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STREET AMBULANCES FOR LONDON.
1642
I
injured. An excessive degree of the lesion is complicated by laceration of the vagina, the Univer- bladder, and the intervening connective tissue. disposal Rupture of the symphysis is frequently accompanied modern by partial rupture of one or both of the sacro-iliae medical science. Further than this, the hope was synchondroses. Sometimes the accident is recoexpressed that with its new equipment the hospital gnised at once by feeling the bone give way or by an might soon become the centre to which every audible snap, or it may not be detected until the medical practitioner in the district would find his patient begins to sit up or get up, and finds herself way for guidance in modern methods of diagnosis, disabled. Complications of the injury are common, treatment, and research. If this ideal is realised to such as rupture of the anterior vaginal wall, the full the Radcliffe Infirmary will have give an rupture of the bladder, severe hæmorrhage from lead in one of the most important medical move- rupture of veins, and suppuration of the joint
the hospital on the one hand to the natural and invaluable complement scientific department of pathology in the sity, and on the other hand to place at the - of the hospital staff every resource of
’enabling
become to the
’ments of recent times.
Treatment conof the cellular tissues. sists of firm strapping and rest, with appropriate Dr. Ill, in attention to any complications. opening the discussion on Dr. Tuley’s paper, thought he must have met ten such cases himself, and gave details of several of them. Of the two next speakers the first said that he knew of five cases which had never been reported, while the second had encountered four in his hospital experience. It seems clear that, at this rate, there must be hundreds, if not thousands, of unreported cases, and, quite possibly, there may be a good many minor degrees of this accident which are not recognised at all. It is the impression of several of the authorities who have reported instances of it that rickets and contracted pelvis predispose towards rupture of the symphysis pubis, mainly, no doubt, because they lead to dystocia and to forceps delivery, with prolonged or over-violent traction. A bibliography is appended to Dr. Tuley’s paper. or
____
STREET AMBULANCES FOR LONDON.
IN accordance with the request of the London ’County Council the Ambulance Committee of the Metropolitan Asylums Board have presented to the Board a scheme for the provision of street ambu]lances for the metropolis. The Ambulance Committee suggest that the scheme should be temporary .and controlled by the Asylums Board, who could make use of the seven existing stations, supplementing them by 12 additional depots, each furnished with an electrically driven ambulance. ’Two men, competent motor drivers and skilled in The ,first aid, could be stationed at each depot. would be relied .ordinary telephonic machinery upon for the calls, each station or depot being connected with a head office, and the service would be night and day. The. Ambulance Committee are to be heartily congratulated on the prompt production .of a practical scheme to meet a crying want, .and we are glad to know that their recommendations have been adopted by their authority. The ,development in London of telephones and the great facilities offered by motor traffic have been used by the Committee as a basis of their scheme ito excellent effect. The capital cost of the scheme is estimated at .f:18,000, and the annual cost at £17,800, but the cost of the sites to be required for the new depots is not included in these figures. It should be added that there will be absolutely no connexion between the accident service and the .service in respect of infectious diseases. We hope that we shall soon see the scheme in actual work.
RUPTURE OF THE SYMPHYSIS PUBIS IN LABOUR. A CASE of this unusual complication of childbirth this reported in the American Journal of Obstetrics 1for November by Dr. H. E. Tuley. The recorded cases number something under 150, but the discussion which followed the presentation of the case to the American Association of Obstetricians and Gynaecologists at their twenty-sixth annual meeting makes it probable that only a small proportion ,of those actually diagnosed have been reported. Nearly 30 per cent. of the recorded cases have ’occurred quite spontaneously-that is, without forceps delivery or any similar adventitious violence. In one such case the child was actually born within ; an unruptured amniotic sac, showing that intrauterine pressure can scarcely have been excessive. !But in the majority of cases excessive or misdirected forceps traction is the cause of this accident. The rupture is usually complete. It may take place in the median line, or at one side between the - cartilage and the pubic bone. If the injury is slight ,the synovial cavity of the symphysis may ’not be
THE FREQUENCY OF AMENTIA AS RELATED TO SEX. IN
considering
the sex-incidence of disease one
may be led into mistakes
by ignoring the importance of the economic factor. Many men are taken to our institutions because they are no longer fit to retain their place among their fellow-workers. With women the case is different. They are kept at home if A affectionately ignorantly. paper in the Medical Record of Oct. 25th, by Miss L. S. Hollingworth, appears to show that if the number of females in institutions for the feeble-minded is less than that of males, the explanation is that women are not mentally competitive to the same extent as men. She has made a study of the defective individuals who pass through the Clearing House for Mental Defectives in New York, and has found that in 1000 individuals there were 568 males and 432 females. Of those over 16 years of age there were 78 males and 159 females ; of those over 30 years of age there were 9 males and 28 females. From 2 to 16 years of age there is a marked predominance of males, but after that age the females are greatly in excess. By the Binet scale the average age at examination is older for girls than for boys at all mental ages. Similarly the deviations from these averages are greater in all cases for girls than for boys. This shows that a boy will be brought to the Clearing House at an earlier age than is a girl of the same degree of defectiveness. Females survive in the social milieu beyond the age of 16 twice as frequently as boys, and thrice as frequently after the age of 30. Of ancillary interest is the number of children procreated by those feebleminded individuals. In no case was there a history of procreation by the males, but 159 females over 16 years old had had 44 children, 31 of which were illegitimate. Of these 159 women 18 were married
I
injured. An excessive degree of the lesion is complicated by laceration of the vagina, the Univer- bladder, and the intervening connective tissue. disposal Rupture of the symphysis is frequently accompanied modern by partial rupture of one or both of the sacro-iliae medical science. Further than this, the hope was synchondroses. Sometimes the accident is recoexpressed that with its new equipment the hospital gnised at once by feeling the bone give way or by an might soon become the centre to which every audible snap, or it may not be detected until the medical practitioner in the district would find his patient begins to sit up or get up, and finds herself way for guidance in modern methods of diagnosis, disabled. Complications of the injury are common, treatment, and research. If this ideal is realised to such as rupture of the anterior vaginal wall, the full the Radcliffe Infirmary will have give an rupture of the bladder, severe hæmorrhage from lead in one of the most important medical move- rupture of veins, and suppuration of the joint
the hospital on the one hand to the natural and invaluable complement scientific department of pathology in the sity, and on the other hand to place at the - of the hospital staff every resource of
’enabling
become to the
’ments of recent times.
