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A CHANCE FOR EPILEPTIC CHILDREN.
143 in any way possible, and the research whose aim is to further knowledge by accurately controlled tests. The mental hospital physician takes a lamp, groups a dozen patients round it, finds that they improve physically and mentally, and that their convalescence is hastened, and declares that ultra-violet light is a valuable The factor in the treatment of mental disease. physical chemist points out that three-quarters of the rays he is using are not ultra-violet at all, that the patients are receiving other kinds of treatment as well, and that many purely psychological factors It is, however, for the scientific worker come in. and the clinician to meet together and to clear up ambiguity, and there is urgent need for research to this end. Till the nomenclature is cleared up noI one would deny to the clinician the right to administer and to extol a technique which in actual fact appears to him to do his patients good. The general conclusion seems to be that at the present stage-after all, a very early one-artificial sunlight treatment, particularly the carbon arc, is a good therapeutic measure for mental patients, even though its exponents have not yet distinguished between the various factors which may be responsible for the of his
patients
worker
results obtained.
____
CHEMICAL WARFARE.
These questions are, however, frankly faced by Dr. L. P. Lockhart in the January number of the National Review. This writer, indeed, considers the questions settled and anticipates a war in which gas attack upon the civil population will be the decisive weapon. He declares that " the hope that the use of gas against civilians can be prohibited is opposed to the whole trend and evolution of twentiethcentury warfare in its relation to the economic and scientific needs of the modern State." Viscount Grey of Fallodon is quoted as saying that " it is by bringing home to each succeeding generation what the realities of modern war are, how vastly more catastrophic and destructive it is to the whole population than ever before, that we shall form a public opinion which will help to secure peace," but the argument of Dr. Lockhart, in which he is supported by Mr. J. B. S. Haldane, is that poison gas is so humane that the public can be educated to anticipate its use and " trained to realise that, with the proper measures, they have little to fear." Our possible enemies must not be expected, however, to remain ignorant of these proper measures, and this latest advance in Schrecklichkeit will surely go the way of all other warlike inventions. We hope that the wit and goodwill of mankind will succeed in breaking this vicious circle but, if the outlook is as bad as Dr. Lockhart thinks, then it is plainly our duty to prepare ourselves for the work we shall be called upon to do in alleviating the sufferings of the civil population in the next war. The extent of this preparation is wider than one might expect; Dr. Lockhart advocates, for example, that city, borough, and county councils should be responsible for the creation and maintenance of adequate anti-gas defence, and he presses the new and urgent need for the removal of our large hospitals from the centre of London on the’ ground that they may cease to function in time of war. Perhaps it is well that we should be thus reminded of the alternatives before us. ...
TEN years have passed since the war, and a generation is growing up that knows little of the experiences that led to the almost universal hope that war would become obsolete. That hope now seems remoter, and it is possible that the races of mankind will, like the characters in a Greek tragedy, be driven on to disaster by forces within themselves that use reason as a weapon rather than a guide. " If you wish for peace, prepare for war " is a maxim that, universally used, leads to preparations that progressively increase, and the statesmen of many nations are even now struggling to arrest the increase. One of the first of their efforts was directed towards the exclusion of the use of poisonous gases in warfare, and various international agreements have been A CHANCE FOR EPILEPTIC CHILDREN. signed with that object. Yet there is a belief, freely THE epileptic boy or girl who has been excluded expressed, that our objections to its use are as futile as were our ancestors’ objections to the introduction from school because his fits are so frequent or severe of firearms in war, and that no nation will, when is in an unhappy position. If school is an unsuitable put to the test, refrain from the employment of all place for him, small homes or crowded streets are the means at its disposal in spite of paper agreements. more unsuitable still. To the handicap of this Further, it is argued that gas is a more humane disease is added the further handicap of want of He grows up literally without a chance weapon than high explosives, inasmuch as its use education. against the civil population would bring greater in life. Medical men who come across these cases and speedier military and political advantage with in private practice, or in the out-patient departments less suffering and death. The side would win that of hospitals, will therefore be glad to know that first produced uncontrollable panic