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wrecked men. They emphasise the need for ensuringthat life-craft are launched, and that men succeed inboarding them. McCance et al. analysed the effects ofmany factors influencing the chance of survival in life-craft. The most important was the temperature. On seasbelow 5°C the mortality in life-craft was 25% ; the lowmortality in life-craft in the whole series was partly due tothe fact that only a small proportion of the sinkings werein very cold waters. In cold regions the mortality was20% in lifeboats compared with 40% on rafts. Evidentlythe degree of protection afforded by the life-craft is veryrelevant, and there is ample justification for the workthat has gone into developing the modern tented life-raft.3

Water-supplies in life-craft were almost as importantas the temperature. The death-rate varied from 33%where no water was available to 2% where there was aplentiful supply. A supply of 4-8 oz. per man per day.seems to be the least for avoiding a high death-rate fromdehydration. One of the most striking features was thedisastrous effect of drinking sea-water. In 163 craftfor which data were available, 39% of the occupantsdied in craft where sea-water is known to have beendrunk, compared with 3% in craft where there was noreport of sea-water drinking-a difference which, it wasfound, was not due to differences between the two groupsin the duration of the voyage, the environmental

temperature, or the amount of fresh water. This grimwarning should become widely known. As McCance et.al. show, provision of enough fresh water in life-craft willremove most of the temptation to drink sea-water.

3. See Lancet, Oct. 13, 1956, p. 770.

OBSTETRICS UNDER DIFFICULTIES

THOSE of us who feel tired and fractious after a busyoutpatient session or a long surgery should read aboutantenatal clinics in Ibadan, Nigeria, at which up to 500patients attend each session. Dr. J. B. Lawson andDr. Una Lister have compiled a clinical report of thework of the department of obstetrics of UniversityCollege, Ibadan, in the period from April 1, 1953, to Dec.31, 1954. The new University College Hospital shouldbe completed next year and will provide 110 beds forobstetrics and gynaecology. Meanwhile 45 obstetricalbeds in the Adeoyo Hospital have had to serve as theprincipal, maternity unit for a population of about

750,000. In these beds 5582 patients were deliveredin the twenty-one months covered by the report. Atthe start of the period the medical staff of the unitconsisted of the two consultants and a junior house-surgeon holding a local qualification.

Record-keeping in Ibadan is difficult because only asmall minority of patients know their age or the dateof their last menstrual period. In telling their histories,patients and interpreters give the answers which theythink would be the most acceptable, and it is usual to

:suppress unhappy incidents such as stillbirths. If a

previous pregnancy has resulted in a stillbirth, a patientmay not only conceal this information but give a differentname in the hope of changing her luck. In such circum-:stances the obstetricians might well have despaired ofproducing a clinical report. Not so Dr. Lawson andDr. Lister, whose account is of great value.

In the twenty-one months there were 76 maternaldeaths (13 per 1000 total births). The stillbirth andneonatal-death rates were 70-4 and 61-8 per 1000 totalbirths. For emergency cases the maternal mortalitywas 49.6 per 1000 and the stillbirth-rate 207 per 1000.Anaemia is perhaps the biggest individual problem.Because hospital beds were so few, anaemic patientscould be admitted only if their haemoglobin level wasless than 50% ; there were 182 such cases. There were35 cases of ruptured uterus with 14 deaths, and 175.cases of obstructed labour with 23 deaths. The incidence

of toxaemia of pregnancy was low, and rheumatic cardiacdisease and pulmonary embolism were not observed.

It is gratifying to know that the superintendent mid-wife received recognition from the people of lbadanin that she was installed by the Olubadan as chief lyaAbiye (mother of all living children). For the wholestaff the chief sources of encouragement have been theerection of the new building and the growing confidenceof the people, which is leading them to seek advice earlierin their pregnancies.

1. Sulkin, S. E., Pike, R. M. Amer. J. publ. Hlth, 1951, 41, 769.2. Smadel, J. E. Ibid, p. 788.3. Long, E. F. Ibid, p. 782.4. Anderson, R. E., Stein, L., Moss, M. L., Gross, N. H. J. Bact.

1952, 64, 473.5. Wedum, A. G. Amer. J. publ. Hlth, 1953, 43, 1428.6. Reitman, M., Wedum, A. G. Publ. Hlth Rep., Wash. 1956,

71, 659.

