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916 Hospital, now called the Hospital for Women and Children for the past 13 years. She gave figures of the number oj patients treated at the hospital in each year since 1893, anc these showed a decrease from 736 patients in that year t( 340 in 1912. This fall, she said, was partly due to a changt in general conditions and partly to the fact that in tht - earlier years women came to the hospital from garrison towns, The figures were also very much influenced by the fact thai in the earlier years patients were of a class who left the hospital directly they were free from symptoms ; at the present time the patients remain in the hospital for longei periods and finish their treatment. During the present yea] the number of patients was much larger than had beer the case in corresponding periods for a number of years. Miss Garrett thought this was probably the result of the greateI publicity of the subject during the last few months. The name of the hospital was changed some years ago, and this had had good results in getting rid of prejudice against the hospital; in particular, cases now came to the hospital at an earlier stage of the disease. Most of the patients treated at the hospital were very young girls, the average age being 20, and there were very few professional prostitutes. At the twenty-fourth meeting evidence was given by Dr. Amand Routh, consulting physician to the Charing Cross Hospital and to the Samaritan Free Hospital for Women .and Children. Dr. Routh said that from figures which he had obtained he had formed the conclusion that the infant mortality before the period of full birth was as high as in the first year of !life, so that the total mortality during the intra-uterine life .and the first year after birth was about one-fourth of the possible children. He thought that syphilis was the main cause of stillbirths, and also probably of a large proportion of -early intra-uterine deaths, and he suggested various measures which might be adopted with the object of obtaining reliable statistics, of assisting diagnosis, and of facilitating the Application of treatment. These measures included the extension of the compulsory registration of stillbirths to the whole country; arrangements under which poor women might ’receive medical supervision during pregnancy ; the provision -of the pre-maternity wards in every locality ; the formation and endowment of research laboratories in all general and lying-in hospitals ; and arrangements for financial assistance to poor pregnant women during the later months of preg- nancy. Dr. Routh said he was not in favour of the com- pulsory notification of venereal diseases, for unless anonymity could be secured and be believed in many men and most women would not consult a doctor, but would either remain untreated or consult venereal quacks who would greatly multiply. He felt that voluntary notification would be entirely unreliable statistically. He advocated the estab- lishment of venereal clinics in all districts, but thought it was important that they should not be known by any name of the nature of " venereal." BIRMINGHAM CHILDREN’S HOSPITAL. - The annual meeting of this institution was held on Feb. 23rd. The report of the board of management showed that the number of patients treated during 1913 was : in-patients 914, compared with 845 in 1912 ; out- patients 13,897, against 12,295 ; and casualties 628, against 686. The average length of stay in hospital was 22-18 days, and the average cost per week for each inmate (staff and patients) was 4s. 7d., as against 4s. 5d. in 1912. The new building is well in hand, and the opening ceremony is expected to take place in the summer of 1915. 9000 are still required to open the new hospital free of debt. During the year the committee has been impressed with the necessity of removing the out-patient department from Steelhouse-lane to the new site, as the present accommodation is very inadequate for the present work. The cost of a new out-patient department would be about £10,000, but against this there would be very con- siderable economies in annual expenditure. The accounts of ordinary income and expenditure show a deficiency of £235, as compared with 86 in the previous year, owing partly to an increase in expenditure and partly to a falling - off in special items of revenue. During the year there were 151 deaths, giving a death-rate of 16’5 per cent., as compared with 15 per cent. the previous year. Public Health. REPORTS OF SCHOOL MEDICAL OFFICERS. Radnorshire County Council.