- Email: [email protected]
SHORTAGE OF DIETITIANS
763
(m). Alcohol and arsenic (anti-syphilitic treatment) figure
prominently among suggested Eetiological factors,5-’ but these probably include liver noxa of many kinds and contributory
liver damage consequent upon earlier illnesses cannot be ignored. Such cases may, therefore, arise sporadically. Exposure to sunshine is probably an evocative agent for the skin lesions in groups n and III, but this has been included with alcohol and heavy metals as a primary astiological factor by
Ippen.8 Accurate differentiation of these forms, especially between 11 and III, is not merely an academic exercise. Patients in groupsI and 11 are susceptible to acute episodes which might end fatally, while, according to present experience, those in group in are not. There are on record many instances of these acute manifestations being precipitated by the use of barbiturates, including thiopentone for anaesthesia, and other drugs. It is thus very desirable that these cases should be fully investigated. H. D. BARNES
L. C. TURCHETTI TUCCIMEI.
Clara Thompson, and Carl Rogers, to mention a few, of whom are even mentioned in his references.
none
Littlemore Hospital, Oxford.
M. J. ORTEGA.
SHORTAGE OF DIETITIANS
SiR,-We are very interested in your annotation of Sept. 17 on the shortage of dietitians. I write, however, to point out that integrated courses of training for dietitians lasting three years have already been established. A course of three years, including six months at a recognised hospital dietetic department, has been in existence for some years at the Battersea College of The requirements for entry include Technology. and either physics or biology (or zoology) at chemistry advanced level in the General Certificate of Education. A four-year integrated course has just been instituted at the Leeds College of Technology, and candidates with advanced-level chemistry and biology may be admitted directly to the second year-that is, for a three-year cour4.;e.
VOLUNTARY ISOLATION SIR,-Having had close experience of 85 separate groups at work in the Antarctic over the past 11 years I was interested to read an extract from your annotation9 on this subject. Only three weeks earlier I had written a letter to one of our scientific advisers in England in which I said that ability and qualifications were " 75% of the necessary background to successful living on a base. It does not matter how active and strong and cheerful a man is, if he cannot keep the engines running, or the base on the air, then the others will have no time for him and he himself will lose his self-respect, a state which readily gives rise to neurosis." This bears out the statement that " The overriding criterion is that a man should be efficient at his job ". We have also had a few, fortunately very few, perfect examples of the " type of newly graduated scientist, unworldlv but intellectuallv arrosant ". J. R. GREEN Secretary,
Falkland Islands Dependencies
Survey.
PSYCHOANALYSIS
SIR,-In the preface to the 1960 edition of Clinical Psychiatry, Dr. Mayer-Gross complains that his detailed critique of psychoanalysis in the introduction to his book in 1954 was not challenged. Two reasons at once come to mind: (1) Readers of psychiatric literature, perhaps more than those in other fields, are very selective, and generally read only the publications of kindred minds. I think this would also itself explain his contention that the attempted re-export of psychoanalytic teaching from America into Europe was " largely in its original naive form ". By 1954, the body of psychoanalytic work pursued in America is greatly modified in form from orthodox psychoanalysis, although this still had its champions, perhaps proportionately more in England than in America. (2) The grounds for criticism were also ancient in derivation. In fact, in the chapter on the psychological treatment of schizophrenia in the 1960 edition, Speer (1927) is still quoted as having arrived at the judgment that psychoanalytic methods leave the patient unaffected by treatment. American psychiatry today is greatly influenced by the works of Harry Stack Sullivan, Frieda Froom-Reichmann, 5. 6. 7. 8. 9.
Brunsting, L. A. A.M.A. Arch. Derm. Syph. 1954, 70, 551. Berman, J., Bielicky, T. Dermatologica, 1956, 113, 78. Tappeiner, S. Wien. klin. Wschr. 1953, 65, 143. Ippen, H. Berufsdermatosen. 1959, 7, 256. Lancet, 1960, i, 1231.
B.
