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COUNTY COUNCILS AND ISOLATION HOSPITALS.
COUNTY COUNCILS AND ISOLATION HOSPITALS.
1462
old objection that lessened risk means lowered wages has still some force. The society aims at finding a respirator which shall be simple in construction, light, cheap, and sightly, one which can be worn for hours without interference with respiration, and one which will not permit expired air to be breathed again. An apparatus satisfy- ’ ing all these requirements would have a certain sphere of usefulness, but we are a little doubtful whether the
The psychical element is, concludes an attack. Dr. Wallace, a factor of growing importance in many diseases and in hay f ever it plays an important part. Dr. Dunbar, the physician in charge of the Institute of Hygiene at Hamburg, states in the Deutsche Medicinische Wochenschrift, No. 9, 1903, that he has succeeded in isolating the toxic substance from the pollen of grasses which is capable of producing hay fever in predisposed persons. He was thus society is working on the right lines. Even supposing able to reproduce attacks of the disease in winter by subThis that a thoroughly efficient respirator impermeable to dust cutaneous injection of a minute dose of the same. toxic substance is not the ethereal or oily constituent of the were devised we fear that the difficulty of getting workpeople to wear it would not be easily overcome. Even if pollen grains but is apparently, adds Dr Dunbar, an alkaworn it would afford no protection against poisonous vapours loidal body. The attack of hay fever produced by it is and while it might limit the field of pneumonokoniosis intense. An attempt was made to produce an antitoxic and enterokoniosis it would have no application to the im- serum from the blood of animals inoculated with this toxin. portant group of lesions included under the term dermato- After some trials this was successfully effected and in the koniosis. The plan of carrying on the work before an upcast course of his experiments he inoculated eight patients with shaft so that dust and vapours are at once borne away hay fever by instilling into the eye finely-ground pollen by a current of air seems rather the one deserving of grains suspended in water. In every case the physical and encouragement. subjective symptoms of hay fever were reproduced in varying degrees of intensity. The new serum was then tested by RECENT DISCOVERIES ON THE CAUSATION AND mixing some of it with the pollen and applying the mixture to the eye. "The eye itched slightly and appeared conTREATMENT OF HAY FEVER. but these symptoms disappeared in less than 30 gested," THREE interesting contributions to the subject of the minutes. The serum was equally effective against the pollen causation and treatment of hay fever have been recently of various cereals. published. In the Berliner Klinische Wochenschrift, of March 2nd Dr. G. Rosenfeld of Berlin refers to the question COUNTY COUNCILS AND ISOLATION HOSPITALS. of hay fever as caused by the pollen of certain flowers and THE E,sex county council is apparently the first to take adds to the list a plant hitherto unrecognised as a causeviz., the plantus occidentalis which is found in bloom in the advantage of the Isolation Hospital Acts and to make grants neighbourhood of Stuttgart from the middle of May to the systematically to the authorities which have provided isolaend of June, during which time hay fever is prevalent in that tion hospitals. Prior to the recent amending Act grants could locality. The symptoms of hay fever caused by it are of the only be made to hospitals erected under the Act of 1893, usual type and can be reproduced by experimental insuffla- now grants can be made to any hospital, but the sanction of tion of the pollen into the nostrils. In the -zVeTv York the Local Government Board is necessary if the hospital Medical Record of March 28th Dr. Raymond Wallace is erected out of current rates and therefore without the emphasises the fact that a neurotic predisposition to the plans having received the approval of that Board. At the affection exists in persons who develop hay fever. Persons commencement of this year the Essex county council who are "naturally highly strung, excitable, irritable, announced that it was prepared to make grants towards neurasthenic, havingnerves ’ which are literallyon the the maintenance of isolation hospitals and that applicasurface,’ are those who are more liable to this affection than tions were to be made before a given date. Applications " are the more phlegmatic types." The element of periodicity were received from 17 out of the 19 authorities in the county which is generally observed in attacks indicates that a which had provided hospitals. All these hospitals have been psychical factor is concerned in the etiology of hay fever examined and reported upon by the county medical officer of as exemplified in the case of a patient who has had attacks health and the marks awarded range from 55 to 100, the on August 15th of one year and who began to suffer in latter being the maximum. In awarding the marks every subsequent years on the same date. A neurotic young point in connexion with the