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THE BELFAST HEALTH COMMISSION AND IRISH URBAN MORTALITY.
1432
THE
CHILD’S HOLIDAY.
doses must be administered frequently in order to be of With the exception of the tubercle bacillus, he assumed that service. If the heart has not completely stopped suprarenin if bacteria fail to vegetate upon suitable media under causes more active contractions and a consequent rise of favourable conditions they have at least lost their virulence blood pressure, which a few doses at short intervals may and their power to infect, especially when ingested by the On account of the reluctance with which the render permanent. But if the heart has ceased absolutely mouth. no results. bacillus tubercle suprarenin yields grows on culture media Dr. Rosenau resorted to inoculations into guinea-pigs in order to THE CHILD’S HOLIDAY. The experiments determine its thermal death-point. So many are the arguments which have been repeatedly were designed to imitate the conditions of practical put forward in favour of country holidays for town children pasteurisation, the micro-organisms being heated in open that it is surprising that there should be any need to plead test-tubes and the temperature and other factors being year by year on behalf of those who will become the parents accurately controlled. The results of nine series of tests of the next generation. Whether we regard the matter from upon guinea-pigs with five cultures showed that in milk the the point of view of altruism or of national self-interest tubercle bacillus loses its virulence and infective power when there can be no doubt that a fortnight’s holiday in the heated at 60° C. for 20 minutes and at 650 C. for a much shorter country means not only good to the child but good also time. As the milk in these tests was very heavily infected to the community as a whole. Canon Barnett in a with virulent cultures it is justifiable to assume that ordinary letter to the press on behalf of the Children’s Country milk, which practically never contains such an enormous Holiday Fund makes a shrewd observation which applies amount of infection under natural conditions, would be with particular force to the class of children whose rendered safe for human consumption, so far as tubercle habits are formed amidst surroundings which daily become bacilli are concerned, by heating it at 60° C. for 20 minutes. This procedure was found to be efficient in the case of the more and more pernicious to child growth and this notof enteric fever, diphtheria, cholera, dysentery, and of all the conditions domestic sanitaorganisms withstanding improved tion. For the growth of towns as it takes place at present Malta fever, some of which succumb in less than 20 minutes, Thus the typhoid bacillus is or at a lower temperature. means the curtailment of sunlight and fresh air, two natural birthrights which nothing can replace and which no growing killed in two minutes and the majority of the diphtheria child should be denied. Canon Barnett says :"Education bacilli and cholera vibrio are killed at 55° C., the remainder in a form of enjoyment which depends not upon outside dying at 60° C. The dysentery bacillus is rather more reexcitement but on increased powers of observation and sistant to heat than the typhoid bacillus, sometimes withadmiration would do more for national strength than standing a temperatura of 60° C. for five minutes but not At a recent meeting of the Children’s for ten minutes. So far as can be judged from the meagre many laws." Fresh Air Mission Miss Alice Ravenhill also pointed out evidence at hand a temperature of 60° C. for 20 minutes is that no amount of exercise in schools could take the more than sufficient to destroy the infective principle of place of spontaneous free play. With both these observa- Malta fever in milk. It is not destroyed when subjected to tions we are in agreement. Another point worthy of 55°C. for a short time, but the majority of these organisms consideration is the fact that although the healthy child die at 580 C. and all are killed at 60° C. will sleep anywhere, yet in our crowded cities quiet sleep is harder for him to obtain than in the country where he can THE BELFAST HEALTH COMMISSION AND enjoy its full bounty. No body of men knows better than IRISH URBAN MORTALITY. the medical profession the good which is done by the THE Belfast Health Commissioners in their recently issued societies which provide country holidays for poor children, call attention to a fact which, if of general applicareport and not only are medical men themselves subscribers to seems to afford some explanation of the marked excess tion, these societies but they can do much to