- Email: [email protected]
MOBILE ELECTROENCEPHALOGRAM SERVICE
738
despite their numerical minority in Malaya. Danaraj5 was careful to exclude patients with microfilarxmia when studying the effects of diethylcarbamazine in the treatment of eosinophilic lung. But because this antifilarial drug dramatically relieved the symptoms of tropical eosinophilia and because the complement-fixation test with Dilofilaria immitis antigen was strongly positive in all cases, Danaraj et al.6 postulated an infection with filarial parasites of animal origin. Full development could not take place as man was not a suitable host: hence the negative blood-films. Unexpected evidence supporting this hypothesis has now been described in a preliminary note by Buckley.’7 In an investigation of the possibility that Malayan animals act as reservoirs of human filariasis, a volunteer was inoculated in July, 1955, with W. malayi larvae of monkey origin. Microfiarrie were not subsequently found in the blood; but in November, 1955, the volunteer developed a cough and increasing eosinophilia, which by December had reached 60% of a total white blood-cell count of 20,400 per c.mm. Only symptomatic treatment was taken; the cough continued for three months, and eosinophilia of 30-50% persisted throughout 1956. In May, 1957, W. pahangi of cat origin was inoculated; and ten weeks later similar symptoms recurred, eosinophils increasing to 75% in a total white blood-cell count of 40,500 per c.mm. The cough and eosinophilia were quickly relieved by a course of diethylcarbamazine. The filarial complement-fixation test became positive to a titre of 1 : 80 in the first and 1 : 640 in the second episode. This evidence strongly supports the suggestion that animal filarial infection causes tropical eosinophilia; and no doubt lung biopsy at night-for that is when the cough becomes most troublesome-will shortly confirm the identity of the parasite. But will it solve the problem of why Indians are so much more prone to the illness than other Asian peoples ?
Indians
MOBILE ELECTROENCEPHALOGRAM SERVICE
THE value of electroencephalography in neurological investigation has increased in the past decade; and it is now recognised as an integral part of a full neurological service. But the apparatus is costly, and the knowledge and experience required for its profitable use still tend to limit its availability. The majority of neurological centres in this country provide this service; and electroencephalography is also practised in mental hospitals. These arrangements probably satisfy most of the present demand:
but it may be doubted however whether this is as grea1 as it should be, for the adequate investigation of all cases of epilepsy includes an E.E.G. even though the evidence provided is sometimes negative. In the differential diagnosis of vasomotor syncope, and even in the investigatior of apparently cardiological causes of loss of consciousness it may also be of value. The early recognition of localisec brain damage, whether from trauma, neoplasm, or vas. cular change, may be greatly expedited by it. Its value as a screening-test for the psychiatric disorders whicl may be due to a structural brain lesion is increasingh recognised. And in the investigation of episodic behaviour disorders, especially in the young, it has an importan place. These are some of its routine clinical applications In addition there is a zone of psychiatric and neurologica work in which the instrument is a useful research tool 6.
7.
Danaraj, T. J., da Silva, L. S., Schacher, J. F. Proc. Alumni Ass. Malaya, 1957, 10, 109. Buckley, J. J. C. Trans. R. Soc. trop. Med. Hyg. 1958, 52, 335.
Judged by its potential applications this method of investigation should without doubt be more readily available, This problem has presented itself in Michigan, where E.E.G. facilities were badly distributed in terms of population. In 1951 a mobile E.E.G. unit was organised; and this has proved a success.’ The number of patients seen in the past seven years has increased from 95 to 190, though the mileage covered has remained much the same. Technical advances, and especially the emergence of efficient transistorised machines, have greatly increased the portability of these instruments, and the providence of a mobile E.E.G. service for outlying hospitals and clinics is no longer much of a transport problem. Such a development, with mobile teams based on a wellequipped E.E.G. centre, might prove more satisfactory and certainly more economical in technical and medical staff than the multiplication of small units at peripheral hospitals. A growing demand for E.E.G. services is already apparent. It is as well to have some plans to meet this
efficiently
and
economically.
