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Mr. H. Snell, M.P., questioned the witness to the actual facilities patients enjoyed to make a real complaint privately, especially as five or six visitors were together going round. The witness said encouragement was given to patients REPORTS OF MEDICAL OFFICERS OF HEALTH. to say anything which was on their minds, and this THE following table gives some of the health was not difficult as the majority of the patients statistics for three counties and three boroughs for were seen in their rooms, not in a large place where there were a number of patients. Answering the 1923:asked there was any risk who whether Chairman, that patients might be deterred from making complaints because of possible punishment afterwards, or being made to feel that it might be the worse for them afterwards, he replied that he felt sure that in the three institutions which came into his visitations nothing of the kind occurred. The next witness was Sir James Barr, also a medical visitor, appointed under Section 177 of the Act, in the Liverpool area, to Tue Brook Asylum. He explained that he had performed this function 40 years. He considered that the provisions of the Act were efficacious as a safeguard against the undue detention of patients. The medical proprietor had always been anxious for the recovery of his patients, and he took every suggestion made to him in regard to both treatment and administration. He had not heard a complaint for years, even about diet. Complaints were more common and emphatic from undoubted cases of insanity than from those on the way to recovery, and the only complaints he had were from the first of these, and mostly took the form of objecting to their detention. There Kent. might be a difference of opinion sometimes as to when Dr. Alfred Greenwood draws attention to the effect a recovering patient might be let out. There were of the housing shortage on the birth-rate. six in the institution, young people are prevented from getting marriedMany only about voluntary boarders and but he thought this class should be encouraged. those who do marry have often to live in rooms where If people were to understand clearly that the benefits children are not wanted. The highest infant mortalityof an institution could be had without certification rates among the urban districts in the county were 72 at an earlier and more probably cases would come in Penge and 64 in Chislehurst, while Lydd and Sandcurable stage of their illness. Most of the cases gate had 44 and 43 births respectively and no infant he in under the voluntary gaise regarded deaths. coming The lowest rates after and Sandgate as not properly belonging to that class ; they were were Sandwich 15, Herne Bay 19,Lydd Tenterden 21, and the would be better for certifiable. He thought it 24. Among the rural districts the lowest Ashford judicial authority to see a patient, in preference to rates were 13 in Blean, 25 in Maidstone, 26 in Thanet, telling a patient he could see the judicial authority. and 28 in Tonbridge, while the highest were 77 in He did not see any special advantage in having two 69 in Bridge, 68 in Faversham, and 65 in medical certificates. In reply to Lord Russell, who Tenterden, Cranbrook. For the whole county the infant mortalityasked whether care was take to let the patient know rate was the lowest on record. that it was when the judicial authority was present The notifications of enteric fever totalled 115 as that the opportunity for an appeal against incarceration occurred, he said the point was that the judicial compared with 87 in the previous year. In Rochester city three schoolboys were thought to have contracted authority must satisfy himself that the patient must the disease from eating monkey-nuts spilt into the be detained. of the river near the sewer outfall during the Mr. Snell asked whether the desire of the mud of a cargo. The endeavour to form " care " unloading medical proprietor to cure his patients quickly was and " after-care " committees throughout the county due to hiswish to have a good statistical record. for tuberculous patients is only meeting with partial The witness replied that there was no financial reason In many districts the attitude adopted success. as there were new against it, always plenty of patients. towards the movement is that this is the business When a man was approaching the stage of conof the State, that it is difficult to raise the necessary his was attention drawn the fact to valescence, funds, and that such committees cannot find employby the medical proprietor. ment. The county tuberculosis scheme does not Answering Mrs. Mathers, the witness said that include the home nursing of tuberculous patients. difficulty was sometimes experienced in getting Dental treatment, ancillary nourishment, and surgical relatives to undertake to look after patients on their appliances are provided in cases where the financial discharge from the institution. circumstances of the patient are insufficient. There Sir Humphry Rolleston, dealing with the protec- are 87 open-air shelters in use and these are much tion to medical men certifying which the witness appreciated. They were used last year by 129 patients, wished to have increased by law, asked whether and particular care is paid to the suitability of the Sir James Barr had any suggestions to offer. site chosen for the shelter. Thirty-one cases from In reply, the witness said he had no specific recom- Kent