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What is a dispensary?
448
TUDERCLE
Dr. McDoUGALL (We8~ ltiding) pointed out that II. moderate rlsa in pulse.rate. 80 to DO, with 110 rise in temperature, ohen indicated sub. IloCute diseuse. lIe found that such cases often had a very high leucocyte count and the prognosis was bad. IIe believed In the Arueth count, toge~her with 0. total leucocyte count. Dr. PATItRSON agreed that autolnoculatlcn could occur without rise of temperat~rd. but with incroased pulse-rate, Sir IIB:NBY QAUVUN made an appeal for provision of more beds for adult ncu -pulmcnary cases. Non·pulmonary disease had, .up to now been called surgical tubetculosis and treatcd by surgeous in ~eneml hospitals. Conservative metbods, while correcting deformity, had at ~he B.a.me time proved more uti8fl,ctory. Tbe basis of these 18 the treatment of 0. general diaease by general methods, with adjuvant methods for local maulloatations (e.g., X ray, heliotheupy, vaccines). General treatment included climatic hygiene, dietetics, &c. Slides were then shown demonstrating the work at Alton and Sandy Point, the speaker empuasising the value of education. Ab~ces8 aspiratiou was als? de~ribod,. together with methods of producing Ilquefuction. lIeliothemry powerfully accelerated cure by bactoricil1a action and inflammatory teaponse. The exposure must be ca.re{ully dosed so as llot to cause necrosis. Ultrl\.violet ray. had very little, H o.ny, ,P0netra.ting p.>wer. The Iunctioua of lurgery (IU bone Il.ud joint tubercle) were now limited, especlo.lly In t.he treatmcnt of children. Dr. U. A. ELLlS Bo.id thILt the treatment of lupus glLve the ke)·note of all kinds of tubercuh'llliB, by differentiating between tuberculous and ncn .tuberculous t1esue. The methods of knife spoon and Cl\ustics were replaced by contr~ll\ld methods. He referred Bpecially to picric brass llo.ijlo. This bad 80 specific action upon tuberculous tlBSUO without toxic eaect. lIr. Ellis nlso described the usa of brass iu suppositories for intcrual tubcrculoals, Bro. 1 In 4 W&1 used in cod·liver oil for phl)'c-
(Junc.1920
tenulre. The action of an these prepa.ra.t.ions was, he thought, due to the liberat.ion of .. trypLie ferment. Dr. :MARTiN (Lea.sowc), Dr. FItR:U.lt1>':~ (Leeds}, and Dr. WILLIUIS (Dewsbury), alsu spoke. [Th" '-t11Ort3 01 Section. D, E, F, G, II, 1; J, K, L, Q,/\a AI wm apIJ6ar i/\ tJu 1"~1I 'uu,,)
SOJIET'l OF SUPERINTE~DENT~ OF TUBERCULOSIS INSTITUTIO~.S. A well·attended genernl meetlng of tho Society Wll.8 held at the l'resident.'s bouse on Monday, May 17, at 4 p.m, A loug li,,~ o( new members were elected. Dr. GEORGIt Jo~lo:. and Or. P. C. VURIER-JO:iXS fel~ compelld from pressure of other work to resign frOID the Executlvo Committee,l\ud Drs.H. O. DLANroat> and S. VittlE: PUt1S0:l were elected ta filllbeir places, _ Professor LEO:iARD HILL gave an tuterll't.lng address on .. Tbo Principles lnvolved In tho Science of Fresh Air Treatment and Ventilation," wbich was followed by questions and an interesting discussion, in the COUflIO of which the heating of rOQmS by tho method ot heaLing tho floor found general favour. . After a. brief discussion on .. Tbll 'I'rainlng of Sanatorium Nurses," tho following resoluLion was passed: .. Tho.t a.commltteo he appointe.! to consider the whole qucstion of the tralnlult of nurses for tho treatment of tuberculoals;' Dr. E:iTHIl:R CARLINO, Dr. MARCUS l)4Tl:nso~. Dr. NOEL DARD5WELL, and Dr. II. O.1Ju:c. FORO (11.3 convener) were elected to Iorm this Bub-committee. ,A discussion on I I The llclath'e Values Butter aud Marga.rine in the Trllatmont of Tuborculosis" resulted in an exprosalon of opinion in favour of tho choaper commodity 10 long as vltamines in the diet were 1I0t O\·er. looked. The consideration of tho employment of ox-patients upon sanatorium St.a.Ull, a.nd. o( tbe granting of Ieave to pationts at holiday and other times, wero postpcncd until tbo next meeting.
