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THE CONFERENCE ON CONSUMPTION AT MANCHESTER.
1645 great multiparity of the poor as compared with the country will be absolutely deprived of the necessary attendrich, and falls in with Dr. Eden’s previous statement as ance in his hour of need. He will be in just the same regards the great predominance of multiparity in cancer of position as he is to-day. Surely it requires no more than ordinary intelligence to see the difference between the cervix over cancer of the corpus uteri. It being accepted by all that multiparity is one of the that course and the course of any body of industrial contributory causes of cervical cancer, and knowing the workers-say coal-miners or transport men-who, unless great fertility of the poor as compared with the better classes, and until their demands are conceded, stop all work of that one would expect a very large preponderance of cervical kind, refusing to do it themselves or to allow others to do carcinoma among the poor. it, whereby the community at large and every individual in As to the reason why multiparity encourages the incidence it is deprived of the particular necessary of existence for his the very
of cancer, it is certain that any scar tissues and tissues own use. Each individual sick person will be able to receive exposed to continued irritation are more liable to cancer the service that his necessity demands for such fee as he can than healthy organs. This also explains the association of afford, or even in fitting cases for none at all, even though all club contract practice is repudiated and the profession as cancer of the body of the uterus with fibroids, the pressure of the fibroids possibly leading to some change in the mucous a whole refuses to work the medical benefit of the Insurance Act. In short, the doctor does not "strike." membrane that produces carcinoma. I am, Sir, yours faithfully.
R. LEONARD LEY, M.B., B. C. Cantab, L.R.C.P. Lond. June 11th, 1912.
M.R.C.S. Eng.,
THE MEDICAL PROFESSION AND THE NATIONAL INSURANCE ACT.
I am, June 6th, 1912.
Sir,
yours
faithfully, K. M.
__________________
THE CONFERENCE ON CONSUMPTION AT MANCHESTER.
(FROM
OUR OWN
CORRESPONDENT.)
To the Editor of THE LANCET. THE fourth annual conference of the National Association am given to understand from more or less official that the two chief points in the profession’s protest for the Prevention of Consumption and Other Forms of Milton Hall, Manchester, on against the medical administration of the Insurance Act will Tuberculosis was held at the was It attended by about 600 not and cannot be granted by the Chancellor of the Ex- June 5th, 6th, and 7th. of the principal civic including nor the Insurance Commissioners : I refer delegates, representatives to chequer by (1) the £2 a week income-limit ; and (2) the 8s. 6d. capitation authorities of the United Kingdom. The delegates were gave a conversazione in grant in cases where that method of payment is adopted welcomed by the Lord Mayor, who authorities also gave a recep(indeed, the Act implicitly seems to contemplate no other theirinhonour. The University tion the Museum of the University. method). If this be true, is it not time that the profession was made Opening Address. aware of the fact, and I would like to ask, What must now W. medical officer of health of LiverProfessor E. HOPE, be the attitude of the profession ? Time is rapidly passing, and delivered an opening address in which pool, presided and though I believe we are organising pretty rapidly against he showed how the sanitary undertakings, especially unjust and ungenerous treatment, our efforts are at present municipal schemes forgreat the supply of pure water to cities, were scattered in aim to as somewhat doubts to the owing being coincident with the great decline in the death rate from tuberexact and precise object against which they should be of the city of Manchester culous disease. The directed ; it is high time these efforts were focussed and had accumulated a experiences amount of valuable material large I am, Sir, yours faithfully, strengthened. for the elucidation of the modes of spread of consumption. FRED. J. SMITH. The control of poor dwellings was a great difficulty. Many homes became notoriously unhealthy from the point of view of consumption, not because the building itself was To the Editor of THE LANCET. vicious in its plan or construction, but because of the way in SIR,-In an article in the Daily Mail of June 3rd on the which it was occupied ; the subletting, the overcrowding, labour unrest, entitled "What we Want," Mr. Vernon the insufficient cubic space and consequent foul, vitiated air, Hartshorn, putting the case for the labouring classes as as everybody knew, favoured the development and spread of regards the ’’present social upheaval, makes the following tuberculosis. The proper control of houses such as these was The demand which members of the British a problem of great magnitude in every large town, and constatement : Medical Association are making for what represents to them stituted an important element in the control of tuberculosis. a fair minimum living wage stands on exactly the same In Liverpool it was found that formerly the mortality from footing as the underground workers’ claim to a guaranteed phthisis over large areas of this class of dwelling averaged minimum which represents his modest estimate of a 4 per 1000 per annum, but after clearance and rehousing Then he adds: "Both claims are being schemes had been carried out the rate was reduced to 1’ 9 livelihood." advanced by the same methods. The doctor puts forward per 1000. In Liverpool at one time 18,000 