of 1 /1
1175 infection. There is one point in connexion with voluntary notification that Dr. Raw mentions which we think re- quires further explanation. He considers that notification should be made compulsory in cases of public institutions where patients suffering from the disease come under the notice of the officials. Would he apply this rule to patients attending the out-patient rooms of the hospitals. 7 Here, again, we think a clear distinction should be made between notification of "closed" and "open" cases of tuberculosis. If the medical officer in charge considered that the circumstances of the individual rendered close super- vision necessary, then the case should be notified; but it would frequently happen that unnecessary hardship would be placed on individuals who had no tubercle bacilli in the sputum or who clearly appreciated the nature of the disease and who were willing and able to take all necessary pre- cautions. We still maintain, however, that constant and increased attention to hygiene and education of the patient are the strongest measures that can be adopted in the pre- vention of the disease and we echo Dr. Raw’s concluding words: The final victory over tuberculosis will not be gained by compulsion but by the earnest and steady cooperation of science and perseverance." THE WORK OF THE PIONEER MOTOR AMBU- LANCE OF LONDON. IN the issue of THE LANCET of May 18th last, p. 1373, we fully described the excellent electric motor ambu- lance which had then been recently installed in the City of London under the control of the City police. On Oct. 17th we had an opportunity of again inspecting it on the occasion of a demonstration of its working given before Mr. Henry Morris, President of the Royal College of Surgeons of England, and other gentlemen interested in ambulance work, the display being under the control of Captain J. Nott Bower, Commissioner of the City police force, who with Mr. Reginald Harrison, the president of the Metropolitan Street Ambulance Association, and Mr. F. Gordon Brown, the City police surgeon, has been largely responsible for the successful institution of the motor system. At the display last week a telephone message was received at the Old Jewry Police Office at 3.3 P.M. that there was an accident in Guildhall yard; the ambulance which is stationed in King Edward-street, next to St. Bartholomew’s Hospital, was summoned by telephone and arrived in a few minutes at the Guildhall, where it was met by the inspecting party. A "dummy" patient was provided who was supposed to have a fractured femur and this the constables on duty pro- ceeded to put up in a workman-like and efficient manner. The patient was conveyed to the St. Bartholomew’s station in the ambulance which glides so smoothly through the traffic that it has been dubbed the White Swan," the time from the receipt of the first call at the central police office to the arrival of the patient at the hospital being only 13 minutes. At present there are 52 call-boxes in the City of London operated only by the City police, all of whom have had a first-aid training. The following return shows the number of cases taken to hospital by electric ambulance and hand litters since the establishment of the motor ambulance system on May 13th:- As Captain Nott Bower says in his report, from a police point of view the saving of 11 minutes for each case is most im- portant. It clears crowds and obstruction from the streets I for that period and saves the time of the police for other duties. The contrast to an accident patient between the jolting of a hand litter and the smooth travelling in the ambulance is great and in this way the saving of sufEerings to the sick and injured must have been considerable, as has been warmly acknowledged by many of those whom the police have conveyed to St. Bartholomew’s Hospital in the electric car. Mr. Anthony A. Bowlby, C.M.G., surgeon to the hospital, has written as follows on the subject : "The patients who have been brought in the new ambulance have been very well looked after by the police. They have evi- dently been very carefully lifted and moved and have suffered much less pain in transit than if they had been conveyed in any ot’o.er way. I think the new ambulance is a complete success." And Mr. Ludlam, superintendent of the New York Hospital and superintendent of the ambulance service of New York, writes from that city: " I saw the new motor ambulance at St. Bartholomew’s, and was deeply interested in it, and pleased at the enthusiasm and intelligence displayed by the men in charge. The vehicle itself is admirably adapted to the purposes for which it is intended, and is, in some respects, I think, in advance of the type in use in New York. Its record is excellent. I was told it had been in commission for three months without breakdown and without expenditure for repair. This speaks volumes for the excellent construction, and for the intelli- gent care taken of it. Evidently those in charge of the ambulance are proud of it, and of the fact that they arrive at the scene of accident within a very few minutes after the receipt of the call. The fact that the time from the occurrence of an accident to the delivery of the patient at the hospital is thus reduced to a very few minutes, and that the transportation is made with a minimum of suffering to the patient, should be unanswerable argument in favour of the new system." A CASE OF POISONING BY POTASSIUM CHLORATE. A FATAL case of poisoning by potassium chlorate studied in the wards of Professor Klemperer at the Moabit Hospital at Berlin is recorded in the Allgemeine Medioinisohe Cent’J’aZ- Zeitnng of July 6th by Dr. Hans Hirschfeld, the changes produced in the blood being given in detail and with special care. The influence of the drug upon the red blood corpuscles is well known but in this case some changes were found in the white corpuscles which have not hitherto been observed. The patient was a young woman, aged 19 years, who had taken 20 grammes of potassium chlorate on June 4th. Two days later she was admitted into hospital show- ing the typical bluish-grey tinge of the skin with slightly icteric conjunctivas and passing scanty dark- brown urine containing large quantities of methsemoglobin. Venesection was at once performed and a transfusion of defibrinated human blood was carried out, as a result of which the general condition was somewhat improved. In the next few days but very little urine was passed and oedema, vomiting, and signs of cardiac weakness rapidly developed. At the same time, however, the condition of the blood improved and the bluish-grey colouration of the face gave place to great pallor. The treatment adopted included infusion of salt solution, hot-air baths, pilocarpine injections, and administration of oxygen. The patient died on June 13th, having lived nine days after taking the chlorate of potas- sium. In regard to the result of the examination made of the blood, the most severe changes were observed on the day of admission-i.e., on the third day after the poisoning. A large proportion of the erythrocytes showed a more or less advanced decolourisation of the stroma and the small pigmented bodies containing methsemoglobin first described by Ehrlich, appeared within them. They were observed

