1462 COUNTY COUNCILS AND ISOLATION HOSPITALS.

old objection that lessened risk means lowered wages hasstill some force. The society aims at finding a respiratorwhich shall be simple in construction, light, cheap, and

sightly, one which can be worn for hours without inter-

ference with respiration, and one which will not permitexpired air to be breathed again. An apparatus satisfy- ’ing all these requirements would have a certain sphereof usefulness, but we are a little doubtful whether the

society is working on the right lines. Even supposingthat a thoroughly efficient respirator impermeable to dustwere devised we fear that the difficulty of getting work-people to wear it would not be easily overcome. Even if

worn it would afford no protection against poisonous vapoursand while it might limit the field of pneumonokoniosisand enterokoniosis it would have no application to the im-portant group of lesions included under the term dermato-koniosis. The plan of carrying on the work before an upcastshaft so that dust and vapours are at once borne awayby a current of air seems rather the one deserving of

encouragement. -

RECENT DISCOVERIES ON THE CAUSATION AND

TREATMENT OF HAY FEVER.

THREE interesting contributions to the subject of the

causation and treatment of hay fever have been recentlypublished. In the Berliner Klinische Wochenschrift, ofMarch 2nd Dr. G. Rosenfeld of Berlin refers to the questionof hay fever as caused by the pollen of certain flowers andadds to the list a plant hitherto unrecognised as a cause-viz., the plantus occidentalis which is found in bloom in theneighbourhood of Stuttgart from the middle of May to theend of June, during which time hay fever is prevalent in that locality. The symptoms of hay fever caused by it are of theusual type and can be reproduced by experimental insuffla-tion of the pollen into the nostrils. In the -zVeTv York

Medical Record of March 28th Dr. Raymond Wallace

emphasises the fact that a neurotic predisposition to the

affection exists in persons who develop hay fever. Persons

who are "naturally highly strung, excitable, irritable,neurasthenic, having nerves ’ which are literally on thesurface,’ are those who are more liable to this affection thanare the more phlegmatic types."

" The element of periodicitywhich is generally observed in attacks indicates that a

psychical factor is concerned in the etiology of hay feveras exemplified in the case of a patient who has had attackson August 15th of one year and who began to suffer in

subsequent years on the same date. A neurotic youngwoman, aged 25 years, known to Dr. Wallace, suffers

regularly from three attacks per diem on certain days.Thus upon arising from bed she always anticipates anattack and it always comes on unless she can abort it byfirm pressure upon the upper lip. In the afternoon at the

lunch hour a second attack follows and at night on retiringto her bedroom the third attack occurs. Another case was

that of a young man, aged 30 years and of neurotic con-stitution. He suffers from hay fever in a regular and periodicfashion. Under medical treatment he does not have morethan four or five attacks during the day. When at work inhis office he is seldom troubled with an attack. But if he

is spending the evening in society his mind dwells uponthe possibility of an attack and of the embarrassment

likely to be caused. He then has two or three attacks

and is compelled to leave the room. Dr. Wallace has foundthat strong sunlight will in some persons provoke an attackof hay fever with its attendant symptoms of sneezing, vaso-motor congestion of the nostrils, and coryza, the attack

being caused reflexly by excitation of the vaso-motor

centres through the optic nerve, and in the same way ithas been observed that dust, pollen, and certain odours

may act through the trigeminal and olfactory nerves and

provoke an attack. The psychical element is, concludes

Dr. Wallace, a factor of growing importance in manydiseases and in hay f ever it plays an important part. Dr.

Dunbar, the physician in charge of the Institute of Hygieneat Hamburg, states in the Deutsche Medicinische Wochen-

schrift, No. 9, 1903, that he has succeeded in isolating thetoxic substance from the pollen of grasses which is capableof producing hay fever in predisposed persons. He was thus

able to reproduce attacks of the disease in winter by sub-cutaneous injection of a minute dose of the same. This

toxic substance is not the ethereal or oily constituent of thepollen grains but is apparently, adds Dr Dunbar, an alka-loidal body. The attack of hay fever produced by it isintense. An attempt was made to produce an antitoxicserum from the blood of animals inoculated with this toxin.After some trials this was successfully effected and in thecourse of his experiments he inoculated eight patients withhay fever by instilling into the eye finely-ground pollengrains suspended in water. In every case the physical andsubjective symptoms of hay fever were reproduced in varyingdegrees of intensity. The new serum was then tested bymixing some of it with the pollen and applying the mixtureto the eye. "The eye itched slightly and appeared con-gested," but these symptoms disappeared in less than 30minutes. The serum was equally effective against the pollenof various cereals.

