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The British Red Cross Society and rheumatism
a08
PUBLIC HEALTH.
JUNI':,
suffering from scarlet fever and whoopingcough and highest for diphtheria. The complication rates were highest for whoopingcough and enteritis. (d) Direct comparison of the clinical attacks amongst the inoculated individuals and the control group (uninocufated) shows a significant advantage to the former, in respect of initial manifestations, severity of main features and complication and fatality rates. The report, which was prepared by members of tim Public Health Department staff under the general editorship of Dr. J. A. H. Brincker, Principal Medical Officer in the Department, is one of real importance containing information of value to all medical officers of health.
only a justifiable but a desirable procedure. All cases asked to leave were such that they were fit to resume their place in the outside world and follow their occupation under ordinary conditions. By this means a much larger number of cases will be afforded the opportunities of working in the village settlement with all its attendant advantages. From the purely medical point of view interest is added to the report by the inclusion of a number of original articles. Mr. Laurence O'ShaughnessY provides two articles on thoracic surgery, and Dr. J. B. McDougall and Dr. J. H. Crawford discuss the relation of gassing to Buerger's disease.
The British Legion Village Settlement.
E annual report for 1935 of the British T HRed Cross Society's clinic in London for
H E R E is no doubt that the village settlement is the ideal unit in the treatment of pulmonary tuberculosis. The latest report of Dr. J. B. McDougall, Medical Director of the British Legion Village, Preston Hall, near Maidstone, Kent, which shows the results that can be achieved, is therefore of particular interest. The sanatorium has been considerably enlarged during the past two years and, including Douglas House, Bournemouth, which is used for patients requiring convalescence, there is accommodation for 399 patients. During the two years ending September 30th, 1935, 880 patients were admitted and 681 discharged. That the sanatorium is completely up to date in the matter of treatment can be judged from the fact that, since the inception of the surgical block in the latter part of 1933, a total of 145 thoracic operations have been performed. Preston Hall industries continue to do well. In the past ten years the total sales per annum have increased from £15,981 to £79,809, while the wages paid to settlers have risen from £8,968 to £25,293 : than this there could be no better testimonial to the efficiency of the scheme. The population employed by and dependent on the settlement on September 30th, 1935, was 635. Dr. McDougall states that the village settlement scheme at Preston Hall is practically self-supporting. The policy of asking arrested (clinically recovered) cases to leave the village settlement and take up accommodation elsewhere has been put into force. This appears to be not
T
The British Red Cross Society and Rheumatism. rheumatism, recently issued, is particularly noteworthy since it contains comparative statistics for the first five complete years of work. These and the reports of the medical board and of administration show that the need for this clinic and for a considerable extension of its services has been proved b e y o n d all shadow of doubt. Sir Arthur Stanley in his foreword says : " The available space and time for treatments have been taxed to the uttermost, and yet some patients have been obliged to wait longer than we should have wished to commence their treatment. The neea for accommodation for in-patient treatment and for specialised convalescent treatment is urgent; the progress in research only serves to show how much more research is required to solve the innumerable problems presented by rheumatic diseases; and the social problems of the patients themselves exercise all our ingenuity in finding financial and other methods of solution." The total number of attendances for treatment in 1935 was 89,810, as compared with 77,892 in 1931. Of those patients discharged during 1935, 51 per cent. were working throughout the period of their treatment, and a further 21 per cent. were off work at the start but proposed to return to work when discharged--a striking testimony to the success of the clinic in attracting patients suffering from the early manifestations of rheumatism. T h o u g h it is recognised that many factors must modify interpretations of statistics, it is claimed that of 2,314 patients
1936.
PUBLIC HEALTH.
discharged in 1935, 50"9 per cent. were cured or free from symptoms; 35"1 per cent. definitely improved; 13"2 per cent. unchanged or only slightly improved; and 0'8 per cent. worse. The financial statements show that, excluding subscriptions and donations, the clinic has worked at a loss of approximately ~3,500 per annum, so that the committee is faced with the necessity of raising a considerable sum, in addition to income from fees, with which to meet the continually increasing demands of up-to-date treatment for rheumatism. The samaritan fund of the clinic has, during the year, received a first grant of £2,000 from the trustees of Mrs. Katherine Cargill's estate to establish the " Katherine Cargill " treatment fund.
