- Email: [email protected]
THE HEALTH OF THE NAVY IN 1923,
1272
pudding, or Benger’s food can be given. On the ninth day the patient gets pounded fish and a lightly boiled egg. An enema on the third day or earlier may bring relief from flatulence, and a weak aperient, such as inf. sennea 3SS., is ordered on the fourth day. Conlet him have bodily and mental and visceral rest. If valescence is usually smooth if the patient rallies from thirst can be really controlled by proctoclysis not even his shock and survives the first few days. Later, fluids need be given by mouth for 24 hours, but in subphrenic abscesses or a haematemesis may occur, the absence of vomiting small drinks bring great and in this event patients mostly succumb in the end. relief to the patient and need not be withheld. Conclusion. Subsequent feeding must depend upon the general cure permanently at least onecondition. In feeble patients begin with clear fluids suture will Simple at the end of 24 hours. In vigorous patients give half of those patients who survive. It is time to talk only water by mouth for 48 hours. Glucose (5 per cent.) of further operative measures when several months in the rectal saline is always useful. Morphia, gr. -4, have elapsed, should symptoms of indigestion still is indicated for the first night, but is not usually persist. required again. Nothing but clear fluids (albuminCHARLES A. PANNETT, B.SC., M.D. Lond., water, weak tea, raisin tea, beef juice) are given for F.R.C.S. Eng., four days ; on the fifth citrated milk may be added, Professor of Surgery, University of London, and and by the seventh a little bread-and-butter, milk Surgeon to St. Mary’s Hospital. After-treatment. period immediately following operation the Fowler sitting position is essential, abundant fluid by rectum necessary, and starvation by mouth of the greatest use. Having got the patient through his crisis, In the
Special Articles. THE HEALTH OF THE NAVY IN 1923, THE Statistical Report of the Health of the Navy for the year 1923, just published by H.M. Stationery Office (pp. 149, 5s.), shows an improved standard of health. Compared with the preceding year, there were fewer cases of illness, fewer accidents, fewer deaths, fewer invalidings, and fewer men daily on the sick list. The appended table shows the distribution of the casualties. In 1923 there was a reduction of about 8000 in the total naval establishment, which falls readily into three great groups-viz., the Atlantic Fleets, the fleets abroad, and the Home Station, the latter including recruits, men under training, and those awaiting discharge. For some reason unexplained the 3710 marines at headquarters are separated off from the 89,100 other men in the Service, who are called the Total Force. The death-rate was 2-9 per 1000 in the fleets abroad and 1-4 in the Atlantic Fleet. There were 38 deaths from injuries and accidents, 18 from drowning, 17 from tubercle, 15 from diseases
HEALTH STATISTICS
IN THE
Figures for 1922
are
of the intestines, 13 from suicide, 12 from pneumonia, 11 from heart disease ; the total of deaths was 194:—2-17 per 1000. The invalidings were, in order of magnitude, as follow : diseases of the eye, 200 ; diseases of the ear, 158 ; gonorrhoea, 151 ; tuberculosis, 143 (50 less than in 1922) ; neurasthenia, 101 ; heart diseases, 86 ; and injuries, 56. In all there were 16-08 per 1000 invalided, a reduction of 20 per cent. in the year. To judge from the curve of actual invalidings the reduction was most marked at the younger ages and in the earlier years of service. This suggests more careful recruiting or better care of the recruit, or both. The Blue-book records events, without stopping to explain the reason for them, but it appears that the benefit is now being reached of the long campaign for better ventilation, for not only are pneumonia and tuberculosis decreased, but also respiratory diseases, such as catarrh, bronchitis, and
I
pleurisy.
Vaccinations and revaccinations to the number of 23,000 are mentioned, which makes it the more difficult to understand how an officer who contracted small-pox at Smyrna had managed to escape revaccination all his time in the Service. There were but 863 cases of influenza in 1923, epidemic only in ships in Australia and New Zealand ; in 1922 there were 4514 cases, of which the maximum, 1837, was in ther
GROUPS, ROYAL NAVY, 1923.
in italics,
on
the left of columns.
