- Email: [email protected]
War-time nurseries
I0
P U B L I C H E A L T H , October, 1942
n o t e t h a t Case 121, w h i c h d i d n o t s h o w t h i s type of regular d o u b l e infection, e i t h e r i n t h e s p e c i m e n s c h a r t e d or i n those o m i t t e d b e t w e e n t h e I 5 0 t h a n d 2 0 8 t h day, Ultimately cleared completely, b e i n g negative in 11 well-spaced s p e c i m e n s of b o t h faeces a n d urine. T a b l e I shows t h e increasing n u m b e r o f " u r i n e + faeces m ,, s p e c i m e n s i n the later weeks, e m p h a s i s i n g t h e i m p o r t a n c e of e x a m i n i n g u r i n e as well as faeces before discharge. T h e s p e c i m e n s f r o m " p e r m a n e n t carriers " (Cases 122-129) are o m i t t e d f r o m these figures, as are s p e c i m e n s of u r i n e s u b m i t t e d w i t h o u t faeces, Or faeces w i t h o u t urine. TABLE I Weeks
1 &2
3&4
No. % F+U--26 F+U+ 6 F--U+ 2
76 18 6
5&6
7&8
9&10
ll&12
No. %
No. %
No. %
No. %
No. %
53 I7 3
63 38 24
37 24 33
9 17 27
4 10 18
Total positive 34
73
73 23 4
50 30 20
125
39 26 35
94
17 33 50
53
12 31 57
32
T h e steady increase in u r i n a r y positive results is obvious. T a b l e I I s h o w s t h e age a n d sex d i s t r i b u t i o n of the 129 cases t o g e t h e r w i t h t h e n u m b e r o f " p e r m a n e n t carriers " as defined above. TABLE I I Males
Females
Age No. of cases
No. of " carriers "
No. of cases
No. of " carriers "
0-5 ... 5-15 ... t 5 - 2 5 ... 25--45 ... 45 and over
5 8 14 17 5
0 0 0 0 0
3 17 29 20 11
0 0 1 3 4
Total ...
49
0
80
8
O u r figures, t h o u g h o n a smaller scale, c o n f i r m those of H o l t V a u g h a n , a n d W r i g h t (1942), i n p a r t i c u l a r t h e i r suggestion as to t h e g r e a t e r likelihood of females o v e r 40 b e c o m i n g carriers. I t c a n b e s e e n f r o m t h e c h a r t t h a t a r o u g h c u r v e ( d r a w n halfway b e t w e e n t h e last positive a n d first finally negative s p e c i m e n s ) c a n be c o n s t r u c t e d i n d i c a t i n g a progressive decrease i n t h e n u m b e r of excretors w i t h increasing time. T h e shape of t h e curve m a y suggest p r o b l e m s as to t h e d i s t r i b u t i o n w i t h i n t h e c o m m u n i t y of resistance to c o n t i n u e d infection w i t h Bact. paratyphosum B. T h e r e are, however, two sources of e r r o r w h i c h p r e c l u d e exact m a t h e m a t i c a l t r e a t m e n t : 1. D o u b t or delays i n diagnosis m a y i n t r o d u c e a n i r r e g u l a r i t y i n t o t h e l e f t - h a n d p o r t i o n of t h e c u r v e ; we have i n c l u d e d 9 cases diagnosed serologically, f r o m w h i c h Bact. paratyphosum B was n e v e r isolated ; these m a y possibly n o t have b e e n r e c e n t cases at all, or s p e c i m e n s m a y have b e e n received too late i n the disease. 2. A m o r e i m p o r t a n t source of error is i n t r o d u c e d b y t h e n e e d for i n c l u d i n g cases (68 o u t of t h e 129) f r o m w h i c h o n l y 2 consecutive negative s p e c i m e n s are recorded. T h i s is i n a d e q u a t e e v i d e n c e of f r e e d o m f r o m i n f e c t i o n : 13 cases, for instance, h a d 2 .consecutive negatives a n d 3 cases e v e n 3 consecutive n e g a t i v e s , a n d were subsequentl3 f o u n d to b e positive i n t h e n e x t s p e c i m e n , one of these (Case 128) b e c o m i n g , indeed, a " p e r m a n e n t carrier." A practical c o n c l u s i o n f r o m the data is t h a t t h e longer p a t i e n t s have b e e n f o u n d to be infective t h e larger m u s t b e t h e n u m b e r of consecutive negative s p e c i m e n s to e n s u r e a reasonable degree of safety. I t is n o t suggested t h a t t h e y s h o u l d b e k e p t i n h o s p i t a l all t h e -time, b u t t h e i r personal hygiene, a n d particularly t h e i r e m p l o y m e n t , m u s t b e controlled a s far as possible while t h e r e is any chance of t h e i r i n f e c t i n g others.
