TREATMENT OF SCORPION STINGS.

200 number of pauper patients contained in them from 12,669 to 108,837. The " Board of Control," in entering on its new functions re mental deficiency, to this record in regard to lunacy as one of points " uninterrupted progress." It may strike some thoughtful minds as a demonstration of the unfortunate result of the isolation of mental science from general medical science, of the lack of hospital treatment for uncertifiable cases, and the dearth of such provision as would facilitate the adoption of reasonable preventive measures. To tackle this vital problem with the slightest hope of success we must completely reverse our preconceived ideas of insanity. It is not a " possession by the Evil One." The patient ought to receive appropriate residential medical care (cheering, controlling, or calming, as the case may be) while he is still capable of appreciating it and of voluntarily entering a hospital. Numbers are made suicidal by the dread of an asylum. Numbers are made worse by the anxiety of their friends and by the inexperience of most well-intentioned general practitioners. Many are handed over to imprisonment when, if a hospital had been available at an early period, such a course would have been entirely unnecessary. Until the veil which shrouds the subject in morbid obscurity is removed, until we come to regard mental illness in a purely medical light, it is abundantly clear that we can make no We need for the treatment of mental progress. trouble something very different from the crude domination so often administered by ignorant, wellmeaning, but quite incompetent nurses and caretakers. The restoration of mental balance is a thing so delicate, that it requires the application of our highest intelligence and most sympathetic comprehension. It will often be found that bodily ailment or the stress arising from the natural vicissitudes of human life lies at the root of the trouble. If these are carefully attended to we shall often be well repaid. Taking Dr. Mercier’s excellent advice in his text-book we must "explain the unknown by the known," and start from the principles of common-sense. Now, in this war crisis, we are face to face with circumstances which bring these two modes of treatment into vivid contrast. How do we treat our soldiers ? Many of them are sent back from the firing line disabled by severe nerve-shock, or by If the exhaustion of prolonged nerve-strain. cases recover most of these wounded, transitory with rest and sleep, while their wounds are being cured in the base hospitals. This would seem to indicate that hospital treatment would benefit the unwounded also, with the further aid of convalescent homes to promote complete recovery. But the War Office have taken over from the Lunacy Commission (" Board of Control ") institutions fitted up for the internment of.lunatics and deficients, and which till now have been used for that purpose. They have there placed these soldiers in charge of the pre-existing asylum medical officers, who have been gazetted officers of the Royal Army Medical Corps. The special experience of these officers in relation to nerve disturbance is limited to that acquired in the task of taking charge of lunatics. A civilian could not be placed in charge of asylum officers without being legally certified and having the right to appeal to a magistrate. The soldier is not certified, and being excluded from any right of appeal to judicial intervention, he is obliged to go wherever he is sent. It rests, therefore, with his superiors

and with his country to see that he is treated Cases which in civilian life would be " uncertifiable " should not, when in the army, be treated as lunatics. The cause of their loss of balance is quite definite. The injury has been sustained in fighting for their country. Are they for this to be penalised ?2 If access to a magistrate is denied them, that is not a valid reason why advantage should be taken of their defencelessness to place them while uncertifiable in institutions which are asylums in everything but name and under conditions and control which are paraphrased as military but in essentials are nothing else than those of lunacy. The War Office still screens these methods under the fiction that the taint of lunacy has disappeared beneath the cloak of military regimen. But the continuance of this mode of treatment may prove very detrimental both to the soldier’s present unnerved state of mind and future prospects. It may react injuriously both on the welfare of the army and of the country. Remonstrance after remonstrance has been sent up since the war began by over 60 Members of Parliament and many peers to the Medical Director-General, but to little avail. The practice is continued. The new " Maudsley Mental Hospital" might be utilised with great benefit for the soldiers, but the proposal in the L.C.C. Bill now before Parliament is to turn it into a county asylum. What is required for these nerve-shaken soldiers is a really effective intercepting centre, where it should be obligatory to send all these " borderline " cases on arrival in England, for diagnosis and sifting of each case, to discover if it is "certifiable." If not, these soldiers should on no account be placed in asylum atmosphere and under lunacy authorities. The most successful way of avoiding " stigma," as well as of securing recovery, is to treat these soldiers, if uncertifiable, on a basis. This is by far the most hopeful and encouraging plan. And encouragement counts for a great deal. Even transiently excited cases might with appropriate arrangement be very successfully treated on the same lines as delirious cases are dealt with in ordinary hospitals. I am, Sir, yours faithfully, S. E. WHITE, M.B., B.Sc. Lond. 1915. July 15th,

fairly.

hospital

TREATMENT OF SCORPION STINGS. To the Editor of THE LANCET.

is,

SIR,-The pain caused by the sting of a scorpion I believe, very great. In the Bible (Rev. ix. 5)

it is mentioned as " the torment of a scorpion when it striketh a man." A few days ago I had a letter from a patient asking where she could get snake lancets such as I described for the treatment of snake-bites in a paper by the late Sir Joseph Fayrer, Sir Leonard Rogers, and myself in the Royal Society’s Proceedings some years ago. She wished for these lancets as she has two sons going to the Dardanelles, and she has heard that scorpions are rather plentiful there. I think that the permanganate of potash in the snake lancet would also be useful for scorpion stings, and many people might like to know where to get the lancets. They can be got at about 6d. each from Messrs. Arnold, Smithfield, London, E.C., and more elaborate ones from Messrs. Ferris, of Bristol, at about 3s. 6d. These prices seemed to me too high to allow the lancet to be used on a large scale by people in India, and I must express my obligations -to

201 Messrs. Wm. Mitchell

(Pens), Limited, 8,

Warwick-

lane, London, E.C., who, with much trouble, have succeeded in producing them at rather less than

2. each, with

a

large quantities. Sir, yours faithfully,

reduction I am,

on

THE

NOTIFICATION OF BIRTHS EXTENSION BILL.