were admitted to various vocational training mendations, but at present medical men felt so strongly colonies during the year; and 29 patients were on the matter that unless a man or woman were discharged, of whom only 11 completed their course palpably and dangerously insane they could not be of training. The opinions of the tuberculosis officers got to certify. They felt they might be liable at any in the county vary considerably as to the benefits time to have to withstand an action at law. He of sanatorium treatment as at present carried out. added that he would prefer the mechanism for dealing Dr. F. J. Pierce, medical officer of Lenham Sanatorium, with incipient cases to be attached to the mental speaks of the useful work done by the training section Two trades are taught-namely, hospital, in preference to a general hospital, such as at Lenham. the Liverpool Royal Infirmary; it would be more furniture repairing and upholstery, and general house specialised, and the surroundings and atmosphere repairs. Of the 49 men discharged from Lenham would be quieter and more congenial. during the year 30 completed the 12 months’ course
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of training and were found to be adapted to the new They are as follows :-trade and in several instances exceptionally capable Pence. Maternity and child welfare .... 2’427 workmen were turned out. The training section have 0’218 Venereal diseases ........ effected a valuable improvement by the completion 4’783 Tuberculosis ........ of a verandah for the west wing of the sanatorium. 0’711 General public health Mental deficiency .. 0’844 Commenting on the high death-rate from cancer, 2’623 Medical inspection of school-children .. Dr. Greenwood says this disease may be now said to ’, have usurped the title formerly bestowed on tuber- ’ Total..., .,11’076 culosis-" the white man’s scourge." A study of the table for the six districts confirms this dictum. There are only nine other counties in England and Details are given of the efforts made to coordinate Wales, he says, where the total cost of these public The medical services is lower than in Cheshire. cancer research by the institution of the British Empire Cancer Campaign in the early part of the county has at present six county midwives who receive a grant of £60 per annum and keep their year. Dr. W. L. Cassells, the whole-time V.D. medical own fees. The grant is given to enable a midwife to officer, gives a hopeful report on the work. He settle in an area where there is no trained midwife thinks the work of the clinics is largely responsible practising and is withdrawn when she has a practice Of the 250 practising A con- sufficient to support herself. for the decrease in the number of new cases. siderable number of congenital cases have been sent midwives J81 are trained and 69 are untrained. to the clinics as the result of lectures given during Twenty-six of them cannot take the’temperature or the summer to the nurses, midwives, and health pulse of their patients. The number of cases of visitors, on the signs and symptoms of venereal ophthalmia has steadily lessened since each midwife The attendances at the clinics show an was provided with collosol argentum in a drop-bottle. disease. increase largely owing to the better facilities for the Of the 56 cases of ophthalmia, four severe cases were intermediate treatment of gonorrhoea. The list of treated in hospital and a nurse was engaged to attend general practitioners approved for " arsenobenzol " four other cases at home. All the cases are said to treatment now contains 86 names. The work of the have recovered without any scar or injury to sight. county pathological laboratory increases steadily, and Building activity has been moderately well mainan experimental branch was established during the tained, and there is a tendency to urbanisation in year at Sheerness. The laboratory has been approved many parts of the Wirral rural district. for official examinations of Grade A and certified Very few local authorities have put into operation milks. A large variety of work is carried out, the full powers conferred by the Milk and Dairies including the examination of tissue sections and bloodleave a great deal to be inspected by Dr. sugar tests. desired in the matter of cubic space ventilation and Essex. cleanliness. Very few local authorities have initiated Dr. W. A. Bullough refers to the bad reputation for the detection of tuberculosis in cattle. which Essex " seems to possess " with regard to any system Dr. Young points out that the medical officer of a tetanus. " A London coroner, in August, stated that in the case of a milk-borne outbreak, is about a dozen deaths from lockjaw, which had been large town, put in a difficult position by the fact that the milk brought to his notice within the last two years, had may be a mixture of milks from a score or more of all come from Essex." The heavily manured marketIn the case of a recent outbreak in a metrofarms. garden land round about Barking, Romford, &c., borough the suspected milk came from Dr. Bullough has seems to be indicated by rumour. 