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NEW METHODS AT BUXTON.
1070 excluded by present-day conditions. Hence, from the committees should indicate whether there is any reason to health point of view, there would be no justifi- suppose that such duplication exists, and if they are able cation in segregating such cases as we have amongst to obtain exact figures after eliminating duplicate entries, The disease itself iss sufficiently distressing these should be included in their reports. us. 2. The views of the committees on the extent of the without adding thereto the ferocious measures of the Middle Ages, when segregation led to a morbid fear of need of further beds in terms of the several classes of beds would chance contacts. The Ministry of Health has recently specified in the questionnaire. (The Commission particularly wish to know the views of the committees on had occasion to investigate an instance in which one the question of how far the need in their areas should be of the nurses trained at St. Giles’s Homes has under- met by the provision of hospital beds or alternatively by taken, on her own initiative and expense, to furnish the provision of more recovery or convalescent beds.) an asylum for some of these unfortunate persons, 3. The observations of the committees on the prospects and to provide them with access to the most modern of the hospitals succeeding in carrying out any scheme they medical treatment. It is, we admit, uncongenial to may have in view for providing further beds and for mainmany people to live within sight of their less fortunate taining them. In this connexion the Commission would to know whether the committees have formed any comrades, whether they be morally, mentally, or be glad as to any alternative method of providing additional physically afflicted. We can with good conscience opinion beds in their area. assure them that there is no hygienic or public What convalescent accommodation there is available ground for anxiety or interference, though it would for4.the inhabitants of the area, apart from beds controlled that at some be denied places-for example, hardly the hospitals. health resorts-the presence of a home for lepers by 5. Whether there is any arrangement for utilising vacant might damage local interests. Where this is not so Poor-law inthmary accommodation to supplement the interference with a deed of mercy would be deplorable. voluntary hospital accommodation in their area. It is only the very rich or the very heartless who can 6. The observations of the committee regarding any elude the reminder of such inequalities in our present vacant beds there may be in the hospitals in their area, social life. particularly as to how far vacant beds could be utilised
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NEW METHODS AT BUXTON. THE formal
the President of the of London of a remodelled installation of hot baths at Buxton is an event of no little importance in British hydrology. It cannot be denied that, under new methods of investigation, the spas of all countries are being classified afresh, and true progress consists in the well-considered development of the special indications for each water. It is not always easy to define these differential. Recent researches carried out by spa practitioners in the mineral waters hospitals, in which we are glad to see that Buxton is bearing an honourable part, have been recorded in the Archives of 3-Iledical Hydrology. They reveal unexpected.actions and differences between springs. The Committee for the Study of Medical Hydrology in Great Britain has, during the past year, arranged lectures at the University of London and at various medical schools. These have been set up in the hope of familiarising medical men with the practice ofi hydrology in Britain and other countries, and also of i instructing senior students in the principles upon which this practice is founded. It can hardly be doubted that even a few men, qualified by serious study, could do much to advance both the science and practice of hydrology in any country. Such opportunities for special training seem especially desirable, and even necessary, in England, if the British spas and the modes of treatment which they offer are to be looked upon, in Sir Humphry Rolleston’s words, as a national asset. To utilise such resources in the proper manner is, we think, both a medical and public question, and ought no longer to be left to unassisted efforts of individuals, or even of enlightened public authorities.
Royal College
reopening by of Physicians
-e.g., by a system of transfer of patients. 7. Whether the committees have conferred with the medical officers of health in their area, and what views the latter may have expressed on the question of hospital accommodation.
Local committees are also asked to make any as to how far the difficulties created by shortage of accommodation could be met by means of cooperation with areas adjoining their own.
suggestions
RADIOGRAPHY OF THE THE
interpretation
of
PYLORUS.
