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"THE CAIRO LUNATIC ASYLUM."
ROYAL FREE HOSPITAL: THE OPENING OF THE NEW BUILDINGS.
56
for each such member. In my experience, mixed provident society-containing men, women, and children-I find that nine days’ sickness per member per annum is an excessive estimate, and that six days is nearer the mark-the reason being that in the large friendly societies (in which the members receive sickness pay) it is seldom the case that a man returns to work directly he is fit to do so ; in fact, during the last third of his nominal sickness he often has no medical attendance at all. I quite agree with Dr. Thurstan " that it is possible for the profession to form an association amongst themselves," as this has already been done in many places, but that a shilling per member per month will be paid by the British artisan is an expectation which will not be realised for many years. We have to fight the lay societies, run on commercial lines, who want to sweat " us for their own profit ; and in order to do this we must accept the current rates, gradually raising them after we have obtained control. I am, Sirs, yours faithfully, W. G. DICKINSON. Wandsworth, S.W., July 1st, 1895.
;E8 per
annum a
however, of
view and arrange for patients to attend in batches at various and fixed hours throughout the day ? There can be no difficulty in arranging this by means of different-coloured letters for the unendowed hospitals with different hours appointed, and for the open hospitals more receiving hours being fixed, or different hours arranged for the various London districts. I am, Sirs, yours faithfully, A. EDMUND KING. St. Philip’s Vicarage, Sydenham. KING
"THE CAIRO LUNATIC ASYLUM."
To the Editors of THE LANCET. with all who are interested in the SIRS,-In medical and sanitary prosperity of Egypt, I am delighted to learn that at last a specialist in lunacy has been placed in charge of the Cairo Asylum, and have no doubt that before Dr. Warnock’s two years have elapsed the advantages resulting from the appointment will have become so evident that ’ it will be made permanent. Notwithstanding her population of seven or eight millions, Egypt possesses one single establishment only for the of the insane of all classes ; and hitherto, for lack ROYAL FREE HOSPITAL: THE OPENINGreception of a competent physician, there has been no attempt to. OF THE NEW BUILDINGS. treat the demented patients in accordance with modern To the Editors of THE LANCET. scientific methods; but you will, I trust, allow me British SIRS, -As President of the Royal Free HospitalI have the to say that as soon as the asylum was placed under honour to announce that their Royal Highnesses the Prince control in 1884 an endeavour was made to find occupaand Princess of Wales have graciously consented to open the tion for the inmates, so that they should not be obliged "to sit idly on their beds all day." Dr. Sand with and Dr. new front building of the hospital on Monday, Jaly 22nd. The cost of the new buildings and of various other improve- Keatinge commenced the reform by instituting workshops on ments which have been carried out during the past two years as large a scale as was practicable, and in my time lunatics amounts to .E30.000, towards which sum £24,000 has already were 11 engaged in the garden, laundry, and kitchen,"" while a few worked as tailors and carpenters, and a good many as been raised. I now ask your favourable consideration to the appeal of matmakers, the latter industry bringing in a small revenue the committee, feeling assured that I may rely upon your which was expended, by special permission of the Finance on the purchase of tobacco and other luxuries. generosity to assist them in obtaining the sum of £6000 Committee, Of the patients could not be compelled to. course, which is still required to enable them to carry on the work unless they chose, and in spite of the allurebenevolent work of the hospital free from debt. ments of cigarettes and coffee it was impossible to induce I have the honour to be, Sirs, your obedient servant, the majority to do anything. Many of them, to the best of DUFFERIN AND AVA. British Embassy, Paris, July lst, 1895. my belief, were simply incurably lazy, preferring a life of well-fed idleness in prison to hard labour and scanty food outside. I recollect the man who posed as the Mahdi, but. DETENTION IN THE OUT-PATIENT never heard of his attainments as a gardener. It will be DEPARTMENT. interesting to learn later Dr. Warnock’s views regarding the cause of the wonderful freedom from mental derangeTo the Editors of THE LANCET. ment enjoyed by the Egyptian people. There is probably no SIRS,-Your interest in the sick poor attending our in the world where the insane are relatively so country London hospitals, and your Efiorts for the success of the I am. Sirs, yours faithfully, infrequent. annual collections on Hospital Sunday are so well known H. R. GREENE. St. John’s, Woking, July 1st, 1895. that I feel sure I may rely upon your sympathy for that vast number of out-patients who daily throng the hospitals. In the Graphic of June 15h, beneath a