the best use of fever beds

1
865 AN ANTHROPOLOGIST ON JOHN BULL. THE first social evening of the session was held at the Royal Society of Medicine on Monday last, when a very large company of Fellows and guests were received by Sir JAMES BERRY, the President, and Lady BERRY. The speaker of the evening was Sir ARTHUR KEITH, who entitled his witty and entertaining address John Bull: a Study in Anthropology. He took as his text the familiar John Bull of BERNARD PARTRIDGE, remarking that not only was the famous Punch artist the son of one anatomist and father of another, but also he had drawn John’s features with peculiar racial and anatomical insight. The artist, he said, could convey with his pencil that John is bluff, honest, kind-hearted, and generous, with a hearty contempt for everything savouring of pretence, meanness, or dishonesty. The anthropologist with his craniometer, on the other hand, had as yet found no precise method of recording or measuring these characteristics. John is dolichocephalic, but has rather a massive brain. His face shows none of the sharpness and angularity of certain other British types. TENNIEL’s John Bull was an old, old man, but since then he appeared to have grown gradually younger. In the year 1712 the Scotsman, Dr. JOHN ARBUTHNOT, in his " History of John Bull," described the character he had selected as the essential English- man and to whom he had given this name. " In the main," he said, "John Bull was an honest, plain-dealing fellow, choleric, bold, and of a very inconstant temper ; he dreaded not Lewis Baboon (France) either at backsword, single falchion, or cudgel play ; but then he was apt to quarrel with his best friends, especially if they pretended to govern him ; if you flattered him, you might lead him like a child. John’s temper depended very much upon the air ; his spirits rose and fell with the weather- glass. John was quick and understood his business very well ; but no man alive was more careless in looking into his accounts, or more cheated by partners, apprentices, and servants. This was occasioned by being a boon companion, loving his bottle and his diversions, for, to say truth, no man kept a better house than John nor spent his money more generously." A second Scotsman, JAMES GILLRAY, an audacious . and brutal caricaturist, developed John Bull from a loose-j owled, putty-faced farm labourer, as he had drawn him, into a typical country publican. Although many of GILLRAY’s drawings showed a very different concep- tion of John Bull from those of ARBUTHNOT and TENNIEL, yet some of them certainly foreshadowed Punch’s John Bull. The lecturer demonstrated with photographs of English public men how rare in fact was this " typical Englishman," and suggested that he was met more often in Yorkshire than elsewhere. Neither in face nor colouring was John Bull, he said, a true Saxon, and to find his prototype it was necessary to go far back in our island story to certain immigrants early in the second millennium B.C. These ancient invaders appeared to have originated beyond the Caucasus, where big noses and round heads still abound, and their blood can be traced, said the speaker, chiefly among our landed, professional and business men. While the typical John Bull is not uncommon in Ireland, he is almost unknown in Scotland and on the continent. Hostile French cartoonists gave John Bull a lantern jaw, loose lips, a rabbit mouth, defective chin, and sharp nose, and this caricature accurately represents the anthropological changes which the faces of the British people are most apt to undergo. German artists in the stress of war picked out the prognathous jaw, ample mouth, shrunken snub nose, and cruel countenance occasionally found among prosperous and unprincipled city men. Despite these attempts to crystallise the essentials of English character in one symbolic figure, the supply of individual types remains inexhaustible, as artists and novelists reveal every week, and before anthro- pologists lies the tremendous task of reducing this complexity to a scientific unity. Among the interesting exhibits in the library of the Royal Society of Medicine were a collection of X ray photographs and engravings of medical men. Annotations. THE BEST USE OF FEVER BEDS. " Ne quid nimis." AT its meeting last week the Metropolitan Asylums Board decided on a change of policy in the allocation of beds in hospitals to the various prevalent infectious diseases. Of the total 4185 beds then occupied in M.A.B. hospitals, 2285 contained patients suffering from diphtheria, 1527 from scarlet fever, 194 from whooping-cough, 106 from enteric fever, 34 from measles, 21 from puerperal fever, and 18 from other diseases ; the beds allotted in special hospitals to ophthalmia, marasmus, small-pox, tuberculosis, post- encephalitic and convalescent cases are not included in these figures, which, as wil. be seen, bear no relation to the relative fatality of the various infections. Out of every million people living in London during the last 15 years, 251 have died annually from measles, and only 42 from scarlet fever, the mortality-rate per cent. in the Board’s hospitals during the same period being 10-6 for measles and 1-5 for scarlet fever. When the Board decided at the beginning of this period-that is, in 1910-to receive measles and whooping-cough it was with the definite intention of restricting their admission to the number of beds available after the prior claims of scarlet fever and diphtheria had been satisfied. As far as diphtheria is concerned, the claim remains paramount, but so mild has been the type of scarlet fever in London during recent years that the Board believe the large majority of these cases would have recovered whatever the conditions under which they were treated. Moreover, the value of isolation in the treatment of scarlet fever is by no means established, although it is possible that the more severe complications, such as nephritis and otitis media, may occur less often in hospital than in patients treated at home. Even under non-epidemic conditions it would be impracticable to isolate all the cases of scarlet fever, diphtheria, and measles in the metropolis, and to do so would require enormous expenditure on new buildings during an epidemic. period, when the number of measles cases may run up to 100,000 in the year ; but the ratepayer may quite properly inquire whether he is well-served by an expenditure of Is. 4d. per head per annum on the simple isolation of all cases of scarlet fever, when the case-mortality of this disease has gone down from 10 per cent. in the ’seventies to less than 1 per cent. at the present time. Having such considerations as this. in view, the Metropolitan Asylums Board, with the approval of the Ministry of Health and the local authorities concerned, have decided to modify the present scheme of allocation of beds, so as to give measles a considerable proportion of the beds now allocated to scarlet fever. As soon as the one competes. against the other for admission, the borough medical officer of health will select cases of either in accordance with the necessities and home conditions of the individual case. This decision fulfils a principle, already enunciated in these columns, that while no. sanitary authority should or could undertake the- isolation of all infectious disease in its area, its utility would be greatly enhanced if it could undertake to deal with selected cases of all kinds, putting in the forefront those from institutions and from poor homes, the new cases in a locality and all those of severe type. It might be feared that such a re- allocation would increase the difficulties of preventing cross-infection, but recent experience of bed-isolation at Fazakerley and other places shows that this problem may not be as difficult of solution as was once supposed.

