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INSATIABLE CURIOSITY AT THE LISTER
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sulphonamide therapy cannot be assessed on these Rgures. The most important differences between the two series were that in 1938-42, 38’5% of the cases were older than forty-five years as compared with only 17% in 1930-32, and the incidence of infections with types 11 and iai pneumococei was greater in the more recent series.. The rise in the fatality-rate with advancing age is very clearly showni the rate was only 2-98% for ages between eleven and forty and as high as 19-5% for those The incidence of baeteri2emia, as deterover forty. mined by routine blood-culture on admission to hospital, was higher in the older age-groups, and the extent of consolidation was greater. In people over forty pneumococcus type ill was the infection most to be feared, but below this age the mortality from this type of infection was low. There was no evidence that the incidence of empyema had increased as a result of sulphonamide therapy. Delayed resolution was the most common, complication and its incidence in patients over forty was nearly twice as great as in those under forty. The age of the patient certainly seems to be the most important factor in determining the prognosis of pneumococcal pneumonia, but the fatality-rate also increased with the interval between onset of illness and admission to hospital. The lesson here is that admission should not be delayed until unequivocal signs of consolidation appear, but should be arranged at once if the patient’s
portional grants from the funds, strictly unconnected (in theory) with the work done, have been made to the workers, with striking results.
But such experiments have been frowned on, and orders to discontinue them have been issued. It is orders of this kind-made no doubt for excellent administrative reasons-that make people apprehensive about working in a National Health Service, and we trust the ministries concerned will speedily realise that their decision is in nobody’s interest. For the future, since it has been realised that the national economic health depends on the national productivity, it should not be too much to hope that efforts will be made to give every capable patient a part to play in the scheme of national production. Such work must be done at the standard rates of pay. And if the patient leaves the hospital with a little nest-egg of saving certificates, industry, the community, the patient, and the patient’s family will all have
gained.
CURIOSITY AT THE LISTER NEITHER preoccupation with the war nor war weariness itself can damp the ardour of the two-score members of the staff of the Lister Institute in their pursuit of preventive medicine. Actually, as Sir Henry Dale reported to the governing body on June 19, many of them are working in corners of other research institutes, devoting time to the different committees set up by the history suggests pneumonia. Medical Research Council, and they have richly earned OCCUPATIONAL INCENTIVES the tribute paid in his concluding sentence to their THE case for occupational therapy-planned occupawholehearted service rendered under difficult conditions. tion for hospital patients-is proved. Physical lesions During the year under review 31 scientific papers from heal quicker when mind and muscles are occupied, and the laboratories have appeared, most of them in the the mental benefits are even more striking. " Brownedspecial journals, a few of wider application in Nature offness," which shows itself in grumbling irritability, dis- or the weekly medical press. The subjects have ranged over the preparation of a curative serum for louse-borne appears, and hospital wards cease to be oases of cattish gossip ; the patient realises that he is still capable of typhus, an antigen against Shiga dysentery infection, the creative effort, still an active rather than a passive habits of the various anaerobes causing gas gangrene, and member of the community, one who does besides being the intriguing properties of hyaluronidase and gramicidin. done by. There is less agreement however about the Familiarity with kaolin has enabled the serum unit to nature of the occupation. It is perhaps inevitable that filter the entire output of London transfusion depots the occupational therapist should start in the field of before despatching the plasma’to Cambridge for drying. arts and crafts ; and if the patient happens to be a Volunteers at Sheffield have revealed in their livers unsailor, familiar with such activities in the ordinary course expected reserves of vitamin A, which may by the way of life, he will think it no shame to pass the time in have come from potatoes. Factory workers and other hospital making a rug, a basket or a ship for insertion women in Oxford, although many of them show dental into a bottle. But the soldier or civilian does not always fluorosis, are not in general undernourished. Cheerful take kindly to raffia .and coloured felt. The story is is the news that 200 new bacterial strains have been told of a man who had spent many hours making a toy deposited