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A QUESTION TO BE FACED.
637 conditions of the nervous system bromides, especiwhen the pain partakes of the characters of the second ally division described above. In similar conditions the "antineuralgics" are often successful. 2. Remedies which act by counter-irritation : blisters, sinapisms, liniments, and plasters, and the use of the faradaic brush. Dr. Goldscheider adds that these remedies act, not by the hypercemia which they produce, but by the sensory effects which directly follow, and he enters very fully into the theory of such action. 3. Means which bring about changes in the circulation : local bloodletting, cold, heat, and hydro-therapy. 4. Massage and graduated exercises. Under the latter head he includes movements which are employed in neuralgia of the legs and arms, and for painful joints. 5. Means which are employed to act directly on the central nervous system: hypnotism and suggestion.
in
some
quite severe and annoying. They, however, in a few days without any treatment. (d) In 4 disappeared cases marked albuminuria was observed at the time of admission. In these cases albumin disappeared from the urine in the course of the treatment. Pyrexia was accompanied by albumin in the urine, but there was no reason to believe that any renal trouble was caused by the injections. (e) Five cases developed paresis of the soft palate. I wish to note, in that as well as culture examinations conclusion, microscopic were made in every case, and Dr. Kitasato’s report only deals with those cases in which Lomer’s bacilli were demonstrated to be present."
being
-
A QUESTION TO BE FACED. THE medical officer of health for the Rye (Sussex) rural sanitary authority has called attention to the earnest need of the neighbourhood for an isolation hospital. There is yearly a large influx of a very susceptible and dangerous class-the hop-pickers, who literally swarm into and through the union from London, Brighton, Hastings, Maidstone, and the coast in both directions; and, further, the shipping in the harbour of Rye, which is within the area covered by the report, carries on a trade with Rotterdam, Cherbourg, the Baltic, and other ports. The medical officer urges that a solution of the difficulty might be found by some arrangement with the Rye urbin sanitary authority, and advises his council to again take the matter up. He also recommends the serious consideration of the adoption of the Local Government Board’s model by-laws for dealing with the immigrant fraternity. The health of the district, it should be stated, was last year very satisfactory. There were but four mild cases of scarlet fever, two of erysipelas, and one (fatal) of puerperal fever. Influenza had been epidemic, but the total corrected rural death-rate was but 14-4 per 1000 in a population of 7597.
PROFESSOR KITASATO’S WORK IN TOKIO.
in
some
-
WOMEN AND HOSPITAL BOARDS. A MOVEMENT-which the test of time alone can prove to be
good or bad in its effects-favouring the admission of women to seats upon hospital boards of management seems to be in progress. The example set at Edinburgh by the election of Miss Louisa Stephenson has been followed at the Royal Hospital, Portsmouth, by the addition of four women members to its committee of management and the admission of two to the The ladies who were selected, at a House Committee. somewhat noisy meeting of the subscribers, to fill the post were Miss Agnes Weston, whose experience of Portsmouth must by this time be both extensive and peculiar; Mrs. Ward, a lady guardian ; Mrs. Will Hawksley, and Mrs. Guise Tucker. The resolutions, which met with great opposition, were brought forward by the late honorary chaplain of the institution (the Rev. W. Hawksley), who had resigned his position in consequence of the refusal of the then committee of management to allow ladies to visit in the lock wards of the institution. ____
THE WORKING CLASSES AND OUR HOSPITALS. of the Surrey Iron a letter on the financial straits of Guy’s Hospital, arising from the depreciation of landed investments, write to the Times commending the system pursued at their works since 1892, by which the men, when paid their wages, mostly put in a box on the pay-desk a penny or a halfpenny, or whatever they feel inclined. At the end of the year the firm adds an amount equal to that contributed by the men, and so a sum varying from £10 in 1892 to £25 in 1896 is sent to the Hospital Saturday Fund. Messrs. Myer and Co. testify that " the working classes do not desire to be the recipients of eleemosynary aid." It is certain that these classes have been more anxious to contribute to hospitals of late years than they were. But we are scarcely satisfied with the statements in Messrs. Myer and Co.’s letter. The subscriptions do not seem to be such as to imply any systematic or deeply conscientious effort-" a penny or a halfpenny or whatever they may feel inclined " does not suggest any great feat of self-denial on the part of either masters or men. It is gratifying to be assured that the working classes do not desire eleemosynary assistance. But there are some There has been manifest indications on the other side. lately, especially since the establishment of the Hospital
