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Proceedings of metropolitan branch of the incorporated society of medical officers of health
PUBLIC HEALTH, Ttj~ ~ournal of ttjt t~nrorporat~l~ .~ritt~ of :f~tMraI Offi~r~; of ~tatttj. S U B S C R I B E R S ' C O P I E S o/ PUBLIC H E A L T H are snpplied at lOS.6d. per annum. Single copies One Shilling, BOUND V O L U M E S . - - C o p i e s o f Volume V I I I . are now ready, bound in cloth, gilt lettered, price IOS. 6d. A f e w copies of Vols. L to V I I . , except VoL I I L , are also on hand. CLOTH COVERS for Bindin#the Volumes, price Is. 6d., may be had ly order o/any bboksclZer. Orders should be addressed to E. kY. Allen, 4, Ave Alaria La.w, ,g. C.
ADVERTISEMENTS. -- Communications rdatin~ to Advertisements skouDt be addr,:sse,l to 3Zessrs. U.'. Zt. ~ L. Collingridoe, 148 and "49, Aldersg:ate Street, E. C.
All Communications to
the Editor should be addressed to x9, Blornfield Road, MaidaVale, W. If sent to any other address no responsibility can be accepted for delay or loss.
~veCv A%ader of a ¢'up~er bejbJ~ ll~e SocieZy, or Conlribulor of a Signed Article, is entitled to twenty-five copies of the issue of PUIqLICHEALTHcon/aining the contribuEon z~ question ; but ap~blication k r this or any smaller number m u s t be m a d e to t/z6 F d i t o r not Z,~ter l/lal~ trig T\VENTYFOURTH c[apP OJe t ~ ]]10tltll~ ~Y¢~)~0ll$ ~0 b z s e r N o n o f t/ze Contribution.
Medical Offcers o f Arealth and other Corresi~ondents are reguesled to send regularly all published reports and matters of interest bearing upon Sanitation to the Editor,
NOTICES. THE Provincial Meeting of the Incorporated Society will be held at Bristol on Saturday, July 24th. Full particulars will be announced in our next issue.
PROCEEDINGS OF METROPOLITAN BRANCH OF T H E INCORPORATED SOCIETY OF M E D I C A L OFFICERS OF HEALTH. A MEETING of this Branch was held at No. ~97
tiigh tlolborn, W.C., on Friday, May i4th , 1897. Present : Dr. W. H. Kempster (President) in the Chair; Drs. S. R. Lovett, Joseph Priestley, G. E. Yarrow, R. Dudfield, T. Orme Dudfield, E. Gwynn, F. J. Allan, Oliver Field, C. Renner, and the following visitors, Messrs. 5. Rideal, F. W. Passmore, E. l)anut, A. Zimmerman, M. Carteighc, and II. Helbing. ~l'l NUTILS,
The minutes of the last meeting were read, approved, and signed by the PRESIDENT. I~.EPOR'r OF COL;NCIL.
The HOE. SECRETARY read the Report of Council intimating that arrangements were being made for holding a conjoint summer meeting with the Home Counties Branch on July ~oth next. Resolved on the motion of Dr. T. O. DUDFmLD, seconded by Dr. GWYNN, that the report be received and adopted. SANITARY INSTITUTE CONGRESS.
The Hox. SECaLTA~Y read a letter from the Secretary of the Sanitary Institute inviting the Branch to appoint Delegates to attend the Congress of the Institute at Leeds. Resolved that no action be taken. By permission of the Meeting, item No. 6 on the Agenda was then proceeded with.
PUERPERAL FEVER. WE are requested to call attention to the joint meeting of the Metropolitan and Home Counties Branches of the Society, which will take place at Oxford, on Saturday, July roth. During the day there will be a river trip to Reading. Reserved carriages will be provided by the 9.5 ° a.m. train from Paddington to Oxford, and by the return train (about 8.3o p.m.) from Reading to Paddington. Dinner will be served at Wallingford, and high tea at Reading. Friends of the members of the Branches (ladies and gentlemen) and members of other Branches and their friends will be welcomed. Dr. Field or Dr. Gruggen will supply any information required. The approximate expense, for the round trip from London, will be about i5s. , including all refreshments, etc. A complete programme will be given in our next issue. No. *zo.
