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Reports on the public health for 1893 of the Cape of Good Hope
R E P O R T S ON T H E P U B L I C H E A L T H OF T H E various French observers, amongst them Rodet and Roux; have found the bacillus coli in some cases of typhoid tever present in the intestinal contents, almost in pure culture. Nevertheless the mesenteric glands and the spleen in such cases do not contain the bacillus toll, but the typhoid fever bacillus. ~The intestine (the ileum) of man, be it noted, is never without the bacillus coli, and there is no difficulty whatever in obtaining it in a number of colonies from any intestinal contents ; but the bacillus obtained from the mesenteric glands and from the spleen, during the second and third week of the disease, is invariably the typhoid fever bacillus, and not the bacillus coli; though during the second and third week of a case of enteric fever, both species can be identified without difficulty in the contents of the ileum or in the typhoid stool. There is then the strongest presumption~ short of actual proof, that this particular organism called the typhoid bacillus, which differs essentially from the bacillus coli, stands in an intimate relation to the disease enteric fever. R E P O R T S ON T H E P U B L I C H E A L T H F O R i893 OF T H E C A P E OF GOOD HOPE. WE have been favoured with a copy sent us from the Local Government and Health Branch of the Colonial Secretary's Office, Cape of Good Hope, of the Health Report of the Colony. It is an exceedingly interesting document, and gives abundant evidence of the interest that is beginning to be felt for the Public Health there. The Health Department has only recently been evolved, but the Colony is still without a proper Health Act, or any power of local compulsion. A Births and Deaths Registration Bill has been passed, and will come into force at the beginning of the year. We make the following extracts from Dr. Gregory's Report : "Although a large amount of work connected with the public health, and more especially with that portion relating to the care of lunatics, lepers, and the pauper chronic sick, was all along effected by the Colonial Secretary's Office, it was not until the year ~89~ that any attempt was made to organise a separate department for the proper carrying out of this important and ever-increasing work, at which time, with admirable administrative foresight, advantage was taken by the present Under-Colonial Secretary of the changes in the official staff consequent upon his accession to that post to establish two important branches of his department, namely, a Statistical Branch and a Local Government and Public Health Branch, the latter of which took over the whole of the work connected with local government by municipality, village board and divisional council, with the administration of the various Acts of Parlia-
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merit relating thereto ; the management of hospitals and asylums with the care of lunatics, lepers, paupers, and pauper chronic sick ; the administration of the Public Health Acts, the Contagious Diseases Prevention Act, the Leprosy Repression Act, the Lunacy Act, the Dairy Act, and other statutes relating to matters of public health and State medicine ; while to it the various district surgeons, health officers and other officials have been made accountable in respect of their duties so far as they affect these subjects." With regard to the Local Authorities : - " T h e reports show us that in the great majority of urban centres sanitation is in a very backward state, and in many it is in a merely rudimentary condition, if, indeed, it can be said to exist at all. Indeed, the extraordinarily outspoken admissions contained in several of the reports as to the entire absence of all sanitation within the districts with which they deal cannot fail to carry conviction." Contagious Diseases (Syphilis) are dealt with under a special Act, which is divided into two parts. Part I. deals only with prostitutes, and Part II. with syphilis occurring among the population generally. The working of Part II. is particularly interesting, inasmuch as the disease can be watched in the aspect of an ordinary contagious disease. It is rendered necessary owing to the fact that the disease is rife among the coloured classes, "and cases are reported where entire families, or even groups of families, have been affected, generally through the medium of nursemaids or farm servants. As regards Part I. : - " By far the most satisfactory featurewas being the real ultimate aim of the Act--is the very great diminution shown nearly all round in the proportion of women found to be diseased. ~' In referring to LE~R0SY, Dr. Gregory makes some very important statements : - " A careful study of the numbers of lepers in different districts of the Colony affords some interesting information as to the relative prevalence of the disease in different parts, and, indirectly, valuable evidence in favour of the belief that the disease is spread bycontagion. " i . Leprosy is between five and six times more prevalent among natives and coloured persons than among whites. "2. Speaking generally, the Europeans appear to be less frequently affected in relation to the coloured in those districts which are more purely zafi~e in the character of their coloured population ; that is, in those districts in which the native element is less likely to be intimately associated with the European. "3. Geographical contiguity appears to influence the spreading of the disease, for it occurs with varying degrees of prevalency in different parts of the Colony, there being several areas, consisting of
I46
RECENT RESEARCH.
