, a fact pointed out by Localio, and Hinton,2 who advise sterilisation by boiling for 10-20i minutes. Since the individual fibres contract on heating and may rupture if wound on a rigid bobbin, rewinding’ on soft rubber tubing or in skeins before boiling is advised. In the actual operation the user, of cotton should adhere to Halsted’s original principles-interrupted sutures only, many fine sutures rather than a few coarse ones, no bridging of dead spaces, and the avoidance of a mixture of absorbable and non-absorbable materials. Meade and Long would use cotton in all cases except where a continuous suture is essential, as in some intestinal anastomoses. They found that, while 14% of clean wounds sewn with catgut became infected, the figures for silk and cotton were only 2-7 % and 4 % ; in primarily contaminated cases all of the catgut series and 70 % of the silk became infected, but nearly half of those sewn with cotton healed by first intention. They conclude that cotton is better adapted for use in a contaminated or infected field than any other material, since it gives rise to minimal oedema and cellular reaction. The economy of using cotton is obvious and this factor alone seems to justify some trials in this country.
by the deputation. They pointed out that over 300 nurseries are now in operation in the country as a whole (40 being in the London area) and 742 are in preparation. This figure is not, in fact, impressive. When the conference arranged by the Nursery School Association and the National Society of Day Nurseries met last November1 there were 163 day nurseries in the whole of the country. Thus the number in action has been barely doubled in four months ; but Miss Florence Horsbrugh estimated at the same conference that the need was for 10,000 day nurseries. Though this figure is probably beyond our powers of achievement for some time to come, we might at least try to progress on a scale which bears some relation to it ; at the present rate it will take 22 years. The Ministry, indeed, assured the deputation that it was hoped that the pace would now be considerably increased, so that the point will be reached where every mother with young children wishing to take up war work would have the choice between a nursery and private arrangements. At the House of Commons debate on woman-power on March 5, Miss Horsbrugh remarked that for those mothers who lacked helpful neighbours the registered guardians scheme of the Ministry of Labour should be able to provide help. AIR-RAID SHELTERS: NATURAL AND 11V
,
,
A
PROGRESS
WITH
WAR-TIME
NURSERIES
DEPUTATION
from the London Women’s
Parliament,
composed of factory workers, shop stewards, representatives of factory management, housewives, councillors, doctors and teachers, was received by the Ministry of Health
on
March
5, to discuss war-time nurseries.
Cases of
delay in setting up nurseries, and of the difficulties experienced by mothers in finding somewhere to put their children while they themselves were in the factories, were considered, and the deputation offered the cooperation of the Women’s Parliament in pushing forward with the establishment of war-time nurseries. The representatives of the management of three factories and the shop stewards were able to show how bad timekeeping, absenteeism, failure to respond to the demand for overtime and night shift work, and the continual loss of trained women from industry were all due to lack - of care for the children. In reply, representatives of the Ministry said that the Ministry was anxious that nurseries should be available in each area to meet the need, and undertook to inquire into every case of delay mentioned 1.
Meade, W. H. and Long, C. H. J. Amer. med. Ass. 1941, 117,
2140. 2. Localio, S. A. and Hinton, J. W. Surg. Gynec. Obstet. 1941, 72, 615.
lilU1S1i IntI’lilS
01 L11C
cuu11liry lS11ellierlS
ACQUIRED
am 11U Ilium Mian
waiting-rooms, used for brief periods at long .intervals protection against an infernal but temporary hailstorm. As such they have no special hygienic requirements other than ventilation and sanitary conveniences. But in towns liable to severe bombardment the hygiene
as
of shelters must be appropriate to overcrowded underhouses in which conditions favour the spread of infection and infestation. Mr. G. Morley Davies,22 sanitary inspector for Bristol, has discussed the problems which arise in artificial " shelters, and Dr. Edward Hughes,3medical officer of health for Dover, has done the same for natural shelters.. In the cave shelters of Dover the chief disadvantages are dampness and laok of ventilation ; and in all shelters the dangers of spread of infection and vermin must be specially guarded against. Following the suggestion in the Horder report, spraying with hypochlorite solution is now a routine measure. In Bristol, shelters habitually occupied at night are sprayed daily, those used intermittently at night are sprayed every three days, and surface shelters used only during alerts are sprayed once every ten days. In Dover shelters are sprayed daily. In addition a method of disinfestation is used regularly in the Bristol shelters ; a 6% solution of an organic thiocyanate (known in America asLethane 384 special’) is used as a fumigant, being disseminated through an atomising spray-gun by a petrol-driven compressor. This was used and found to be effective where vermin were presumed to be present; when their presence is certain a concentration of 10% can be used, and is believed to be strong enough to destroy live insects and all accessible ova. Dormitory shelters in Bristol are fumigated regularly once a week with the 6% solution, and it has been found that only food need be protected against it-everything else can safely be sprayed. There is some evidence that fabrics and fittings regularly treated in this way are no longer regarded by vermin as desirable residences, and thus the method is a safeguard against re-infestation. In Dover similar measures do not seem to have been necessary, but bedding is often inspected, and it has rarely been necessary to order disinfestation or destruction. The dampness of cave-shelters has been partly overcome by putting in concrete or tarmac floors, and sprinkling them with clean sawdust, and by improving ventilation. in Bristol the installation of mechanical ventilators in four shelters made a great difference in relative humidity as
ground
"
1. See
Lancet, 1941, ii, 583. 2. J. R. Sanit. Inst. 1942, 62, 54. 3. Med. Offr, 1942, 67, 13.