Ju~=, z897,
Dr. R. D U D F I E L D moved, " T h a t it is desirable
that there should be a system of interchange of in. formation between the various Metropolitan Officers of Health as to nurses and midwives attending cases of Puerperal Fever ; and that the Metropoli,an Asylums Board be requested to include such information in their weekly returns of notification." I n moving the resolution Dr. DUDFIELD said their present defence against the spread of Puerperal Fever was very weak. It would be strengthened if Medical Officers would send the information specified to the Metropolitan Asylums Board, that Board to append such information to the weekly return of notifications sent to the Metropolitan Medical Officers of Health. Dr. GWY/CNseconded the resolution. He had known cases in his district where the disease had evidently been conveyed by the midwives, but he ¥
282
PROCEEDINGS
OF
THE
was o f opinion that medical m e n carried it about as m u c h as midwives. I n his district a m o n g the better class people the douche was m u c h used by nurses. Many of the nurses carried about their own syringes, which were a great source of danger. Dr. ALLAN suggested that the last clause in the resolution should be omitted. Dr. R. DUDFIELD said it was inserted only as a m e a n s of getting the interchange of the information. THF, CI-IAIRMAN suggested the desirability of submitting the proposal to the H o n . Solicitor before anything was d o n e and also that the Branch should undertake the interchange of information. Dr. R. DUDFIELD, by permission of the Meeting, altered his motion by omitting the clause relating to the Metropolitan Asylums Board, a n d the m o t i o n as altered was put to the Meeting and carried. T h e Secretary was requested to submit the proposal to the Solicitor and take the necessary steps in the matter. Disinfectants and Disinfecting, r e s u m e d discussion. Dr. ALLAN r e o p e n i n g the discussion : As the result of experiments I am satisfied that sulphur fumes cannot be relied upon as a disinfectant after Smallpox, Enteric Fever, and Phthisis. But I believe that they are sufficient after Diphtheria and Scarlet Fever for the disinfection of rooms. Rooms which can be stripped and whitewashed need not be fumigated, it being sufficient to moisten the paper before removal and then to burn it. All woodwork should be thoroughly washed with soap and water and afterwards washed again with a solution of perchloride if desired (as after Small-pox and Enteric Fever). Sulphur fumes might be useful in reaching crevices, in weakening the power of some germs, in killing others, in breaking up organic compounds, and giving time for the dust to settle in the room so that it may be washed up. In rooms wh.~re stripping of the wallpaper does not seem demanded sulphur fumes may be used after Diphtheria and Scarlet Fever with subsequent washing with soap and water of all woodwork. After Enteric Fever I think thorough washing of woodwork with a solution of perchloride or some other disinfectant, should be carried out, but I am not yet decided as to how the walls should be treated. The spray answers the purposej and various disinfectants may be used without damage to the paper. The use of formic aldehyde as a gas gives promise of being useful, but I am not prepared to express a definite opinion yet for or against it. Drs. ZIMMERMANand HELBING each exhibited apparatus for using formic aldehyde and explained their workings. Dr. RIDEAL desired to add to his remarks at the last meeting a few words as to the density of formic aldehyde in c~mparison with that of sulphurous acid. The relative densities showed that the diffusion of formic aldehyde would be considerably greater than that of sulphurous acid, the ratio being about 3 to 2. The PRZSlDENTsaid he used sulphurous acid and found it satisfactory, but in some cases where he feIt the infection was likely to persist in the furniture and apartments he had ordered the addition of one ounce of corrosive sublimate to every pound of sulphur, the result being, in his opinion, very satisfactory. The Branch was much indebted to the gentlemen who had exhibited their apparatus. Their discussion would be of use because it had brought to their notice a new disinfectant in formic aldehyde, the use of which might prove of the greatest advantage. Dr. ALLEN, in reply expressed the obligations he was under to the gentlemen who had shown them the various
METROPOLITAN
BRANCH.