sublet houses his claim on the grounds of justice and his indispensable accommodated 160,000 people, but the standard of air-space value to the community. The underground worker does the had been increased from 250 cubic feet per head, not same. The doctor is prepared to strike if his claim is not including children, to 400 cubic feet for each man, woman, and conceded. This is a so child. At present there were only two convictions for overSo is the underground worker." frequently repeated misstatement that it must be definitely crowding where formerly there were seven. Other factors in contradicted as widely and as emphatically as possible, and I the reduction of the death-rate were open-air schools, the am glad to see that you have disposed of it in the leading principle of which should be applied to all schools, and the article in THE LANCET of June lst. The doctor does not purification of the milk-supply. Without healthy homes conHealth congresses and propose to " strike " at all in the sense in which the word is sumption could not be eradicated. generally used. He does not refuse to do the necessary exhibitions were most valuable aids in the education of the work. He will continue to tend the sick as he has always public. Probably one of the reasons of the decline in popularity done on the terms he has always accepted-viz., that the of sanatoriums amongst the public generally was the extravaindividuals served should pay him for services rendered gant hopes that had been built on them by uninformed persons. on a scale commensurate with their capabilities-and to attend Regarding the milk-supply, Professor Hope said it was a to urgent and emergency cases without question to his lamentable thing that owing to the inertness of so many probable payment therefor, and to give his services with rural sanitary authorities the condition of large numbers of the generosity that has always characterised the profession country cowsheds was bad in the extreme. The consequence as a whole in those cases where payment is out of the was that the cows were riddled with tuberculosis and the question. What he does refuse to do is to work on a milk was contaminated. But, one after another, great particular plan and for a particular fee that is being thrust towns had actually been forced to seek Parliamentary powers upon him against his sense of right and justice. If the to prohibit the importation into their districts of the doctor resigns all his contract practice and refuses to work diseased products of cows kept in the filthy and insanitary the Insurance Act, not a single individual in the whole cowsheds of country places, and the fact stood out that the
SIR,-I
sources
1646 milk from cows kept within the precincts of cities was freer from tuberculosis, and consequently purer and more wholesome, than that coming from many rural districts, with their greater facilities and more healthy surroundings, were these only availed of. But it was only the large towns which had these powers, and the milk excluded from these centres found its way into unprotected communities. Liverpool ’, (following the lead of Manchester) obtained powers of this kind in the year 1900, and it was a fact, the interpretation of which Professor Hope left to others, that coincidently with putting these powers into operation two things had followed. One was that the tuberculous milk from the country had largely diminished year by year in amount, and the other was that tuberculosis amongst young children (who were the greatest milk consumers) had diminished also in an almost corre-
sponding degree. Tuberculosis in Childhood.
Hospital and College, shortly be published in
It will attracted much attention. THE LANCET. Mrs. M. D. POWER SWEENEY gave a paper with many details of the question of open-air schools, including their cost. In London the gross cost per head per year was about E24, against less than f,7in the ordinary schools.
Ventilation of
Work-places.
Dr. A. RANSOME dealt specially with the necessity of providing fresh air in work places. Previously it had been found that it was not the humidity in weaving-sheds that was the The standard of ventilacause of trouble, but the foul air. tion first established in this country for work-places was 9 per cent. carbon dioxide per 10,000 of air. He regretted that the new Home Office regulations lowered the standard to 11
per 10,000. The following resolution was unanimously adopted :— That this association protests against any lowering of the standard o ventilation in any of the work-places in the kingdom, and that a copy of this resolution be forwarded to the Home Secretary. National Insurance Act and Tuberculosis. The afternoon was devoted to the discussion of the powers and duties of sanitary authorities and the working of the National Insurance Act in connexion with tuberculosis. Dr. W. LESLIE MACKENZIE dealt with the new duties imposed on local and central authorities by sanatorium benefits. Dr. H. W. MCCONNEL, of the Kelling Sanatorium, complained that no mention of the after-care of patients discharged from sanatoriums was made in the Act. Dr. A. K. CHALMERS, medical officer of health of Glasgow, said that in Scotland, where the people occupied tenement houses, the idea of sanatorium treatment was abused. The average cost per bed for sanatoriums, he said, was not less than £300. Mr. F. E. FREMANTLE, medical officer of health for Hert. fordshire, stated that in this country sanatoriums had actually been erected at a cost of £100 and even E50 per bed. The TOWN CLERK of Dundee and Dr. F. E. WYNNE, medical officer of health of Wigan, criticised the Interim Report of the Tuberculosis Committee.
