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THE ORGANISATION OF A PURE MILK-SUPPLY.
1841
dast, it is the opinion of this meeting of postal medical benefit by further stay and
treatment
or
whether transfer
officers that the present
position of medical officers is un- to another institution was desirable. There would be an satisfactory when dealing with the sanitation of the post- out-patient department connected with the hospital from - office buildings for which they are held responsible, because which patients could be received into the wards and where sanitary defects, when reported upon by them, in many cases students would have an opportunity to familiarise themselves remain unremedied. It is hereby suggested that it would be advantageous if with the diagnosis and treatment of the minor forms of Her Majesty’s Office of Works, after conference with medical mental alienation and disorder. The practitioner who wa - officers, were to carry out necessary sanitary recommenda- often called upon to treat such cases and whose knowledge tions made through the recognised departmental channels." regarding them was very slight could here acquire useful Here it may be explained that the Association of British knowledge and experience. Under the roof of such a Postal Medical Officers extends throughout the United the psychopathic hospital already established pathological Kingdom and that nearly every medical officer in the employ institute of the New York asylums would naturally find its of the Post Office is a member of this association. home. The proposed reception hospitals, of which the first Further, one of the objects of the members of this asso- will be erected at Rochester, N.Y., are designed to form dation is voluntarily to study and to consider all means part of the existing State hospital system. Controlled by by which they can discover, and all measures by which the same board of managers, they will be " in close they can prevent, the spread of disease among the touch with progressive scientific work wherever found, be 160,000 employes of the British postal services. The asso- that within or beyond the walls of the present buildings." ciation has, at its own expense, collected much in- It is finally pointed out that the scheme advocated is not formation on this subject and has not lost any oppor- entirely new. For many years such psychopathic hospital tunity of bringing the facts thus collected to the notice of have been established in Vienna, Heidelberg, Strassburg, competent authorities. Under these conditions it is urged Leipsic, and other cities. That of Giessen, opened in 1896, that the appointment of an outside sanitary inspector to is the most recent, and is considered to be the best by Dr. visit and to examine the post-offices, &c., is an unnecessary Frederick Peterson of New York who visited that and other expenditure of public funds and that this may occasion institutions in 1899. Until overcrowding of patients is considerable amount of friction. When the recommendations that have already repeatedly been made by the postal medical officers have been taken into account and carried out it will be time enough to move for further inspection should the measures proposed To appoint now another and a conprove inefficacious. of trolling class inspectors seems to infer that the inspection as it now exists is inefficient, whereas the inefficiency rests in the fact that the recommendations made have not been carried out. Under such circumstances it is very natural that the postal medical officers should protest against the proposed amendment to the Bill now before Parliament, and we hope that their arguments will receive full consideration.
a
relieved there can be no proper classification and without proper classification but little progress can be made towards satisfactory treatment. The time has come when all efforts should be made to secure these ends-viz., the prevention of the preventable insanities and the proper classification and cure of the curable insanities. The provision of psychowas one of the to such ends. means pathic hospitals
THE
ORGANISATION OF A
PURE
MILK-SUPPLY.