Costing Returns : Part H. E Ministry of Health have issued a T Hcircular to county and county borough councils enclosing part 11 of the costing returns for 1934-35. This part contains particulars of poor law institutions (other than hospitals) and casual wards, and shows the average weekly cost per inmate under various heads of expenditure in each institution of either class. These particulars are collected and issued annually by the Ministry in order to assist local authorities in the economical administration of the institutions under their control. In recent years the value of costing methods in securing business efficiency has become increasingly recognised, not only in industry but also in local government. Other examples in the sphere of local government are provided by the costing returns for sewage disposal works, for refuse collection and disposal and for street cleansing, which are referred to in the Ministry's annual reports. The average net cost for poor law institutions (other than hospitals and separate casual wards) is shown by the present returns to be as follows : N e t cost. 1930-31. 1932-33. 1934-35. Total amount ... A~8,234,170£7,733,374 A~7,819,980 Average per inmate per week . . . . . 24s. 8"9d. '23s. 4"9d. 24s. 9'ld. Ditto, after deducting for casuals .. 23s. 11"5d. 22s. 2-9d. 23s. 9'0d. Part I of these returns, which contained information for poor law hospitals, general hospitals administered by local authorities,
309
sanatoria, and maternity homes and hospitals, was published in March and has already been noted here. Both parts may be obtained, price ls. 3d., direct from His Majesty's Stationery Office or through any bookseller.
Orthodichlorbenzene and Vermin Infestations. has been and is S bI Ne iCnEg orthodichlorbenzene used to a considerable extent in inhabited houses in a number of districts, particular importance attaches to the statements contained in the circular (1544) of the Ministry of Health dealing with the matter and setting out the conclusions reached as a result of further investigations, carried out since the issue of the " Memorandum on the Bed-bug and How to Deal with It " (Memo. 180 Med.), with undiluted and diluted orthodichlorbenzene. These have shown that whilst satisfactory results have been obtained as far as the destruction of bed-bugs is concerned, it has been found in practice that it is difficult to take adequate precautions against the fumes, and the period which is necessary for proper ventilation is so long as to render the method impracticable for use in occupied premises. The toxicity of the fumes to human beings is not known at present but experiments on animals have indicated that they may be toxic in low. concentrations. P e n d i n g further enquiry, therefore, the Minister considers it undesirable that orthodichlorbenzene, whether in an undiluted or a diluted form, should be used for the disinfestation of inhabited houses. No doubt, even though no evidence of any harmful effects has been detected, it will be considered advisable in all areas to discontinue the use of the material. THE "' Bostock Hill Memorial " Shield, offered annually by the Royal Sanitary Institute for the best celebration of Health Week in the ;Empire outside the British Isles, has been awarded for the Health W e e k and Exhibition held in R a n g o o n in 1935, which was organised by the Burma Branch of the Indian Red Cross Society. A m o n g other entrants, the adjudicators considered that the celebration of Empire Health Week in Lagos, Nigeria, was deserving of the highest commendation. They also commended the celebrations in Pretoria, Transvaal, and Port-ofSpain, Trinidad,
PUBLIC HEALTH.
JUNI':,
suffering from scarlet fever and whoopingcough and highest for diphtheria. The complication rates were highest for whoopingcough and enteritis. (d) Direct comparison of the clinical attacks amongst the inoculated individuals and the control group (uninocufated) shows a significant advantage to the former, in respect of initial manifestations, severity of main features and complication and fatality rates. The report, which was prepared by members of tim Public Health Department staff under the general editorship of Dr. J. A. H. Brincker, Principal Medical Officer in the Department, is one of real importance containing information of value to all medical officers of health.
only a justifiable but a desirable procedure. All cases asked to leave were such that they were fit to resume their place in the outside world and follow their occupation under ordinary conditions. By this means a much larger number of cases will be afforded the opportunities of working in the village settlement with all its attendant advantages. From the purely medical point of view interest is added to the report by the inclusion of a number of original articles. Mr. Laurence O'ShaughnessY provides two articles on thoracic surgery, and Dr. J. B. McDougall and Dr. J. H. Crawford discuss the relation of gassing to Buerger's disease.
The British Legion Village Settlement.
E annual report for 1935 of the British T HRed Cross Society's clinic in London for
H E R E is no doubt that the village settlement is the ideal unit in the treatment of pulmonary tuberculosis. The latest report of Dr. J. B. McDougall, Medical Director of the British Legion Village, Preston Hall, near Maidstone, Kent, which shows the results that can be achieved, is therefore of particular interest. The sanatorium has been considerably enlarged during the past two years and, including Douglas House, Bournemouth, which is used for patients requiring convalescence, there is accommodation for 399 patients. During the two years ending September 30th, 1935, 880 patients were admitted and 681 discharged. That the sanatorium is completely up to date in the matter of treatment can be judged from the fact that, since the inception of the surgical block in the latter part of 1933, a total of 145 thoracic operations have been performed. Preston Hall industries continue to do well. In the past ten years the total sales per annum have increased from £15,981 to £79,809, while the wages paid to settlers have risen from £8,968 to £25,293 : than this there could be no better testimonial to the efficiency of the scheme. The population employed by and dependent on the settlement on September 30th, 1935, was 635. Dr. McDougall states that the village settlement scheme at Preston Hall is practically self-supporting. The policy of asking arrested (clinically recovered) cases to leave the village settlement and take up accommodation elsewhere has been put into force. This appears to be not
T
The British Red Cross Society and Rheumatism. rheumatism, recently issued, is particularly noteworthy since it contains comparative statistics for the first five complete years of work. These and the reports of the medical board and of administration show that the need for this clinic and for a considerable extension of its services has been proved b e y o n d all shadow of doubt. Sir Arthur Stanley in his foreword says : " The available space and time for treatments have been taxed to the uttermost, and yet some patients have been obliged to wait longer than we should have wished to commence their treatment. The neea for accommodation for in-patient treatment and for specialised convalescent treatment is urgent; the progress in research only serves to show how much more research is required to solve the innumerable problems presented by rheumatic diseases; and the social problems of the patients themselves exercise all our ingenuity in finding financial and other methods of solution." The total number of attendances for treatment in 1935 was 89,810, as compared with 77,892 in 1931. Of those patients discharged during 1935, 51 per cent. were working throughout the period of their treatment, and a further 21 per cent. were off work at the start but proposed to return to work when discharged--a striking testimony to the success of the clinic in attracting patients suffering from the early manifestations of rheumatism. T h o u g h it is recognised that many factors must modify interpretations of statistics, it is claimed that of 2,314 patients
1936.