1273 Atlantic Fleet. Malaria is lessened this year, which, the East Indies Station, is perhaps to be associated
PARIS.
on
with the fumigation of all ships on completion of their annual refit at Bombay. One case was invalided for frequent recurrence of blackwater fever. There three apparently quite unrelated cases of were meningococcal infection. Tuberculosis has decreased remarkably, case, invaliding, and death rates per 1000 being 1-86, 1-60, 0-19, as against 2-26, 1-99, 0-37 in 1922. The attack rate of the sick berth staff is again reduced, now to 2-67. The rate of 4-55 among telegraphists causes question, their cases being distributed Infection is believed to ,over nearly all the stations. have been limited at Hong-Kong by disinfecting boats with formalin after their refits, lest infection may have been left behind by spitting dockyard labourers, a promising line of advance. Marines at headquarters seem to have only half the liability (1-9) they manifest on ships (3-31). As this year there are fewer cases of gonorrhoea, the total incidence of venereal disease is reduced, and, as usual, there is least among marines at headquarters. It is more prevalent abroad, especially in China. The further results of the closing of brothels in Gibraltar are unmentioned. " The great majority of the infections ’have been contracted by men under the influence of alcohol " is an opinion from China. Two deaths from cholera are reported and one from (clinical) relapsing fever. In regard to the latter it does not appear that blood films were sent home for confirmatory opinion. Diseases of teeth and gums, of mouth and pharynx, continue to decrease ; much attention has been given to dental repair, two-thirds of the defective teeth are being conserved, and only one-third extracted. Cases of scabies are fewer and each a shorter time under treatment. Malignant new growths are also fewer. No statement is made of health conditions among cadets at Dartmouth. There are fewer boys under training ; their pneumonia rate is reduced and their tuberculosis rate is identical, rather below that of the rest of the Service-3 cases of pneumonia, The 3 cases of tuberculosis among 1700 boys. Admiralty might very well publish fuller information about the feeding and management of these boys; it would be welcomed by those in charge of schools.
INDIAN MEDICAL SERVICE. ANNUAL DINNER. EIGHTY-ONE officers of the Indian Medical Service sat down to the annual dinner at the Trocadero, London, on June 16th. Lieut.-Colonel R. H. Elliot, D.Sc., F.R.C.S., was in the chair, and the guests were Sir Richard Luce, Sir Dawson Williams, and Dr. E. C. Morland. The other members of the Service present were as follows :— Ma.jor-Genera.ls : Sir R. H. Charles, G.C.V.O., D. H. Deare, C.I.E.; T. Grainger, C.B. ; G. F. A. Harris, C.S.I.; H. Hendley, C.S.I. ; J. B. Smith, C.B., C.I.E.
Air Vice-Marshal: D. Munro, C.B., C.I.E. Colonels : J. Crimmin, V.C., C.B., C.I.E. ; C. M. Goodbody, ,C.I.E., D.S.O. ; T. A. Granger, C.M.G. ; C. R. M. Green; J. A. Hamilton, C.M.G. ; R. A. Needham, C.I.E., D.S.O. ; J. J. Pratt ; H. Austin Smith, C.I.E.; T. Stodart, C.I.E. ; P. C. H. Striokland; R. G. Turner, C.M.G., D.S.O. ; C. N. C. Wimberley, C.M.G. Lieut.-Colonels : A. W. Alcock, C.I.E., F.R.S. ; W. G. P. Alpin, O.B.E.; J. Anderson, C.I.E.; L. A. P. Anderson; R. W. Anthony; J. T. Calvert, C.I.E.; R. Markham Carter, H. P. Cook ; W. V. Coppinger, D.S.O. ; J. W. Cornwall; <.B. ; D. G. Crawford ; J. M. Crawford, O.B.E. ; C. A. Gill; W. D. Hayward ; W. M. Houston ; E. V. Hugo, C.M.G. ; W. W. Jeudwine, C.M.G. ; J. G. Jordan ; H. C. Keates; H. Kirkpatrick ; J. C. G. Kunhardt; Clayton Lane ; J. L. Lunham; F. P. Mackie, O.B.E. ; J. W. D. Megaw, C.I. E. ; F. 0. N. Mell, C.I. E. A. Miller; W. 0. S. Murphy; E. A. R. Newman, C.I.E.; H.R.Nutt; F. O’Kinealy, C.I.E., C.V.O.; Sir L. Rogers, C.I.E., F.R.S. ; E. R. Rost, O.B.E.; S. Browning Smith, C.M.G. ; R. Steen ; T. G. N. Stokes; Ashton Street; W. A. Sykes, D.S.O. ; C. Thomson; W. H. Thornhill ; H. J. Walton; D. Warliker ; R. T. Wells; W. S. Willmore; H. R. Woolbert; A. W. Cook Young ; A. C. Younan. Majors : A. F. Babonau, C.I.E., O.B.E. ; Sir T. J. Carey Evans, M.C. ; C. H. Fielding ; N. H. Hume ; N. C. Kapur ; G. R. Lynn, D.S.O. ; A. C. Macrae;V.B. Nesfield; E. S. Phipson, D.S.O. ; A. L. Sheppard; J. A. Sinton, V.C., O.B.E.; W. L. Watson, O.B.E.; W. E. R. Williams, O.B.E.
