THE COST OF THE INEBRIATE REFORMATORY OF THE LONDON COUNTY COUNCIL.

THE COST OF THE INEBRIATE REFORMATORY OF THE LONDON COUNTY COUNCIL.

412 upon the intestinal digestive juices. The loss in body weight was found to be very slight, amounting to 0 ’ 2 kilogramme per day in the subjects t...

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412 upon the intestinal digestive juices. The loss in body weight was found to be very slight, amounting to 0 ’ 2 kilogramme per day in the subjects taking freshly preserved milk and 0 ’ 5 kilogramme in those taking milk that had been preserved

days. An increase was noted in the volume of the urine and in the moisture in the fæces. Dr. Wiley argues that a retarded katabolism cannot be beneficial to health as old tissues cannot be expected to function as perfectly as newer tissues. There was a general tendency to produce a slight decrease in the temperature of the body which was probably associated with the retardation in the breaking down of tissues. There was also a slight tendency to produce albumin in the urine. Dr. Wiley finally concludes that the addition of formaldehyde to foods tends to derange metabolism, to disturb the normal functions, and to produce irritation and undue stimulation of the secretory activities. Its use, therefore, is never justifiable. Milk is the most prone of all ordinary foods to undergo deterioration and requires the most careful treatment, so that the temptation to use such an efficient preservative as formaldehye is great, especially in the summer. All the conditions which relate to its use deserve the greatest care and consideration because it is effective in minute quantities which are difficult to detect. Apart from the harmfulness or otherwise of formaldehyde, its use as a preservative of milk or cream is especially inadvisable because in dilute solution it prevents the growth of acid-forming bacteria while it does not retard the growth of many harmful micro-organisms. In other words, the milk is prevented from becoming sour and thus! indicating its age, and the danger signal is removed. while the other organisms which are capable of producing disease continue to multiply. two

Lille, Brest, and Toulon, which were thereby converted into. nurseries for the army medical officers of the future. It wa;. during the Revolution, however, and also under the Empire that the advancement of the French Army Medical Service, Then it was that, in the words of a was most conspicuous. French contemporary,the heroes Virey, Larrey, Desgenettes, Coste, Heurteloup, and Lorenti, men whose names are alike imperishably graven in the hearts of their fellow countrymen and on the brazen plates of the Arc de Triomphe, were destined to cover themselves with glory. On every battlefield of Europe did these patriots follow the soldier, enduring his fatigue, sharing his privations and assuaging his anguish. During the Restoration the chief medical figure in the army is that of Broussais, the iconoclast. To him, as to a sapper,, nothing was sacred. The theories and doctrines of centuries yielded to his ardour and so great was his reputation that the whole of the rising medical generation used to collect at the Val-de-Grace in order to listen to him. In Algeria the chief medical personality is Maillot. Of this great surgeon it may truly be said that it was he who rendered possible the colonisation of France’s great dependency. Thanks to, Maillot that province was doubly conquered; first, at the bayonet’s point and secondly by quinine. With, Maillot’s name should be associated the names of MoricheauBeaupre, Guyon, Hutin, and Baudens, the last named being with justice styled the Larrey of Africa. Not the least instructive portion of this interesting work is that devoted to the Crimean and Italian campaigns. The record is lamentable, but it is only by due consideration of the faults and defects of the past that success in the future After years of failure and sufferance the can be assured. of the French autonomy Army Medical Service was voted in 1882. ____

THE MEDICAL DEPARTMENT OF THE FRENCH ARMY: ITS EVOLUTION AND CAMPAIGNS, 1708-1882.

THE

COST OF THE INEBRIATE REFORMATORY OF THE LONDON COUNTY COUNCIL.

