service. The Chicago regulations specifically require that a very
long I got I have
single physician be in charge of the nursery and responsible
for its conduct, which seems more satisfactory from the stand¬
point of enforcement.
New York's regulation 10 (a), to be adequately carried out,
would require prostatic examination for all male individuals,
and urinary and stool examinations on all personnel on duty in
the maternity division. Furthermore, to be of value, such
examinations would have to be repeated at monthly intervals.
Chicago's regulations require nose and throat cultures, Dick
and Schick tests, and examination for focal infections. Atten¬
tion is focused on infections which might be responsible for
outbreaks of disease in the maternity division and nursery, such
as tonsillar or sinus infections, and diarrhea, as well as on
existing or recent active communicable infection in potential
carriers.
New York's regulation 13 (a) requires that personnel "shall
wash their hands with soap and hot water and immerse them
in a suitable disinfectant solution." Chicago's regulations do
not require disinfectant solutions but stress thorough hand
washing. Disinfectant solutions are not effective for hand
sterilization. There are many who believe that when disinfec¬
tant solutions are available there is carelessness in hand wash¬
ing while, if they are not provided, hand washing is more
thorough and satisfactory.
New York's regulation 13 (a) makes no provision as to the
drying of the hands. Chicago's rules require drying on indi¬
vidual towels.
New York's regulation 13 (b) requires that physicians visit¬
ing mothers in wards wear a face mask, cap and gown. This
is not required in the Chicago regulations, since it is felt that
it will do little to prevent infections and that it is an unneces¬
sary hardship to wear a mask, cap and gown just to visit a
patient.
New York's regulation 13 (d) requires a mother to wear a
face mask during the time she is breast feeding her baby. By
the Chicago regulations, the mother is required to wear a mask
only when she has an infection of the upper part of the respira¬
tory tract.
New York's regulation 14 (a) requires that a minimum of
visiting be permitted, but no statement is made concerning what
is considered a minimum of visiting. The Chicago regulations
specifically permit two visitors a day, exclusive of the husband.
The Chicago regulations require each hospital to establish
its own adequate obstetric staff and requirements for the calling
of consultations, and for the conduct of maternity divisions which
will prohibit the abuse of oxytocics, analgesics and operative
procedures during.deliveries. It is hoped that these regulations
will aid in reducing the number of deaths from cerebral hemor¬
rhage, asphyxia, and prematurity. The New York regulations
do not require these things.
The Chicago regulations will tend to prevent not only gastro¬
intestinal infections but all infections of the newborn and will
tend to protect the mother, fetus, and newborn from many dis¬
asters other than those due to infectious agents.
Herman N. Bundesen, M.D., Chicago.
President, Board of Health.
BENZEDRINE SULFATE\p=m-\A WARNING
To the Editor:\p=m-\Icannot refrain from saying a word of
approval with regard to your editorial on "Benzedrine Sulfate
Warning." I am a neurasthenic doctor 65 years of age
and when some months ago a sample of benzedrine sulfate
\p=m-\A
fell into my hands with the accompanying literature I had to
try it. It worked like a charm; if I got up in the morning
feeling somewhat dragged out and took a tablet of benzedrine
sulfate I felt pretty well all day and could do my work with-
out tiring; the result was that I took it almost daily. Before
Downloaded From: by a Johns Hopkins University User on 04/21/2018
so I couldn't sleep and couldn't eat.
never been much of an eater but could eat reasonably well.
It never occurred to me that the benzedrine sulfate could be
at the bottom of it and I had a gastrointestinal series run
and a rectal examination made ; it finally dawned on me that
the benzedrine sulfate had something to do with it and I
promptly stopped it. I can now sleep pretty well but have
not as yet recovered my appetite. I am glad once more to
confirm the wisdom and the conservative attitude of The
Journal. Donald Maclean, M.D., Reno, Nev.
Queries and Minor Notes
The answers here published have been prepared by competent
authorities. they do not, however, represent the opinions of
any official bodies unless specifically stated in the reply.
Anonymous communications and queries on postal cards will not
be noticed. Every letter must contain the writer's name and
address, but these will be omitted on request.
ANESTHESIA FOR DELIVERY IN HOME
To the Editor:—What type of anesthesia would be best to use for
delivery in the home in a rural community? Please give information as
to dosage, method of administration, time for giving, length of time that
it is effective, and any other helpful information. jj r) California
Answer.—Satisfactory and safe analgesia in labor, particu¬
larly for patients to be delivered in the home, is as yet not
available. It must be realized that analgesic drugs of all kinds
are likely to add to the complications of labor and delivery.
Undoubtedly, some form of analgesia must be used in the
majority of cases. It is thus necessary to acquaint oneself with
one method, to learn its limitations and the complications that
are likely to result from its use and to be prepared to meet
these when they occur.
Morphine and scopolamine properly administered probably
offer the safest analgesia for the patient to be confined in her
home. In the usual primiparous labor morphine from 0.01 to
0.016 Gm. (one-sixth to one-fourth grain) and scopolamine
from 0.00025 to 0.0005 Gm. (3^60 to Y\zo grain) can be given
when the cervix is completely effaced and dilated sufficiently
to admit two or three fingers (from 3 to 4 cm.). In the large
majority of cases this will be sufficient to carry the patient to
the end of the first stage of labor. Some form of inhalation
anesthetic, usually ether, can be used during the second stage.
It is rarely advisable to repeat these drugs unless the labor is
unusually prolonged, in which case a much smaller dose should
be used. It has been the experience of some that scopolamine
in ampules is more efficacious than the tablets.
The only serious complication that may result from the use
of these drugs is morphine narcosis of the baby. This is more
likely to occur when the drug is administered less than four
hours before the birth of the child. It is likewise more apt to
occur following a difficult delivery or in the event that the baby-
is premature. It is most important to learn how to resuscitate
asphyxiated babies. The simplest and most effective procedure
is to clear the air passages by means of a hard rubber catheter
and to carry on respiration artificially by means of this catheter
until breathing has been well established. The baby should be
kept warm during the process of resuscitation. If these mea¬
sures are carried out, no baby need be lost as a result of the
analgesia administered to the mother (Shute, Evan, and Davis,
M. E. : The Effect on the Infant of Morphine Administered in
Labor, Surg., Gynec. & Obst. 57:727 [Dec] 1933).
VITAL STATISTICS
To the Editor:—What do the figures on vital statistics mean? When
a death rate is given, does that refer to the number of deaths from a
given disease according to the whole population of the town at the time
of the report, or does it refer to the number of deaths according to the
incidence of the disease?
M.D., New York.
Answer.—The death rate of a city is the number of deaths
divided by the population. It is usually expressed per thousand
or per hundred thousand persons, is frequently on an annual
basis, may be for specific population groups (by age, sex or
color) and may or may not be by diagnosis. The other rate
referred to (the proportion of cases which terminated fatally)
is customarily termed a "case fatality rate," not a "death rate."