Captains : S. L. Bhatia, M.C. ; J. H. Grove-White.
(FROM
OUR OWN
CORRESPONDENT.)
The Campaign against Alcoholism. FOR some time past the Academy of Medicine has been preoccupied with the national danger resulting from a recrudescence of alcoholism, and a Commission has been studying the various measures which might be taken to prevent it. Prof. Marcel Labbe submitted. the following resolutions which were adopted and transmitted to the proper authorities : The antialcoholic regulations of the war should remain in force and be vigorously applied. The law in regard to absinthe substitutes should be revised and strictly applied. The number of places where alcoholic liquors are sold should be limited, the application of this measure being facilitated by social ameliorations such as healthy housing construction for the workers and the creation of places of popular recreation. The use of grapes as food and of non-fermented grape juice should be popularised as well as the industrial utilisation of alcohol. Anti-alcoholic education should be organised in all classes of society. Other resolutions are being studied, amongst them the question of home distillation, of increasing the duties on alcoholic liquors, and of creating houses of entertainment where only non-alcoholic liquors can be consumed. Indemnities for Hospital Personnel. As I have already remarked, no protection has heretofore been provided against infection or accident incurred by the medical or nursing staff when on duty in hospital. Nearly every other kind of occupation is provided for, either by the law of 1898 or by new clauses added to it since. In view of several recent deaths among internes at Paris hospitals, the Minister of Labour is promoting legislation to extend the application to hospital personnel so that, for example, disability of 100 per cent. would entitle to a pension of 9706 frs. The widow of a deceased member of the staff would receive annually 2912 frs. ; one child would be allotted 2184 frs., two children 3640 frs., three children 5096 frs., and four children 5825 frs. In the absence of widow or children the father and mother of the deceased would receive Such in outline are the lines 2912 frs. annually. of the provisions being urged by the Minister of Labour which will undoubtedly be realised very soon. Arsenic in Puerperal Infection. Dr. Maurice Riviere, professor of clinical obstetrics at Bordeaux, is employing organic salts of arsenic for puerperal infection, whether syphilitic or not, and advises this method to the exclusion of any other, especially fixation abscess. He finds that arsenical injection generally suffices to avoid complications and to limit infection. In practice sulfarsenol is preferred, a subcutaneous injection of 0-12 g. repeated at need every other day up to a total of five or six injections. In some cases the dose is increased to 0-18 g. Intravenous injection is reserved for grave forms of disease or those in which the usual methods of treatment have been tried and failed. The medication is said to have been equally efficacious in cutting short an attack of phlegmasia alba dolens. Ovarian Grafts in Psychopathic Conditions. Dr. Toulouse, director of the mental prophylactic service at the Asile St. Anne, has been trying ovarian homografts in two cases of melancholia and in six cases of catatonic syndrome. The grafts were obtained from women who had undergone operation for heemorrhagic fibroma and they were inserted beneath the skin of the patient. In the two melancholic cases and in two cases of dementia preecox a notable improvement followed which persisted. The first results are only regarded as an indication for further investigation. The graft has survived in favourable cases for from I-Ii years, and at the worst it survived 14-21 days. In one of the patients who was considered cured some slight evidence of relapse in the mental condition has since been noted.
