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THE METROPOLITAN ASYLUMS BOARD.1
610 the problem, teaching the public the nature and the immensity of the narcotic peril. Such a campaign would not only educate the public, but would also probably convert some of the static power of Govern-
sick should be better met, and it is to be hoped that action is approaching. The section dealing with infectious diseases leaves a rather mixed impression of satisfaction and the ments into kinetic energy. reverse, when we study the record of progressive work in the metropolis to provide for the treatment of the epidemic group. story of scarlet fever is a cheerful one ; it can be seen from the figures that the disease can now be regarded as one which is THE METROPOLITAN ASYLUMS normally unlikely to end fatally, the case-mortality is considerably under half what it was 30 years ago, BOARD.1 while the notifications are less, though the average THE annual report of the Metropolitan Asylums population of the area concerned is greater by some Board, which has just appeared, contains, as usual, 80,000 persons. Measles must always be a difficult a large amount of well-arranged information condisease to summarise in statistical terms, because of cerning the treatment of infectious diseases in the its sudden incidence in large epidemics and their important area of its work, and it is to this section rapid cessation. Further, the Board deals only with that the main attention, both of the medical profession a proportion of the cases, as accommodation for and of the public, will be paid. The responsibilities measles is found elsewhere during the early stage of an of the Board, however-and it is sometimes forgotten outbreak, the demand for hospital treatment only -are of a much wider range than this section indicates. occurring after a certain limit has been reached. If we include the work in tuberculosis done by the Therefore an epidemic may make grave demands Board under the heading of the care of infectious on the accommodation of the Board suddenly, diseases, there still remain some six other principal which demand declines with proportionate rapidity. directions in which services are discharged which Reference to the statistical table supplied in this are invaluable to the public ; for the duties of the report will show how the help of the Board is sought Board include the management of hospitals and with increasing urgency for brief periods, during institutions for children suffering from specified epidemics of measles, and how promptly the need contagious diseases as well as for those requiring for assistance dies away. The figures for small-pox special treatment in hospitals or convalescent homes ; are satisfactory, the past year being the twenty-third the provision for certain classes of mental defectives in succession since the disease has secured any firm and epileptics ; the care of Poor-law lads in training hold throughout the metropolitan area. A brief for the sea, both for the Navy and the mercantile history of small-pox in London, so far as the activities marine ; while a certain proportion of the casual poor of the Board have been concerned, is included in an fall under their jurisdiction as an authority which was appendix, and would make salutary reading at the instituted more than half a century ago by an order present moment for a good many persons. The of the then Poor-law Board. Arrangements have been references to encephalitis lethargica are significant, made only this week with the Ministry of Health, and are supported by a note on the arrangements under which cases of puerperal fever to be referred which have been secured for the treatment of cases, to the Board are to be grouped in certain hospitals written by Dr. GORDON PuGH, chief medical officer for special care and study. The Board also furnishes of the Children’s Service of the Board. The note shows London with ambulances. Under these headings this that the need for institutional treatment in juvenile report makes a clear statement of work done and cases of encephalitis lethargica is great and may be results obtained, and it is possible that the figures increasing in urgency, having regard alike to the recent in connexion with the last-named activity will be extension of the disease in London, the non-existence a surprise to many, having regard to the frequent of facilities for dealing with the cases, and the special complaint that the metropolis is lacking in proper dimcultics incidental to the mentality of patients facilities for the transport of the sick. The ambulance in the later stages. During the second quarter of service, by land and river, of the Board during the 1924 there was a high notification rate of the disease, year in question, dealt with over 72,000 removals, 391 cases out of 611 occurring during that quarter, an increase on the previous year of 10,000, while the while it is now recognised that, quite apart distance covered in the combined journeys amounts from its intrinsic seriousness, apparent cure of the to a total mileage of 725,000 miles, being an increase disease is frequently followed by obscure afterof about 40 per cent. over the mileage of the previous effects, developing into physical, and especially year. This increase is indicative of a growing practice psychical, disturbances of an anxious nature. on the part of the medical profession and the general Abnormalities of conduct have been observed which public to employ the ambulances of the Board in might bring, and which possibly have brought, patients lieu of less specialised means of transport for the within the sphere of the criminal law, when their conveyance of patients and invalids over considerable actions have been dictated by the remaining influences distances. This willingness to use the ambulances of the disease, and this is a state of affairs to the remedy of the Board accentuates the fact that public comments of which attention should be directed at once. on the dearth of ambulances in London nearly always We refer, finally, to the anxious position revealed have the same origin; they are aroused by some by the figures in relation to diphtheria, whose prevaldefault in dealing with cases of accident in the street. ence is sometimes regarded with complacency because The whole of this question has been under anxious the antitoxin treatment, devised 30 years ago, consideration for some time, and was referred by produced such wonderfully favourable results. But the Minister of Health over two years ago to the steady though the progress, which can be recorded, Voluntary Hospitals Commission, when a conference may have been in the treatment of diphtheria, it was held on the position of ambulance services has been too slow, for the figures show that, in London generally in the metropolitan area. The need for at any rate, the forces of the disease have latterly better organisation and supply of transport of the been gathering power. Compared with the septennial period 1897-1903, the. septennial period 1918-1924, 1 Annual Report of the Metropolitan Asylums Board, gives only superficially the idea of any progress at 1924-25. Pp. 364. Office of the Board. 5s.
