JULY 18, 1936 ENGLANP AND WALES M THEBRMTIg S 149 Society of Medicine, the Medical Society of London, the professor of midwifery. In 1912 he was appointed regius Society of Apothecaries, and the Hunterian, Harveian, professor of midwifery, and for many years was physician and Chelsea Clinical Societies. The toast was-responded to the Maternity Hospital and gynaecologist to the Royal to by Mr. H. L. Eason, Vice-Chancellor of the University Infirmary. Professor Theodore Shennan was pathologist of London, and by Dr. Robert Hutchison, president of the to the Royal Infirmary of Edinburgh and lecturer in Royal Society of Medicine, who said that he was glad his pathology and bacteriology in the school of medicine of society had not swallowed all the smaller ones, because the Royal Colleges at Edinburgh for a number of years, he believed the smaller medical societies had a distinct but for the last twenty-two years he has been regius function. The members knew each other better, and the professor of pathology in Aberdeen. politeness which so cramped the style of discussion in the larger societies had a less inhibiting influence in the smaller New Hospital at Paisley bodies. Among these smaller societies the West London A new hospital for infectious diseases at Paisley, which was a model. has cost approximately £150,000, was opened on July 7th. This hospital, which stands on the main Hawkhead road, Psychotherapy and the Church will provide accommodation for over 180 patients, and A circular letter signed by the Archbishop of York as c6nsists of seven pavilions. One of the pavilions is a chairman, and Canon J. F. L. Southam of Chester and cubicle block with accommodation for thirty patients, and Canon F. Paton-Williams of Manchester as joint secre- is designed for isolating doubtful cases. Others are in- taries, states that an opportunity has arisen to promote tended for pneumonia (thirty beds), diphtheria (twenty- the co-operation of the clergy (and church people generally) one beds), scarlet fever (thirty beds), measles (twenty with medical psychologists (and the medical profession beds), whooping-cough (twenty beds), and tuberculosis generally). (thirty beds). The pavilions are single-story buildings " The practice of psychotherapy has developed greatly in with verandas and a solarium. In the nurses' hlome recent years, and is bound to play an increasing part in the forty-nine nurses and six sisters will be accommodated, treatment of those suffering from the varous forms of disease and the administrative block, in addition to dining and -mental and otherwise-which are caused in whole or in sitting rooms, contains rooms for the matron, medical part by psychical conditions. It is evident that medical work officers. and maids. of this kind comes into very close relations with some parts of the pastoral work of the clergy, and co-operation betwNeen clergy and medical psychologists is greatly to be desired. CORRESPONDENCE Also it is evident that the practice of psychotherapy involves action to which the principles of the Christian religion and ethics are directly relevant; if these are neglected great harm Poliomyelitis may result. " SIR,-In his interesting paper on epidemic polio- Accordingly Miss Graham Ikin, a psychologist, has myelitis, Sir Arthur MacNalty pays me the compliment been entrusted with a mission to give lectures, to lead of citing a classification of the pathological and clinical conferences, or to meet individuals with a view to spread- events in this disease that was formulated by me some ing that understanding of the subject which is needed as nine years ago. a preliminary to co-operation. She will not herself prac- At the time it was made this classification was an tise as a lay psychotherapist, but will aim at bringing acceptable generalization of the state of our knowledge. together those who practise psychotherapy and those who In the history of poliomyelitis research nine years is a as pastors give spiritual guidance. Among those support- ing the enterprise are the Bishops of Bradford and Man- long time, and no one wouId now accept this generaliza- chester ; Dr. J. R. Rees, director of the Institute of tion a-s in accord with what we have since learned of the Medical Psychology; and Dr. H. P. Newsholme, M.O.H., nature of poliomyelitis from the work of Weston Hurst Birmingham. The medical members of the committee to and Farebrother in this country and that of others in which Miss Ikin will be responsible are Professor John America and Germany. Hay, Dr. Neil Macleod, Dr. T. WV. Mitchell, and Professor A conception of poliomyelitis as a virus infection of the Maxwell Tellingr. nervous system exclusively is now generally accepted. The clinical and pathological evidence upon which the belief in an initial stage of generalized systemic infection Scotland was based is now thought to require and to be capable of