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SICKNESS AND DISABLEMENT BENEFITS.
663 able discussion accompanying them, raises several questions of speculative interest to the neurologist. Of the children having residual paraplegia, conventionally classed as cerebral diplegia, in whom mental development was normal, may not a percentage have been suffering from spinal injury below the cervical enlargement ?:’ The extent to which afferent functions persist, or return, in the damaged cord appears to differ in the infant and in the adult ; in one child two months old micturition was elicited by nocuous stimulation of a flaccid limb. Observation of further material of this kind should yield evidence on the action of isolated spinal elements and thus supplement information gained during the From the practical standpoint Dr. Crothers war. and Dr. Putnam lay special stress on the apparent liability of traction during delivery to cause spinal damage, and the importance of determining the extent to which traction can or should be avoided. They recognise that this question must be answered by obstetricians, and invite their cooperation in deciding the attitude which should be adopted, on the grounds that " the striking contrast between the apparent incidence of injury and the almost total ignoring of the subject by writers of obstetrical textbooks justifies us in suggesting that a definite shift uf emphasis is desirable."
cases, and the
DISABLEMENT BENEFITS. Ax important section of Sir Alfred NVatson’s address on National Health Insurance, delivered before the Iloyal Statistical Society on March 15th, dealt with the claims for sickness and disablement benefits. Among both men and women the claims for sickness benefit fell greatly during the war years; this was particularly the case in regard to women. who in 1916-17 drew less than two-thirds of the sum drawn by them in 1913-14. Since the war the claims fur sickness benefit haveagain risen, but the cost in 1925—26 showed that, on the average, sickness among men was still considerably below the level of 1913-14.
men and women together it is about 200,000 persons are now permanently disabled and drawing benefit from the approved societies. Sir Alfred Watson went on to explain the seasonal variation of sickness ; the claims made in the winter months average from 50 to 100 per cent. more than the summer minimum. The claims for maternity benefit bring out clearly the changes which are occurring in the birth-rate ; among the wives of insured men in the years 101U-23 the claims were 88 per cent. of those expected by the financial standard. The birth-rate (compared with the married population at the reproductive ages) has thus fallen by about 20 per cent. since the beginning of the century, while the proportion of the married in the population has substantially grown, the increase in this respect being 20 per cent. at the ages 20 to 25, 10 per cent. at ages 25-30, and 5 per cent. or more in other age-groups. In comparison with the birthrates among wives of insured men, the great majority of whom are not employed outside the home, Sir Arthur Watson finds the birth-rates among employed married women to be significantly low ; the proportion varied with age, being, for example, 69 per cent. at ages 25 to 30 and (!1per cent. at ages 30 to 35. His address, although expressly stated to be a statistical review. was felt to be very enlightening on some of the social implications of our health insurance system.
concern.
estimated
Taking that
SICKNESS AND
Among women the indications are less satisfactory, the figures suggesting that within a short period the earlier level will again be reached. Comparing the sickness experience of a representative sample of men in the vears 1921-23 with late nineteenthsuch as that of the Manchester century Unity of Oddfellows in the years 1893-97, Sir Alfred Watson remarked on the improvement shown in the health of the community, the " rate of sickness " having fallen on the average by about 20 per cent. He traced this to a large reduction, at all ages, in the proportion of the insured who claimed benefit ;-, among men of ages 40 to 45, 160 in 1000 drew benefit in 1921-23 against 246 in 1000 in 1893-97. The duration of sickness, on the other hand, has increased, the new average at the ages cited being 5-0 weeks per case against 4-3 weeks shown by the older tabulatiun. Special and not unsatisfactory causes may explain these features ; they do not necessarily indicate any real increase in the length of incapacity. Among unmarried women the proportion who fall sick is, as a rule, somewhat less than among men of the same age, but the duration of incapacity is much longer, and on the whole, therefore, the average amount of sickness per insured woman is greater than among men. Among married women, both the number claiming and the duration of the claim are relatively greater than among the unmarried ; the duration of sickness benefit in the case of a married the very high woman claimant averages in fact Disablement benefit (which figure of 8ï weeks. is entered upon when sickness benefit has been paid for 26 weeks) is found to be an increasing quantity among all sections of the insured. This. said Sir Alfred Watson, was expected by the promoters of the scheme as it grew to maturity, and so far as men are concerned the cost is well within the expectation indicated by the older friendly society experiences. The extent of the claims of women in respect of disablement benefit, however, is occasioning some
