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VOCATIONAL TRAINING IN CONNEXION WITH SANATORIUMS.
956
VOCATIONAL TRAINING IN CONNEXION WITH SANATORIUMS.
in view of the serious condition of the national Some anxiety is expressed in this regard as to the future, but inasmuch as even in a difficult year the needs of the University have been further recognised, we may trust, with Sir Cooper Perry, that it will never be found necessary to effect reductions in respect of " this most remunerative of the national industries."
exchequer.
____
A FURTHER AID TO DIFFERENTIAL DIAGNOSIS.
THE value of the variation in the blood count and blood picture as a means of differential diagnosis in many diseases has long been well known, and it is also well known that it is valueless in the diagnosis of many other conditions. Löhr1 brings forward another property of the red blood corpuscles, the variation in which gives us a means of assistance in those cases where the blood count is not of material help. His method is as follows. The blood from the patient is collected from a vein, by means of a 1-c.cm. syringe, containing a 5 per cent. solution of sodium citrate, blood and citrate being in the proportion of 4: 1. ’The fluids are thoroughly mixed, and then injected into a glass tube 6-5 cm. high, of a diameter of 5 mm., and holding exactly 1 c.cm. The tube is marked from the top downwards at intervals of 6, 12, 18, 24 mm. ’The rate at which the red corpuscles sink is now observed, the time they take to arrive at the fourth mark being that which Lohr uses for purposes of comparison. It is important that all observers working on any new experiment such as this should use the same technique, so that the results may be compared.2 Lohr finds that the normal time taken by the corpuscles to sink; called by him B.S. (Blutsenkung) in the newly born up to the fifteenth week is 1500 minutes. From that age onwards the time diminishes until for a healthy man it reaches 1200 to 1400 minutes, and for a woman 800 to 1000 minutes. After the menopause the woman’s B.S. rises to that of a man’s, while during menstruation it diminishes to 600 minutes. No daily variation, or variation following meals or injection of such substances as adrenalin, pilocarpine, and physostigmine has been found. The following diseases were found to have a normal B.S.: Goitre, with or without signs of hyperthyroidism, 253; acromegaly, 1; chondrodystrophia, 1; diverticulum of the oesophagus, 1; cardiospasm, 3; early and late rickets, with their complications of scoliosis, coxa vara, genu varum and valgum, 30 ; osteochondritis of the elbow, knee, and -ankle, 30 ; cartilaginous exostosis, 1 : old slipped internal semilunar cartilage, 4. In the following conditions a marked decrease in the B.S. was found : All inflammatory conditions, acute or chronic, in direct proportion to the magnitude of the inflammatory process-e.g., in pneumonia and in diffuse peritonitis the B.S. descended to 15-50 minutes (the normal in these cases being about 1500 minutes). The magnitude of a pulmonary or bone tuberculous lesion could also be accurately gauged, and it is remarkable that a symptomless chronic rheumatic arthritis also showed a marked decrease (3 cases). Chronic ulcers of the skin or gastro-duodenal region showed no change in the B.S., but if a fresh inflammatory process, such as perigastritis developed, a diminution in the B.S. immediately indicated it. Similar changes in the B.S. were observed in cases suffering from malignant tumours. The larger the tumour and the more extensive the metastases, the lower the B.S. and vice Out of 100 cases 2 gave an increased B.S. versa. Innocent tumours showed a normal B.S. 100 uncomplicated fractures showed a diminished B.S. occurring at the earliest 12 hours after the accident, and always within 24 hours, lasting until the fracture was consolidated. Here also the magnitude of the fracture was indicated by the B.S., a fracture of the femur lowering it a great deal more than one of the toe. In 50 cases 1 Deutsche medizinische Wochenschrift, March 24th, 1922. 2 Further details of the technique may be found in Löhr’s article in the Grenzgebiete der Medizin und Chirurgie, Band xxxiv., Heft 2, 1921. 3 The numbers indicate the number of cases examined.