100 different farms. Dr. Young thinks it would be been investigating. He finds that the deaths from an immense help to such a medical officer if he were tetanus in Essex during the four years 1918-21 able to rule out the carefully managed farms and number 3-7 per cent. of the total tetanus deaths in concentrate on the undesirable ones. LTnfortunately of the Essex and Wales, whereas England population for Dr. Young’s theory, milk-borne epidemics in the is 2-4 per cent. of the population of England and havefrequently been associated with unrecogWales. He thinks the result cannot be regarded as a past nised cases of disease and have been known to occur for of the the tetanus bad justification reputation in connexion with farms of good repute. county. A prophylactic serum is supplied to any medical practitioner by the public health department Ealing. and during 1923 three doctors were so supplied. A Dr. Thomas Orr mentions that the maternity and at Saffron Walden child welfare centre and the school clinic are located small outbreak of typhoid fever was thought to be associated with an insanitary in the same centrally situated building, and that by encampment of van-dwellers. A number of the local this arrangement the work of these two branches children attended their entertainments and purchased of health is facilitated and coordination activity sweetmeats from these people. In the case of another During the year ten applications for small outbreak at Tendring, the first case was thought promoted. as registration purveyors of milk were received. Ofso have contracted the infection by bathing in the two were refused on account of unsuitable these, Stour at a place where the water is unsafe to drink. premises; one application from a person retailing The boy infected had been submerged and had milk in Ealing, whose premises were in an adjoining swallowed a considerable quantity of water. was granted after the receipt of a satisfactory district, The public health department during 1923 underfrom the medical officer of health of this report took some research work into the possibility of a The housing difficulties still adjoining district. relationship between the amount of silica present in remain the same, says Dr. Orr, and little progress can water and the incidence of cancer. The conclusions be made until the Government evolve a large and reached did not indicate any such relationship. practicable scheme of house building on a good to the infected that female Owing experience patients basis. The school shows a great improvement with venereal disease are very reluctant to attend in the teeth of the report of Thus the children. clinics, the experiment has been tried of treating entrants with sound teeth has gone uppercentage from 23 in infected mothers and children at their own homes. 1915 to 55-2 in 1923, the percentage of the " interThe report as to the alleged disease has been received from 26-2 to 52-5, and the percentage of mediates " from midwives and others and the treatment has been As regards the leavers " from 35-7 to 80-5. successfully carried out by two women medical in the infants, Dr. Orr can only attribute officers on the county staff. It is hoped to extend improvement it to the steady educational work done by the health this method of treatment. visitors and school nurses. The parents are beginningto appreciate that sound teeth are of prime importance Cheshire. Dr. Meredith Young says that for the first time it to health, and that the best way to secure sound teeth is possible to give the cost of the various public health is by proper mastication, the selection of a suitable services of the county per head of the population. diet, and the avoidance of sweetmeats between meals. ......
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OBITUARY.
Of the 14 cases of dysentery, two were reported from TVimbledon. Macclesfield, 1 from Bristol, 1 from Liverpool, 1 from Wimbledon, says Dr. A. Gilmour, has always been Clitheroe (R.D.), 2 from Leicester, 4 from Friern Barnet regarded as one of London’s most desirable dormi- (Msx.), 1 from Woking, 2 from Reigate. tories. Many persons are desirous of residing in this Deaths.—In the aggregate of great towns, including district, but to build houses which would only be attractive to those at present residing outside the London, there were 4 deaths from enteric fever, none from district would do nothing to relieve the overcrowding small-pox, 11 from scarlet fever, 38 from diphtheria, 59 from that exists. Besides, the Wimbledon area is prac- measles, 86 from influenza. In London itself the deaths diphtheria numbered 14, and from infantile diarrhoea 7. tically built up with the exception of a few isolated sites to which restrictive regulations apply, or which are not on lines of transport. The congestion in Wimbledon can, therefore, only be relieved by building in other districts. Owing to the need for internal structural repairs, the accommodation of the South Wimbledon day nursery was cut down towards the end of the year from something over 40 to 30. It is HERBERT WILLIAMSON, M.A., M.B., B.CH. CAMB., surprising to learn that a day nursery is needed at F.R.C.P. LOND., Wimbledon. One reason is the number of laundries PHYSICIAN ACCOUCHEUR TO ST. BARTHOLOMEW’S HOSPITAL. in Wimbledon which attract the working mothers. IT is with consternation that his contemporaries Another reason is the dearth of domestic servants. The occupations of the’ mothers for 1923 were, and many friends have learnt of the unexpected death principally, laundresses 22, domestic servants 6, of Dr. Williamson, at the age of 52. He seemed, least and charwomen 9. The proportion of widows is not of all men, doomed to die in the plenitude of his stated. Economically the proposition appears to be powers, and indeed of late years he appeared to those