J. JAMIESON
Secretary, The British Dietetic Association.
We are grateful to Miss Jamieson for this information, and also for sending us a copy of the report1 of a fact-finding committee set up last year by the British Dietetic Association. 740 questionaries were sent to dietitians, and in the 391 returned the great majority expressed dissatisfaction with the present situation. Frequent comments were made about poor salaries in the National Health Service, the length of training required,
the lack of status in hospitals, and the misuse of dietitians’ services.-ED. L. CONTROL OF HOSPITAL CROSS-INFECTION
SIR,-Iwas interested
to read the article of Sept. 10 Professor Elek and Dr. by Fleming on a new technique for the control of hospital cross-infection using BRL.1241 in a maternity unit, because I described2 a rather similar technique in 1956 by which a successful attempt was made to reduce nasal infection in a residential nursery which catered for 20 children up to 3 years old. The infection had been present for many months but responded in an amazing way to the use of’Aeryl 4’ in an electrically operatedPhantomyser ’ spray. The results of this were assessed clinically, a successful result being shown by the disappearance by the 24th day of nasal discharge in 14 of the 17 babies involved. The conclusions I drew from my investigations were:
(1) The infection had been maintained by infection of babies shortly after entering, and continual reinfection thereafter. (2) The effects of the spray were mainly mechanical-i.e., in the formation of droplet nuclei carried down from the atmosphere to
the floor.
(3) Although situation it
this
was at
was
not an
ideal method of
any rate successful in this
dealing with the particular instance.
sorry to learn that the Medical Research Council had found my method successful in dealing with infection in residential nurseries run by Dr. Barnardo’s, though I suspect that the method they adopted entailed the use of a vaporiser instead of an atomiser. I hope that the article by Professor Elek and Dr. Fleming will stimulate further interest in a method which I feel could play an important part in dealing with the problem of cross-infection in hospitals.
I
was
not
-
Civic Centre,
J. ADRIAN GILLET.
Dagenham. 1. Nutrition, 1960, 2. Med. Offr, 1951,
14, no. 86, 5.
2.
(m). Alcohol and arsenic (anti-syphilitic treatment) figure
prominently among suggested Eetiological factors,5-’ but these probably include liver noxa of many kinds and contributory
liver damage consequent upon earlier illnesses cannot be ignored. Such cases may, therefore, arise sporadically. Exposure to sunshine is probably an evocative agent for the skin lesions in groups n and III, but this has been included with alcohol and heavy metals as a primary astiological factor by
Ippen.8 Accurate differentiation of these forms, especially between 11 and III, is not merely an academic exercise. Patients in groupsI and 11 are susceptible to acute episodes which might end fatally, while, according to present experience, those in group in are not. There are on record many instances of these acute manifestations being precipitated by the use of barbiturates, including thiopentone for anaesthesia, and other drugs. It is thus very desirable that these cases should be fully investigated. H. D. BARNES
L. C. TURCHETTI TUCCIMEI.
Clara Thompson, and Carl Rogers, to mention a few, of whom are even mentioned in his references.
none
Littlemore Hospital, Oxford.
M. J. ORTEGA.
SHORTAGE OF DIETITIANS
SiR,-We are very interested in your annotation of Sept. 17 on the shortage of dietitians. I write, however, to point out that integrated courses of training for dietitians lasting three years have already been established. A course of three years, including six months at a recognised hospital dietetic department, has been in existence for some years at the Battersea College of The requirements for entry include Technology. and either physics or biology (or zoology) at chemistry advanced level in the General Certificate of Education. A four-year integrated course has just been instituted at the Leeds College of Technology, and candidates with advanced-level chemistry and biology may be admitted directly to the second year-that is, for a three-year cour4.;e.