THE RIGHTS OF THE AGED
THE care of old people can be one of the most difficult duties of a community; and some of its problems have been sharply outlined by a recent case when a magistrates’ court for the third time refused the appeal of a 90-year-old spinster for her freedom and extended by three months an order for her detention in hospital Her chief difficulty was apparently not shortage of money but of domestic help. She had sufficient means but had been living in a neglected home and had no-one to look after her. The authorities were clearly reluctant to deprive her of her liberty, but they felt that in hospital she was receiving care and attention she could not get at home. The medical officer of health said that it was difficult for anyone to help her, for she was " such an independent old lady ". Everyone was anxious to do the right thing, and for this particular old lady a further stay in hospital may well be the best solution. But obviously she is unhappy not to be living in her own home, and her appeal makes clear once again the difficulty of assessing the community’s right to interfere with the aged citizen’s liberty. How far should we respect their preference for independence, discomfort, and even dirt to incarceration in the most hygienic surroundings ? Old people who are living alone may not be the easiest neighbours. They may be uncertain in temper, irregular in their habits, sketchy in their cleaning, resentful of help and advice. Shaky hands, shortsightedness, and forgetfulness may bring risk of fire. Sometimes it may prove impossible to leave them to their solitary and frail independence. But before asking them to relinquish it, we should be sure that they are causing others danger and real distress rather than merely inconvenience and a perhaps irrational feeling of guilt. Dr. Droller’s article on p. 739 suggests that often much help can be provided by a suitably organised outpatient department, 1. Rolfe, A. L., Derbyshire, A. J., Bohn, Z. S. 167, 1723. 2. Birmingham Post, Sept. 26, 1958.
J. Amer. Med. Ass. 1958,
THE INDEX and title-page to Vol. I, 1958, which was completed with THE LANCET of June 28, is to be issued next week. A copy will be sent gratis to subscribers on receipt of a postcard addressed to the Manager of THE LANCET, 7, Adam Street, Adelphi, W.C.2. Subscribers who have not already indicated their desire to receive indexes regularly as published should do so now.
despite their numerical minority in Malaya. Danaraj5 was careful to exclude patients with microfilarxmia when studying the effects of diethylcarbamazine in the treatment of eosinophilic lung. But because this antifilarial drug dramatically relieved the symptoms of tropical eosinophilia and because the complement-fixation test with Dilofilaria immitis antigen was strongly positive in all cases, Danaraj et al.6 postulated an infection with filarial parasites of animal origin. Full development could not take place as man was not a suitable host: hence the negative blood-films. Unexpected evidence supporting this hypothesis has now been described in a preliminary note by Buckley.’7 In an investigation of the possibility that Malayan animals act as reservoirs of human filariasis, a volunteer was inoculated in July, 1955, with W. malayi larvae of monkey origin. Microfiarrie were not subsequently found in the blood; but in November, 1955, the volunteer developed a cough and increasing eosinophilia, which by December had reached 60% of a total white blood-cell count of 20,400 per c.mm. Only symptomatic treatment was taken; the cough continued for three months, and eosinophilia of 30-50% persisted throughout 1956. In May, 1957, W. pahangi of cat origin was inoculated; and ten weeks later similar symptoms recurred, eosinophils increasing to 75% in a total white blood-cell count of 40,500 per c.mm. The cough and eosinophilia were quickly relieved by a course of diethylcarbamazine. The filarial complement-fixation test became positive to a titre of 1 : 80 in the first and 1 : 640 in the second episode. This evidence strongly supports the suggestion that animal filarial infection causes tropical eosinophilia; and no doubt lung biopsy at night-for that is when the cough becomes most troublesome-will shortly confirm the identity of the parasite. But will it solve the problem of why Indians are so much more prone to the illness than other Asian peoples ?
