- Email: [email protected]
HOME HELPS.
827
meningitis, in which Gram-negative diplococci, more than 860 g. As the daily consumption presumably meningococci, were found in films realises 200,000 kg., the shortage amounts to made from the purpuric spots. Several writers 20,000 kg., representing a loss to the public of have noted inflammatory reaction around the about 13,200 pesetas per diem value in bread. vessels involved. In connexion with the presence This statement is remarkable, since short weight of meningococci in the petechiae of cerebro-spinal is much more easily checked than are sins of fever, it is of interest to recall the fact that typhoid adulteration. bacilli have been found in the rose spots of typhoid ____
fever.
LOCAL INJECTIONS
____
FOR
GOITRE.
Dr. J. E. Sheehan, of New York, published in BREAD ABROAD. 1917 a report of 17 cases of goitre treated by IN view of the intention of our Government to injections into the gland of carbolic acid, tincture reduce the bread subsidy in the coming financial of iodine, and glycerine in equal parts. In the year by 45 millions, which involves a rise in the Journal of the American Medical Association for price of bread to the consumer of 2
It will be
from these figures that the most serious advance in the price of bread is in Austria, while the situation in France is not very agreeable when it is officially stated that the wheat deficit is so great that the import would have to amount to half the consumption and " a fleet of 2 million tons would be required to trainsport it." This country may be grateful to its food administrators who have maintained a breadsupply throughout the war and who do not now propose, in spite of reducing an enormous subsidy, an alarming advance in prices in the future. According to the journal quoted above, frauds are being perpetrated on the public in Madrid by means of short weight of bread. The kilogramme loaf, we are told, rarely weighs 950 g. and not often seen
causes a fibrosis in the gland and an obliteration of that part of the gland injected. Such injections are said to be especially favourable in the ordinary parenchymatous goitres of young Of 55 patients of this type so treated women. 76’4 per cent. were cured. In 14 toxic cases relief was afforded in 80 per cent. The treatment was useless in the cystic or colloid form. In fact, in these cases the authors state that if treatment be persisted in it may do harm, causing a sudden enlargement of the gland which may seriously interfere with respiration. In suitable cases-that is, in all but the cystic or colloid form of goitre-it quiets the heart’s action, improves the appetite, has a favourable effect on metabolism, stays emaciation, and reduces the mental irritability. It is the custom of Dr. Sheehan and Dr. Newcomb to inject with this mixture all goitre cases which are to be operated on, as the relief of the toxic symptoms aids appreciably in the success of the operation. The procedure is stated to be a safe one if the technique is not at fault.
eventually
____
HOME
HELPS.
AFTER skilled help at the confinement-and not very far after, moreover-comes next in importance
in the home to relieve the mother of the anxieties of household management during the first few weeks of the new life. It is perhaps impossible for anyone except the mother herself to realise the intolerable burden which cleaning, cooking, sending the children well-groomed to school, and the hundred tasks of the house, mean to a woman already fully occupied with the manifold minor-but none the less straining-anxieties and accidents inevitable in the nursing of a young infant. There can be no doubt that, second to a midwife or doctor in her time of
help
1 New York Medical Record, Oct. 6th, 1917.
828
trial, the greatest gift to the working mother would the diffuse eruption sometimes be home help during the time of recovery. Such help is, of course, now a recognised public health measure, thanks to the initiative and foresight shown by the Local Government Board in its wellknown Memorandum of August, 1918, in which the various aspects of maternity and child welfare were epitomised. It would be interesting to know how many local authorities have so far made use of their opportunities. It is not, perhaps, fair to judge by the annual reports of medical ofricers of health for 1918, which are all that are so far open to inspection. These came too closely on the heels of the Memorandum in question for much action to be possible. At any rate, it is apparent that action did not in fact follow, for, in a perusal of 26 consecutive annual reports, taken at random, of counties and of large towns and cities, not a single instance was found in which the subject was discussed; and in only one was the matter mentioned at all, and then rather as a pious aspiration than as a practical problem. There is this to be said in extenuation of the omission; it is not easy to propound a working scheme for the purpose. Is the home help, in the first place, to be a whole-time or a part-time servant of the authority? From every point of view, except perhaps that of cost, the whole-time help is preferable. How is she to be obtained ? The type needed is to be found among the cronies of the mothers who attend welfare centres, and probably the best course is to use the welfare centre as an intelligence department for the purpose. Through it the chances of finding the suitable type are reasonably great. The training in simple cooking, household cleaning, washing, and marketing-in which the help-elect is probably already no mean performer-can best be done through the welfare centre. It is clearly best that she should pivot on the welfare centre at which many of her clients will attend rather than be attached to some more detached section of the public health department. The financial question may be a difficulty; it is unlikely that the whole of her salary can be met by the contributions of patients, even with the institution of a form of insurance in the case of all expectant mothers at the centre. But the financial is not the greatest difficulty. The kernel of the problem is the mother herself, who in many cases will, after a day or two of intense relief, resent the invasion of her territory and the exploration of her pet cubby-holes by a strange woman. A successful scheme must take into account the psychology of home-life. --
SYPHILIS OF THE
ACCORDING to Dr.
