'Like a possession of the devil'. The diffusion of Nightingale nursing and Anglo-Australian relations

The main focus of this paper is on the difficulties Lucy Osburn experienced in transferring British ideals of Nightingale nursing to an Australian colony. Neither Nightingale nor Osburn allowed for the impact of colonial culture and politics on the nurses in Sydney. In particular, the improved economic and social prospects of the five nurses who accompanied Osburn had a profound impact on their behaviour. As well, the political ambitions of the two men responsible for the invitation to the Nightingale nurses, Henry Parkes and Alfred Roberts, remained dominant. Nightingale, on the other side of the world, could do little but acquiesce to colonial opinion. The paper describes how the endeavour in Australia progressed, what became of the careers and lives of the central participants and the impact it had on the development of nursing in both countries.

A "lamentable failure"? The founding of Nightingale nursing in Australia, 1868-1884

Florence Nightingale's private assessment was that Lucy Osburn failed in her attempt to found Nightingale nursing in Australia. This assessment is directly at odds with those of historians who have unquestioningly accepted Osburn's success. An alternative narrative of the founding of Nightingale nursing in Australia is provided through examining why Nightingale thought Osburn failed. The judgment of failure had little to do with nursing practice or care. Nightingale's judgment was based on the personal characteristics she expected of the Nightingale nurse and her fear of public exposure of problems at the Nightingale School of Nursing at St Thomas's Hospital.

Defining relationships and limiting power: two leaders of Australian nursing, 1868-1904

This paper analyses aspects of the relationship between nursing and medicine during 1868-1904, in terms of power, gender and authority. A biographical approach is used with a focus on two leading nurses in Australia and their relationship with two leading medical practitioners. The first nurse is Lucy Osburn, the figurehead of the first generation of Nightingale nursing in Australia. The second nurse represents the second generation when Nightingale nursing had largely won acceptance and was firmly established in Australian hospitals: she is Susan McGahey. Their main medical antagonists were Dr Alfred Roberts and Dr Anderson Stuart. A struggle over the control of nursing is evident in these relationships. The outcome transcended personalities, greatly influenced the structure of modern nursing, and marked the rising tide of medical domination in Australia.

Managing the patient with a chest drain: a review

This article describes a preliminary review of the literature on the nursing management of patients with chest drains before pursuing a systematic review of the evidence. Current evidence is patchy and the answers to basic questions are not easily identified. It is clear that further evidence must be gathered and critically appraised before definitive recommendations can be made.

Educating patients about congestive cardiac failure

This paper describes the knowledge nurses need to educate patients about congestive cardiac failure. Its definition is presented, along with careful examination of the process by which it occurs. This includes a presentation of the related physiologies of left and right heart failure and their causes. Diagnosis and prognosis are considered, followed by discussion regarding treatment and its aims. Finally the lifestyle changes for patients with congestive cardiac failure are summarised.

R-verapamil: pharmacokinetics and effects on PR interval, blood pressure and heart rate

1. This study in healthy normotensive male volunteers investigated the pharmacokinetics and the effects on electrocardiographic PR interval, blood pressure and heart rate of single oral doses of the single isomer R-verapamil (250, 500 and 1000 mg) in comparison to placebo and 240 mg racemic verapamil. 2. After 500 and 1000 mg R-verapamil there were significant prolongations in PR interval, maximal at 1-2 h after dosing and coincident with peak plasma drug concentrations, but these were not significantly different from the maximum prolongation obtained with 240 mg racemic verapamil. 3. After 1000 mg R-verapamil there was a significant hypotensive effect, particularly on standing. 4. Single doses of 500 and 1000 mg R-verapamil produced peak plasma drug concentrations in the range 1000-3000 ng ml-1. If this concentration range is appropriate for adjuvant cancer chemotherapy it can be predicted that similar steady state concentrations will occur with a dosage regimen of 300 mg 3 times daily.

Bioassay of transforming growth factor-beta activity in acidic protein extracts from primary breast cancer specimens

Acidic protein extracts have been made from breast tumour specimens, collected at the time of primary surgery. The extracts were partially purified by gel filtration and then tested for transforming growth factor-beta activity in a reproducible cell 3H-thymidine incorporation assay. Purified TGF-beta causes a reproducible increase in NRK colony formation and inhibits incorporation of 3H-thymidine by mink lung cells. However, some of the breast cancer extracts were stimulatory in the mink lung lung assay implying that a mitogenic factor like epidermal growth factor (EGF) was co-purified. Fourteen out of thirty extracts were scored positive for TGF-beta in the NRK colony forming assay and these tumours presented at an earlier clinical stage and were predominantly well differentiated.

The decline of myths and myopia? The use and abuse of nursing history

Since 1980 a 'new' history of nursing has been emerging, one that attempts to address serious problems within nursing historiography such as the subordination of nursing history to medical history. There is a need for nurses to reject the narrow celebratory narratives produced by typical amateur medical historians. While problems of 'outsiders' writing the history of professions have been highlighted, problems inherent in the production of their own history by 'insiders' have been overlooked. A critical approach to the history of nursing will display different qualities and emphases to most previous writing in this field.

