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USE OF PETHIDINE BY MIDWIVES
723 On the other hand, for protecting mice against Bact. coli infection, serum from a calf immunised with endotoxin proved about 30 times more potent than a commercial Bact. coli antiserum. Possibly, therefore, a serum could be prepared that would protect young calves against " white diarrhoea," and the immunity might extend to other members of the colon-typhoid group. If it is true that most of the lethal effects of infantile gastro-enteritis are caused by special strains of the colon-typhoid group, as suggested by the work of Giles and Sangster2 and Mackerras and Mackerras,3 a similar serum might be valuable in this condition. If really potent, it should at least help in elucidating the aetiology of the disease.
antigens.
THE AGED WHO ARE
MENTALLY INFIRM from people suffering relatively mild degrees of mental infirmity have of recent years been admitted to mental hospitals under certificate, largely because there was nowhere else to send them when they were sick. This desperate resort has blocked mental-hospital beds which could be used for the treatment of acute and MANY old
recoverable patients of all ages. The Ministry of Health4 has therefore asked the regional hospital boards to consider providing, for people of 65 and over who have deteriorated mentally, both short-stay psychiatric units and long-stay annexes. In the future, geriatric departments are to be developed in the larger hospital centres, usually in the general hospital of a group ; and the Ministry propose that each such department should include a short-stay psychiatric unit capable of dealing with elderly patients whose mental state does not call for immediate mental-hospital treatment. Such a unit will be used to establish the diagnosis and give short-term treatment ; and the stay of any patient will not usually exceed 6 weeks. Some of the patients will be well enough to return home after treatment, some will need care in long-stay annexes, a few will need mental-hospital care, and a proportion will die. It is suggested that the wards should not hold more than 25 beds, and should be divided up so that patients can be classified into small groups ; a few single rooms should be available. Long-stay annexes are to be provided for patients without serious behaviour disorders, as distinct from the more disturbed types. The Ministry thinks it may be convenient to associate such annexes either with mental hospitals, general hospitals, or hospitals for the chronic sick, depending on local conditions. At all events they should be within convenient reach of most visiting relatives or friends. If they are in buildings actually in the mental-hospital grounds they should cease to be a part of the hospital and should have a separate entrance, but they should none the less be linked with the mental hospital in some way, since the staff should include mental nurses and psychiatric social workers, and the medical care should be supervised by a psychiatric consultant. The object is not to set up new mental hospitals for the treatment of acute psychoses ; and the Minister is therefore willing to direct that long-stay annexes shall be used " for the reception of persons who are suffering from mental infirmity due to old age and who do not require detention." This gets rid of any question of certification. Mental deterioration associated with grossly disturbed behaviour will, as formerly, be treated in a mental hospital, and so will acute recoverable mental illness. Patients will be referred to the longstay annexes from the short-stay units, or sent direct from their own homes by the family doctor attending them. The Minister specially recommends that the -
2. Giles, C., Sangster, G. J. Hyg., Camb. 1948, 46, 1. 3. Mackerras, I. M., Mackerras, M. J. Ibid, 1949, 47, 166. 4. Circular R.H.B. (50) 26.
long-stay
annexes
should be
"simple
and
home-like
in character." PETHIDINE BY MIDWIVES THE Dangerous Drugs Regulations which came into force at the beginning of this month authorise the possession and use of pethidine by midwives. The value of pethidine in obstetrics is now well established, and the It marks a further step in new regulation is welcome. the growing recognition by the medical profession and the Home Office of the wisdom of allowing preparations classed as dangerous drugs to be supplied to trained persons who are not medically qualified, for relief of pain under special circumstances. The careful framing of the regulation leaves little possibility of abuse ; the safeguards might even be termed drastic. The amount to be supplied is limited to the quantity of pethidine which would be necessary for the administration of 200 mg. to each pregnant woman whose name is recorded in the personal register which it is already obligatory for the midwife to maintain. A record of supply and administration of the drug must be kept ; and, of course, when not actually in use, the pethidine will be kept under lock and key. It is presumed that full instruction -in the use and limitations of pethidine will be a part of the course of training of midwives, and that it will be emphasised that the drug is intended for use only when the patient is in labour. It should not be necessary to remind the midwife that if the patient has to be referred to a doctor or transferred to hospital, full information about the use of analgesics should be given. This new regulation should go some way towards solving the difficult problem of how best to equip the midwife to supply analgesia to women who are being delivered at home. Pethidine has now 12 been shown to be a safe analgesic, easy to give and with few sideeffects. Used with discrimination, it should be of considerable value, and we hope that after a year or two an attempt will be made to assess the results. In conclusion, dare we hope that further regulations will be made to allow of the wider use of analgesics in first-aid ? USE OF
TEACHERS ON TOUR MANY people have said that it is important that the periphery of medical practice should be more closely linked with the centre. Practical schemes to further this agreed policy are less common. But last month Manchester Regional Hospital Board approved two interesting suggestions to this end put forward by Sir ’Harry Platt. During the past two years some halfdozen orthopaedic conferences have been held at strategic points in the region, and the success of these meetings led Platt to suggest that the time had come when the system should be extended to other subjects. A beginning might well be made, he thought, with conferences on general medicine, general surgery, obstetrics and gynaecology, and paediatrics. His second suggestion breaks fresh ground. He proposes that not less than once a year a visitor distinguished in one of the main clinical fields should be invited to spend a week, or better still a fortnight, at each peripheral key centre. There he would take charge at the local hospital of the clinical department of his own specialty, conduct ward rounds, and give talks. On one or two evenings there might be discussions to which the general practitioners of the area would be invited. Judging by the enthusiasm for surgical Saturday afternoons which Dr. Collings observed in the Highlands of Scotland, this might well be one of the best parts of a good idea. Platt is keen that the distinguished visitor should live in the town and get to know some of
’
1. Roby, C., Schumann, W. R. Amer. J. Obstet. Gynec. 45, 318. 2. Barnes, J. Brit. med. J. 1947, i, 437.
1943,
antigens.