groups of contiguous districts, which appear to be its chief habitats. " 4 . Density of population, or in other words contiguity of persons, appears to affect the prevalency of the disease, for this increases in direct ratio to the density of the population. " This is seen on comparing the density of population with the ratio of leprosy per io,ooo of inhabitants as they occur in the above-mentioned groups of districts. Groupof Districts. Densityof Ratioof Leprosy Population. per xo,ooo. Western districts (Cape--Caledon group) . . . . . . . . . 24"0 i3"I South-eastern districts 20"z 6"5 Eastern districts... ...... I6'2 Io"6 South-western districts .,. IO'O 5'6 North-eastern districts . . . . . . 5"5 4"0 Northern Border districts .. 4"6 6"7 Western districts (Clanwilliam222 Bredasdorp group) . . . . . . 3"5 4"3 North-western and Central districts ......... I "2 0"4 " I t will be seen that the decrease in the proportion of leprosy forms, with the exceptions of the two groups containing the south-eastern districts and the northern border districts, an almost regularly descending scale. " T h e s e conclusions seem to point to the contagiousness of leprosy. They also would point to the fact of the contagiousness being slight in comparison with other infectious disease.s with which we are acquainted, otherwise, the disease should long ago have disseminated itself fairly evenly throughout the Colony."
RECENT RESEARCH. QUANTITATIVE DETERMINATION OF THE DUST IN THE AIR, WITH A DESCRIPTION OF A NEW AEROSCOPE.--ArCMV. f ~ r Hygiene.
By DR. CARLARENS~of W/irzburg. THE writer commences by a reference to previous workers on this subject, especially to Fodor, Hesse and Uffelmann, and Tissandier. The last-nalfled estimated that the dust of Paris consisted of 2 5 - - 3 4 per cent. of organic matter and 66--75 per cent. of inorganic. Arens' apparatus consists of a bellows-like arrangement, capable of holding five litres of air. Taking the place of the nozzle is a y - s h a p e d tube provided with taps so that air drawn in by one of the arms may be expelled by the other. H e assured himself that it was air-tight, by smearing the edges with soap and water, and seeing if on pressure any bubbles were blown. The end of the y tube through which air was to be expelled is fixed on to a glass tube 8"1o c.m. long, stuffed with cotton wool. In half to threequarters of an hour 200 litres can easily be made
to pass through the wool, and the difference in weight of the tube (after drying)before and after the experiment, represents the amount of dust in the air drawn through. Some of the results he obtained are interesting. Mgnns. of dust per Place. c.b.m, of air. Dwelling Room . . . . . . . . . . . . "I Laboratory . . . . . . . . . . . . . . . I "4 Schoolroom . . . . . . 8"o Horse-hair IVIanufactory ... :'.: ::: Io'o Sawing Works ............ XT"o Woollen Manufactory ......... 2o'o Snuff Factory (during work} . . . . . . 72"o Cement Factory . . . . . . . . . . . . 224"o To catch the dust in the out-let shaft as far as possible, the author has devised a box with an opening for the air to enter below and above for it to have exit. Overlapping ledges stretch diagonally from side to side, covered with flannel. A small stream of water keeps these ledges wet. The dust sticks to the moistened flannel, and the air, thus freed of dust, passes through. The apparatus has been introduced with great success at a horsehair factory. DUST IN VARIOUSTRADES, WITH ESPECIAL REFERENCE TO ITS "VARIOUSSHAPES AND MECHANICAL ACTION ON WORKMEN.--.l]rC~[73. f ~ r f-fyffiene. By DR. H. WEOMANN~Assistant to the Factory Inspector of the ISt District. THIS paper is especially useful from the illustrations attached to it. There are some fifty plates showing the microscopical appearances of the various forms of dust met with in different occupations. They are Undoubtedly t h e most comprehensive and useful that we have seen bearing on this interesting subject. Treating first shortly of the action of dust on the skin and eyes, the writer dwells upon its action on the lungs. Scarcely anyone who continuously breathes a dusty atmosphere escapes an acute catarrh set up by the irritation. In some cases, subsequent continued exposure to the same influences will not produce other serious effects. In others, however, the dust penetrates into the bronchial tubes and sets up chronic mischieL In the sputum the characteristic cells lining their wails can be seen. Many who survive this stage do not suffer further. But in certain cases the dust fills at first single air ceils, and then groups of them, destroying the waUs and rendering them useless for breathing purposes. The lymphatics become invaded and.the glands converted into hard lumps ; sometimes even the dust particles get into the bloodvessels and are carried to other organs, as the liver, kidneys, and spleen. The author does not believe that consumption caused by inhaling dust constantly is by a n y means the same thing as tubercular consumption, although it undoubtedly predisposes to a condition
C A P E OF GOOD HOPE.
