THE CLIMATE OF MADEIRA

494 of sugar into the blood a normal nocturnal phenomenon The bad results are not due to in r fficiency of staff corresponding to the nocturnal fall of temperature but to the fact that toly. a limit umber of infants ,’]L" and pulse-rate ?One would have thought the contrary ; can be properly attended to with the facilities availit seems more likely to be correlated with the able. In the treatment of sick infants perfect nursing diminished oxidation and output of CO2 which technique is no doubt the primary necessity but, in the construction of new hospitals, more attention accompanies the resting hours. should be paid to the provision of ample accommodaI am, Sir, yours faithfully, MARTIN O. RAVEN. tion and suitable apparatus for carrying it into Broadstairs, Kent, Feb. 25th, 1933. practice if the dangers attending the residence of infants in hospital are to be avoided. I am. Sir. vours faithfullv. LYMPHOGRANULOMA INGUINALE GEOFFREY B. FLEMING. To the Editor of THE LANCET Royal Hospital for Sick Children, Glasgow, Feb. 27th, 1933. SIR,-May I be permitted to thank Dr. Hanschell for drawing attention to a point which he suggests THE CLIMATE OF MADEIRA I had not made quite clear ?‘ Until some better To the Editor of THE LANCET nomenclature has been introduced it is still useful to term to cases the lymphogranuloma inguinale apply SIR,-The tepid oceanic currents bathing these in which infection has been acquired in temperate subtropical regions seem associated with an immunity countries, sometimes referred to as poradenitis from chill which in the 72 years of my medical nostras, while reserving the name climatic bubo or experience has been undisturbed by any serious poradenitis tropica to those infected in the tropics. departure from an established stability of temperature. When I said that I believed cases of lymphogranuloma For though we have suffered from unusual drizzle inguinale were possibly going unrecognised in this and cloudy skies the thermometer in this most trying country, I quoted the figures of the Royal Albert season has hardly varied one degree from 57° F. Dock V.D. clinic, among others, merely as showing: at our official 9 A.M. reading. This is a winterless that my opinion was not shared by every one. I shelter in convalescence from "flu," pneumonia, did not suggest that cases were being missed at thati and renal malady; and catarrhal chill, with consequent It is the one V.D. clinic perhaps where clinic. is hardly known in the revitalising sunshine relapse, unrivalled opportunity exists for the diagnosis of: of Madeira. lymphogranuloma inguinale (poradenitis nostras), as: I write to point out that in spite of prevailing to the same clinic come a continuous stream oft weather conditions our stability of climate here has .seafarers suffering from climatic bubo (poradenitis; suffered no serious from its known transgression trobica). I am. Sir. vours faithfullv. no winter resort has established conditions quality; HUGH S. STANNUS. more potent in convalescence. Wimpole-street, W., Feb. 25th, 1933. I am, Sir, yours faithfully, MICHAEL GRABHAM. Feb. Madeira, 10tb. 1933. CONTROL OF INFECTIONS IN CHILDREN’S WARDS DYSENTERY AS A CAUSE OF SUDDEN DEATH I To the Editor of THE LANCET To the Editor of THE LANCET SiR,-Dr. Spence’s letter appearing in your issue SIR,-I was interested to read Dr. Eileen Harvey’s ,of Feb. 25th serves a most useful purpose in calling in your issue of Jan. 28th, but the statement paper attention to the subject of infection in the wards of that infection with sudden death due to children’s hospitals. Its special importance lies in B. fulminating had not been previously reported Sonne the emphasis laid on the spread of non-specific infec- is dysenterice incorrect. As long ago as 1921, K. Mita1 tions, especially those of the respiratory and alimen- described a series of 73 cases which included six tary tracts, among infants in children’s hospitals. deaths, of which three occurred within 36-60 hours Dr. Spence’s brief rules are admirable in most respects, from the onset. In 1925 W. G. Savage and P. Bruce though I cannot agree with the suggestion that White2 reported three outbreaks of food-poisoning infants should be segregated into groups of approxi- in one of which there was a case with death 91) (No. mately the same age. I always try to distribute the 18 hours from the onset. In 1928 13reported the infants’ cots among those of the older children. In case of a boy, aged 10, who died 16t hours after the this way I think a certain amount of cross infection in this case I isolated the organism from the onset ; may be avoided. contents of the large intestine and from the enlarged The spread of respiratory infection can, to a large lymph glands in the ileocsecal angle. In the same year extent, be controlled by structural arrangements F. H. A. Clayton and J. W. Hunter4 reported a case which limit the dissemination of infective material which terminated fatally in about 13 hours. In all through the atmosphere. Gastro-intestinal infection, the above cases complete identification of the organism on the other hand, is probably carried directly or by isolation was made ; in Dr. Harvey’s case no such indirectly by the hands of the attendant. Faulty proof is forthcoming. nursing technique is therefore its chief cause. In all true that infections with Sonne’s While it is but our most modern children’s hospitals the facilities bacillus are perfectlymild and clear up quickly, it is usually for exercising proper cleanliness are insufficient, and obvious that the possibility of severe and fatal types to my mind it is here that the chief fault lies. How- of infection with this organism has been recognised ever well trained and however careful nurses may be, for some time. it is impossible for them to avoid errors in technique I am, Sir, yours faithfully, if they have neither room nor apparatus for employW. HOWEL EVANS. Feb. 23rd, 1933. Liverpool, ing their craft. The tools, not the workman, are to blame. 1 Jour. Infeot. Dis., 1921, xxix., 580. 2 Med. Research Council, Spec. Rep. Ser. No. 92. In my experience I have found that one is courting 3 Brit. Med. Jour., 1928, ii., 96. - disaster if too many infants are congregated in a ward. 4 THE LANCET, 1928, ii., 649. ,