Treatment conof the cellular tissues. sists of firm strapping and rest, with appropriate Dr. Ill, in attention to any complications. opening the discussion on Dr. Tuley’s paper, thought he must have met ten such cases himself, and gave details of several of them. Of the two next speakers the first said that he knew of five cases which had never been reported, while the second had encountered four in his hospital experience. It seems clear that, at this rate, there must be hundreds, if not thousands, of unreported cases, and, quite possibly, there may be a good many minor degrees of this accident which are not recognised at all. It is the impression of several of the authorities who have reported instances of it that rickets and contracted pelvis predispose towards rupture of the symphysis pubis, mainly, no doubt, because they lead to dystocia and to forceps delivery, with prolonged or over-violent traction. A bibliography is appended to Dr. Tuley’s paper. or
____
STREET AMBULANCES FOR LONDON.
IN accordance with the request of the London ’County Council the Ambulance Committee of the Metropolitan Asylums Board have presented to the Board a scheme for the provision of street ambu]lances for the metropolis. The Ambulance Committee suggest that the scheme should be temporary .and controlled by the Asylums Board, who could make use of the seven existing stations, supplementing them by 12 additional depots, each furnished with an electrically driven ambulance. ’Two men, competent motor drivers and skilled in The ,first aid, could be stationed at each depot. would be relied .ordinary telephonic machinery upon for the calls, each station or depot being connected with a head office, and the service would be night and day. The. Ambulance Committee are to be heartily congratulated on the prompt production .of a practical scheme to meet a crying want, .and we are glad to know that their recommendations have been adopted by their authority. The ,development in London of telephones and the great facilities offered by motor traffic have been used by the Committee as a basis of their scheme ito excellent effect. The capital cost of the scheme is estimated at .f:18,000, and the annual cost at £17,800, but the cost of the sites to be required for the new depots is not included in these figures. It should be added that there will be absolutely no connexion between the accident service and the .service in respect of infectious diseases. We hope that we shall soon see the scheme in actual work.
RUPTURE OF THE SYMPHYSIS PUBIS IN LABOUR. A CASE of this unusual complication of childbirth this reported in the American Journal of Obstetrics 1for November by Dr. H. E. Tuley. The recorded cases number something under 150, but the discussion which followed the presentation of the case to the American Association of Obstetricians and Gynaecologists at their twenty-sixth annual meeting makes it probable that only a small proportion ,of those actually diagnosed have been reported. Nearly 30 per cent. of the recorded cases have ’occurred quite spontaneously-that is, without forceps delivery or any similar adventitious violence. In one such case the child was actually born within ; an unruptured amniotic sac, showing that intrauterine pressure can scarcely have been excessive. !But in the majority of cases excessive or misdirected forceps traction is the cause of this accident. The rupture is usually complete. It may take place in the median line, or at one side between the - cartilage and the pubic bone. If the injury is slight ,the synovial cavity of the symphysis may ’not be
THE FREQUENCY OF AMENTIA AS RELATED TO SEX. IN
considering
the sex-incidence of disease one
may be led into mistakes
by ignoring the importance of the economic factor. Many men are taken to our institutions because they are no longer fit to retain their place among their fellow-workers. With women the case is different. They are kept at home if A affectionately ignorantly. paper in the Medical Record of Oct. 25th, by Miss L. S. Hollingworth, appears to show that if the number of females in institutions for the feeble-minded is less than that of males, the explanation is that women are not mentally competitive to the same extent as men. She has made a study of the defective individuals who pass through the Clearing House for Mental Defectives in New York, and has found that in 1000 individuals there were 568 males and 432 females. Of those over 16 years of age there were 78 males and 159 females ; of those over 30 years of age there were 9 males and 28 females. From 2 to 16 years of age there is a marked predominance of males, but after that age the females are greatly in excess. By the Binet scale the average age at examination is older for girls than for boys at all mental ages. Similarly the deviations from these averages are greater in all cases for girls than for boys. This shows that a boy will be brought to the Clearing House at an earlier age than is a girl of the same degree of defectiveness. Females survive in the social milieu beyond the age of 16 twice as frequently as boys, and thrice as frequently after the age of 30. Of ancillary interest is the number of children procreated by those feebleminded individuals. In no case was there a history of procreation by the males, but 159 females over 16 years old had had 44 children, 31 of which were illegitimate. Of these 159 women 18 were married