CONTINENTAL ANGLO-AMERICAN MEDICAL SOCIETY

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1367 and in this country on the effects of histamine in rheumatic conditions, but a more detailed account of the clinical results in the various types of cases treated would have been of value. Only one type of case seems to have shown marked improvement when treated by the hypodermic method-viz., peri-articular arthritis in the hand with circulatory disturbance. They were unable to obtain any clinical evidence of the characteristic histamine effect by ionisation methods and attribute the results to local galvanism, heat, and counter irritation only. They are alone in this finding however, as other observers appear to obtain readily the complete gamut of physiological effects by this method, as by the use of histamine hypodermically. That the response to histamine varies from patient to patient and at different times in the same patient is surely an argument against injection, a,s ionisation can be so regulated that no untoward systemic symptoms need ever arise. Having prescribed over 3000 histamine treatments at the Royal Baths, Harrogate, during the last three seasons, my findings are that good results may be definitely obtained in many types of rheumatism. Identical results are reported by Dr. McKenna and various continental writers. I am, Sir, yours faithfully, Harrogate, June 12th. A. A. BISSET. A. A. BISSET. THIOL-HISTAMINE To the Editor of THE LANCET SIR,-My attention has been drawn to certain articles you have published recently upon prepara- tions of histamine for rheumatism, wherein whatever credit is due for their discovery has been given to German workers. I introduced thiol-histamine in 1917, since when I have used it on a large scale. Frequent references have been made to the prepara- tion in my works on the Nature of Disease, and you were kind enough to publish a letter for me on May 6th, 1933. May I ask you to be so kind as to correct the omission to which I am referring. I am, Sir, yours faithfully, J. E. R. McDoNAGH. Wimpole-street, W., June 16th. J. E. R. MCDONAGH. DISTRICT ALMONERS To the Editor of THE LANCET SIR,-It is now generally recognised that almoners are indispensable in all our hospitals ; and suggestions are being made that there should be district almoners, whose services would be available to all. It is unnecessary to tell those who have worked on the visiting or resident staff of a hospital in recent years what an almoner can do, but there must be many in practice who have never been able to write upon a hospital patient’s card " Will the Lady Almoner please do this or that," and consequently many who do not realise how much an almoner can do to help to get the best results out of treatment. It will interest these to know that the almoner can usually procure all those things for a patient that doctor or nurse cannot procure: abdominal belts, and all other types of surgical appliances, extra nourishment or particular articles of diet, dressings, and special care of any sort for those otherwise unable to obtain them. Patients with advanced cancer ; those with Graves’s disease whose home conditions are unsuitable ; children who have come from a distance for the specialist’s opinion are recommended treatment with rest in bed and may not even have a bed to themselves ; all these and many other similar cases can be dealt with by an almoner. Convalescence can be arranged, and although the patient at first mention of this may fear the loss of his job by so long an absence, yet it is usual to nnd that an almoner can approach his firm and get over this difficulty, often obtaining a grant partially to cover the cost. Naturally the services of an almoner are not for the well-to-do, but with the assistance of a district almoner practitioners could give better service to their patients, such a large proportion of whom are in varying degrees of domestic or financial difficulties. It would be interesting to hear the views of other practitioners on this subject as it is felt that before further steps can be taken it is necessary to have an idea of the support that can be obtained. I am, Sir, yours faithfully, GEOFFREY HALE. Eccleston-square, S.W., June 16th. GEOFFREY HALE. CONTINENTAL ANGLO-AMERICAN MEDICAL SOCIETY To the Editor of THE LANCET r SIR,-On July 27th at 12.30 P.M. this society will meet for luncheon at the Bournemouth Pavilion on the occasion of the B.M.A. annual meeting. It is hoped that all former members now resident in Great Britain will endeavour to attend on the first such occasion since the war. Any doctors attending the meeting who have patients wintering on the continent will be welcomed at the luncheon. Those who wish to be present should communicate with Dr. E. L. Gros (President) 23 Ave. Maréchal-Foch, Paris, Dr. R. Pryce-Mitchell, Villa Henri, Monte- Carlo, or with the undersigned. I am, Sir, yours faithfully, TOM A. WILLIAMS. Royal Societies Club, 63, St. James’s-street, S.W.1, June 19th. BIRMINGHAM HOSPITALS CENTRE.-The Prince of Wales will lay the foundation-stone of the Birmingham Hospitals Centre at Edgbaston on Oct. 23rd. On the same day he will cut the first sod on the site of the Birming- ham University Medical School, which is an integral part of the hospitals centre project. It is expected that the first portion of the new hospital will be ready for opening in October, 1937. SCARBOROUGH HospiTAL.-The detailed plans for Scarborough’s new hospital, which is to be built at a cost of over 100,000, are now available. The buildings are to be fireproof, and as far as possible soundproof. Advantage has been taken of a sheltered situation to have large sunny balconies and a solarium for the children. The hospital will have 140 beds, including a number for paying patients, and three operating theatres. The theatres have a ventilating plant which makes it possible to change the air or raise or lower the temperature very rapidly. The X ray therapy and light treatment departments and the massage and ortho- paedic rooms are on the ground floor and are connected by two bed lifts with the wards. The out-patients’ depart- ment has a large waiting-room where there will be a refreshment counter, and a shelter for prams has also been provided. The dispensary is easily accessible both to the wards and to the out-patients’ department. The kitchen is a self-contained unit and the food will be served from heated trolleys so that appetising and hot dishes may reach the most distant wards. The laundry and boiler room are also self-contained, and a supplementary electrical battery room will be able to provide current for the operating theatres and other parts of the institution if the municipal supply should fail. There are rooms for the visiting and administrative staff in the main building, and a separate home for the sisters and nurses. TOM A. WILLIAMS.

