Convalescence and Sick Leave in the Army.

760 Association on Thursday, April 1st, when he made possible, but it will be mainly to convalescent a statement which should, in our opinion, go institutions that he will go. Private hospitality is far to clear up the existing difficulties. Dealing too devoid of regulation to be useful, while the-unin the first place with the widespread conviction satisfactory nature of the food in the homes of the that there was an abundant surplus of medical soldiers on sick furlough makes reception by their officers in some places at home, he pointed out that families inadvisable. There is perhaps no subject upon which medical such surplus was only apparent, and that there advice is more frequently sought than the question was a place for every one of the men now holding commissions to serve with units which would be of the best method of bridging over the interval sent abroad probably in a very short time. He which must occur between the bed of sickness and assured the meeting that when everything that dis- the activity of daily life. For ordinary patients tribution could effect had been done, there would this interval is half way between the control of the remain a serious shortage of whole-time medical physician and the resumption of whatever free will officers to serve with the troops wherever they might is permitted by the ordinary occupation. During be sent. He then made the statement, which appears the interval the control of authority is relaxed to some extent, while by degrees the convaon p. 775 of this issue of THE LANCET, wherein, while assistance the warmly acknowledging already lescent man feels that, with returning strength, received from the civil medical practitioners of the he is fit to run alone. Though the control country, he accepted the fact that the help now is relaxed advice is desired. The medical man required must be given upon the part-time is asked where the time of convalescence should principle. Mr. T. JENNER VERRALL, the Chairman be spent, how the days should be occupied, of Representative Meetings of the British Medical what treatment, if any, should be continued, what Association, promised that the Association would rules of life should be followed. The answers to do all in its power to arrange some scheme of all these questions are dependent on the nature of mutual aid, while medical men have before them the the previous illness, and to a great extent they excellent example of the Scottish Medical Service must vary with the circumstances of the patient. Emergency Committee as a guide. We feel certain In general terms it may be thought to be sufficient that medical men who respond to Sir ALFRED to advise a convalescent home for those who have Further inquiry, KEOGH’s repeated invitation to apply to the War been inmates of hospitals. Office, if they desire to help the country at this however, soon shows the limits of this panacea. juncture, will find that any doubts they may have Many convalescent homes rigidly restrict the class of patients to be admitted; apart from as to the conditions of service will be removed. The conditions may call upon their patriotism, but questions of surgical dressings or continued they need not also be a puzzle to their intelligence. surgical treatment, it is often found that the patients in convalescent homes are required to be able to perform various personal services. For those more men are happily circumstanced, medical Convalescence and Sick Leave in asked to consider whether the time of convalesthe cence is to be spent at some specially selected EARLY in the war a wave of pity led many to place, or whether it may not be more conducive to prepare to do their best for wounded soldiers. quick recovery for the patient to go to friends Throughout the kingdom in private dwellings pre- living in the country. Undoubtedly sympathy and parations were made for the reception of small kindly intercourse are factors which must often be numbers of men, in pathetic ignorance of the diffi- reckoned with. They are of inestimable service culties that might be encountered if they ever when they tend to distract from the memories of arrived. Our benevolent citizens could scarcely the period of danger; they may be positively be expected to realise that the cordiality of their harmful if, through lack of tact, they encourage move might be embarrassing or even unwelcome gloomy reminiscences. to the authorities. The offer of kindly treatment, The soldier on sick furlough occupies a position of good food and surroundings, and of personal which is scarcely comparable to that of a civilian. devotion seemed to mean so much when freely It may be assumed that his wounds or illnesses tendered that officialdom was blamed unjustly have not been sufficiently disabling to remove all when the days passed without any tangible re- hope of future service, and it therefore is desirable, cognition. Numbers of wounded arrived in this in the interest of the nation, that he should be country, were treated in hospital, and then, so far restored to efficiency at the earliest date. On the as the members of the public were aware, they other hand, if he is one who has returned from were sent out on sick furlough and returned foreign service he has earned a furlough which to their homes, where the conditions must fre- he might legitimately desire to spend with his quently be far from the ideal of convalescence. wife and family. Provided that this can be In the near future the pressure on the accom- accomplished without impairing his efficiency, the modation available at the hospitals will induce a dictates of humanity would offer no obstacle. natural tendency to discharge the wounded or sick Speedy restoration must, however, be the first soldier on sick leave at the earliest moment consideration, and for this it must, we think, be

Army.