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Page 1: THE BEST USE OF FEVER BEDS

865

AN ANTHROPOLOGIST ON JOHN BULL.THE first social evening of the session was held

at the Royal Society of Medicine on Monday last,when a very large company of Fellows and guestswere received by Sir JAMES BERRY, the President, andLady BERRY. The speaker of the evening was SirARTHUR KEITH, who entitled his witty and entertainingaddress John Bull: a Study in Anthropology. Hetook as his text the familiar John Bull of BERNARDPARTRIDGE, remarking that not only was the famousPunch artist the son of one anatomist and father ofanother, but also he had drawn John’s features withpeculiar racial and anatomical insight. The artist,he said, could convey with his pencil that John isbluff, honest, kind-hearted, and generous, with a

hearty contempt for everything savouring of pretence,meanness, or dishonesty. The anthropologist withhis craniometer, on the other hand, had as yet foundno precise method of recording or measuring thesecharacteristics. John is dolichocephalic, but hasrather a massive brain. His face shows none of thesharpness and angularity of certain other Britishtypes. TENNIEL’s John Bull was an old, old man,but since then he appeared to have grown graduallyyounger. In the year 1712 the Scotsman, Dr. JOHNARBUTHNOT, in his " History of John Bull," describedthe character he had selected as the essential English-man and to whom he had given this name.

" In the main," he said, "John Bull was an honest,plain-dealing fellow, choleric, bold, and of a very inconstanttemper ; he dreaded not Lewis Baboon (France) either atbacksword, single falchion, or cudgel play ; but then hewas apt to quarrel with his best friends, especially if theypretended to govern him ; if you flattered him, you mightlead him like a child. John’s temper depended very muchupon the air ; his spirits rose and fell with the weather-glass. John was quick and understood his business verywell ; but no man alive was more careless in looking intohis accounts, or more cheated by partners, apprentices, andservants. This was occasioned by being a boon companion,loving his bottle and his diversions, for, to say truth, noman kept a better house than John nor spent his moneymore generously."A second Scotsman, JAMES GILLRAY, an audacious

. and brutal caricaturist, developed John Bull from aloose-j owled, putty-faced farm labourer, as he had drawnhim, into a typical country publican. Although manyof GILLRAY’s drawings showed a very different concep-tion of John Bull from those of ARBUTHNOT andTENNIEL, yet some of them certainly foreshadowedPunch’s John Bull. The lecturer demonstrated withphotographs of English public men how rare in factwas this " typical Englishman," and suggested thathe was met more often in Yorkshire than elsewhere.