interest the of urban mortality in Ireland dealt with in an annotation benevolent public in so excellent a cause. Both the in these columns. The Commissioners Children’s Fresh Air Mission, St. Peter’s Schools, Onslow- recently publi3hed that the medical officer of health apstreet, Farringdon-road, London, E. C., and the Children’s naturally complain the by corporation of Belfast receives no statistical Country Holiday Fund, 18, Buckingham-street, Strand, pointed returns of deaths registered from time to time within that London, W.C., are urgently in need of funds for the conborough, and that he is thus unable to analyse the mortinuance of their truly national work. I tality of its population with due regard to its age and sex constitution and to the assigned causes of the THE THERMAL DEATH-POINTS OF PATHOGENIC This statement obviously suggests inquiry as deaths. MICRO-ORGANISMS IN MILK. to the precise cause of this serious deficiency in Irish A BULLETIN on the thermal death-points of patho- sanitary organisation. The Commissioners refer in their genic micro-organisms by Dr. Milton J. Rosenau has report to the 14 local medical officers, who, it may be recently been published by the United States Treasury presumed, are acting as dispensary medical officers and, in Department.’ The pathogenic organisms most frequently accordance with the Irish Registration Act, also as registrars found in milk are those causing tuberculosis, enteric of births and deaths within the borough of Belfast. This fever, diphtheria, scarlet fever, and Malta fever, and system, which is unfavourably criticised by the Comthe temperature at which milk should be pasteurised missioners, does not, however, appear to suggest any hinges on their thermal death-points. As none of the necessary or insuperable obstacle to the desirable receipt by organisms causing these diseases has resisting spores the the medical officer of health of detailed periodical returns of application of moderate heat is sufficient to render them all deaths registered within the borough. It is, we believe, harmless in milk. The streptococci, staphylococci, and most true that there is in Ireland no statutory obligation imposed of the bacteria associated with infantile diarrhcea are also on the local registrars of births and deaths to furnish to readily destroyed by heat. Dr. Rosenau found that it is the local sanitary authority, if so required, on payment difficult to determine precisely at what temperature a micro- of certain statutory fees, detailed periodical returns of deaths organism diea, owing to the fact that its failure to grow registered, similar to the obligation enacted in Sec. 28 of upon artificial media is not always a sure sign of death. 37 and 38 Vict., Cap. 88, which applies only to registrars of births and deaths in England and Wales. We cannot, how1 Bulletin No. 42, Hygienic Laboratory, United States Public Health and Marine Hospital Service, Washington, 1908, pp. 85. ever, believe that the Irish dispensary medical officers, acting
THE STODDART SEWAGE DISTRIBUTOR.-LOOKING BACK.
registrars of births and deaths, would raise any objection to furnishing such returns of deaths to local medical officers of health if the sanitary authorities desired them and were prepared to pay for them at the same rate authorised by the English Registration Act. These death returns are, indeed, so obviously essential to the efficient performance of the duties of a medical officer of health to enable him duly to advise his sanitary authority as to the health condition of as
1433
invited, will be "Some Inter-relations of Thoracic and Abdominal Disease." ____
WE regret to announce the death on Tuesday, May 5th, of Dr. Theodore Duka at the ripe age of 83 years. Dr. who was a retired member of the Indian Medical Duka, Service, fought with distinction in the Austro-Hungarian War of Independence under Kossuth, and we shall take;an early opportunity of publishing some notes on his interesting
his district that if any real difficulty exists in obtaining those returns we entirely endorse the recommendation of the career. Belfast Commissioners that such difficulty should be solved Mr. W. Watson Cheyne will deliver the Wightman lecture by legislation without delay. A medical officer of health the Society for the Study of Disease in Children on before without prompt and detailed information of all the deaths 22nd, at 5 P.M. The lecturer has taken as occurring within his district is thereby deprived of the main Friday next, May "The Defensive Arrangements of the Body as his subject, source of his power to promote health progress. Illustrated by the Incidence of Disease in Children and ___
Adults." THE
STODDART
SEWAGE
-
DISTRIBUTOR.
