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CLEAN MILK IN HOSPITALS.
1205
CLEAN MILK IN HOSPITALS.
urated, and the beverages consist of diuretic mineral water, increased in proportion as the power of elimination on the part of the kidney becomes more marked. (2)Syndrome of Hypertension.-It is in the syndrome of hypertension that the regime of fluids perhaps requires the most delicate handling ; but it is also in this syndrome that when it is well ordered and strictly supervised, its utility is specially manifest. It was only a short while ago that this water treatment of hypertension was first attempted. A few years ago it would have seemed to be a dangerous error to suggest the giving of fluids to patients whose greatest trouble was that of hypertension. It was known, however, that the evolution of these cases of hypertension was characterised by a tendency on the part of the organism to auto-intoxication, principally due to renal and hepatic angio-sclerosis. Physicians
MILK IN HOSPITALS. To the Editor of THE LANCET. SIR,-Since the autumn of 1917 the health committee of the city of Worcester has had a small herd
CLEAN
of dairy cows, free from tuberculosis, in a farm which it has established adjoining the isolation hospital. The committee for some years previous to 1917 had endeavoured to obtain milk from the neighbouring farmers from cows certified to be free from tuberculosis, but no farmer in the neighbourhood would contract for milk on those terms. The small herd of cows is managed by a herdswoman who is well trained and competent for the work, and the results have year by year been very satisfactory. It is an astonishing thing to me that the educated British public are so apathetic as regards their milk attached to hydro-mineral diuretic stations have supply.-I am, Sir, yours faithfully, MABYN READ, M.D., shown by their detoxication treatment that the real Medical Officer of Health, Worcester. May 26th, 1925. did in not consist to such danger giving beverages patients, but in withholding the beverages from them. EXCESSIVE INFANT MORTALITY AT At one time the classic treatment was the dry diet. MARKET DRAYTON. To-day the good effects of treatment by diuresis are z, recognised ; fluid regime in cases of hypertension is To the Editor of THE LANCET. well-defined and definitely established. But the water SiR,-I note in your issue of May 16th a reprint treatment requires caution. The treatment must be supervised with the sphygmomanometer at hand, and of my question to the Minister of Health with regard with the check upon elimination of urine always in to the infantile mortality of Market Drayton which view, for over-distension of the vascular system is double that of the neighbouring Newport, and is always possible, and excess of arterial pressure thrice that of Wellington, the other contiguous may result from an attack of angio-spasm. But with locality. I presume that there must be reasons for these precautions good results may be obtained from this unhappy phenomenon, which I see was noticed diuresis treatment such as that employed at Vittel. at a public meeting in the place itself held early in The dosage of fluids is carefully regulated and the this month. As a report on the subject exists, it is fluids are taken fasting, early in the morning or late curious to speculate on the reasons which have at night, the patient lying down (clino-statism). The prevented it from being made public. In the interests sum-total of the fluid ingested should never be great. of Market Drayton itself one would have supposed One must always aim at adequate diuresis without that the evil being recognised, the remedy should be polyuria, which could only be preceded by an increase prescribed.-I am, Sir, yours faithfully, House of Commons, May 27the, 1925. C. W. C. OMAN. in the volume of blood and increase of blood pressure, causes of immediate events. untoward possible The patients who secrete much water during the day BAKER’S ITCH AND WORKMEN’S should be put on a relatively large amount of fluids. COMPENSATION. But those who secrete water mainly during the night To the Editor of THE LANCET. (nycturia) should be very carefully watched. All excitants of the cardiac nervous system, alcohol, coffee, SiR,-The question raised is hardly as simple as and tea, should be forbidden. The bouillons and meat- Captain J. T. Ainslie Walker would suggest. I have juice which possess vaso-constrictor properties and had under my purview as many cases of dermatitis cause a rise in the blood pressure should also be in confectioners as in bakers. The symptoms in interdicted. And it is very particularly in such cases both have been practically indistinguishable. No that beverages taken late at night are specially improvers are used in the confectionery trade. Again, desirable. Drinks at meals should always be restricted. of the number of cases of " baker’s itch " which have In the been under my personal care, so far as I could ascer(3) The Nitrogen-Retention Syndrome. the nitrogen-retention