Summary
A c h a r t is p r e s e n t e d s h o w i n g l a b o r a t o r y results o n a large n u m b e r of s p e c i m e n s of faeces a n d u r i n e e x a m i n e d d u r i n g a n o u t b r e a k caused b y Bact. paratyphosum B at K e t t e r i n g . I t is c o n c l u d e d t h a t (1) u r i n e s h o u l d be s u b m i t t e d as well as faeces, p a r t i c u l a r l y before discharge of patients, i n view of t h e r e m a r k able f r e q u e n c y of u r i n a r y c a r r i e r s ; (2) elderly f e m a l e s a r e i n c l i n e d to b e infective longer a n d develop t h e carrier state m o r e easily t h a n other, cases, a n d (3) at least i n the later stages of t h e disease, 5 or m o r e negative specimens, a d e q u a t e l y spaced, are n e e d e d to e x c l u d e infectivity. REFERENCES HOGG, C. B., and KNOX, R. (1942). 3t. Hyg., 44, 5, 6, p. 553. HOLT, H. B., VAUGHAN,A. C. T., and WRIGHT,H. D. (1942). Lancet, 1,133.
CORRESPONDENCE WAR-TIME NURSERIES
To the Editor of PUBLIC HEALTH SIR,--I have read with interest the articles on war-time nurseries appearing in your issue of August, 1942 (p. 192) by Dr. Holt and Dr. Irvine. Possibly considerations of space prevented both these writers from telling the full story of their nurseries, but the impression gained from their articles is that in their respective towns the wartime nursery problem has not been dealt with in so comprehensive a manner as has been regarded as essential in Western-super-Mare. I n this town we have two full-time and four part-time war-time nurseries, and we are shortly to open a residential nursery in addition. All of these are under the direction of a superintendent of nurseries, attached to my staff who has had extensive training and experience both in this country and in America. Dr. Holt gave a list of essentials, such as laundry and domestic offices, which should be provided at a nursery, but omits all reference to nursery rooms and schoolrooms, which are surely the primary essentials. I n this town we have solved the laundry problem by operating a small central laundry serving all our nurseries, and some of our sick-bays and hostels in addition. T h e same writer divides the staff into two categories, nursing and domestic, but we have considered a teaching staff, experienced in nursery work, as essential for the older children from 2 to 5. I was sorry to find both of these Writers stating categorically that the home and family circle is necessarily the best place for the upbringing of a young child. This may, indeed, be so, but I venture to suggest very strongly that the case is by no means proven, and that most workers in the field of public health, particularly those with experience in some of the larger industrial areas, cannot have failed to observe very large numbers of homes and family circles which are, in every way, inferior to any nursery from the point of view of the child's welfare. As this touches upon a problem which is being more and more discussed at the present time, I think that it is essential that we should approach it with absolutely open minds, free from any emotional bias, so that we may hope to arrive at the truth about the whole family problem. One point which might well be considered in this connection is that many writers and speakers are urging nowadays that women should have larger families and, almost in the same breath, that women should play a fuller part in socio-potitical life as equal citizens with men. Apart from any other consideration, it seems to me that these two aims are quite incompatible and cannot be achieved together unless fairly extensive provision is made for the care of young children, during scme part of the day, apart from their mothers, as the care of a home and even one young child is very much a full-time job, not usually leaving any leisured periods. I am, etc., C. G. EASTWOOD,
Medical Officer of Health.
Weston-super-Mare. August 19th, 1942.
At a Sessional meeting of the Royal Sanitary Institute, to be held at the Hallum Municipal Hospital,. West Bromwich, on October 10th, at 11 a.m., Dr. W. S. Walton and Mr. W. W. Foakes will read papers on some practicaI health probtems of to-day. At the Institute headquarters, 90, Buckingham Palace Road, London, S.W.1, on October 21st, at 2.30 p.m., a discussion on scabies will be opened by Dr. Henry MacCormac, Dr. Thomas Standring and Major C. G. Johnson.
