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TRAINING OF NURSES
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editorial of Sept. 9 was also written shor’tly before our European conference. This can hardly be considered a very statesmanlike approach to a difficult problem. Could you not have waited until you had heard the further facts which were reported in Prague this week ? Department of Neurology, Radcliffe Infirmary, Oxford.
W. RITCHIE RUSSELL Chairman of the U.K. Committee for Poliomyelitis.
*
DETERMINISM, RESPONSIBILITY, AND ILLNESS SIR,-I want to thank Dr. Merskey and Mr. Clarke (Sept. 1) for dealing with my questions and stating their
assumptions and preconceptions more fully. It is difficult to be wholly " scientific and objective, and without special pleading "; since the type of scientific method advocated as being of primary importance in the study of human behaviour is itself a form of special pleading. Such bias must always be taken into account, so as not to detract from the value of such scientific findings by a tendency to exclude or minimise other methods of study and findings in this complex field. Discipline and restraint are necessary for the more difficult task of attempting to resolve and reconcile these differences in the quest for more adequate theory, rather than the less exacting procedure of setting up one method and approach as superior and more important than others. The dualistic theory put forward by the authors creates the problem of who or what decides which universe of discourse is appropriate to a given situation. It seems unsatisfactory to leave them as apparently unrelated alternatives. Although the authors finally come down on the side of determinism, is it not really the more difficult question of how much of determinism and free will there is in any given human behaviour ? St. George’s Hospital, Stafford.
H. M. FLANAGAN.
TRAINING OF NURSES
SIR,-The nurses are being urged by the Industrial Court to put their salary structure in order by March 31, 1963. I think it would be equally worth putting the professional strata right at the same time, and I would suggest the following: All hospitals which are medical teaching schools should become the State-enrolled-nurse training schools of the United Kingdom. I suggest this because the great work in surgery, medicine, and specialisation is done in these hospitals, and therefore they are the best training centres for the bedside It would also give the doctors the opportunity of nurse. planning and supervising the clinical teaching of the pupil, and of growing up with the nurses they always say they wantnot the academic, but the practical. All men and women who want to become State-registered nurses would take their training in hospitals geared, not to teaching the future doctors, but to teaching and training the future team-leaders in nursing. These schools of nursing would be the regional-board hospitals, approved by the General Nursing Council, throughout the country. The results would be: (a) Removing a lot of chips from the shoulders of the nurses who have trained in non-medical teaching hospitals, but who believe they are as good nurses but have less kudos. (b) Producing a State-registered nurse with a feeling of equality with all other State-registered nurses trained after March 31, 1963. (c) Producing a State-enrolled nurse who would not have an inferiority complex, and if it is social/matrimonial status the candidate is seeking, State-enrolled nursing will become fashionable. Richmond,
Surrey.
E WALSH E. A A. WALSH. WALSH.
PREMATURITY, TETRACYCLINE, AND OXYTETRACYCLINE IN TOOTH DEVELOPMENT
SIR,-We have reported1 the finding of pigmentation, with or without enamel hypoplasia, in deciduous teeth of children who were given tetracycline in the neonatal period, and the apparent rarity of these complications after oxytetracycline therapy. Prof. M. A. Rushton (May 5), Mr. Stewart (May 5), and Dr. Miller (May 19) suggested that prematurity alone, or the disease for which the drug was given, rather than tetracycline, may have been responsible for the enamel hypoplasia. To elucidate this problem we investigated 46 prematurely born children to determine the incidence of tooth deformity. In a separate survey 21 children who had been given oxytetracycline in the neonatal period were also investigated to assess the effects of this drug on dentition. We examined the records of all babies born at the King Edward Memorial Hospital for Women in Perth in the twelve months from January, 1960, to January, 1961. 46 children whose birthweight was less than 2-5 kg. (this being taken as the criterion of " prematurity ") were traced. The teeth were examined and the gestation period, birthweight, any significant illness, and details of the administration of antibiotics were noted. Enamel hypoplasia was diagnosed when there was naked-eye deformity of the teeth. This was usually manifested in the canines and molars as abnormally sharp cusps and obvious deficiency of the enamel. The average birthweight in this group was 2-06 kg., and the average gestation period was 35-1 weeks. 32 children had normal teeth. 6 of these had illnesses: conjunctivitis (3), respiratory distress (2), and cyanotic attacks (1). None had been given tetracycline. 14 children had abnormal teeth. Of this group, 1 had kemicterus and had received oxytetracycline. He had enamel hypoplasia and slight yellow pigmentation. The other 13 had all been given tetracycline in doses ranging from 120 to 750 mg. 9 had enamel hypoplasia and pigmentation, and 4 had pigmentation alone. The drug was given for respiratory distress in 4 cases, for conjunctivitis in 2, for cyanotic attacks in 2, for pustules in 2, for pneumonia in 1, and prophylactically in 2, 21 children who had been given oxytetracycline in the neonatal period were traced. Most of them had been given the drug in the first week of life. In each instance we recorded the birthweight, gestational age, the dose of oxytetracycline, the duration of treatment, and the reason for giving the drug. This group includes the 8 cases previously
