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Infantile paralysis in broadstairs
114
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eventually from starvation, not from lack o f food, but from lack of power to assimilate it. A contrast to this picture is afforded by the fact that dysentery in temperate Europeans and well-nourished natives is r e l a t i v e l y a mild complaint attended by a very low mortality. These remarks on dysentery apply in the main to the other principal diseases, malaria and phthisis~ but one realises that the prevention of malaria and phthisis is a task which of necessity must take years to influence. It is a task which from the nature of things cannot be completed u n t i l the n a t i v e s change their habits and the c o u n t r y is opened up a n d inhabited by a settled population living in their own homes in place of a very large proportion of immigrants whose object is to earn sufficient money to enable them to return to their native lands as soon as possible. These aims make for a low standard of living which favours the ravages of disease,
HEALTH.
JANUARY,
Those who live in glass houses cannot throw stones, and, though I have spoken of defects and difficulties elsewhere, we in England are not free from defects in sanitary administration or free from difficulties so far as health problems are concerned. We, at any rate, know they are there, discuss them at our meetings and conferences, and yet only make slow progress in improving matters. Take phthisis as an instance, and note, having so much in our favour, how little we have attained in the shape of actual prevention. How much harder must it be in a tropical country where the enervating climate, the uneducated natives with their habits and prejudices, the crude water supplies in undeveloped country, all conspire to defeat the aims of the sanitarian. In spite of all these drawbacks steady improvement has been made and will continue to be made, but the task is a heavy one.
I n f a n t i l e Paralysis in Broadstairs. By A, M. WATTS , M.D., ~B.S., Durh., M . R . C . S . , L . R . C . P . , D . P , H . , Medical Officer of Health, East K e n t (No. 1) United District.
Though the alarm aroused by the outbreak of poliomyelitis at Broadstairs has subsided, the following note by Dr. lYatts is of interest as containing information that may prove help[ul. b a n District of Broadstairs, which T atH EtheU rcensus of 1921 had a population of 15,471, has recently obtained an unenviable notoriety o w i n g to an outbreak of this disease which occurred in the month of October, 1926. The first notifications were received by the M e d i c a l Officer of Health on October lath, and between that date and October 29th, 62 cases were notified, one notification being subsequently withdrawn, leaving a total of 61. DUring the month of November one further case occurred. In addition to t h e s e cases, two boys who attended the private school first affected were removed to their homes a n d afterwards developed the complaint. Then, there was the case of a waiter who was employed in a hotel in Broadstairs during the season, who left the town on October 6th, and developed the disease on t h e 16th. He died in a L o n d o n hospital on October 21st. Also that of a young woman who stayed in Broadstairs from October 2nd to 9th, and was taken ill on the 18th, and died on the 22nd. The brother-in-law of th'e headmaster of one of the private schools where cases occurred, :who had
Been staying in Bmadstairs for three weeks, visited the school on October 10th, and had lunch there. He left the town the following day, and was taken ill with the complaint on the 16th. It will thus 'be seen that the total number of cases in connection with the outbreak was probably not less than 67. Owing to its reputation as a healthy seaside resort there are many private boarding schools and day schools in the district, the population in these schools being about 1,150 children. Some 850 children attend the elementary schools, 150 a secondary school, and there are convalescent homes with accommodation for 900 persons, mainly children. The total number of private schools is about 26, and in 13 of these cases of infantile paralysis occurred, 35 children, one mistress and two members of the domestic staffs being affected. In one convalescent home 5 cases occurred, two children and three members of the staff, and in another convalescent home there was one case. :Only three children attending the elementary schools were notified, but three children living in Broadstairs and attending
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PUBLIC