r The whole of the rest of the day and part of the second ‘ day were devoted to the discussion of the question of tuberculosis in childhood. ’ Dr. R. W. PHILIP (Edinburgh) read a paper on the Prevalence of Tuberculosis in Childhood. Tuberculosis of the adult and adolescent was the harvest of seed sown in childhood. He thought they were too prone to confine their attention to the completed picture of the disease. Fresh air must be brought into the poor man’s nursery. He urged the importance of detecting the presence of tuberculosis in school children. Professor S. DELÉPINE gave an account of the infectivity of human and bovine tuberculosis. Tuberculosis could be communicated from animal to man as well as from man to man. The sputum of tuberculosis, even when dried and floating as dust, was infective. Among children under five years there were only 100 cases of lung disease to 850 cases of disease of other organs, while between 35 and 45 years of age there were 100 cases of lung disease to less than 6 of other forms. It was impossible to resist the conclusion that children were more likely to be infected through their food. Tuberculous cows’ milk, as he had proved both by experiments and observations, constituted the most important infecting material vu rrmay Councellor ARTHUR NEAL (Sheffield) dealt of bovine origin. Whatever the channel of infection, some bacilli might pass into the blood and give rise to tuberculosis both eloquently and exhaustively with the different questions in various parts of the body. Localised tuberculosis of the raised in the Interim Report, which he regarded as a lymphatic glands, bones, liver, spleen, and other organs, when valuable document for local authorities. He took a very not associated with pulmonary tuberculosis, was generally optimistic view of the provisions of the new Act, even as due to infection through the alimentary tract. regards its finance. He believed that the working of the Dr. NATHAN RAW dealt with the same subject. He stated Act would pay the local authorities, not only in health and that 20-25 per cent. of the cows in the country were tuber- happiness, but even in money. Dr. C. KILLICK MILLARD, medical officer of health culous, and in 2 per cent. the udders were infected. Abdominal and other forms of tuberculosis were common, but of Leicester, did not share Mr. Neal’s optimism with consumption was rare in children under 12. The other forms regard to the financial aspects of the Act. The report of tuberculosis were of bovine origin, and consumption was demanded 9000 sanatorium beds and the same number of of human origin. The nation would do well to spend other hospital beds, with 250 to 300 dispensaries. These could in £2,000,000 getting rid of cows affected by tuberculosis be provided, the difficulty was their maintenance. Each sanatorium bed would cost 25s. per week, and other hospital of the udders. He urged the boiling of milk. Dr. J. E. SQUIRE stated that the death-rate from tuberculous beds Sl, and each dispensary.f.lOOO a year. These figures diseases was low during school age and highest before and seemed to presage a heavy financial loss to the local authorities. The chronic consumptive-who was sure to break after it. * Mrs. LESLIE MACKENZIE showed lantern slides of open-air down after a course of treatment-would upset all financial schools and country homes which had been established by calculations. The Countess of ABERDEEN presided in the afternoon and the Edinburgh school board. referred to the work of the Women’s Health Association in E. D. TELFORD on the (Manchester) spoke hospital Mr. He advocated an extension of such schools for Ireland and the good results achieved. In 1907 the deaths school. children afflicted with surgical tuberculosis. The ordinary from all forms of tuberculous disease in Ireland were 11,679 hospitals could not cope with them, their wards being crowded and in 1911 the number was 9623, a reduction of one-sixth, with acute diseases. All that was necessary to save these which was equal to 40 fewer deaths every week. Miss M. E. BROADBENT, of the Children’s Aid Association, children was that they be maintained in a special institution under proper conditions of hygiene and surgical treatment suggested grants to voluntary organisations by the Insurance for a length of time sufficient for their cure. They must get Committees. Mr. E. S. KEMP, of the London Charity Organisation hold of these cases early, place them in a specially equipped for an them there indefinite timemaintain Society, pointed out that most consumptives would be Post institution, usually two or three years-and under these conditions notOffice contributors and their sick pay would soon be only would the great majority be saved, but they would be exhausted. Other Papers and Lectures. saved without deformity. Some provision should be made for teaching them, since they were often mentally above the Amongst others who took part in proceedings were Professor G. SIMS WOODHEAD, Mr. JOHN PRIESTLEY, who average. On the second day the discussion on tuberculosis in spoke on the Special Factors making for the Extension of children was continued. The difficulty of early diagnosis Tuberculosis in the School and the Measures of its Prevenof the disease in children largely accounted for the varying tion, and Mr. C. E. LAST, of the Millfield Home for Children estimates of the rarity or otherwise of the disease. for Pulmonary Tuberculosis, who dealt with Open-air Schools. The paper by Mr. H. J. GAUVAIN, of the Treloar Cripples’ The evening lectures were given by Dr. SQUIRE, Dr. R. W.
1647
PHILIP,
and Professor SIMS WOODHEAD.
The Conference
value of the
proposals
the cost is small.
The
purchase
of
under’ the auspices of the city of Manchester and the the land necessary for the construction of the street and the county borough of Salford. laying out of the street would amount to £50,000. It would In connexion with the Conference an exhibition is being be necessary to expend .631,000 on the purchase of plots to held in Salford with the object of educating the public in the east of the proposed street, so that a sum of £81,000 is regard to the dread disease. The exhibition will be trans- essential for the carrying out of the infirmary ideals. If in ferred to Deansgate, Manchester, and then to the Hulme addition to this the corporation decides, as it is hoped it
was
Town hall from June 21st to 27th. The Conference was extremely successful, the evening lectures delivered by medical men dealing with wide questions of the relation of the public to tuberculosis. Salford, too, is participating vigorously in the crusade against consumption. The mayor stated that in 1879 the death-rate in Salford from phthisis was 29 per 10,000, but in 1910 it had fallen to 13 per 10,000 owing to the improvement that had been effected in housing and general sanitation, and in the habits and material conditions of the people. There were 400 deaths per annum in Salford from phthisis, while the consumptive population of England and Wales was somewhere about 300,000.