BLADDER.
Loyd Thomson,! of Hot Springs, on syphilis of the bladder
Arkansas, the literature
comparatively meagre. Of 84 cases on record only 58 are accepted by him as authentic. He thinks it probable, however, that this number does not represent the true incidence of the condition, and that it would be more frequently found if more attention were paid to it. He suggests that if the vesical mucosa of every case of syphilis in the eruptive stage were examined with the cystoscope is
involvement of this viscus would be found in a of cases. In the early stage of syphilis there is more or less congestion of the mucous membrane of the bladder resembling
large percentage
1
The American Journal of
Syphilis, January, 1920.
seen in the mouth there be a distinct papular may pharynx, eruption with or without erosion or ulceration. In the later stages the most frequent type of lesion is the ulcerating gumma, which may be either single The usual site of the lesions in the or multiple. early or late stage is round one of the ureteral orifices, but other portions of the bladder wall may be attacked. In the early stage the most frequent symptom is frequent and painful micturition, heematuria being the predominant manifestation of the late stage, and often the only one. There is, however, nothing characteristic in the symptoms or cystoscopic picture of syphilis of the bladder, and the diagnosis must rest upon the history, the presence or absence of the manifestations of syphilis, including the Wassermann reaction, and upon the result of specific therapy. The prognosis, on the whole, is good. Only 4 of the 58 cases died, death being due to the malignancy of the syphilitic infection. In all the other cases complete recovery followed the use of specific remedies.
and
or
CRUSADE AGAINST ANKYLOSTOMIASIS IN BENGAL.
THE prevalence of hookworm disease amongst the native population of Bengal and its very serious results in deterioration of health are wellknown facts. Within the past year consideration of the whole subject has resulted in the initiation by His Excellency Lord Ronaldshay, Governor of Bengal, of an organised campaign for control and prevention of the disease. The work has been undertaken by Dr. C. A. Bentley, Sanitary Commissioner, with the assistance of Dr. Borland McVail, Dr. R. G. Griffin, and Dr. S. P. Gupta. One of these officers has charge of the organisation in respect of mills, factories, and railways; another in respect of tea-gardens and coal-mines ; and the third in respect of municipalities and police in Burdwan. The nature of the crusade can be illustrated by reference to the first of the three sections-that of mills and factories. The prime object was to secure the interest and support of both employers and employees. In March, 1919, there was held a meeting of superintendents and managers of the mills, together with medical men and senior employees. The gathering was presided over by the chairman of the Jute Mills Association, and was addressed by Dr. Bentley, who pointed out the prevalence of the disease and its effects, not merely direct in the way of ill-health, but also financial in the loss resulting from deterioration of physique amongst mill-workers. It was explained that the line of attack would be by the institution of laboratories at which the necessary microscopical examination of infected material could be made, and treatment adopted for those found to be affected. This proposal was favourably received, premises for a laboratory were provided at one of the mills and work has been begun. In initiating the campaign account had to be taken of the suspicions and susceptibilities of the workers, who, it was found, were apt to suppose that discovery of their being infected with the disease would lead to dismissal from employment. At first the scheme was confined to microscopic examination to ascertain the degree of prevalence of ankylostomiasis, and even this had to be carried on with discretion. In the early examinations, only about 50 per cent. were found infected, but this was probably due, in part, to the inexperience of some of the microscopists, as indicated by the fact that in one mill
meningitis, in which Gram-negative diplococci, more than 860 g. As the daily consumption presumably meningococci, were found in films realises 200,000 kg., the shortage amounts to made from the purpuric spots. Several writers 20,000 kg., representing a loss to the public of have noted inflammatory reaction around the about 13,200 pesetas per diem value in bread. vessels involved. In connexion with the presence This statement is remarkable, since short weight of meningococci in the petechiae of cerebro-spinal is much more easily checked than are sins of fever, it is of interest to recall the fact that typhoid adulteration. bacilli have been found in the rose spots of typhoid ____
fever.
