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Proceedings of the West of England and South Wales Branch of the incorporated society of medical officers of health
PROCEEDINGS
WEST OF
ENGLAND
Dr. WIOHTWmK desired to explain that he was not opposed to compulsory vaccination if it was really compulsory--if they could carry it out, as, for instance, it was in Germany. The PRESIDENT said his experience agreed very much with Dr. Vacher's, and he also endorsed what had been said as to the operation being considered a serious o n e ; or if not sermus, as the public generally regarded that word, then as an important one which ought to be undertaken with proper antiseptic precautions. With regard to compulsion, he thought they could not at present afford to do without it ; and he emphasized strongly a remark made by Dr. Willoughby that revaccination should also be compulsory. H e was also of opinion that the certificates of successful vaccinations should specify the number and area of wellmarked cicatrices. Dr. S~A:rON, in reply, stated that he was very glad to have heard the opinion expressed by the President on the subject of compulsion. Coming as it did from the President of that society, it would no doubt carry very great weight. They would, however, remember that in his opening observations he had very carefully kept free from the subject the Royal Commission had to decide. H e took it that they might have discussed the subject outside the question of compulsion. H e did not think it was a matter for discussion at that meeting. I I e was afraid if they were to discuss that question, and Dr. Haughton gave them the pleasure of his company they would have to extend the discussion over a great many evenings. With regard to the question of the seriousness (in the sense of importance) of the operation raised by Dr. Wightwick, he was glad to know that at the present time a great deal more attention was given to the subject of vaccination in the medical schools than heretofore. Referring to the question of revaecination, Dr. Seaton read the following extract from the article from which he had already quoted in his opening speech : " While adhering generally to the recommendations of Dr. Seaton respecting ' revaccination at puberty ' as a practice, the present writer (Dr. Edward Seaton) would draw attention to the very important effects produced in this country by able sanitary administration, combined with the 'systematic notification of infectious diseases.' By the help of this system, which is now generally adopted by sanitary authorities throughout Great Britain, it should be easy, as the present writer knows from experience, for sanitary authorities to prevent the spread of small-pox. Alway s assuming our present system of compulsory vaccination to be maintained, spread of small-pox may be checked by isolation of the sick in hospitals, and by freely offering opportunities for revaccination of the best kind when and where it is most needed. U n d e r these conditions revaccination, as a practice, may be safely left to the age of puberty, the sanitary authorities being relied
AND SOUTH
WALES
BRANCH.
~69
upon to give special warning of danger from smallpox to persons concerned. The period of puberty is, on the whole, most suitable for revaceination, inasmuch as at later periods of life loss of valuable time may sometimes be entailed by the sore arm which occasionally follows the operation." Dr. Seaton thought with Dr. Littlejohn that compu!sion was no doubt one of the means of education in this subject, and was a means which'ought nevec to be lost sight of. H e would again remind them that he had not led the discussion in the direction as to whether compulsion was desirable or not. PROCEEDINGS OF THE WEST OF ENGLAND AND SOUTH WALES BRANCH OF THE INCORPORATED SOCIETY OF MEDICAL OFFICERS OF HEALTH. A ~ ~ETINGof the above branch was h old at the offices of the Sanitary Authority, Prince Street, Bristol, on January xxth. Present : Drs. D. S. Davies, E. Davies, Bond, Brabazon, Heaven, Parry, Crossman, and Dowson, and Messrs. F. W. Stoddart, and J. Cooke Hurle. After the confirmation of the minutes of the last meeting, Dr. Walter Dowson, D P . H , of Bristol, was duly elected a member of the branch, and Mr. Joseph Larke Wheatley, Town Clerk of Cardiff, was elected an associate. Dr. J. T. Hyatt, Shepton Mallet, proposed, and Dr.Brabazon seconded the name of Dr. Frederick Stockwel], M.O.H. Wincanton Rural S . A , as a Fellow. The next item on the agenda was a resolution to be proposed by Dr. Sheen, of Cardiff, " T h a t the bye-law, fixing the branch subscription at 3 s. 6d. per annum, be altered re read 2s. 6d." I n the absence of Dr. Sheen, the resolution was moved by Dr. Crossman, in order that the opinion of the meeting might be taken on the matter. Dr. Parry was the seconder. The President-elect requested the treasurer to inform the meeting as to the financial position of the branch, and the probable expenditure during the present year ; after hearing the statement Dr. Brabazon moved as an amendment, " T h a t it is not expedient to make any alteration in the subscription for this year." This amendment was duly seconded, put to the meeting, and carried. Dr. 131~ABAZON,Bath, then put a few points before the meeting, with reference to the words, "nuisance or injurious to health." Was the word " o r " entirely disjunctive ? If so, then it seemed to be the duty of the medical officer to advise hm authority to take action for common nuisances whether affecting health or not. H e instanced a case where great pressure was brought to bear to induce h i m to condemn, as a nuisance to be dealt with by the authority, a collection of matter, which, though occasionally offensive, could not be said to