THE Public Control Committee of the London County Council has issued a report in repudiation of certain criticisms. which have been passed upon its policy in respect to the inebriate reformatory at Farmfield in the recently issued report of the Departmental Committee upon the working of the existing Inebriates Acts. The Departmental Committee included in its report a tabular statement of the approximate cost of establishment per bed in 11 certified public reformatories and put this figure for Farmfield at £403, in contrast to amounts ranging from £100 to .6200 for seven other similar institutions. The Public Control Committee objects that the method adopted in making this comparison was unusual and unfair and that by the ordinary method of reckoning the cost of the Farmfield reformatory was .6230 a bed. The Public Control Committee has strong reason to believe that five of the reformatories, which were apparently established at a very low cost, were involved in no heavy capital expenditure, but either hold their premises on lease or have converted, disused workhouses to their present uses. The Departmental Committee has, however, taken the total capital expenditure as the basis of its reckoning and to this the Council’s Public Control Committee objects. Neither does it agree with the Departmental Committee that buildings of a Martiniere, La Faye, Ledran, Garengeot, Cat, Bouchet, suitable nature could be erected for .6150 a bed, but conBazieu, Desport, and especially of Ravaton who is entitled siders that incorrigible inebriates should be detained under to peculiar veneration as a founder of modern military conditions no less favourable than is the case with surgery. The list of members included also the names of lunatics. Exception is also taken to a paragraph in many practitioners of medicine who did much to improve the Committee’s report in which the elaboDepartmental the hygienic condition of the soldier. Amongst these were ration of fittings and ornamentation of certain public Remy, Fort, Dezon, Portius, Jourdan, Le Cointe, Meyserey, asylums for the insane is described, for it is pointed Collombier, Hautesierck, and Dehorne, a notable syndicate out that this description has no justifiable refer under whose auspices was founded in 1782 the Journal de ence to Farmfield, although the context suggests that Medeoine Militaire. In 1775 five schools were established in 1 Archives de Médecine connexion with the military hospitals at Strasburg, Metz, Militaire, November, 1908, p. 397.

work with the above title has been brought out in Paris by the publishing house BergerLevrault, the authors being Surgeon-Major Brice and Captain Bottet, who are introduced in a laudatory preface by Inspector-General Delorme. Under the old régime army surgeons were either chosen by the colonels of regiments or else received commissions directly from the authorities at headquarters. In both cases the work consisted solely in attendance on sick soldiers, all administrative duties, including supply and command, being carried out by commissaries who alone were responsible for the In maintenance of order in the military hospitals. 1731 the Academy of Surgery was founded by Louis XV. at the request of his personal medical attendant, Dr. Mareschal, Duke of Bievre. The surgical celebrities of the period who were desirous of serving their king and country were all members of this institution and used to meet regularly, when not absent on duty, for the discussion of technical matters, one of the subjects most frequently discussed being the nature and treatment of gunshot injuries. Amongst the more celebrated names in this category mention may be made of La Peyronie, La A VERY

