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897 Public Health Services. KEPORTS OF MEDICAL OFFICER OF HEALTH. y, County Borough of Plymouth. 1926 statistics: population—211,350; birth-rate, P( 17-2; deatli-rates per 1000 of the population: P all causes, 12-3 ; tuberculosis, 1-0 ; cancer, 1.5; respiratory diseases with influenza, 2 -0; heart disease, at 1.5. Death-rates per 1000 births : neonatal. 2.9; af infant, 72 ; mothers from. childbirth, 3-0. " Dr. A. T. Nankivell in last year’s report said he would like to see every medical member of his staff en- gaged in some research work and, following up this st idea, he writes the introciuctiun to this year’s report se and leaves it to his staff to deal in special reports with various aspects of the public health work in Plymouth and its institutions. The cost of the maternity and child welfare work is less than a penny rate. An additional woman doctor and two more health visitors H iiave been appointed ; ultra-violet light has been installed at Stonehouse and a new centre approved at fi Beaumont Park. Dr. Ann Clark reports that ante- tf natal clinics have been increased from one to four ti per week and that the antenatal work of the nursing e: associations is now conducted by her staff. She also reports in detail as to the results of light treatment, rf which has been chiefly beneficial in rickets, but cases d vf malnutrition. chronic bronchitis. anæmia, and skin a disease have also responded well. To achieve the aim p that no confinements shall take place in squalid and a dirty homes, a long and difficult fight is needed, 1-c says Dr. Nankivell, in order to overcome the west s country prejudice which exists against lying-in lumnes and in favour of mothers being confined in their own a tenements, however unsuitable these may be. li Plymouth also needs a convalescent home for debilit- p ated mothers. a hostel where little children may be n cared for when the mother is in hospital or sanatorium, and day nurseries. a The school service needs a residential open-air school t o in the country, an increase in the dental staff, and a a third dental clinic. During the last three years the Wassermann test was recommended for 307 children. In 26 cases the parents refused. In 72 a positive result a was obtained ; 810 of these children being at ordinary t schools, 22 at mental deficiency schools. 14 at ope’l-air 7 schools, one at a school for the deaf, and one not I at school. I)r. Cx. D. Kettlewell, the V.D. officer, ( says it has always been recognised that a large number of congenital syphilitics were not being treated in - Plymouth. Special efforts have been made in recent ( years to search them out, and a table is given showing the nature of the 533 cases which have been treated at the centre since 1919. Of these, 3)3 were children of school age and included 66 cases of serious eye 1 trouble, mostly due to ulceration : -, 7 deaf children ; 23 sufferers from bone disease, of whom 10 were cripples and 2 had been absent front school for over two years owing to the offensive smell from the nose; 15 cases of skin disease ; and 71 mentally deficient (of whom nearly all have improved greatly under treatment). Thirty-three of the brothers and sisters, who themselvesshowed " no signs," were treated tentatively and the majority improved generally in health and development. ’’ Physically all congenital children are stunted," says the report, " ill-developed, and diminutive, many of 10 and 12 years are physically aged 6." The estimate is put forward that there are 1000 congenital syphilitics among the children in Plymouth needing treatment, including the 313 already receiving it. School teachers and nurses have given the very greatest help in searching out these children. Dr. ]Kettlewell points out the handicap for life of these subjects, many being quite unable to earn a living, while many will live in institutions for the blind and mentally defective, tragedies some of which might have been averted if the children had been treated early enough. Plymouth has now obtained hospital accommodation on shore for small-pox at the Lee Mill Hospital of the Plympton rural district council, and it is intended to add 20 beds to this hospital; the port medical ouicer. Dr. Arthur Massey, points out that Plymouth is specially exposed to risk through its shipping and that the hospital ship Flamingo was quite unfitted to fulfil the function of providing accommodation for small- pox. One case was landed from shipboard during the year without spread. The damage done by rats in Plymouth is estimated at .S300.000 annually. Energetic warfare is waged against them all the year round and not only in a "rat week.’’ Dr. Massey urges, however, that much could be done by naval architects to reduce " rodent amenities " to a minimum, when the ships are con- structed. The experiment was tried of spraying the sea gulls with a, special methylene-blue solution to find out if they went from the sewage outfalls to the fresh water reservoirs. " No blue gulls were afterwards seen around reservoirs or docks—a fact which has not been satisfactorily explained." Sir Alexander Houston’s contention, it may be remembered, is that at some of the Metropolitan Water Board reservoirs frequented by gulls. the tendency for the B. coli to be reduced by storage of the water may be more than counteracted by the number of 13. coli in the excreta of the gulls dropped into the water. The tuberculosis death-rate, as shown by a chart, remained stationary during 1920-24, but showed a distinct decline in both 1925 and 1926. More hospital ancl sanatorium accommodation is needed for both pulmonary and non-pulmonary cases, as there is always a distressing waiting-list. The shortage of low-rented houses remains acute. Sooner or later, says Dr. Nankivell. we shall have to recognise that , subsidised houses for persons who can only pay 2s. (id- a week rent are needed in every town. He would also like to see municipal hostels or common lodging-houses - provided, one for men, one for women, and one for rnarried coulpes. , Three insanitary areas were scheduled more than a year ago but progress is very slow. The renovation of houses, however, continues to be satisfactory and wvners spent about £28,000 in repairing old ? property during 1926. Over 800 samples of milk . were examined bacteriologically and as the vendors are always informed of adverse findings this helps Iv to improve the cleanliness of the milk-supply. About 700 churns come in daily. and Dr. Nankivell would like to have the contents of each churn examined , once a month instead of once a year, as at present. r The demand for clean milk grows ; 3:1 dairymen sell " Certihed " or - " Grade A " milk. The M. and C. W. t centrea obtain " Certified," the isolation hospital - " Grade A (t.t.) " and the relief milk for consumptives is " Grade A." i Health propagandism has included many lectures e bv the medical staff. the issue of a booklet " Health ; Hints "—to the extent of 55,000 copies, a free health e film week, leaflets and posters, and much help from the r press. e REPORTS OF I-’oRT MEDICAL OFFICERS. v d The Tyne. d Ix hi" report for 1926 to the Tyne Port Sanitary n Authority Dr. W. E. Harker states that he visited rl 5(i vessels on account of sickness reported or suspected 1, on board, and removed from ships one case of influenza, y one of diphtheria, and one of enteric fever. No ve infectious disease was found among the 9114 alien n passengers, who were mostly clean. No case of cholera, -3 plague, or yellow fever came under notice, but 3171 rats were caught on 78 vessels. On 15 ships a total se of 229 rats were killed with sulphur dioxide ; hydro- .p cyanic acid was not employed. Just over half the le dead rats were black, and none of them was infected is with plague. Seventeen ships had their drinking- ie water tanks emptied and purified because they came .n from ports at which cholera was present or suspected. The main food imports into the Tyne were wheat,. )n sugar, eggs, and fruit ;’ no condemnations are reported. w The fish landed was good ; 28 of 7921 fishing boats
Transcript
Page 1: Public Health Services

