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STATE CONTROL OF HOSPITALS.
792
I another to go into hospital. Again, a may be encountered. It is impossible to commence insulin therapy without a knowledge of the blood-sugar content at the outset. It has been stated that the practitioner can himself estimate the sugar in the blood, and sets of apparatus are on the market for the purpose at quite low figures. During the last six months a large number of medical practitioners have visited chemical pathologists asking for advice and tuition on the method most suited to their needs. Speaking generally, two methods are open to them : the volumetric method of MACLEAN or the colorimetric method of FOLIN. The former is cheap in the way of necessary apparatus, but requires a great deal of skill, A good whilst the latter is easy but expensive. colorimeter is an absolute essential to FOLIN’S method, and this may cost anything in the region of f,30. Choice falls usually on the first method, but too often, after a short period in the laboratory learning the technique, the attempt is abandoned. For the most part the busy doctor cannot give the necessary time, and therefore cannot obtain reasonable results. It is impossible to become a chemical pathologist after a For the solution of a difficult few days’ training. position there are two possibilities. The first is the one adopted by the United States and Canada. There every patient undergoes a preliminary course of treatment in hospital where his dose of insulin and diet are worked out. During this time the patient is taught about his disease, how to test his own urine, and how to sterilise a syringe and to administer his insulin. When the investigations are complete, which is usually in about a fortnight, he is sent out with a supply of insulin and urine-testing outfit, and is told to report to his doctor once a month. If any sugar appears in the urine he returns to hospital at once, where a new diet is worked out for him. According to workers in those countries the scheme works admirably. The other solution is for the blood analysis to be done at some central institution, just in the same manner that Wassermann reactions are done for many doctors. Prof. FOLIN suggests that blood may be suitably preserved for sugar determinations by the addition of a little formalin. This has been tried and has been found to work splendidly. Bloods have been kept as long as 56 hours without any change in the blood-sugar being demonstrated. reason or
verging
caseregulate
street collections and except that (quite unorticially) a few journals and some societies display a certain vigilance in these matters. As for any coordination of hospitals in England or any power to close them or rearrange their objects, we can produce no example except the control exercised within strict limits by the Metropolitan Asylums
on coma
Board over the various institutions which it administers. Our Ministry of Health, on its inception in 1919, was ordered by Parliament to take steps to coordinate measures conducive to the health of the people, but in the matter of hospitals the Ministry has not a clean slate upon which to write. For the history of our hospital legislation is ancient and intricate. It is interwoven in its early stages with religious foundations, maisons de dieu, and houses of correction for the poor. There are inconvenient chapters about mortmain and the doctrine of charitable uses. But if the law has sometimes disallowed bequests for philanthropic objects, it has given cast-iron support to anything in the nature of a trust. The Charity Commissioners may here and there permit the sale of a site or may encourage the making of some minor change by means of a private Act of Parliament, but, on the whole, would-be reformers and coordinators have no primrose path to tread. Countries with less history have more opportunity. Already in different parts of Canada and Australia legislatures are finding it necessary on the one hand to organise new municipal hospital districts based on public finances and, on the other hand, to regulate the conduct of private hospitals. The measures now initiated in Victoria may be adopted elsewhere within the Empire. If we cannot imitate them in this country, and if, indeed, we may not wish to do so, we shall nevertheless their progress with keen interest.
watch
THE FUTURE OF NEUROLOGY. NEUROLOGY to-day stands in a peculiarly interesting position. No thoughtful observer can fail to be impressed with the existence of conflicting tendencies which do not make for progress ; the neurologist
himself is well aware of a change in outlook and scope which will haveto be faced squarely if he values peace of mind. We do not know when the term " neuro" logist came into vogue, nor, for that matter, can we define the limits of his specialty, but we have always supposed it concerns the totality of the problems presented by the nervous system in health and disease. STATE CONTROL OF HOSPITALS. The later decades of last century and the earlier years ON another page our Australian correspondent of this constituted a period of immense activity in summarises an important new measure for the control neurological classification and description, a time when and coordination of hospitals in the State of Victoria. the clinico-pathological method ruled supreme, when All charitable institutions, he explains, will now have the neurologist busied himself with numerous problems to be registered ; no financial appeal may now be of organic nervous disease and utilised anatomical made, and no contributions may now be received, on and physiological data as a basis on which to erect behalf of any unregistered foundation ; in addition his knowledge of his subject. Trained in this eminently the State has armed itself with power to close or reasonable fashion, grounded on the firm foundation amalgamate hospitals and to declare the use to which of anatomy, he proceeded to deal with nervous disease they may be put. Many social developments initiated as it presented itself to him clinically without any by the Governments of Overseas Dominions have uneasiness in respect of his competence to deal with be more interested ultimately been adopted by the mother country, but, every type of case. While one might " in another functional clinical and with our admirable voluntary hospital system and our in organic " absence of enthusiasm for central control, it is unlikely material, neither felt any embarrassment in handling that in this lead England will quickly follow the a case of hemiplegia or of hysteria indifferently. Some We in this country have never of the greatest neurologists of other years—CHARCOT, lead of Victoria. had any adequate system of registration although a WEIR VTmcHF,Lr., HUGHLINGS JACKSON-made contrihundred years ago Parliament did direct that charitable butions to both organic and functional neurology of No distinction donations should be registered in order to avoid loss surpassing interest and worth. and encourage payment. Nor have we any control prevailed between the " organic" and the "functional" over charitable appeals, except that the police for the simple and adequate reason that no distinction