among the home there is to be a further opportunity for London population of the other and, since defence against epileptic children to go to a school in the country, hostile aircraft is apparently an unsolved problem, where they will receive the education of which they and poison gas is easily manufactured almost as a stand so much in need, combined with active medical secondary product of industrial chemistry, we must supervision and treatment. The London County admit the force of the argument and realise that in Council has arranged that some 80 additional places our next experience of civilised warfare its bodily shall be made available at Lingfield Epileptic Colony, effects will be brought home to all, irrespective of Surrey, where the instruction given resembles that associated with the ordinary public elementary school. age or sex. With these considerations as the St. John Ambulance Association has published In addition, manual training and open-air occupation a brochure by Major F. R. Humphreys, late are provided. The children are housed in villas and R.A.M.C.(T.) and Royal Air Force, on Protection I special attention is devoted to their comfort and of the Civil Population in Chemical Warfare, whichI recreative pursuits, whilst it is possible to ensure describes in simple language the effects of the different ’, regularity of hours so essential to successful poison gases likely to be used, with the defensive treatment. Continuous observation, which is, of procedure to be adopted by the victims, and outlines course, desirable for all patients suffering from the special duties that would fall to first-aid units. epilepsy in its varying manifestations, is maintained In the preface Major-General P. S. Wilkinson by the medical superintendent, and the children are announces that the manual has the approval of the sent home as soon as their condition may be deemed Chemical Warfare Research Department of the War to be arrested. In cases where the epilepsy persists, Office and assumes that detailed organisations will residence at the school is permitted up to the age of be set up to deal with the work of defence. Medical 16 years. Children between the ages of 7 and 14, men who feel the need for information will undoubtresident in the Countv of London, are eligible for edly find the manual useful; it deals only with the admission, and all applications should be addressed material issues immediately concerned with gas to the Education Officer, The County Hall, S.E. 1. attack and makes no reference to wider questions In view of the fact that, in the past, there has been that inevitably arise in the mind of the reader. a considerable waiting-list, speedy application is
justification,
I
the
144 advised.
The
more
urgent
cases
will receive
priority portion of the eggs sent up to the wards could genuinely
but, subject to this proviso, applications will be dealt with in the order in which they are received, and every effort will be made to secure admission as early as possible. It should be noted that the provision at this school is made for educable children only. SUPPLY OF EGGS TO HOSPITALS. DURING the next few months the marketing of eggs will undergo a number of changes that may well give rise to fundamental reforms. The " national mark scheme," beginning on Feb. lst, is a voluntary one, but already nearly a hundred accredited packers have promised their adherence to it. Under this scheme eggs will be graded for retailing in three classes, according to size, and only new-laid eggs The will be sold under the " national mark." scheme is designed to help British producers to secure the market in this country, and its success, of course, depends on the extent to which the producers seize the opportunity, and the purchasers support them by demanding " national mark " eggs. On March Ist there will come into operation a clause of the Agricultural Produce (Grading and Marking) Act, 1928, requiring retailers to mark all home-produced eggs that have been preserved. Later on, probably in April, an Order in Council will come into force, insisting that imported eggs shall be marked with their country of origin, and another clause of the Act will require all home-produced eggs that have been cold-stored or -gas-stored to be marked before they leave the store. These changes affect the public health very closely. Eggs are extensively used in the home and play an important part in many invalid diets ; they are easily prepared, readily assimilated, and contain more nutriment than most other natural foods. But it is important that they should be fresh. Mr. James Gatecliff, in an interesting booklet1 on the subject, goes so far as to say that the stale egg is not merely useless but actually harmful, and proceeds to criticise the supply of eggs to hospitals on the ground that insufficient care is taken to get them fresh. Egg-purchasing has, of course, a peculiar difficulty for the hospital authority, who must obtain large supplies of reliable eggs at the lowest possible rate. At present many institutions put out tenders for their egg-supply, making as the chief, or only, condition that the eggs shall weigh at least 2 oz. Many egg-distributors deplore this proviso, because the average pullet at its first laying season produces an egg which is just under 2 oz. in