HOSPITAL COOKS AND COOKERY.
2
188 protection, and can only be guarded against by safe working methods adopted by the workers themselves and also by foremen and managers. Tnstances are quoted of the beneficial results of " safety-first " work ; both frequency rates and severity rates always fall. The outstanding wonder is that a policy which gives such great financial returns is being adopted with comparative slowness. One movement worthy of note as combining safety and health is the substi- tution of abrasive wheels for natural grindstones. The abrasive wheel is safer as regards accidents due to bursting, and does not, during grinding, generate fine silica dust; fortunately operations are performed better and more quickly on abrasive wheels. The abolition of the old-time grindstone and with it of " grinders’ rot "-i.e., tuberculous silicosis-cannot now be far distant. The increased demand for electric accumulators for wireless sets has led to adoption of new regulations to protect workers from lead poison- ing. Dust in cotton cardrooms has again called for investigation, as appliances, introduced 10 to 15 years ago for removing it, and with it " strippers’ asthma," have been losing their efficiency ; progress, in the light of experience gained, seems certain. More and more interest is reported to be taken in standards of illumination, and the department is lending scientific aid to employers to demonstrate how improvements may be effected ; already the minimum standards recommended by the Departmental Com- mittee on lighting are receding into the background as economically insufficient. THE ENGLISHMAN’S HEIGHT. WHAT is the height of the average Englishman ? I Is it changing gradually ? Is evolution, as tested by this and other measurements of the human body, proceeding in England to-day ? These are some of the questions which were discussed by Sir Arthur Keith in a recent paper before the Royal Institution of Great Britain, entitled Concerning the Rate of Man’s Evolution. The difficulties attendant on a biometric survey of any nation or group of nations are notorious. Before the war it was commonly supposed that the average English- man stood 5 ft. 8 in. in height, but figures gathered since have shown that is too high by at least 2 in. A popular pocket cyclopaedia gives the average height of a man as 5 ft. 7 in., and if the heights of children are considered, with which Sir Arthur Keith was not, incidentally, concerned, the discrepancies between various authorities are even more marked, for striking differences have been shown to exist for country and town children, rich and poor children, in the same country. If the different European nations are considered, figures from trustworthy sources go to show that the Belgian school-boy of 7, for example, is on the average 2 in. shorter than an English boy of the same age. These examples have been quoted to show how difficult it is to carry out satisfactory biometric investigations, even among living subjects, and when it comes to the measurement of fossilised remains, such difficulties are obviously accentuated. Putting aside these difficulties, how- ever, Sir Arthur Keith was concerned with the broad question of whether evolution is proceeding at an appreciable rate at the present day in this country. Here geological and anthropological evidence appears ’ to be at variance. On the one hand, the minute come I parison of 50 skulls taken from English graves known I to be at least 1000 years old with skulls of a corre- sponding number of men and women who had lived in England during the eighteenth and nineteenth centuries seemed to show that evolution is now at work in our midst. The palate presents the chief changes, and other modifications are seen in the e configuration of the bones of the nose and jaws. The cause for this appears to lie deeper than a mere disuse of the jaws, for the changes described appear 1 The World’s Health. May, 1924. Pp. 145. to affect about only 30 per cent. of the modern population, although all live on approximately the same dietary. Such biometric evidence, however, is distinctly opposed by certain geological dis- coveries, and particularly that at Galley Hill in 188, " The Galley Hill man," says Sir Arthur Keith. " was of the modern European type," and yet on geological evidence the stratum in which this skeleton was found fixes its age at hundreds of thousands of years, and even the more modern " cultural" " investigations, based upon the workmanship of the implements found in the same strata, would assign to the Galley Hill man an antiquity of 100,000 years. If the primitive human types discovered at Piltdown, Heidelberg, Java, and Rhodesia are considered in view of the fact that there is broad agreement as to the early dates at which these types lived, then