LOCAL INJECTIONS
____
FOR
GOITRE.
Dr. J. E. Sheehan, of New York, published in BREAD ABROAD. 1917 a report of 17 cases of goitre treated by IN view of the intention of our Government to injections into the gland of carbolic acid, tincture reduce the bread subsidy in the coming financial of iodine, and glycerine in equal parts. In the year by 45 millions, which involves a rise in the Journal of the American Medical Association for price of bread to the consumer of 2
It will be
from these figures that the most serious advance in the price of bread is in Austria, while the situation in France is not very agreeable when it is officially stated that the wheat deficit is so great that the import would have to amount to half the consumption and " a fleet of 2 million tons would be required to trainsport it." This country may be grateful to its food administrators who have maintained a breadsupply throughout the war and who do not now propose, in spite of reducing an enormous subsidy, an alarming advance in prices in the future. According to the journal quoted above, frauds are being perpetrated on the public in Madrid by means of short weight of bread. The kilogramme loaf, we are told, rarely weighs 950 g. and not often seen
causes a fibrosis in the gland and an obliteration of that part of the gland injected. Such injections are said to be especially favourable in the ordinary parenchymatous goitres of young Of 55 patients of this type so treated women. 76’4 per cent. were cured. In 14 toxic cases relief was afforded in 80 per cent. The treatment was useless in the cystic or colloid form. In fact, in these cases the authors state that if treatment be persisted in it may do harm, causing a sudden enlargement of the gland which may seriously interfere with respiration. In suitable cases-that is, in all but the cystic or colloid form of goitre-it quiets the heart’s action, improves the appetite, has a favourable effect on metabolism, stays emaciation, and reduces the mental irritability. It is the custom of Dr. Sheehan and Dr. Newcomb to inject with this mixture all goitre cases which are to be operated on, as the relief of the toxic symptoms aids appreciably in the success of the operation. The procedure is stated to be a safe one if the technique is not at fault.
eventually
____
HOME
HELPS.
AFTER skilled help at the confinement-and not very far after, moreover-comes next in importance
in the home to relieve the mother of the anxieties of household management during the first few weeks of the new life. It is perhaps impossible for anyone except the mother herself to realise the intolerable burden which cleaning, cooking, sending the children well-groomed to school, and the hundred tasks of the house, mean to a woman already fully occupied with the manifold minor-but none the less straining-anxieties and accidents inevitable in the nursing of a young infant. There can be no doubt that, second to a midwife or doctor in her time of
help
1 New York Medical Record, Oct. 6th, 1917.
828
trial, the greatest gift to the working mother would the diffuse eruption sometimes be home help during the time of recovery. Such help is, of course, now a recognised public health measure, thanks to the initiative and foresight shown by the Local Government Board in its wellknown Memorandum of August, 1918, in which the various aspects of maternity and child welfare were epitomised. It would be interesting to know how many local authorities have so far made use of their opportunities. It is not, perhaps, fair to judge by the annual reports of medical ofricers of health for 1918, which are all that are so far open to inspection. These came too closely on the heels of the Memorandum in question for much action to be possible. At any rate, it is apparent that action did not in fact follow, for, in a perusal of 26 consecutive annual reports, taken at random, of counties and of large towns and cities, not a single instance was found in which the subject was discussed; and in only one was the matter mentioned at all, and then rather as a pious aspiration than as a practical problem. There is this to be said in extenuation of the omission; it is not easy to propound a working scheme for the purpose. Is the home help, in the first place, to be a whole-time or a part-time servant of the authority? From every point of view, except perhaps that of cost, the whole-time help is preferable. How is she to be obtained ? The type needed is to be found among the cronies of the mothers who attend welfare centres, and probably the best course is to use the welfare centre as an intelligence department for the purpose. Through it the chances of finding the suitable type are reasonably great. The training in simple cooking, household cleaning, washing, and marketing-in which the help-elect is probably already no mean performer-can best be done through the welfare centre. It is clearly best that she should pivot on the welfare centre at which many of her clients will attend rather than be attached to some more detached section of the public health department. The financial question may be a difficulty; it is unlikely that the whole of her salary can be met by the contributions of patients, even with the institution of a form of insurance in the case of all expectant mothers at the centre. But the financial is not the greatest difficulty. The kernel of the problem is the mother herself, who in many cases will, after a day or two of intense relief, resent the invasion of her territory and the exploration of her pet cubby-holes by a strange woman. A successful scheme must take into account the psychology of home-life. --
SYPHILIS OF THE
ACCORDING to Dr.
