- Email: [email protected]
Pending legislation—A forecast
12o
PROCEEDINGS
OF THE
PROCEEDINGS OF THE HOME COUNTIES BRANCH OF THE INCORPORATED SOCIETY OF MEDICAL OFFICERS OF HEALTH. A ME~TING of the above was held at the H o l b o r n Restaurant on December 9th, the following members being present: Dr. Woodforde (President), Kenwood, Morrison, Seaton, Shadwell, Tew, Thresh, Williamson, and the Honorary Secretary. T h e adjourned discussion on the Notification Act was opened by the President, and after each point had been very fully debated the following resolutions regarding changes required in the Act were put to the meeting and carried : - i. That the fees should remain as at present ; 2. That, erysipelas should not be removed from the list of notifiable diseases ; 3. That dual notification should be enforced ; 4. That the onus of proving bon8 fide ignorance should rest with the defendant, whose defence should be invalid unless he was able to satisfy the Court that he taken all proper and reasonably necessary steps to ascertain the nature of the complaintl 5, That the time has now arrived for the Act to be made compulsory ; and 6. That it is desirable that in the case of outbreaks of cholera, small-pox, and typhoid fever immediate notification should be given to the ( ounty medical officer of health. It was proposed by Dr. Kenwood, and seconded by Dr. Seaton, that copies of these resolutions of the H o m e Counties Branch be forwarded to the Council of the Incorporated Society of Medical Officers of Health, and that the Council be asked to consider the matter with a view to amendment of the Act. This was carried unanimously.
Arouses Let i~z Zodgings.--A recent report by the Medical Officer of Health to the London County Council shows that in thirty-one of the Metropolitan Sanitary Districts the number of houses registered in pursuance of bye-laws made under the Public Health (London) Act, I89I , ranged from 1,5oo in Kensington to six in Plumstead. In eleven districts no houses were regulated at the date of t h e report. Lambeth has only recently obtained byelaws under the Act. The Public Health Committee of the Council draw attention to the fact that nearly six years have elapsed since the Act came into force, and recommend the Council to exercise the powers they possess under the Act, for securing the carrying out of the bye-laws. The Committee suggest that a complaint should be made to the Locat Government Board against the authority for Bethnal Green, in the first instance, and that further recommendations for dealing with the other authorities should be brought forward at a future date.
HOME
COUNTIES
BRANCH.
PENDING LEGISLATION--A FORECAST. IT is not in any spirit of unthankfulness t h a t w e abstain from reviewing the history of the past year, but owing to our inability to gauge the true perspective o f its events. A mere catalogue of such events would be of little use. It is as premisses to logical deductions that such facts obtain their value. W e propose, therefore, to endeavour to forecast certain legislative proposals which we hope will engage the attention of Parliament during the coming Session. First and foremost we would place vaccination. The Government are pledged to give their early consideration to this question, and already eighteea months have elapsed since the Royal Commission presented their final report. We had hoped that the Council of the Incorporated Society would have expressed an opinion on the matter before this. T h e delay, we believe, has been due to the time required by the Branches for the full discussion of the Memorandum forwarded to them in March last by the Council. Whenever such opinion be forthc6ming, we trust that it will be unanimous and without ambiguity. What the Government proposals are to be it is almost impossible to foresee. Unless the Report of the Commission be ignored, there must be radical changes both in legislation and in practice. I n any case, we feel that to relegate vaccination to a secondary position in the prevention of small-pox, would be to court disaster. Next in general importance is the amendment of the law regulating the food supply, both as regards adulteration and the prevention o f tuberculosis. T h e latter subject can hardly be discussed during the next Session, as the Royal Commission on Tuberculosis have not yet presented their report. With regard to adulteration, the Government are definitely pledged, and we venture to think that the ahnost universal condemnation of the perfunctory Bill of last session will have the effect of compelling them to adopt all, or almost all, of the proposals contained in the Report of the Food Products Adulteration Committee of 1896. We believe that all interested in the food trade would welcome a strong Bill, the existing muddle being intolerable. An amendment of the law governing notification would be welcomed by many authorities and officers, but we doubt whether the subject is sufficiently ripe for legislation. When it is taken in hand we hope that provision will be made for securing the active co-operation of school authorities and officers. T o metropolitan officers the foreshadowed reorganisation of London local authorities is of prime interest. The hints dropped have been tco vague to enable us to decide whether the] new
CURRENT
PUBLIC
HEALTH
authorities are to be " d i s t r i c t councils" or ,, municipalities" either of the old or of a new (progressive) type. Will the Report of the Royal Commission of 1894 be followed and a limited number of authorities be created ? or will the existing number be retained ? In the former event, what will become of the various officers ? Metropolitan health offÉcers enjoy "fixity of tenure," and it will be no light task to adjust their lawful claims. I n the coming Session two Bills for Superannuation will be introduced, one the Bill of last year, which proposed to extend the provisions of the Poor-Law Officers' Superannuation Act, x896 , to all officers and servants of all local authorities other than Poor-Law ; the other, a Bill limited to metropolitan officers. The latter will propose to make the • permissive Act of 1866, under which such officers have an equitable right to superannuation, compulsory, on the condition that such officers contribute to the superannuation fund on the scale laid down in the above-mentioned Act of I896. F r o m the remarks made by the President of the Local Government Board, when receiving the deputation from the Superannuation Conference in the beginning of last year, we gather that the latter Bill will not be opposed by Government. H o w far the Government will support it will depend on the attitude of the metropolitan authorities. T h e Bill of last Session, dealing with the amendment of the definitions of " s e w e r " and " d r a i n " in the Metropolis Management Acts, will be re-introduced in the ensuing Session. The last Bill was " b l o c k e d " to protect certain interests, but we should think that the growing demand for an alteration in the existing law will ensure early iegislation. I f only a fraction Of the legislation here foreshadowed be attempted, the Council of the Incorporated Society will have a full programme of work before them. CURRENT
PUBLIC HEALTH LITERATURE.