Indians
MOBILE ELECTROENCEPHALOGRAM SERVICE
THE value of electroencephalography in neurological investigation has increased in the past decade; and it is now recognised as an integral part of a full neurological service. But the apparatus is costly, and the knowledge and experience required for its profitable use still tend to limit its availability. The majority of neurological centres in this country provide this service; and electroencephalography is also practised in mental hospitals. These arrangements probably satisfy most of the present demand:
but it may be doubted however whether this is as grea1 as it should be, for the adequate investigation of all cases of epilepsy includes an E.E.G. even though the evidence provided is sometimes negative. In the differential diagnosis of vasomotor syncope, and even in the investigatior of apparently cardiological causes of loss of consciousness it may also be of value. The early recognition of localisec brain damage, whether from trauma, neoplasm, or vas. cular change, may be greatly expedited by it. Its value as a screening-test for the psychiatric disorders whicl may be due to a structural brain lesion is increasingh recognised. And in the investigation of episodic behaviour disorders, especially in the young, it has an importan place. These are some of its routine clinical applications In addition there is a zone of psychiatric and neurologica work in which the instrument is a useful research tool 6.
7.
Danaraj, T. J., da Silva, L. S., Schacher, J. F. Proc. Alumni Ass. Malaya, 1957, 10, 109. Buckley, J. J. C. Trans. R. Soc. trop. Med. Hyg. 1958, 52, 335.
Judged by its potential applications this method of investigation should without doubt be more readily available, This problem has presented itself in Michigan, where E.E.G. facilities were badly distributed in terms of population. In 1951 a mobile E.E.G. unit was organised; and this has proved a success.’ The number of patients seen in the past seven years has increased from 95 to 190, though the mileage covered has remained much the same. Technical advances, and especially the emergence of efficient transistorised machines, have greatly increased the portability of these instruments, and the providence of a mobile E.E.G. service for outlying hospitals and clinics is no longer much of a transport problem. Such a development, with mobile teams based on a wellequipped E.E.G. centre, might prove more satisfactory and certainly more economical in technical and medical staff than the multiplication of small units at peripheral hospitals. A growing demand for E.E.G. services is already apparent. It is as well to have some plans to meet this
efficiently
and
economically.
THE RIGHTS OF THE AGED
THE care of old people can be one of the most difficult duties of a community; and some of its problems have been sharply outlined by a recent case when a magistrates’ court for the third time refused the appeal of a 90-year-old spinster for her freedom and extended by three months an order for her detention in hospital Her chief difficulty was apparently not shortage of money but of domestic help. She had sufficient means but had been living in a neglected home and had no-one to look after her. The authorities were clearly reluctant to deprive her of her liberty, but they felt that in hospital she was receiving care and attention she could not get at home. The medical officer of health said that it was difficult for anyone to help her, for she was " such an independent old lady ". Everyone was anxious to do the right thing, and for this particular old lady a further stay in hospital may well be the best solution. But obviously she is unhappy not to be living in her own home, and her appeal makes clear once again the difficulty of assessing the community’s right to interfere with the aged citizen’s liberty. How far should we respect their preference for independence, discomfort, and even dirt to incarceration in the most hygienic surroundings ? Old people who are living alone may not be the easiest neighbours. They may be uncertain in temper, irregular in their habits, sketchy in their cleaning, resentful of help and advice. Shaky hands, shortsightedness, and forgetfulness may bring risk of fire. Sometimes it may prove impossible to leave them to their solitary and frail independence. But before asking them to relinquish it, we should be sure that they are causing others danger and real distress rather than merely inconvenience and a perhaps irrational feeling of guilt. Dr. Droller’s article on p. 739 suggests that often much help can be provided by a suitably organised outpatient department, 1. Rolfe, A. L., Derbyshire, A. J., Bohn, Z. S. 167, 1723. 2. Birmingham Post, Sept. 26, 1958.
J. Amer. Med. Ass. 1958,
THE INDEX and title-page to Vol. I, 1958, which was completed with THE LANCET of June 28, is to be issued next week. A copy will be sent gratis to subscribers on receipt of a postcard addressed to the Manager of THE LANCET, 7, Adam Street, Adelphi, W.C.2. Subscribers who have not already indicated their desire to receive indexes regularly as published should do so now.