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At Royal Leamington Spa
PUBLIC H E A L TH THE JOURNAL OF THE SOCIETY OF MEDICAL OFFICERS OF HEALTH. No. 7. Vol. XL.
APRIL, 1927.
PUBLIC HEALTH, the Official Organ of the Society of Medical Officers of Health, i's prepared to receive a certain number of approved advertisements. Application should be made to the ExecutiveSecretary o] the Society, at 1, Upper Montague Street, Russell Square, London, W.C.1. Subscription price, 31s. 6d. per annum, post free in advance. Single Copies, 2s. 6d.. post free.
Contents. PAGE
EDITORIAL~ At Royat Leamingt6n Spa . . . . . . . . . . .
197
A Cruel and Wasteful D i s e a s e oa~ Childhood . . . .
198
T h e T r e a t m e n t of Flour withChemica!Substfinces
199
The Health of the Worker
201
..........
The Commoz~ Lodging-House and the Common .... . . : Lodging-House Class ...
202
Maternal and Neo-Natat Mortalities
203
......
SPECL~L ARTICLE$~ Ph&peral Feve( and Puerperal pyr~xia. By ARg-t{iBALI9 DONALD, M.A., M.D., F.R,(].P., Consulting Honorary Surgfion, St. Mary's Hospital, Man~hester ; T:~o~As A. Gi3bDlCELLOW, C;BiE., M.D. ; J.. JOHNStONe J-ERr-Is, M.D., D , P . H . , Medical Officer Of Health, L e e d s ; D. SAGE N~U~LiND, M . D . , C h . B , M e d i c a l S u p e r i n : tende~t MancheSter-City Fever H o s p i t a l ; and
PAGE
Professor W. W. C. TOPLEY, -M.D., F.R.C.P,, Professor in Bacteriology, Victoria University, Manchester . . . . . . . . . . . . . . .
205
Ut Ira Dieam. Being Comments, apropos, and other~ wise, on Sundry Matters . . . . . . . . . . . .
219
SOCIETY OF MEDICAL OFFICERS OF HEALTH-Notices ...............
221
Council Meeting . . . . . . . . . . . . Ordinary Meeting ............... The Central Midwives' Board ... . . . . . . . The Welsh Branch ... ......... The Metropolitan Branch ......... The Northern Branch ... ......... The North-Western Branch ......... The Yorkshire Branch ......... ... The Maternity and Child Wetfare Group ... The Southern Branch .........
221
222 223 22~ 226 227 227
228 229 231
CORRESPONDENCE-" This
Advertising Fever "
. . . . . . . . .
232
Editorial. At Royal Leamington Spa. l I T may have been a remorse of conscience, 1[as they say, on the part of members of the Council of the Society that accounted for the very much better attendance at the meeting h~ld on March 18th at Leamington Spa. Or there may have been other reasons : amongst them the possession by Leamington of certain attractions denied to Manchester, for example, or a definite anticipation that there awaited the Society at the hands of the Mayor and Council of this famous spa, who had extended the invitation, a most warm welcome and kindly hospitality. If there was such~I}~ anticipation it received ample c o n f i r m a t i ~
and members were loud in their appreciation of the hospitality shown, and the excellence of the arrangements made for their convenience, comfort and entertainment. Some of that praise went also to the President and Mrs. Snell for the part they played in the reception of the Society. To the President particularly, members were indebted for the admirable manner in which he voiced the thanks of all present, in reply to the speech of welcome by the Deputy Mayor, at the hincheon, which was only one of the entertainments provided. So far as work was concerned, conceivably ~ r o s e out of the amenities of the meeting that
198
PUBLIC
this was of the h i g h e s t order, .not excepting t h a t d 0 n e at the Council, where, as will be seen t:mwi the special report in the appropriate part of this number, the chief question discussed was the establishment of a Health Education Committee and the starting off of. this body on what may be hoped will prove a highly successful and useful career. T h e ordinary meeting, like all such meetings in the provinces, and unlike the majority o f : t h o s e held at headquarters, was very well attended, and though the subject for discussion,~ " The Co-ordination of Child Welfare and School Medical W o r k , " was an attractive one, the feeling cannot be escaped that it would have been much better and certainly more enterprising if the time devoted to it had been given to a fuller description of the spa treatment in Leamington, and a more complete inspection of fhe arrangements provided. Of the meeting as a whole, however, it may safely be said that it h a s added further jUstification to that afforded by those at Newcastleupon-Tyne, Glasgow and Manchester to such as pressed for the introduction O f some grrangement under which a certain number of r~eetings each year should be held elsewhere than in London.
k Cruel and Wasteful Disease of Childhood. H I S disease is acute rheumatism, and this description is applied f0 it in the .preface to the report (Special Report Series, No. 114), published b y the Medical Research Council in which the results are given of an investigation into the relation between social conditions and acute rheumatism, organised b y the London Committee for Child Life Investigation, under the Chairmanship of Dr. (.~. F, Sl;ill. ' K n o w i n g that in England and W a l e s s o m e 58,000 deaths occur annually f~:6m rheumatism and rheumatic heart disease, a n d that i n London alone there are to-day, i n the neighbourhood of 10,000 children suffering" from heart affections following this disease, Who will not regard 'the description as just, and such an investigati.0n as that directed by D r . ' S t i l ! a s appropriate ? R e a d i n g t h e r e p o r t there can be none but will agree that it has been carried out with the utmost skill and the m o s t painstaking thoroughness. Having regard to the composition: of the band of .workers chosen to make the investigations and "to sort the results a n d test their statistical
T
HEALTH.
