- Email: [email protected]
IN MEMORY OF MANSON.
142 occurred on the side opposite that of the Those who have seen such cases suggest that in them the condition is caused by sudden paralysis of the diaphragm, either complete or partial; certainly in many there has been neither clinical nor post-mortem evidence of plugging of bronchi by secretion. Those who base their conclusions only on postoperative cases tend to consider that most if not all are due to blockage of a bronchus with viscid secretion which cannot be coughed up-either because of its consistency, or through weakness of the cough mechanism, or both. Opinion is again divided on whether the collapse is primary and the pneumonia secondary, or vice versa. FULLER considers the latter the most likely. He makes no mention of the treatment of the condition by posture, but the successful results of placing the patient on his sound side and making him cough, or of lowering the level of the head, may be regarded as evidence in favour of what may be termed the " plug of mucus " theory. As in most controversies, a little of the truth probably lies on both sides, some cases being caused in one way, some in the other, and yet others by a combination of the two. A final solution of this problem is not likely to be reached quickly, but if it did nothing more, FULLER’S paper would be useful because it emphasises the very high incidence of chest complications in surgical practice. The need is for a carefully controlled series of experiments in a large number of cases, whereby the effects of varying such factors as posture (both during and after operation), preparation of the patient, type of incision, and anaesthetic can be assessed. Probably these complications will never be abolished altogether, but as a result of such an investigation their incidence might well be reduced.
collapse injury.
IN MEMORY OF MANSON. PATRICK MANSON died nearly ten years ago. His name is familiar to the world, but as yet nothing has been done to perpetuate the memory of a great man, a man whose achievements in medical science have added much to the general prosperity of our Empire, while promoting the outlook of health and well-being for the whole world. For he may be said, in face of earlier theories and suppositions having a similar objective, to have been the first to establish the principle of the transmission of disease by insects, and thus to have transformed in large measure, by the recognition of this principle, the chances and opportunities of human life in the tropics. Justly may MANSON be acclaimed, under the title bestowed on him at the International Medical Congress held in London the year preceding the war, as the Father of Modern Tropical Medicine, and justly may it be asked where is the tangible monument to his fame7 MANSON’S career makes an inspiring story of unremitting industry. At the age of 22, in 1866, as a Scottish medical graduate, he went to Formosa to act as medical officer to a group of merchants and missionaries. He found himself immediately in a pathological environment the expressions of which were entirely unknown to him and the setiology of which was for the most part unknown equally to the medical profession on the spot and to scientific workers and academic teachers all the world over. His studies in Formosa were soon interrupted, but at Amoy, in China, where he transferred himself in 1871, to act as medical officer to the Chinese Maritime Customs, he settled down to work methodically at the treatment of tropical diseases. Here he distinguished filaria in blood, being unaware that this had been done
already, when a return to England gave him the opportunity of reading the existing literature of elephantiasis. Being, in 1876, again at Amoy, he spenttwo years in working out the life-history of filaria, the results of which were published through the intervention of T. S. COBBOLD, the famous helminthologist, in 1879. But MANSON was now working assiduously and recording experiments, with hourly records of temperature, among his native patients in the search for the parasite of malaria, and in a letter which he wrote to COBBOLD, and which is quoted in the obituary notice in our columns, he alludes to the embarrassment under which such investigators as himself were placed, " crippled as we are with the necessity of making our daily bread." But it is doubtful if MANSON would have succeeded in realising any of his ideals had he not possessed the range of practical knowledge and adaptability which he acquired as a healer of the sick. For ten years, with short intervals in England (during one of which he worked for the first time with an oil immersion lens) he remained in China, much of the time in Hong-Kong, and carried on a general practice while pursuing the researches whose grand message was now becoming clear. He confirmed his work on filariasis with the better apparatus at his disposal, made original researches into sprue, and kept the results of his unintermittent industry in careful records. When he returned to England in 1890 he did so with an unrivalled personal knowledge of the inflictions of tropical disease, and a determination to attempt the placing of tropical hygiene upon a scientific basis from which organised attempts could be made to counteract