(FROM A
LEEDS. CORRESPONDENT.)
OUR OWN
Scheme of Extension in Connexion with the General Infirmary. AT the usual monthly meeting of the city council a deputation from the weekly board of the infirmary, accompanied by Mr. William Middlebrook, the president of the King Edward .Memorial Fund, who was Lord Mayor at the time the fund was started, had an opportunity of laying before the members of the corporation a scheme of infirmary extension of very farreaching importance. The standing orders were suspended so that Mr. Charles Lupton, the chairman of the weekly board, should have an opportunity of explaining the scheme in
Large
detail. As has been mentioned in this column more than once the need for extension of the infirmary is a very urgent one. It was wisely decided that so far as Leeds was concerned the best memorial which could be raised to the memory of King Edward would be a reconstruction of, and a substantial addition to, the great institution which as Prince of Wales he opened in the year 1868. The scheme of enlargement and of reconstruction which Mr. Lupton unfolded to the corporation was, as he said, one which had been thought out mainly in the interests of the infirmary, but it had appeared to the board to be one which would effect such an improvement in the access to certain important parts of the city and would be such a great public improvement that the board had adopted the bold course of purchasing a large amount of property to the east and north of the infirmary, feeling confident that the scheme would command the sympathy and the support of the public and of the corporation. To the north and east of the present buildings there is a large amount of property to which the term ’’ slum "may without impropriety be applied. Practically the whole of this has been bought by the infirmary, and the corporation is now asked to repurchase from the infirmary as much of this property as may suffice for the construction of a new wide thoroughfare which would continue the line of Calverley-street, which runs between the town hall and the municipal buildings, and curving to the west would strike Fenton-street some distance to the north of the infirmary. All the property to the south and west of this projected street would be available for the extension of the infirmary, and it has been secured by the institution. The streets within its area would be abolished, for their place would be more than taken by the new thoroughfare, and room for the expansion of the infirmary would be secured which would probably make the future of the institution secure for many years to come. It is not an absolutely essential part of the scheme, but it would greatly add to its excellence, especially from the point of view of its being a public improvement, if in addition to constructing the new road the corporation should, as has been suggested, demolish the existing Were this property at the back of the town hall. done a large open space would be formed between the town hall and the eastward extension of the infirmary. Of course, the scheme would cost a good deal, but in view of the
will, to create
an
open space
as
explained
above
an
additional
.E50,OOO will be required. It is, of course, true that something may be reasonably set against this in the way of the sale of surplus property and in an increase of rateable value, but in any case the money would be well spent considering the immense improvement which would be effected in the neighbourhood. Should the area requisite for the construction of the street and the land to the east thereof be taken, as is suggested, by the corporation for a sum of .621,649, the additional area at the disposal of the infirmary for immediate and future extensions will have cost some £50,000. It may be remembered that the King Edward Fund amounts to about £110,000, though it is hoped that the full amount which was asked for-namely, .6150,000, may be ultimately obtained. About £50,000, therefore, will be available for building and reconstruction. It is intended to build one new large ward pavilion serial with those at present existing on the south aspect of the infirmary, with accommodation for about 100 patients ; to construct a suite of operating theatres for which there is urgent need, and to extend the accommodation for the nursing staff. These with certain minor but necessary aims must demand the immediate attention of the authorities of the infirmary. Room will also be secured for the addition of two extra ward pavilions of the same size as that which is to be immediately commenced, so that for many years it is felt that the present site will be adequate to the requirements of the infirmary. It is gratifying to find that, so far as can be seen, the scheme has commended itself to all parties in the corporation. The infirmary stands high in the estimation of the public of Leeds, and it is with a feeling of pride that they can look forward to the carrying out of the great scheme which has been outlined.
BRISTOL
(FROM
OUR OWN
CORRESPONDENT.)
Bristol Health Exhibition and Conference. set by many of the large "health week," Bristol has had a health exhibition and conference at the Victoria Rooms, under the auspices of the Nurses’ Social Union. Some were at first disposed to cavil at this decision, but it is now generally acknowledged that the exhibition is admirable from the educational point of view. Many interesting exhibits were sent by the General, Children’s, and Eye Hospitals, but the majority came from the Nurses’ Social Union itself. These were divided into 13 sections, and many of them were One section, for example, of the utmost practical value. consisted entirely of " expedients "-i.e., devices to show how much in the way of nursing appliances might be made of simple and inexpensive material, such as is likely to be available in an emergency in a cottage. Other sections of particular interest were exhibits of cookery appliances economising fuel, and a group relating to baby and infant care. In one corner was a realistic waxwork group depicting a surgical case in a slum room before and after the visit of the district nurse. Various admirable demonstrations of infant care, simple needlework, and similarly practical subjects were given several times daily. One small side room was occupied by exhibits designed exclusively for medical practitioners and nurses ; this contained an interesting series of wax models and pamphlets. There were also a number of stalls, one of which, under the management of the health committee of the city council, exhibited a set of microscopic and other preparations illustrative of pathogenic bacteria and their modes of dissemination. The Red Cross Society, the ambulance brigades, and boy scouts have given displays in the adjoining rink, and every day has had its special dramatic and other entertainments. The first day of the exhibition was reserved
INSTEAD of
English
following the example
towns and
having
a
of cancer, it is certain that any scar tissues and tissues own use. Each individual sick person will be able to receive exposed to continued irritation are more liable to cancer the service that his necessity demands for such fee as he can than healthy organs. This also explains the association of afford, or even in fitting cases for none at all, even though all club contract practice is repudiated and the profession as cancer of the body of the uterus with fibroids, the pressure of the fibroids possibly leading to some change in the mucous a whole refuses to work the medical benefit of the Insurance Act. In short, the doctor does not "strike." membrane that produces carcinoma. I am, Sir, yours faithfully.