position, construction, and woman, aged 25 years, known to Dr. Wallace, suffers administration of the hospitals was taken into account, regularly from three attacks per diem on certain days. together with the adequacy of the accommodation for the The sanitary committee has adopted Thus upon arising from bed she always anticipates an districts served. attack and it always comes on unless she can abort it by these marks as the basis upon which the grant shall be made firm pressure upon the upper lip. In the afternoon at the and recommended that each authority should receive 2s. per The lunch hour a second attack follows and at night on retiring mark per bed for the year ending March 31st, 1903. to her bedroom the third attack occurs. Another case was best hospitals will therefore receive a grant of £10 per bed It is probable, however, that that of a young man, aged 30 years and of neurotic con- and the worst £510s. stitution. He suffers from hay fever in a regular and periodic next year some other basis will be adopted, as the differfashion. Under medical treatment he does not have more ence between the various hospitals is not sufficiently well than four or five attacks during the day. When at work in marked to encourage the improvements and reforms which his office he is seldom troubled with an attack. But if he the county council wishes to see carried out. Of the is spending the evening in society his mind dwells upon 17 hospitals to which grants have been allotted six were the possibility of an attack and of the embarrassment erected out of current rates and therefore the approval of likely to be caused. He then has two or three attacks the Local Government Board will be necessary before the and is compelled to leave the room. Dr. Wallace has found grants can be paid. These hospitals are all wood and iron that strong sunlight will in some persons provoke an attack structures of a so-called "temporary" character and it of hay fever with its attendant symptoms of sneezing, vaso- remains to be seen whether the Board will sanction grants to motor congestion of the nostrils, and coryza, the attack such hospitals. The possibility of a refusal is evidently being caused reflexly by excitation of the vaso-motor recognised, as the sanitary committee recommends, if the centres through the optic nerve, and in the same way it Board’s sanction is withheld, that no grant should be made has been observed that dust, pollen, and certain odours to any hospital. The table prepared by the county medical may act through the trigeminal and olfactory nerves and officer contains a mass of interesting information. Amongst
provoke
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A STATE REGISTER OF TRAINED NURSES FOR POOR-LAW INFIRMARIES.
1463
tried to pass one and failed they will still be eligible for the posts of superintendent nurses. It is true that in the report of the departmental committee upon nursing in workhouses recently issued there is a recommendation of a defined curriculum with a final examination, but thereis nothing beyond the recommendation and the matter is treated in a vague unsatisfying manner, wanting in all indications of the scope of the curriculum, without suggestions as to the persons who are to arrange the details of the A STATE REGISTER OF TRAINED NURSES FOR scheme, but with merely a stipulation that there shall bePOOR-LAW INFIRMARIES. two independent examiners, one of them being a lady from AT a conjoint conference convened by the Matrons’ Councila recognised training school. We leave the subject with the and by the Society for the State Registration of Trainedobservation that the"present chaotic state of the nursing Nurses on May 8th at 20, Hanover-square, W., a paper wasprofession" (the wording is not ours) may be brought to an read by Miss Eleanor C. Barton, matron of the Chelseaend, but the organisation of the chaos will require the conof Trained Nursescerted action of the nursing authorities of the large training Infirmary, entitled ’’ State Registration " The writer of the paperinstitutions ; the Local Government Board is not likely to as it affects Poor-law Infirmaries." seemed to be in favour of the establishment by the State ofinitiate a scheme that will give general satisfaction but it. a register of trained nurses, but she advanced nothing in themay sanction one. nature of argument to support such a procedure on the part PHLEBITIS OF INFECTIOUS ORIGIN IN of the Local Government Board beyond the conjecture that CHLOROSIS. "when the State registration is inaugurated and the is a rare complication of chlorosis VENOUS thrombosis present chaotic state of the nursing profession is at and its pathology is not fully known. In some cases it an end the trained and disciplined nurses of our metropolitan infirmaries, who have as yet hardly been appre- depends on phlebitis, which in its turn has been ascribed to. ciated as they ought to be, will form a large and microbes. They have been found in the blood of the valuable addition to the nurses of Great Britain."" The inflamed vein and in the general circulation, but in no. paper almost failed to carry out the promise of its title, for case have they been found in the venous lesion. Hence the it