-Medical inspection is in a very primitive condition in Radnorshire. Dr. L. W. Pole reports that as he is not supplied with adequate assistance about half his time is taken up with clerical work. Because of this second visits to schools have been impossible, and no reinspection or following-up work has been systematically carried out nor any sanitary survey of the schools made. Goitre prevails largely, but whereas in 1911 the percentage of cases among children inspected was 3’4, in 1912 it was 2’1 1 only. The total children inspected were 1314, and belonged to four age groups, those about 5, 7, 10, and 13 years old respectively. Salop County Council.—Dr. James Wheatley lays emphasis on the necessity for bringing the ordinary child up to the highest pitch of physical fitness possible by removing unphysiological modes of living. The preventive work should consist of improvement of school premises, provision of proper playgrounds, efficient physical exercises, hygienic instruction of children, and cooperation with the sanitary authority to prevent damage to health before school age. The school medical officer’s report is sent to the head teachers of each school and has in consequence been very widely read. This useful practice might well be imitated elsewhere. The total number of children examined in the year was 13,227, of whom 3750 were reinspections and 734 were "specials." With reference to defective vision atten- tion is called tc the defective type of school Bibles The adoption of the British Association standards for the type of all new books is recommended and the prevention of needlework or any work involving eye-strain under eight years. East Sussex County Council.-Mr. A. G. R. Foulerton’s report includes, and gives special prominence to, special studies by Dr. Arthur Beeley on pulmonary tuberculosis among school children in the county, and by Mr. George Finch on the local distribution of cases of tonsils and adenoids. The total children examined since medical inspection began have been taken as the basis of the tuberculosis report. These children are 47,168 in number, and among these 20 cases of pulmonary tuberculosis have been found. Owing to some cases being second examinations these figures cannot be used to give a percentage, but in 24,128 which are available the percentage is 0’04. The phthisis death- rate per 1000 in 1910 for all ages in England and Wales was 1-08, in East Sussex 0’8. The low per- centage of school children affected is ascribed partly to the absence of large towns and partly to only a small proportion of the population being engaged in un- healthy trades. But the chief factor is probably the method of diagnosis. Mere harshness of breath sounds and pro- longation of expiration have not been accepted as evidence of tuberculosis by themselves, nor have catarrhal signs. More cases of tonsils and adenoids occur in rural areas than in urban. The distinctly urban districts of Seaford, Newhaven, and Portslade-by-Sea give percentages of occurrence of cases of enlarged tonsils and adenoids 3’6, 2-8, and 2-2: the urban districts which have predominantly rural" characteristics of Haywards Heath and Burgess Hill give percentages of 3’72 and 3.6 respectively. The school medical officer suggests dampness as a cause ; the probability would seem to be that dirty and carious teeth are commoner in the relatively backward country districts and that enlarged adenoids and tonsils depend frequently upon chronic infection from the mouth. Devonshire County Council.—Among 17,967 children exa- mined only 0 05 per cent. were found to have tuberculosis. Lantern lectures on tuberculosis are given in different districts by the medical officers. No reappearance of cerebro-spinal meningitis is recorded, and this is ascribed to the wet season proving unfavourable to the transmission of the virus. The various defects noted are given in tables classified according to sex, district, and age, with a paragraph of explanatory comment beneath. The method is simple and effective and makes the report easy of reference. No curative treatment is carried out except in a few cases by individual effort. Less than 40 per cent. of defects needing
Transcript
Page 1: Public Health