APRIL,
significance , this cannot be wondered at. Of the accuracy of the: investigations and the reliability of the conclusions there is no~r00m for-doubt. That these conclusions are largely of a riegative character the rePort admits, and for those who did :the work as for those on whose behalf it was undertaken there is sadness in .this. Even though they .are m a i n l y negatiye, however, . there is !eft certain room for optimism so far as the victims and possible victims a r e eoncei'ned, :a certain a m o u n t of light b e i n g , thrown in the direction of causation a n d some indication obtained as to the li:ne tO .be followed in :relation to prevention. From the report it is to be gathered that_., everything that could possibly, be regarded as a social condition was investigated amongst the class of children to whom it was limited. The reason for the limitation to the class from which hospital patients are drawn was, of course, that acute:-rheumatism is notoriously common_amongst the children of this class, and rarer among those of the more favourably Situfited. A n d it w a s primarily to discover why this should be: S0':that, "having marshallea all t h e differen-ces there a r e in circumstances and surroundings betweefi the two classes, arrangements-were made for a minute investigation of each one of them in a number of centres in all their aspects by individuals presumably. . with special knowledge of each aspect. The field covered was wide; a n d was all the wider gitice, whereVer it was .possible, Observations were controlled, the Conditions being investigated in re!afi0n to children who escaped as well :as to those who were attacked. The total number of affected children passed under review was over 700, :some of them attending the Children's Hospital, Great Ormond Street, some St. Thomas's Hospital, and some the Royal Hospital for S i c k Childen; ' Gla~sgow. Amongst these and the controls locally chosen with the object of arriving at some deeisi0n as to the relation of heredity;: there(was close enquiry into familial incideneeof rheumatism. Research was conducted also into the-relation of throat conditions to acute rheumatism, a n d in this.connection and for control pu.rposes was e.xtended to take in a number of children attending p o o r Law schools, Evidence as to infectivity w.as also sought; and it is interesting to note that contrary t o w h a t is p r o b a b l y the general, view, the evidence obtained was more or less at any rate in favour of those wbo believe in the existence o f a
APRIL, 1927.
PUBLIC HEALTH, the Official Organ of the Society of Medical Officers of Health, i's prepared to receive a certain number of approved advertisements. Application should be made to the ExecutiveSecretary o] the Society, at 1, Upper Montague Street, Russell Square, London, W.C.1. Subscription price, 31s. 6d. per annum, post free in advance. Single Copies, 2s. 6d.. post free.
Contents. PAGE
EDITORIAL~ At Royat Leamingt6n Spa . . . . . . . . . . .
197
A Cruel and Wasteful D i s e a s e oa~ Childhood . . . .
198
T h e T r e a t m e n t of Flour withChemica!Substfinces
199
The Health of the Worker
201
..........
The Commoz~ Lodging-House and the Common .... . . : Lodging-House Class ...
202
Maternal and Neo-Natat Mortalities
203
......
SPECL~L ARTICLE$~ Ph&peral Feve( and Puerperal pyr~xia. By ARg-t{iBALI9 DONALD, M.A., M.D., F.R,(].P., Consulting Honorary Surgfion, St. Mary's Hospital, Man~hester ; T:~o~As A. Gi3bDlCELLOW, C;BiE., M.D. ; J.. JOHNStONe J-ERr-Is, M.D., D , P . H . , Medical Officer Of Health, L e e d s ; D. SAGE N~U~LiND, M . D . , C h . B , M e d i c a l S u p e r i n : tende~t MancheSter-City Fever H o s p i t a l ; and
PAGE
Professor W. W. C. TOPLEY, -M.D., F.R.C.P,, Professor in Bacteriology, Victoria University, Manchester . . . . . . . . . . . . . . .
205
Ut Ira Dieam. Being Comments, apropos, and other~ wise, on Sundry Matters . . . . . . . . . . . .
219
SOCIETY OF MEDICAL OFFICERS OF HEALTH-Notices ...............
221
Council Meeting . . . . . . . . . . . . Ordinary Meeting ............... The Central Midwives' Board ... . . . . . . . The Welsh Branch ... ......... The Metropolitan Branch ......... The Northern Branch ... ......... The North-Western Branch ......... The Yorkshire Branch ......... ... The Maternity and Child Wetfare Group ... The Southern Branch .........
221
222 223 22~ 226 227 227
228 229 231
CORRESPONDENCE-" This
Advertising Fever "
. . . . . . . . .