DR. A. NAKAGAWA sends us the following interesting communication. 11 Ser?tm Treatment of Dip7ath,eric.-Dr. Kitasato has just published a detailed report of 353 cases treated at the institute with the serum prepared under his supervision. For those who have no access to the original a few brief extracts may be of some interest. Mortality Professor Kitasato collected from reliable sources 26,521 cases of diphtheria in Japan previously to serum-therapy, with 14,996 deaths (56 per cent.) ; while of 353 cases treated here from Nov. 13th, 1894, to Nov. 25th, 1895, there were only 31 deaths (8’78 per cent.). There is reason to believe that the mortality can still be lowered if the treatment could be commenced early in the course of the disease. Thus in 110 cases in which injections were made within forty-eight hours after the invasion all ended in recovery. On the other hand, of 33 cases treated after the eighth day of the disease 11 were lost. Some of the patients were brought into the institute in a moribund condition, and 6 children died within five hours I after admission, 6 more within ten hours ; altogether 21 cases (two-thirds of the total mortality) were lost within the first twenty-four hours. As to the effect of the serum on the course of the disease the first thing to be noted is (a) the fall of temperature ; in many cases the defervescence was almost critical, and it takes place usually at the end of twenty-four to forty-eight hours. Secondly, (b) the separation of the false membrane, which takes place, as a rule, after the return of the temperature towards the normal. Very large casts of the trachea and larger bronchi have been coughed up. (c) Urticaria-like eruptions were observed in very many cases,
MESSRS. HORATIO MYER
AND
CO.
Works, Vauxhall-walk, having received
Saturday Fund, a disposition to regard hospitals as places to which the working man could go as of right and demand attendance for the ordinary ailments This is an entire misand accidents of his family. conception of the raison d’etre of our hospital system and
one
which cannot be
too
soon
removed.
Hospitals are essentially charitable institutions for the reception of cases of a gravity beyond the ordinary means of a working man. And for meeting such cases there is a great reserve of charity and pity in all classes. But Messrs. Myer and Co. and others will make a great mistake if they think that the voluntary hospital system can be
in
some
quite severe and annoying. They, however, in a few days without any treatment. (d) In 4 disappeared cases marked albuminuria was observed at the time of admission. In these cases albumin disappeared from the urine in the course of the treatment. Pyrexia was accompanied by albumin in the urine, but there was no reason to believe that any renal trouble was caused by the injections. (e) Five cases developed paresis of the soft palate. I wish to note, in that as well as culture examinations conclusion, microscopic were made in every case, and Dr. Kitasato’s report only deals with those cases in which Lomer’s bacilli were demonstrated to be present."
being
-
A QUESTION TO BE FACED. THE medical officer of health for the Rye (Sussex) rural sanitary authority has called attention to the earnest need of the neighbourhood for an isolation hospital. There is yearly a large influx of a very susceptible and dangerous class-the hop-pickers, who literally swarm into and through the union from London, Brighton, Hastings, Maidstone, and the coast in both directions; and, further, the shipping in the harbour of Rye, which is within the area covered by the report, carries on a trade with Rotterdam, Cherbourg, the Baltic, and other ports. The medical officer urges that a solution of the difficulty might be found by some arrangement with the Rye urbin sanitary authority, and advises his council to again take the matter up. He also recommends the serious consideration of the adoption of the Local Government Board’s model by-laws for dealing with the immigrant fraternity. The health of the district, it should be stated, was last year very satisfactory. There were but four mild cases of scarlet fever, two of erysipelas, and one (fatal) of puerperal fever. Influenza had been epidemic, but the total corrected rural death-rate was but 14-4 per 1000 in a population of 7597.