I7o
PROCEEDINGS
OF T H E N O R T H - W E S T E R N
be injurious to health. H e would be glad to hear the views of members on the question. A discussion followed, in which Mr. J. Cooke Hurle, Dr. Bond, Dr. E. Davies, and others took part. Dr. BOND mentioned the ease where the word " o r " was decided to mean " a n d . " Since then many cases bad been decided that "nuisance o r " is correct. He thought, however, that for a sanitary authority to take action the nuisance should be one which affects the public health, though it may not be absolutely "injurious." It would be sufficient for the thing complained of to be a possible source of danger, and many nuisances were constantly dealt with which, though not at the time absolutely injurious to health, were still contingent sources of danger. H e thought it was the duty of the authority to take cognizance of, and deal with, all matters affecting the comfort of the public, but he was not sure that it was their duty to d~ so when it was only the comfort of the individual which was affected. Dr. D. S. DAVIES was of opinion that such slight nuisances as burning coke, decaying vegetable matters, etc., which may affect comfort, and to some extent health, by leading to taste in the mouth, loss of appetite, etc., should be dealt with, although not producing definite disease. Some of the matters which authorities were asked to deal with were quite beyond their powers, as when gravely requested to prevent noise from persons turning out of publics, or, as in one case where a third illegitimate child had been born in a house, and the authority was asked to prevent a repetition of such an occurrence. Dr. E. DAVIES remarked that evidently it was not necessary that a nuisance should be "injurious" before action was taken, because it is penal to keep any swine or pigstye in any dwelling house (in an urban district) "~o as to be a nuisance to any person." Dr. BRABAZOS thanked the members /or their expression of opinion, and would be inclined to take a less restricted view of the matter in future. H e further said he should be glad to see the word "dangerous" substituted for "injurious" (as in the London Public Health Act), as clearing the ground considerably. By consent of those present, Mr. F. W. Stoddart's paper on "Some Points in Water Analysis" was deferred till the next meeting, in order that discussion might not be curtailed. After deciding that the next meeting should be at Cardiff on the first Thursday in April at three p.m., the meeting terminated. CoPIEs OF TRANSACTIONS OF SOCIETY of Medical Officers of Health for x886- 7 will be purchased by Dr. Wightwick, Hen. Sec. (to whom communications on the subject should be addressed), for full price.
BRANCH.
P R O C E E D I N G S OF T H E N O R T H - W E S T E R N B R A N C H OF T H E I N C O R P O R A T E D S O C I E T Y OF M E D I C A L O F F I C E R S Oh" HEALTH. THE ordinary meeting of this branch was held at the rooms of the Chemical Club, Manchester, on Friday, February 9th, at four p.m. Present : Drs. Paget (president), Adams, Anderson, Armitage, J. Barr, Edlin, Etches, Gornall, Hannah, Niven, Park, Porter, Sidebotham, Vacher, and Wheatley. A letter was read from Dr. Sergeant, regretting his inability to be present, and enclosing some printed slips of his " N o t e s on the Isolation Hospitals Act, ~893," which were distributed among the memberg. A letter was read from the hen. secretary of the Birmingham and Midland Branch, stating that " a t the last meeting of the council of this branch it was unanimously resolved that, in the opinion of this council, the relation of the branches to the society as a whole calls for reconsideration, and that a sub-committee be appointed to invite the views of the other branch councils on the question." In forwarding this resolution the writer was " empowered to suggest that a meeting of such subcommittee might be held in a central place, and the points which call for consideration discussed in detail." The HeN. SECRETARYsaid he thought it better to submit this letter from the Birmingham and Midland Branch at an ordinary meeting of the North-Western Branch, though it appeared to be addressed to the council. It was proposed by Dr. GORNALL, and seconded by Dr. ARMITAGE, that the formation of a subcommittee for the purpose suggested be approved of, and that the president, treasurer, and hen. secretary be appointed as delegates to act on the said sub-committee. This was agreed to unanimously. The PRESIDENT then briefly drew attention to the recent distinction gained by two members and past presidents of the branch. Since the last monthly meeting of the branch two important appointments had been made. Medical officers of health had been appointed for Liverpool and Manchester. The gentlemen elected, Dr. H o p e and Dr. Niven, were well known to the profession. Their work had placed them where they ought to be. All would congratulate them, and the branch was to be congratulated on having them as members. The President then called upon Dr. Anderson to open the discussion on THE
ADMINISTRATION OF SMALL INFECTIOUS DISEASES HOSPITALS. By A. JASPER ANDERSON, M.A., M.B., NI.O.H. Blackpool.