The response of breast cancer cells to steroid and peptide growth factors

Four breast cancer cell lines covering a wide range of receptor characteristics were examined for their growth responses to oestradiol, insulin, EGF and the anti-oestrogen, tamoxifen. Stimulated cellular growth using both the MTT assay and 3H-thymidine incorporation into DNA, was measured against controls grown in a steroid reduced environment. The ER positive MCF-7 cell line showed clear growth responses to E2, insulin and EGF. This was also demonstrated, although to a lesser extent in the ZR-75-1 line which expresses lower levels of ER. In combination, these factors gave an additive growth response but the addition of EGF to maximal concentrations of insulin and oestradiol produced no further increase in growth. In contrast to these results, the two ER negative cell lines examined, MCF-7 Adr and MDA-MB-231 showed no growth response to exogenously applied steroids and in the case of MCF-7 Adr high concentrations of EGF were able to inhibit the growth of this cell line. They also showed high rates of growth in a steroid depleted environment which tends to suggest these cells are growing autonomously through autocrine growth factor induction.

Decreased NADPH:cytochrome P-450 reductase activity and impaired drug activation in a mammalian cell line resistant to mitomycin C under aerobic but not hypoxic conditions

Mitomycin C (MMC) is regarded as the prototype bioreductive alkylating agent in clinical use. To elucidate the biochemical basis of MMC resistance, we isolated a drug resistant derivative (designated CHO-MMC) of a Chinese hamster ovary cell line (CHO-K1) by exposure to progressively higher concentrations of MMC. CHO-MMC cells exhibited a 17-fold increase in resistance to MMC and were 33-fold cross-resistant to the monofunctional derivative, decarbamoyl mitomycin C. In contrast, CHO-MMC cells showed only a 2-fold level of resistance to BMY 25282, a more easily activated analogue of MMC, and exhibited parental sensitivity to MMC under radiobiologically hypoxic conditions. CHO-MMC cells showed no increased resistance to a range of DNA damaging agents including several other alkylating agents (e.g., melphalan and methyl methanesulfonate). Cross-resistance to drugs associated with the multidrug resistant phenotype (e.g., Adriamycin and vincristine) was present only at very low levels. Using a specific high performance liquid chromatography technique, we examined the rates of reduction of MMC and BMY 25282 in cell extracts from CHO-K1 and CHO-MMC cells under both aerobic (air) and hypoxic (N2) conditions. Reduction rates for both drugs were at least 30-fold faster under nitrogen than in air. Metabolism of MMC was undetectable in air but was readily detectable under nitrogen and was 2- 3-fold slower in CHO-MMC cell extracts than in CHO-K1 cell extracts. Although BMY 25282 was more readily reduced under nitrogen, no difference was detected between extracts from CHO-K1 or CHO-MMC cells in the rate of reduction of BMY 25282 under either air or nitrogen. The activity of NADPH:cytochrome P-450 (cytochrome c) reductase, an enzyme implicated in the bioreductive activation of MMC, was 3-4-fold lower in CHO-MMC cells than in the parental line. These findings suggest that the resistance of CHO-MMC cells to MMC under aerobic conditions may be due to impaired metabolic activation of the drug as a result of a decrease in NADPH:cytochrome P-450 reductase activity. This supports the view that decreased bioreductive enzyme activity may be a significant mechanism for acquired resistance to MMC in tumor cells in vivo and that more readily activated analogues may be potentially useful in overcoming this specific form of resistance.

The effects of three bioreductive drugs (mitomycin C, RSU-1069 and SR4233) on cell lines selected for their sensitivity to mitomycin C or ionising radiation

We have investigated the cross-sensitivity of a number of cell lines to three different classes of bioreductive drugs under both aerobic and hypoxic conditions. The cell lines used were selected for their sensitivity to DNA-damaging agents and fall into two groups. One group, MMC cells derived from CHO-K1 cells (Robson et al., 1985), show a range of sensitivities to mitomycin C in air. The second group, irs cells were cloned from V79 Chinese hamster fibroblasts (Jones et al., 1987) and exhibit sensitivity to ionising radiation. The sensitivity of both groups of cells to mitomycin C (MMC), RSU-1069 and SR4233 was assessed under aerobic and hypoxic conditions. No difference in aerobic or hypoxic toxicity of MMC was observed for CHO-K1 or MMC sensitive cell lines (MMC-2 and MMC-3). However, the MMC-resistant cell line (MMCr) was 10 times more sensitive under hypoxic than aerobic conditions. This suggests that MMCr cells lack or are deficient in the enzymes responsible for activating MMC under aerobic conditions compared to other MMC cells. In contrast, differential toxicities of between 3 and 30 have been observed for all CHO cells treated with RSU-1069 and SR4233. Treatment of V79 and irs cells with RSU-1069 and SR4233 also resulted in selective toxicity towards hypoxic cells. Differential toxicities between 50 and 100 were observed for V79 cells. For both RSU-1069 and SR4233, the hypoxic toxicities were similar in V79 and irs cells but in air, the radiation sensitive cells were up to 10 times more sensitive than wild type cells.

