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TETANUS TREATED WITH INTRAVENOUS MEPHENESIN
565 while immersed at night in the bed of a running stream. If mortification of the flesh is to benefit the soul (and one doubts whether it has other justification) it should be voluntary and not
importance of mental ill health as a public-health problem, but clearly a person so trained is hardly to be compared with a health visitor.
compulsory.
Having said that, let me make suggestions for the improvement of the training of both the general nurse and the health visitor. Firstly, they should be made the headmaster and his entire staff, the matron, and the aware that a third to a half of all hospital beds are for chaplain, are lustrating themselves with ice-water, to the mentally ill, and that mental and nervous troubles practise what they preach. Or are they ? approach this proportion of all ill health. There is no Middlesex Hospital, better way of doing this than by prescribing a period of J. W. DICKSON. London, W.1. training in a mental hospital amounting to not less than six months out of the three years’ general training. The TETANUS TREATED WITH INTRAVENOUS title Registered General Nurse is, at present, a misleading MEPHENESIN one. Secondly, during her post-registration training the SjR,ňln his report of a case of tetanus treated with health visitor would greatly benefit by some time spent mephenesin (Feb. 26) Dr. Docherty makes the surprising working with the authorised officer of a local authority statement that the drug " does not act on the higher and with the psychiatric social worker attached to a centres and therefore does not affect consciousness." hospital or clinic. With this additional training the health The dosage used in this case-up to 18 g. in twenty-four visitor would be much better qualified to work in the hours-is low and would not be expected to have any field of mental health. such effect given slowly intravenously, as it was. But Usher Institute, drowsiness is the most commonly reported side-effect of DONALD CAMERON. University of Edinburgh. and have more than once seen I complete mephenesin, DIET AND ATHEROSCLEROSIS though brief loss of consciousness follow rapid intravenous infusion of the pure drug in saline. Pronounced SIR,-Many of your readers will be familiar with the drowsiness is almost invariable with doses of 2-4 g. given laboratory and field studies of Professor Keys and his intravenously in five to fifteen minutes, and such doses associates1 bearing on the correlation between fat intake, can be needed in tetanus. Mephenesin in large doses is serum-cholesterol concentration, and incidence of atheroa powerful cerebral depressant, and sedation with the sclerosis, which is now the leading cause of death among usual drugs may have to be reduced to avoid overadults in the United States and possibly in other Western sedation when large doses of mephenesin (e.g., about Further supporting evidence has been countries.2 10g. in an hour) are used. Commercial liquid preparations published from this centre 34 where we have noted, also contain alcohol, which adds to the sedative effect. firstly, that low serum-cholesterol values are found in the South African Bantu, whose fat intake provides little D. R. LAURENCE. Eetv Gardens, Surrey. more than a third of the proportion of calories that it does in Americans ; and secondly, necropsy evidence MENTAL HEALTH AND PUBLIC HEALTH shows that the severer of atherosclerosis SiR,ňIn an address to a joint meeting of the Scottish are far less common complications the Bantu than among among branch of the Society of Medical Officers of Health and American hospital populations. comparable the Scottish division of the Royal Medico-Psychological It is thus tempting to assign considerable significance Association, Dr. MacQueensaid : to the level of fat intake in the aetiology of the disease. "The Health Visitors-about one for every 2,500 people At the same time there are two contradictory items of in the best staffed areas and one for every 5,000 in the worst evidence which cannot be ignored and which caution areas-are again not experts in psychology ; they have their too much significance to level of fat general nursing training, with nowadays a slender intro- against attaching
shuddering plunge is mitigated for the spartan children, as they reflect that at the same time No doubt the
"
duction to
psychology included, a subsequent midwifery training, and-usually after two or three years as a hospital staff nurse and a ward sister-a course of full-time study for the Health Visitor’s Certificate, this course lasting at present from six months to one academic year but likely in the near future to become standardised everywhere as an academic year, and
some six or mental health."
including
demonstrations
on
seven
lectures
or
lecture-
In his letter of Feb. 26 he asks whether I am " aware of the very large amount of time devoted in the health visitor’s training to the psychology of development andallied subjects." There is no mention of psychology in the syllabus of general training of the General Nursing Council for Scotland. Mental diseases are mentioned : a minimum of two hours’ teaching in the three years of training is recommended. I think that this, barely a day’s work out of four to six years’ training, gives an orientation towards physical illness and away from mental illness which unsuits the health visitor for work in the field of mental
health. On the other hand, our doctors get a much better impression of the importance of mental ill health during their course of training. In Edinburgh the medical student is required to attend 40 lectures on psychiatry and psychology and 20 clinical demonstrations ; and there is an elective clinical course in the wards of the Edinburgh mental hospitals. The postgraduate students in the c.P.H. and D.P.H. courses get 20 lectures and demonstrations on mental health and 20 lectures on applied psychology. This may not reflect adequately the 1.
