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SEPSIS IN THE NEWBORN
374 such people will not be corrected. The public’s use of Doctor is as a vulgarism : they cannot be bothered to say general practitioner or medical attendant. F. HILTON. THE PLIGHT OF HOSPITAL PHARMACY
SiR,-All that Sir Hugh Linstead says (Feb. 2) applies with equal force to physiotherapists, and indeed all of the so-called auxiliaries. It is surely time that a complete review was made of salaries and conditions of these grades, and a degree of reality introduced. DAVID WHITE.
With regard to know that during the past eight years only two babies under the age of 4 months, who had been born in the Princess Mary Maternity Hospital, have been admitted to the psediatnc wards in the region for treatment. This figure gives an idea of the meagre reward which we would expect to be gained by a four-month follow-up of all the babies discharged from the hospital during a period of two years. In short, we would like to suggest that the planning of an investigation of this kind ought to be based upon the solid foundation of a knowledge of the natural history of the conditions which it is proposed to study, in the particular institution concerned (rather than upon generalisations which may be true of some institutions, but not of others) : and that it may be wiser to budget for a result which is " not conclusive " (but which will tell one what one wants to know), rather than to strive after some arbitrary standard of conclusiveness, and risk finding oneself to be engaged in the laborious pursuit of a
true incidence of such serious lesions.
staphylococcal osteitis, for instance,
we
SEPSIS IN THE NEWBORN SiR,-The purpose of the investigation reported in the article by one of use to which your annotation of Jan. 26 refers, was a very limited one : to find out if, in a maternity hospital, a relatively simple technique for the routine care of the skin of the newborn could safely be will-o’-the-wisp. substituted, during the first week or two of life, for the LAETITIA BRUCE Princess Mary Maternity Hospital, traditional technique involving regular bathing. We GERALD NELIGAN. Newcastle upon Tyne. found no increase in the incidence of various skin troubles (including staphylococcal lesions) among the babies THE Rh BLOOD-GROUPS cared for by the simpler method. was SIR,-I pleased to read that Dr. Nicholas (Jan. 19) Your annotation was mainly devoted to making two that, irrespective of nomenclature, the suggestions for remedying the fact that the investigation acknowledges " use of most likely genotypes " leads to paradoxes. was " not conclusive as far as sepsis is concerned," and The that the paradox was introduced into is point we would welcome the opportunity to make a brief reply literature blood-group by the CDE protagonists, as can to these suggestions. be seen by consulting the book of Race and Sanger. While it is undeniably true that, mathematically " In my own writings I have always been scrupulous in speaking, an investigation lasting two years... would distinguishing phenotypes from genotypes, and so have have been more conclusive " (always provided that the all other workers who thoroughly understand the subject, one observer had had the stamina to see it through), and who therefore avoid the CDE notations. I trust that we do not think that any corresponding practical advanDr. Nicholas’s letter means that he intends to persuade tage will inevitably result from such a prolongation of an Dr. Race and other CDE protagonists to abandon the investigation of this kind. We certainly would not expect use of " most This will be the first likely genotypes." to encounter the acid test you so confidently predictedin their confusion, and then there are step clearing up " a flare-up... with widespread infection and severe some two dozen additional paradoxes for which CDE lesions." During the period of the past ten years, for protagonists are responsible,l which await Dr. Nicholas’s which we have accurate day-to-day records of the attention. incidence of skin sepsis in the Princess Mary Maternity Your leading article of July 21 last year stated that there has been a of deal good unexplained the CDE Hospital, notations have " given every satisfaction, fluctuation from time to time (no doubt partly attributbeing easy to remember and understand." This state. able to unconscious differences between the standards