their terrors. He became physician to the Seamen’s Hospital, was appointed lecturer on tropical diseases in the medical school of St. George’s Hospital, and in 1897 medical officer to the Colonial Office. Here his work came to the notice of JOSEPH CHAMBERLAIN, that prince of Colonial Ministers, and here the well known story of the dissemination of malaria com. mences, as far as its public recording is concerned. MANSON’S work upon elephantiasis pointed to a physiological and mechanical connexion between an immature organism and the presence of a mature worm in the blood. He saw that an intervening agent and one that was capable of piercing the skin of the human body and of absorbing the human blood thus infected was necessary, and the possible role of the mosquito had occurred to him. The tremendous analogy was suggested by experiments already undertaken before his return to England, but for private circumstances it was impossible for him to return to tropical districts and pursue his investigations. It was then that the splendid cooperation with RONALD Ross took place, for Ross agreed to carry on MANSON’S researches in India, and everyone knows the grand result. The work was confirmed by personal experiment in the most malarious parts of Italy by Dr. G. C. Low and Dr. Louis SAMBON, and later, in London, by MANSON’S son, the late Dr. THURBURN MANSON, and to-day the world is reaping immeasurable benefits therefrom, benefits which must grow by geometrical progression as the years go by. An appeal will be issued shortly for subscriptions to provide a material memorial to MANSON and his work. The memorial is to take the form of a permanent home for the Society of Tropical Medicine and Hygiene, in the foundation of which MANSON was one of the pioneers, as he was the first president. The movement requires no advocacy from us ; its reasons we have just summarised, with the knowledge that to our readers every word would be familiar. The invitation to honour MANSON should find ample
143 response from all classes, while practical force is added to it by the generosity of the Fellows of the Society, who are not wealthy individually or as a corporation. Towards the object of the appeal the Fellows of the
Society themselves have subscribed ;E6000; the
1:20,000 still needed should certainly be found promptly outside their circle, especially as the public
hasi an incalculable
debt to pay to MANSON’S memory.
THE PUBLIC DENTIST. RESORT to the dentist is less of a habit in this country than it is, for example, in America, and large numbers of our people to whom dental hygiene is more or less of a novelty are prone to lapse when the pressure of propaganda slackens and temporary immunity from pain or discomfort has been obtained. In spite of the offer of dental treatment as additional benefit under the Insurance Acts to increasing numbers of insured persons during the last seven years, the demand for such treatment, even under the stimulus of novelty and of substantial grants towards the cost, has never exceeded 15 per cent. of those eligible and is now gradually sinking. The report of
the Departmental Committee on the evils associated with unqualified practice of dentistry, issued in 1919, resulted in the passing of the Dentists Act of 1921, but the recommendations which it contained for the provision of adequate dental treatment to certain classes of the community have remained a dead letter. It is with the object of bringing into prominence those aspects of public dental service that the British Dental Association has revised and re-issued a report on Dental Treatment and National Health which first appeared in 1920. The main features of this amended report are summarised on p. 155 of our present issue. It regards the organisation of dental treatment for expectant and nursing mothers, for the pre-school child, for the child of school age, for the adolescent, for adults under the National Health Insurance Act, and for adults outside the scope of that Act who are unable to afford the fees of the private dental practitioner-all this as in the nature of a public responsibility ; such dental treatment as is necessary as an adjunct to the effective treatment of tuberculosis and of venereal disease is put in the same category. Finally, the report presses for a coordinated scheme of education in oral hygiene for the young with the object of preventing dental disease. Each of these requirements is dealt with in detail in separate sections of the report, and the result is a document worthy of the attention of the Ministry of Health and of local authorities and of all persons interested in the health of the nation. It may be noted that the tendency of dental opinion, as voiced by its professional association, is not only towards extension of public administration but also towards extension of the employment of the public dental officer. With the exception of the insured adult, and possibly of the adolescent, it appears to be conceded that public dental service should be relegated in an increasing degree to the whole-time dental officer. It has been long recognised as undesirable for the dental treatment of elementary school-children provided by local education authorities to be given in the private consulting rooms of dentists, and the same applies with certain exceptions to dental treatment given on a comprehensive basis to school-children. Even in the case of the insured adult there seems to be a leaning in the report towards the limited use of the treatment centre, although as in the case of medical benefit it is desirable for the freedom to obtain treatment from
