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SOCIAL SERVICE
300 be said that international equilibrium can never be secure enough to justify disarmament. On the other hand, if we cannot prove ideals, we can prove things about them ; and if we could prove to our potential opponents that they would be happier by exchanging theirs for ours the period of vigilance would have an end. CHEMOTHERAPY OF LEPROSY REPORTS on the efficacy of sulphone drugs in leprosy accumulate. Davey1 says that at the Uzuakoli Settlement in West Africa 17 patients with lepromatous leprosy, after long-continued but largely unavailing treatment with hydnocarpus oil, were treated for from five to ten months withSulphetrone,’ which proved relatively atoxic in the dosage of 3 g. daily six days a week. The general condition of all of them improved, and in all but 2 there was moderate (8 cases) or marked (7) retrogression of the leprotic lesions, though the bacteriological improvement has not so far equalled this. In some patients the drug produced a mild lepra reaction. In 11 of the 17 the lepromin test changed from negative to positive, indicating an allergising action. Johansen and Erickson2 record briefly their experience in treating lepromatous leprosy withPromizole,’ whose effect they find comparable to that of ’Promanide ’ andDiasone.’ It is slightly less toxic than the other two but it has to be taken in doses 6-8 times as large ; the daily consumption of 12 to 18 tablets over long periods is unpalatable and distasteful, and as its cost is high they propose to abandon it in favour of the other sulphones. With long-continued sulphone therapy 2 of their patients became bacteriologically negative. Faget and Erickson3 describe severe toxic effects from the continued treatment of leprosy with relatively large doses of streptomycin. Though benefit has not been conclusively demonstrated, they believe that clinical and bacteriological improvement has followed both injection and local application. Investigation, they think, should go on. SOCIAL SERVICE "
We sometimes fail to realise how fundamental to the health of a democratic society is the volunteer-the man who, in addition to doing his daily job, is ready freely to give up part of his leisure for some cause or other that he believes in.... These people who care about causes ; the adherents, the supporters, the belongers ; the Chairmen, the Treasurers, Secretaries, Committee Members ; they have a special significance in our society."
Mr. Herbert Morrison, addressing the annual meeting of the London Council of Social Service on July 12, was discussing the statutory pattern which, in our country, fits into and complements the voluntary pattern. As an example of statutory social advance he talked of our educational system. We are short of everything we need, he said : teachers, buildings-everything except children, though we could do with more of them. But already we have 9000 more teachers than we had before the war, and we hope to have nearly 50,000 more by 1952. Over 400 new schools are being built, and 52% of all children are now having dinners at school, compared with 4% before the war; 88% now have free milk. Under the further education and training scheme State scholarships, with full maintenance grants when necessary, have been more than doubled, and these are apart from local-authority awards. Other examples which he quoted were the National Insurance and Assistance Acts, the encouragement of foodproduction by the State, the National Health Service, and the provisions for the disabled. Interlocking with all these is the work of the bodies like the London Council of Social Service.4 During the year the numbers 1. Davey, T. F. Leprosy Rev. 1948, 19, 55. 2. Johansen, F. A., Erickson, P. T. Ibid, p. 62. 3. Faget, G. H., Erickson, P. T. Ibid, p. 64. Obtainable from the 4. Annual Report, 1947-48.
Street, Bedford Square, W.C.1.
of local councils in the.London boroughs have multiplied, and-thanks to the powers now given to local authorities to provide entertainment-arts councils are being set up in many places to serve the leisure needs of the community. It has been found that community associations and centres, though they suit some parts of London, are inappropriate to others. In districts where there are large blocks of flats, small housing estates, or groups of prefabricated houses, small clubs are more welcome than neighbourhood units. The council’s development officer has helped to start such clubs in many places. The plan has been first to find out by means of a questionary what kinds of things the tenants would like to do in their spare time ; and a team of students from the London School of Economics has helped considerably with these surveys. The Goldsmiths’ College, New Cross, has provided a training course for’ those undertaking work at community associations and centres. The welfare of old people is receiving more and more attention, and some 200 clubs have now been established for them in various boroughs. Mobile meals are provided in 17 areas, and 8 homes or hostels for old people have been opened during the year, with more to come. The National Corporation for the Care of Old People is supporting this aspect of the council’s work with a grant for two years. Citizens’ advice bureaux have been maintained, though-since local authorities are now beginning to set up their own information bureauxthey are fewer than they were during the war. The 67 bureaux directed by the council dealt with 191,130 inquiries during the year ; and this year, as a result of new
even more
queries
are
expected.
GLUCOSE AND PHOSPHATE IN DIABETIC KETOSIS
OPINION has been
fairly equally
divided
on
whether
to give glucose as well as insulin in the early stages of treatment of diabetic acidosis, while the blood-sugar is still high. From comparison of results in a small series Franks and othersargue that its use is disadvantageous. The differences they record in mortality may not be significant, but it is noteworthy that the patients receiving glucose required about twice as much insulin as the controls ; the CO2 combining power of the serum returned to normal more slowly ; and there was no difference in the rate of disappearance of ketosis. Study of the chloride and water balances suggest that, through excess glycosuria, the maintained diuresis in the glucose series actually led to cellular dehydration. The same authors2 have also made observations on the phosphate metabolism in diabetic coma. It has long been known that there is a phosphorus diuresis during the onset of diabetic ketosis, and that insulin treatment is followed by a sustained fall in phosphorus excretion and in the inorganic phosphate level in the plasma. The effect, therefore, was tried of infusing 500 ml. of a buffered phosphate solution containing at first 1.3g. and later 2-6 g.’ of phosphorus. This infusion kept the phosphate level in the blood normal, and direct evidence of phosphate deficiency was afforded by the failure of bloodphosphate to rise and by the absence of phosphate diuresis, even after the larger quantities. From the clinical standpoint the most striking effect of the phosphate was an immediate improvement in the patients’ mental condition and diminution in fatalities. There were also signs of improvement in carbohydrate utilisation and a rise in COcombining power. These results need further confirmation, but they suggest that in treating diabetic coma glucose should not be given until the blood-sugar has fallen towards normal, and that intravenous phosphate infusion should be given about 4-8 hours after insulin treatment is begun. Franks, M., Berris, R. F., Kaplan, N. O., Myers, G. B. Arch. intern. Med. 1947, 80, 739. 2. Franks, M., et al. Ibid, 1948, 81, 42. 1.
