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AUSTRALASIA
1015
campaign. An impressive sum even in these days of successive devaluations ; but judging by the latest vital statistics finance is only one aspect of this
AUSTRALASIA
(FROM
OUR OWN
CORRESPONDENT)
perplexing problem. INCIDENCE OF CANCER IN PARIS
Monsieur Marcel Moine, the prolific statistician, reports a study of the behaviour of cancer in Paris since 1901. Taking the two five-year periods 1901-05 and 1930-34, he shows that the frequency of cancer in Paris has apparently risen in the interval by 21-1 per cent. The annual average was 109 per 100,000 inhabitants in the first period, and 132 in the second period. The figures for 1935 and 1936 show the same rising tendency. But if due account is taken of the shifting of the age-distribution of the population in favour of the higher ages, the above figures lose much of their sinister import, for between 1901 and 1931 (census years) the number of persons between the ages of forty and fifty-nine per 1000 inhabitants has risen from 241 to 280, and for persons over sixty, from 80 to 102. And when the same age-groups are compared, it would even seem that between the ages of twenty and fifty-nine there has been a fall instead of a rise in the cancer rate. It is only after the age of sixty, that the cancer rate has risen between 1901 and 1934-a rise of 15-5 per cent. With regard to the seat of the disease, the digestive tract and peritoneal cavity head the list in frequency for women as well as for men, the latter showing a comparatively high cancer rate for the mouth and respiratory tract. The cutaneous forms of cancer are almost equally distributed between the sexes and, when the necessary corrections have been made, the male cancer rate is 9-1 per cent. higher than the female cancer rate at all ages though, if account is taken only of the ages thirty to forty-nine, the female cancer rate is the higher of the two. THE
OVERWORKED
SCHOLAR
The important place given to the overworked scholar in the Hygiene Congress in Paris last autumn might be taken as a hopeful sign of the times were it not for a historical survey of this subject by Dr. Clement Launay who shows in the lYlouve?nent Sanitaire (No. 166) that the unequal contest between the doctor and the schoolmaster is a very old one and has hitherto ended in favour of the latter and his passion for the scholastic endowment of his pupils at all costs. Rabelais was an unsuccessful pioneer in this field, and Montaigne and Rousseau also put their hands to this plough without cutting very deep. In 1886 and 1887 the French Academy of Medicine devoted half a score of meetings to the same subject, and the resolutions it adopted on behalf of the overworked scholar were treated as pious wishes to be denied all executive expression. Since then protests by the medical profession have not ceased, and in 1929 the Comite National de l’Enfance conducted a full-dress inquiry under the direction of Prof. Nobecourt. In the same year the Academy of Medicine appointed a commission to investigate the matter, and its report formed the basis of resolutions voted by the Academy. They recommended more time to scholars for games and physical exercises at the expense of the educational curriculum. Since 1929 medical opinion has stiffened still further in favour of a healthier scholastic routine, but whenever the doctor and schoolmaster have met over this difficulty, they have done so to disagree. As long as the latter thinks only in terms of examinations and marks, it looks as if he will continue to have his own way.