the private dental practitioner (as provided in the National Health Insurance Act, 1928) to be claimed by the great majority. One gratifying fact is clearly brought out in the report. The framework of a complete dental service is already in existence and what is now required is to fill up certain gaps and to complete the service in accordance with the need for it. There are comparatively few local education authorities which have made no provision for dental treatment, but it is estimated that at present there is only an average of one school dentist to every 11,000 elementary school-children, whereas the number necessary to provide adequate attention is, at the lowest, one dentist to every 5000 children. Moreover, the number of maternity and child welfare centres where dental treatment is provided is regrettably small. There is one class mentioned in the report for which no provision has been made-namely, the adolescentwho on leaving school has lost his access to the school dental clinic and is not yet eligible for additional benefit, an age-group, be it remembered, in which the incidence of dental disease is high. The Association would do well to work out a scheme by which treatment could be provided for this class and what it would cost. Finally, the British Dental Association calls attention to an administrative measure for which the time is held to be ripe-namely, the provision of some central dental control. In the Navy and Army dental officers of appropriate rank are responsible, under the director-general of the respective medical services, for the administration of the Royal Naval Dental Service and the Army Dental Corps. The claim that the time has now come for a similar appointment at the Ministry of Health under its chief medical officer appears to be a reasonable one. BRITISH EMPIRE CANCER CAMPAIGN.-Lord
Reading
presided at the quarterly meeting of the Grand Council of the Campaign on Monday last. The Council confirmed the action of the Scientific Advisory Committee and the Finance Committee in approving that Dr. Thomas Lumsden, who has been carrying out immunisation work at the Lister Institute, shall in future carry on his work in the laboratories of the London Hospital, to which he has been formally
appointed Honorary Director of Cancer Research. The Campaign will continue to make its financial grant direct
to Dr. Lumsden for the purposes of the continuance of his work. The Council confirmed the recommendation of the Executive Committee that the request for affiliation to the Campaign by the Manchester and District Radium Institute should be acceded to. Sir Charles Martin, Director of the Lister Institute, was elected a member of the Grand Council, at the request of the Queensland Branch of the Campaign as its representative. It was reported that in accordance with the invitation of the National Radium Commission, an informal conference was held between representatives of that body, the Medical Research Council, King Edward’s Hospital Fund, and this Campaign, on the general subject of radium. The Campaign had been represented by the two Vice-Chairmen of the Grand Council, Lord Dawson of Penn and Sir John Bland-Sutton, and by the Chairman of the Executive Committee, Mr. J. P. Lockhart-Mummery. It was stated that similar conferences would be resumed at an early date with a view to the Campaign assisting in every way the coordination of the radium supplies of the country. At the informal conference the General Secretary of the Campaign reported that it appeared that when the present supplies of radium ordered by the Radium Commission were available, together with the 4-gramme bomb now at the Westminster Hospital, as well as orders placed by private institutions, the total amount of radium available in England, would approximate 60 grammes. It Scotland, and Wales contemplated that this amount will be still further increased when the final orders are placed by the National Radium Commission and the various branches of the British Empire Cancer Campaign. The Secretary reported that formal approval had now been given for the transference of the offices of the Campaign to 12, Grosvenorcrescent, Hyde Park Corner. In the new building the Campaign will be the tenants of the Joint Council of St. John and the Red Cross. It is hoped that the removal will take place immediately after the Easter recess.
is
collapse injury.