weight, but otherwise entirely satisfactory. They say that the hospitals could save money, without any deterioration in the qualitv of the eggs they receive, if they changed the 2 oz. standard. Mr. Gatecliff, however, maintains that at the present time many hospitals save money at the expense of their patients, and declares roundly that " the present methods of obtaining eggs for charitable institutions is not only a disgrace but a national scandal." He records a visit to a large relief institution in London, where he found that the so-called " new-laid " eggs were at least three weeks old. He relates that a large London hospital sent out tenders for first-grade British newlaid eggs and turned down a tender of Is. 10d. a dozen as too expensive at a time when a number of poultry-farmers-between them supplying some 100,000 eggs a week-informed him that their lowest cut-price for really fresh eggs was 2s. 3d. per dozen. Mr. Gatecliff suggests as a remedy that firms of established reputation should be instructed by the hospital authority to purchase eggs at statutory market prices, thus abandoning the present system of commercial tendering. It might be interesting for the conscientious hospital administrator to investigate his egg-supply for, say, a week, and see what pro-
be classed as new-laid and suitable for the invalid. A simple test to determine the age of an egg is to drop it gently into 5 or 6 in. of water in a flatbottomed vessel, 1 oz. of common salt having been added for each pint of water. A new-laid egg will fall to the bottom and lie flat on its side. An egg between 12 and 21 days old will settle at an angle, the broad end rising. As age progresses the angle increases, until the egg stands upright on its base. Later still, it will float upright, while the " election egg " will float on its side on the surface. This test will not work with eggs preserved in lime or waterglass, but there are three useful guides to the preserved egg. First, the shell will crack from crown to base in boiling ; this is specific. Secondly, the yolk is displaced, often touching the shell. Thirdly, the white is watery and has lost its firmness and
elasticity.
If Mr. Gatecliff’s accusation is grave one ; otherwise it calls for
justified it is a disproof. Dr. G. Clark Trotter, medical officer of health for Islington, who writes a preface to Mr. Gatecliff’s booklet, initiated in our columns a correspondence2 which revealed the difficulty experienced under the old regulations, both by the public in obtaining new-laid eggs and by the medical officer of health in ensuring that the eggs on sale in his .area were properly described by the retailer. The new arrangements have long been desired by reputable egg-marketing firms, and they seem to meet the needs of our correspondents very adequately. Certainly no hospital ordering its eggs under the " national mark scheme " need fear Mr. Gatecliff’s investigations, and it is surely not too much to ask that all hospital authorities should see that the food of their patients is at least as pure as their drugs.
PUBLIC HEALTH IN GUERNSEY. Channel THE Islands have a deserved reputation for salubrious climate and other amenities. It is interesting to compare the conditions of public health with those of England and Wales and to note the problems which the local authorities have to face. The report for 1927 of the medical officer of health for Guernsey tells us that Guernsey has an area of about 25 square miles and a population just under 40,000. Its natural beauties are great, its soil very fertile, and the climate attractive, cooler in summer and warmer in winter than on the mainland. The average hours of sunshine over 34 years have been The water-supply from deep wells belongs 1897. to the Government and is " of exceptional purity." During 1927 Guernsey exported 24,509 tons of tomatoes, 3217 tons of flowers, 1165 tons of grapes, and 2304 tons of vegetables. Presumably the islanders have plenty of these requisites for themselves. Most of the fruit is grown under glass. An additional export was 195,591 tons of granite for road-making. The milk herds are free from tuberculosis. The health statistics are good in parts. Infant mortality is higher than in England and Wales and about double the New Zealand rate75 for 1927. The neonatal rate, 46, was also high. The pre-school child rate was 24. On the other hand, the maternal rate from childbirth is about half that of England or New Zealand. During the last 27 years there have been 24,593 births and 53 maternal deaths from childbirth-a rate of 2-15 per 1000 births. During the last two years one-seventh of the total births took place in the Lady Ozanne Maternity Home. There is no health visitation or effort to educate the At the end of 1927 arrangements were mothers. made for " part-time " school nurses. The tuberGranite culosis death - rate is somewhat high. quarrying is acknowledged to be an occupation predisposing to phthisis, owing to the presence of free silica in the rock, but one would not expect raising flowers and fruit under glass to be an unhealthy 1 Eggs ; A Treatise on their Food Value and a Helpful Guide to Securing the Genuine Article. Nov., 1928. W. Speaight and 2 THE LANCET, 1927, ii., 141, et seq. Sons, Ltd., 98, Fetter-lane, E.C.4.
patients
worker
results obtained.
