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REVOLT FROM THE BEDPAN
595 possess the experience in dealing with voluntary workers desired by Dr. Harding. For the time being other activities have competed for the services of these two bodies, though, at no previous time has there been so much opportunity to use them in association with the district-nursing service. The district nurses are the only section of the nursing community who are associated with the health services, Their position as distinct from the hospital services. deserves to be as widely appreciated by all who are concerned with the health of the people as their services are by their patients.’ C. E. A. BEDWELL Chairman, Metropolitan Federation of Queen’s District Nursing Associations.
already
SIR,—Miss Steel (Oct. 4) aptly describes the problem outlined by me in my previous letter (Sept. 27) as the no-man’s-land of social medicine, and she seems to agree that this territory could well be covered to a considerable extent by voluntary workers. Whether the supervision of these workers. is effected through the health visitor under the local authority, or the almoner at the divisional health centre referred to by Miss Sayle, seems to me immaterial-a question in fact of availability of
personnel.
The chairman of the Nursing Recruitment Committee, in the Times of Oct. 8, refers to the shortage of health visitors and to the extension of their duties when the National Health Service Act comes into force in 1948. It is clear that very careful use of all our trained medical social workers will be essential in the years ahead, if the ever-widening fields of work which will be their province are to be properly covered. My plea is that those voluntary workers who for so many years have satisfactorily filled a gap in our social services may be given an opportunity to help cover that part of the field where specific medicosocial training is not necessary. A. E. B. HARDING.
writing
MENINGITIS LEPTOSPIROSA
SIR,—In stressing the importance of anicteric Weil’s disease, particularly that form presenting as an innocent leptomeningitis, Dr. Buzzard and Dr. Wylie (Sept. 20) have recorded
almost identical with others seen in Hampshire during the past ten years. I have now had the good fortune to see some 40 cases of proved Weil’s disease ; about half remained anicteric throughout, and over a dozen of these have presented as cases of meningitis showing pleocytosis in the cerebrospinal fluid (c.s.F.). These too were in young people who were apparently infected by contact with river water, though 3 had done nothing more daring than paddle. One, an A.T.S. girl of 30, had had no such exposure, but her billet was shown to be rat-infested. All my cases, however, have shown several features, clinical and laboratory, which seem to have been lacking in the Oxford series ; and it was these very features which directed attention to the correct diagnosis. All showed muscle tenderness of varying degree which persisted until convalescence had been established. I have come to rely so much on this sign that in searching for Well’s disease during this summer it has seemed sufficient when going through the infective-hepatitis wards to squeeze each patient’s biceps. Though I have not found nitrogen retention approaching that seen in the icteric cases, yet blood-urea findings have always been suggestively close to the upper limits of normality for young people ; and my figures have been higher than those recorded by Buzzard and Wylie. I have seen levels of 50 mg. per 100 ml. and higher in most of the cases. This examination was, however, made two and sometimes three days earlier than in the Oxford series. It seems possible that nitrogen retention is a very early feature, and as I have written elsewhere,Ifeel that " this is by far the most important single laboratory finding " in the early stages. In Winchester it was arranged that Dr. C. H. Wrigley, the honorary pathologist, should estimate the urea content of the c.s.F. whenever pleocytosis with normal chlorides was found ; this led to a correct diagnosis in several 1.
cases
Robertson, K. M.
Brit. med. J. 1946, ii, 810.
early cases. In no case was there an excess of polymorphs in the C.s.F. ; indeed, the cells have been almost entirely lymphocytes, and case 1 from Oxford with 88 % polymorphs must be unusual. During what has surely been the most tempting summer for bathers in a generation I have seen no cases of Weil’s disease in Germany, and I have wondered if the same brilliant sunshine which led possible victims into the water also cut short the life of the young leptospira, which is known to dislike direct sunlight. I understand that no cases have been diagnosed in Winchester this summer-an experience unusual in recent years. I recall that the period July 27 to Sept. 13, 1946, during which all the Oxford cases were seen, was , , characterised by peculiarly British " summer" weather. KENNETH ROBERTSON. 94th (Hamburg) British Military Hospital, B.A.O.R. REVOLT FROM THE BEDPAN SIR,-Stimulated by your advice and encouragement I designed, with the engineer of this hospital, a chair for use in taking patients to the w.c. ; it closely resembles that used for eight years in the Central Hospital, Orebro, which is described by Professor Bohmansson and Dr. Malmros in your issue of Oct. 4. These chairs have now been used for several months, and I can endorse the views of your contributors on their extreme usefulness. The work of the nurses is reduced and a distasteful task almost eliminated from the ward. Patients greatly prefer to be taken to the w.c. in these chairs and to defaecate in decent seclusion and in a comfortable and effective position; and the effort is much less than that involved in the use of the bedpan. Patients with advanced tuberculosis can use the chair with advantage. The valuable suggestion of your contributors should be widely adopted in hospitals. Most advances in treatment seem to add more work to overburdened staffs; it is refreshing to meet one which diminishes the amount of work to be done and at the same time greatly improves the comfort and welfare of patients. F. A. H. SIMMONDS County Sanatorium, Clare Hall, South Mimms, Barnet.