syndrome permeability of the tain, only about one-half were using flour which was improvers. kidneys is specially affected in all its modalities. supposed to contain I am, Sir, yours faithfully, Here ureemia assumes a threatening aspect. The diet R. PROSSER WHITE. Wigan, June 2nd, 1925. should be of low nitrogen content, as often as possible As a and dechlorurated. slightly lacto-vegetarian The water is no longei rule there is no oedema. THE BATEMAN APPEAL FUND. retained by the salt and is not dependent upon chloride To the Editor of THE LANCET. retention. But, as a set-off, arterial hypertension and -cardio-vascular phenomena are almost always present, ! SIR,-In spite of the generous and chivalrous At all costs, fatigue of the heart must be avoided, of THE LANCET, and in spite of the appeals With that aim in view the amount of fluids must b( that others of us have made-made on behalf of one reduced and they must be distributed in small doses of us in dire distress-only a few more pounds have frequently repeated in order to obtain adequate been added to this fund. It is difficult to realise that diuresis. " The Fractional Diuresis Test," which 7 such indifference can exist in our profession; a discussed at length in THE LANCET,’ indicates what if British court of justice seems no longer our standard the secretory power of the kidney for water, and givef of right and wrong. It is harder still to think what the precise indications for the drink regime. If a kidne) the great names of the past would think of our can only eliminate 60 c.cm. of water at the most ever3 indifference; generosity was ever their supreme half-hour, or else 50 or 30 c.cm., it is 60, 50, or 30 c.cm characteristic. I enclose a third small contribution of water that should be given as a maximum ever3 in the hope that those who are too busy, those who half-hour. Thus one is enabled to obtain the maximun are successful, those who are indifferent, and all diuresis without in any way overtaxing the cardio those who pass by, may for a moment pause and put vascular system. themselves in Dr. Bateman’s position and by so I am, Sir, yours faithfully, may be stimulated to help a colleague passing P. L. VIOLLE, a physical and mental anguish we may all through Consulting Physician at Vittel; Director of the hope to be spared. May 25th, 1925. Laboratory, Institute of Hydrology, Paris. I am, Sir, yours faithfully, A. GRAHAM-STEWART. THE LANCET, 1924, i., 998. Margate, May 31st, 1925. u
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-
support
doing Iwell
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CLEAN MILK IN HOSPITALS.
urated, and the beverages consist of diuretic mineral water, increased in proportion as the power of elimination on the part of the kidney becomes more marked. (2)Syndrome of Hypertension.-It is in the syndrome of hypertension that the regime of fluids perhaps requires the most delicate handling ; but it is also in this syndrome that when it is well ordered and strictly supervised, its utility is specially manifest. It was only a short while ago that this water treatment of hypertension was first attempted. A few years ago it would have seemed to be a dangerous error to suggest the giving of fluids to patients whose greatest trouble was that of hypertension. It was known, however, that the evolution of these cases of hypertension was characterised by a tendency on the part of the organism to auto-intoxication, principally due to renal and hepatic angio-sclerosis. Physicians
MILK IN HOSPITALS. To the Editor of THE LANCET. SIR,-Since the autumn of 1917 the health committee of the city of Worcester has had a small herd
CLEAN
of dairy cows, free from tuberculosis, in a farm which it has established adjoining the isolation hospital. The committee for some years previous to 1917 had endeavoured to obtain milk from the neighbouring farmers from cows certified to be free from tuberculosis, but no farmer in the neighbourhood would contract for milk on those terms. The small herd of cows is managed by a herdswoman who is well trained and competent for the work, and the results have year by year been very satisfactory. It is an astonishing thing to me that the educated British public are so apathetic as regards their milk attached to hydro-mineral diuretic stations have supply.