I45
merit relating thereto ; the management of hospitals and asylums with the care of lunatics, lepers, paupers, and pauper chronic sick ; the administration of the Public Health Acts, the Contagious Diseases Prevention Act, the Leprosy Repression Act, the Lunacy Act, the Dairy Act, and other statutes relating to matters of public health and State medicine ; while to it the various district surgeons, health officers and other officials have been made accountable in respect of their duties so far as they affect these subjects." With regard to the Local Authorities : - " T h e reports show us that in the great majority of urban centres sanitation is in a very backward state, and in many it is in a merely rudimentary condition, if, indeed, it can be said to exist at all. Indeed, the extraordinarily outspoken admissions contained in several of the reports as to the entire absence of all sanitation within the districts with which they deal cannot fail to carry conviction." Contagious Diseases (Syphilis) are dealt with under a special Act, which is divided into two parts. Part I. deals only with prostitutes, and Part II. with syphilis occurring among the population generally. The working of Part II. is particularly interesting, inasmuch as the disease can be watched in the aspect of an ordinary contagious disease. It is rendered necessary owing to the fact that the disease is rife among the coloured classes, "and cases are reported where entire families, or even groups of families, have been affected, generally through the medium of nursemaids or farm servants. As regards Part I. : - " By far the most satisfactory featurewas being the real ultimate aim of the Act--is the very great diminution shown nearly all round in the proportion of women found to be diseased. ~' In referring to LE~R0SY, Dr. Gregory makes some very important statements : - " A careful study of the numbers of lepers in different districts of the Colony affords some interesting information as to the relative prevalence of the disease in different parts, and, indirectly, valuable evidence in favour of the belief that the disease is spread bycontagion. " i . Leprosy is between five and six times more prevalent among natives and coloured persons than among whites. "2. Speaking generally, the Europeans appear to be less frequently affected in relation to the coloured in those districts which are more purely zafi~e in the character of their coloured population ; that is, in those districts in which the native element is less likely to be intimately associated with the European. "3. Geographical contiguity appears to influence the spreading of the disease, for it occurs with varying degrees of prevalency in different parts of the Colony, there being several areas, consisting of
I46
RECENT RESEARCH.
groups of contiguous districts, which appear to be its chief habitats. " 4 . Density of population, or in other words contiguity of persons, appears to affect the prevalency of the disease, for this increases in direct ratio to the density of the population. " This is seen on comparing the density of population with the ratio of leprosy per io,ooo of inhabitants as they occur in the above-mentioned groups of districts. Groupof Districts. Densityof Ratioof Leprosy Population. per xo,ooo. Western districts (Cape--Caledon group) . . . . . . . . . 24"0 i3"I South-eastern districts 20"z 6"5 Eastern districts... ...... I6'2 Io"6 South-western districts .,. IO'O 5'6 North-eastern districts . . . . . . 5"5 4"0 Northern Border districts .. 4"6 6"7 Western districts (Clanwilliam222 Bredasdorp group) . . . . . . 3"5 4"3 North-western and Central districts ......... I "2 0"4 " I t will be seen that the decrease in the proportion of leprosy forms, with the exceptions of the two groups containing the south-eastern districts and the northern border districts, an almost regularly descending scale. " T h e s e conclusions seem to point to the contagiousness of leprosy. They also would point to the fact of the contagiousness being slight in comparison with other infectious disease.s with which we are acquainted, otherwise, the disease should long ago have disseminated itself fairly evenly throughout the Colony."