VOLUNTARY ISOLATION SIR,-Having had close experience of 85 separate groups at work in the Antarctic over the past 11 years I was interested to read an extract from your annotation9 on this subject. Only three weeks earlier I had written a letter to one of our scientific advisers in England in which I said that ability and qualifications were " 75% of the necessary background to successful living on a base. It does not matter how active and strong and cheerful a man is, if he cannot keep the engines running, or the base on the air, then the others will have no time for him and he himself will lose his self-respect, a state which readily gives rise to neurosis." This bears out the statement that " The overriding criterion is that a man should be efficient at his job ". We have also had a few, fortunately very few, perfect examples of the " type of newly graduated scientist, unworldlv but intellectuallv arrosant ". J. R. GREEN Secretary,
Falkland Islands Dependencies
Survey.
PSYCHOANALYSIS
SIR,-In the preface to the 1960 edition of Clinical Psychiatry, Dr. Mayer-Gross complains that his detailed critique of psychoanalysis in the introduction to his book in 1954 was not challenged. Two reasons at once come to mind: (1) Readers of psychiatric literature, perhaps more than those in other fields, are very selective, and generally read only the publications of kindred minds. I think this would also itself explain his contention that the attempted re-export of psychoanalytic teaching from America into Europe was " largely in its original naive form ". By 1954, the body of psychoanalytic work pursued in America is greatly modified in form from orthodox psychoanalysis, although this still had its champions, perhaps proportionately more in England than in America. (2) The grounds for criticism were also ancient in derivation. In fact, in the chapter on the psychological treatment of schizophrenia in the 1960 edition, Speer (1927) is still quoted as having arrived at the judgment that psychoanalytic methods leave the patient unaffected by treatment. American psychiatry today is greatly influenced by the works of Harry Stack Sullivan, Frieda Froom-Reichmann, 5. 6. 7. 8. 9.
Brunsting, L. A. A.M.A. Arch. Derm. Syph. 1954, 70, 551. Berman, J., Bielicky, T. Dermatologica, 1956, 113, 78. Tappeiner, S. Wien. klin. Wschr. 1953, 65, 143. Ippen, H. Berufsdermatosen. 1959, 7, 256. Lancet, 1960, i, 1231.
B.
J. JAMIESON
Secretary, The British Dietetic Association.
We are grateful to Miss Jamieson for this information, and also for sending us a copy of the report1 of a fact-finding committee set up last year by the British Dietetic Association. 740 questionaries were sent to dietitians, and in the 391 returned the great majority expressed dissatisfaction with the present situation. Frequent comments were made about poor salaries in the National Health Service, the length of training required,
the lack of status in hospitals, and the misuse of dietitians’ services.-ED. L. CONTROL OF HOSPITAL CROSS-INFECTION
SIR,-Iwas interested
to read the article of Sept. 10 Professor Elek and Dr. by Fleming on a new technique for the control of hospital cross-infection using BRL.1241 in a maternity unit, because I described2 a rather similar technique in 1956 by which a successful attempt was made to reduce nasal infection in a residential nursery which catered for 20 children up to 3 years old. The infection had been present for many months but responded in an amazing way to the use of’Aeryl 4’ in an electrically operatedPhantomyser ’ spray. The results of this were assessed clinically, a successful result being shown by the disappearance by the 24th day of nasal discharge in 14 of the 17 babies involved. The conclusions I drew from my investigations were:
(1) The infection had been maintained by infection of babies shortly after entering, and continual reinfection thereafter. (2) The effects of the spray were mainly mechanical-i.e., in the formation of droplet nuclei carried down from the atmosphere to
the floor.
(3) Although situation it
this
was at
was
not an
ideal method of
any rate successful in this
dealing with the particular instance.
sorry to learn that the Medical Research Council had found my method successful in dealing with infection in residential nurseries run by Dr. Barnardo’s, though I suspect that the method they adopted entailed the use of a vaporiser instead of an atomiser. I hope that the article by Professor Elek and Dr. Fleming will stimulate further interest in a method which I feel could play an important part in dealing with the problem of cross-infection in hospitals.
I
was
not
-
Civic Centre,
J. ADRIAN GILLET.
Dagenham. 1. Nutrition, 1960, 2. Med. Offr, 1951,
14, no. 86, 5.
2.