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CONVALESCENCE.
302
CONVALESCENCE.-THE CAUSES OF ITRA-UTERINE DEATH.
him to do
so
many
foot-pounds
of work
underground ? viewpoint
Many political economists fail to appreciate,
or
argue
of medicine and in
cases, and that it has
dealing with acute neglected the care of the con-
if there were such failure, that calculations must valescent. Patients are left " half cured." Convalesgive way before the laws of life, whereas they should cence is as much a mental as a physical condition, be founded upon those laws. Dublin, the American and occupational therapy combined with prescribed medical statistician, has suggested forcibly that the graduated exercise is of as much importance as good real value of human life at any time amounts to five food and country air. Arguments on the economic times that of property, while healthy life is of more side are no less convincing. Convalescent homes are value than unhealthy life. Public health has so greatly far less costly than hospitals to construct, and the improved as to be deserving of an improved governance cost of maintaining a patient in them is estimated to match. Whether adoption of the comprehensive at one-third of the cost of a hospital case. Again, as
programme advocated in this report-and the programme has the merit of boldness in some fields,
even though so neglectful of certain fundamentalswould meet the need, we do not presume to discuss. One advantage it possesses in strongly advocating development of the homeland, the place where the people live, by extended road construction, by more
garden cities, by slum clearance on a large scale, by developing docks, harbours, canals, and electrical supply. Health, like wages, must be earned by work, and, in so far as this development would find work where to-day there exists unemployment, it would further improve the nation’s health. The means to this end are set out well in this report which is long, but well written; it deals in sequence with the condition of industry, and the organisation of business, with industrial relations, national development, and finance ; finally come 36 closely printed pages of summary of conclusions. For us the interest lies in the contribution made to furthering the economics of health. Health is largely a product of environment and food, and by health is meant both physical and mental vigour. Both environment and food-supply in the homeland can be improved. By the time England has been made a land fit for heroes to live in, a heroic race will be found inhabiting it, and indeed to have made the land fit for their habitation. Meanwhile it isThat unto him who works, and feels he works, This
same
grand year is
ever
at the doors.
CONVALESCENCE. EVERYONE with experience of hospital practice will agree that, owing to the pressure of a long waitinglist, many patients must be discharged in an only partially cured condition. In England a fortunate minority do indeed obtain a few weeks at one of the convalescent homes attached to the larger hospitals, but of necessity the majority must return to their own homes, which, as a rule, cannot provide a suitable Some of these environment for convalescence. patients continue to attend as out-patients for tonics or dressings, but many take their final leave of the hospital still feeling far from strong and receive little or no further guidance and encouragement to help to restore sufficient vigour and self-confidence Confor a return to full work. In a new book on valescence, Historical and Practical,"1 Dr. John Bryant records the efforts that have been made in the past by different countries to remedy this defect and to prevent this class of patient drifting to chronic invalidism, a prey to charlatans, and a burden to the rates. London took the lead with the Metropolitan Convalescent Institution established in 1844, and was followed by Paris in 1857, when Napoleon III. decreed the foundation of special convalescent hospitals at Vincennes and Vesinet. America was slow to follow this example, and it was not till 1915 that the Burke Relief Foundation was established for New York and equipped with every facility for occupational therapy. Armed with a keen interest and wide experience of military and civilian practice in this type of work, Dr. Bryant writes with authority and a wealth of detail. Struck by the scantiness of the literature on the subject, he insists that the profession is absorbed in the laboratory "
1 Convalescence, Historical and Practical. M.D. 1927.
By John Bryant, New York : The Sturgis Fund of the Burke Foundation.
Pp. 269.
