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HUMIDITY AND TUBERCLE.
1090 - effective in preventing relapses when administered alone as it is in combination with quinine. (4) Plasmoquine has a toxic action on crescents of subtertian malaria, and after a few doses mosquitoes feeding on infected individuals do not become infected. The use of plasmoquine thus, if this observation is confirmed, will be of great importance in malaria control. (5) If given in too large a dosage, or over too prolonged a period, plasmoquine may cause toxic symptoms. In a small percentage of cases there may be, as with quinine, an idiosyncrasy to the drug. The daily dosage should not exceed 0-06 g., and this should not be continued over a period exceeding six days unless the patient is under close observation. (6) The toxic
symptoms
are
that the suceptibility and to infection with a virulent strain of tubercle bacillus was no different at a temperature of 80° F. with 79 per cent. relative humidity, and a temperature of 69° F. with 45 per These observers rightly cent. relative humidity. remark that what is true of the guinea-pig is not necessarily true for other animals and human beings, especially in this case as the guinea-pig is originally but the value of work of this a tropical animal; kind is that it can be carried out under accurately controlled conditions, in which there are fewer unknown factors in the equation to be solved.
experiment they found resistance of guinea-pigs
headache, giddiness, gastric distress,
and cyanosis, and the drug may cause death. At the onset of toxic symptoms there is a leucocytosis and degeneration of the erythrocytes. (7) The administration of quinine in combination with plasmoquine apparently prevents the development of toxic symptoms and, because of this, and the therapeutic action of the two drugs on different phases of the parasite, they should always be given in combination in order to get the best clinical results. (8) Experience shows that for an adult the amount of quinine to be given daily in combination with plasmoquine depends upon the clinical symptoms. In chronic cases 1 g. daily will suffice; in acute cases 2-3 g. daily are necessary in order to obtain optimal results. (9) In ambulatory cases the daily dosage of plasmoquine should not exceed 0-04 g. in combination with 1-2 g. of quinine for a period not exceeding six days. Whenever possible all cases so treated should return for re-examination within three to four days after the course is completed. ____
HUMIDITY AND TUBERCLE. THE high relative humidity which preceded theI violent storms of last week had the usual depressing effect on those who cannot readily get rid of their superfluous heat. It seems that there are many people whose dermal organ is trained to react only to a small range of atmospheric conditions and who are easily upset by a dry wind or by moist stillness. While the devastating effect of these extremes is no doubt largely confined to those whose mechanism of heat balance is inefficient, a certain amount of evidence has accumulated as to the effect of rainbearing winds on the health of the general population. In his last annual report to the Derbyshire Health Committee, of which a summary in other respects is given in another column. Dr. W. M. Ash records the results of an investigation into the influence of such winds upon cases of early phthisis in that county. The material analysed is a series of 306 firststage cases which had been treated at the county sanatorium and followed up at their homes for four years after discharge. Dr. Ash comes to the conclusion that in Derbyshire, as Dr. W. Gordon found in Devonshire, and others havefound in West Shropshire and elsewhere, there is evidence that patients with early phthisis die more often and recover more rarely when residing in exposure to strong prevalent rain-bearing winds than when residing in shelter from them. If these observations are of wide application they have their obvious bearing on the choice of sites for sanatoriums and for the residence of the individual tuberculous patient. Exact proof of this thesis is beset with a multitude of difficulties, suspected and unsuspected by those who have worked The equation can hardly be solved on the subject. where there are so many unknowns. A small but useful contribution, however, comes from the School of Hygiene and Public Health at the Johns Hopkins University, Baltimore, where two observershave analysed the effect of high humidity and moderately
high temperature on the susceptibility and resistance to tuberculosis in guinea-pigs. The result was in effect negative, for under the conditions of the 1 Anna M. Baetjer and Linda B. Lange : Amer. Jour. of Hyg., 1928, viii., 935.