____
CHEMICAL WARFARE.
These questions are, however, frankly faced by Dr. L. P. Lockhart in the January number of the National Review. This writer, indeed, considers the questions settled and anticipates a war in which gas attack upon the civil population will be the decisive weapon. He declares that " the hope that the use of gas against civilians can be prohibited is opposed to the whole trend and evolution of twentiethcentury warfare in its relation to the economic and scientific needs of the modern State." Viscount Grey of Fallodon is quoted as saying that " it is by bringing home to each succeeding generation what the realities of modern war are, how vastly more catastrophic and destructive it is to the whole population than ever before, that we shall form a public opinion which will help to secure peace," but the argument of Dr. Lockhart, in which he is supported by Mr. J. B. S. Haldane, is that poison gas is so humane that the public can be educated to anticipate its use and " trained to realise that, with the proper measures, they have little to fear." Our possible enemies must not be expected, however, to remain ignorant of these proper measures, and this latest advance in Schrecklichkeit will surely go the way of all other warlike inventions. We hope that the wit and goodwill of mankind will succeed in breaking this vicious circle but, if the outlook is as bad as Dr. Lockhart thinks, then it is plainly our duty to prepare ourselves for the work we shall be called upon to do in alleviating the sufferings of the civil population in the next war. The extent of this preparation is wider than one might expect; Dr. Lockhart advocates, for example, that city, borough, and county councils should be responsible for the creation and maintenance of adequate anti-gas defence, and he presses the new and urgent need for the removal of our large hospitals from the centre of London on the’ ground that they may cease to function in time of war. Perhaps it is well that we should be thus reminded of the alternatives before us. ...
TEN years have passed since the war, and a generation is growing up that knows little of the experiences that led to the almost universal hope that war would become obsolete. That hope now seems remoter, and it is possible that the races of mankind will, like the characters in a Greek tragedy, be driven on to disaster by forces within themselves that use reason as a weapon rather than a guide. " If you wish for peace, prepare for war " is a maxim that, universally used, leads to preparations that progressively increase, and the statesmen of many nations are even now struggling to arrest the increase. One of the first of their efforts was directed towards the exclusion of the use of poisonous gases in warfare, and various international agreements have been A CHANCE FOR EPILEPTIC CHILDREN. signed with that object. Yet there is a belief, freely THE epileptic boy or girl who has been excluded expressed, that our objections to its use are as futile as were our ancestors’ objections to the introduction from school because his fits are so frequent or severe of firearms in war, and that no nation will, when is in an unhappy position. If school is an unsuitable put to the test, refrain from the employment of all place for him, small homes or crowded streets are the means at its disposal in spite of paper agreements. more unsuitable still. To the handicap of this Further, it is argued that gas is a more humane disease is added the further handicap of want of He grows up literally without a chance weapon than high explosives, inasmuch as its use education. against the civil population would bring greater in life. Medical men who come across these cases and speedier military and political advantage with in private practice, or in the out-patient departments less suffering and death. The side would win that of hospitals, will therefore be glad to know that first produced uncontrollable panic among the home there is to be a further opportunity for London population of the other and, since defence against epileptic children to go to a school in the country, hostile aircraft is apparently an unsolved problem, where they will receive the education of which they and poison gas is easily manufactured almost as a stand so much in need, combined with active medical secondary product of industrial chemistry, we must supervision and treatment. The London County admit the force of the argument and realise that in Council has arranged that some 80 additional places our next experience of civilised warfare its bodily shall be made available at Lingfield Epileptic Colony, effects will be brought home to all, irrespective of Surrey, where the instruction given resembles that associated with the ordinary public elementary school. age or sex. With these considerations as the St. John Ambulance Association has published In addition, manual training and open-air occupation a brochure by Major F. R. Humphreys, late are provided. The children are housed in villas and R.A.M.C.