____

COUNTY COUNCILS AND ISOLATION HOSPITALS.

THE E,sex county council is apparently the first to take

advantage of the Isolation Hospital Acts and to make grantssystematically to the authorities which have provided isola-tion hospitals. Prior to the recent amending Act grants couldonly be made to hospitals erected under the Act of 1893,now grants can be made to any hospital, but the sanction ofthe Local Government Board is necessary if the hospitalis erected out of current rates and therefore without the

plans having received the approval of that Board. At the

commencement of this year the Essex county councilannounced that it was prepared to make grants towardsthe maintenance of isolation hospitals and that applica-tions were to be made before a given date. Applicationswere received from 17 out of the 19 authorities in the countywhich had provided hospitals. All these hospitals have beenexamined and reported upon by the county medical officer ofhealth and the marks awarded range from 55 to 100, the

latter being the maximum. In awarding the marks everypoint in connexion with the position, construction, and

administration of the hospitals was taken into account,

together with the adequacy of the accommodation for thedistricts served. The sanitary committee has adoptedthese marks as the basis upon which the grant shall be madeand recommended that each authority should receive 2s. permark per bed for the year ending March 31st, 1903. The

best hospitals will therefore receive a grant of £10 per bedand the worst £5 10s. It is probable, however, that

next year some other basis will be adopted, as the differ-ence between the various hospitals is not sufficiently wellmarked to encourage the improvements and reforms whichthe county council wishes to see carried out. Of the

17 hospitals to which grants have been allotted six were

erected out of current rates and therefore the approval ofthe Local Government Board will be necessary before the

grants can be paid. These hospitals are all wood and ironstructures of a so-called "temporary" character and it

remains to be seen whether the Board will sanction grants tosuch hospitals. The possibility of a refusal is evidentlyrecognised, as the sanitary committee recommends, if theBoard’s sanction is withheld, that no grant should be madeto any hospital. The table prepared by the county medicalofficer contains a mass of interesting information. Amongst

1463A STATE REGISTER OF TRAINED NURSES FOR POOR-LAW INFIRMARIES.

other items it appears that the permanent isolation hospitalsin Essex have cost from £360 to .E700 per bed to erect, andthat the establishment and patients’ expenses have variedfrom £28 to E167 per bed. There can be no doubt that the

attention which the county council is giving to this subjectwill ultimately result in a great improvement in the hospitalaccommodation and administration throughout the county.

A STATE REGISTER OF TRAINED NURSES FORPOOR-LAW INFIRMARIES.

AT a conjoint conference convened by the Matrons’ Counciland by the Society for the State Registration of Trained

Nurses on May 8th at 20, Hanover-square, W., a paper wasread by Miss Eleanor C. Barton, matron of the Chelsea

Infirmary, entitled ’’ State Registration of Trained Nursesas it affects Poor-law Infirmaries." " The writer of the paperseemed to be in favour of the establishment by the State ofa register of trained nurses, but she advanced nothing in thenature of argument to support such a procedure on the partof the Local Government Board beyond the conjecture that"when the State registration is inaugurated and the

present chaotic state of the nursing profession is at

an end the trained and disciplined nurses of our metro-

politan infirmaries, who have as yet hardly been appre-ciated as they ought to be, will form a large andvaluable addition to the nurses of Great Britain." " The Ipaper almost failed to carry out the promise of its title, forit did not-except in the extract given above-show themanner in which State registration of nurses will affectthe Poor-law infirmaries. The paper touched lightly, fromthe nurses’ point of view, upon the various branches of

infirmary work and it also enumerated the great teach-

ing opportunities afforded by the nursing of the many agedpatients and others suffering from chronic diseases found inthe wards of the modern infirmaries but rejected from thewards of the hospitals. With the actual statements con-

tained in the paper we are quite in agreement, but

underlying those statements there appeared to be two

assumptions upon each of which we may make a few

comments. The first was that the Local Government

Board has the intention of establishing in the near

future a system of State registration for nurses ; and thesecond was that there will be an examination conducted bya State-appointed board of examiners. So far as we can