916

Hospital, now called the Hospital for Women and Childrenfor the past 13 years. She gave figures of the number oj

patients treated at the hospital in each year since 1893, ancthese showed a decrease from 736 patients in that year t(340 in 1912. This fall, she said, was partly due to a changtin general conditions and partly to the fact that in tht- earlier years women came to the hospital from garrison towns,The figures were also very much influenced by the fact thaiin the earlier years patients were of a class who left the

hospital directly they were free from symptoms ; at the

present time the patients remain in the hospital for longeiperiods and finish their treatment. During the present yea]the number of patients was much larger than had beerthe case in corresponding periods for a number of years. MissGarrett thought this was probably the result of the greateIpublicity of the subject during the last few months. Thename of the hospital was changed some years ago, and thishad had good results in getting rid of prejudice against thehospital; in particular, cases now came to the hospital at anearlier stage of the disease. Most of the patients treated atthe hospital were very young girls, the average age being 20,and there were very few professional prostitutes.

At the twenty-fourth meeting evidence was given by Dr.Amand Routh, consulting physician to the Charing CrossHospital and to the Samaritan Free Hospital for Women.and Children.

Dr. Routh said that from figures which he had obtained hehad formed the conclusion that the infant mortality beforethe period of full birth was as high as in the first year of!life, so that the total mortality during the intra-uterine life.and the first year after birth was about one-fourth of the

possible children. He thought that syphilis was the maincause of stillbirths, and also probably of a large proportion of-early intra-uterine deaths, and he suggested various measureswhich might be adopted with the object of obtaining reliablestatistics, of assisting diagnosis, and of facilitating theApplication of treatment. These measures included theextension of the compulsory registration of stillbirths to thewhole country; arrangements under which poor women might’receive medical supervision during pregnancy ; the provision-of the pre-maternity wards in every locality ; the formationand endowment of research laboratories in all general andlying-in hospitals ; and arrangements for financial assistanceto poor pregnant women during the later months of preg-nancy. Dr. Routh said he was not in favour of the com-

pulsory notification of venereal diseases, for unless

anonymity could be secured and be believed in many menand most women would not consult a doctor, but would eitherremain untreated or consult venereal quacks who would

greatly multiply. He felt that voluntary notification wouldbe entirely unreliable statistically. He advocated the estab-lishment of venereal clinics in all districts, but thought it wasimportant that they should not be known by any name of thenature of " venereal."

BIRMINGHAM CHILDREN’S HOSPITAL. - Theannual meeting of this institution was held on Feb. 23rd.The report of the board of management showed thatthe number of patients treated during 1913 was :

in-patients 914, compared with 845 in 1912 ; out-

patients 13,897, against 12,295 ; and casualties 628,against 686. The average length of stay in hospitalwas 22-18 days, and the average cost per week foreach inmate (staff and patients) was 4s. 7d., as against4s. 5d. in 1912. The new building is well in hand, and theopening ceremony is expected to take place in the summerof 1915. 9000 are still required to open the new hospitalfree of debt. During the year the committee has been

impressed with the necessity of removing the out-patientdepartment from Steelhouse-lane to the new site, as the

present accommodation is very inadequate for the presentwork. The cost of a new out-patient department would beabout £10,000, but against this there would be very con-siderable economies in annual expenditure. The accountsof ordinary income and expenditure show a deficiency of£235, as compared with 86 in the previous year, owingpartly to an increase in expenditure and partly to a falling- off in special items of revenue. During the year therewere 151 deaths, giving a death-rate of 16’5 per cent., ascompared with 15 per cent. the previous year.

Public Health.REPORTS OF SCHOOL MEDICAL OFFICERS.

Radnorshire County Council.-Medical inspection is in a

very primitive condition in Radnorshire. Dr. L. W. Polereports that as he is not supplied with adequate assistanceabout half his time is taken up with clerical work. Becauseof this second visits to schools have been impossible, and noreinspection or following-up work has been systematicallycarried out nor any sanitary survey of the schools made.Goitre prevails largely, but whereas in 1911 the percentageof cases among children inspected was 3’4, in 1912 it was2’1 1 only. The total children inspected were 1314, andbelonged to four age groups, those about 5, 7, 10, and 13years old respectively.

Salop County Council.—Dr. James Wheatley lays emphasison the necessity for bringing the ordinary child up to thehighest pitch of physical fitness possible by removingunphysiological modes of living. The preventive workshould consist of improvement of school premises, provisionof proper playgrounds, efficient physical exercises, hygienicinstruction of children, and cooperation with the sanitaryauthority to prevent damage to health before school age.The school medical officer’s report is sent to the headteachers of each school and has in consequence been verywidely read. This useful practice might well be imitatedelsewhere. The total number of children examined in theyear was 13,227, of whom 3750 were reinspections and 734were "specials." With reference to defective vision atten-tion is called tc the defective type of school Bibles Theadoption of the British Association standards for the typeof all new books is recommended and the prevention ofneedlework or any work involving eye-strain under eightyears.

