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Isolation hospitals
PUBLIC HEALTH.
191~. ISOLATION HOSPITALS.*
T HEa
Local Government Board have issued report on Isolation Hospitals which gives account of the "more modern developraents in the design of isolation hospitals," and contains much information concerning the cost of construction of hospitals which have been provided by various sanitary authorities. The fact that this report has been written by Dr. H. Franktiff Parsons is the best guarantee of its value which the reader can desire. In his introductory chapter Dr. Parsons refers to Sir Richard Thorne's original report on hospitals for infectious diseases which was published in 1882, and was re-issued in 19oo with a preface by Sir William Power who was then the Medical Officer of the Board. Sir William Power pointed out that " while the general considerations set forth in the first part of the report (i.e. the report of 1882) still held good, needing modification only in one respect, none of the individual hospitals described in the second part of the report afforded models which could with advantage be closely followed at the present day." Hence the need for some description of more modern hospitals than those existing at the time of Sir Richard Thorne's first report, and for the supply to sanitary authorities of information on hospital design and construction more deserving of utitisation than that which was available thirty years ago. In an interesting chapter on the utility of isolation hospitals, Dr. Parsons states reasons which may be urged for and against the view that isolation hospitals have been effective in diminishing the prevalence of scarlet fever. There appears to be no reason for doubting that the decline in recent years is in the main a natural phenomenon, and the recrudescence of diphtheria a few years ago supplies ground for thinking that the trend of epidemic prevalence generally is independent of such control as is exercised by isolation of recognized cases of this disease. The acceptance of this view does not, however, militate against that which recognizes that isolation hospitals serve a useful purpose not only in relieving households of the incubus of infective persons in their midst, but also of limiting the period during which these persons are a source of danger to other members of the family. While, therefore, the old belief that infectious disease can be ~"Repor t on Isolatlon Hospital% by H , Franklilx Parsons, M.D. (Supplement to the Aroma! Report of tim Medical Officer of the Board for i9~o-: 0" London : H , M . Stationery Office, 1912~ Cd. 6342.
"stamped o u t " by isolation in hospital, is no longer heard of, the view that isolation hospitals are of practical value is still maintained. In respect of smallpox, Dr. Parsons observes that there is no question of the value of isolation in a suitably situated hospital in preventing the spread of the disease. Dr. Parsons' opinion on this point will be abundantly endorsed by medical officers of health, who have had experience of the readiness with which smallpox spreads when persons suffering from this disease are left in their own homes, the inmates of which are unprotected by vaccination. In the same way, while the value of a well-placed smallpox hospital is still recognized tile need for application of the lessons taught by Sir William Power concerning the influence of smallpox hospitals still remains, and the condition under which the establishment of these institutions is approved by the Board has not needed to be modified by subsequent experience. Variation in the type of scarlet fever, to which we have already referred, is probably responsible, in some degree at any rate, for the fact that Dr. Parsons was called upon to discuss in his report new methods of dealing with cases of this disease, both inside and outside hospitals. Dr. Curgenven and Dr. Robert Mitne's method of inunction, it has been suggested, might render hospital isolation unnecessary. On this point Dr. Parsons tells us that the experience of hospital superintendents, who have tried the method, has not been favourable, and he cites that of Dr. Biernacki at the Plaistow hospital in this respect. The subject of the planning and construction of isolation l~ospitats constitutes perhaps the most important matter with which this report deals, and in its consideration in an early stage Dr. Parsons has had the co-operation of Mr. Kitchin, the architect of the Board. Later Mr. Kitchin'stother duties prevented him from continuing this work. Dr. Parsons discusses at length the sufficiency of the different methods by which infection may be thought to be communicated, and considers these in relation to the different designs of hospitals which have been provided. Thus, the "barrier system" is merely a system of control of attendants, and leaves patients suffering from different infectious diseases in a~rial communication with each other. A more complete system may be provided by the patients' beds being structurally and completely separated from