tl~e County Council Secondary School at Ramsgate contracted the complaint. In addition to the above 50 cases there were 12 others only indirectly connected with schools or institutions. As r e g a r d s the private boarding schools where no day scholars attended there were five affected, 20 children having the complaint out of 249 in attendance. It is an interesting fact that during the five years ended 1925, only two cases of the disease were notified in the Urban District, and they occurred last year (1925), that no cases were notified this year (1926) prior to October 14th, that no cases were notified during the first ten months of the year in the Borough of Margate, in the adjacent rural district of the Isle of Thanet, and only two in the Borough of Ramsgate, and also that the outbreak did not spread to the surrounding districts. Four deaths took place. (1) A boy of 10 years, who was taken ill on October 10th, and died 48 hours later. (2) A young woman of 28 who was taken ill on the evening of the 12th, and died at midnight on the 14th. (3) A boy of 8 who was taken ill on the 10th, with vomiting. His symptoms subsided, but on the 15th his temperature rose to 102. He developed paralysis of the lower limbs, then of most of the muscles of the upper limbs, finally of the diaphragm, and death eventually took place on October 23rd. (4) A boy of 5 who was taken ill on the 25th and died the next day showed paralysis of the palate as an initial symptom. One of the two boys removed from a boarding school who developed the disease after reaching home eventually died. As to the way the infection was introduced into the schools : it is a well-known fact that many people spent their summer holidays on the Continent this year, and there were outbreaks of infantile paralysis on the coast of B r i t t a n y . The fatal case in the school at Broadstairs which was apparently the first affected spent his holiday in Brittany, and it is possible that he introduced the disease into the school ; at another school the first case, an abortive one, spent his holiday in Brittany; in another school a boy who died spent his holiday in N o r w a y . A s is well known, t h e disease may be conveyed f r o m person to person by healthy carriers, and the investigations which were made in connection with this outbreak tend to show more than ever the importance of this factor. Then again,
HEALTH.
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climatic conditions must not be overlooked, and it is perhaps worthy of note that the weather in September was exceptionally fine and warm. Enquiries were made in 54 of the cases with regard to vaccination, and it was found that in none of them had vaccination been recently carried out. The age of the oldest person notified was 30 years, a n d that of the youngest one year. The number of males was 38 and of females 24. It is u s u a l l y found that more maIes are affected than females, but in the case of the boarding schools attacked three were for boys, and two for girls. As regards treatment, only a small proportion of the patients, viz., 9, were removed to the Joint Isolation Hospital. Of these; 5 belonged to a convalescent home and two are members of the staffs of two private boarding schools. The other cases were isolated in their own homes or in the schools which they attended. The cases which were notified varied in the intensity of their symptoms. Some were very mild, others very serious. Two boys who attended the same school and sat next to each other presented evidence of the meningeal type of the disease, and both recovered. In several cases the first symptoms subsided for a few days, and then recurred with increased severity. Most of the schools affected were situated in the northern portion of the district and near the sea. The school with the largest number of cases was the one situated nearest to the sea. One important point in connection with the outbreak should be mentioned, and that is that each boarding school has its own medical attendant who advises the principal on health matters as well as treating the children and staff. The doctors attending the schools, in conjunction with certain London physicians whom they called in in consultation, decided to isolate the schools as far as possible, and advised parents to allow their children to remain. A certain number of parents of children in affected and non-affected schools removed their boys and girls, and one affected school eventually closed completely at the middle of November, and re-opened in another seaside resort for the remainder of the term, The interesting features of the outbreak were the facts that the disease was limited mainly t o children attending private schools in the district, that the poorer members of the
116
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Community almost entirely escaped, and that the outbreak started suddenly and subsided suddenly. On October 14th, and the five following days 31 cases were notified in twelve private schools. The private schools affected had very little communication, if any, with each other. The boys of the school in which cases were first notified did not attend church, although some of the pupils from other schools
HEALTH.
JANL*AR¥,
did, and a m o n g other preventive measures adopted was the disinfection of the church, and the exclusion from services of all children from private schools. As to the effect of the complaint on the. patients attacked, it has been found from enquiries made in connection with 56 cases, that there was evidence of paralysis in 29.