IT is undoubtedly a gain to public health that the supply of milk is being undertaken on a large scale, for the organisation of a large business is calculated to include arrangements for the scientific control of the purity of the milk, involving the employment of a scientific staff. Obviously PSYCHOPATHIC HOSPITALS. these arrangements are beyond the capacity of the ordinary IN the eighth annual report of the State Charities Aid Icowkeeper or milkman acting alone. The fact is, the proI of milk has for too long been carried on in a ruleAssociation of New York presented to the State Commission duction dn Lunacy in November last, after referring to two distinct Iof-thumb way. Now, however, that it is known that results which have after years of constant effort been attained milk is one of the most powerful factors amongst us --viz., economy of asylum administration and adequate as a carrier of disease it becomes incumbent upon provision against overcrowding of patients in institutions- all milk-producers upon their part to ensure, as far the report deals with a scheme for founding psychopathic as possible, the supply of milk about which no suspicion can hospitals for the acutely insane in the State of New York. be reasonably entertained. We are glad to think that our The curative treatment of insanity was as yet (said the big dairy supply companies recognise this responsibility and report) in its infancy. The insane had been regarded for accordingly spare no expense in taking precautions to secure too long a period as persons for whom custodial care the supply of milk derived from healthy cows. The of was In the States of us that the Union inform required. only many Aylesbury Dairy Company they prepare a numbers of them were still to be found in gaols and poor- regular set of printed forms which have to be filled up by houses. To promote the advancement of knowledge re- the various persons concerned in the production and congarding treatment it was necessary to secure the best medical signment of milk. Thus on the application of a dairy skill that the country afforded. If a hospital for the recep- farmer to be allowed to contract for the supply of milk he tion of a limited number of acute cases of insanity (say, 600) must fill up a form relating to the entire circumstances under could be established at some place readily accessible from which he can supply the milk. These circumstances are New York the association felt assured that it would receive considered by the and everything being satisfacfreely the services of the most eminent alienists of New tory the farmer signs a contract subject to the farm York who would gladly serve as attending and consulting being reported upon favourably by the medical officer physicians. Into such a hospital would be gathered all of health of the district, and to the water-supply cases of supposed insanity and recent cases of certified being passed by the company’s resident analyst. Then, insanity, and here they would be examined and classified and not till then, is milk allowed to be sent to the by the attending physicians before being placed in suit- company. These relations once established the farm is able wards. Cases of general paralysis or other marked visited at least once monthly by the medical officer of forms of incurable insanity would be sent to other health who has a form provided for him to fill up. Again, institutions appropriate to such cases. Cases possibly a form is provided for the veterinary surgeon in which he is curable would be kept for a limited period ia the recep- to report the condition of every animal, and should the tion hospital until it was decided whether they could slightest suspicion of tuberculous disease be entertained the
company
1842 tuberculin test is applied and the result is reported. In the event of infectious sickness breaking out on the farm the milk is immediately stopped until a certificate is furnished from the medical officer of health to the effect that the company may continue to receive milk from the farm without danger to their customers. Lastly, in cases of infectious sickness occurring in the house of a customer delivery by the ordinary service is discontinued and all supplies are sent by special messenger. Precautions like these are admirable, and if strictly carried out would soon render the conveyance of disease by milk a thing of the past. We believe that the Aylesbury Dairy Company were amongst the first to establish a milk business on these excellent sanitary lines, and we are glad. to know that their example has been followed by other great milk companies in London and the provinces.
THE ARMY MEDICAL SERVICE. As
by a reference to our Mr. Brodrick declined column Parliamentary Intelligence at the present stage of affairs and under existing circumstances to make any definite statement about the proposed re-organisation of the medical department beyond saying that various measures are in progress to that end. In reply to a question by Captain Norton, as to whether, in view of the fact that there was at the head of the Army Medical Department at the present time only an Acting Director-General shortly about to retire from the service, the Secretary of State for War would say when a new Director-General would be appointed, Mr. Brodrick said : "No, I can make no statement on the subject," accompanying it with a remark to the effect which we have already stated. It is needless to say that this state of uncertainty has a very injurious effect on the medical service and a deterrent influence on any intending medical candidates. There is no end of speculation and conjecture, but nothing is really known as to what are the intentions of the War Office or what is to be the outcome of the present condition of affairs. After what Mr. Brodrick has said on previous occasions there must, we imagine, be a searching inquiry on the part of the Secretary of State into the causes which have led to that condition, the effect of which has been to empty the Army Medical Service of candidates. The sooner this is undertaken the better for all concerned and the promulgation by Mr. Brodrick of the names of those who constitute the committee is anxiously awaited. our
readers
will
see
ACUTE DERMATITIS FROM A HAIR-DYE CONTAINING HYDROCHLORATE OF PARAPHENYLENE DIAMINE. IN the Tournal of the American Medical Association of May 18th Dr. A. D. Mewborn has published an important case of acute dermatitis from the use of a hair-dye which is much used in France and which contains hydrochlorate of paraphenylene diamine. A point of particular interest is that the application of this dye to the scalp may produce lesions on distant parts of the skin or even a general eruption. This fact might easily cause to be overlooked, particularly as patients are prone to deny the A woman, aged 44 years, had severe use of a hair-dye. dermatitis of the face and a pruriginous papulovesicular eruption on the arms and thighs. The forehead was swollen, red, and shiny, and there were a few small vesicles near the margin of the hair. The eyelids, especially the upper, were puffy and the conjunctivae were slightly congested. The ears were red and swollen; along their upper borders were numerous small vesicles which were filled with straw-coloured fluid and which in places had formed granular crusts. The nose and cheeks were slightly
theeruption
swollen.