pudding, or Benger’s food can be given. On the ninth day the patient gets pounded fish and a lightly boiled egg. An enema on the third day or earlier may bring relief from flatulence, and a weak aperient, such as inf. sennea 3SS., is ordered on the fourth day. Conlet him have bodily and mental and visceral rest. If valescence is usually smooth if the patient rallies from thirst can be really controlled by proctoclysis not even his shock and survives the first few days. Later, fluids need be given by mouth for 24 hours, but in subphrenic abscesses or a haematemesis may occur, the absence of vomiting small drinks bring great and in this event patients mostly succumb in the end. relief to the patient and need not be withheld. Conclusion. Subsequent feeding must depend upon the general cure permanently at least onecondition. In feeble patients begin with clear fluids suture will Simple at the end of 24 hours. In vigorous patients give half of those patients who survive. It is time to talk only water by mouth for 48 hours. Glucose (5 per cent.) of further operative measures when several months in the rectal saline is always useful. Morphia, gr. -4, have elapsed, should symptoms of indigestion still is indicated for the first night, but is not usually persist. required again. Nothing but clear fluids (albuminCHARLES A. PANNETT, B.SC., M.D. Lond., water, weak tea, raisin tea, beef juice) are given for F.R.C.S. Eng., four days ; on the fifth citrated milk may be added, Professor of Surgery, University of London, and and by the seventh a little bread-and-butter, milk Surgeon to St. Mary’s Hospital. After-treatment. period immediately following operation the Fowler sitting position is essential, abundant fluid by rectum necessary, and starvation by mouth of the greatest use. Having got the patient through his crisis, In the
Special Articles. THE HEALTH OF THE NAVY IN 1923, THE Statistical Report of the Health of the Navy for the year 1923, just published by H.M. Stationery Office (pp. 149, 5s.), shows an improved standard of health. Compared with the preceding year, there were fewer cases of illness, fewer accidents, fewer deaths, fewer invalidings, and fewer men daily on the sick list. The appended table shows the distribution of the casualties. In 1923 there was a reduction of about 8000 in the total naval establishment, which falls readily into three great groups-viz., the Atlantic Fleets, the fleets abroad, and the Home Station, the latter including recruits, men under training, and those awaiting discharge. For some reason unexplained the 3710 marines at headquarters are separated off from the 89,100 other men in the Service, who are called the Total Force. The death-rate was 2-9 per 1000 in the fleets abroad and 1-4 in the Atlantic Fleet. There were 38 deaths from injuries and accidents, 18 from drowning, 17 from tubercle, 15 from diseases
HEALTH STATISTICS
IN THE
Figures for 1922
are
of the intestines, 13 from suicide, 12 from pneumonia, 11 from heart disease ; the total of deaths was 194:—2-17 per 1000. The invalidings were, in order of magnitude, as follow : diseases of the eye, 200 ; diseases of the ear, 158 ; gonorrhoea, 151 ; tuberculosis, 143 (50 less than in 1922) ; neurasthenia, 101 ; heart diseases, 86 ; and injuries, 56. In all there were 16-08 per 1000 invalided, a reduction of 20 per cent. in the year. To judge from the curve of actual invalidings the reduction was most marked at the younger ages and in the earlier years of service. This suggests more careful recruiting or better care of the recruit, or both. The Blue-book records events, without stopping to explain the reason for them, but it appears that the benefit is now being reached of the long campaign for better ventilation, for not only are pneumonia and tuberculosis decreased, but also respiratory diseases, such as catarrh, bronchitis, and
I
pleurisy.
Vaccinations and revaccinations to the number of 23,000 are mentioned, which makes it the more difficult to understand how an officer who contracted small-pox at Smyrna had managed to escape revaccination all his time in the Service. There were but 863 cases of influenza in 1923, epidemic only in ships in Australia and New Zealand ; in 1922 there were 4514 cases, of which the maximum, 1837, was in ther
GROUPS, ROYAL NAVY, 1923.
in italics,
on
the left of columns.