council, 7, Bayley
legislation,
-
We sometimes fail to realise how fundamental to the health of a democratic society is the volunteer-the man who, in addition to doing his daily job, is ready freely to give up part of his leisure for some cause or other that he believes in.... These people who care about causes ; the adherents, the supporters, the belongers ; the Chairmen, the Treasurers, Secretaries, Committee Members ; they have a special significance in our society."
Mr. Herbert Morrison, addressing the annual meeting of the London Council of Social Service on July 12, was discussing the statutory pattern which, in our country, fits into and complements the voluntary pattern. As an example of statutory social advance he talked of our educational system. We are short of everything we need, he said : teachers, buildings-everything except children, though we could do with more of them. But already we have 9000 more teachers than we had before the war, and we hope to have nearly 50,000 more by 1952. Over 400 new schools are being built, and 52% of all children are now having dinners at school, compared with 4% before the war; 88% now have free milk. Under the further education and training scheme State scholarships, with full maintenance grants when necessary, have been more than doubled, and these are apart from local-authority awards. Other examples which he quoted were the National Insurance and Assistance Acts, the encouragement of foodproduction by the State, the National Health Service, and the provisions for the disabled. Interlocking with all these is the work of the bodies like the London Council of Social Service.4 During the year the numbers 1. Davey, T. F. Leprosy Rev. 1948, 19, 55. 2. Johansen, F. A., Erickson, P. T. Ibid, p. 62. 3. Faget, G. H., Erickson, P. T. Ibid, p. 64. Obtainable from the 4. Annual Report, 1947-48.
Street, Bedford Square, W.C.1.
of local councils in the.London boroughs have multiplied, and-thanks to the powers now given to local authorities to provide entertainment-arts councils are being set up in many places to serve the leisure needs of the community. It has been found that community associations and centres, though they suit some parts of London, are inappropriate to others. In districts where there are large blocks of flats, small housing estates, or groups of prefabricated houses, small clubs are more welcome than neighbourhood units. The council’s development officer has helped to start such clubs in many places. The plan has been first to find out by means of a questionary what kinds of things the tenants would like to do in their spare time ; and a team of students from the London School of Economics has helped considerably with these surveys. The Goldsmiths’ College, New Cross, has provided a training course for’ those undertaking work at community associations and centres. The welfare of old people is receiving more and more attention, and some 200 clubs have now been established for them in various boroughs. Mobile meals are provided in 17 areas, and 8 homes or hostels for old people have been opened during the year, with more to come. The National Corporation for the Care of Old People is supporting this aspect of the council’s work with a grant for two years. Citizens’ advice bureaux have been maintained, though-since local authorities are now beginning to set up their own information bureauxthey are fewer than they were during the war. The 67 bureaux directed by the council dealt with 191,130 inquiries during the year ; and this year, as a result of new
even more
queries
are
expected.
GLUCOSE AND PHOSPHATE IN DIABETIC KETOSIS
OPINION has been
fairly equally
divided
on
whether
to give glucose as well as insulin in the early stages of treatment of diabetic acidosis, while the blood-sugar is still high. From comparison of results in a small series Franks and othersargue that its use is disadvantageous. The differences they record in mortality may not be significant, but it is noteworthy that the patients receiving glucose required about twice as much insulin as the controls ; the CO2 combining power of the serum returned to normal more slowly ; and there was no difference in the rate of disappearance of ketosis. Study of the chloride and water balances suggest that, through excess glycosuria, the maintained diuresis in the glucose series actually led to cellular dehydration. The same authors2 have also made observations on the phosphate metabolism in diabetic coma. It has long been known that there is a phosphorus diuresis during the onset of diabetic ketosis, and that insulin treatment is followed by a sustained fall in phosphorus excretion and in the inorganic phosphate level in the plasma. The effect, therefore, was tried of infusing 500 ml. of a buffered phosphate solution containing at first 1.3g. and later 2-6 g.’ of phosphorus. This infusion kept the phosphate level in the blood normal, and direct evidence of phosphate deficiency was afforded by the failure of bloodphosphate to rise and by the absence of phosphate diuresis, even after the larger quantities. From the clinical standpoint the most striking effect of the phosphate was an immediate improvement in the patients’ mental condition and diminution in fatalities. There were also signs of improvement in carbohydrate utilisation and a rise in COcombining power. These results need further confirmation, but they suggest that in treating diabetic coma glucose should not be given until the blood-sugar has fallen towards normal, and that intravenous phosphate infusion should be given about 4-8 hours after insulin treatment is begun. Franks, M., Berris, R. F., Kaplan, N. O., Myers, G. B. Arch. intern. Med. 1947, 80, 739. 2. Franks, M., et al. Ibid, 1948, 81, 42. 1.
council, 7, Bayley
legislation,
-