897

Public Health Services.KEPORTS OF MEDICAL OFFICER OF HEALTH. y,

County Borough of Plymouth.1926 statistics: population—211,350; birth-rate, P(

17-2; deatli-rates per 1000 of the population: Pall causes, 12-3 ; tuberculosis, 1-0 ; cancer, 1.5;respiratory diseases with influenza, 2 -0; heart disease, at

1.5. Death-rates per 1000 births : neonatal. 2.9; afinfant, 72 ; mothers from. childbirth, 3-0.

"

Dr. A. T. Nankivell in last year’s report said he would like to see every medical member of his staff en- gaged in some research work and, following up this st

idea, he writes the introciuctiun to this year’s report se

and leaves it to his staff to deal in special reports with various aspects of the public health work in Plymouthand its institutions. The cost of the maternity and child welfare work is less than a penny rate. Anadditional woman doctor and two more health visitors Hiiave been appointed ; ultra-violet light has been installed at Stonehouse and a new centre approved at fiBeaumont Park. Dr. Ann Clark reports that ante- tfnatal clinics have been increased from one to four ti

per week and that the antenatal work of the nursing e:

associations is now conducted by her staff. She alsoreports in detail as to the results of light treatment, rf

which has been chiefly beneficial in rickets, but cases dvf malnutrition. chronic bronchitis. anæmia, and skin a

disease have also responded well. To achieve the aim pthat no confinements shall take place in squalid and a