MEDICAL RESEARCH
Medical Research Endowment Act, passed Commonwealth Government last July, an annual endowment for medical research in Australia, and as a first contribution the sum of E30,000 was placed on the estimates for 1937. At its last meeting the National Health and Medical Research Council approved of assistance to university departments, to independent institutes, and to about ten young research workers. It also made possible the initiation of research into puerperal morbidity, streptococci, poliomyelitis, rheumatism, and tuberculosis. Dealing with maternal morbidity and mortality, the Council recommended that in every State there should be a mobile blood transfusion unit, a group of consultants who would be available immediately on call, an efficient antenatal system, and a consultative committee who would investigate every maternal death within practicable range of the metropolis. It is proposed that the Commonwealth Government should make payment of maternity allowance conditional upon the production of a certificate to show that medical advice has been sought at least three months before delivery, and the Council urged that hospital accommodation be increased so that it shall never be necessary to discharge any woman before the eleventh day after childbirth. THE
by the provides
CONTROL OF BIOLOGICAL PRODUCTS
Standards laid down by the League of Nations form the basis of legislation embodied in the Therapeutic Substances Act, 1937, introduced by the Commonwealth Government. A therapeutic substance is defined as one which is " wholly or in part derived from microscopic organisms, or from living cellular tissues, or from glands removed from animals after slaughter," and no control is exercised over such more strictly chemical substances as the arsenobenzols, digitalis, and strophanthus. Previous to this legislation the ’definition of therapeutic units was not uniform in Australia. Three States recognised the units adopted by the Hygienic Laboratory of Washington, U.S.A., and two States had not adopted any standard. The Act now standardises the definition of therapeutic units throughout Australia. The Commonwealth Serum Laboratories have been recognised as the Australian depôt for the international prototypes, and is the only Australian source of therapeutic sera. Sera of other sources are imported but have to contend against high tariffs. The Commonwealth Serum Laboratories have served very well the demands of such products in Australia and New Zealand. INTERNATIONAL AIR SERVICES
In August, 1937, the flight of Mrs. Earhart Putman, before its tragic ending, linked Australia and New Guinea directly with the yellow fever areas of tropical Africa. In December, 1937, an even more significant event was the meeting in Auckland harbour of the Imperial Airways Centaurus and the Pan-American Airways Samoa Clipper. These flying boats were pioneering the new services which will shortly touch five continents within the fortnight from Southampton to San Francisco. These services will definitely end that isolation, in time and space, which formerly protected Australia, New Zealand, and the Pacific
1016 Islands
the importation of disease from It is reported that the new New ZealandUnited States service will provide for a fortnightly
against
overseas.
carriage of mails, express freight and passengers, taking three and a half days to reach San Francisco, and four days to New York. The close watch maintained on conditions along air routes makes it unlikely, however, that even the most rapid advance of air traffic will outstrip the precautions that are being taken to safeguard the public health of countries en
improvement in the scale of salaries of dispensary medical officers was made in nine areas, the maximum scale approved by the Department being JE250-E350 The conditions of granting short leave of a year. absence on urgent private affairs to dispensary medical officers were made more easy. Six officers took advantage of the regulations which permit leave of absence for purposes of study.
some
route.
BUCHAREST (FROM
IRELAND
(FROM
OUR OWN
CORRESPONDENT)
THE PUBLIC HEALTH
THE annual report of the Department for Local Government and Public Health for the year ended March 31st, 1937, has appeared months earlier than it was expected. Reference is made to several regulations bearing on the administration of the Milk and Dairies Act, 1935, which were made by the Minister during the year. It is stated that the Act and the regulations provide a comprehensive code for securing effective control of the milk-supply intended for human consumption. The duty of ensuring the purity and cleanliness of the milk-supply is imposed on the local sanitary authorities, and this local administration, though unavoidable, is the weak point, for up to the present the local authorities, with few exceptions, have shown little interest in sanitary progress. The gradual decline in the incidence of infectious diseases recorded in previous reports did not continue during the year ; the increase was due to an extensive but mild epidemic of scarlet fever, and despite the increase in incidence there was a satisfactory decrease in mortality. The number of deaths from infectious disease during the year was 1601, being less by 303 than in the previous year, and 551 below the average for the five years 1931-35. There was a considerable fall in the incidence of both typhoid and diphtheria ; in the case of the former the decline is believed to be due to improved sanitation, and in the case of the latter to the campaign of immunisation which has been most effective in the urban areas. The decline in these diseases may be regarded, it is stated, as an index of the good work of the county medical officers of health. The deaths from tuberculosis were less by 290 than in the previous They represented a mortality-rate of 1.17 year. per 1000 of the population. The problem of maternal mortality is a cause of grave concern, and no substantial reduction in the death-rate from pregnancy and childbearing has taken place in recent years. Notwithstanding the attention the subject has received there has been a gradual rise in the number of deaths from puerperal sepsis and from other accidents of pregnancy and childbirth during the past six years. In 1931 the rate was 4.30 per 1000 births, and in the successive years since it has been 4-55, 444, 468, 467, and 4-70. Sepsis is the chief among these causes of death. Infant mortality is also discouraging, reaching a rate of 74-15 per 1000 births in the year under review, which is the highest since 1926. The figures given under the head of " medical charities " show that during the year the dispensary medical officers attended 848,132 cases, of which 167,299 were attended at their homes. There are 652 dispensary medical officers. During the year