SMALL-Pox IN G E R M A N Y IN 1895. Med. S t a l i s t ~ i t # z . a.d. K . Ges. .4mr. ZU. 2.
T h e figures for this year are very instructive. T h e deaths were 27 (against 88 in the previous year, and an annual average of 116 in the last ten years) in 18 localities. In Berlin there were 5 deaths, in Rybnik 4, whilst in other places, 14 of which were close to the frontiers, the deaths were single. Unvaccinated infants under two years .contributed i * deaths, and children between three and ten years 7. Of the latter children 3 were known to be unvaccinated, and the other 4 h a d no marks. Two of the 27 deceased persons were adults under forty, one of whom contracted the
LITERATURE.
12i
disease during a visit to Russia, a n d 7 were above f o r t y - - t vaccinated in infancy only, i re-vaccinated over forty years previously, and 5 of whose vaccination no evidence was to be had. Only 15 cases of small-pox were reported among the 2o,ooo,ooo inhabitants of the States to the South of Prussia, which always suffers most from its contiguity with Russia, Holland, and France, and its maritime intercourse with other countries. The outbreak at Berlin began with a Russian who had arrived but a few days previously, and involved 9 other adults, vaccinated in infancy only, a l l of whom had the disease in a very mild form, and .6 infants still unvaccinated, of whom 5 died. Were vaccination performed, as with us, within a few months of birth, the deaths throughout the Empire would probably not have exceeded a dozen, or I in 42000,000, instead of about i in z,ooo,ooo. O f the I , / 6 4 deaths that have occurred in the last ten years, 919, or 79 per cent., were within a few miles of the frontiers, viz., 764 on the east and south-east, 55 on the south and west, and i o o in the seaport towns on the north. VACCINATION I~ GERMANY IN ~895. Kubler.
3/Yed. Slat.
~/fitt~. a. d. K .
Ges. A .
2Yd. iv., -~. 2. * Liable.
Presented.
l~esisting Vaccination.