THE APPRAISAL FORM. AN account1 has reached us from America of a method of stimulating different forms of public health work which appears to have been used in some 200 cities during the past three years. It consists of a voluntary periodical stocktaking based not on the local need for civil health work, nor on the results of such work, nor even (except indirectly) on its quality, but on the amount of activity shown by the various local health agencies, official or voluntary. From a simple score card for dairies introduced in 1903 by the Health Officer of the District of Columbia and taken up by the Department of Agriculture, the idea of assessing health activity in this way developed in the United States through a series of more or less independent local schemes, some of which failed to fulfil any serious purpose through faulty methods of drawing up their schedules. The latest and most widely adopted form results from the joint efforts of the Committee on Administrative Practice of the American Public Health Association and of the American Child Health Association. It is issued by the former under the title of " Appraisal Form for City Health Work." The form is described as a document of 68 pages and the essential part of it-i.e., the scoring device-is divided into 11 sections, each section representing one of the common chief public health activities in cities. These are: vital statistics, communicable disease control, venereal disease control, tuberculosis control, prenatal hygiene, infant hygiene, pre-school hygiene, school-child hygiene, sanitation, including food, milk, water, and sewer control, laboratory service, and popular health instruction. Each of these is divided again into a number of " criteria," 131 in all, each with a numerical score attached to it. For instance, under communicable diseases come " nurses’ visits per case under tuberculosis, and so forth; diphtheria," " clinic visits per 100 deaths,"" cases reported per annual death " ; under sanitation, " dwellings with sewer connexion per cent ...... milk pasteurised per cent.," and so on. An arbitrary standard of score was fixed, being based on the score reached by 25 per cent. of a group of cities in a preliminary trial. The assumption is obviously made, under several headings, that in no city all the cases needing treatment are reached ; otherwise it is hard to see why it should count to a city’s credit to have a high percentage of, e.g., tonsil and adenoid operations, or of heart and lung defects placed under a physician’s care, or of glasses fitted or teeth extracted, all reckoned on the total number of school-children rather than on the relative need of the individual. One wonders, too, whether-even in American cities-the social class of the people concerned would not affect such scores as the percentage of nurses’ visits or clinic visits in prenatal, infant, or pre-school welfare work, the percentage here again being reckoned on the total live births or pre-school population respectively. These and other points are, however, under consideration, and the need for changing standards and criteria is recognised. Industrial health measures and those for which the need is confined to special areas, such as malaria 1 The Validity of the Appraisal Form as a Measure of Administrative Health Practice. By Philip S. Platt. Published by the American Public Health Association.
symptoms
are
that the suceptibility and to infection with a virulent strain of tubercle bacillus was no different at a temperature of 80° F. with 79 per cent. relative humidity, and a temperature of 69° F. with 45 per These observers rightly cent. relative humidity. remark that what is true of the guinea-pig is not necessarily true for other animals and human beings, especially in this case as the guinea-pig is originally but the value of work of this a tropical animal; kind is that it can be carried out under accurately controlled conditions, in which there are fewer unknown factors in the equation to be solved.
