STATUS OF NURSE TUTORS

1023 TABLE H——CORRELATION OF NUMBER AND

SEX

OF

NEWBORN

INFANTS I

i

Data of Brryce et al., and Bo.orman

No. of infants

i Ratio of

Ratio of

Infants

ex

mothers

O./E.

M./F.

mothers

BexB OexB OexO BexO

0-94 1-07 102 1.00

1-38 1-22

1-18 1-17

BexB OexB BexO

Obs.Ezp. 390 301 3152 301

-

2590 1132 1096

Data of Sanghvi and Johnstone

infants i

367 323 3221 301

Ii

2581 1154 1154

AexA OexA AexO

1.00 0-98 0-95

JI-

I1

No. of infants

ex

1-09 1-06

Male

OexO

197 115 105 105 696

AexO I OexA I AexA

254 236 540

I

I0-97

I Female

1

143 94 89 593

I

I

232 222 556

No. of children

classes[I

Mating Female

Male

86 84 7

81 73 6

.

B x AB z-8 z 1B x 0 B x A

FATHERS

WITH

f IINo. of children

84

84 8

75

75 8

i

Mating

II classes

0xB

A x B

Male

Female

74 73 88

59 63 3

AB xB! l

II

10. Allan, T. M. Unpublished observations. 11. Sanghvi, L. D. Lancet, 1952, i, 214. 12. Boorman, K. E.

Ann.

Eugen., Lond. 1950, 15, 120.

Jakobowicz, R., MacArthur, N., Penrose,

Ibid, p. 271. 14. Allan, T. M. Lancet, 1953, i, 1156.

x

0 families. "

Bacteriology Department, University of Aberdeen.

T. M. ALLAN.

ERYTHROMYCIN IN DIPHTHERIA

SIR,-After your annotation of Oct. 23, these 3

cases.

may be of interest.

hospital orderly, aged 19, began to have a sore throat Jan. 12, 1954. The throat swab gave a growth of Coryncbacterium diphtherim of virulent mitis type. She was admitted to this hospital on Jan. 20 and a course of parenteral and local penicillin was given. The organism persisted in nose and throat and other local treatment was tried without success. On March 16, the tonsils were removed, but the carrier state persisted. On April 23, a course of erythromycin waa started : swabs became negative in 48 hours and remained so until May 17 when she was discharged. She received a 10-day course of 300 mg. 6-hourly. A child, aged 6, was admitted to this hospital on May 28 1954, with Sonne dysentery. A routine throat swab gave a growth of C. diphtherice of virulent mitis type. The organism was still present a week later and treatment with erythromycin was started. The organism disappeared in 3 days and remained absent until her discharge on June 23. A 10-day course of 700 mg. daily was given. A child, aged 7, was admitted to this hospital on July 8, 1954, for tonsil and adenoid operation. Routine nose and throat swabs showed C. diphtherice of virulent mitis type. Operation was performed on July 8. On July 14, the organism was still present in nose and throat. Erythromycin waa started : swabs became negative in 48 hours and remained The course was reduced to 5 days at 200 mg. 6-hourly, so. and the patient was discharged free from organism on Aug. 7. A female

on

first experience of the use of erythromycin diphtheria, and the first swab was not taken until 48 hours after the start of treatment. It may well be that the organism disappears within 24 hours, as in Blute’s This is

our

in

is done in table m, in which, on the one hand, the sex-ratio data of Sanghvi are added to those of Johnstone and, on the other, the 2000 mother-newborn infant combinations of Boorman 12 are added to the 7856 of Bryce et al.13 Table 11 shows that the classes of infant which are in excess in the series of Bryce et al. and Boorman are, in general, the classes of infant which in the series of Sanghvi and Johnstone have a high sex-ratio. (In the other seven, much smaller, classes—i.e., those in which the infant and the mother have, together, at least one A and at least one B gene 14-the The only appreciable correlation is much more marked.) exception is the shortage of B infants of B mothers in the series of Bryce et al. and Boorman; it is noteworthy that in Johnstone’s series of 2141 father-infant combinations and 2429 mother-infant combinations the class of B infants of B mothers is almost the only one which is smaller in total numbers than the corresponding class of father-infant combinations. There are 92 B infants of B fathers and only 81 B infants of B mothers, the expected number of the latter being 104. As the former class have, in this series, a low sex-ratio and the latter a high sex-ratio the over-all shortage in the latter class would suggest that there is an exceptional loss of B

13. Bryce, L. M.,

in A

Aberdeen and North-East of Scotland Blood Transfusion Service,

’

Number of families

"

