1
396 and the various forms of pleasure-seeking must be tactfully counselled. Medicaments to curb the activities of the sympathetic nervous system, such as belladonna, may be administered before meals, and especial attention should be directed to securing regular hours of sleep, for which purpose sedatives such as valerian and the bromides are recommended. This is all very well, a critic may say, but how is one to tell that this sort of treatment is all that is required, and how many times will a real case of gastric ulcer or of malignant disease give much the same sort of vague story as this other type of case ? Dr. Michon does not despise radiological assistance, but he thinks the diagnosis pretty evident from the patient’s appearance and behaviour. Look at this man, he says, still young, who comes to consult you for gastric trouble. His rapidly roaming eye looks first at one corner of your consulting room, then at another, now stares you straight in the face, now is off on another tour of inspection. His restless face looks as if the worst is about to happen, and in a brief and nervous way he describes his symptoms, none of which really suggest the idea of an organic lesion. Such, he holds, and with good reason, is the clinical picture of the " anxious little tachyphage "- a figure who is becoming increasingly common in these islands. Possibly the best way to combat this occupational disease would be to invite the Three- hours-for-lunch Club to start a mission in England. HEALTH AT THE JAMBOREE. THE organisation of the Boy Scouts’ World Jam- boree at Arrowe Park, Birkenhead, nowhere showed to better advantage than in the medical department. The hospital, which was in charge of the Medical Commissioner, Lieut.-Colonel J. C. Holdich Leicester, consisted of nine marquees and six bell tents. Four of the marquees were wards, each holding 16 beds. Another was divided into two parts, one-third of its space being used as a dispensary and the rest as an emergency operating theatre. A sixth marquee, similarly divided, served as a dental clinic and an out-patient department. The remaining three were used respectively as an office, a store, and a dining- tent for the staff. One of the bell tents was a store- room for patients’ clothing and the other five were isolation wards. A small portable plant supplied the hospital with electric light, and all the units were linked by telephone. Cooking was all done out-of- doors under a corrugated iron roof. The Cheshire Girl Guides Association supplied the entire nursing and executive staff, whilst Colonel Leicester was assisted in his medical work by three local practi- tioners and a number of local honorary consultants. The dental clinic was under the supervision of Mr. H. H. Tomlinson, who was assisted by a staff of six dentists. More than 30,000 scouts attended the camp, and it is surprising that in the three weeks only 321 had to be admitted to hospital. Of these, 52 were evacuated to local hospitals as being likely to need attention for more than a few days; this figure included nine cases of infectious disease sent to Birkenhead Fever Hospital. All the rest returned to their units relieved or cured. Tonsillitis accounted for 70 cases, and the next commonest types of ailment for which admission was necessary were cuts, stings, or bruises (39 cases). These were closely followed by chills, malaria, and malaise (28 cases), and pyrexia (26 cases). There were 21 fractures and dislocations, 14 sprains, 15 cases of constipation and colic, and 14 of other stomach troubles. Considering the mud and damp in which the camp has lived, the proportion of respiratory disorders was low ; there were 11 cases of asthma, bronchitis, and catarrh, 8 of "influenza," and 7 of pneumonia and pleurisy. Coughs and colds might have been expected to number more than 80, while rheumatism accounted for only 3 admissions. Twenty operations were performed for the reduction of fractures and repair of other injuries. The out- patients’ department was attended by 1229 boys, 271 of whom had cuts and wounds (68 septic), and 125 had boils. Scalds; burns, sunburns, and abrasions accounted for 108 more. Naturally the greatest number of in-patients were English: 160. French followed with 47, and Scottish 12, Welsh 12, Irish 11, and Ameri- can 9, came next. A really remarkable absence of epidemic disease and of serious illness in such a large concourse was very largely due to the efficient hygienic precautions taken by the Assistant Camp Chief (Health), Major M. B. Ritchie, ably seconded by the Hygiene Commissioner, Dr. Richard Wyse. The stagnant pools in the woodland areas were freed from infestation and the water-supply was carefully planned. The latrines were adequate in number and suitably placed, and an expert staff saw to their emptying and cleansing. The camp was patrolled by members of the St. John Ambulance Brigade and the British Red Cross Society, and whenever possible the boys were medically examined before coming to camp. There is a first-aid post under medical supervision at the rest camp organised at Earl’s Court for scouts who wish to stay in London before or after the Jamboree. Here, again, local hospitals are cooperating cordially. The organisers and medical staff are to be congratulated on the success of their work, which may well form a model for future encampments of the same kind. THE TREATMENT OF ENURESIS IN CHILDREN, THE psychological causation of nocturnal enuresis in children is much emphasised nowadays, and many writers discredit all forms of treatment by medica- ments, diet, restriction of fluid, or the various forms of surgical intervention. Two recent papers illustrate possible methods of approach along the lines of what is called psychiatry. Dr. R. C. Hamill holds the view that enuresis is a conduct disorder and can be perfectly well stopped when the child so desires. He explains to both child and mother that the only reason why the bed is wet is that the child prefers a wet bed to getting up, and once the child admits this and assumes responsibility for its conduct a cure is effected. In Dr. Hamill’s opinion any other suggestion will only be detrimental to the child’s interests ; to accuse the tonsils, prepuce, hereditary influences, and so on will merely furnish the child with excuses for its ill-behaviour. With a young child the mother must quietly assume that nothing short of a dry bed every night can possibly be expected from her offspring, and with an older one, who can understand Dr. Hamill’s ingenious explanation of conscious control during sleep, a few talks at the psychiatric clinic will usually complete the cure. Out of 80 cases thus treated 40 were entirely rid of the habit, and of the other 40 some were improved, some not improved but still under treatment, and some had been lost sight of. Dr. Hamill claims that this treatment is " specific," and Dr. 1. S. Wile makes a similar confident claim of great success for two methods of treating enuresis which he brings forward.2 2 Dr. Wile says that for cases of enuresis in institutions the method of personal approach to each child is quite impossible, so in the first of his two methods a " group approach " was employed. In this scheme the inmates of the institution-the Hebrew Orphan Asylum in New York City-were divided into teams, and the object of the campaign was explained separately to the boys and girls. Each team elected a captain, and each week the percentage of dryness was calculated for the various teams so as to foster the competition spirit. The method employed by the teams was left to their discretion, but the usual plan was to wake up the offending members or to encourage the weaker members to greater efforts by means which are not stated but can be imagined. When a member of one of these 1 Jour. Amer. Med. Assoc., July 27th, p. 254. 2 Med. Times, August, 1929, p. 223.