reported.1 Oxytetracycline was given for respiratory distress in 4 cases, for conjunctivitis in 4, for pyrexia in 3, for pustules in 1, for infected umbilicus in 1, for cellulitis in 1, and prophylactically in 7. The average birthweight was 2’82 kg.; the average gestational period was 38 weeks. The average total dose of oxytetracycline was 620 mg. (an average total dose of 210 mg. per kg. with an average daily dose of 38 mg. per kg.). 2 children had abnormal teeth. 1 was a mentally defective child, previously described, who had superficial yellow pigmentation of the teeth which did not fluoresce in ultraviolet light. There was. no associated enamel hypoplasia. The 2nd child had kernicterus due to rhesus incompatibility. 700 mg. of oxytetracycline had been given in the neonatal period. The teeth showed moderate enamel hypoplasia with slight yellow pigmentation. Other than varying degrees of caries, the remaining children had normal teeth. 2 children whose birthweights were 2-2 kg. and 1’6 kg. received 630 and 750 mg. per kg., yet neither had abnormal teeth. Kernicterus is often followed by severe enamel hypoplasia. Forrester and Miller2 examined 13 children who had had kernicterus, and found that all had tooth deformity. They also described enamel hypoplasia in some premature babies, and noted that most of these children 1. 2.
Wallman, I. S., Hilton, H. B. Lancet, 1962, i, 827. Forrester, R. M., Miller, J. Arch. Dis. Childh. 1955, 30, 224.
editorial of Sept. 9 was also written shor’tly before our European conference. This can hardly be considered a very statesmanlike approach to a difficult problem. Could you not have waited until you had heard the further facts which were reported in Prague this week ? Department of Neurology, Radcliffe Infirmary, Oxford.
W. RITCHIE RUSSELL Chairman of the U.K. Committee for Poliomyelitis.
*
DETERMINISM, RESPONSIBILITY, AND ILLNESS SIR,-I want to thank Dr. Merskey and Mr. Clarke (Sept. 1) for dealing with my questions and stating their
assumptions and preconceptions more fully. It is difficult to be wholly " scientific and objective, and without special pleading "; since the type of scientific method advocated as being of primary importance in the study of human behaviour is itself a form of special pleading. Such bias must always be taken into account, so as not to detract from the value of such scientific findings by a tendency to exclude or minimise other methods of study and findings in this complex field. Discipline and restraint are necessary for the more difficult task of attempting to resolve and reconcile these differences in the quest for more adequate theory, rather than the less exacting procedure of setting up one method and approach as superior and more important than others. The dualistic theory put forward by the authors creates the problem of who or what decides which universe of discourse is appropriate to a given situation. It seems unsatisfactory to leave them as apparently unrelated alternatives. Although the authors finally come down on the side of determinism, is it not really the more difficult question of how much of determinism and free will there is in any given human behaviour ? St. George’s Hospital, Stafford.
H. M. FLANAGAN.
TRAINING OF NURSES
SIR,-The nurses are being urged by the Industrial Court to put their salary structure in order by March 31, 1963. I think it would be equally worth putting the professional strata right at the same time, and I would suggest the following: All hospitals which are medical teaching schools should become the State-enrolled-nurse training schools of the United Kingdom. I suggest this because the great work in surgery, medicine, and specialisation is done in these hospitals, and therefore they are the best training centres for the bedside It would also give the doctors the opportunity of nurse. planning and supervising the clinical teaching of the pupil, and of growing up with the nurses they always say they wantnot the academic, but the practical. All men and women who want to become State-registered nurses would take their training in hospitals geared, not to teaching the future doctors, but to teaching and training the future team-leaders in nursing. These schools of nursing would be the regional-board hospitals, approved by the General Nursing Council, throughout the country. The results would be: (a) Removing a lot of chips from the shoulders of the nurses who have trained in non-medical teaching hospitals, but who believe they are as good nurses but have less kudos. (b) Producing a State-registered nurse with a feeling of equality with all other State-registered nurses trained after March 31, 1963. (c) Producing a State-enrolled nurse who would not have an inferiority complex, and if it is social/matrimonial status the candidate is seeking, State-enrolled nursing will become fashionable. Richmond,
Surrey.
