PUBLIC HEALTH AT THE LABOUR CONFERENCE.

1319

public health officers. Our only regret is that the Bill does not, as originally intended, include all whole-time officers, and we hope that what Sir Philip Magnus calls the other fifth of the loaf will be forthcoming during an early session of Parliament. THE

sumption, leaves a wide margin for luxury and waste. The public would like some guidance on where and how to

BRONCHO-PNEUMONIA OF OLD PERSONS. THE frequency of pneumonia and broncho-pneumonia as a final cause of death in the aged is well known. Charcot has related how insidious the onset of pneumonia often was amongst the aged inmates of the Salpetriere Hospital at Paris. Drs. G. Roussy and R, Lerouhave recently published an anatomicalpathological investigation on the subject of bronchopneumonia of the aged, founded on the material furnished by their department for old persons at the Hospice Paul Brousse at Villejuif. Amongst 300 post-mortem examinations (1919-21) they found lobar pneumonia in 4 cases and broncho-pneumonia in 162 cases. According to their elaborate macroscopic and microscopic examination of the lungs, there are frequently basal lesions of the nature of chronic arteritis and pulmonary sclerosis playingI an important part in the production of the bronchopneumonic condition. The lesions in question lead to the occurrence of a complete or partial vascular thrombosis, with ischaemia and even necrosis, more or less complete, of the corresponding portion of the A secondary microbic pulmonary parenchyma. infection then takes place, and it is easy to understand that the secondary infection of an infarct in the lungs is more likely to occur than of one in the kidneys or brain. The authors claim that their aspect of the matter enables us to understand the frequency of fatal broncho-pneumonia among bedridden persons, suffering from cerebral arterio-sclerosis. According to them, the idea of hypostatic congestion of the lungs fails to explain why such patients can keep to their beds for years without suffering from pulmonary complications, suddenly to be carried off by fatal broncho-pneumonia. THE

DRY METROPOLIS.

THE Metropolitan Water Board has intimated to the Ministry of Health that in consequence of the prolonged- drought it is necessary at the present time to conserve the water-supplies of the metropolis, and a circular has been issued to sanitary authorities suggesting the restricted use of water for such purposes as flushing sewers or watering streets and recreation grounds. Drought does not strike like lightning and there has been ample warning that London will be short of water this summer. Thames water provides nearly 60 per cent. of the total supply, the Lee coming second with 23 per cent., well-water only yielding the small remainder of 17 per cent. ; and during the month of March the average daily natural flow over Teddington Weir was, in round figures, 890 million gallons, or 1230 million gallons below the daily average of the last 40 years. In the same month the rainfall of the whole Lee basin was under 1 inch, and the months before and since have been equally dry. The river reservoirs with their immense storage capacity of nearly 13 thousand million gallons may seem inexhaustible, but with the normal demand they would give out in 50 days ; and the band of chalk under the London clay, although full of water like a sponge, only yields what the pumps are capable of raising. Not since 1899 has there been any such drought. We are better off now than then, for the precious fluid is no longer vended to us by a number of competing companies with the interests of shareholders to consider, and timely notice of the shortage will havebeen given to the Ministry whose business it is to decide in what directions economy may be practised without danger to the public health. Thirtyeight gallons per head, per day, the normal rate of con1

Annales de Médecine, Paris, 1921, is., pp. 161-196,

save

water if and when the need arises.

Drain-

by water carriage is so automatic and fool-proof, street-cleaning by the sanitary authority so regular, that the average citizen develops little personal sense of responsibility for keeping his city clean and sweet. We confess to some misgiving, however, about the economies suggested for a start. The normal sewer flush may be excessive ; the Ministry of Health doubtless knows that it is. But to limit street watering just when the season of zymotic diarrhoea is beginningIn 1899 no one could that is open to question. define the effect of drought on the public health ; was it the heat, the dirt, or the dryness of the subsoil that was the potent factor ? Wre are not much wiser now ; the spectre of epidemic diarrhoea may again overshadow London should July be hot as well as dry. There may be the same spike on the infant mortality age

chart for 1921 as there was in the hot summer of 1911. Until we have proved that watering the narrow crowded streets does not help to keep away summer diarrhoea are we hardly justified in economising there, rather than on baths and leaky taps. The thoroughfares with a minimum of horse traffic and a top dressing of petrol and lubricating oil may probably be left safely to take care of themselves. _____