R. LEONARD LEY, M.B., B. C. Cantab, L.R.C.P. Lond. June 11th, 1912.
M.R.C.S. Eng.,
THE MEDICAL PROFESSION AND THE NATIONAL INSURANCE ACT.
I am, June 6th, 1912.
Sir,
yours
faithfully, K. M.
__________________
THE CONFERENCE ON CONSUMPTION AT MANCHESTER.
(FROM
OUR OWN
CORRESPONDENT.)
To the Editor of THE LANCET. THE fourth annual conference of the National Association am given to understand from more or less official that the two chief points in the profession’s protest for the Prevention of Consumption and Other Forms of Milton Hall, Manchester, on against the medical administration of the Insurance Act will Tuberculosis was held at the was It attended by about 600 not and cannot be granted by the Chancellor of the Ex- June 5th, 6th, and 7th. of the principal civic including nor the Insurance Commissioners : I refer delegates, representatives to chequer by (1) the £2 a week income-limit ; and (2) the 8s. 6d. capitation authorities of the United Kingdom. The delegates were gave a conversazione in grant in cases where that method of payment is adopted welcomed by the Lord Mayor, who authorities also gave a recep(indeed, the Act implicitly seems to contemplate no other theirinhonour. The University tion the Museum of the University. method). If this be true, is it not time that the profession was made Opening Address. aware of the fact, and I would like to ask, What must now W. medical officer of health of LiverProfessor E. HOPE, be the attitude of the profession ? Time is rapidly passing, and delivered an opening address in which pool, presided and though I believe we are organising pretty rapidly against he showed how the sanitary undertakings, especially unjust and ungenerous treatment, our efforts are at present municipal schemes forgreat the supply of pure water to cities, were scattered in aim to as somewhat doubts to the owing being coincident with the great decline in the death rate from tuberexact and precise object against which they should be of the city of Manchester culous disease. The directed ; it is high time these efforts were focussed and had accumulated a experiences amount of valuable material large I am, Sir, yours faithfully, strengthened. for the elucidation of the modes of spread of consumption. FRED. J. SMITH. The control of poor dwellings was a great difficulty. Many homes became notoriously unhealthy from the point of view of consumption, not because the building itself was To the Editor of THE LANCET. vicious in its plan or construction, but because of the way in SIR,-In an article in the Daily Mail of June 3rd on the which it was occupied ; the subletting, the overcrowding, labour unrest, entitled "What we Want," Mr. Vernon the insufficient cubic space and consequent foul, vitiated air, Hartshorn, putting the case for the labouring classes as as everybody knew, favoured the development and spread of regards the ’’present social upheaval, makes the following tuberculosis. The proper control of houses such as these was The demand which members of the British a problem of great magnitude in every large town, and constatement : Medical Association are making for what represents to them stituted an important element in the control of tuberculosis. a fair minimum living wage stands on exactly the same In Liverpool it was found that formerly the mortality from footing as the underground workers’ claim to a guaranteed phthisis over large areas of this class of dwelling averaged minimum which represents his modest estimate of a 4 per 1000 per annum, but after clearance and rehousing Then he adds: "Both claims are being schemes had been carried out the rate was reduced to 1’ 9 livelihood." advanced by the same methods. The doctor puts forward per 1000. In Liverpool at one time 18,000 sublet houses his claim on the grounds of justice and his indispensable accommodated 160,000 people, but the standard of air-space value to the community. The underground worker does the had been increased from 250 cubic feet per head, not same. The doctor is prepared to strike if his claim is not including children, to 400 cubic feet for each man, woman, and conceded. This is a so child. At present there were only two convictions for overSo is the underground worker." frequently repeated misstatement that it must be definitely crowding where formerly there were seven. Other factors in contradicted as widely and as emphatically as possible, and I the reduction of the death-rate were open-air schools, the am glad to see that you have disposed of it in the leading principle of which should be applied to all schools, and the article in THE LANCET of June lst. The doctor does not purification of the milk-supply. Without healthy homes conHealth congresses