H u m a n e S l a u g h t e r i n g of A n i m a l s for Food. By C. KILLICI~ MILLARD, M.D., D.Sc., Medical Officer of Health, Leicester. The slaughtering of food animals is a matter in which the Medical Officer of Health is, for a variety of reasons, compelled to take an interest, and in this paper Dr. KilIick MiIlard, who has devoted much attention to the study of humane methods, raises points that are worthy of consideration. r~HE subject of humane slaughtering of J - a n i m a l s is a highly controversial one, and t h e questions at issue are not quite so easily settled as som e appear to think. The chief points of controversy are : (1) the stunning of animals as a preliminary to cutting the throat, and (2) the use of a " mechanically operated instrument " suitable and sufficient for the purpose of s~unning, i.e., the instrument popularly known as the " humane killer:" The first is provided for in Model Bye-law 9 (a), and the second in Model Byelaw 9 (b). The battle was fought out in Leicester two years ago, the various stages in the contest being a s follows : - (1) Representations made to the Health Committee b y an influential deputation from the local b r a n c h of the R . S . P . C . A , advocating the making the use of " humane killers " compulsory. (2) Deputation from the Leicester Butchers' Association protesting against such a measure. (3) The appointment of a special sub-committee by the Health Committee to study the question in all its bearings and report. (4) The Sub-Committee go into the matter very thoroughly. T h e y visit slaughterhouses in Leicester and elsewhere, i n c l u d i n g places where the use of humane killers has been compulsory for some time. T h e y receive a report from the Medical Officer of Health upon a special demonstration of slaughtering by various methods organised by the Butchers in Birmingham under the auspices o f the Birmingham Corporation. T h e y also have an interview with Sir George Newman at the
Ministry of Health. (5) The Sub-Committee present their report which recommends : ~ (a) Ttiat new bye-laws in regard to slaughterhouses and slaughtering be prepared. (b) That the use of the humane killer be made compulsory, but that in the case of pigs its operation be postponed for 12 months. (¢) That new public abattoirs be provided. (d) That private slaughterhouses be abolished. (6) The report is accepted by the full Health Committee. (7) The question comes~ before the City Council and the report of the Health Committee is carried, after a full-dress debate, by a very small majority. (8) New bye-laws are prepared, embodying Model bye-law 9 (b) with the proviso that as regards pigs the use of humane killers b e postponed for 12 months. (9) Another full-dress debate takes place in the City Council with the result that an amendment that the bye-taw relating to the use of " humane killers " be omitted, is carried by a small majority. This result was, of course, a victory for the butchers, and a serious disappointment to the R.S.P.C.A. U p to the present the quest.ion has not again been brought forward. Arguments against the use of " Humane Kiillers." The arguments against the use of humane killers are pretty well-known. Tl~e chief are :
PUBLIC
eventually from starvation, not from lack o f food, but from lack of power to assimilate it. A contrast to this picture is afforded by the fact that dysentery in temperate Europeans and well-nourished natives is r e l a t i v e l y a mild complaint attended by a very low mortality. These remarks on dysentery apply in the main to the other principal diseases, malaria and phthisis~ but one realises that the prevention of malaria and phthisis is a task which of necessity must take years to influence. It is a task which from the nature of things cannot be completed u n t i l the n a t i v e s change their habits and the c o u n t r y is opened up a n d inhabited by a settled population living in their own homes in place of a very large proportion of immigrants whose object is to earn sufficient money to enable them to return to their native lands as soon as possible. These aims make for a low standard of living which favours the ravages of disease,
HEALTH.
JANUARY,
Those who live in glass houses cannot throw stones, and, though I have spoken of defects and difficulties elsewhere, we in England are not free from defects in sanitary administration or free from difficulties so far as health problems are concerned. We, at any rate, know they are there, discuss them at our meetings and conferences, and yet only make slow progress in improving matters. Take phthisis as an instance, and note, having so much in our favour, how little we have attained in the shape of actual prevention. How much harder must it be in a tropical country where the enervating climate, the uneducated natives with their habits and prejudices, the crude water supplies in undeveloped country, all conspire to defeat the aims of the sanitarian. In spite of all these drawbacks steady improvement has been made and will continue to be made, but the task is a heavy one.
I n f a n t i l e Paralysis in Broadstairs. By A, M. WATTS , M.D., ~B.S., Durh., M . R . C . S . , L . R . C . P . , D . P , H . , Medical Officer of Health, East K e n t (No. 1) United District.