or
LETTERS. WUAT IS ... DnrENu.nt? DKAn l~DITon,-I am interested In tbe lotter from Dr. J. Dickinson Leigh, In the May i~~uo of TUBItRCLE, as I have long been of opinion thILt tho term ,. Tuberculosis Dispensary" III a misnomer, Tuberculosis patientll cannot be treated satlsfa.ctorily as out-patients, and every Ilottempt to run ~ tuberculos~s dispensa.ryon t~e liDOS of • hospital out.pallent department 11 bound to fllil. It III well known by this t.1me thi\t very little can 00 dono for tuberculosis in t.he way of drugs, And It ill a.great atep forward to have disa.bused the mind of the pl\tiont of tho universal eilicacl of tbe II bott.1o of physic," 10 the Report 0 the Inter.Depo.rtmental Committee (Appendix 2), Sir George Newman 111),1, with reference to dlsponsaries, tbat tho
results obtained bad not come up to ellpt'CU. tion; ho goes on to Bay tbat the functionl 0( A disJlousary aro varioua .. but lDlliuly it Is a clea.rtnj:( bcusc," This, i think, ill now proU,. ficnorally recognized, except in tholle ar..... wbero tuberculosia diilXlusarles Arl! pra.cticl1l1r synonymous with tubcrllulln dispenaarioJ_ a contingency ..gainst which mllny '\\"arniug voices were raised eome .even or eight years ago. If we rogard II. tuberculosis dlspol usa r, ... an out-patient department (wbicb, accordillg t.o Dr. Leigb, iii tbe view adopted by lU08~ bta.lth authorities in the North), what. meot is there (apart from tuberculin) avallable for phthisical f.ntients? It can be lummed up 80S cod-liver oi , cough.mlxtures-whicb IboulJ be given with discrimination and not eu.
btl.'.
J.
nne, 19201.
1TBEHCLE
.
coti raged - d r llg ll of questi ona ble va lue, s uc h iag cr/ll)ll()to and the like, and oecasi onul di g-cR , th"e mixtures and tonics, N ow all these C'ITI
Im p roperly proscribed Ly the patien t' s
O IVII
panel doctor. and arc milch bet ter J ~ft i ll his bands, It would he a wa s te o f pu bl ic m o ne ys t4 keep up dispensaries for such purposes ns th is, fAit lUI guard llgfl.lnst the degencrut ion I)f t.he tube~ul Olli ll
dispen sary al ong th ese Iincs, L e t hold to the views th at th e d isp cn sary is primarily a sort.iug-houso and co nst Jlt a.tiv ,! c¢utn. and lJo medium through which the tuber . cnlO-'li" offieor may keep in touch wi th 11.11 vatielltl; well enough to attend pcr iod icalh', so r.lmt Ilill advice may alw a vs he aVllila hle: No doubt oth er m ethods mu v result i ll t he Iitt4'udaflCO of larger num bers paticnts , bu t WIJ should sat our fa ces ste l\d fM,t ly agn in .4 the wndency to judge o f the S IlCCO~ ~ of d is pen sary work by the number o f p vt ie n ts on th e Look s, \\1mn all iR said, mu ch of th o most irnUi
of
pt>dant work of th o tuberculosis o llL'e r lies otluido th e d lsponsary. In t he eMu uf th o poor . it II! the homo conditi on s th a t, con stituto the root of the difficulty of deal ing wit h Ln bc r. culosls, and much of th o wo rk of the tubor , C~IOili s .o ffi~or will be tak ~n up with d ealing With thlJl side of the que sti on. In concl usion , 1 would suggest that as t he t erm" di sp en sarY" CfmVtlYK a wrong impressi on ,a bett er te rm \\'ol;l ,l 110 .. Tuberoulosis Centre," or "Tubercul osis
l'linic." .
E . W" :ATIlI':ltIm AD , Tuberculosis Ol)icer, hie of Ely.
4·J!11 THE NIWTnOPJIll . "; C OV-iT.
