THE HOSPITALS OF LONDON.
1
408 speaking from his exceptionally large experience, agreed with Dr. James that at present there was no means of arriving at a satisfactory prognosis. Our ignorance in this matter comes partly from not knowing the relative aetiological importance of such factors as heredity, overwork, emotional stress, septic foci, and unhealthy environment, all of which may play their part. Dr. A. A. Petrie remarked that the examinations which appeared to precipitate the attack were usually not of an exacting standard, and suggested that the cause of the trouble was the attempt to do too much. Such attempts-perhaps fortunately for the race-are exceedingly common in the adolescent, as, indeed, are all sorts of " abnormal " behaviour. There is reason, however, for taking them seriously, and ideally speaking, the child whose progress does not seem to be satisfactory should always be under the watchful though inconspicuous care of an expert, who can distinguish true danger-signals from develop- mental will-o’-the-wisps. HEALTH OF THE ROYAL AIR FORCE. DURING 1926 the average strength of the R.A.F. was 32,985 men, which was almost the same as in the previous year, and the statistics of illness are very similar.l Compared with the other ranks officers suffered slightly less from disease, but very much more from accidents, of which 112 proved fatal in the Force as a whole. Two-thirds of these occurred in flying, but although the number remains large, it is decreasing in relation to the number of hours flown. The mortality from disease was low, the chief causes being pneumonia and pulmonary tuberculosis, each of which caused six deaths. A small epidemic of diphtheria occurred in the neighbourhood of Halton in Buckinghamshire, and the 1742 apprentices at the station were Schick-tested and, where necessary, immunised. No case of diphtheria developed among them, but there was a small outbreak of scarlet fever, which seemed to be milk-borne. In Iraq, whence most of the cases of dysentery were reported, 31 carriers were found among the personnel handling food. In the same country there was an increase of malaria as a result of floods, and heat-stroke caused five deaths, four of the patients having hyperpyrexia and lingering on for many days. At one time the temperature was over 120 °F in the shade, and humidity was high. In Iraq 130 patients were carried by aeroplane, 82 of them in air-ambulances. Food-poisoning did not occur because, it is thought, inspection is so careful. In the selection of personnel much reliance is placed on the " flying aptitude " apparatus, which measures reaction-times, and quickly gives an estimate of the probable efficiency as an aviator of a candidate or of an officer under training. This estimate is surprisingly similar to that reached by a good instructor after his longer period of observation. Tests of this kind also help good men to improve, and are of great use in estimating the degree of recovery reached by convales- cents after slight concussions, showing when they may be allowed to fly again. THE HOSPITALS OF LONDON. IT is now becoming widely recognised, as our correspondence columns testify, that any large decisions about the relations between voluntary hospitals and public authorities will have an important influence on the future of the medical profession, and as Dr. F. N. Kay Menzies pointed out at a council meeting of the Charity Organisation Society on Feb. 13th the problems involved are far too big and important to be dealt with on purely partisan or political lines. Speaking not as the medical officer of health to the London County Council, but rather as a private individual, Dr. Menzies reviewed the situation as he sees it to-day, and brought forward cogent arguments in favour of the cooperation which he 1 Health of the Royal Air Force, 1926. H.M. Stationery Office. believes necessary. Although, he said, nearly 70 per cent. of the voluntary hospitals were able to pay their way in 1926, as compared with 44 per cent. in 1920, there was an admitted shortage of 12,000 beds, to meet which a capital expenditure of at least 8 million pounds would be needed, and an additional mainten- ance charge of 1 to 2 millions per annum. There was, moreover, a steady increase in demand for hospital beds, owing to the constant introduction of new methods of diagnosis and treatment, and it was evident that the burden of providing the required accommodation was becoming too great for the voluntary hospitals to bear alone. The burden was, in fact, being shifted, for whereas at the beginning of the century the public health authorities were con- cerned solely with problems of communal hygiene, they were now undertaking more and more the treat- ment of the individual. The poor-law authorities of London, including the Metropolitan Asylums Board, now provided nearly 80,000 beds for the treatment of the sick, and public bodies undertook out of public funds the institutional treatment of nearly five-sixths of the sick in London. If the Minister of Health’s proposals for poor-law reform came into operation, over 100,000 beds would come under the single control of the London County Council, who would then have eight times as many beds at their disposal as were contained in all the voluntary hospitals of London. It would be absurd, said Dr. Menzies, to suppose that such a change would not affect the latter, for without cooperation it would mean, in the end, their extinction. Fortunately such cooperation was not