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MEDICAL SERVICES IN THE ARMY
Mt’JDICAJ. SERVICES IN THE ARMY
the results of
laboratory tests as any guide antiseptics ; at present such tests commonly ignored or discounted in practice.
accept
to the choice of are
He instanced iodoform and mercurochrome as antiseptics which have been condemned by laboratory evidence but are still widely used. The method of testing proposed by Prof. FLEMING gave results, according to Dr. GARROD, which suggested that all antiseptics did more harm than good, and for the conditions which the method was designed to imitate this conclusion might well be correct. But there remained the possibility of destroying bacteria in a wound before tissue invasion had taken place ; it had been shown repeatedly by animal experiment that this was possible with flavine. Dr. GARROD considered that a test in which blood was used merely as a hindrance to bactericidal action might serve to assess the merits of surgical antiseptics in intelligible and comparable
Subsequent speakers appeared ready to accept series of conclusions which were certainly negative and may even have appeared cynical. Prof. FLEMING’s plea for the introduction of a generally recognised method of testing surgical antiseptics is fully justified by the present confusion in this department of medicine. The observation that no adequate accounts of antiseptics and
terms.
a
their powers and limitations are included in most surgical text-books leads to the question whether
on this subject is really capable of coordination into any authoritative statement. Such conclusions as could be brought together in such a statement have been obtained by the use of endless different methods, the results of which are mostly not comparable. It is clear that either antiseptics must continue to be judged largely by their clinical effects, a matter which among the almost infinite variety of situations and infections to which they are applied is not easy, or else a method of laboratory evaluation must be devised which will be appropriate, exact, and
existing knowledge
generally acceptable. MEDICAL SERVICES IN THE ARMY A RECENT discussion in the House of Commons the army estimates gave the Financial Secretary of the War Office the opportunity of reviewing the medical services in the army. These, he said, covered in some form or other the whole of human activities. The purview of the War Office extended from the midwife to the undertaker and ranged over all the periods of life between ; they provided nurses, doctors, teachers and chaplains ; they fed, clothed and housed many thousands of persons in all kinds of climates. To provide all these services he was asking this year for a vote of 950,000. No one, he thought, would dispute the necessity for the provision of medical attention to the troops, but few people realised that the R.A.M.C. had its special problems in peace no less than in war. The distribution of troops in overseas garrisons under widely variant geographic and climatic conditions called for specialised medical on
knowledge beyond
that which was ordinarily attainable at and behind the day-to-day medical supervision there was going on a careful
753
research into medical problems peculiar to the army. Research of this kind had in the past been of untold value to the surrounding civil population. In the case of undulant fever, for centuries an endemic disease of Malta, the discovery of the cause and therewith the means of prevention was entirely the work of the R.A.M.C. Research of like importance was now going on into antityphoid inoculation. When the activities of this great health service came to be more fully investigated by the public they would, he felt sure, form a very different idea of its value not only to the Army but to humanity at large. For some time there had been a disconcerting lack of candidates for commissions in the R.A.M.C., partly, no doubt, due to financial considerations which were receiving attention. Conditions of service had already been materially improved, promotion had been hastened and the period necessary to qualify for a gratuity on retirement had been reduced. It was now, he said, possible for an officer to take a short-service commission for five years and then retire with a gratuity of .El 000 if he was not appointed to a permanent commission. The service should now attract young men on qualification. The life was interesting and there was plenty of opportunity for specialisation by those who were keen on study and research. Mr. HACKING concluded his survey with the remark that he was confident that were the work of the R.A.M.C. better known there would be a still wider field of selection of candidates. In the debate Sir ARNOLD WILSON deplored the state of many of the barracks abroad, emphasised the need of further welfare work among the wives and children of soldiers, and asked that dental care in the army should be raised to the standard of that available in civil life. He regretted the dropping of antimalarial work in certain stations owing to financial stringency, remarking that in India they were spending only 11. a head on antimalarial work compared with 1158. 4d. spent in the Panama Canal zone. The result was that malaria had been a greater scourge in 1933 than in the previous years. Sir FRANCIS FREMANTLE congratulated the Government on having put into force many of the recommendations of the Warren-Fisher Committee with the result that since June of last year 40 medical recruits had been taken into the army medical service, the largest number since the war. But the difficulty of ensuring permanent promotion still remained in spite of the increase from 113 to 155 in special posts. He warmly endorsed Sir A. Wilson’s plea for improvement of married quarters and hoped it would be only the beginning of a general clean-up right through the garrisons of the Empire. A FORTNIGHT ago we announced in these columns two generous donations to radium research under the auspices of the Medical Research Council, the Department of Scientific and Industrial Research and the Royal Colleges with the loan of radium element from the Belgian supply. This research work is being carried out at the Radium Institute in Portland-place. The patients are housed and maintained by the Institute, which also provides certain staff services as its contribution towards the cost.