thighs
On the forearms and anterior and inner sides of the-.
were numerous
small, mostly perifollicular, papules-
and a few small vesicles. The patient said that she had had at intervals during the past seven years a somewhat similareruption which was diagnosed as eczema. The greaterintensity of the eruption along the border of the hair and on the upper part of the ears suggested examina-tion of the hair, which showed signs of having been dyed in the temporal and frontal regions. The patient admitted that she had been using a French hair-dye, for three weeks. A day or two after commencing its use she felt a prickling sensation in the eyes which was fol-lowed by intense inflammation of the face. This dermatitis produced by hair-dye is well known at the Hopital Saint Louis, Paris. Its zone-like distribution in the upper third of the face, ,the swollen eyelids, and the vesicles on the margins of the ears are characteristic. Fournier sometimes astonishes a patient by saying : ’’Madame, you dye your hair;, you use a dye composed of two liquids ; you apply the dark liquid first and then the clear liquid." Such is the method of applying hydrochlorate of paraphenylene diamine. The first solution is an aqueous or alcoholic solution of the substance; it is applied to the hair on a brush or sponge. The second solution is oxygenated water and is applied a few seconds later on another brush or sponge. The effect is almost instantaneous.. a substance which gives off irritating Quinone (CSH’102), is The hair has at first a violet tint. fumes, produced. This becomes darker under the use of the oxygenated water, and tints varying from auburn to jet black may be. obtained. The eruption is almost always found on the border of the hair or on the upper lip in those who dye the moustache. The forehead, neck, ears, entire face, shoulders,. The arms, and even the whole body may be affected. eruption may appear after the first application or not until the dye has been used for several months. Some subjects have no eruption but complain of prickling in the eyes for days after its use. Intense itching is another characteristic;. it may be most marked in the scalp. The eruption consists of erythematous, urticarial, papular, and vesicular lesions. Its involution is slow ; the skin remains rough, cedematous, and desquamating for weeks. Brocq has described a grave erysipelatoid form of eruption with fever and adenitis. He saw a young woman who had desquamation of the whole body with great depression and fever. He recommends that in view of the increasing number and severity of the cases a law should be enacted that this dye must be labeled, 11 Dangerous to persons who have had eczema or who have irritable skins." G. Tissothas arrived at the conclusion thatr all hair-dyes are dangerous and may produce inflammatory or toxic symptoms, and that their sale should be regulated. Paraphenylene diamine he considers to be the most dangerous. As to the treatment, sedative applications should be used ; in the grave forms the hair should be removed, as the dye which remains in it continues to act as anirritant. Of the production of lesions on the body generally explanations may be given-the transference of the irritant by the hands, the absorption of the drug into the blood, and a nervous influence.
several
THE HOUSING OF THE WORKING CLASSES.