E WALSH E. A A. WALSH. WALSH.
PREMATURITY, TETRACYCLINE, AND OXYTETRACYCLINE IN TOOTH DEVELOPMENT
SIR,-We have reported1 the finding of pigmentation, with or without enamel hypoplasia, in deciduous teeth of children who were given tetracycline in the neonatal period, and the apparent rarity of these complications after oxytetracycline therapy. Prof. M. A. Rushton (May 5), Mr. Stewart (May 5), and Dr. Miller (May 19) suggested that prematurity alone, or the disease for which the drug was given, rather than tetracycline, may have been responsible for the enamel hypoplasia. To elucidate this problem we investigated 46 prematurely born children to determine the incidence of tooth deformity. In a separate survey 21 children who had been given oxytetracycline in the neonatal period were also investigated to assess the effects of this drug on dentition. We examined the records of all babies born at the King Edward Memorial Hospital for Women in Perth in the twelve months from January, 1960, to January, 1961. 46 children whose birthweight was less than 2-5 kg. (this being taken as the criterion of " prematurity ") were traced. The teeth were examined and the gestation period, birthweight, any significant illness, and details of the administration of antibiotics were noted. Enamel hypoplasia was diagnosed when there was naked-eye deformity of the teeth. This was usually manifested in the canines and molars as abnormally sharp cusps and obvious deficiency of the enamel. The average birthweight in this group was 2-06 kg., and the average gestation period was 35-1 weeks. 32 children had normal teeth. 6 of these had illnesses: conjunctivitis (3), respiratory distress (2), and cyanotic attacks (1). None had been given tetracycline. 14 children had abnormal teeth. Of this group, 1 had kemicterus and had received oxytetracycline. He had enamel hypoplasia and slight yellow pigmentation. The other 13 had all been given tetracycline in doses ranging from 120 to 750 mg. 9 had enamel hypoplasia and pigmentation, and 4 had pigmentation alone. The drug was given for respiratory distress in 4 cases, for conjunctivitis in 2, for cyanotic attacks in 2, for pustules in 2, for pneumonia in 1, and prophylactically in 2, 21 children who had been given oxytetracycline in the neonatal period were traced. Most of them had been given the drug in the first week of life. In each instance we recorded the birthweight, gestational age, the dose of oxytetracycline, the duration of treatment, and the reason for giving the drug. This group includes the 8 cases previously
reported.1 Oxytetracycline was given for respiratory distress in 4 cases, for conjunctivitis in 4, for pyrexia in 3, for pustules in 1, for infected umbilicus in 1, for cellulitis in 1, and prophylactically in 7. The average birthweight was 2’82 kg.; the average gestational period was 38 weeks. The average total dose of oxytetracycline was 620 mg. (an average total dose of 210 mg. per kg. with an average daily dose of 38 mg. per kg.). 2 children had abnormal teeth. 1 was a mentally defective child, previously described, who had superficial yellow pigmentation of the teeth which did not fluoresce in ultraviolet light. There was. no associated enamel hypoplasia. The 2nd child had kernicterus due to rhesus incompatibility. 700 mg. of oxytetracycline had been given in the neonatal period. The teeth showed moderate enamel hypoplasia with slight yellow pigmentation. Other than varying degrees of caries, the remaining children had normal teeth. 2 children whose birthweights were 2-2 kg. and 1’6 kg. received 630 and 750 mg. per kg., yet neither had abnormal teeth. Kernicterus is often followed by severe enamel hypoplasia. Forrester and Miller2 examined 13 children who had had kernicterus, and found that all had tooth deformity. They also described enamel hypoplasia in some premature babies, and noted that most of these children 1. 2.
Wallman, I. S., Hilton, H. B. Lancet, 1962, i, 827. Forrester, R. M., Miller, J. Arch. Dis. Childh. 1955, 30, 224.