RECENT RESEARCH. QUANTITATIVE DETERMINATION OF THE DUST IN THE AIR, WITH A DESCRIPTION OF A NEW AEROSCOPE.--ArCMV. f ~ r Hygiene.
By DR. CARLARENS~of W/irzburg. THE writer commences by a reference to previous workers on this subject, especially to Fodor, Hesse and Uffelmann, and Tissandier. The last-nalfled estimated that the dust of Paris consisted of 2 5 - - 3 4 per cent. of organic matter and 66--75 per cent. of inorganic. Arens' apparatus consists of a bellows-like arrangement, capable of holding five litres of air. Taking the place of the nozzle is a y - s h a p e d tube provided with taps so that air drawn in by one of the arms may be expelled by the other. H e assured himself that it was air-tight, by smearing the edges with soap and water, and seeing if on pressure any bubbles were blown. The end of the y tube through which air was to be expelled is fixed on to a glass tube 8"1o c.m. long, stuffed with cotton wool. In half to threequarters of an hour 200 litres can easily be made
to pass through the wool, and the difference in weight of the tube (after drying)before and after the experiment, represents the amount of dust in the air drawn through. Some of the results he obtained are interesting. Mgnns. of dust per Place. c.b.m, of air. Dwelling Room . . . . . . . . . . . . "I Laboratory . . . . . . . . . . . . . . . I "4 Schoolroom . . . . . . 8"o Horse-hair IVIanufactory ... :'.: ::: Io'o Sawing Works ............ XT"o Woollen Manufactory ......... 2o'o Snuff Factory (during work} . . . . . . 72"o Cement Factory . . . . . . . . . . . . 224"o To catch the dust in the out-let shaft as far as possible, the author has devised a box with an opening for the air to enter below and above for it to have exit. Overlapping ledges stretch diagonally from side to side, covered with flannel. A small stream of water keeps these ledges wet. The dust sticks to the moistened flannel, and the air, thus freed of dust, passes through. The apparatus has been introduced with great success at a horsehair factory. DUST IN VARIOUSTRADES, WITH ESPECIAL REFERENCE TO ITS "VARIOUSSHAPES AND MECHANICAL ACTION ON WORKMEN.--.l]rC~[73. f ~ r f-fyffiene. By DR. H. WEOMANN~Assistant to the Factory Inspector of the ISt District. THIS paper is especially useful from the illustrations attached to it. There are some fifty plates showing the microscopical appearances of the various forms of dust met with in different occupations. They are Undoubtedly t h e most comprehensive and useful that we have seen bearing on this interesting subject. Treating first shortly of the action of dust on the skin and eyes, the writer dwells upon its action on the lungs. Scarcely anyone who continuously breathes a dusty atmosphere escapes an acute catarrh set up by the irritation. In some cases, subsequent continued exposure to the same influences will not produce other serious effects. In others, however, the dust penetrates into the bronchial tubes and sets up chronic mischieL In the sputum the characteristic cells lining their wails can be seen. Many who survive this stage do not suffer further. But in certain cases the dust fills at first single air ceils, and then groups of them, destroying the waUs and rendering them useless for breathing purposes. The lymphatics become invaded and.the glands converted into hard lumps ; sometimes even the dust particles get into the bloodvessels and are carried to other organs, as the liver, kidneys, and spleen. The author does not believe that consumption caused by inhaling dust constantly is by a n y means the same thing as tubercular consumption, although it undoubtedly predisposes to a condition