1

also highest for the infants of 0 fathers, next highest for those of A fathers, and lowest for those of B fathers. When, however, one excludes from Johnstone’s series the combinations in which the infant and the father, or the infant and the mother, have the same group (see table I), it is seen that the descending order on the maternal side is completely instead of partially reversed on the paternal side. Johnstone emphasises the fact that in his series the infants of B fathers have a low sex-ratio and the infants of B mothers a high sex-ratio, and table I suggests that such opposing parental tendencies may also be found to a lesser extent in 0 and A fathers and mothers. An attempt was made 8 to correlate the sex-ratio of the newborn infants in Sanghvi’s series of 2195 mother-infant combinations with size of family in Waterhouse and Hogben’s series of 1239 families with 4139 children-an attempt which has proved unsuccessful 10 and which, indeed, was criticised at the time by Sanghvi.ll Furthermore, Johnstone gives the sex of 3791 children of 2100 families, one child of each family being newborn, and here too no relation is found between sex-ratio of offspring and size of family. Clearly, however, the only valid correlation of the sex-ratio of newborn infants in respect of viability is with the number of newborn infants (taking account wherever possible of the birth-rank), and this TABLE III-COMPARISON OF CHILDREN OF B CHILDREN OF B MOTHERS

female offspring by B mothers. The possibility of a general loss of female offspring by B mothers is supported by John. stone’s series of 2100 families with 3791 children, for here omitting the mating class B x B (table m), there are 177 daughters of B fathers, 160 sons of B fathers, 155 sons of B mothers, and only 125 daughters of B mothers. (The shortage of the last class occurs in birth-ranks one, two, and three plus, and the ratio of all children of B fathers to all children of B mothers is six to five in each of these ranks.) That the loss, if such there is, may indeed be of B females is suggested by the fact that the shortage of B children found by Waterhouse and Hogben3 in the mating class father 0 X mother B has been shown by Waterhouse 15 to be entirely one of females. " Evidently," Waterhouse and Hogben3 remarked, The mechanism of this loss is not comparable to that of A children

L. S.

cases.

There appears to be no doubt that erythromycin is the most potent antibiotic for dealing with the diphtheria bacillus, and, though it cannot replace antitoxin in treatment ’of the disease, it should be employed in conjunction in order to rid the patient of the organism as

early

as

possible.

South Western Hospital, Stockwell, London, S.W.9.

J. C. BLAKE.

STATUS OF NURSE TUTORS

SIR,—As a tutor carrying out the duties of a principal tutor in the mental-health service, may I mention two facts which, in my opinion, are causes of the shortage of tutors. In doing so, I am supporting a body of men and women who have been pushed out into the cold whenever increases of salaries have been discussed-namely, the unqualified tutors who make up a large proportion of the total number of tutors employed in the health service, the majority of them in the mental-health service. The first question concerns pay. Up to qualified

1949

unqualified tutors were paid the same salary as tutors less E30 p.a. In 1949 increases in salary wera

15. Waterhouse, J. A. H.

Personal communication, 1952.

1024 awarded to nursing staffs in mental hospitals. The increase awarded to existing unqualified tutors was, to use a colloquialism, " an Irishman’s rise " and meant, if they accepted it, a reduction of salary. Since then there have been two further increases in pay for many of the nursing staff in the mental-health service but nothing for unqualified tutors. Under the Rushcliffe Committee the unqualified tutor’s salary was approximately 11s. 6d. per week less than the qualified tutor’s salary ; today under the Whitley Council the difference is approximately £2. Uncertificated matrons and chief male nurses suffer a loss of only £20 p.a. in comparison with a difference of £120 for uncertificated tutors who, in many cases, are better qualified since both general and mental qualifications are expected of a

PERIPHERAL GANGRENE IN HEART-FAILURE SIR,—In your issue of Oct. 23, Dr. Swan commented on our failure to refer to some recent papers on peipheral symmetrical gangrene, including one of his OWL of 1951. In our original draft of the paper we included a table surveying the recorded cases that we were able to trace-a total of 12.1-8 The paper was subsequently shortened, and in the end we thought it sufficient to make the point that, although there was only a small number of papers on the subject, it was probably a relatively common condition. T. BIRD C. S. LEITHEAD

tutor.

K. G. LOWE.

Dundee.

