1917 The Lancet  
2) First thoroughly mop the affected parts with tinctura iodi; then rub on argent. nitratis 10 gr. (0'6 gm.), spirit. aetheris nitrosi 1 oz. (30 gm.). Repeat this treatment if necessary, and apply the benzoic acid ointment between whiles. For the treatment of p8orlasis in soldiers it is but waste of time to try internal remedies. They are generally disappointing, and, in any case, show no results for weeks. It is better to at once apply local remedies. The following ointment is often successful
more » ... in removing the eruotion:— S. The ointment to be writ rubbed in twice daily with a piece of flannel. This ointment, which is made with a stiff basis-ung. paraffin.-is usually more effectual than when made with simple vaseline. If this ointment fails, ung. chrysarobini B. P. should be employed, with the usual precautions of avoiding the face, hands, and scalp, and relaxing the treatment if chrysarobin erythema appears at any part. The patient should be kept in bed when chrysarobin ointment is used. The treatment of psoriasis will be usually slow, but for most of these complaints it may be said that with prompt and efficient treatment the period of ho-pitalisation will be reduced to a week or so, while inefficient treatment may prolong that period to many weeks or months, or lead even to eventual discharge of men from the Army with the complaint still uncured. This, then, is the excuse, if such be needed, for venturing to discuss these somewhat banal subjects. THE fact that the great war rapidly developed largely into a trench warfare has caused head injuries to figure very prominently in the casualty lists. One of the after-consequences of many of these head injuries is partial or complete loss of sight, and as a result the war had not been many months in progress before a number of discharged blinded soldiers were thrown on to the nation's charity. As in many other matters the nation was not prepared for this state of things, and St. Dunstan's was the first, as it has now grown to be the final and complete, answer to the urgent cry for help from the sufferers. Everybody now knows that St. Dunstan's was initiated, put into being, and carried on to what it now is by the self-devotion and genius for organisation of Sir Arthur Pearson, who has given the whole of his marvellous energies, and incidentally has largely sacrificed his health, to perfecting a scheme for the training of blinded soldiers and sailors. St. Dunstan's started just a short 22 months ago in a large house in the Bays water-road. Thence in March, 1915, it moved to its present quarters in Regent's Park, where on the 15 acres of available land it now lodges about 180 men, and here the greater part of the training is carried out. But St. Dunstan's stands for much more than this. It now includes the Regent's Park College, recently made over by the generosity of the Baptist College Committee, with its possible accommodation for about 200 more men. In addition two large h 'uses in Portland-place serve as accommodation for blinded officers, and two houses in Paddington are also being used to lodge some of the men for whom there is no available space at St. Dunstan's for the moment. Further, four convalescent homes (two at Brighton, one at Blackheath, and one at Torquay), with accommodation between them for 112 patients, serve a most useful purpose in providing the men with week-end and longer trips to rebuild their health. These homes have proved a very great boon, as numbers of the men suffer a great deal from headache and malaise long after their wounds have healed. Moreover, the work at St. Dunstan's does not end with the training of the men, but purposes to settle them after training-i.e., to provide homes for them, to set them up in bnsiness, and to supervise them after settlement. Thus the " settlement" and after-care" departments of St. Dunstan's have grown into a great and responsible undertaking, and the work is of necessity very rapidly increasing. It is a, work which requires great organisation, and already has advanced to the stage of portioning the United Kingdom into districts, each with its own supervising secretary and branch establishment. At the present moment there are 388 blinded soldiers and sailors on the books at St. Dunstan's. Of these, 280 are actually at St. Dunstan's or its attendant convalescent homes, whilst 108 are in hospital either waiting admission or sent into hospital as requiring medical treatment in some form. For the purposes of admission a man is considered fit whose sight is so injured that he is incapable of leading an independent existence. There are many, therefore, who can distinguish light. though a large majority are absolutely blind. A difficulty has existed in regard to a certain number of cases which are partly or wholly functional-cases of bad "shell shock," as it is loosely called, for example. To sift and apportion the functional and organic elements in many of these cases is a matter of great difficulty, and to train a purely functional blindness as if it were an organic blindness may be the worst possible treatment. However, ways and means have generally been found to deal with these cases, and the convalescent homes have proved very valuable adjuncts in helping to the right decision. The great factor in the success which has attended St. Dunstan's is the youth of most of the patients. It is far better to go blind young than to lose sight after middle age. The buoyancy of youth, its power of repair, mental as well as physical, and its inherent faculty of living in and for the present without undue inquiry into a remote future, make it possible for blinded youth quickly to pick up the severed threads and start life again. Such elasticity is out of the reach of the aged, and consequently the training of the youthful blind is far easier and far more gratifying in its results than training applied to the old. At St. Dunstan's the men are all taught to shun self-pity. Commiseration is avoided, and from the start the man is encouraged to accept his lot as an inconvenience and not as a disability. He has got to make the best of it, and the best is a very good one if it is learnt aright. A visit to St. Dunstan's at any time will speedily assure the stranger that this spirit is quickly and cheerfully accepted, for there is no cheerier place in London. Another and equally important point in the training is the teaching of inriependence. The blind man instinctively becomes increasingly dependent on others if left to himself, and the greatest pains are taken at St. Danstan's to show the' men how to shift as far as possible for themselves. Various simple devices are adopted and after a very short stay the man will be found cheerily going about his own business without a thought of seeking outside help. A more subtle difficulty is the natural " suspicion " of a blind man. Everybody instinctively gauges the value of a word by watching the speaker, and the loss of this faculty of watching weighs very heavily on many blinded people. The feeling of distrust soon wears off at St. Dunstan's in the life of good fellowship amongst others similarly handicapped, aided by the inspiration afforded by the experiences of those who have lived at the hostel for some time. The actual training of the men occupies a work day of four hours, two hours being given up daily to learning Braille and typewriting, and two hours to the learning of handicrafts or trade. The hours are not long, but the blind man has to visualise everything mentally, and has consequently to concentrate intensely upon all his work. Thus the blind man gets tired much more quickly than the sighted man even when "fit,"and very many at St. Dunstan's are anything but " fit." Typing is quickly learnt, and if an " efficiency " test is passed the man on leaving the hostel is presented with a Remington typewriter. Braille presents many difficulties to the older and to the more uneducated men, as also to a good many of those who have had severe head injuries. I am in hopes that a simplified Braille may be devised to meet this need. For a selected few massage, poultry farming, and telephoning form very suitable occupations ; but these are not for the majority, who are set to learn simpler things, such as mat-ra-iking. basket-and hamper-making, carpentering, or cobbling. Two of these rougher trades are usually learnt by each man. The average time occupied in
doi:10.1016/s0140-6736(01)47976-1 fatcat:attiu3myjzgo3elax2655ha4mi