another interpretation. New Edinburgh Professors A summary of this new conception and a discussion of The University Court of the University of Edinburgh its bearings upon treatment were submitted by me three has transferred Professor D. Murray Lyon from the years ago at the Annual Meeting of the Association in Christison chair of therapeutics in the University of Dublin, and it is by this summary that I should prefer Edinburgh to the Moncrieff Arnott chair of clinical medi- to be cited rather than by views formulated at a com- cine, to be vacated by Professor Edwin Matthew on paratively remote epoch and now completely obsolete. September 30th next. It is understood that in future the The Dublin paper was published in this Journal on professor of clinical medicine will be relieved from duties December 30th, 1933.-I am, etc., in the Royal Infirmary of Edinburgh and will be trans- ferred to the Western General Municipal Hospital. To fill London, W.1, July 11th. F. M. R. WALSHE. the vacancy thus created in the chair of therapeutics, the University Court has appointed Dr. Derrick Melville Dunlop, who is at present one of the assistant physicians Epidemic Nausea and Vomiting to the Royal Infirmary. Dr. Dunlop, who graduated SIR,-An epidemic of vomiting occurred in one bf the M.B., Ch.B. at Edinburgh in 1926 and M.D. in 1927, is school camps in South Wales, with symptoms closely also lecturer on therapeutics and assistant to the professor resembling those described by Drs. R. Miller and M. of tuberculosis in Edinburgh University. Raven in their communication to the Jouxnal of June 20th Aberdeen Professorial Resignations (p. 1242). At a meeting of the Aberdeen University Court on The first case was seen at the camp surgery on Sunday, July 10th the resignations of Professor Robert Gordon May 31st, wvhen I was present. A boy came to see the M'Kerron from the chair of midwifery and of Professor nurse on account of abdominal pain, and very shortly after- Theodore Shennan from the chair of pathology were wards, about 4.30 p..m., had violent vomiting. A few minutes announced. Professor M'Kerron joined the teaching staff later, wthen I saw hiim, he appeared to have greatly improved, of Aberdeen University in 1891 as assistant to the but he was kept in one of the isolation cubicles for the night, professor of physiology, and was later assistant to the so as to be under the supervision of the niurse. During the 150 JULY 18, 1936 CORRESPONDENCE MEDICAL IOURNAL next few days more cases of vomiting occurred, the highest and infection from the water supply was therefore ruled out. number being on June 2nd, when five teachers and thirty- Grade A (T.T.) milk was consumed, either raw or cooked, seven boys were affected. In all, eight teachers and fifty by all in the camp. I obtained a sample of the milk for boys were concerned. examination at the Beck Laboratory, Swansea. I also took The total number ot teachers was seventeen, the boys a specimen of vomited matter for examination at that labora- numbering 187. Thirty-three boys, with three teachers, tory, and further specimens of vomited matter and of faeces occupied each of five huts. Hut D was occupied by twenty- were sent on June 4th. two boys and two teachers. (A third of this hut is par- The permanent staff, consisting of seven persons, were not titioned off to provide for surgery, isolation cubicles, and affected in this outbreak, but the senior cook had suffered nurse's bedroom.) The following table shows the distribution from an attack of diarrhoea of short duration on May 30tlh. of the cases in the six huts, with the number of teachers He had quite recovered from this by the next morning and and boys affected each day. was on duty as usual, the state of the bowels having become normal. When I visited the camp on June 3rd I gave instruc- Huts A B C D E F All Hiits tions that during the next week he must not handle any raw foodstuffs-meat, milk, vegetables, etc. These instruc- T. B. T. B. T. B. T. B. T. B. T. B. T. B. tions were given on the assumption that he might have been the source of the outbreak. May 31st - - -- 1 .. 1 The following report of Dr. Sladden, Beck Laboratory, Swansea, gives the result of his examinations: June lst - 5 2 - - - - 1 3 _ 3 8 Milk Supply.-Milk count entirely satisfactory, of " certi- 2nd 1 8 1 5 214 - 3 1 6 5 37 fied " standard. Special cultures showed no food-poisoning 3rd -.1 ..-- -1 bacteria or other bacteria likely to cause gastritis, except a few staphylococci, in fluid media only. ,4th - - - -- 3 .. 3 Vomits.-Boy, B. B., June 2nd: Chemical and micro-

