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part-time nurse need undertake night duty unless she wishes.Those who do 24-28 hours weekly on day shifts, or three nightsa week, are regarded as regularly employed.

" Reserves "

are on the waiting-list for regular duty. Those who do lessthan 24 hours’ day work a week, or less than three nights, areregarded as casual workers.On day duty trained nurses get 2s. 6d. an hour, enrolled

assistant nurses 2s., nursing attendants ls. 9d., and nursingorderlies Is. 6d. On night duty the rates are Sl 5s. nightlyfor a trained nurse, fl for an enrolled assistant nurse, 17s. 6d.for a nursing attendant, and 15s. for a nursing orderly. Anynurses doing more than 28 hours’ day duty, or more than

three nights weekly, are paid proportionately on the Rushcliffescale. _

These rates, when compared with the present cost ofdomestic help, cannot be called high ; yet they haveattracted women to part-time service, which shows thatobjections to work in hospitals are not primarily financial.

Transport in public-hire motor-cars is provided from

approved centres, and travelling time is allowed as an extra.In cases where part-time nurses have to make a considerablejourney by bus or train they may be allowed fares. Time isallowed for meals on duty, and night staff have a break oftwo hours besides the time allowed for meals. All meals areserved in the nurses’ quarters, not on the wards, and aresubstantial. The morning and evening shifts, for example,are given a meal of fried sausages, or scrambled eggs, or beanson toast, with tea, coffee, or cocoa; the afternoon shiftand those on night duty get a two-course dinner and a cupof tea. Night staff coming from a distance may also be givenbreakfast on coming off duty. Every part-time worker gets2 or 3 dresses of the appropriate colour for her rank, and 3caps and 6 aprons; these are all of modern type, and arelaundered without charge.

Regularly employed part-time nurses are given four weeks’leave with pay after the first year’s service. They are alsoallowed sick-pay at reasonable rates.

Some 150 part-time nurses are now working in thenine county infirmaries, and more are wanted, thoughsome infirmaries already have a waiting-list of nursingstaff. At no time have any of the infirmaries or theirwards been closed for lack of staff ; and at one infirmarya new wing of 12 beds for operable cases of malignantdisease has been opened, and is staffed almost entirelyby part-time nurses.The scheme has not proved unduly expensive, despite

the provision of transport. Sums formerly spent onengaging nurses from cooperatives have been saved, andthe authority has not had to provide quarters andpersonal laundry for part-time workers. The patientsare well satisfied : Dr. Haslett describes them as " fullof praise for the attention they receive." For one thing,night staff having been reduced to a minimum, allmorning bed-making and washing is left to the day staff,and patients are allowed to sleep undisturbed till 7 A.M. ;for another, many of the part-timers are older womenwho take a personal interest in their patients, andthanks to their short span of duty they come to work ina fresh and responsive spirit. The wards are no longermade tidy in time for the doctor’s morning visit ; andthe doctors are glad of it. They see the nurses going onwith their work while they make their rounds, and theycan judge nursing standards better. The full-time nursingstaff now do an 8-hour span of work, either from 8 A.M.to 4 P.M. or 12 NOON to 8 P.M. With the meals allowed on

duty their hours have fallen considerably below 48 aweek, and they fully approve the part-time system. Itis worth emphasising this, because full-time nurses havesometimes objected to the introduction of a part-timescheme on the ground that part-timers get the choice ofthe pleasant shifts, while the permanent staff are obligedto take the unpopular shifts. Actually, the work of thefull-time staff is so much lightened and so much betterdistributed that this objection has little force. It isalso sometimes said that matrons dislike the systembecause it needs so much organising. This may beanswered from Mr. Shee’s experience that " there are

no stronger advocates of the scheme in the county todaythan the matrons."

Here surely is an answer to one of our most acute

nursing problems, the care of the chronic sick. Localauthorities with infirmaries to staff should write for theGloucestershire memorandum.

GRANULOMATOUS LESIONS OF LIVER IN

KALA-AZAR

THE atrophic and fibrotic lesions of the liver due toLeishmania donovani in visceral leishmaniasis in manhave been described many times. So have the granulo.matous lesions of the skin in post-kala-azar dermal leish-manioid, which appears as an occasional sequel tovisceral leishmaniasis, usually a year or so after treatment,and has been thought to indicate a readjustment betweenman and his parasite.’ But in visceral leishmaniasis ofdogs, caused by L. canis, which despite its alias is almostcertainly identical with L. donovani, granulomatouslesions of the liver and other viscera were described byRedaelli.2 Now Bogliolo 3 reports the discovery of suchhepatic lesions in visceral leishmaniasis in man ; apartfrom the granulomatous foci, the rest of the liverpresents the appearance which is characteristic of visceralleishmaniasis affecting that organ, there being no othersigns of inflammation. He interprets the formation ofthese granulomatous lesions as a local reaction to theproducts of disintegration of dead parasites, indepen-dent of the atrophy and fibrosis initiated by the livingparasites.

EXPERIMENTAL ARTHRITIS

THE study of rheumatic diseases in man has beenhindered by the absence of spontaneous or easily inducedarthropathies in animals. On the bacteriological side itis at least clear that various streptococci can producearthritis when injected into the joints of rabbits and otheranimals; and rabbits sensitised by an intravenous

injection of streptococci are more likely to developarthritis after a joint infection than uninoculated controls.These and similar findings have led to speculation aboutthe sequence of events in humaq rheumatic disease,but the comparison of experimental and human infectionsdoes not lead far. One of the more interesting types ofarthritis which occurs naturally in pigs and sheep iscaused by Brysipelothrix rhusiopathicu. Swine erysipelasis not uncommon in this country and takes two forms :an acute septicaemia or

" the diamonds," and a chronicinfection with endocarditis or arthritis as the mainmanifestation. At a meeting of the Heberden Societyon Oct. 25, Dr. D. H. Collins recalled that he and Dr.ViUiam Goldie had shown that in young pigs the diseaseis contagious and may be conveyed as an arthritis andnot as an acute exanthematous disease. With repeatedintravenous injections of the organism they were ableto produce arthritis in pigs, and examination of theinflammatory changes in the joints showed focal collec-tions of lymphoid and plasma cells in the &bgr;ynovial villiand other changes similar to those found in humanarthritis. Human infection with E. rhusiopathiae iswell known as causing erysipeloid, but this is rarelyfollowed by arthritic changes ; and there is no evidencethat the organism is important in cases of human arthritis.With the discovery that pleuropneumonia-like organ-

isms can cause arthritis in wild and domestic animals,many investigators sought these bacteria in human infec-tions, and in 1939 it was claimed that they had beenrecovered from cases of rheumatic fever. This claimwas later withdrawn, and since then they have not beencultivated from either joint exudates or tissues of patientswith rheumatoid arthritis or rheumatic fever; but this

1. Napier, L. E., Krishnan, K. V. Indian med. Gaz. 1931, 66, 603.2. Redaelli, P. Ricerche e Studi sulla Leishmaniosi Viscerale del

Mediterraneo, Catania, 1933.3. Bogliolo, L. Arqu. Clin. 1946, 3, 186.