evolution must have been comparatively rapid to produce modern man. As such anthropological evidence accumulates it forces the conclusion that the geological arguments connected with the Galley Hill man must be rejected. It is obvious, however, that much confusion still remains to be cleared up, and perhaps present-day anthropologists will consider their successors of many generations hence and bury an account of the measurements of an average Englishman of the twentieth century in the foundations of, say, a new Waterloo Bridge. HOSPITAL COOKS AND COOKERY. THAT hospital food is always monotonous and often badly cooked is a venerable complaint, sometimes true and sometimes less true. Of late, however, the diffi- culty of getting food for hundreds of people well cooked has been conspicuously less than that of getting it cooked at all. Most hospitals are finding that cooks, male or female, are exceedingly shy and elusive creatures, not easily tempted even by what would once have seemed a wickedly lavish display of Treasury notes. The Metropolitan Asylums Board, which has 19 large hospitals in its charge, has suffered sore things in its kitchens. In 14 of them there were 57 vacancies in six months; at one hospital the kitchen staff has been incomplete for nearly two years ; in another, over a period of 11 months no assistant cook could be induced to stay for more than a month. In some of these cases there may have been exceptional local drawbacks, but this unhappy experi- ence suggests either that there is something wrong with the pay or the conditions of service or that the expectations and outlook of the kitchen staff are unreasonable. However this may be, the Board have determined upon heroic measures. Cooking is to become (as it ought to be) a dignified service, almost, in fact, a learned profession. The invidious word " cook " is to be discarded ; the artists who have hitherto suffered under that designation will hence- forth be " kitchen-superintendents," and will have at their disposition aspir.ants for the cordon met with the title of " assistant-superintendents." These presiding officers of the kitchen (they are to be " qualified women ") will be paid 2200 a year, rising to 2220, they will have a month’s holiday in the year (about double the allowance of the doctor in the wards upstairs), and will be arrayed in a uniform the style and cut of which will probably require consideration as grave as that recently given to the outdoor costume of the registered nurse. "Kitchenmaid " has never had a very gracious sound-it conjures up too graphically visions of Shakespeare’s " greasy Jane that keels the pot," and it is now to be replaced by the more euphonious title of " kitchen-assistant," with jB55 a year " and all found attached to it. If by the establishment of a culinary hierarchy, in which " kitchen assistants " may become " assistant- super- intendents " and eventually " superintendents," the Asylums Board can solve its difficulties, it will have deserved well of all forms of " institution." Great numbers of clever and competent women, even when they hold a cookery certificate, find it impossible
Transcript of HOSPITAL COOKS AND COOKERY.
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protection, and can only be guarded against by safeworking methods adopted by the workers themselvesand also by foremen and managers. Tnstances are
quoted of the beneficial results of " safety-first "work ; both frequency rates and severity rates alwaysfall. The outstanding wonder is that a policy whichgives such great financial returns is being adoptedwith comparative slowness. One movement worthyof note as combining safety and health is the substi-tution of abrasive wheels for natural grindstones.The abrasive wheel is safer as regards accidents due tobursting, and does not, during grinding, generatefine silica dust; fortunately operations are performedbetter and more quickly on abrasive wheels. Theabolition of the old-time grindstone and with it of" grinders’ rot "-i.e., tuberculous silicosis-cannotnow be far distant. The increased demand for electricaccumulators for wireless sets has led to adoption ofnew regulations to protect workers from lead poison-ing. Dust in cotton cardrooms has again called forinvestigation, as appliances, introduced 10 to 15
years ago for removing it, and with it " strippers’asthma," have been losing their efficiency ; progress,in the light of experience gained, seems certain.More and more interest is reported to be taken instandards of illumination, and the department islending scientific aid to employers to demonstrate howimprovements may be effected ; already the minimumstandards recommended by the Departmental Com-mittee on lighting are receding into the backgroundas economically insufficient.
THE ENGLISHMAN’S HEIGHT.