232
Editorial. At Royal Leamington Spa. l I T may have been a remorse of conscience, 1[as they say, on the part of members of the Council of the Society that accounted for the very much better attendance at the meeting h~ld on March 18th at Leamington Spa. Or there may have been other reasons : amongst them the possession by Leamington of certain attractions denied to Manchester, for example, or a definite anticipation that there awaited the Society at the hands of the Mayor and Council of this famous spa, who had extended the invitation, a most warm welcome and kindly hospitality. If there was such~I}~ anticipation it received ample c o n f i r m a t i ~
and members were loud in their appreciation of the hospitality shown, and the excellence of the arrangements made for their convenience, comfort and entertainment. Some of that praise went also to the President and Mrs. Snell for the part they played in the reception of the Society. To the President particularly, members were indebted for the admirable manner in which he voiced the thanks of all present, in reply to the speech of welcome by the Deputy Mayor, at the hincheon, which was only one of the entertainments provided. So far as work was concerned, conceivably ~ r o s e out of the amenities of the meeting that
198
PUBLIC
this was of the h i g h e s t order, .not excepting t h a t d 0 n e at the Council, where, as will be seen t:mwi the special report in the appropriate part of this number, the chief question discussed was the establishment of a Health Education Committee and the starting off of. this body on what may be hoped will prove a highly successful and useful career. T h e ordinary meeting, like all such meetings in the provinces, and unlike the majority o f : t h o s e held at headquarters, was very well attended, and though the subject for discussion,~ " The Co-ordination of Child Welfare and School Medical W o r k , " was an attractive one, the feeling cannot be escaped that it would have been much better and certainly more enterprising if the time devoted to it had been given to a fuller description of the spa treatment in Leamington, and a more complete inspection of fhe arrangements provided. Of the meeting as a whole, however, it may safely be said that it h a s added further jUstification to that afforded by those at Newcastleupon-Tyne, Glasgow and Manchester to such as pressed for the introduction O f some grrangement under which a certain number of r~eetings each year should be held elsewhere than in London.
k Cruel and Wasteful Disease of Childhood. H I S disease is acute rheumatism, and this description is applied f0 it in the .preface to the report (Special Report Series, No. 114), published b y the Medical Research Council in which the results are given of an investigation into the relation between social conditions and acute rheumatism, organised b y the London Committee for Child Life Investigation, under the Chairmanship of Dr. (.~. F, Sl;ill. ' K n o w i n g that in England and W a l e s s o m e 58,000 deaths occur annually f~:6m rheumatism and rheumatic heart disease, a n d that i n London alone there are to-day, i n the neighbourhood of 10,000 children suffering" from heart affections following this disease, Who will not regard 'the description as just, and such an investigati.0n as that directed by D r . ' S t i l ! a s appropriate ? R e a d i n g t h e r e p o r t there can be none but will agree that it has been carried out with the utmost skill and the m o s t painstaking thoroughness. Having regard to the composition: of the band of .workers chosen to make the investigations and "to sort the results a n d test their statistical
T
HEALTH.
APRIL,
significance , this cannot be wondered at. Of the accuracy of the: investigations and the reliability of the conclusions there is no~r00m for-doubt. That these conclusions are largely of a riegative character the rePort admits, and for those who did :the work as for those on whose behalf it was undertaken there is sadness in .this. Even though they .are m a i n l y negatiye, however, . there is !eft certain room for optimism so far as the victims and possible victims a r e eoncei'ned, :a certain a m o u n t of light b e i n g , thrown in the direction of causation a n d some indication obtained as to the li:ne tO .be followed in :relation to prevention. From the report it is to be gathered that_., everything that could possibly, be regarded as a social condition was investigated amongst the class of children to whom it was limited. The reason for the limitation to the class from which hospital patients are drawn was, of course, that acute:-rheumatism is notoriously common_amongst the children of this class, and rarer among those of the more favourably Situfited. A n d it w a s primarily to discover why this should be: S0':that, "having marshallea all t h e differen-ces there a r e in circumstances and surroundings betweefi the two classes, arrangements-were made for a minute investigation of each one of them in a number of centres in all their aspects by individuals presumably. . with special knowledge of each aspect. The field covered was wide; a n d was all the wider gitice, whereVer it was .possible, Observations were controlled, the Conditions being investigated in re!afi0n to children who escaped as well :as to those who were attacked. The total number of affected children passed under review was over 700, :some of them attending the Children's Hospital, Great Ormond Street, some St. Thomas's Hospital, and some the Royal Hospital for S i c k Childen; ' Gla~sgow. Amongst these and the controls locally chosen with the object of arriving at some deeisi0n as to the relation of heredity;: there(was close enquiry into familial incideneeof rheumatism. Research was conducted also into the-relation of throat conditions to acute rheumatism, a n d in this.connection and for control pu.rposes was e.xtended to take in a number of children attending p o o r Law schools, Evidence as to infectivity w.as also sought; and it is interesting to note that contrary t o w h a t is p r o b a b l y the general, view, the evidence obtained was more or less at any rate in favour of those wbo believe in the existence o f a