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PUBLIC HEALTH IN BOMBAY.
1351 one category those who remained with their parents and in another those who were taken away from them. Another point to inquire into would be, What became of children born of decidedly delicate but not tuberculous parents ? Did such parents transmit to their children a special predisposition to tuberculosis. Individuals living in tuberculous surroundings and remaining perfectly healthy should be examined in relation to their family history and their general circumstances and habits of life. Further information might be gained by noting the life-history of people whose bodies after death showed no trace of tuberculosis. Infants and elder children born of a tuberculous stock should be injected with tuberculin and the results recorded, notice being directed to the point as to whether such infants were suckled by the mother or were brought up by hand. In cases of deaths of individuals, apparently not tuberculous, taking place during the critical age (from 17 to 20 years) as a result of accident, infectious if disease or other malady not tuberculous, the lymphatic glands should be examined as to evidences of tuberculosis. Special attention should be paid to the tonsils. Children who have suffered from adenoids should be kept under observation with a view to observe any possible relation with tuberculosis. Another question requiring " answer was, When does the " habitus phthisicus develop ? A comparative table should be drawn up of the measurements of children at different ages, placing in one class children of healthy ancestry and in another those with a history of tuberculous parentage. The relation of chlorosis to tuberculosis was another matter requiring
investigation.
PUBLIC HEALTH IN BOMBAY. IN his annual report for the year 1904 Dr. J. A. Turner, executive health officer of the municipality of Bombay, commences with the statements that the population of the city, estimated by the census of 1901, was 776,006, and that the area of the city and the island of Bombay is 22’ 45 square miles. The number of births registered during 1904 was 19,556 ; this is the highest number ever registered in Bombay and gives a general birth-rate of 25’ 20 per 1000 of the population. In the classification of the population according to religion and race the highest birth-rate-namely, 40’21 per 1000-occurred among the Jains who number only 14,248, or less than one-fiftieth of the general population ; the proportion of Europeans is smaller still, the
total number being 12,273, and the birth-rate among them was 14-74 per 1000. The number of deaths during 1904, exclusive of stillborn children, was 42,676, giving an annual death-rate of 54’ 99 per 1000 of population, which was the ’i The number of deaths from lowest mortality since 1897. the 12 principal zymotic diseases was 18,397, being 8892 less than in the previous year and giving a zymotic death-rate of 23’70 per 1000 of population. The deaths attributed to some of the zymotic diseases were as follows : small-pox, 568; measles, 229 ; plague, 13,538 ; enteric fever, 55 ; malarial fever, 2361 ; cholera, 219 ; dysentery, 921 ; and puerperal septicsemia, 363. In every section of the city there was a decrease in the number of plague deaths during the year. Of the deaths from this cause registered in each month of 1904 the lowest number was 203 in July and the highest was 4098 in March ; the greatest number of deaths from plague on any one day was 187 on April 1st. Several pages of the report are devoted to such questions as the cleansing of house drains, the removal of house and street refuse, horse and cattle stables, bakehouses, the supply of pure milk to the poor, the providing of bathing and washing places, the collection and disposal of night-soil, overcrowding, hospital accommodation and ambulances, and- the measures to be taken against the importation of disease by persons coming from infected districts. Under this last heading Dr. Turner recommends (1) that the names of those who arrive from infected localities and their addresses in Bombay should be furnished to the health department; (2) that any person arriving in Bombay while suffering from plague, cholera, or small-pox should in any circumstances go to a hospital ; and (3) that all the relatives and friendstravelling in contact with the patients should either go for ten days to the camps provided by the municipality or remain under observation in their homes. Under this proposed system