PUBLIC
16
each other, and the compartments being entered from the open air, or from the same corridor, or the compartments may be separated from each other only by partitiorfs not reaching the ceiling. Dr. Parsons says that the experiences of Dr. Biernacl~i with the "barrier" system, and of Dr. Caiger with the partially separated cubicles at the South Western Hospital are that these methods suffice to prevent cross infection in the case of diseases of short " striking distance," namely, those in which transmission is chiefly by mediate infection, but that they fail where infection is more diffusible and can be conveyed by a6rial convection, such as chicken pox, measles, and in less degree, scarlet fever. An especially useful' chapter in the report is that devoted t o the planning of such compartment and cubicle blocks, the different designs being illustrated by plans. Another important question discussed is that of the cost of construction. This appears to have increased in recent years, partly as the result of increased cost of labour and building materials. In connection with this subjectl Dr. Parsons sets out the suggestions made by the Local Government Board for reducing the cost. It does not appear, howeyer, that the advantages in respect of cost by the construction of temporary buildings is as great as would appear when all the circumstances are considered. Cost is of course necessarily dependent on design and it is here Dr. Parson's report will be of especial value to sanitary authorities desiring to avoid unnecessary expenditure when considering the requirements of their districtsi The report is a useful supplement to that of Sir Richard T h e m e , and it provides in every way the "information which is needed at the present time. Tnv EXCESS oF BIRTHS OVER DEATHS.--In the House of Commons, on April 2nd, Mr. Lynch asked the president of the Local Government Board whaf was the excess of births over deaths in Great Britain for each of the IO years ending with 191 i, and including ttlat year and what was the rate per ~,ooo of such excess in relation to the population. Mr. Burns (in a written answer) replied: Tile excess of births over deaths in Great Britain in each.of the io years 19o2-11 and the rate of such excess per i,oeo persons living are shown in the following table : Excessot Rate per 1 Excess of Rateper Year.
births o v e r deaths, 19o2 . . 4 5 9 , 2 9 7 1903 "" 4 9 1 ' 1 6 6 I 9 0 4 "" 4 5 0 , 2 2 7 1905 . , 4 6 5 , 1 3 6 1906 ,. 460,170
moopersonsI Year.
.. "" "" .. ..
hving. 12"26 12"98 11"75 12'O8 11'81
] I I [
1907 I908 1909 1910 191:I
.. .. .. .. ..
birthsover deaths, 445,365 473,451
tooopersons living. ti'32 1I"88 450,506 .. II'22 4 6 5 , 4 7 o . . II'4~8 403,462 .. 9'86 .
.. ..
HEALTH.
OCTOBER,
H E A L T H WORK IN N E W YORK, U.S.A. MOVING
PICTURE
TUBERCUI,OSIS
EXI:IIBITION5.
For a number of years the Department of Health has given stereopticon tuberculosis exhibitions at night during the summer months in tile public parks o[ tile city. In 191I, the Tuberculosis Committee of the Charity Olganization Society assisted in this work by furnishing a lecturer for a number of the exhibitions. But tile lectures proved unsuccessful, the conditions being so poorly adapted for public speaking. Such audiences must be instructed by being interested and amused. During" i912 , therefore, moving pictures are being given :in place of the lectures, five of the best " tuberculosis" and "tlealth ~' tilms being used, accompanied by the usual stereopticon views. Although the cost has been materially increased, yet the results in the form of increased attendance, and wider dissemination of information to the public, justify the expenditure. The Tuberculosis Committee of the Charity Organization Society has actively assisted the Department of Health in this work, selecting the films, and supervising the exhibitions. Handbills announcing each exhibition are distributed by the tuberculosis nurses of the department throughout the district surrounding the park, and notices are also posted in the park itself. The exhibitions begin at 8 p.m. TIlE
RESPONSIBILITY IN
THE
OF PHYSICIANS
REPOI.tTING
OF
AND
MIDWIVES
BIRTHS.