Medical Director.
SIR,—Having read with interest the article by Professor Bohmansson and Dr. Malmros, I should like to submit what I believe to be an advance on their suggestion. I have devised a bed which is located over a water-closet pan, and can be manipulated by the patient. The bed has a flap which can be raised to make an opening for the water-closet, and the whole bed can be lowered or raised to allow the patient to sit in a normal position during defecation. The bed can be operated without the presence or assistance of nurses, and it can be used without moving the patient from bed, thus covering the needs of the bulk of public-assistance institutions. The
the chronic sick in cost of fitting the water-closet pans would soon be recovered by the saving of labour, and the offensive odour from bedpans would be eliminated. Drawings for this bed are in the hands of a firm of hospital-bed manufacturers (Messrs. Whitnelds), and it is hoped that a prototype will shortly be in operation. W. G. BOOTH.
CONVALESCENT HOMES SIR,—As patient recently returned from a convalescent home, perhaps my experience may guide those trying to bring -about improvements. I was taken to the home from a London hospital, and since it was the a
first time, after a severe major operation, that I had been dressed and out of the hospital ward, I arrived almost in a state of collapse. The front door was opened by a domestic servant who, without greeting, reprimanded me for being late. I had expected to go straight to bed, but the front door having been shut on my son who had brought me, I was asked to follow her upstairs. I looked at the formidable flight with dismay but managed to crawl unaided to the landing, where I had to stand and wait while the maid unpacked my case. Having been shown my bed in a dormitory for ten, I was asked to come downstairs and see the matron. On
already
SIR,—Miss Steel (Oct. 4) aptly describes the problem outlined by me in my previous letter (Sept. 27) as the no-man’s-land of social medicine, and she seems to agree that this territory could well be covered to a considerable extent by voluntary workers. Whether the supervision of these workers. is effected through the health visitor under the local authority, or the almoner at the divisional health centre referred to by Miss Sayle, seems to me immaterial-a question in fact of availability of
personnel.
The chairman of the Nursing Recruitment Committee, in the Times of Oct. 8, refers to the shortage of health visitors and to the extension of their duties when the National Health Service Act comes into force in 1948. It is clear that very careful use of all our trained medical social workers will be essential in the years ahead, if the ever-widening fields of work which will be their province are to be properly covered. My plea is that those voluntary workers who for so many years have satisfactorily filled a gap in our social services may be given an opportunity to help cover that part of the field where specific medicosocial training is not necessary. A. E. B. HARDING.
writing
MENINGITIS LEPTOSPIROSA
SIR,—In stressing the importance of anicteric Weil’s disease, particularly that form presenting as an innocent leptomeningitis, Dr. Buzzard and Dr. Wylie (Sept. 20) have recorded
almost identical with others seen in Hampshire during the past ten years. I have now had the good fortune to see some 40 cases of proved Weil’s disease ; about half remained anicteric throughout, and over a dozen of these have presented as cases of meningitis showing pleocytosis in the cerebrospinal fluid (c.s.F.). These too were in young people who were apparently infected by contact with river water, though 3 had done nothing more daring than paddle. One, an A.T.S. girl of 30, had had no such exposure, but her billet was shown to be rat-infested. All my cases, however, have shown several features, clinical and laboratory, which seem to have been lacking in the Oxford series ; and it was these very features which directed attention to the correct diagnosis. All showed muscle tenderness of varying degree which persisted until convalescence had been established. I have come to rely so much on this sign that in searching for Well’s disease during this summer it has seemed sufficient when going through the infective-hepatitis wards to squeeze each patient’s biceps. Though I have not found nitrogen retention approaching that seen in the icteric cases, yet blood-urea findings have always been suggestively close to the upper limits of normality for young people ; and my figures have been higher than those recorded by Buzzard and Wylie. I have seen levels of 50 mg. per 100 ml. and higher in most of the cases. This examination was, however, made two and sometimes three days earlier than in the Oxford series. It seems possible that nitrogen retention is a very early feature, and as I have written elsewhere,Ifeel that " this is by far the most important single laboratory finding " in the early stages. In Winchester it was arranged that Dr. C. H. Wrigley, the honorary pathologist, should estimate the urea content of the c.s.F. whenever pleocytosis with normal chlorides was found ; this led to a correct diagnosis in several 1.