P U B L I C H E A L T H , October, 1942
n o t e t h a t Case 121, w h i c h d i d n o t s h o w t h i s type of regular d o u b l e infection, e i t h e r i n t h e s p e c i m e n s c h a r t e d or i n those o m i t t e d b e t w e e n t h e I 5 0 t h a n d 2 0 8 t h day, Ultimately cleared completely, b e i n g negative in 11 well-spaced s p e c i m e n s of b o t h faeces a n d urine. T a b l e I shows t h e increasing n u m b e r o f " u r i n e + faeces m ,, s p e c i m e n s i n the later weeks, e m p h a s i s i n g t h e i m p o r t a n c e of e x a m i n i n g u r i n e as well as faeces before discharge. T h e s p e c i m e n s f r o m " p e r m a n e n t carriers " (Cases 122-129) are o m i t t e d f r o m these figures, as are s p e c i m e n s of u r i n e s u b m i t t e d w i t h o u t faeces, Or faeces w i t h o u t urine. TABLE I Weeks
1 &2
3&4
No. % F+U--26 F+U+ 6 F--U+ 2
76 18 6
5&6
7&8
9&10
ll&12
No. %
No. %
No. %
No. %
No. %
53 I7 3
63 38 24
37 24 33
9 17 27
4 10 18
Total positive 34
73
73 23 4
50 30 20
125
39 26 35
94
17 33 50
53
12 31 57
32
T h e steady increase in u r i n a r y positive results is obvious. T a b l e I I s h o w s t h e age a n d sex d i s t r i b u t i o n of the 129 cases t o g e t h e r w i t h t h e n u m b e r o f " p e r m a n e n t carriers " as defined above. TABLE I I Males
Females
Age No. of cases
No. of " carriers "
No. of cases
No. of " carriers "
0-5 ... 5-15 ... t 5 - 2 5 ... 25--45 ... 45 and over
5 8 14 17 5
0 0 0 0 0
3 17 29 20 11
0 0 1 3 4
Total ...
49
0
80
8
O u r figures, t h o u g h o n a smaller scale, c o n f i r m those of H o l t V a u g h a n , a n d W r i g h t (1942), i n p a r t i c u l a r t h e i r suggestion as to t h e g r e a t e r likelihood of females o v e r 40 b e c o m i n g carriers. I t c a n b e s e e n f r o m t h e c h a r t t h a t a r o u g h c u r v e ( d r a w n halfway b e t w e e n t h e last positive a n d first finally negative s p e c i m e n s ) c a n be c o n s t r u c t e d i n d i c a t i n g a progressive decrease i n t h e n u m b e r of excretors w i t h increasing time. T h e shape of t h e curve m a y suggest p r o b l e m s as to t h e d i s t r i b u t i o n w i t h i n t h e c o m m u n i t y of resistance to c o n t i n u e d infection w i t h Bact. paratyphosum B. T h e r e are, however, two sources of e r r o r w h i c h p r e c l u d e exact m a t h e m a t i c a l t r e a t m e n t : 1. D o u b t or delays i n diagnosis m a y i n t r o d u c e a n i r r e g u l a r i t y i n t o t h e l e f t - h a n d p o r t i o n of t h e c u r v e ; we have i n c l u d e d 9 cases diagnosed serologically, f r o m w h i c h Bact. paratyphosum B was n e v e r isolated ; these m a y possibly n o t have b e e n r e c e n t cases at all, or s p e c i m e n s m a y have b e e n received too late i n the disease. 2. A m o r e i m p o r t a n t source of error is i n t r o d u c e d b y t h e n e e d for i n c l u d i n g cases (68 o u t of t h e 129) f r o m w h i c h o n l y 2 consecutive negative s p e c i m e n s are recorded. T h i s is i n a d e q u a t e e v i d e n c e of f r e e d o m f r o m i n f e c t i o n : 13 cases, for instance, h a d 2 .consecutive negatives a n d 3 cases e v e n 3 consecutive n e g a t i v e s , a n d were subsequentl3 f o u n d to b e positive i n t h e n e x t s p e c i m e n , one of these (Case 128) b e c o m i n g , indeed, a " p e r m a n e n t carrier." A practical c o n c l u s i o n f r o m the data is t h a t t h e longer p a t i e n t s have b e e n f o u n d to be infective t h e larger m u s t b e t h e n u m b e r of consecutive negative s p e c i m e n s to e n s u r e a reasonable degree of safety. I t is n o t suggested t h a t t h e y s h o u l d b e k e p t i n h o s p i t a l all t h e -time, b u t t h e i r personal hygiene, a n d particularly t h e i r e m p l o y m e n t , m u s t b e controlled a s far as possible while t h e r e is any chance of t h e i r i n f e c t i n g others.