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Page 1: HEALTH AT THE JAMBOREE

396

and the various forms of pleasure-seeking must betactfully counselled. Medicaments to curb theactivities of the sympathetic nervous system, such asbelladonna, may be administered before meals, andespecial attention should be directed to securingregular hours of sleep, for which purpose sedativessuch as valerian and the bromides are recommended.This is all very well, a critic may say, but how isone to tell that this sort of treatment is all that isrequired, and how many times will a real case ofgastric ulcer or of malignant disease give much thesame sort of vague story as this other type of case ?Dr. Michon does not despise radiological assistance,but he thinks the diagnosis pretty evident from thepatient’s appearance and behaviour. Look at thisman, he says, still young, who comes to consult youfor gastric trouble. His rapidly roaming eye looksfirst at one corner of your consulting room, then atanother, now stares you straight in the face, now isoff on another tour of inspection. His restless facelooks as if the worst is about to happen, and in abrief and nervous way he describes his symptoms,none of which really suggest the idea of an organiclesion. Such, he holds, and with good reason, is theclinical picture of the " anxious little tachyphage "-a figure who is becoming increasingly common inthese islands. Possibly the best way to combat thisoccupational disease would be to invite the Three-hours-for-lunch Club to start a mission in England.

HEALTH AT THE JAMBOREE.

THE organisation of the Boy Scouts’ World Jam-boree at Arrowe Park, Birkenhead, nowhere showedto better advantage than in the medical department.The hospital, which was in charge of the MedicalCommissioner, Lieut.-Colonel J. C. Holdich Leicester,consisted of nine marquees and six bell tents. Fourof the marquees were wards, each holding 16 beds.Another was divided into two parts, one-third of itsspace being used as a dispensary and the rest as anemergency operating theatre. A sixth marquee,similarly divided, served as a dental clinic and anout-patient department. The remaining three wereused respectively as an office, a store, and a dining-tent for the staff. One of the bell tents was a store-room for patients’ clothing and the other five wereisolation wards. A small portable plant supplied thehospital with electric light, and all the units werelinked by telephone. Cooking was all done out-of-doors under a corrugated iron roof. The CheshireGirl Guides Association supplied the entire nursingand executive staff, whilst Colonel Leicester wasassisted in his medical work by three local practi-tioners and a number of local honorary consultants.The dental clinic was under the supervision of Mr.H. H. Tomlinson, who was assisted by a staff of sixdentists.More than 30,000 scouts attended the camp, and

