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The telephone and hospitals for infectious diseases
ANNOTATIONS. whereas cresyt is a very good one. For disinfection on a large scale (cesspools, etc.), the quantity required of Cu SO4, acidulated with one per cent. H2 SO~, is five or six kilos per metre cubed; of chlorinated lime with one per cent. H Cl, nine or ten kilos per metre cubed. Cholera stools are more readily disinfectedthan typhoid motions. To properly disinfect typhoid stools within one hour at ~5 deg. C., requires Io grammes Cu SO4, with an equal quantity of H i SO4 per litre. About double this quantity of acidulated chloride of lime or of cresyl is efficient i eresyl is especially active as a disinfectant of cholera stools. Caustic Iime, potash, and soda, lysot, solveol and solutol were also tried, but were less active and more expensive than the three combinations alluded to above.
THE TELEPHONE AND HOSPITALS FOR I N F E C T I O U S DISEASES. By ANTONY ROCHE, M.R.C.P.I., Professor of Hygiene, Catholic Universily Medical School, Dublin ; Examiner the Royal University of Ireland ; Fellow of the Sanitary Institute, etc. IN cases of infections diseases it is desirable to remove as far as possible any objection or difficulty to notification and removal to hospital of patients. It is also desirable to lessen the visits to in[ectious hospitals of the friends and relatives of the patients. Of course, the friends and relatives are not permitted to see the sufferers, still even calling involves a certain amount of risk. At the same time the enforced separation is much felt by the patients and relatives, so anything that will tend to remove this natural feeling would commend itself alike to those responsible for the public health and to our common instincts of humanity. In the present epidemic of small-pox in Dublin, it has been found that the poor will not, when attacked with the disease, send for the doctor for fear of removal to hospital. When remonstrated with, their usual reply i~ that they do not fear going to hospital, but complain that they cannot see or hear of their friends whilst there. I have proposed, then, that such hospitals be connected by telephone with one or more central stations, and that the relatives or friends may at any time, free of charge, communicate as to the condition, wishes, etc., of the sufferer. It would be necessary to employ some men to work the telephone, but such trivial expense should not stand in the way of such a reform. When the sufferer is in condition to receive or reply to the message, I should permit it. The very feeling that the actual condition of the patient could easily be ascertained at any time, would in itself do much to allay the anxiety of the relatives, and reconcile them to the necessary separation. Much time would be saved to the poor in going and waiting at the hospital gate. I do not see why there should not be permanent
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stations connected by telephone with all hospitals in the town, where the poor could obtain information as to the condition of their patients.
ANNOTATIONS. TIIE BIRTH RATE IN ENGLAND. The mean annual birth rate was 3.1"9 in the ten years i883-92. In ~892 it was 30"5, in i893 it was 30'8. There was, therefore, a slight recovery in the latter year, though with this exception it was the lowest on record. Whether these figures indicate that we have reached the bottom of the decline of the birth rate, which has been one of the most remarkable facts in English statistics (and those of other countries) since the year I876 , it is too early to forecast. It is satisfactory, however, from an imperial standpoint that the natural increase of our population has not reached that state of non-existence which we see in France. The variations in the birth rate of the thirty-three great towns of England and Wales are worthy of further study than they have hitherto received. The low birth-rate of a manufacturing town like Huddersfield is a very striking fact, and indicates an age distribution of the population making for a low death rate. This much may be said without committing ourselves to the exploded fallacy that a high birth-rate means a high death-rate, or its converse. FACTORS INFLUENCING THE DEATH-RATE. It is a common error to assume that because the death rate of a district is lower than that of another district, the former is necessarily the healthier. There are other factors influencing the death rate which require to be considered. For instance, a district containing a proportionately large number of elderly people will, other things being equal, haye a higher death rate than a district with a smaller number. A suburb consisthlg mainly of better~class residences will contain a large number of domestics, and as the ages of the latter will be within those age-periods in which the least number of deaths occur, the death rate of such a place will 'thereby be lowered. It is almost unnecessary to say that the social status of the inhabitants of any place is an'important factor in its death rate. A high birth rate increases the death rate, at least for a time, but in ten to fifteen years, presuming that there is no marked emigration of young persons, the death rate wilt become lower, inasmuch as there will then be a large number of persons between the ages of five and twenty-five, during which period the incidence of mortality is at its lowest. Inversely, a low birth rate at first lowers the death rate, but after a lapse of years increases it, the number of persons between the ages of five and twenty-five being small. Another factor in T