Summary
A c h a r t is p r e s e n t e d s h o w i n g l a b o r a t o r y results o n a large n u m b e r of s p e c i m e n s of faeces a n d u r i n e e x a m i n e d d u r i n g a n o u t b r e a k caused b y Bact. paratyphosum B at K e t t e r i n g . I t is c o n c l u d e d t h a t (1) u r i n e s h o u l d be s u b m i t t e d as well as faeces, p a r t i c u l a r l y before discharge of patients, i n view of t h e r e m a r k able f r e q u e n c y of u r i n a r y c a r r i e r s ; (2) elderly f e m a l e s a r e i n c l i n e d to b e infective longer a n d develop t h e carrier state m o r e easily t h a n other, cases, a n d (3) at least i n the later stages of t h e disease, 5 or m o r e negative specimens, a d e q u a t e l y spaced, are n e e d e d to e x c l u d e infectivity. REFERENCES HOGG, C. B., and KNOX, R. (1942). 3t. Hyg., 44, 5, 6, p. 553. HOLT, H. B., VAUGHAN,A. C. T., and WRIGHT,H. D. (1942). Lancet, 1,133.
CORRESPONDENCE WAR-TIME NURSERIES
To the Editor of PUBLIC HEALTH SIR,--I have read with interest the articles on war-time nurseries appearing in your issue of August, 1942 (p. 192) by Dr. Holt and Dr. Irvine. Possibly considerations of space prevented both these writers from telling the full story of their nurseries, but the impression gained from their articles is that in their respective towns the wartime nursery problem has not been dealt with in so comprehensive a manner as has been regarded as essential in Western-super-Mare. I n this town we have two full-time and four part-time war-time nurseries, and we are shortly to open a residential nursery in addition. All of these are under the direction of a superintendent of nurseries, attached to my staff who has had extensive training and experience both in this country and in America. Dr. Holt gave a list of essentials, such as laundry and domestic offices, which should be provided at a nursery, but omits all reference to nursery rooms and schoolrooms, which are surely the primary essentials. I n this town we have solved the laundry problem by operating a small central laundry serving all our nurseries, and some of our sick-bays and hostels in addition. T h e same writer divides the staff into two categories, nursing and domestic, but we have considered a teaching staff, experienced in nursery work, as essential for the older children from 2 to 5. I was sorry to find both of these Writers stating categorically that the home and family circle is necessarily the best place for the upbringing of a young child. This may, indeed, be so, but I venture to suggest very strongly that the case is by no means proven, and that most workers in the field of public health, particularly those with experience in some of the larger industrial areas, cannot have failed to observe very large numbers of homes and family circles which are, in every way, inferior to any nursery from the point of view of the child's welfare. As this touches upon a problem which is being more and more discussed at the present time, I think that it is essential that we should approach it with absolutely open minds, free from any emotional bias, so that we may hope to arrive at the truth about the whole family problem. One point which might well be considered in this connection is that many writers and speakers are urging nowadays that women should have larger families and, almost in the same breath, that women should play a fuller part in socio-potitical life as equal citizens with men. Apart from any other consideration, it seems to me that these two aims are quite incompatible and cannot be achieved together unless fairly extensive provision is made for the care of young children, during scme part of the day, apart from their mothers, as the care of a home and even one young child is very much a full-time job, not usually leaving any leisured periods. I am, etc., C. G. EASTWOOD,
Medical Officer of Health.
Weston-super-Mare. August 19th, 1942.
At a Sessional meeting of the Royal Sanitary Institute, to be held at the Hallum Municipal Hospital,. West Bromwich, on October 10th, at 11 a.m., Dr. W. S. Walton and Mr. W. W. Foakes will read papers on some practicaI health probtems of to-day. At the Institute headquarters, 90, Buckingham Palace Road, London, S.W.1, on October 21st, at 2.30 p.m., a discussion on scabies will be opened by Dr. Henry MacCormac, Dr. Thomas Standring and Major C. G. Johnson.