1273 Atlantic Fleet. Malaria is lessened this year, which, the East Indies Station, is perhaps to be associated
PARIS.
on
with the fumigation of all ships on completion of their annual refit at Bombay. One case was invalided for frequent recurrence of blackwater fever. There three apparently quite unrelated cases of were meningococcal infection. Tuberculosis has decreased remarkably, case, invaliding, and death rates per 1000 being 1-86, 1-60, 0-19, as against 2-26, 1-99, 0-37 in 1922. The attack rate of the sick berth staff is again reduced, now to 2-67. The rate of 4-55 among telegraphists causes question, their cases being distributed Infection is believed to ,over nearly all the stations. have been limited at Hong-Kong by disinfecting boats with formalin after their refits, lest infection may have been left behind by spitting dockyard labourers, a promising line of advance. Marines at headquarters seem to have only half the liability (1-9) they manifest on ships (3-31). As this year there are fewer cases of gonorrhoea, the total incidence of venereal disease is reduced, and, as usual, there is least among marines at headquarters. It is more prevalent abroad, especially in China. The further results of the closing of brothels in Gibraltar are unmentioned. " The great majority of the infections ’have been contracted by men under the influence of alcohol " is an opinion from China. Two deaths from cholera are reported and one from (clinical) relapsing fever. In regard to the latter it does not appear that blood films were sent home for confirmatory opinion. Diseases of teeth and gums, of mouth and pharynx, continue to decrease ; much attention has been given to dental repair, two-thirds of the defective teeth are being conserved, and only one-third extracted. Cases of scabies are fewer and each a shorter time under treatment. Malignant new growths are also fewer. No statement is made of health conditions among cadets at Dartmouth. There are fewer boys under training ; their pneumonia rate is reduced and their tuberculosis rate is identical, rather below that of the rest of the Service-3 cases of pneumonia, The 3 cases of tuberculosis among 1700 boys. Admiralty might very well publish fuller information about the feeding and management of these boys; it would be welcomed by those in charge of schools.
INDIAN MEDICAL SERVICE. ANNUAL DINNER. EIGHTY-ONE officers of the Indian Medical Service sat down to the annual dinner at the Trocadero, London, on June 16th. Lieut.-Colonel R. H. Elliot, D.Sc., F.R.C.S., was in the chair, and the guests were Sir Richard Luce, Sir Dawson Williams, and Dr. E. C. Morland. The other members of the Service present were as follows :— Ma.jor-Genera.ls : Sir R. H. Charles, G.C.V.O., D. H. Deare, C.I.E.; T. Grainger, C.B. ; G. F. A. Harris, C.S.I.; H. Hendley, C.S.I. ; J. B. Smith, C.B., C.I.E.
Air Vice-Marshal: D. Munro, C.B., C.I.E. Colonels : J. Crimmin, V.C., C.B., C.I.E. ; C. M. Goodbody, ,C.I.E., D.S.O. ; T. A. Granger, C.M.G. ; C. R. M. Green; J. A. Hamilton, C.M.G. ; R. A. Needham, C.I.E., D.S.O. ; J. J. Pratt ; H. Austin Smith, C.I.E.; T. Stodart, C.I.E. ; P. C. H. Striokland; R. G. Turner, C.M.G., D.S.O. ; C. N. C. Wimberley, C.M.G. Lieut.-Colonels : A. W. Alcock, C.I.E., F.R.S. ; W. G. P. Alpin, O.B.E.; J. Anderson, C.I.E.; L. A. P. Anderson; R. W. Anthony; J. T. Calvert, C.I.E.; R. Markham Carter, H. P. Cook ; W. V. Coppinger, D.S.O. ; J. W. Cornwall; <.B. ; D. G. Crawford ; J. M. Crawford, O.B.E. ; C. A. Gill; W. D. Hayward ; W. M. Houston ; E. V. Hugo, C.M.G. ; W. W. Jeudwine, C.M.G. ; J. G. Jordan ; H. C. Keates; H. Kirkpatrick ; J. C. G. Kunhardt; Clayton Lane ; J. L. Lunham; F. P. Mackie, O.B.E. ; J. W. D. Megaw, C.I. E. ; F. 0. N. Mell, C.I. E. A. Miller; W. 0. S. Murphy; E. A. R. Newman, C.I.E.; H.R.Nutt; F. O’Kinealy, C.I.E., C.V.O.; Sir L. Rogers, C.I.E., F.R.S. ; E. R. Rost, O.B.E.; S. Browning Smith, C.M.G. ; R. Steen ; T. G. N. Stokes; Ashton Street; W. A. Sykes, D.S.O. ; C. Thomson; W. H. Thornhill ; H. J. Walton; D. Warliker ; R. T. Wells; W. S. Willmore; H. R. Woolbert; A. W. Cook Young ; A. C. Younan. Majors : A. F. Babonau, C.I.E., O.B.E. ; Sir T. J. Carey Evans, M.C. ; C. H. Fielding ; N. H. Hume ; N. C. Kapur ; G. R. Lynn, D.S.O. ; A. C. Macrae;V.B. Nesfield; E. S. Phipson, D.S.O. ; A. L. Sheppard; J. A. Sinton, V.C., O.B.E.; W. L. Watson, O.B.E.; W. E. R. Williams, O.B.E.