pyloric radiography
tends
to become more precise. Herrnheiserl in discussing X ray appearances of the pylorus and the pyloric antrum in the diagnosis of ulcers in these situations, draws attention to four morphological changes that occur in these conditions before any actual stenosis becomes manifest-viz., the pyloric or pre-pyloric niche, the contraction and reaction of the pyloric canal, and the formation of diverticula. The pyloric or prepyloric niche is situated usually on the lesser curvature, and varies in size up to aboutcm. It is a sign of a simple ulcer, though malignancy cannot be absolutely excluded. If present, it is very strong evidence of an ulcer in the pyloric region. Contraction as opposed to actual defect, and analogous to hour-glass contraction of the body of the stomach, is of more frequent occurrence than the already mentioned sign, and is usually found along the greater curvature about t-2 cm. from the pylorus. It remains unaltered in size, has clear-cut edges, and its depth may reach 1 cm. or more. In anew growth a somewhat similar appearance occurs, but Retraction the edges are diffuse and irregular. includes a flattening or elongation of the pyloric antrum or canal, and occurs practically always on the lesser curvature; whilst the greater curvature is full and rounded, the canal itself may be excentric or, THE COMING VOLUNTARY HOSPITALS if the flattening occurs all round, assumes a conical shape and is frequently twice its normal length. The CONFERENCE. condition may be associated with simple ulceration THE best method of completing the investigation of the duodenum with or without pyloric adhesions, into hospital accommodation will be the principal less frequently with new growth, rarely with a subject of discussion at the Conference of Local chronic appendicitis. Formation of diverticula occur Voluntary Hospital Committees, which is to be held typically on the greater curvature between the pyloric on June 18th. In order to focus the points for canal and a contraction area from simple ulceration, discussion at this Conference, the Voluntary Hos- and is frequently present in the pre-stenotic stage of pitals Commission has asked the local committees to the pylorus. Actual pouching from ulceration rarely obtain from each hospital in their area particulars occurs in the pyloric canal, and is differentiated from of beds, length of stay, and waiting lists. The local a niche by its being along the anterior aspect of the committees are also asked to furnish reports on the organ. In a malignant ulcer the outline is irregular following points :and indistinct, and there are other obvious changes The article gives an 1. It is not an uncommon practice for patients awaiting in the contour of the viscus. hospital treatment to put down their names on the waiting indication of the direction taken by clinical teaching lists of two or more hospitals. The difticulty, therefore, in of German radiologists. computing the number of persons awaiting hospital treatThe local ment is the elimination of duplicate entries. 2 Med. Klinik, May 4th, 1924. ____
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public
____
NEW METHODS AT BUXTON. THE formal
the President of the of London of a remodelled installation of hot baths at Buxton is an event of no little importance in British hydrology. It cannot be denied that, under new methods of investigation, the spas of all countries are being classified afresh, and true progress consists in the well-considered development of the special indications for each water. It is not always easy to define these differential. Recent researches carried out by spa practitioners in the mineral waters hospitals, in which we are glad to see that Buxton is bearing an honourable part, have been recorded in the Archives of 3-Iledical Hydrology. They reveal unexpected.actions and differences between springs. The Committee for the Study of Medical Hydrology in Great Britain has, during the past year, arranged lectures at the University of London and at various medical schools. These have been set up in the hope of familiarising medical men with the practice ofi hydrology in Britain and other countries, and also of i instructing senior students in the principles upon which this practice is founded. It can hardly be doubted that even a few men, qualified by serious study, could do much to advance both the science and practice of hydrology in any country. Such opportunities for special training seem especially desirable, and even necessary, in England, if the British spas and the modes of treatment which they offer are to be looked upon, in Sir Humphry Rolleston’s words, as a national asset. To utilise such resources in the proper manner is, we think, both a medical and public question, and ought no longer to be left to unassisted efforts of individuals, or even of enlightened public authorities.
Royal College
reopening by of Physicians
-e.g., by a system of transfer of patients. 7. Whether the committees have conferred with the medical officers of health in their area, and what views the latter may have expressed on the question of hospital accommodation.
Local committees are also asked to make any as to how far the difficulties created by shortage of accommodation could be met by means of cooperation with areas adjoining their own.
suggestions
RADIOGRAPHY OF THE THE
interpretation
of
PYLORUS.
pyloric radiography
tends
to become more precise. Herrnheiserl in discussing X ray appearances of the pylorus and the pyloric antrum in the diagnosis of ulcers in these situations, draws attention to four morphological changes that occur in these conditions before any actual stenosis becomes manifest-viz., the pyloric or pre-pyloric niche, the contraction and reaction of the pyloric canal, and the formation of diverticula. The pyloric or prepyloric niche is situated usually on the lesser curvature, and varies in size up to aboutcm. It is a sign of a simple ulcer, though malignancy cannot be absolutely excluded. If present, it is very strong evidence of an ulcer in the pyloric region. Contraction as opposed to actual defect, and analogous to hour-glass contraction of the body of the stomach, is of more frequent occurrence than the already mentioned sign, and is usually found along the greater curvature about t-2 cm. from the pylorus. It remains unaltered in size, has clear-cut edges, and its depth may reach 1 cm. or more. In anew growth a somewhat similar appearance occurs, but Retraction the edges are diffuse and irregular. includes a flattening or elongation of the pyloric antrum or canal, and occurs practically always on the lesser curvature; whilst the greater curvature is full and rounded, the canal itself may be excentric or, THE COMING VOLUNTARY HOSPITALS if the flattening occurs all round, assumes a conical shape and is frequently twice its normal length. The CONFERENCE. condition may be associated with simple ulceration THE best method of completing the investigation of the duodenum with or without pyloric adhesions, into hospital accommodation will be the principal less frequently with new growth, rarely with a subject of discussion at the Conference of Local chronic appendicitis. Formation of diverticula occur Voluntary Hospital Committees, which is to be held typically on the greater curvature between the pyloric on June 18th. In order to focus the points for canal and a contraction area from simple ulceration, discussion at this Conference, the Voluntary Hos- and is frequently present in the pre-stenotic stage of pitals Commission has asked the local committees to the pylorus. Actual pouching from ulceration rarely obtain from each hospital in their area particulars occurs in the pyloric canal, and is differentiated from of beds, length of stay, and waiting lists. The local a niche by its being along the anterior aspect of the committees are also asked to furnish reports on the organ. In a malignant ulcer the outline is irregular following points :and indistinct, and there are other obvious changes The article gives an 1. It is not an uncommon practice for patients awaiting in the contour of the viscus. hospital treatment to put down their names on the waiting indication of the direction taken by clinical teaching lists of two or more hospitals. The difticulty, therefore, in of German radiologists. computing the number of persons awaiting hospital treatThe local ment is the elimination of duplicate entries. 2 Med. Klinik, May 4th, 1924. ____
I