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INFECTIOUS DISEASE IN ENGLAND AND WALES DURING THE WEEK ENDED MARCH 10TH, 1934
652 school medical officer. The total number of students examined under this experiment would be rather less than 4000, since this year only three evening institutes are to be included; but if the experiment proves successful it might be extended to all the evening institutes which have between them some 30,000 students. Thus, with the 4000 in the day continuation schools, if 75 per cent. of the scholars agreed, the total number of examinees would be nearly 25,000 in London alone. Even so, and if all the other education authorities followed the example of London, still only part of the 14-16 year-old group would be brought in ; for every year some 300,000 children leave the elementary schools to seek employment, and thus lose all medical care. And yet under the Education Act of 1921 any authority may exercise like powers over children and young persons attending any school or educational institution, whether aided by them or not, if so requested by the managers thereof. Under this clause it would seem to be legally possible to obtain facilities for the medical care of those attending the juvenile instruction centres, even though financial aid might have to be given to the authorities concerned. In a letter to the Times of March 6th, Mr. H. W. Jevons says that " recent visits to five juvenile instruction centres in a north-eastern depressed area undoubtedly show the need for medical investigation ... the teachers at each centre agreed that inspection was needed." It is unfortunately a fact that these particular young persons of 14 to 16 are just those who would scarcely ever secure medical attention on their own initiative or that of their
inspecting
parents.
INFECTIOUS DISEASE IN ENGLAND AND WALES DURING THE WEEK ENDED MARCH 10TH, 1934
Notifications.-The following were notified during the
disease
cases
week :
of infectious Small-pox, 5
(last week 11) ; scarlet fever, 3210 ; diphtheria, 1224 ; enteric fever. 21 ; acute pneumonia (primary or
influenzal), 1723 ; puerperal fever, 69 ; puerperal pyrexia, 132 ; cerebro-spinal fever, 22 ; acute poliomyelitis, 4 ; acute polio-encephalitis, 4 ; encephalitis lethargica, 5 ; dysentery, 12 ; ophthalmia neonatorum, 101. No case of cholera, plague, or typhus fever was notified during the week. The number of cases in the Infectious Hospitals of the London County Council on March 19th-20th was as follows : Small-pox, 15 under treatment, 5 under observation (last week 17 altogether); scarlet fever, 1706 ; diphtheria, 1872; enteric fever, 8 ; measles, 3297 (last week 3040) ; whooping-cough, 334 ; puerperal fever, 27 mothers (plus 8 babies) ; encephalitis lethargica, 261 ; poliomyelitis, 5 ; " other diseases," 112. At St. Margaret’s Hospital there were 20 babies (plus 9 mothers) with ophthalmianeonatorum.
Deaths.-In 118 great towns, including London, there was no death from small-pox, 3 (1) from enteric fever, 141 (55) from measles, 12 (4) from scarlet fever, 42 (7) from whooping-cough, 37 (9) from diphtheria, 47 (14) from diarrhoea and enteritis under two years, and 99 (23) from influenza. The figures in parentheses are those for London itself. Birmingham and Dudley reported deaths from enteric fever. The fatal cases of influenza included 5 in Stoke-on-Trent, 4 each in Liverpool and Birmingham. There were 12 fatal cases of measles in Liverpool, 11 in Middlesbrough, 8 each in Leeds and Manchester, 4 each in Willesden and Newcastle-on-Tyne, 3 in Bristol. Whooping-cough caused 7 deaths at Liverpool. Six deaths from diphtheria were reported from Leeds, 4 from Liverpool, 3 from Merthyr Tydfil.
The number of stillbirths notified during the week was
295
to a rate of 43 per 1000 total in London.
(corresponding
births), including 45
SPECIAL ARTICLES MEDICINE AND THE LAW
Dekrysil Treatment: the Paddington Inquest AT the Paddington coroner’s court last Saturday the adjourned inquest on Miss Vivian Philcox, a young dancer who had sought to reduce her weight by treatment which included dekrysil tablets, ended in Death was a verdict of death by misadventure. found due to nitrophenol poisoning. Dr. Roche Lynch, giving evidence of examination of certain organs, said he found traces of nitrophenol in the intestines and stomach. All drugs of the nitrophenol type, he added, were known as liver poisons ; it was a question of degree as to how much was taken. There was significant fresh evidence last Saturday of the purchase by Miss Philcox of a second bottle of 25 of the capsules on Feb. 20th in addition to the first bottle of 25 purchased on Feb. 1st under medical advice. It appeared that she took 7 tablets under medical supervision and, if a bottle found afterwards to contain 8 tablets was the second bottle she bought, she had possibly taken 17 tablets between Feb. 20th and her death on Feb. 22nd. The result of the inquest was to exculpate all concerned except the unfortunate patient herself, who had evidently disregarded professional advice in her anxiety to reduce her weight so as to retain her professional work. The chemist from whom she bought the tablets had cautioned her to take them only under doctor’s orders. The manufacturers’ label on the bottle was a clear warning, "to be In administered only on medical prescription."
addition each package contained a warning leaflet to the use of the capsules, the suggested dosage being one capsule daily. The leaflet stated that the effects should be carefully studied, and the appearance of nausea or intolerance to the drug must lead to special investigation ; with regard to toxic symptoms, if the metabolic rate was increased to over 50 per cent., it was a signal for the immediate withdrawal of the treatment. No blame, observed Mr. Idris Evans, the deputy coroner, could attach to the medical practitioner, who had given Miss Philcox careful directions, and could not be held responsible if those directions were disobeyed. There remains the question of the future control of the drug. The manufacturers had suggested to the authorities that it be placed on the Poisons List so as to secure that it could not be bought except on medical prescription. A formal official reply had been received to the effect that the matter was having consideration. The deputy coroner remarked that he was aware that departments move slowly. It is, however, only fair to remember that the whole question of setting up the new Poisons List is now receiving fresh attention by a new body as the result of the Pharmacy and Poisons Act of last year. This particular drug could have been added to the poisons schedule under the law which is about to disappear; but it would have been natural enough to refer the question as part of the general survey which highly competent authorities are now conducting. The deputy coroner trusted that the Poisons Board would take some early action ; meanwhile, he observed, the publicity of the inquest should deter other members of the public who might be tempted to expedite treatment in defiance of medical advice. as
inspecting
parents.