The Commissioner of Health, Ernst. J. Lederle, Ph.D., calls attention to the fact that the number of births recorded in New York City during the past five months of 1912 was 56;258 as against 56,082 for the corresponding period of 1911. This rate would indicate a decrease of 1'1o per i,ooo of the population which means, if this low birth rate is to continue, that there will be 5,69o fewer births recorded during the year I912 than during 1911. It is not believed that this decline in the statistics is due to natural causes. A comparison of the birth and death indices for the month of May in the Borough of Manhattan shows that there were 17 children under three months of age who died during the nlonth of May whose births had not been recorded. Remembering that one out of every five children dies during the first three months of life, and that as this method of ascertaining the number of births not reported applies necessarily only to those that have died, it is very evident that the number of births not reported during the month of May must be considerably larger than the 17 referred to. Again, the decline is most marked in the Borough of Brooklyn where the birth rate has fallen over two points during the first five months of the year,
191~. ISOLATION HOSPITALS.*
T HEa
Local Government Board have issued report on Isolation Hospitals which gives account of the "more modern developraents in the design of isolation hospitals," and contains much information concerning the cost of construction of hospitals which have been provided by various sanitary authorities. The fact that this report has been written by Dr. H. Franktiff Parsons is the best guarantee of its value which the reader can desire. In his introductory chapter Dr. Parsons refers to Sir Richard Thorne's original report on hospitals for infectious diseases which was published in 1882, and was re-issued in 19oo with a preface by Sir William Power who was then the Medical Officer of the Board. Sir William Power pointed out that " while the general considerations set forth in the first part of the report (i.e. the report of 1882) still held good, needing modification only in one respect, none of the individual hospitals described in the second part of the report afforded models which could with advantage be closely followed at the present day." Hence the need for some description of more modern hospitals than those existing at the time of Sir Richard Thorne's first report, and for the supply to sanitary authorities of information on hospital design and construction more deserving of utitisation than that which was available thirty years ago. In an interesting chapter on the utility of isolation hospitals, Dr. Parsons states reasons which may be urged for and against the view that isolation hospitals have been effective in diminishing the prevalence of scarlet fever. There appears to be no reason for doubting that the decline in recent years is in the main a natural phenomenon, and the recrudescence of diphtheria a few years ago supplies ground for thinking that the trend of epidemic prevalence generally is independent of such control as is exercised by isolation of recognized cases of this disease. The acceptance of this view does not, however, militate against that which recognizes that isolation hospitals serve a useful purpose not only in relieving households of the incubus of infective persons in their midst, but also of limiting the period during which these persons are a source of danger to other members of the family. While, therefore, the old belief that infectious disease can be ~"Repor t on Isolatlon Hospital% by H , Franklilx Parsons, M.D. (Supplement to the Aroma! Report of tim Medical Officer of the Board for i9~o-: 0" London : H , M . Stationery Office, 1912~ Cd. 6342.
"stamped o u t " by isolation in hospital, is no longer heard of, the view that isolation hospitals are of practical value is still maintained. In respect of smallpox, Dr. Parsons observes that there is no question of the value of isolation in a suitably situated hospital in preventing the spread of the disease. Dr. Parsons' opinion on this point will be abundantly endorsed by medical officers of health, who have had experience of the readiness with which smallpox spreads when persons suffering from this disease are left in their own homes, the inmates of which are unprotected by vaccination. In the same way, while the value of a well-placed smallpox hospital is still recognized tile need for application of the lessons taught by Sir William Power concerning the influence of smallpox hospitals still remains, and the condition under which the establishment of these institutions is approved by the Board has not needed to be modified by subsequent experience. Variation in the type of scarlet fever, to which we have already referred, is probably responsible, in some degree at any rate, for the fact that Dr. Parsons was called upon to discuss in his report new methods of dealing with cases of this disease, both inside and outside hospitals. Dr. Curgenven and Dr. Robert Mitne's method of inunction, it has been suggested, might render hospital isolation unnecessary. On this point Dr. Parsons tells us that the experience of hospital superintendents, who have tried the method, has not been favourable, and he cites that of Dr. Biernacki at the Plaistow hospital in this respect. The subject of the planning and construction of isolation l~ospitats constitutes perhaps the most important matter with which this report deals, and in its consideration in an early stage Dr. Parsons has had the co-operation of Mr. Kitchin, the architect of the Board. Later Mr. Kitchin'stother duties prevented him from continuing this work. Dr. Parsons discusses at length the sufficiency of the different methods by which infection may be thought to be communicated, and considers these in relation to the different designs of hospitals which have been provided. Thus, the "barrier system" is merely a system of control of attendants, and leaves patients suffering from different infectious diseases in a~rial communication with each other. A more complete system may be provided by the patients' beds being structurally and completely separated from