WHAT is the height of the average Englishman ? IIs it changing gradually ? Is evolution, as testedby this and other measurements of the humanbody, proceeding in England to-day ? These are
some of the questions which were discussed by SirArthur Keith in a recent paper before the RoyalInstitution of Great Britain, entitled Concerningthe Rate of Man’s Evolution. The difficultiesattendant on a biometric survey of any nation orgroup of nations are notorious. Before the war itwas commonly supposed that the average English-man stood 5 ft. 8 in. in height, but figures gatheredsince have shown that is too high by at least 2 in.A popular pocket cyclopaedia gives the averageheight of a man as 5 ft. 7 in., and if the heights ofchildren are considered, with which Sir Arthur Keithwas not, incidentally, concerned, the discrepanciesbetween various authorities are even more marked,for striking differences have been shown to exist forcountry and town children, rich and poor children, inthe same country. If the different European nationsare considered, figures from trustworthy sources
go to show that the Belgian school-boy of 7, forexample, is on the average 2 in. shorter than an
English boy of the same age. These examples havebeen quoted to show how difficult it is to carryout satisfactory biometric investigations, even amongliving subjects, and when it comes to the measurementof fossilised remains, such difficulties are obviouslyaccentuated. Putting aside these difficulties, how-ever, Sir Arthur Keith was concerned with the broadquestion of whether evolution is proceeding at anappreciable rate at the present day in this country.Here geological and anthropological evidence appears ’to be at variance. On the one hand, the minute come Iparison of 50 skulls taken from English graves known Ito be at least 1000 years old with skulls of a corre-sponding number of men and women who had livedin England during the eighteenth and nineteenthcenturies seemed to show that evolution is now atwork in our midst. The palate presents the chiefchanges, and other modifications are seen in the econfiguration of the bones of the nose and jaws.The cause for this appears to lie deeper than a meredisuse of the jaws, for the changes described appear
1 The World’s Health. May, 1924. Pp. 145.
to affect about only 30 per cent. of the modernpopulation, although all live on approximatelythe same dietary. Such biometric evidence, however,is distinctly opposed by certain geological dis-coveries, and particularly that at Galley Hill in 188," The Galley Hill man," says Sir Arthur Keith." was of the modern European type," and yet ongeological evidence the stratum in which this skeletonwas found fixes its age at hundreds of thousandsof years, and even the more modern " cultural" "
investigations, based upon the workmanship of theimplements found in the same strata, would assignto the Galley Hill man an antiquity of 100,000 years.If the primitive human types discovered at Piltdown,Heidelberg, Java, and Rhodesia are considered inview of the fact that there is broad agreement as tothe early dates at which these types lived, thenevolution must have been comparatively rapid toproduce modern man. As such anthropologicalevidence accumulates it forces the conclusion thatthe geological arguments connected with the GalleyHill man must be rejected. It is obvious, however,that much confusion still remains to be clearedup, and perhaps present-day anthropologists willconsider their successors of many generations henceand bury an account of the measurements of anaverage Englishman of the twentieth century in thefoundations of, say, a new Waterloo Bridge.
HOSPITAL COOKS AND COOKERY.