OUR OWN
CORRESPONDENT)
A REVIEW OF FOREIGN MEDICAL DIPLOMAS
No person may practise medicine in Rumania without the authorisation of "libera practica" accorded by the Ministry of Labour, Public Health, and Social Welfare, without an announcement in the official gazette 3[onitprul Official, and the inscription of his name in a list kept by the College of Physicians. Free practice of medicine is allowed on the recommendation of the administrative commission on the basis of the following certificates : (a) diploma delivered or recognised by a faculty of medicine in Rumania, (b) certificate of Rumanian citizenship. Physicians holding medical diplomas obtained abroad and who desire to practise in Rumania are required to have their diplomas recognised through a procedure called "nostrification." This consists of two parts, (1) equivalisation, and (2) nostrification proper, and may be accomplished at any one of the three State universities in Bucharest, Jassy, and Cluj. A number of foreign candidates have been rejected by reason of insufficient or unsatisfactory documents and a certain bogus lawyer is now known to have offered his help to some of them. He had a workshop for forging false certificates of matriculation and other documents. His help was especially requisitioned by candidates who had studied at universities, where the course of studies takes only five years (as for instance in Bologna, Italy), because at the Rumanian faculty a six-year medical course is required. In such cases the gap could only be bridged by a forged document. Although it is known that only a few people availed themselves of the help of this impostor, the authorities have deemed it advisable to subject to review all diplomas obtained by means of nostrification since the enlargement of Rumania in 1919. The National Medical Association, seeing that the matter has been widely ventilated in the lay press, has supported this review in order to restore the trust of the public in medical men and to maintain professional prestige. The Minister went even further and has ordered that all diplomas obtained abroad are to be produced for inspection. In consequence of this order diplomas obtained, for instance, in Vienna University as long as 30 and even 40 years ago, have to be brought up. The inspection is to be carried out by a committee appointed by the Ministry of Health and consists of a judge, who is a member of the Bucharest court of as president, two physicians, one pharmacist, and one lawyer. The committee will verify and pronounce on all the documents on grounds of which medical and pharmaceutical libera practica " was granted, and is empowered to withdraw the concession if the applicant’s certificates do not justify his right to practise in Rumania. Doctors who acquired their diplomas before 1918 had to send in their original diplomas and a certified duplicate. If the diploma is not in Latin or in German an officially
appeal,
"
campaign. An impressive sum even in these days of successive devaluations ; but judging by the latest vital statistics finance is only one aspect of this
AUSTRALASIA
(FROM
OUR OWN
CORRESPONDENT)
perplexing problem. INCIDENCE OF CANCER IN PARIS
Monsieur Marcel Moine, the prolific statistician, reports a study of the behaviour of cancer in Paris since 1901. Taking the two five-year periods 1901-05 and 1930-34, he shows that the frequency of cancer in Paris has apparently risen in the interval by 21-1 per cent. The annual average was 109 per 100,000 inhabitants in the first period, and 132 in the second period. The figures for 1935 and 1936 show the same rising tendency. But if due account is taken of the shifting of the age-distribution of the population in favour of the higher ages, the above figures lose much of their sinister import, for between 1901 and 1931 (census years) the number of persons between the ages of forty and fifty-nine per 1000 inhabitants has risen from 241 to 280, and for persons over sixty, from 80 to 102. And when the same age-groups are compared, it would even seem that between the ages of twenty and fifty-nine there has been a fall instead of a rise in the cancer rate. It is only after the age of sixty, that the cancer rate has risen between 1901 and 1934-a rise of 15-5 per cent. With regard to the seat of the disease, the digestive tract and peritoneal cavity head the list in frequency for women as well as for men, the latter showing a comparatively high cancer rate for the mouth and respiratory tract. The cutaneous forms of cancer are almost equally distributed between the sexes and, when the necessary corrections have been made, the male cancer rate is 9-1 per cent. higher than the female cancer rate at all ages though, if account is taken only of the ages thirty to forty-nine, the female cancer rate is the higher of the two. THE
OVERWORKED
SCHOLAR
The important place given to the overworked scholar in the Hygiene Congress in Paris last autumn might be taken as a hopeful sign of the times were it not for a historical survey of this subject by Dr. Clement Launay who shows in the lYlouve?nent Sanitaire (No. 166) that the unequal contest between the doctor and the schoolmaster is a very old one and has hitherto ended in favour of the latter and his passion for the scholastic endowment of his pupils at all costs. Rabelais was an unsuccessful pioneer in this field, and Montaigne and Rousseau also put their hands to this plough without cutting very deep. In 1886 and 1887 the French Academy of Medicine devoted half a score of meetings to the same subject, and the resolutions it adopted on behalf of the overworked scholar were treated as pious wishes to be denied all executive expression. Since then protests by the medical profession have not ceased, and in 1929 the Comite National de l’Enfance conducted a full-dress inquiry under the direction of Prof. Nobecourt. In the same year the Academy of Medicine appointed a commission to investigate the matter, and its report formed the basis of resolutions voted by the Academy. They recommended more time to scholars for games and physical exercises at the expense of the educational curriculum. Since 1929 medical opinion has stiffened still further in favour of a healthier scholastic routine, but whenever the doctor and schoolmaster have met over this difficulty, they have done so to disagree. As long as the latter thinks only in terms of examinations and marks, it looks as if he will continue to have his own way.