THE King has approved of the retention of the title of OUR attention has been called to the above through a honourableby Sir William Bisset Berry, M.D. Aberd., on pamphlet sent to us entitled I I The Best Method of Sewage his retirement from the office of Speaker of the House of Disposal for all Communities" by F. Stoddart, F.I.C.E. Assembly of the Colony of the Cape of Good Hope which he The system advocated is, first, the passing of the sewage has held for a period of more than three years. through a specially constructed tank, which is a modified form of the well-known Cameron tank. In this the solid WE much regret to announce the death on May llth of constituents are dissolved and the whole is thrown into a conDr. C. J. Cullingworth, consulting obstetric physician to St. dition of instability by the action of anaerobic bacteria. Thomas’s Hospital, and one of the most active advocates Secondly, the sprinkling of the resultant fluid by means of of the improvement of midwifery nursing. Mr. Stoddai’t’s patent distributor over a filter composed of coke or burnt ballast. The advantage of this arrangement over other similar systems lies in the method of the distribution THE eighty-seventh session of the General Council of of the liquid, which is carried by a series of metal channels Medical Education and Registration will commence on and drips and sprinkled evenly over the whole surface of Tuesday, May 26th, at 2 o’clock P.M., under the presithe filter bed. Mr. Stoddart claims that by this means the dency of Dr. Donald MacAlister. filter does not become clogged and can be used continuously without rest. It also adapts itself to the exigencies of a private installation, the irregularities in the flow in these The nitrifying cases generally constituting a difficulty. power of the filter, which depends upon the presence of bacteria of the aerobic class, is increased by its form of conFROM struction. This consists of a mound formed of the filtering THE medium and kept in position by iron stays or brick piers, thus giving free access of air to every part. The mound THE following very sensible petition is to be presented to is built upon a concrete bed, round which an open channel the House of Commons, against the impolitic and illiberal This effluent, it is tax which it is is carried to collect the Effluent. proposed by the Chancellor of the Exchequer is free from asserted, any unpleasant smell and is of to levy upon all surgical diplomas :sufficient purity to be discharged into a stream or ornamental The Humble Petition of the Royal College of Surgeons of water. Judging from the illustrations and descriptions Edinburgh; given in the pamphlet it would seem to be a system complying Showeth, That your petitioners have observed, with the greatest with all the conditions known to be necessary for achieving the end desired. The great difficulty to be overcome in most regret and alarm, that it is proposed to Parliament to exact a stamp-duty, a tax of 10. upon the admission or license sewage convertion systems is the want of attention (when by of any person to be a member or licentiate of any College they are adapted to private houses). The necessary amount of Surgeons.’ of watchfulness, however slight this may be, in these cases Your petitioners beg leave respectfully, but most earnestly, is frequently absent. Mr. Stoddart, however, gives descrip- to represent, that the acquisition of a proper medical and tions of some installations carried out on a small scale which surgical education necessary for all those who undertake the duties of general practice, requires a long period of time, have been found to work satisfactorily. and is attended with a very heavy expense, for which it is long before any adequate return can be obtained, and that the class of young men educated for surgery possess very THE King has granted to Mr. Alexander Granville, limited means. M.R.C.S. Eng., L.R.C.P. Lond., licence and authority to It has long been well known, that the education of those accept and to wear the Insignia of the Fourth Class of the who apply for licenses and diplomas has been, in many Imperial Ottoman Order of the Medjidieh conferred upon respects defective ; and the different colleges and public him by His Highness the Khedive of Egypt in recognition of bodies who have the power of granting these testimonials, have, for some time past, and particularly of late, envaluable services rendered. deavoured to remedy this defect, by extending the course of study required from those to whom diplomas or licenses are TIE opening lecture of the summer post-graduate course given. The greatest obstacle which your petitioners, and it. of the Mount Vernon Hospital will be given by Sir Williaml is believed the other public bodies, have encountered, in H. Allchin, M.D. Lond., F.R.C.P. Lond., in the lecture roomli effecting this desirable object, has arisen from their knowof the difficulties imposed upon young men, by the at the out-patient department of the hospital, 7, Fitzroy. ledge increase of expense necessarily attending it ; and they have square, W., on Thursday, May 21st, at 5 P.M. The subjec1t carefully avoided adding anything to this expense, except of the lecture, to which qualified medical practitioners ar(a what may be absolutely required to obtain the improved
Looking Back.
