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WHITHER THE ALMONER?
38
At the recent annual school dinner the chairman described a plan of decentralised organisation in which a social welfare office under the direction of an almoner would be placed on each floor of the hospital. She would then have the threefold duty of (1) providing the honorary concerned with a preliminary report from the practitioner together with such other information as may be necessary ; Now that preparations for the 1941 census in British (2) arranging the visit so as to reduce waiting to Africa are afoot, the time has surely come to try the a minimum ; (3) finally supplying the practitioner method of sample surveys as an addition to a tech- with a report. To these duties the chairman added nique that has hitherto failed to produce satisfactory yet another-that of arranging for the patient’s admission to hospital. These cumulative functions results. will place upon the almoner in the new Westminster SOME NERVOUS COMPLICATIONS OF a great weight of responsibility. At a first glance she seems to be the most suitable person for the CHEMOTHERAPY since she is in touch with all departments of the IN a leading article on August 13th we referred to job, and knows what hospital attendance means hospital some of the unpleasant complications occasionally to the patient. Whether it is altogether a step in arising from the use of Uleron for gonorrhoea, and on the right direction remains to be seen. Inquiry Oct. 15th we published an example of peripheral into means has probably gone far enough and the neuritis attributed to this cause. Further examples almoner’s training fits her for administration. But appear in the Dermatologische Wochenschrift, where to local doctors and arranging admission to Schubert1 records the case of a young man who ’was reporting the wards are medical matters, and anything that cured of gonorrhoea by taking uleron but developed weakens contact between hospital staff and practiacute transverse myelitis of the spinal cord a forttioner is to be deprecated. The almoner should night later and died after another month. Autopsy not claim medical knowledge, nor is it in the established " softening " (myelosis) of the cord, and interest to employ her on work which doeshospital’s not use although there is a suspicion of over-dosage before her special knowledge of social problems. It looks admission to Schubert’s clinic, and the issues of this as though the honorary staff could do with efficient case are further complicated by the onset of symptoms secretarial assistance, without taking the almoner having coincided with the hardships of a long ski off the medico-social work which is her primary tour, the facts appear significant. They become more function. Actually the taking of social histories is so when read in conjunction with another report of in the same ratio as the realisation of the transverse myelitis, with recovery2 and with a increasing effect of environment on the patient’s condition. 3 summary of 31 collected cases of paresis of the legs It is this part of the almoner’s work which is essential possibly attributable to the drug. It is suggested to the medical staff. Cooperation between medical that the risk of complications may be relatively and social welfare units should ensure a well-balanced greater in children than in adults. team. it is only possible to say that the African population is probably now either stationary, or subject to a very slow increase." Official assumptions about the extent of infantile mortality cannot be confirmed nor can one estimate the effect on the birth-rate of certain native customs. The difficulties of enumeration among primitive peoples are manifold and consequently census returns are by no means reliable.
WHITHER THE ALMONER? THE 29th report of the Cecily Northcote Trust before us is an example of how " the ideal of organised and comprehensive social care for all patients" may become an integral part in the life of a hospital. The phrase taken from the text of the report is the modern equivalent of Sir Thomas Browne’s: " There are infirmities, not only of body but of soul and fortunes, which do require the merciful hand of our abilities." A series of case reports shows the almoner at St. Thomas’s Hospital not only inquiring into means and assessing payments but also giving the patient that social help contemporaneous with and shaped by medical treatment which is so necessary in most cases for carrying out the recommendations of the medical staff. Careful study of the individual patient in hospital helps to show his existence not as a series of unconnected crises but, in the main, This as an inexorable sequence of cause and effect. is a big task already, but the new Westminster Hospital envisages yet another sphere of work for the almoner. Mr. Rock Carling proposes that in the outpatient department to be opened in the coming May it should be the almoner’s task to organise the consultations and subsequent treatment. She is to arrange the work by appointment and if, by a slip, a patient should arrive on the wrong day, it would fall to her to get one of the whole-time medical staff to make preliminary investigation, pending consultation with an honorary. But that is not all. M., Derm. 1 Schubert, 2
Wschr. Nov. 19, 1938, p. 1361. Lilienthal, W., Ibid, July 9, 1938, p. 833. 3 Döllken, H., Ibid, Oct. 29, 1938, p. 1273.
RELIEF OF PAIN IN ARTHRITIS
FOR many years Leriche and others on the Continent have been in the habit of injecting local anaesthetics into or around joints in order to relieve the pain of chronic arthritis and kindred conditions. . The relief obtained in this way lasts considerably longer than would be expected and can be further prolonged by the use of oily solutions which are absorbed slowly and allow a gradual liberation of the anaesthetic. It has also been found that when the pain returns it tends to be less severe, and that after one or more injections the relief is sometimes more or less permanent. The explanation of this is doubtful, but such drugs as procaine clearly produce an analgesia that long’ outlasts their anaesthetic effect, and it has been suggested that they act by interrupting some reflex vicious circle of pain, spasm, and congestion. In the last four years Tarsy1 of Brooklyn has treated 172 cases of chronic painful conditions in and around joints by local and regional injections, and he reports that 126 of these were improved, most of them very definitely, and that in many the improvement has been maintained for from one to two years. He used either a 1 per cent. solution of procaine or a solution of Eucupin in oil. He recommends the former for general use because of its ease of administration, the oily solution being reserved for intractable cases. The method is most satisfactory in degenerative and traumatic rather than in infective arthritis, though Tarsy obtained a few exceptionally good results in rheumatoid arthritis,
1 Tarsy,
J.
M., Med. Rec.
Oct. 5, 1938, p. 2 69.