PROFESSOR KITASATO’S WORK IN TOKIO.
in
some
-
WOMEN AND HOSPITAL BOARDS. A MOVEMENT-which the test of time alone can prove to be
good or bad in its effects-favouring the admission of women to seats upon hospital boards of management seems to be in progress. The example set at Edinburgh by the election of Miss Louisa Stephenson has been followed at the Royal Hospital, Portsmouth, by the addition of four women members to its committee of management and the admission of two to the The ladies who were selected, at a House Committee. somewhat noisy meeting of the subscribers, to fill the post were Miss Agnes Weston, whose experience of Portsmouth must by this time be both extensive and peculiar; Mrs. Ward, a lady guardian ; Mrs. Will Hawksley, and Mrs. Guise Tucker. The resolutions, which met with great opposition, were brought forward by the late honorary chaplain of the institution (the Rev. W. Hawksley), who had resigned his position in consequence of the refusal of the then committee of management to allow ladies to visit in the lock wards of the institution. ____
THE WORKING CLASSES AND OUR HOSPITALS. of the Surrey Iron a letter on the financial straits of Guy’s Hospital, arising from the depreciation of landed investments, write to the Times commending the system pursued at their works since 1892, by which the men, when paid their wages, mostly put in a box on the pay-desk a penny or a halfpenny, or whatever they feel inclined. At the end of the year the firm adds an amount equal to that contributed by the men, and so a sum varying from £10 in 1892 to £25 in 1896 is sent to the Hospital Saturday Fund. Messrs. Myer and Co. testify that " the working classes do not desire to be the recipients of eleemosynary aid." It is certain that these classes have been more anxious to contribute to hospitals of late years than they were. But we are scarcely satisfied with the statements in Messrs. Myer and Co.’s letter. The subscriptions do not seem to be such as to imply any systematic or deeply conscientious effort-" a penny or a halfpenny or whatever they may feel inclined " does not suggest any great feat of self-denial on the part of either masters or men. It is gratifying to be assured that the working classes do not desire eleemosynary assistance. But there are some There has been manifest indications on the other side. lately, especially since the establishment of the Hospital
DR. A. NAKAGAWA sends us the following interesting communication. 11 Ser?tm Treatment of Dip7ath,eric.-Dr. Kitasato has just published a detailed report of 353 cases treated at the institute with the serum prepared under his supervision. For those who have no access to the original a few brief extracts may be of some interest. Mortality Professor Kitasato collected from reliable sources 26,521 cases of diphtheria in Japan previously to serum-therapy, with 14,996 deaths (56 per cent.) ; while of 353 cases treated here from Nov. 13th, 1894, to Nov. 25th, 1895, there were only 31 deaths (8’78 per cent.). There is reason to believe that the mortality can still be lowered if the treatment could be commenced early in the course of the disease. Thus in 110 cases in which injections were made within forty-eight hours after the invasion all ended in recovery. On the other hand, of 33 cases treated after the eighth day of the disease 11 were lost. Some of the patients were brought into the institute in a moribund condition, and 6 children died within five hours I after admission, 6 more within ten hours ; altogether 21 cases (two-thirds of the total mortality) were lost within the first twenty-four hours. As to the effect of the serum on the course of the disease the first thing to be noted is (a) the fall of temperature ; in many cases the defervescence was almost critical, and it takes place usually at the end of twenty-four to forty-eight hours. Secondly, (b) the separation of the false membrane, which takes place, as a rule, after the return of the temperature towards the normal. Very large casts of the trachea and larger bronchi have been coughed up. (c) Urticaria-like eruptions were observed in very many cases,
MESSRS. HORATIO MYER
AND
CO.
Works, Vauxhall-walk, having received
Saturday Fund, a disposition to regard hospitals as places to which the working man could go as of right and demand attendance for the ordinary ailments This is an entire misand accidents of his family. conception of the raison d’etre of our hospital system and
one
which cannot be
too
soon
removed.
Hospitals are essentially charitable institutions for the reception of cases of a gravity beyond the ordinary means of a working man. And for meeting such cases there is a great reserve of charity and pity in all classes. But Messrs. Myer and Co. and others will make a great mistake if they think that the voluntary hospital system can be