Health record

PUBLIC HEALTH, October, 1943 domestic hygiene. T h e President of the Institute, Mr. A. L. Thomson, mentioned some glaring examples of failure to make adequate provision for satisfactory domestic storage and collection. In the metropolitan area, for example, the refuse has actually to be carried through the house--often through the living room--either by the dustman or by the occupier himself, in 63% of cases. T h a t insanitary contraption, the ashpit, which should be condemned outright for its offensiveness and danger, still survives. T h e enforcement of the provision of a satisfactory refuse receptacle is not universal, with the result that nondescript containers, often with some of their contents spilled beside them, are to be found in many streets of towns, while the primitive dust chute, in which the refuse is expected to find its way by gravity to a subterranean pit, is in use even in relatively modern buildings. Mr. Thomson, in his address to the conference, was not prepared to condemn the portable bin. Bins, he said, were not a source of nuisance unless misused, but they should be periodically cleansed, or, better still, cleansed after every emptying, so that they were as clean and presentable as other domestic sanitary fitments. A greater measure of effective control over bins seems to be called for. This might be carried out, as it is already in some progressive towns, by taking powers to supply and maintain bins on a rental basis, or, as in other towns, by making this cleansing service a charge on the rates. A special subject of importance is the disposal of refuse from block dwellings. T h e early types of chutes were insanitary abominations, but this, as Mr. T h o m s o n said, does not necessarily condemn the chute system. Those early chutes were badly designed, but if chutes are properly constructed they do provide a ready means of refuse disposal and so discourage the prolonged retention of refuse in the flat. If tenants have to descend flights of stairs in order to dispose of their refuse there is every temptation to let it remain for longer periods before getting rid of it. T h e problem is one of arranging convenient early disposal, and, pending disposal, of satisfactory household storage. One workable scheme mentioned is to provide every house with a small covered pail. I n block dwellings in G e r m a n y special lifts are provided to take the dustbin down and the coal scuttle up. One method used employs water for the removal of solid as well as liquid wastes, and it is said that in the United States large use is made of mechanical systems whereby a good part of the domestic waste passes down the sink. A grinding Unit is fitted to and immediately under the sink for the purpose of macerating food wastes into a pulp which can then be washed down the ordinary plumbing and drainage systems. Such devices are capable of dealing with food wastes at the rate of 1 lb. per minute, but as they also consume water at the rate of two and a half gallons a minute they would be likely, in this country, to bring the Water Board to the alert. Moreover, the cost of the grinder, worked by electricity, is said to be high, and clogging does occur with some materials, such as pea pods. All that can really be said for it is that it dbes eliminate the inartistic garbage tin. T h e Garchey system is, again, more expensive than satisfactorily managed bin storage and removal, but it does enable the housewife to get rid immediately of any refuse of less than 5 inches diameter. Some figures were presented to the conference concerning the effect which the war has had on refuse disposal. Generally speaking, there is in town refuse now a very small amount of paper content and putrescible matter and an increase in fine dust and in unclassified non-combustible matter. I n Glasgow, for example, in the summer of 1936, the amount of vegetable and putrescible matter in the refuse of a small part of the city was 20.35% of the whole, and of paper 20'30%, and in the summer of 1943 these amounts had fallen to 4.27 and 1-60% respectively. On the other hand, the proportion of fine dust increased from 29.74 to 43-68%, and of unclassified noncombustible matter from 4.73 to 11.02%. These changes are to be attributed, in the main, to the controls placed on paper and textiles, to the general practice of separate household collections for waste food and bones, and to the relative scarcity and poorer quality of coal. This has had a remarkably adverse effect on incineration for steam-raising or power

production. In Glasgow the units generated at the. refuse power works, which were 38 m i l l i o n in 1938-39, fell to eight million in 1942-43, and the units per ton of refuse received fell from 235 to 91. If the present compulsory powers with regard to the separation of salvage materials are continued after the war there will be difficulty in justifying any attempt at incineration of city refuse, at all events on a large scale.

Health Record The Summary Report of the Ministry of Health for the year ended March 31st, 1943, has just been issued.* I n his foreword the Minister of Health observes that the year was remarkable for a series of favourable records in the vital statistics. T h e general death-rate among the civilian population, the Report states, was remarkably low. Among females the standardised rate was 6-84 per thousand living---8% better than in any previous year, notwithstanding the inclusion of deaths in this country from enemy action and the withdrawal of large numbers of healthy young women from the civilian population. Among civilian males the standardised rate of 9.52 was also the lowest recorded, in spite of the considerable effect of selective recruitment. Mortality of children at ages 1 to 5, which had declined by no less than 47% between 1931-35 and 1939, showed a further improvement of 2% in 1942. At the school ages of 5 to 15, the low level reached in 1939 was regained. T h e total of live births (654,039) was greater than that in 1941 by 66,811, and, taken with the total of deaths registered in England and Wales, gives a natural increase during 1942 of 173,902. T h e rate of 15.8 per thousand is the highest since 1931. For many groups of diseases, new low records in the n u m b e r of deaths (including non-civilians dying in England and Wales) were established. These include pneumonia, influenza, diphtheria, scarlet fever, rheumatic fever, gastric ulcer and other diseases of the stomach. Deaths from influenza (3,401) were fewer by 3,500 than ~n 1941. T h e principal diseases showing an increase in deatlas compared with 1941 include cancer (though the standardised death-rate showed no rise), Hodgkin's disease, coronary disease, angina pectoris, enteritis and diarrhoea. T h e total incidence of infectious disease was less by nearly 30% than in 1941. Scarlet fever was the only disease in which there was a substantial increase. Diphtheria figures were the lowest in the past 19 years. T h e incidence of enteric fever (~yphoid and paratyphoid) was the lowest ever recorded. Sickness benefit claims on Approved Societies under the N.H.I. Scheme were much above the pre-war average. This is true of all four quarters of the year; and is not accounted for by any epidemic. After making due allowances for members of the lower age groups who have left civilian employment for the Armed Forces, these claims suggest a considerable increase per head in short-term sickness. T h e n u m b e r of civilians suffering from syphilis attending treatment centres for the first time in 1942 was 9,046. With Service cases added, this represents an increase of 29.6% compared with 1941--as against a rise of 40% between 1940 and 1941. T h e increase in new syphilitic infections since the beginning of war now amounts to about 120%. With regard to tuberculosis, " the position in the third year of war was better than could reasonably have been expected two years ago." There was a distinct check in the wartime increase in the death-rate from tuberculosis. Total number of deaths from all forms was 25,547 - - a b o u t 2,500 less than in 1940, 3,000 less than in 1941, and much the same as in the last pre-war year, 1938. (The 1938 figure was the lowest on record and well u n d e r half the corresponding figure for 1918.) '" While these figures give ground for satisfaction," says the Report, " vigilance must be maintained. There was a rise of about 3~/o in the n u m b e r of n e ~ cases reported last year, and under the trying conditions on total war it is not unlikely that the death-rate will tend to rise again." T h e infant mortality rate of 49 per thousand live births compares with 59 in 1941, and is the first rate below 50 ever recorded. Maternal mortality rate was 2-47 per thousand. * H.M.S.O.

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