611 but these discoveries do not make much obvious none whatever is claimed in the report. The number of notifications, though higher in the difference to life, and most people would prefer a latter of these periods, is not out of proportion to solution of the sock problem. A naive contribution the increase which has taken place in the average to the explanation of our habits is recorded1 by Dr. population, and the death-rate per cent. is in the S. A. Levine and his colleagues at Harvard. They found .same period only still what it was in the earlier period. last year that some of the runners in a Marathon (or But in the intermediate 14 years the notifications marathon-they print the word and it indifferently, were much less numerous, while figures indicating is a nice point) who were particularly exhausted the seven year rate per 1000 persons living are con- showed an low blood-sugar and symptoms abnormally siderably higher for the last septennial period than comparable to those of an overdose of insulin. On for the two preceding periods. The statistics and the further analysis it appeared that exercise such as words of the Board alike show that the offensive first somewhat increases the blood-sugar, but running power of diphtheria is increasing in greater ratio the afterwards drops back to normal, at percentage and would seem that we have it than the defence, it which remains until, in some individuals, a further been lulled into inactivity by the gratifying experiences the time when they get profoundly fall about appears which followed the introduction of the antitoxin On a tired. repetition of the race this year these The fact that the position to-day is treatment. their findings, and got some of the observers confirmed infinitely better in respect of diphtheria than it was 30 years ago is a legitimate source of satisfaction. runners to demonstrate that eating candies was very It is In the matter of case-mortality a steadily declining reviving when exhaustion began to appear. rate reached its minimum in 1924. This is the lowest interesting to know that physical exhaustion is figure on record and proves, if proof were wanted, associated with a low percentage of sugar in the that the use of antitoxin has saved untold lives. But blood, and we are led to wonder whether the same the continuance of a high attack-rate in the metropolis is true of the tired, sleepy state which supervenes calls for anxious thought. It seems to the Board that when a maximum discharge of adrenalin enables the time has come for the adoption of measures the subject to have a really violent emotion. But calculated to restrict more effectively than hitherto the most curious thing is that neither the authors the depredations of the disease, and in this connexion nor the subjects at Harvard seem to have been aware the recent figures for New York City, which are that the consumption of sugar in one form or another quoted in the report, should be studied by those is very widely known as preventive and curative of who believe that white lump sugar taking an active part in the maintenance of public fatigue.is Those and not some artifice of a deceitful sugar health. All will agree with the opinion of the Board really that a case has been made out for strict consideration. manufacturer will take it in that convenient form ; others pin their faith on a bull’s-eye about the sixteenth hole ; a long-distance cyclist will start out with a long stick of barley-sugar in his mouth, and gradually incorporate it ; sugar cakes are a sine qua non at SUGAR AND ATHLETICS. an athletic tea-party. We almost suspect that the THE most entertaining function of modern scientific Harvard Marathonians havebeen taking advice about their diet from physiologists-a very dangerous discovery in the departments of applied physiology, thing to do-instead of from their mothers. However domestic science, and the like is to find out not what well science may explain diet it is apt to choose it We badly, because it neglects the accumulated sum of we ought to do, but why we do what we do. know now-more or less-why we should eat cabbage ; human prejudices in the field which interests mankind more than anything else. we know why a man cannot run a mile as fast as he
all, and
can run 100 yards and cannot hope to do so; we have a rationale for loafing in the sun. We do not THE NEW CONCEPTION OF LEPROSY. know why we use soap to clean ourselves with, nor how to wash woollen socks without shrinking them ; THE conception of leprosy as a progressive and science has addressed itself to these problems, but inevitably fatal disease is one well established in has failed to find a solution satisfying to the house- popular and to a great extent also in medical a recent article wife. No serious attention appears to have been given opinion ; but, as is pointed out in in the Medical Journal of Australia (July llth, 1925), rabbit to the problems of why no one can eat daily, this conception is not necessarily founded on fact. and why a white silk shirt must not be dried in the Some 29 years ago Dr. G. H. Taylor, who is at present open like a cotton one for fear it will go yellow. medical officer to the New South Wales Government Still, much has been and more will be discovered, and railways, in a systematic investigation of the patients in the general