this. A staff of eight, consisting of a matron, a nurse, who watched his career to grow in stature both as a physician, a trusted colleague, and a wise and a cook, and five maids, look after the children of about 40 women, in order that these latter may go out to prudent man of affairs. When Herbert Williamson first came to London work elsewhere as laundresses and domestic servants. The payments made by the mothers are 6d. for and St. Bartholomew’s Hospital from Cambridge, in one child, 10d. for two, and Is. 2d. for three per 1894, he very quickly made a mark, and even before The whole scheme is only rendered possible he was qualified was recognised by his teachers-and, day. if subscriptions or State and rate subsidies are what is perhaps more significant, by his fellows--as a man of exceptional powers of mind and industry, forthcoming. and still more of exceptional charm. There were few Dover. indeed who knew him in those days who did not Dr. A. B. McMaster thinks that the provision of an foresee for him a fortunate and prosperous career ; open-air school will be valuable in the prevention of and when after qualification and the holding of the tuberculosis. The question is at present being con- usual house appointments he appeared for a time sidered by the education committee. Owing to the to hesitate between the claims of surgery and gynaecontinued housing shortage, a number of large houses it did not to his contemporaries appear to be a cology, have been subdivided into flats and others have been matter of much moment. Whichever career he should Dr. McMaster choose sublet as " houses-let-in-lodgings." they felt he must arrive among the first in thinks that private enterprise should be encouraged the Nor were they deceived. From the profession. to build more houses under the £100 grant scheme. moment he to teach it was clear that beyond began The particulars given for the port administration other men he had the gift of imparting knowledge, to the for incessant the show need vigilance prevent and from the moment he entered on private practice introduction of infectious diseases. The passengers it was evident that his care and clinical instinct, landed at Dover from the five cross-Channel daily backed by his personal charm, were an assurance of services in 1923 numbered almost half a million, being success. about 100,000 more than in 1921 and 50,000 more He was already in extensive private practice when than in 1922. About a quarter of the persons landed in 1906 an opportunity arrived for his seniors to were aliens and three-quarters Britons, either returning his merits by the creation of an additional home or visitors from another part of the Empire. recognise in the obstetric and gynaecological departments, post The short voyage does not enable the captain of the and Williamson became a member of the staff of vessel to know whether he is carrying persons St. Bartholomew’s Hospital earlier than any of his suffering from an infectious disease. Passengers may contemporaries. Since that date, as his seniority also be incubating disease, and this has occurred has so has his influence in all the councils of grown during the year with regard to small-pox. An his and for the last few years none has examination of the customs, railway, and vessels’ beencolleagues, in such request for guidance and deliberation staffs showed that most of them were well protected in all the manifold difficulties of hospital by revaccinations done during the war. Another work. Nor were his merits in this post-war respect unvalued is who source of infection the possible passenger outside his own school. and he undertook much work travels overland from Marseilles. Such persons can in various connexions, as an examiner and on only be traced by the help of the customs’ officers, committees concerned with the teaching of his officer. Only four subjects. Of his private professional work it need only given readily to the port medical cases suffering from infectious disease were discovered be said here that he had all and often more than he among the passengers and removed to the isolation could manage to do, and that his devotion They were cases of diphtheria, scarlet to his possibly hospital. and no less to his hospital, patients, fever, whooping-cough, and chicken-pox respectively. led, no doubt, to the deterioration inprivate the good health which he had for many years enjoyed. None, however, could have supposed, even in the last few weeks, INFECTIOUS DISEASE IN EN GLAND AND WALES that his health was seriously undermined, and even DURING THE W’EEK ENDED DEC. 13TH, 1924. his closest friends and the colleagues most intimately Notifications.—The following cases of infectious disease associated with him in work did not suspect more were notified during the week :-Small-pox, 82 ; scarlet than a passing indisposition. He left his home, it is fever, 2026 ; diphtheria, 1103 ; enteric fever, 66 ; pneu- believed, for a walk, hoping to rid himself of the monia, 1136 ; puerperal fever, 37 ; cerebro-spinal fever, 10 ; malaise and lassitude induced by a recent attack of acute poliomyelitis, 15 ; acute polio-encephalitis, 1 ; influenza and by a consistent habit of overwork, encephalitis lethargica, 41 ; continued fever, 1 ; dysentery, and. wemay hope, passed suddenly and painlessly 14 ; ophthalmia neonatorum, 104. There were no cases of from the world which respected, admired, and loved cholera, plague, or typhus fever notified during the week. him.