Enhancement of the anti-tumor effect of melphalan in experimental mice by some vaso-active agents

A comparison is made between the vaso-active agents hydralazine, nifedipine, and verapamil for their ability to increase the anti-tumor effectiveness of melphalan. Treatment of mice with hydralazine (5 mg/kg) 15 mins after melphalan increases by a factor of approximately 2.5 melphalan-induced delay in growth of either the RIF-1 or KHT tumors. Similar enhancements are obtained when measurement is made of the surviving fraction of tumor cells in vitro following treatment in vivo with hydralazine and melphalan. Further, tumor cell kill is also increased when nifedipine is administered with melphalan compared with the effect of melphalan alone. These enhanced effects are observed if the vaso-active agents are given before or after melphalan. Hydralazine (5 mg/kg) induces close to 100% radiobiological hypoxia in the RIF-1 and KHT tumors. In contrast, Nifedipine has no effect on tumor hypoxic fraction at a dose of 10 mg/kg although the anti-tumor effectiveness of melphalan is substantially increased. However, a higher dose of 50 mg/kg nifedipine causes a large increase in tumor hypoxic fraction, an effect that persists for several hours. Verapamil causes no change in the fraction of hypoxic cells in the KHT tumor and increases, only slightly, the anti-tumor effect of melphalan.

Induction of tumour hypoxia post-irradiation: a method for increasing the sensitizing efficiency of misonidazole and RSU 1069 in vivo

It is known that hydralazine can decrease blood flow to experimental murine tumours. A consequence of this, in the KHT sarcoma, is the induction of close to 100 per cent radiobiological hypoxia, which lasts for nearly 2 h following i.v. injection of 5 mg/kg hydralazine to the mouse. This phenomenon is exploitable in order to increase the apparent sensitizing efficiency of the nitroheterocyclic radiosensitizers, misonidazole and RSU 1069, and is demonstrated using the treatment schedule: sensitizer----60 min----X-rays----1 min----hydralazine. Such a strategy will first take advantage of the radiosensitizing properties of the nitroimidazole, then after irradiation the hydralazine should allow expression of the differential toxicity towards hypoxic cells known to occur with misonidazole and RSU 1069. Misonidazole gives an enhancement ratio (ER) of 1.3 at 100 mg/kg, rising to 2.0 at 1000 mg/kg. Where hydralazine is given after irradiation, no additional cell kill is observed with 1000 mg/kg. In contrast, at lower doses of misonidazole, hydralazine induces a substantial increase in cell killing such that the ER obtained with 100 mg/kg is the same as that achieved with 1000 mg/kg misonidazole when used alone with radiation. Similarly, 20 mg/kg RSU 1069 with radiation followed by hydralazine is equivalent to the radiosensitizing effect of 80 mg/kg RSU 1069 without hydralazine. In addition, doses of RSU 1069 that normally give no radiosensitization (5 or 10 mg/kg) produce substantial increases in cell killing when combined with hydralazine.

Potentiation of the anti-tumour effect of melphalan by the vasoactive agent, hydralazine

The vaso-active drug hydralazine causes a considerable increase in the cytotoxic effect of melphalan towards the KHT tumour in mice. The enhancement in response, measured as the concentration of melphalan required to achieve a given tumour response, is 3.0 and 2.35 when determined using the regrowth delay assay and the technique for determining surviving fraction in vitro following treatment in vivo respectively. In contrast, measurement of systemic toxicity shows that the addition of hydralazine only causes a small increase (ER = 1.15) in melphalan damage. This suggests that the drug combination may have some therapeutic benefit. The tumour specificity for the action of hydralazine is supported by the finding that binding of 3H-misonidazole is increased in tumours but not in other tissues when mice are treated with hydralazine. Increased binding of labelled misonidazole is associated with an increase in the level and duration of hypoxia, which will occur as a consequence of changes in tumour blood flow brought about by hydralazine. However, hypoxia per se is not responsible for the enhanced effect of melphalan, since the agent BW12C, which also induces substantial tumour hypoxia as a result of changing the O2 affinity of haemoglobin, has no effect on melphalan tumour cytotoxicity.

Cross-reaction in radioimmunoassay between human chorionic gonadotrophin and plasma from various species

Radioimmunological cross-reactions between human chorionic gonadotrophin and heterologous plasma and pituitary extracts from various species have been examined. Where serial dilutions of a sample do not yield a curve parallel with similar dilutions of the reference standard, quantitative estimations are not possible, but relative potencies can be determined. Such relative potencies against purified heterologous gonadotrophins may be useful for the study of species whose gonadotrophins have not been purified adequately for isotopic labelling in a species-specific radioimmunoassay.