LABORATORY INFECTIONS

IT used to be said that the late Sir John Ledinghamwas the only bacteriologist in England who had workedwith Pasteurella tularensis and escaped infection. Thereare few bacteria with a reputation so evil and most ofthese are rarely met with in this country. It has longbeen known that all species of brucella and rickettsiashould be handled carefully.1 2 Enteric fever is commoneramong bacteriologists than it should be. Some recentevidence suggests that those who work in hospitallaboratories may acquire tuberculosis rather commonlycompared with those in other jobs.3 Bacteriology hashad its martyrs, but the death of many’ of these wasdue to one disease-yellow fever-and the bacteriologistwould have to admit that some of his infections havebeen due to carelessness and nothing more. Accidentalinfections in the laboratory have now become the subjectof renewed interest. Some of this arises from catastropheswhose history is well known, and some from more

speculative reasoning based on new observations on thedistribution of bacteria.The airborne dispersal of bacteria has been assumed

for many years, but such exact knowledge as we haveof it is comparatively recent. Not only may the viablebacteria in aerial suspension be identified and counted,but it is possible on occasion to show that these mayinitiate both local and systemic infections. The route ofinfection for the latter has generally been assumed to bethrough the lungs-and the history of anthrax confirmsthis-but experimentally it has been shown that infec-tions with brucella and salmonella may occur by wayof the eyes. The methods used for studying the bacterialcontent of the air in operating-theatres have been appliedto the bacteriological laboratory and the findings havecaused some alarm.4-6 Removing the rubber bung froma tube containing a fluid culture ; blowing the last fewdrops from a pasteur pipette ; even spreading a cultureon a petri dish-each of these simple manoeuvres dis-perses a certain number of bacteria. Centrifuging aculture is safe enough-until the tube breaks-and, notsurprisingly, a homogeniser will release a substantialbacterial cloud if the fit of its parts is imperfect. Oneof the most nephelogenic operations is the post-mortemexamination of an infected animal, and there is reasonto fear that the same may be true of human necropsy.All these are only examples of everyday procedures whichhave been shown to produce bacterial aerosols; there

may be others.Some infections acquired in the laboratory are almost

certainly due to airborne bacteria, but the quantitativeaspects of this peril are obscure. If the risk were a

grave one, the bacteriologist should stand between themerchant seaman and the bartender in the tables of

morbidity. He seems, in fact, to have much the samehealth as his colleagues in other departments. Yet itwould be foolish to be too complacent. Few have noticedhow bacteriological technique has altered within living

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memory. The change has been towards quantitativemethods which involve far greater use of pipettes ; ; tomore extensive cultures on a larger number of petridishes ; to more use of the centrifuge ; and to the cul-tivation of potentially dangerous organisms, such as

tubercle bacilli, on a far larger scale. Where the methodsof chemical engineering have-been adapted to the manu-facture of large quantities of bacterial cultures the riskwould seem even greater. At the same time realisationof the dangers of bacterial aerosols has stimulated thedevelopment of protective devices. For those who workwith viruses an inoculation cabinet in which all manipula-tion is carried out is a matter of course.7 8 The infectious

particles set free within it are killed by ultraviolet lightor led into the outside air by suction. Such a cabinetmay be used for animal inoculation and examination aswell as for handling cultures. The cups of the centrifugemay be covered with metal caps so that the breakageof a tube can do no harm. Changes in the design anduse of pipettes can reduce their potential danger.9 Allsuch precautions can lessen the risk, but so long as thebacteriologist wears the same white coat (with or withoutbuttons) for work, for tea, and for an hour in the libraryhe is falling below the standard which he preaches tothe surgeons. There seems no end to the improvementswhich might be suggested in equipment and method, but,in the absence of a murrain among the bacteriologists,it will probably be wise to assemble a little more informa-tion before these are instituted in whole or in part.We should like to know whether the bacteriologists

and their staffs are more subject to some or all infectionsthan, say, the biochemists. If they are not, furtheraction might be limited to situations where experiencehas taught us to expect danger. If the bacteriologistsare shown to be a sickly crew, this should be an immediatecall to define those manoeuvres which are dangerous andto forbid them, to modify them, or to devise measuresof protection. The difficulties of the last are likely tobe as much psychological as technical. Almost anyprotective measure is liable to make work harder or

longer or more complicated, and experience in industryhas shown that unless the risk to be avoided is both

grave and obvious most people prefer to believe that theyare the lucky ones.

1. Keeney, E. L. Bull. Johns Hopk. Hosp. 1946, 78, 113.2. Shepard, C. C., May, C. W., Topping, N. H. J. Lab. clin. Med.1945, 30, 712.3. Wedum, A. G. Ibid, 1950, 35, 648.