did not-except in the extract given above-show the importance of the following case described at the meeting of the Society Medicale des Hopitaux of Paris by M. Paul manner in which State registration of nurses will affect the Poor-law infirmaries. The paper touched lightly, from Sainton and M. Andre Jousset. A well-developed girl, aged the nurses’ point of view, upon the various branches of 18 years, was admitted to hospital on Feb. 6th. A fortnight, infirmary work and it also enumerated the great teach- previously she noticed oedema of the right ankle. Soon pain ing opportunities afforded by the nursing of the many aged in the position of the external saphenous vein followed. She patients and others suffering from chronic diseases found in was pale and the skin was waxy white, slightly tinged with the wards of the modern infirmaries but rejected from the yellow. There was marked oedema of the right foot, ankle, wards of the hospitals. With the actual statements con- and calf. A systolic, musical, almost whistling murmur Over the tained in the paper we are quite in agreement, but was heard at the right border of the sternum. underlying those statements there appeared to be two left jugular vein near the clavicle vibration could be felt and assumptions upon each of which we may make a few a loud continuous souffle could be heard. The appetite On Feb. 13th The first was that the Local Government was diminished and there was constipation. comments. Board has the intention of establishing in the near the right thigh was swollen and was five centimetres in future a system of State registration for nurses ; and the circumference more than the left and its superficial The pain was increased and second was that there will be an examination conducted by veins were well marked. So far as we can situated in the position of the deep vessels of the limb. a State-appointed board of examiners. ascertain there is of the intention mentioned no evidence With this extension of the phlebitis the general condition, whatever. Neither has it yet been clearly shown that previously good, changed. There were slight pyrexia (an the public and the authorities of the two great nursing evening temperature of 101.3° F.), malaise, and anorexia. have The urine become darker and contained indican. The blood institutions (the hospitals and the infirmaries) the of State was very pale and of specific gravity 1052 (instead of 1055). arrived at an agreement upon desirability The red corpuscles numbered 2,300,000 per cubic millimetre, have to believe of nurses. We reason registration that certain of these authorities hold the opinion that there was poikilocytosis, and the hæmoglobin index was 0 62.. it would be unwise to inaugurate a system of registration The white corpuscles numbered 10,000 per cubic millimetre. until a defined curriculum and a recognised examination On Feb. 20th the swelling extended from the thigh to the have been established. Granting that the Local Government abdomen and the course of the internal and external iliac Board had taken in hand the formation of a State register vessels was tender. At the same time the cedematous skin of nurses, there would still be little probability of the became "marbled" with fine varicosities of ecchymotic On creation of a State-appointed board of examiners. A appearance, especially at the upper part of the thigh. a in Feb. 22nd the of stitch the review of the action of the Local Government Board right patient complained during the past few years will lead inevitably to the side and at the base of the lung behind slight dulness and On the followconclusion that there exists no predilection for examina- diminished respiratory murmur were found. tions of nurses on the part of that Board. Women who ing day she complained to the patient in the next bed have worked for 12 months in the sick wards of a that "she could not feel her left leg and yet felt pain She turned several times in the bed. suddenly workhouse and have received a small, indefinite amount of in it."" teaching are, without examination, to be accepted as placed her hand on her chest, complained of being stifled, qualified nurses by that Board. The superintendent nurses had an attack of severe dyspnœa without cyanosis, and died appointed under the General Order of 1897 are only in half an hour. At the necropsy the thyroid gland was found required to have had a course of instruction for three to weigh 15 grammes (instead of 25) ; the thymus gland years. They may have availed themselves of their was persistent and weighed 13 grammes (the normal weight opportunities to the smallest possible degree, for they in an infant). The aorta was narrow. The right pleural Even if they have; cavity contained 300 grammes of serous effusion and there have no examination to pass. other items it appears that the permanent isolation hospitals in Essex have cost from £360 to .E700 per bed to erect, and that the establishment and patients’ expenses have varied from £28 to E167 per bed. There can be no doubt that the attention which the county council is giving to this subject will ultimately result in a great improvement in the hospital accommodation and administration throughout the county.