INFECTIOUS DISEASE IN ENGLAND AND WALES DURING THE WEEK ENDED MARCH 10TH, 1934
Notifications.-The following were notified during the
disease
cases
week :
of infectious Small-pox, 5
(last week 11) ; scarlet fever, 3210 ; diphtheria, 1224 ; enteric fever. 21 ; acute pneumonia (primary or
influenzal), 1723 ; puerperal fever, 69 ; puerperal pyrexia, 132 ; cerebro-spinal fever, 22 ; acute poliomyelitis, 4 ; acute polio-encephalitis, 4 ; encephalitis lethargica, 5 ; dysentery, 12 ; ophthalmia neonatorum, 101. No case of cholera, plague, or typhus fever was notified during the week. The number of cases in the Infectious Hospitals of the London County Council on March 19th-20th was as follows : Small-pox, 15 under treatment, 5 under observation (last week 17 altogether); scarlet fever, 1706 ; diphtheria, 1872; enteric fever, 8 ; measles, 3297 (last week 3040) ; whooping-cough, 334 ; puerperal fever, 27 mothers (plus 8 babies) ; encephalitis lethargica, 261 ; poliomyelitis, 5 ; " other diseases," 112. At St. Margaret’s Hospital there were 20 babies (plus 9 mothers) with ophthalmianeonatorum.
Deaths.-In 118 great towns, including London, there was no death from small-pox, 3 (1) from enteric fever, 141 (55) from measles, 12 (4) from scarlet fever, 42 (7) from whooping-cough, 37 (9) from diphtheria, 47 (14) from diarrhoea and enteritis under two years, and 99 (23) from influenza. The figures in parentheses are those for London itself. Birmingham and Dudley reported deaths from enteric fever. The fatal cases of influenza included 5 in Stoke-on-Trent, 4 each in Liverpool and Birmingham. There were 12 fatal cases of measles in Liverpool, 11 in Middlesbrough, 8 each in Leeds and Manchester, 4 each in Willesden and Newcastle-on-Tyne, 3 in Bristol. Whooping-cough caused 7 deaths at Liverpool. Six deaths from diphtheria were reported from Leeds, 4 from Liverpool, 3 from Merthyr Tydfil.
The number of stillbirths notified during the week was
295
to a rate of 43 per 1000 total in London.
(corresponding
births), including 45
SPECIAL ARTICLES MEDICINE AND THE LAW
Dekrysil Treatment: the Paddington Inquest AT the Paddington coroner’s court last Saturday the adjourned inquest on Miss Vivian Philcox, a young dancer who had sought to reduce her weight by treatment which included dekrysil tablets, ended in Death was a verdict of death by misadventure. found due to nitrophenol poisoning. Dr. Roche Lynch, giving evidence of examination of certain organs, said he found traces of nitrophenol in the intestines and stomach. All drugs of the nitrophenol type, he added, were known as liver poisons ; it was a question of degree as to how much was taken. There was significant fresh evidence last Saturday of the purchase by Miss Philcox of a second bottle of 25 of the capsules on Feb. 20th in addition to the first bottle of 25 purchased on Feb. 1st under medical advice. It appeared that she took 7 tablets under medical supervision and, if a bottle found afterwards to contain 8 tablets was the second bottle she bought, she had possibly taken 17 tablets between Feb. 20th and her death on Feb. 22nd. The result of the inquest was to exculpate all concerned except the unfortunate patient herself, who had evidently disregarded professional advice in her anxiety to reduce her weight so as to retain her professional work. The chemist from whom she bought the tablets had cautioned her to take them only under doctor’s orders. The manufacturers’ label on the bottle was a clear warning, "to be In administered only on medical prescription."
addition each package contained a warning leaflet to the use of the capsules, the suggested dosage being one capsule daily. The leaflet stated that the effects should be carefully studied, and the appearance of nausea or intolerance to the drug must lead to special investigation ; with regard to toxic symptoms, if the metabolic rate was increased to over 50 per cent., it was a signal for the immediate withdrawal of the treatment. No blame, observed Mr. Idris Evans, the deputy coroner, could attach to the medical practitioner, who had given Miss Philcox careful directions, and could not be held responsible if those directions were disobeyed. There remains the question of the future control of the drug. The manufacturers had suggested to the authorities that it be placed on the Poisons List so as to secure that it could not be bought except on medical prescription. A formal official reply had been received to the effect that the matter was having consideration. The deputy coroner remarked that he was aware that departments move slowly. It is, however, only fair to remember that the whole question of setting up the new Poisons List is now receiving fresh attention by a new body as the result of the Pharmacy and Poisons Act of last year. This particular drug could have been added to the poisons schedule under the law which is about to disappear; but it would have been natural enough to refer the question as part of the general survey which highly competent authorities are now conducting. The deputy coroner trusted that the Poisons Board would take some early action ; meanwhile, he observed, the publicity of the inquest should deter other members of the public who might be tempted to expedite treatment in defiance of medical advice. as