PUBLIC HEALTH AT THE LABOUR CONFERENCE. THE British Labour Party with its three million members, who for the most part are trade-unionists and voters, holds its annual conference on June 21st at Brighton. Though the conference sits for only

four days, the agenda paper gives the text of no less than 248 resolutions and amendments, many of them dealing with world politics, diplomatic questions and recondite economic problems, which even the keenest intellects of the day might find it hard to grasp. Only towards the end of the agenda do we reach the question of education, when the Northampton Labour Party is to demand better treatment of school children’s teeth, and complains of the almost total lack of any provision for such serious physical defects as spinal curvature, pigeon chest, and of the insufficiency of nursery schools and open-air schools for delicate children. Twelve proposals on the drink problem all, in one form or another, condemn existing public houses. The Carlisle experiment seems to meet with most approval, the sale of drink only being tolerated where food is provided as well as facilities for social intercourse. Several resolutions demand local option and State control of the On the housing difficulty, the trade in alcohol. executive committee has a resolution denouncing the Government for obstructing, during the last two and a half years, the erection of the half million The Government is new houses it had promised. admonished itself to supply the needed material and thus break up profiteering combinations. The Stepney Trades Council proposes the rationing of house accommodation and the stopping of superfluous house building-namely, luxurious dwellings-while others are forced to live in hovels unfit for human habitation. In regard to old age and other pensions, a number of resolutions are tabled to increase the amounts given, several Trades Councils endorsing a scheme for a State bonus to replace existing organisations for providing subsistence in cases of distress by a national pool collected from the national income at its source. The Poor-law, we imagine, itself disappears in the pool. Demands for better organised and more extensive help to mothers and to widows who have the charge of families are perhaps more Likely to find immediate acceptance. In fact, the endowment of motherhood, on a more or less extended 3cale, has already entered the domain of practical politics. With regard to the Workman’s Compensation Acts, a resolution advocates compensation for accidents on the same basis as that upon which

1320

pensions are granted ; another urges that the schedule of industrial diseases should be extended asthma and other so as to include coal miners’ diseases caused or aggravated by the occupation on which workmen were engaged 12 months before they were disabled. Finally, we notice that the National Union of Ships Stewards, Cooks, Butchers and Bakers have come forward with a demand to be included in the advantages already granted to seamen and firemen. One resolution which deserves to be quoted, runs: " In view of the alarming increase of consumption among seamen, this Conference demands an inquiry into the living accommodation provided on board ships." Such are the principal war

proposals

affecting

appalling length

health,

public

smothered in the midst of and

political complexity. a

unfortunately programme of Laws are of

little avail if they are not understood and approved by the community, and we rejoice that the Labour Party is turning to the study of health legislation. It is to be hoped that by next year the political situation will have so improved as to enable these matters to be more fully discussed than on the present occasion. HEALTH

OF

TROOPS IN THE CAMPAIGN.

PALESTINE

THE POSITION OF THE VOLUNTARY HOSPITALS. REPORT OF LORD CAVE’S COMMITTEE. THE

Report-,

of the Committee

on

Hospital Finance

(Lord Cave’s Committee) appeared last week, when

published the recommendations. We comment these in a leading article. An official summary of the document runs as follows :1. The present financial difficulties of the hospitals The receipts from voluntary are due to the war. subscriptions, donations, and legacies have not fallen off-on the contrary, they have risen by 67 per cent. since 1913. But during the war the cost of provisions,, drugs, dressings, fuel, and labour has increased to such an extent that the expenditure of the hospitals has increased by IR8 per cent. since 1913. The aggregate deficits of all the voluntary hospitals of Great Britain for the present year are estimated at we on