picture faithfully repre"CHOREA GRAVIDARUM." senting the common spectacle at the receiving-rooms of most To the Editors of THE LANCET. of the large hospitals, the following’ occurs: "In the SIRS,-I am interested to see from the summary of waiting-room, depressing and rather murky looking in spite of its large area of window-glass and its ostentatious air of Dr. R. C. Buist’s paper on Chorea Gravidarum, reported being well scrubbed every morning, the patients sit awaiting in THE LANCET of June 22nd, that the exaggerated their turn to see the surgeon. They are of many ages and of statements regarding the mortality of this disease are In a paper on this subject published one class; but the characteristic which is most strikingly being corrected. It is in vol. xxxiii. of the Transactions of the Obstetrical common to all is their patience and their quietude." the experience of the parochial clergy that the weary hours Society of London, 1892, I drew attention to this point of waiting to see the physician, or to obtain the medicine showing that the chief reasons for these conflicting stateafter the interview, are a cause of intense mental, and not in- ments seem to be due (1) to the fact that only the frequently, of physical saffarirrg to the patients. Some- severe cases are published, and (2) to the small number of times a mother will have to wait for hours with a sick child authentic published cases from which conclusions may b& in a vitiated atmosphere, and amid most painful surroundings. drawn. With regard to the causation of maternal deaths, For many delicate invalids sufferirg is prolonged in the it is necessary to recollect that, owing to the cachectic melancholy waiting-room for four, six, or even eight hours state of the system, delivery either at term or prematurely is waiting the convenience of surgeons, physicians, and apothe- prone to be attended by additional risks, and more liability caries. Some come from a diaitance, while others have to to septicaemia. The extreme exhaustion which takes place in give up a whole day’s work and lose a day’s wages for an severe forms of the disease leads to death before the fcetna i interview of a few minutes. Why has there been so little delivered. This is brought about by the anaemia, the rapid reform in this direction ?? Is it that the physicians and emaciation occurring in some cases, the intensity of the movesurgeons are in league to resent the smallest interference ?? ments, and in addition the loss of sleep wearing out the Or is it that governors or secretaries will not attend to already partially exhausted nervous system. In the paper mendetails ao minor in their estimation, so important in the eyes tioned the indications given for the induction of prematureof the sufferer and his friends ?? We clergy are often labour are these : (1) where the mother’s system is showing called upon to defend in public, or in private, the hospital signs of exhaustion from the intensity of the movements and system from the attacks of antivivisectors, sectarians, the deficiency of sleep, and where a continuance of the and ignorant or prejudiced persons, but this is a pregnant state is dangerous ; (2) where mania or a serious grievance which has no defence, and will, if continued, mental affection exists; and (3) where grave complications alienate the best supporters of our hospitals. Will the such as heart diseaEe exist. When the literature of the subauthorities consider this matter from the patient’s point of ject is examined so many cases are found described as chorea common
56
for each such member. In my experience, mixed provident society-containing men, women, and children-I find that nine days’ sickness per member per annum is an excessive estimate, and that six days is nearer the mark-the reason being that in the large friendly societies (in which the members receive sickness pay) it is seldom the case that a man returns to work directly he is fit to do so ; in fact, during the last third of his nominal sickness he often has no medical attendance at all. I quite agree with Dr. Thurstan " that it is possible for the profession to form an association amongst themselves," as this has already been done in many places, but that a shilling per member per month will be paid by the British artisan is an expectation which will not be realised for many years. We have to fight the lay societies, run on commercial lines, who want to sweat " us for their own profit ; and in order to do this we must accept the current rates, gradually raising them after we have obtained control. I am, Sirs, yours faithfully, W. G. DICKINSON. Wandsworth, S.W., July 1st, 1895.
;E8 per
annum a
however, of
view and arrange for patients to attend in batches at various and fixed hours throughout the day ? There can be no difficulty in arranging this by means of different-coloured letters for the unendowed hospitals with different hours appointed, and for the open hospitals more receiving hours being fixed, or different hours arranged for the various London districts. I am, Sirs, yours faithfully, A. EDMUND KING. St. Philip’s Vicarage, Sydenham. KING
"THE CAIRO LUNATIC ASYLUM."