Though the alarm aroused by the outbreak of poliomyelitis at Broadstairs has subsided, the following note by Dr. lYatts is of interest as containing information that may prove help[ul. b a n District of Broadstairs, which T atH EtheU rcensus of 1921 had a population of 15,471, has recently obtained an unenviable notoriety o w i n g to an outbreak of this disease which occurred in the month of October, 1926. The first notifications were received by the M e d i c a l Officer of Health on October lath, and between that date and October 29th, 62 cases were notified, one notification being subsequently withdrawn, leaving a total of 61. DUring the month of November one further case occurred. In addition to t h e s e cases, two boys who attended the private school first affected were removed to their homes a n d afterwards developed the complaint. Then, there was the case of a waiter who was employed in a hotel in Broadstairs during the season, who left the town on October 6th, and developed the disease on t h e 16th. He died in a L o n d o n hospital on October 21st. Also that of a young woman who stayed in Broadstairs from October 2nd to 9th, and was taken ill on the 18th, and died on the 22nd. The brother-in-law of th'e headmaster of one of the private schools where cases occurred, :who had
Been staying in Bmadstairs for three weeks, visited the school on October 10th, and had lunch there. He left the town the following day, and was taken ill with the complaint on the 16th. It will thus 'be seen that the total number of cases in connection with the outbreak was probably not less than 67. Owing to its reputation as a healthy seaside resort there are many private boarding schools and day schools in the district, the population in these schools being about 1,150 children. Some 850 children attend the elementary schools, 150 a secondary school, and there are convalescent homes with accommodation for 900 persons, mainly children. The total number of private schools is about 26, and in 13 of these cases of infantile paralysis occurred, 35 children, one mistress and two members of the domestic staffs being affected. In one convalescent home 5 cases occurred, two children and three members of the staff, and in another convalescent home there was one case. :Only three children attending the elementary schools were notified, but three children living in Broadstairs and attending
a927.
PUBLIC
tl~e County Council Secondary School at Ramsgate contracted the complaint. In addition to the above 50 cases there were 12 others only indirectly connected with schools or institutions. As r e g a r d s the private boarding schools where no day scholars attended there were five affected, 20 children having the complaint out of 249 in attendance. It is an interesting fact that during the five years ended 1925, only two cases of the disease were notified in the Urban District, and they occurred last year (1925), that no cases were notified this year (1926) prior to October 14th, that no cases were notified during the first ten months of the year in the Borough of Margate, in the adjacent rural district of the Isle of Thanet, and only two in the Borough of Ramsgate, and also that the outbreak did not spread to the surrounding districts. Four deaths took place. (1) A boy of 10 years, who was taken ill on October 10th, and died 48 hours later. (2) A young woman of 28 who was taken ill on the evening of the 12th, and died at midnight on the 14th. (3) A boy of 8 who was taken ill on the 10th, with vomiting. His symptoms subsided, but on the 15th his temperature rose to 102. He developed paralysis of the lower limbs, then of most of the muscles of the upper limbs, finally of the diaphragm, and death eventually took place on October 23rd. (4) A boy of 5 who was taken ill on the 25th and died the next day showed paralysis of the palate as an initial symptom. One of the two boys removed from a boarding school who developed the disease after reaching home eventually died. As to the way the infection was introduced into the schools : it is a well-known fact that many people spent their summer holidays on the Continent this year, and there were outbreaks of infantile paralysis on the coast of B r i t t a n y . The fatal case in the school at Broadstairs which was apparently the first affected spent his holiday in Brittany, and it is possible that he introduced the disease into the school ; at another school the first case, an abortive one, spent his holiday in Brittany; in another school a boy who died spent his holiday in N o r w a y . A s is well known, t h e disease may be conveyed f r o m person to person by healthy carriers, and the investigations which were made in connection with this outbreak tend to show more than ever the importance of this factor. Then again,
HEALTH.
