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The zymotic death-rate
PUBLIG HEALTH: 3ournai of the 3ncorporateO ociet ? ot fli- eoical Omcer or lbealtb. VOL. XVI.
OCTOBER, 1903.
No. 1.
EDITORIAL. THE ZYMOTIC DEATH-RATE. NOTWITHSTANDINGfrequent comments on the subject, we note that the "zymotic death.rate" s~ill maintains its popularity in many quarters as sm adequate test of the sanitary condition of a district. It is still preserved in the quarterly and annual summaries of the Registrar-General, though in this instance any fallacious conclusions that might otherwise be drawn from its statement in Column 6, Table I I . ; o f the annual summary are obviated by the statement, in Columns 7 to 13 inclusive, of the separate death-rate from smallpox, measles, scarlet fever, diphtheria, whooping-cough, fever, and diarrhoea respectively. In many reports, however, these separate rates are not given, and it appears to be assumed that the condition of a district a s to infectious diseases can be gauged from the "zymotic d~ath-rate" a l o n e . Even in the Registrar-General's returns we should welcome the abolition of Column 6, especially if i t could be replaced by a statement of the phthisis death-rate in each town. This, if practicable, would constitute an important advance in t h e value of these comparative returns. The value Of the zymotic death-rate clearly must depend on the relative magnitude of its seven constituents. A large epidemic of whooping.cough or measles, for instance, would temporarily magnify the rate, although its significance as an index of public health administration would be Mtogether different from that furnfshed by a high mortality from small-pox or enteric fever. A high mortality from diarrhoea again, continued over a 'series of years, gives an interesting m s , h i into the social as well as the sanitary eonditi?n of a district, wh~ h is quite concealed when it is wrapped up in the zymotic deathrate. In this instance it is advantageous not only to separate the 1
2
T h e Zymotic Death.Rate
tP.buoHealth
mortality due to diarrhoea from that caused by the six other zymotic diseases, but also to state it, as recommended by Dr. Newsholme,* in terms of the infantile population, among whom the majority of the deaths from epidemic diarrhoea occur. We look forward to the time when the " zymotic death-rate" will have disappeared from sight and use ; when a careful study will be made in all annual reports of medical officers of health of the deathrate and of the sickness-rate from each infectious disease; when these rates will be compared with the corresponding rates for a long series of preceding years ; when average rates for groups of years will be eschewed or used most sparingly ; and when the death-rate and the sickness-rate from phthisis will take its place in every annual report as perhaps the most important index of the health conditions of a community.
LECTURING before the Society of Arts on the " Future of Gas Lighting," Professor Vivian B. Lewes said with regard to acetylene that this gas could be dissolved in acetone, and in this way 100 cubic feet of the gas could be compressed into 1 cubic foot of cylinder space, and that in this form the gas was admirably adapted for train, tram, and omnibus lighting. He also showed that with this compressed acetylene, in conjunction with the incandescent mantle, a light of 146 candles per cubic foot of gas could be obtained. LEAD-PoisONING IN HOUSE PAIt~TERS.--In my capacity as Certifying Factory Surgeon, I received instructions in November from H.I~L Inspector of Factories to investigate and report upon the circumstances connected with the death of a resident of Llanelly, who died in that town as the result of lead-poisoning, contracted whilst engaged as a painter in Gorseinon. The unfortunate man was very rarely employed in the workshop, being scarcely ever required to mix paints, as he was a comparatively unskilled painter employed only in priming, and had only taken to painting about six months before his death, through having been compelled by an accident to one of his feet to quit his former occupation and seek light work. There can be no doubt that his death was due to his habRual extreme carelessness as to the cleansing of his hands and finger-nails before partaking of food. House-painters, as such, are outside the scope of the Factory Acts, and therefore nothing can be done by the Factory Inspectors to remove the conditions which conduce to lead-poisoning in them; the only power the Inspector possesses of exercising control is in regard to the comparatively short period during which a painter is employed in a workshop mixing lead paints. The prevention of lead-pmsoning in house-painters, therefore, depends upon their own intelligent and conscientioas use of the necessary precautions, and they should invariably exercise scrupulous care to secure thorough cleanliness of the hands before meals by the free use of soap and water and the vigorous use of the nail-brush.--Dm TI~AFFOI~DMITCHELL, ATtn. Ro?9., 1901. Presidential Address, PUBLICHEALTH,December, 1899.