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Mr. H. Snell, M.P., questioned the witness to the actual facilities patients enjoyed to make a real complaint privately, especially as five or six visitors were together going round. The witness said encouragement was given to patients REPORTS OF MEDICAL OFFICERS OF HEALTH. to say anything which was on their minds, and this THE following table gives some of the health was not difficult as the majority of the patients statistics for three counties and three boroughs for were seen in their rooms, not in a large place where there were a number of patients. Answering the 1923:asked there was any risk who whether Chairman, that patients might be deterred from making complaints because of possible punishment afterwards, or being made to feel that it might be the worse for them afterwards, he replied that he felt sure that in the three institutions which came into his visitations nothing of the kind occurred. The next witness was Sir James Barr, also a medical visitor, appointed under Section 177 of the Act, in the Liverpool area, to Tue Brook Asylum. He explained that he had performed this function 40 years. He considered that the provisions of the Act were efficacious as a safeguard against the undue detention of patients. The medical proprietor had always been anxious for the recovery of his patients, and he took every suggestion made to him in regard to both treatment and administration. He had not heard a complaint for years, even about diet. Complaints were more common and emphatic from undoubted cases of insanity than from those on the way to recovery, and the only complaints he had were from the first of these, and mostly took the form of objecting to their detention. There Kent. might be a difference of opinion sometimes as to when Dr. Alfred Greenwood draws attention to the effect a recovering patient might be let out. There were of the housing shortage on the birth-rate. six in the institution, young people are prevented from getting marriedMany only about voluntary boarders and but he thought this class should be encouraged. those who do marry have often to live in rooms where If people were to understand clearly that the benefits children are not wanted. The highest infant mortalityof an institution could be had without certification rates among the urban districts in the county were 72 at an earlier and more probably cases would come in Penge and 64 in Chislehurst, while Lydd and Sandcurable stage of their illness. Most of the cases gate had 44 and 43 births respectively and no infant he in under the voluntary gaise regarded deaths. coming The lowest rates after and Sandgate as not properly belonging to that class ; they were were Sandwich 15, Herne Bay 19,Lydd Tenterden 21, and the would be better for certifiable. He thought it 24. Among the rural districts the lowest Ashford judicial authority to see a patient, in preference to rates were 13 in Blean, 25 in Maidstone, 26 in Thanet, telling a patient he could see the judicial authority. and 28 in Tonbridge, while the highest were 77 in He did not see any special advantage in having two 69 in Bridge, 68 in Faversham, and 65 in medical certificates. In reply to Lord Russell, who Tenterden, Cranbrook. For the whole county the infant mortalityasked whether care was take to let the patient know rate was the lowest on record. that it was when the judicial authority was present The notifications of enteric fever totalled 115 as that the opportunity for an appeal against incarceration occurred, he said the point was that the judicial compared with 87 in the previous year. In Rochester city three schoolboys were thought to have contracted authority must satisfy himself that the patient must the disease from eating monkey-nuts spilt into the be detained. of the river near the sewer outfall during the Mr. Snell asked whether the desire of the mud of a cargo. The endeavour to form " care " unloading medical proprietor to cure his patients quickly was and " after-care " committees throughout the county due to hiswish to have a good statistical record. for tuberculous patients is only meeting with partial The witness replied that there was no financial reason In many districts the attitude adopted success. as there were new against it, always plenty of patients. towards the movement is that this is the business When a man was approaching the stage of conof the State, that it is difficult to raise the necessary his was attention drawn the fact to valescence, funds, and that such committees cannot find employby the medical proprietor. ment. The county tuberculosis scheme does not Answering Mrs. Mathers, the witness said that include the home nursing of tuberculous patients. difficulty was sometimes experienced in getting Dental treatment, ancillary nourishment, and surgical relatives to undertake to look after patients on their appliances are provided in cases where the financial discharge from the institution. circumstances of the patient are insufficient. There Sir Humphry Rolleston, dealing with the protec- are 87 open-air shelters in use and these are much tion to medical men certifying which the witness appreciated. They were used last year by 129 patients, wished to have increased by law, asked whether and particular care is paid to the suitability of the Sir James Barr had any suggestions to offer. site chosen for the shelter. Thirty-one cases from In reply, the witness said he had no specific recom- Kent were admitted to