East Sussex County Council.-Mr. A. G. R. Foulerton’sreport includes, and gives special prominence to, specialstudies by Dr. Arthur Beeley on pulmonary tuberculosis

among school children in the county, and by Mr. George Finchon the local distribution of cases of tonsils and adenoids.The total children examined since medical inspection beganhave been taken as the basis of the tuberculosis report.These children are 47,168 in number, and among these 20cases of pulmonary tuberculosis have been found. Owing tosome cases being second examinations these figures cannotbe used to give a percentage, but in 24,128 which areavailable the percentage is 0’04. The phthisis death-rate per 1000 in 1910 for all ages in England andWales was 1-08, in East Sussex 0’8. The low per-centage of school children affected is ascribed partlyto the absence of large towns and partly to only asmall proportion of the population being engaged in un-healthy trades. But the chief factor is probably the methodof diagnosis. Mere harshness of breath sounds and pro-longation of expiration have not been accepted as evidence oftuberculosis by themselves, nor have catarrhal signs. Morecases of tonsils and adenoids occur in rural areas than inurban. The distinctly urban districts of Seaford, Newhaven,and Portslade-by-Sea give percentages of occurrence ofcases of enlarged tonsils and adenoids 3’6, 2-8, and 2-2:the urban districts which have predominantly rural"characteristics of Haywards Heath and Burgess Hill givepercentages of 3’72 and 3.6 respectively. The schoolmedical officer suggests dampness as a cause ; the probabilitywould seem to be that dirty and carious teeth are commonerin the relatively backward country districts and that enlargedadenoids and tonsils depend frequently upon chronicinfection from the mouth.

Devonshire County Council.—Among 17,967 children exa-mined only 0 05 per cent. were found to have tuberculosis.Lantern lectures on tuberculosis are given in different districtsby the medical officers. No reappearance of cerebro-spinalmeningitis is recorded, and this is ascribed to the wetseason proving unfavourable to the transmission of the virus.The various defects noted are given in tables classifiedaccording to sex, district, and age, with a paragraph ofexplanatory comment beneath. The method is simple andeffective and makes the report easy of reference. Nocurative treatment is carried out except in a few cases byindividual effort. Less than 40 per cent. of defects needing

Page 2: Public Health

917

remedy have been treated. The backward condition of

"following-up" " and hygienic work may be inferred when wenote that Brixham is marked out for distinction as havingsomething over 100 children who now clean their teeth

(under the stimulus of a tooth-brush club) as against nochildren formerly.Durham County Council.—The report of Dr. Eustace Hill

incorporates individual reports by three of the assistantmedical officers and by the school nurse, who also acts a,-.

"health visitor." In this the social conditions aspect ofmedical inspection is brought prominently forward. A

county ophthalmologist, Dr. A. T. Paterson, is employed intreating disease of the eyes and defective vision.

VITAL STATISTICS.

HEALTH OF ENGLISH TOWNS.IN the 97 English and Welsh towns, with populations

exceeding 50,000 persons at the last Census and whoseaggregate population at the middle of this year is estimatedat 18,120,059 persons, 8598 births and 5286 deaths were

registered during the week ended Saturday, March 21st.The annual rate of mortality in these towns, which hadbeen 15’1, 15-8, and 15-4 per 1000 in the three precedingweeks, further declined to 15’2 per 1000 in the week undernotice. During the 11 weeks of the current quarter themean annual death-rate in these towns averaged 16-4, against16’1 per 1000 in London during the same period. Among theseveral towns the death-rate last week ranged from 5-3 inEast Ham, 6’6 in Edmonton, 6’7 in Oxford, 6’9 in Swindon,and 7-4 in Bath, to 23-7 in Burnley, 23-9 in Plymouth, 24-1 inDudley, 24-7 in Bury, and 27-0 in Swansea,