experience,
CONTINUOUS RECORDS OF BODY TEMPERATURES. PROBABLY few clinicians realise the numerous pitfalls that exist in clinical thermometers until failures of those they read of the early struggles and who were pioneers in the subject.1 Apart from the experimental work of many investigators who have striven to provide a satisfactory clinical method of recording temperatures, a small body of workers have made, with almost infinite patience, experiment after experiment to obtain continuous temperature records throughout the 24 hours. With these efforts the names of Lombard and Clifford Allbutt, Gamgee and Sims Woodhead will always be associated. Gamgee began with a thermocouple combined with a photographic recording apparatus which consisted of a revolving drum covered with a sensitised bromide paper. Subsequently the evolution of the ThompsonD’Arsonval galvanometer enabled him to advance his methods a stage further. On Gamgee’s death, Woodhead, who had previously been interested in the subject, returned to the work and was joined by Dr. P. C. Varrier-Jones. The continuous photographic recorder was discarded in favour of the quasicontinuous Darwin thread recorder with a d’Arsonval galvanometer, an apparatus which gives an inked dot on the revolving paper of a drum at regular intervals. Finally an electric resistance thermometer was devised consisting of a fine platinum wire wound round two strips of mica notched at both sides and the whole enclosed in a silver tube without coming into actual contact with the platinum wire. This thermometer coil is connected bv flexible wires (with " compensating leads) to a Wheatstone bridge on which the resistance can be measured by means of the defection of a galvanometer. As the electrical resistance of the platinum wire varies with the temperature, it is possible, by measuring this resistance, to determine the temperature of the platinum which "
thus acts as a thermometer. Recording is carried out with the Darwin thread recorder as with the later models of the thermocouple thermometer. Full working details for the use of this apparatus are given in the book. The temperatures are taken per rectum. With the use of this apparatus quasi-continuous temperature records have been made from patients 1 The Significance of Temperature Variations in Tuberculous Disease. A Study in Continuous and Quasi-continuous Temperature Records of Man and Animals in Health and Disease. By P. C. Varrier-Jones. M.A., M.R.C.S., L.R.C.P., Medical Director,
Papworth Village Settlement. 1926. Pp. 174. 5s.
Cambridge :
Papworth Press.
cases, and the
DISABLEMENT BENEFITS. Ax important section of Sir Alfred NVatson’s address on National Health Insurance, delivered before the Iloyal Statistical Society on March 15th, dealt with the claims for sickness and disablement benefits. Among both men and women the claims for sickness benefit fell greatly during the war years; this was particularly the case in regard to women. who in 1916-17 drew less than two-thirds of the sum drawn by them in 1913-14. Since the war the claims fur sickness benefit haveagain risen, but the cost in 1925—26 showed that, on the average, sickness among men was still considerably below the level of 1913-14.
men and women together it is about 200,000 persons are now permanently disabled and drawing benefit from the approved societies. Sir Alfred Watson went on to explain the seasonal variation of sickness ; the claims made in the winter months average from 50 to 100 per cent. more than the summer minimum. The claims for maternity benefit bring out clearly the changes which are occurring in the birth-rate ; among the wives of insured men in the years 101U-23 the claims were 88 per cent. of those expected by the financial standard. The birth-rate (compared with the married population at the reproductive ages) has thus fallen by about 20 per cent. since the beginning of the century, while the proportion of the married in the population has substantially grown, the increase in this respect being 20 per cent. at the ages 20 to 25, 10 per cent. at ages 25-30, and 5 per cent. or more in other age-groups. In comparison with the birthrates among wives of insured men, the great majority of whom are not employed outside the home, Sir Arthur Watson finds the birth-rates among employed married women to be significantly low ; the proportion varied with age, being, for example, 69 per cent. at ages 25 to 30 and (!1per cent. at ages 30 to 35. His address, although expressly stated to be a statistical review. was felt to be very enlightening on some of the social implications of our health insurance system.
