RADIOGRAMS OF THE LUNG IN PNEUMONIA
Transcript of RADIOGRAMS OF THE LUNG IN PNEUMONIA
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company-which was an institution run on business Ilines-might make an experiment with a well-thought-out scheme in some secluded local community. In
Bdiscussing Lord Dawson’s paper, Sir Alfred Watsonpointed out the difficulty from the commercial point Iof view for an insurance company in fixing satisfactory
Ipremiums to secure the cost of medical benefits in afamily; for the increasing cost, following continuedmedical improvements, opened up the possibility of Ifuture loss. But in some form or another we trustthat Lord Dawson’s suggestion may take concreteshape.
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Annotations.
SMOKE ABATEMENT.
" Ne quid nimi!!."
THERE is general agreement that a smoke-pollutedatmosphere not only interferes with the amenities oflife but also affects the health of the community.
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Tn summarising the annual health reports of thevarious districts we have frequently drawn attentionto the higher death-rates from respiratory diseases,when town is compared with country and when adirty-aired town is compared with a clean-aired town.Estimates are put forward from time to time to showthat most of the smoke pollution in industrial towns,perhaps two-thirds or three-quarters, is caused bydomestic fires. It is somewhat difficult to reconcilethese estimates with the smoke-palls and gloom of,say, the manufacturing towns of Lancashire and theWest Riding as compared with the comparativelydean air of towns such as Derby, Leicester, Notting-ham, and Swindon. But perhaps it is waste of timeto endeavour to apportion the blame accuratelybetween domestic and industrial smoke, for both aregross offenders. It is hardly questioned now that,except for a few metallurgical processes, industrialsmoke is unnecessary. Chimneys serving boiler-furnaces where proper appliances and adequateplant are provided need not offend if due care isexercised by the stokers. Thus, with a trifling altera-tion in the law, industrial smoke might be a thing ofthe past if local authorities, stimulated by the Ministryof Health and backed by an enlightened public.opinion, would but do their duty. At the recentconference in Manchester, promoted by the SmokeAbatement League, every phase of the question was.discussed, and the proposition was laid down that in’order to get the public to use a smokeless fuel theprice of such fuel must not exceed that of coal. Itwas further shown that progress was being madetowards the production of such a smokeless fuel fordomestic use. Dr. H. Osborne, medical officer ofhealth for Salford, makes a valuable contribution tothe whole subject in his annual report for 1923. Heemphasises the working man’s liking for the cheerfulblaze of the open fire, and states its advantages overthe gas-fire on health grounds as a promoter ofventilation and a useful destructor for house refuse.His remedy for domestic smoke is therefore theprohibition of the burning of raw coal in open grates.and the substitution of a smokeless fuel. One suchproduct he has recently tested. It gave a beautiful,glowing fire, burned away without any attention toa. soft powdery ash, and gave off no smoke. He doesnot mention, however, how this fuel is likely to com--pare in price with raw coal. Dr. Osborne mentionsthe health value of the visible rays from an open fire,but presumably the gas fire would retain this value. Gashas the advantage over other fuels in its comparativefreedom from sulphur products. He further statesthat the gas-fire is a poor ventilator, that there is amuch larger proportion of carbonic oxide in its fluegases, and that the danger of down-draught bringingcarbon monoxide into the room is considerable. Werecognise that there is much carelessness in thefixing of gas fittings. They are frequently fixed with-out proper flues, and no adequate attention is given
to the important matter of testing the gas fittingsfor leaks. Every gas company should in return forits monopoly have placed upon it the statutoryobligation to test for leaks on request and in returnfor a reasonable fee. As was pointed out frequentlyin the recent conference at Manchester, the first stepin securing cleaner air is to convince the public thatdomestic smoke is unnecessary, and that the air ofour towns might be nearly as clean as the air of thecountry. When a powerful educated public opinionhas been created, we feel sure that the competitionbetween the producers of electricity, gas, and smoke-less fuel will meet the demand.
RADIOGRAMS OF THE LUNG IN PNEUMONIA.
La Semana llTedica. gives, in a recent issue,what Dr. Carlos Hensen, the writer, probablywith justice claims to be unique, a series ofeight plates of the lung in an attack of acutelobar pneumonia. They were taken in a periodof 12 days (the first apparently within a fewhours of the initial rigor) at the patient’s request, andthey illustrate the condition as shown by X rays onthe first, second, fourth, sixth, eighth, ninth, tenth,and twelfth days, but the exact date of the last is notgiven. They form a very interesting series, thoughnot adding anything material to our knowledge ofthe pathology of the disease. Perhaps the mostinteresting point is the very considerable enlargementof the mediastinal glands, which shows after the lunghas practically cleared up. This glandular enlarge-ment does not reach its maximum till after the diseasehas begun to subside and is most prominent in thelast picture of the series. The other point is that theconsolidated area as seen extends well over to theright side of the vertebral column. This accords withthe clinical fact that tubular breathing is so frequentlyheard along the paravertebral border of the unaffectedside without implying any bilateral involvement.The series is worth studying, if only as illustrating thecomplete accord of the X ray and clinical findings,and is likely to remain unique owing to the rarity ofthe circumstances which would justify taking radio-grams in acute pneumonia.
TUBERCULOSIS DISPENSARIES IN FRANCE.
THE high tuberculosis death-rate from which Francehas suffered for many years appears to be decliningas a sequel if not a result of the well-directed impulsegiven to the anti-tuberculosis movement by theRockefeller Foundation. The work of French organisa-tions has also been remarkably successful in severalinstances, and an account published by Prof. P.Courmont in the Journal de Medeeine de Lyon forOctober shows, among other things, how direct therelation may be between tuberculosis dispensary workon the one hand and the decline of the tuberculosisdeath-rate on the other. The first dispensary inLyons was established in 1905 in cooperation withthe Bacteriological Institute. After 1917 several newdispensaries were established, a total of seven beingprovided up to the present time. The functions ofthese dispensaries are much the same as those in thiscountry ; examinations are made and advice is givenin the dispensary itself, whence visiting nurses,numbering 18, go to the patients’ homes and help withadvice and in other ways. The dispensaries also pro-vide for disinfection of rooms, furniture, and clothing,help to transfer infants from infected to healthyhomes, and keep in touch with the school medicalservice. Altogether there are more than 500, tuber-culosis dispensaries in France, and if the resultsobtained by the dispensaries in Lyons are a truesample of the achievements of the French dispensariesas a whole, it is obvious that they are carrying out amost excellent work at an amazingly small cost.In 1923 the annual cost per patient treated’by thedispensaries in Lyon was less than 100 francs. In thesame period 2049 children were attended to, as many