My object is to bring prominently a few subjects to the front for thorough discussion. The subject is one of very great practical importance to all
WEST OF
ENGLAND
Dr. WIOHTWmK desired to explain that he was not opposed to compulsory vaccination if it was really compulsory--if they could carry it out, as, for instance, it was in Germany. The PRESIDENT said his experience agreed very much with Dr. Vacher's, and he also endorsed what had been said as to the operation being considered a serious o n e ; or if not sermus, as the public generally regarded that word, then as an important one which ought to be undertaken with proper antiseptic precautions. With regard to compulsion, he thought they could not at present afford to do without it ; and he emphasized strongly a remark made by Dr. Willoughby that revaccination should also be compulsory. H e was also of opinion that the certificates of successful vaccinations should specify the number and area of wellmarked cicatrices. Dr. S~A:rON, in reply, stated that he was very glad to have heard the opinion expressed by the President on the subject of compulsion. Coming as it did from the President of that society, it would no doubt carry very great weight. They would, however, remember that in his opening observations he had very carefully kept free from the subject the Royal Commission had to decide. H e took it that they might have discussed the subject outside the question of compulsion. H e did not think it was a matter for discussion at that meeting. I I e was afraid if they were to discuss that question, and Dr. Haughton gave them the pleasure of his company they would have to extend the discussion over a great many evenings. With regard to the question of the seriousness (in the sense of importance) of the operation raised by Dr. Wightwick, he was glad to know that at the present time a great deal more attention was given to the subject of vaccination in the medical schools than heretofore. Referring to the question of revaecination, Dr. Seaton read the following extract from the article from which he had already quoted in his opening speech : " While adhering generally to the recommendations of Dr. Seaton respecting ' revaccination at puberty ' as a practice, the present writer (Dr. Edward Seaton) would draw attention to the very important effects produced in this country by able sanitary administration, combined with the 'systematic notification of infectious diseases.' By the help of this system, which is now generally adopted by sanitary authorities throughout Great Britain, it should be easy, as the present writer knows from experience, for sanitary authorities to prevent the spread of small-pox. Alway s assuming our present system of compulsory vaccination to be maintained, spread of small-pox may be checked by isolation of the sick in hospitals, and by freely offering opportunities for revaccination of the best kind when and where it is most needed. U n d e r these conditions revaccination, as a practice, may be safely left to the age of puberty, the sanitary authorities being relied
AND SOUTH
WALES
BRANCH.
~69
upon to give special warning of danger from smallpox to persons concerned. The period of puberty is, on the whole, most suitable for revaceination, inasmuch as at later periods of life loss of valuable time may sometimes be entailed by the sore arm which occasionally follows the operation." Dr. Seaton thought with Dr. Littlejohn that compu!sion was no doubt one of the means of education in this subject, and was a means which'ought nevec to be lost sight of. H e would again remind them that he had not led the discussion in the direction as to whether compulsion was desirable or not. PROCEEDINGS OF THE WEST OF ENGLAND AND SOUTH WALES BRANCH OF THE INCORPORATED SOCIETY OF MEDICAL OFFICERS OF HEALTH. A ~ ~ETINGof the above branch was h old at the offices of the Sanitary Authority, Prince Street, Bristol, on January xxth. Present : Drs. D. S. Davies, E. Davies, Bond, Brabazon, Heaven, Parry, Crossman, and Dowson, and Messrs. F. W. Stoddart, and J. Cooke Hurle. After the confirmation of the minutes of the last meeting, Dr. Walter Dowson, D P . H , of Bristol, was duly elected a member of the branch, and Mr. Joseph Larke Wheatley, Town Clerk of Cardiff, was elected an associate. Dr. J. T. Hyatt, Shepton Mallet, proposed, and Dr.Brabazon seconded the name of Dr. Frederick Stockwel], M.O.H. Wincanton Rural S . A , as a Fellow. The next item on the agenda was a resolution to be proposed by Dr. Sheen, of Cardiff, " T h a t the bye-law, fixing the branch subscription at 3 s. 6d. per annum, be altered re read 2s. 6d." I n the absence of Dr. Sheen, the resolution was moved by Dr. Crossman, in order that the opinion of the meeting might be taken on the matter. Dr. Parry was the seconder. The President-elect requested the treasurer to inform the meeting as to the financial position of the branch, and the probable expenditure during the present year ; after hearing the statement Dr. Brabazon moved as an amendment, " T h a t it is not expedient to make any alteration in the subscription for this year." This amendment was duly seconded, put to the meeting, and carried. Dr. 131~ABAZON,Bath, then put a few points before the meeting, with reference to the words, "nuisance or injurious to health." Was the word " o r " entirely disjunctive ? If so, then it seemed to be the duty of the medical officer to advise hm authority to take action for common nuisances whether affecting health or not. H e instanced a case where great pressure was brought to bear to induce h i m to condemn, as a nuisance to be dealt with by the authority, a collection of matter, which, though occasionally offensive, could not be said to
