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THE ADMINISTRATIVE TREATMENT OF PULMONARY TUBERCULOSIS IN GLASGOW.
1364 the temperature remained permanently normal after the the work done by the tuberculosis dispensaries established in eighth day of the illness, while in the other after the seventh the city and the home visitation and supervision connected day there was an irregular fever lasting several days. In therewith, and we are in agreement with his contention that both cases Widal’s reaction became positive during the the extension of this line of work holds out the best hopes course of the illness. Mr. Maberly rightly deprecates the for the future. Our Glasgow correspondent reports this week drawing of definite conclusions from so small a number of the recent resolution of the health committee of his city cases, but he is encouraged to hope that entericin gives advocating such a course, and also the adoption of compromise of being a valuable drug in the treatment of enteric pulsory notification. Finally, Dr. Chalmers’s belief is that fever. The evidence he offers of its value is sufficient to to grapple with the problem effectively it will be neceswarrant a more extended trial, and it is to be hoped that he sary to replace in sanatoriums the accommodation which has will give details of the manner of its preparation with a view been withdrawn from the general hospitals in Glasgow. to this object being carried out. case
THE ADMINISTRATIVE TREATMENT OF PULMONARY TUBERCULOSIS IN GLASGOW. IN connexion with the problem of dealing with the consumptives of a large city an interesting memorandum has been prepared by Dr. A. K. Chalmers, medical officer of health of Glasgow. In this document Dr. Chalmers draws attention to the alteration that has gradually taken place during the last 30 years in the manner of providing institutional treatment in these cases. At the beginning of that period such treatment was provided in the general and Poorlaw hospitals. But long before the present movement in favour of sanatoriums began the practice of the general hospitals in Glasgow in relation to consumption underwent a change which of itself was calculated sooner or later to raise the question of special hospitals for the treatment of the disease. Although this change would appear to have begun at a date subsequent to the discovery of the tubercle bacillus, it was determined rather by altered views of treatment than by any theory of infectivity. Between the years 1880-84 and 1907 the proportion of admissions for phthisis to the total medical admissions fell from 15 to under 3 per cent. in the Royal Infirmary, and from 16 to 2 per cent. in the Western Infirmary. Of recent years special has been made for of phthisis in the the treatment provision of parish hospitals Glasgow (272 beds) and the parish of Govan hospital (144 beds). Sanatoriums have also been erected at Bellefield (52 beds), Bridge-of-Weir (140 beds), and Lanfine (14 beds). The Poor-law institutions at Lanfine are available without charge to those who are eligible ; at Bridge-of-Weir children are admitted free, males pay on an average about 15s. weekly, and females somewhat less ;; at Bellefield some are admitted free, while the amount paid by the others averages over all admissions 7s. 6d. per week. These institutions serve to illustrate some of the anomalies attending our present methods of providing medical relief. The consumptive pauper is able to obtain accommodation and treatment at any time in a Poor-law sanatorium, but there is no equivalent provision for the consumptive who may be just above him in the social scale. And, again, the consumptive wife is refused the provision which would be available for her husband in similar circumstances. Dr. Chalmers goes into the cost of providing sanatorium treatment for all cases in the city. He estimates that as fully 1200 deaths occur annually in Glasgow from pulmonary tuberculosis, the number of persons who become tuberculous during the year, allowing for recoveries, must considerably exceed this. By the provision of 100 beds for training purposes, that is to say for teaching patients the proper course of procedure, a number of patients equivalent to the number of deaths could be afforded one month’s training at a cost for maintenance alone of about J:.8000 annually, pl1lS the annual interest on the capital sum spent on site. The obvious criticism is that nothing approaching effective treatment-i.e., cure of the disease—could be undertaken in the time allotted to each patient. Dr. Chalmers then turns to
THE UNIVERSITY OF LONDON AND THE MEDICAL FACULTY. WE report in another column the proceedings at the interesting meeting of the Faculty of Medicine of the University of London on Monday last, when the fate at the hands of the Senate of the scheme for the creation of a Faculty Board was duly reported. It will be remembered that the Faculty had approved by resolution the formation of a Board which could fairly place medical views before the Senate in an authoritative way. This the three members of the Faculty upon the Senate cannot hope to do, while no coherence of view or attitude can be expected from the whole body of the Faculty. The formation of this Faculty Board was approved by the Academic Council but not, we understand, by the External Council ; and now the Senate has followed the lead of the latter body, proposing to create a Board merely empowered to report to the Faculty instead of a working body desired by the Faculty which would have possessed advisory powers to the Senate, and possibly in the future some executive authority. The Royal Commission which is now sitting may be expected to take notice of the circumstances. ____
THE TREATMENT OF PELLAGRA. IN view of the increasing prevalence of this disease in the United States an important monograph on ’’ The Prognosis and Treatment of Pellagra " by Dr. C. H. Lavinder has been published by the Public Health and Marine Hospital Service of the United States. As regards the treatment of pellagra, Dr. Lavinder remarks that there is no known specific for the disease, thus showing that little progress has been made since Sir Henry Holland wrote in the Medico-Chirurgical Transactions (London, 1820) : "In short, it appears certain that mere medicine has done very little for the relief of " pellagra." Lombroso, in his search for a remedy, got the idea of using arsenic, and the results exceeded by far his expectations. But he does not seem to have regarded arsenic as a true specific for pellagra, although considering it a valuable remedy in some cases, acting in a certain sense as an antidote for the toxins of spoiled maize, to which he attributed the disease. Of the more recently introduced of it was arsenic preparations thought well to try atoxyl and soamin, but they proved of little value in Dr. Lavinder’s hands, although he was not willing to discard them as useless. He found Fowler’s solution of benefit in some cases. Dr. Babcock used both atoxyl and soamin extensively at the State Insane Asylum at Columbia, South Carolina, but he did not observe any permanent benefit from the treatment They were administered by intramuscular injection in doses of 0’ 2 to 0’ 5 gramme every other day for two or three doses, followed by an interval of about ten days. He also thinks that Fowler’s solution is a remedy of importance. Dr. Wood of Wilmingtc,n, North Carolina, speaks disparagingly of atoxyl as a result of his experience. It is clear, therefore, that the newer arsenical remedies are not generally so favourably regarded as the older form, Fowler’s solution, which has been used by Lombroso in doses of from