The other contributing fact was that pointed out by Mr. Christie in his letter of Oct. 2 : tutors in the mentalhealth service are not designated for superannuation purposes as mental-health officers and are therefore not entitled to retire after thirty years’ service but only on the completion of forty years. They are training others to be mental-health officers but are not recognised as such themselves. Right these two anomalies and I feel sure that a great step will have been made to attract more nurses to this branch of nursing, and many unqualified tutors will be content to stay in tutorial work and not seek administrative posts where they are at present more certain of receiving a much better deal. Prudhoe-on-Tyne,

Northumberland. SIR,—I

MARRIED HOUSEMAN

SIR,—Nowadays a surprising number of applicants house-appointments are married. If, as often happens, a candidate is refused because he is married, he may find it difficult to register and start earning his living. If, in addition, he has a baby, he and his wife are treated as though they have plague, and may find it impossible -to obtain accommodation. The Services have learnt that a man will not stay in the

for

Service if he has to remain

quarters

Similarly, American price variations cannot be so interesting to us as those noted in our own supplies. For example, the price of ergometrine tablets rose steeply between 1949 and 1951, since when it has gradually fallen to a point which, however, is still appreciably above its original level. J. R. ELLIOTT Pharmacist to the Hospital.

PATIENTS’ DAMAGES

SIR,-Dr. Farnan, in his letter of Oct. 30, does not between right to treatment and in treatment. The patient’s right to demand

distinguish

care

must learn the

J. W. SHACKLE.

9

treatment at a voluntary hospital was, presumably, on a par with his right to demand supply at a charitably established soup kitchen. His claim as a ratepayer, as distinct from any legal right, to treatment at a municipal hospital (which had power, but not duty, to provide), was doubtless a sound one. Legal right, however, seems to have been established only in 1948, when the 1946 Act put a duty on all State hospitals. Right to proper care in treatment is another matter, and here one assumes, in the absence of a legal view, that such a right was established, in whatever hospital,’ once the patient accepted and was accepted. The smoothness of the 1948 change-over in the voluntary hospital system-speaking of the medical teaching hospitals-was due to the continuity of administration at these establishments. Administration of the municipal hospitals was, generally speaking, torn up by the roots. W. J. CRABB. Shirley, Croydon. .

’

’

’

to draw attention to the danger that may arise in I infants after infection with the tubercle bacillus even though no radiological abnormality can be seen. Dr, Sekulich, in commenting on this in his letter of Oct. 16, says" we should aim at an exact diagnosis of the type and form of tuberculous ’‘ disease ’ present." lIe goes " This will include : (1) radiologically on to state : invisible benign primary disease with at least a positive tuberculin reaction ..." It would be helpful if Dr. Sekulich would state how he arrives at this particular " exact diagnosis." That many children have radiologically invisible primary disease is obvious but how does Dr. Sekulich know which of these are benign’ Or is his classificationapplied only in retrospect when the disease has run its course ? To be able to pick out. in any group of recently infected infants without radio. logical abnormalities, those which will remain benign and those likely to become malignant would indeed be a great advance. It is because I am unable to do this thatI advocate chemotherapy in infected infants irrespective of radiological changes. If Dr. Sekulich can indeed separate out the benign cases many will wish to share his knowledge. One other point in Dr. Sekulich’s letter that I would like to refer to is his statement " that it is only after primary disease ... has become quiescent that secondary disease can arise." The term " secondary disease " is I feel unfortunate but if by secondary disease" Dr. Sekuhct means the condition more frequently referred toaadult-type pulmonary tuberculosis or chronic pulmonary tuberculosis or bronchogenic phthisis, then he surely must be in error, for these conditions sometimes follow so closely after the initial infection that the primary disease cannot possibly have had time to becolli’

was

’

right to

Hospitals

SIR,—One of the main points in my letter of Oct.

ignored.

appear to

bachelor, or if decent married

TUBERCULOSIS IN CHILDREN

last week under this heading. This drug has been known in Great Britain, since it introduction, as ergometrine, and is still described under that title in the latest British Pharmacopœia with the name ergonovine, as a synonym, in small print. It seems a great pity that the official American title should have been used throughout this annotation and the British name completely

Dispensary,

a

provided.

London, W.1.

SYNTHETIC ERGONOVINE was very surprised to read your annotation

The

not

lesson too.

J. A. McKENZIE. MCKENZIE.

St. Bartholomew’s Hospital, London, E.C.1.

are

"

quiescent. Brentwood.

,

1. 2. 3. 4. 5. 6. 7. 8.

F. J. BENTLEY.

Abrahams, D. G. Brit. Heart J. 1948, 10, 191. Aubertin, C.. Rimé, G. Pr. Méd. 1926, 34, 97. Evans, M. E. Brit. Heart J. 1948, 10, 34. Evans, W., Benson, R. Ibid, p. 39. Hejtmancik, M. R., Bruce, E. I. Amer. Heart J. 1953, 45, 289. Perry, C. B., Davie, T. B. Brit. med. J. 1939, i, 15. Schwartz, S. P., Biloon, S. Amer. Heart J. 1931, 7, 84. Swan, W. G. A., Henderson, C. B. Brit. Heart J. 1951, 13, 68.