THE WORK OF THE PIONEER MOTOR AMBULANCE OF LONDON

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1175

infection. There is one point in connexion with voluntarynotification that Dr. Raw mentions which we think re-

quires further explanation. He considers that notification

should be made compulsory in cases of public institutionswhere patients suffering from the disease come under thenotice of the officials. Would he apply this rule to

patients attending the out-patient rooms of the hospitals. 7Here, again, we think a clear distinction should be madebetween notification of "closed" and "open" cases of

tuberculosis. If the medical officer in charge consideredthat the circumstances of the individual rendered close super-vision necessary, then the case should be notified; but it

would frequently happen that unnecessary hardship wouldbe placed on individuals who had no tubercle bacilli in thesputum or who clearly appreciated the nature of the diseaseand who were willing and able to take all necessary pre-cautions. We still maintain, however, that constant andincreased attention to hygiene and education of the patientare the strongest measures that can be adopted in the pre-vention of the disease and we echo Dr. Raw’s concludingwords: The final victory over tuberculosis will not be gainedby compulsion but by the earnest and steady cooperation ofscience and perseverance."

THE WORK OF THE PIONEER MOTOR AMBU-LANCE OF LONDON.

IN the issue of THE LANCET of May 18th last, p. 1373,we fully described the excellent electric motor ambu-

lance which had then been recently installed in the Cityof London under the control of the City police. On

Oct. 17th we had an opportunity of again inspecting it onthe occasion of a demonstration of its working given beforeMr. Henry Morris, President of the Royal College of Surgeonsof England, and other gentlemen interested in ambulance

work, the display being under the control of Captain J. NottBower, Commissioner of the City police force, who with Mr.Reginald Harrison, the president of the Metropolitan StreetAmbulance Association, and Mr. F. Gordon Brown, the Citypolice surgeon, has been largely responsible for the successfulinstitution of the motor system. At the display last week atelephone message was received at the Old Jewry PoliceOffice at 3.3 P.M. that there was an accident in

Guildhall yard; the ambulance which is stationed in

King Edward-street, next to St. Bartholomew’s Hospital,was summoned by telephone and arrived in a few minutes atthe Guildhall, where it was met by the inspecting party. A

