509

doubtful whether any of these end-points is suffi-

ciently precise, although they may be useful in

monitoring other forms of treatment. A novelobservation concerning the relationship of oestrogensto neutrophil counts has been made by CRUICKSHANKet al. A positive correlation between oestrogen levelsand neutrophil counts and a negative correlation withhaemoglobin was noted in a group of 20 infertilewomen undergoing treatment with gonadotrophin.5A regression equation was used to predict pre-ovulatory oestrogen levels during treatment, and inthe preliminary series accuracy was achieved in 70%of samples. Although this is encouraging, there wasa fairly high standard deviation, so that in its presentform the method cannot safely replace the determina-tion of oestrogens.A number of shortened methods for oestrogen

determinations have now been described. BROWNet al.6 measure total oestrogens and are able to makeresults available within 31/2 hours of receiving thesample. Using this method they reported in a seriesof 222 courses of treatment a pregnancy from every5-2 courses and clinical symptoms of overstimulationin only 7 cycles (3-2%). The oestrogens averagedabout 200 ;jt.g. per 24 hours at the time of givinghuman chorionic gonadotrophin and 50-100 g. inthe normal cycle; but it is hard to know what to

accept as a safe level. Another important factor maybe the rate of increase in oestrogens at the time of

giving human chorionic gonadotrophin. BUTLER 7

compared the oestrone excretion in the normal cyclewith that in induced cycles and showed that manytreatments produced rates of increase which were toohigh or too low. He found that the closest fit resultedfrom the administration of gonadotrophin in threeinjections on alternate days. BROWN et al. gave theless convenient, but more commonly used, dailyinjections. This produced a latent period of 3-4 daysduring which there was no change in oestrogenexcretion, followed by progressive increases. A con-venient criterion to accept for excessive stimulationwas an oestrogen value exceeding 100 {jLg. per 24 hourswithin 5 days of starting treatment.The latest work is described on p. 482 by Professor

ScoTT and his colleagues, who have attempted todevise a more exact method of monitoring treatment.They observed a linear relationship between the logof the 24-hour urinary oestrone excretion and time.They suggest that it may be possible to predictoestrone levels on subsequent days, so that the besttime to give chorionic gonadotrophin may be pin-pointed. Treatment could also be withheld if the

steepness of the slope of the increasing oestrone wastoo great and threatened hyperstimulation.4. Cruickshank, J. M., Morris, R., Butt, W. R., Crooke, A. C. J. Obstet

Gynœc. Br. Commonw. 1970, 77, 634.5. Cruickshank, J. M. ibid. p. 644.6. Brown, J. B., Evans, J. H., Adey, F. D., Taft, H. P., Townsend, L

ibid. 1969, 76, 289.7. Butler, J. K. Proc. R. Soc. Med. 1969, 62, 34.

CHILDREN IN ISOLATION UNITS

LARGE numbers of children are admitted to isolationunits every year. Some are admitted because they needhospital care and must be isolated because of an infec-tive risk to other patients. Others are admitted toisolation units, not because they are seriously ill, butbecause they develop an infectious disease in circum-stances which do not allow home care. Examples arechildren in residential accommodation and childrenfrom deprived and overcrowded households. Thestress of isolation in hospital may be added to analready disturbed background of, for example, parentalseparation. Until lately, the only solutions to this prob-lem on the hospital side were a policy of rapid dis-charge to make the child’s stay as short as possible, andgenuinely unrestricted visiting. But although infec-tious-disease units have a better record than paediatricwards in encouraging unrestricted visiting, the samefactors which first lead to admission often also mean

poor visiting of the children in hospital. For similarreasons, rooming-in of the mother is rarely possible,even where facilities are offered.

For some years the Save the Children Fund has

supported the formation of playgroups in hospitals,and has helped to train playleaders to run them. Theusual type of playgroup cannot be organised in anisolation ward because it is rarely possible to put thechildren into groups, but children in isolation maybenefit from this kind of help no less, and possibly more,than those in ordinary wards. An experiment in apply-ing the methods of play therapy to children in isolationwas started three years ago at St. George’s Hospital, inTooting, London, when, with the help of the Save theChildren Fund, a playleader joined the staff of theinfectious-disease unit. The result was a notableincrease in happiness and activity in the wards;fears that the nursing staff would be left with all thepainful tasks while the playleader took over all the

pleasant relationships with the children proved ground-less. On the contrary, the special skills and methodsof the playleader have been disseminated through thewards, and have had a generally beneficial effect on thestandard of child care. But the playleader’s task ismuch more difficult in an isolation unit than it is in an

open ward. She can usually be with only one child ata time, and barrier-nursing precautions must often beused, so that the time available for each child is muchless than in the conventional playgroup.An addition to the facilities in the infectious-disease

unit at St. George’s has helped to reduce the isolationbarrier further. This is the installation of an internaltelephone system for the children’s use. Each cubicleis equipped with a socket; and the handsets, eight forthe two wards, can be distributed to the cubicles

occupied by children of suitable age and clinical con-dition. The handsets are of a conventional type,and with the aid of a very simple internal directory thechildren can phone other children in the ward, or theplayleader, or nurse, and can be telephoned by them.The system was installed by an industrial company atcost price, and was paid for by the Friends of St.George’s Hospital. It has rapidly become very popularwith the patients, and almost as popular with themedical and nursing staff.