cases
Robertson, K. M.
Brit. med. J. 1946, ii, 810.
early cases. In no case was there an excess of polymorphs in the C.s.F. ; indeed, the cells have been almost entirely lymphocytes, and case 1 from Oxford with 88 % polymorphs must be unusual. During what has surely been the most tempting summer for bathers in a generation I have seen no cases of Weil’s disease in Germany, and I have wondered if the same brilliant sunshine which led possible victims into the water also cut short the life of the young leptospira, which is known to dislike direct sunlight. I understand that no cases have been diagnosed in Winchester this summer-an experience unusual in recent years. I recall that the period July 27 to Sept. 13, 1946, during which all the Oxford cases were seen, was , , characterised by peculiarly British " summer" weather. KENNETH ROBERTSON. 94th (Hamburg) British Military Hospital, B.A.O.R. REVOLT FROM THE BEDPAN SIR,-Stimulated by your advice and encouragement I designed, with the engineer of this hospital, a chair for use in taking patients to the w.c. ; it closely resembles that used for eight years in the Central Hospital, Orebro, which is described by Professor Bohmansson and Dr. Malmros in your issue of Oct. 4. These chairs have now been used for several months, and I can endorse the views of your contributors on their extreme usefulness. The work of the nurses is reduced and a distasteful task almost eliminated from the ward. Patients greatly prefer to be taken to the w.c. in these chairs and to defaecate in decent seclusion and in a comfortable and effective position; and the effort is much less than that involved in the use of the bedpan. Patients with advanced tuberculosis can use the chair with advantage. The valuable suggestion of your contributors should be widely adopted in hospitals. Most advances in treatment seem to add more work to overburdened staffs; it is refreshing to meet one which diminishes the amount of work to be done and at the same time greatly improves the comfort and welfare of patients. F. A. H. SIMMONDS County Sanatorium, Clare Hall, South Mimms, Barnet.
Medical Director.
SIR,—Having read with interest the article by Professor Bohmansson and Dr. Malmros, I should like to submit what I believe to be an advance on their suggestion. I have devised a bed which is located over a water-closet pan, and can be manipulated by the patient. The bed has a flap which can be raised to make an opening for the water-closet, and the whole bed can be lowered or raised to allow the patient to sit in a normal position during defecation. The bed can be operated without the presence or assistance of nurses, and it can be used without moving the patient from bed, thus covering the needs of the bulk of public-assistance institutions. The
the chronic sick in cost of fitting the water-closet pans would soon be recovered by the saving of labour, and the offensive odour from bedpans would be eliminated. Drawings for this bed are in the hands of a firm of hospital-bed manufacturers (Messrs. Whitnelds), and it is hoped that a prototype will shortly be in operation. W. G. BOOTH.
CONVALESCENT HOMES SIR,—As patient recently returned from a convalescent home, perhaps my experience may guide those trying to bring -about improvements. I was taken to the home from a London hospital, and since it was the a
first time, after a severe major operation, that I had been dressed and out of the hospital ward, I arrived almost in a state of collapse. The front door was opened by a domestic servant who, without greeting, reprimanded me for being late. I had expected to go straight to bed, but the front door having been shut on my son who had brought me, I was asked to follow her upstairs. I looked at the formidable flight with dismay but managed to crawl unaided to the landing, where I had to stand and wait while the maid unpacked my case. Having been shown my bed in a dormitory for ten, I was asked to come downstairs and see the matron. On