5Eth ------scopical examination-normal; bacteriological-negative results. R. W. C., D. E., and H. M.: All negative bacterio- 1 13 3 5 2 18 -2 1 6 1 6 8 50 logically. Faeces. D. E. and T. D. W.: No evidence of colitis or of infection by food-poisoning bacteria. The following notes relate to eight teachers and forty-seven who Conclusions.This milk supply is satisfactory, but an boys, came for a two-weeks stay at the camp on earlier supply may have become contaminated at the camp. May 22nd. No complete information was obtained in the case Absence of enteritis or colitis, and very rapid recovery, is of three boys who vomited on June 4th, the day before they against Salmonella infection as a cause, and there is no left the camp. Inquiry showed that the principal symptoms bacteriological evidence of this. The history suggests trans- before an attack oi vomiting were: abdominal pain (thirty mission of a bacterial infection on May 30th by the cook cases); chilly sensations (twenty-seven cases); headache to the milk supply, the infection being possibly staphylococcal, (eighteen cases); giddiness (fourteen cases); nausea (nine producing toxins and gastritis but not progressing into the cases); diarrhoea (seven cases); the last two symptoms mainly intestines. These examinations, however, bring no satisfactory affecting the teachers (nausea in seven and diarrhoea in six). evidence to support this theory. In no case was there any rise of temperature. In five cases (two teachers and three boys) there was no vomiting, but -I am, etc., nausea was complained of. Vomiting occurred once in twenty- L. W. POLE, six cases; twice in seventeen cases; three times in five boys Llanelly, July 10th. Med-ical Officer of Health. four times in two boys. Vomiting came on suddenly, oftenl without any warning. In ten cases the amount of vomited material was small, but in the other cases it was copious. In Mortality and Phthisis in Mental Hospitals thirty-seven cases the vomited material was undigested stew, tuberculosis in sub- which had been eaten at SIR,-A study of the incidence of dinner-time (1 p.m.) on the same on the day. In thirteen cases the vomited material was watery normal groups is helpful in casting light aetiology and sometimes yellowish. of the disease. The contention that the existence of In one case vomiting was at 10 a.m. three boys vomited tuberculosis among patients in mental institutions is re- between 1.30 p.m. and tea-time (4.30 p.m.); but in the lated to the twofold question of ventilation and diet, and majority of cases vomiting took place after tea and up till mid- more especially to the latter, is supported by the increase night (thirty-five cases). In the early hours of the morning in the death rate from this disease during the war years there were five cases. In all cases there was apparently com- when the supply of food was depleted. In a communica- plete recovery in forty-eight hours, many feeling quite well tion made in 1919 by Dr. Ashby Elkins and myself on within twenty-four hours and ready for meals. These were, however, reduced in quantity. the death rate from tuberculosis, based chiefly on post- The principal symptoms complained of after an attack ol mortem findings in a mental hospital during a period of vomiting were: abdominal pain (fourteen cases); headache twenty years, the following figures were included: (seventeen cases); giddiness (fifteen cases); chilly sensations (twenty-seven cases). The appetite was good after an attack from Tuberculosis YearveBPrage'ntSNum eRthgDeath s flmMortalityfr-o in twenty-one cases, fair in thirteen cases, and poor in seven- YYera verfag ie nt All Causes teen cases. The pulse was rather slow but regular, and the efsaidentsResident ~~~~Deaths Rate per 1,030 tongue was slightly coated in all cases. As a measure of precaution a dose of mist. alba was given to each 'patient, 1913 2,051 197 59 29.0 but apart from this there was no treatment beyond some 1914 2,099 172 42 20.0 restriction of diet already referred to. On the morning of June 5th, when the boys and teachers were due to leave the 1915 2,045 240 70 34.2 camp, the camp director reported that all were ready and fit 1916 2,041 283 102 49.9 for their journey- home. 1917 1,941 459 141 ,2.6 When I visited the camp on May 31st no cases of vomitirig had been reported, the first to be recorded being that of the 1918 1,769 542 2^8 117.6 boy who came to the camp surgery while I was there, and who complained of abdominal pain, which was soon followed In investigating the probable causes responsible for the by a sudden attack of vomiting. Following a telephone cOn- above versation with the camp nurse on June 3rd I paid a visit marked increase in the death rate given in the to the camp, as she reported that a large number of cases table several points of special significance were noted. of vomiting had occurred on the previous evening and during The inmates included a large proportion of mental defec- the early hours of Wednesday morning. No cases of vomliting tives of low-grade type whose resistance to invasion by had been reported as having occurred in the village near by, the tubercle bacillus was far below norrhal, and whose