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LARGER SCOPE FOR THE RED CROSS.
521
imbecile, may be dealt with either by means of an remarks apply to such parasitic flagellata as order made by a justice, after the presentation of Giardia intestinalis, Trichomonas intestinalis, and a
petition,
a
statement of
declaration, and
particulars,
a
statutory Chilomastix mesnili, each of which is capable of producing flagellate diarrhoea; each of them also is difficult of elimination from the alimentary tract when once established there. Distressing
couple of medical certificates, or, if below the age of 21, as the result of In an application by his parent or guardian. this latter case, however, there are required not only two medical certificates but also two certificates by " a judicial authority." The contrast in methods does not end with the reception of the patient. Cases under the Mental Deficiency Act have to be seen from time to time by visiting justices, reports about them have to be sent to the Board of Control, and, generally, they are responsible for the consumption of much paper and ink. Local Government Board cases carry on quite satisfactorily without these refinements. There is no authority for their detention-they simply stay. It is rather striking to find in one institution and in the same ward of the institution two patients of similar type yet under such diverse conditions. We are not, at the moment, concerned to point the moral, but the situation is worthy of the attention of those who may have to reconcile the vagaries of the law relating to mental defect. a
diarrhoea in adults and some forms of "green" or infantile diarrhoea in Johannesburg have been traced to the presence of these parasites, and with their elimination by treatment the diarrhoea has ceased. There is a possibility that many obscure intestinal troubles, difficult to deal with, may be due to these of these flagellates
INTESTINAL ENTOZOA AMONG THE NATIVE LABOURERS IN JOHANNESBURG.
THE South African Institute for Medical Research has recently published an interesting report by Miss Annie Porter, D.Sc. Lond., parasitologist to the Institute, entitled " A Survey of the Intestinal Entozoa, both Protozoal and Helminthic, Observed Johannesburg from June to Among Natives in 1 The natives employed in November, 1917." Johannesburg are gathered from various parts of Africa, including the East Coast, Cape Province, the Transvaal, Basutoland, and Natal, and among them infestation by endoparasites, both protozoa and helminths, is common. As many as six kinds of parasitic organisms have been found simultaneously in a single intestine. The parasitic protozoa found in the stools of the natives include Entamaeba histolytica, Giardia intestinalis, Trichomonas intestinalis, and Chilomastix mesnibi; the first of these is associated with amoebic dysentery and the last three with various flagellate diarrhoeas; and Isospora bigemina, which can Entamceba coli and cause coccidial diarrhoea. are Spirochteta eurygyrata very widely distributed parasites; they have long been habituated to life in the human intestine, but nevertheless it has been found that they multiply more abundantly in an unhealthy intestine, and their presence in large numbers may serve as an indication of intestinal disorder. Miss Porter regards the number of infections with E. histolytica as some index of the number of sporadic cases normally present among a population living under normal conditions; and also as an indication of the possibilities of amoebic: dysentery occurring in epidemic form should conditions of living lower the standard of health now prevailing. It is suggested that under less favourable conditions it is possible for diseases, now relatively quiescent and sporadic, to become fulminating:and epidemic. The main modes of transmission of E. histolytica to man are by direct infection of foodl and water and indirectly by the agency of flies. Carriers of cysts are serious sources of danger toI persons with whom they may associate. The same’’ .
.
1 Publications of the South African Institute for Medical Research. Edited by W. Watkins-Pitchford, M.D. Lond. No. XI. Pp. 58. 5s. .
