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PUBLIC HEALTH
1177
PUBLIC HEALTH HEALTH OF SCOTLAND IN 1938 THE laws of Scotland are different from those of England and administered in a different manner, but since the two Local Government Acts of 1929 the dispensation of public health in the two countries has become almost uniform except in housing and maternity and the special medical service of the Highlands and Islands. The annual report of the Department of Health
(Cmd. 5969. Edinburgh: H.M. Stationery
Office. 4s.)
shows that the health of Scotland in 1938 was better in almost all directions than in any previous year of which records are available. The birth-rate was 17-7 against 17-65 in. 1937. In common with all British communities, the lowest birth-rate was recorded in 1933 when it was 17-62. The general death-rate was 12-6. The report contains no commentary on general mortality, but gives full details of infantile, child and maternal mortalities, which with the mortality from infections are the chief variables in the mortality table. Infantile mortality was 70 per 1000 births, the lowest recorded in Scotland and a substantial improvement on the previous low record of 76-8 in 1935. The rate is still unfavourable compared with that of England and Wales, which was 53 in 1937, but the reduction of the rate in Glasgow to 87 from 104 in 1937 and in Dundee to 77 from 87 are highly promising, particularly that of Glasgow, which contains over a fifth of the total population of all Scotland and has never previously had an infantile-mortality rate below 101. The maternal mortality was 4-9, a rise of one point above that of 1937. In Scotland as in England the variations in maternal mortality are now mainly dependent on the fatality of puerperal sepsis which in the last few years has fallen greatly. A table of the mortality of school-children aged 5-14 shows a decline to 1-9 per 1000 for those aged 5-9 and to 1-3 for those aged 10-14. The three chief causes of death of school-children are tuberculosis, diphtheria and violence, all approximately equal in their toll and together causing 45 per cent. of all child deaths. Then follow appendicitis, heartdisease and pneumonia, roughly equal in toll, and causing about a third of the deaths in the first group. Of these six major killing diseases of children, tuberculosis is the only one that falls consistently.
Nearly 104,000.persons were notified as suffering from infectious diseases in Scotland in 1937. Outstanding features in the year’s epidemiology were high incidence of measles with 26,948 notifications and 549 deaths ; high incidence of diphtheria with 10,786 notifications and 430 deaths ; the serious outbreak of enteric fever at Hawick ; high incidence of Sonne dysentery in the early part of the year; and a low level for tuberculosis. Diphtheria is the blackest spot, for we know this can be almost abolished, yet immunisation makes little or no progress in Scotland. The notifications of dysentery totalled 2648, of which 45 per cent. occurred in the first quarter. A pandemic of Sonne dysentery spread over all Europe and most other parts of the world in 1937-38. No fatality of any consequence was reported from anywhere and in general it was so mild that probably nine out of ten of the cases escaped notification. The outbreak of enteric fever in the burgh of Hawick is the subject of a special report in the appendix. The disease was true typhoid (eberthella) and was spread by a carrier through the medium of cream-filled pastries. There were 107
with only 5 deaths. The age-sex distribution extraordinary, more than half the cases being females aged 15-55. The differential incidence gave the key to the solution of the method of spread and probably also accounts for the unusually low fatalityrate (4-67 per cent.). Tuberculosis reached the low level of. 69 deaths per 100,000 population. The mortalities from both respiratory and non-respiratory tuberculosis were low records of 52 and 17 respectively. There were 48 notifications of infective jaundice, but it is doubtful if all were true leptospiral disease. Infective jaundice has been notifiable in Scotland since 1924. At first it chiefly affected miners, or at cases
was
least was first recognised in them, but since 1934 most of the cases have been detected in fish-workers, particularly in Aberdeen. The maternity service of Scotland is, or rather will
be, governed by the Maternity Services (Scotland) Act of 1937 which set up an official midwifery service on different lines from the service in England. Owing to various difficulties and dissensions there has been considerable delay in the service getting into action, but at the end of 1938, of 55 local authorities responsible for submitting schemes, 47 had done so. It appears, however, that only 16 of these have been approved and none is as yet full working. Registration of stillbirths was made compulsory in Scotland in 1938. The report for 1938 starts with a long chapter on housing, which is far more difficult in Scotland than in England. Since 1919 the number of state-aided houses built amounted to 246,832, but another quarter of a million are required before the working classes can be reasonably well housed. In 1937 the local authorities completed 19,160 houses, a satisfactory increase on the figures of the previous year which reflects the easing of the many difficulties housing in Scotland has had to face. Housing in the remoter districts is a problem of its own for which special grants from the national exchequer have to be made. National health insurance in Scotland covers 2,244,000 persons exclusive of juveniles. Insurance practice is similar to that in England, but the Scots require fewer bottles of medicine than the English and the Scottish Office issues an annual report on morbidity amongst insured persons. These annual reports are the chief source of information on the general morbidity of the British peoples and are amongst the most valuable annuals published by any Government
department. The number of poor persons in receipt of relief fell in all Scotland from 46 per 1000 in December, 1937, to 45 in December, 1938. The incidence is highest in the Clyde valley, Glasgow heading the list with 82 per 1000 in 1938 against 85 per 1000 in 1937. Transfusion Service in War-time The arrangements to be made for the supply of blood for transfusions in London in war-time are now being worked out, and full details of the scheme will shortly be issued by the British Red Cross Society. The quarterly circular of the London Transfusion Service points out that in its present form the service would cease to exist, as ordinary patients would be transferred to hospitals outside the area. The few emergency cases arising-other than casualties-would receive blood from the store being organised at Cheam for war victims. Existing donors will have the option of enrolling at their local hospitals or of giving blood to one of the four great stores that are being arranged at Luton, Slough, Worcester Park, and Maidstone.