°

The 5286 deaths from all causes were 52 fewer than thenumber in the previous week, and included 444 which werereferred to the principal epidemic diseases, against numbersrising from 397 to 441 in the four preceding weeks. Of these444 deaths, :155 resulted from whooping-cough, 107 frommeasles, 73 from infantile diarrhoeal diseases, 51 from diph-theria, 37 from scarlet fever, and 21 from enteric fever, butnot one from small-pox. The mean annual death-ratefrom these diseases last week was equal to 1-3, against1-2 and 1-3 per 1000 in the two preceding weeks. Thedeaths attributed to whooping-cough, which had steadilyincreased from 110 to 143 in the four preceding weeks,further rose to 155 last week, and caused the highestannual death-rates of 1-3 in Gateshead and in Swansea,1-4 in Plymouth and in South Shields, 1-7 in Exeter,1-8 in Darlington, 2-0 in Dudley, 2-1 in Sheffield, and2-7 in Great Yarmouth. The deaths referred to measles,which had been 101, 118, and 113 in the three precedingweeks, further declined to 107 last week; the highest death-rates from this disease were 1-1 in Bradford, in Sheffield,and in Cardiff, 1-8 in Nottingham and in Stockton-on-Tees,1-9 in Burnley and in Barnsley, 2-0 in Dudley, and 3-0 inSwansea. The fatal cases of diarrhoea and enteritis(among infants under 2 years), which had been 83, 59,and 74 in the three preceding weeks, were 73 last week;of this number 17 were registered in London, 6 in Liver-pool, 6 in Manchester, 3 in Burnley, and 3 in Leeds. Thedeaths attributed to diphtheria, which had been 72,60, and 67 in the three preceding weeks, fell to51 last week, and included 16 in London and 3 in

Liverpool. The deaths referred to scarlet fever, whichhad been 34, 34, and 31 in the three preceding weeks,rose to 37 last week,* of which 8 occurred in London, 4 inLiverpool, and 3 in Birmingham. The fatal cases of entericfever, which had been 8, 20, and 13 in the three precedingweeks, rose to 21 last week, and included 4 in London, 3 inManchester, and 2 in Sheffield.The number of scarlet fever patients under treatment in

the Metropolitan Asylums and the London Fever Hos-pitals, which had steadily decreased from 3599 to 3222 in theseven preceding weeks, had further declined to 3173 onSaturday last; 319 new cases were admitted during theweek, against 401, 340, and 320 in the three precedingweeks. These hospitals also contained on Saturday last1295 cases of diphtheria, 338 of whooping-cough, 129 ofmeasles, 79 of enteric fever, and 1 of small-pox. The 1228deaths from all causes in London were 10 fewer than thenumber in the previous week, and corresponded to anannual death-rate of 14-2 per 1000. The deaths referred todiseases of the respiratory system, which had been 243, 260,and 223 in the three preceding weeks, rose to 250 in theweek under notice, but were 153 below the number in thecorresponding week of last year.Of the 5286 deaths from all causes in the 97 towns, 185

were attributed to different forms of violence, and 388 werethe subject of coroners’ inquests. The causes of 37, or 0-7per cent., of the total deaths were not certified either by aregistered medical practitioner or by a coroner after inquest.All the causes of death were duly certified in Londonand in its 14 suburban districts, Manchester, Leeds, Bristol,

Bradford, Hull, Newcastle-on-Tyne, and in 56 other smaller-towns. Of the 37 uncertified causes of death, 6 were registeredin Birmingham, 6 in Liverpool, 3 in St. Helens, and 2 eachin Warrington, Rochdale, Sunderland, South Shields, andGateshead.

-

HEALTH OF SCOTCH TOWNS.

In the 16 largest Scotch towns, with an aggregate populationestimated at 2,293,200 persons at the middle of this year, 1208births and 729 deaths were registered during the week endedSaturday, March 21st. The annual rate of mortality in thesetowns, which had been 17-5, 16-6, and 17-9 per 1000 in thethree preceding weeks, declined to 16-6 per 1000 in theweek under notice. During the 11 weeks of the currentquarter the mean annual death-rate in these towns averaged.18’4, or 2’0 per 1000 above the corresponding rate in the 9Tlarge English towns. Among the several towns the death-ratelast week ranged from 6’8 in Hamilton, 11-7 in Clydebank,.and 11-8 in Dundee and in Kilmarnock, to 20’0 in Aberdeen,21-6 in Leith, and 24-1 in Greenock.The 729 deaths from all causes were 58 fewer than the