Natural reservoirs found in such domestic vermin as rats, mice, and cockroaches, whose excrement may infect cereal or farinaceous food. The other source of infection is the cysts voided in the stools of human carriers. The danger from the promiscuous habits of some of the natives is evident; they may by their evacuations contaminate water and foliage, as well as afford opportunities for transmission of infection by flies. Helminthic infections are widely distributed among the native workers of Johannesburg ; eosinophilia and anaemia are common results of worm infestation, and generally lower the vitality of the infected person. For eliminating worm infections it is necessary to inculcate sanitary habits not only as regards the preparation of food but also with respect to the disposal of excrement. Numerous cases of infestation by Taenia saginata and T. solium were detected arising from the eating of imperfectly cooked beef or pork. The disposal of infected human excrement containing tapeworm eggs should be effected in such a way that no contamination occurs of herbage on which pigs or cattle may feed. By preventing the development of tapeworm eggs into bladder-worms in pigs and cattle, the development of tapeworms in man is rendered impossible. The presence of Hymenolepsis in man is the result of defective protection of food from contamination by rats and mice, the fleas infesting these animals conveying the bladderNematode infections in the worms to human food. natives were common, especially ankylostomiasis ; Ascaris lumbricoides and Trichuris trichiura were also found frequently. A few cases of trematode infection were discovered-namely, Schistosoma Miss Porter concludes her paper by mansoni. saying that ".No animal parasite is entirely harmless to man," so that neither protozoon nor helminth can be disregarded.
organisms. are
____
AN Inter-Allied Conference of Red Cross Societies will shortly be held in Cannes to consider the programme of a meeting to be called at Geneva 30 days after the signing of peace, for the purpose of extending the scope and broadening the basis of Red Cross work throughout the world. A number of important medical and surgical questions will come up at the Conference and require expert discussion; among those who have placed their services at the disposal of the British Red Cross Society for this purpose are Sir Arthur Newsholme, Sir Ronald Ross, Sir Robert Philip, Dr. F. N. Kay Menzies, Dr. F. Truby King, Sir Walter Fletcher, Sir Leslie MacKenzie, Colonel S. Lyle Cummins, and Colonel L. W. Harrison. As was pointed out
by Sir Arthur Stanley in
an address given before Brighton Division of the British Red Cross Society on March 14th, wherever distress and suffering exist there the symbol of the Red
the
522 Cross should be. Numberless ways in which the REPORT ON THE Red Cross could help in the rebuilding of the KEMP PROSSOR COLOUR SCHEME. world will suggest themselves, two of the most BY E. N. SNOWDEN, M.B., B.S. LOND., M.R.C.S., pressing needs being the prevention of tuberculosis and the promotion of child welfare. The suggestion CAPTAIN, R.A.M.C. (T.). has been made that some of the 1300 hospitals the Clearing Hospital, R.A.M.C.) Maudsley Neurological (From, which are now being disbanded should be retained by the Red Cross for the treatment of tuberculous THE Kemp Prossor colour method for treatment of neurocases, along with the provision of proper home logical patients at the Maudsley Hospital is exhibited in the accommodation. The formation of a central council decoration of a section of the hospital-the officers’ flat for of child welfare under the presidency of the Red 11 officer patients and Ward 4 for other ranks. The following is a brief description of Ward 4 and serves Cross Societies, coordinating all the efforts at to illustrate the whole scheme. The ward consists of three is engaging sympathetic present widely scattered, consideration. In these and other ways the generous rooms. Room A is decorated with a ceiling of sky blue, with yellow walls (the so-called "sunlight"yellow). The response of comfortable humanity to want and bed-covers It has blue and locker curtains are green. will not be manifested the war, during suffering, flower vases and screen covers. The whole scheme of decora. allowed to fade away in peace. tion is intended to represent spring, the yellow being said to be stimulating. Room B : The ceiling is blue, the walls yellow, the bed-covers and locker curtains are purple, and the screen THE MEDICAL SUPPLEMENT OF THE MEDICAL covers are blue. This also is intended to be stimulating. RESEARCH COMMITTEE. Room C : The ceiling is blue, the walls are coloured, the WITH reference to this publication we have been upper part pink with a yellow dado. A narrow green line asked to call attention to the following statement divides these colours. It has blue bed and screen covers. This scheme is intended to assist concentration. There are of the Committee:three chief side rooms: (1) Yellow and green, stimulating " Since the end of hostilities the Medical Research Committee have had under consideration the question of con- effect ; (2) purple and blue, soothing effect ; (3) yellow and