various vocational training mendations, but at present medical men felt so strongly colonies during the year; and 29 patients were on the matter that unless a man or woman were discharged, of whom only 11 completed their course palpably and dangerously insane they could not be of training. The opinions of the tuberculosis officers got to certify. They felt they might be liable at any in the county vary considerably as to the benefits time to have to withstand an action at law. He of sanatorium treatment as at present carried out. added that he would prefer the mechanism for dealing Dr. F. J. Pierce, medical officer of Lenham Sanatorium, with incipient cases to be attached to the mental speaks of the useful work done by the training section Two trades are taught-namely, hospital, in preference to a general hospital, such as at Lenham. the Liverpool Royal Infirmary; it would be more furniture repairing and upholstery, and general house specialised, and the surroundings and atmosphere repairs. Of the 49 men discharged from Lenham would be quieter and more congenial. during the year 30 completed the 12 months’ course
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of training and were found to be adapted to the new They are as follows :-trade and in several instances exceptionally capable Pence. Maternity and child welfare .... 2’427 workmen were turned out. The training section have 0’218 Venereal diseases ........ effected a valuable improvement by the completion 4’783 Tuberculosis ........ of a verandah for the west wing of the sanatorium. 0’711 General public health Mental deficiency .. 0’844 Commenting on the high death-rate from cancer, 2’623 Medical inspection of school-children .. Dr. Greenwood says this disease may be now said to ’, have usurped the title formerly bestowed on tuber- ’ Total..., .,11’076 culosis-" the white man’s scourge." A study of the table for the six districts confirms this dictum. There are only nine other counties in England and Details are given of the efforts made to coordinate Wales, he says, where the total cost of these public The medical services is lower than in Cheshire. cancer research by the institution of the British Empire Cancer Campaign in the early part of the county has at present six county midwives who receive a grant of £60 per annum and keep their year. Dr. W. L. Cassells, the whole-time V.D. medical own fees. The grant is given to enable a midwife to officer, gives a hopeful report on the work. He settle in an area where there is no trained midwife thinks the work of the clinics is largely responsible practising and is withdrawn when she has a practice Of the 250 practising A con- sufficient to support herself. for the decrease in the number of new cases. siderable number of congenital cases have been sent midwives J81 are trained and 69 are untrained. to the clinics as the result of lectures given during Twenty-six of them cannot take the’temperature or the summer to the nurses, midwives, and health pulse of their patients. The number of cases of visitors, on the signs and symptoms of venereal ophthalmia has steadily lessened since each midwife The attendances at the clinics show an was provided with collosol argentum in a drop-bottle. disease. increase largely owing to the better facilities for the Of the 56 cases of ophthalmia, four severe cases were intermediate treatment of gonorrhoea. The list of treated in hospital and a nurse was engaged to attend general practitioners approved for " arsenobenzol " four other cases at home. All the cases are said to treatment now contains 86 names. The work of the have recovered without any scar or injury to sight. county pathological laboratory increases steadily, and Building activity has been moderately well mainan experimental branch was established during the tained, and there is a tendency to urbanisation in year at Sheerness. The laboratory has been approved many parts of the Wirral rural district. for official examinations of Grade A and certified Very few local authorities have put into operation milks. A large variety of work is carried out, the full powers conferred by the Milk and Dairies including the examination of tissue sections and bloodleave a great deal to be inspected by Dr. sugar tests. desired in the matter of cubic space ventilation and Essex. cleanliness. Very few local authorities have initiated Dr. W. A. Bullough refers to the bad reputation for the detection of tuberculosis in cattle. which Essex " seems to possess " with regard to any system Dr. Young points out that the medical officer of a tetanus. " A London coroner, in August, stated that in the case of a milk-borne outbreak, is about a dozen deaths from lockjaw, which had been large town, put in a difficult position by the fact that the milk brought to his notice within the last two years, had may be a mixture of milks from a score or more of all come from Essex." The heavily manured marketIn the case of a recent outbreak in a metrofarms. garden land round about Barking, Romford, &c., borough the suspected milk came from Dr. Bullough has seems to be indicated by rumour. 