- Email: [email protected]
" HIGH ISOLATION " ACCOMMODATION FOR INFECTIOUS DISEASES
1340 AN ANTIBACTERIAL GEL FOR USE WITH VAGINAL RADIUM APPLICATORS
SIR,-At the time of removal from the patient of gynaecological radium applicators and the accompanying vaginal gauze pack a strong odour due to necrotic tumour tissue and microorganisms is usually noticed. This is disagreeable, sometimes even nauseating, to nursing staff and patients, but at the Christie Hospital we have usually considered this unpleasantness to be a fact of life about which little could be done. Recently, however, we have used ’Gynaflex’ gel (Geistlich) with such striking success that the once-common odour is now a rarity on the wards. Gynaflex is an antibacterial, antifungal gel containing 2.5 % noxytiolin. The contents of one plastic disposable applicator are released high in the patient’s vagina on the evening before radium insertion. So far we have had no patient complain about this procedure, nor have we seen any case of hypersensitivity or other side-effect. Christie Hospital &
Holt Radium
Institute,
Withington, Manchester M20
I. J. KERBY.
9BX.
" HIGH ISOLATION " ACCOMMODATION FOR INFECTIOUS DISEASES
SIR,-Sophisticated provision for the isolation of infectious conditions in modern Swedish units was described to the participants at a recent meeting of infectious-disease societies of Europe and America in Seattle. Facilities in these special units include controlled exhaust ventilation to prevent airborne spread of infection, with differential air-pressures guarded by airlocks. The rooms are big enough to accommodate bulky apparatus used in treatment, and also to permit admission of mother/baby pairs or two members of one affected family. Visitors can safely see patients through glazed areas and talk to them by intercom. without entering the infected areas. Although time did not allow full discussion of these arrangements, this will no doubt be taken further in subsequent international meetings. In my own view it is doubtful whether expensive arrangements to prevent airborne infection are essential for all types of infection, but I suggest that " high isolation " with controlled, filtered, exhaust ventilation is necessary for the following potentially dangerous conditions in which airborne spread 1. Smallpox. 2. Severe acute
C.B.E., D.S.O., M.C., M.R.C.S., F.R.C.G.P.
Brigadier H. L. Glyn Hughes, the first senior administrative medical
of the
South-East and former Metropolitan Regional Hospital Board, director of the South-East London General Practitioner Centre, died on Nov. 24 at the age of 81. officer
The son of a doctor, he was educated at Epsom and University College Hospital, London, qualifying in 1915, He served as a medical officer with the Wiltshire Regiment and the Grenadier Guards during the 1914-18 war. In the 1939-45 war he served in France with the Fifth Army, was evacuated from Dunkirk, and was subsequently made assistant director of medical services to the Guards Armoured Division and deputy director of medical services to VIII Corps and Second Army. At the relief of Belsen he was responsible for the care of the inmates and for cleaning up the camp. In 1945 he became vice-director of medical services, B.A.O.R., and was appointed c.B.E. Between the wars he was in general practice; he became director of the South-East London General Practitioner Centre at Peckham in 1958. He was also honorary physician to the Queen.
F. D. B. writes:
" Hughie’s career as a general practitioner (a phase of his life of which he was very proud), as a distinguished soldier in two wars, as an able administrator, and as a lifelong sportsman, and, in particular, a rugby-player, is well known to a wide circle of friends and to an even larger television audience, owing to his appearance on the programme ’This is Your Life ’. His M.c. and his D.S.O. with two bars can speak for themselves, for he could not easily be induced to speak of his own exploits. As is often the case with such men, improbable and apocryphal stories abound. " Perhaps his most outstanding characteristic was abounding energy. He always had to see for himself and participate, whether on the battlefield, at the relief of Belsen, in the ward, or on the sports-ground. At 80 he still playing golf, touring with the Barbarians, and stewarding at Twickenham. On retiring from the Army at the end of the war he "
pneumonia, undiagnosed or due to fulminating influenza, tuberculosis, psittacosis, anthrax, or plague. 3. Severe discharging antibiotic-resistant staphylococcal infection. "
HUGH LLEWELYN GLYN HUGHES
was
occurs:
4.