wards of the Coast Hospital, New we may expect in time a due recognition by the public South pointed out that thickening and tenderwho are curious about dietetics of the renaissance of ness ofWales, the ulnar and peroneal nerves and slight healthiness which emerged from the discovery by anaesthesia of the parts supplied were not uncommon the Dutch of cabbages which would stand the winter. in individuals, in some of whom healed leprous There has been going on the annual lamentation at lesions were found post mortem. Unfortunately, this the lack of interest shown by the general public in work appears to have received little recognition in the proceedings of the British Association for the official quarters, while Dr. Taylor himself at that time did not recognise the grave danger to the comAdvancement of Science. The truth no doubt is in munity of such cases. The recent writings of E. Muir the first place that the public takes a great deal more (THE LANCET, Jan. 24th, 1925, p. 169) certainly interest in the Association than the Association confirm much of Taylor’s work, for he has demonthinks, while in the second place real scientific dis- strated leprosy bacilli in many persons who do not coveries leave the public moderately unmoved, because manifest leprous lesions, and in others who appear to recover It therefore becomes they do not concern their familiar activit.es. It is apparent thatspontaneously. Dr. Taylor’s original conception of the very good to know about the shape and balance disease is one of considerable historical value. of the earth, or why the amoeba is of a more useful 1 S. A. Levine, Burgess Gordon, and C. L. Derrick : Some size than the rhinoceros, and it is wonderful that Changes in the Chemical Constituents of the Blood following a mere men should be able to find out such things, Marathon Race. Jour. Amer. Med. Assoc., 1924, lxxxii., 1778.
sick should be better met, and it is to be hoped that action is approaching. The section dealing with infectious diseases leaves a rather mixed impression of satisfaction and the ments into kinetic energy. reverse, when we study the record of progressive work in the metropolis to provide for the treatment of the epidemic group. story of scarlet fever is a cheerful one ; it can be seen from the figures that the disease can now be regarded as one which is THE METROPOLITAN ASYLUMS normally unlikely to end fatally, the case-mortality is considerably under half what it was 30 years ago, BOARD.1 while the notifications are less, though the average THE annual report of the Metropolitan Asylums population of the area concerned is greater by some Board, which has just appeared, contains, as usual, 80,000 persons. Measles must always be a difficult a large amount of well-arranged information condisease to summarise in statistical terms, because of cerning the treatment of infectious diseases in the its sudden incidence in large epidemics and their important area of its work, and it is to this section rapid cessation. Further, the Board deals only with that the main attention, both of the medical profession a proportion of the cases, as accommodation for and of the public, will be paid. The responsibilities measles is found elsewhere during the early stage of an of the Board, however-and it is sometimes forgotten outbreak, the demand for hospital treatment only -are of a much wider range than this section indicates. occurring after a certain limit has been reached. If we include the work in tuberculosis done by the Therefore an epidemic may make grave demands Board under the heading of the care of infectious on the accommodation of the Board suddenly, diseases, there still remain some six other principal which demand declines with proportionate rapidity. directions in which services are discharged which Reference to the statistical table supplied in this are invaluable to the public ; for the duties of the report will show how the help of the Board is sought Board include the management of hospitals and with increasing urgency for brief periods, during institutions for children suffering from specified epidemics of measles, and how promptly the need contagious diseases as well as for those requiring for assistance dies away. The figures for small-pox special treatment in hospitals or convalescent homes ; are satisfactory, the past year being the twenty-third the provision for certain classes of mental defectives in succession since the disease has secured any firm and epileptics ; the care of Poor-law lads in training hold throughout the metropolitan area. A brief for the sea, both for the Navy and the mercantile history of small-pox in London, so far as the activities marine ; while a certain proportion of the casual poor of the Board have been concerned, is included in an fall under their jurisdiction as an authority which was appendix, and would make salutary reading at the instituted more than half a century ago by an order present moment for a good many persons. The of the then Poor-law Board. Arrangements have been references to encephalitis lethargica are significant, made only this week with the Ministry of Health, and are supported by a note on the arrangements under which cases of puerperal fever to be referred which have been secured for the treatment of cases, to the Board are to be grouped in certain