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1462
old objection that lessened risk means lowered wages has still some force. The society aims at finding a respirator which shall be simple in construction, light, cheap, and sightly, one which can be worn for hours without interference with respiration, and one which will not permit expired air to be breathed again. An apparatus satisfy- ’ ing all these requirements would have a certain sphere of usefulness, but we are a little doubtful whether the
The psychical element is, concludes an attack. Dr. Wallace, a factor of growing importance in many diseases and in hay f ever it plays an important part. Dr. Dunbar, the physician in charge of the Institute of Hygiene at Hamburg, states in the Deutsche Medicinische Wochenschrift, No. 9, 1903, that he has succeeded in isolating the toxic substance from the pollen of grasses which is capable of producing hay fever in predisposed persons. He was thus society is working on the right lines. Even supposing able to reproduce attacks of the disease in winter by subThis that a thoroughly efficient respirator impermeable to dust cutaneous injection of a minute dose of the same. toxic substance is not the ethereal or oily constituent of the were devised we fear that the difficulty of getting workpeople to wear it would not be easily overcome. Even if pollen grains but is apparently, adds Dr Dunbar, an alkaworn it would afford no protection against poisonous vapours loidal body. The attack of hay fever produced by it is and while it might limit the field of pneumonokoniosis intense. An attempt was made to produce an antitoxic and enterokoniosis it would have no application to the im- serum from the blood of animals inoculated with this toxin. portant group of lesions included under the term dermato- After some trials this was successfully effected and in the koniosis. The plan of carrying on the work before an upcast course of his experiments he inoculated eight patients with shaft so that dust and vapours are at once borne away hay fever by instilling into the eye finely-ground pollen by a current of air seems rather the one deserving of grains suspended in water. In every case the physical and encouragement. subjective symptoms of hay fever were reproduced in varying degrees of intensity. The new serum was then tested by RECENT DISCOVERIES ON THE CAUSATION AND mixing some of it with the pollen and applying the mixture to the eye. "The eye itched slightly and appeared conTREATMENT OF HAY FEVER. but these symptoms disappeared in less than 30 gested," THREE interesting contributions to the subject of the minutes. The serum was equally effective against the pollen causation and treatment of hay fever have been recently of various cereals. published. In the Berliner Klinische Wochenschrift, of March 2nd Dr. G. Rosenfeld of Berlin refers to the question COUNTY COUNCILS AND ISOLATION HOSPITALS. of hay fever as caused by the pollen of certain flowers and THE E,sex county council is apparently the first to take adds to the list a plant hitherto unrecognised as a causeviz., the plantus occidentalis which is found in bloom in the advantage of the Isolation Hospital Acts and to make grants neighbourhood of Stuttgart from the middle of May to the systematically to the authorities which have provided isolaend of June, during which time hay fever is prevalent in that tion hospitals. Prior to the recent amending Act grants could locality. The symptoms of hay fever caused by it are of the only be made to hospitals erected under the Act of 1893, usual type and can be reproduced by experimental insuffla- now grants can be made to any hospital, but the sanction of tion of the pollen into the nostrils. In the -zVeTv York the Local Government Board is necessary if the hospital Medical Record of March 28th Dr. Raymond Wallace is erected out of current rates and therefore without the emphasises the fact that a neurotic predisposition to the plans having received the approval of that Board. At the affection exists in persons who develop hay fever. Persons commencement of this year the Essex county council who are "naturally highly strung, excitable, irritable, announced that it was prepared to make grants towards neurasthenic, havingnerves ’ which are literallyon the the maintenance of isolation hospitals and that applicasurface,’ are those who are more liable to this affection than tions were to be made before a given date. Applications " are the more phlegmatic types." The element of periodicity were received from 17 out of the 19 authorities in the county which is generally observed in attacks indicates that a which had provided hospitals. All these hospitals have been psychical factor is concerned in the etiology of hay fever examined and reported upon by the county medical officer of as exemplified in the case of a patient who has had attacks health and the marks awarded range from 55 to 100, the on August 15th of one year and who began to suffer in latter being the maximum. In awarding the marks every subsequent years on the same date. A neurotic young point in connexion with the position, construction, and woman, aged 25 years, known to Dr. Wallace, suffers