871

FOWLER’S POSITION

SiR,-Mr. Layton girds on his armour and clanks intobattle without caring whether the lady he sets out torescue is a maid in the clutches of an ogre or a witch dyingfrom natural causes.He says that the Fowler position attacked by Spalding

and me is a " bastard " Fowler. On the contrary we

attack the genuine Fowler, with its immobility, and lookon the bastard variety as, by comparison, harmless. Itis the hourly struggle between nurse and patient thatmitigates its worst dangers : it is the abolition of exertionthat renders it so fatal.

Mr. Layton claims that the Fowler position is excellentfor the treatment of respiratory infections. With thisstatement I would not attempt to disagree : but when heasks whether embolism has been recorded after theFowler position without the abdomen being opened,I would remind him that cases of fatal pulmonaryembolism from the medical wards far outnumber thosefrom the surgical departments. Abdominal section iscontributory, not because it damages veins but becauseit slows the venous pump, and thrombophlebitis starts,not in the veins of the pelvis but in thbse of the calf.Lastly, :1B11’; Layton reminds us that Lane and other

great men advocated it. We must not use great names(to quote a wag) as the drunkard uses lamp-posts, forsupport rather than for illumination. Lane was a

pioneer, ready to adopt good work wherever he foundit. He accepted Fowler’s views in 1906 : he would havebeen the first to accept Spalding’s exposure of theirunsoundness in 1946.

Lives of great men should remind usWe can make our lives sublime

Only when we leave behind usCrazes that have,had their time.

London, W.I. HENEAGE OGILVIE.

PHOTOMETRIC MEASUREMENT OF BACTERIALGROWTH

SiB,—Your annotation of May 11 directs attention to atopic which is assuming increasing importance to workersin widely divergent spheres of activity. Apart from theirmedical aspects, the problems inherent in the estimationof the relative numbers present in bacterial populationshave both scientific interest and industrial applications.

It was stated in your annotation that a serious limita-tion to the usefulness of photometric methods wasimposed by their insensitivity to the lower bacterialdensities. This disadvantage can, however, be over-

come by the use of the principle referred to in a recentcommunication to N afN,re.1 The apparatus there brieflydescribed is capable of a considerably higher sensitivitythan systems based on measurement of the reductionin transmitted light.Measurements are made of the degree of scattering

which takes place when a parallel beam of light is passedthrough the culture medium under examination. Incontrast to the transmission methods, this method givesprogressively increasing readings with the developmentof the bacterial population. Apart from its consider-ably greater sensitivity (which can be adjusted verysimply to cover an appreciable range), the new methodpossesses the additional merit that photocell fatigueis not so likelv to occur and even if it does it cannotbe mistaken for the initial stages of bacterial growth.This is in contrast with the transmission methods wherethe onset of fatigue produces a result identical with thatgiven by a small increase in the bacterial population.

In view of the variation which can be made in thesensitivity of an apparatus employing the light-scatterprinciple, it is not possible to give figures for its maximumsensitivity, but no difficulty has been experienced indetecting the growth resulting from 5 hours’ incubationof an inoculum equivalent to the addition of 1 ml.of a 24-hour culture of Bact. typhosum to 100 litres ofbroth. Using the same sensitivity adjustments and a5-hour incubation-period, full-scale deflection can beobtained with an inoculum equivalent to 1 ml. of a24-hour culture of Bact. typhosum in approximately4 litres of broth. Results of a similar order have beenattained with cultures of Staph. aureus.

1. Needham, N. V. Nature, Lond. March 23, 1946, p. 374.

The figures you give for the accuracy of photo-metric methods (;j= 1 to 3 %) could probably be improved,but even this degree of accuracy compares favourablywith that normally attributed to the alternative methodsmentioned-hoemocytometer counts and plating. Wilsonet al.,2 in a comprehensive examination of this question,give the accuracy of plating methods, as applied tomilk analyses, as ± 90 % for a single plate, the correspond-ing figure for plates in triplicate being ± 52 %. There isso much in common between the probable sources oferror in plating and haemocytometer counts-i.e.,counting difficulties, measurement of small amounts,inaccuracy in the pipettes, and variable numbers ofbacteria adhering to the internal surfaces of the pipettes-that it seems reasonable to assume that, unless verystringent precautions are taken, the error of a singlehaemocytometer count will approximate to those men-tioned for plating.From the standpoint of the time required to carry

out a determination, the photoelectric methods are

unquestionably superior, it being possible to exceedvour figure of 20 cultures Der hour bv a wide marsm.

N. V. NEEDHAM.Cooper Technical Bureau, Berkhamsted.

DRUGS AND THE NATIONAL HEALTH SERVICE

SiR,-The high cost of new drugs and apparatus isdefended by the manufacturers as a necessary part ofresearch costs. Before the war the Government provideda limited sort of protection to the public against unfairor prohibitive prices for a few very important drugs likeinsulin ; but the early costs of the more effective sulphon-amides were only to be met, for working people, throughthe hospitals ; and for several years one of the mosteffective, sulphadiazine, was sold at a price which madethe research which had gone to produce it benefit onlythe well-to-do. Now folic acid, which (if claims arejustified) will replace liver injections in the treatment ofpernicious anaemia and sprue, and which will cure certainhitherto refractory ansemias, is to be marketed at 3s.a tablet, the effective daily dose being about four tablets.

During the war, Fleming’s discovery of penicillin asa remedy was exploited exclusively by the Governmentfor the people as a whole and was supplied free-i.e.,the whole cost fell on taxation. It is now to be sold ata controlled but not negligible price.You will agree that the National Health Service must

not run the risk of incurring the criticism levelled atpanel practice, of limiting the cost of drugs and apparatusprescribed, and surcharging the " extravagant " doctor.But’neither must it be possible for fortunes to be madeout of drugs at the public expense. I believe that theadvantages accruing from the commercial exploitationof pharmacy and instrument manufacture, in the direc-tion of independent research and cheapness of manufac-ture, are all outweighed by permitting the advertisementof doubtful, inferior, or unproved remedies. The solutionof this problem, as has been magnificently demonstratedin the case of penicillin, is the endowment of researchlaboratories in the universities and in association witha nationalised drug industry, experimental work beingencouraged in the health service whenever’ conditionsallow of reliable results. The field of commercial " privateenterprise " should be limited to cosmetics and thesimpler kinds of home remedies.

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Inverness. D. G. LEYS.SHORTAGE OF NURSES

SiR,-Prof. J. W. McNee draws an alluring picture ofa cadet corps of nursing candidates crossing a modern" bridge " to hospital portals beyond. Parental eyes willhowever peer further into the future, seeking to knowwhat then awaits their treasured young. Will it be aremodelled service comparable with other trainings ?Or will it still be the indefensible double life of a full-timeemployee who must also study for a professional status ?

Professor McNee shows himself the imaginativeplanner ; so one hopes he has joined the ranks of thosewho seek to recast the conditions of the nurse’s hospitalHtc

Moor Park, Middlesex. ESTHER CARLING.

2. Wilson, G. S., Twigg, G. S., Wright, R. C., Hendry, C. B., Powell,M. C., Maier, I. Spec. Rep. Ser. med. Res. Coun., Lond. no. 206,1935.