experiment they found resistance of guinea-pigs
headache, giddiness, gastric distress,
and cyanosis, and the drug may cause death. At the onset of toxic symptoms there is a leucocytosis and degeneration of the erythrocytes. (7) The administration of quinine in combination with plasmoquine apparently prevents the development of toxic symptoms and, because of this, and the therapeutic action of the two drugs on different phases of the parasite, they should always be given in combination in order to get the best clinical results. (8) Experience shows that for an adult the amount of quinine to be given daily in combination with plasmoquine depends upon the clinical symptoms. In chronic cases 1 g. daily will suffice; in acute cases 2-3 g. daily are necessary in order to obtain optimal results. (9) In ambulatory cases the daily dosage of plasmoquine should not exceed 0-04 g. in combination with 1-2 g. of quinine for a period not exceeding six days. Whenever possible all cases so treated should return for re-examination within three to four days after the course is completed. ____
HUMIDITY AND TUBERCLE. THE high relative humidity which preceded theI violent storms of last week had the usual depressing effect on those who cannot readily get rid of their superfluous heat. It seems that there are many people whose dermal organ is trained to react only to a small range of atmospheric conditions and who are easily upset by a dry wind or by moist stillness. While the devastating effect of these extremes is no doubt largely confined to those whose mechanism of heat balance is inefficient, a certain amount of evidence has accumulated as to the effect of rainbearing winds on the health of the general population. In his last annual report to the Derbyshire Health Committee, of which a summary in other respects is given in another column. Dr. W. M. Ash records the results of an investigation into the influence of such winds upon cases of early phthisis in that county. The material analysed is a series of 306 firststage cases which had been treated at the county sanatorium and followed up at their homes for four years after discharge. Dr. Ash comes to the conclusion that in Derbyshire, as Dr. W. Gordon found in Devonshire, and others havefound in West Shropshire and elsewhere, there is evidence that patients with early phthisis die more often and recover more rarely when residing in exposure to strong prevalent rain-bearing winds than when residing in shelter from them. If these observations are of wide application they have their obvious bearing on the choice of sites for sanatoriums and for the residence of the individual tuberculous patient. Exact proof of this thesis is beset with a multitude of difficulties, suspected and unsuspected by those who have worked The equation can hardly be solved on the subject. where there are so many unknowns. A small but useful contribution, however, comes from the School of Hygiene and Public Health at the Johns Hopkins University, Baltimore, where two observershave analysed the effect of high humidity and moderately
high temperature on the susceptibility and resistance to tuberculosis in guinea-pigs. The result was in effect negative, for under the conditions of the 1 Anna M. Baetjer and Linda B. Lange : Amer. Jour. of Hyg., 1928, viii., 935.
THE APPRAISAL FORM. AN account1 has reached us from America of a method of stimulating different forms of public health work which appears to have been used in some 200 cities during the past three years. It consists of a voluntary periodical stocktaking based not on the local need for civil health work, nor on the results of such work, nor even (except indirectly) on its quality, but on the amount of activity shown by the various local health agencies, official or voluntary. From a simple score card for dairies introduced in 1903 by the Health Officer of the District of Columbia and taken up by the Department of Agriculture, the idea of assessing health activity in this way developed in the United States through a series of more or less independent local schemes, some of which failed to fulfil any serious purpose through faulty methods of drawing up their schedules. The latest and most widely adopted form results from the joint efforts of the Committee on Administrative Practice of the American Public Health Association and of the American Child Health Association. It is issued by the former under the title of " Appraisal Form for City Health Work." The form is described as a document of 68 pages and the essential part of it-i.e., the scoring device-is divided into 11 sections, each section representing one of the common chief public health activities in cities. These are: vital statistics, communicable disease control, venereal disease control, tuberculosis control, prenatal hygiene, infant hygiene, pre-school hygiene, school-child hygiene, sanitation, including food, milk, water, and sewer control, laboratory service, and popular health instruction. Each of these is divided again into a number of " criteria," 131 in all, each with a numerical score attached to it. For instance, under communicable diseases come " nurses’ visits per case under tuberculosis, and so forth; diphtheria," " clinic visits per 100 deaths,"" cases reported per annual death " ; under sanitation, " dwellings with sewer connexion per cent ...... milk pasteurised per cent.," and so on. An arbitrary standard of score was fixed, being based on the score reached by 25 per cent. of a group of cities in a preliminary trial. The assumption is obviously made, under several headings, that in no city all the cases needing treatment are reached ; otherwise it is hard to see why it should count to a city’s credit to have a high percentage of, e.g., tonsil and adenoid operations, or of heart and lung defects placed under a physician’s care, or of glasses fitted or teeth extracted, all reckoned on the total number of school-children rather than on the relative need of the individual. One wonders, too, whether-even in American cities-the social class of the people concerned would not affect such scores as the percentage of nurses’ visits or clinic visits in prenatal, infant, or pre-school welfare work, the percentage here again being reckoned on the total live births or pre-school population respectively. These and other points are, however, under consideration, and the need for changing standards and criteria is recognised. Industrial health measures and those for which the need is confined to special areas, such as malaria 1 The Validity of the Appraisal Form as a Measure of Administrative Health Practice. By Philip S. Platt. Published by the American Public Health Association.