concern.
estimated
Taking that
SICKNESS AND
Among women the indications are less satisfactory, the figures suggesting that within a short period the earlier level will again be reached. Comparing the sickness experience of a representative sample of men in the vears 1921-23 with late nineteenthsuch as that of the Manchester century Unity of Oddfellows in the years 1893-97, Sir Alfred Watson remarked on the improvement shown in the health of the community, the " rate of sickness " having fallen on the average by about 20 per cent. He traced this to a large reduction, at all ages, in the proportion of the insured who claimed benefit ;-, among men of ages 40 to 45, 160 in 1000 drew benefit in 1921-23 against 246 in 1000 in 1893-97. The duration of sickness, on the other hand, has increased, the new average at the ages cited being 5-0 weeks per case against 4-3 weeks shown by the older tabulatiun. Special and not unsatisfactory causes may explain these features ; they do not necessarily indicate any real increase in the length of incapacity. Among unmarried women the proportion who fall sick is, as a rule, somewhat less than among men of the same age, but the duration of incapacity is much longer, and on the whole, therefore, the average amount of sickness per insured woman is greater than among men. Among married women, both the number claiming and the duration of the claim are relatively greater than among the unmarried ; the duration of sickness benefit in the case of a married the very high woman claimant averages in fact Disablement benefit (which figure of 8ï weeks. is entered upon when sickness benefit has been paid for 26 weeks) is found to be an increasing quantity among all sections of the insured. This. said Sir Alfred Watson, was expected by the promoters of the scheme as it grew to maturity, and so far as men are concerned the cost is well within the expectation indicated by the older friendly society experiences. The extent of the claims of women in respect of disablement benefit, however, is occasioning some
experience,
CONTINUOUS RECORDS OF BODY TEMPERATURES. PROBABLY few clinicians realise the numerous pitfalls that exist in clinical thermometers until failures of those they read of the early struggles and who were pioneers in the subject.1 Apart from the experimental work of many investigators who have striven to provide a satisfactory clinical method of recording temperatures, a small body of workers have made, with almost infinite patience, experiment after experiment to obtain continuous temperature records throughout the 24 hours. With these efforts the names of Lombard and Clifford Allbutt, Gamgee and Sims Woodhead will always be associated. Gamgee began with a thermocouple combined with a photographic recording apparatus which consisted of a revolving drum covered with a sensitised bromide paper. Subsequently the evolution of the ThompsonD’Arsonval galvanometer enabled him to advance his methods a stage further. On Gamgee’s death, Woodhead, who had previously been interested in the subject, returned to the work and was joined by Dr. P. C. Varrier-Jones. The continuous photographic recorder was discarded in favour of the quasicontinuous Darwin thread recorder with a d’Arsonval galvanometer, an apparatus which gives an inked dot on the revolving paper of a drum at regular intervals. Finally an electric resistance thermometer was devised consisting of a fine platinum wire wound round two strips of mica notched at both sides and the whole enclosed in a silver tube without coming into actual contact with the platinum wire. This thermometer coil is connected bv flexible wires (with " compensating leads) to a Wheatstone bridge on which the resistance can be measured by means of the defection of a galvanometer. As the electrical resistance of the platinum wire varies with the temperature, it is possible, by measuring this resistance, to determine the temperature of the platinum which "
thus acts as a thermometer. Recording is carried out with the Darwin thread recorder as with the later models of the thermocouple thermometer. Full working details for the use of this apparatus are given in the book. The temperatures are taken per rectum. With the use of this apparatus quasi-continuous temperature records have been made from patients 1 The Significance of Temperature Variations in Tuberculous Disease. A Study in Continuous and Quasi-continuous Temperature Records of Man and Animals in Health and Disease. By P. C. Varrier-Jones. M.A., M.R.C.S., L.R.C.P., Medical Director,
Papworth Village Settlement. 1926. Pp. 174. 5s.
Cambridge :
Papworth Press.