s.1,000,000 (para. 8). 2. The

voluntary system is, therefore, temporarily jeopardy. The Committee ask, Is the voluntary system worth saving ? " and their conclusion is,. " Weare convinced that it is." Apart from the immense sum of voluntary subscriptions and donations (estimated at £3,000,000 a year), the voluntary system secures gratuitous and skilled service, both lay and medical, of inestimable value. It preserves. freedom in medicine, and is of incalculable advantage to the welfare of the sick, the training of the medical profession, and the progress of medical research. The breakdown of the voluntary system would imperil these services and impose a constantly growing charge upon public funds (para. 15). 3. The Committee are of opinion that if the voluntary hospitals are to be saved immediate assistance must be given by the State, such assistance to be strictly limited to a definite period of two years, and to be given only to hospitals which show that they are taking all possible steps to re-establish their financial position. A grant so limited and conditioned would re-establish the hospitals in the self-supporting position which they occupied before the war, and would in

"

General Liman von Sanders, in his apolog y’ for the defeat in 1918 of the Turkish Army Group which he commanded in Palestine, urges in extenuation that " there was a great epidemic of disease during the summer months, malaria and dysentery taking a heavy toll of the armies." It was known this must have been so, but it is satisfactory to haveit stated by authority, and it shows that in this, as in all wars, a medical service which is ineffective lowers the fighting efficiency of the troops it is supposed to serve. Further, the statement supports the opinion we have already expressed that Lord Allenby’s skilfully planned and magnificently successful operations on Sept. 19th, 19.18, could not have been set going-there would not have been the troops to make them possible-but for the excellent work of the Royal Army Medical Corps, which planned the anti-malarial measures in the Auja Valley, and not be inconsistent with the maintenance of the voluntary system (para. 16). so kept the loss of strength from malarial fevers in 4. The Committee draw attention to a number of Palestine, in the worst sector, down to 10 per cent. of the troops in the four months preceding the great steps which managers of voluntary hospitals can themselves take to improve the financial position of attack. the hospitals under their charge—e.g., review of expenditure, particularly in the light of comparative THE Census, which was postponed last April, will costs which could be ascertained by the general The names of be taken next Sunday, June 19th. of a uniform system of accounts (paras. adoption those dying before midnight on Sunday or born after 24 and 25) ; cooperative buying of drugs, apparatus, midnight must be omitted. stores, and some kinds of provisions (para. 26) ; removal of convalescent cases to auxiliary hospitals 27) ; coordination of appeals for subscriptions THE William Gibson Research Scholarship (Second (para. 28) ; further development of new sources of (para. Award) for medical women has been awarded by the income, such as subscriptions from wage-earners and Council of the Roval Society of Medicine to Miss employers, and other contributory schemes, examples Gertrude M. A. Herzfeld, F.R’.C.S. Edin. of which are quoted in the Report (paras. 29 to 40) ; contributions from Approved Societies (para: 43). 5. To give effect to the temporary State assistance THE first British Congress of Obstetrics and Gynaethe Committee make the following recommendain held cology, Birmingham on June 3rd and 4th, tions :was attended by delegates from societies in Edinburgh, (1), (2) That a Hospitals Commission and Voluntary Glasgow, the Midlands, the -North of England, as well Hospitals Committees be formed for the country as a as from the Royal Society of Medicine. We hope to the King Edward’s Hospital Fund for London whole, notice of this --

give an extended

very successful

meeting.

continuing to perform the functions of the latter for the Metropolitan Police District. (3), (4) That Poor-law guardians be authorised to enter THE annual general meeting of the Research into arrangements as to the use of infirmaries, and that Defence Society will be held at the house of the county councils be empowered to contribute to the expenses Medical Society of London, 11, Chandos-street, of voluntary hospitals committees. (5) That failing the provision in the National Health Cavendish-square, London, on Wednesday, June Insurance Acts of a " hospital benefit," the courts be 29th, under the presidency of Lord Lamington. A authorised to award to hospitals compensation under short address will be given by Dr. H. H. Dale, C.B.E., the Employers’ Liability and Workmen’s Compensation F.R.S., on the Work of the National Institute forActs. Medical Research. (6) That local authorities be authorised to pay the cost of the treatment in hospitals of persons in their employ. Journal of the Royal United Service Institution, May, (7) That the payment out of technical education funds of grants for the training of nurses be considered. 1921, p. 327. 1