Document B7oVpyb6QK6qmw1BD326aDQj

1312 |UNt 17, 1967 ANNOTATIONS THE UNIX']. in all circumstances. Situations arise where (he use of asbestos can save more lives than it can possibly endanger. Perhaps a reasonable perspective can be generated by a free and Crank discussion of risks between management and labour, replacing some of (he evasions of the past. 'Workers in general arc witting to take a calculated risk for the benefit of the community if they fed they have bad it frankly explained to them and if they have confidence that all reasonable practical measures are bong taken to protea them. Annotations MAN-POWER IN THE HOSPITAL SERVICES Management techniques developed by Industry for industry should, h is often urged, be adopted more widely m the health servicer. The analogy is far from complete, however, and nowhere more significantly chan hi the demand for, and supply of, man-power. In busi ness, once sales have been predicted, the needs for men, machines, and materials more or less fall into place: in the health services the nearest equivalent to sales-- demand for cue--has not behaved as expected (u Or. Robert Kemp shows on p. 1316). True, industry needs its quota of trained specialists, but on the whole its demands for education and formal preparation are much leu exacting than those of the hospital service, and re training plays an important role. Platform speakers at the animal conference of the Institute of Hospital Administrators, in London last week, indicated that the nature of the man-power prob lem varied from paint to point to the hospital service. The Minuter of Health, referring to the National Board for Prices and Incomes report oo psy and of mamad wotkers in public services, talked of overmanning: Prof A. L- d'Abreu felt certain that " we arc about to face an inevitable shortage of awliNi manpower "; while Mr. W. R. B. Robinson, from the Ministry of Labour, observed that recruitment ta the "H*fi nd dental services was ax a rate doae to thu implicit in the (now St-fined) National Plan. Professor d'Abreu did not hold out much hope when be re-tempbaaised thu the out put of our tnedkal schools would not faciTMc for some time and that countries such ss l"d might adopt a less permissive attitude to those of(heir gmdoates who stay oa in the U.K. and underpin its hospital service. Nor wss there much comfort in his sinister him that "... non- medical disciplines are naturally worried by the thought that... medicine seems to be having an unfair share of the todank cakt*M If these warnings are to be heeded, the .only short term cure it to make better use of what ii available. But to what extent are implications of Inefficiency true of the health services, remembering that criticisms of this type may be evoked simply because the means for necessary expansion ate missing ? No-one knows, nor does there yet seem to be a nationally coordinated effort to find out. Measuring the gaps and overlaps, and gM|vimvwtiwg (jo Hew Towns, for example) to find the meant to avoid them, is one of the most urgent tasks facing administra tors. But no scan can be made without adequate statistical information, for this is a major management cool, the sense of the conference wss that this information i, not sysicmstic^ly collected, at least as far as hospital man-power is concerned. A PENICILLIN AGAINST PSEUDOMONAS? The hactcria! infections which afflict man today might be divided into " wild ** and " domestic The former ate those from which the ciaitkal ideas of bacteriology were drawn: a virulent parasite plus a susceptible host equals disease. These diseases such as tuberculosis or gonoirhcea respond to modern treatment far better than could have been imagined in 1930, and they sake up only i small part of the time of the working bacteriologist. Today it is the domestic Infections which occupy him. These are not ** new " in the sense that they are caused by newly discovered organisms, but their prevalence and their interest have increased from a variety of causes. They art not specific infectiona (in which each organism causes its own assembly of symptoms) and they are often associated with a mixture of bacterial species. Many of the organisms are of endogenous origin; and host im munity seems to play a small part. They are not " caused " by antibiotics, but their occurrence is linked with the use of these drugs. The extermination of an organism by an antibiotic in vivo seldom results in sterility, but more usually an invasioa by an paganism resistant to the anti biotic. A change of antibiotic to deal with chi* secondary infection may result in a mum ofthe first organism or the establishment of a third. Whether healing results will depend oo the invarivcoess of the organism* and the general and local resistance of the body. Antibacterial measures slooc are no guarantee of cure. It is generally true of domestic infections that the organisms which cause them arc either naturally resistant to many of the more commonly used antibiotics or have acquired resist ance. Nowadays the published warnings of acquired resistance usually follow the launching of any new anti biotic by only a few months. Another characteristic of domestic Infections is they are common in hospitals. It is not only the varicose ulcer which is infected but the Hw, surgical wound, and the catrier-catc among the hospital staff of these strains resistant to many antibiotics is almost always far above that found in the population tt large. A partial explanation ofthe high incidence of these infections in bospiuds is dv age and conditions of the inmates. The susceptibility of the old to infection with the " hospital staphylococci** has often been noticed. Equally liable to infection are those with debSitating disease* such as or those tinder treatment with tteroidi. Not only have the doctor's drugs changed-- without doubt for the better--but so have his patients. Some of the difficulties in handling these domestic infections are illus(taxed in a paper on p. 1269 by Dr. Bramfitr and his colleagues. Few organisms give so much trouble in the wards u Prouus spp. and Pseudomonas acrufimna (pyocyarua). Both are responsible for intract able urinary infection and, while neither is usually thought of as a virulent organism, the second has been the cause of disasters in premature infants, after ophthalmic operations, and when introduced into the central nervous system. Either may be found in superficial infections or in the wintry trsa by itself or in conjunction with such organisms as a staphylococcus or Streptococcus fttealis. Because of the exuberant growth of the gram-negative