ascertain there is of the intention mentioned no evidence

whatever. Neither has it yet been clearly shown that

the public and the authorities of the two great nursinginstitutions (the hospitals and the infirmaries) have

arrived at an agreement upon the desirability of State

registration of nurses. We have reason to believe

that certain of these authorities hold the opinion thatit would be unwise to inaugurate a system of registrationuntil a defined curriculum and a recognised examinationhave been established. Granting that the Local GovernmentBoard had taken in hand the formation of a State registerof nurses, there would still be little probability of the

creation of a State-appointed board of examiners. A

review of the action of the Local Government Board

during the past few years will lead inevitably to theconclusion that there exists no predilection for examina-tions of nurses on the part of that Board. Women whohave worked for 12 months in the sick wards of a

workhouse and have received a small, indefinite amount ofteaching are, without examination, to be accepted as

qualified nurses by that Board. The superintendent nursesappointed under the General Order of 1897 are onlyrequired to have had a course of instruction for three

years. They may have availed themselves of their

opportunities to the smallest possible degree, for theyhave no examination to pass. Even if they have

tried to pass one and failed they will still be eligiblefor the posts of superintendent nurses. It is true that in

the report of the departmental committee upon nursing inworkhouses recently issued there is a recommendation of adefined curriculum with a final examination, but there-is nothing beyond the recommendation and the matter istreated in a vague unsatisfying manner, wanting in allindications of the scope of the curriculum, without sugges-tions as to the persons who are to arrange the details of the

scheme, but with merely a stipulation that there shall be-two independent examiners, one of them being a lady froma recognised training school. We leave the subject with theobservation that the" present chaotic state of the nursingprofession" (the wording is not ours) may be brought to anend, but the organisation of the chaos will require the con-certed action of the nursing authorities of the large traininginstitutions ; the Local Government Board is not likely toinitiate a scheme that will give general satisfaction but it.

may sanction one. -

PHLEBITIS OF INFECTIOUS ORIGIN INCHLOROSIS.

VENOUS thrombosis is a rare complication of chlorosis

and its pathology is not fully known. In some cases it

depends on phlebitis, which in its turn has been ascribed to.microbes. They have been found in the blood of theinflamed vein and in the general circulation, but in no.

case have they been found in the venous lesion. Hence the

importance of the following case described at the meetingof the Society Medicale des Hopitaux of Paris by M. PaulSainton and M. Andre Jousset. A well-developed girl, aged18 years, was admitted to hospital on Feb. 6th. A fortnight,previously she noticed oedema of the right ankle. Soon painin the position of the external saphenous vein followed. Shewas pale and the skin was waxy white, slightly tinged withyellow. There was marked oedema of the right foot, ankle,and calf. A systolic, musical, almost whistling murmurwas heard at the right border of the sternum. Over theleft jugular vein near the clavicle vibration could be felt anda loud continuous souffle could be heard. The appetitewas diminished and there was constipation. On Feb. 13ththe right thigh was swollen and was five centimetres in

circumference more than the left and its superficialveins were well marked. The pain was increased andsituated in the position of the deep vessels of the limb.With this extension of the phlebitis the general condition,previously good, changed. There were slight pyrexia (anevening temperature of 101.3° F.), malaise, and anorexia.The urine become darker and contained indican. The blood

was very pale and of specific gravity 1052 (instead of 1055).The red corpuscles numbered 2,300,000 per cubic millimetre,there was poikilocytosis, and the hæmoglobin index was 0 62..The white corpuscles numbered 10,000 per cubic millimetre.On Feb. 20th the swelling extended from the thigh to theabdomen and the course of the internal and external iliacvessels was tender. At the same time the cedematous skin

became "marbled" with fine varicosities of ecchymoticappearance, especially at the upper part of the thigh. OnFeb. 22nd the patient complained of a stitch in the rightside and at the base of the lung behind slight dulness anddiminished respiratory murmur were found. On the follow-

ing day she complained to the patient in the next bedthat "she could not feel her left leg and yet felt painin it." " She turned several times in the bed. suddenlyplaced her hand on her chest, complained of being stifled,had an attack of severe dyspnœa without cyanosis, and diedin half an hour. At the necropsy the thyroid gland was foundto weigh 15 grammes (instead of 25) ; the thymus glandwas persistent and weighed 13 grammes (the normal weightin an infant). The aorta was narrow. The right pleural

; cavity contained 300 grammes of serous effusion and there