At the recent annual school dinner the chairman described a plan of decentralised organisation in which a social welfare office under the direction of an almoner would be placed on each floor of the hospital. She would then have the threefold duty of (1) providing the honorary concerned with a preliminary report from the practitioner together with such other information as may be necessary ; Now that preparations for the 1941 census in British (2) arranging the visit so as to reduce waiting to Africa are afoot, the time has surely come to try the a minimum ; (3) finally supplying the practitioner method of sample surveys as an addition to a tech- with a report. To these duties the chairman added nique that has hitherto failed to produce satisfactory yet another-that of arranging for the patient’s admission to hospital. These cumulative functions results. will place upon the almoner in the new Westminster SOME NERVOUS COMPLICATIONS OF a great weight of responsibility. At a first glance she seems to be the most suitable person for the CHEMOTHERAPY since she is in touch with all departments of the IN a leading article on August 13th we referred to job, and knows what hospital attendance means hospital some of the unpleasant complications occasionally to the patient. Whether it is altogether a step in arising from the use of Uleron for gonorrhoea, and on the right direction remains to be seen. Inquiry Oct. 15th we published an example of peripheral into means has probably gone far enough and the neuritis attributed to this cause. Further examples almoner’s training fits her for administration. But appear in the Dermatologische Wochenschrift, where to local doctors and arranging admission to Schubert1 records the case of a young man who ’was reporting the wards are medical matters, and anything that cured of gonorrhoea by taking uleron but developed weakens contact between hospital staff and practiacute transverse myelitis of the spinal cord a forttioner is to be deprecated. The almoner should night later and died after another month. Autopsy not claim medical knowledge, nor is it in the established " softening " (myelosis) of the cord, and interest to employ her on work which doeshospital’s not use although there is a suspicion of over-dosage before her special knowledge of social problems. It looks admission to Schubert’s clinic, and the issues of this as though the honorary staff could do with efficient case are further complicated by the onset of symptoms secretarial assistance, without taking the almoner having coincided with the hardships of a long ski off the medico-social work which is her primary tour, the facts appear significant. They become more function. Actually the taking of social histories is so when read in conjunction with another report of in the same ratio as the realisation of the transverse myelitis, with recovery2 and with a increasing effect of environment on the patient’s condition. 3 summary of 31 collected cases of paresis of the legs It is this part of the almoner’s work which is essential possibly attributable to the drug. It is suggested to the medical staff. Cooperation between medical that the risk of complications may be relatively and social welfare units should ensure a well-balanced greater in children than in adults. team. it is only possible to say that the African population is probably now either stationary, or subject to a very slow increase." Official assumptions about the extent of infantile mortality cannot be confirmed nor can one estimate the effect on the birth-rate of certain native customs. The difficulties of enumeration among primitive peoples are manifold and consequently census returns are by no means reliable.
WHITHER THE ALMONER? THE 29th report of the Cecily Northcote Trust before us is an example of how " the ideal of organised and comprehensive social care for all patients" may become an integral part in the life of a hospital. The phrase taken from the text of the report is the modern equivalent of Sir Thomas Browne’s: " There are infirmities, not only of body but of soul and fortunes, which do require the merciful hand of our abilities." A series of case reports shows the almoner at St. Thomas’s Hospital not only inquiring into means and assessing payments but also giving the patient that social help contemporaneous with and shaped by medical treatment which is so necessary in most cases for carrying out the recommendations of the medical staff. Careful study of the individual patient in hospital helps to show his existence not as a series of unconnected crises but, in the main, This as an inexorable sequence of cause and effect. is a big task already, but the new Westminster Hospital envisages yet another sphere of work for the almoner. Mr. Rock Carling proposes that in the outpatient department to be opened in the coming May it should be the almoner’s task to organise the consultations and subsequent treatment. She is to arrange the work by appointment and if, by a slip, a patient should arrive on the wrong day, it would fall to her to get one of the whole-time medical staff to make preliminary investigation, pending consultation with an honorary. But that is not all. M., Derm. 1 Schubert, 2
Wschr. Nov. 19, 1938, p. 1361. Lilienthal, W., Ibid, July 9, 1938, p. 833. 3 Döllken, H., Ibid, Oct. 29, 1938, p. 1273.
RELIEF OF PAIN IN ARTHRITIS
FOR many years Leriche and others on the Continent have been in the habit of injecting local anaesthetics into or around joints in order to relieve the pain of chronic arthritis and kindred conditions. . The relief obtained in this way lasts considerably longer than would be expected and can be further prolonged by the use of oily solutions which are absorbed slowly and allow a gradual liberation of the anaesthetic. It has also been found that when the pain returns it tends to be less severe, and that after one or more injections the relief is sometimes more or less permanent. The explanation of this is doubtful, but such drugs as procaine clearly produce an analgesia that long’ outlasts their anaesthetic effect, and it has been suggested that they act by interrupting some reflex vicious circle of pain, spasm, and congestion. In the last four years Tarsy1 of Brooklyn has treated 172 cases of chronic painful conditions in and around joints by local and regional injections, and he reports that 126 of these were improved, most of them very definitely, and that in many the improvement has been maintained for from one to two years. He used either a 1 per cent. solution of procaine or a solution of Eucupin in oil. He recommends the former for general use because of its ease of administration, the oily solution being reserved for intractable cases. The method is most satisfactory in degenerative and traumatic rather than in infective arthritis, though Tarsy obtained a few exceptionally good results in rheumatoid arthritis,
1 Tarsy,
J.
M., Med. Rec.
Oct. 5, 1938, p. 2 69.