- Email: [email protected]
THE CARNEGIE UNITED KINGDOM TRUST AND INFANT AND MATERNAL WELFARE.
28
EMPYEMA AFRER PNEUMONIA.
end of the
subject of infant and maternal welfare, and that bhey have apparently placed the matter in the hands of Dr. Hope in order that he may draw up a report on the matter; but we must, at the same time, express surprise at the manner of conducting the inquiry. We should have thought
operation with the gradual return of in others the effect was more decided sensation; and persistent, a diminution of 15-20 mm. requiring injections of infundibulin and camphor to restore it. The maximum observed was a diminution of 45 mm. In the remaining 21 cases there was no appreciable effect on the arterial blood pressure. These results are somewhat different from those of Solaro and Borghi, who recorded a rapid and constant lowering of blood pressure of 10-50 mm. These observers, however, used a mixture of stovaine and novocaine. From a general point of view, therefore, it may be accepted that spinal anaesthesia by novocaine alone has little influence on the arterial pressure, and that in those cases in which it is affected the lowering is usually transitory, and that when it is persistent the administration of the usual remedies will restore it to normal in a short time, varying from a few hours to a maximum of 24. Dr. Amaglio considers that spinal anaesthesia by novocaine merits a more extensive practical application in view of the researches of Dialti and Pozzilli on the influence of ether and chloroform narcosis on the blood pressure, which was decided. For whereas in ether narcosis there is a preliminary period of a marked rise in arterial pressure which then returns slowly to normal, chloroform narcosis, on the other hand, produces from the commencement a noticeable lowering, which is sometimes restored after a longer or shorter time, but which at other times persists or becomes so accentuated as to threaten life. Ether being in this respect preferable to chloroform, by comparison spinal anaesthesia having very slight influence on the blood pressure should be logically preferable to either.
that all the required information would have been in the possession of the Local Government Board, and that it might have been obtained from them direct without troubling medical officers of health to fill up- special inquiry forms for the Carnegie trustees giving information which these officers have doubtless already supplied to the central public health authority. Medical officers of health have nowadays a very large number of official returns to fill up-some think far too many-and, at the present time, when most of them are short of staff owing to the exigencies of war, it is rather surprising that this additional, and, as it seems to us, unnecessary, burden is sought to be placed upon them. Dr. Hope’s letter to the medical officers of health of the districts to which the schedule of inquiry has been sent is vague as to the use to which the Carnegie trustees intend to put the information on infant and maternal welfare once they have got it, and it is unfortunate that he was not a little more explicit on This branch of public health the point. work is at present under the control of two Government departments-i.e., the Local Government Board and Board of Education-both of which are empowered to make grants of public money to assist in financing local schemes. It is to be hoped that the Carnegie trustees do not intend to make an already complicated position mqre complicated; the proverb of too many cooks spoiling the broth is none the less true because it is trite, and it would be sad if it became applicable THE CARNEGIE UNITED KINGDOM TRUST AND to the activities of those who have at heart the INFANT AND MATERNAL WELFARE. welfare of mothers and children in this country. WE understand that the Carnegie United Kingdom Trust, desirous of obtaining a comprehensive report EMPYEMA AFTER PNEUMONIA. upon the provision made throughout the country PNEUMONIA, is without doubt the commonest for promoting the physical welfare of mothers and of cause empyema. Empyema is no less one of infants, have prepared a schedule containing a the commonest pneumonia. Dr. G. large number of questions indicating the scope of Nilson1 has metsequels of 32 cases of empyema with the inquiry and the aspects of the subject upon which information is sought. Copies of this schedule among 465 patients treated for pneumonia at the have been sent to the medical officers of health of Karlskrona Seamen’s Hospital between the years the larger sanitary districts, together with a copy 1903 and 1915, and discusses the treatment of the of a letter signed by Dr. E. W. Hope, the medical condition. Borelius, describing in 1914 34 cases of officer of health of Liverpool, requesting that the metapneumonic empyema met with at Lund, found 12 recovered after a single thoracocentesis and required information should be sent to him in that of the pleural exudate, while 5 more withdrawal order that the Carnegie trustees " may be in a recovered after repeated pleural puncture; the position to decide what steps of a practical nature remaining 17 required operation, the removal can be taken by them (if any), and generally to The average durations assist in the solution of the problems in ques- of a piece of a rib. of these treatments were 37 days, 107 days, and tion." The schedule, which covers the ground in 52 and Borelius came to the condays respectively, a fairly comprehensive manner, is divided into Section A contains inquiries into clusion that primary thoracotomy, the resection of seven sections. the general sanitary condition of the district. a piece of a rib, should therefore be regarded as the Section B concerns itself with the activities of normal treatment of such empyemas. In describing local authorities with special reference to infant his own experience Dr. Nilson remarks that certain as 1903, 1909, and 1915, impress themand maternal welfare ; while Section C requires years, such " selves as pneumonia years " in the personnel of similar information in respect to the activities of and also as " empyema years." the navy, During , voluntary agencies. Section D is devoted to the such years the cases of pneumonia averaged 60 Poor-law aspect of the question; Section E to, information connected with midwives; Section F instead of the usual 35, and the percentage to education in mothercraft, and under Section G developing empyema rose from the average 7 per cent. to 11 per cent. The empyema declares itself space is provided for general observations by the; medical officer of health of the district. It is four or five weeks, on the average, after the satisfactory to know that the Carnegie trustees are, beginning of the pneumonia;; the three earliest taking a practical interest in the very important 1 Nordiskt med. Arkiv, Stockholm, 1915, xlviii., Afd. I., Kirurgi, hft.2. I
I
.
