HOSPITAL POLICY.

253 the liquid mixture to the confectioner. It is hard to Ophthalmia in Newly-born Infants. appreciate the need for this middle process. Another the of notifications given showing method to dry only the whites in China, and to ophthalmia occurring in the newly-born, and the cask the isyolks, adding 2 per cent. of boric acid. On for the with corneal years complications percentage the dried 1911 to 1921, and that 1921 gives the most favourable arrival in this country water is added to and are then mixed with the yolks, whites, they percentage-viz., 2-28. The number of cases with more boric acid being added. Various improvements corneal involvement was 21. All were treated at methods of handling the eggs are recommended. the Royal Eye Hospital, and the total damage roll in the was the loss of one eye in two cases. Clean Feeding. The campaign against flies proved a failure, owing An been carried out with regard to the has inquiry to the fact that the manure, although promptly removed from the stables, was stored on allotments, methods used for cleansing drinking and eating at tips, railway sidings, and iron foundries. In the utensils at public-houses and eating places, and shows last-named case the manure is used in the making of that in many instances the methods are anything but satisfactory. As a result of this inquiry a workable cores for hollow castings. appliance for sterilising utensils has been designed by Chinese Eggs. Messrs. Richmond & Co., Warrington, and is on view An investigation has been undertaken, at the at the Manchester Corporation Gas Show Rooms, instance of the Ministry of Health, as to eggs imported Deansgate. from China. By one method the eggs are dried without preservative, and with care and a quick Manchester does not apparently take smoke sale this method is satisfactorv. The confectioner abatement seriously. On page 198 we are told that may use the dried egg himself. In some cases,i 372 half-hour observations were taken during the however, merchants add water and boric acid at thei year, while the table on page 204 gives the number of rate of 2 lb. to 100 lb. of the mixture, and supplyi observations as only 250. A

table is

HOSPITAL POLICY.

Correspondence.

HOSPITAL SAVINGS ASSOCIATION.

Editor of THE LANCET. SIR,-As representing a London hospital at which, after an exhaustive consideration of the scheme put POST-OPERATIVE "MANIA." forward by the above association, complete agreement has throughout been maintained between the lay To the Editor of THE LANCET. and medical representatives, we feel it our duty to SIR,-I have read the account of the above condition by Dr. W. J. Tyson in your last issue and enumerate the following points in connexion with this scheme in the hope that the question may be properly hope I may be permitted to supplement it. In the first place the title is an unhappy one, for ventilated and more forcibly brought to the attention unless the term mania be used in a sloppy or of those who are most affected by it-the medical profession in London-as well as those otherwise semipopular way, it does not correctly describe post- interested in hospitals. which is a delirious or confusional operative insanity, the Briefly, following are, in our opinion, substantial insanity, as different from mania as an abscess is from grounds of objection to the scheme, which, it is conOf course some people still talk of religious a cancer. and suicidal " mania " when they mean melancholia, sidered, undermines, whether it succeeds or whether but in the interest of scientific medicine the term it fails, the very voluntary system which it purports mania should be restricted to the elated phase of to seek to save :(a) If the scheme succeeds :— manic-depressive insanity. In it the patient is, except in the most acute conditions, lucid, not 1. Through the agency of a body chiefly representative of confused, and not usually hallucinated. Further, the a section of the patients, it involves serious interference with causes assigned for this form of insanity, though many the present independent management of hospitals. and various, are among the most definite, in actual 2. It definitely imports, despite all statements to the To the

"Audi alteram partem."

-

"

"

’

cases,

in

the

whole

domain

of

mental

disease.

contrary,

an

element of insurance risk.

3. The proposed interference with the present almoning Hereditary predisposition need not be present as in most other forms of insanity, for it is par excellence arrangements must be to the disadvantage not only of those an acquired insanity. No brain exists but which may members of the profession who are connected with hospitals, succumb to the effects of toxaemia, of exhaustion, or but also of the general practitioner. 4. The issue is acutely forced as to the payment of the of drugs, provided the action of these be sufficiently honorary medical staffs and management of hospitals. ,-

intense or prolonged. The only symptoms mentioned in the case described are, first that the patient’s mind began to wander, and then that she quickly became maniacal. Wandering " is characteristic of delirious, of confusional, insanity and not of mania, so it is presumed by maniacal is meant excitement, which also frequently in delirious or confusional insanity. The occurs characteristics of this form of insanity may be summed up as follows : Definite cause ; sudden onset ; mental confusion ; multiple and vivid hallucinations ; variable emotional condition, usually anxiety ; excitement or stupor ; acute physical illness or prostration ; short

We would here emphasise the point that the question of staff funds in the provinces is and must remain an essentially different problem from that of establishing staff funds in London. 5. By its nature, the scheme definitely controverts the existing principles of the voluntary system.

"

good recovery or death ; loss of memory of incidents during illness. Lastly, though the description is not brought up to date, a full account of this form of insanity and a bibliography will be found in Cerebral and Mental Symptoms in Relation to Somatic Disease, Anaesthetics and Toxic Agents, Traumata and Surgical Procedures," by J. C. Simpson, M.D. (London : J. Bale, Sons and Danielsson, 1898).-I am, Sir, yours faithfully,

(b) If the scheme is put into operation and fails

course ;

"

University

of

GEORGE M. ROBERTSON. Edinburgh, Jan. 29th, 1923.

:—

The odium of failure will not fall on the Association, but will probably be borne by and react on the hospitals themselves, thus providing data for those in favour of State or municipal control.

I

We cannot too strongly condemn representations such as that this scheme involves questions of finance only, or that so far it has received the substantial consideration and unqualified approval of the hospitals of London. We are, Sir, yours faithfully, F. W. DAVY, Vice-Chairman.

HARRY

CAMPBELL,

Senior Physician. West End Hospital for Nervous Diseases, 73, Welbeckstreet, London, W., Jan. 29th, 1923.