(T.) and Royal Air Force, on Protection I special attention is devoted to their comfort and of the Civil Population in Chemical Warfare, whichI recreative pursuits, whilst it is possible to ensure describes in simple language the effects of the different ’, regularity of hours so essential to successful poison gases likely to be used, with the defensive treatment. Continuous observation, which is, of procedure to be adopted by the victims, and outlines course, desirable for all patients suffering from the special duties that would fall to first-aid units. epilepsy in its varying manifestations, is maintained In the preface Major-General P. S. Wilkinson by the medical superintendent, and the children are announces that the manual has the approval of the sent home as soon as their condition may be deemed Chemical Warfare Research Department of the War to be arrested. In cases where the epilepsy persists, Office and assumes that detailed organisations will residence at the school is permitted up to the age of be set up to deal with the work of defence. Medical 16 years. Children between the ages of 7 and 14, men who feel the need for information will undoubtresident in the Countv of London, are eligible for edly find the manual useful; it deals only with the admission, and all applications should be addressed material issues immediately concerned with gas to the Education Officer, The County Hall, S.E. 1. attack and makes no reference to wider questions In view of the fact that, in the past, there has been that inevitably arise in the mind of the reader. a considerable waiting-list, speedy application is
justification,
I
the
144 advised.
The
more
urgent
cases
will receive
priority portion of the eggs sent up to the wards could genuinely
but, subject to this proviso, applications will be dealt with in the order in which they are received, and every effort will be made to secure admission as early as possible. It should be noted that the provision at this school is made for educable children only. SUPPLY OF EGGS TO HOSPITALS. DURING the next few months the marketing of eggs will undergo a number of changes that may well give rise to fundamental reforms. The " national mark scheme," beginning on Feb. lst, is a voluntary one, but already nearly a hundred accredited packers have promised their adherence to it. Under this scheme eggs will be graded for retailing in three classes, according to size, and only new-laid eggs The will be sold under the " national mark." scheme is designed to help British producers to secure the market in this country, and its success, of course, depends on the extent to which the producers seize the opportunity, and the purchasers support them by demanding " national mark " eggs. On March Ist there will come into operation a clause of the Agricultural Produce (Grading and Marking) Act, 1928, requiring retailers to mark all home-produced eggs that have been preserved. Later on, probably in April, an Order in Council will come into force, insisting that imported eggs shall be marked with their country of origin, and another clause of the Act will require all home-produced eggs that have been cold-stored or -gas-stored to be marked before they leave the store. These changes affect the public health very closely. Eggs are extensively used in the home and play an important part in many invalid diets ; they are easily prepared, readily assimilated, and contain more nutriment than most other natural foods. But it is important that they should be fresh. Mr. James Gatecliff, in an interesting booklet1 on the subject, goes so far as to say that the stale egg is not merely useless but actually harmful, and proceeds to criticise the supply of eggs to hospitals on the ground that insufficient care is taken to get them fresh. Egg-purchasing has, of course, a peculiar difficulty for the hospital authority, who must obtain large supplies of reliable eggs at the lowest possible rate. At present many institutions put out tenders for their egg-supply, making as the chief, or only, condition that the eggs shall weigh at least 2 oz. Many egg-distributors deplore this proviso, because the average pullet at its first laying season produces an egg which is just under 2 oz. in weight, but otherwise entirely satisfactory. They say that the hospitals could save money, without any deterioration in the qualitv of the eggs they receive, if they changed the 2 oz. standard. Mr. Gatecliff, however, maintains that at the present time many hospitals save money at the expense of their patients, and declares roundly that " the present methods of obtaining eggs for charitable institutions is not only a disgrace but a