100

application of current of varying voltage for a period of 30 to60 seconds. A control knob allows the therapist to alter thevoltage so that clonic movements can be reduced to a slighttwitching which indicates the course of the convulsion.Ectonus is a refined method which is both safer and moreeffective therapeutically than the traditional (" straight " or" one-shot ") E.C.T. In 1953 Dr. Russell and his colleagues 1described " itensified E.C.T." to which method later the term"

fused-dosage " or " interrupted fused-dosage " (LF.D.)was applied. Many of us who used it regarded this method asitself an improvement on the traditional method, but the sametherapists would probably now regard LF.D. as having beenfor the most part replaced by ectonus; but in acute mania, andsome emergencies such as threatened suicide or refusal offood, one might prefer i.F.D. to ectonus for its greater potencyand quicker results. No-one, I believe, with good experienceof the two newer techniques and who had used them in therecommended way, would ever want to return to the cruderolder method. But more than most, psychiatrists are slow tochange.

Just over a year ago a series of articles was publishedgiving a full account of the combination of ectonus E.C.T. withpromazine drugs, the name ectonus-promazine therapy or

E.P.T. being given"to this planned combination.2It is strongly recommended that, whether ectonus or other

technique is used, the electrical part of the combined treat-ment should be given intensively-i.e., on successive days.With ectonus the course on average would be one dose a dayfor seven successive days. This corresponds closely to whatJacoby 3 calls " regressive shock therapy," a method wherebyE.c.T. is given by intensive daily dosage to the extent of produc-ing a transient but severe confusional state. Dr. Jacoby’stechnique, however, involved the use of the older method ofE.C.T. With E.P.T. good and lasting recoveries are achieved,5and the period of confusion lasts only four or five days and ismuch less severe than that described by Dr. Jacoby. It is

important to note too that recovery of memory is rapid andcomolete.

ALLAN A. MACDOUGALL.Lennox Castle Hospital,

Lennoxtown,Stirlingshire.

1. Russell, R. J., Page, L. G. M., Jillett, R. L. Lancet, 1953, ii, 1177.2. MacDougall, A. A., Campbell, D. Nursing Mirror, 1957, 106, Nov. 29,

Dec. 6, 13.3. Jacoby, M. G. Brit. med. J. 1958. i, 282.4. Jacoby, M. G., Babikian, H. M. N.Y. St. J. Med. 1958, 58, 2965.5. MacDougall, A. A. Brit. med. J. 1958, i, 1180.

STAPHYLOCOCCAL INFECTION IN HOSPITALS

SIR,-Your recent editorials on problems of infectionin hospitals have been most praiseworthy. They haveperhaps been just a little above the head of one whois so little advanced that he is still at the stage of havingto battle with problems of ordinary domestic cleanliness;

but nevertheless your remarks not only are appreciatedbut also act as a stimulus to further efforts.

In an effort to get the walls of a hospital cleaned, Ihave been reduced to the somewhat dubious pastime ofwriting on the walls of the main corridors. Being a

progressive individual, I felt that I could combine in oneaction both a cleansing and an educational effect upon ouradministrators by writing in water on a background ofdirt the words shown in the accompanying photograph.

To illustrate further my difficulties I may add that myinitial efforts were not successful. The words were merelysmeared out, and the smears remained for ten days. Itwas only when I was observed by a member of the hos.pital administration actually having photographs takenthat something was done about it.You can easily imagine that at one stage in my cam.

paign I felt that I might have to emulate that eccentriccharacter of the time of the Great Plague, SolomonEccles, and face the management committee dressed in aloin-cloth and wearing on my head a brazier of live coalsshouting the words " After the Pestilence cometh theFire. Prepare to meet thy Doom ". I would be quiteprepared to do this if I thought it would do any good-which I doubt-but I feel sure that the support of youreditorials and valuable space will prove far more effective.

Meanwhile, just in case, my wife and daughter havestarted to knit me a loin-cloth.

Gateshead, Co. Durham. STANLEY WAY.STANLEY WAY.Gateshead,Co. Durham.

1. Mackay-Dick, J., Robinson, J. F. J. R. Army med. Cps, 1957, 103, 186.2. Hobson, A. C. M.D. Thesis, University of London, 1952.3. Hughes, W. D. Annual Report of Consultant Physician, FARELF, 1954.4. Fairburn, A. C., Semple, S. J. G. Lancet, 1956, i, 13.5. Trimble, A. P. Annual Report of Consultant Physician, FARELF, 1955;

Proc. R. Soc. Med. 1957, 50, 125.6. McCrumb, F. R. Amer. J. trop. Med. Hyg. 1957, 6, 238.7. Smith, J. Brit. J. industr. Med. 1949, 6, 213.8. Varfolomeeva, A. A. Soviet Med., Moscow 1951, 11, 29.9. Doherty R. L. Aust. Ann. Med. 1955, 4, 53.

" REGISTRAR PROBLEM "

SIR,-Have those who could act on the registrarproblem never read Twenty Years A-growing by MauriceO’Sullivan? In which the following truth is written:" Did you never hear how the life of man is divided? 1Twenty years a-growing, twenty years in blossom, twentyyears a-stooping and twenty years declining."

" NEARLY OUT OF BLOOM."

TREATMENT OF LEPTOSPIROSIS WITH

OXYTETRACYCLINE

SIR,-We were interested to read the article on lepto-spirosis by Dr. Russell (Nov. 29).

Factors governing the fall in the mortality of lepto-spirosis include (a) better diagnosis identifying mildcases previously unrecognised, and (b) early diagnosisfacilitating skilled medical and nursing care. Also ofmuch significance in the improved prognosis of severeleptospirosis is the skilled application of modern know-ledge in the early recognition of water and salt depletionand its remedy, and the maintenance of correct hydrationand electrolyte balance. No longer is it true to say, asone writer did less than a decade ago, that more lives arelost by intravenous fluid administration than are savedby it.Our decision not to have actual controls in our work was

deliberately taken. Much of the work on the diagnosis, clinicalmanifestations, and methods of treatment reported from post-war Malaya was done on security forces in British militaryhospitals.2-6 The annual reports of the successive consultant ’;physicians FARELF were a mine of information. Furthermore,we believed that there was sufficient evidence that penicillinwas effective in man, provided it was given early enough, oftenenough, and in adequate dosage. 7-9 Accordingly, as so muchwork had been done in the previous five years on securityforces in Malaya, from the same leptospiral environments thatwe were to draw our cases, we felt that the patients studied byour predecessors could act as phantom controls. Indeed, inthe original script on our work, reference was made to thesecontrols; but inadvertently it was not included in the work aspublished.