number in the previous week, and included 66 which werereferred to the principal epidemic diseases, against 73 and’77 in the two preceding weeks. Of these 66 deaths, 38.resulted from measles, 10 from whooping-cough, 7 from,scarlet fever, 6 from diphtheria, and 5 from infantile diarrhoealdiseases, but not one from enteric fever or from small-pox. The mean annual death-rate from these diseases last,week was equal to 1’5, against 1-3 per 1000 in the 97 larg&English towns. The deaths attributed to measles, whichhad been 48, 36, and 34 in the three preceding weeks,rose to 38 last week; of this number, 24 were registeredin Glasgow, 7 in Edinburgh, and 2 in Paisley. The-deaths referred to whooping-cough, which had been13, 10, and 8 in the three preceding weeks, rose.

to 10 last week, of which 8 occurred in Glasgow. Thefatal cases of scarlet fever, which had been 13, 7,and 8 in the three preceding weeks, were 7 last week,and included 3 in Glasgow and 2 in Edinburgh. The deaths.attributed to diphtheria, which had been 11, 5, and 14 in thethree preceding weeks, declined to 6 last week, of which3 were recorded in Glasgow. The deaths of infants (under2 years) referred to diarrhoea and enteritis, which had been13,14, and 10 in the three preceding weeks, fell to 5 last week,,and included 3 in Glasgow.The deaths referred to diseases of the respiratory system,

which had been 116,126, and 137 in the three preceding weeks,.declined to 117 in the week under notice ; 22 deaths resultedfrom different forms of violence, against 32 and 24 in thetwo preceding weeks. -

HEALTH OF IRISH TOWNS.In the 27 town districts of Ireland, with an aggregate.

population estimated at 1,205,280 persons at the middleof this year, 636 births and 463 deaths were registeredduring the week ended Saturday, March 14th. The annual’rate of mortality in these towns, which had been 19-1,20-8, and 19-2 per 1000 in the three preceding weeks,rose to 20’0 per 1000 in the week under notice. During.the ten weeks of the current quarter the mean annualdeath-rate in these Irish towns averaged 21’5 per 1000 ;in the 97 large English towns the corresponding rate didnot exceed 16’6, while in the 16 Scotch towns it was equalto 18-5 per 1000. The annual death-rate during the weekunder review was equal to 22’1 in Dublin (against 14’3 inLondon and 19-5 in Glasgow), 19-1 in Belfast, 17-0 in Cork,15’2 in Londonderry, 20’3 in Limerick, and 15’2 in Water-ford, while in the 21 smaller towns the mean death-raterose to 20-5 per 1000.The 463 deaths from all causes were 19 in excess of the

number in the previous week, and included 35 which werereferred to the principal epidemic diseases, against 35.and 33 in the two preceding weeks. Of these 35 deaths,14 resulted from infantile diarrhoeal diseases, 8 frommeasles, 4 from scarlet fever, 4 from whooping-cough,4 from diphtheria, and 1 from enteric fever, but not one-from small-pox. The mean annual death-rate from these

diseases was equal to 1°5 per 1000; in the 97 largeEnglish towns the corresponding rate did not exceed1-3, while in the 16 Scotch towns it reached 1’8 per1000. The deaths of infants (under 2 years) attri-buted to diarrhoea and enteritis, which had been 10, 9,and 12 in the three preceding weeks, further rose to 14,of which 8 occurred in Belfast and 5 in Dublin. The deathsreferred to measles, which had been 3, 8, and 4 in th&three preceding weeks, rose to 8, and included 5 in Dublin.The 4 fatal cases of scarlet fever, of which 3 occurred inBelfast, were 3 below the average in the earlier weeks of thequarter. The deaths attributed to whooping-cough, whichhad been 6, 6, and 9 in the three preceding weeks, declined-to 4, and comprised 2 in Dublin and 2 in Belfast. The 4,deaths referred to diphtheria, of which 2 were recorded inBelfast, were slightly in excess of the average in ’the earlierweeks of the quarter. The fatal case of enteric feveroccurred at Dundalk.


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