THE TELEPHONE AND HOSPITALS FOR I N F E C T I O U S DISEASES. By ANTONY ROCHE, M.R.C.P.I., Professor of Hygiene, Catholic Universily Medical School, Dublin ; Examiner the Royal University of Ireland ; Fellow of the Sanitary Institute, etc. IN cases of infections diseases it is desirable to remove as far as possible any objection or difficulty to notification and removal to hospital of patients. It is also desirable to lessen the visits to in[ectious hospitals of the friends and relatives of the patients. Of course, the friends and relatives are not permitted to see the sufferers, still even calling involves a certain amount of risk. At the same time the enforced separation is much felt by the patients and relatives, so anything that will tend to remove this natural feeling would commend itself alike to those responsible for the public health and to our common instincts of humanity. In the present epidemic of small-pox in Dublin, it has been found that the poor will not, when attacked with the disease, send for the doctor for fear of removal to hospital. When remonstrated with, their usual reply i~ that they do not fear going to hospital, but complain that they cannot see or hear of their friends whilst there. I have proposed, then, that such hospitals be connected by telephone with one or more central stations, and that the relatives or friends may at any time, free of charge, communicate as to the condition, wishes, etc., of the sufferer. It would be necessary to employ some men to work the telephone, but such trivial expense should not stand in the way of such a reform. When the sufferer is in condition to receive or reply to the message, I should permit it. The very feeling that the actual condition of the patient could easily be ascertained at any time, would in itself do much to allay the anxiety of the relatives, and reconcile them to the necessary separation. Much time would be saved to the poor in going and waiting at the hospital gate. I do not see why there should not be permanent
233
stations connected by telephone with all hospitals in the town, where the poor could obtain information as to the condition of their patients.
ANNOTATIONS. TIIE BIRTH RATE IN ENGLAND. The mean annual birth rate was 3.1"9 in the ten years i883-92. In ~892 it was 30"5, in i893 it was 30'8. There was, therefore, a slight recovery in the latter year, though with this exception it was the lowest on record. Whether these figures indicate that we have reached the bottom of the decline of the birth rate, which has been one of the most remarkable facts in English statistics (and those of other countries) since the year I876 , it is too early to forecast. It is satisfactory, however, from an imperial standpoint that the natural increase of our population has not reached that state of non-existence which we see in France. The variations in the birth rate of the thirty-three great towns of England and Wales are worthy of further study than they have hitherto received. The low birth-rate of a manufacturing town like Huddersfield is a very striking fact, and indicates an age distribution of the population making for a low death rate. This much may be said without committing ourselves to the exploded fallacy that a high birth-rate means a high death-rate, or its converse. FACTORS INFLUENCING THE DEATH-RATE. It is a common error to assume that because the death rate of a district is lower than that of another district, the former is necessarily the healthier. There are other factors influencing the death rate which require to be considered. For instance, a district containing a proportionately large number of elderly people will, other things being equal, haye a higher death rate than a district with a smaller number. A suburb consisthlg mainly of better~class residences will contain a large number of domestics, and as the ages of the latter will be within those age-periods in which the least number of deaths occur, the death rate of such a place will 'thereby be lowered. It is almost unnecessary to say that the social status of the inhabitants of any place is an'important factor in its death rate. A high birth rate increases the death rate, at least for a time, but in ten to fifteen years, presuming that there is no marked emigration of young persons, the death rate wilt become lower, inasmuch as there will then be a large number of persons between the ages of five and twenty-five, during which period the incidence of mortality is at its lowest. Inversely, a low birth rate at first lowers the death rate, but after a lapse of years increases it, the number of persons between the ages of five and twenty-five being small. Another factor in T