DI~AII EIlIrOR,-I notice i ll Y')\Ir :'IJ",' isslio ~ J; h~ rt eri t.icism of D r, Trcdgoi d' s r,ll"l"l t pub ,
Iicn t.ion on .. 'l'h e S ignilje;lll ce o f th o Ar not.h Co u n t in th o H a' 1ll0I',i,t ol og,\' o f T u 1>.!rc nl o'lis, " At th o co nc lusio n of yo u r rev iew you S;l )' , " It would ho int()f('Rt.ing to kn ow whether t he phen omenon is found in Ill) eases wi th i' wn'a sed production and de s t ru c tio n o f wh ite cnll x, HH:h a " g ra ve un n-m ins finn infective d iseas es. Furth ern~ore, ,a muel? larger st'ri t's of norm ills, (' ~pecl all'y 111 ,nJ la l. ' Ol~ t o n u t.rit.ion , w o wl,h a n d me tabolt sm, I ~ re q u ire d he fon ! a n y grcut rel ian ce ca n he placod u pon tl " , t est , ' ; III two articles on th o lcu cocv to co u n t in p ulm onary tu hcrculosi s wh ich apjJPIHod in the 1~" 1~1 5 h Joltl'l~,!-l If '1'lIher('It I"si,~ for ()l: t.,]mr , l ~lf",l\nd Apri}, l Ull, I sho wed tl m t c Olls id er. ai d e )l1l p l) r ~ lLn ~(' s li ou ld j,~ a t tu c ho.l. 110 1, on ly b th e 'l llall ta l rve c ha nge III t,he polym orph» . nuclear noutral,llllc lou cocytos. but al.",) to tho qua ntltll.Li~'o c ha nge w!J;{'!J call hed clllOlIstrat'ld bj' S IlC CC'SS I \ ' O t ot a l !l Ot H,l t,s, Si nce tho puhlien . t.ion of t hese t wo art. icl es, I have no ,l itional expe r imen ta l informa ti on th at in th e presen ce of acute tubercul ous toxn -miu, e. g" m ili arv t u bercle , th ~rc is 110 pol ym urph ou uc le.u- I'll. ~P ()Il ~C III sp ite o f m a rk ell " d ev iat ion t o till:
lclt,..
Mall ]3, 1\)20.
JOHN
JJi'llJ 9, 1920.
HOSPITALS AND SANATORIUMS.
Solarium, Derbyshire Sanatorium, Ohesterfield .
n,
IIfcJ)fll: U ,H.L,
'J'11 11I"rl' II !,"i , Ollirrr (0
J'vrkshire W.U.
TUDERCLE
Dr. McDoUGALL (We8~ ltiding) pointed out that II. moderate rlsa in pulse.rate. 80 to DO, with 110 rise in temperature, ohen indicated sub. IloCute diseuse. lIe found that such cases often had a very high leucocyte count and the prognosis was bad. IIe believed In the Arueth count, toge~her with 0. total leucocyte count. Dr. PATItRSON agreed that autolnoculatlcn could occur without rise of temperat~rd. but with incroased pulse-rate, Sir IIB:NBY QAUVUN made an appeal for provision of more beds for adult ncu -pulmcnary cases. Non·pulmonary disease had, .up to now been called surgical tubetculosis and treatcd by surgeous in ~eneml hospitals. Conservative metbods, while correcting deformity, had at ~he B.a.me time proved more uti8fl,ctory. Tbe basis of these 18 the treatment of 0. general diaease by general methods, with adjuvant methods for local maulloatations (e.g., X ray, heliotheupy, vaccines). General treatment included climatic hygiene, dietetics, &c. Slides were then shown demonstrating the work at Alton and Sandy Point, the speaker empuasising the value of education. Ab~ces8 aspiratiou was als? de~ribod,. together with methods of producing Ilquefuction. lIeliothemry powerfully accelerated cure by bactoricil1a action and inflammatory teaponse. The exposure must be ca.re{ully dosed so as llot to cause necrosis. Ultrl\.violet ray. had very little, H o.ny, ,P0netra.ting p.>wer. The Iunctioua of lurgery (IU bone Il.ud joint tubercle) were now limited, especlo.lly In t.he treatmcnt of children. Dr. U. A. ELLlS Bo.id thILt the treatment of lupus glLve the ke)·note of all kinds of tubercuh'llliB, by differentiating between tuberculous and ncn .tuberculous t1esue. The methods of knife spoon and Cl\ustics were replaced by contr~ll\ld methods. He referred Bpecially to picric brass llo.ijlo. This bad 80 specific action upon tuberculous tlBSUO without toxic eaect. lIr. Ellis nlso described the usa of brass iu suppositories for intcrual tubcrculoals, Bro. 1 In 4 W&1 used in cod·liver oil for phl)'c-