in the national collection at Elstree, where the rabbit for his two-year-old son. When he had finished$ daily turnover keeps up. Dr. Drury, who has been the thought suddenly struck him :" What did you do over many outside activities, may not readily presiding " Learned to make rabbits." in the war, Daddy " find elbow-room for all these developing activities when That was the end of his occupational therapy. they return beneath one roof under his direction. The demand for out-workers in various war industries CARPAL MECHANICS has given the occupational therapist a chance to place before her patients something that is more closely related THE workings of the wrist and carpus have been the to their ordinary industrial life. Furthermore, the subject of much speculation in the search for a mechanical substitution of radio valves for machine-gun components analogy and a basis for the treatment of injuries in this for brown cows or toy tanks has a stimulating effect; region. MacConaill’s views have already been discussed the patient feels once more that he is one of the comhere,l and now some co-workers of Lambrinudi have put munity making his contribution to the common struggle forward2 the conception he had begun to develop before -as indeed he is. Nevertheless there is still one thing his death. In considering the movements of dorsiflexion and palmar flexion, the wrist and carpus are best thought lacking. Work done for industry must be paid for ; but the Ministries of Health and Labour have ruled of in a longitudinal section through the radius, lunate that patients receiving National Health Insurance money and capitate. This represents a link, with three members shall not be paid. So the out-workers’ earnings are and two pivots, one at the centre of rotation of the paid into general amenity and hospital comforts radio-lunate joint, where practically all dorsiflexion funds. occurs, and one at the lunate-capitate joint, where most Progressive occupational therapists have realised that of palmar flexion takes place. This is an advantageous hospital patients do not differ greatly from their fellow arrangement, combining an extensive total range with men. If these patients can be paid for what they do, smaller individual movements-thus in a wrist-arc of their enthusiasm is doubled, their output goes up, and, 100° each joint may move only 50°. So the articular in the handling of money, the process of mental rehabili1. MacConaill, M. A. Lancet, 1941, i, 285. tation is carried a big step further. Ways have there2. Gilford, W. W., Bolton, R. H. and Lambrinudi, C. Guy’s Hosp. fore been sought to circumvent the regulations. ProRep. 1943, 92, 52. .
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INSATIABLE
sulphonamide therapy cannot be assessed on these Rgures. The most important differences between the two series were that in 1938-42, 38’5% of the cases were older than forty-five years as compared with only 17% in 1930-32, and the incidence of infections with types 11 and iai pneumococei was greater in the more recent series.. The rise in the fatality-rate with advancing age is very clearly showni the rate was only 2-98% for ages between eleven and forty and as high as 19-5% for those The incidence of baeteri2emia, as deterover forty. mined by routine blood-culture on admission to hospital, was higher in the older age-groups, and the extent of consolidation was greater. In people over forty pneumococcus type ill was the infection most to be feared, but below this age the mortality from this type of infection was low. There was no evidence that the incidence of empyema had increased as a result of sulphonamide therapy. Delayed resolution was the most common, complication and its incidence in patients over forty was nearly twice as great as in those under forty. The age of the patient certainly seems to be the most important factor in determining the prognosis of pneumococcal pneumonia, but the fatality-rate also increased with the interval between onset of illness and admission to hospital. The lesson here is that admission should not be delayed until unequivocal signs of consolidation appear, but should be arranged at once if the patient’s
portional grants from the funds, strictly unconnected (in theory) with the work done, have been made to the workers, with striking results.
But such experiments have been frowned on, and orders to discontinue them have been issued. It is orders of this kind-made no doubt for excellent administrative reasons-that make people apprehensive about working in a National Health Service, and we trust the ministries concerned will speedily realise that their decision is in nobody’s interest. For the future, since it has been realised that the national economic health depends on the national productivity, it should not be too much to hope that efforts will be made to give every capable patient a part to play in the scheme of national production. Such work must be done at the standard rates of pay. And if the patient leaves the hospital with a little nest-egg of saving certificates, industry, the community, the patient, and the patient’s family will all have
gained.