SALFOBD, like so many other places, feels the difficulty of providing dwellings for working people. The corporation obtained a provisional order some years ago for the demolition of some insanitary property and paid JZ.4 13s. 6d. per square yard for the land. One condition of the order was that provision should be made for the rehousing of the people as soon as possible. The chairman of the Health 1
Thèse de Paris, 1898.
dast, it is the opinion of this meeting of postal medical benefit by further stay and
treatment
or
whether transfer
officers that the present
position of medical officers is un- to another institution was desirable. There would be an satisfactory when dealing with the sanitation of the post- out-patient department connected with the hospital from - office buildings for which they are held responsible, because which patients could be received into the wards and where sanitary defects, when reported upon by them, in many cases students would have an opportunity to familiarise themselves remain unremedied. It is hereby suggested that it would be advantageous if with the diagnosis and treatment of the minor forms of Her Majesty’s Office of Works, after conference with medical mental alienation and disorder. The practitioner who wa - officers, were to carry out necessary sanitary recommenda- often called upon to treat such cases and whose knowledge tions made through the recognised departmental channels." regarding them was very slight could here acquire useful Here it may be explained that the Association of British knowledge and experience. Under the roof of such a Postal Medical Officers extends throughout the United the psychopathic hospital already established pathological Kingdom and that nearly every medical officer in the employ institute of the New York asylums would naturally find its of the Post Office is a member of this association. home. The proposed reception hospitals, of which the first Further, one of the objects of the members of this asso- will be erected at Rochester, N.Y., are designed to form dation is voluntarily to study and to consider all means part of the existing State hospital system. Controlled by by which they can discover, and all measures by which the same board of managers, they will be " in close they can prevent, the spread of disease among the touch with progressive scientific work wherever found, be 160,000 employes of the British postal services. The asso- that within or beyond the walls of the present buildings." ciation has, at its own expense, collected much in- It is finally pointed out that the scheme advocated is not formation on this subject and has not lost any oppor- entirely new. For many years such psychopathic hospital tunity of bringing the facts thus collected to the notice of have been established in Vienna, Heidelberg, Strassburg, competent authorities. Under these conditions it is urged Leipsic, and other cities. That of Giessen, opened in 1896, that the appointment of an outside sanitary inspector to is the most recent, and is considered to be the best by Dr. visit and to examine the post-offices, &c., is an unnecessary Frederick Peterson of New York who visited that and other expenditure of public funds and that this may occasion institutions in 1899. Until overcrowding of patients is considerable amount of friction. When the recommendations that have already repeatedly been made by the postal medical officers have been taken into account and carried out it will be time enough to move for further inspection should the measures proposed To appoint now another and a conprove inefficacious. of trolling class inspectors seems to infer that the inspection as it now exists is inefficient, whereas the inefficiency rests in the fact that the recommendations made have not been carried out. Under such circumstances it is very natural that the postal medical officers should protest against the proposed amendment to the Bill now before Parliament, and we hope that their arguments will receive full consideration.
a
relieved there can be no proper classification and without proper classification but little progress can be made towards satisfactory treatment. The time has come when all efforts should be made to secure these ends-viz., the prevention of the preventable insanities and the proper classification and cure of the curable insanities. The provision of psychowas one of the to such ends. means pathic hospitals
THE
ORGANISATION OF A
PURE
MILK-SUPPLY.