hospitals written by Dr. GORDON PuGH, chief medical officer for special care and study. The Board also furnishes of the Children’s Service of the Board. The note shows London with ambulances. Under these headings this that the need for institutional treatment in juvenile report makes a clear statement of work done and cases of encephalitis lethargica is great and may be results obtained, and it is possible that the figures increasing in urgency, having regard alike to the recent in connexion with the last-named activity will be extension of the disease in London, the non-existence a surprise to many, having regard to the frequent of facilities for dealing with the cases, and the special complaint that the metropolis is lacking in proper dimcultics incidental to the mentality of patients facilities for the transport of the sick. The ambulance in the later stages. During the second quarter of service, by land and river, of the Board during the 1924 there was a high notification rate of the disease, year in question, dealt with over 72,000 removals, 391 cases out of 611 occurring during that quarter, an increase on the previous year of 10,000, while the while it is now recognised that, quite apart distance covered in the combined journeys amounts from its intrinsic seriousness, apparent cure of the to a total mileage of 725,000 miles, being an increase disease is frequently followed by obscure afterof about 40 per cent. over the mileage of the previous effects, developing into physical, and especially year. This increase is indicative of a growing practice psychical, disturbances of an anxious nature. on the part of the medical profession and the general Abnormalities of conduct have been observed which public to employ the ambulances of the Board in might bring, and which possibly have brought, patients lieu of less specialised means of transport for the within the sphere of the criminal law, when their conveyance of patients and invalids over considerable actions have been dictated by the remaining influences distances. This willingness to use the ambulances of the disease, and this is a state of affairs to the remedy of the Board accentuates the fact that public comments of which attention should be directed at once. on the dearth of ambulances in London nearly always We refer, finally, to the anxious position revealed have the same origin; they are aroused by some by the figures in relation to diphtheria, whose prevaldefault in dealing with cases of accident in the street. ence is sometimes regarded with complacency because The whole of this question has been under anxious the antitoxin treatment, devised 30 years ago, consideration for some time, and was referred by produced such wonderfully favourable results. But the Minister of Health over two years ago to the steady though the progress, which can be recorded, Voluntary Hospitals Commission, when a conference may have been in the treatment of diphtheria, it was held on the position of ambulance services has been too slow, for the figures show that, in London generally in the metropolitan area. The need for at any rate, the forces of the disease have latterly better organisation and supply of transport of the been gathering power. Compared with the septennial period 1897-1903, the. septennial period 1918-1924, 1 Annual Report of the Metropolitan Asylums Board, gives only superficially the idea of any progress at 1924-25. Pp. 364. Office of the Board. 5s.
611 but these discoveries do not make much obvious none whatever is claimed in the report. The number of notifications, though higher in the difference to life, and most people would prefer a latter of these periods, is not out of proportion to solution of the sock problem. A naive contribution the increase which has taken place in the average to the explanation of our habits is recorded1 by Dr. population, and the death-rate per cent. is in the S. A. Levine and his colleagues at Harvard. They found .same period only still what it was in the earlier period. last year that some of the runners in a Marathon (or But in the intermediate 14 years the notifications marathon-they print the word and it indifferently, were much less numerous, while figures indicating is a nice point) who were particularly exhausted the seven year rate per 1000 persons living are con- showed an low blood-sugar and symptoms abnormally siderably higher for the last septennial period than comparable to those of an overdose of insulin. On for the two preceding periods. The statistics and the further analysis it appeared that exercise such as words of the Board alike show that the offensive first somewhat increases the blood-sugar, but running power of diphtheria is increasing in greater ratio the afterwards drops back to normal, at percentage and would seem that we have it than the defence, it which remains until, in some individuals, a further been lulled into inactivity by the gratifying experiences the time when they get profoundly fall about appears which followed the introduction of the antitoxin On a tired. repetition of the race this year these The fact that the position to-day is treatment. their findings, and got some of the observers confirmed infinitely better in respect of diphtheria than it was 30 years ago is a legitimate source of satisfaction. runners to demonstrate that