primary healing in wounds in healthy individuals, a lowering of the B.S. occurred within 24 hours, and lasted six to ten days. In severe anaphylactic shock the B.S. was raised, but after disappearance of the shock, it sank to a minimum, and only slowly regained the normal in about six days. Epilepsy (2) showed an increased B.S. during the fit. As a result of about 1000 examinations, Lohr
of
arrives at the conclusion that the estimation of the sinking time of red corpuscles is of value in surgical practice, particularly in the following conditions : (a) In abdominal surgery to decide the magnitude of an inflammatory process, especially in appendicitis, for during a quiescent period the B.S. is normal; (b) in diseases of the joints to distinguish tuberculous and suppurative osteomyelitis from osteochondritis and
Perthé’s disease, rickets (coxa vara, &c.), old fractures, and flat-foot, and in estimating the advisability of mobilisation of a tuberculous joint which is thought to be healed ; (c) in distinguishing carcinoma of the oesophagus from cardiospasm and diverticulum ; and
(d) to distinguish any form of inflammation, even though latent, from a non-inflammatory process. VOCATIONAL TRAINING
CONNEXION WITH SANATORIUMS. IN
THE concurrent treatment and vocational training men suffering from tuberculosis has been the subject of consultation between the Ministry of Health, the Treasury, and the Ministry of Pensions, and a circular has been issued for the information of county and county borough and metropolitan councils and their tuberculosis officers. Arrangements have been made for training in market-gardening, poultry-, pigand bee-keeping ; in rural carpentry, furniture and house repairing; in tin-smithing, art-metal work, brush and basket making ; in jewelry, watch, clock, and china repairing at various specified sanatoriums where training sections have been provided at Government expense. These courses have been designed to give men desiring to work on their own account in suburbs,
of ex-Service
country towns,
or
large villages
a
general training
which should enable them to earn a living, though it is not anticipated that the training given will make men commercially successful at once. Patients recommended for a course of vocational training, even for the less heavy occupations, should be capable of doing at least four hours work daily without ill-effect, and since, even with the, aid of war pensions, it will be difficult for patients to make good in competition with healthy workers, it is important that only those who have a reasonable prospect of securing arrest of the disease should be selected for admission. Payment will not be made for work done during training, but under certain conditions a bonus and a grant for tools will be obtainable at the end of the course. The procedure to be adopted by applicant and the tuberculosis officer is detailed in the circular ; the provisions made to ensure that no money is wasted in training obviously unsuitable candidates and, on the other hand, that a temporary set-back or a mistake in selection of a special vocation shall not prejudice a man’s chance of receiving training, appear to be well considered. In no case may a course of vocational training exceed 12 months in duration; no patient will be admitted to training whose course cannot be completed by .Tune 30th, 1924. EXPERIMENTAL ADMINISTRATION COLLOIDAL SILICA.
OF
THE April number of the British Journal of Experi. mental Patho7ogy contains two interesting papers by W. E. Gye and W. J. Purdy on the Poisonous Properties of Colloidal Silica. The first paper deals with the results which follow the subcutaneous, intraperitoneal, and intravenous injection of large doses of colloidal " silica, orthosilicic acid," into mice and rabbits and
guinea-pigs. Subcutaneous injections
are
followed by
VOCATIONAL TRAINING IN CONNEXION WITH SANATORIUMS.
in view of the serious condition of the national Some anxiety is expressed in this regard as to the future, but inasmuch as even in a difficult year the needs of the University have been further recognised, we may trust, with Sir Cooper Perry, that it will never be found necessary to effect reductions in respect of " this most remunerative of the national industries."
exchequer.
____
A FURTHER AID TO DIFFERENTIAL DIAGNOSIS.
THE value of the variation in the blood count and blood picture as a means of differential diagnosis in many diseases has long been well known, and it is also well known that it is valueless in the diagnosis of many other conditions. Löhr1 brings forward another property of the red blood corpuscles, the variation in which gives us a means of assistance in those cases where the blood count is not of material help. His method is as follows. The blood from the patient is collected from a vein, by means of a 1-c.cm. syringe, containing a 5 per cent. solution of sodium citrate, blood and citrate being in the proportion of 4: 1. ’The fluids are thoroughly mixed, and then injected into a glass tube 6-5 cm. high, of a diameter of 5 mm., and holding exactly 1 c.cm. The tube is marked from the top downwards at intervals of 6, 12, 18, 24 mm. ’The rate at which the red corpuscles sink is now observed, the time they take to arrive at the fourth mark being that which Lohr uses for purposes of comparison. It is important that all observers working on any new experiment such as this should use the same technique, so that the results may be compared.2 Lohr finds that the normal time taken by the corpuscles to sink; called by him B.S. (Blutsenkung) in the newly born up to the fifteenth week is 1500 minutes. From that age onwards the time diminishes until for a healthy man it reaches 1200 to 1400 minutes, and for a woman 800 to 1000 minutes. After the menopause the woman’s B.S. rises to that of a man’s, while during menstruation it diminishes to 600 minutes. No daily variation, or variation following