I7o
PROCEEDINGS
OF T H E N O R T H - W E S T E R N
be injurious to health. H e would be glad to hear the views of members on the question. A discussion followed, in which Mr. J. Cooke Hurle, Dr. Bond, Dr. E. Davies, and others took part. Dr. BOND mentioned the ease where the word " o r " was decided to mean " a n d . " Since then many cases bad been decided that "nuisance o r " is correct. He thought, however, that for a sanitary authority to take action the nuisance should be one which affects the public health, though it may not be absolutely "injurious." It would be sufficient for the thing complained of to be a possible source of danger, and many nuisances were constantly dealt with which, though not at the time absolutely injurious to health, were still contingent sources of danger. H e thought it was the duty of the authority to take cognizance of, and deal with, all matters affecting the comfort of the public, but he was not sure that it was their duty to d~ so when it was only the comfort of the individual which was affected. Dr. D. S. DAVIES was of opinion that such slight nuisances as burning coke, decaying vegetable matters, etc., which may affect comfort, and to some extent health, by leading to taste in the mouth, loss of appetite, etc., should be dealt with, although not producing definite disease. Some of the matters which authorities were asked to deal with were quite beyond their powers, as when gravely requested to prevent noise from persons turning out of publics, or, as in one case where a third illegitimate child had been born in a house, and the authority was asked to prevent a repetition of such an occurrence. Dr. E. DAVIES remarked that evidently it was not necessary that a nuisance should be "injurious" before action was taken, because it is penal to keep any swine or pigstye in any dwelling house (in an urban district) "~o as to be a nuisance to any person." Dr. BRABAZOS thanked the members /or their expression of opinion, and would be inclined to take a less restricted view of the matter in future. H e further said he should be glad to see the word "dangerous" substituted for "injurious" (as in the London Public Health Act), as clearing the ground considerably. By consent of those present, Mr. F. W. Stoddart's paper on "Some Points in Water Analysis" was deferred till the next meeting, in order that discussion might not be curtailed. After deciding that the next meeting should be at Cardiff on the first Thursday in April at three p.m., the meeting terminated. CoPIEs OF TRANSACTIONS OF SOCIETY of Medical Officers of Health for x886- 7 will be purchased by Dr. Wightwick, Hen. Sec. (to whom communications on the subject should be addressed), for full price.
BRANCH.
P R O C E E D I N G S OF T H E N O R T H - W E S T E R N B R A N C H OF T H E I N C O R P O R A T E D S O C I E T Y OF M E D I C A L O F F I C E R S Oh" HEALTH. THE ordinary meeting of this branch was held at the rooms of the Chemical Club, Manchester, on Friday, February 9th, at four p.m. Present : Drs. Paget (president), Adams, Anderson, Armitage, J. Barr, Edlin, Etches, Gornall, Hannah, Niven, Park, Porter, Sidebotham, Vacher, and Wheatley. A letter was read from Dr. Sergeant, regretting his inability to be present, and enclosing some printed slips of his " N o t e s on the Isolation Hospitals Act, ~893," which were distributed among the memberg. A letter was read from the hen. secretary of the Birmingham and Midland Branch, stating that " a t the last meeting of the council of this branch it was unanimously resolved that, in the opinion of this council, the relation of the branches to the society as a whole calls for reconsideration, and that a sub-committee be appointed to invite the views of the other branch councils on the question." In forwarding this resolution the writer was " empowered to suggest that a meeting of such subcommittee might be held in a central place, and the points which call for consideration discussed in detail." The HeN. SECRETARYsaid he thought it better to submit this letter from the Birmingham and Midland Branch at an ordinary meeting of the North-Western Branch, though it appeared to be addressed to the council. It was proposed by Dr. GORNALL, and seconded by Dr. ARMITAGE, that the formation of a subcommittee for the purpose suggested be approved of, and that the president, treasurer, and hen. secretary be appointed as delegates to act on the said sub-committee. This was agreed to unanimously. The PRESIDENT then briefly drew attention to the recent distinction gained by two members and past presidents of the branch. Since the last monthly meeting of the branch two important appointments had been made. Medical officers of health had been appointed for Liverpool and Manchester. The gentlemen elected, Dr. H o p e and Dr. Niven, were well known to the profession. Their work had placed them where they ought to be. All would congratulate them, and the branch was to be congratulated on having them as members. The President then called upon Dr. Anderson to open the discussion on THE
ADMINISTRATION OF SMALL INFECTIOUS DISEASES HOSPITALS. By A. JASPER ANDERSON, M.A., M.B., NI.O.H. Blackpool.
My object is to bring prominently a few subjects to the front for thorough discussion. The subject is one of very great practical importance to all