115
climatic conditions must not be overlooked, and it is perhaps worthy of note that the weather in September was exceptionally fine and warm. Enquiries were made in 54 of the cases with regard to vaccination, and it was found that in none of them had vaccination been recently carried out. The age of the oldest person notified was 30 years, a n d that of the youngest one year. The number of males was 38 and of females 24. It is u s u a l l y found that more maIes are affected than females, but in the case of the boarding schools attacked three were for boys, and two for girls. As regards treatment, only a small proportion of the patients, viz., 9, were removed to the Joint Isolation Hospital. Of these; 5 belonged to a convalescent home and two are members of the staffs of two private boarding schools. The other cases were isolated in their own homes or in the schools which they attended. The cases which were notified varied in the intensity of their symptoms. Some were very mild, others very serious. Two boys who attended the same school and sat next to each other presented evidence of the meningeal type of the disease, and both recovered. In several cases the first symptoms subsided for a few days, and then recurred with increased severity. Most of the schools affected were situated in the northern portion of the district and near the sea. The school with the largest number of cases was the one situated nearest to the sea. One important point in connection with the outbreak should be mentioned, and that is that each boarding school has its own medical attendant who advises the principal on health matters as well as treating the children and staff. The doctors attending the schools, in conjunction with certain London physicians whom they called in in consultation, decided to isolate the schools as far as possible, and advised parents to allow their children to remain. A certain number of parents of children in affected and non-affected schools removed their boys and girls, and one affected school eventually closed completely at the middle of November, and re-opened in another seaside resort for the remainder of the term, The interesting features of the outbreak were the facts that the disease was limited mainly t o children attending private schools in the district, that the poorer members of the
116
PUBLIC
Community almost entirely escaped, and that the outbreak started suddenly and subsided suddenly. On October 14th, and the five following days 31 cases were notified in twelve private schools. The private schools affected had very little communication, if any, with each other. The boys of the school in which cases were first notified did not attend church, although some of the pupils from other schools
HEALTH.
JANL*AR¥,
did, and a m o n g other preventive measures adopted was the disinfection of the church, and the exclusion from services of all children from private schools. As to the effect of the complaint on the. patients attacked, it has been found from enquiries made in connection with 56 cases, that there was evidence of paralysis in 29.
H u m a n e S l a u g h t e r i n g of A n i m a l s for Food. By C. KILLICI~ MILLARD, M.D., D.Sc., Medical Officer of Health, Leicester. The slaughtering of food animals is a matter in which the Medical Officer of Health is, for a variety of reasons, compelled to take an interest, and in this paper Dr. KilIick MiIlard, who has devoted much attention to the study of humane methods, raises points that are worthy of consideration. r~HE subject of humane slaughtering of J - a n i m a l s is a highly controversial one, and t h e questions at issue are not quite so easily settled as som e appear to think. The chief points of controversy are : (1) the stunning of animals as a preliminary to cutting the throat, and (2) the use of a " mechanically operated instrument " suitable and sufficient for the purpose of s~unning, i.e., the instrument popularly known as the " humane killer:" The first is provided for in Model Bye-law 9 (a), and the second in Model Byelaw 9 (b). The battle was fought out in Leicester two years ago, the various stages in the contest being a s follows : - (1) Representations made to the Health Committee b y an influential deputation from the local b r a n c h of the R . S . P . C . A , advocating the making the use of " humane killers " compulsory. (2) Deputation from the Leicester Butchers' Association protesting against such a measure. (3) The appointment of a special sub-committee by the Health Committee to study the question in all its bearings and report. (4) The Sub-Committee go into the matter very thoroughly. T h e y visit slaughterhouses in Leicester and elsewhere, i n c l u d i n g places where the use of humane killers has been compulsory for some time. T h e y receive a report from the Medical Officer of Health upon a special demonstration of slaughtering by various methods organised by the Butchers in Birmingham under the auspices o f the Birmingham Corporation. T h e y also have an interview with Sir George Newman at the
Ministry of Health. (5) The Sub-Committee present their report which recommends : ~ (a) Ttiat new bye-laws in regard to slaughterhouses and slaughtering be prepared. (b) That the use of the humane killer be made compulsory, but that in the case of pigs its operation be postponed for 12 months. (¢) That new public abattoirs be provided. (d) That private slaughterhouses be abolished. (6) The report is accepted by the full Health Committee. (7) The question comes~ before the City Council and the report of the Health Committee is carried, after a full-dress debate, by a very small majority. (8) New bye-laws are prepared, embodying Model bye-law 9 (b) with the proviso that as regards pigs the use of humane killers b e postponed for 12 months. (9) Another full-dress debate takes place in the City Council with the result that an amendment that the bye-taw relating to the use of " humane killers " be omitted, is carried by a small majority. This result was, of course, a victory for the butchers, and a serious disappointment to the R.S.P.C.A. U p to the present the quest.ion has not again been brought forward. Arguments against the use of " Humane Kiillers." The arguments against the use of humane killers are pretty well-known. Tl~e chief are :