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PREGNANCY TOXÆMIA UNDER CONTROL
INTERNATIONAL CAMPAIGN AGAINST RHEUMATIS1V2
under laboratory conditions proved futile. Treatment with permanganate was also disappointing, except in the case of tabellaria, but ozone and activated carbon-in popular language "super-charcoal "-were generally effective. For algal control additions of 01 to 0’5 parts per million of copper sulphate have given fair results, but recently a combination of copper, ammonia and chlorine, named for convenience cuprichloramine, has proved Added to the raw to be a more effective algicide. water before it reaches the reservoirs the algal are killed and sink to the bottom ; although without visible means of locomotion they are able while living to remain suspended in water against the effect of gravity. The superiority of cuprichloramine appears to reside in the penetrating property of ammonia which then brings into effect the toxic actions of copper and chlorine, and it would appear quite uncertain whether the liberation of oxygen by chlorine has any lethal effect. The presence, amongst the exhibits, of cuprammonium, which by dilution and chlorination is converted into cuprichloramine, is one of many illustrations of the march of progress, and of the continuous care exercised by the Metropolitan Water Board in the interests of the consumer.
INTERNATIONAL CAMPAIGN AGAINST RHEUMATISM
influentially signed, will calling serious attention
be found on a to a modest organisation on whose efforts there has followed widespread activity, but which are for the moment embarrassed for want of funds. Communications of this sort are too apt to be looked at askance from the outset owing to the large demands made. A big sum is named, usually to be raised by some capitation fee to be received voluntarily from the mass of the medical profession, and at once the probable failure of the request for subscriptions is seen. Here only immediate need is pleaded, and that is so comparatively small that it ought to be met at once. The International Campaign against Rheumatism was formed in London ten years ago as a league, with the blessing of the Ministry of Health. A conference at which France, Holland, Denmark, Switzerland, Roumania, and this country were represented, resulted in the setting up of a central international council whose duty it should be to distribute the facts and arouse the general conscience to the evils that follow conditions generically termed rheumatism, and to the possibility of abating those evils by organised effort. The Acta Rheumatologica, a periodical in three languages, was produced and widely circulated and a small central bureau and library were opened. Important international congresses were arranged with the help of national committees and with the support of representatives of the countries most seriously affected, and in this way examination of many outstanding problems related to rheumatism has been conducted. The expenses so far incurred at the bureau and for the production of the journal, the Acta Rheumatologica, have been discharged by personal subscriptions and by contributions from the national groups. But the latter source has largely dried up under the economic conditions under which the world is abiding. It is in the nature of a shock to learn that this policy of abstention has been pursued in this country, which, embarrassed as it may be, cannot plead a position comparable to that existent in the other countries which have hitherto supported the movement. A sum of £ 1000 is all that is required in the A LETTER,
later page
1397
present emergency, while a guaranteed annual subscription of some similar sum would enable the League to pursue efforts which have already been of high practical value. We feel that, when the situation so clearly set out in the letter referred to is realised, the obvious remedy should follow. PREGNANCY TOXÆMIA UNDER CONTROL AUTHORITATIVE statements as to how far antenatal can prevent deaths from pregnancy toxaemia are few and far between. It is useful therefore to have a report from Fallsi on his experience of 500 cases of eclamptogenic toxaemia seen at the universities of Illinois and Iowa over a period of twelve years. While the series is relatively small, it has the advantages of being accumulated under the personal supervision of one man and under one system of treatment. The prenatal care given was simple but thorough, consisting chiefly in examination of blood pressure and urine twice a week from the 28th week onwards. The treatment of the toxaemia itself was orthodox ; in the fulminating cases pregnancy was terminated by Caesarean section, and in others by induction of labour. Such procedures as intravenous injection of magnesium sulphate or glucose were not considered essential. There were only two deaths; indeed, so low was the incidence of eclampsia that Falls almost bewails the fact that he was unable to demonstrate the treatment of this condition to his students once in two years. On the other hand he can congratulate himself on having reduced the mortality in his cases of pregnancy toxaemia to the usual level of mortality among pregnant women in general. That such results are obtainable has often been emphasised in this country, but the rigorous antenatal supervision that should be the rule is still too often neglected, and apathy and
supervision
indifference
are
regrettably
common.
THE ROME HOSPITAL CONGRESS THE fourth international congress of hospitals, held in Rome from May 19th to 26th, did some serious work in spite of the distractions of the Eternal City. Six hundred delegates represented 47 nations. The first subject on the agenda was one of the most important, being the hospital as a link in a systematic public health chain, and Dr. J. L. Brownlie’s paper, of which we published an abstract last week (he was unfortunately unable to be present) showed where the Scottish health authority is aiming. Later in the congress Dr. A. F. Cooney, who with two colleagues represented the Irish Hospitals Commission, dealt with the cognate subject of the importance of the hospital staff in relation to the community. Hitherto, he said, the advice of the hospital had usually been sought for illness. Now the public health authorities are coming to seek its aid in the prevention and preventive treatment of disease, a change with which hospital policy must reckon. Dr. W. Alter of Syracuse, opening a discussion on the out-patient department, insisted that it should include occupational therapy. The restoration and assurance of the patient’s power to work at his calling must, he said, never be lost sight of and never be prejudiced by false romantic views as to light and air. " His occupation should only be changed when it is unavoidable "-a remark in singular harmony with recent correspondence in our own columns. Dr. T. J. Heldt, of Detroit (Mich.), surprised the congress with his assertion that in the 1 Falls, F. p. 316.