dirty homes, a long and difficult fight is needed, 1-c

says Dr. Nankivell, in order to overcome the west s

country prejudice which exists against lying-in lumnes and in favour of mothers being confined in their own a

tenements, however unsuitable these may be. liPlymouth also needs a convalescent home for debilit- pated mothers. a hostel where little children may be n

cared for when the mother is in hospital or sanatorium,and day nurseries. aThe school service needs a residential open-air school t o

in the country, an increase in the dental staff, and a a

third dental clinic. During the last three years the Wassermann test was recommended for 307 children. In 26 cases the parents refused. In 72 a positive result a

was obtained ; 810 of these children being at ordinary tschools, 22 at mental deficiency schools. 14 at ope’l-air 7

schools, one at a school for the deaf, and one not Iat school. I)r. Cx. D. Kettlewell, the V.D. officer, (

says it has always been recognised that a large number of congenital syphilitics were not being treated in -Plymouth. Special efforts have been made in recent (

years to search them out, and a table is given showingthe nature of the 533 cases which have been treatedat the centre since 1919. Of these, 3)3 were childrenof school age and included 66 cases of serious eye 1trouble, mostly due to ulceration : -, 7 deaf children ;23 sufferers from bone disease, of whom 10 werecripples and 2 had been absent front school for over two years owing to the offensive smell from thenose; 15 cases of skin disease ; and 71 mentallydeficient (of whom nearly all have improved greatlyunder treatment). Thirty-three of the brothers andsisters, who themselvesshowed " no signs," were treatedtentatively and the majority improved generally inhealth and development. ’’ Physically all congenitalchildren are stunted," says the report,

"

ill-developed,and diminutive, many of 10 and 12 years are physicallyaged 6." The estimate is put forward that thereare 1000 congenital syphilitics among the childrenin Plymouth needing treatment, including the 313already receiving it. School teachers and nurses havegiven the very greatest help in searching out thesechildren. Dr. ]Kettlewell points out the handicapfor life of these subjects, many being quite unableto earn a living, while many will live in institutionsfor the blind and mentally defective, tragedies someof which might have been averted if the childrenhad been treated early enough.Plymouth has now obtained hospital accommodation

on shore for small-pox at the Lee Mill Hospital of the

Plympton rural district council, and it is intendedto add 20 beds to this hospital; the port medical ouicer.Dr. Arthur Massey, points out that Plymouth isspecially exposed to risk through its shipping and thatthe hospital ship Flamingo was quite unfitted to fulfilthe function of providing accommodation for small-pox. One case was landed from shipboard during theyear without spread.The damage done by rats in Plymouth is estimated

at .S300.000 annually. Energetic warfare is wagedagainst them all the year round and not only in a"rat week.’’ Dr. Massey urges, however, that muchcould be done by naval architects to reduce " rodentamenities " to a minimum, when the ships are con-structed. The experiment was tried of spraying thesea gulls with a, special methylene-blue solution tofind out if they went from the sewage outfalls to thefresh water reservoirs. " No blue gulls were afterwardsseen around reservoirs or docks—a fact which hasnot been satisfactorily explained." Sir AlexanderHouston’s contention, it may be remembered, is thatat some of the Metropolitan Water Board reservoirsfrequented by gulls. the tendency for the B. colito be reduced by storage of the water may be morethan counteracted by the number of 13. coli in theexcreta of the gulls dropped into the water.The tuberculosis death-rate, as shown by a chart,

remained stationary during 1920-24, but showed adistinct decline in both 1925 and 1926. More hospital

ancl sanatorium accommodation is needed for bothpulmonary and non-pulmonary cases, as there is

always a distressing waiting-list. The shortage oflow-rented houses remains acute. Sooner or later,says Dr. Nankivell. we shall have to recognise that

, subsidised houses for persons who can only pay 2s. (id-a week rent are needed in every town. He would also

like to see municipal hostels or common lodging-houses- provided, one for men, one for women, and one for’ rnarried coulpes., Three insanitary areas were scheduled more thana year ago but progress is very slow. The renovationof houses, however, continues to be satisfactoryand wvners spent about £28,000 in repairing old? property during 1926. Over 800 samples of milk. were examined bacteriologically and as the vendorsare always informed of adverse findings this helpsIv to improve the cleanliness of the milk-supply. About700 churns come in daily. and Dr. Nankivell wouldlike to have the contents of each churn examined, once a month instead of once a year, as at present.r The demand for clean milk grows ; 3:1 dairymen sell