THAT hospital food is always monotonous and oftenbadly cooked is a venerable complaint, sometimes trueand sometimes less true. Of late, however, the diffi-culty of getting food for hundreds of people wellcooked has been conspicuously less than that ofgetting it cooked at all. Most hospitals are findingthat cooks, male or female, are exceedingly shy andelusive creatures, not easily tempted even by whatwould once have seemed a wickedly lavish displayof Treasury notes. The Metropolitan Asylums Board,which has 19 large hospitals in its charge, has sufferedsore things in its kitchens. In 14 of them there were57 vacancies in six months; at one hospital thekitchen staff has been incomplete for nearly twoyears ; in another, over a period of 11 months noassistant cook could be induced to stay for more thana month. In some of these cases there may have beenexceptional local drawbacks, but this unhappy experi-ence suggests either that there is something wrongwith the pay or the conditions of service or that theexpectations and outlook of the kitchen staff are
unreasonable. However this may be, the Board havedetermined upon heroic measures. Cooking is tobecome (as it ought to be) a dignified service, almost,in fact, a learned profession. The invidious word" cook " is to be discarded ; the artists who havehitherto suffered under that designation will hence-forth be " kitchen-superintendents," and will haveat their disposition aspir.ants for the cordon met withthe title of " assistant-superintendents." Thesepresiding officers of the kitchen (they are to be" qualified women ") will be paid 2200 a year, risingto 2220, they will have a month’s holiday in the year(about double the allowance of the doctor in the wardsupstairs), and will be arrayed in a uniform the styleand cut of which will probably require considerationas grave as that recently given to the outdoor costumeof the registered nurse. "Kitchenmaid " has neverhad a very gracious sound-it conjures up toographically visions of Shakespeare’s " greasy Janethat keels the pot," and it is now to be replaced by themore euphonious title of " kitchen-assistant," withjB55 a year " and all found attached to it. If by theestablishment of a culinary hierarchy, in which" kitchen assistants " may become " assistant- super-intendents " and eventually " superintendents," theAsylums Board can solve its difficulties, it will havedeserved well of all forms of " institution." Greatnumbers of clever and competent women, even whenthey hold a cookery certificate, find it impossible
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to earn 2200 a year, plus board and lodging, and suchterms ought to attract a class which, in addition tobeing reasonable and contented, can cook a potato,and actually knows when a rice pudding is
" done."We understand that in some general hospitals anexpert " food adviser " has been appointed, whoseduties comprise the choice of an adequate variationof the diets, the collection of the food at the bestmarkets, and supervision of the kitchen staff, withthe responsibility for seeing that the food is efficientlycooked, and that it is served to the wards hot andconvenient for distribution to the patients.
POOR-LAW HOSPITALS AND TUBERCULOSIS.
REFORM of the Poor-law, although placed in theforefront of the political programme, has not yettaken very definite shape. The Minister of Healthannounced in Parliament on May 27th that he proposedto begin by transferring administrative functionswithout altering the present law. Two circulars(607 and 607A), dated July 21st, issued to boards ofguardians and municipal councils respectively, indicateone direction in which the Ministry of Health isproposing to secure effective cooperation within thelimits of the existing law. There are at present inPoor-law institutions a number of cases of -pulmonarytuberculosis at a stage which affords reasonableprospect of arrest of the disease. Such cases wouldbe better in a residential institution run by a localauthority under a tuberculosis scheme. To attainthis measure of cooperation the Ministry makes thereasonable suggestion to boards of guardians that theyshould appoint the local tuberculosis officer as con-sultant at the Poor-law institutions. The guardianswould then have the benefit of the clinical servicesof an officer with personal knowledge of the medicalhistory of the patient. The tuberculosis officer wouldbe requested to examine the. patient either beforeadmission or as soon as possible after admission tothe Poor-law hospital, with a view to consider whetherthe case is one for sanatorium treatment. TheMinistry goes on to advise boards of guardians,contemplating additional accommodation for tuber-culous patients, to consider whether this provisionshould not be ordinarily undertaken by county andborough councils. Further accommodation for thetreatment of non-pulmonary tuberculosis is earnestlycommended to the attention of these councils, as wellas a proper orthopaedic scheme for dealing with thecrippling deformities of children. The recommenda-tions of the Ministry, if carried out, will anticipatein one direction the need for Poor-law reform.