"dummy" patient was provided who was supposed to havea fractured femur and this the constables on duty pro-ceeded to put up in a workman-like and efficient manner.The patient was conveyed to the St. Bartholomew’s stationin the ambulance which glides so smoothly through thetraffic that it has been dubbed the White Swan," the timefrom the receipt of the first call at the central police office tothe arrival of the patient at the hospital being only 13minutes. At present there are 52 call-boxes in the City ofLondon operated only by the City police, all of whom havehad a first-aid training. The following return shows thenumber of cases taken to hospital by electric ambulance andhand litters since the establishment of the motor ambulance

system on May 13th:-

As Captain Nott Bower says in his report, from a police pointof view the saving of 11 minutes for each case is most im-portant. It clears crowds and obstruction from the streets I

for that period and saves the time of the police for otherduties. The contrast to an accident patient between thejolting of a hand litter and the smooth travelling in theambulance is great and in this way the saving of sufEeringsto the sick and injured must have been considerable, as hasbeen warmly acknowledged by many of those whom thepolice have conveyed to St. Bartholomew’s Hospital in theelectric car. Mr. Anthony A. Bowlby, C.M.G., surgeon tothe hospital, has written as follows on the subject : "Thepatients who have been brought in the new ambulance havebeen very well looked after by the police. They have evi-dently been very carefully lifted and moved and havesuffered much less pain in transit than if they had beenconveyed in any ot’o.er way. I think the new ambulanceis a complete success." And Mr. Ludlam, superintendentof the New York Hospital and superintendent of theambulance service of New York, writes from that city:" I saw the new motor ambulance at St. Bartholomew’s, andwas deeply interested in it, and pleased at the enthusiasmand intelligence displayed by the men in charge. The

vehicle itself is admirably adapted to the purposes for whichit is intended, and is, in some respects, I think, in advanceof the type in use in New York. Its record is excellent. I

was told it had been in commission for three months withoutbreakdown and without expenditure for repair. This speaksvolumes for the excellent construction, and for the intelli-gent care taken of it. Evidently those in charge of theambulance are proud of it, and of the fact that they arriveat the scene of accident within a very few minutes after

the receipt of the call. The fact that the time from the

occurrence of an accident to the delivery of the patientat the hospital is thus reduced to a very few minutes,and that the transportation is made with a minimum of

suffering to the patient, should be unanswerable argumentin favour of the new system."

A CASE OF POISONING BY POTASSIUMCHLORATE.

A FATAL case of poisoning by potassium chlorate studiedin the wards of Professor Klemperer at the Moabit Hospitalat Berlin is recorded in the Allgemeine Medioinisohe Cent’J’aZ-Zeitnng of July 6th by Dr. Hans Hirschfeld, the changesproduced in the blood being given in detail and with specialcare. The influence of the drug upon the red blood corpusclesis well known but in this case some changes were found inthe white corpuscles which have not hitherto been observed.The patient was a young woman, aged 19 years, who hadtaken 20 grammes of potassium chlorate on June 4th.Two days later she was admitted into hospital show-

ing the typical bluish-grey tinge of the skin with

slightly icteric conjunctivas and passing scanty dark-

brown urine containing large quantities of methsemoglobin.Venesection was at once performed and a transfusion ofdefibrinated human blood was carried out, as a result of

which the general condition was somewhat improved. In

the next few days but very little urine was passed andoedema, vomiting, and signs of cardiac weakness rapidlydeveloped. At the same time, however, the condition of theblood improved and the bluish-grey colouration of the facegave place to great pallor. The treatment adopted includedinfusion of salt solution, hot-air baths, pilocarpine injections,and administration of oxygen. The patient died on June 13th,having lived nine days after taking the chlorate of potas-sium. In regard to the result of the examination made of theblood, the most severe changes were observed on the day ofadmission-i.e., on the third day after the poisoning. A

large proportion of the erythrocytes showed a more or lessadvanced decolourisation of the stroma and the small

pigmented bodies containing methsemoglobin first describedby Ehrlich, appeared within them. They were observed