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and in this country on the effects of histamine inrheumatic conditions, but a more detailed account ofthe clinical results in the various types of cases treatedwould have been of value. Only one type of caseseems to have shown marked improvement whentreated by the hypodermic method-viz., peri-articulararthritis in the hand with circulatory disturbance.They were unable to obtain any clinical evidence ofthe characteristic histamine effect by ionisationmethods and attribute the results to local galvanism,heat, and counter irritation only. They are alone inthis finding however, as other observers appear toobtain readily the complete gamut of physiologicaleffects by this method, as by the use of histaminehypodermically.That the response to histamine varies from patient

to patient and at different times in the same patient issurely an argument against injection, a,s ionisationcan be so regulated that no untoward systemicsymptoms need ever arise. Having prescribed over3000 histamine treatments at the Royal Baths,Harrogate, during the last three seasons, my findingsare that good results may be definitely obtained inmany types of rheumatism. Identical results arereported by Dr. McKenna and various continentalwriters. I am, Sir, yours faithfully,

Harrogate, June 12th. A. A. BISSET.A. A. BISSET.

THIOL-HISTAMINE

To the Editor of THE LANCET

SIR,-My attention has been drawn to certainarticles you have published recently upon prepara-tions of histamine for rheumatism, wherein whatevercredit is due for their discovery has been given toGerman workers. I introduced thiol-histamine in

1917, since when I have used it on a large scale.Frequent references have been made to the prepara-tion in my works on the Nature of Disease, and youwere kind enough to publish a letter for me on

May 6th, 1933. May I ask you to be so kind as tocorrect the omission to which I am referring.

I am, Sir, yours faithfully,J. E. R. McDoNAGH.

Wimpole-street, W., June 16th.J. E. R. MCDONAGH.

DISTRICT ALMONERS

To the Editor of THE LANCET

SIR,-It is now generally recognised that almonersare indispensable in all our hospitals ; and suggestionsare being made that there should be district almoners,whose services would be available to all.