761 life of routine in a suitable convalescent home offers the best prospects. The home would require to be under military discipline, since the cheeriness of the convalescent soldier might be misunderstood and even be troublesome in a home where civilians With received. were judicious management and understanding the convalescent soldier is

freely admitted that the

a

is, however, another side to the case. Taking the 1912 return of the Registrar-General for England and Wales as an example, measles caused 12,756 deaths in the year and whoopingcough 8407 deaths, and these figures were not exceptionally large. Local health authorities and the public generally have become alive to the There

seriousness of the measles and

whooping-cough

most, delightful being, but he requires just factors in the death-rate, and besides this

little control occasionally, and to be effective this control must be exerted by someone whose authority he respects. The difficulty of arranging for continuous supervision is perhaps the reason why so many of the offers of convalescent treatment have not been accepted by the authorities at the War Office. It might perhaps be possible to arrange for a non-commissioned officer to be responsible for due observance of regulations in small convalescent homes, but it is probable that more satisfactory results would be attained by the formation of larger homes, which should be under the management of permanent officials with military rank. On leaving such homes the men should be physically fit for service and should only be entitled to such further furlough as is necessitated by their work in the front. While under convalescent treatment in a home, or while on furlough subsequently, there can be no doubt of the importance of a sufficiently liberal diet or of strict limitation of alcohol. a

realising the that due to

are

large invalidity, particularly ear mischief, which results from the complications of measles and secondary septic infections. The frequency with which tubercuamount of

losis supervenes on attacks of both diseases is also well known. In respect of fatality and of complications there is a very striking contrast between children of more well-to-do parentswho can be isolated in airy rooms, receive adequate medical and nursing aid, and be well looked after and fed during convalescence-and the children of working-class households who are usually under much less favourable conditions. Public health authorities can set them. selves to reduce the handicap of the latter class. Owing to the numbers concerned routine treatment of measles in isolation hospitals is hardly practicable, though these hospitals should be available for special cases. But much can be done by systematic and frequent domiciliary visits of trained nurses, and by health visitors under medical supervision, to see that in working-class homes the illness best available conditions are secured Notification of Measles, and convalescence, and that medicalduring advice and and other practical assistance are obtained where needed. Authorities prepared to make arrangeA CIRCULAR which has been issued by the ments on these lines will find the adoption of Local Government Board to local authorities notification of great assistance to the states that the central department is willing, on compulsory work. the application of any sanitary authority, to make The system in the case of measles, rubella, compulsorily notifiable the first case of measles, and whooping-cough is, however, exceptional German measles, or whooping-cough which occurs in that no approach to completeness can be in a household in the district concerned. It unless parents themselves accept the becomes important, therefore, to consider the expected to notify. As a strict matter of law, obligation advantages which the adoption of local notification are parents already liable under the Notifiof these diseases is likely to secure. cation Acts, in addition to the medical practiIt is not at all probable that notification can for notification of the diseases to which lead to much diminution in their prevalence tioner, these Acts apply, but in practice this obligation has or in their regular recurrence at epidemic seldom been enforced or recognised to be binding. periods. All three diseases are highly infectious It will be important to ascertain by experience how during the days before the characteristic symptoms far notification by parents can be successfully lead to medical aid being called, and the pressed in regard to the diseases here in question, ability to infect will in most cases have been as it may well be the case that the children needfreely exercised before any intimation can have ing the greatest amount of attention will be found reached the local authority. The notification of in households where notification requirements have measles has, in fact, been tried in a large number been neglected. of areas in the past, and in many cases has been abandoned on the ground that no appreciable BY the will of the late Mr. George Stowell, impression was made on the figures of measles of Great Torrington, the testator left, subject to the prevalence, and that no obvious benefit resulted life interest of his wife, £1000 to the trustees of from the considerable sum spent on notificaEpsom College upon trust, to pay the income for tion fees. Judged by the standard of pre- one year to a boy, who shall have been educated at valence notification of whooping-cough and of the school for five years, to enable him to further his rubella would probably be equally disappointing. training.

Compulsory Rubella,

Whooping-cough.