A Sanitary Bulletin.

1771 the fall and winter months." Moreover, the attention of the department has been directed to the venti. lation of street cars and the Sanitary Commissioner has

is

THE LANCET. LONDON: SATURDAY, DECEMBER 21, 1907.

A

Sanitary

WE have received from

Bulletin.

Chicago

an

extremely interesting

document which is entitled a "Bulletin"from the Health Department of that city and is published weekly by the School of Sanitary Instruction in Madison-street. It is described as being intended to afford instruction in sanitary matters, chiefly to the laity, and to help the medical profession by "popular education in non-technical phrase." The number before us, bearing date of Nov. 23rd, 1907, consists of six octavo pages printed in double columns and containing a brief account of the state of health of the city for the week just past, followed by an outline of the duties discharged by the sanitary authorities during its course. These duties comprised the supervision and isolation of infectious diseases, bacterial and other examinations in the laboratories, milk inspection, ice inspection, food inspection, and ambulance work, and the summary of them is followed by a notification that the bulletin is now being placed in the hands of every physician, clergyman, school principal, and newspaper publisher in the city, besides being sent to all health officers of surrounding towns and to such laymen and organisations as may be interested in, or of service to, the work of saf eguarding the public health. The department, we are told,

during

decided to recommend to the traction companies that an open trailer should be attached to each train for the accommodation of people who recognise that danger lurks in the air of closed unventilated cars and who realise the healthful effects of the open air. It would, we think, be difficult to exaggerate the possible good effects of a publication of this nature, concise in form, simple in character, trifling in bulk, transparently clear in diction, and frequent in recurrence. We have in this country many excellent publications on sanitary subjects but they are addressed rather to experts than to the public and they have to contend against many defects of form as well as of substance. Nothing could be more admirable, in their way, than the annual reports of the medical officer to the County of London but each report is a bulky folio containing so large an amount of material that much of it can only be expressed in tabular form, and hence tends to repel, rather than to attract, a large number of those who might study it with advantage. The reports frequently issued by the Local Government Board, and containing the results of the investigations made by medical inspectors, are usually in the highest degree instructive but they fail to reach the public directly, and the daily and weekly press seldom bestow upon them the notice which they deserve. A similar remark applies also to the annual reports of county medical officers of health. All these documents, moreover, lack the force which the Chicago bulletin must derive from the saepe oadendo, from the weekly " pegging away,’’ if we may use the phrase of one of the greatest of Americans, by which the facts which they reiterate cannot fail in time to be driven home even

has

long recognised in the daily press a potent auxiliary in development of sanitary science, and observing with regret that the absence of the sensational and the spectacular

to

the

the

in the work limits the space accorded to it in the columns of newspapers, has determined to meet the difficulties so arising

are

it

comparatively unintelligent community and by which daily work of the sanitary authorities is described while is still fresh, while it is grappling with evils which a

in actual existence in the next street and which

threaten the health or safety of those who read while of the circulation bulletin. The increased story the paper is yet in their hands. The story of a by largely of the week’s procedure, simple enough in itself, is told in present danger to health, and of what is now being the simplest and plainest language, without the introduction done to obviate it, must always, as human nature is of a single word of unintelligible technicality from the constituted, appeal far more strongly to the mind than beginning to the end of the narrative, and the record is the story of a similar danger which existed two years throughout as practical as it is simple. We read, for ago and against which the energies of health officers were example, that "meat inspectors reported 36 markets and then more or less successfully directed. The attitude of the groceries in bad sanitary condition. These were given 15 British paterfamilias towards dangerous nuisances is fredays’ notice to make the necessary changes. 67 places pre- quently much like that of the Russian peasant who said viously found in bad sanitary condition were re-inspected. that heaven was very high and the CZAR a long way off, and It was found that 60 had complied with the department’a who therefore failed to realise the mere possibility of any instructions, and suit was entered against the seven who mitigation of the evils of his lot. No medical man doubts had not complied." A similar record appears against milk that the disease-rate of the country might be reduced at dealers and ice dealers, and 88,547 pounds of foodstuffs were least one-half by proper sanitary administration, or condemned and destroyed during the week. The month oj that the cost of such reduction would be recouped by November, up to the date of the publication, had been excep the consequent pecuniary saving. The chief, if not the tionally healthy and readers are told that the mild weather sole, impediment is the apathy which proceeds from a

by enabling people to be more out of doors than is usual a1. ignorance. this season, had been largely contributory to the result The population of Chicago now numbers more than This leads to the reflection that " if people would live more I 2,000,000 and the sanitary organisation necessary for the in the open air and less in overheated and ill-ventilate( l maintenance of the high existing standard of health there quarters pneumonia would be much less prevalent than i tmust be very much larger than that of any extra-metropolitan