LANCET, SATURDAY, May 15th, 1830.
’
THE
CHILD’S HOLIDAY.
doses must be administered frequently in order to be of With the exception of the tubercle bacillus, he assumed that service. If the heart has not completely stopped suprarenin if bacteria fail to vegetate upon suitable media under causes more active contractions and a consequent rise of favourable conditions they have at least lost their virulence blood pressure, which a few doses at short intervals may and their power to infect, especially when ingested by the On account of the reluctance with which the render permanent. But if the heart has ceased absolutely mouth. no results. bacillus tubercle suprarenin yields grows on culture media Dr. Rosenau resorted to inoculations into guinea-pigs in order to THE CHILD’S HOLIDAY. The experiments determine its thermal death-point. So many are the arguments which have been repeatedly were designed to imitate the conditions of practical put forward in favour of country holidays for town children pasteurisation, the micro-organisms being heated in open that it is surprising that there should be any need to plead test-tubes and the temperature and other factors being year by year on behalf of those who will become the parents accurately controlled. The results of nine series of tests of the next generation. Whether we regard the matter from upon guinea-pigs with five cultures showed that in milk the the point of view of altruism or of national self-interest tubercle bacillus loses its virulence and infective power when there can be no doubt that a fortnight’s holiday in the heated at 60° C. for 20 minutes and at 650 C. for a much shorter country means not only good to the child but good also time. As the milk in these tests was very heavily infected to the community as a whole. Canon Barnett in a with virulent cultures it is justifiable to assume that ordinary letter to the press on behalf of the Children’s Country milk, which practically never contains such an enormous Holiday Fund makes a shrewd observation which applies amount of infection under natural conditions, would be with particular force to the class of children whose rendered safe for human consumption, so far as tubercle habits are formed amidst surroundings which daily become bacilli are concerned, by heating it at 60° C. for 20 minutes. This procedure was found to be efficient in the case of the more and more pernicious to child growth and this notof enteric fever, diphtheria, cholera, dysentery, and of all the conditions domestic sanitaorganisms withstanding improved tion. For the growth of towns as it takes place at present Malta fever, some of which succumb in less than 20 minutes, Thus the typhoid bacillus is or at a lower temperature. means the curtailment of sunlight and fresh air, two natural birthrights which nothing can replace and which no growing killed in two minutes and the majority of the diphtheria child should be denied. Canon Barnett says :"Education bacilli and cholera vibrio are killed at 55° C., the remainder in a form of enjoyment which depends not upon outside dying at 60° C. The dysentery bacillus is rather more reexcitement but on increased powers of observation and sistant to heat than the typhoid bacillus, sometimes withadmiration would do more for national strength than standing a temperatura of 60° C. for five minutes but not At a recent meeting of the Children’s for ten minutes. So far as can be judged from the meagre many laws." Fresh Air Mission Miss Alice Ravenhill also pointed out evidence at hand a temperature of 60° C. for 20 minutes is that no amount of exercise in schools could take the more than sufficient to destroy the infective principle of place of spontaneous free play. With both these observa- Malta fever in milk. It is not destroyed when subjected to tions we are in agreement. Another point worthy of 55°C. for a short time, but the majority of these organisms consideration is the fact that although the healthy child die at 580 C. and all are killed at 60° C. will sleep anywhere, yet in our crowded cities quiet sleep is harder for him to obtain than in the country where he can THE BELFAST HEALTH COMMISSION AND enjoy its full bounty. No body of men knows better than IRISH URBAN MORTALITY. the medical profession the good which is done by the THE Belfast Health Commissioners in their recently issued societies which provide country holidays for poor children, call attention to a fact which, if of general applicareport and not only are medical men themselves subscribers to seems to afford some explanation of the marked excess tion, these societies but they can do much to interest the of urban mortality in Ireland