of ment is based on a misconception, since when workers different observers) : but there has been only one episode the CDE notations it is because they do not under. a " which might be described as flare-up." In May, 1951, use the subject. Those who thoroughly understand stand when a change was made in the technique for the routine Rh-Hr serology and genetics have no difficulty with care of the cord, there was a rapid rise in the incidence of the correct Rh-Hr nomenclature, because this merely skin sepsis so that in June 35% of the babies in the translates facts know into symbols. Your they already hospital developed one or more pustules during their editorial also states " that it seems unlikely that outside stay (fortunately there were no " severe lesions "). The the United States pathologists and others will wish to situation was promptly brought under control again by over from the Fisher-Race to the Wiener change a further change in the technique for the care of the cord. nomenclature-a which would involve much change Past experience, therefore, would lead us to be wary of effort." This statement is also incorrect, because almost the apparently innocent change in technique which may all those who are now using the CDE notations are lead to unfortunate and unforeseen consequences on a " using the co-called shorthand " notations. What large scale. But it would not lead us to expect at least also is entailed therefore is not to learn something new, but one flare-up " every two years. to discard something old which has been shown to be It is also undeniably true that, as compared with the All intelligent workers will welcome such follow-up period which we relied upon (the duration of incorrect. a simplification. the babies’ stay in hospital), a follow-up of four months In a recent article,2 it is pointed out that the medicomight have revealed some sepsis later." But even if legal expert is expected to master all intricacies of there is any causal connection between the serious Rh-Hr serology and genetics. If such an expert use· visceral or bony lesions which may appear later, and the CDE notations, this demonstrates his lack of under" the relatively small skin lesion appearing in the first of the subject, and may be used by a lawyer standing week," which has healed rapidly, we would not have to challenge his qualifications. The argument that the a to find of these later different incidence expected use of these symbols is needed to simplify the matter lesions in two groups of babies which had shown the same for the judge and jury is fallacious, because the competent incidence of the initial skin lesions. Furthermore, it is of one of the advantages working in a provincial centre 1. Wiener, A. S.: The Rh-Hr Types; a Budget of Paradoxes. J. forensic Med. (South Africa), 1955, 2, 224. that one should be able to obtain an accurate idea of the 2. Wiener, A. S.: Blood Grouping Tests in Disputed Parentage. 1. Bruce, L. J. Obstet. Gynœc. Brit. Emp. 1956, 63, 735. Ibid, 1956, 3, 138, "
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SiR,-All that Sir Hugh Linstead says (Feb. 2) applies with equal force to physiotherapists, and indeed all of the so-called auxiliaries. It is surely time that a complete review was made of salaries and conditions of these grades, and a degree of reality introduced. DAVID WHITE.
With regard to know that during the past eight years only two babies under the age of 4 months, who had been born in the Princess Mary Maternity Hospital, have been admitted to the psediatnc wards in the region for treatment. This figure gives an idea of the meagre reward which we would expect to be gained by a four-month follow-up of all the babies discharged from the hospital during a period of two years. In short, we would like to suggest that the planning of an investigation of this kind ought to be based upon the solid foundation of a knowledge of the natural history of the conditions which it is proposed to study, in the particular institution concerned (rather than upon generalisations which may be true of some institutions, but not of others) : and that it may be wiser to budget for a result which is " not conclusive " (but which will tell one what one wants to know), rather than to strive after some arbitrary standard of conclusiveness, and risk finding oneself to be engaged in the laborious pursuit of a
true incidence of such serious lesions.
