544

by their application to the whole surface of the body.Bier’s treatment with protein bodies should also befurther investigated, and the effect of blood-letting,.alterations in diet, and other means of influencing thegeneral condition. Sauerbruch concludes : " Whoknows but that we shall not soon learn how to stimu-late and artificially assist the processes which causespontaneous cure in malignant growths ? I am con-vinced that the X rays will play a large part in thiswork, but the improvement will take place not in theincrease of their physical effect but rather in theirpower of adaptation to the particular purpose and theparticular kind of tumour to be dealt with. For thepresent, however, while the action of X rays are souncertain early diagnosis and early operation remainfor the surgeon the only available hope of cure."

VOLUNTARY TREATMENT IN MENTAL

HOSPITALS.

IN the annual reports for 1921 of the physicianssuperintendent of the Royal Edinburgh Hospital,Morning side, and of the Crichton Royal MentalHospital, Dumfries, particular attention is paid to thesystem of voluntary treatment and the great need ofits extension to include treatment of early and mildcases of mental illness among the rate-aided class ofthe community. Writing of the Morningside Hospital,Dr. G. M. Robertson states that the voluntaryproportion of 50 per cent. of all admissions to CraigHouse has now remained steady during three yearars ..accepting this fact as an indication of the trend ofpublic feeling, he concludes, first, that the publicdo not consider certification desirable or necessaryfor one half of the patients who need treatment inmental hospitals, and secondly, that this same propor-tion of patients have, in the early stage of their.disease at least, some insight into their own con-dition, and are, at any rate, susceptible to argumentconcerning it. At the Dumfries mental hospitalthere were 127 voluntary and 182 certificated entries." The voluntaries," writes Dr. C. C. Easterbrook," suffered from the same kinds of nervous and mentalillnesses as the certificated patients, but mostly inearlier stages or milder degrees." The earlier thetreatment, the more hope is there of recovery, andto quote Dr. Robertson’s words :-

"Voluntary admission encourages earlier treatment ofmental disorders than a procedure in which one has to waittill the illness has reached a stage at which the patient may ibe legally certified to be insane.... Again, nothing ismore conducive to the efficient administration of a mentalhospital than the presence there of large numbers of voluntarypatients. Their views and criticisms cannot possibly beignored, as those might conceivably be of persons who arevery insane, especially as voluntary patients possess theright of leaving an institution on giving three days’ notice.of their intention to do so, if dissatisfied with their treat-ment."The practice of voluntary treatment is so generally

admitted to be admirable that its extension toinclude cases of persons unable to pay for such treat-ment becomes a matter of common justice. At

present the poor are debarred from this great advan-tage because the Government gives a grant-in-aid toparish councils for the maintenance of certifiedlunatics, but nothing for the upkeep of voluntarypatients. Thus, to obtain treatment for mentaldisease, however mild, a poor patient must undergoa judicial process, be certified as a lunatic, and thenbe legally committed under an order of detentiongranted by a sheriff or magistrate. This system ofcompulsory pauperisation and certification is, inDr. Easterbrook’s opinion, largely responsible for thefrequent unwillingness of relatives to send the patientto a mental hospital until it becomes absolutelynecessary to do so. The procedure, he suggests,should be on lines similar to, but not identical with,those followed in the case of the private voluntarypatient. Formal application should be made, as atpresent, to one of the Commissioners or simply to the- (General Board of Control, but it should be supported

bv the recommendation of the patient’s usual medicalattendant, and in a rate-aided case, countersigned bythe clerk to the district board of control, or otherappropriate public official accepting financial respon-sibility for the case. The sanction of the Boardshould be received by the patient before his admission,and should contain an instruction to the patient tothe effect that he can leave the hospital on givingthe superintendent reasonable notice. A period ofseven days is suggested in this connexion, insteadof the present period of three days, which is con-

sidered too short. Further, with reference to themental condition of a person eligible for admissionas a voluntary patient, the writers of both reportsfall foul of the ambiguous phrasing of the ScottishStatute of 1886, wherein the voluntary patient isrequired to be" any person who is desirous of sub-mitting himself to treatment, but whose mentalcondition is not such as to render it legal to grant

certificates of insanity in his case." Dr. Easterbrookpoints out that a better definition would be " anyperson who is desirous of submitting himself to treat-ment," with no debatable clause referring to certifi-cation. The patient’s own willingness to come,and his doctor’s recommendation, should suffice togain his admission. ____

THE EFFECT OF COPPER ON VITAMIN C.

IT is known that the antiscorbutic vitamin in milk,orange-juice or tomato-juice, is, to a certain extent,destroyed by oxidation. A. F. Hess and L. J. Unger,in view of the well-known action of catalysts in increas-ing oxidative processes, and the frequent presence oftraces of copper in milk, have made experiments toascertain the effect of the addition of small amountsof copper to milk.

1 To this end two groups of guinea-pigs were fed with equal amounts of milk which inthe one instance had been heated in a glass vesselto 60° C. for 40 minutes, and in the other instancehad been heated in a copper vessel to the same degrees.Each animal received daily dried milk to the equivalentof 100 c.cm. of fluid milk, and oats in addition. Noneof the guinea-pigs fed on the milk heated in the glassvessel developed scurvy during a period of fourmonths ; they did not, however, make normal gainsin weight as the quota of antiscorbutic vitamin wasinadequate. On the other hand, the animals fed withthe same quantity of milk which had been heated ina copper vessel all developed scurvy, and died afterabout four weeks. This milk contained 1-4 parts ofcopper per million. That this nutritional failure wasdue to a lack of antiscorbutic vitamin was demon-strated by the excellent gains of a third group of guinea-pigs which were given milk heated in the copper vessel,but received in addition 2 c.cm. daily of orange-juice.Milk frequently becomes contaminated with copper inthe course of commercial pasteurisation or condensa-tion. The authors remark that it seems possible thatthese traces of copper may contribute to the destruc-tion of the antiscorbutic vitamin and account, in somedegree, for the varying content of this factor in heatedmilk. It is also possible that the copper ingested withthe food, especially in infants whose diet consistsmainly of milk, may exert an effect within the animalbody. ____

TRACHOMA AND OPHTHALMIA IN EGYPT.

! ACCORDING to the report of the OphthalmologicalSociety of Egypt on the means of prophylaxis againsttrachoma and ophthalmia, it is no exaggeration to saythat about 90 per cent. of the whole population ofEgypt are infected with trachoma, while the proportionof those blind in both eyes to the total population is1 in 82, mostly from the infection of acute ophthalmia.The most disquieting fact that appears from thereport is that in spite of the existence of 18 ophthalmichospitals with a staff of 32 ophthalmic surgeons, therewas no appreciable amelioration in the condition ofaffairs during the decade 1907-1917. We do not believe

1 Proc. Soc. for Expt. Biol. and Med., xix., December, 1921