Obituary
Typhus, until bathed and de-loused.
High isolation
"
is also desirable for :
5. Severe undiagnosed fever, which could embrace 6. Undiagnosed severe "new" infection-e.g., Lassa fever-and 7. Undiagnosed severe systemic-respiratory infections conditioned by immunosuppression or similar medical pro-
cedures.
If available, " high isolation " could also be useful for: 8. Measles, chickenpox, and eczema vaccinatum. 9. Virulent " new " pandemic influenza, although the facilities could obviously not be provided on the scale necessary to meet this challenge.
In my view, most other infections can be contained by less expensive measures to avoid transmission by faecal/oral and other non-airborne routes. The views of other experienced colleagues would be useful. University Department Infectious Diseases, Ruchill Hospital, Glasgow G20 9NB.
of
NORMAN R. GRIST.
became the first senior administrative medical officer of the South-East Metropolitan Regional Hospital Board at the start of the National Health Service. Forthwith he moved a camp-bed into his office, but spent most of the daytime hours touring round Kent, East Sussex, and his quarter of London, sizing up the resources and staff of his region-and his region it most certainly was. He quickly established a plan of campaign for the region’s development. His striking appearance-a piercing eye amid strong features-and his capacity for quick and confident decision made him a natural leader, commanding loyalty and respect from subordinates. Off the games-field it might be said that he was not a good team man, and he certainly did not take too kindly to the slow tempo of deliberation in committee. His methods were not always orthodox, and he had little use for the procrastinator and less for the idle. His own enthusiasm for causes made it difficult for him to say no. He loved action, and if it didn’t come to him he sought it. " On his second retirement at 65 he plunged into a new activity at the Peckham Health Centre, which he directed for ten years. As a founder member and treasurer of the College of General Practitioners he helped to initiate the
SIR,-At the time of removal from the patient of gynaecological radium applicators and the accompanying vaginal gauze pack a strong odour due to necrotic tumour tissue and microorganisms is usually noticed. This is disagreeable, sometimes even nauseating, to nursing staff and patients, but at the Christie Hospital we have usually considered this unpleasantness to be a fact of life about which little could be done. Recently, however, we have used ’Gynaflex’ gel (Geistlich) with such striking success that the once-common odour is now a rarity on the wards. Gynaflex is an antibacterial, antifungal gel containing 2.5 % noxytiolin. The contents of one plastic disposable applicator are released high in the patient’s vagina on the evening before radium insertion. So far we have had no patient complain about this procedure, nor have we seen any case of hypersensitivity or other side-effect. Christie Hospital &
Holt Radium
Institute,
Withington, Manchester M20
I. J. KERBY.
9BX.
" HIGH ISOLATION " ACCOMMODATION FOR INFECTIOUS DISEASES
SIR,-Sophisticated provision for the isolation of infectious conditions in modern Swedish units was described to the participants at a recent meeting of infectious-disease societies of Europe and America in Seattle. Facilities in these special units include controlled exhaust ventilation to prevent airborne spread of infection, with differential air-pressures guarded by airlocks. The rooms are big enough to accommodate bulky apparatus used in treatment, and also to permit admission of mother/baby pairs or two members of one affected family. Visitors can safely see patients through glazed areas and talk to them by intercom. without entering the infected areas. Although time did not allow full discussion of these arrangements, this will no doubt be taken further in subsequent international meetings. In my own view it is doubtful whether expensive arrangements to prevent airborne infection are essential for all types of infection, but I suggest that " high isolation " with controlled, filtered, exhaust ventilation is necessary for the following potentially dangerous conditions in which airborne spread 1. Smallpox. 2. Severe acute
C.B.E., D.S.O., M.C., M.R.C.S., F.R.C.G.P.