PUBLIC HEALTH HEALTH OF SCOTLAND IN 1938 THE laws of Scotland are different from those of England and administered in a different manner, but since the two Local Government Acts of 1929 the dispensation of public health in the two countries has become almost uniform except in housing and maternity and the special medical service of the Highlands and Islands. The annual report of the Department of Health
(Cmd. 5969. Edinburgh: H.M. Stationery
Office. 4s.)
shows that the health of Scotland in 1938 was better in almost all directions than in any previous year of which records are available. The birth-rate was 17-7 against 17-65 in. 1937. In common with all British communities, the lowest birth-rate was recorded in 1933 when it was 17-62. The general death-rate was 12-6. The report contains no commentary on general mortality, but gives full details of infantile, child and maternal mortalities, which with the mortality from infections are the chief variables in the mortality table. Infantile mortality was 70 per 1000 births, the lowest recorded in Scotland and a substantial improvement on the previous low record of 76-8 in 1935. The rate is still unfavourable compared with that of England and Wales, which was 53 in 1937, but the reduction of the rate in Glasgow to 87 from 104 in 1937 and in Dundee to 77 from 87 are highly promising, particularly that of Glasgow, which contains over a fifth of the total population of all Scotland and has never previously had an infantile-mortality rate below 101. The maternal mortality was 4-9, a rise of one point above that of 1937. In Scotland as in England the variations in maternal mortality are now mainly dependent on the fatality of puerperal sepsis which in the last few years has fallen greatly. A table of the mortality of school-children aged 5-14 shows a decline to 1-9 per 1000 for those aged 5-9 and to 1-3 for those aged 10-14. The three chief causes of death of school-children are tuberculosis, diphtheria and violence, all approximately equal in their toll and together causing 45 per cent. of all child deaths. Then follow appendicitis, heartdisease and pneumonia, roughly equal in toll, and causing about a third of the deaths in the first group. Of these six major killing diseases of children, tuberculosis is the only one that falls consistently.
Nearly 104,000.persons were notified as suffering from infectious diseases in Scotland in 1937. Outstanding features in the year’s epidemiology were high incidence of measles with 26,948 notifications and 549 deaths ; high incidence of diphtheria with 10,786 notifications and 430 deaths ; the serious outbreak of enteric fever at Hawick ; high incidence of Sonne dysentery in the early part of the year; and a low level for tuberculosis. Diphtheria is the blackest spot, for we know this can be almost abolished, yet immunisation makes little or no progress in Scotland. The notifications of dysentery totalled 2648, of which 45 per cent. occurred in the first quarter. A pandemic of Sonne dysentery spread over all Europe and most other parts of the world in 1937-38. No fatality of any consequence was reported from anywhere and in general it was so mild that probably nine out of ten of the cases escaped notification. The outbreak of enteric fever in the burgh of Hawick is the subject of a special report in the appendix. The disease was true typhoid (eberthella) and was spread by a carrier through the medium of cream-filled pastries. There were 107
with only 5 deaths. The age-sex distribution extraordinary, more than half the cases being females aged 15-55. The differential incidence gave the key to the solution of the method of spread and probably also accounts for the unusually low fatalityrate (4-67 per cent.). Tuberculosis reached the low level of. 69 deaths per 100,000 population. The mortalities from both respiratory and non-respiratory tuberculosis were low records of 52 and 17 respectively. There were 48 notifications of infective jaundice, but it is doubtful if all were true leptospiral disease. Infective jaundice has been notifiable in Scotland since 1924. At first it chiefly affected miners, or at cases
was
least was first recognised in them, but since 1934 most of the cases have been detected in fish-workers, particularly in Aberdeen. The maternity service of Scotland is, or rather will
be, governed by the Maternity Services (Scotland) Act of 1937 which set up an official midwifery service on different lines from the service in England. Owing to various difficulties and dissensions there has been considerable delay in the service getting into action, but at the end of 1938, of 55 local authorities responsible for submitting schemes, 47 had done so. It appears, however, that only 16 of these have been approved and none is as yet full working. Registration of stillbirths was made compulsory in Scotland in 1938. The report for 1938 starts with a long chapter on housing, which is far more difficult in Scotland than in England. Since 1919 the number of state-aided houses built amounted to 246,832, but another quarter of a million are required before the working classes can be reasonably well housed. In 1937 the local authorities completed 19,160 houses, a satisfactory increase on the figures of the previous year which reflects the easing of the many difficulties housing in Scotland has had to face. Housing in the remoter districts is a problem of its own for which special grants from the national exchequer have to be made. National health insurance in Scotland covers 2,244,000 persons exclusive of juveniles. Insurance practice is similar to that in England, but the Scots require fewer bottles of medicine than the English and the Scottish Office issues an annual report on morbidity amongst insured persons. These annual reports are the chief source of information on the general morbidity of the British peoples and are amongst the most valuable annuals published by any Government
department. The number of poor persons in receipt of relief fell in all Scotland from 46 per 1000 in December, 1937, to 45 in December, 1938. The incidence is highest in the Clyde valley, Glasgow heading the list with 82 per 1000 in 1938 against 85 per 1000 in 1937. Transfusion Service in War-time The arrangements to be made for the supply of blood for transfusions in London in war-time are now being worked out, and full details of the scheme will shortly be issued by the British Red Cross Society. The quarterly circular of the London Transfusion Service points out that in its present form the service would cease to exist, as ordinary patients would be transferred to hospitals outside the area. The few emergency cases arising-other than casualties-would receive blood from the store being organised at Cheam for war victims. Existing donors will have the option of enrolling at their local hospitals or of giving blood to one of the four great stores that are being arranged at Luton, Slough, Worcester Park, and Maidstone.