To the Editors of THE LANCET. with all who are interested in the SIRS,-In medical and sanitary prosperity of Egypt, I am delighted to learn that at last a specialist in lunacy has been placed in charge of the Cairo Asylum, and have no doubt that before Dr. Warnock’s two years have elapsed the advantages resulting from the appointment will have become so evident that ’ it will be made permanent. Notwithstanding her population of seven or eight millions, Egypt possesses one single establishment only for the of the insane of all classes ; and hitherto, for lack ROYAL FREE HOSPITAL: THE OPENINGreception of a competent physician, there has been no attempt to. OF THE NEW BUILDINGS. treat the demented patients in accordance with modern To the Editors of THE LANCET. scientific methods; but you will, I trust, allow me British SIRS, -As President of the Royal Free HospitalI have the to say that as soon as the asylum was placed under honour to announce that their Royal Highnesses the Prince control in 1884 an endeavour was made to find occupaand Princess of Wales have graciously consented to open the tion for the inmates, so that they should not be obliged "to sit idly on their beds all day." Dr. Sand with and Dr. new front building of the hospital on Monday, Jaly 22nd. The cost of the new buildings and of various other improve- Keatinge commenced the reform by instituting workshops on ments which have been carried out during the past two years as large a scale as was practicable, and in my time lunatics amounts to .E30.000, towards which sum £24,000 has already were 11 engaged in the garden, laundry, and kitchen,"" while a few worked as tailors and carpenters, and a good many as been raised. I now ask your favourable consideration to the appeal of matmakers, the latter industry bringing in a small revenue the committee, feeling assured that I may rely upon your which was expended, by special permission of the Finance on the purchase of tobacco and other luxuries. generosity to assist them in obtaining the sum of £6000 Committee, Of the patients could not be compelled to. course, which is still required to enable them to carry on the work unless they chose, and in spite of the allurebenevolent work of the hospital free from debt. ments of cigarettes and coffee it was impossible to induce I have the honour to be, Sirs, your obedient servant, the majority to do anything. Many of them, to the best of DUFFERIN AND AVA. British Embassy, Paris, July lst, 1895. my belief, were simply incurably lazy, preferring a life of well-fed idleness in prison to hard labour and scanty food outside. I recollect the man who posed as the Mahdi, but. DETENTION IN THE OUT-PATIENT never heard of his attainments as a gardener. It will be DEPARTMENT. interesting to learn later Dr. Warnock’s views regarding the cause of the wonderful freedom from mental derangeTo the Editors of THE LANCET. ment enjoyed by the Egyptian people. There is probably no SIRS,-Your interest in the sick poor attending our in the world where the insane are relatively so country London hospitals, and your Efiorts for the success of the I am. Sirs, yours faithfully, infrequent. annual collections on Hospital Sunday are so well known H. R. GREENE. St. John’s, Woking, July 1st, 1895. that I feel sure I may rely upon your sympathy for that vast number of out-patients who daily throng the hospitals. In the Graphic of June 15h, beneath a picture faithfully repre"CHOREA GRAVIDARUM." senting the common spectacle at the receiving-rooms of most To the Editors of THE LANCET. of the large hospitals, the following’ occurs: "In the SIRS,-I am interested to see from the summary of waiting-room, depressing and rather murky looking in spite of its large area of window-glass and its ostentatious air of Dr. R. C. Buist’s paper on Chorea Gravidarum, reported being well scrubbed every morning, the patients sit awaiting in THE LANCET of June 22nd, that the exaggerated their turn to see the surgeon. They are of many ages and of statements regarding the mortality of this disease are In a paper on this subject published one class; but the characteristic which is most strikingly being corrected. It is in vol. xxxiii. of the Transactions of the Obstetrical common to all is their patience and their quietude." the experience of the parochial clergy that the weary hours Society of London, 1892, I drew attention to this point of waiting to see the physician, or to obtain the medicine showing that the chief reasons for these conflicting stateafter the interview, are a cause of intense mental, and not in- ments seem to be due (1) to the fact that only the frequently, of physical saffarirrg to the patients. Some- severe cases are published, and (2) to the small number of times a mother will have to wait for hours with a sick child authentic published cases from which conclusions may b& in a vitiated atmosphere, and amid most painful surroundings. drawn. With regard to the causation of maternal deaths, For many delicate invalids sufferirg is prolonged in the it is necessary to recollect that, owing to the cachectic melancholy waiting-room for four, six, or even eight hours state of the system, delivery either at term or prematurely is waiting the convenience of surgeons, physicians, and apothe- prone to be attended by additional risks, and more liability caries. Some come from a diaitance, while others have to to septicaemia. The extreme exhaustion which takes place in give up a whole day’s work and lose a day’s wages for an severe forms of the disease leads to death before the fcetna i interview of a few minutes. Why has there been so little delivered. This is brought about by the anaemia, the rapid reform in this direction ?? Is it that the physicians and emaciation occurring in some cases, the intensity of the movesurgeons are in league to resent the smallest interference ?? ments, and in addition the loss of sleep wearing out the Or is it that governors or secretaries will not attend to already partially exhausted nervous system. In the paper mendetails ao minor in their estimation, so important in the eyes tioned the indications given for the induction of prematureof the sufferer and his friends ?? We clergy are often labour are these : (1) where the mother’s system is showing called upon to defend in public, or in private, the hospital signs of exhaustion from the intensity of the movements and system from the attacks of antivivisectors, sectarians, the deficiency of sleep, and where a continuance of the and ignorant or prejudiced persons, but this is a pregnant state is dangerous ; (2) where mania or a serious grievance which has no defence, and will, if continued, mental affection exists; and (3) where grave complications alienate the best supporters of our hospitals. Will the such as heart diseaEe exist. When the literature of the subauthorities consider this matter from the patient’s point of ject is examined so many cases are found described as chorea common