-I am, Sir, yours faithfully, MABYN READ, M.D., shown by their detoxication treatment that the real Medical Officer of Health, Worcester. May 26th, 1925. did in not consist to such danger giving beverages patients, but in withholding the beverages from them. EXCESSIVE INFANT MORTALITY AT At one time the classic treatment was the dry diet. MARKET DRAYTON. To-day the good effects of treatment by diuresis are z, recognised ; fluid regime in cases of hypertension is To the Editor of THE LANCET. well-defined and definitely established. But the water SiR,-I note in your issue of May 16th a reprint treatment requires caution. The treatment must be supervised with the sphygmomanometer at hand, and of my question to the Minister of Health with regard with the check upon elimination of urine always in to the infantile mortality of Market Drayton which view, for over-distension of the vascular system is double that of the neighbouring Newport, and is always possible, and excess of arterial pressure thrice that of Wellington, the other contiguous may result from an attack of angio-spasm. But with locality. I presume that there must be reasons for these precautions good results may be obtained from this unhappy phenomenon, which I see was noticed diuresis treatment such as that employed at Vittel. at a public meeting in the place itself held early in The dosage of fluids is carefully regulated and the this month. As a report on the subject exists, it is fluids are taken fasting, early in the morning or late curious to speculate on the reasons which have at night, the patient lying down (clino-statism). The prevented it from being made public. In the interests sum-total of the fluid ingested should never be great. of Market Drayton itself one would have supposed One must always aim at adequate diuresis without that the evil being recognised, the remedy should be polyuria, which could only be preceded by an increase prescribed.-I am, Sir, yours faithfully, House of Commons, May 27the, 1925. C. W. C. OMAN. in the volume of blood and increase of blood pressure, causes of immediate events. untoward possible The patients who secrete much water during the day BAKER’S ITCH AND WORKMEN’S should be put on a relatively large amount of fluids. COMPENSATION. But those who secrete water mainly during the night To the Editor of THE LANCET. (nycturia) should be very carefully watched. All excitants of the cardiac nervous system, alcohol, coffee, SiR,-The question raised is hardly as simple as and tea, should be forbidden. The bouillons and meat- Captain J. T. Ainslie Walker would suggest. I have juice which possess vaso-constrictor properties and had under my purview as many cases of dermatitis cause a rise in the blood pressure should also be in confectioners as in bakers. The symptoms in interdicted. And it is very particularly in such cases both have been practically indistinguishable. No that beverages taken late at night are specially improvers are used in the confectionery trade. Again, desirable. Drinks at meals should always be restricted. of the number of cases of " baker’s itch " which have In the been under my personal care, so far as I could ascer(3) The Nitrogen-Retention Syndrome. the nitrogen-retention syndrome permeability of the tain, only about one-half were using flour which was improvers. kidneys is specially affected in all its modalities. supposed to contain I am, Sir, yours faithfully, Here ureemia assumes a threatening aspect. The diet R. PROSSER WHITE. Wigan, June 2nd, 1925. should be of low nitrogen content, as often as possible As a and dechlorurated. slightly lacto-vegetarian The water is no longei rule there is no oedema. THE BATEMAN APPEAL FUND. retained by the salt and is not dependent upon chloride To the Editor of THE LANCET. retention. But, as a set-off, arterial hypertension and -cardio-vascular phenomena are almost always present, ! SIR,-In spite of the generous and chivalrous At all costs, fatigue of the heart must be avoided, of THE LANCET, and in spite of the appeals With that aim in view the amount of fluids must b( that others of us have made-made on behalf of one reduced and they must be distributed in small doses of us in dire distress-only a few more pounds have frequently repeated in order to obtain adequate been added to this fund. It is difficult to realise that diuresis. " The Fractional Diuresis Test," which 7 such indifference can exist in our profession; a discussed at length in THE LANCET,’ indicates what if British court of justice seems no longer our standard the secretory power of the kidney for water, and givef of right and wrong. It is harder still to think what the precise indications for the drink regime. If a kidne) the great names of the past would think of our can only eliminate 60 c.cm. of water at the most ever3 indifference; generosity was ever their supreme half-hour, or else 50 or 30 c.cm., it is 60, 50, or 30 c.cm characteristic. I enclose a third small contribution of water that should be given as a maximum ever3 in the hope that those who are too busy, those who half-hour. Thus one is enabled to obtain the maximun are successful, those who are indifferent, and all diuresis without in any way overtaxing the cardio those who pass by, may for a moment pause and put vascular system. themselves in Dr. Bateman’s position and by so I am, Sir, yours faithfully, may be stimulated to help a colleague passing P. L. VIOLLE, a physical and mental anguish we may all through Consulting Physician at Vittel; Director of the hope to be spared. May 25th, 1925. Laboratory, Institute of Hydrology, Paris. I am, Sir, yours faithfully, A. GRAHAM-STEWART. THE LANCET, 1924, i., 998. Margate, May 31st, 1925. u
-.
-
support
doing Iwell
-