with adequate convalescent accommodation to fall back on, the average stay in hospital can be shortened and expensive hospital extensions may be avoided by a more rapid turnover of patients. Finally, the rates are relieved of the burden of a large number of chronic invalids. The book consists of a series of articles by Dr. Bryant, revised and incorporated in a single volume. This construction leads to lack of continuity of argument and some repetition, but the work is of real value in pointing the remedy of a serious defect in our present hospital and public health systems. The chapters describing the Burke Relief Foundation and the occupational therapy employed in the U.S. military convalescent camps during the war are of particular interest. They show what can be done given sufficient resources and enthusiasm, and should be read by all who are interested in the future of our hospital and public health services. ____
THE CAUSES OF INTRA-UTERINE DEATH. THE Medical Research Council published in 1926 a clinical and pathological study, by Dr. Eardley Holland and Dr. Janet Lane-Claypon,l of 1673 dead births and neonatal deaths. This summarised the combined investigations of many workers at different centres throughout the country. In a further report just issued Mr. A. C. Palmer publishes a detailed account of one of these investigations, dealing with 144 cases of foetal death observed at the London Hospital; 141 of the patients were Whitechapel women delivered in their own homes by students or nurses from the hospital; three were private patients of members of the staff. A complete necropsy, including weights and measurements, was performed on all the infants, and the placenta, when obtained, was weighed, measured, and examined macroscopically and microscopically. Most of the sections were prepared according to Levaditi’s method and investigated for syphilis ; other specimens were stained with Ehrlich’s haematoxylin and eosin, with Weigert’s iron heematoxylin and van Gieson’s mixture or with Weigert’s fuchselin and lithium carmine. Others were examined fresh on dark-ground illumination. Eardley Holland’s first investigation, published in 1922, showed that about 20 per cent. of stillborn foetuses are macerated. Of this series 39, or 27 per cent., were macerated and 35-9 per cent. of these were proved to be syphilitic by the identification of the Spironema pallidum in their tissues. Toxaemia of pregnancy, indicated by albuminuria in the mother, probably accounted for the death of 11, 7-6 per cent. of the total or 28-2 per cent. of the macerated. The cause of death in 12 more was obscure, but maternal albuminuria could only be certainly excluded in one of these. Maternal morbus cordis and foetal malformation each accounted for one death. Asphyxia accounted for the death of 91 out of the 99 nonmacerated foetuses, in 12 of whom intracranial haemorrhage from excessive moulding appeared to be the fatal factor. Of the eight cases showing no asphyxia three had foetal anasarca and the others all died from conditions, such as hydrocephalus and eclampsia, which would have caused asphyxia had the child lived long enough. Of the six infants who breathed for a short time after delivery, four had asphyxia and one had intracranial haemorrhages. 1 Special Report Series No. 109. Office.
1926.
3s. 6d.
2 Ibid., No. 118.
London: H.M. Stationery 1928.
3s.
CONVALESCENCE.-THE CAUSES OF ITRA-UTERINE DEATH.
him to do
so
many
foot-pounds
of work
underground ? viewpoint
Many political economists fail to appreciate,
or
argue
of medicine and in
cases, and that it has
dealing with acute neglected the care of the con-
if there were such failure, that calculations must valescent. Patients are left " half cured." Convalesgive way before the laws of life, whereas they should cence is as much a mental as a physical condition, be founded upon those laws. Dublin, the American and occupational therapy combined with prescribed medical statistician, has suggested forcibly that the graduated exercise is of as much importance as good real value of human life at any time amounts to five food and country air. Arguments on the economic times that of property, while healthy life is of more side are no less convincing. Convalescent homes are value than unhealthy life. Public health has so greatly far less costly than hospitals to construct, and the improved as to be deserving of an improved governance cost of maintaining a patient in them is estimated to match. Whether adoption of the comprehensive at one-third of the cost of a hospital case. Again, as
programme advocated in this report-and the programme has the merit of boldness in some fields,
even though so neglectful of certain fundamentalswould meet the need, we do not presume to discuss. One advantage it possesses in strongly advocating development of the homeland, the place where the people live, by extended road construction, by more
garden cities, by slum clearance on a large scale, by developing docks, harbours, canals, and electrical supply. Health, like wages, must be earned by work, and, in so far as this development would find work where to-day there exists unemployment, it would further improve the nation’s health. The means to this end are set out well in this report which is long, but well written; it deals in sequence with the condition of industry, and the organisation of business, with industrial relations, national development, and finance ; finally come 36 closely printed pages of summary of conclusions. For us the interest lies in the contribution made to furthering the economics of health. Health is largely a product of environment and food, and by health is meant both physical and mental vigour. Both environment and food-supply in the homeland can be improved. By the time England has been made a land fit for heroes to live in, a heroic race will be found inhabiting it, and indeed to have made the land fit for their habitation. Meanwhile it isThat unto him who works, and feels he works, This
same
grand year is
ever
at the doors.
