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A TREATMENT OF RHEUMATISM
1344 TREATMENT OF NEUROSES IN AIR-RAIDS
THE E.M.S. AND PARLIAMENT
SiB—In his letter in your last issue, Sir Ernest Graham-Little makes certain statements which should not be allowed to go forward unchallenged. He is evidently under a misapprehension as to the functions and composition of the Central Emergency Committee. I should like, therefore, to remind him of the following facts. 1. The Central Emergency Committee was set up for the express purpose of supplying medical personnel to the fighting services and to the Ministry of Health. The committee had no authority to advise on policy or strategy although many of its members have repeatedly deplored the imposition of any such limitation of activity. 2. There are not less than 16 consultants on the Central Emergency Committee who represent on a functional basis the whole sphere of consulting
practice. Central Emergency Committee is not the profound dislocation of hospital life in London and the unsatisfactory conditions of the E.M.S. which resulted from that dislocation. The strategic plan adopted by the Ministry of Health was drawn up in advance of the emergency by the London sector officers. 3. The
THE incidence of psychiatric or neurotic casualties to result from air-raids is a question on which there is considerable divergence of opinion. Some say that such casualties will occur in large numbers, but those with practical experience of air-raids suggest that this view is mistaken. Professor Mira, for example, who was in Madrid and Barcelona during the Spanish war, states definitely that the incidence of neuroses was comparatively small, so small that there was not sufficient employment for the psychiatrists in Spain, some of them having to be transferred to general medical work. Any scheme for dealing with psychiatric or neurotic casualties must therefore be on a basis which will admit of indefinite expansion should circumstances require it, although it is far from certain that these circumstances will arise. The scheme elaborated by the Ministry of Health has been constructed with this in mind.
likely
responsible for
I am,
Sir,
yours
faithfully, HARRY PLATT.
A TREATMENT OF RHEUMATISM
Sm,—Before R.A.M.C. I
I
was
called up for service in the
getting some interesting results in the treatment of rheumatism, and I am writing this letter before they are completed because there seems no possibility of my continuing with this treatment was
for a considerable time. I came to the conclusion that there was a possibility that the septic focus that has so often been sought for might be situated in the skin. I thought that the multiple foci in the deep parts of the sweat glands would account for the popular beliefs concerning rheumatism, such as the effect of cold and wet, and also for the incomplete results in the physical treatment. To reach this part a fat-soluble antiseptic that could be rubbed in was needed. This seemed so simple that I thought my theory must be wrong, but when I looked for one I found that there were very few, simply weak ones such as the salicylates. Then a new antiseptic, Azochloramid, was brought to my notice. This can be obtained in a solution of triacetin which makes a solution in olive oil. I have been rubbing this solution into the skin in cases of superficial rheumatism and even in the cases of arthritis. The results have been most encouraging, even curative. I would be grateful if other general practitioners would give this so simple a treatment a trial, and let me know their results. I am, Sir, yours faithfully, W. A. BALL. SODIUM DIPHENYL HYDANTOINATE IN a letter in our issue of Dec. 9, Messrs. Glaxo Laboratories Ltd. pointed out that Epanutin is not the
only preparation of sodium diphenyl hydantoinate on the market, and that a G.L. preparation was now available under the name Solantoin. Messrs. Parke, Davis & Co. now remind us that the original work on anticonvulsants by Drs. Putnam and Merritt was carried out in the United States with a drug supplied by P., D. & Co. which is now known there as
LONDON AREA
The special arrangements for dealing with neurotic casualties are of course closely linked with the main Emergency Hospital Scheme in the area. Each sector contains a large number of hospitals which are so organised that casualties arriving at first-aid posts or casualty hospitals within the sector, and which cannot be dealt with other than temporarily at this level, will be evacuated to hospitals further afield in the same sector. This procedure, while admirably adapted to the rapid and appropriate disposal of organic injuries, requires considerable modification in its application to neurotic cases. First, in many of the cases success is dependent upon early treatment obtainable near the site of onset. Secondly, if being cases of simple fright and mild neuroses are immediately evacuated to hospitals further down the line the accommodation required for organic cases under the conditions of a severe air-raid might be unduly strained. Thirdly, owing to the psychological factors underlying neurotic disorder this procedure might lead to a great increase in the incidence of such disorder. Fourthly, it is undesirable that neurotic cases should be treated in the same wards and under the same conditions as organic cases, as this again may tend to accentuate and prolong neurotic illness. Lastly, more severe neurotic cases require special methods and expert care, which may not be available in general hospitals. It is therefore essential to secure that neurotic cases are dealt with adequately in the simple " front-line at first-aid posts and casualty hospitals-from which the large majority may be returned to their own homes after any necessary preliminary treatment; next, that only those cases which in the opinion of an expert require more prolonged treatment are sent down the line, facilities being provided for the careful sorting out of such cases; and, finally, that cases so sent down go to special hospitals, where the staff and methods suitable for these cases are available. In order to secure these ends the following machinery has been established. Each sector has been
"
Dilantin " and in this
country
as
"
Epanutin.11
mentioned in the Journal of the Furthermore, American Medical Association (Sept. 17, 1938), the study was aided by a grant from that company, and almost all the subsequent independent clinical trials in Europe and in America were conducted with their as
product.