1772

community in the United Kingdom. The difference, however is only one of magnitude, not of kind, and that which is donE in Chicago has also to be done, although on a smaller scale in every great provincial city in this country. Many of thesE cities greatly pride themselves on the steady pursuit of ar enlightened policy in all public affairs, and it is not too muct to hope that some of them, under the guidance of thei] medical officers of health, may be induced to follow the example of Chicago and to sanction the issue by those officers of weekly reports of an analogouf kind, showing week by week the action which has been taken and the results which have been obtained, as well as the dangers actually present and then requiring to be guarded against. In the bulletin under consideration we read that the November infantile mortality of Chicago, reduced to an annual rate, has been less than 93 per 1000, against 114 in

November, 1906,

and that the total annual death-rate has

been 13 ’ 24. In the week under consideration 81 deaths were due to pneumonia, against 90 in the corresponding week of

consumption, 51 to heart disease, 48 to and 26 to cancer ; while the mortality from Bright’s disease, scarlet fever, and diphtheria was so small as to typhoid fever, last year, 57 to

be

insignificant, except in so far as the cases might represent possible infection on a larger scale. On the whole

centres of

the

record, whether of action

or

of results, is

which it is proposed to deal with the present urgent need of the widespread training and supply of midwives. It contends, on the contrary, that in the four years during which its association has existed it has means

by

great deal. It has trained and supplied midwives for several county nursing associations, it has cooperated done

a

with the London County Council in its lectures to midwives, it has midwives of its training at work in many districts, and lately it has circulated to all local authorities a pamphlet containing a large amount of im-

portant statistical information bearing on this question. Further, it is because it now feels that it has acquired enough experience and accumulated enough information to utilise to the utmost any sums with which it may be intrusted that it is emboldened to come before the

public

with

an

without liberal

urgent appeal to carry out the work which support is absolutely impossible.

The committee considers that the elaboration of a compre. hensive scheme for the whole country must be a matter for time and the most careful

thought

and deliberate

action,

and to this it is

giving its most earnest consideration. This is a view that we must all endorse. The suggestion that some such scheme as that on which the Queen’s Jubilee nurses are

of which

supported and supplied would seem to be the ideal was only rendered possible by the

but this scheme

plan, populous a community may be justly generous action of the late Queen VICTORIA who presented proud. Among other noteworthy matters it is observed the gift of E50,000 from the women of England to be used that " immunisation of those exposed to diphtheria has for this purpose. The committee now appeals for funds to been practised to a considerable extent by the inspectors, place the nursing of the poor in childbirth on the same and is believed to have aided in reducing the number footing as their nursing in ordinary sickness, and it is preof new cases," and that the number of examinations of pared to train and to distribute, and possibly in some inschool pupils by the school medical inspectors during the stances to support, as many midwives as the funds intrusted week amounted to 26,252, with the result that 455 children to it will provide for. It calculates that .E25 will train the authorities of

one

so

excluded from school on account of infectious diseases. It is believed that by this procedure epidemics both of diphtheria and of scarlet faver have been prevented and that through the vigilance now exercised very few instances of contagious disease among children are, or can be, concealed. The bulletin declares, in typical American phraseology, ’’ that we uncover about all cases which are not promptly reported." We trust that before long we may see English communities offering to Chicago the flattering homage of imitation. were

The

and Supply of Midwives.

Training

a

midwife, C50 will

train

and endow

a

midwife for

a

year, and each L500 invested will train and permanently endow a midwife. Possibly some such scheme as that adumbrated by the committee will prove a solution of the difficulty concerning the supply of midwives, which is

already becoming

a

agree with likely to obtain

most serious one, but

the T6maes that the association is

more

we

response from the charitable public if it will bring forward a definite and well-thought-out scheme so that the subscribers may form some idea as to how their money is to be expended and what the result is likely to be. No a

scheme will prove successful unless it is worked in collaboration with the various local authorities so that the midwife may be supervised properly and work in harmony not only

THE work of the Association for

Promoting the Training with the local authority but also with the local practitioners, and Supply brought recently to the and it is of the utmost importance that local interest should attention of our readers. We havejust published several be excited and that the inhabitants of the different localities interesting articles and letters whose bearing on the training to be provided with midwives should feel that they must play and supply of midwives is obvious, while the association their part if necessary in helping them to make a living. The held a meeting on Thursday, Dec. 5th, which was widely goodwill and cooperation of the neighbouring practitioners reported and which was also made the subject of a leading will be an important factor in insuring the smooth working article in the 7’tm. With regard to this article the execu- of any such scheme and in further insuring that the midwife of Midwives has been

tive committee of the association has written to controvert shall make a living wage at any rate in those districts where the statement made by the Times of Dec. 7th that the meeting it is possible for her to do so. convened by that association will hardly satisfy either its proWe must confess that we were disappointed at the moters or the general public who had looked for information of most of the more important speakers at the which was not forthcoming. The committee denies that meeting on Dec. 5th to place before their audience any there has been any failure on its part to state definitely the as to what exactly was intended to be done,

I failure

information