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AN HISTORICAL REVIEW OF PUBLIC HEALTH.
341 are engaged, it is of the highest every searcher for knowledge towards the understanding of life should realise that the truth If may, nay must, be many-sided, and that, because his I, "Ne quid minims." truth does not at once conform to another’s, therefore ’! the other is wrong. It is unfortunate that the broad view is so rarely to be found, but let us plead for a THE MEMBERSHIP OF THE ROYAL COLLEGE OF PHYSICIANS OF LONDON. more concerted attack upon this most evasive of WE do not know if the significance of the amended problems, seeking that the recognition of the usefulness 112 of the College has been fully appreciated By-law or whether .of principles, physiological, psychological be not obscured by the unbalanced and premature by our readers. The by-law now runs, Every candidate for the Membership shall furnish proof of having forcing of conclusions. attained the age of 23 years," whereas the age for admission to the examination for the diploma was formerly 25 years. This means that men of 23 years of age can now take the examination and gain the RHEUMATIC INFECTION IN diploma without waiting for two years, by which time many of them have settled down into practice CHILDHOOD. and have neither the time nor the inclination to submit Many men at 23 FROM the point of view of public welfare few subjects themselves to an examination. and their have finished house appointments, just .could be found of greater importance than that of not yet faded, their examination having knowledge was infection in which discussed rheumatic childhood, recent clinical experience admirably fits them for the st a joint meeting of the Sections of Diseases of Children trial before them. In the past some men, who might and of Public Medicine at the annual meeting of the have secured the M.R.C.P. had they been 25, have British Medical Association on July 22nd. The toll embarked on some special line of work, such as of human life from heart disease originating from this pathology or X rays, and so when they became .cause during the school age amounts, according to Dr. eligible were both immersed in special work and ROBERT A. ASKINS, of Bristol, to between 12,000 lost touch with general medicine, and especially and 20,000 annually in England and Wales alone, with the important branch of routine clinical examinawhilst the hospitals have difficulty in finding accom- tion. As time went on these men rose to eminence in special branch of medicine, but were not eligible modation for both the early cases and those suffering their for the F.R.C.P. because they had not taken the from serious sequelae. A full account of this discussion M.R.C.P., and they and also the Royal College of will be found elsewhere in this issue, where it will be Physicians of London were the losers. At the Royal seen that practically all the speakers urged the need College of Surgeons of England the final examination for speedy research into the many problems involved. for the F.R.C.S. can be passed before the age of 25 Dr. F. J. POYNTON, who has done great public service years, while the successful candidate has to wait for until he attains that age. At the during many years in this respect, reiterated the the diploma of of London this relaxation College Royal Physicians necessity for closer inquiry concerning various setio- was not allowed.
in these
fields
importance that
Annotations. "
"
logical factors, especially as regards home surroundings,
____
the various modes of onset, the prevalence of chorea, and the importance of nervous over-strain among AN HISTORICAL REVIEW OF PUBLIC HEALTH. WE print this week the fourth and last instalment school-children. There appeared to be little doubt in of Dr. J. H. L. Cumpston’s reflections on public the minds of the various speakers as to the infective I health administration, provoked by a visit to America but of of the nature disease ; them, including and many England paid by him in his capacity of principal Dr. ROBERT HUTCHISON, the President, held strongly administrative health officer to the Commonwealth to the view that acute rheumatism cannot properly of Australia. Dr. Cumpston lays his finger on some be described as a disease of slums, but is rather to be weak points in administration which are largely the found amongst the children of the more well-to-do result of the haphazard way in which the whole .artisan class. This belief is borne out in an article by structure has grown up. No doubt his kindly but Dr. VINCENT CoATES and Dr. R. E. THOMAS which we trenchant criticism will be taken to heart by those and we propose in the next few weeks publish to-day. These observers have made careful concerned, further material for laying down sound to provide 50 cases clinical and setiological inquiry concerning of international hygiene by seeing how the principles selected at random from a much larger series of school- various countries have solved the problem children seen during school inspection and at clinics. in the European of careful studies made by the Health light They find that in practically every case the parents of the League of Nations. of the affected children were in steady work and During the present year several other senior of the medical profession have written belonged to the skilled artisan section of society, the sketches of the motives and principles which have various income of the families head