" Certihed " or - " Grade A " milk. The M. and C. W.t centrea obtain " Certified," the isolation hospital-

" Grade A (t.t.) " and the relief milk for consumptives

is " Grade A."i Health propagandism has included many lecturese bv the medical staff. the issue of a booklet

" Health; Hints "—to the extent of 55,000 copies, a free healthe film week, leaflets and posters, and much help from ther press.e

REPORTS OF I-’oRT MEDICAL OFFICERS.vd The Tyne.d Ix hi" report for 1926 to the Tyne Port Sanitaryn Authority Dr. W. E. Harker states that he visitedrl 5(i vessels on account of sickness reported or suspected1, on board, and removed from ships one case of influenza,y one of diphtheria, and one of enteric fever. Nove infectious disease was found among the 9114 alienn passengers, who were mostly clean. No case of cholera,-3 plague, or yellow fever came under notice, but 3171

rats were caught on 78 vessels. On 15 ships a totalse of 229 rats were killed with sulphur dioxide ; hydro-.p cyanic acid was not employed. Just over half thele dead rats were black, and none of them was infectedis with plague. Seventeen ships had their drinking-ie water tanks emptied and purified because they came.n from ports at which cholera was present or suspected.

The main food imports into the Tyne were wheat,.)n sugar, eggs, and fruit ;’ no condemnations are reported.w The fish landed was good ; 28 of 7921 fishing boats

Page 2: Public Health Services

898

had to be cleansed and deodorised. In 6538 inspectionsof ships sanitary defects were found in 11 per cent.of foreign-going and in 6 per cent. of coasting vessels.Peaks, fo’c’sles, w.c.’s, and bilges of 541 vesselswere found dirty and were cleansed ; 1016 old bedswere burned on account of infection. Many structuraldefects were noted and rectified. The 18 waterboats of the port were examined and their tanksfound in good condition.The Tyne Floating Hospital is now reserved for

the isolation and treatment of the more dangerousinfections from overseas, and is also equipped as acleansing station. Other infectious cases are sentto the City Hospital. The usual measures weretaken for the treatment of venereal disease, butDr. Harker offers no estimate of their usefulness.The work of the port decreased during 1926 by

20 or 30 per cent., probably because of the coaldispute.

INFECTIOUS DISEASE IN ENGLAND AND WALES DURING THE WEEK ENDED

APRIL 9TH, 1927.

Notifications.—The following cases of infectiousdisease were notified during the week :—Small-pox,391 (last week 392) ; scarlet fever, 1271 ; diphtheria,943; enteric fever, 40 ; pneumonia, 1052 ; puerperal fever, 32 puerperal pyrexia, 101 ; cerebro-spinal fever, 10 ; acute poliomyelitis, 7 ; encephalitislethargica, 30 ; continued fever, 2 ; dysentery, 6 ;ophthalmia neonatorum, 132. No case of cholera,plague, or typhus fever was notified during the week. 1No further cases of small-pox were notified in Kent or f

Surrey. Deaths.—In the aggregate of great towns, including s

London, there was no death from small-pox, 2 (0) r

from enteric fever, 7(j (5) from measles, 2 (0) from a

scarlet fever, 76 (19) from whooping-cough, 28 (9) v

from diphtheria, 37 (6) from diarrhoea and enteritis (under two years, and 120 (14) from influenza. The t

figures in parentheses are those for London itself. ____.__________ t

THE 1921 CENSUS.—The General Report on the tCensus of England and Wales, 1021, published on April 19th 0(H.M. Stationery Office, 5s.) completes the series of officialvolumes issued in respect of the 1921 Census, dealing with athe country as a whole in much the same way as the report missued with each county volume dealt with the local figures. n

