700

Arrangements would be easier in domiciliary practicethan in hospital, where six or even a dozen husbands

might have to be accommodated at any one time. Fewlabour suites have the means to deal with such numbers.A nurse or doctor would have to be continuously respons-ible for these husbands, meeting them at the entrance,checking that there is no respiratory or skin infection,showing them the lavatory, ensuring that they have gownsand overshoes and know how to put them on, leadingthem to the correct labour room, making certain that theyremain in the right place and do not get in the way, andtaking care of them if they feel faint or collapse. (Onehusband accidentally pushed a foot under the release barat the head of the delivery bed so that his wife’s head andshoulders dropped almost to the floor. His screams,

thought to be for his wife’s safety, were in fact for himself,and it took a doctor, two nurses, and a porter ten minutesto extricate his foot from under the release bar.) Thelabour suite is the busiest place in any maternity hospital,and the load on medical and nursing staffs is already great.In fairness to them and to their patients, we must studycarefully all the implications of bringing husbands intothe labour ward and not pay too much attention at this

stage to the vociferous minority who see nothing but goodin husbands sharing the labour experience.

NEUROLOGICAL COMPLICATIONSOF LUNG CANCER

A SHORT monograph 1 in Spanish by Jeri, based on astudy of 383 patients with lung carcinoma in Peru, con-tains features of interest. He says that cancer of the lungis relatively rare in Peru. In 2094 verified cases of malig-nant disease seen in one year, there were 92 men withbronchial carcinoma and 26 women. The 383 cases onwhich this monograph is based were seen over ten yearsin a small institution devoted to neoplastic disease. It is

interesting to compare his figures concerning neuro-

myopathies with experience in other countries. Jeri foundthat 12-5% of patients with lung cancer showed evidenceof a neuromyopathy-an incidence similar to the 14-2% ina comparable series 2 in England. In both series, neuro-myopathy was slightly less common in women than in men.The neurological and myopathic syndromes, however,appeared with rather different frequencies in the two

groups: this is probably due in part to subjective differ-ences of classification between different observers; and,moreover, Jeri puts a larger number into more than onecategory. He found a higher incidence of cerebellar

deficiency and motor neuropathy than Croft and Wilkin-son did. In both series the incidence of sensory neuro-

pathy, usually a very clear-cut syndrome, was almostidentical. If Jeri’s classifications " muscular dystrophy "

and " myastheniform syndrome " are grouped together onthe one hand, and Croft and Wilkinson’s " myopathyincluding myasthenia " and " neuromyopathy " are

combined on the other, there is a similar incidence: 52%in Jeri’s series and 63% in Croft and Wilkinson’s exhibitedone or other of these manifestations. Allowing fordifferences of classification, therefore, the incidence ofsyndromes in the two groups was similar, except forcerebellar deseneration and motor neuropathv. It is not1. Jeri, R. Las Manifestaciones Neurologicas del Carcinoma Broncogenica:

Observaciones Clinico-Patologicas en una Serie Consecutiva de 383Pacientes. Lima, 1963.

2. Croft, P. B., Wilkinson, M. Brain, 1965, 88, 435.

always easy to distinguish clinically between cerebellardegeneration and a cerebellar metastasis.The frequency with which mental disorder may be the

presenting symptom of a carcinomatous neuropathy hasbeen emphasised in the past, and Jeri again draws attentionto this aspect. 21 of his 48 patients with neuromyopathyhad mental abnormality manifested as confusion, depres-sion, stupor, dementia, or emotional instability.

BARRIERS TO INFECTION

AT the Royal Alexandra Hospital for Sick Children inBrighton a system of strict barrier nursing has beentried and found successful in the control of cross-infec-tion. The system was first introduced in the 8 cubiclesof the gastroenteritis unit. When it proved feasible, itwas later extended to the infants’ ward, which catered forchildren under two years, including newborn and pre-mature infants. 13 of its 27 beds were in individualcubicles.Each cubicle in which the system was operated was

fumigated with formalin vapour after the patient’s dis-charge. Each was provided with the equipment neededfor basic nursing procedures and with sink, piped oxygen,and foot-operated buzzer besides. Only food and linenhad to travel between it and the world outside. Before

entering a cubicle, the nurse put on a clean gown; andwhen she was ready to leave, this was rolled up, insideout, and left in a bag in the cubicle. The used gownswere collected periodically for laundering or autoclavingas appropriate. No gown was left hanging in the cubicleto become contaminated on the inside and to come intocontact with the nurse’s dress at the next opportunity.Soiled napkins, linen, and waste were removed in bagsbrought to the cubicle door by an orderly. No linen wasever sluiced in the ward. Soiled linen from the gastro-enteritis unit was sluiced in an outhouse before beingsent to the laundry.

In this same unit, despite these precautions, there werestill instances of cross-infection with Escherichia coli.These were finally attributed to airborne bacteria carriedbetween cubicles on cross-draughts. Continuous samp-ling of the air revealed that, when a baby’s napkin waschanged, organisms were scattered round the cubicle,but they quickly settled once the procedure was com-pleted. Accordingly, a period of waiting was introduced:after a napkin change, at least five minutes were to elapsebefore the cubicle door was opened; Cross-infection withcoliform organisms then became less common on the

unit-although still not unknown. Its successful controlon the infants’ ward was found to depend as much onthe exclusion of babies with symptoms suggestive ofgastroenteritis and prompt transfer to the unit of anyfound to be harbouring pathogenic strains of Esch. colias on the barrier procedure.The method of nursing was implemented concurrently

with a policy of unrestricted visiting by parents. Indeed,on the infants’ ward, about 1 child in 3 had his motherliving with him in the cubicle. Nevertheless, the systemworked. It was, however, demanding of staff. The 8 cotsof the gastroenteritis unit were served by 1 sister, 1 staff-nurse, 5 students, and 3 orderlies; 2 students and anorderly were on duty at night. Clearly, all-staff, parents,and visiting doctors-were conscientious above theaverage in adherins to this exactins routine.1. Gibson, M., Mann, T. P. Nursing Times, Sept. 24, 1965, p. 1309; ibid.

Oct. 1, 1965, p. 1334.