eating candies was very It is In the matter of case-mortality a steadily declining reviving when exhaustion began to appear. rate reached its minimum in 1924. This is the lowest interesting to know that physical exhaustion is figure on record and proves, if proof were wanted, associated with a low percentage of sugar in the that the use of antitoxin has saved untold lives. But blood, and we are led to wonder whether the same the continuance of a high attack-rate in the metropolis is true of the tired, sleepy state which supervenes calls for anxious thought. It seems to the Board that when a maximum discharge of adrenalin enables the time has come for the adoption of measures the subject to have a really violent emotion. But calculated to restrict more effectively than hitherto the most curious thing is that neither the authors the depredations of the disease, and in this connexion nor the subjects at Harvard seem to have been aware the recent figures for New York City, which are that the consumption of sugar in one form or another quoted in the report, should be studied by those is very widely known as preventive and curative of who believe that white lump sugar taking an active part in the maintenance of public fatigue.is Those and not some artifice of a deceitful sugar health. All will agree with the opinion of the Board really that a case has been made out for strict consideration. manufacturer will take it in that convenient form ; others pin their faith on a bull’s-eye about the sixteenth hole ; a long-distance cyclist will start out with a long stick of barley-sugar in his mouth, and gradually incorporate it ; sugar cakes are a sine qua non at SUGAR AND ATHLETICS. an athletic tea-party. We almost suspect that the THE most entertaining function of modern scientific Harvard Marathonians havebeen taking advice about their diet from physiologists-a very dangerous discovery in the departments of applied physiology, thing to do-instead of from their mothers. However domestic science, and the like is to find out not what well science may explain diet it is apt to choose it We badly, because it neglects the accumulated sum of we ought to do, but why we do what we do. know now-more or less-why we should eat cabbage ; human prejudices in the field which interests mankind more than anything else. we know why a man cannot run a mile as fast as he
all, and
can run 100 yards and cannot hope to do so; we have a rationale for loafing in the sun. We do not THE NEW CONCEPTION OF LEPROSY. know why we use soap to clean ourselves with, nor how to wash woollen socks without shrinking them ; THE conception of leprosy as a progressive and science has addressed itself to these problems, but inevitably fatal disease is one well established in has failed to find a solution satisfying to the house- popular and to a great extent also in medical a recent article wife. No serious attention appears to have been given opinion ; but, as is pointed out in in the Medical Journal of Australia (July llth, 1925), rabbit to the problems of why no one can eat daily, this conception is not necessarily founded on fact. and why a white silk shirt must not be dried in the Some 29 years ago Dr. G. H. Taylor, who is at present open like a cotton one for fear it will go yellow. medical officer to the New South Wales Government Still, much has been and more will be discovered, and railways, in a systematic investigation of the patients in the general wards of the Coast Hospital, New we may expect in time a due recognition by the public South pointed out that thickening and tenderwho are curious about dietetics of the renaissance of ness ofWales, the ulnar and peroneal nerves and slight healthiness which emerged from the discovery by anaesthesia of the parts supplied were not uncommon the Dutch of cabbages which would stand the winter. in individuals, in some of whom healed leprous There has been going on the annual lamentation at lesions were found post mortem. Unfortunately, this the lack of interest shown by the general public in work appears to have received little recognition in the proceedings of the British Association for the official quarters, while Dr. Taylor himself at that time did not recognise the grave danger to the comAdvancement of Science. The truth no doubt is in munity of such cases. The recent writings of E. Muir the first place that the public takes a great deal more (THE LANCET, Jan. 24th, 1925, p. 169) certainly interest in the Association than the Association confirm much of Taylor’s work, for he has demonthinks, while in the second place real scientific dis- strated leprosy bacilli in many persons who do not coveries leave the public moderately unmoved, because manifest leprous lesions, and in others who appear to recover It therefore becomes they do not concern their familiar activit.es. It is apparent thatspontaneously. Dr. Taylor’s original conception of the very good to know about the shape and balance disease is one of considerable historical value. of the earth, or why the amoeba is of a more useful 1 S. A. Levine, Burgess Gordon, and C. L. Derrick : Some size than the rhinoceros, and it is wonderful that Changes in the Chemical Constituents of the Blood following a mere men should be able to find out such things, Marathon Race. Jour. Amer. Med. Assoc., 1924, lxxxii., 1778.