there would be no inspection of railway passengers and no delay in traffic. The routine would be that when a city or town was infected with plague, aholera, or small-pox the passengers leaving the city must be provided with forms in which their names, destination, and address are written in English or vernacular ; this form would be given up at the destination to the railway authorities, who would hand it over to the sanitary authorities. With respect to the control of plague in the city Dr. Turner expresses strong opinions as to the necessity for evacuating overcrowded and infected areas and providing huts and camps for the displaced inhabitants. He, however, complains that the work of the health department is hampered in various ways, chiefly by the Port Trust which wishes to have the existing camps and hospital discontinued. With regard to prophylactic inoculation against plague Dr. Turner saysThe officers of the Plague ResearchLaboratory are perfectly satisfied and have satisfied Government that the fluid now prepared is absolutely sterile and that it confers a greater immunity than previously, and that the inoculation is harmless, and that the operation properly done cannot cause any ill-effects....... In. Bombay during the last eight years the case-rate or the number of persons attacked is 25 per 1000 and the mortality-rate is 85 per cent. of those attacked. The latest inoculation figures give the case-rate amongst the inoculated as 18 per 1000 and the mortality as 23 per cent. of those attacked." He goes on to say that from his personal know-ledge of the people he is sure that unless some great inducement to accept inoculation is offered to them very little can be done. He considers that a sufficient inducement might be constituted by a system of life insurance in accordancewith which the Government would pay 100 rupees to the nearest relatives of inoculated persons who die from plaguewithin one year after inoculation. In one of the appendices to Dr. Turner’s report Dr. N. H. Choksy, the special assistant health officer, devotes considerable space to a criticism of certain views on the patho-logy of plague propounded by Dr. William Hunter of Hong-Kong. With regard to the treatment of the diseaseDr. Choksy describes the results obtained in Bombay by the employment of carbolic acid, izal, adrenalin chloride, and five various serums. Of all these adrenalin seemed to be the most useful ; among 668 cases treated with it there were 463 deaths, or a mortality of 69’ 3 per cent. In another appendix on the treatment of cholera Dr. Choksy speaks favourably of the administration of cyanide of mercury as suggested by Dr. A. Mayr in 1900. The cyanide is given in doses of one-tenth of a grain dissolved in an ounce of water with a little simple syrup. This is repeated every two or three hours according to the frequency of the motions until they cease. If the patient is in the collapsestage with infrequent motions only a few doses are required. Rectal injections, consisting of a pint of warm water to which are added a drachm of sodium chloride and one and ahalf drachms of sodium bicarbonate, are given at intervals varying from four to six hours, every effort being made to prevent rapid expulsion by elevating the hips, raising the these injections are rapidly absorbed foot of the bed, &c. ; and the secretion of urine is quickly re-established. No alcohol is given : the only food allowed is hot strong black coffee without milk or sugar.
THE ADMINISTRATION OF POOR-LAW INFIRMARIES. ONE of the principal subjects discussed at the annual of the North Midland Poor-law Conference at Leicester on Oct. 18th and 19th had reference to the administration of the Poor-law infirmaries. Dr. JOHN DODD, the medical officer at Leicester workhouse infirmary, who introduced the subject, said it had always been the custom and practice to look on Poorlaw infirmaries as places for the aged and sick to die in. The position was this,-Was a town which spent, say, between ,86000 and .E.7000 a year on an infectious diseases hospital and anything from
meetings
investigation.
PUBLIC HEALTH IN BOMBAY. IN his annual report for the year 1904 Dr. J. A. Turner, executive health officer of the municipality of Bombay, commences with the statements that the population of the city, estimated by the census of 1901, was 776,006, and that the area of the city and the island of Bombay is 22’ 45 square miles. The number of births registered during 1904 was 19,556 ; this is the highest number ever registered in Bombay and gives a general birth-rate of 25’ 20 per 1000 of the population. In the classification of the population according to religion and race the highest birth-rate-namely, 40’21 per 1000-occurred among the Jains who number only 14,248, or less than one-fiftieth of the general population ; the proportion of Europeans is smaller still, the
total number being 12,273, and the birth-rate among them was 14-74 per 1000. The number of deaths during 1904, exclusive of stillborn children, was 42,676, giving an annual death-rate of 54’ 99 per 1000 of population, which was the ’i The number of deaths from lowest mortality since 1897. the 12 principal zymotic diseases was 18,397, being 8892 less than in the previous year and giving a zymotic death-rate of 23’70 per 1000 of population. The deaths attributed to some of the zymotic diseases were as follows : small-pox, 568; measles, 229 ; plague, 13,538 ; enteric fever, 55 ; malarial fever, 2361 ; cholera, 219 ; dysentery, 921 ; and puerperal septicsemia, 363. In every section of the city there was a decrease in the number of plague deaths during the year. Of the deaths from this cause registered in each month of 1904 the lowest number was 203 in July and the highest was 4098 in March ; the greatest