meals or injection of such substances as adrenalin, pilocarpine, and physostigmine has been found. The following diseases were found to have a normal B.S.: Goitre, with or without signs of hyperthyroidism, 253; acromegaly, 1; chondrodystrophia, 1; diverticulum of the oesophagus, 1; cardiospasm, 3; early and late rickets, with their complications of scoliosis, coxa vara, genu varum and valgum, 30 ; osteochondritis of the elbow, knee, and -ankle, 30 ; cartilaginous exostosis, 1 : old slipped internal semilunar cartilage, 4. In the following conditions a marked decrease in the B.S. was found : All inflammatory conditions, acute or chronic, in direct proportion to the magnitude of the inflammatory process-e.g., in pneumonia and in diffuse peritonitis the B.S. descended to 15-50 minutes (the normal in these cases being about 1500 minutes). The magnitude of a pulmonary or bone tuberculous lesion could also be accurately gauged, and it is remarkable that a symptomless chronic rheumatic arthritis also showed a marked decrease (3 cases). Chronic ulcers of the skin or gastro-duodenal region showed no change in the B.S., but if a fresh inflammatory process, such as perigastritis developed, a diminution in the B.S. immediately indicated it. Similar changes in the B.S. were observed in cases suffering from malignant tumours. The larger the tumour and the more extensive the metastases, the lower the B.S. and vice Out of 100 cases 2 gave an increased B.S. versa. Innocent tumours showed a normal B.S. 100 uncomplicated fractures showed a diminished B.S. occurring at the earliest 12 hours after the accident, and always within 24 hours, lasting until the fracture was consolidated. Here also the magnitude of the fracture was indicated by the B.S., a fracture of the femur lowering it a great deal more than one of the toe. In 50 cases 1 Deutsche medizinische Wochenschrift, March 24th, 1922. 2 Further details of the technique may be found in Löhr’s article in the Grenzgebiete der Medizin und Chirurgie, Band xxxiv., Heft 2, 1921. 3 The numbers indicate the number of cases examined.
primary healing in wounds in healthy individuals, a lowering of the B.S. occurred within 24 hours, and lasted six to ten days. In severe anaphylactic shock the B.S. was raised, but after disappearance of the shock, it sank to a minimum, and only slowly regained the normal in about six days. Epilepsy (2) showed an increased B.S. during the fit. As a result of about 1000 examinations, Lohr
of
arrives at the conclusion that the estimation of the sinking time of red corpuscles is of value in surgical practice, particularly in the following conditions : (a) In abdominal surgery to decide the magnitude of an inflammatory process, especially in appendicitis, for during a quiescent period the B.S. is normal; (b) in diseases of the joints to distinguish tuberculous and suppurative osteomyelitis from osteochondritis and
Perthé’s disease, rickets (coxa vara, &c.), old fractures, and flat-foot, and in estimating the advisability of mobilisation of a tuberculous joint which is thought to be healed ; (c) in distinguishing carcinoma of the oesophagus from cardiospasm and diverticulum ; and
(d) to distinguish any form of inflammation, even though latent, from a non-inflammatory process. VOCATIONAL TRAINING
CONNEXION WITH SANATORIUMS. IN
THE concurrent treatment and vocational training men suffering from tuberculosis has been the subject of consultation between the Ministry of Health, the Treasury, and the Ministry of Pensions, and a circular has been issued for the information of county and county borough and metropolitan councils and their tuberculosis officers. Arrangements have been made for training in market-gardening, poultry-, pigand bee-keeping ; in rural carpentry, furniture and house repairing; in tin-smithing, art-metal work, brush and basket making ; in jewelry, watch, clock, and china repairing at various specified sanatoriums where training sections have been provided at Government expense. These courses have been designed to give men desiring to work on their own account in suburbs,
of ex-Service
country towns,
or
large villages
a
general training
which should enable them to earn a living, though it is not anticipated that the training given will make men commercially successful at once. Patients recommended for a course of vocational training, even for the less heavy occupations, should be capable of doing at least four hours work daily without ill-effect, and since, even with the, aid of war pensions, it will be difficult for patients to make good in competition with healthy workers, it is important that only those who have a reasonable prospect of securing arrest of the disease should be selected for admission. Payment will not be made for work done during training, but under certain conditions a bonus and a grant for tools will be obtainable at the end of the course. The procedure to be adopted by applicant and the tuberculosis officer is detailed in the circular ; the provisions made to ensure that no money is wasted in training obviously unsuitable candidates and, on the other hand, that a temporary set-back or a mistake in selection of a special vocation shall not prejudice a man’s chance of receiving training, appear to be well considered. In no case may a course of vocational training exceed 12 months in duration; no patient will be admitted to training whose course cannot be completed by .Tune 30th, 1924. EXPERIMENTAL ADMINISTRATION COLLOIDAL SILICA.
OF
THE April number of the British Journal of Experi. mental Patho7ogy contains two interesting papers by W. E. Gye and W. J. Purdy on the Poisonous Properties of Colloidal Silica. The first paper deals with the results which follow the subcutaneous, intraperitoneal, and intravenous injection of large doses of colloidal " silica, orthosilicic acid," into mice and rabbits and
guinea-pigs. Subcutaneous injections
are
followed by