To the Editor

of THE LANCET.

SIR,-This Bill proposes to make the Notification of Births Act, 1907, apply to all areas in the United New Cavendish-street, W., July 17th, 1915. Kingdom. Some of its points require careful attention. Unfortunately it neglects to provide for the payment of any fee to the person notifying. SANITATION IN THE DARDANELLES. When we consider that all vital statistics, insurance To the Editor of THE LANCET. of life calculations, and many other national SIR,—As an Advisory Medical Committee is pro- questions are placed upon doctors, and that no ceeding to the Dardanelles, it may be of interest if fee is paid to them for notifying and certifying, I give some details about certain of the diseases we can see that the limit of medical charity has there which I gathered a few years ago when been passed. A fee of 3s. 6d. should be paid out of surgeon to H.M.S. Lancaster. The sanitary condi- the public funds. A most important point is that the Bill is tion of the towns (villages) on both sides of the Straits is very poor-" streets of steps " bordered by defective in regard to a practical definition of " stillbirth." Section 1 (5) of the 1907 Act states whitewashed houses, very dirty, very squalid, hovels mostly. The water-supply is from shallow that only stillbirths of and over the age of 7 months springs and streams frequently polluted by sewage ; intra-uterine life shall be notified. The defect is drains there are none. The scavenging was done further emphasised when we see that the definiby prowling dogs. Everything was unkempt tion given by the Central Midwives Board is: "A and unclean. The country is very rough and child is deemed to be stillborn after being com" The hills are composed of barren. many pletely born it has not breathed or shown any stones," interspersed by bushes of thorns which sign of life." Here no intra-uterine age is mentioned, There are muscatel grapes and so the midwife may notify only fully developed tear and hurt. in the cultivated patches and some olives. Mos- infants. I would suggest the following clause be quitoes play a part in the life there. Stegomyia added to the Bill: Every stillborn child in which fasciata, Culex pipiens and fatigans account for the external sex organs-that is from the fourth dengue fever and some of the so-called Weil’s and a half month and upwards of intra-uterine life disease perhaps. Anophelines are represented by -shall be notified by the medical practitioner or Cellia pharoensis and Anopheles maculipennis- midwife or person present at the birth. The age found in some of the pools of the ravines; aad and sex of the child shall be notified and whether in one village at least they convey malaria, which the child has been born out of wedlock. The fact In the early autumn these, with phle- shall also be notified as to whether the child was was rife. botomus flies, caused much fever. The house-fly, alive during its birth, or showed symptoms of death with blue-bottles and sarcophagus galore, were a in the womb before its birth for some hours or days pest. And when the sea-water at high Mediter- before birth. Only one form of official notification ranean left salt puddles and pools a marine form shall be used, such being supplied free by Each year a mosquito, Acartomyia zammittii, annoyed us all the Registrar-General offices. day long. The game consists of a few red-leg return showing the total number of stillbirths partridges and occasional quail in October, and in notified, with the age, sex, legitimacy, and appearcold winters, when the snow reaches Mount Athos ance of life or death shall be laid before Parand streaks the slopes of the Eumoea, there are liament by the three Registrar-Generals of the woodcock which give good shooting. Incidentally, United Kingdom. The present war compels us to there are some wonderful chameleons and butter- afford more protection to the intra-uterine child. flies to be found near the site of Troy on It is quite easy to criminally prevent an infant the Asiatic shore which would please a collector. during its birth from breathing, and both criminal Typhoid fever was in the villages, dengue occurred abortion, fceticide, and infanticide are on the in outbreaks, three-day fever was present every increase. I would almost prefer to have it made summer, and Malta fever appeared from time to compulsory that every conception must be notified, time when the few Syrian goats were interbred for this would give us an insight into the real with imported Maltese animals. Small-pox was loss to England through children being stillborn. In 1890 I found that at 71 burial board cemeteries common, measles killed the children, scarlet fever was rare, typhus fever frequent. The peasant Turk in England 6321 stillbirths had been interred in there is a lazy, cheerful, amiable man, religious but one year alone. The late Dr. Cameron, M.P., tolerant. He speaks a multi-tongue of Turkish, called attention in the Commons to these statistics, - Greek, Yiddish, mixed with patois French and and then moved for a full return. It showed that Italian words. All are Mohammedans. The officials, during 1890 the number of stillbirths interred in soldiers, and lighthouse keepers received such pay England and Wales was 17,335, and that 4562 had as they could find or impose. Their occupation been interred without a doctor’s certificate. It was fishing ; and their hobbies were gambling, will be noted that the return did not include any swindling, and thieving. The women were veiled burial grounds other than those belonging to public in the presence of strangers. The Governor at burial boards, probably about 10,000. In 1893 a Gallipoli possessed a harem which was supported further return-" Stillbirths in England and other - out of the local customs dues. Its occupants were Countries "-was issued. It is most unfortunate fair, fat, comely, and immodest; the children were that the large1’ the child and the later the marriage naked. The port health officer wore a coat of parents, the more likely is the child to be still"’borrowed" from a European naval lieutenant, born, and, further, that more male children than and his trousers were remarkable by their absence. female are stillborn. This imposes a great loss to The climate is superb, and the bathing excellent. the country of future husbands and men. I am, Sir, yours faithfully, I am, Sir, yours faithfully, E. HALFORD ROSS. ROBERT R. RENTOUL. Sackville-stret, W., July 19th, 1915. 1..IVerpOOI, July mn, iMio. LAUDER BRUNTON.

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