apparatus and also to Dr. Rideal for the benefit of his chemical e~cperience. He felt very strongly that in a great many instances the stripping anct whitewashing did more good than anything else. In scarlet fever and diphtheria, sulphur might be efficient, tbut even then more good was done with the soap and water and whitewash. They wanted a disinfectant that was so reIiable that they need not strip the paper off the walls. They were not likely to adopt the system of spraying as in Paris. He hoped they might find in formic aldehyde, if they could use it in a simple form, a substitute for sulphur. Dr. LOVETT m o v e d that a cordial vote of thanks be given to Dr. Allan and the visitors who had kindly assisted in the discussion. Dr. YARROW s e c o n d e d the motion, which was put to the meeting and carried unanimously. T h e meeting then p r o c e e d e d to consider the paper on the R e p o r t of the Royal C o m m i s s i o n on Vaccination, read before the Society by Dr. Bond, which had been r e m i t t e d to the branches for consideration. T h e H o n o r a r y Secretary read the M e m o r a n d u m submitted by the Council o f the Society. Dr. YARROW said the extension of the age for compulsory vaccination would increase the difficulties of carrying out the law, as far as L o n d o n was concerned, tenfold. T h e longer the vaccination was postponed the greater was the difficulty in tracing the children. H i s experience was that it was better to vaccinate as early as possible. H e suggested that every medical m a n should be a public vaccinator. I f every medical man vaccinated his own patients there would not be half the objection there was at present. T h a t course would of necessity involve a standard of efficiency. T h e CHAIRMAN suggested the desirability of some resolution being passed expressing the opinion o f the Branch as to the utility of the administration of the vaccination laws being transferred from the guardians to the sanitary authorities. Dr. LOVETT m o v e d " T h a t this Branch is ,of opinion that the carrying out o f public vaccination should be controlled by the sanitary authorities in each district, and that the powers at present exercised by boards of guardians should be transferred to such sanitary authorities who carry out all other measures for the prevention of infectious diseases." T h e motion having b e e n seconded by Dr. YARROW was put to the m e e t i n g and carried unanimously. After s o m e further discussion it was resolved that the consideration of the subject be now adjourned to the next m e e t i n g of the Branch.
WE note with regret that the Public H e a l t h (Scotland) Bill is being sadly mutilated in C o m mons' Committee, and we trust that the Law and Parliamentary C o m m i t t e e of the Incorporated Society will take the m a t t e r under the:r i m m e diate consideration.
ADVERTISEMENTS. -- Communications rdatin~ to Advertisements skouDt be addr,:sse,l to 3Zessrs. U.'. Zt. ~ L. Collingridoe, 148 and "49, Aldersg:ate Street, E. C.
All Communications to
the Editor should be addressed to x9, Blornfield Road, MaidaVale, W. If sent to any other address no responsibility can be accepted for delay or loss.
~veCv A%ader of a ¢'up~er bejbJ~ ll~e SocieZy, or Conlribulor of a Signed Article, is entitled to twenty-five copies of the issue of PUIqLICHEALTHcon/aining the contribuEon z~ question ; but ap~blication k r this or any smaller number m u s t be m a d e to t/z6 F d i t o r not Z,~ter l/lal~ trig T\VENTYFOURTH c[apP OJe t ~ ]]10tltll~ ~Y¢~)~0ll$ ~0 b z s e r N o n o f t/ze Contribution.
Medical Offcers o f Arealth and other Corresi~ondents are reguesled to send regularly all published reports and matters of interest bearing upon Sanitation to the Editor,
NOTICES. THE Provincial Meeting of the Incorporated Society will be held at Bristol on Saturday, July 24th. Full particulars will be announced in our next issue.