The first and most important section deals with the numbers Sof the population, its distribution throughout the country, Cits growth since the preceding census in comparison with Gthat of earlier periods, and also with the contemporaneous itgrowth of other nations. The population numbered rather more than 37 millions, 649 to each square mile on the vaverage, or about an acre per head, a density greater than Ithat of any country in the world for which statistics are itavailable. Nearly 80 per cent. of the population were aenumerated as living in urban areas, and of these practically irhalf were found in comparatively dense aggregates repre- brented by 46 towns each containing more than 100,000 persons. The rate of growth of the smallest towns is above frthe average for the whole country, and the rate appears to ,

increase as the towns get larger, until the populations reach 0

a figure in the neighbourhood of 100,000. After this the rate of increase tends to slacken off, suggesting that oj100,000 roughly marks a limit of effective aggregation mbeyond which the advantage of further accretion begins to Tbe offset by counterbalancing disadvantages. Prominentamongst the towns which showed little increase or which P]decreased during the decenniurn are those associated with tc’rhe textile industrv in Lancashire and Yorkshire. The new friasction on Dependency and Orphanhood provides a survey leof the sizes, age constitution and distribution of economically n(

dependent families in relation to their parents. Thecompara- e,tive rarity of the large family in general is exemplified by the aTaverage which for all married men taken together measured only 1.27 children apiece. More than 43 per cent. of themarried men returned no children under 16, while in another gr23 per cent. there was one child only. Miners returned the si,largest families on the whole, but even so their average was 01only 1.82 for each married man, while in the case of profes- msional men the figure sinks as low as 0’90. The fertility mstudy, derived indirectly from the dependency statistics, ,throws light upon certain aspects of the birth-rate in this country which is not obtainable from the ordinary regis- sh.tration- records. te

Correspondence.

TESTS FOR DRUNKENNESS.

" Audi alteram nartem."

To the Editor of THE LANCET.

SIR,—The British Medical Association Committee,under the able and wise guidance of its Chairman.Major-General Sir William Macpherson, gave thefullest attention to all possible methods for determin-ing whether a person concerned was so much underthe influence of alcohol as to have lost control of hisfaculties to such an extent as to render him unableto execute safely the occupation in which he wasengaged at the material time." The evidence putbefore the Committee proved conclusively :-

(1) That in different individuals the quantity of alcoholrequired to impair the function of the higher nerve centreswas subject to great variations-e.g., in a person un-accustomed to alcoholic consumption a very slight amountmight cause serious impairment, while in the case of theperson inured to the effects of alcohol relatively largeamounts might be ingested without appreciable impairmentof control of the faculties.

(2) That in the performance of complex occupationalacts such as the driving of a motor-car an experiencfddriver might be little affected by relatively large amountsof alcohol since his long experience of driving has causedhis control of the car to become almost automatic.

On the other hand, a driver of less experience who1.as to think of each of the special actions required’or the complete control of his car before theirexecution would be seriously affected by a relativelysmall amount in his driving etliciency, whereas as’egards other occupations to which he had long beenaccustomed his faculty control might be perfect. Itvas considerations such as these which caused theCommittee to refrain from placing definite limits on.he percentage of alcohol in the blood, cerebro-spinalluid, or urine which would serve as absolute indica-;ions of drunkenness.The Committee attached the highest importance

o the valuable work of Dr. Southgate on the excretion)f alcohol in the urine and its presence in the blood.nd each member of the Committee was providedvith a copy of his paper. I myself presided at theneeting of the Medico-Legal Society at which Dr.louthgate and Dr. Godfrey Carter read their paper)n the Excretion of Alcohol in the Urine as axuide to Alcoholic Intoxication, and at that meet-ng I described this work as a most important andaluable contribution to the science of toxicology.n the present state of our knowledge, however, it ismpossible to give exact figures of the percentage ofIcohol in blood or urine, which would in anyidividual mean that the borderland of sobriety hadeen passed, and the authors of the paper refrainedrom giving such an exact figure.Apart from this difficulty there were definite legal

bjections to the application of the test by the pro-s-cuting authority-for example, the taking of a samplef blood from an accused person who was unwillingiight be technically regarded as a legal assault.’here is no objection to the application of the testrovided that the accused person is willing, and it isbe hoped that this test will be used with increased

’equency, and so lead to an extension of our know-,dge in the diagnosis of drunkenness. I can imagineo better defence for an accused person than thevidence that the blood and urine at the time ofrrest were free from alcohol.The diagnosis of drunkenness is attended with --

reat difficulty, and the Committee stated that nongle test by itself would, as a rule, justify a decisionne way or the other. Dr. Southgate is under aLisapprehension when he suggests that the Cora-ittee regarded the smell of alcohol as a test forrunkenness. A careful perusal of the report williow that all that was claimed for the olfactory- st was that " the smell of alcoholic liquor in the


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