and propose to " strike " at all in the sense in which the word is sumption could not be eradicated. generally used. He does not refuse to do the necessary exhibitions were most valuable aids in the education of the work. He will continue to tend the sick as he has always public. Probably one of the reasons of the decline in popularity done on the terms he has always accepted-viz., that the of sanatoriums amongst the public generally was the extravaindividuals served should pay him for services rendered gant hopes that had been built on them by uninformed persons. on a scale commensurate with their capabilities-and to attend Regarding the milk-supply, Professor Hope said it was a to urgent and emergency cases without question to his lamentable thing that owing to the inertness of so many probable payment therefor, and to give his services with rural sanitary authorities the condition of large numbers of the generosity that has always characterised the profession country cowsheds was bad in the extreme. The consequence as a whole in those cases where payment is out of the was that the cows were riddled with tuberculosis and the question. What he does refuse to do is to work on a milk was contaminated. But, one after another, great particular plan and for a particular fee that is being thrust towns had actually been forced to seek Parliamentary powers upon him against his sense of right and justice. If the to prohibit the importation into their districts of the doctor resigns all his contract practice and refuses to work diseased products of cows kept in the filthy and insanitary the Insurance Act, not a single individual in the whole cowsheds of country places, and the fact stood out that the
SIR,-I
sources
1646 milk from cows kept within the precincts of cities was freer from tuberculosis, and consequently purer and more wholesome, than that coming from many rural districts, with their greater facilities and more healthy surroundings, were these only availed of. But it was only the large towns which had these powers, and the milk excluded from these centres found its way into unprotected communities. Liverpool ’, (following the lead of Manchester) obtained powers of this kind in the year 1900, and it was a fact, the interpretation of which Professor Hope left to others, that coincidently with putting these powers into operation two things had followed. One was that the tuberculous milk from the country had largely diminished year by year in amount, and the other was that tuberculosis amongst young children (who were the greatest milk consumers) had diminished also in an almost corre-
sponding degree. Tuberculosis in Childhood.
Hospital and College, shortly be published in
It will attracted much attention. THE LANCET. Mrs. M. D. POWER SWEENEY gave a paper with many details of the question of open-air schools, including their cost. In London the gross cost per head per year was about E24, against less than f,7in the ordinary schools.
Ventilation of
Work-places.
Dr. A. RANSOME dealt specially with the necessity of providing fresh air in work places. Previously it had been found that it was not the humidity in weaving-sheds that was the The standard of ventilacause of trouble, but the foul air. tion first established in this country for work-places was 9 per cent. carbon dioxide per 10,000 of air. He regretted that the new Home Office regulations lowered the standard to 11
per 10,000. The following resolution was unanimously adopted :— That this association protests against any lowering of the standard o ventilation in any of the work-places in the kingdom, and that a copy of this resolution be forwarded to the Home Secretary. National Insurance Act and Tuberculosis. The afternoon was devoted to the discussion of the powers and duties of sanitary authorities and the working of the National Insurance Act in connexion with tuberculosis. Dr. W. LESLIE MACKENZIE dealt with the new duties imposed on local and central authorities by sanatorium benefits. Dr. H. W. MCCONNEL, of the Kelling Sanatorium, complained that no mention of the after-care of patients discharged from sanatoriums was made in the Act. Dr. A. K. CHALMERS, medical officer of health of Glasgow, said that in Scotland, where the people occupied tenement houses, the idea of sanatorium treatment was abused. The average cost per bed for sanatoriums, he said, was not less than £300. Mr. F. E. FREMANTLE, medical officer of health for Hert. fordshire, stated that in this country sanatoriums had actually been erected at a cost of £100 and even E50 per bed. The TOWN CLERK of Dundee and Dr. F. E. WYNNE, medical officer of health of Wigan, criticised the Interim Report of the Tuberculosis Committee.