tinuing in another form the compilation of abstracts and blue, stimulating effect. The corridor is yellow and green. reviews of foreign publications in medical science which, Effeots of Coloecr Boheme on Patients. with a view to special war conditions, have hitherto been The colours are well chosen and the whole effect of the issued in the Medical Supplement to the Daily Review of the Foreign Press. The Medical Supplement as such will be dis- wards is bright and pleasing, if somewhat unrestful to the continued after the April number, but representations have ordinary observer. With regard to the effect of this scheme been made to the Committee from many quarters urging of decoration on the patients, careful inquiry from the the continuation upon a permanent basis of a summary medical officers, sisters, and patients has elicited the of a similar kind. It appears to have been found in following facts :many directions that the Supplement has served a 1. There is less crime (in the military sense) in Ward4 useful purpose in aiding both the progress of research and its application to practical problems. The Medical than in any of the other wards. This fact is of importance Research Committee have made arrangements accord- and needs further trial and investigation, as it appears to be ingly to publish in monthly issues periodical collec- a strong point in favour of the colour scheme. It may be tions of abstracts and reviews of work done in the medical mere coincidence. It may be due to the influence on the sciences and recorded either in British and American men of a tactful and suitable charge sister. A measure of publications or in those of other countries. It is intended the value of the sister’s management in a neurological ward to leave a short interval between the cessation of the is the presence or absence of military offences. Further, it Supplement and the beginning of the new periodical, and it is is possible that the men have a pride in the ward as being a first number will on Oct. lst at that the next, hoped appear the beginning of the academical year. Its size will be a large show place, and their conduct consequently improves. If 8vo, uniform with that (for instance) of the Quarterly this last factor is of importance it would naturally disappear Journal of Medicine and of an increasing number of other if the whole hospital were treated in the same way. These scientific journals. The contents will be in the form of comments indicate a path for further investigation of the abstracts of individual papers, with occasional critical fact. summaries of grouped results, taken from published work 2. A patient diagnosed as "hysteria"was put into the making advance in particular branches of medical science." side room. In two days he became hopelessly purple A detailed prospectus of the new publication will depressed and was removed to Ward A, where he recovered. shortly be prepared, when it will be sent upon 3. A patient with "neurasthenia"was told that his application made to the Medical Research Com- headaches would be removed if he were living in the purple room, and he stated that this occurred. I will comment on mittee, 15, Buckingham-street, Strand, W.C.2. this fact later. 4. Two patients who were placed in Ward A (yellow) Sir Robert Jones will act as honorary consultant declared that they would go mad if they were left there. to the Ministry of Pensions for orthopeadic cases. After two days this attitude of mind was changed to acquiescence with their surroundings. It is a common IN view of the impending retirement of Sir experience that we can become accustomed to any surroundHorace Monro, K.C.B., Permanent Secretary to the ings, and that the mind has the capacity of dissociating Local Government Board, and in order to facilitate from consciousness any conditions that are unpleasing and the unification of the departments which will be by that means protecting itself from disturbance. 5. A young officer who had been unable to sleep for many brought together in the Ministry of Health on the unless with the help of sedative while in nights passage of the Bill now before Parliament, the France was placed in a room in which purpledrugs predominated. Local the Government Board of has President He slept soundly all night without any drug. This case has appointed Sir Robert Morant, K.C.B., chairman of been quoted as an example of the soothing effect of the the National Health Insurance Commission, and purple room, but any medical officer who has dealt with Mr. John Anderson, C.B., secretary to that Com- neurological cases can quote dozens of similar instances mission, and at present acting as secretary to the where the patient gave the credit for his improvement to the fact that he was back in England and his anxiety removed, Ministry of Shipping, to be additional Secretaries and where there was nothing in his surroundings that was to the Local Government with func-
Board,
special
tions and responsibilities in relation to the organisation of the new Department, continuing their Insurance functions. Sir Robert Morant and Mr. Anderson have been designated as First and Second
Secretary respectively in the
new
Ministry.
peculiar.