CONVALESCENCE. EVERYONE with experience of hospital practice will agree that, owing to the pressure of a long waitinglist, many patients must be discharged in an only partially cured condition. In England a fortunate minority do indeed obtain a few weeks at one of the convalescent homes attached to the larger hospitals, but of necessity the majority must return to their own homes, which, as a rule, cannot provide a suitable Some of these environment for convalescence. patients continue to attend as out-patients for tonics or dressings, but many take their final leave of the hospital still feeling far from strong and receive little or no further guidance and encouragement to help to restore sufficient vigour and self-confidence Confor a return to full work. In a new book on valescence, Historical and Practical,"1 Dr. John Bryant records the efforts that have been made in the past by different countries to remedy this defect and to prevent this class of patient drifting to chronic invalidism, a prey to charlatans, and a burden to the rates. London took the lead with the Metropolitan Convalescent Institution established in 1844, and was followed by Paris in 1857, when Napoleon III. decreed the foundation of special convalescent hospitals at Vincennes and Vesinet. America was slow to follow this example, and it was not till 1915 that the Burke Relief Foundation was established for New York and equipped with every facility for occupational therapy. Armed with a keen interest and wide experience of military and civilian practice in this type of work, Dr. Bryant writes with authority and a wealth of detail. Struck by the scantiness of the literature on the subject, he insists that the profession is absorbed in the laboratory "
1 Convalescence, Historical and Practical. M.D. 1927.
By John Bryant, New York : The Sturgis Fund of the Burke Foundation.
Pp. 269.
with adequate convalescent accommodation to fall back on, the average stay in hospital can be shortened and expensive hospital extensions may be avoided by a more rapid turnover of patients. Finally, the rates are relieved of the burden of a large number of chronic invalids. The book consists of a series of articles by Dr. Bryant, revised and incorporated in a single volume. This construction leads to lack of continuity of argument and some repetition, but the work is of real value in pointing the remedy of a serious defect in our present hospital and public health systems. The chapters describing the Burke Relief Foundation and the occupational therapy employed in the U.S. military convalescent camps during the war are of particular interest. They show what can be done given sufficient resources and enthusiasm, and should be read by all who are interested in the future of our hospital and public health services. ____
THE CAUSES OF INTRA-UTERINE DEATH. THE Medical Research Council published in 1926 a clinical and pathological study, by Dr. Eardley Holland and Dr. Janet Lane-Claypon,l of 1673 dead births and neonatal deaths. This summarised the combined investigations of many workers at different centres throughout the country. In a further report just issued Mr. A. C. Palmer publishes a detailed account of one of these investigations, dealing with 144 cases of foetal death observed at the London Hospital; 141 of the patients were Whitechapel women delivered in their own homes by students or nurses from the hospital; three were private patients of members of the staff. A complete necropsy, including weights and measurements, was performed on all the infants, and the placenta, when obtained, was weighed, measured, and examined macroscopically and microscopically. Most of the sections were prepared according to Levaditi’s method and investigated for syphilis ; other specimens were stained with Ehrlich’s haematoxylin and eosin, with Weigert’s iron heematoxylin and van Gieson’s mixture or with Weigert’s fuchselin and lithium carmine. Others were examined fresh on dark-ground illumination. Eardley Holland’s first investigation, published in 1922, showed that about 20 per cent. of stillborn foetuses are macerated. Of this series 39, or 27 per cent., were macerated and 35-9 per cent. of these were proved to be syphilitic by the identification of the Spironema pallidum in their tissues. Toxaemia of pregnancy, indicated by albuminuria in the mother, probably accounted for the death of 11, 7-6 per cent. of the total or 28-2 per cent. of the macerated. The cause of death in 12 more was obscure, but maternal albuminuria could only be certainly excluded in one of these. Maternal morbus cordis and foetal malformation each accounted for one death. Asphyxia accounted for the death of 91 out of the 99 nonmacerated foetuses, in 12 of whom intracranial haemorrhage from excessive moulding appeared to be the fatal factor. Of the eight cases showing no asphyxia three had foetal anasarca and the others all died from conditions, such as hydrocephalus and eclampsia, which would have caused asphyxia had the child lived long enough. Of the six infants who breathed for a short time after delivery, four had asphyxia and one had intracranial haemorrhages. 1 Special Report Series No. 109. Office.
1926.
3s. 6d.
2 Ibid., No. 118.
London: H.M. Stationery 1928.
3s.