national scandal." He records a visit to a large relief institution in London, where he found that the so-called " new-laid " eggs were at least three weeks old. He relates that a large London hospital sent out tenders for first-grade British newlaid eggs and turned down a tender of Is. 10d. a dozen as too expensive at a time when a number of poultry-farmers-between them supplying some 100,000 eggs a week-informed him that their lowest cut-price for really fresh eggs was 2s. 3d. per dozen. Mr. Gatecliff suggests as a remedy that firms of established reputation should be instructed by the hospital authority to purchase eggs at statutory market prices, thus abandoning the present system of commercial tendering. It might be interesting for the conscientious hospital administrator to investigate his egg-supply for, say, a week, and see what pro-
be classed as new-laid and suitable for the invalid. A simple test to determine the age of an egg is to drop it gently into 5 or 6 in. of water in a flatbottomed vessel, 1 oz. of common salt having been added for each pint of water. A new-laid egg will fall to the bottom and lie flat on its side. An egg between 12 and 21 days old will settle at an angle, the broad end rising. As age progresses the angle increases, until the egg stands upright on its base. Later still, it will float upright, while the " election egg " will float on its side on the surface. This test will not work with eggs preserved in lime or waterglass, but there are three useful guides to the preserved egg. First, the shell will crack from crown to base in boiling ; this is specific. Secondly, the yolk is displaced, often touching the shell. Thirdly, the white is watery and has lost its firmness and
elasticity.
If Mr. Gatecliff’s accusation is grave one ; otherwise it calls for
justified it is a disproof. Dr. G. Clark Trotter, medical officer of health for Islington, who writes a preface to Mr. Gatecliff’s booklet, initiated in our columns a correspondence2 which revealed the difficulty experienced under the old regulations, both by the public in obtaining new-laid eggs and by the medical officer of health in ensuring that the eggs on sale in his .area were properly described by the retailer. The new arrangements have long been desired by reputable egg-marketing firms, and they seem to meet the needs of our correspondents very adequately. Certainly no hospital ordering its eggs under the " national mark scheme " need fear Mr. Gatecliff’s investigations, and it is surely not too much to ask that all hospital authorities should see that the food of their patients is at least as pure as their drugs.
PUBLIC HEALTH IN GUERNSEY. Channel THE Islands have a deserved reputation for salubrious climate and other amenities. It is interesting to compare the conditions of public health with those of England and Wales and to note the problems which the local authorities have to face. The report for 1927 of the medical officer of health for Guernsey tells us that Guernsey has an area of about 25 square miles and a population just under 40,000. Its natural beauties are great, its soil very fertile, and the climate attractive, cooler in summer and warmer in winter than on the mainland. The average hours of sunshine over 34 years have been The water-supply from deep wells belongs 1897. to the Government and is " of exceptional purity." During 1927 Guernsey exported 24,509 tons of tomatoes, 3217 tons of flowers, 1165 tons of grapes, and 2304 tons of vegetables. Presumably the islanders have plenty of these requisites for themselves. Most of the fruit is grown under glass. An additional export was 195,591 tons of granite for road-making. The milk herds are free from tuberculosis. The health statistics are good in parts. Infant mortality is higher than in England and Wales and about double the New Zealand rate75 for 1927. The neonatal rate, 46, was also high. The pre-school child rate was 24. On the other hand, the maternal rate from childbirth is about half that of England or New Zealand. During the last 27 years there have been 24,593 births and 53 maternal deaths from childbirth-a rate of 2-15 per 1000 births. During the last two years one-seventh of the total births took place in the Lady Ozanne Maternity Home. There is no health visitation or effort to educate the At the end of 1927 arrangements were mothers. made for " part-time " school nurses. The tuberGranite culosis death - rate is somewhat high. quarrying is acknowledged to be an occupation predisposing to phthisis, owing to the presence of free silica in the rock, but one would not expect raising flowers and fruit under glass to be an unhealthy 1 Eggs ; A Treatise on their Food Value and a Helpful Guide to Securing the Genuine Article. Nov., 1928. W. Speaight and 2 THE LANCET, 1927, ii., 141, et seq. Sons, Ltd., 98, Fetter-lane, E.C.4.