THE AGED WHO ARE
MENTALLY INFIRM from people suffering relatively mild degrees of mental infirmity have of recent years been admitted to mental hospitals under certificate, largely because there was nowhere else to send them when they were sick. This desperate resort has blocked mental-hospital beds which could be used for the treatment of acute and MANY old
recoverable patients of all ages. The Ministry of Health4 has therefore asked the regional hospital boards to consider providing, for people of 65 and over who have deteriorated mentally, both short-stay psychiatric units and long-stay annexes. In the future, geriatric departments are to be developed in the larger hospital centres, usually in the general hospital of a group ; and the Ministry propose that each such department should include a short-stay psychiatric unit capable of dealing with elderly patients whose mental state does not call for immediate mental-hospital treatment. Such a unit will be used to establish the diagnosis and give short-term treatment ; and the stay of any patient will not usually exceed 6 weeks. Some of the patients will be well enough to return home after treatment, some will need care in long-stay annexes, a few will need mental-hospital care, and a proportion will die. It is suggested that the wards should not hold more than 25 beds, and should be divided up so that patients can be classified into small groups ; a few single rooms should be available. Long-stay annexes are to be provided for patients without serious behaviour disorders, as distinct from the more disturbed types. The Ministry thinks it may be convenient to associate such annexes either with mental hospitals, general hospitals, or hospitals for the chronic sick, depending on local conditions. At all events they should be within convenient reach of most visiting relatives or friends. If they are in buildings actually in the mental-hospital grounds they should cease to be a part of the hospital and should have a separate entrance, but they should none the less be linked with the mental hospital in some way, since the staff should include mental nurses and psychiatric social workers, and the medical care should be supervised by a psychiatric consultant. The object is not to set up new mental hospitals for the treatment of acute psychoses ; and the Minister is therefore willing to direct that long-stay annexes shall be used " for the reception of persons who are suffering from mental infirmity due to old age and who do not require detention." This gets rid of any question of certification. Mental deterioration associated with grossly disturbed behaviour will, as formerly, be treated in a mental hospital, and so will acute recoverable mental illness. Patients will be referred to the longstay annexes from the short-stay units, or sent direct from their own homes by the family doctor attending them. The Minister specially recommends that the -
2. Giles, C., Sangster, G. J. Hyg., Camb. 1948, 46, 1. 3. Mackerras, I. M., Mackerras, M. J. Ibid, 1949, 47, 166. 4. Circular R.H.B. (50) 26.
long-stay
annexes
should be
"simple
and
home-like
in character." PETHIDINE BY MIDWIVES THE Dangerous Drugs Regulations which came into force at the beginning of this month authorise the possession and use of pethidine by midwives. The value of pethidine in obstetrics is now well established, and the It marks a further step in new regulation is welcome. the growing recognition by the medical profession and the Home Office of the wisdom of allowing preparations classed as dangerous drugs to be supplied to trained persons who are not medically qualified, for relief of pain under special circumstances. The careful framing of the regulation leaves little possibility of abuse ; the safeguards might even be termed drastic. The amount to be supplied is limited to the quantity of pethidine which would be necessary for the administration of 200 mg. to each pregnant woman whose name is recorded in the personal register which it is already obligatory for the midwife to maintain. A record of supply and administration of the drug must be kept ; and, of course, when not actually in use, the pethidine will be kept under lock and key. It is presumed that full instruction -in the use and limitations of pethidine will be a part of the course of training of midwives, and that it will be emphasised that the drug is intended for use only when the patient is in labour. It should not be necessary to remind the midwife that if the patient has to be referred to a doctor or transferred to hospital, full information about the use of analgesics should be given. This new regulation should go some way towards solving the difficult problem of how best to equip the midwife to supply analgesia to women who are being delivered at home. Pethidine has now 12 been shown to be a safe analgesic, easy to give and with few sideeffects. Used with discrimination, it should be of considerable value, and we hope that after a year or two an attempt will be made to assess the results. In conclusion, dare we hope that further regulations will be made to allow of the wider use of analgesics in first-aid ? USE OF
TEACHERS ON TOUR MANY people have said that it is important that the periphery of medical practice should be more closely linked with the centre. Practical schemes to further this agreed policy are less common. But last month Manchester Regional Hospital Board approved two interesting suggestions to this end put forward by Sir ’Harry Platt. During the past two years some halfdozen orthopaedic conferences have been held at strategic points in the region, and the success of these meetings led Platt to suggest that the time had come when the system should be extended to other subjects. A beginning might well be made, he thought, with conferences on general medicine, general surgery, obstetrics and gynaecology, and paediatrics. His second suggestion breaks fresh ground. He proposes that not less than once a year a visitor distinguished in one of the main clinical fields should be invited to spend a week, or better still a fortnight, at each peripheral key centre. There he would take charge at the local hospital of the clinical department of his own specialty, conduct ward rounds, and give talks. On one or two evenings there might be discussions to which the general practitioners of the area would be invited. Judging by the enthusiasm for surgical Saturday afternoons which Dr. Collings observed in the Highlands of Scotland, this might well be one of the best parts of a good idea. Platt is keen that the distinguished visitor should live in the town and get to know some of
’
1. Roby, C., Schumann, W. R. Amer. J. Obstet. Gynec. 45, 318. 2. Barnes, J. Brit. med. J. 1947, i, 437.
1943,