PUBLIC
16
each other, and the compartments being entered from the open air, or from the same corridor, or the compartments may be separated from each other only by partitiorfs not reaching the ceiling. Dr. Parsons says that the experiences of Dr. Biernacl~i with the "barrier" system, and of Dr. Caiger with the partially separated cubicles at the South Western Hospital are that these methods suffice to prevent cross infection in the case of diseases of short " striking distance," namely, those in which transmission is chiefly by mediate infection, but that they fail where infection is more diffusible and can be conveyed by a6rial convection, such as chicken pox, measles, and in less degree, scarlet fever. An especially useful' chapter in the report is that devoted t o the planning of such compartment and cubicle blocks, the different designs being illustrated by plans. Another important question discussed is that of the cost of construction. This appears to have increased in recent years, partly as the result of increased cost of labour and building materials. In connection with this subjectl Dr. Parsons sets out the suggestions made by the Local Government Board for reducing the cost. It does not appear, howeyer, that the advantages in respect of cost by the construction of temporary buildings is as great as would appear when all the circumstances are considered. Cost is of course necessarily dependent on design and it is here Dr. Parson's report will be of especial value to sanitary authorities desiring to avoid unnecessary expenditure when considering the requirements of their districtsi The report is a useful supplement to that of Sir Richard T h e m e , and it provides in every way the "information which is needed at the present time. Tnv EXCESS oF BIRTHS OVER DEATHS.--In the House of Commons, on April 2nd, Mr. Lynch asked the president of the Local Government Board whaf was the excess of births over deaths in Great Britain for each of the IO years ending with 191 i, and including ttlat year and what was the rate per ~,ooo of such excess in relation to the population. Mr. Burns (in a written answer) replied: Tile excess of births over deaths in Great Britain in each.of the io years 19o2-11 and the rate of such excess per i,oeo persons living are shown in the following table : Excessot Rate per 1 Excess of Rateper Year.
births o v e r deaths, 19o2 . . 4 5 9 , 2 9 7 1903 "" 4 9 1 ' 1 6 6 I 9 0 4 "" 4 5 0 , 2 2 7 1905 . , 4 6 5 , 1 3 6 1906 ,. 460,170
moopersonsI Year.
.. "" "" .. ..
hving. 12"26 12"98 11"75 12'O8 11'81
] I I [
1907 I908 1909 1910 191:I
.. .. .. .. ..
birthsover deaths, 445,365 473,451
tooopersons living. ti'32 1I"88 450,506 .. II'22 4 6 5 , 4 7 o . . II'4~8 403,462 .. 9'86 .
.. ..
HEALTH.
OCTOBER,
H E A L T H WORK IN N E W YORK, U.S.A. MOVING
PICTURE
TUBERCUI,OSIS
EXI:IIBITION5.
For a number of years the Department of Health has given stereopticon tuberculosis exhibitions at night during the summer months in tile public parks o[ tile city. In 191I, the Tuberculosis Committee of the Charity Olganization Society assisted in this work by furnishing a lecturer for a number of the exhibitions. But tile lectures proved unsuccessful, the conditions being so poorly adapted for public speaking. Such audiences must be instructed by being interested and amused. During" i912 , therefore, moving pictures are being given :in place of the lectures, five of the best " tuberculosis" and "tlealth ~' tilms being used, accompanied by the usual stereopticon views. Although the cost has been materially increased, yet the results in the form of increased attendance, and wider dissemination of information to the public, justify the expenditure. The Tuberculosis Committee of the Charity Organization Society has actively assisted the Department of Health in this work, selecting the films, and supervising the exhibitions. Handbills announcing each exhibition are distributed by the tuberculosis nurses of the department throughout the district surrounding the park, and notices are also posted in the park itself. The exhibitions begin at 8 p.m. TIlE
RESPONSIBILITY IN
THE
OF PHYSICIANS
REPOI.tTING
OF
AND
MIDWIVES
BIRTHS.
The Commissioner of Health, Ernst. J. Lederle, Ph.D., calls attention to the fact that the number of births recorded in New York City during the past five months of 1912 was 56;258 as against 56,082 for the corresponding period of 1911. This rate would indicate a decrease of 1'1o per i,ooo of the population which means, if this low birth rate is to continue, that there will be 5,69o fewer births recorded during the year I912 than during 1911. It is not believed that this decline in the statistics is due to natural causes. A comparison of the birth and death indices for the month of May in the Borough of Manhattan shows that there were 17 children under three months of age who died during the nlonth of May whose births had not been recorded. Remembering that one out of every five children dies during the first three months of life, and that as this method of ascertaining the number of births not reported applies necessarily only to those that have died, it is very evident that the number of births not reported during the month of May must be considerably larger than the 17 referred to. Again, the decline is most marked in the Borough of Brooklyn where the birth rate has fallen over two points during the first five months of the year,