PROCEEDINGS OF METROPOLITAN BRANCH OF T H E INCORPORATED SOCIETY OF M E D I C A L OFFICERS OF HEALTH. A MEETING of this Branch was held at No. ~97
tiigh tlolborn, W.C., on Friday, May i4th , 1897. Present : Dr. W. H. Kempster (President) in the Chair; Drs. S. R. Lovett, Joseph Priestley, G. E. Yarrow, R. Dudfield, T. Orme Dudfield, E. Gwynn, F. J. Allan, Oliver Field, C. Renner, and the following visitors, Messrs. 5. Rideal, F. W. Passmore, E. l)anut, A. Zimmerman, M. Carteighc, and II. Helbing. ~l'l NUTILS,
The minutes of the last meeting were read, approved, and signed by the PRESIDENT. I~.EPOR'r OF COL;NCIL.
The HOE. SECRETARY read the Report of Council intimating that arrangements were being made for holding a conjoint summer meeting with the Home Counties Branch on July ~oth next. Resolved on the motion of Dr. T. O. DUDFmLD, seconded by Dr. GWYNN, that the report be received and adopted. SANITARY INSTITUTE CONGRESS.
The Hox. SECaLTA~Y read a letter from the Secretary of the Sanitary Institute inviting the Branch to appoint Delegates to attend the Congress of the Institute at Leeds. Resolved that no action be taken. By permission of the Meeting, item No. 6 on the Agenda was then proceeded with.
PUERPERAL FEVER. WE are requested to call attention to the joint meeting of the Metropolitan and Home Counties Branches of the Society, which will take place at Oxford, on Saturday, July roth. During the day there will be a river trip to Reading. Reserved carriages will be provided by the 9.5 ° a.m. train from Paddington to Oxford, and by the return train (about 8.3o p.m.) from Reading to Paddington. Dinner will be served at Wallingford, and high tea at Reading. Friends of the members of the Branches (ladies and gentlemen) and members of other Branches and their friends will be welcomed. Dr. Field or Dr. Gruggen will supply any information required. The approximate expense, for the round trip from London, will be about i5s. , including all refreshments, etc. A complete programme will be given in our next issue. No. *zo.
Ju~=, z897,
Dr. R. D U D F I E L D moved, " T h a t it is desirable
that there should be a system of interchange of in. formation between the various Metropolitan Officers of Health as to nurses and midwives attending cases of Puerperal Fever ; and that the Metropoli,an Asylums Board be requested to include such information in their weekly returns of notification." I n moving the resolution Dr. DUDFIELD said their present defence against the spread of Puerperal Fever was very weak. It would be strengthened if Medical Officers would send the information specified to the Metropolitan Asylums Board, that Board to append such information to the weekly return of notifications sent to the Metropolitan Medical Officers of Health. Dr. GWY/CNseconded the resolution. He had known cases in his district where the disease had evidently been conveyed by the midwives, but he ¥
282
PROCEEDINGS
OF
THE
was o f opinion that medical m e n carried it about as m u c h as midwives. I n his district a m o n g the better class people the douche was m u c h used by nurses. Many of the nurses carried about their own syringes, which were a great source of danger. Dr. ALLAN suggested that the last clause in the resolution should be omitted. Dr. R. DUDFIELD said it was inserted only as a m e a n s of getting the interchange of the information. THF, CI-IAIRMAN suggested the desirability of submitting the proposal to the H o n . Solicitor before anything was d o n e and also that the Branch should undertake the interchange of information. Dr. R. DUDFIELD, by permission of the Meeting, altered his motion by omitting the clause relating to the Metropolitan Asylums Board, a n d the m o t i o n as altered was put to the Meeting and carried. T h e Secretary was requested to submit the proposal to the Solicitor and take the necessary steps in the matter. Disinfectants and Disinfecting, r e s u m e d discussion. Dr. ALLAN r e o p e n i n g the discussion : As the result of experiments I am satisfied that sulphur fumes cannot be relied upon as a disinfectant after Smallpox, Enteric Fever, and Phthisis. But I believe that they are sufficient after Diphtheria and Scarlet Fever for the disinfection of rooms. Rooms which can be stripped and whitewashed need not be fumigated, it being sufficient to moisten the paper before removal and then to burn it. All woodwork should be thoroughly washed with soap and water and afterwards washed again with a solution of perchloride if desired (as after Small-pox and Enteric Fever). Sulphur fumes might be useful in reaching crevices, in weakening the power of some germs, in killing others, in breaking up organic compounds, and giving time for the dust to settle in the room so that it may be washed up. In rooms wh.