MacQueen, I.
A. G.
Publ. Hlth, Lond. 1954, 68, 24.
intake per
se.
Firstly, the fat intake of Eskimos is high ; it supplies over 40% of their calories.5 Yet available data (admittedly incomplete) indicate that their serum-cholesterol values are not abnormally elevated; moreover, cardiovascular disease is almost unknown among these people, or, for that matter, among the inhabitants of the Yukon, who also have a high fat consumption.6 Secondly, low serum-cholesterol values are found among strict vegetarians despite their high fat intake : in three recent investigations fat supplied 33%, 34%, and 35% respectively of their calories.7-9 It is not yet known, however, whether vegetarians in Western countries suffer less than nonvegetarians from severe atherosclerosis. Arising from our investigations on the Bantu, there is
aspect which impressed us and to which attention might be drawn-namely, a low-fat intake is only one feature of their pattern of diet ; furthermore, a low one
incidence of atherosclerosis is but one feature of their disease pattern. The Bantu diet, while probably adequate in calories and gross protein, is low in animal protein,’ fat, cholesterol, sugar, certain mineral salts, and vitamins, 1. Keys, A. Voeding, 1952, 13, 539. 2. Morrison, L. M. Ann. intern. Med. 1952, 37, 1172. 3. Walker, A. R. P., Arvidsson, U. B. J. clin. Invest. 1954, 33, 1358. 4. Higginson, J., Pepler, W. J. Ibid, p. 1366. 5. Sinclair, H. M. Proc. Nutr. Soc. 1953, 12, 69. 6. Duncan, A. C. Lancet, 1947, ii, 919. 7. Groen, J., Tjong, B. K., Kamminga, C. E., Willebrands, A. F. Voeding, 1952, 13, 556. 8. Donath, W. F., Fischer, I. A., Eysbergen, H. C. M., Wijn, J. F. Ibid, 1953, 14, 153. 9. Hardinge, M. G., Stare, F. J. Amer. J. clin. Nutr. 1954, 2, 83.
importance of mental ill health as a public-health problem, but clearly a person so trained is hardly to be compared with a health visitor.
compulsory.
Having said that, let me make suggestions for the improvement of the training of both the general nurse and the health visitor. Firstly, they should be made the headmaster and his entire staff, the matron, and the aware that a third to a half of all hospital beds are for chaplain, are lustrating themselves with ice-water, to the mentally ill, and that mental and nervous troubles practise what they preach. Or are they ? approach this proportion of all ill health. There is no Middlesex Hospital, better way of doing this than by prescribing a period of J. W. DICKSON. London, W.1. training in a mental hospital amounting to not less than six months out of the three years’ general training. The TETANUS TREATED WITH INTRAVENOUS title Registered General Nurse is, at present, a misleading MEPHENESIN one. Secondly, during her post-registration training the SjR,ňln his report of a case of tetanus treated with health visitor would greatly benefit by some time spent mephenesin (Feb. 26) Dr. Docherty makes the surprising working with the authorised officer of a local authority statement that the drug " does not act on the higher and with the psychiatric social worker attached to a centres and therefore does not affect consciousness." hospital or clinic. With this additional training the health The dosage used in this case-up to 18 g. in twenty-four visitor would be much better qualified to work in the hours-is low and would not be expected to have any field of mental health. such effect given slowly intravenously, as it was. But Usher Institute, drowsiness is the most commonly reported side-effect of DONALD CAMERON. University of Edinburgh. and have more than once seen I complete mephenesin, DIET AND ATHEROSCLEROSIS though brief loss of consciousness follow rapid intravenous infusion of the pure drug in saline. Pronounced SIR,-Many of your readers will be familiar with the drowsiness is almost invariable with doses of 2-4 g. given laboratory and field studies of Professor Keys and his intravenously in five to fifteen minutes, and such doses associates1 bearing on the correlation between fat intake, can be needed in tetanus. Mephenesin in large doses is serum-cholesterol concentration, and incidence of atheroa powerful cerebral depressant, and sedation with the sclerosis, which is now the leading cause of death among usual drugs may have to be reduced to avoid overadults in the United States and possibly in other Western sedation when large doses of mephenesin (e.g., about Further supporting evidence has been countries.2 10g. in an hour) are used. Commercial liquid preparations published from this centre 34 where we have noted, also contain alcohol, which adds to the sedative effect. firstly, that