6. The patients who occupy beds in the pink room (0) show a tendency to sit there rather than in the other rooms. 7. Medical officers who have had cases under treatment in this ward, and in other wards simultaneously, find that there is no difference in the results achieved. The patients do not
imbecile, may be dealt with either by means of an remarks apply to such parasitic flagellata as order made by a justice, after the presentation of Giardia intestinalis, Trichomonas intestinalis, and a
petition,
a
statement of
declaration, and
particulars,
a
statutory Chilomastix mesnili, each of which is capable of producing flagellate diarrhoea; each of them also is difficult of elimination from the alimentary tract when once established there. Distressing
couple of medical certificates, or, if below the age of 21, as the result of In an application by his parent or guardian. this latter case, however, there are required not only two medical certificates but also two certificates by " a judicial authority." The contrast in methods does not end with the reception of the patient. Cases under the Mental Deficiency Act have to be seen from time to time by visiting justices, reports about them have to be sent to the Board of Control, and, generally, they are responsible for the consumption of much paper and ink. Local Government Board cases carry on quite satisfactorily without these refinements. There is no authority for their detention-they simply stay. It is rather striking to find in one institution and in the same ward of the institution two patients of similar type yet under such diverse conditions. We are not, at the moment, concerned to point the moral, but the situation is worthy of the attention of those who may have to reconcile the vagaries of the law relating to mental defect. a
diarrhoea in adults and some forms of "green" or infantile diarrhoea in Johannesburg have been traced to the presence of these parasites, and with their elimination by treatment the diarrhoea has ceased. There is a possibility that many obscure intestinal troubles, difficult to deal with, may be due to these of these flagellates
INTESTINAL ENTOZOA AMONG THE NATIVE LABOURERS IN JOHANNESBURG.
THE South African Institute for Medical Research has recently published an interesting report by Miss Annie Porter, D.Sc. Lond., parasitologist to the Institute, entitled " A Survey of the Intestinal Entozoa, both Protozoal and Helminthic, Observed Johannesburg from June to Among Natives in 1 The natives employed in November, 1917." Johannesburg are gathered from various parts of Africa, including the East Coast, Cape Province, the Transvaal, Basutoland, and Natal, and among them infestation by endoparasites, both protozoa and helminths, is common. As many as six kinds of parasitic organisms have been found simultaneously in a single intestine. The parasitic protozoa found in the stools of the natives include Entamaeba histolytica, Giardia intestinalis, Trichomonas intestinalis, and Chilomastix mesnibi; the first of these is associated with amoebic dysentery and the last three with various flagellate diarrhoeas; and Isospora bigemina, which can Entamceba coli and cause coccidial diarrhoea. are Spirochteta eurygyrata very widely distributed parasites; they have long been habituated to life in the human intestine, but nevertheless it has been found that they multiply more abundantly in an unhealthy intestine, and their presence in large numbers may serve as an indication of intestinal disorder. Miss Porter regards the number of infections with E. histolytica as some index of the number of sporadic cases normally present among a population living under normal conditions; and also as an indication of the possibilities of amoebic: dysentery occurring in epidemic form should conditions of living lower the standard of health now prevailing. It is suggested that under less favourable conditions it is possible for diseases, now relatively quiescent and sporadic, to become fulminating:and epidemic. The main modes of transmission of E. histolytica to man are by direct infection of foodl and water and indirectly by the agency of flies. Carriers of cysts are serious sources of danger toI persons with whom they may associate. The same’’ .
.
1 Publications of the South African Institute for Medical Research. Edited by W. Watkins-Pitchford, M.D. Lond. No. XI. Pp. 58. 5s. .