BLADDER.
Loyd Thomson,! of Hot Springs, on syphilis of the bladder
Arkansas, the literature
comparatively meagre. Of 84 cases on record only 58 are accepted by him as authentic. He thinks it probable, however, that this number does not represent the true incidence of the condition, and that it would be more frequently found if more attention were paid to it. He suggests that if the vesical mucosa of every case of syphilis in the eruptive stage were examined with the cystoscope is
involvement of this viscus would be found in a of cases. In the early stage of syphilis there is more or less congestion of the mucous membrane of the bladder resembling
large percentage
1
The American Journal of
Syphilis, January, 1920.
seen in the mouth there be a distinct papular may pharynx, eruption with or without erosion or ulceration. In the later stages the most frequent type of lesion is the ulcerating gumma, which may be either single The usual site of the lesions in the or multiple. early or late stage is round one of the ureteral orifices, but other portions of the bladder wall may be attacked. In the early stage the most frequent symptom is frequent and painful micturition, heematuria being the predominant manifestation of the late stage, and often the only one. There is, however, nothing characteristic in the symptoms or cystoscopic picture of syphilis of the bladder, and the diagnosis must rest upon the history, the presence or absence of the manifestations of syphilis, including the Wassermann reaction, and upon the result of specific therapy. The prognosis, on the whole, is good. Only 4 of the 58 cases died, death being due to the malignancy of the syphilitic infection. In all the other cases complete recovery followed the use of specific remedies.
and
or
CRUSADE AGAINST ANKYLOSTOMIASIS IN BENGAL.
THE prevalence of hookworm disease amongst the native population of Bengal and its very serious results in deterioration of health are wellknown facts. Within the past year consideration of the whole subject has resulted in the initiation by His Excellency Lord Ronaldshay, Governor of Bengal, of an organised campaign for control and prevention of the disease. The work has been undertaken by Dr. C. A. Bentley, Sanitary Commissioner, with the assistance of Dr. Borland McVail, Dr. R. G. Griffin, and Dr. S. P. Gupta. One of these officers has charge of the organisation in respect of mills, factories, and railways; another in respect of tea-gardens and coal-mines ; and the third in respect of municipalities and police in Burdwan. The nature of the crusade can be illustrated by reference to the first of the three sections-that of mills and factories. The prime object was to secure the interest and support of both employers and employees. In March, 1919, there was held a meeting of superintendents and managers of the mills, together with medical men and senior employees. The gathering was presided over by the chairman of the Jute Mills Association, and was addressed by Dr. Bentley, who pointed out the prevalence of the disease and its effects, not merely direct in the way of ill-health, but also financial in the loss resulting from deterioration of physique amongst mill-workers. It was explained that the line of attack would be by the institution of laboratories at which the necessary microscopical examination of infected material could be made, and treatment adopted for those found to be affected. This proposal was favourably received, premises for a laboratory were provided at one of the mills and work has been begun. In initiating the campaign account had to be taken of the suspicions and susceptibilities of the workers, who, it was found, were apt to suppose that discovery of their being infected with the disease would lead to dismissal from employment. At first the scheme was confined to microscopic examination to ascertain the degree of prevalence of ankylostomiasis, and even this had to be carried on with discretion. In the early examinations, only about 50 per cent. were found infected, but this was probably due, in part, to the inexperience of some of the microscopists, as indicated by the fact that in one mill