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These patients -’have often had years of experience ofdoctors and are quick to distinguish one who is experi-enced from one who is not. The hysteria which followedthe intradural injection may have originated in the

preoperative visit in the ward.These principles apply equally to emergencies at night

and during the weekend. Registrars are in sole chargein many hospitals, and however well they work a com-sultant should be able to do better on some occasions.There should therefore always be a consultant availablefor difficult and serious cases. The case mentioned byDr. Mushin would come into this category. Had shebeen ansesthetised by a more experienced person theserious sequelae would probably not have occurred.Portsmouth. H. B. C. SANDIFORD.H. B. C. SANDIFORD.

TREATMENT OF SCARLET FEVER

SiR,-I share Dr. Krarup’s surprise (March 29) thatthere exist doctors who do not use penicillin in thetreatment of " scarlet fever." I am always bewilderedwhen I hear of cases of " scarlet fever " being admittedto hospital, of isolation of contacts, of stovings andfumigations.When I qualified ten years ago-in England, I hope

Dr. Krarup will note-I had already been taught thatat least thirty different types of group-A (Lancefield andHare) streptococci had been isolated by Griffith fromcases of " scarlet fever," and that any streptococcalthroat infection, whether due to organisms which pro-duced an erythrogenic toxin or not, might be clinically asserious, and as liable to immediate and late complications,as " scarlet fever."Accordingly I have never diagnosed, nor used the

term, " scarlet fever," nor yet notified a case. I oftensee scarlet fever " in association with acute tonsillitis ;I have seen it when the only lesion is a boil on thebuttock, or when a slight purulent infection of a laparo-tomy scar has been the cause.As the use of the term still causes dismay to patients,

nurses, and all school authorities, is it not high timethat tonsillitis (with or without a " scarlet fever

"

rash)replaced’the term

" scarlet fever " R

Hildenborough, Kent. C. GLAISHER.C. GLAISHER.

WHAT SHOULD THE NURSE BE TAUGHT ?

SiR,-As matron of a nurse-training school, I read theletter from Dr. Cropper and Dr. Houghton (April 5)both with interest and with dismay.

I am fully in agreement with their desire for a simplifiedtheoretical syllabus, and am glad to see the.revised Stateexaminations giving greater prominence to practicalnursing, that essential of the training which theoreticalwork can augment but never replace.The first part of the letter, however, caused me great

concern. Many senior members of the nursing andteaching professions are greatly disturbed by the growingnumber and wide acceptance of schemes whereby youngpeople from 15 years of age are employed in hospitals.From a purely material point of view these schemes area heavy financial burden upon our already overtaxedhealth service, and are already tending to defeat theirown ends.A number of girls, attracted by the salaries offered and

by the excitement of working in hospital, and commonlyunder the delusion that they are starting their nursingcareer in the best possible way, are leaving school earlierthan they would normally have done, thus creating thegap between school and training which the cadet courseis intended to fill. When training eventually starts, thewastage among these candidates is, in my experience,very high-from lack of basic education, from disillusion-ment when confronted with genuine nursing duties, orfrom sheer weariness and loss of enthusiasm after so longa period of J.n.stitution,al work. Because ’PI this, I have

lost more than one promising student when half-waythrough her training.Worst of all is the danger of permitting junior nurses

to do any work in a hospital when at present there is nomeans of ensuring that the recommended conditions ofservice are enforced. Although in recognised cadetschemes every care is taken that the approved conditionsare strictly adhered to, there are far too many hospitalswhere, for lack of other staff, young girls are regularlyemployed in actual nursing duties-not only on day buton night duty.

Years ago child labour was abolished in the mines andthe factories of this land. In our twentieth-century healthservice children are engaged in nursing the sick. Can weof all people, members of the medical and nursingprofessions, view such a situation with equanimity ? z

Addenbrooke’s Hospital, L. J. OTTLEYCambridge. Matron.

L. J. OTTLEYMatron.

Addenbrooke’s Hospital,Cambridge.

ARTIFICIAL RESPIRATION

SiR,-In -answer to Dr. Hicks (April 5), I did not meanto condemn any method of resuscitation, but I objectedto the suggestion that Schafer’s method should be

officially replaced by Nielsen’s.I adhere to my opinion, not only because thousands

have been trained to carry out the Schafer method

efficiently, but because it is the only -method whichmakes full use of the diaphragm. At the same time itallows other methods, such as Nielsen’s, to be used ifhelp is at hand. If the value of the diaphragm is to bedisregarded, the rocking stretcher must also retire to thebackground.

Only four days ago, a fellow practitioner witnessed myresuscitation of a patient with acute asphyxia by Schafer’smethod, along with the principle of the rocking stretcher.The heart-sounds were inaudible with the stethoscope ; andit was exactly twenty minutes before the welcome grunt was-heard, and another five minutes before we could say thatbreathing was established. In this case, as in others which Ihave experienced, the regular diaphragmatic movements, inmy opinion, served to stimulate contraction of the heart.

I consider therefore that Schafer’s method should be-retained. If advantage is to be taken of the value of the,diaphragm, either the Schafer or the rocking-stretchermethod should be used ; but these may be combinedwith other methods. ’

.

Hemel Hempstead. GILBERT BURNET.GILBERT BURNET.

SELF-DEMAND FEEDING OF INFANTS

SIR,—I have read with interest the article by Professor-Illingworth and Dr. Stone (April 5) on the merits ’ofself-demand feeding of infants. If it serves to drawattention to the need to avoid a rigid routine in baby-feeding the results will prove most valuable. On theother hand, I think it would be a mistake to create the-impression that any routine in baby-feeding is undesirable.I think that some confusion may arise as a result of theterms used. The authors refer at the beginning of the-article to the benefits of an " elastic feeding schedule "and later refer to their results as showing the advantagesof " self-demand breast-feeding." I think it is importantto distinguish between these two phrases. Most mothers-welcome some guidance regarding the frequency andduration of feeds, and they will find an elastic feedingschedule a help. On the other hand, they are likely toget into difficulties if they are led to think that every-thing can be left to Nature and that baby can be fed atany time of the day or night.

’

Babies as a rule naturally get into fairly regularhabits, and if the mother without being in the least rigidcan help to form habits that involve feeding baby atreasonable hours she will save herself a lot of trouble-to the benefit of both herself and her baby.

L.C.C. Divisional Offices, W. H. S. WALLACE.128, Brook Drive, London, S.E.11. W. H. S. WALLACE.W. H. S. WALLACE.L.C.C. Divisional Offices,

128, Brook Drive, London, S.E.11.