1415

patterns both containing 28% of calories from fat, one ofwhich was richer in polyunsaturated fatty acids. Underthe condition of the experiment there was no significantdifference between these two subgroups, and the degree ofunsaturation did not seem to influence serum-cholesterollevels or mortality. While these results suggest that

dietary measures may be effective in controlling hyper-lipidxmia, the problem remains of adherence to suchrestrictions for long periods; and it may be, as Olivermaintains.,2 that the use of a pill or capsule such asclofibrate is a more realistic approach.

BEDS IN SPAIN

A HEALTH service must know, or at least make credibleassumptions about, the number of beds it should provide.Obviously the number of acute beds needed depends onhow they are used and whether treatment is also offeredat home, convalescent hospitals, or rehabilitation centres;and many attempts have been made to find, if not a scien-tific, at least a calculated basis for the number of acutebeds needed by the N.H.S. The results have achieved astaggering inconsistency because no two studies had thesame conception of what was an acute bed, nor made thesame assumptions of the effect of supporting services orother types of beds. Despite this, the Ministry of Healthbased the 1966 revision of the Hospital Plan on a norm of3-3 acute beds per 1000 population. To its credit, inplanning the experimental hospitals at Frimley and BurySt. Edmunds, it recognised the fallacies attending a fixednorm and altered the rules of play in its own favour.

Making the assumption, still to be proved financially andadministratively attainable, that other services can bemoved into a higher gear, the Ministry is now happilyplanning on a norm of 2 acute beds per 1000 population.Another effort to reconsider the problems of bed-use asa basis for future practice is therefore timely, and theScottish Hospital Centre’s proposals are interesting.The Scottish team believes that bed provision must be

based on more knowledge of current practice in bed useand of the possibilities of progressive patient care.

Accordingly it embarked on an investigation into 4350acute beds in forty-two Scottish hospitals, ranging fromteaching hospitals to small general hospitals. Each patientin these beds was seen and classified in terms of medicaland nursing dependency, and the team may well be rightin thinking that they secured more consistent results thanin surveys based on questionaries. Some 30% of thepatients in teaching hospitals and 36% of those in a dis-trict general hospital could have been looked after in

simpler, cheaper, and more lightly-staffed " supporting "

beds if these were available. The survey did not confirmthat a large number of acute beds were blocked by long-term geriatric patients.

Supporting beds which would relieve the load on acutebeds can, of course, be supplied in many ways-from theold-style convalescent hospital to the modern reablementunit and day ward-but to be fully effective they shouldbe adjacent to the acute wards. Practical experience ininducing doctors to relieve pressure in overcrowded wardsby using vacant accommodation even a few miles distantis not encouraging. The team’s hypothetical solution,1. " Hostels " in Hospitals? By J. S. MEREDITH, M. A. ANDERSON, A. C.

PRICE, and J. LEITHEAD. London: Oxford University Press for theNuffield Provincial Hospitals Trust. 1968. Pp. 175. 21s.

based on their factual findings, is a supporting-bed unitof 100 beds attached to a medium or large district generalor teaching hospital and designed to house mainly ambu-lant patients, capable of looking after themselves, andneeding little nursing and medical care. Provision is madefor a few single rooms and 38 " roomettes ". (The sensi-bilities of the Scots in the use of language seem to havebeen dulled.) The cost of such a unit is assessed at E1190per bed as against E1732 per acute bed (of Building Notestandard), with a nurse/patient ratio of 1 to 7-7 as

against nearly 1/1. Corresponding reductions would bepossible for other grades of staff. Undoubtedly a support-ing unit of this kind could be an asset to an overcrowdedgeneral hospital, but it would demand a high quality ofadministration to ensure that the supporting beds wereused intelligently and consistently for the right patientsand not allowed to disappear, as second-rate accommoda-tion, in the general pool of beds in the hospital.

ORF

THERE is a bit of the collector in most of us. Anuncommon disease, even though it carries no risk to life orlimb, sticks in the memory and if it is one derived fromfarm animals it brings a welcome whiff of sweat and thehayfield into the outpatient department. So it is thatfew doctors forget their first patient with contagiouspustular dermatitis of sheep or, if Anglo-Saxon be

preferred, orf. It is primarily a disease of lambs and itis prevalent in the spring. In spite of its name it affectsthe mucosa rather than the skin. In the absence of

secondary bacterial infection it kills very few, but itchecks growth and " pulls them down ". Humans

acquire the disease by handling infected lambs. It

appears as a raised maculopapule, usually single and onthe fingers or forearm. After 10-14 days a nodule

develops with a weeping centre which later is covered

by a crust and ultimately disappears leaving slightscarring. Malaise and fever are uncommon and the lesionis seldom acutely painful. The cause is a specific virusof the pox group which can be isolated on human amnioncells or, more rapidly and conveniently, recognised by acharacteristic shape and pattern under the electron

microscope.1 Serological tests are available, but, beingretrospective, they are usually less useful.There are six or more pox viruses more or less specific

to individual species of farm and domestic animals.Those which cause vaccinia, orf, and milker’s nodes

(which is the same as or very closely related to that whichcauses orf) can produce accidental infection in man andit is possible that some of others do so. An orf-like

lesion, quite distinct in appearance from milker’s nodes,is sometimes seen in men who handle cattle but have nocontact with sheep. (Investigation of infections of thissort is often delayed until the ulcerated swelling has failedto yield to homely remedies or an antibiotic ointment).The experts can distinguish these pox viruses by electronmicroscopy, by their habits of growth on tissue-cultures,and by serology but, with experience, the characters ofthe disease which they produce in their natural hostsand in man can commonly be distinguished by the nakedeye. A- paper 2 from Kentucky now shows that thesedifferences are founded on differences in the histological1. Naginton, J., Newton, A. A., Horne, R. W. Virology, 1964, 23, 461.2. Leavell, U. W., Jr., McNamara, M. J., Muelling, R., Talbert, W. M.,

Rucker, R. C., Dalton, A. J. J. Am. med. Ass. 1968, 204, 657.