impossible- indeed it had already begun-and he was unable to understand why a thoroughly practical scheme could not be devised, by which the voluntary hospitals and the public authorities concerned with the prevention and treatment of disease might work harmoniously together. ____ B.C.G. IN THE LABORATORY. A FEW weeks agolwe commented on some Japanese investigations on the power of B.C.G. vaccine to protect guinea-pigs against tuberculosis, and it is interesting to find in the British Journal of Experi- mental Pathology for February an account of similar experiments by Dr. C. C. Okell and Dr. H. J. Parish, of the Wellcome Physiological Research Laboratories. Their object was to repeat Prof. A. Calmette’s original observations, and the work was divided into four experiments, in which guinea-pigs were given B.C.G. intravenously or subcutaneously, and were later tested for immunity to virulent infection. A period of 5 to 12 weeks was allowed for the development of this immunity, and suitable controls were employed throughout. On the whole the results may be regarded as satisfactory, and Dr. Okell and Dr. Parish say that from their experiments " it seems clear that by means of B.C.G. guinea-pigs can be partially and in some cases completely protected from infection with a dose of virulent bacilli." There is no reasonable doubt, they consider, that the vaccine gave rise to a significant immunity, but they are not prepared to say that as a means of prophylaxis B.C.G. proved better than other vaccines which have had their vogue in the past. The best results were obtained in the last experiment, when a minimal infecting dose was used, and in this group 27 per cent. of the animals were completely protected. The vaccinated guinea-pigs either showed no recog- nisable sign of tuberculous infection, or else were found to have generalised tuberculosis similar to that seen in the controls. The vaccine itself never seemed to produce any of the lesions of the disease during the period of experiment, but attention is drawn to a statement by S. A. Petroff, A. Branch, and W. Steenken.2 that they were able to obtain virulent " variants " from cultures of B.C.G. This suggests that the attenuated organism is capable of dangerous reversion, but Dr. Okell and Dr. Parish, in view of the fact that it proved harmless in their own experiments, 1 THE LANCET, Jan. 14th, p. 92. 2 Proc. Soc. Exp. Biol. and Med., 1927, xxv., 14.
Transcript of THE HOSPITALS OF LONDON.
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speaking from his exceptionally large experience,agreed with Dr. James that at present there was nomeans of arriving at a satisfactory prognosis. Ourignorance in this matter comes partly from notknowing the relative aetiological importance of suchfactors as heredity, overwork, emotional stress, septicfoci, and unhealthy environment, all of which mayplay their part. Dr. A. A. Petrie remarked that theexaminations which appeared to precipitate the attackwere usually not of an exacting standard, and suggestedthat the cause of the trouble was the attempt to dotoo much. Such attempts-perhaps fortunately forthe race-are exceedingly common in the adolescent,as, indeed, are all sorts of " abnormal " behaviour.There is reason, however, for taking them seriously,and ideally speaking, the child whose progress doesnot seem to be satisfactory should always be underthe watchful though inconspicuous care of an expert,who can distinguish true danger-signals from develop-mental will-o’-the-wisps.
HEALTH OF THE ROYAL AIR FORCE.
DURING 1926 the average strength of the R.A.F.was 32,985 men, which was almost the same as in theprevious year, and the statistics of illness are verysimilar.l Compared with the other ranks officerssuffered slightly less from disease, but very much morefrom accidents, of which 112 proved fatal in the Forceas a whole. Two-thirds of these occurred in flying,but although the number remains large, it is decreasingin relation to the number of hours flown. Themortality from disease was low, the chief causes beingpneumonia and pulmonary tuberculosis, each ofwhich caused six deaths. A small epidemic ofdiphtheria occurred in the neighbourhood of Haltonin Buckinghamshire, and the 1742 apprentices at thestation were Schick-tested and, where necessary,immunised. No case of diphtheria developed amongthem, but there was a small outbreak of scarlet fever,which seemed to be milk-borne. In Iraq, whence mostof the cases of dysentery were reported, 31 carrierswere found among the personnel handling food. Inthe same country there was an increase of malaria asa result of floods, and heat-stroke caused five deaths,four of the patients having hyperpyrexia and lingeringon for many days. At one time the temperature wasover 120 °F in the shade, and humidity was high.In Iraq 130 patients were carried by aeroplane, 82 ofthem in air-ambulances. Food-poisoning did notoccur because, it is thought, inspection is so careful.In the selection of personnel much reliance is placedon the " flying aptitude " apparatus, which measuresreaction-times, and quickly gives an estimate of theprobable efficiency as an aviator of a candidate or ofan officer under training. This estimate is surprisinglysimilar to that reached by a good instructor after hislonger period of observation. Tests of this kind alsohelp good men to improve, and are of great use inestimating the degree of recovery reached by convales-cents after slight concussions, showing when they maybe allowed to fly again.