THE sudden death occurred last week at the ageof 67 of Mr. F. E. Beddard, D.Sc., for many yearsprosector to the Zoological Society of London.Frank Evers Beddard, who was educated at Harrowand New College, Oxford, made his first mark inscience as one of the naturalists who worked out thematerial collected by the Challenger expedition.3Zany of his contributions to mammalian anatomywere thoroughly original, and he was elected to theRoyal Society while quite a young man. He wrote Ithe volume on mammals in the Cambridge NaturalHistory, and several interesting monographs on suchsubjects as the classification of birds, the geographicaldistribution of animals, and the natural history ofwhales. To THE LANCET he sent frequent andilluminating notes on zoology, in which his use of Isimple language for the description of technical Imatter was remarkable.
INDEX TO " THE LAXCET," VOL. I., 1925. ITHE Index and Title-page to Vol. 1., 1925, which Iwas completed with the issue of June 27th, willshoitly be published. A copy will be sent gratisto subscribers on receipt of a post-card addressedto the Manager of THE LANCET, 1, Bedford-street,Strand, W.C. 2.
Modern Technique in Treatment.A Series of Special Articles, contributed by
invitation, on the Treatment of Medicaland Surgical Conditions.
CXXXII.THE TREATMENT OF EPIDEMIC DIARRHCEA.ALTHOUGH the prevalence of infantile diarrhoea in
the hot months has been noted for centuries, there isstill no common agreement as to its cause. While itis generally accepted that bottle-feeding, heat, andinfection all play a part, it is still a matter of disputewhether it is purely a zymotic disease or whetherthe remaining factors are primary. Probably themajority of cases are due to an extended form of thediarrhoea (usually fermentative) which occurs ininfantile dyspepsia and are, therefore, more in thenature of a chemical disturbance of digestion, ther6le of bacteria being only secondary. With the factsso uncertain, it is better, from the practical view-point, while taking every precaution to excludeextraneous infection (by milk, dirty utensils, and soforth) to pay equal attention to the composition ofthe food and, in particular, to the avoidance ofmixtures too rich in sugar, especially when combinedwith much fat. Lately, suspicion has been cast onthe whey.The fact that epidemic diarrhoea is limited to hot
weather makes it evident that the effects of a hightemperature must be accounted the most importantof exciting causes. It is probable that heat not onlyinfluences unfavourably the digestion and absorptionof food, but also by depressing vitality helps tolower the power of resistance.
The Clinical Picture.The clinical picture varies according to the severity
of the condition. In the milder cases the diarrhoeais accompanied by slight fever without much generaldisturbance. - In the more severe types, of which the" choleraic " represent the extreme, the symptoms losetheir purely alimentary character and become wide-spread. This change is dependent mainly upon lossof fluid and upon toxic absorption. Evidences ofthis are found in the rapid loss of weight, inelasticskin, pinched features, sunken eyes and depressedfontanelle, rapid feeble pulse, and anuria. Toxicsymptoms are chiefly conspicuous in the nervoussystem in the form of restlessness, drowsiness, andfinally coma. Another leading symptom of thisclass may be
" air hunger," evidenced by rapid, deep,and often irregular breathing. In detailing thera-peutic measures one would first urge the necessityboth of studying the clinical picture as a guide totreatment and of watching these patients from hourto hour, in view of the rapid advance.
There are two distinct phases-the acute one,where the main indication is elimination by stoppingall food and evacuating the bowel; and the later one,which the main problem is to find a suitable diet.
I The Zt2a7tcagemezt of a Case.1. General Measures.-If there is much collapse a
mustard bath (at 100° to 105° F.) should be given.After this the child should be put to bed and keptwarm in a well-ventilated room or even in the freshair. The clothing should be light, and scrupulouscleanliness in the child’s person should be secured.Napkins must be changed frequently and removedfrom the room. Excoriation of the buttocks can beprevented by cleanliness and the use of starch andboric powder ; in the event of the buttocks becomingsore an efficacious application is lime-water and oliveoil in equal parts. The baby should be bathed twice
l daily with tepid water and the mouth carefully; swabbed with cold water.l 2. Elimination.-If there is abdominal distension, with fever and offensive stools, castor oil should be
given, or, if this is vomited, calomel gr. may be