PUBLIC HEALTH.
discharged in 1935, 50"9 per cent. were cured or free from symptoms; 35"1 per cent. definitely improved; 13"2 per cent. unchanged or only slightly improved; and 0'8 per cent. worse. The financial statements show that, excluding subscriptions and donations, the clinic has worked at a loss of approximately ~3,500 per annum, so that the committee is faced with the necessity of raising a considerable sum, in addition to income from fees, with which to meet the continually increasing demands of up-to-date treatment for rheumatism. The samaritan fund of the clinic has, during the year, received a first grant of £2,000 from the trustees of Mrs. Katherine Cargill's estate to establish the " Katherine Cargill " treatment fund.
Costing Returns : Part H. E Ministry of Health have issued a T Hcircular to county and county borough councils enclosing part 11 of the costing returns for 1934-35. This part contains particulars of poor law institutions (other than hospitals) and casual wards, and shows the average weekly cost per inmate under various heads of expenditure in each institution of either class. These particulars are collected and issued annually by the Ministry in order to assist local authorities in the economical administration of the institutions under their control. In recent years the value of costing methods in securing business efficiency has become increasingly recognised, not only in industry but also in local government. Other examples in the sphere of local government are provided by the costing returns for sewage disposal works, for refuse collection and disposal and for street cleansing, which are referred to in the Ministry's annual reports. The average net cost for poor law institutions (other than hospitals and separate casual wards) is shown by the present returns to be as follows : N e t cost. 1930-31. 1932-33. 1934-35. Total amount ... A~8,234,170£7,733,374 A~7,819,980 Average per inmate per week . . . . . 24s. 8"9d. '23s. 4"9d. 24s. 9'ld. Ditto, after deducting for casuals .. 23s. 11"5d. 22s. 2-9d. 23s. 9'0d. Part I of these returns, which contained information for poor law hospitals, general hospitals administered by local authorities,
309
sanatoria, and maternity homes and hospitals, was published in March and has already been noted here. Both parts may be obtained, price ls. 3d., direct from His Majesty's Stationery Office or through any bookseller.
Orthodichlorbenzene and Vermin Infestations. has been and is S bI Ne iCnEg orthodichlorbenzene used to a considerable extent in inhabited houses in a number of districts, particular importance attaches to the statements contained in the circular (1544) of the Ministry of Health dealing with the matter and setting out the conclusions reached as a result of further investigations, carried out since the issue of the " Memorandum on the Bed-bug and How to Deal with It " (Memo. 180 Med.), with undiluted and diluted orthodichlorbenzene. These have shown that whilst satisfactory results have been obtained as far as the destruction of bed-bugs is concerned, it has been found in practice that it is difficult to take adequate precautions against the fumes, and the period which is necessary for proper ventilation is so long as to render the method impracticable for use in occupied premises. The toxicity of the fumes to human beings is not known at present but experiments on animals have indicated that they may be toxic in low. concentrations. P e n d i n g further enquiry, therefore, the Minister considers it undesirable that orthodichlorbenzene, whether in an undiluted or a diluted form, should be used for the disinfestation of inhabited houses. No doubt, even though no evidence of any harmful effects has been detected, it will be considered advisable in all areas to discontinue the use of the material. THE "' Bostock Hill Memorial " Shield, offered annually by the Royal Sanitary Institute for the best celebration of Health Week in the ;Empire outside the British Isles, has been awarded for the Health W e e k and Exhibition held in R a n g o o n in 1935, which was organised by the Burma Branch of the Indian Red Cross Society. A m o n g other entrants, the adjudicators considered that the celebration of Empire Health Week in Lagos, Nigeria, was deserving of the highest commendation. They also commended the celebrations in Pretoria, Transvaal, and Port-ofSpain, Trinidad,