THE GOWERS LECTURE

THOUGH the name of Sir William Gowers will not besoon forgotten, we are glad that it should now haveformal commemoration. Of the sum of money left byhis two daughters for this purpose, part has been spenton a Gowers library at the National Hospital, QueenSquareńa general library and reading-room, used bypatients and staff alike, which besides its own books hasa regular supply from the borough of Holborn. (Here isan innovation that surely deserves to be copied by otherhospitals interested in breaking down the formality ofan institution.) The other part of the memorial is alectureship for which a portrait medal has been struck.This honour is bestowed by a committee which includesthe senior physicians of the National Hospital and ofUniversity College Hospital ; and it is fitting that theirchoice should fall on a man who, like Gowers, hasdone his work at both of these hospitals-Sir FrancisWalshe, F.R.S. The subject of Sir Francis’s lecture will bethe Nature and Dimensions of Nosography in ModernMedicine, and it will be given on Thursday, Nov. 15, at8.15 p.m., at the house of the Royal Society of Medicine.Sir Ernest Gowers, chairman of the National Hospital,"ill preside, and Sir Russell Brain, P.R.C.P., will presentthe medal. Though a number of invitations have beensent out, no ticket will be required for admission.

MUCOPROTEINS IN WOUND INFECTIONS

IT has long been known that the mucoproteins foundin mucus have protective properties of advantage to thehuman body.1 2 Moreover, mucoproteins are associatedwith processes of healing ; sufferers from the commoncold, for example, know that they are on the way torecovery when their nasal secretions cease to flow likewater and instead become viscous and sticky. When awound begins to heal mucoproteins increase in theexudate, and mucoproteins have a greater capacity toincrease viscosity than simple proteins possess.

Experimental work by Howes and Armitage 3 providessome evidence that mucoproteins plus antibiotics maybe more effective than antibiotics alone in preventinginfection of wounds inflicted so as to crush some tissuein the back muscles of rabbits. When such wounds werecontaminated with staphylococcus cultures or floor dirtthey were always purulent when first dressed 4 dayslater. If, when they were made, such wounds weretreated by a single injection of streptomycin and sulphon-amide, or by various other antibacterial agents, andwere also packed open with gauze saturated with thesame drugs, they were always free from infection andhad healthy granulations four days later. If three hours

elapsed between contamination and treatment in thismanner, about half of the wounds were infected.

By a double-acid method at least two mucoproteinswere precipitated together from rabbit blood in order totest their influence on the course of wounds made andtreated as already described. The crushed and con-taminated wounds were treated by the injection intotheir base and into adjacent tissues of 10 ml. either of theantibacterial mixture alone or of the antibacterialmixture with mucoprotein powder dissolved in it to givea mucoprotein concentration of 0.1%. Each of the10-ml. injections was made by a series of needle insertionsthrough the contaminated tissue to a depth of 1/4 inchin such a way that small quantities were widely distributedaround the area of the wound ; finally the wound waspacked open with gauze soaked in 5 ml. of the solutionunder investigation. In each rabbit two wounds weremade : one was treated with antibacterial solution alone,and the other with antibacterial solution containingmucoprotein. All wounds were then covered with gauzecontaining petroleum jelly, which was held in place by acircular bandage ; no other treatment was given and thewounds were inspected first 4 days later and thereafterat subsequent daily dressings. In a second series of

experiments wounds were not treated until 17 and 72hours after being made and contaminated ; these woundswere dressed daily from these times.

Immediate treatment with antibacterial drugs aloneprevented infection unless antibiotic-resistant bacteriawere present. With 4 hours’ delay in treatment 50% ofthe ’wounds became infected, with 17 hours’ delay 72%,and with 72 hours’ delay 85%. The bacteria isolatedfrom these wounds were not resistant to the antibacterial

drugs used. For the wounds treated with antibacterialdrugs plus mucoprotein the infection-rates were 10%after 4 hours’ delay in treatment, 44% after 17 hours’delay (both substantial reductions compared with woundstreated with antibacterial agents alone), but 71% after72 hours’ delay (that is, only a slight reduction, whichmight have arisen by chance alone). All wounds treatedwith mucoproteins without antibiotics became infected.Histological examination of the wounds revealed thatthose of the rabbits given mucoproteins and antibacterialdrugs showed a very narrow zone of leucocytes superficialto the granulations, compared with much deeper zonesof leucocytes in wounds treated with antibacterial drugs1. Goldsworthy, N. E., Florey, H. Brit. J. exp. Path. 1930, 11, 192.2. Florey, H. Proc. R. Soc. B. 1955, 143, 147.3. Howes, E. L., Armitage, C. Surgery, 1956, 40, 247.