Primary Vaccination (un:~er 2 years) ... 1,677,32I 1,186,674 2oi,975 ~- I2 % Re-vaccination (I3th year) ... 1,39I,oi9 x,I43,ozI 36,o54~ 2"5 ~o Withheld in defiance of orders : ~ Primary Vaccination ... 39,369 = 19"4 Re-vaccination . . . . . . 7,234 - - 20"o % of those resisting. H u m a n lymph was used in I ' I 6 per cent., calf lymph in 98"84. T h e percentage of successful operations varied in primary vaccinations from 99"68 in the Province of Swabia, to 92"o3 in Ltibeck, and in re-vaccinations from 99"63 in the Black Forest, to 5"89 in the city of Hamburg. [The extraordinarily low percentage of successful re-vaccinations in Hamburg is owing to the permanence of the immunity conferred by the primary vaccination in that city performed with Voigt's strain of variolovaccine obtained by him in i881p and since used almost exclusively. I have on a former occasion noted as the weak point in the German system the delay of primary vaccination to the second year of life, infants under two years furnishing the great majority of cases of, and deaths from small-pox. It will be seen * The numbers given as ~ liable," are those of the births in the years 1894 and I882 respectively, cr the maximum possible ; the difference bet~veenthese and the sum of those presented for and evading vaccination representing approxlmately the deaths and emigration in the respective intervals.--REP. K
PROCEEDINGS
OF THE
PROCEEDINGS OF THE HOME COUNTIES BRANCH OF THE INCORPORATED SOCIETY OF MEDICAL OFFICERS OF HEALTH. A ME~TING of the above was held at the H o l b o r n Restaurant on December 9th, the following members being present: Dr. Woodforde (President), Kenwood, Morrison, Seaton, Shadwell, Tew, Thresh, Williamson, and the Honorary Secretary. T h e adjourned discussion on the Notification Act was opened by the President, and after each point had been very fully debated the following resolutions regarding changes required in the Act were put to the meeting and carried : - i. That the fees should remain as at present ; 2. That, erysipelas should not be removed from the list of notifiable diseases ; 3. That dual notification should be enforced ; 4. That the onus of proving bon8 fide ignorance should rest with the defendant, whose defence should be invalid unless he was able to satisfy the Court that he taken all proper and reasonably necessary steps to ascertain the nature of the complaintl 5, That the time has now arrived for the Act to be made compulsory ; and 6. That it is desirable that in the case of outbreaks of cholera, small-pox, and typhoid fever immediate notification should be given to the ( ounty medical officer of health. It was proposed by Dr. Kenwood, and seconded by Dr. Seaton, that copies of these resolutions of the H o m e Counties Branch be forwarded to the Council of the Incorporated Society of Medical Officers of Health, and that the Council be asked to consider the matter with a view to amendment of the Act. This was carried unanimously.
Arouses Let i~z Zodgings.--A recent report by the Medical Officer of Health to the London County Council shows that in thirty-one of the Metropolitan Sanitary Districts the number of houses registered in pursuance of bye-laws made under the Public Health (London) Act, I89I , ranged from 1,5oo in Kensington to six in Plumstead. In eleven districts no houses were regulated at the date of t h e report. Lambeth has only recently obtained byelaws under the Act. The Public Health Committee of the Council draw attention to the fact that nearly six years have elapsed since the Act came into force, and recommend the Council to exercise the powers they possess under the Act, for securing the carrying out of the bye-laws. The Committee suggest that a complaint should be made to the Locat Government Board against the authority for Bethnal Green, in the first instance, and that further recommendations for dealing with the other authorities should be brought forward at a future date.
HOME
COUNTIES
BRANCH.
PENDING LEGISLATION--A FORECAST. IT is not in any spirit of unthankfulness t h a t w e abstain from reviewing the history of the past year, but owing to our inability to gauge the true perspective o f its events. A mere catalogue of such events would be of little use. It is as premisses to logical deductions that such facts obtain their value. W e propose, therefore, to endeavour to forecast certain legislative proposals which we hope will engage the attention of Parliament during the coming Session. First and foremost we would place vaccination. The Government are pledged to give their early consideration to this question, and already eighteea months have elapsed since the Royal Commission presented their final report. We had hoped that the Council of the Incorporated Society would have expressed an opinion on the matter before this. T h e delay, we believe, has been due to the time required by the Branches for the full discussion of the Memorandum forwarded to them in March last by the Council. Whenever such opinion be forthc6ming, we trust that it will be unanimous and without ambiguity. What the Government proposals are to be it is almost impossible to foresee. Unless the Report of the Commission be ignored, there must be radical changes both in legislation and in practice. I n any case, we feel that to relegate vaccination to a secondary position in the prevention of small-pox, would be to court disaster. Next in general importance is the amendment of the law regulating the food supply, both as regards adulteration and the prevention o f tuberculosis. T h e latter subject can hardly be discussed during the next Session, as the Royal Commission on Tuberculosis have not yet presented their report. With regard to adulteration, the Government are definitely pledged, and we venture to think that the ahnost universal condemnation of the perfunctory Bill of last session will have the effect of compelling them to adopt all, or almost all, of the proposals contained in the Report of the Food Products Adulteration Committee of 1896. We believe that all interested in the food trade would welcome a strong Bill, the existing muddle being intolerable. An amendment of the law governing notification would be welcomed by many authorities and officers, but we doubt whether the subject is sufficiently ripe for legislation. When it is taken in hand we hope that provision will be made for securing the active co-operation of school authorities and officers. T o metropolitan officers the foreshadowed reorganisation of London local authorities is of prime interest. The hints dropped have been tco vague to enable us to decide whether the] new
CURRENT
PUBLIC
HEALTH
authorities are to be " d i s t r i c t councils" or ,, municipalities" either of the old or of a new (progressive) type. Will the Report of the Royal Commission of 1894 be followed and a limited number of authorities be created ? or will the existing number be retained ? In the former event, what will become of the various officers ? Metropolitan health offÉcers enjoy "fixity of tenure," and it will be no light task to adjust their lawful claims. I n the coming Session two Bills for Superannuation will be introduced, one the Bill of last year, which proposed to extend the provisions of the Poor-Law Officers' Superannuation Act, x896 , to all officers and servants of all local authorities other than Poor-Law ; the other, a Bill limited to metropolitan officers. The latter will propose to make the • permissive Act of 1866, under which such officers have an equitable right to superannuation, compulsory, on the condition that such officers contribute to the superannuation fund on the scale laid down in the above-mentioned Act of I896. F r o m the remarks made by the President of the Local Government Board, when receiving the deputation from the Superannuation Conference in the beginning of last year, we gather that the latter Bill will not be opposed by Government. H o w far the Government will support it will depend on the attitude of the metropolitan authorities. T h e Bill of last Session, dealing with the amendment of the definitions of " s e w e r " and " d r a i n " in the Metropolis Management Acts, will be re-introduced in the ensuing Session. The last Bill was " b l o c k e d " to protect certain interests, but we should think that the growing demand for an alteration in the existing law will ensure early iegislation. I f only a fraction Of the legislation here foreshadowed be attempted, the Council of the Incorporated Society will have a full programme of work before them. CURRENT
PUBLIC HEALTH LITERATURE.