It is unnecessary to tell those who have worked onthe visiting or resident staff of a hospital in recentyears what an almoner can do, but there must bemany in practice who have never been able to writeupon a hospital patient’s card " Will the Lady Almonerplease do this or that," and consequently many whodo not realise how much an almoner can do to helpto get the best results out of treatment. It willinterest these to know that the almoner can usuallyprocure all those things for a patient that doctor ornurse cannot procure: abdominal belts, and allother types of surgical appliances, extra nourishmentor particular articles of diet, dressings, and specialcare of any sort for those otherwise unable to obtainthem.

Patients with advanced cancer ; those with Graves’sdisease whose home conditions are unsuitable ;children who have come from a distance for thespecialist’s opinion are recommended treatment withrest in bed and may not even have a bed to themselves ;

all these and many other similar cases can be dealtwith by an almoner.

Convalescence can be arranged, and although thepatient at first mention of this may fear the loss ofhis job by so long an absence, yet it is usual to nndthat an almoner can approach his firm and get overthis difficulty, often obtaining a grant partially tocover the cost.

Naturally the services of an almoner are not forthe well-to-do, but with the assistance of a districtalmoner practitioners could give better service totheir patients, such a large proportion of whom arein varying degrees of domestic or financial difficulties.

It would be interesting to hear the views of otherpractitioners on this subject as it is felt that beforefurther steps can be taken it is necessary to have anidea of the support that can be obtained.

I am, Sir, yours faithfully,GEOFFREY HALE.

Eccleston-square, S.W., June 16th.GEOFFREY HALE.

CONTINENTAL ANGLO-AMERICAN MEDICALSOCIETY

To the Editor of THE LANCET

r SIR,-On July 27th at 12.30 P.M. this society willmeet for luncheon at the Bournemouth Pavilionon the occasion of the B.M.A. annual meeting. Itis hoped that all former members now resident inGreat Britain will endeavour to attend on the firstsuch occasion since the war. Any doctors attendingthe meeting who have patients wintering on thecontinent will be welcomed at the luncheon. Thosewho wish to be present should communicate withDr. E. L. Gros (President) 23 Ave. Maréchal-Foch,Paris, Dr. R. Pryce-Mitchell, Villa Henri, Monte-Carlo, or with the undersigned.

I am, Sir, yours faithfully,TOM A. WILLIAMS.

Royal Societies Club, 63, St. James’s-street, S.W.1,June 19th.

BIRMINGHAM HOSPITALS CENTRE.-The Prince ofWales will lay the foundation-stone of the BirminghamHospitals Centre at Edgbaston on Oct. 23rd. On the sameday he will cut the first sod on the site of the Birming-ham University Medical School, which is an integral partof the hospitals centre project. It is expected that thefirst portion of the new hospital will be ready for openingin October, 1937.

SCARBOROUGH HospiTAL.-The detailed plans forScarborough’s new hospital, which is to be built ata cost of over 100,000, are now available. The

buildings are to be fireproof, and as far as possiblesoundproof. Advantage has been taken of a shelteredsituation to have large sunny balconies and a solariumfor the children. The hospital will have 140 beds,including a number for paying patients, and three

operating theatres. The theatres have a ventilating plantwhich makes it possible to change the air or raise or lowerthe temperature very rapidly. The X ray therapy andlight treatment departments and the massage and ortho-paedic rooms are on the ground floor and are connectedby two bed lifts with the wards. The out-patients’ depart-ment has a large waiting-room where there will be arefreshment counter, and a shelter for prams has also beenprovided. The dispensary is easily accessible both to thewards and to the out-patients’ department. The kitchenis a self-contained unit and the food will be served fromheated trolleys so that appetising and hot dishes mayreach the most distant wards. The laundry and boilerroom are also self-contained, and a supplementary electricalbattery room will be able to provide current for theoperating theatres and other parts of the institution if themunicipal supply should fail. There are rooms for thevisiting and administrative staff in the main building, anda separate home for the sisters and nurses.

TOM A. WILLIAMS.