it is surprising that in the three weeks only 321 hadto be admitted to hospital. Of these, 52 were evacuatedto local hospitals as being likely to need attentionfor more than a few days; this figure included ninecases of infectious disease sent to Birkenhead FeverHospital. All the rest returned to their unitsrelieved or cured. Tonsillitis accounted for 70 cases,and the next commonest types of ailment for whichadmission was necessary were cuts, stings, or bruises(39 cases). These were closely followed by chills,malaria, and malaise (28 cases), and pyrexia (26 cases).There were 21 fractures and dislocations, 14 sprains,15 cases of constipation and colic, and 14 of otherstomach troubles. Considering the mud and dampin which the camp has lived, the proportion ofrespiratory disorders was low ; there were 11 casesof asthma, bronchitis, and catarrh, 8 of "influenza,"and 7 of pneumonia and pleurisy. Coughs and coldsmight have been expected to number more than 80,while rheumatism accounted for only 3 admissions.Twenty operations were performed for the reductionof fractures and repair of other injuries. The out-

patients’ department was attended by 1229 boys,271 of whom had cuts and wounds (68 septic), and125 had boils. Scalds; burns, sunburns, and abrasionsaccounted for 108 more. Naturally the greatest numberof in-patients were English: 160. French followed with47, and Scottish 12, Welsh 12, Irish 11, and Ameri-can 9, came next. A really remarkable absence ofepidemic disease and of serious illness in such a largeconcourse was very largely due to the efficienthygienic precautions taken by the Assistant CampChief (Health), Major M. B. Ritchie, ably secondedby the Hygiene Commissioner, Dr. Richard Wyse.The stagnant pools in the woodland areas were freedfrom infestation and the water-supply was carefullyplanned. The latrines were adequate in number andsuitably placed, and an expert staff saw to theiremptying and cleansing. The camp was patrolled bymembers of the St. John Ambulance Brigade andthe British Red Cross Society, and whenever possiblethe boys were medically examined before comingto camp. There is a first-aid post under medicalsupervision at the rest camp organised at Earl’sCourt for scouts who wish to stay in London beforeor after the Jamboree. Here, again, local hospitalsare cooperating cordially. The organisers andmedical staff are to be congratulated on the successof their work, which may well form a model for futureencampments of the same kind.

THE TREATMENT OF ENURESIS IN CHILDREN,

THE psychological causation of nocturnal enuresisin children is much emphasised nowadays, and manywriters discredit all forms of treatment by medica-ments, diet, restriction of fluid, or the various formsof surgical intervention. Two recent papers illustratepossible methods of approach along the lines of whatis called psychiatry. Dr. R. C. Hamill holds theview that enuresis is a conduct disorder and can beperfectly well stopped when the child so desires.He explains to both child and mother that the onlyreason why the bed is wet is that the child prefersa wet bed to getting up, and once the child admitsthis and assumes responsibility for its conduct acure is effected. In Dr. Hamill’s opinion any othersuggestion will only be detrimental to the child’sinterests ; to accuse the tonsils, prepuce, hereditaryinfluences, and so on will merely furnish the childwith excuses for its ill-behaviour. With a youngchild the mother must quietly assume that nothingshort of a dry bed every night can possibly be expectedfrom her offspring, and with an older one, who canunderstand Dr. Hamill’s ingenious explanation ofconscious control during sleep, a few talks at thepsychiatric clinic will usually complete the cure.

Out of 80 cases thus treated 40 were entirely rid ofthe habit, and of the other 40 some were improved,some not improved but still under treatment, andsome had been lost sight of. Dr. Hamill claims thatthis treatment is " specific," and Dr. 1. S. Wilemakes a similar confident claim of great success fortwo methods of treating enuresis which he bringsforward.2 2 Dr. Wile says that for cases of enuresisin institutions the method of personal approach toeach child is quite impossible, so in the first of histwo methods a " group approach " was employed.In this scheme the inmates of the institution-theHebrew Orphan Asylum in New York City-weredivided into teams, and the object of the campaignwas explained separately to the boys and girls. Eachteam elected a captain, and each week the percentageof dryness was calculated for the various teams soas to foster the competition spirit. The methodemployed by the teams was left to their discretion,but the usual plan was to wake up the offendingmembers or to encourage the weaker members togreater efforts by means which are not stated butcan be imagined. When a member of one of these

1 Jour. Amer. Med. Assoc., July 27th, p. 254.2 Med. Times, August, 1929, p. 223.