I
"
"
I another to go into hospital. Again, a may be encountered. It is impossible to commence insulin therapy without a knowledge of the blood-sugar content at the outset. It has been stated that the practitioner can himself estimate the sugar in the blood, and sets of apparatus are on the market for the purpose at quite low figures. During the last six months a large number of medical practitioners have visited chemical pathologists asking for advice and tuition on the method most suited to their needs. Speaking generally, two methods are open to them : the volumetric method of MACLEAN or the colorimetric method of FOLIN. The former is cheap in the way of necessary apparatus, but requires a great deal of skill, A good whilst the latter is easy but expensive. colorimeter is an absolute essential to FOLIN’S method, and this may cost anything in the region of f,30. Choice falls usually on the first method, but too often, after a short period in the laboratory learning the technique, the attempt is abandoned. For the most part the busy doctor cannot give the necessary time, and therefore cannot obtain reasonable results. It is impossible to become a chemical pathologist after a For the solution of a difficult few days’ training. position there are two possibilities. The first is the one adopted by the United States and Canada. There every patient undergoes a preliminary course of treatment in hospital where his dose of insulin and diet are worked out. During this time the patient is taught about his disease, how to test his own urine, and how to sterilise a syringe and to administer his insulin. When the investigations are complete, which is usually in about a fortnight, he is sent out with a supply of insulin and urine-testing outfit, and is told to report to his doctor once a month. If any sugar appears in the urine he returns to hospital at once, where a new diet is worked out for him. According to workers in those countries the scheme works admirably. The other solution is for the blood analysis to be done at some central institution, just in the same manner that Wassermann reactions are done for many doctors. Prof. FOLIN suggests that blood may be suitably preserved for sugar determinations by the addition of a little formalin. This has been tried and has been found to work splendidly. Bloods have been kept as long as 56 hours without any change in the blood-sugar being demonstrated. reason or
verging
caseregulate
street collections and except that (quite unorticially) a few journals and some societies display a certain vigilance in these matters. As for any coordination of hospitals in England or any power to close them or rearrange their objects, we can produce no example except the control exercised within strict limits by the Metropolitan Asylums
on coma
Board over the various institutions which it administers. Our Ministry of Health, on its inception in 1919, was ordered by Parliament to take steps to coordinate measures conducive to the health of the people, but in the matter of hospitals the Ministry has not a clean slate upon which to write. For the history of our hospital legislation is ancient and intricate. It is interwoven in its early stages with religious foundations, maisons de dieu, and houses of correction for the poor. There are inconvenient chapters about mortmain and the doctrine of charitable uses. But if the law has sometimes disallowed bequests for philanthropic objects, it has given cast-iron support to anything in the nature of a trust. The Charity Commissioners may here and there permit the sale of a site or may encourage the making of some minor change by means of a private Act of Parliament, but, on the whole, would-be reformers and coordinators have no primrose path to tread. Countries with less history have more opportunity. Already in different parts of Canada and Australia legislatures are finding it necessary on the one hand to organise new municipal hospital districts based on public finances and, on the other hand, to regulate the conduct of private hospitals. The measures now initiated in Victoria may be adopted elsewhere within the Empire. If we cannot imitate them in this country, and if, indeed, we may not wish to do so, we shall nevertheless their progress with keen interest.
watch
THE FUTURE OF NEUROLOGY. NEUROLOGY to-day stands in a peculiarly interesting position. No thoughtful observer can fail to be impressed with the existence of conflicting tendencies which do not make for progress ; the neurologist
himself is well aware of a change in outlook and scope which will haveto be faced squarely if he values peace of mind. We do not know when the term " neuro" logist came into vogue, nor, for that matter, can we define the limits of his specialty, but we have always supposed it concerns the totality of the problems presented by the nervous system in health and disease. STATE CONTROL OF HOSPITALS. The later decades of last century and the earlier years ON another page our Australian correspondent of this constituted a period of immense activity in summarises an important new measure for the control neurological classification and description, a time when and coordination of hospitals in the State of Victoria. the clinico-pathological method ruled supreme, when All charitable institutions, he explains, will now have the neurologist busied himself with numerous problems to be registered ; no financial appeal may now be of organic nervous disease and utilised anatomical made, and no contributions may now be received, on and physiological data as a basis on which to erect behalf of any unregistered foundation ; in addition his knowledge of his subject. Trained in this eminently the State has armed itself with power to close or reasonable fashion, grounded on the firm foundation amalgamate hospitals and to declare the use to which of anatomy, he proceeded to deal with nervous disease they may be put. Many social developments initiated as it presented itself to him clinically without any by the Governments of Overseas Dominions have uneasiness in respect of his competence to deal with be more interested ultimately been adopted by the mother country, but, every type of case. While one might " in another functional clinical and with our admirable voluntary hospital system and our in organic " absence of enthusiasm for central control, it is unlikely material, neither felt any embarrassment in handling that in this lead England will quickly follow the a case of hemiplegia or of hysteria indifferently. Some We in this country have never of the greatest neurologists of other years—CHARCOT, lead of Victoria. had any adequate system of registration although a WEIR VTmcHF,Lr., HUGHLINGS JACKSON-made contrihundred years ago Parliament did direct that charitable butions to both organic and functional neurology of No distinction donations should be registered in order to avoid loss surpassing interest and worth. and encourage payment. Nor have we any control prevailed between the " organic" and the "functional" over charitable appeals, except that the police for the simple and adequate reason that no distinction
I
"
"