the results of
laboratory tests as any guide antiseptics ; at present such tests commonly ignored or discounted in practice.
accept
to the choice of are
He instanced iodoform and mercurochrome as antiseptics which have been condemned by laboratory evidence but are still widely used. The method of testing proposed by Prof. FLEMING gave results, according to Dr. GARROD, which suggested that all antiseptics did more harm than good, and for the conditions which the method was designed to imitate this conclusion might well be correct. But there remained the possibility of destroying bacteria in a wound before tissue invasion had taken place ; it had been shown repeatedly by animal experiment that this was possible with flavine. Dr. GARROD considered that a test in which blood was used merely as a hindrance to bactericidal action might serve to assess the merits of surgical antiseptics in intelligible and comparable
Subsequent speakers appeared ready to accept series of conclusions which were certainly negative and may even have appeared cynical. Prof. FLEMING’s plea for the introduction of a generally recognised method of testing surgical antiseptics is fully justified by the present confusion in this department of medicine. The observation that no adequate accounts of antiseptics and
terms.
a
their powers and limitations are included in most surgical text-books leads to the question whether
on this subject is really capable of coordination into any authoritative statement. Such conclusions as could be brought together in such a statement have been obtained by the use of endless different methods, the results of which are mostly not comparable. It is clear that either antiseptics must continue to be judged largely by their clinical effects, a matter which among the almost infinite variety of situations and infections to which they are applied is not easy, or else a method of laboratory evaluation must be devised which will be appropriate, exact, and
existing knowledge
generally acceptable. MEDICAL SERVICES IN THE ARMY A RECENT discussion in the House of Commons the army estimates gave the Financial Secretary of the War Office the opportunity of reviewing the medical services in the army. These, he said, covered in some form or other the whole of human activities. The purview of the War Office extended from the midwife to the undertaker and ranged over all the periods of life between ; they provided nurses, doctors, teachers and chaplains ; they fed, clothed and housed many thousands of persons in all kinds of climates. To provide all these services he was asking this year for a vote of 950,000. No one, he thought, would dispute the necessity for the provision of medical attention to the troops, but few people realised that the R.A.M.C. had its special problems in peace no less than in war. The distribution of troops in overseas garrisons under widely variant geographic and climatic conditions called for specialised medical on
knowledge beyond
that which was ordinarily attainable at and behind the day-to-day medical supervision there was going on a careful
753
research into medical problems peculiar to the army. Research of this kind had in the past been of untold value to the surrounding civil population. In the case of undulant fever, for centuries an endemic disease of Malta, the discovery of the cause and therewith the means of prevention was entirely the work of the R.A.M.C. Research of like importance was now going on into antityphoid inoculation. When the activities of this great health service came to be more fully investigated by the public they would, he felt sure, form a very different idea of its value not only to the Army but to humanity at large. For some time there had been a disconcerting lack of candidates for commissions in the R.A.M.C., partly, no doubt, due to financial considerations which were receiving attention. Conditions of service had already been materially improved, promotion had been hastened and the period necessary to qualify for a gratuity on retirement had been reduced. It was now, he said, possible for an officer to take a short-service commission for five years and then retire with a gratuity of .El 000 if he was not appointed to a permanent commission. The service should now attract young men on qualification. The life was interesting and there was plenty of opportunity for specialisation by those who were keen on study and research. Mr. HACKING concluded his survey with the remark that he was confident that were the work of the R.A.M.C. better known there would be a still wider field of selection of candidates. In the debate Sir ARNOLD WILSON deplored the state of many of the barracks abroad, emphasised the need of further welfare work among the wives and children of soldiers, and asked that dental care in the army should be raised to the standard of that available in civil life. He regretted the dropping of antimalarial work in certain stations owing to financial stringency, remarking that in India they were spending only 11. a head on antimalarial work compared with 1158. 4d. spent in the Panama Canal zone. The result was that malaria had been a greater scourge in 1933 than in the previous years. Sir FRANCIS FREMANTLE congratulated the Government on having put into force many of the recommendations of the Warren-Fisher Committee with the result that since June of last year 40 medical recruits had been taken into the army medical service, the largest number since the war. But the difficulty of ensuring permanent promotion still remained in spite of the increase from 113 to 155 in special posts. He warmly endorsed Sir A. Wilson’s plea for improvement of married quarters and hoped it would be only the beginning of a general clean-up right through the garrisons of the Empire. A FORTNIGHT ago we announced in these columns two generous donations to radium research under the auspices of the Medical Research Council, the Department of Scientific and Industrial Research and the Royal Colleges with the loan of radium element from the Belgian supply. This research work is being carried out at the Radium Institute in Portland-place. The patients are housed and maintained by the Institute, which also provides certain staff services as its contribution towards the cost.