CURIOSITY AT THE LISTER NEITHER preoccupation with the war nor war weariness itself can damp the ardour of the two-score members of the staff of the Lister Institute in their pursuit of preventive medicine. Actually, as Sir Henry Dale reported to the governing body on June 19, many of them are working in corners of other research institutes, devoting time to the different committees set up by the history suggests pneumonia. Medical Research Council, and they have richly earned OCCUPATIONAL INCENTIVES the tribute paid in his concluding sentence to their THE case for occupational therapy-planned occupawholehearted service rendered under difficult conditions. tion for hospital patients-is proved. Physical lesions During the year under review 31 scientific papers from heal quicker when mind and muscles are occupied, and the laboratories have appeared, most of them in the the mental benefits are even more striking. " Brownedspecial journals, a few of wider application in Nature offness," which shows itself in grumbling irritability, dis- or the weekly medical press. The subjects have ranged over the preparation of a curative serum for louse-borne appears, and hospital wards cease to be oases of cattish gossip ; the patient realises that he is still capable of typhus, an antigen against Shiga dysentery infection, the creative effort, still an active rather than a passive habits of the various anaerobes causing gas gangrene, and member of the community, one who does besides being the intriguing properties of hyaluronidase and gramicidin. done by. There is less agreement however about the Familiarity with kaolin has enabled the serum unit to nature of the occupation. It is perhaps inevitable that filter the entire output of London transfusion depots the occupational therapist should start in the field of before despatching the plasma’to Cambridge for drying. arts and crafts ; and if the patient happens to be a Volunteers at Sheffield have revealed in their livers unsailor, familiar with such activities in the ordinary course expected reserves of vitamin A, which may by the way of life, he will think it no shame to pass the time in have come from potatoes. Factory workers and other hospital making a rug, a basket or a ship for insertion women in Oxford, although many of them show dental into a bottle. But the soldier or civilian does not always fluorosis, are not in general undernourished. Cheerful take kindly to raffia .and coloured felt. The story is is the news that 200 new bacterial strains have been told of a man who had spent many hours making a toy deposited in the national collection at Elstree, where the rabbit for his two-year-old son. When he had finished$ daily turnover keeps up. Dr. Drury, who has been the thought suddenly struck him :" What did you do over many outside activities, may not readily presiding " Learned to make rabbits." in the war, Daddy " find elbow-room for all these developing activities when That was the end of his occupational therapy. they return beneath one roof under his direction. The demand for out-workers in various war industries CARPAL MECHANICS has given the occupational therapist a chance to place before her patients something that is more closely related THE workings of the wrist and carpus have been the to their ordinary industrial life. Furthermore, the subject of much speculation in the search for a mechanical substitution of radio valves for machine-gun components analogy and a basis for the treatment of injuries in this for brown cows or toy tanks has a stimulating effect; region. MacConaill’s views have already been discussed the patient feels once more that he is one of the comhere,l and now some co-workers of Lambrinudi have put munity making his contribution to the common struggle forward2 the conception he had begun to develop before -as indeed he is. Nevertheless there is still one thing his death. In considering the movements of dorsiflexion and palmar flexion, the wrist and carpus are best thought lacking. Work done for industry must be paid for ; but the Ministries of Health and Labour have ruled of in a longitudinal section through the radius, lunate that patients receiving National Health Insurance money and capitate. This represents a link, with three members shall not be paid. So the out-workers’ earnings are and two pivots, one at the centre of rotation of the paid into general amenity and hospital comforts radio-lunate joint, where practically all dorsiflexion funds. occurs, and one at the lunate-capitate joint, where most Progressive occupational therapists have realised that of palmar flexion takes place. This is an advantageous hospital patients do not differ greatly from their fellow arrangement, combining an extensive total range with men. If these patients can be paid for what they do, smaller individual movements-thus in a wrist-arc of their enthusiasm is doubled, their output goes up, and, 100° each joint may move only 50°. So the articular in the handling of money, the process of mental rehabili1. MacConaill, M. A. Lancet, 1941, i, 285. tation is carried a big step further. Ways have there2. Gilford, W. W., Bolton, R. H. and Lambrinudi, C. Guy’s Hosp. fore been sought to circumvent the regulations. ProRep. 1943, 92, 52. .
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INSATIABLE