Captains : S. L. Bhatia, M.C. ; J. H. Grove-White.
(FROM
OUR OWN
CORRESPONDENT.)
The Campaign against Alcoholism. FOR some time past the Academy of Medicine has been preoccupied with the national danger resulting from a recrudescence of alcoholism, and a Commission has been studying the various measures which might be taken to prevent it. Prof. Marcel Labbe submitted. the following resolutions which were adopted and transmitted to the proper authorities : The antialcoholic regulations of the war should remain in force and be vigorously applied. The law in regard to absinthe substitutes should be revised and strictly applied. The number of places where alcoholic liquors are sold should be limited, the application of this measure being facilitated by social ameliorations such as healthy housing construction for the workers and the creation of places of popular recreation. The use of grapes as food and of non-fermented grape juice should be popularised as well as the industrial utilisation of alcohol. Anti-alcoholic education should be organised in all classes of society. Other resolutions are being studied, amongst them the question of home distillation, of increasing the duties on alcoholic liquors, and of creating houses of entertainment where only non-alcoholic liquors can be consumed. Indemnities for Hospital Personnel. As I have already remarked, no protection has heretofore been provided against infection or accident incurred by the medical or nursing staff when on duty in hospital. Nearly every other kind of occupation is provided for, either by the law of 1898 or by new clauses added to it since. In view of several recent deaths among internes at Paris hospitals, the Minister of Labour is promoting legislation to extend the application to hospital personnel so that, for example, disability of 100 per cent. would entitle to a pension of 9706 frs. The widow of a deceased member of the staff would receive annually 2912 frs. ; one child would be allotted 2184 frs., two children 3640 frs., three children 5096 frs., and four children 5825 frs. In the absence of widow or children the father and mother of the deceased would receive Such in outline are the lines 2912 frs. annually. of the provisions being urged by the Minister of Labour which will undoubtedly be realised very soon. Arsenic in Puerperal Infection. Dr. Maurice Riviere, professor of clinical obstetrics at Bordeaux, is employing organic salts of arsenic for puerperal infection, whether syphilitic or not, and advises this method to the exclusion of any other, especially fixation abscess. He finds that arsenical injection generally suffices to avoid complications and to limit infection. In practice sulfarsenol is preferred, a subcutaneous injection of 0-12 g. repeated at need every other day up to a total of five or six injections. In some cases the dose is increased to 0-18 g. Intravenous injection is reserved for grave forms of disease or those in which the usual methods of treatment have been tried and failed. The medication is said to have been equally efficacious in cutting short an attack of phlegmasia alba dolens. Ovarian Grafts in Psychopathic Conditions. Dr. Toulouse, director of the mental prophylactic service at the Asile St. Anne, has been trying ovarian homografts in two cases of melancholia and in six cases of catatonic syndrome. The grafts were obtained from women who had undergone operation for heemorrhagic fibroma and they were inserted beneath the skin of the patient. In the two melancholic cases and in two cases of dementia preecox a notable improvement followed which persisted. The first results are only regarded as an indication for further investigation. The graft has survived in favourable cases for from I-Ii years, and at the worst it survived 14-21 days. In one of the patients who was considered cured some slight evidence of relapse in the mental condition has since been noted.