(Junc.1920
tenulre. The action of an these prepa.ra.t.ions was, he thought, due to the liberat.ion of .. trypLie ferment. Dr. :MARTiN (Lea.sowc), Dr. FItR:U.lt1>':~ (Leeds}, and Dr. WILLIUIS (Dewsbury), alsu spoke. [Th" '-t11Ort3 01 Section. D, E, F, G, II, 1; J, K, L, Q,/\a AI wm apIJ6ar i/\ tJu 1"~1I 'uu,,)
SOJIET'l OF SUPERINTE~DENT~ OF TUBERCULOSIS INSTITUTIO~.S. A well·attended genernl meetlng of tho Society Wll.8 held at the l'resident.'s bouse on Monday, May 17, at 4 p.m, A loug li,,~ o( new members were elected. Dr. GEORGIt Jo~lo:. and Or. P. C. VURIER-JO:iXS fel~ compelld from pressure of other work to resign frOID the Executlvo Committee,l\ud Drs.H. O. DLANroat> and S. VittlE: PUt1S0:l were elected ta filllbeir places, _ Professor LEO:iARD HILL gave an tuterll't.lng address on .. Tbo Principles lnvolved In tho Science of Fresh Air Treatment and Ventilation," wbich was followed by questions and an interesting discussion, in the COUflIO of which the heating of rOQmS by tho method ot heaLing tho floor found general favour. . After a. brief discussion on .. Tbll 'I'rainlng of Sanatorium Nurses," tho following resoluLion was passed: .. Tho.t a.commltteo he appointe.! to consider the whole qucstion of the tralnlult of nurses for tho treatment of tuberculoals;' Dr. E:iTHIl:R CARLINO, Dr. MARCUS l)4Tl:nso~. Dr. NOEL DARD5WELL, and Dr. II. O.1Ju:c. FORO (11.3 convener) were elected to Iorm this Bub-committee. ,A discussion on I I The llclath'e Values Butter aud Marga.rine in the Trllatmont of Tuborculosis" resulted in an exprosalon of opinion in favour of tho choaper commodity 10 long as vltamines in the diet were 1I0t O\·er. looked. The consideration of tho employment of ox-patients upon sanatorium St.a.Ull, a.nd. o( tbe granting of Ieave to pationts at holiday and other times, wero postpcncd until tbo next meeting.
or
LETTERS. WUAT IS ... DnrENu.nt? DKAn l~DITon,-I am interested In tbe lotter from Dr. J. Dickinson Leigh, In the May i~~uo of TUBItRCLE, as I have long been of opinion thILt tho term ,. Tuberculosis Dispensary" III a misnomer, Tuberculosis patientll cannot be treated satlsfa.ctorily as out-patients, and every Ilottempt to run ~ tuberculos~s dispensa.ryon t~e liDOS of • hospital out.pallent department 11 bound to fllil. It III well known by this t.1me thi\t very little can 00 dono for tuberculosis in t.he way of drugs, And It ill a.great atep forward to have disa.bused the mind of the pl\tiont of tho universal eilicacl of tbe II bott.1o of physic," 10 the Report 0 the Inter.Depo.rtmental Committee (Appendix 2), Sir George Newman 111),1, with reference to dlsponsaries, tbat tho
results obtained bad not come up to ellpt'CU. tion; ho goes on to Bay tbat the functionl 0( A disJlousary aro varioua .. but lDlliuly it Is a clea.rtnj:( bcusc," This, i think, ill now proU,. ficnorally recognized, except in tholle ar..... wbero tuberculosia diilXlusarles Arl! pra.cticl1l1r synonymous with tubcrllulln dispenaarioJ_ a contingency ..gainst which mllny '\\"arniug voices were raised eome .even or eight years ago. If we rogard II. tuberculosis dlspol usa r, ... an out-patient department (wbicb, accordillg t.o Dr. Leigb, iii tbe view adopted by lU08~ bta.lth authorities in the North), what. meot is there (apart from tuberculin) avallable for phthisical f.ntients? It can be lummed up 80S cod-liver oi , cough.mlxtures-whicb IboulJ be given with discrimination and not eu.
btl.'.
J.
nne, 19201.