100 different farms. Dr. Young thinks it would be been investigating. He finds that the deaths from an immense help to such a medical officer if he were tetanus in Essex during the four years 1918-21 able to rule out the carefully managed farms and number 3-7 per cent. of the total tetanus deaths in concentrate on the undesirable ones. LTnfortunately of the Essex and Wales, whereas England population for Dr. Young’s theory, milk-borne epidemics in the is 2-4 per cent. of the population of England and havefrequently been associated with unrecogWales. He thinks the result cannot be regarded as a past nised cases of disease and have been known to occur for of the the tetanus bad justification reputation in connexion with farms of good repute. county. A prophylactic serum is supplied to any medical practitioner by the public health department Ealing. and during 1923 three doctors were so supplied. A Dr. Thomas Orr mentions that the maternity and at Saffron Walden child welfare centre and the school clinic are located small outbreak of typhoid fever was thought to be associated with an insanitary in the same centrally situated building, and that by encampment of van-dwellers. A number of the local this arrangement the work of these two branches children attended their entertainments and purchased of health is facilitated and coordination activity sweetmeats from these people. In the case of another During the year ten applications for small outbreak at Tendring, the first case was thought promoted. as registration purveyors of milk were received. Ofso have contracted the infection by bathing in the two were refused on account of unsuitable these, Stour at a place where the water is unsafe to drink. premises; one application from a person retailing The boy infected had been submerged and had milk in Ealing, whose premises were in an adjoining swallowed a considerable quantity of water. was granted after the receipt of a satisfactory district, The public health department during 1923 underfrom the medical officer of health of this report took some research work into the possibility of a The housing difficulties still adjoining district. relationship between the amount of silica present in remain the same, says Dr. Orr, and little progress can water and the incidence of cancer. The conclusions be made until the Government evolve a large and reached did not indicate any such relationship. practicable scheme of house building on a good to the infected that female Owing experience patients basis. The school shows a great improvement with venereal disease are very reluctant to attend in the teeth of the report of Thus the children. clinics, the experiment has been tried of treating entrants with sound teeth has gone uppercentage from 23 in infected mothers and children at their own homes. 1915 to 55-2 in 1923, the percentage of the " interThe report as to the alleged disease has been received from 26-2 to 52-5, and the percentage of mediates " from midwives and others and the treatment has been As regards the leavers " from 35-7 to 80-5. successfully carried out by two women medical in the infants, Dr. Orr can only attribute officers on the county staff. It is hoped to extend improvement it to the steady educational work done by the health this method of treatment. visitors and school nurses. The parents are beginningto appreciate that sound teeth are of prime importance Cheshire. Dr. Meredith Young says that for the first time it to health, and that the best way to secure sound teeth is possible to give the cost of the various public health is by proper mastication, the selection of a suitable services of the county per head of the population. diet, and the avoidance of sweetmeats between meals. ......
Young
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1362
OBITUARY.
Of the 14 cases of dysentery, two were reported from TVimbledon. Macclesfield, 1 from Bristol, 1 from Liverpool, 1 from Wimbledon, says Dr. A. Gilmour, has always been Clitheroe (R.D.), 2 from Leicester, 4 from Friern Barnet regarded as one of London’s most desirable dormi- (Msx.), 1 from Woking, 2 from Reigate. tories. Many persons are desirous of residing in this Deaths.—In the aggregate of great towns, including district, but to build houses which would only be attractive to those at present residing outside the London, there were 4 deaths from enteric fever, none from district would do nothing to relieve the overcrowding small-pox, 11 from scarlet fever, 38 from diphtheria, 59 from that exists. Besides, the Wimbledon area is prac- measles, 86 from influenza. In London itself the deaths diphtheria numbered 14, and from infantile diarrhoea 7. tically built up with the exception of a few isolated sites to which restrictive regulations apply, or which are not on lines of transport. The congestion in Wimbledon can, therefore, only be relieved by building in other districts. Owing to the need for internal structural repairs, the accommodation of the South Wimbledon day nursery was cut down towards the end of the year from something over 40 to 30. It is HERBERT WILLIAMSON, M.A., M.B., B.CH. CAMB., surprising to learn that a day nursery is needed at F.R.C.P. LOND., Wimbledon. One reason is the number of laundries PHYSICIAN ACCOUCHEUR TO ST. BARTHOLOMEW’S HOSPITAL. in Wimbledon which attract the working mothers. IT is with consternation that his contemporaries Another reason is the dearth of domestic servants. The occupations of the’ mothers for 1923 were, and many friends have learnt of the unexpected death principally, laundresses 22, domestic servants 6, of Dr. Williamson, at the age of 52. He seemed, least and charwomen 9. The proportion of widows is not of all men, doomed to die in the plenitude of his stated. Economically the proposition appears to be powers, and indeed of late years he appeared to those this. A staff of eight, consisting of a