IT is undoubtedly a gain to public health that the supply of milk is being undertaken on a large scale, for the organisation of a large business is calculated to include arrangements for the scientific control of the purity of the milk, involving the employment of a scientific staff. Obviously PSYCHOPATHIC HOSPITALS. these arrangements are beyond the capacity of the ordinary IN the eighth annual report of the State Charities Aid Icowkeeper or milkman acting alone. The fact is, the proI of milk has for too long been carried on in a ruleAssociation of New York presented to the State Commission duction dn Lunacy in November last, after referring to two distinct Iof-thumb way. Now, however, that it is known that results which have after years of constant effort been attained milk is one of the most powerful factors amongst us --viz., economy of asylum administration and adequate as a carrier of disease it becomes incumbent upon provision against overcrowding of patients in institutions- all milk-producers upon their part to ensure, as far the report deals with a scheme for founding psychopathic as possible, the supply of milk about which no suspicion can hospitals for the acutely insane in the State of New York. be reasonably entertained. We are glad to think that our The curative treatment of insanity was as yet (said the big dairy supply companies recognise this responsibility and report) in its infancy. The insane had been regarded for accordingly spare no expense in taking precautions to secure too long a period as persons for whom custodial care the supply of milk derived from healthy cows. The of was In the States of us that the Union inform required. only many Aylesbury Dairy Company they prepare a numbers of them were still to be found in gaols and poor- regular set of printed forms which have to be filled up by houses. To promote the advancement of knowledge re- the various persons concerned in the production and congarding treatment it was necessary to secure the best medical signment of milk. Thus on the application of a dairy skill that the country afforded. If a hospital for the recep- farmer to be allowed to contract for the supply of milk he tion of a limited number of acute cases of insanity (say, 600) must fill up a form relating to the entire circumstances under could be established at some place readily accessible from which he can supply the milk. These circumstances are New York the association felt assured that it would receive considered by the and everything being satisfacfreely the services of the most eminent alienists of New tory the farmer signs a contract subject to the farm York who would gladly serve as attending and consulting being reported upon favourably by the medical officer physicians. Into such a hospital would be gathered all of health of the district, and to the water-supply cases of supposed insanity and recent cases of certified being passed by the company’s resident analyst. Then, insanity, and here they would be examined and classified and not till then, is milk allowed to be sent to the by the attending physicians before being placed in suit- company. These relations once established the farm is able wards. Cases of general paralysis or other marked visited at least once monthly by the medical officer of forms of incurable insanity would be sent to other health who has a form provided for him to fill up. Again, institutions appropriate to such cases. Cases possibly a form is provided for the veterinary surgeon in which he is curable would be kept for a limited period ia the recep- to report the condition of every animal, and should the tion hospital until it was decided whether they could slightest suspicion of tuberculous disease be entertained the
company
1842 tuberculin test is applied and the result is reported. In the event of infectious sickness breaking out on the farm the milk is immediately stopped until a certificate is furnished from the medical officer of health to the effect that the company may continue to receive milk from the farm without danger to their customers. Lastly, in cases of infectious sickness occurring in the house of a customer delivery by the ordinary service is discontinued and all supplies are sent by special messenger. Precautions like these are admirable, and if strictly carried out would soon render the conveyance of disease by milk a thing of the past. We believe that the Aylesbury Dairy Company were amongst the first to establish a milk business on these excellent sanitary lines, and we are glad. to know that their example has been followed by other great milk companies in London and the provinces.
THE ARMY MEDICAL SERVICE. As
by a reference to our Mr. Brodrick declined column Parliamentary Intelligence at the present stage of affairs and under existing circumstances to make any definite statement about the proposed re-organisation of the medical department beyond saying that various measures are in progress to that end. In reply to a question by Captain Norton, as to whether, in view of the fact that there was at the head of the Army Medical Department at the present time only an Acting Director-General shortly about to retire from the service, the Secretary of State for War would say when a new Director-General would be appointed, Mr. Brodrick said : "No, I can make no statement on the subject," accompanying it with a remark to the effect which we have already stated. It is needless to say that this state of uncertainty has a very injurious effect on the medical service and a deterrent influence on any intending medical candidates. There is no end of speculation and conjecture, but nothing is really known as to what are the intentions of the War Office or what is to be the outcome of the present condition of affairs. After what Mr. Brodrick has said on previous occasions there must, we imagine, be a searching inquiry on the part of the Secretary of State into the causes which have led to that condition, the effect of which has been to empty the Army Medical Service of candidates. The sooner this is undertaken the better for all concerned and the promulgation by Mr. Brodrick of the names of those who constitute the committee is anxiously awaited. our
readers
will
see
ACUTE DERMATITIS FROM A HAIR-DYE CONTAINING HYDROCHLORATE OF PARAPHENYLENE DIAMINE. IN the Tournal of the American Medical Association of May 18th Dr. A. D. Mewborn has published an important case of acute dermatitis from the use of a hair-dye which is much used in France and which contains hydrochlorate of paraphenylene diamine. A point of particular interest is that the application of this dye to the scalp may produce lesions on distant parts of the skin or even a general eruption. This fact might easily cause to be overlooked, particularly as patients are prone to deny the A woman, aged 44 years, had severe use of a hair-dye. dermatitis of the face and a pruriginous papulovesicular eruption on the arms and thighs. The forehead was swollen, red, and shiny, and there were a few small vesicles near the margin of the hair. The eyelids, especially the upper, were puffy and the conjunctivae were slightly congested. The ears were red and swollen; along their upper borders were numerous small vesicles which were filled with straw-coloured fluid and which in places had formed granular crusts. The nose and cheeks were slightly
theeruption
swollen.