dealt with in an annotation benevolent public in so excellent a cause. Both the in these columns. The Commissioners Children’s Fresh Air Mission, St. Peter’s Schools, Onslow- recently publi3hed that the medical officer of health apstreet, Farringdon-road, London, E. C., and the Children’s naturally complain the by corporation of Belfast receives no statistical Country Holiday Fund, 18, Buckingham-street, Strand, pointed returns of deaths registered from time to time within that London, W.C., are urgently in need of funds for the conborough, and that he is thus unable to analyse the mortinuance of their truly national work. I tality of its population with due regard to its age and sex constitution and to the assigned causes of the THE THERMAL DEATH-POINTS OF PATHOGENIC This statement obviously suggests inquiry as deaths. MICRO-ORGANISMS IN MILK. to the precise cause of this serious deficiency in Irish A BULLETIN on the thermal death-points of patho- sanitary organisation. The Commissioners refer in their genic micro-organisms by Dr. Milton J. Rosenau has report to the 14 local medical officers, who, it may be recently been published by the United States Treasury presumed, are acting as dispensary medical officers and, in Department.’ The pathogenic organisms most frequently accordance with the Irish Registration Act, also as registrars found in milk are those causing tuberculosis, enteric of births and deaths within the borough of Belfast. This fever, diphtheria, scarlet fever, and Malta fever, and system, which is unfavourably criticised by the Comthe temperature at which milk should be pasteurised missioners, does not, however, appear to suggest any hinges on their thermal death-points. As none of the necessary or insuperable obstacle to the desirable receipt by organisms causing these diseases has resisting spores the the medical officer of health of detailed periodical returns of application of moderate heat is sufficient to render them all deaths registered within the borough. It is, we believe, harmless in milk. The streptococci, staphylococci, and most true that there is in Ireland no statutory obligation imposed of the bacteria associated with infantile diarrhcea are also on the local registrars of births and deaths to furnish to readily destroyed by heat. Dr. Rosenau found that it is the local sanitary authority, if so required, on payment difficult to determine precisely at what temperature a micro- of certain statutory fees, detailed periodical returns of deaths organism diea, owing to the fact that its failure to grow registered, similar to the obligation enacted in Sec. 28 of upon artificial media is not always a sure sign of death. 37 and 38 Vict., Cap. 88, which applies only to registrars of births and deaths in England and Wales. We cannot, how1 Bulletin No. 42, Hygienic Laboratory, United States Public Health and Marine Hospital Service, Washington, 1908, pp. 85. ever, believe that the Irish dispensary medical officers, acting
THE STODDART SEWAGE DISTRIBUTOR.-LOOKING BACK.
registrars of births and deaths, would raise any objection to furnishing such returns of deaths to local medical officers of health if the sanitary authorities desired them and were prepared to pay for them at the same rate authorised by the English Registration Act. These death returns are, indeed, so obviously essential to the efficient performance of the duties of a medical officer of health to enable him duly to advise his sanitary authority as to the health condition of as
1433
invited, will be "Some Inter-relations of Thoracic and Abdominal Disease." ____
WE regret to announce the death on Tuesday, May 5th, of Dr. Theodore Duka at the ripe age of 83 years. Dr. who was a retired member of the Indian Medical Duka, Service, fought with distinction in the Austro-Hungarian War of Independence under Kossuth, and we shall take;an early opportunity of publishing some notes on his interesting
his district that if any real difficulty exists in obtaining those returns we entirely endorse the recommendation of the career. Belfast Commissioners that such difficulty should be solved Mr. W. Watson Cheyne will deliver the Wightman lecture by legislation without delay. A medical officer of health the Society for the Study of Disease in Children on before without prompt and detailed information of all the deaths 22nd, at 5 P.M. The lecturer has taken as occurring within his district is thereby deprived of the main Friday next, May "The Defensive Arrangements of the Body as his subject, source of his power to promote health progress. Illustrated by the Incidence of Disease in Children and ___
Adults." THE
STODDART
SEWAGE
-
DISTRIBUTOR.