THE E.M.S. AND PARLIAMENT
SiB—In his letter in your last issue, Sir Ernest Graham-Little makes certain statements which should not be allowed to go forward unchallenged. He is evidently under a misapprehension as to the functions and composition of the Central Emergency Committee. I should like, therefore, to remind him of the following facts. 1. The Central Emergency Committee was set up for the express purpose of supplying medical personnel to the fighting services and to the Ministry of Health. The committee had no authority to advise on policy or strategy although many of its members have repeatedly deplored the imposition of any such limitation of activity. 2. There are not less than 16 consultants on the Central Emergency Committee who represent on a functional basis the whole sphere of consulting
practice. Central Emergency Committee is not the profound dislocation of hospital life in London and the unsatisfactory conditions of the E.M.S. which resulted from that dislocation. The strategic plan adopted by the Ministry of Health was drawn up in advance of the emergency by the London sector officers. 3. The
THE incidence of psychiatric or neurotic casualties to result from air-raids is a question on which there is considerable divergence of opinion. Some say that such casualties will occur in large numbers, but those with practical experience of air-raids suggest that this view is mistaken. Professor Mira, for example, who was in Madrid and Barcelona during the Spanish war, states definitely that the incidence of neuroses was comparatively small, so small that there was not sufficient employment for the psychiatrists in Spain, some of them having to be transferred to general medical work. Any scheme for dealing with psychiatric or neurotic casualties must therefore be on a basis which will admit of indefinite expansion should circumstances require it, although it is far from certain that these circumstances will arise. The scheme elaborated by the Ministry of Health has been constructed with this in mind.
likely
responsible for
I am,
Sir,
yours
faithfully, HARRY PLATT.
A TREATMENT OF RHEUMATISM
Sm,—Before R.A.M.C. I
I
was
called up for service in the
getting some interesting results in the treatment of rheumatism, and I am writing this letter before they are completed because there seems no possibility of my continuing with this treatment was
for a considerable time. I came to the conclusion that there was a possibility that the septic focus that has so often been sought for might be situated in the skin. I thought that the multiple foci in the deep parts of the sweat glands would account for the popular beliefs concerning rheumatism, such as the effect of cold and wet, and also for the incomplete results in the physical treatment. To reach this part a fat-soluble antiseptic that could be rubbed in was needed. This seemed so simple that I thought my theory must be wrong, but when I looked for one I found that there were very few, simply weak ones such as the salicylates. Then a new antiseptic, Azochloramid, was brought to my notice. This can be obtained in a solution of triacetin which makes a solution in olive oil. I have been rubbing this solution into the skin in cases of superficial rheumatism and even in the cases of arthritis. The results have been most encouraging, even curative. I would be grateful if other general practitioners would give this so simple a treatment a trial, and let me know their results. I am, Sir, yours faithfully, W. A. BALL. SODIUM DIPHENYL HYDANTOINATE IN a letter in our issue of Dec. 9, Messrs. Glaxo Laboratories Ltd. pointed out that Epanutin is not the
only preparation of sodium diphenyl hydantoinate on the market, and that a G.L. preparation was now available under the name Solantoin. Messrs. Parke, Davis & Co. now remind us that the original work on anticonvulsants by Drs. Putnam and Merritt was carried out in the United States with a drug supplied by P., D. & Co. which is now known there as
LONDON AREA
The special arrangements for dealing with neurotic casualties are of course closely linked with the main Emergency Hospital Scheme in the area. Each sector contains a large number of hospitals which are so organised that casualties arriving at first-aid posts or casualty hospitals within the sector, and which cannot be dealt with other than temporarily at this level, will be evacuated to hospitals further afield in the same sector. This procedure, while admirably adapted to the rapid and appropriate disposal of organic injuries, requires considerable modification in its application to neurotic cases. First, in many of the cases success is dependent upon early treatment obtainable near the site of onset. Secondly, if being cases of simple fright and mild neuroses are immediately evacuated to hospitals further down the line the accommodation required for organic cases under the conditions of a severe air-raid might be unduly strained. Thirdly, owing to the psychological factors underlying neurotic disorder this procedure might lead to a great increase in the incidence of such disorder. Fourthly, it is undesirable that neurotic cases should be treated in the same wards and under the same conditions as organic cases, as this again may tend to accentuate and prolong neurotic illness. Lastly, more severe neurotic cases require special methods and expert care, which may not be available in general hospitals. It is therefore essential to secure that neurotic cases are dealt with adequately in the simple " front-line at first-aid posts and casualty hospitals-from which the large majority may be returned to their own homes after any necessary preliminary treatment; next, that only those cases which in the opinion of an expert require more prolonged treatment are sent down the line, facilities being provided for the careful sorting out of such cases; and, finally, that cases so sent down go to special hospitals, where the staff and methods suitable for these cases are available. In order to secure these ends the following machinery has been established. Each sector has been
"
Dilantin " and in this
country
as
"
Epanutin.11
mentioned in the Journal of the Furthermore, American Medical Association (Sept. 17, 1938), the study was aided by a grant from that company, and almost all the subsequent independent clinical trials in Europe and in America were conducted with their as
product.