staphylococcal osteitis, for instance,
we
SEPSIS IN THE NEWBORN SiR,-The purpose of the investigation reported in the article by one of use to which your annotation of Jan. 26 refers, was a very limited one : to find out if, in a maternity hospital, a relatively simple technique for the routine care of the skin of the newborn could safely be will-o’-the-wisp. substituted, during the first week or two of life, for the LAETITIA BRUCE Princess Mary Maternity Hospital, traditional technique involving regular bathing. We GERALD NELIGAN. Newcastle upon Tyne. found no increase in the incidence of various skin troubles (including staphylococcal lesions) among the babies THE Rh BLOOD-GROUPS cared for by the simpler method. was SIR,-I pleased to read that Dr. Nicholas (Jan. 19) Your annotation was mainly devoted to making two that, irrespective of nomenclature, the suggestions for remedying the fact that the investigation acknowledges " use of most likely genotypes " leads to paradoxes. was " not conclusive as far as sepsis is concerned," and The that the paradox was introduced into is point we would welcome the opportunity to make a brief reply literature blood-group by the CDE protagonists, as can to these suggestions. be seen by consulting the book of Race and Sanger. While it is undeniably true that, mathematically " In my own writings I have always been scrupulous in speaking, an investigation lasting two years... would distinguishing phenotypes from genotypes, and so have have been more conclusive " (always provided that the all other workers who thoroughly understand the subject, one observer had had the stamina to see it through), and who therefore avoid the CDE notations. I trust that we do not think that any corresponding practical advanDr. Nicholas’s letter means that he intends to persuade tage will inevitably result from such a prolongation of an Dr. Race and other CDE protagonists to abandon the investigation of this kind. We certainly would not expect use of " most This will be the first likely genotypes." to encounter the acid test you so confidently predictedin their confusion, and then there are step clearing up " a flare-up... with widespread infection and severe some two dozen additional paradoxes for which CDE lesions." During the period of the past ten years, for protagonists are responsible,l which await Dr. Nicholas’s which we have accurate day-to-day records of the attention. incidence of skin sepsis in the Princess Mary Maternity Your leading article of July 21 last year stated that there has been a of deal good unexplained the CDE Hospital, notations have " given every satisfaction, fluctuation from time to time (no doubt partly attributbeing easy to remember and understand." This state. able to unconscious differences between the standards of ment is based on a misconception, since when workers different observers) : but there has been only one episode the CDE notations it is because they do not under. a " which might be described as flare-up." In May, 1951, use the subject. Those who thoroughly understand stand when a change was made in the technique for the routine Rh-Hr serology and genetics have no difficulty with care of the cord, there was a rapid rise in the incidence of the correct Rh-Hr nomenclature, because this merely skin sepsis so that in June 35% of the babies in the translates facts know into symbols. Your they already hospital developed one or more pustules during their editorial also states " that it seems unlikely that outside stay (fortunately there were no " severe lesions "). The the United States pathologists and others will wish to situation was promptly brought under control again by over from the Fisher-Race to the Wiener change a further change in the technique for the care of the cord. nomenclature-a which would involve much change Past experience, therefore, would lead us to be wary of effort." This statement is also incorrect, because almost the apparently innocent change in technique which may all those who are now using the CDE notations are lead to unfortunate and unforeseen consequences on a " using the co-called shorthand " notations. What large scale. But it would not lead us to expect at least also is entailed therefore is not to learn something new, but one flare-up " every two years. to discard something old which has been shown to be It is also undeniably true that, as compared with the All intelligent workers will welcome such follow-up period which we relied upon (the duration of incorrect. a simplification. the babies’ stay in hospital), a follow-up of four months In a recent article,2 it is pointed out that the medicomight have revealed some sepsis later." But even if legal expert is expected to master all intricacies of there is any causal connection between the serious Rh-Hr serology and genetics. If such an expert use· visceral or bony lesions which may appear later, and the CDE notations, this demonstrates his lack of under" the relatively small skin lesion appearing in the first of the subject, and may be used by a lawyer standing week," which has healed rapidly, we would not have to challenge his qualifications. The argument that the a to find of these later different incidence expected use of these symbols is needed to simplify the matter lesions in two groups of babies which had shown the same for the judge and jury is fallacious, because the competent incidence of the initial skin lesions. Furthermore, it is of one of the advantages working in a provincial centre 1. Wiener, A. S.: The Rh-Hr Types; a Budget of Paradoxes. J. forensic Med. (South Africa), 1955, 2, 224. that one should be able to obtain an accurate idea of the 2. Wiener, A. S.: Blood Grouping Tests in Disputed Parentage. 1. Bruce, L. J. Obstet. Gynœc. Brit. Emp. 1956, 63, 735. Ibid, 1956, 3, 138, "
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