THE King has approved of the retention of the title of OUR attention has been called to the above through a honourableby Sir William Bisset Berry, M.D. Aberd., on pamphlet sent to us entitled I I The Best Method of Sewage his retirement from the office of Speaker of the House of Disposal for all Communities" by F. Stoddart, F.I.C.E. Assembly of the Colony of the Cape of Good Hope which he The system advocated is, first, the passing of the sewage has held for a period of more than three years. through a specially constructed tank, which is a modified form of the well-known Cameron tank. In this the solid WE much regret to announce the death on May llth of constituents are dissolved and the whole is thrown into a conDr. C. J. Cullingworth, consulting obstetric physician to St. dition of instability by the action of anaerobic bacteria. Thomas’s Hospital, and one of the most active advocates Secondly, the sprinkling of the resultant fluid by means of of the improvement of midwifery nursing. Mr. Stoddai’t’s patent distributor over a filter composed of coke or burnt ballast. The advantage of this arrangement over other similar systems lies in the method of the distribution THE eighty-seventh session of the General Council of of the liquid, which is carried by a series of metal channels Medical Education and Registration will commence on and drips and sprinkled evenly over the whole surface of Tuesday, May 26th, at 2 o’clock P.M., under the presithe filter bed. Mr. Stoddart claims that by this means the dency of Dr. Donald MacAlister. filter does not become clogged and can be used continuously without rest. It also adapts itself to the exigencies of a private installation, the irregularities in the flow in these The nitrifying cases generally constituting a difficulty. power of the filter, which depends upon the presence of bacteria of the aerobic class, is increased by its form of conFROM struction. This consists of a mound formed of the filtering THE medium and kept in position by iron stays or brick piers, thus giving free access of air to every part. The mound THE following very sensible petition is to be presented to is built upon a concrete bed, round which an open channel the House of Commons, against the impolitic and illiberal This effluent, it is tax which it is is carried to collect the Effluent. proposed by the Chancellor of the Exchequer is free from asserted, any unpleasant smell and is of to levy upon all surgical diplomas :sufficient purity to be discharged into a stream or ornamental The Humble Petition of the Royal College of Surgeons of water. Judging from the illustrations and descriptions Edinburgh; given in the pamphlet it would seem to be a system complying Showeth, That your petitioners have observed, with the greatest with all the conditions known to be necessary for achieving the end desired. The great difficulty to be overcome in most regret and alarm, that it is proposed to Parliament to exact a stamp-duty, a tax of 10. upon the admission or license sewage convertion systems is the want of attention (when by of any person to be a member or licentiate of any College they are adapted to private houses). The necessary amount of Surgeons.’ of watchfulness, however slight this may be, in these cases Your petitioners beg leave respectfully, but most earnestly, is frequently absent. Mr. Stoddart, however, gives descrip- to represent, that the acquisition of a proper medical and tions of some installations carried out on a small scale which surgical education necessary for all those who undertake the duties of general practice, requires a long period of time, have been found to work satisfactorily. and is attended with a very heavy expense, for which it is long before any adequate return can be obtained, and that the class of young men educated for surgery possess very THE King has granted to Mr. Alexander Granville, limited means. M.R.C.S. Eng., L.R.C.P. Lond., licence and authority to It has long been well known, that the education of those accept and to wear the Insignia of the Fourth Class of the who apply for licenses and diplomas has been, in many Imperial Ottoman Order of the Medjidieh conferred upon respects defective ; and the different colleges and public him by His Highness the Khedive of Egypt in recognition of bodies who have the power of granting these testimonials, have, for some time past, and particularly of late, envaluable services rendered. deavoured to remedy this defect, by extending the course of study required from those to whom diplomas or licenses are TIE opening lecture of the summer post-graduate course given. The greatest obstacle which your petitioners, and it. of the Mount Vernon Hospital will be given by Sir Williaml is believed the other public bodies, have encountered, in H. Allchin, M.D. Lond., F.R.C.P. Lond., in the lecture roomli effecting this desirable object, has arisen from their knowof the difficulties imposed upon young men, by the at the out-patient department of the hospital, 7, Fitzroy. ledge increase of expense necessarily attending it ; and they have square, W., on Thursday, May 21st, at 5 P.M. The subjec1t carefully avoided adding anything to this expense, except of the lecture, to which qualified medical practitioners ar(a what may be absolutely required to obtain the improved
Looking Back.
LANCET, SATURDAY, May 15th, 1830.
’