1TBEHCLE
.
coti raged - d r llg ll of questi ona ble va lue, s uc h iag cr/ll)ll()to and the like, and oecasi onul di g-cR , th"e mixtures and tonics, N ow all these C'ITI
Im p roperly proscribed Ly the patien t' s
O IVII
panel doctor. and arc milch bet ter J ~ft i ll his bands, It would he a wa s te o f pu bl ic m o ne ys t4 keep up dispensaries for such purposes ns th is, fAit lUI guard llgfl.lnst the degencrut ion I)f t.he tube~ul Olli ll
dispen sary al ong th ese Iincs, L e t hold to the views th at th e d isp cn sary is primarily a sort.iug-houso and co nst Jlt a.tiv ,! c¢utn. and lJo medium through which the tuber . cnlO-'li" offieor may keep in touch wi th 11.11 vatielltl; well enough to attend pcr iod icalh', so r.lmt Ilill advice may alw a vs he aVllila hle: No doubt oth er m ethods mu v result i ll t he Iitt4'udaflCO of larger num bers paticnts , bu t WIJ should sat our fa ces ste l\d fM,t ly agn in .4 the wndency to judge o f the S IlCCO~ ~ of d is pen sary work by the number o f p vt ie n ts on th e Look s, \\1mn all iR said, mu ch of th o most irnUi
of
pt>dant work of th o tuberculosis o llL'e r lies otluido th e d lsponsary. In t he eMu uf th o poor . it II! the homo conditi on s th a t, con stituto the root of the difficulty of deal ing wit h Ln bc r. culosls, and much of th o wo rk of the tubor , C~IOili s .o ffi~or will be tak ~n up with d ealing With thlJl side of the que sti on. In concl usion , 1 would suggest that as t he t erm" di sp en sarY" CfmVtlYK a wrong impressi on ,a bett er te rm \\'ol;l ,l 110 .. Tuberoulosis Centre," or "Tubercul osis
l'linic." .
E . W" :ATIlI':ltIm AD , Tuberculosis Ol)icer, hie of Ely.
4·J!11 THE NIWTnOPJIll . "; C OV-iT.
DI~AII EIlIrOR,-I notice i ll Y')\Ir :'IJ",' isslio ~ J; h~ rt eri t.icism of D r, Trcdgoi d' s r,ll"l"l t pub ,
Iicn t.ion on .. 'l'h e S ignilje;lll ce o f th o Ar not.h Co u n t in th o H a' 1ll0I',i,t ol og,\' o f T u 1>.!rc nl o'lis, " At th o co nc lusio n of yo u r rev iew you S;l )' , " It would ho int()f('Rt.ing to kn ow whether t he phen omenon is found in Ill) eases wi th i' wn'a sed production and de s t ru c tio n o f wh ite cnll x, HH:h a " g ra ve un n-m ins finn infective d iseas es. Furth ern~ore, ,a muel? larger st'ri t's of norm ills, (' ~pecl all'y 111 ,nJ la l. ' Ol~ t o n u t.rit.ion , w o wl,h a n d me tabolt sm, I ~ re q u ire d he fon ! a n y grcut rel ian ce ca n he placod u pon tl " , t est , ' ; III two articles on th o lcu cocv to co u n t in p ulm onary tu hcrculosi s wh ich apjJPIHod in the 1~" 1~1 5 h Joltl'l~,!-l If '1'lIher('It I"si,~ for ()l: t.,]mr , l ~lf",l\nd Apri}, l Ull, I sho wed tl m t c Olls id er. ai d e )l1l p l) r ~ lLn ~(' s li ou ld j,~ a t tu c ho.l. 110 1, on ly b th e 'l llall ta l rve c ha nge III t,he polym orph» . nuclear noutral,llllc lou cocytos. but al.",) to tho qua ntltll.Li~'o c ha nge w!J;{'!J call hed clllOlIstrat'ld bj' S IlC CC'SS I \ ' O t ot a l !l Ot H,l t,s, Si nce tho puhlien . t.ion of t hese t wo art. icl es, I have no ,l itional expe r imen ta l informa ti on th at in th e presen ce of acute tubercul ous toxn -miu, e. g" m ili arv t u bercle , th ~rc is 110 pol ym urph ou uc le.u- I'll. ~P ()Il ~C III sp ite o f m a rk ell " d ev iat ion t o till:
lclt,..
Mall ]3, 1\)20.
JOHN
JJi'llJ 9, 1920.
HOSPITALS AND SANATORIUMS.
Solarium, Derbyshire Sanatorium, Ohesterfield .
n,
IIfcJ)fll: U ,H.L,
'J'11 11I"rl' II !,"i , Ollirrr (0
J'vrkshire W.U.