IN MEMORY OF MANSON. PATRICK MANSON died nearly ten years ago. His name is familiar to the world, but as yet nothing has been done to perpetuate the memory of a great man, a man whose achievements in medical science have added much to the general prosperity of our Empire, while promoting the outlook of health and well-being for the whole world. For he may be said, in face of earlier theories and suppositions having a similar objective, to have been the first to establish the principle of the transmission of disease by insects, and thus to have transformed in large measure, by the recognition of this principle, the chances and opportunities of human life in the tropics. Justly may MANSON be acclaimed, under the title bestowed on him at the International Medical Congress held in London the year preceding the war, as the Father of Modern Tropical Medicine, and justly may it be asked where is the tangible monument to his fame7 MANSON’S career makes an inspiring story of unremitting industry. At the age of 22, in 1866, as a Scottish medical graduate, he went to Formosa to act as medical officer to a group of merchants and missionaries. He found himself immediately in a pathological environment the expressions of which were entirely unknown to him and the setiology of which was for the most part unknown equally to the medical profession on the spot and to scientific workers and academic teachers all the world over. His studies in Formosa were soon interrupted, but at Amoy, in China, where he transferred himself in 1871, to act as medical officer to the Chinese Maritime Customs, he settled down to work methodically at the treatment of tropical diseases. Here he distinguished filaria in blood, being unaware that this had been done
already, when a return to England gave him the opportunity of reading the existing literature of elephantiasis. Being, in 1876, again at Amoy, he spenttwo years in working out the life-history of filaria, the results of which were published through the intervention of T. S. COBBOLD, the famous helminthologist, in 1879. But MANSON was now working assiduously and recording experiments, with hourly records of temperature, among his native patients in the search for the parasite of malaria, and in a letter which he wrote to COBBOLD, and which is quoted in the obituary notice in our columns, he alludes to the embarrassment under which such investigators as himself were placed, " crippled as we are with the necessity of making our daily bread." But it is doubtful if MANSON would have succeeded in realising any of his ideals had he not possessed the range of practical knowledge and adaptability which he acquired as a healer of the sick. For ten years, with short intervals in England (during one of which he worked for the first time with an oil immersion lens) he remained in China, much of the time in Hong-Kong, and carried on a general practice while pursuing the researches whose grand message was now becoming clear. He confirmed his work on filariasis with the better apparatus at his disposal, made original researches into sprue, and kept the results of his unintermittent industry in careful records. When he returned to England in 1890 he did so with an unrivalled personal knowledge of the inflictions of tropical disease, and a determination to attempt the placing of tropical hygiene upon a scientific basis from which organised attempts could be made to counteract their terrors. He became physician to the Seamen’s Hospital, was appointed lecturer on tropical diseases in the medical school of St. George’s Hospital, and in 1897 medical officer to the Colonial Office. Here his work came to the notice of JOSEPH CHAMBERLAIN, that prince of Colonial Ministers, and here the well known story of the dissemination of malaria com. mences, as far as its public recording is concerned. MANSON’S work upon elephantiasis pointed to a physiological and mechanical connexion between an immature organism and the presence of a mature worm in the blood. He saw that an intervening agent and one that was capable of piercing the skin of the human body and of absorbing the human blood thus infected was necessary, and the possible role of the mosquito had occurred to him. The tremendous analogy was suggested by experiments already undertaken before his return to England, but for private circumstances it was impossible for him to return to tropical districts and pursue his investigations. It was then that the splendid cooperation with RONALD Ross took place, for Ross agreed to carry on MANSON’S researches in India, and everyone knows the grand result. The work was confirmed by personal experiment in the most malarious parts of Italy by Dr. G. C. Low and Dr. Louis SAMBON, and later, in London, by MANSON’S son, the late Dr. THURBURN MANSON, and to-day the world is reaping immeasurable benefits therefrom, benefits which must grow by geometrical progression as the years go by. An appeal will be issued shortly for subscriptions to provide a material memorial to MANSON and his work. The memorial is to take the form of a permanent home for the Society of Tropical Medicine and Hygiene, in the foundation of which MANSON was one of the pioneers, as he was the first president. The movement requires no advocacy from us ; its reasons we have just summarised, with the knowledge that to our readers every word would be familiar. The invitation to honour MANSON should find ample
143 response from all classes, while practical force is added to it by the generosity of the Fellows of the Society, who are not wealthy individually or as a corporation. Towards the object of the appeal the Fellows of the
Society themselves have subscribed ;E6000; the
1:20,000 still needed should certainly be found promptly outside their circle, especially as the public
hasi an incalculable
debt to pay to MANSON’S memory.