THE ADMINISTRATIVE TREATMENT OF PULMONARY TUBERCULOSIS IN GLASGOW. IN connexion with the problem of dealing with the consumptives of a large city an interesting memorandum has been prepared by Dr. A. K. Chalmers, medical officer of health of Glasgow. In this document Dr. Chalmers draws attention to the alteration that has gradually taken place during the last 30 years in the manner of providing institutional treatment in these cases. At the beginning of that period such treatment was provided in the general and Poorlaw hospitals. But long before the present movement in favour of sanatoriums began the practice of the general hospitals in Glasgow in relation to consumption underwent a change which of itself was calculated sooner or later to raise the question of special hospitals for the treatment of the disease. Although this change would appear to have begun at a date subsequent to the discovery of the tubercle bacillus, it was determined rather by altered views of treatment than by any theory of infectivity. Between the years 1880-84 and 1907 the proportion of admissions for phthisis to the total medical admissions fell from 15 to under 3 per cent. in the Royal Infirmary, and from 16 to 2 per cent. in the Western Infirmary. Of recent years special has been made for of phthisis in the the treatment provision of parish hospitals Glasgow (272 beds) and the parish of Govan hospital (144 beds). Sanatoriums have also been erected at Bellefield (52 beds), Bridge-of-Weir (140 beds), and Lanfine (14 beds). The Poor-law institutions at Lanfine are available without charge to those who are eligible ; at Bridge-of-Weir children are admitted free, males pay on an average about 15s. weekly, and females somewhat less ;; at Bellefield some are admitted free, while the amount paid by the others averages over all admissions 7s. 6d. per week. These institutions serve to illustrate some of the anomalies attending our present methods of providing medical relief. The consumptive pauper is able to obtain accommodation and treatment at any time in a Poor-law sanatorium, but there is no equivalent provision for the consumptive who may be just above him in the social scale. And, again, the consumptive wife is refused the provision which would be available for her husband in similar circumstances. Dr. Chalmers goes into the cost of providing sanatorium treatment for all cases in the city. He estimates that as fully 1200 deaths occur annually in Glasgow from pulmonary tuberculosis, the number of persons who become tuberculous during the year, allowing for recoveries, must considerably exceed this. By the provision of 100 beds for training purposes, that is to say for teaching patients the proper course of procedure, a number of patients equivalent to the number of deaths could be afforded one month’s training at a cost for maintenance alone of about J:.8000 annually, pl1lS the annual interest on the capital sum spent on site. The obvious criticism is that nothing approaching effective treatment-i.e., cure of the disease—could be undertaken in the time allotted to each patient. Dr. Chalmers then turns to
THE UNIVERSITY OF LONDON AND THE MEDICAL FACULTY. WE report in another column the proceedings at the interesting meeting of the Faculty of Medicine of the University of London on Monday last, when the fate at the hands of the Senate of the scheme for the creation of a Faculty Board was duly reported. It will be remembered that the Faculty had approved by resolution the formation of a Board which could fairly place medical views before the Senate in an authoritative way. This the three members of the Faculty upon the Senate cannot hope to do, while no coherence of view or attitude can be expected from the whole body of the Faculty. The formation of this Faculty Board was approved by the Academic Council but not, we understand, by the External Council ; and now the Senate has followed the lead of the latter body, proposing to create a Board merely empowered to report to the Faculty instead of a working body desired by the Faculty which would have possessed advisory powers to the Senate, and possibly in the future some executive authority. The Royal Commission which is now sitting may be expected to take notice of the circumstances. ____
THE TREATMENT OF PELLAGRA. IN view of the increasing prevalence of this disease in the United States an important monograph on ’’ The Prognosis and Treatment of Pellagra " by Dr. C. H. Lavinder has been published by the Public Health and Marine Hospital Service of the United States. As regards the treatment of pellagra, Dr. Lavinder remarks that there is no known specific for the disease, thus showing that little progress has been made since Sir Henry Holland wrote in the Medico-Chirurgical Transactions (London, 1820) : "In short, it appears certain that mere medicine has done very little for the relief of " pellagra." Lombroso, in his search for a remedy, got the idea of using arsenic, and the results exceeded by far his expectations. But he does not seem to have regarded arsenic as a true specific for pellagra, although considering it a valuable remedy in some cases, acting in a certain sense as an antidote for the toxins of spoiled maize, to which he attributed the disease. Of the more recently introduced of it was arsenic preparations thought well to try atoxyl and soamin, but they proved of little value in Dr. Lavinder’s hands, although he was not willing to discard them as useless. He found Fowler’s solution of benefit in some cases. Dr. Babcock used both atoxyl and soamin extensively at the State Insane Asylum at Columbia, South Carolina, but he did not observe any permanent benefit from the treatment They were administered by intramuscular injection in doses of 0’ 2 to 0’ 5 gramme every other day for two or three doses, followed by an interval of about ten days. He also thinks that Fowler’s solution is a remedy of importance. Dr. Wood of Wilmingtc,n, North Carolina, speaks disparagingly of atoxyl as a result of his experience. It is clear, therefore, that the newer arsenical remedies are not generally so favourably regarded as the older form, Fowler’s solution, which has been used by Lombroso in doses of from