matron, a nurse, who watched his career to grow in stature both as a physician, a trusted colleague, and a wise and a cook, and five maids, look after the children of about 40 women, in order that these latter may go out to prudent man of affairs. When Herbert Williamson first came to London work elsewhere as laundresses and domestic servants. The payments made by the mothers are 6d. for and St. Bartholomew’s Hospital from Cambridge, in one child, 10d. for two, and Is. 2d. for three per 1894, he very quickly made a mark, and even before The whole scheme is only rendered possible he was qualified was recognised by his teachers-and, day. if subscriptions or State and rate subsidies are what is perhaps more significant, by his fellows--as a man of exceptional powers of mind and industry, forthcoming. and still more of exceptional charm. There were few Dover. indeed who knew him in those days who did not Dr. A. B. McMaster thinks that the provision of an foresee for him a fortunate and prosperous career ; open-air school will be valuable in the prevention of and when after qualification and the holding of the tuberculosis. The question is at present being con- usual house appointments he appeared for a time sidered by the education committee. Owing to the to hesitate between the claims of surgery and gynaecontinued housing shortage, a number of large houses it did not to his contemporaries appear to be a cology, have been subdivided into flats and others have been matter of much moment. Whichever career he should Dr. McMaster choose sublet as " houses-let-in-lodgings." they felt he must arrive among the first in thinks that private enterprise should be encouraged the Nor were they deceived. From the profession. to build more houses under the £100 grant scheme. moment he to teach it was clear that beyond began The particulars given for the port administration other men he had the gift of imparting knowledge, to the for incessant the show need vigilance prevent and from the moment he entered on private practice introduction of infectious diseases. The passengers it was evident that his care and clinical instinct, landed at Dover from the five cross-Channel daily backed by his personal charm, were an assurance of services in 1923 numbered almost half a million, being success. about 100,000 more than in 1921 and 50,000 more He was already in extensive private practice when than in 1922. About a quarter of the persons landed in 1906 an opportunity arrived for his seniors to were aliens and three-quarters Britons, either returning his merits by the creation of an additional home or visitors from another part of the Empire. recognise in the obstetric and gynaecological departments, post The short voyage does not enable the captain of the and Williamson became a member of the staff of vessel to know whether he is carrying persons St. Bartholomew’s Hospital earlier than any of his suffering from an infectious disease. Passengers may contemporaries. Since that date, as his seniority also be incubating disease, and this has occurred has so has his influence in all the councils of grown during the year with regard to small-pox. An his and for the last few years none has examination of the customs, railway, and vessels’ beencolleagues, in such request for guidance and deliberation staffs showed that most of them were well protected in all the manifold difficulties of hospital by revaccinations done during the war. Another work. Nor were his merits in this post-war respect unvalued is who source of infection the possible passenger outside his own school. and he undertook much work travels overland from Marseilles. Such persons can in various connexions, as an examiner and on only be traced by the help of the customs’ officers, committees concerned with the teaching of his officer. Only four subjects. Of his private professional work it need only given readily to the port medical cases suffering from infectious disease were discovered be said here that he had all and often more than he among the passengers and removed to the isolation could manage to do, and that his devotion They were cases of diphtheria, scarlet to his possibly hospital. and no less to his hospital, patients, fever, whooping-cough, and chicken-pox respectively. led, no doubt, to the deterioration inprivate the good health which he had for many years enjoyed. None, however, could have supposed, even in the last few weeks, INFECTIOUS DISEASE IN EN GLAND AND WALES that his health was seriously undermined, and even DURING THE W’EEK ENDED DEC. 13TH, 1924. his closest friends and the colleagues most intimately Notifications.—The following cases of infectious disease associated with him in work did not suspect more were notified during the week :-Small-pox, 82 ; scarlet than a passing indisposition. He left his home, it is fever, 2026 ; diphtheria, 1103 ; enteric fever, 66 ; pneu- believed, for a walk, hoping to rid himself of the monia, 1136 ; puerperal fever, 37 ; cerebro-spinal fever, 10 ; malaise and lassitude induced by a recent attack of acute poliomyelitis, 15 ; acute polio-encephalitis, 1 ; influenza and by a consistent habit of overwork, encephalitis lethargica, 41 ; continued fever, 1 ; dysentery, and. wemay hope, passed suddenly and painlessly 14 ; ophthalmia neonatorum, 104. There were no cases of from the world which respected, admired, and loved cholera, plague, or typhus fever notified during the week. him.
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Obituary.