Natural reservoirs found in such domestic vermin as rats, mice, and cockroaches, whose excrement may infect cereal or farinaceous food. The other source of infection is the cysts voided in the stools of human carriers. The danger from the promiscuous habits of some of the natives is evident; they may by their evacuations contaminate water and foliage, as well as afford opportunities for transmission of infection by flies. Helminthic infections are widely distributed among the native workers of Johannesburg ; eosinophilia and anaemia are common results of worm infestation, and generally lower the vitality of the infected person. For eliminating worm infections it is necessary to inculcate sanitary habits not only as regards the preparation of food but also with respect to the disposal of excrement. Numerous cases of infestation by Taenia saginata and T. solium were detected arising from the eating of imperfectly cooked beef or pork. The disposal of infected human excrement containing tapeworm eggs should be effected in such a way that no contamination occurs of herbage on which pigs or cattle may feed. By preventing the development of tapeworm eggs into bladder-worms in pigs and cattle, the development of tapeworms in man is rendered impossible. The presence of Hymenolepsis in man is the result of defective protection of food from contamination by rats and mice, the fleas infesting these animals conveying the bladderNematode infections in the worms to human food. natives were common, especially ankylostomiasis ; Ascaris lumbricoides and Trichuris trichiura were also found frequently. A few cases of trematode infection were discovered-namely, Schistosoma Miss Porter concludes her paper by mansoni. saying that ".No animal parasite is entirely harmless to man," so that neither protozoon nor helminth can be disregarded.
organisms. are
____
AN Inter-Allied Conference of Red Cross Societies will shortly be held in Cannes to consider the programme of a meeting to be called at Geneva 30 days after the signing of peace, for the purpose of extending the scope and broadening the basis of Red Cross work throughout the world. A number of important medical and surgical questions will come up at the Conference and require expert discussion; among those who have placed their services at the disposal of the British Red Cross Society for this purpose are Sir Arthur Newsholme, Sir Ronald Ross, Sir Robert Philip, Dr. F. N. Kay Menzies, Dr. F. Truby King, Sir Walter Fletcher, Sir Leslie MacKenzie, Colonel S. Lyle Cummins, and Colonel L. W. Harrison. As was pointed out
by Sir Arthur Stanley in
an address given before Brighton Division of the British Red Cross Society on March 14th, wherever distress and suffering exist there the symbol of the Red
the
522 Cross should be. Numberless ways in which the REPORT ON THE Red Cross could help in the rebuilding of the KEMP PROSSOR COLOUR SCHEME. world will suggest themselves, two of the most BY E. N. SNOWDEN, M.B., B.S. LOND., M.R.C.S., pressing needs being the prevention of tuberculosis and the promotion of child welfare. The suggestion CAPTAIN, R.A.M.C. (T.). has been made that some of the 1300 hospitals the Clearing Hospital, R.A.M.C.) Maudsley Neurological (From, which are now being disbanded should be retained by the Red Cross for the treatment of tuberculous THE Kemp Prossor colour method for treatment of neurocases, along with the provision of proper home logical patients at the Maudsley Hospital is exhibited in the accommodation. The formation of a central council decoration of a section of the hospital-the officers’ flat for of child welfare under the presidency of the Red 11 officer patients and Ward 4 for other ranks. The following is a brief description of Ward 4 and serves Cross Societies, coordinating all the efforts at to illustrate the whole scheme. The ward consists of three is engaging sympathetic present widely scattered, consideration. In these and other ways the generous rooms. Room A is decorated with a ceiling of sky blue, with yellow walls (the so-called "sunlight"yellow). The response of comfortable humanity to want and bed-covers It has blue and locker curtains are green. will not be manifested the war, during suffering, flower vases and screen covers. The whole scheme of decora. allowed to fade away in peace. tion is intended to represent spring, the yellow being said to be stimulating. Room B : The ceiling is blue, the walls yellow, the bed-covers and locker curtains are purple, and the screen THE MEDICAL SUPPLEMENT OF THE MEDICAL covers are blue. This also is intended to be stimulating. RESEARCH COMMITTEE. Room C : The ceiling is blue, the walls are coloured, the WITH reference to this publication we have been upper part pink with a yellow dado. A narrow green line asked to call attention to the following statement divides these colours. It has blue bed and screen covers. This scheme is intended to assist concentration. There are of the Committee:three chief side rooms: (1) Yellow and green, stimulating " Since the end of hostilities the Medical Research Committee have had under consideration the question of con- effect ; (2) purple and blue, soothing effect ; (3) yellow and tinuing in another form the compilation of abstracts and blue, stimulating effect. The corridor is yellow and green. reviews of foreign publications