~re stripping of the wallpaper does not seem demanded sulphur fumes may be used after Diphtheria and Scarlet Fever with subsequent washing with soap and water of all woodwork. After Enteric Fever I think thorough washing of woodwork with a solution of perchloride or some other disinfectant, should be carried out, but I am not yet decided as to how the walls should be treated. The spray answers the purposej and various disinfectants may be used without damage to the paper. The use of formic aldehyde as a gas gives promise of being useful, but I am not prepared to express a definite opinion yet for or against it. Drs. ZIMMERMANand HELBING each exhibited apparatus for using formic aldehyde and explained their workings. Dr. RIDEAL desired to add to his remarks at the last meeting a few words as to the density of formic aldehyde in c~mparison with that of sulphurous acid. The relative densities showed that the diffusion of formic aldehyde would be considerably greater than that of sulphurous acid, the ratio being about 3 to 2. The PRZSlDENTsaid he used sulphurous acid and found it satisfactory, but in some cases where he feIt the infection was likely to persist in the furniture and apartments he had ordered the addition of one ounce of corrosive sublimate to every pound of sulphur, the result being, in his opinion, very satisfactory. The Branch was much indebted to the gentlemen who had exhibited their apparatus. Their discussion would be of use because it had brought to their notice a new disinfectant in formic aldehyde, the use of which might prove of the greatest advantage. Dr. ALLEN, in reply expressed the obligations he was under to the gentlemen who had shown them the various
METROPOLITAN
BRANCH.
apparatus and also to Dr. Rideal for the benefit of his chemical e~cperience. He felt very strongly that in a great many instances the stripping anct whitewashing did more good than anything else. In scarlet fever and diphtheria, sulphur might be efficient, tbut even then more good was done with the soap and water and whitewash. They wanted a disinfectant that was so reIiable that they need not strip the paper off the walls. They were not likely to adopt the system of spraying as in Paris. He hoped they might find in formic aldehyde, if they could use it in a simple form, a substitute for sulphur. Dr. LOVETT m o v e d that a cordial vote of thanks be given to Dr. Allan and the visitors who had kindly assisted in the discussion. Dr. YARROW s e c o n d e d the motion, which was put to the meeting and carried unanimously. T h e meeting then p r o c e e d e d to consider the paper on the R e p o r t of the Royal C o m m i s s i o n on Vaccination, read before the Society by Dr. Bond, which had been r e m i t t e d to the branches for consideration. T h e H o n o r a r y Secretary read the M e m o r a n d u m submitted by the Council o f the Society. Dr. YARROW said the extension of the age for compulsory vaccination would increase the difficulties of carrying out the law, as far as L o n d o n was concerned, tenfold. T h e longer the vaccination was postponed the greater was the difficulty in tracing the children. H i s experience was that it was better to vaccinate as early as possible. H e suggested that every medical m a n should be a public vaccinator. I f every medical man vaccinated his own patients there would not be half the objection there was at present. T h a t course would of necessity involve a standard of efficiency. T h e CHAIRMAN suggested the desirability of some resolution being passed expressing the opinion o f the Branch as to the utility of the administration of the vaccination laws being transferred from the guardians to the sanitary authorities. Dr. LOVETT m o v e d " T h a t this Branch is ,of opinion that the carrying out o f public vaccination should be controlled by the sanitary authorities in each district, and that the powers at present exercised by boards of guardians should be transferred to such sanitary authorities who carry out all other measures for the prevention of infectious diseases." T h e motion having b e e n seconded by Dr. YARROW was put to the m e e t i n g and carried unanimously. After s o m e further discussion it was resolved that the consideration of the subject be now adjourned to the next m e e t i n g of the Branch.
WE note with regret that the Public H e a l t h (Scotland) Bill is being sadly mutilated in C o m mons' Committee, and we trust that the Law and Parliamentary C o m m i t t e e of the Incorporated Society will take the m a t t e r under the:r i m m e diate consideration.