number of deaths from plague on any one day was 187 on April 1st. Several pages of the report are devoted to such questions as the cleansing of house drains, the removal of house and street refuse, horse and cattle stables, bakehouses, the supply of pure milk to the poor, the providing of bathing and washing places, the collection and disposal of night-soil, overcrowding, hospital accommodation and ambulances, and- the measures to be taken against the importation of disease by persons coming from infected districts. Under this last heading Dr. Turner recommends (1) that the names of those who arrive from infected localities and their addresses in Bombay should be furnished to the health department; (2) that any person arriving in Bombay while suffering from plague, cholera, or small-pox should in any circumstances go to a hospital ; and (3) that all the relatives and friendstravelling in contact with the patients should either go for ten days to the camps provided by the municipality or remain under observation in their homes. Under this proposed system
there would be no inspection of railway passengers and no delay in traffic. The routine would be that when a city or town was infected with plague, aholera, or small-pox the passengers leaving the city must be provided with forms in which their names, destination, and address are written in English or vernacular ; this form would be given up at the destination to the railway authorities, who would hand it over to the sanitary authorities. With respect to the control of plague in the city Dr. Turner expresses strong opinions as to the necessity for evacuating overcrowded and infected areas and providing huts and camps for the displaced inhabitants. He, however, complains that the work of the health department is hampered in various ways, chiefly by the Port Trust which wishes to have the existing camps and hospital discontinued. With regard to prophylactic inoculation against plague Dr. Turner saysThe officers of the Plague ResearchLaboratory are perfectly satisfied and have satisfied Government that the fluid now prepared is absolutely sterile and that it confers a greater immunity than previously, and that the inoculation is harmless, and that the operation properly done cannot cause any ill-effects....... In. Bombay during the last eight years the case-rate or the number of persons attacked is 25 per 1000 and the mortality-rate is 85 per cent. of those attacked. The latest inoculation figures give the case-rate amongst the inoculated as 18 per 1000 and the mortality as 23 per cent. of those attacked." He goes on to say that from his personal know-ledge of the people he is sure that unless some great inducement to accept inoculation is offered to them very little can be done. He considers that a sufficient inducement might be constituted by a system of life insurance in accordancewith which the Government would pay 100 rupees to the nearest relatives of inoculated persons who die from plaguewithin one year after inoculation. In one of the appendices to Dr. Turner’s report Dr. N. H. Choksy, the special assistant health officer, devotes considerable space to a criticism of certain views on the patho-logy of plague propounded by Dr. William Hunter of Hong-Kong. With regard to the treatment of the diseaseDr. Choksy describes the results obtained in Bombay by the employment of carbolic acid, izal, adrenalin chloride, and five various serums. Of all these adrenalin seemed to be the most useful ; among 668 cases treated with it there were 463 deaths, or a mortality of 69’ 3 per cent. In another appendix on the treatment of cholera Dr. Choksy speaks favourably of the administration of cyanide of mercury as suggested by Dr. A. Mayr in 1900. The cyanide is given in doses of one-tenth of a grain dissolved in an ounce of water with a little simple syrup. This is repeated every two or three hours according to the frequency of the motions until they cease. If the patient is in the collapsestage with infrequent motions only a few doses are required. Rectal injections, consisting of a pint of warm water to which are added a drachm of sodium chloride and one and ahalf drachms of sodium bicarbonate, are given at intervals varying from four to six hours, every effort being made to prevent rapid expulsion by elevating the hips, raising the these injections are rapidly absorbed foot of the bed, &c. ; and the secretion of urine is quickly re-established. No alcohol is given : the only food allowed is hot strong black coffee without milk or sugar.
THE ADMINISTRATION OF POOR-LAW INFIRMARIES. ONE of the principal subjects discussed at the annual of the North Midland Poor-law Conference at Leicester on Oct. 18th and 19th had reference to the administration of the Poor-law infirmaries. Dr. JOHN DODD, the medical officer at Leicester workhouse infirmary, who introduced the subject, said it had always been the custom and practice to look on Poorlaw infirmaries as places for the aged and sick to die in. The position was this,-Was a town which spent, say, between ,86000 and .E.7000 a year on an infectious diseases hospital and anything from
meetings