interesting

413 tuberculosis, and concluded that the prolonged use of the injections ameliorated, and even cured, the pulmonary le lesions of tuberculosis. In consequence of these reports M Reynier gave subcutaneous injections of ten centigrammes M. of cinnamate of sodium every second day with results w1 which surprised him. The following is an example. A je jeweller, aged 25 years, was admitted into hospital on M March 26th, 1906, suffering from vomiting and constipation. TI The abdomen was tympanitic and he had the abdominal fa facies. Laparotomy was performed but only dilated coils of That unfair comment with regard to the Farmfield reformatory is intestine in were found and the abdomen was closed. On made in the report of the Departmental Committee on the working of the condition was so low that the following days patient’s the Inebriates Acts ; that the attention of the Secretary of State for the Home Department and of Sir John Dickson-Poynder, Bart., the chairman death On the third day after operation he d( was expected. of the Departmental Committee, be called to the matter ; that they be Attention was asked to take the necessary steps for the amendment of the report of passed flatus and after an enema a stool. the Departmental Committee so as to secure that the Council’s position to his chest. He a then directed expectorated large amount in the matter shall be more clearly indicated ; and that they be further in of the event this course to take such There were signs of consolidation nummular asked, of being impracticable, sputum. action as will give similar publicity to the Council’s views as has been of the at the ar softening apices lungs., The temperature the case with regard to those of the Departmental Committee on the and subject. A diet of milk, eggs, and 100 grammes of was 102 .2&ogr; F. In June of last year we had occasion to criticise the Council’s raw meat daily was ordered. A liqueur glass of"iodine ra action in terminating its arrangement whereby habitual w wine " (made by adding 100 grammes of glycerine and eight London drunkards committed from the police courts were grammes of tincture of iodine to a litre of wine) was given gi received into the certified reformatories of the National daily. Every other day a subcutaneous injection of ten Institution for Inebriates, thereby severely restricting the c( in ten cubic centicentigrammes of cinnamate of sodium m of’’physiological serum " was given. operation of the Inebriates Act of 1898. As the motive of metres During the this retrograde step was probably a desire to save the rates first month the patient lost weight and the fever continued at the expense of the taxes-for the only alternative to the but bl the cough diminished. After April 25th the fever ceased and he gained weight. On May 30th the cough had ceased. reformatory for habitual drunkenness is the prison-we can understand that the Council feels galled at an accusation of On 0 June 15th he was discharged cured of his pulmonary lesions and weighing 65 kilogrammes (a gain of 18 kiloextravagance in administering the Act in question. Whilst IE Percussion showed some slight dulness but rales sympathising with its situation we cannot agree that the new grammes). g reformatories should be modelled entirely on public lunatic were no longer heard. He resumed his occupation. At the asylums. There has been regrettable extravagance in the bbeginning of 1907 he had a relapse and recovered under the erection of many of those institutions for which there can be same g. treatment. M. Reynier reported several other similar no excuse in houses of correction for inebriates. c cases. As to the mode of action of cinnamate of sodium, he that this is partly explained by the leucocytosis s suggests it which a produces and,partly by some specific action on the CINNAMATE OF SODIUM IN TUBERCULOSIS. bacillus or its toxins. Under the influence of the drug the IN 1890 Dr. Landerer, a hospital surgeon of Stuttgart, number of bacilli in the sputum are first increased, as if the stated that he had obtained remarkable results from cinnamic had acquired some expulsive power, then they acid (one of the active principles of cinnamon) in the treat- patient diminish and disappear concurrently with the gradually ment of both surgical and pulmonary tuberculosis. AfterE Possibly the cinnamate has, according to expectoration. wards he used sodium cinnamate, which is more soluble. the ingenious hypothesis of Behring, the power of combining He gave intravenous injections not exceeding 25 milliwith the toxins of the tubercle bacillus and rendering them grammes. His results appeared to be so good that heinnocuous. It may be objected that the administration of ’regarded the acid and its salts as almost a specific for raw meat and other measures were also adopted. M. Reynier tuberculosis. He described sections of the tissues showing states that without these measures the same results have oicatrisation obtained as a result of the injections. Subbeen obtained by other observers but less rapidly. He sequent researches have shown that cinnamate of sodium has recommends all the measures as to one complemental the.power of stimulating leucocytosis to which its curative another. properties appear to be due. It may be remembered that in searching for a palliative for inoperable cancer Dr. H. Lovell A NEW TRYPANOSOME. Drage, for this reason, used cinnamate of sodium and its IN November last Dr. J. Rose Bradford communicated to allies. At a meeting of the Académie de Medecine of Paris the Royal Society a Preliminary Note on the Occurrence of a - on Dec. lst, 1908, M. Paul Reynier reported good results New Variety of Trypanosomiasis on the Island of Zanzibar, from cinnamate of sodium in surgical and pulmonary tuberby Dr. Alexander Edington, late director of the Bactericulosis, and referred to similar results obtained by Spanish logical Institute for Cape Colony. It appears that while practitioners. One of these, Dr. Sancho Herrero, found a visit to the stables of the Sultan of Zanzibar an that by Dr. Landerer’s method he obtained only improve- making Indian veterinary surgeon drew Dr. Edington’s attention to ment but not cure. He therefore abandoned intraan "aged" Arab stallion which was suffering from fever, venous injection for subcutaneous or intramuscular injecwith swelling of the chest, legs, and abdomen, from which tion by which he could give much larger doses of illness the animal ultimately died. In blood taken from this cinnamate of sodium-at first 3 centigrammes, then 10, horse some very small trypanosomes were found of a size 20, 60, and 70 centigrammes. He reported a number of somewhat like that of the Trypanosoma dimorphon, but cases of advanced tuberculosis cured by these large doses. rather more delicate, and the blunt end frequently tapered Other Spanish physicians have reported similar results. Dr. to an abrupt point which was somewhat characteristic. A José Codina Castellvi published in the Revista de Medicina specimen slide sent to the Pasteur Institute, Paris, evoked y Cirurgia Practica a long paper in which he analysed the from M. Mesnil the opinion that he concurred in the view effects of cinnamate of sodium on the fever, cough, and the resembled in some the

such conditions exist there under the London County Council’s sanction. On the contrary, reference is made to the report of the Inspector of Inebriate Reformatories for the year 1901 who wrote of Farmfield after its enlargement, ’’ The new buildings may be considered a model for similar institutions." To sum up, the control committee strongly resents the accusations of extravagance to which the Departmental Committee’s report has given rise and makes the following recommendation to the London County Council :-

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