in medical science which, Effeots of Coloecr Boheme on Patients. with a view to special war conditions, have hitherto been The colours are well chosen and the whole effect of the issued in the Medical Supplement to the Daily Review of the Foreign Press. The Medical Supplement as such will be dis- wards is bright and pleasing, if somewhat unrestful to the continued after the April number, but representations have ordinary observer. With regard to the effect of this scheme been made to the Committee from many quarters urging of decoration on the patients, careful inquiry from the the continuation upon a permanent basis of a summary medical officers, sisters, and patients has elicited the of a similar kind. It appears to have been found in following facts :many directions that the Supplement has served a 1. There is less crime (in the military sense) in Ward4 useful purpose in aiding both the progress of research and its application to practical problems. The Medical than in any of the other wards. This fact is of importance Research Committee have made arrangements accord- and needs further trial and investigation, as it appears to be ingly to publish in monthly issues periodical collec- a strong point in favour of the colour scheme. It may be tions of abstracts and reviews of work done in the medical mere coincidence. It may be due to the influence on the sciences and recorded either in British and American men of a tactful and suitable charge sister. A measure of publications or in those of other countries. It is intended the value of the sister’s management in a neurological ward to leave a short interval between the cessation of the is the presence or absence of military offences. Further, it Supplement and the beginning of the new periodical, and it is is possible that the men have a pride in the ward as being a first number will on Oct. lst at that the next, hoped appear the beginning of the academical year. Its size will be a large show place, and their conduct consequently improves. If 8vo, uniform with that (for instance) of the Quarterly this last factor is of importance it would naturally disappear Journal of Medicine and of an increasing number of other if the whole hospital were treated in the same way. These scientific journals. The contents will be in the form of comments indicate a path for further investigation of the abstracts of individual papers, with occasional critical fact. summaries of grouped results, taken from published work 2. A patient diagnosed as "hysteria"was put into the making advance in particular branches of medical science." side room. In two days he became hopelessly purple A detailed prospectus of the new publication will depressed and was removed to Ward A, where he recovered. shortly be prepared, when it will be sent upon 3. A patient with "neurasthenia"was told that his application made to the Medical Research Com- headaches would be removed if he were living in the purple room, and he stated that this occurred. I will comment on mittee, 15, Buckingham-street, Strand, W.C.2. this fact later. 4. Two patients who were placed in Ward A (yellow) Sir Robert Jones will act as honorary consultant declared that they would go mad if they were left there. to the Ministry of Pensions for orthopeadic cases. After two days this attitude of mind was changed to acquiescence with their surroundings. It is a common IN view of the impending retirement of Sir experience that we can become accustomed to any surroundHorace Monro, K.C.B., Permanent Secretary to the ings, and that the mind has the capacity of dissociating Local Government Board, and in order to facilitate from consciousness any conditions that are unpleasing and the unification of the departments which will be by that means protecting itself from disturbance. 5. A young officer who had been unable to sleep for many brought together in the Ministry of Health on the unless with the help of sedative while in nights passage of the Bill now before Parliament, the France was placed in a room in which purpledrugs predominated. Local the Government Board of has President He slept soundly all night without any drug. This case has appointed Sir Robert Morant, K.C.B., chairman of been quoted as an example of the soothing effect of the the National Health Insurance Commission, and purple room, but any medical officer who has dealt with Mr. John Anderson, C.B., secretary to that Com- neurological cases can quote dozens of similar instances mission, and at present acting as secretary to the where the patient gave the credit for his improvement to the fact that he was back in England and his anxiety removed, Ministry of Shipping, to be additional Secretaries and where there was nothing in his surroundings that was to the Local Government with func-
Board,
special
tions and responsibilities in relation to the organisation of the new Department, continuing their Insurance functions. Sir Robert Morant and Mr. Anderson have been designated as First and Second
Secretary respectively in the
new
Ministry.
peculiar.
6. The patients who occupy beds in the pink room (0) show a tendency to sit there rather than in the other rooms. 7. Medical officers who have had cases under treatment in this ward, and in other wards simultaneously, find that there is no difference in the results achieved. The patients do not