weekly gross per actuated public health progress. Sir Arthur Newsbeing from five to seven shillings in about 45 per cent. of cases and above this figure in the remainder. In holme in his book emphasised the fundamental value of the crude dictum that the search for .a considerable number of cases the houses inhabited public health was a crusade against organic filth, by the patients were damp, but overcrowding was though the value of personal hygiene is fully notably absent. As regards treatment the most recognised in its pages and scientific work with pressing need of the moment was considered by most educational effort to secure its application are speakers to be the establishment of more clinics for urged. Prof. E. A. Winslow, of Yale, has stressed the the care of such children, and the provision of personal side of public health work, the value of’ institutions where long-continued rest could be public health nursing, and of educational work. It evident that only by a vue toute ensemble can the properly obtained. The success of the Hartfield is truth be encompassed. The sketch now before whole Hospital in Sussex has in this respect been very us by a distinguished leader of the medical profession encouraging. In view of the drain on the life and in America will prevent any too narrow view of the wealth of the population which rheumatic fever and factors of reform which have our present preceded its consequences at present entail, expenditure on 1 Public Health in Theory and Practice: An Historical such establishments and on adequate research centres Review. By W. H. Welch, M.D., LL.D. Yale University should be a sound national investment. Press. London : Oxford University Press. 4s. 6d.
Bureau
members
‘
342 condition. The occasion of the second annual Sedgwick z’ dental profession, and those not the least influential, lecture was utilised by Dr. W. H. Welch, of Baltimore,I are feeling that the Board may be going a little to review the pioneer work of this great AmericanI too fast. An editorial article in the British Dental sanitarian. Dr. Welch contends that America’s chief Journal for August regards the proposals with dislike. contribution to public health progress has been in if not alarm, as an abandonment of the cherished the extended use of the laboratory as a means of tradition inculcated by the British Dental Association control of disease ; and the outstanding examples of for nearly half a century-"Thou shalt not advertise." this are the work of the Lawrence Experiment In this article it is pointed out very forcibly how the Station on water purification and the introduction stunt game " is now so irrevocably associated in the by Hermann Biggs of laboratory diagnosis as a means public mind with some private interest lurking behind of controlling infectious disease in New York. A more it, that the advertising pitch has been spoiled for recent contribution of America to public health orthodox professional play. The Journal is all in consists in its prohibition of the sale of alcoholic favour of propaganda through educational authorities, drinks, and it is not irrelevant to contrast this with school teachers, medical officers of health, health Dr. Welch’s reference to the compulsory control of societies, and the like, and sees in the education of a disease by diet as evidenced by the obligatory parent and child in good dental habits, through the administration of lime-juice begun in the British Navy provision of good school dentistry, an agency for It is rather a in 1796. The lecture brings out very lucidly the improvement without reproach. value of a working hypothesis in the advancement piquant position for the dental profession, a section and application of knowledge, and the whole history of which has in the past not been loth to use all of public health can be written around successive available methods of publicity, now to be putting the hypotheses on which action, more or less successful, brake on the Dental Board’s proposed campaign of has been based. In respect of tuberculosis we have propaganda. We are in full sympathy with propaganda the well entrenched older views of the constitutional on the need for a healthy mouth, but we share the element in tuberculosis, and on the other hand the dislike felt by the British Dental Journal for a scheme remark of Koch, which Dr. Welch heard him make, of propaganda which entails extensive press publicity, that so far as tuberculosis is concerned " predis- the engagement of a special journalist, and a request position is merely proximity to the bacillus." Atten- for subsidies from the dental profession and the tion is drawn to the millions spent for the eradication dental trade. With regard to the dental trade, we of yellow fever, and wasted, under the influence of are sure that the best manufacturers concerned wish for no such publicity ; and whatever its immediate a wrong hypothesis as to its origin ; and it is added " the same is largely true of typhus." This remark success, the public will inevitably suspect in it a cannot be taken too literally, for from England subtle way of increasing the income of the dental typhus had been almost completely banished before profession. It would, we believe, defeat its own end, its transmission by body lice, and probably in no other and the Journal is probably right in thinking the way, was suspected. The lecture is worthy of its scheme to be in the nature of a kite flown by the author and will be read