2
1350 the University Medical School and the voluntary hospitals. It is intended that all the statutory hospitals shall be used for teaching purposes, and it is hoped that the professors and heads of depart- ments of the medical school will become ex-officio consultants to the municipal hospitals. The exact details of the working arrangements between the town council and the medical school and voluntary hospitals have yet to be settled. The town council have now to provide for the parish council infants, and this has been done by the provi- sion of ten additional cots, free from the poor-house environment, at Burnside Home for Mothers and Children. This home now has accommodation for 10 mothers and 42 children, and is mainly utilised for the admission of married women after confinement, with the object of providing them with rest and instruction in baby care. Unmarried mothers are also admitted for their first pregnancy. Another home with accommodation for 8 mothers and 10 infants is mainly used for unmarried mothers both before and after confinement. The marasmus ward in the city hospital provides 22 cots for infants suffering chiefly from nutritional disorders. As another part of the hospital reorganisation scheme arrangements have been made for the admission of post-encephalitics and epileptics as voluntary patients to Kingseat Mental Hospital. In the new hospital scheme the town council is working in full coöpera- tion with the county council and the authorities of the other North-Eastern counties. Dr. Kinloch visualises ultimately a hospital organisation for Scotland on a regional basis grouped mainly around the four medical schools. The report contains a review of infant mortality, undertaken by Dr. Hilda Menzies, who shows that, whereas in 1856-60 the Aberdeen infant mortality was considerably lower than that of Edinburgh, Dundee, or Glasgow, this superiority was lost in 1886-95, and in 1921-25 the figures were : Edinburgh 91, Glasgow 107, Dundee 113, Aberdeen 115. From her investigation Dr. Menzies finds that the infant mortality from " develop- mental diseases " during these 70 years has increased by 79 per cent. in Aberdeen, by 3 per cent. in Edin- burgh, and by 1 per cent. in Dundee, whilst in Glasgow it has decreased by 9 per cent. The increase appears to be a real one in Aberdeen, and the reason why Aberdeen has lost its early advantage over the other three Scottish towns deserves the closest investiga- tion. It has been suggested by other observers that the introduction of a foreign element has added to the vigour of the stock, and it is note- worthy that Glasgow, the town of the most hybrid stock, has shown the steadiest rate of decrease in infant mortality, whereas Aberdeen, the town of the purest race, has come off worst for infant mortality from " developmental diseases." ANTERIOR POLIOMYELITIS. Dr. W. M. Dickie gives many interesting details I of the epidemic of anterior poliomyelitis in California in 1927, and of the measures taken against it. The epidemic was at its height in July and August, and of 1270 cases reported, 237 proved fatal. How inadequate is the old name of " infantile paralysis " for the disease is shown. by the fact that out of 1385 cases in which the age was recorded, 145 (or over 10 per cent.) of the patients were aged 20 or over. In this epidemic the average age at onset was perhaps unusually high, for nearly 70 per cent. of those affected were 4 years old or more, whilst nearly 40 per cent. were over 9. During the acute illness serum treatment was tried in a small proportion of the cases, but does not seem to have been very useful. A large number of deformities and disabilities inevitably remains in the track of the disease, and the organisation which deals with them largely resembles those existing in many parts of this country. Thirty- 1 Jour. Amer. Med. Assoc., Nov. 10th, p. 1417. one hospitals throughout the State are open to orthopaedic cases on a charitable or partly charitable basis, nine of them in San Francisco, five in Los Angeles. Ten of those in rural communities are well equipped, but the remaining seven in rural com- munities are stated to be not adequately equipped for treatment. There are orthopaedic clinics in 13 of the counties of the State. By a recent Act of the legislative assembly of California, called the Crippled Children’s Act, children up to the age of 18 years may obtain materials or appliances necessary for treatment at the public expense, but the machinery by which this help is to be obtained seems to be rather too elaborate for efficiency and likely to waste time. The State department concerned is also authorised to receive and administer gifts for the relief of cripples and to arrange through local agencies for diagnostic clinics or conferences. Since the passage of the Act 20 patients have been hospitalised, the average cost being 1000 dollars. High though this cost may seem, it has been only kept down to this level by a special hospital rate of 4 dollars a day and a special operating fee charged to the department by the surgeons concerned. Dr. Dickie thinks that the Crippled Children’s Act is not entirely satisfactory. He advocates a plan whereby the State should pay one-third of the cost of treatment, charitable agencies and friends the remainder. He realises, as has been done here and elsewhere, that the long after- treatment of many of these cases cannot be carried on in hospital wards owing to its expense, and is impracticable in most homes. He therefore advocates the provision of convalescent homes. ACID URINARY DISINFECTANTS. INFECTIONS of the urinary tract are often treated by administering salts which alter the reaction of the urine and thus discourage bacterial growth. In acid urine hexamethylenetetramine may be given in combination with these salts for the antiseptic effect of the formaldehyde which is liberated from it in an acid medium. The results thus obtained are difficult to assess owing to wide variation in the type of cases treated and differences of dosage. K. Kelsted and E. Schiodt,l of Copenhagen, have attempted to place this acidosis therapy on a more accurate basis by finding the difference in pH of urine before and after treatment, and in their preliminary review quote the work of Rostoski who showed that the addition of acid urine to broth cultures of colon bacilli and staphylococci had an inhibitory effect on growth, this effect being proportional to the acidity. They describe their results of treatment in 28 cases of chronic pyelitis and 42 of chronic cystitis, all of which were thoroughly investigated clinically and bacteriologically, and if necessary by cystoscopy and ureteral catheterisation. The hydrogen-ion con- centration of the urine was measured at intervals both before and during treatment. To acidify the urine they gave calcium or ammonium chloride in tablet form in doses of from 3 to 8 grammes daily, and in 14 cases of pyelitis and 16 of cystitis these were used alone for periods of from 8 to 35 days. In only one of them, a B. coli pyelitis, did the urine become sterile, and this was the one in which the acidity was greatest, reaching pH 4-7. In the next test the acid treatment was given together with urinary dis- infectants ; the 70 cases were treated for periods ranging from 16 to 120 days, hexamine or salol being given in 1 g. doses, or hexylresorcinol in 0-3 g. doses, three times a day. Acidity of the urine was produced in nearly all the patients, but only in seven was it sufficiently strong to give a prospect of much inhibi- tion of bacterial growth from acidity alone, though all the samples were acid enough for the formaldehyde to be bactericidal. Five out of 28 cases of pyelitis- which were mostly long-standing-recovered com- pletely, and the urine was proved to be sterile. Of the 42 cases of cystitis six developed sterile urine. Acta Med. Scand., 1928, lxix., 268.