low serum-cholesterol values are found in the South African Bantu, whose fat intake provides little D. R. LAURENCE. Eetv Gardens, Surrey. more than a third of the proportion of calories that it does in Americans ; and secondly, necropsy evidence MENTAL HEALTH AND PUBLIC HEALTH shows that the severer of atherosclerosis SiR,ňIn an address to a joint meeting of the Scottish are far less common complications the Bantu than among among branch of the Society of Medical Officers of Health and American hospital populations. comparable the Scottish division of the Royal Medico-Psychological It is thus tempting to assign considerable significance Association, Dr. MacQueensaid : to the level of fat intake in the aetiology of the disease. "The Health Visitors-about one for every 2,500 people At the same time there are two contradictory items of in the best staffed areas and one for every 5,000 in the worst evidence which cannot be ignored and which caution areas-are again not experts in psychology ; they have their too much significance to level of fat general nursing training, with nowadays a slender intro- against attaching
shuddering plunge is mitigated for the spartan children, as they reflect that at the same time No doubt the
"
duction to
psychology included, a subsequent midwifery training, and-usually after two or three years as a hospital staff nurse and a ward sister-a course of full-time study for the Health Visitor’s Certificate, this course lasting at present from six months to one academic year but likely in the near future to become standardised everywhere as an academic year, and
some six or mental health."
including
demonstrations
on
seven
lectures
or
lecture-
In his letter of Feb. 26 he asks whether I am " aware of the very large amount of time devoted in the health visitor’s training to the psychology of development andallied subjects." There is no mention of psychology in the syllabus of general training of the General Nursing Council for Scotland. Mental diseases are mentioned : a minimum of two hours’ teaching in the three years of training is recommended. I think that this, barely a day’s work out of four to six years’ training, gives an orientation towards physical illness and away from mental illness which unsuits the health visitor for work in the field of mental
health. On the other hand, our doctors get a much better impression of the importance of mental ill health during their course of training. In Edinburgh the medical student is required to attend 40 lectures on psychiatry and psychology and 20 clinical demonstrations ; and there is an elective clinical course in the wards of the Edinburgh mental hospitals. The postgraduate students in the c.P.H. and D.P.H. courses get 20 lectures and demonstrations on mental health and 20 lectures on applied psychology. This may not reflect adequately the 1.
MacQueen, I.
A. G.
Publ. Hlth, Lond. 1954, 68, 24.
intake per
se.
Firstly, the fat intake of Eskimos is high ; it supplies over 40% of their calories.5 Yet available data (admittedly incomplete) indicate that their serum-cholesterol values are not abnormally elevated; moreover, cardiovascular disease is almost unknown among these people, or, for that matter, among the inhabitants of the Yukon, who also have a high fat consumption.6 Secondly, low serum-cholesterol values are found among strict vegetarians despite their high fat intake : in three recent investigations fat supplied 33%, 34%, and 35% respectively of their calories.7-9 It is not yet known, however, whether vegetarians in Western countries suffer less than nonvegetarians from severe atherosclerosis. Arising from our investigations on the Bantu, there is
aspect which impressed us and to which attention might be drawn-namely, a low-fat intake is only one feature of their pattern of diet ; furthermore, a low one
incidence of atherosclerosis is but one feature of their disease pattern. The Bantu diet, while probably adequate in calories and gross protein, is low in animal protein,’ fat, cholesterol, sugar, certain mineral salts, and vitamins, 1. Keys, A. Voeding, 1952, 13, 539. 2. Morrison, L. M. Ann. intern. Med. 1952, 37, 1172. 3. Walker, A. R. P., Arvidsson, U. B. J. clin. Invest. 1954, 33, 1358. 4. Higginson, J., Pepler, W. J. Ibid, p. 1366. 5. Sinclair, H. M. Proc. Nutr. Soc. 1953, 12, 69. 6. Duncan, A. C. Lancet, 1947, ii, 919. 7. Groen, J., Tjong, B. K., Kamminga, C. E., Willebrands, A. F. Voeding, 1952, 13, 556. 8. Donath, W. F., Fischer, I. A., Eysbergen, H. C. M., Wijn, J. F. Ibid, 1953, 14, 153. 9. Hardinge, M. G., Stare, F. J. Amer. J. clin. Nutr. 1954, 2, 83.