MEDICAL RESEARCH
Medical Research Endowment Act, passed Commonwealth Government last July, an annual endowment for medical research in Australia, and as a first contribution the sum of E30,000 was placed on the estimates for 1937. At its last meeting the National Health and Medical Research Council approved of assistance to university departments, to independent institutes, and to about ten young research workers. It also made possible the initiation of research into puerperal morbidity, streptococci, poliomyelitis, rheumatism, and tuberculosis. Dealing with maternal morbidity and mortality, the Council recommended that in every State there should be a mobile blood transfusion unit, a group of consultants who would be available immediately on call, an efficient antenatal system, and a consultative committee who would investigate every maternal death within practicable range of the metropolis. It is proposed that the Commonwealth Government should make payment of maternity allowance conditional upon the production of a certificate to show that medical advice has been sought at least three months before delivery, and the Council urged that hospital accommodation be increased so that it shall never be necessary to discharge any woman before the eleventh day after childbirth. THE
by the provides
CONTROL OF BIOLOGICAL PRODUCTS
Standards laid down by the League of Nations form the basis of legislation embodied in the Therapeutic Substances Act, 1937, introduced by the Commonwealth Government. A therapeutic substance is defined as one which is " wholly or in part derived from microscopic organisms, or from living cellular tissues, or from glands removed from animals after slaughter," and no control is exercised over such more strictly chemical substances as the arsenobenzols, digitalis, and strophanthus. Previous to this legislation the ’definition of therapeutic units was not uniform in Australia. Three States recognised the units adopted by the Hygienic Laboratory of Washington, U.S.A., and two States had not adopted any standard. The Act now standardises the definition of therapeutic units throughout Australia. The Commonwealth Serum Laboratories have been recognised as the Australian depôt for the international prototypes, and is the only Australian source of therapeutic sera. Sera of other sources are imported but have to contend against high tariffs. The Commonwealth Serum Laboratories have served very well the demands of such products in Australia and New Zealand. INTERNATIONAL AIR SERVICES
In August, 1937, the flight of Mrs. Earhart Putman, before its tragic ending, linked Australia and New Guinea directly with the yellow fever areas of tropical Africa. In December, 1937, an even more significant event was the meeting in Auckland harbour of the Imperial Airways Centaurus and the Pan-American Airways Samoa Clipper. These flying boats were pioneering the new services which will shortly touch five continents within the fortnight from Southampton to San Francisco. These services will definitely end that isolation, in time and space, which formerly protected Australia, New Zealand, and the Pacific
1016 Islands
the importation of disease from It is reported that the new New ZealandUnited States service will provide for a fortnightly
against
overseas.
carriage of mails, express freight and passengers, taking three and a half days to reach San Francisco, and four days to New York. The close watch maintained on conditions along air routes makes it unlikely, however, that even the most rapid advance of air traffic will outstrip the precautions that are being taken to safeguard the public health of countries en
improvement in the scale of salaries of dispensary medical officers was made in nine areas, the maximum scale approved by the Department being JE250-E350 The conditions of granting short leave of a year. absence on urgent private affairs to dispensary medical officers were made more easy. Six officers took advantage of the regulations which permit leave of absence for purposes of study.
some
route.