administration of the hospitals was taken into account, regularly from three attacks per diem on certain days. together with the adequacy of the accommodation for the The sanitary committee has adopted Thus upon arising from bed she always anticipates an districts served. attack and it always comes on unless she can abort it by these marks as the basis upon which the grant shall be made firm pressure upon the upper lip. In the afternoon at the and recommended that each authority should receive 2s. per The lunch hour a second attack follows and at night on retiring mark per bed for the year ending March 31st, 1903. to her bedroom the third attack occurs. Another case was best hospitals will therefore receive a grant of £10 per bed It is probable, however, that that of a young man, aged 30 years and of neurotic con- and the worst £510s. stitution. He suffers from hay fever in a regular and periodic next year some other basis will be adopted, as the differfashion. Under medical treatment he does not have more ence between the various hospitals is not sufficiently well than four or five attacks during the day. When at work in marked to encourage the improvements and reforms which his office he is seldom troubled with an attack. But if he the county council wishes to see carried out. Of the is spending the evening in society his mind dwells upon 17 hospitals to which grants have been allotted six were the possibility of an attack and of the embarrassment erected out of current rates and therefore the approval of likely to be caused. He then has two or three attacks the Local Government Board will be necessary before the and is compelled to leave the room. Dr. Wallace has found grants can be paid. These hospitals are all wood and iron that strong sunlight will in some persons provoke an attack structures of a so-called "temporary" character and it of hay fever with its attendant symptoms of sneezing, vaso- remains to be seen whether the Board will sanction grants to motor congestion of the nostrils, and coryza, the attack such hospitals. The possibility of a refusal is evidently being caused reflexly by excitation of the vaso-motor recognised, as the sanitary committee recommends, if the centres through the optic nerve, and in the same way it Board’s sanction is withheld, that no grant should be made has been observed that dust, pollen, and certain odours to any hospital. The table prepared by the county medical may act through the trigeminal and olfactory nerves and officer contains a mass of interesting information. Amongst
provoke
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____
A STATE REGISTER OF TRAINED NURSES FOR POOR-LAW INFIRMARIES.
1463
tried to pass one and failed they will still be eligible for the posts of superintendent nurses. It is true that in the report of the departmental committee upon nursing in workhouses recently issued there is a recommendation of a defined curriculum with a final examination, but thereis nothing beyond the recommendation and the matter is treated in a vague unsatisfying manner, wanting in all indications of the scope of the curriculum, without suggestions as to the persons who are to arrange the details of the A STATE REGISTER OF TRAINED NURSES FOR scheme, but with merely a stipulation that there shall bePOOR-LAW INFIRMARIES. two independent examiners, one of them being a lady from AT a conjoint conference convened by the Matrons’ Councila recognised training school. We leave the subject with the and by the Society for the State Registration of Trainedobservation that the"present chaotic state of the nursing Nurses on May 8th at 20, Hanover-square, W., a paper wasprofession" (the wording is not ours) may be brought to an read by Miss Eleanor C. Barton, matron of the Chelseaend, but the organisation of the chaos will require the conof Trained Nursescerted action of the nursing authorities of the large training Infirmary, entitled ’’ State Registration " The writer of the paperinstitutions ; the Local Government Board is not likely to as it affects Poor-law Infirmaries." seemed to be in favour of the establishment by the State ofinitiate a scheme that will give general satisfaction but it. a register of trained nurses, but she advanced nothing in themay sanction one. nature of argument to support such a procedure on the part PHLEBITIS OF INFECTIOUS ORIGIN IN of the Local Government Board beyond the conjecture that CHLOROSIS. "when the State registration is inaugurated and the is a rare complication of chlorosis VENOUS thrombosis present chaotic state of the nursing profession is at and its pathology is not fully known. In some cases it an end the trained and disciplined nurses of our metropolitan infirmaries, who have as yet hardly been appre- depends on phlebitis, which in its turn has been ascribed to. ciated as they ought to be, will form a large and microbes. They have been found in the blood of the valuable addition to the nurses of Great Britain."" The inflamed vein and in the general circulation, but in no. paper almost failed to carry out the promise of its title, for case have they been found in the venous lesion. Hence the it did not-except in the extract given above-show the importance