r The whole of the rest of the day and part of the second ‘ day were devoted to the discussion of the question of tuberculosis in childhood. ’ Dr. R. W. PHILIP (Edinburgh) read a paper on the Prevalence of Tuberculosis in Childhood. Tuberculosis of the adult and adolescent was the harvest of seed sown in childhood. He thought they were too prone to confine their attention to the completed picture of the disease. Fresh air must be brought into the poor man’s nursery. He urged the importance of detecting the presence of tuberculosis in school children. Professor S. DELÉPINE gave an account of the infectivity of human and bovine tuberculosis. Tuberculosis could be communicated from animal to man as well as from man to man. The sputum of tuberculosis, even when dried and floating as dust, was infective. Among children under five years there were only 100 cases of lung disease to 850 cases of disease of other organs, while between 35 and 45 years of age there were 100 cases of lung disease to less than 6 of other forms. It was impossible to resist the conclusion that children were more likely to be infected through their food. Tuberculous cows’ milk, as he had proved both by experiments and observations, constituted the most important infecting material vu rrmay Councellor ARTHUR NEAL (Sheffield) dealt of bovine origin. Whatever the channel of infection, some bacilli might pass into the blood and give rise to tuberculosis both eloquently and exhaustively with the different questions in various parts of the body. Localised tuberculosis of the raised in the Interim Report, which he regarded as a lymphatic glands, bones, liver, spleen, and other organs, when valuable document for local authorities. He took a very not associated with pulmonary tuberculosis, was generally optimistic view of the provisions of the new Act, even as due to infection through the alimentary tract. regards its finance. He believed that the working of the Dr. NATHAN RAW dealt with the same subject. He stated Act would pay the local authorities, not only in health and that 20-25 per cent. of the cows in the country were tuber- happiness, but even in money. Dr. C. KILLICK MILLARD, medical officer of health culous, and in 2 per cent. the udders were infected. Abdominal and other forms of tuberculosis were common, but of Leicester, did not share Mr. Neal’s optimism with consumption was rare in children under 12. The other forms regard to the financial aspects of the Act. The report of tuberculosis were of bovine origin, and consumption was demanded 9000 sanatorium beds and the same number of of human origin. The nation would do well to spend other hospital beds, with 250 to 300 dispensaries. These could in £2,000,000 getting rid of cows affected by tuberculosis be provided, the difficulty was their maintenance. Each sanatorium bed would cost 25s. per week, and other hospital of the udders. He urged the boiling of milk. Dr. J. E. SQUIRE stated that the death-rate from tuberculous beds Sl, and each dispensary.f.lOOO a year. These figures diseases was low during school age and highest before and seemed to presage a heavy financial loss to the local authorities. The chronic consumptive-who was sure to break after it. * Mrs. LESLIE MACKENZIE showed lantern slides of open-air down after a course of treatment-would upset all financial schools and country homes which had been established by calculations. The Countess of ABERDEEN presided in the afternoon and the Edinburgh school board. referred to the work of the Women’s Health Association in E. D. TELFORD on the (Manchester) spoke hospital Mr. He advocated an extension of such schools for Ireland and the good results achieved. In 1907 the deaths school. children afflicted with surgical tuberculosis. The ordinary from all forms of tuberculous disease in Ireland were 11,679 hospitals could not cope with them, their wards being crowded and in 1911 the number was 9623, a reduction of one-sixth, with acute diseases. All that was necessary to save these which was equal to 40 fewer deaths every week. Miss M. E. BROADBENT, of the Children’s Aid Association, children was that they be maintained in a special institution under proper conditions of hygiene and surgical treatment suggested grants to voluntary organisations by the Insurance for a length of time sufficient for their cure. They must get Committees. Mr. E. S. KEMP, of the London Charity Organisation hold of these cases early, place them in a specially equipped for an them there indefinite timemaintain Society, pointed out that most consumptives would be Post institution, usually two or three years-and under these conditions notOffice contributors and their sick pay would soon be only would the great majority be saved, but they would be exhausted. Other Papers and Lectures. saved without deformity. Some provision should be made for teaching them, since they were often mentally above the Amongst others who took part in proceedings were Professor G. SIMS WOODHEAD, Mr. JOHN PRIESTLEY, who average. On the second day the discussion on tuberculosis in spoke on the Special Factors making for the Extension of children was continued. The difficulty of early diagnosis Tuberculosis in the School and the Measures of its Prevenof the disease in children largely accounted for the varying tion, and Mr. C. E. LAST, of the Millfield Home for Children estimates of the rarity or otherwise of the disease. for Pulmonary Tuberculosis, who dealt with Open-air Schools. The paper by Mr. H. J. GAUVAIN, of the Treloar Cripples’ The evening lectures were given by Dr. SQUIRE, Dr. R. W.
1647
PHILIP,
and Professor SIMS WOODHEAD.
The Conference
value of the
proposals
the cost is small.
The
purchase
of
under’ the auspices of the city of Manchester and the the land necessary for the construction of the street and the county borough of Salford. laying out of the street would amount to £50,000. It would In connexion with the Conference an exhibition is being be necessary to expend .631,000 on the purchase of plots to held in Salford with the object of educating the public in the east of the proposed street, so that a sum of £81,000 is regard to the dread disease. The exhibition will be trans- essential for the carrying out of the infirmary ideals. If in ferred to Deansgate, Manchester, and then to the Hulme addition to this the corporation decides, as it is hoped it
was
Town hall from June 21st to 27th. The Conference was extremely successful, the evening lectures delivered by medical men dealing with wide questions of the relation of the public to tuberculosis. Salford, too, is participating vigorously in the crusade against consumption. The mayor stated that in 1879 the death-rate in Salford from phthisis was 29 per 10,000, but in 1910 it had fallen to 13 per 10,000 owing to the improvement that had been effected in housing and general sanitation, and in the habits and material conditions of the people. There were 400 deaths per annum in Salford from phthisis, while the consumptive population of England and Wales was somewhere about 300,000.
(FROM A
LEEDS. CORRESPONDENT.)