THE HOSPITALS OF LONDON.
IT is now becoming widely recognised, as our
correspondence columns testify, that any largedecisions about the relations between voluntaryhospitals and public authorities will have an importantinfluence on the future of the medical profession, andas Dr. F. N. Kay Menzies pointed out at a councilmeeting of the Charity Organisation Society on
Feb. 13th the problems involved are far too big andimportant to be dealt with on purely partisan or
political lines. Speaking not as the medical officer ofhealth to the London County Council, but rather asa private individual, Dr. Menzies reviewed thesituation as he sees it to-day, and brought forwardcogent arguments in favour of the cooperation which he
1 Health of the Royal Air Force, 1926. H.M. StationeryOffice.
believes necessary. Although, he said, nearly 70 percent. of the voluntary hospitals were able to pay theirway in 1926, as compared with 44 per cent. in1920, there was an admitted shortage of 12,000 beds,to meet which a capital expenditure of at least 8 millionpounds would be needed, and an additional mainten-ance charge of 1 to 2 millions per annum. There was,moreover, a steady increase in demand for hospitalbeds, owing to the constant introduction of newmethods of diagnosis and treatment, and it wasevident that the burden of providing the requiredaccommodation was becoming too great for thevoluntary hospitals to bear alone. The burden was,in fact, being shifted, for whereas at the beginning ofthe century the public health authorities were con-cerned solely with problems of communal hygiene,they were now undertaking more and more the treat-ment of the individual. The poor-law authorities ofLondon, including the Metropolitan Asylums Board,now provided nearly 80,000 beds for the treatment ofthe sick, and public bodies undertook out of publicfunds the institutional treatment of nearly five-sixthsof the sick in London. If the Minister of Health’sproposals for poor-law reform came into operation,over 100,000 beds would come under the single controlof the London County Council, who would then haveeight times as many beds at their disposal as werecontained in all the voluntary hospitals of London. Itwould be absurd, said Dr. Menzies, to suppose thatsuch a change would not affect the latter, for withoutcooperation it would mean, in the end, their extinction.Fortunately such cooperation was not impossible-indeed it had already begun-and he was unable tounderstand why a thoroughly practical scheme couldnot be devised, by which the voluntary hospitals andthe public authorities concerned with the preventionand treatment of disease might work harmoniouslytogether. ____
B.C.G. IN THE LABORATORY.
A FEW weeks agolwe commented on some Japaneseinvestigations on the power of B.C.G. vaccine toprotect guinea-pigs against tuberculosis, and it isinteresting to find in the British Journal of Experi-mental Pathology for February an account of similarexperiments by Dr. C. C. Okell and Dr. H. J. Parish,of the Wellcome Physiological Research Laboratories.Their object was to repeat Prof. A. Calmette’s originalobservations, and the work was divided into fourexperiments, in which guinea-pigs were given B.C.G.intravenously or subcutaneously, and were latertested for immunity to virulent infection. A periodof 5 to 12 weeks was allowed for the development ofthis immunity, and suitable controls were employedthroughout. On the whole the results may be regardedas satisfactory, and Dr. Okell and Dr. Parish say thatfrom their experiments " it seems clear that by meansof B.C.G. guinea-pigs can be partially and in somecases completely protected from infection with a doseof virulent bacilli." There is no reasonable doubt,they consider, that the vaccine gave rise to a significantimmunity, but they are not prepared to say that as ameans of prophylaxis B.C.G. proved better than othervaccines which have had their vogue in the past. Thebest results were obtained in the last experiment, whena minimal infecting dose was used, and in this group27 per cent. of the animals were completely protected.The vaccinated guinea-pigs either showed no recog-nisable sign of tuberculous infection, or else werefound to have generalised tuberculosis similar tothat seen in the controls. The vaccine itself neverseemed to produce any of the lesions of the diseaseduring the period of experiment, but attention isdrawn to a statement by S. A. Petroff, A. Branch, andW. Steenken.2 that they were able to obtain virulent" variants " from cultures of B.C.G. This suggeststhat the attenuated organism is capable of dangerousreversion, but Dr. Okell and Dr. Parish, in view of thefact that it proved harmless in their own experiments,
1 THE LANCET, Jan. 14th, p. 92.2 Proc. Soc. Exp. Biol. and Med., 1927, xxv., 14.