with interest by all. Dr. Board to test the feeling of the dental profession. Welch rightly takes the view that courses of hygiene I in the medical student’s curriculum do not suffice ; for EYE SURGEON AND NURSE. there is no subject of medical study without some ’ IT has often been said or implied that it is not the on and teacher bearing preventive medicine, every should consider it his duty to emphasise these aspects. business of the nurse to know anything about the procedures which the surgeon may choose to adopt. But many surgeons have found that it is just such DENTAL PROPAGANDA. knowledge which is likely to increase her value, and AT the May meeting of the Dental Board of the certainly a theatre sister who does not know the uses United Kingdom a good deal of time and thought of the instruments of which she has charge is likely were given to the subject of propaganda on the care to make mistakes which one who has familiarity of the teeth. Mr. F. Dyke Acland, the chairman of with their use will avoid. For the nursing of the Board, stated in his opening address that he was eye cases a general training is not enough, and impressed by the amount of general good-will existing for operative work it is genuinelv essential for the in many quarters towards the great object which the nurse to have expert guidance if she is to do justice to Dental Board had in view-namely, the improvement her patient. For these reasons we should like to of the dental health of the nation. He expressed his commend a practical handbookfor the ophthalmic belief that effective publicity might be attained nurse which she cannot fail to find useful. This little without very considerable expenditure, if only it was book is evidently written by one who has had experience properly directed and guided, and at a later stage in in the training of probationers in an eye hospital. It the proceedings the Board went on to allot a sum not is neither too elementary nor is it prolix. Written in exceeding 24000 during the present year for the simple language, each chapter is of practical value and So far the publicity work the illustrations are very clear. Just so much purpose of propaganda. of the Board has largely been in association with explanation of the anatomy of the eye is given as education and health authorities. During last year, nurses need. Bandaging is well illustrated and a form for instance, more than 132,000 copies of a leaflet of bandage described which, so far as we know, is were distributed through 347 education authorities peculiar to the Western Ophthalmic Hospital, where among teachers in primary and secondary schools ; it is found to be very effective. After a chapter on requests for . dental films, including the popular the external diseases of the eye, which includes " Tommy Tucker’s Tooth," were received from essential directions to the nurse in dealing with cases 25 education and health authorities. But the Board, of contagious ophthalmia, she is introduced to the not content with this valuable educational work, operating theatre, and the greater part of the book is set up an Advisory Committee with a view to working taken up by an excellent description of her duties out the methods for a more general campaign. This in the preparation of patients for operation, in Committee included representatives of the various the operating theatre itself, and during the afterdental associations, the Board of Education, the Food treatment of operation cases. A useful chapter is Education Society, the National Association of appended on operations in a private house. In the Insurance Committees, and of a number of manu- section on local anaesthesia stress is properly laid on facturers of dental supplies. The recommendations precautions against the roughening of the corneal of this Advisory Committee, as presented to the Board, epithelium that a careless instillation of cocaine causes. included the spending of a sum of 27000 in the first Exact directions are given for sterilising dressings, year on a scheme of press propaganda, the engage- preparing swabs, and the sterilisation of sutures and ment of a journalist of suitable qualifications, and By Mary Mason Springgay, Matron 1 Ophthalmic Nursing. the envisaging of a campaign lasting three years at of the Western Ophthalmic Hospital, London. With 67 illusleast. It is in this direction that some members of the trations. London: Methuen and Co. 1925. Pp.133. 5s. "
in these
fields
importance that
Annotations. "
"
logical factors, especially as regards home surroundings,
____
the various modes of onset, the prevalence of chorea, and the importance of nervous over-strain among AN HISTORICAL REVIEW OF PUBLIC HEALTH. WE print this week the fourth and last instalment school-children. There appeared to be little doubt in of Dr. J. H. L. Cumpston’s reflections on public the minds of the various speakers as to the infective I health administration, provoked by a visit to America but of of the nature disease ; them, including and many England paid by him in his capacity of principal Dr. ROBERT HUTCHISON, the President, held strongly administrative health officer to the Commonwealth to the view that acute rheumatism cannot properly of Australia. Dr. Cumpston lays his finger on some be described as a disease of slums, but is rather to be weak points in administration which are largely the found amongst the children of the more well-to-do result of the haphazard way in which the whole .artisan class. This belief is borne out in an article by structure has grown up. No doubt his kindly but Dr. VINCENT CoATES and Dr. R. E. THOMAS which we trenchant criticism will be taken to heart by those and we propose in the next few weeks publish to-day. These observers have made careful concerned, further material for laying down sound to provide 50 cases clinical and setiological inquiry concerning of international hygiene by seeing how the principles selected at random from a much larger series of school- various countries have solved the problem children seen during school inspection and at clinics. in the European of careful studies made by the Health light They find that in practically every case the parents of the League of Nations. of the affected children were in steady work and During the present year several other senior of the medical profession have written belonged to the skilled artisan section of society, the sketches of the motives and principles which have various income of the families head weekly gross per actuated public health progress. Sir Arthur Newsbeing from five to seven shillings in about 45 per cent. of cases and above this figure in the remainder. In holme in his book emphasised the fundamental value of the crude dictum that the search for .a considerable number of cases the houses inhabited public health was a crusade against organic filth, by the patients were damp, but overcrowding was though the value of personal hygiene is fully notably absent. As regards treatment the most recognised in its pages and scientific work with pressing need of the moment was considered by most educational effort to secure its application are speakers to be the establishment of more clinics for urged. Prof. E. A. Winslow, of Yale, has stressed the the care of such children, and the provision of personal side of public health work, the value of’ institutions where long-continued rest could be public health nursing, and of educational work. It evident that only by a vue toute ensemble can the properly obtained. The success of the Hartfield is truth be encompassed. The sketch now before whole Hospital in Sussex has in this respect been very us by a distinguished leader of the medical profession encouraging. In view of the drain on the life and in America will prevent any too narrow view of the wealth of the population which rheumatic fever and factors of reform which have our present preceded its consequences at present entail, expenditure on 1 Public Health in Theory and Practice: An Historical such establishments and on adequate research centres Review. By W. H. Welch, M.D., LL.D. Yale University should be a sound national investment. Press. London : Oxford University Press. 4s. 6d.
Bureau
members
‘
342 condition. The occasion of the second annual Sedgwick z’ dental profession, and those not the least influential, lecture was utilised by Dr. W. H. Welch, of Baltimore,I are feeling that the Board may be going a little to review the pioneer work of this great AmericanI too fast. An editorial article in the British Dental sanitarian. Dr. Welch contends that America’s chief Journal for August regards the proposals with dislike. contribution to public health progress has been in if not alarm, as an abandonment of the cherished the extended use of the laboratory as a means of tradition inculcated by the British Dental Association control of disease ; and the outstanding examples of for nearly half a century-"Thou shalt not advertise." this are the work of the Lawrence Experiment In this article it is pointed out very forcibly how the Station on water purification and the introduction stunt game " is now so irrevocably associated in the by Hermann Biggs of laboratory diagnosis as a means public mind with some private interest lurking behind of controlling infectious disease in New York. A more it, that the advertising pitch has been spoiled for recent contribution of America to public health orthodox professional play. The Journal is all in consists in its prohibition of the sale of alcoholic favour of propaganda through educational authorities, drinks, and it is not irrelevant to contrast this with school teachers, medical officers of health, health Dr. Welch’s reference to the compulsory control of societies, and the like, and sees in the education of a disease by diet as evidenced by the obligatory parent and child in good dental habits, through the administration of lime-juice begun in the British Navy provision of good school dentistry, an agency for It is rather a in 1796. The lecture brings out very lucidly the improvement without reproach. value of a working hypothesis in the advancement piquant position for the dental profession, a section and application of knowledge, and the whole history of which has in the past not been loth to use all of public health can be written around successive available methods of publicity, now to be putting the hypotheses on which action, more or less successful, brake on the Dental Board’s proposed campaign of has been based. In respect of tuberculosis we have propaganda. We are in full sympathy with propaganda the well entrenched older views of the constitutional on the need for a healthy mouth, but we share the element in tuberculosis, and on the other hand the dislike felt by the British Dental Journal for a scheme remark of Koch, which Dr. Welch heard him make, of propaganda which entails extensive press publicity, that so far as tuberculosis