OUR OWN
Scheme of Extension in Connexion with the General Infirmary. AT the usual monthly meeting of the city council a deputation from the weekly board of the infirmary, accompanied by Mr. William Middlebrook, the president of the King Edward .Memorial Fund, who was Lord Mayor at the time the fund was started, had an opportunity of laying before the members of the corporation a scheme of infirmary extension of very farreaching importance. The standing orders were suspended so that Mr. Charles Lupton, the chairman of the weekly board, should have an opportunity of explaining the scheme in
Large
detail. As has been mentioned in this column more than once the need for extension of the infirmary is a very urgent one. It was wisely decided that so far as Leeds was concerned the best memorial which could be raised to the memory of King Edward would be a reconstruction of, and a substantial addition to, the great institution which as Prince of Wales he opened in the year 1868. The scheme of enlargement and of reconstruction which Mr. Lupton unfolded to the corporation was, as he said, one which had been thought out mainly in the interests of the infirmary, but it had appeared to the board to be one which would effect such an improvement in the access to certain important parts of the city and would be such a great public improvement that the board had adopted the bold course of purchasing a large amount of property to the east and north of the infirmary, feeling confident that the scheme would command the sympathy and the support of the public and of the corporation. To the north and east of the present buildings there is a large amount of property to which the term ’’ slum "may without impropriety be applied. Practically the whole of this has been bought by the infirmary, and the corporation is now asked to repurchase from the infirmary as much of this property as may suffice for the construction of a new wide thoroughfare which would continue the line of Calverley-street, which runs between the town hall and the municipal buildings, and curving to the west would strike Fenton-street some distance to the north of the infirmary. All the property to the south and west of this projected street would be available for the extension of the infirmary, and it has been secured by the institution. The streets within its area would be abolished, for their place would be more than taken by the new thoroughfare, and room for the expansion of the infirmary would be secured which would probably make the future of the institution secure for many years to come. It is not an absolutely essential part of the scheme, but it would greatly add to its excellence, especially from the point of view of its being a public improvement, if in addition to constructing the new road the corporation should, as has been suggested, demolish the existing Were this property at the back of the town hall. done a large open space would be formed between the town hall and the eastward extension of the infirmary. Of course, the scheme would cost a good deal, but in view of the
will, to create
an
open space
as
explained
above
an
additional
.E50,OOO will be required. It is, of course, true that something may be reasonably set against this in the way of the sale of surplus property and in an increase of rateable value, but in any case the money would be well spent considering the immense improvement which would be effected in the neighbourhood. Should the area requisite for the construction of the street and the land to the east thereof be taken, as is suggested, by the corporation for a sum of .621,649, the additional area at the disposal of the infirmary for immediate and future extensions will have cost some £50,000. It may be remembered that the King Edward Fund amounts to about £110,000, though it is hoped that the full amount which was asked for-namely, .6150,000, may be ultimately obtained. About £50,000, therefore, will be available for building and reconstruction. It is intended to build one new large ward pavilion serial with those at present existing on the south aspect of the infirmary, with accommodation for about 100 patients ; to construct a suite of operating theatres for which there is urgent need, and to extend the accommodation for the nursing staff. These with certain minor but necessary aims must demand the immediate attention of the authorities of the infirmary. Room will also be secured for the addition of two extra ward pavilions of the same size as that which is to be immediately commenced, so that for many years it is felt that the present site will be adequate to the requirements of the infirmary. It is gratifying to find that, so far as can be seen, the scheme has commended itself to all parties in the corporation. The infirmary stands high in the estimation of the public of Leeds, and it is with a feeling of pride that they can look forward to the carrying out of the great scheme which has been outlined.
BRISTOL
(FROM
OUR OWN
CORRESPONDENT.)
Bristol Health Exhibition and Conference. set by many of the large "health week," Bristol has had a health exhibition and conference at the Victoria Rooms, under the auspices of the Nurses’ Social Union. Some were at first disposed to cavil at this decision, but it is now generally acknowledged that the exhibition is admirable from the educational point of view. Many interesting exhibits were sent by the General, Children’s, and Eye Hospitals, but the majority came from the Nurses’ Social Union itself. These were divided into 13 sections, and many of them were One section, for example, of the utmost practical value. consisted entirely of " expedients "-i.e., devices to show how much in the way of nursing appliances might be made of simple and inexpensive material, such as is likely to be available in an emergency in a cottage. Other sections of particular interest were exhibits of cookery appliances economising fuel, and a group relating to baby and infant care. In one corner was a realistic waxwork group depicting a surgical case in a slum room before and after the visit of the district nurse. Various admirable demonstrations of infant care, simple needlework, and similarly practical subjects were given several times daily. One small side room was occupied by exhibits designed exclusively for medical practitioners and nurses ; this contained an interesting series of wax models and pamphlets. There were also a number of stalls, one of which, under the management of the health committee of the city council, exhibited a set of microscopic and other preparations illustrative of pathogenic bacteria and their modes of dissemination. The Red Cross Society, the ambulance brigades, and boy scouts have given displays in the adjoining rink, and every day has had its special dramatic and other entertainments. The first day of the exhibition was reserved
INSTEAD of
English
following the example
towns and
having
a