OCTOBER, 1903.
No. 1.
EDITORIAL. THE ZYMOTIC DEATH-RATE. NOTWITHSTANDINGfrequent comments on the subject, we note that the "zymotic death.rate" s~ill maintains its popularity in many quarters as sm adequate test of the sanitary condition of a district. It is still preserved in the quarterly and annual summaries of the Registrar-General, though in this instance any fallacious conclusions that might otherwise be drawn from its statement in Column 6, Table I I . ; o f the annual summary are obviated by the statement, in Columns 7 to 13 inclusive, of the separate death-rate from smallpox, measles, scarlet fever, diphtheria, whooping-cough, fever, and diarrhoea respectively. In many reports, however, these separate rates are not given, and it appears to be assumed that the condition of a district a s to infectious diseases can be gauged from the "zymotic d~ath-rate" a l o n e . Even in the Registrar-General's returns we should welcome the abolition of Column 6, especially if i t could be replaced by a statement of the phthisis death-rate in each town. This, if practicable, would constitute an important advance in t h e value of these comparative returns. The value Of the zymotic death-rate clearly must depend on the relative magnitude of its seven constituents. A large epidemic of whooping.cough or measles, for instance, would temporarily magnify the rate, although its significance as an index of public health administration would be Mtogether different from that furnfshed by a high mortality from small-pox or enteric fever. A high mortality from diarrhoea again, continued over a 'series of years, gives an interesting m s , h i into the social as well as the sanitary eonditi?n of a district, wh~ h is quite concealed when it is wrapped up in the zymotic deathrate. In this instance it is advantageous not only to separate the 1
2
T h e Zymotic Death.Rate
tP.buoHealth
mortality due to diarrhoea from that caused by the six other zymotic diseases, but also to state it, as recommended by Dr. Newsholme,* in terms of the infantile population, among whom the majority of the deaths from epidemic diarrhoea occur. We look forward to the time when the " zymotic death-rate" will have disappeared from sight and use ; when a careful study will be made in all annual reports of medical officers of health of the deathrate and of the sickness-rate from each infectious disease; when these rates will be compared with the corresponding rates for a long series of preceding years ; when average rates for groups of years will be eschewed or used most sparingly ; and when the death-rate and the sickness-rate from phthisis will take its place in every annual report as perhaps the most important index of the health conditions of a community.
LECTURING before the Society of Arts on the " Future of Gas Lighting," Professor Vivian B. Lewes said with regard to acetylene that this gas could be dissolved in acetone, and in this way 100 cubic feet of the gas could be compressed into 1 cubic foot of cylinder space, and that in this form the gas was admirably adapted for train, tram, and omnibus lighting. He also showed that with this compressed acetylene, in conjunction with the incandescent mantle, a light of 146 candles per cubic foot of gas could be obtained. LEAD-PoisONING IN HOUSE PAIt~TERS.--In my capacity as Certifying Factory Surgeon, I received instructions in November from H.I~L Inspector of Factories to investigate and report upon the circumstances connected with the death of a resident of Llanelly, who died in that town as the result of lead-poisoning, contracted whilst engaged as a painter in Gorseinon. The unfortunate man was very rarely employed in the workshop, being scarcely ever required to mix paints, as he was a comparatively unskilled painter employed only in priming, and had only taken to painting about six months before his death, through having been compelled by an accident to one of his feet to quit his former occupation and seek light work. There can be no doubt that his death was due to his habRual extreme carelessness as to the cleansing of his hands and finger-nails before partaking of food. House-painters, as such, are outside the scope of the Factory Acts, and therefore nothing can be done by the Factory Inspectors to remove the conditions which conduce to lead-poisoning in them; the only power the Inspector possesses of exercising control is in regard to the comparatively short period during which a painter is employed in a workshop mixing lead paints. The prevention of lead-pmsoning in house-painters, therefore, depends upon their own intelligent and conscientioas use of the necessary precautions, and they should invariably exercise scrupulous care to secure thorough cleanliness of the hands before meals by the free use of soap and water and the vigorous use of the nail-brush.--Dm TI~AFFOI~DMITCHELL, ATtn. Ro?9., 1901. Presidential Address, PUBLICHEALTH,December, 1899.