THE PUBLIC DENTIST. RESORT to the dentist is less of a habit in this country than it is, for example, in America, and large numbers of our people to whom dental hygiene is more or less of a novelty are prone to lapse when the pressure of propaganda slackens and temporary immunity from pain or discomfort has been obtained. In spite of the offer of dental treatment as additional benefit under the Insurance Acts to increasing numbers of insured persons during the last seven years, the demand for such treatment, even under the stimulus of novelty and of substantial grants towards the cost, has never exceeded 15 per cent. of those eligible and is now gradually sinking. The report of
the Departmental Committee on the evils associated with unqualified practice of dentistry, issued in 1919, resulted in the passing of the Dentists Act of 1921, but the recommendations which it contained for the provision of adequate dental treatment to certain classes of the community have remained a dead letter. It is with the object of bringing into prominence those aspects of public dental service that the British Dental Association has revised and re-issued a report on Dental Treatment and National Health which first appeared in 1920. The main features of this amended report are summarised on p. 155 of our present issue. It regards the organisation of dental treatment for expectant and nursing mothers, for the pre-school child, for the child of school age, for the adolescent, for adults under the National Health Insurance Act, and for adults outside the scope of that Act who are unable to afford the fees of the private dental practitioner-all this as in the nature of a public responsibility ; such dental treatment as is necessary as an adjunct to the effective treatment of tuberculosis and of venereal disease is put in the same category. Finally, the report presses for a coordinated scheme of education in oral hygiene for the young with the object of preventing dental disease. Each of these requirements is dealt with in detail in separate sections of the report, and the result is a document worthy of the attention of the Ministry of Health and of local authorities and of all persons interested in the health of the nation. It may be noted that the tendency of dental opinion, as voiced by its professional association, is not only towards extension of public administration but also towards extension of the employment of the public dental officer. With the exception of the insured adult, and possibly of the adolescent, it appears to be conceded that public dental service should be relegated in an increasing degree to the whole-time dental officer. It has been long recognised as undesirable for the dental treatment of elementary school-children provided by local education authorities to be given in the private consulting rooms of dentists, and the same applies with certain exceptions to dental treatment given on a comprehensive basis to school-children. Even in the case of the insured adult there seems to be a leaning in the report towards the limited use of the treatment centre, although as in the case of medical benefit it is desirable for the freedom to obtain treatment from
the private dental practitioner (as provided in the National Health Insurance Act, 1928) to be claimed by the great majority. One gratifying fact is clearly brought out in the report. The framework of a complete dental service is already in existence and what is now required is to fill up certain gaps and to complete the service in accordance with the need for it. There are comparatively few local education authorities which have made no provision for dental treatment, but it is estimated that at present there is only an average of one school dentist to every 11,000 elementary school-children, whereas the number necessary to provide adequate attention is, at the lowest, one dentist to every 5000 children. Moreover, the number of maternity and child welfare centres where dental treatment is provided is regrettably small. There is one class mentioned in the report for which no provision has been made-namely, the adolescentwho on leaving school has lost his access to the school dental clinic and is not yet eligible for additional benefit, an age-group, be it remembered, in which the incidence of dental disease is high. The Association would do well to work out a scheme by which treatment could be provided for this class and what it would cost. Finally, the British Dental Association calls attention to an administrative measure for which the time is held to be ripe-namely, the provision of some central dental control. In the Navy and Army dental officers of appropriate rank are responsible, under the director-general of the respective medical services, for the administration of the Royal Naval Dental Service and the Army Dental Corps. The claim that the time has now come for a similar appointment at the Ministry of Health under its chief medical officer appears to be a reasonable one. BRITISH EMPIRE CANCER CAMPAIGN.-Lord
Reading
presided at the quarterly meeting of the Grand Council of the Campaign on Monday last. The Council confirmed the action of the Scientific Advisory Committee and the Finance Committee in approving that Dr. Thomas Lumsden, who has been carrying out immunisation work at the Lister Institute, shall in future carry on his work in the laboratories of the London Hospital, to which he has been formally
appointed Honorary Director of Cancer Research. The Campaign will continue to make its financial grant direct
to Dr. Lumsden for the purposes of the continuance of his work. The Council confirmed the recommendation of the Executive Committee that the request for affiliation to the Campaign by the Manchester and District Radium Institute should be acceded to. Sir Charles Martin, Director of the Lister Institute, was elected a member of the Grand Council, at the request of the Queensland Branch of the Campaign as its representative. It was reported that in accordance with the invitation of the National Radium Commission, an informal conference was held between representatives of that body, the Medical Research Council, King Edward’s Hospital Fund, and this Campaign, on the general subject of radium. The Campaign had been represented by the two Vice-Chairmen of the Grand Council, Lord Dawson of Penn and Sir John Bland-Sutton, and by the Chairman of the Executive Committee, Mr. J. P. Lockhart-Mummery. It was stated that similar conferences would be resumed at an early date with a view to the Campaign assisting in every way the coordination of the radium supplies of the country. At the informal conference the General Secretary of the Campaign reported that it appeared that when the present supplies of radium ordered by the Radium Commission were available, together with the 4-gramme bomb now at the Westminster Hospital, as well as orders placed by private institutions, the total amount of radium available in England, would approximate 60 grammes. It Scotland, and Wales contemplated that this amount will be still further increased when the final orders are placed by the National Radium Commission and the various branches of the British Empire Cancer Campaign. The Secretary reported that formal approval had now been given for the transference of the offices of the Campaign to 12, Grosvenorcrescent, Hyde Park Corner. In the new building the Campaign will be the tenants of the Joint Council of St. John and the Red Cross. It is hoped that the removal will take place immediately after the Easter recess.
is