of the following case described at the meeting of the Society Medicale des Hopitaux of Paris by M. Paul manner in which State registration of nurses will affect the Poor-law infirmaries. The paper touched lightly, from Sainton and M. Andre Jousset. A well-developed girl, aged the nurses’ point of view, upon the various branches of 18 years, was admitted to hospital on Feb. 6th. A fortnight, infirmary work and it also enumerated the great teach- previously she noticed oedema of the right ankle. Soon pain ing opportunities afforded by the nursing of the many aged in the position of the external saphenous vein followed. She patients and others suffering from chronic diseases found in was pale and the skin was waxy white, slightly tinged with the wards of the modern infirmaries but rejected from the yellow. There was marked oedema of the right foot, ankle, wards of the hospitals. With the actual statements con- and calf. A systolic, musical, almost whistling murmur Over the tained in the paper we are quite in agreement, but was heard at the right border of the sternum. underlying those statements there appeared to be two left jugular vein near the clavicle vibration could be felt and assumptions upon each of which we may make a few a loud continuous souffle could be heard. The appetite On Feb. 13th The first was that the Local Government was diminished and there was constipation. comments. Board has the intention of establishing in the near the right thigh was swollen and was five centimetres in future a system of State registration for nurses ; and the circumference more than the left and its superficial The pain was increased and second was that there will be an examination conducted by veins were well marked. So far as we can situated in the position of the deep vessels of the limb. a State-appointed board of examiners. ascertain there is of the intention mentioned no evidence With this extension of the phlebitis the general condition, whatever. Neither has it yet been clearly shown that previously good, changed. There were slight pyrexia (an the public and the authorities of the two great nursing evening temperature of 101.3° F.), malaise, and anorexia. have The urine become darker and contained indican. The blood institutions (the hospitals and the infirmaries) the of State was very pale and of specific gravity 1052 (instead of 1055). arrived at an agreement upon desirability The red corpuscles numbered 2,300,000 per cubic millimetre, have to believe of nurses. We reason registration that certain of these authorities hold the opinion that there was poikilocytosis, and the hæmoglobin index was 0 62.. it would be unwise to inaugurate a system of registration The white corpuscles numbered 10,000 per cubic millimetre. until a defined curriculum and a recognised examination On Feb. 20th the swelling extended from the thigh to the have been established. Granting that the Local Government abdomen and the course of the internal and external iliac Board had taken in hand the formation of a State register vessels was tender. At the same time the cedematous skin of nurses, there would still be little probability of the became "marbled" with fine varicosities of ecchymotic On creation of a State-appointed board of examiners. A appearance, especially at the upper part of the thigh. a in Feb. 22nd the of stitch the review of the action of the Local Government Board right patient complained during the past few years will lead inevitably to the side and at the base of the lung behind slight dulness and On the followconclusion that there exists no predilection for examina- diminished respiratory murmur were found. tions of nurses on the part of that Board. Women who ing day she complained to the patient in the next bed have worked for 12 months in the sick wards of a that "she could not feel her left leg and yet felt pain She turned several times in the bed. suddenly workhouse and have received a small, indefinite amount of in it."" teaching are, without examination, to be accepted as placed her hand on her chest, complained of being stifled, qualified nurses by that Board. The superintendent nurses had an attack of severe dyspnœa without cyanosis, and died appointed under the General Order of 1897 are only in half an hour. At the necropsy the thyroid gland was found required to have had a course of instruction for three to weigh 15 grammes (instead of 25) ; the thymus gland years. They may have availed themselves of their was persistent and weighed 13 grammes (the normal weight opportunities to the smallest possible degree, for they in an infant). The aorta was narrow. The right pleural Even if they have; cavity contained 300 grammes of serous effusion and there have no examination to pass. other items it appears that the permanent isolation hospitals in Essex have cost from £360 to .E700 per bed to erect, and that the establishment and patients’ expenses have varied from £28 to E167 per bed. There can be no doubt that the attention which the county council is giving to this subject will ultimately result in a great improvement in the hospital accommodation and administration throughout the county.
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