is concerned " predis- the engagement of a special journalist, and a request position is merely proximity to the bacillus." Atten- for subsidies from the dental profession and the tion is drawn to the millions spent for the eradication dental trade. With regard to the dental trade, we of yellow fever, and wasted, under the influence of are sure that the best manufacturers concerned wish for no such publicity ; and whatever its immediate a wrong hypothesis as to its origin ; and it is added " the same is largely true of typhus." This remark success, the public will inevitably suspect in it a cannot be taken too literally, for from England subtle way of increasing the income of the dental typhus had been almost completely banished before profession. It would, we believe, defeat its own end, its transmission by body lice, and probably in no other and the Journal is probably right in thinking the way, was suspected. The lecture is worthy of its scheme to be in the nature of a kite flown by the author and will be read with interest by all. Dr. Board to test the feeling of the dental profession. Welch rightly takes the view that courses of hygiene I in the medical student’s curriculum do not suffice ; for EYE SURGEON AND NURSE. there is no subject of medical study without some ’ IT has often been said or implied that it is not the on and teacher bearing preventive medicine, every should consider it his duty to emphasise these aspects. business of the nurse to know anything about the procedures which the surgeon may choose to adopt. But many surgeons have found that it is just such DENTAL PROPAGANDA. knowledge which is likely to increase her value, and AT the May meeting of the Dental Board of the certainly a theatre sister who does not know the uses United Kingdom a good deal of time and thought of the instruments of which she has charge is likely were given to the subject of propaganda on the care to make mistakes which one who has familiarity of the teeth. Mr. F. Dyke Acland, the chairman of with their use will avoid. For the nursing of the Board, stated in his opening address that he was eye cases a general training is not enough, and impressed by the amount of general good-will existing for operative work it is genuinelv essential for the in many quarters towards the great object which the nurse to have expert guidance if she is to do justice to Dental Board had in view-namely, the improvement her patient. For these reasons we should like to of the dental health of the nation. He expressed his commend a practical handbookfor the ophthalmic belief that effective publicity might be attained nurse which she cannot fail to find useful. This little without very considerable expenditure, if only it was book is evidently written by one who has had experience properly directed and guided, and at a later stage in in the training of probationers in an eye hospital. It the proceedings the Board went on to allot a sum not is neither too elementary nor is it prolix. Written in exceeding 24000 during the present year for the simple language, each chapter is of practical value and So far the publicity work the illustrations are very clear. Just so much purpose of propaganda. of the Board has largely been in association with explanation of the anatomy of the eye is given as education and health authorities. During last year, nurses need. Bandaging is well illustrated and a form for instance, more than 132,000 copies of a leaflet of bandage described which, so far as we know, is were distributed through 347 education authorities peculiar to the Western Ophthalmic Hospital, where among teachers in primary and secondary schools ; it is found to be very effective. After a chapter on requests for . dental films, including the popular the external diseases of the eye, which includes " Tommy Tucker’s Tooth," were received from essential directions to the nurse in dealing with cases 25 education and health authorities. But the Board, of contagious ophthalmia, she is introduced to the not content with this valuable educational work, operating theatre, and the greater part of the book is set up an Advisory Committee with a view to working taken up by an excellent description of her duties out the methods for a more general campaign. This in the preparation of patients for operation, in Committee included representatives of the various the operating theatre itself, and during the afterdental associations, the Board of Education, the Food treatment of operation cases. A useful chapter is Education Society, the National Association of appended on operations in a private house. In the Insurance Committees, and of a number of manu- section on local anaesthesia stress is properly laid on facturers of dental supplies. The recommendations precautions against the roughening of the corneal of this Advisory Committee, as presented to the Board, epithelium that a careless instillation of cocaine causes. included the spending of a sum of 27000 in the first Exact directions are given for sterilising dressings, year on a scheme of press propaganda, the engage- preparing swabs, and the sterilisation of sutures and ment of a journalist of suitable qualifications, and By Mary Mason Springgay, Matron 1 Ophthalmic Nursing. the envisaging of a campaign lasting three years at of the Western Ophthalmic Hospital, London. With 67 illusleast. It is in this direction that some members of the trations. London: Methuen and Co. 1925. Pp.133. 5s. "