Brigadier H. L. Glyn Hughes, the first senior administrative medical
of the
South-East and former Metropolitan Regional Hospital Board, director of the South-East London General Practitioner Centre, died on Nov. 24 at the age of 81. officer
The son of a doctor, he was educated at Epsom and University College Hospital, London, qualifying in 1915, He served as a medical officer with the Wiltshire Regiment and the Grenadier Guards during the 1914-18 war. In the 1939-45 war he served in France with the Fifth Army, was evacuated from Dunkirk, and was subsequently made assistant director of medical services to the Guards Armoured Division and deputy director of medical services to VIII Corps and Second Army. At the relief of Belsen he was responsible for the care of the inmates and for cleaning up the camp. In 1945 he became vice-director of medical services, B.A.O.R., and was appointed c.B.E. Between the wars he was in general practice; he became director of the South-East London General Practitioner Centre at Peckham in 1958. He was also honorary physician to the Queen.
F. D. B. writes:
" Hughie’s career as a general practitioner (a phase of his life of which he was very proud), as a distinguished soldier in two wars, as an able administrator, and as a lifelong sportsman, and, in particular, a rugby-player, is well known to a wide circle of friends and to an even larger television audience, owing to his appearance on the programme ’This is Your Life ’. His M.c. and his D.S.O. with two bars can speak for themselves, for he could not easily be induced to speak of his own exploits. As is often the case with such men, improbable and apocryphal stories abound. " Perhaps his most outstanding characteristic was abounding energy. He always had to see for himself and participate, whether on the battlefield, at the relief of Belsen, in the ward, or on the sports-ground. At 80 he still playing golf, touring with the Barbarians, and stewarding at Twickenham. On retiring from the Army at the end of the war he "
pneumonia, undiagnosed or due to fulminating influenza, tuberculosis, psittacosis, anthrax, or plague. 3. Severe discharging antibiotic-resistant staphylococcal infection. "
HUGH LLEWELYN GLYN HUGHES
was
occurs:
4.
Obituary
Typhus, until bathed and de-loused.
High isolation
"
is also desirable for :
5. Severe undiagnosed fever, which could embrace 6. Undiagnosed severe "new" infection-e.g., Lassa fever-and 7. Undiagnosed severe systemic-respiratory infections conditioned by immunosuppression or similar medical pro-
cedures.
If available, " high isolation " could also be useful for: 8. Measles, chickenpox, and eczema vaccinatum. 9. Virulent " new " pandemic influenza, although the facilities could obviously not be provided on the scale necessary to meet this challenge.
In my view, most other infections can be contained by less expensive measures to avoid transmission by faecal/oral and other non-airborne routes. The views of other experienced colleagues would be useful. University Department Infectious Diseases, Ruchill Hospital, Glasgow G20 9NB.
of
NORMAN R. GRIST.
became the first senior administrative medical officer of the South-East Metropolitan Regional Hospital Board at the start of the National Health Service. Forthwith he moved a camp-bed into his office, but spent most of the daytime hours touring round Kent, East Sussex, and his quarter of London, sizing up the resources and staff of his region-and his region it most certainly was. He quickly established a plan of campaign for the region’s development. His striking appearance-a piercing eye amid strong features-and his capacity for quick and confident decision made him a natural leader, commanding loyalty and respect from subordinates. Off the games-field it might be said that he was not a good team man, and he certainly did not take too kindly to the slow tempo of deliberation in committee. His methods were not always orthodox, and he had little use for the procrastinator and less for the idle. His own enthusiasm for causes made it difficult for him to say no. He loved action, and if it didn’t come to him he sought it. " On his second retirement at 65 he plunged into a new activity at the Peckham Health Centre, which he directed for ten years. As a founder member and treasurer of the College of General Practitioners he helped to initiate the