SMALL-Pox IN G E R M A N Y IN 1895. Med. S t a l i s t ~ i t # z . a.d. K . Ges. .4mr. ZU. 2.
T h e figures for this year are very instructive. T h e deaths were 27 (against 88 in the previous year, and an annual average of 116 in the last ten years) in 18 localities. In Berlin there were 5 deaths, in Rybnik 4, whilst in other places, 14 of which were close to the frontiers, the deaths were single. Unvaccinated infants under two years .contributed i * deaths, and children between three and ten years 7. Of the latter children 3 were known to be unvaccinated, and the other 4 h a d no marks. Two of the 27 deceased persons were adults under forty, one of whom contracted the
LITERATURE.
12i
disease during a visit to Russia, a n d 7 were above f o r t y - - t vaccinated in infancy only, i re-vaccinated over forty years previously, and 5 of whose vaccination no evidence was to be had. Only 15 cases of small-pox were reported among the 2o,ooo,ooo inhabitants of the States to the South of Prussia, which always suffers most from its contiguity with Russia, Holland, and France, and its maritime intercourse with other countries. The outbreak at Berlin began with a Russian who had arrived but a few days previously, and involved 9 other adults, vaccinated in infancy only, a l l of whom had the disease in a very mild form, and .6 infants still unvaccinated, of whom 5 died. Were vaccination performed, as with us, within a few months of birth, the deaths throughout the Empire would probably not have exceeded a dozen, or I in 42000,000, instead of about i in z,ooo,ooo. O f the I , / 6 4 deaths that have occurred in the last ten years, 919, or 79 per cent., were within a few miles of the frontiers, viz., 764 on the east and south-east, 55 on the south and west, and i o o in the seaport towns on the north. VACCINATION I~ GERMANY IN ~895. Kubler.
3/Yed. Slat.
~/fitt~. a. d. K .
Ges. A .
2Yd. iv., -~. 2. * Liable.
Presented.
l~esisting Vaccination.
Primary Vaccination (un:~er 2 years) ... 1,677,32I 1,186,674 2oi,975 ~- I2 % Re-vaccination (I3th year) ... 1,39I,oi9 x,I43,ozI 36,o54~ 2"5 ~o Withheld in defiance of orders : ~ Primary Vaccination ... 39,369 = 19"4 Re-vaccination . . . . . . 7,234 - - 20"o % of those resisting. H u m a n lymph was used in I ' I 6 per cent., calf lymph in 98"84. T h e percentage of successful operations varied in primary vaccinations from 99"68 in the Province of Swabia, to 92"o3 in Ltibeck, and in re-vaccinations from 99"63 in the Black Forest, to 5"89 in the city of Hamburg. [The extraordinarily low percentage of successful re-vaccinations in Hamburg is owing to the permanence of the immunity conferred by the primary vaccination in that city performed with Voigt's strain of variolovaccine obtained by him in i881p and since used almost exclusively. I have on a former occasion noted as the weak point in the German system the delay of primary vaccination to the second year of life, infants under two years furnishing the great majority of cases of, and deaths from small-pox. It will be seen * The numbers given as ~ liable," are those of the births in the years 1894 and I882 respectively, cr the maximum possible ; the difference bet~veenthese and the sum of those presented for and evading vaccination representing approxlmately the deaths and emigration in the respective intervals.--REP. K