thighs
On the forearms and anterior and inner sides of the-.
were numerous
small, mostly perifollicular, papules-
and a few small vesicles. The patient said that she had had at intervals during the past seven years a somewhat similareruption which was diagnosed as eczema. The greaterintensity of the eruption along the border of the hair and on the upper part of the ears suggested examina-tion of the hair, which showed signs of having been dyed in the temporal and frontal regions. The patient admitted that she had been using a French hair-dye, for three weeks. A day or two after commencing its use she felt a prickling sensation in the eyes which was fol-lowed by intense inflammation of the face. This dermatitis produced by hair-dye is well known at the Hopital Saint Louis, Paris. Its zone-like distribution in the upper third of the face, ,the swollen eyelids, and the vesicles on the margins of the ears are characteristic. Fournier sometimes astonishes a patient by saying : ’’Madame, you dye your hair;, you use a dye composed of two liquids ; you apply the dark liquid first and then the clear liquid." Such is the method of applying hydrochlorate of paraphenylene diamine. The first solution is an aqueous or alcoholic solution of the substance; it is applied to the hair on a brush or sponge. The second solution is oxygenated water and is applied a few seconds later on another brush or sponge. The effect is almost instantaneous.. a substance which gives off irritating Quinone (CSH’102), is The hair has at first a violet tint. fumes, produced. This becomes darker under the use of the oxygenated water, and tints varying from auburn to jet black may be. obtained. The eruption is almost always found on the border of the hair or on the upper lip in those who dye the moustache. The forehead, neck, ears, entire face, shoulders,. The arms, and even the whole body may be affected. eruption may appear after the first application or not until the dye has been used for several months. Some subjects have no eruption but complain of prickling in the eyes for days after its use. Intense itching is another characteristic;. it may be most marked in the scalp. The eruption consists of erythematous, urticarial, papular, and vesicular lesions. Its involution is slow ; the skin remains rough, cedematous, and desquamating for weeks. Brocq has described a grave erysipelatoid form of eruption with fever and adenitis. He saw a young woman who had desquamation of the whole body with great depression and fever. He recommends that in view of the increasing number and severity of the cases a law should be enacted that this dye must be labeled, 11 Dangerous to persons who have had eczema or who have irritable skins." G. Tissothas arrived at the conclusion thatr all hair-dyes are dangerous and may produce inflammatory or toxic symptoms, and that their sale should be regulated. Paraphenylene diamine he considers to be the most dangerous. As to the treatment, sedative applications should be used ; in the grave forms the hair should be removed, as the dye which remains in it continues to act as anirritant. Of the production of lesions on the body generally explanations may be given-the transference of the irritant by the hands, the absorption of the drug into the blood, and a nervous influence.
several
THE HOUSING OF THE WORKING CLASSES.
SALFOBD, like so many other places, feels the difficulty of providing dwellings for working people. The corporation obtained a provisional order some years ago for the demolition of some insanitary property and paid JZ.4 13s. 6d. per square yard for the land. One condition of the order was that provision should be made for the rehousing of the people as soon as possible. The chairman of the Health 1
Thèse de Paris, 1898.