BUCHAREST (FROM
IRELAND
(FROM
OUR OWN
CORRESPONDENT)
THE PUBLIC HEALTH
THE annual report of the Department for Local Government and Public Health for the year ended March 31st, 1937, has appeared months earlier than it was expected. Reference is made to several regulations bearing on the administration of the Milk and Dairies Act, 1935, which were made by the Minister during the year. It is stated that the Act and the regulations provide a comprehensive code for securing effective control of the milk-supply intended for human consumption. The duty of ensuring the purity and cleanliness of the milk-supply is imposed on the local sanitary authorities, and this local administration, though unavoidable, is the weak point, for up to the present the local authorities, with few exceptions, have shown little interest in sanitary progress. The gradual decline in the incidence of infectious diseases recorded in previous reports did not continue during the year ; the increase was due to an extensive but mild epidemic of scarlet fever, and despite the increase in incidence there was a satisfactory decrease in mortality. The number of deaths from infectious disease during the year was 1601, being less by 303 than in the previous year, and 551 below the average for the five years 1931-35. There was a considerable fall in the incidence of both typhoid and diphtheria ; in the case of the former the decline is believed to be due to improved sanitation, and in the case of the latter to the campaign of immunisation which has been most effective in the urban areas. The decline in these diseases may be regarded, it is stated, as an index of the good work of the county medical officers of health. The deaths from tuberculosis were less by 290 than in the previous They represented a mortality-rate of 1.17 year. per 1000 of the population. The problem of maternal mortality is a cause of grave concern, and no substantial reduction in the death-rate from pregnancy and childbearing has taken place in recent years. Notwithstanding the attention the subject has received there has been a gradual rise in the number of deaths from puerperal sepsis and from other accidents of pregnancy and childbirth during the past six years. In 1931 the rate was 4.30 per 1000 births, and in the successive years since it has been 4-55, 444, 468, 467, and 4-70. Sepsis is the chief among these causes of death. Infant mortality is also discouraging, reaching a rate of 74-15 per 1000 births in the year under review, which is the highest since 1926. The figures given under the head of " medical charities " show that during the year the dispensary medical officers attended 848,132 cases, of which 167,299 were attended at their homes. There are 652 dispensary medical officers. During the year
OUR OWN
CORRESPONDENT)
A REVIEW OF FOREIGN MEDICAL DIPLOMAS
No person may practise medicine in Rumania without the authorisation of "libera practica" accorded by the Ministry of Labour, Public Health, and Social Welfare, without an announcement in the official gazette 3[onitprul Official, and the inscription of his name in a list kept by the College of Physicians. Free practice of medicine is allowed on the recommendation of the administrative commission on the basis of the following certificates : (a) diploma delivered or recognised by a faculty of medicine in Rumania, (b) certificate of Rumanian citizenship. Physicians holding medical diplomas obtained abroad and who desire to practise in Rumania are required to have their diplomas recognised through a procedure called "nostrification." This consists of two parts, (1) equivalisation, and (2) nostrification proper, and may be accomplished at any one of the three State universities in Bucharest, Jassy, and Cluj. A number of foreign candidates have been rejected by reason of insufficient or unsatisfactory documents and a certain bogus lawyer is now known to have offered his help to some of them. He had a workshop for forging false certificates of matriculation and other documents. His help was especially requisitioned by candidates who had studied at universities, where the course of studies takes only five years (as for instance in Bologna, Italy), because at the Rumanian faculty a six-year medical course is required. In such cases the gap could only be bridged by a forged document. Although it is known that only a few people availed themselves of the help of this impostor, the authorities have deemed it advisable to subject to review all diplomas obtained by means of nostrification since the enlargement of Rumania in 1919. The National Medical Association, seeing that the matter has been widely ventilated in the lay press, has supported this review in order to restore the trust of the public in medical men and to maintain professional prestige. The Minister went even further and has ordered that all diplomas obtained abroad are to be produced for inspection. In consequence of this order diplomas obtained, for instance, in Vienna University as long as 30 and even 40 years ago, have to be brought up. The inspection is to be carried out by a committee appointed by the Ministry of Health and consists of a judge, who is a member of the Bucharest court of as president, two physicians, one pharmacist, and one lawyer. The committee will verify and pronounce on all the documents on grounds of which medical and pharmaceutical libera practica " was granted, and is empowered to withdraw the concession if the applicant’s certificates do not justify his right to practise in Rumania. Doctors who acquired their diplomas before 1918 had to send in their original diplomas and a certified duplicate. If the diploma is not in Latin or in German an officially
appeal,
"