;
,
EMPYEMA AFRER PNEUMONIA.
end of the
subject of infant and maternal welfare, and that bhey have apparently placed the matter in the hands of Dr. Hope in order that he may draw up a report on the matter; but we must, at the same time, express surprise at the manner of conducting the inquiry. We should have thought
operation with the gradual return of in others the effect was more decided sensation; and persistent, a diminution of 15-20 mm. requiring injections of infundibulin and camphor to restore it. The maximum observed was a diminution of 45 mm. In the remaining 21 cases there was no appreciable effect on the arterial blood pressure. These results are somewhat different from those of Solaro and Borghi, who recorded a rapid and constant lowering of blood pressure of 10-50 mm. These observers, however, used a mixture of stovaine and novocaine. From a general point of view, therefore, it may be accepted that spinal anaesthesia by novocaine alone has little influence on the arterial pressure, and that in those cases in which it is affected the lowering is usually transitory, and that when it is persistent the administration of the usual remedies will restore it to normal in a short time, varying from a few hours to a maximum of 24. Dr. Amaglio considers that spinal anaesthesia by novocaine merits a more extensive practical application in view of the researches of Dialti and Pozzilli on the influence of ether and chloroform narcosis on the blood pressure, which was decided. For whereas in ether narcosis there is a preliminary period of a marked rise in arterial pressure which then returns slowly to normal, chloroform narcosis, on the other hand, produces from the commencement a noticeable lowering, which is sometimes restored after a longer or shorter time, but which at other times persists or becomes so accentuated as to threaten life. Ether being in this respect preferable to chloroform, by comparison spinal anaesthesia having very slight influence on the blood pressure should be logically preferable to either.
that all the required information would have been in the possession of the Local Government Board, and that it might have been obtained from them direct without troubling medical officers of health to fill up- special inquiry forms for the Carnegie trustees giving information which these officers have doubtless already supplied to the central public health authority. Medical officers of health have nowadays a very large number of official returns to fill up-some think far too many-and, at the present time, when most of them are short of staff owing to the exigencies of war, it is rather surprising that this additional, and, as it seems to us, unnecessary, burden is sought to be placed upon them. Dr. Hope’s letter to the medical officers of health of the districts to which the schedule of inquiry has been sent is vague as to the use to which the Carnegie trustees intend to put the information on infant and maternal welfare once they have got it, and it is unfortunate that he was not a little more explicit on This branch of public health the point. work is at present under the control of two Government departments-i.e., the Local Government Board and Board of Education-both of which are empowered to make grants of public money to assist in financing local schemes. It is to be hoped that the Carnegie trustees do not intend to make an already complicated position mqre complicated; the proverb of too many cooks spoiling the broth is none the less true because it is trite, and it would be sad if it became applicable THE CARNEGIE UNITED KINGDOM TRUST AND to the activities of those who have at heart the INFANT AND MATERNAL WELFARE. welfare of mothers and children in this country. WE understand that the Carnegie United Kingdom Trust, desirous of obtaining a comprehensive report EMPYEMA AFTER PNEUMONIA. upon the provision made throughout the country PNEUMONIA, is without doubt the commonest for promoting the physical welfare of mothers and of cause empyema. Empyema is no less one of infants, have prepared a schedule containing a the commonest pneumonia. Dr. G. large number of questions indicating the scope of Nilson1 has metsequels of 32 cases of empyema with the inquiry and the aspects of the subject upon which information is sought. Copies of this schedule among 465 patients treated for pneumonia at the have been sent to the medical officers of health of Karlskrona Seamen’s Hospital between the years the larger sanitary districts, together with a copy 1903 and 1915, and discusses the treatment of the of a letter signed by Dr. E. W. Hope, the medical condition. Borelius, describing in 1914 34 cases of officer of health of Liverpool, requesting that the metapneumonic empyema met with at Lund, found 12 recovered after a single thoracocentesis and required information should be sent to him in that of the pleural exudate, while 5 more withdrawal order that the Carnegie trustees " may be in a recovered after repeated pleural puncture; the position to decide what steps of a practical nature remaining 17 required operation, the removal can be taken by them (if any), and generally to The average durations assist in the solution of the problems in ques- of a piece of a rib. of these treatments were 37 days, 107 days, and tion." The schedule, which covers the ground in 52 and Borelius came to the condays respectively, a fairly comprehensive manner, is divided into Section A contains inquiries into clusion that primary thoracotomy, the resection of seven sections. the general sanitary condition of the district. a piece of a rib, should therefore be regarded as the Section B concerns itself with the activities of normal treatment of such empyemas. In describing local authorities with special reference to infant his own experience Dr. Nilson remarks that certain as 1903, 1909, and 1915, impress themand maternal welfare ; while Section C requires years, such " selves as pneumonia years " in the personnel of similar information in respect to the activities of and also as " empyema years." the navy, During , voluntary agencies. Section D is devoted to the such years the cases of pneumonia averaged 60 Poor-law aspect of the question; Section E to, information connected with midwives; Section F instead of the usual 35, and the percentage to education in mothercraft, and under Section G developing empyema rose from the average 7 per cent. to 11 per cent. The empyema declares itself space is provided for general observations by the; medical officer of health of the district. It is four or five weeks, on the average, after the satisfactory to know that the Carnegie trustees are, beginning of the pneumonia;; the three earliest taking a practical interest in the very important 1 Nordiskt med. Arkiv, Stockholm, 1915, xlviii., Afd. I., Kirurgi, hft.2. I
I
.
;
,