H. :
Amer. Jour. Obst. and
Gyn., March, 1935,
under laboratory conditions proved futile. Treatment with permanganate was also disappointing, except in the case of tabellaria, but ozone and activated carbon-in popular language "super-charcoal "-were generally effective. For algal control additions of 01 to 0’5 parts per million of copper sulphate have given fair results, but recently a combination of copper, ammonia and chlorine, named for convenience cuprichloramine, has proved Added to the raw to be a more effective algicide. water before it reaches the reservoirs the algal are killed and sink to the bottom ; although without visible means of locomotion they are able while living to remain suspended in water against the effect of gravity. The superiority of cuprichloramine appears to reside in the penetrating property of ammonia which then brings into effect the toxic actions of copper and chlorine, and it would appear quite uncertain whether the liberation of oxygen by chlorine has any lethal effect. The presence, amongst the exhibits, of cuprammonium, which by dilution and chlorination is converted into cuprichloramine, is one of many illustrations of the march of progress, and of the continuous care exercised by the Metropolitan Water Board in the interests of the consumer.
INTERNATIONAL CAMPAIGN AGAINST RHEUMATISM
influentially signed, will calling serious attention
be found on a to a modest organisation on whose efforts there has followed widespread activity, but which are for the moment embarrassed for want of funds. Communications of this sort are too apt to be looked at askance from the outset owing to the large demands made. A big sum is named, usually to be raised by some capitation fee to be received voluntarily from the mass of the medical profession, and at once the probable failure of the request for subscriptions is seen. Here only immediate need is pleaded, and that is so comparatively small that it ought to be met at once. The International Campaign against Rheumatism was formed in London ten years ago as a league, with the blessing of the Ministry of Health. A conference at which France, Holland, Denmark, Switzerland, Roumania, and this country were represented, resulted in the setting up of a central international council whose duty it should be to distribute the facts and arouse the general conscience to the evils that follow conditions generically termed rheumatism, and to the possibility of abating those evils by organised effort. The Acta Rheumatologica, a periodical in three languages, was produced and widely circulated and a small central bureau and library were opened. Important international congresses were arranged with the help of national committees and with the support of representatives of the countries most seriously affected, and in this way examination of many outstanding problems related to rheumatism has been conducted. The expenses so far incurred at the bureau and for the production of the journal, the Acta Rheumatologica, have been discharged by personal subscriptions and by contributions from the national groups. But the latter source has largely dried up under the economic conditions under which the world is abiding. It is in the nature of a shock to learn that this policy of abstention has been pursued in this country, which, embarrassed as it may be, cannot plead a position comparable to that existent in the other countries which have hitherto supported the movement. A sum of £ 1000 is all that is required in the A LETTER,
later page
1397
present emergency, while a guaranteed annual subscription of some similar sum would enable the League to pursue efforts which have already been of high practical value. We feel that, when the situation so clearly set out in the letter referred to is realised, the obvious remedy should follow. PREGNANCY TOXÆMIA UNDER CONTROL AUTHORITATIVE statements as to how far antenatal can prevent deaths from pregnancy toxaemia are few and far between. It is useful therefore to have a report from Fallsi on his experience of 500 cases of eclamptogenic toxaemia seen at the universities of Illinois and Iowa over a period of twelve years. While the series is relatively small, it has the advantages of being accumulated under the personal supervision of one man and under one system of treatment. The prenatal care given was simple but thorough, consisting chiefly in examination of blood pressure and urine twice a week from the 28th week onwards. The treatment of the toxaemia itself was orthodox ; in the fulminating cases pregnancy was terminated by Caesarean section, and in others by induction of labour. Such procedures as intravenous injection of magnesium sulphate or glucose were not considered essential. There were only two deaths; indeed, so low was the incidence of eclampsia that Falls almost bewails the fact that he was unable to demonstrate the treatment of this condition to his students once in two years. On the other hand he can congratulate himself on having reduced the mortality in his cases of pregnancy toxaemia to the usual level of mortality among pregnant women in general. That such results are obtainable has often been emphasised in this country, but the rigorous antenatal supervision that should be the rule is still too often neglected, and apathy and
supervision
indifference
are
regrettably
common.
THE ROME HOSPITAL CONGRESS THE fourth international congress of hospitals, held in Rome from May 19th to 26th, did some serious work in spite of the distractions of the Eternal City. Six hundred delegates represented 47 nations. The first subject on the agenda was one of the most important, being the hospital as a link in a systematic public health chain, and Dr. J. L. Brownlie’s paper, of which we published an abstract last week (he was unfortunately unable to be present) showed where the Scottish health authority is aiming. Later in the congress Dr. A. F. Cooney, who with two colleagues represented the Irish Hospitals Commission, dealt with the cognate subject of the importance of the hospital staff in relation to the community. Hitherto, he said, the advice of the hospital had usually been sought for illness. Now the public health authorities are coming to seek its aid in the prevention and preventive treatment of disease, a change with which hospital policy must reckon. Dr. W. Alter of Syracuse, opening a discussion on the out-patient department, insisted that it should include occupational therapy. The restoration and assurance of the patient’s power to work at his calling must, he said, never be lost sight of and never be prejudiced by false romantic views as to light and air. " His occupation should only be changed when it is unavoidable "-a remark in singular harmony with recent correspondence in our own columns. Dr. T. J. Heldt, of Detroit (Mich.), surprised the congress with his assertion that in the 1 Falls, F. p. 316.
H. :
Amer. Jour. Obst. and
Gyn., March, 1935,