Neither in face nor colouring was John Bull, he said,a true Saxon, and to find his prototype it was necessaryto go far back in our island story to certain immigrantsearly in the second millennium B.C. These ancientinvaders appeared to have originated beyond theCaucasus, where big noses and round heads stillabound, and their blood can be traced, said the speaker,chiefly among our landed, professional and businessmen. While the typical John Bull is not uncommon inIreland, he is almost unknown in Scotland and on thecontinent. Hostile French cartoonists gave JohnBull a lantern jaw, loose lips, a rabbit mouth, defectivechin, and sharp nose, and this caricature accuratelyrepresents the anthropological changes which thefaces of the British people are most apt to undergo.German artists in the stress of war picked out theprognathous jaw, ample mouth, shrunken snub nose,and cruel countenance occasionally found amongprosperous and unprincipled city men. Despite theseattempts to crystallise the essentials of Englishcharacter in one symbolic figure, the supply ofindividual types remains inexhaustible, as artistsand novelists reveal every week, and before anthro-pologists lies the tremendous task of reducing thiscomplexity to a scientific unity.Among the interesting exhibits in the library of

the Royal Society of Medicine were a collection ofX ray photographs and engravings of medical men.

Annotations.

THE BEST USE OF FEVER BEDS.

" Ne quid nimis."

AT its meeting last week the Metropolitan AsylumsBoard decided on a change of policy in the allocationof beds in hospitals to the various prevalent infectiousdiseases. Of the total 4185 beds then occupied inM.A.B. hospitals, 2285 contained patients sufferingfrom diphtheria, 1527 from scarlet fever, 194 fromwhooping-cough, 106 from enteric fever, 34 from

measles, 21 from puerperal fever, and 18 from otherdiseases ; the beds allotted in special hospitals toophthalmia, marasmus, small-pox, tuberculosis, post-encephalitic and convalescent cases are not included inthese figures, which, as wil. be seen, bear no relationto the relative fatality of the various infections.Out of every million people living in London duringthe last 15 years, 251 have died annually from measles,and only 42 from scarlet fever, the mortality-rateper cent. in the Board’s hospitals during the sameperiod being 10-6 for measles and 1-5 for scarlet fever.When the Board decided at the beginning of thisperiod-that is, in 1910-to receive measles and

whooping-cough it was with the definite intention ofrestricting their admission to the number of bedsavailable after the prior claims of scarlet fever anddiphtheria had been satisfied. As far as diphtheria isconcerned, the claim remains paramount, but so mildhas been the type of scarlet fever in London duringrecent years that the Board believe the large majorityof these cases would have recovered whatever theconditions under which they were treated. Moreover,the value of isolation in the treatment of scarlet feveris by no means established, although it is possiblethat the more severe complications, such as nephritisand otitis media, may occur less often in hospital thanin patients treated at home. Even under non-epidemicconditions it would be impracticable to isolate allthe cases of scarlet fever, diphtheria, and measles inthe metropolis, and to do so would require enormousexpenditure on new buildings during an epidemic.period, when the number of measles cases may runup to 100,000 in the year ; but the ratepayer mayquite properly inquire whether he is well-served byan expenditure of Is. 4d. per head per annum on thesimple isolation of all cases of scarlet fever, when thecase-mortality of this disease has gone down from10 per cent. in the ’seventies to less than 1 per cent. atthe present time. Having such considerations as this.in view, the Metropolitan Asylums Board, with theapproval of the Ministry of Health and the localauthorities concerned, have decided to modify thepresent scheme of allocation of beds, so as to givemeasles a considerable proportion of the beds nowallocated to scarlet fever. As soon as the one competes.against the other for admission, the borough medicalofficer of health will select cases of either in accordancewith the necessities and home conditions of theindividual case. This decision fulfils a principle,already enunciated in these columns, that while no.sanitary authority should or could undertake the-isolation of all infectious disease in its area, its utilitywould be greatly enhanced if it could undertake todeal with selected cases of all kinds, putting in theforefront those from institutions and from poorhomes, the new cases in a locality and all those ofsevere type. It might be feared that such a re-

allocation would increase the difficulties of preventingcross-infection, but recent experience of bed-isolationat Fazakerley and other places shows that thisproblem may not be as difficult of solution as was oncesupposed.